Classification of upper-limb dysfunction severity and prediction of independence in activities of daily living after cervical spinal-cord injury.

STUDY DESIGN: Prospective observational study. OBJECTIVES: Classification of spinal-cord injury and prediction of independence in activities of daily living (ADL) based on performance evaluations such as upper-limb function have not been reported. Therefore, this study aimed to establish a severity classification and calculate cutoff values for independence in ADL using the Capabilities of Upper Extremity Test (CUE-T) for individuals with cervical spinal-cord injury (CSCI). SETTING: A spinal-cord injury rehabilitation center in Japan. METHODS: This study included individuals with subacute CSCI. Collected data included the CUE-T and Spinal Cord Independence Measure III (SCIM III) scores. The severity classification was used for the hierarchical cluster analysis using the CUE-T. The cutoff values of CUE-T scores for independence in ADL were calculated using an adjustment model with logistic regression analysis. The dependent variable was binary (independent/non-independent) for each SCIM III Self-care item, and the independent variable was CUE-T. RESULTS: A total of 71 participants were included in the analysis. The severity of upper-limb dysfunction was classified into four categories using CUE-T. Significant differences in upper-limb function and ADL were observed between clusters. The cutoff values for CUE-T score for independence in ADL ranged from 37 to 91 points. All cutoff values showed good results in the internal validation, sensitivity analysis. CONCLUSIONS: This study determined the severity of upper limb function in CSCI and the cutoff values of CUE-T scores for independence in ADL. These results may help set criteria and goals for interventions in the clinical and research fields. SPONSORSHIP: None.

Movement analysis of the distal transverse arch of the dominant hand while grasping and pinching objects: A descriptive, correlational research study.

BACKGROUND: The distal transverse arches obtained from active and passive motions of the hand and the used range of motion (u-ROM) of the hand arch in activities of daily living have rarely been reported. PURPOSE: This study aimed to investigate the distal transverse arch angle of the dominant hand, the influence of age, and the u-ROM of the arch when grasping and pinching objects. STUDY DESIGN: Descriptive and correlational research design. METHODS: The active and passive distal transverse arches of the dominant hand of 104 healthy subjects were measured using a goniometer. Additionally, the hand arch was measured when the subjects grasped and pinched objects. These data were used to analyze the correlation with age and to calculate the u-ROM (u-ROM %) rate of the distal transversal arch. Furthermore, the u-ROM% between the ring and fifth finger components of the hand arch was compared. RESULTS: The active and passive dorsal arch angles were 135.8 (10.0°) and 169.9 (11.5°), respectively. The distal transverse arch angle tended to decline with age (active: r = -0.18, p = 0.07, 95% confidence interval = -0.36 to 0.02; passive: r = -0.40, p ≤ 0.001, 95% confidence interval = -0.55 to -0.23). The u-ROM% of the hand arch in grasping and pinching ranged from 65.5 (9.8)% to 84.6 (11.6)% and from 52.1 (7.9)% to 67.4 (9.1)%, respectively, against active and passive motions. The ring finger component was significantly higher than the fifth finger component (active: p = 0.08 to <0.001, effect size = -0.17 to -0.69; passive: p ≤ 0.001, effect size= -0.71 to -0.86). A similar trend was observed in both men and women. CONCLUSIONS: Therapists should evaluate the movement of the distal transverse arch of the injured hand in detail and consider the age, sex, and component of the hand arch when intervening.

Verification of the minimal clinically important difference of the Capabilities of Upper Extremity Test in patients with subacute spinal cord injury.

CONTEXT: The number of patients with cervical spinal cord injury (CSCI) is increasing, and the Capabilities of Upper Extremity Test (CUE-T) is recommended for introduction in clinical trials. We calculated the minimal clinically important difference (MCID) of the CUE-T using an adjustment model with an interval of 1 month. DESIGN: This was a prospective study. SETTING: This study was conducted with participants from the Chiba Rehabilitation Center in Japan. PARTICIPANTS: The participants were patients with subacute CSCI. INTERVENTIONS: The CUE-T and spinal cord independence measure (SCIM) III were performed twice within an interval of 1 month. OUTCOME MEASURES: The MCID was calculated using an adjustment model based on logistic regression analysis. The participants were classified into an improvement group and a non-improvement group based on the amount of change in the two evaluations using the 10-point SCIM III MCID as an anchor. RESULTS: There were 52 participants (56.8 ± 13.5 years old, 45 men/7 women) with complete or incomplete CSCI: 18 in the improvement group and 34 in the non-improvement group. A significant regression equation was obtained when calculating the MCID, and the total, hand, and side scores were 7.7, 2.0, and 3.7 points, respectively. CONCLUSION: The calculated MCID of the CUE-T in this study was 7.7 points. The results of this study provide useful criteria for implementation in clinical trials. Future studies should use patient-reported outcomes, a more recommended anchor, and calculate the MCID using methods such as the patient's condition.

Evaluation of hand functions and distal radioulnar joint instability in elite wheelchair basketball athletes: a cross-sectional pilot study.

BACKGROUND: Wrist injury affects wheelchair basketball players' performance; however, the relationship between distal radioulnar joint (DRUJ) instability and hand functions is unclear. This cross-sectional pilot study investigated DRUJ instability in elite female wheelchair basketball athletes using force-monitor ultrasonography. METHODS: Nine elite female wheelchair basketball athletes (18 wrists) were included in the study. A triangular fibrocartilage complex (TFCC) injury was confirmed using magnetic resonance imaging (MRI). Hand functions were evaluated based on the range of motion (ROM) of wrist palmar flexion, dorsiflexion, radial deviation, and ulnar deviation; grip strength; arm circumference; forearm circumference; and DRUJ instability or pain using the ballottement test. The Mann-Whitney U test was used to compare parameters between the TFCC-injured and intact wrists. Radioulnar displacement was measured using force-monitor ultrasonography and pressure data, and the displacement-to-force ratio was used as an indicator of DRUJ instability. The correlation between the DRUJ displacement-to-force ratio and each hand function assessment was evaluated using Pearson correlation coefficient for the TFCC-injured and intact wrists. A generalized linear mixed model (GLMM) was used to estimate the relationship between hand functions and DRUJ instability. RESULTS: TFCC injuries in seven wrists were confirmed using MRI findings (38.9%). The ulnar deviation ROM values of the TFCC-injured wrist (n = 7) and intact (n = 11) groups were 38.6 ± 8.0° and 48.6 ± 7.8°, respectively. The ulnar deviation ROM was significantly smaller in the TFCC-injured wrists (p = 0.02, r = - 0.54). In the TFCC-injured wrists, no correlation was observed between the displacement-to-force ratio and the hand function assessment. In contrast, the displacement-to-force ratio negatively correlated with grip strength, arm circumference, and forearm circumference in the intact wrists (Pearson correlation coefficient r = - 0.78, - 0.61, and - 0.74, respectively). The GLMM showed that the displacement-to-force ratio significantly affected grip strength, arm circumference, and forearm circumference in the intact group. CONCLUSIONS: In intact wrists, correlations were observed between hand functions such as upper arm/forearm strength and DRUJ stability evaluated using ultrasound. Maintaining and strengthening grip strength, forearm circumference, and arm circumference are associated with DRUJ stability and may be related to TFCC injury prevention in wheelchair basketball athletes. TRIAL REGISTRATION: The protocol was registered with the UMIN Clinical Trials Registry (UMIN000043343) [Date of first registration: 16/02/2021].

Application of force-monitor ultrasonography to assess distal radioulnar joint instability in patients with triangular fibrocartilage complex injury.

Introduction: In this study, we evaluated the differences and measurement accuracy in the force-displacement relationship of the distal radioulnar joint (DRUJ) between patients with triangular fibrocartilage complex (TFCC) injury and healthy controls using force-monitor ultrasonography. Methods: This study included 11 TFCC injury patients and 22 healthy controls. We evaluated differences in the force-displacement relationship of the DRUJ in these patients using force-monitor ultrasonography. Cyclic compression was applied to the dorsal surface of the ulnar head. Distance between the dorsal surface of the distal radius and ulnar head at the DRUJ level was measured in the initial and pressed-down positions. Changes in radioulnar displacement, applied force, and displacement-to-force ratio were measured. Furthermore, we compared the parameters between the affected and unaffected wrists and between TFCC injury patients and controls. Results: The radioulnar displacement and displacement-to-force ratio were significantly larger in the affected wrists than in the unaffected wrists (P = 0.003 and P = 0.02). The affected/unaffected side ratio of radioulnar displacement and displacement-to-force ratio were significantly larger in the TFCC injury patients than in the controls (P = 0.003 and P = 0.02). The area under the curve was 0.82 for the affected/unaffected ratio of the radioulnar displacement. The optimal cutoff value indicated by the receiver-operating characteristic curve for the affected/unaffected ratio of the radioulnar displacement was 1.71; the sensitivity and specificity were 82% and 86%, respectively. Conclusions: Assessing the DRUJ instability with force-monitor ultrasonography may help identify TFCC-injured wrists.

Quantitative assessment of the course of distal radioulnar joint instability.

Introduction: There is a lack of methods to objectively evaluate improvement in distal radioulnar joint (DRUJ) instability through treatment. We used ultrasonography to assess DRUJ instability and calculated the minimal detectable change (MDC) in healthy individuals. MDC was used to evaluate post-treatment changes in a patient with triangular fibrocartilage complex (TFCC) injury. Methods: DRUJ instability was evaluated using force-monitor ultrasonography in eight healthy male participants to determine MDC and in a man in his 60s who underwent surgery and rehabilitation for TFCC injury (Palmer classification: type 2C). In the patient, DRUJ instability was measured pre-operatively, 3 months postoperatively, and 1 year post-operatively. Self-reported hand and upper limb functional ability were also recorded. The transducer of the force-monitor ultrasonographic system was used to apply cyclic compressions to the wrists automatically and measure DRUJ displacements. The amount of displacement was calculated using the distance between the radius and ulna before and during cyclic compression to the wrists. The applied pressure was measured as the force to the wrist, and the displacement-to-force ratio was calculated. Results: The 95% confidence MDC95 for radioulnar displacement, displacement force, and displacement-to-force ratio were 0.27-0.31 mm, 0.30-0.59 N, and 0.12-0.15 mm/N, respectively. The patient's post-operative decrease in displacement exceeded the MDC95. DRUJ stability, pain, and use of the affected hand in daily life improved. Discussion: Force-monitor ultrasonography can quantitatively evaluate post-treatment improvement in DRUJ stability over time. MDC for DRUJ instability can assess recovery after treatment or rehabilitation and determine changes resulting from interventions.

Assessment of distal radioulnar joint stability in healthy subjects: Changes with dominant hand, sex, and age.

This study aimed to elucidate the differences in distal radioulnar stability in dominant/nondominant hand, sex, and age. Bilateral wrists of 60 healthy subjects were evaluated using force-monitoring ultrasonography. This apparatus was developed to apply cyclic compression and measure applied force to displacement during an ultrasound exam. The transducer was placed on the dorsal side of the distal radioulnar joint, and the center of the ulnar head was displayed on the monitor. The distance between the dorsal surface of the distal radius and the ulnar head was measured at an initial and at a pressed-down position. The radioulnar displacement, applied force to displacement, and displacement-to-force ratio were evaluated. The results were compared between the dominant and nondominant hands, and between males and females, and among different age groups. There were no significant differences in the parameters between the dominant and nondominant hands. The applied force to displacement was significantly greater in the male group compared with the female group. There were significant effects for the different age groups in all parameters (displacement: F = 3.67, p = .008; applied-force: F = 3.08, p = .019; displacement-to-force ratio: F = 4.66, p = .002). Our results indicated that the stability of distal radioulnar joint differed depending on age and sex. Age and sex should be considered when assessing distal radioulnar joint stability.

Reliability of Quantitative Assessment of Distal Radioulnar Joint Stability With Force-Monitor Ultrasonography.

The purpose of this study was to evaluate the reliability of ultrasound assessment of the displacement-force relationships for distal radioulnar joint (DRUJ) stability. Non-dominant wrists of 10 healthy male subjects were evaluated by force-monitor ultrasonography. This apparatus was developed to apply cyclic compression to the wrist with pre-determined transducer displacement conditions in the range of 0.1-3.0 mm. The subject's wrist was placed on the table with the forearm in the pronated position. The transducer was placed on the dorsal surface of the distal radius and ulna, perpendicular to the long axis of the forearm. The center of the ulnar head was at the DRUJ level. The distance between the dorsal surface of the distal radius and the ulnar head was measured at an initial and a pressed-down position. Changes in radioulnar displacement, force to the wrist and the displacement/force ratio were evaluated. The measurements were performed independently by two raters. The intra-class correlation coefficients (ICCs) for the radioulnar displacement were 0.76, 0.68, and 0.93, in the 1.0, 2.0, and 3.0 mm transducer displacement conditions, respectively. The ICCs for the force to the wrist were 0.18, 0.67, and 0.34, in different transducer displacement conditions, respectively. The ICCs for the displacement/force ratios were 0.68, 0.67, and 0.97, in different transducer displacement conditions, respectively. The highest ICC for the radioulnar displacement and the displacement/force ratio was observed in the 3.0 mm displacement condition. This assessment of displacement-force relationships may be useful to quantify DRUJ stability. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2053-2060, 2019.

Right half-field eye patching may not be an effective approach for chronic hemispatial neglect--a two-case investigation.

Right half-field eye-patched glasses intervention was performed in two chronic stroke patients with unilateral spatial neglect. Eye movement on the neglect side, the center of gravity as an index of the internal midline bias, neglect sign tests, and the regional cerebral blood flow (rCBF) were measured before and after intervention. The improvement of eye movement was not shown clearly after intervention. The center of gravity shifted significantly to the right and backward. Letter and star cancellation tests were improved in both the cases. Line bisection test showed improvement in one patient. However, line cancellation and line bisection tests were worsened in the other. The rCBF was not changed after intervention. This case study suggests that right half-field eye patching might not be an effective intervention.

Prism intervention helped sustainability of effects and ADL performances in chronic hemispatial neglect: a follow-up study.

PURPOSE: To investigate the sustainability of effect and the changes in basic and instrumental activities of daily living (ADL and IADL) after long-term prism intervention, we carried out a follow-up assessment on five subjects with hemispatial neglect in the chronic stage. METHOD: At 2-3.5 years after the end of prism intervention, we measured six parameters: 1) eye movement of the neglect side when watching three different video clips, 2) center of gravity as an index of subjective internal midline bias, 3) star and letter cancellation tests, 4) the line bisection test, and ADL scales: 5) Barthel Index and 6) Lawton's IADL scale. In addition, we interviewed and observed the subjects' present ADL performance at home. RESULTS: The eye movement on the neglect side significantly increased compared with that before intervention. The center of gravity was shifted significantly to the left side and forward. The improvement in cancellation and line bisection tests was also observed. All subjects showed improvement in ADL performance. Two of the subjects could return to work after intervention. CONCLUSION: The results suggested that long-term prism intervention might effectively exert long-lasting effects and bring benefits to ADL performance for subjects with hemispatial neglect.

Long-term effects of prism adaptation on chronic neglect after stroke.

UNLABELLED: Previous studies have discussed the effectiveness or ineffectiveness of prism adaptation for neglect patients. PURPOSE: The aim of present study was to determine the long-term effect of prism adaptation with activity performance instead of pointing performance on chronic neglect patients. SUBJECTS: Seven patients with chronic unilateral spatial neglect were recruited. METHODS: We performed an 8-week intervention using prismatic glasses. Changes in eye movement before and after intervention were measured using an eye mark recorder system. We also assessed intentional spatial bias in terms of center of gravity in the standing position using a tactile sensor scan system. Additionally, regional cerebral blood flow was measured using SPECT (IMP) before and after intervention. RESULTS: Eye movements significantly improved on the neglected side (p<0.01), and the effects were sustained for up to 6 weeks after the removal of the prism. The center of gravity significantly moved to the left and forward. Furthermore, rCBF showed a significant increase at the parietal cortex, pericalleosal area of the left hemisphere (P<0.05). CONCLUSION: These results suggest that intervention using prismatic glasses could improve eye movement on the neglected side and correct intentional spatial bias. Prism intervention might be one valuable method for the activation of the important areas of the brain in neglect patients.

The relationship between cerebral blood flow and cognitive function in patients with brain insult of various etiology.

The relationship between the mean cerebral blood flow (CBF) and cognitive function was investigated in patients with brain insult. This study included 72 patients aged 24-85 years treated for the following diseases: cerebral infarction (21), intracerebral hemorrhage (4), subarachnoid hemorrhage (2), brain tumor (14), cerebral contusion (12), normal pressure hydrocephalus (13), Alzheimer's disease (2), and others (4). First-pass radionuclide angiography using Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO) was performed for the measurement of the mean CBF, and the Sturb-Black Mental Status Examination for the neuropsychological evaluation. The mean CBF and the score of the neuropsychological test were significantly reduced compared with those of the age-matched controls. Regardless of etiology, the mean CBF and the score of neuropsychological test were significantly reduced, and a significant correlation was observed except for the patients with cerebral contusion. The quantitative measurement of CBF using 99mTc-HMPAO is reliable to estimate the neuropsychological state.

Function of the upper extremity and ability to perform housework following reconstructive surgery of the shoulder joint using a free vascularized fibula bone graft: a case report.

The cases of two female patients who underwent reconstructive surgery using free vascularized fibular bone grafting of the proximal humerus are reported. Both patients were evaluated 1 year postoperatively for active range of motion; an Enneking evaluation and activities-of-daily-living (housework) assessment were also done. Patient 1 regained flexion and abduction to 110 degrees, and patient 2 regained flexion and abduction to 90 degrees. On the Enneking test, the patients achieved scores of 23 and 25 points, respectively. On the activities-of-daily-living housework assessment, patient 1 performed at 91.0% and patient 2 at 60.6%. In both cases, neither active range of motion nor the Enneking scores accurately reflected the functional abilities of the reconstructed limbs. It is important that upper extremity therapists evaluate and consider functional abilities in activities of daily living, such as housework, in the early phases of rehabilitation.