Walker-Assisted Gait in Rehabilitation: A Study of Biomechanics and Instrumentation

While walkers are commonly prescribed to improve patient stability and ambulatory ability, quantitative study of the biomechanical and functional requirements for effective walker use is limited. To date no one has addressed the changes in upper extremity kinetics that occur with the use of a standard walker, which was the objective of this study. A strain gauge-based walker instrumentation system was developed for the six degree-of-freedom measurement of resultant subject hand loads. The walker dynamometer was integrated with an upper extremity biomechanical model. Preliminary system data were collected for seven healthy, right-handed young adults following informed consent. Bilateral upper extremity kinematic data were acquired with a six camera Vicon motion analysis system using a Micro-VAX workstation. Internal joint moments at the wrist, elbow, and shoulder were determined in the three clinical planes using the inverse dynamics method. The walker dynamometer system allowed characterization of upper extremity loading demands. Significantly differing upper extremity loading patterns were Identified for three walker usage methods. Complete description of upper extremity kinetics and kinematics during walker-assisted gait may provide insight into walker design parameters and rehabilitative strategies

Current perspective of venous thrombosis in the upper\ud extremity

Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous thrombosis. In this review an overview of the different risk factors, possible treatments and the complications for patients with a venous thrombosis of the upper extremity is give

A Rehabilitation Engineering Course for Biomedical Engineers

This paper describes an upper division elective course in rehabilitation engineering that addresses prosthetics and orthotics, wheelchair design, seating and positioning, and automobile modifications for individuals with disabilities. Faculty lectures are enhanced by guest lectures and class field trips. Guest lecturers include a prosthetist and a lower extremity amputee client, an engineer/prosthetist specializing in the upper extremity, and a rehabilitation engineer. The lower extremity prosthetist and his client present a case study for prosthetic prescription, fabrication, fitting, alignment, and evaluation. The engineer/prosthetist contrasts body-powered versus externally powered upper extremity prostheses and associated design, fitting, and functional considerations; he also discusses myoelectric signal conditioning, signal processing, and associated control strategies for upper extremity prosthetic control. Finally, the rehabilitation engineer presents case studies related to assessment and prescription of mobility aids, environmental control systems, and children\u27s toys. The course also includes visits to a local prosthetic and orthotic facility to observe typical fabrication, fitting, and alignment procedures and a driver rehabilitation program for exposure to driver assessment, training, and common vehicle modifications. These applications of biomedical engineering to persons with disabilities have been well received by the students and have furthered interdisciplinary design and research projects

Is Workstyle a Mediating Factor for Pain in the Upper Extremity Over Time?

Introduction Upper extremity musculoskeletal disorders influence workers’ quality of life. Workstyle may be one factor to deal with in workers with pain in the upper extremity. The objective of this study was to determine if workstyle is a mediating factor for upper extremity pain in a changing work environment of office workers over time. Methods Office workers with upper extremity pain filled out a Workstyle questionnaire (WSF) at baseline (n = 110). After 8 and 12 months follow-up assessment took place. Participants were divided into a good and an adverse workstyle group at baseline. The presence of upper extremity pain in both groups was calculated and relative risks were determined. Chi-square tests were used. Results Eight months after baseline, 80% of the adverse and 45% of the good workstyle group reported pain. The relative risk (RR) of having upper extremity pain for the adverse compared to the good workstyle group was 1.8 (95% CI 1.08–2.86) (P = 0.055). Twelve months after baseline, upper extremity pain was more often presented in the adverse workstyle compared to the good workstyle group (RR = 3.0, (95% CI 1.76–5.11), P = 0.003). Twelve months after baseline, 100% of the adverse workstyle group and 33% of the good workstyle group reported pain in the upper extremity. Conclusion Workstyle seems to be a mediating factor for upper extremity pain in office workers in a changing work environment. It is recommended to assess workstyle among office workers with upper extremity pain, and to include workstyle behaviour in treatments

Evaluation of Upper Extremity Movement Characteristics during Standardized Pediatric Functional Assessment with a Kinect®-based Markerless Motion Analysis System

A recently developed and evaluated upper extremity (UE) markerless motion analysis system based on the Microsoft® Kinect® has potential for improving functional assessment of patients with hemiplegic cerebral palsy. 12 typically-developing adolescents ages 12-17 were evaluated using both the Kinect-based system and the Shriners Hospitals for Children Upper Extremity Evaluation (SHUEE), a validated measure of UE motion. The study established population means of UE kinematic parameters for each activity. Statistical correlation analysis was used to identify key kinematic metrics used to develop automatic scoring algorithms. The Kinect motion analysis platform is technically sound and can be applied to standardized task-based UE evaluation while providing enhanced sensitivity in clinical analysis and automation through scoring algorithms

Upper Extremity Biomechanics of Children with Spinal Cord Injury during Wheelchair Mobility

While much work is being done evaluating the upper extremity joint dynamics of adult manual wheelchair propulsion, limited work has examined the pediatric population of manual wheelchair users. Our group used a custom pediatric biomechanical model to characterize the upper extremity joint dynamics of 12 children and adolescents with spinal cord injury (SCI) during wheelchair propulsion. Results show that loading appears to agree with that of adult manual wheelchair users, with the highest loading primarily seen at the glenohumeral joint. This is concerning due to the increased time of wheelchair use in the pediatric population and the impact of this loading during developmental years. This research may assist clinicians with improved mobility assessment methods, wheelchair prescription, training, and long-term care of children with orthopaedic disabilities

Postural control influence on upper extremity function among children with cerebral palsy: a literature review

Performance of upper extremity function and movement sequence is influenced by postural control. Motor disorders lead to deficits in postural control, which subsequently may lead to postural instability of children with cerebral palsy (CWCP). This will limit their upper extremity activity performance. Management strategies help to support and enhance the CWCP’s upper extremity function so that they may engage with the activities of daily living. The purpose of this paper is to review previous literature on the influence of postural control towards upper extremity function. Literature searches were conducted in various electronic databases, including ProQuest, Science Direct, Springer Link, Sage, Wiley Online Library, and Google Scholar using specific key terms. Search terms included children with cerebral palsy; postural control; postural adjustments; upper extremity function; reaching and sitting and from references of retrieved articles. Nineteen journal articles published between 2000 and May 2015 were found. Most search results consisted of experimental studies, while others are reviews, case studies, and cross-sectional studies. Findings show that, postural control has a major influence on upper extremity function. In conclusion, it is necessary to highlight the importance of both factors to the CWCP parents or caregivers, as understanding and awareness on this matter is still inadequate in the community. Hence, a study is needed on the awareness of the postural control influence on upper extremity function among caregivers, as well as examining the implementation of management strategies in community settings

The Effects Of Upper Body vs Lower Body Training On Rate-Pressure Product

Lower body activities such as walking, running, and cycling have traditionally been used as the activity mode during physiological exercise testing. Interest in specific responses to upper extremity exercise has increased since upper body cycle ergometry became an important alternative exercise mode in the 1970s. Previous research on upper extremity exercise utilized upper body cycle ergometry or a standard push-pull rowing movement. Few upper extremity studies measured rate-pressure product. The purpose of this study was to compare rate-pressure product between lower extremity exercise utilizing upright cycling and primarily upper extremity exercise on a double arm swing Ski Erg ergometer. Hemodynamic response was measured using an automated motion tolerant exercise test monitor. The study utilized one dependent variable (rate-pressure product) and four independent variables (exercise mode, exercise intensity, age group, and gender). A repeated measures ANOVA was conducted to determine the effects of exercise mode, gender, and age group on rate-pressure product at identical exercise workloads. Significant differences in rate-pressure product were found for exercise mode, but not for gender or age group. Mean rate-pressure product increase for each workload was then compared using the Tukey LSD post hoc test. Rate-pressure product increase during each workload of upper extremity was significantly greater than during the corresponding lower extremity workload. This finding provides further evidence that greater hemodynamic demand during upper extremity exercise is a generalized response which occurs in response to isolated upper extremity exercise independent of the exact arm movement or specific muscle involvement. The findings also indicate greater hemodynamic response to upper extremity exercise is independent of gender or age group

Occupational Therapist’S Role In Addressing The Psychological Impacts Of Pain In Clients With Upper Extremity Conditions

Background & Purpose: The experience of pain is different for every client (Felman, 2020). There are various ways to feel and describe the pain (Felman, 2020). A maladaptive response to pain has been associated with increased pain and physical limitations in clients with upper extremity pain (Verhiel et al., 2019). Upper extremity impairments can result in the disruption of many activities of daily living and instrumental activities of daily living (American Occupational Therapy Association, 2014). Clients with upper extremity pain often resort to maladaptive coping strategies, such as catastrophic thinking (Verhiel et al., 2019). The most common psychological factors related to upper extremity pain include anxiety, depression, pain catastrophizing, and problems related to work and sleep dysfunction (Hamasaki et al., 2018). Despite the significance of upper extremity pain, many therapists do not formally address the psychological factors of pain. Some occupational therapists may lack confidence in addressing the psychological factors due to the social stigmas of mental health symptoms, the lack of time, and inadequate training about how to address psychological factors of upper extremity pain (Knaak et al., 2017; Vranceanu et al., 2017). The purpose of this scholarly project was to develop a product to address the needs of occupational therapy clients demonstrating psychological factors of pain related to upper extremity conditions. Based on best-practice evidence and models of practice, this scholarly project used the findings from the literature review to develop a guide that will aid occupational therapists with psychologically based interventions to address the psychological factors of pain with upper extremity conditions. Methodology: A needs assessment was conducted through a review of the literature to determine the needs of clients who are experiencing both pain due to upper extremity conditions and psychological symptoms that accompany that pain. PubMED, CINHAL, ClinicalKey, SAGEPub, Elsevier, and PsycINFO were searched using such combinations as: upper extremity pain AND psychological interventions AND occupational therapy, cognitive behavioral therapy AND pain management, cognitive distortions AND pain, Healthy coping skills AND pain. The Model of Human Occupation (MOHO) (Clifford O’Brien, 2017) was used to guide the creation and intended use of the product to assist occupational therapists in addressing the psychological factors of the pain of clients with upper extremity conditions. This model was applied to understand how the psychological factors of upper extremity pain can affect a client\u27s volition, habituation, performance capacity, and occupational identity (Clifford O’Brien, 2017). This scholarly project was informed, too, by a concurrent doctoral experience placement in an outpatient orthopedic practice setting. Outcome: This project resulted in a 4-part module for occupational therapists to use to address the needs in the areas of psychological impacts of pain for clients with upper extremity conditions. The target population is clients across the life span with upper extremity conditions who receive services in an outpatient occupational therapy orthopedic setting. This product includes intervention information to address the red flags of pain, cognitive distortions related to pain and restructuring pain thoughts, relaxation techniques, and learning to accept living with pain. This product will help occupational therapists establish specific needs and priorities of their clients’ concerning diagnoses and pain management. The product intends to add an important dimension to intervention, maximize the overall occupational performance (Clifford O’Brien, 2017), and contribute to the health and well-being of clients with upper extremity conditions