Functional, motor, and sensory assessment instruments upon nerve repair in adult hands: Systematic review of psychometric properties

© 2018 The Author(s). Background: Outcome after nerve repair of the hand needs standardized psychometrically robust measures. We aimed to systematically review the psychometric properties of available functional, motor, and sensory assessment instruments after nerve repair. Methods: This systematic review of health measurement instruments searched databases from 1966 to 2017. Pairs of raters conducted data extraction and quality assessment using a structured tool for clinical measurement studies. Kappa correlation was used to define the agreement prior to consensus for individual items, and intraclass correlation coefficient (ICC) was used to assess reliability between raters. A narrative synthesis described quality and content of the evidence. Results: Sixteen studies were included for final critical appraisal scores. Kappa ranged from 0.31 to 0.82 and ICC was 0.81. Motor domain had manual muscle testing with Kappa from 0.72 to 0.93 and a dynamometer ICC reliability between 0.92 and 0.98. Sensory domain had touch threshold Semmes-Weinstein monofilaments (SWM) as the most responsive measure while two-point discrimination (2PD) was the least responsive (effect size 1.2 and 0.1). A stereognosis test, Shape and Texture Identification (STI), had Kappa test-retest reliability of 0.79 and inter-rater reliability of 0.61, with excellent sensibility and specificity. Manual tactile test had moderate to mild correlation with 2PD and SWM. Function domain presented Rosén-Lundborg score with Spearman correlations of 0.83 for total score. Patient-reported outcomes measurements had ICC of 0.85 and internal consistency from 0.88 to 0.96 with Patient-Rated Wrist and Hand Evaluation with higher score for reliability and Spearman correlation between 0.38 and 0.89 for validity. Conclusions: Few studies included nerve repair in their sample for the psychometric analysis of outcome measures, so moderate evidence could be confirmed. Manual muscle test and Rotterdam Intrinsic Hand Myometer dynamometer had excellent reliability but insufficient data on validity or responsiveness. Touch threshold testing was more responsive than 2PD test. The locognosia test and STI had limited but positive supporting data related to validity. Rosén-Lundborg score had emerging evidence of reliability and validity as a comprehensive outcome following nerve repair. Few questionnaires were considered reliable and valid to assess cold intolerance. There is no patient-reported outcome measurement following nerve repair that provides comprehensive assessment of symptoms and function by patient perspective

Kinematic analysis and muscle activity of the upper extremity while performing a functional task

Introdução: O membro superior é um arranjo de segmentos e articulações que atuam de forma sincronizada para a execução das atividades de vida diária. Sua estabilidade ocorre por meio de componentes estáticos e dinâmicos envolvendo os músculos. Ferramentas como a eletromiografia e a análise cinemática tem sido amplamente utilizadas para avaliações quantitativas e objetivas do membro superior. O objetivo deste estudo foi avaliar as estratégias de controle motor utilizadas pelo membro superior durante a execução de uma tarefa funcional relacionada à alimentação. Método: Foram incluídos no estudo 25 voluntários destros saudáveis sem história prévia de disfunções musculoesqueléticas nos membros superiores. Para a coleta dos dados eletromiográficos foi utilizado o equipamento da marca Delsys® (Trigno® Wireless Systems). A preparação da pele seguiu as recomendações do Projeto SENIAM. Os eletrodos foram posicionados nos músculos trapézio superior, deltoides anterior, médio e posterior, bíceps braquial e tríceps braquial, peitoral maior, serrátil anterior, extensor radial longo e curto do carpo, extensor ulnar do carpo, flexor ulnar do carpo e flexor superficial dos dedos. Para a análise cinemática foi utilizado o sistema para análise de imagens 3D (Vicon Motion Systems Ltd®), composto por 8 câmeras infravermelho, que captam o movimento por meio do do rastreamento de 16 marcadores reflexivos passivos. A partir da análise cinemática foram construídos sistemas de coordenadas locais do tronco, braço, antebraço e mão seguindo as recomendações da Sociedade Internacional de Biomecânica. Os dados eletromiográficos e cinemáticos foram adquiridos de forma sincronizada e simultânea por meio do do Vicon Nexus Software® e o processamento dos sinais foi realizado off-line em programas personalizados no software Matlab® (versão R2014a, 2014). A confiabilidade dos ângulos obtidos foi confirmada por meio de movimentos reais mensurados com goniômetro. Foi selecionada a tarefa \"Despejar Água\" pertencente ao Teste Funcional do Membro Superior Elui - Teste Elui. Para a análise dos dados a tarefa foi dividida em 3 fases de acordo com a demanda do movimento: Alcance, Deslocamento e Liberação. Foi utilizada análise de variância (ANOVA) e pos hoc de Bonferroni (p≤0.05). Resultados: O tempo de execução da tarefa foi em média 14,6±3,5 segundos. A ADM foi significativamente maior durante a fase de Deslocamento para todos os movimentos avaliados, com exceção de flexão/extensão do punho. Nenhuma diferença significativa foi encontrada entre as fases de alcance e liberação, exceto abdução/adução de ombro, que apresentou o maior ADM na fase de Alcance. Na fase de Alcance houve significativa atividade de serrátil anterior, deltoides anterior e médio e tríceps braquial, enquanto na fase de Deslocamento atividade muscular significativa principalmente para trapézio superior, serrátil anterior e tríceps braquial. Durante a fase de Liberação, apenas o músculo tríceps braquial apresentou diferença significativa na atividade muscular. Conclusão: Nossos resultados sugerem que atividades diárias que requerem deslocamento da extremidade superior no espaço tridimensional, com tarefas de alcance, exigem mais movimento da articulação do ombro. Por outro lado, durante sustentação de carga que necessitem de estabilidade o cotovelo e punho são as articulações mais requisitadas. O músculo tríceps braquial parece desempenhar um papel importante na função da extremidade superior independentemente da demanda da tarefa.Introduction: The upper extremity is an arrangement of threads and joints that act in a synchronized form to carry out the activities of daily life. Its stability occurs through static and dynamic components involving the muscles. Tools like the electromyography and kinematics analysis has been widely used for quantitative and objective assessments of the upper extremity. The aim of this study was to evaluate the motor control strategies used by upper extremity during the execution of a functional food-related task. Method: 25 healthy volunteers, right-handed, without previous history of upper extremity musculoskeletal disorders, were included in this study. For electromyographic data collection the udes equipment was Delsys ® (Trigno ® Wireless Systems). The preparation of skin followed the recommendations of SENIAM Project. The electrodes were positioned in the upper trapezius, anterior, middle and posterior deltoids, biceps brachii and triceps brachii, pectoralis major, serratus anterior, extensor carpi radialis brevis, and long extensor Carpi ulnaris muscle, flexor Carpi ulnaris muscle and superficial flexor Digitorum. For kinematic analysis a motion system for 3D image analysis (Vicon Motion Systems Ltd ®), composed of 8 infrared cameras, which capture the movement through 16 reflexive markers trace liabilities, was used. From the kinematic analysis, local coordinates systems were built from the trunk, arm, forearm and hand following the recommendations of the international society of biomechanics. Kinematic and electromyographic data were acquired synchronized and simultaneously via Vicon Nexus ® Software and signal processing was performed offline in custom programs in Matlab® (version R2014a, 2014) software. The reliability of angles obtained was confirmed by actual movements measured with a goniometer. The task \"Pour Water\" belonging to the functional test of the upper extremity Elui was selected. For data analysis the task was divided into 3 phases according to specific demand of movement: reach, transport and release. Statistical analysis was performed by means of analysis of variance (ANOVA) and post hoc Bonferroni (p ≤ 0.05). Results: Task execution time was on average 14.6 ± 3.5 seconds. ROM was significantly higher during the transport phase for all movements assessed, with the exception of wrist flexion/extension. No significant difference was found between the phases of reach and release, except abduction/adduction of shoulder, which presented the highest average ROM. In the reach phase there was significant activity of serratus anterior, anterior and middle deltoids and triceps brachii, while in transport phase significant muscle activity phase primarily for upper trapezius, serratus anterior and triceps brachii. During the release phase, only the triceps brachii muscle showed significant difference in muscle activity. Conclusion: our results suggest that daily activities that require displacement in three-dimensional space, as reaching tasks, require more shoulder movement. On the other hand, during load support requiring stability, elbow and wrist joints are more required. The triceps brachii muscle seems to play an important role in the function of upper extremity regardless of task demand

Influence of static wrist orthosis on muscle activity and shoulder and elbow range of motion during a functional task: a biomechanical study

<p></p><p>ABSTRACT Orthoses are therapeutic resources that are appropriate to protect and remedy deformities or to help in the performance of certain functions; however, its use may lead to proximal compensations in the shoulder. Thus, this study aims to evaluate the influence of dorsal static 30° extension orthoses on the shoulder and elbow biomechanics in 25 asymptomatic individuals during a functional task. The range of motion and muscle activation was collected by simultaneous and synchronized analysis during the Elui functional test related to feeding, under the conditions with and without the orthosis. In order to allow a comparison of the different subjects and muscles, the data were analyzed by EMG signal of each muscle and, for kinematic analysis, pre-defined marker coordinate systems were constructed. The captured signals were filtered and processed by custom software, and the t-test for paired samples, SPSS® software, p<0.05, was used. We found significant increase in activation of the anterior deltoid and pectoralis major muscle in the reach phase and upper trapezius, anterior and posterior deltoid in the release phase with the orthosis. The kinematic analysis showed a significant increase in the range of motion of shoulder abduction movements, elbow flexion and pronation in the displacement phase and shoulder extension and elbow flexion movements in the release phase. Our findings suggest that the use of static wrist orthosis while performing a task can lead to compensations, with predominant activation of more proximal muscles of the upper limb.</p><p></p