A comparative study of efficacy and functionality of ten commercially available wrist-hand orthoses in healthy females:Wrist range of motion and grip strength analysis

Objective Wrist-hand orthoses(WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion(ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength. Design Randomised comparative functional study of the wrist/hand with and without WHOs. Participants Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for ten weeks. Main outcome measures The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained. Results From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4). Conclusion WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practice and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users’ needs

Differentiating Variations in Thumb Position From Recordings of the Surface Electromyogram in Adults Performing Static Grips, a Proof of Concept Study

Hand gesture and grip formations are produced by the muscle synergies arising between extrinsic and intrinsic hand muscles and many functional hand movements involve repositioning of the thumb relative to other digits. In this study we explored whether changes in thumb posture in able-body volunteers can be identified and classified from the modulation of forearm muscle surface electromyography (sEMG) alone without reference to activity from the intrinsic musculature. In this proof-of-concept study, our goal was to determine if there is scope to develop prosthetic hand control systems that may incorporate myoelectric thumb-position control. Healthy volunteers performed a controlled-isometric grip task with their thumb held in four different opposing-postures. Grip force during task performance was maintained at 30% maximal-voluntary force and sEMG signals from the forearm were recorded using 2D high-density sEMG (HD-sEMG arrays). Correlations between sEMG amplitude and root-mean squared estimates with variation in thumb-position were investigated using principal-component analysis and self-organizing feature maps. Results demonstrate that forearm muscle sEMG patterns possess classifiable parameters that correlate with variations in static thumb position (accuracy of 88.25±0.5% anterior; 91.25±2.5% posterior musculature of the forearm sites). Of importance, this suggests that in transradial amputees, despite the loss of access to the intrinsic muscles that control thumb action, an acceptable level of control over a thumb component within myoelectric devices may be achievable. Accordingly, further work exploring the potential to provide myoelectric control over the thumb within a prosthetic hand is warranted

A comparative study of the efficacy and functionality of 10 commercially available wrist-hand orthoses in healthy females during activities of daily living

Objective: Optimal wrist/hand function facilitates the performance of activities of daily living (ADL), which are associated with independent living and increased quality of life. Rheumatological, musculoskeletal, and neurological conditions or injuries can negatively impact hand/wrist function, with wrist-hand orthoses (WHOs) being prescribed to control motion and improve wrist alignment whilst enhancing hand/wrist functionality. The objective of this follow-up study was to quantify and assess the efficacy and functionality of 10 commercially available WHOs during five ADLs. Design: Randomised comparative functional study of the wrist/hand with and without WHOs. Participants: Ten right-handed healthy female participants with no underlying condition or pain affecting the wrist/hand that could influence their ability to undertake ADLs. Main outcome measures: The primary outcome was ascertaining the impact of each WHO during five ADLs. Movement was quantified in sagittal, coronal, and transverse planes with and without WHO use. The resting position, maximum mean flexion, extension, pronation, supination, and radial and ulnar deviation attained were quantified, with the time spent in wrist flexion, wrist flexion and ulnar deviation, wrist extension >15°, and radial deviation recorded. Finally, the time to complete each task was compared between conditions. Results: At rest, four WHOs maintained the desired sagittal plane wrist position, with only one preventing radial deviation with variation observed in the transverse plane. All WHOs reduced mean maximum flexion, with only 10 out of 50 tests (20%) showing a successful restriction of flexion (p 15° for a significant amount of time (p  Conclusion: The WHOs did not control movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief and were found to increase the time to complete the ADLs. Multifactorial design aspects influenced functionality, and there is a clear need for WHO redesign

Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries : a quantitative assessment from Myanmar

Background: Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). Objective: The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. Study design: The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. Methods: Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. Results: Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. Conclusion: The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL

High Density Surface Electromyography Activity of the Lumbar Erector Spinae Muscles and Comfort/Discomfort Assessment in Piano Players:Comparison of two chairs

Introduction: At a professional level, pianists have a high prevalence of playing-related musculoskeletal disorders. This exploratory crossover study was carried out to assess and compare quantitatively [using high density surface electromyography (HDsEMG)], and qualitatively (using musculoskeletal questionnaires) the activity of the lumbar erector spinae muscles (ESM) and the comfort/discomfort in 16 pianists sitting on a standard piano stool (SS) and on an alternative chair (A-chair) with lumbar support and a trunk-thigh angle between 105° and 135°. Materials and Methods: The subjects played for 55 min and HDsEMG was recorded for 20 s every 5 min. For the quantitative assessment of the muscle activity, the spatial mean of the root mean square (RMS(ROA)) and the centroid of the region of activity (ROA) of the ESM were compared between the two chairs. For the qualitative assessment, musculoskeletal questionnaire-based scales were used: General Comfort Rating (GCR); Helander and Zhang’s comfort (HZc) and discomfort (HZd); and Body Part Discomfort (BPD). Results: When using the A-chair, 14 out of 16 pianists (87.5%) showed a significantly lower RMS(ROA) on the left and right side (p < 0.05). The mixed effects model revealed that both chairs (F = 28.21, p < 0.001) and sides (F = 204.01, p < 0.001) contributed to the mean RMS(ROA) variation by subject (Z = 2.64, p = 0.004). GCR comfort indicated that participants found the A-Chair to be “quite comfortable,” and the SS to be “uncomfortable.” GCR discomfort indicated that the SS caused more numbness than the A-Chair (p = 0.05) and indicated the A-Chair to cause more feeling of cramps (p = 0.034). No difference was found on HZc (p = 0.091) or HZd (p = 0.31) between chairs. Female participants (n = 9) reported greater comfort when using the A-Chair than the SS (F = 7.09, p = 0.01) with respect to males. No differences between chairs were indicated by the BPD assessment. Conclusion: It is concluded that using a chair with lumbar support, such as the A-chair, will provide greater comfort, less exertion of the ESM and less discomfort than the standard piano stool

Back muscle activity in musicians : comparison between two different chairs

Back pain is a common disorder presented in musicians having a direct impact on their posture and life. This may likely be prevented by the use of a seat with lumbar support. High density sEMG investigates the muscle activity with potential for training (biofeedback)

Use of high-density surface-Electromyography of the forearm as a method for predicting thumb rotation in myoelectric transradial prosthetics

Until now, natural thumb control mechanisms are lacking in the upper limb prosthetic development. This lag is due to the complex anatomy of the musculature of the hand making the upper limb prosthetic research a very complicated area. Several studies have attempted to better our understanding of the neural control of the hand. With applications including clinical rehabilitation, surface-Electromyography (sEMG) has been steadily improving the knowl edge in this area, albeit still very limited. The development of high-density sEMG (HD-sEMG) has drastically increased the sensitivity of EMG tech niques. Despite this research effort, there are significant gaps in the field. Furthermore, current data analysis is almost exclusively performed off-line and so, neurally controlled prostheses are limited to research labs and are not a clinically viable technology. Therefore, it is evident that new tech nologies are required to understand the dexterity of the human hand for prosthetic control. A common theme across the different hand-prosthetic developers is not to have mechanisms to drive the thumb based on muscular contractions. Due to the lack of intuitiveness for an amputee to operate the prosthetic device, it requires several highly demanding training sessions between the patient and the prosthetist. These sessions are oriented for the amputee to be able to control in duration and magnitude, the contractions of the chosen muscles to drive the motors of the prosthesis. In this research, the muscle activity from the forearm is identified and correlated with specific hand movements leading to improve the commercially available myoelectric transradial prosthetics. This was achieved through the understanding of sEMG patterns related to differentiation of thumb op position to different fingers. The acquired signals were investigated based on time-domain analyses (i.e. amplitude signal analysis, root-mean square values, statistical analyses), followed by a joint time and frequency-domain analyses (i.e. coherence estimate and cumulant analysis). Finally, unsupervised machine learning techniques were applied aiming to differentiate the different sEMG patterns during the different thumb opposition. This differentiation leads to a better understanding with regards to prospective controller mechanisms aiming to develop new prosthetic devices enhancing the experience of transradial amputees with the use of their prosthetic.Until now, natural thumb control mechanisms are lacking in the upper limb prosthetic development. This lag is due to the complex anatomy of the musculature of the hand making the upper limb prosthetic research a very complicated area. Several studies have attempted to better our understanding of the neural control of the hand. With applications including clinical rehabilitation, surface-Electromyography (sEMG) has been steadily improving the knowl edge in this area, albeit still very limited. The development of high-density sEMG (HD-sEMG) has drastically increased the sensitivity of EMG tech niques. Despite this research effort, there are significant gaps in the field. Furthermore, current data analysis is almost exclusively performed off-line and so, neurally controlled prostheses are limited to research labs and are not a clinically viable technology. Therefore, it is evident that new tech nologies are required to understand the dexterity of the human hand for prosthetic control. A common theme across the different hand-prosthetic developers is not to have mechanisms to drive the thumb based on muscular contractions. Due to the lack of intuitiveness for an amputee to operate the prosthetic device, it requires several highly demanding training sessions between the patient and the prosthetist. These sessions are oriented for the amputee to be able to control in duration and magnitude, the contractions of the chosen muscles to drive the motors of the prosthesis. In this research, the muscle activity from the forearm is identified and correlated with specific hand movements leading to improve the commercially available myoelectric transradial prosthetics. This was achieved through the understanding of sEMG patterns related to differentiation of thumb op position to different fingers. The acquired signals were investigated based on time-domain analyses (i.e. amplitude signal analysis, root-mean square values, statistical analyses), followed by a joint time and frequency-domain analyses (i.e. coherence estimate and cumulant analysis). Finally, unsupervised machine learning techniques were applied aiming to differentiate the different sEMG patterns during the different thumb opposition. This differentiation leads to a better understanding with regards to prospective controller mechanisms aiming to develop new prosthetic devices enhancing the experience of transradial amputees with the use of their prosthetic

A Comparative Study of Efficacy and Functionality of Ten Commercially Available Wrist-Hand Orthoses in Healthy Females:Wrist Range of Motion and Grip Strength Analysis

OBJECTIVE: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength. DESIGN: Randomised comparative functional study of the wrist/hand with and without WHOs. PARTICIPANTS: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks. MAIN OUTCOME MEASURES: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained. RESULTS: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4). CONCLUSION: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users’ needs