171 research outputs found
Compensations in Dutch matrimonial property law
Echtgenoten plegen lang niet altijd het eigen vermogen strikt te scheiden van het vermogen van de ander en hun gemeenschappelijke vermogen. Zo kan het gebeuren dat een echtgenoot gemeenschappelijk vermogen gebruikt voor de betaling van eigen schulden of met geld van de andere echtgenoot een auto aanschaft, de koopsom van een woning geheel of voor een deel voldoet of een verbouwing van die woning betaalt. In deze en in andere gevallen kunnen tussen echtgenoten over en weer vermogensverschuivingen plaatsvinden. Als er een goede reden is voor die vermogensverschuiving is hoeft deze niet gecorrigeerd te worden. Dat kan anders zijn als een grond voor de vermogensverschuiving ontbreekt. Het algemeen vermogensrecht kent verschillende oplossingen voor het tegengaan of herstellen van ongegronde vermogensverschuivingen. Dat zijn de figuur van de zaaksvervanging en de actie wegens ongerechtvaardigde verrijking. Dat is in het huwelijksvermogensrecht net iets anders. Indien tussen de echtgenoten een grond voor een vermogensverschuiving ontbreekt, ontstaan verplichtingen tot vergoeding. In de rechtspraak en de wet krijgen deze vergoedingen recent veel aandacht. In dit onderzoek is een algemene regel gezocht en gevonden die voor alle vergoedingen toegepast kan worden en een handzame maatstaf vormt voor de rechtspraktijk. Daarnaast is er aandacht voor allerlei juridische aspecten van vergoedingen die van belang zijn bij het maken van huwelijkse voorwaarden en de beoordeling door de rechter van geschillen over vergoedingen.Spouses by no means always strictly separate their own assets from the other's assets and their common assets. For example, one spouse may use common assets to pay his or her own debts or buy a car with the other spouse's money, pay all or part of the purchase price of a house or pay for renovations to that house. In these and other cases, shifts of property can occur back and forth between spouses. If there is a good reason for that shift of property, it need not be corrected. It may be different if there is no ground for the asset shift. General property law has several solutions for countering or correcting unjustified shifts of property. These are the figure of proprietary substitution and the action for unjust enrichment. Things are slightly different in matrimonial property law. If there is no ground for a shift of property between the spouses, obligations to compensate arise. These compensations have recently received a lot of attention in case law and the law. In this study, a general rule was sought and found that can be applied to all compensations and provides a handy benchmark for legal practice. In addition, attention is paid to all kinds of legal aspects of compensation that are important when drawing up prenuptial agreements and the court's assessment of compensation disputes
Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement
BACKGROUND
Children and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability.
METHODS
Children and adolescents aged 6-18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events.
RESULTS
Eleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5-83) than without (55; IQR: 37.5-80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred.
CONCLUSIONS
PEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device. Trial registration Not appropriate
Musculoskeletal balance of the human wrist elucidated using intraoperative laser diffraction
Abstract This review describes a series of experiments in which sarcomere length was measured in human wrist muscles to understand their design. Sarcomere length measurements were combined with studies on cadaveric extremities to generate biomechanical models of human wrist function and to provide insights into the mechanism by which wrist strength balance is achieved. Intraoperative measurements of the human extensor carpi radialis brevis (ECRB) muscle during wrist joint rotation reveal that this muscle appears to be designed to operate on the descending limb of its length-tension curve and generates maximum tension with the wrist fully extended. Interestingly, the synergistic extensor carpi radialis longus (ECRL) also operates on its descending limb but over a much narrower sarcomere length range. This is due to the longer fibers and smaller wrist extension moment arm of the ECRL compared to the ECRB. Sarcomere lengths measured from wrist flexors are shorter compared to the extensors. Using a combination of intraoperative measurements on the flexor carpi ulnaris (FCU) and mechanical measurements of wrist muscles, joints and tendons, the general design of the prime wrist movers emerges: both muscle groups generate maximum force with the wrist fully extended. As the wrist flexes, force decreases due to extensor lengthening along the descending limb of their length-tension curve and flexor shortening along the ascending limb of their length-tension curve. The net result is a nearly constant ratio of flexor to extensor torque over the wrist range of motion and a wrist that is most stable in full extension. These experiments demonstrate the elegant match between muscle, tendon and joints acting at the wrist. Overall, the wrist torque motors appear to be designed for balance and control rather than maximum torque generating capacity
Mechanical considerations in the design of surgical reconstructive procedures
Abstract Tendon transfers are used to restore arm and hand function after injury to the peripheral nerves or after spinal cord injury. Traditional guidelines to choose the length at which the transferred muscle should be attached have a poor scientific foundation. We postulate that passive tension only becomes significant at relatively long lengths and that passive tension as the major factor in intraoperative decision making may result in overstretch of the muscle-tendon unit (MTU) and accompanying low-active force generation. It appears unwise to rely on unknown factors, such as slippage or stress relaxation, to correct an overstretched transfer. Instead, we suggest the use of intra-operative sarcomere length measurements to predict and set the optimal MTU length during reconstructive upper limb surgery.
Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control
From Springer Nature via Jisc Publications RouterIntroduction: Current clinical assessments measure selective voluntary motor control (SVMC) on an ordinal scale. We introduce a playful, interval-scaled method to assess SVMC in children with brain lesions and evaluate its validity and reliability. Methods: Thirty-one neurologically intact children (median [1st-3rd quartile]: 11.6 years [8.5–13.9]) and 33 patients (12.2 years [8.8–14.9]) affected by upper motor neuron lesions with mild to moderate impairments participated. Using accelerometers, they played a movement tracking game (assessgame) with isolated joint movements (shoulder, elbow, lower arm [pro−/supination], wrist, and fingers), yielding an accuracy score. Involuntary movements were recorded simultaneously and resulted in an involuntary movement score. Both scores were normalized to the performance of 33 neurologically intact adults (32.5 years [27.9; 38.3]), which represented physiological movement patterns. We correlated the assessgame outcomes with the Manual Ability Classification System, Selective Control of the Upper Extremity Scale, and a therapist rating of involuntary movements. Furthermore, a robust ANCOVA was performed with age as covariate, comparing patients to their healthy peers at the age levels of 7.5, 9, 10.5, 12, and 15 years. Intraclass correlation coefficients and smallest real differences indicated relative and absolute reliability. Results: Correlations (Kendall/Spearman) for the accuracy score were τ = 0.29 (p = 0.035; Manual Ability Classification System), ρ = − 0.37 (p = 0.035; Selective Control of the Upper Extremity Scale), and ρ = 0.64 (p < 0.001; therapist rating). Correlations for the involuntary movement metric were τ = 0.37 (p = 0.008), ρ = − 0.55 (p = 0.001), and ρ = 0.79 (p < 0.001), respectively. The robust ANCOVAs revealed that patients performed significantly poorer than their healthy peers in both outcomes and at all age levels except for the dominant/less affected arm, where the youngest age group did not differ significantly. Robust intraclass correlation coefficients and smallest real differences were 0.80 and 1.02 (46% of median patient score) for the accuracy and 0.92 and 2.55 (58%) for involuntary movements, respectively. Conclusion: While this novel assessgame is valid, the reliability might need to be improved. Further studies are needed to determine whether the assessgame is sensitive enough to detect changes in SVMC after a surgical or therapeutic intervention.pubpu
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