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.

The potential for reinforcement of unhelpful thinking and feelings of distress was present in half the sentences from the general description of the condition and management recommendation sections in three sources of information describing upper extremity conditions for clinicians.

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.

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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.

Purpose: The purpose of this work is to present a multivariate analysis of the kinematics of an upper limb rehabilitation robot. Comparing multiple concepts of kinematic chains makes it possible to identify advantages and disadvantages and, as a consequence, choosing the optimal solution to create a physical device. Such actions shall contribute towards automation of the rehabilitation process, bringing benefits to both therapists and patients in comparison with conventional rehabilitation. Methods: Multivariate analysis of kinematics was performed on the basis of three concepts of the kinematic chain of an exoskeleton, enabling the rehabilitation of both right and left upper limb within the area of the shoulder joint, elbow joint and wrist. The kinematic chain allows the performance of simple and complex movements. Results: The results of the conducted multivariate kinematic analysis define specific movements and angular ranges, which may be performed while applying one of the proposed concepts of the robot design. The results made it possible to determine the optimum solution to the kinematic diagram and construction design, which best satisfy the expectations for effective rehabilitation. Conclusions: The analysis of the kinematic diagram concept of the exoskeleton should be done in relation to its design (construction form). Considering the obtained parameters, it is necessary to find an optimum concept and wisely manoeuvre the values, in order to avoid a situation in which one significant parameter influences another, equally important one. It is noteworthy that the introduction of changes into particular segments of the kinematic chain often has a significant impact on other segments.