When fatigued, the wrist extensors, which are the primary wrist stabilizers, impair distal upper limb motor performance in a surprisingly similar way as when fatiguing the wrist flexors. It is possible that the wrist extensors are so active as antagonists that they develop an equal degree of fatigue during wrist flexion contractions, making it difficult to truly isolate their impact on performance. Thus, the purpose of this study was to examine how wrist flexion/extension forces are impaired following either agonist or antagonist sustained submaximal wrist contractions. 13 male participants attended four laboratory sessions. In these sessions, fatigue was induced via a sustained submaximal isometric contraction of either wrist flexion or extension. These contractions were held for up to 10 min at 20% of the participant\'s baseline maximal voluntary contraction (MVC) force. Throughout the sustained contraction, intermittent agonist (matching the sustained contraction) or antagonist (opposing the sustained contraction) MVCs were performed. Unsurprisingly, agonist MVC forces decreased significantly more than antagonist (Agonist: 58.5%, Antagonist: 86.5% of MVC, P < 0.001). However, while there were no differences in antagonist wrist extension and flexion MVC decreases (Wrist Flexion: 87.5%, Wrist Extension: 85.5%, P = 0.41), wrist extension MVCs did decrease significantly more than wrist flexion MVCs when forces were expressed relative to the agonist (P = 0.036). These findings partially support the hypothesis that the wrist extensors may be more susceptible to developing fatigue when functioning as antagonists than the wrist flexors. This work will help equip future research into the motor control of the upper limb and the prevention of forearm-related musculoskeletal disorders.

BACKGROUND: Patient access to body-powered and myoelectric upper limb prostheses in the United States is often restricted by a healthcare system that prioritizes prosthesis prescription based on cost and perceived value. Although this system operates on an underlying assumption that design differences between these prostheses leads to relative advantages and disadvantages of each device, there is limited empirical evidence to support this view.
METHODS: This commentary article will review a series of studies conducted by our research team with the goal of differentiating how prosthesis design might impact user performance on a variety of interrelated domains. Our central hypothesis is that the design and actuation method of body-powered and myoelectric prostheses might affect users\' ability to access sensory feedback and account for device properties when planning movements. Accordingly, other domains that depend on these abilities may also be affected. While our work demonstrated some differences in availability of sensory feedback based on prosthesis design, this did not result in consistent differences in prosthesis embodiment, movement accuracy, movement quality, and overall kinematic patterns.
CONCLUSIONS: Collectively, our findings suggest that performance may not necessarily depend on prosthesis design, allowing users to be successful with either device type depending on the circumstances. Prescription practices should rely more on individual needs and preferences than cost or prosthesis design. However, we acknowledge that there remains a dearth of evidence to inform decision-making and that an expanded research focus in this area will be beneficial.

BACKGROUND: Frequent and objective monitoring of motor recovery progression holds significant importance in stroke rehabilitation. Despite extensive studies on wearable solutions in this context, the focus has been predominantly on evaluating limb activity. This study aims to address this limitation by delving into a novel measure of wrist kinematics more intricately related to patients\' motor capacity.
OBJECTIVE: To explore a new wearable-based approach for objectively and reliably assessing upper-limb motor ability in stroke survivors using a single inertial sensor placed on the stroke-affected wrist.
METHODS: Seventeen stroke survivors performed a series of daily activities within a simulated home setting while wearing a six-axis inertial measurement unit on the wrist affected by stroke. Inertial data during point-to-point upper-limb movements were decomposed into movement segments, from which various kinematic variables were derived. A data-driven approach was then employed to identify a kinematic variable demonstrating robust internal reliability, construct validity, and convergent validity.
RESULTS: We have identified a key kinematic variable, namely the 90th percentile of movement segment distance during point-to-point movements. This variable exhibited robust reliability (intra-class correlation coefficient of .93) and strong correlations with established clinical measures of motor capacity (Pearson\'s correlation coefficients of .81 with the Fugl-Meyer Assessment for Upper-Extremity; .77 with the Functional Ability component of the Wolf Motor Function Test; and -.68 with the Performance Time component of the Wolf Motor Function Test).
CONCLUSIONS: The findings underscore the potential for continuous, objective, and convenient monitoring of stroke survivors\' motor progression throughout rehabilitation.

Introduction: Upper limb function loss in cervical spinal cord injury (SCI) contributes to substantial disability, and negatively impacts quality of life. Nerve transfer and tendon transfer surgery can provide improved upper limb function. This study assessed the utilization of nerve and tendon transfer surgery for individuals with tetraplegia in Canada. Methods: Data from the Canadian Institute for Health Information\'s Discharge Abstracts Database and the National Ambulatory Care Reporting System were used to identify the nerve and tendon transfer procedures performed in individuals with tetraplegia (2004-2020). Cases were identified using cervical SCI ICD-10-CA codes and Canadian Classification of Intervention codes for upper extremity nerve and tendon transfers. Data on sex, age at time of procedure, province, and hospital stay duration were recorded. Results: From 2004 to 2020, there were ≤80 nerve transfer procedures (81% male, mean age 38.3 years) and 61 tendon transfer procedures (78% male, mean age 45.0 years) performed (highest in Ontario and British Columbia). Using an estimate of 50% eligibility, an average of 1.3% of individuals underwent nerve transfer and 1.0% underwent tendon transfer. Nerve transfers increased over time (2004-2009, n = <5; 2010-2015, n = 27; 2016-2019, n = 49) and tendon transfers remained relatively constant. Both transfer types were performed as day-surgery or single night stay. Conclusions: Nerve and tendon transfer surgery to improve upper limb function in Canadians with tetraplegia remains low. This study highlights a substantial gap in care for this vulnerable population. Identification of barriers that prevent access to care is required to promote best practice for upper extremity care.
Introduction : La perte de fonction du membre supérieur en cas de lésion de la moelle épinière cervicale (SCI0 contribue à un handicap substantiel avec des répercussions négatives sur la qualité de vie. La chirurgie de transfert des nerfs et des tendons peut apporter une amélioration du fonctionnement du membre supérieur. Cette étude a évalué l\'utilisation de la chirurgie de transfert de nerfs et de tendons pour les patients tétraplégiques au Canada. Méthodes : Des données issues de la base de données des résumés de congés de l\'Institut canadien d\'information sur la santé du système national d\'information sur les soins ambulatoires ont été utilisées pour identifier les procédures de transfert de nerfs et de tendons pratiquées sur des patients tétraplégiques entre 2004 et 2020. Les cas ont été identifiés en utilisant les codes de SCI cervicales du CIM-10-CA et des codes canadiens de classification des interventions pour les transferts de nerfs et de tendons du membre supérieur. Les données sur le sexe et l\'âge au moment de la procédure, la province et la durée de séjour à l\'hôpital ont été consignées. Résultats : Entre 2004 et 2020, il y a eu ≤ 80 procédures de transferts de nerfs (hommes : 81 %, âge moyen : 38,3 ans) et 61 procédures de transfert de tendons (hommes : 78 %, âge moyen : 45,0 ans) pratiquées (principalement en Ontario et en Colombie-Britannique). En estimant une admissibilité de 50 %, une moyenne de 1,3 % des patients a subi un transfert de nerfs et 1,0 % des patients a subi un transfert tendineux. Les transferts de nerfs ont augmenté au fil des années (2004-2009, n = < 5; 2010-2015, n = 27; 2016-2019, n = 49) tandis que le nombre de transferts tendineux est resté relativement stable. Les deux types de transferts ont été pratiqués das le cadre de la chirurgie d\'un jour ou avec une hospitalisation d\'une seule nuit. Conclusions : La chirurgie de transfert de nerfs et de tendons pour l\'amélioration des fonctions des membres supérieurs reste peu utilisée pour les Canadiens tétraplégiques. Cette étude souligne une lacune substantielle des soins pour cette population vulnérable. Il est nécessaire d\'identifier les obstacles qui empêchent l\'accès aux soins afin de promouvoir une meilleure pratique pour les soins du membre supérieur.

Arm dysfunction is one of the disabling manifestations of multiple sclerosis (MS), especially in later stages of the disease. Assessment of the functioning of the upper limbs is necessary to objectify the course of MS, determine the effectiveness of therapy, and individualize rehabilitation measures. The tools that assess the upper extremity dysfunction include tests and questionnaires. Questionnaires (patient-reported outcome measures) represent the special importance, since the opinions and preferences of patients themselves help to implement a patient-centered approach to treatment. The article presents a brief description of three multidimensional MS-specific and four unidimensional MS-nonspecific questionnaires that used in assessment of upper limb function in MS patients. The disease-specific unidimensional Arm Function in Multiple Sclerosis Questionnaire (AMSQ), specifically designed to assess the arm use in patients with MS, is discussed in more detail. The use of AMSQ in the Russian population is possible only after the procedure of cultural adaptation and validation of the Russian version.
Дисфункция рук относится к инвалидизирующим проявлениям рассеянного склероза (РС), особенно на более поздних стадиях заболевания. Оценка функционирования верхних конечностей необходима для объективизации течения РС, определения эффективности терапии, индивидуализации реабилитационных мероприятий. Для оценки используют тесты и опросники, причем опросникам придается особое значение, поскольку мнение и предпочтения самих пациентов помогают реализовать пациент-ориентированный подход к лечению. В статье дается краткая характеристика трех многомерных РС-специфичных и четырех одномерных РС-неспецифичных опросников, которые предполагают оценку функции верхней конечности. Более подробно рассмотрен нозологически специфичный одномерный опросник «Функция руки при рассеянном склерозе» (Arm Function in Multiple Sclerosis Questionnaire, или AMSQ), специально разработанный для оценки использования руки пациентами с РС. Использование AMSQ в российской популяции возможно лишь после проведения процедуры культурной адаптации и валидизации русскоязычной версии.

(1) Background: Restoring arm and hand function is one of the priorities of people with cervical spinal cord injury (cSCI). Noninvasive electromagnetic neuromodulation is a current approach that aims to improve upper-limb function in individuals with SCI. The aim of this study is to review updated information on the different applications of noninvasive electromagnetic neuromodulation techniques that focus on restoring upper-limb functionality and motor function in people with cSCI. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to structure the search protocol. A systematic review of the literature was performed in three databases: the Cochrane Library, PubMed, and Physiotherapy Evidence Database (PEDro). (3) Results: Twenty-five studies were included: four were on transcranial magnetic stimulation (TMS), four on transcranial direct current stimulation (tDCS), two on transcutaneous spinal cord stimulation (tSCS), ten on functional electrical stimulation (FES), four on transcutaneous electrical nerve stimulation (TENS), and one on neuromuscular stimulation (NMS). The meta-analysis could not be completed due to a lack of common motor or functional evaluations. Finally, we realized a narrative review of the results, which reported that noninvasive electromagnetic neuromodulation combined with rehabilitation at the cerebral or spinal cord level significantly improved upper-limb functionality and motor function in cSCI subjects. Results were significant compared with the control group when tSCS, FES, TENS, and NMS was applied. (4) Conclusions: To perform a meta-analysis and contribute to more evidence, randomized controlled trials with standardized outcome measures for the upper extremities in cSCI are needed, even though significant improvement was reported in each non-invasive electromagnetic neuromodulation study.

Upper limb impairment is common after stroke, with a significant impact on the stroke survivor\'s function, social participation and quality of life. Clinical guidelines are needed to inform clinical practise, tailor interventions to improve outcomes and address unresolved research questions. This review contributes to the evidence guiding clinical practise for upper limb motor recovery after stroke by summarising the recommendations from the UK rehabilitation guidelines (National Institute for Health and Care Excellence (NICE) and the Intercollegiate Stroke Working Party (ISWP)) and the European Stroke Organisation (ESO) guidelines, all published in 2023. All three guidelines target researchers, clinical practitioners, stroke survivors and their social networks. An important feature in all three guidelines was therapeutic intensity, with all guidelines recommending increased therapeutic intensity. Unlike the ESO, the NICE and ISWP additionally include specific research recommendations. While the NICE guidelines seem more holistic and target a wider audience, the three guidelines are complimentary. We recommend that a future consensus statement should be developed in partnership between all three organisations, agreeing on scope and using the same terminology, on recommendations to improve stroke rehabilitation in the UK and Europe.

暂无摘要。

This study aimed to evaluate clinical utility of 2D-markerless motion analysis (2DMMA) from a single camera during a reaching-sideways-task in individuals with dyskinetic cerebral palsy (DCP) by determining (1) concurrent validity by correlating 2DMMA against marker-based 3D-motion analysis (3DMA) and (2) construct validity by assessing differences in 2DMMA features between DCP and typically developing (TD) peers. 2DMMA key points were tracked from frontal videos of a single camera by DeepLabCut and accuracy was assessed against human labelling. Shoulder, elbow and wrist angles were calculated from 2DMMA and 3DMA (as gold standard) and correlated to assess concurrent validity. Additionally, execution time and variability features such as mean point-wise standard deviation of the angular trajectories (i.e. shoulder elevation, elbow and wrist flexion/extension) and wrist trajectory deviation by mean overshoot and convex hull were calculated from key points. 2DMMA features were compared between the DCP group and TD peers to assess construct validity. Fifty-one individuals (30 DCP;21 TD; age:5-24 years) participated. An accuracy of approximately 1.5 cm was reached for key point tracking. While significant correlations were found for wrist (ρ = 0.810;p < 0.001) and elbow angles (ρ = 0.483;p < 0.001), 2DMMA shoulder angles were not correlated (ρ = 0.247;p = 0.102) to 3DMA. Wrist and elbow angles, execution time and variability features all differed between groups (Effect sizes 0.35-0.81;p < 0.05). Videos of a reaching-sideways-task processed by 2DMMA to assess upper extremity movements in DCP showed promising validity. The method is especially valuable to assess movement variability.

OBJECTIVE: To simultaneously explore the perspectives and opinions of different invested participant groups on the important considerations for development of upper limb behavioural interventions that drive optimal post-stroke upper limb motor recovery.
METHODS: A qualitative descriptive study in a constructivist epistemology.
METHODS: Purposively selected participant groups (preclinical research n = 9, clinical research n = 9, clinical experience n = 9 and lived experience n = 10).
METHODS: Research participants were selected from top internationally published authors. Experiential participants were recruited internationally, through networks.
RESULTS: Four themes were identified with embedded subthemes. Theme 1: \'Clinical relevance should be the core of a \"good\" research question\' with two subthemes: \'Breaking down silos: forging interdisciplinary research teams\', and \'Beyond the pipeline: bench to bedside and back\'; theme 2: \'Balance restitution and compensation to maximise outcomes\' with three subthemes: \'Good outcome: going beyond an outcome measure\', \'Recovery is a puzzle: measure all the pieces\', and \'Optimising capacity: knowing when and how\'; theme 3: \'Stroke demands personalised solutions\' with two subthemes: \'Condition-specific considerations\', and \'Person-specific considerations\'; theme 4: \'Upper limb recovery requires complex interventions\' with four subthemes: \'Fuelling engagement\', \'Content is crucial\', \'Multidimensional dose\', and \'Therapist sway\'.
CONCLUSIONS: This study suggests that post-stroke upper limb motor interventions are the interactions of multiple intervention elements (e.g. dose and content) shaped by different contextual considerations (e.g. stroke and personal factors). Development of such interventions may need to consider both content and context of the intervention to drive optimal recovery.