Are movement disorders and sensorimotor injuries pathologic synergies? When normal multi-joint movement synergies become pathologic

The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system’s ability to control movement

The significance of wrist immobilization for endoscopic carpal tunnel release

BackgroundOver the years, endoscopic carpal tunnel release (ECTR) has gained significant interest as an alternative to surgery. However, no consensus has been reached on the necessity of postoperative wrist immobilization. This study aims to compare the outcomes of wrist immobilization for a period of 2 weeks to immediate wrist mobilization after ECTR.MethodsA total of 24 patients with idiopathic carpal tunnel syndrome undergoing dual-portal ECTR from May 2020 to Feb 2022 were enrolled and randomly divided into two groups postoperatively. In one group, patients wore a wrist splint for 2 weeks. In another group, wrist mobilization was allowed immediately after surgery. The two-point discrimination test (2PD test); the Semmes–Weinstein monofilament test (SWM test); the occurrence of pillar pain, digital and wrist range of motion (ROM); grip and pinch strength; the visual analog score (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ) score; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and complications were evaluated at 2 weeks and 1, 2, 3, and 6 months after the surgery.ResultsAll 24 subjects finished this study with no dropouts. During the early follow-up, patients with wrist immobilization demonstrated lower VAS scores, lower occurrence of pillar pain, and higher grip and pinch strength compared with the immediate mobilization group. No significant difference was obtained between these two groups in terms of the 2PD test, the SWM test, digital and wrist ROM, BCTQ, and the DASH score. In total, two patients without splints reported transient scar discomfort. No one complained of neurapraxia, injury of the flexor tendon, median nerve, and major artery. At the final follow-up, no significant difference was found in any parameters between both groups. The local scar discomfort mentioned above disappeared and left no serious sequela.ConclusionWrist immobilization during the early postoperative period demonstrated significant pain alleviation along with stronger grip and pinch strength. However, wrist immobilization yielded no obvious superiority regarding clinical outcomes at the final follow-up

Diagnostic Criteria and Management of Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is an entrapment neuropathy involving the median nerve as it passes through the carpal tunnel. CTS is widely recognized as the most common of all nerve entrapment syndromes. CTS develops when irritation causes the tendon sheaths passing through the carpal tunnel to swell, constricting the tunnel and compressing the median nerve. Manifestations of CTS are varied, but usually include pain, numbness and weakness of the hand. Incidence of CTS has risen sharply in the past five years. Prevention of CTS and reduction of it\u27s effects appears to be the best solution for this disorder. Physical therapists are in a key position to provide preventative programs for early, acute cases. The purpose of this study is to identify those people who are at an increased risk for CTS and provide guidelines for the physical therapist\u27s management of CTS. Due to the increased incidence of this condition and rising health care costs, therapeutic management will be in the best interest of all those involved with carpal tunnel syndrome

Effects of Carpal Tunnel Syndrome on adaptation of multi-digit forces to object mass distribution for whole-hand manipulation

Background Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve that results in sensorimotor deficits in the hand. Until recently, the effects of CTS on hand function have been studied using mostly two-digit grip tasks. The purpose of this study was to investigate the coordination of multi-digit forces as a function of object center of mass (CM) during whole-hand grasping. Methods Fourteen CTS patients and age- and gender-matched controls were instructed to grasp, lift, hold, and release a grip device with five digits for seven consecutive lifts while maintaining its vertical orientation. The object CM was changed by adding a mass at different locations at the base of the object. We measured forces and torques exerted by each digit and object kinematics and analyzed modulation of these variables to object CM at object lift onset and during object hold. Our task requires a modulation of digit forces at and after object lift onset to generate a compensatory moment to counteract the external moment caused by the added mass and to minimize object tilt. Results We found that CTS patients learned to generate a compensatory moment and minimized object roll to the same extent as controls. However, controls fully exploited the available degrees of freedom (DoF) in coordinating their multi-digit forces to generate a compensatory moment, i.e., digit normal forces, tangential forces, and the net center of pressure on the finger side of the device at object lift onset and during object hold. In contrast, patients modulated only one of these DoFs (the net center of pressure) to object CM by modulating individual normal forces at object lift onset. During object hold, however, CTS patients were able to modulate digit tangential force distribution to object CM. Conclusions Our findings suggest that, although CTS did not affect patients’ ability to perform our manipulation task, it interfered with the modulation of specific grasp control variables. This phenomenon might be indicative of a lower degree of flexibility of the sensorimotor system in CTS to adapt to grasp task conditions

Natural Language Processing in Biomedical Literature for Analysing the Effects of Neurodynamic in Pain and Disability in Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) a most common peripheral neuropathy characterised by numbness, tingling in the sensory distribution area of the of the median nerve, particularly in the thumb , index finger ,middle finger and radial side of ring finger along with motor weakness, distal to wrist that results into decreased hand grip strength and hand function disability. CTS puts an economy burden on healthcare services as its incidence and prevalence are increasing day by day although a slight decline in numbers has been seen over a period time. Fuzzy logic retains expert information in an intelligent system that may be effectively utilized by others, simulating the cognitive decision-making abilities of the specialist, and helping junior doctors with less expertise make better diagnoses. Therefore, the use of such an expert system is advised to speed up and enhance the accuracy of the diagnosis in patients with suspected CTS by studying different literatures. To device, evidence based therapeutic protocol from biomedical literature for the treatment of pain and disability in CTS. To analyse the effect of openers, sliders, and tensioners on NPRS and disability in carpal tunnel syndrome, using biomedical literature. Therefore, we draw the very encouraging conclusion that further research on the application of such a fuzzy expert system for medical opinion prediction and diagnosis is warranted

Novel Information About The Kinetic Effects Of Equine Shoe Modifications And Kinematic Effects Of Human Digital Devices For Improved Performance In Both Species

Equine shoes are frequently modified to enhance traction for horses that travel on paved surfaces for work, pleasure, or entertainment. Little is known about other common shoe modifications used to enhance traction like calks, tungsten carbide granules, or plastic composition. This information is vital to shoe design to protect the safety and welfare of all service, working, and leisure horses. The objective of the first part of this thesis was to quantify the effect of shoes with and without traction adaptions on kinetic measures in non-lame, light breed horses at a trot. Kinetic data was collected with a force platform from horses while unshod (U) and subsequently shod in random order with five distinct shoes: standard (S), high profile-low surface area calk (HC), low profile-high surface area calk (LC), thin layer tungsten carbide (TLC), and plastic-steel composite (C). Results indicate that in the forelimbs, peak vertical force increased with C versus S (P=0.0001), HC (P=0.0049), LC (P= 0.0110), and TLC (P=0.0246) shoes. In the hind limbs, peak braking force increased with C versus S (PPPP=0.0041). It increased with TLC versus HC (PPP=0.0079) and S shoe (P=0.0474). The human wrist (radiocarpal joints) has complex anatomy and motion that likely contributes to overuse injuries. Digital device use requires distinct wrist motions that may contribute to tissue damage with frequent, prolonged use and static loading. The second part of the thesis aimed to quantify wrist motion in radial-ulnar deviation and flexion-extension planes for use of digital devices and their manual counterparts in dominant and non-dominant hands of male and female professionals. Twelve subjects completed 4 paired daily living activities using digital and manual devices. Left and right wrist 3D motion was recorded with eight markers of a wireless, active motion detection system. This study established baseline values for medial and lateral radiocarpal extension and radial-ulnar deviation angles and ROM using digital devices. Both sex, handedness, and device size influence wrist motion

Musicians and Performance Related Injuries to the Hand

Musicians spend a great amount of energy and time preparing for auditions, competitions, performances, and recitals. The process of developing techniques and learning musical pieces requires practice sessions filled with long hours of repeating musical passages and awkward upper extremity positions. Performance related injuries often result from these conditions. Injuries include joint disorders, musculotendinous disorders, muscle cramps and pain disorders, neurological disorders, and focal dystonia or occupational palsy disorders. Pain, numbness, tingling, muscle cramping, and motor dysfunctions are associated symptoms. If symptoms are ignored and intense performance is continued, the musician can experience tissue damage and permanent loss of function. Research has indicated that the hand, the wrist, and the fingers are the areas of the body where performance related injuries are most frequent. This literature review will focus on the common hand injuries experienced by musicians. Common types of injuries, evaluation procedures, treatments, and prevention techniques specific to the needs of musicians will be discussed

Cumulative trauma disorders in the workplace: bibliography

"This publication provided a compilation of materials describing research conducted by NIOSH on cumulative trauma disorders in the workplace. Selected references, both NIOSH and nonNIOSH, were provided, concentrating on NIOSH activities in preventing work related musculoskeletal disorders, prevention and intervention research at NIOSH for work related musculoskeletal disorders, comments to the Department of Labor on the OSHA proposed rule on ergonomic safety and health management, a manual for musculoskeletal diseases of the upper limbs, a review of physical exercises recommended for video display tube operators, management of upper extremity cumulative trauma disorders, ergonomics and prevention of musculoskeletal injuries, and carpal tunnel syndrome. A bibliography of NIOSH publications on cumulative trauma disorders in the workplace was provided, including numbered publications, testimony, journal articles, grant reports, contract reports, and health hazard evaluations. NonNiosh references were also listed." - NIOSHTIC-2Part I. Selected NIOSH and non-NIOSH References -- A. NIOSH Activities in Preventing Work-Related Musculoskeletal Disorders -- B. Work-Related Musculoskeletal Disorders: Prevention and Intervention Research at NIOSH -- C. Comments to DOL on the Occupational Safety and Health Administration Proposed Role on Ergonomic Safety and Health Management - Part 1 -- C. Comments to DOL on the Occupational Safety and Health Administration Proposed Role on Ergonomic Safety and Health Management - Part 2 -- D. Cumulative Trauma Disorders: A Manual for Musculoskeletal Diseases of the Upper Limbs -- E. A Review of Physical Exercises Recommended for VDT Operators ) -- F. Management of Upper Extremity Cumulative Trauma Disorders -- G. Preventing Illness and Injury in the Workplace: Ergonomics and Prevention of Musculoskeletal Injuries -- H. Carpal Tunnel Syndrome -- -- Part II. Cumulative Trauma Disorders in the Workplace - Bibliography -- A. NIOSH Publications Reports -- 1. Numbered Publications -- 2. Testimony -- 3. Journal Articles -- 4. Grant Reports -- 5. Contract Reports -- 6. Health Hazard Evaluations -- -- B. Selected non-NIOSH ReferencesAlso available via the World Wide Web

Design of a Portable and Compact Gyroscopic Device for Hand Rehabilitation

User centered design is an apt process for developing assistive devices, as user needs are given the utmost importance in this approach. On studying current, state of the art hand rehabilitation devices, it was inferred that there exists a need for a compact and portable hand rehabilitation device – one suitable for patients with adversely limited active range of motion of the hand. This thesis proposes a novel hand-held, portable device that is composed of a fully actuated rotor-gimbal assembly (US Patent Application: 62/413,130). The simultaneous motion of the rotor and gimbal results in a controlled gyroscopic torque that acts on the user’s hand. Based on the hand’s strength and mobility, the user may either synchronize the hand movement with that compelled by the device or restrict it. While the former results in the relaxation of muscles, the latter can potentially increase muscle co-ordination and muscle strength. The target specifications of the device were determined through interviews with personnel specialized in the field of hand rehabilitation. A working principle of the device was then established via a proof-of-concept model and mathematical simulations, which were further used to firm up the design parameters. The dynamic analysis of the device was then conducted to attest the structural integrity. Also, the range of forces imposed by the device on the hand were evaluated to be within safe measures through simulation and consecutive comparison with existing literature. Future work includes fabricating the final device and evaluating its performance via experiments with human subjects. hand were evaluated to be within safe measures through simulation and consecutive comparison with existing literature. Future work includes fabricating the final device and evaluating its performance via experiments with human subjects

Occupational Cumulative Trauma Disorders: Prevention and Treatment

Cumulative Trauma Disorders (CTDs) consist of a group of musculoskeletal injuries caused by overuse or repetitive strain. The purpose of this Independent Study was to review the literature concerning occupational CTDs, the methods of prevention, and treatment as it related to physical therapy. The most beneficial means of controlling CTDs appear to be taking preventative measures with jobsite analysis and employee education. Treatment is varied and dependent upon the actual diagnosis and causative factor. Therapists may attempt heat or cold modalities, work hardening programs, or manual therapy such as strain-counterstrain. An important aspect to treatment is early intervention. Due to the high prevalence of CTDs, it is important for therapists to become aware of its presence, learn to effectively determine the mode of injury, and appropriately treat the injured patient