Search results for: upper limb

Authors: B. W. Kenny, D.Mansour, K. G. Mansour, J. Attia, B. Meads

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There is currently insufficient evidence to make a conclusive statement about safety while immobilized in a short arm cast. There is a paucity of published literature on this topic. The purpose of this study is to specifically evaluate short arm casts and their effect on driving abilities, particularly steering and avoidance of obstacles. The ability to drive safely is extrapolated from this data. In this study, a randomised, controlled, crossover design was used to assess 30 subjects randomised into 2 groups. A Logitech force feedback steering column and simulated driving program with a standardised road course was used. Objective outcome measures were the number of times subjects drove off the track, the number of crashes, time to lap completion and subjective assessment on whether wearing a short arm plaster cast impeded their steering. Recruited subjects had no upper limb pathology. The side of the applied plaster cast was randomised. The mean lap completion time reduced with repetition, the difference being statistically significant. There was no significant difference in mean number of times subjects in casts drove off the track (3 with vs. 3.07 without casts), average number of crashes (1.27 vs 0.97). Steering ability was not reduced whilst a subject was immobilised in a short arm Plaster of Paris cast, despite subject’s own impressions that their steering was impeded. This may help guide doctors in their advice to patients regarding driving in these casts.

Keywords: upper limb, arm injury, plaster cast, splint, driving, automobile, bone fracture

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Authors: Nadia Zahra Karimi Khiavi, Amir Ghiami Rad

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Due to the high likelihood of injuries in karate, karatekas' injuries warrant special treatment. This study explores the prevalence of karate injuries in East Azerbaijan, Iran and provides a model for karatekas to use in the prevention of such injuries. This study employs a descriptive approach. Male and female participants with a brown belt or above in either control or non-control styles in East Azerbaijan province are included in the study's statistical population. A statistical sample size of 100 people was computed using the tools employed (smartpls), and the samples were drawn at random from all clubs in the province with the assistance of the Karate Board in order to give a model for the prevention of karate injuries. Information was gathered by means of a survey that made use of the Standard Questionnaire for Australian Sports Medicine Injury Reports. The information is presented in the form of tables and samples, and descriptive statistics were used to organise and summarise the data. Control and non-control independent t-tests were conducted using SPSS version 20, and structural equation modelling (pls) was utilised for injury prevention modelling at a 0.05 level of significance. The results showed that the most common areas of injury among the control groups were the upper limbs (46.15%), lower limbs (34.61%), trunk (15.38%), and head and neck (3.84%). The most common types of injuries were broken bones (34.61%), sprain or strain (23.13%), bruising and contusions (23.13%), trauma to the face and mouth (11.53%), and damage to the nerves (69.69%). Uncontrolled committees are most likely to sustain injuries to the head and neck (33.33%), trunk (25.92%), upper limbs (22.22%), and lower limbs (18.51%). The most common injuries were to the mouth and face (33.33%), dislocations and fractures (22.22%), aspirin and strain (22.22%), bruises and contusions (18.51%), and nerves (70%), in that order. Among those who practice control kata, injuries to the upper limb account for 45.83%, the lower limb for 41.666%, the trunk for 8.33%, and the head and neck for 4.166%. The most common types of injuries are dislocations and fractures (41.66 per cent), aspirin and strain (29.16 per cent), bruising and bruises (16.66 per cent), and nerves (12.5%). Injuries to the face and mouth were not reported among those practising the control kata. By far, the most common sites of injury for those practising uncontrolled kata were the lower limb (43.74%), upper limb (39.13%), trunk (13.14%), and head and neck (4.34%). The most common types of injuries were dislocations and fractures (34.82%), aspirin and strain (26.08%), bruises and contusions (21.73%), mouth and face (13.14%), and nerves. Teaching the concepts of cooling and warming (0.591) and enhancing the degree of safety in the sports environment (0.413) were shown to play the most essential roles in reducing sports injuries among karate practitioners of controlling and uncontrolled styles, respectively. Use of common sports gear (0.390), Modification of training programme principles (0.341), Formulation of an effective diet plan for athletes (0.284), Evaluation of athletes' physical anatomy, physiology, chemistry, and physics (0.247).

Keywords: sports injuries, karate, prevention, cooling and warming

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Authors: Manik Sharma

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Understanding the anatomy and normal anatomical variations of the lower limb arterial system is undeniably important not only to understand the pathology involving the vessels of the lower limb but also as a part of endovascular intervention and surgical planning in cases that demand them as a part of treatment. There have been very few cases of duplication of SFA cited in the literature, close to six worldwide and this being the seventh case in the world and first to be reported in the Indian population. We incidentally came across this normal variant during US lower limb (US-LL) duplex scan in a patient with claudicating pain in bilateral lower limbs hence suspected of having peripheral vascular disease. It was confirmed on CT-Peripheral Angiography (CT-PA), which was done successively.

Keywords: peripheral vascular disease, claudicating pain, normal anatomical variants, endovascular intervention, duplication, CT-peripheral angiography, duplex scan, Iohexol

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Authors: A. M. Bumbea, A. Musetescu, P. Ciurea, A. Bighea

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Objectives: The authors present a Parsonage Turner syndrome, a rare disease characterized by onset in apparently healthy person with shoulder and/or arm pain, sensory deficit, motor deficit. The causes are not established, could be determinate by vaccination, postoperative, immunologic disease, post traumatic etc. Methods: The authors present a woman case, 32 years old, (in 2006), no medical history, with arm pain and no other symptom. The onset was sudden with pain at very high level quantified as 10 to a 0 to 10 scale, with no response to classical analgesic and corticoids. The only drugs which can reduce the intensity of pain were oxycodone hydrochloride, 60 mg daily and pregabalinum150 mg daily. After two weeks the intensity of pain was reduced to 5. The patient started a rehabilitation program. After 6 weeks the patient associated sensory and motor deficit. We performed electromyography for upper limb that showed incomplete denervation with reduced neural transmission speed. The patient receives neurotrophic drugs and painkillers for a long period and physical and kinetic therapy. After 6 months the pain was reduced to level 2 and the patient maintained only 150 mg pregabalinum for another 6 months. Then, the evaluation showed no pain but general amiotrophy in upper limb. Results: At the evaluation in 2009, the patient developed a rheumatoid syndrome with tender and swelling joints, but no positive inflammation test, no antibodies or rheumatoid factor. After two years, in 2011 the patient develops an increase of antinuclear antibodies. This context certifies the diagnosis of lupus and the patient receives the specific therapy. Conclusions: This case is not a typical case of onset of lupus with PTS, but the onset of PTS could include the onset of an immune disease.

Keywords: lupus, arm pain, patient, swelling

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Authors: Lucy Horrobin, Rebecca Fores

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Background: Muay Thai is an increasingly popular combat sport worldwide. Further academic research in the sport will contribute to its professional development. This research sought to produce normative data in relation to the physical and physiological characteristics of professional Muay Thai boxers, as, currently no such data exists. The ultimate aim being to inform appropriate training programs and to facilitate coaching. Methods: N = 9 professional, adult, male Muay Thai boxers were assessed for the following anthropometric, physical and physiological characteristics, using validated methods of assessment: body fat, hamstring flexibility, maximal dynamic upper body strength, lower limb peak power, upper body muscular endurance and aerobic capacity. Raw data scores were analysed for mean, range and SD and where applicable were expressed relative to body mass (BM). Results: Results showed similar characteristics to those found in other combat sports. Low percentages of body fat (mean±SD) 8.54 ± 1.16 allow for optimal power to weight ratios. Highly developed aerobic capacity (mean ±SD) 61.56 ± 5.13 ml.min.kg facilitate recovery and power maintenance throughout bouts. Lower limb peak power output values of (mean ± SD) 12.60 ± 2.09 W/kg indicate that Muay Thai boxers are amongst the most powerful of combat sport athletes. However, maximal dynamic upper body strength scores of (mean±SD) 1.14 kg/kg ± 0.18 were in only the 60th percentile of normative data for the general population and muscular endurance scores (mean±SD) 31.55 ± 11.95 and flexibility scores (mean±SD) 19.55 ± 11.89 cm expressed wide standard deviation. These results might suggest that these characteristics are insignificant in Muay Thai or under-developed, perhaps due to deficient training programs. Implications: This research provides the first normative data of physical and physiological characteristics of Muay Thai boxers. The findings of this study would aid trainers and coaches when designing effective evidence-based training programs. Furthermore, it provides a foundation for further research relating to physiology in Muay Thai. Areas of further study could be determining the physiological demands of a full rules bout and the effects of evidence-based training programs on performance.

Keywords: fitness testing, Muay Thai, physiology, strength and conditioning

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Authors: Mukesh Roy, Basant Singh Sikarwar, Ravi Prakash, Priya Ranjan, Ayush Goyal

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More than 11% of people suffer from weakness in the bone resulting in inability in walking or climbing stairs or from limited upper body and limb immobility. This motivates a fresh bio-mimicking solution to the design of an exo-skeleton to support human movement in the case of partial or total immobility either due to congenital or genetic factors or due to some accident or due to geratological factors. A deeper insight and detailed understanding is required into the workings of the ball and socket joints. Our research is to mimic ball and socket joints to design snugly fitting exoskeletons. Our objective is to design an exoskeleton which is comfortable and the presence of which is not felt if not in use. Towards this goal, a parametric study is conducted to provide detailed design parameters to fabricate an exoskeleton. This work builds up on real data of the design of the exoskeleton, so that the designed exo-skeleton will be able to provide required strength and support to the subject.

Keywords: bio-mimicking, exoskeleton, ball joint, socket joint, artificial limb, patient rehabilitation, joints, human-machine interface, wearable robotics

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Authors: Hachmia Faqihi, Maarouf Saad, Khalid Benjelloun, Mohammed Benbrahim, M. Nabil Kabbaj

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This paper investigates and presents a cable-driven robot to lower limb rehabilitation use in sagittal plane. The presented rehabilitation robot is used for a trajectory tracking in joint space. The paper covers kinematic and dynamic analysis, which reveals the tensionability of the used cables as being the actuating source to provide a rehabilitation exercises of the human leg. The desired trajectory is generated to be used in the control system design in joint space. The obtained simulation results is showed to be efficient in this kind of application.

Keywords: cable-driven multi-body system, computed-torque controller, lower limb rehabilitation, tracking trajectory

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Authors: Hilal Keklicek, Fatih Erbahceci, Elif Kirdi, Ali Yalcin, Semra Topuz, Ozlem Ulger, Gul Sener

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Objectives and Goals: The stride-to-stride fluctuations in gait is a determinant of qualified locomotion as known as gait variability. Gait variability is an important predictive factor of fall risk and useful for monitoring the effects of therapeutic interventions and rehabilitation. Comparison of gait variability in individuals with trans-tibial lower limb loss and trans femoral lower limb loss was the aim of the study. Methods: Ten individuals with traumatic unilateral trans femoral limb loss(TF), 12 individuals with traumatic transtibial lower limb loss(TT) and 12 healthy individuals(HI) were the participants of the study. All participants were evaluated with treadmill. Gait characteristics including mean step length, step length variability, ambulation index, time on each foot of participants were evaluated with treadmill. Participants were walked at their preferred speed for six minutes. Data from 4th minutes to 6th minutes were selected for statistical analyses to eliminate learning effect. Results: There were differences between the groups in intact limb step length variation, time on each foot, ambulation index and mean age (p < .05) according to the Kruskal Wallis Test. Pairwise analyses showed that there were differences between the TT and TF in residual limb variation (p=.041), time on intact foot (p=.024), time on prosthetic foot(p=.024), ambulation index(p = .003) in favor of TT group. There were differences between the TT and HI group in intact limb variation (p = .002), time on intact foot (p<.001), time on prosthetic foot (p < .001), ambulation index result (p < .001) in favor of HI group. There were differences between the TF and HI group in intact limb variation (p = .001), time on intact foot (p=.01) ambulation index result (p < .001) in favor of HI group. There was difference between the groups in mean age result from HI group were younger (p < .05).There were similarity between the groups in step lengths (p>.05) and time of prosthesis using in individuals with lower limb loss (p > .05). Conclusions: The pilot study provided basic data about gait stability in individuals with traumatic lower limb loss. Results of the study showed that to evaluate the gait differences between in different amputation level, long-range gait analyses methods may be useful to get more valuable information. On the other hand, similarity in step length may be resulted from effective prosthetic using or effective gait rehabilitation, in conclusion, all participants with lower limb loss were already trained. The differences between the TT and HI; TF and HI may be resulted from the age related features, therefore, age matched population in HI were recommended future studies. Increasing the number of participants and comparison of age-matched groups also recommended to generalize these result.

Keywords: lower limb loss, amputee, gait variability, gait analyses

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Authors: Hassan Abo Salem, Guo Feng, Xiaolin Huang

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The objective of this study is to determine the effectiveness of mirror therapy on motor recovery and functional abilities after stroke. The following databases were searched from inception to May 2014: Cochrane Stroke, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, and PEDro. Two reviewers independently screened and selected all randomized controlled trials that evaluate the effect of mirror therapy in stroke rehabilitation.12 randomized controlled trials studies met the inclusion criteria; 10 studies utilized the effect of mirror therapy for the upper limb and 2 studies for the lower limb. Mirror therapy had a positive effect on motor recover and function; however, we found no consistent influence on activity of daily living, Spasticity and balance. This meta-analysis suggests that, Mirror therapy has additional effect on motor recovery but has a small positive effect on functional abilities after stroke. Further high-quality studies with greater statistical power are required in order to accurately determine the effectiveness of mirror therapy following stroke.

Keywords: mirror therapy, motor recovery, stroke, balance

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Authors: Rohin Rameswarapu, Sameer Valsangkar

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Background: Globally, musculoskeletal disorders are the largest single cause of work-related illnesses accounting for over 33% of all newly reported occupational illnesses. Risk factors for MSD need to be delineated to suggest means for amelioration. Material and methods: In this current cross-sectional study, the prevalence of MSDs among workers in an electrical company assembly line, the socio-demographic and job characteristics associated with MSD were obtained through a semi-structured questionnaire. A quantitative assessment of the physical risk factors through the Rapid Upper Limb Assessment (RULA) tool, and measurement of psychosocial risk factors through a Likert scale was obtained. Statistical analysis was conducted using Epi-info software and descriptive and inferential statistics including chi-square and unpaired t test were obtained. Results: A total of 263 workers consented and participated in the study. Among these workers, 200 (76%) suffered from MSD. Most of the workers were aged between 18–27 years and majority of the workers were women with 198 (75.2%) of the 263 workers being women. A chi square test was significant for association between male gender and MSD with a P value of 0.007. Among the MSD positive group, 4 (2%) had a grand score of 5, 10 (5%) had a grand score of 6 and 186 (93%) had a grand score of 7 on RULA. There were significant differences between the non-MSD and MSD group on five out of the seven psychosocial domains, namely job demand, job monotony, co-worker support, decision control and family and environment domains. Discussion: The current cross-sectional study demonstrates a high prevalence of MSD among assembly line works with inherent physical and psychosocial risk factors and recommends that not only physical risk factors, addressing psychosocial risk factors through proper ergonomic means is also essential to the well-being of the employee.

Keywords: musculoskeletal disorders, India, occupational health, Rapid Upper Limb Assessment (RULA)

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Authors: Cláudia Patrocínio, Beatriz Fernandes, Ana Filipa Pires

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Background: Mirror therapy (MT) is used to improve motor function after stroke. During MT, a mirror is placed between the two upper limbs (UL), thus reflecting movements of the non- affected side as if it were the affected side. Objectives: The aim of this review is to analyze the evidence on the effec.tiveness of MT in the recovery of UL function in population with post chronic stroke. Methods: The literature search was carried out in PubMed, ISI Web of Science, and PEDro database. Inclusion criteria: a) studies that include individuals diagnosed with stroke for at least 6 months; b) intervention with MT in UL or comparing it with other interventions; c) articles published until 2023; d) articles published in English or Portuguese; e) randomized controlled studies. Exclusion criteria: a) animal studies; b) studies that do not provide a detailed description of the intervention; c) Studies using central electrical stimulation. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Studies with < 4 on PEDro scale were excluded. Eighteen studies met all the inclusion criteria. Main results and conclusions: The quality of the studies varies between 5 and 8. One article compared muscular strength training (MST) with MT vs without MT and four articles compared the use of MT vs conventional therapy (CT), one study compared extracorporeal shock therapy (EST) with and without MT and another study compared functional electrical stimulation (FES), MT and biofeedback, three studies compared MT with Mesh Glove (MG) or Sham Therapy, five articles compared performing bimanual exercises with and without MT and three studies compared MT with virtual reality (VR) or robot training (RT). The assessment of changes in function and structure (International Classification of Functioning, Disability and Health parameter) was carried out, in each article, mainly using the Fugl Meyer Assessment-Upper Limb scale, activity and participation (International Classification of Functioning, Disability and Health parameter) were evaluated using different scales, in each study. The positive results were seen in these parameters, globally. Results suggest that MT is more effective than other therapies in motor recovery and function of the affected UL, than these techniques alone, although the results have been modest in most of the included studies. There is also a more significant improvement in the distal movements of the affected hand than in the rest of the UL.

Keywords: physical therapy, mirror therapy, chronic stroke, upper limb, hemiplegia

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Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. Alomari, Abdullah A. Al Qurashi, Ahmed S. Abdulhamid, Mohammed S. Alshehri, Majed Alosaimi

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Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD=–0.28, 95% CI –0.53 to –0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR= 0.77, 95% CI –0.58 to 1.03). Conclusions: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events.

Keywords: botulinum toxin type A, limb lengthening, distraction osteogenesis, deformity correction, pain management

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Authors: Sigal Portnoy, Jason Friedman, Eitan Raveh

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Introduction: Sensory substitution is possible due to the capacity of our brain to adapt to information transmitted by a synthetic receptor via an alternative sensory system. Practical sensory substitution systems are being developed in order to increase the functionality of individuals with sensory loss, e.g. amputees. For upper limb prosthetic-users the loss of tactile feedback compels them to allocate visual attention to their prosthesis. The effect of adding vibrotactile feedback (VTF) to the applied force has been studied, however its effect on the allocation if visual attention during dual-tasking and the response during misleading visual feedback have not been studied. We hypothesized that VTF will improve the performance and reduce visual attention during dual-task assignments in healthy individuals using a robotic hand and improve the performance in a standardized functional test, despite the presence of misleading visual feedback. Methods: For the dual-task paradigm, twenty healthy subjects were instructed to toggle two keyboard arrow keys with the left hand to retain a moving virtual car on a road on a screen. During the game, instructions for various activities, e.g. mix the sugar in the glass with a spoon, appeared on the screen. The subject performed these tasks with a robotic hand, attached to the right hand. The robotic hand was controlled by the activity of the flexors and extensors of the right wrist, recorded using surface EMG electrodes. Pressure sensors were attached at the tips of the robotic hand and induced VTF using vibrotactile actuators attached to the right arm of the subject. An eye-tracking system tracked to visual attention of the subject during the trials. The trials were repeated twice, with and without the VTF. Additionally, the subjects performed the modified box and blocks, hidden from eyesight, in a motion laboratory. A virtual presentation of a misleading visual feedback was be presented on a screen so that twice during the trial, the virtual block fell while the physical block was still held by the subject. Results: This is an ongoing study, which current results are detailed below. We are continuing these trials with transradial myoelectric prosthesis-users. In the healthy group, the VTF did not reduce the visual attention or improve performance during dual-tasking for the tasks that were typed transfer-to-target, e.g. place the eraser on the shelf. An improvement was observed for other tasks. For example, the average±standard deviation of time to complete the sugar-mixing task was 13.7±17.2s and 19.3±9.1s with and without the VTF, respectively. Also, the number of gaze shifts from the screen to the hand during this task were 15.5±23.7 and 20.0±11.6, with and without the VTF, respectively. The response of the subjects to the misleading visual feedback did not differ between the two conditions, i.e. with and without VTF. Conclusions: Our interim results suggest that the performance of certain activities of daily living may be improved by VTF. The substitution of visual sensory input by tactile feedback might require a long training period so that brain plasticity can occur and allow adaptation to the new condition.

Keywords: prosthetics, rehabilitation, sensory substitution, upper limb amputation

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Authors: L. Parisi

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Kinematic data wisely correlate vector quantities in space to scalar parameters in time to assess the degree of symmetry between the intact limb and the amputated limb with respect to a normal model derived from the gait of control group participants. Furthermore, these particular data allow a doctor to preliminarily evaluate the usefulness of a certain rehabilitation therapy. Kinetic curves allow the analysis of ground reaction forces (GRFs) to assess the appropriateness of human motion. Electromyography (EMG) allows the analysis of the fundamental lower limb force contributions to quantify the level of gait asymmetry. However, the use of this technological tool is expensive and requires patient’s hospitalization. This research work suggests overcoming the above limitations by applying artificial neural networks.

Keywords: kinetics, kinematics, cyclograms, neural networks, transtibial amputation

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Authors: Karissa A. Graham

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Pyoderma gangrenosum (PG) is a prototypic autoinflammatory neutrophilic dermatosis that is a rare disorder. It presents a diagnostic challenge owing to its variable presentation, clinical overlap with other conditions, it is often associated with other systemic conditions, and there is no definitive histological or laboratory characteristic. The Delphai consensus for PG includes the presence of at least one ulcer on the anterior lower limb. Systemic corticosteroids and immunosuppressive therapies are the mainstay treatment for PG. We describe a case report of delayed diagnosis of ulcerative pyoderma gangrenosum in a 44-year-old male on his forearm. The patient presented with an infected ulcer on his right forearm that had been present for over three years. The patient was a Type 2 Diabetic with no personal or family history of inflammatory bowel disease or other autoimmune diseases. The patient was initially investigated for malignancy, but biopsies returned as chronic inflammatory tissue with neutrophilic infiltrate and no malignancy. The patient was commenced on systemic prednisone for the treatment of pyoderma gangrenosum. The diagnosis of ulcerative PG poses a challenge given the vast differential diagnosis for a cutaneous ulcer (i.e., malignant, vascular, autoimmune, trauma, infective, etc.). Diagnostic accuracy is important given that the treatment for PG with steroids does not go without risks and indeed may be contraindicated in other potential causes of the ulcer. Indeed, more common and more sinister causes of ulcers should be investigated first, as death from PG is quite rare.

Keywords: dermatological diagnosis, dermatosis, pyoderma gangrenosum, rare presentation

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Authors: Mehmet Yildiz, Mehmet Kale

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The primary aim of the present study was to identify the bilateral balance asymmetries when comparing the dominant (DL) vs. the non-dominant leg (NDL) in the collegian soccer players. The secondary aim was to compare the inter-limb asymmetry index (ASI) when differentiating by kicking preference (right-dominant vs. left-dominant). 34 right-dominant leg (RightDL) (age:21.12±1.85, height:174.50±5.18, weight:69.42±6.86) and 23 left-dominant leg (LeftDL), (age:21.70±2.03, height:176.2±6.27, weight:68.73±5.96) collegian football players were tested for bilateral static and dynamic balance. Balance ability was assessed by measuring centre of pressure deviation on a single leg. Single leg static and dynamic balance scores and inter-limb asymmetry index (ASI) were determined. Student t tests were used for the comparison of dominant and nondominant leg balance scores and RightDL and LeftDL football players’ inter-limb asymmetry index of the balance scores. The results showed that there were significant differences in the dynamic balance scores in favour of the nondominant leg, (DL:738±211 vs. NDL:606±226, p < 0.01). Also, it has been seen that LeftDL players have significantly higher inter-limb asymmetry index when compared with rightDL players for both static (rightDL:-7.07±94.91 vs. leftDL:-183.19±354.05, p < 0.01) and dynamic (rightDL: 1.73±49.65 vs. leftDL:27.08±23.34, p < 0.05) balance scores. In conclusion, bilateral dynamic balance asymmetries may be affected using single leg predominantly in the mobilization workouts. Because of having higher inter-limb asymmetry index, left-dominant leg players may be screened and trained to minimize balance asymmetry.

Keywords: bilateral balance, asymmetries, dominant leg, leg preference

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Authors: Alaoui Hamza, Moutacalli Mohamed Tarik, Chebak Ahmed

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The number of people suffering from hemiplegia is growing each year. This lower limb disability affects all the aspects of their lives by taking away their autonomy. This implicates their close relatives, as well as the health system to provide the necessary care they need. The integration of exoskeletons in the medical field became a promising solution to resolve this issue. This paper presents an exoskeleton designed to help hemiplegic people get back the sensation and ability of normal walking. For this purpose, three step models have been created. The first step allows a simple forward movement of the leg. The second method is designed to overcome some obstacles in the patient path, and finally the third step model gives the patient total control over the device. Each of the control methods was designed to offer a solution to the challenges that the patients may face during the walking process.

Keywords: ability of normal walking, exoskeleton, hemiplegic patients, lower limb motion- mechatronics

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Authors: Adrian O'Hagan, Robert McLoughlin

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Considerable focus in the world of insurance risk quantification is placed on modeling loss values from lines of business (LOBs) that possess upper tail dependence. Copulas such as the Joe, Gumbel and Student-t copula may be used for this purpose. The copula structure imparts a desired level of tail dependence on the joint distribution of claims from the different LOBs. Alternatively, practitioners may possess historical or simulated data that already exhibit upper tail dependence, through the impact of catastrophe events such as hurricanes or earthquakes. In these circumstances, it is not desirable to induce additional upper tail dependence when modeling the joint distribution of the loss values from the individual LOBs. Instead, it is of interest to accurately assess the degree of tail dependence already present in the data. The empirical copula and its associated upper tail dependence coefficient are presented in this paper as robust, efficient means of achieving this goal.

Keywords: empirical copula, extreme events, insurance loss reserving, upper tail dependence coefficient

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Authors: Leonardo Costa Pereira, Frederico Santos Santana, Mauro Karnikowski, Luís Sinésio Silva Neto, Aline Oliveira Gomes, Marisete Peralta Safons, Margô Gomes De Oliveira Karnikowski

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In Brazil, projections of population aging follow all world projections, the birth rate tends to be surpassed by the mortality rate around the year 2045. Historically, the population of Brazilian blacks suffered for several centuries from the oppression of dominant classes. A group, especially of blacks, stands out in relation to territorial, historical and social aspects, and for centuries they have isolated themselves in small communities, in order to maintain their freedom and culture. The isolation of the Quilombola communities generated socioeconomic effects as well as the health of these blacks. Thus, the objective of the present study is to verify the association of body composition parameters with lower and upper limb strength and functional capacity in Quilombola remnants. The research was approved by ethics committee (1,771,159). Anthropometric evaluations of hip and waist circumference, body mass and height were performed. In order to verify the body composition, the relationship between stature and body mass (BM) was performed, generating the body mass index (BMI), as well as the dual-energy X-ray absorptiometry (DEXA) test. The Time Up and Go (TUG) test was used to evaluate the functional capacity, and a maximum repetition test (1MR) for knee extension and handgrip (HG) was applied for strength magnitude analysis. Statistical analysis was performed using the statistical package SPSS 22.0. Shapiro Wilk's normality test was performed. For the possible correlations, the suggestions of the Pearson or Spearman tests were adopted. The results obtained after the interpretation identified that the sample (n = 18) was composed of 66.7% of female individuals with mean age of 66.07 ± 8.95 years. The sample’s body fat percentage (%BF) (35.65 ± 10.73) exceeds the recommendations for age group, as well as the anthropometric parameters of hip (90.91 ± 8.44cm) and waist circumference (80.37 ± 17.5cm). The relationship between height (1.55 ± 0.1m) and body mass (63.44 ± 11.25Kg) generated a BMI of 24.16 ± 7.09Kg/m2, that was considered normal. The TUG performance was 10.71 ± 1.85s. In the 1MR test, 46.67 ± 13.06Kg and in the HG 23.93±7.96Kgf were obtained, respectively. Correlation analyzes were characterized by the high frequency of significant correlations for height, dominant arm mass (DAM), %BF, 1MR and HG variables. In addition, correlations between HG and BM (r = 0.67, p = 0.005), height (r = 0.51, p = 0.004) and DAM (r = 0.55, p = 0.026) were also observed. The strength of the lower limbs correlates with BM (r = 0.69, p = 0.003), height (r = 0.62, p = 0.01) and DAM (r = 0.772, p = 0.001). In this way, we can conclude that not only the simple spatial relationship of mass and height can influence in predictive parameters of strength or functionality, being important the verification of the conditions of the corporal composition. For this population, height seems to be a good predictor of strength and body composition.

Keywords: African Continental Ancestry Group, body composition, functional capacity, strength

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Authors: Wann-Yun Shieh, Hsin-Yi Kathy Cheng, Yan-Ying Ju, Yu-Chun Yu, Ya-Cheng Shieh

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Adolescents who have intellectual disabilities often demonstrate maladaptive behaviors in their daily activities due to either physical abnormalities or neurological disorders. These adolescents commonly struggle with their cognition and movement coordination when it comes to executing tasks such as throwing or catching objects smoothly, quickly, and gracefully, in contrast to their typically developing peers. Simply measuring movement time and distance doesn't provide a comprehensive view of their performance challenges. In this study, a ball-playing approach was proposed to assess the cognition and movement coordination of adolescents with intellectual disabilities using a smart ball equipped with an embedded inertial sensor. Four distinct ball games were specifically designed for this smart ball: two focusing on lower limb activities (dribbling along a straight line and navigating a zigzag path) and two centered around upper limb tasks (picking up and throwing and catching the ball). The cognition and movement coordination of 25 adolescents with intellectual disabilities (average age 18.36 ± 2.46 years) with that of 25 typically developing adolescents (average age 18.36 ± 0.49 years) were compared in these four tests. The results clearly revealed significant differences in the cognition and movement coordination between the adolescents with intellectual disabilities and the typically developing adolescents. These differences encompassed aspects such as movement speed, hand-eye coordination, and control over objects across all the tests conducted.

Keywords: cognition, intellectual disabilities, movement coordination, smart ball

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Authors: Lalita Khuna, Sugalya Amatachaya, Pipatana Amatachaya, Thiwabhorn Thaweewannakij, Pattra Wattanapan

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The five times sit-to-stand test (FTSST) has been widely used to quantify lower extremity motor strength (LEMS), dynamic balance ability, and risk of falls in many individuals. Recently, it has been used in ambulatory patients with spinal cord injury (SCI) but variously using with or without hands according to patients’ ability. This difference might affect the validity of the test in these individuals. Thus, this study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI, separately for those who could complete the test with or without hands using LEMS and standard functional measures as gold standards. Moreover, the data of the tests from those who completed the FTSST with and without hands were compared. A total of 56 ambulatory participants with SCI who could complete sit-to-stand with or without hands were assessed for the time to complete the FTSST according to their ability. Then they were assessed for their LEMS scores and functional abilities, including the 10-meter walk test (10MWT), the walking index for spinal cord injury II (WISCI II), the timed up and go test (TUGT), and the 6-minute walk test (6MWT). The Mann-Whitney U test was used to compare the different findings between the participants who performed the FTSST with and without hands. The Spearman rank correlation coefficient (ρ) was applied to analyze the levels of correlation between the FTSST and standard tests (LEMS scores and functional measures). There were significant differences in the data between the participants who performed the test with and without hands (p < 0.01). The time to complete the FTSST of the participants who performed the test without hands showed moderate to strong correlation with total LEMS scores and all functional measures (ρ = -0.71 to 0.69, p < 0.001). On the contrary, the FTSST data of those who performed the test with hands were significantly correlated only with the 10MWT, TUGT, and 6MWT (ρ = -0.47 to 0.57, p < 0.01). The present findings confirm the concurrent validity of the FTSST when performed without hands for LEMS and functional mobility necessary for the ability of independence and safety of ambulatory individuals with SCI. However, the test using hands distort the ability of the outcomes to reflect LEMS and WISCI II that reflect lower limb functions. By contrast, the 10MWT, TUGT, and 6MWT allowed upper limb contribution in the tests. Therefore, outcomes of these tests showed a significant correlation to the outcomes of FTSST when assessed using hands. Consequently, the use of FTSST with or without hands needs to consider the clinical application of the outcomes, i.e., to reflect lower limb functions or mobility of the patients.

Keywords: mobility, lower limb muscle strength, clinical test, rehabilitation

Procedia PDF Downloads 114

Authors: Samaneh Yavari, Christiane Pferrer, Elisabeth Engelke, Alexander Starke, Juergen Rehage

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Background: Nowadays, bovine limb interventions, especially any claw surgeries, raises selection of the most qualified and appropriate local anesthesia technique applicable for any superficial or deep interventions of the limbs. Currently, two local anesthesia methods of Intravenous Regional Anesthesia (IVRA), as well as Nerve Blocks, have been routine to apply. However, the lack of studies investigating the quality and duration as well as quantity and onset of full (complete) local anesthesia, is noticeable. Therefore, the aim of our study was comparing the onset and quality of both IVRA and our modified NBA at the hind limb of dairy cows. For this abstract, only the onset of full local anesthesia would be consider. Materials and Methods: For that reason, we used six healthy non pregnant non lactating Holestein Frisian cows in a cross-over study design. Those cows divided into two groups to receive IVRA and our modified four-point NBA. For IVRA, 20 ml procaine without epinephrine was injected into the vein digitalis dorsalis communis III and for our modified four-point NBA, 10-15 ml procaine without epinephrine preneurally to the nerves, superficial and deep peroneal as well as lateral and medial branches of metatarsal nerves. For pain stimulation, electrical stimulator Grass S48 was applied. Results: The results of electrical stimuli revealed the faster onset of full local anesthesia (p < 0.05) by application of our modified NBA in comparison to IVRA about 10 minutes. Conclusion and discussion: Despite of available references showing faster onset of foot local anesthesia of IVRA, our study demonstrated that our modified four point NBA not only can be well known as a standard foot local anesthesia method applicable to desensitize the hind limb of dairy cows, but also, selection of this modified validated local anesthesia method can lead to have a faster start of complete desensitization of distal hind limb that is remarkable in any bovine limb interventions under time constraint.

Keywords: IVRA, four point NBA, dairy cow, hind limb, full onset

Procedia PDF Downloads 127

Authors: Qinghua Zhang, Yanhe Zhu, Xiang Zhao, Yeqin Yang, Hongwei Jing, Guoan Zhang, Jie Zhao

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This paper presents a wearable reconfigurable supernumerary robotic limb with differential actuated joints, which is lightweight, compact and comfortable for the wearers. Compared to the existing supernumerary robotic limbs which mostly adopted series structure with large movement space but poor carrying capacity, a prototype with the series-parallel configuration to better adapt to different task requirements has been developed in this design. To achieve a compact structure, two kinds of cable-driven mechanical structures based on guide pulleys and differential actuated joints were designed. Moreover, two different tension devices were also designed to ensure the reliability and accuracy of the cable-driven transmission. The proposed device also employed self-designed bearings which greatly simplified the structure and reduced the cost.

Keywords: cable-driven, differential actuated joints, reconfigurable, supernumerary robotic limb

Procedia PDF Downloads 183

Authors: Mihai-Ionut Firescu, Mark A. P. Carson

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We present a case of inferior vena cava agenesis (IVCA) associated with bilateral deep venous thrombosis (DVT) in a patient with Beckwith-Wiedemann syndrome (BWS). In adult patients with BWS presenting with bilateral lower limb oedema, specific aetiological factors should be considered. These include cardiomyopathy and intraabdominal tumours. Congenital malformations of the IVC, through causing relative venous stasis, can lead to lower limb oedema either directly or indirectly by favouring lower limb venous thromboembolism; however, they are yet to be reported as an associated feature of BWS. Given its life-threatening potential, the prompt initiation of treatment for bilateral DVT is paramount. In BWS patients, however, this can prove more complicated. Due to overgrowth, the above-average birth weight can continue throughout childhood. In this case, the patient’s weight reached 170 kg, impacting on anticoagulation choice, as direct oral anticoagulants have a limited evidence base in patients with a body mass above 120 kg. Furthermore, the presence of IVCA leads to a long-term increased venous thrombosis risk. Therefore, patients with IVCA and bilateral DVT warrant specialist consideration and may benefit from multidisciplinary team management, with hematology and vascular surgery input. Conclusion: Here, we showcased a rare cause for bilateral lower limb oedema, respectively bilateral deep venous thrombosis complicating IVCA in a patient with Beckwith-Wiedemann syndrome. The importance of this case lies in its novelty, as the association between IVC agenesis and BWS has not yet been described. Furthermore, the treatment of DVT in such situations requires special consideration, taking into account the patient’s weight and the presence of a significant, predisposing vascular abnormality.

Keywords: Beckwith-Wiedemann syndrome, bilateral deep venous thrombosis, inferior vena cava agenesis, venous thromboembolism

Procedia PDF Downloads 196

Authors: Michinori Nakata, Hiroshi Sakai

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A rough set, which consists of lower and upper approximations, is formulated in information tables containing possibilistic information. First, lower and upper approximations on the basis of possible world semantics in the same way as Lipski did in the field of incomplete databases are shown in order to clarify fundamentals of rough sets under possibilistic information. Possibility and necessity measures are used, as is done in possibilistic databases. As a result, each object has certain and possible membership degrees to lower and upper approximations, which degrees are the lower and upper bounds. Therefore, the degree that the object belongs to lower and upper approximations is expressed by an interval value. And the complementary property linked with the lower and upper approximations holds, as is valid under complete information. Second, the approach based on indiscernibility relations, which is proposed by Dubois and Prade, are extended in three cases. The first case is that objects used to approximate a set of objects are characterized by possibilistic information. The second case is that objects used to approximate a set of objects with possibilistic information are characterized by complete information. The third case is that objects that are characterized by possibilistic information approximate a set of objects with possibilistic information. The extended approach create the same results as the approach based on possible world semantics. This justifies our extension.

Keywords: rough sets, possibilistic information, possible world semantics, indiscernibility relations, lower approximations, upper approximations

Procedia PDF Downloads 295

Authors: Anasuya Ghosh, Subhramoy Chaudhury

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During routine cadaveric dissection at gross anatomy lab of our institution, a radial artery was found with unusual origin and superficial course. Normally the radial artery takes its origin as one of the terminal branches of brachial artery at the level of the neck of radius. It usually lies along the lateral border of fore arm deep to the brachioradialis muscle. While dissecting a 72-year-old Caucasian female cadaver, it was found that the right sided radial artery originated from the upper part of brachial artery of arm, 2 cm below the lower border of teres major muscle, from the lateral aspect of brachial artery. Then the radial artery superficially crossed the brachial artery and median nerve from lateral to medial direction and rested superficially at the cubital fossa. Embryologically, it can be explained as a failure of disappearance, or abnormal persistence of some insignificant embryonic vessels may give rise to this kind of vascular anomalies. As radial artery is one of the most important upper limb arteries, its variation and related complications are clinically significant. This unusual origin and course of radial artery should be kept in mind by all healthcare providers including surgeons and radiologists during routine venipuncture, orthopedic and plastic surgeries of arm, coronary angiographic procedures in radial approach etc. to prevent unwanted complications.

Keywords: brachial artery anomalies, brachio-radial artery, high origin radial artery, superficial radial artery

Procedia PDF Downloads 302

Authors: Rada Somkhuean, Sa-aat Niwitpong, Suparat Niwitpong

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This paper presents the generalized p-values for testing the difference between two future population means when the variances are unknown, in both cases for when the variances are equal and unequal. We also derive a closed form expression of the upper bound of the proposed generalized p-value.

Keywords: generalized p-value, two future population means, upper bound, variances

Procedia PDF Downloads 363

Authors: Sanjana S. Mallya, Roshan Arvind Sivakumar

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Orthotics is the branch of medicine that deals with the provision and use of artificial casts or braces to alter the biomechanical structure of the limb and provide support for the limb. Custom-made orthoses provide more comfort and can correct issues better than those available over-the-counter. However, they are expensive and require intricate modelling of the limb. Traditional methods of modelling involve creating a plaster of Paris mould of the limb. Lately, CAD/CAM and 3D printing processes have improved the accuracy and reduced the production time. Ordinarily, digital cameras are used to capture the features of the limb from different views to create a 3D model. We propose a system to model the limb using Microsoft Kinect2 sensor. The Kinect can capture RGB and depth frames simultaneously up to 30 fps with sufficient accuracy. The region of interest is captured from three views, each shifted by 90 degrees. The RGB and depth data are fused into a single RGB-D frame. The resolution of the RGB frame is 1920px x 1080px while the resolution of the Depth frame is 512px x 424px. As the resolution of the frames is not equal, RGB pixels are mapped onto the Depth pixels to make sure data is not lost even if the resolution is lower. The resulting RGB-D frames are collected and using the depth coordinates, a three dimensional point cloud is generated for each view of the Kinect sensor. A common reference system was developed to merge the individual point clouds from the Kinect sensors. The reference system consisted of 8 coloured cubes, connected by rods to form a skeleton-cube with the coloured cubes at the corners. For each Kinect, the region of interest is the square formed by the centres of the four cubes facing the Kinect. The point clouds are merged by considering one of the cubes as the origin of a reference system. Depending on the relative distance from each cube, the three dimensional coordinate points from each point cloud is aligned to the reference frame to give a complete point cloud. The RGB data is used to correct for any errors in depth data for the point cloud. A triangular mesh is generated from the point cloud by applying Delaunay triangulation which generates the rough surface of the limb. This technique forms an approximation of the surface of the limb. The mesh is smoothened to obtain a smooth outer layer to give an accurate model of the limb. The model of the limb is used as a base for designing the custom orthotic brace or cast. It is transferred to a CAD/CAM design file to design of the brace above the surface of the limb. The proposed system would be more cost effective than current systems that use MRI or CT scans for generating 3D models and would be quicker than using traditional plaster of Paris cast modelling and the overall setup time is also low. Preliminary results indicate that the accuracy of the Kinect2 is satisfactory to perform modelling.

Keywords: 3d scanning, mesh generation, Microsoft kinect, orthotics, registration

Procedia PDF Downloads 163

Authors: P. Cinthuja, J. A. O. A Jayakody, M. P. M. Perera, W. V. D. N. Weerarathna, S.E. Nirosha, D. K. D. C. Indeewari, T. Kaethieswaran, S. B. Adikari

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The aims of the study was to measure physical fitness parameters of school badminton players in the Kandy district and determine the factors contributing to improve the physical fitness. Height, weight, handgrip was measured and sit and reach test, shoulder flexibility test, standing long jump test, 20m sprint speed test, agility T-test and 20 m multistage shuttle run test were performed on 183 school badminton players. Linear regression and correlation tests were performed using body mass index, practiced duration, age category, level of performance, additional sports involvement as independent variables and physical fitness parameter as dependent variables. Results: The present study showed that the upper body power, upper body strength and endurance and speed depended on body mass index both in male and female school badminton players. Speed, agility, flexibility of shoulders, explosive power of shoulder and aerobic endurance depended on the duration of practiced. Furthermore, involvement in additional sports other than badminton did not enhance the performance of badminton players. But it decreased player’s performance by decreasing agility and speed. Age had an effect on the upper body power, explosive power of lower limb, agility and speed both in both males and females. Conclusions: The performance of badminton players could be enhanced by maintaining a proper body mass index. Badminton specific parameter could be improved by increasing the duration of practiced. Involvement in other sports does not give an added advantage to badminton players to improve their performance.

Keywords: agility, Body Mass Index, endurance, badminton

Procedia PDF Downloads 403

Authors: Boonyarat Chaleephay

Abstract:

The purpose of this research paper was to describe the relationship of acupressure points on the anterior surface of the upper limb in accordance with Applied Thai Traditional Massage (ATTM) and the deep structures located at those acupressure points. There were 2 population groups; normal subjects and cadaver specimens. Eighteen males with age ranging from 20-40 years old and seventeen females with ages ranging from 30-97 years old were studies. This study was able to obtain a fundamental knowledge concerning acupressure point and the deep structures that related to those acupressure points. It might be used as the basic knowledge for clinically applying and planning treatment as well as teaching in ATTM.

Keywords: acupressure point (AP), applie Thai traditional medicine (ATTM), paresthesia, numbness

Procedia PDF Downloads 221