UNASSIGNED: The human upper extremity is characterized by inherent motor abundance, allowing a diverse array of tasks with agility and adaptability. Upper extremity functional limitations are a common sequela to Stroke, resulting in pronounced motor and sensory impairments in the contralesional arm. While many therapeutic interventions focus on rehabilitating the weaker arm, it is increasingly evident that it is necessary to consider bimanual coordination and motor control.
UNASSIGNED: Participants were recruited to two groups differing in age (Group 1 (n = 10): 23.4 ± 2.9 years, Group 2 (n = 10): 55.9 ± 10.6 years) for an exploratory study on the use of accelerometry to quantify bilateral coordination. Three tasks featuring coordinated reaching were selected to investigate the acceleration of the upper arm, forearm, and hand during activities of daily living (ADLs). Subjects were equipped with acceleration and inclination sensors on each upper arm, each forearm, and each hand. Data was segmented in MATLAB to assess inter-limb and intra-limb coordination. Inter-limb coordination was indicated through dissimilarity indices and temporal locations of congruous movement between upper arm, forearm, or hand segments of the right and left limbs. Intra-limb coordination was likewise assessed between upper arm-forearm, upper arm-hand, and forearm-hand segment pairs of the dominant limb.
UNASSIGNED: Acceleration data revealed task-specific movement features during the three distinct tasks. Groups demonstrated diminished similarity as task complexity increased. Groups differed significantly in the hand segments during the buttoning task, with Group 1 showing no coordination in the hand segments during buttoning, and strong coordination in reaching each button with the upper arm and forearm guiding extension. Group 2\'s dissimilarity scores and percentages of similarity indicated longer periods of inter-limb coordination, particularly towards movement completion. Group 1\'s dissimilarity scores and percentages of similarity indicated longer periods of intra-limb coordination, particularly in the coordination of the upper arm and forearm segments.
UNASSIGNED: The Expanding Procrustes methodology can be applied to compute objective coordination scores using accessible and highly accurate wearable acceleration sensors. The findings of task duration, angular velocity, and peak roll angle are supported by previous studies finding older individuals to present with slower movements, reduced movement stability, and a reduction of laterality between the limbs. The theory of a shift towards ambidexterity with age is supported by the finding of greater inter-limb coordination in the group of subjects above the age of thirty-five. The group below the age of thirty was found to demonstrate longer periods of intra-limb coordination, with upper arm and forearm coordination emerging as a possible explanation for the demonstrated greater stability.

Assessment of the upper limb is critical to guiding the rehabilitation cycle. Drawbacks of observation-based assessment include subjectivity and coarse resolution of ordinal scales. Kinematic assessment gives rise to objective quantitative metrics, but uptake is encumbered by costly and impractical setups. Our objective was to investigate feasibility and accuracy of computer vision (CV) for acquiring kinematic metrics of the drinking task, which are recommended in stroke rehabilitation research. We implemented CV for upper limb kinematic assessment using modest cameras and an open-source machine learning solution. To explore feasibility, 10 neurotypical participants were recruited for repeated kinematic measures during the drinking task. To investigate accuracy, a simultaneous marker-based motion capture system was used, and error was quantified for the following kinematic metrics: Number of Movement Units (NMU), Trunk Displacement (TD), and Movement Time (MT). Across all participant trials, kinematic metrics of the drinking task were successfully acquired using CV. Compared to marker-based motion capture, no significant difference was observed for group mean values of kinematic metrics. Mean error for NMU, TD, and MT were - 0.12 units, 3.4 mm, and 0.15 s, respectively. Bland-Altman analysis revealed no bias. Kinematic metrics of the drinking task can be measured using CV, and preliminary findings support accuracy. Further study in neurodivergent populations is needed to determine validity of CV for kinematic assessment of the post-stroke upper limb.

BACKGROUND: Worldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP.
METHODS: Children established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children\'s Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers.
RESULTS: Fifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children\'s mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands.
CONCLUSIONS: Bootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation. Trial registration Trial registration number: NCT05403567.

UNASSIGNED: Reconstruction of upper extremity wounds with dermal matrices can reduce the length of hospitalization and surgical complexity without compromising functional outcomes. We aimed to compare costs between Novosorb biodegradable temporizing matrix (BTM) and Integra collagen-chondroitin silicone (CCS) bilayer.
UNASSIGNED: A chart review was performed for patients with isolated upper extremity traumatic wounds who underwent reconstruction with either BTM or CCS between January 2017 and May 2022. Demographic data, surgical procedures, outcomes, and costs were collected for analysis.
UNASSIGNED: Twenty-seven patients were included: 18 BTM and 9 CCS. There were no differences in age, sex, wound size, or dermal template size. Skin grafting was required less frequently in BTM compared with CCS (44.4% vs 55.6%, P = .013). Time to skin graft was longer in the BTM group (43.4 days vs 21.4 days, P = .002). The BTM group experienced fewer complications (33.3% vs 55.6%, P = .002). The mean number of secondary procedures required after template placement was 0.67 in BTM compared with 1.56 in CCS, P = .049. When factoring in the cost of product, the cost of reconstruction with BTM was significantly lower than CCS ($1361.92 vs $3185.71, P = .049).
UNASSIGNED: Novosorb BTM is a more cost-effective option when compared with CCS for reconstruction of upper extremity soft tissue defects.

UNASSIGNED: The aim of the study was to assess the inter-rater and intra-rater agreement of measurements performed with the Luna EMG (electromyography) multifunctional robot, a tool for evaluation of upper limb proprioception in individuals with stroke.
UNASSIGNED: The study was conducted in a group of patients with chronic stroke. A total of 126 patients participated in the study, including 78 women and 48 men, on average aged nearly 60 years (mean = 59.9). Proprioception measurements were performed using the Luna EMG diagnostic and rehabilitation robot to assess the left and right upper limbs. The examinations were conducted by two raters, twice, two weeks apart. The results were compared between the raters and the examinations.
UNASSIGNED: High consistency of the measurements performed for the right and the left hand was reflected by the interclass correlation coefficients (0.996-0.998 and 0.994-0.999, respectively) and by Pearson\'s linear correlation which was very high (r = 1.00) in all the cases for the right and the left hand in both the inter-rater and intra-rater agreement analyses.
UNASSIGNED: Measurements performed by the Luna EMG diagnostic and rehabilitation robot demonstrate high inter-rater and intra-rater agreement in the assessment of upper limb proprioception in patients with chronic stroke. The findings show that Luna EMG is a reliable tool enabling effective evaluation of upper limb proprioception post-stroke.

UNASSIGNED: Complex regional pain syndrome (CRPS) represents a rare complication following injury to a limb. The DASH questionnaire (disability of arm, shoulder, and hand) evaluates everyday arm function. We assessed the DASH and its subitems in comparison to patients with brachial plexus lesions or fracture controls, analysed it over time, and in relation to active range of motion (ROM), to determine patients\' impairment and trajectory.
UNASSIGNED: The dataset included 193 patients with upper extremity CRPS from the noncoding RNA (ncRNA) Pain cohort, 36 fracture controls, and 12 patients with traumatic brachial plexus lesions. For the clinical and psychological characterisation, questionnaires and a goniometer for the measurement of ROM were utilized. Thirty-three patients were followed up after approximately 2.5 years of guideline treatment.
UNASSIGNED: CRPS patients had a similar mean DASH of 54.7 (standard deviation (S.D.) ±21) as brachial plexus lesion patients (M = 51.4, S.D. ± 16.1) but different significantly from fracture controls (M = 21.2, S.D. ± 21.1). Pain and older age were predictors of the DASH. Activities requiring force or impact on the arm, shoulder, or hand were mostly affected in patients with CRPS. After 2.5 years of standard treatment, the mean DASH score fell to 41.3 (S.D. ± 25.2), weakness in leisure activities was recuperated, pain feelings were lessened, and ROM, e.g., wrist flexion, recovered by 36°. Two-thirds of patients improved in both the DASH and the ROM.
UNASSIGNED: CRPS is as disabling as a complete loss of arm function in brachial plexus lesions and exhibits only partial recovery. Developing QuickDASH versions for CRPS patients could reduce the load of questions in clinical studies. It would be prudent to consider the unexpected age dependency of the DASH in future studies. This trial is registered with DRKS00008964.

OBJECTIVE: This study aims to assess how enhancing upper limb function on the affected side of stroke influences the gait of the lower limb.
METHODS: Forty eligible stroke patients were randomly assigned to either a control group or a treatment group, with 20 patients in each group. Both groups underwent dynamic evaluation using artificial intelligence and computer vision before treatment. This evaluation focused on analyzing the range of motion of the shoulder and elbow during the gait cycle, as well as various gait parameters (such as step length, step speed, and percentage of stance phase) on the affected side. Following evaluation, the control group received routine rehabilitation treatment.
RESULTS: The results indicated that there was no significant difference between the two groups before treatment. However, following treatment, there was a notable improvement in the motion of the shoulder and elbow joints on the affected side among patients in the treatment group (p<0.05), whereas the control group showed only slight improvement, which was not statistically significant (p>0.05).
CONCLUSIONS: The improvement in upper limb function on the affected side also appears to positively influence gait recovery. However, it\'s important to note that the observation period was relatively short. Further studies are needed to confirm whether this effect is sustained over the long term.

BACKGROUND: People with Parkinson\'s disease (PwPD) present motor alterations which can impact daily life tasks that require speed and/or accuracy of movement.
OBJECTIVE: A sub analysis of NCT01439022, aiming to estimate the extent to which two different exercise training protocols (global and handwriting upper limb exercise training) impact reaction time, travel speed, and accuracy in PwPD.
METHODS: Seventy PwPD, right-side dominant were randomised 1:1 into two six-month training protocol groups; 35 PwPD performed global exercise training and 35 performed specific training (handwriting upper limb exercise movements). Assessments of speed-accuracy and trade-off were carried out at baseline, after 3 and 6 months of training, and at a 12-month follow-up. The current study used data from a previous publication of a randomised controlled trial that included a 6-month self-managed community exercise programme for PwPD. For the present study we included only the participants who completed the Fitts\' task during the baseline assessment.
RESULTS: In the upper limb assessments, no main effects were found for the number of touches, but the exercise group showed a marginal increase over time on the left side. Error averages on the left side decreased significantly for the exercise group from baseline to 6 and 12 months. The exercise group also presented a lower Error CoV and the Reaction Time CoV increased on the right side. Significant findings for Fitts r on the left side indicated lower values for the exercise group, with improvements continuing at 12 months.
CONCLUSIONS: We report the potential of global exercise interventions to facilitate improvements in reaction time and travel speed, as well as other motor control metrics, with lasting effects at 12 months, particularly on the non-dominant side.

Wearable activity sensors typically count movement quantity, such as the number of steps taken or the number of upper extremity (UE) counts achieved. However, for some applications, such as neurologic rehabilitation, it may be of interest to quantify the quality of the movement experience (QOME), defined, for example, as how diverse or how complex movement epochs are. We previously found that individuals with UE impairment after stroke exhibited differences in their distributions of forearm postures across the day and that these differences could be quantified with kurtosis-an established statistical measure of the peakedness of distributions. In this paper, we describe further progress toward the goal of providing real-time feedback to try to help people learn to modulate their movement diversity. We first asked the following: to what extent do different movement activities induce different values of kurtosis? We recruited seven unimpaired individuals and evaluated a set of 12 therapeutic activities for their forearm postural diversity using kurtosis. We found that the different activities produced a wide range of kurtosis values, with conventional rehabilitation therapy exercises creating the most spread-out distribution and cup stacking the most peaked. Thus, asking people to attempt different activities can vary movement diversity, as measured with kurtosis. Next, since kurtosis is a computationally expensive calculation, we derived a novel recursive algorithm that enables the real-time calculation of kurtosis. We show that the algorithm reduces computation time by a factor of 200 compared to an optimized kurtosis calculation available in SciPy, across window sizes. Finally, we embedded the kurtosis algorithm on a commercial smartwatch and validated its accuracy using a robotic simulator that \"wore\" the smartwatch, emulating movement activities with known kurtosis. This work verifies that different movement tasks produce different values of kurtosis and provides a validated algorithm for the real-time calculation of kurtosis on a smartwatch. These are needed steps toward testing QOME-focused, wearable rehabilitation.

Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl-Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group-time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p < 0.011 for the splenius and F(1, 26) = 9.623, p < 0.005 for the upper trapezius. A significant time-group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p < 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time-group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p < 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p < 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke.