Intra- and Inter-Examiner Reliability of the Viladot Method in Children.

OBJECTIVE: The aim of this study was to evaluate the interexaminer and intraexaminer reliability of classification with the Viladot method of plantar impression obtained by means of a footprinting mat. METHODS: Footprints were taken from 40 participants using a footprinting mat. The images were subjected to analysis by 3 independent examiners. To investigate intraexaminer reliability, the analysis was repeated by 1 of the examiners 1 week later. RESULTS: Excellent intraexaminer reliability was found (κ = 1.0; 95% confidence interval [CI], 0.77-1.0; P < .00). For interexaminer reliability, in the right foot high concordance was found for typical feet (κp = 0.76; 95% CI, 0.58-0.93; P < .00) and excellent concordance for cavus feet and flat feet (respectively: κp = 0.86; 95% CI, 0.68-1.0; P < .00; and κp = 0.81; 95% CI, = 0.63-0.99; P < .00). In the left foot high concordance was observed between the 3 evaluators for typical feet and cavus feet (respectively: κp = 0.75; 95% CI, 0.57-0.93; P < .00; and κp = 0.69; 95% CI, 0.51-0.87; P < .00) and excellent concordance for flat feet (κp = 1.0; 95% CI, 0.82-1.0; P < .00). CONCLUSION: The Viladot method is reliable for analyses involving 1 or more examiners, presenting excellent intraexaminer reliability and high to excellent interexaminer reliability. The Viladot method is a reliable (replicable and consistent) instrument, that is, its repeated application to the same subject produces similar results.

Immediate improvements of supination range of motion and strength following pronator teres muscle friction massage: a clinical trial comparing people with and without supination limited motion.

OBJECTIVES: To investigate the effects of friction massage techniques on the pronator teres muscle on supination range of motion (ROM) and supinator strength in individuals with and without limited supination ROM. METHODS: In total, 26 subjects (13 with limited supination ROM and 13 healthy subjects) volunteered to participate in this study. We used a customized wrist cuff. Supination ROM and supinator strength were measured with a 9-axis inertial motion sensor and load cell. The friction massage protocol was executed with the pronator teres muscle in a relaxed position. Then supination ROM and supinator strength were measured again. RESULTS: There was no significant interaction effect on supination ROM, which was significantly greater in the limited supination and control groups. A post hoc t-test revealed that the limited supination group achieved a significantly increased post-test supination ROM (51.7 ± 7.8°) compared to the pre-test value (43.6 ± 5.2°). In addition, the control group achieved a significant increase in post-test supination ROM (67.7 ± 10.0°) compared to the pre-test value (61.4 ± 7.7°). There was no significant interaction effect on supinator strength. Supinator strength was significantly greater in the limited supination and control groups. A post hoc t-test revealed a significant difference in supinator strength between the pre- and post-test values in the limited supination group. DISCUSSION: Friction massage helps restore a limited ROM of the forearm supination motion and immediately increases supinator muscle strength. This technique can be used as an intervention method to improve muscle strength in patients with limited supination ROM.

The SonicHand Protocol for Rehabilitation of Hand Motor Function: A Validation and Feasibility Study.

Musical sonification therapy is a new technique that can reinforce conventional rehabilitation treatments by increasing therapy intensity and engagement through challenging and motivating exercises. The aim of this paper is to evaluate the feasibility and validity of the SonicHand protocol, a new training and assessment method for the rehabilitation of hand function. The study was conducted in 15 healthy individuals and 15 stroke patients. The feasibility of implementation of the training protocol was tested in stroke patients only, who practiced a series of exercises concurrently to music sequences produced by specific movements. The assessment protocol evaluated hand motor performance during pronation/supination, wrist horizontal flexion/extension, and hand grasp without sonification. From hand position data, 15 quantitative parameters were computed evaluating mean velocity, movement smoothness, and angular excursions of hand/fingers. We validated this assessment in terms of its ability to discriminate between patients and healthy subjects, test-retest reliability and concurrent validity with the upper limb section of the Fugl-Meyer scale (FM), the functional independence measure (FIM), and the Box and Block Test (BBT). All patients showed a good understanding of the assigned tasks and were able to correctly execute the proposed training protocol, confirming its feasibility. A moderate-to-excellent intraclass correlation coefficient was found in 8/15 computed parameters. The moderate-to-strong correlation was found between the measured parameters and the clinical scales. The SonicHand training protocol is feasible and the assessment protocol showed good to excellent between-group discrimination ability, reliability, and concurrent validity, thus enabling the implementation of new personalized and motivating training programs employing sonification for the rehabilitation of hand function.

[Manipulative reduction and percutaneous Kirschner wire internal fixation for grade IV supination-external rotation ankle fractures].

OBJECTIVE: To investigate surgical skills and clinical effects of manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures. METHODS: From May 2013 to October 2016, 35 patients with grade IV supination-external rotation ankle fractures were treated with percutaneous Kirschner wire internal fixation, involving 22 males and 13 females with an average age of 38.2 years ranged from 18 to 65 years old. The time from injury to operation ranged from 2 h to 10 d with an average of 5 d. Reduction quality was assessed by Burwell-Charnley radiological criteria. Baird-Jackson ankle scoring system was used to assess clinical effects. RESULTS: Thirty-three patients were followed up from 10 to 28 months with an average of 14 months. Fracture healing time ranged from 10 to 18 weeks with an average of 12 weeks. According to Burwell-Charnley radiological criteria, 30 cases were obtained anatomic reduction, 3 cases moderate. According to Baird-Jackson ankle scoring system, total score was 93.8±5.4, 17 cases got excellent result, 12 good, 2 fair and 2 poor. CONCLUSIONS: Manipulative reduction and percutaneous Kirschner wire internal fixation in treating grade IV supination-external rotation ankle fractures has advantages of reliable efficacy, less complications. But higher require techniques were required for closed reduction. It is not suitable for severe crushed fracture and compressive articular surface fracture.

Fatores associados à violência obstétrica na assistência ao parto vaginal em uma maternidade de alta complexidade em recife, pernambuco / Factors associated with obstetric abuse in vaginal birth care at a high-complexity maternity unit in recife, pernambuco

Objetivos: analisar os fatores associados à violência obstétrica de acordo com as práticas não recomendadas na assistência ao parto vaginal em uma maternidade escola e de referência da Cidade do Recife. Métodos: estudo transversal, prospectivo, com 603 puérperas, realizado entre agosto a dezembro de 2014. Os dados sociodemográficos, clínicos e de acesso à assistência foram obtidos através dos prontuários e de entrevistas com as pacientes. A prevalência da violência obstétrica foi baseada nas recomendações da Organização Mundial da Saúde sobre as práticas recomendadas para a assistência ao parto vaginal. Para análise dos fatores associados utilizou-se a regressão multivariada de Poisson, considerou-se p<5 por cento. Os dados foram analisados no Stata 12.1 SE. Resultados: a prevalência da violência obstétrica foi de 86,57 por cento. As práticas prejudiciais mais frequentes foram os esforços de puxo (65 por cento), a administração de ocitocina (41 por cento) e o uso rotineiro da posição supina/litotomia (39 por cento). Apenas as variáveis não possuir ensino médio completo (p=0,022) e ter sido assistido por um profissional médico (p<0,001) apresentaram associação significante com a violência obstétrica. Conclusões: o grande número de intervenções obstétricas utilizadas consiste em um ato de violência obstétrica e demonstram que apesar do incentivo do Ministério da Saúde para uma assistência humanizada os resultados ainda estão longe do recomendado.

Objectives: to examine factors associated with obstetric abuse according to practices not recommended for vaginal birth care at a maternity teaching and referral hospital in the city of Recife, Brazil. Methods: a prospective cross-sectional study with 603 puerperal women conducted between August and December 2014. The socio-demographic, clinical and access to care data were obtained from medical records and interviews with patients. The prevalence of obstetric abuse was based on the recommendations of the World Health Organization regarding practices recommended for vaginal birth care. Associated factors were investigated using Poisson's multivariate regression, with a level of significance of p<5 percent. Data were analyzed using Stata 12.1 SE. Results: the prevalence of obstetric abuse was 86.57 percent. The most frequent harmful practices were forced pulling (65 percent), administration ofoxytocin (41 percent) and routine use of the supine/lithotomy position (39 percent). The only variables significantly associated with obstetric abuse were not having graduated high school (p=0.022) and having been attended by a medical professional (p<0.001). Conclusions: the large number of obstetric interventions used amounts to obstetric abuse and shows that, despite the Ministry of Health's promotion of humane care, results fall far short of these recommendations.

Outcomes of arthroscopic treatment of osteochondritis dissecans of the capitellum and description of the technique.

HYPOTHESIS: We hypothesize that a technique for all-arthroscopic fixation of capitellum osteochondritis dissecans (OCD) lesions using suture fixation and autogenous iliac crest bone grafting offers a successful alternative to open internal fixation techniques as shown by 2-year validated patient-reported outcomes. METHODS: Our technique uses arthroscopic all-inside suture fixation with iliac crest autogenous bone grafting. The procedure was performed on 4 elite-level, adolescent athletes presenting with 5 unstable capitellum OCD lesions resulting in elbow pain, limited range of motion, and decreased ability to play. Magnetic resonance imaging showed an unstable OCD lesion, which was correlated with arthroscopy. Postoperatively, patients were evaluated by the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; Oxford Elbow and Mayo Elbow scores; visual analog scale; postoperative range of motion; and return to play. RESULTS: Three female patients and one male patient aged 13 to 15 years underwent the procedure. The mean final follow-up period was 2.8 years. Union was achieved in all patients, as seen on magnetic resonance imaging at a mean of 3 months. At follow-up, the mean loss of extension was 2°. Mean flexion was 153°. There was no loss of supination or pronation. The mean score on the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire was 11. The mean Mayo Elbow score was 88. The mean Oxford Elbow score was 42. The mean visual analog scale score was 2. The mean time to return to play was 4 months. All patients continued to compete at an elite level. There were no infections or cases of fixation failure, and no patients required conversion to open surgery or needed revision surgery. CONCLUSION: Arthroscopic all-inside fixation of unstable OCD lesions is a successful technique, facilitating athletes to return to an elite level of play.

Results of single-staged rotational osteotomy in a child with congenital proximal radioulnar synostosis: subjective and objective evaluation.

BACKGROUND: For congenital proximal radioulnar synostosis, both conservative and operative treatments have been described. Most of the studies describing surgical interventions are based on subjective evaluation of the forearm function and have used severe degree of forearm pronation as an indication for surgery. This study describes a single-staged rotational osteotomy of the proximal third ulna and distal third radius. The aim of the study was to assess the utility of the described surgical procedure by subjective and objective evaluations of the forearm function. METHODS: Forty-eight children with congenital proximal radioulnar synostosis were evaluated by subjective and objective assessments and were followed up prospectively. Subjective evaluation consisted of a set of 12 questions regarding the basic activities of life. Objective evaluation was made using the Jebsen-Taylor hand-function test and a classification system used by Failla and colleagues for 15 tasks described by Morrey and colleagues. Eleven children were treated conservatively. Thirty-six children underwent a single-staged rotational osteotomy of the proximal third ulna and distal third radius. After surgery, the evaluations were repeated. The mean age at surgery was 8.6±3.7 years, and the mean postoperative follow-up period was 54±13 months. RESULTS: All operated forearms showed a statistically significant improvement in functioning after surgery as per the subjective and objective evaluations. The mean time taken to carry out all activities before surgery was 47.7+10.0 seconds, which significantly reduced to 33.3+6.6 seconds after surgery (P=0.0001) as per the results of the Jebsen-Taylor hand-function test. All good (n=19) and fair (n=11) results were converted to excellent (n=30) after surgery as per the modified Failla classification. There were no neurovascular injuries as compared with other published techniques. Only 1 child had delayed union, and 1 had persistent dorsal angulation at the radial osteotomy site. CONCLUSIONS: For patients with congenital radioulnar synostosis and pronation deformity interfering with function and quality of life, the single-staged rotational osteotomy of the radius and ulna is a good alternative procedure. LEVEL OF EVIDENCE: Level IV--therapeutic.

Ankle variability is amplified in older adults due to lower EMG power from 30-60 Hz.

The purpose of this study was to determine the neuromuscular mechanisms of the involved muscles that contribute to the greater positional variability at the ankle joint in older adults compared with young adults. Eleven young adults (25.6±4.9 years) and nine older adults (76.9±5.9 years) were asked to accurately match and maintain a horizontal target line with 5° dorsiflexion of their ankle for 20 s. The loads were 5 and 15% of the one repetition maximum load (1 RM). The visual gain was kept constant at 1° for all trials. Positional variability was quantified as the standard deviation (SD) of the detrended position signal. The neural activation of the tibialis anterior and soleus muscles was quantified as the normalized EMG amplitude, power spectrum density (PSD; EMG oscillations) and coactivation of the two muscles. As expected, positional variability was greater in older adults (older: 0.11±0.06° vs. young: 0.04±0.02°; p=.003). The only significant neural difference occurred for the PSD of the tibialis anterior muscle, where young adults exhibited significantly greater power than older adults from 30-60 Hz. The amplified positional variability of ankle joint in older adults was associated with lower power from 30-60 Hz oscillations in the tibialis anterior muscle (r(2)=.3, p=.01). These results provide novel evidence that older adults exhibit greater positional variability with the ankle joint relative to young adults likely due to their inability to activate the tibialis anterior muscle from 30-60 Hz.

Osteopathic manipulative medicine for carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient's history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.

Muscle fatigue increases the amplitude of fluctuations of tangential forces during isometric contractions.

The orientation of the resultant force during a given contraction depends on the architecture of the muscles involved, and cooperation among muscles may induce force fluctuations in multiple directions. A novel setup for recording three-dimensional forces was developed to assess the effects of muscle fatigue on submaximal contractions. Fifteen subjects performed isometric dorsiflexions, elbow flexions, knee extensions, plantarflexions, and trunk extensions (12 s, 2.5-80% of maximal voluntary force) before and after a fatigue protocol. Electromyography (EMG) was recorded from relevant muscles. The standard deviation of force in the three directions and the agonist EMG amplitude increased with target force (p<.045), while the coefficient of variation of force and total excursions of the center of pressure showed maximal values at low target forces, reaching a plateau at moderate forces. Fatigue induced higher force fluctuations in task-related and tangential directions and increased agonist EMG amplitude for all muscle groups (p<.04). Fluctuations of tangential forces were greater during knee extensions compared with other muscle groups (p<.007). The present data demonstrate that fatigue increases the amplitude of force fluctuations in task-related and tangential forces. Moreover, alternation of activity between multiple synergist muscles is associated with increased fluctuations of tangential forces, especially during fatigue.

Differences in range of motion between dominant and nondominant sides of upper and lower extremities.

OBJECTIVE: The objective of this study was to compare ranges of motion (ROM) between dominant and nondominant sides for the joints of the upper and lower extremities. METHODS: Ninety healthy white women from 18 to 59 years of age were measured in this study. Active and passive ROM were measured for the ankle, knee, hip, shoulder, elbow, and wrist using a standard goniometer. The order of the joints, motion, sides, and active or passive motion testing was randomly selected. A paired t test was used for the comparison between sides. RESULTS: The results of this study showed a statistically significant difference between dominant and nondominant sides for 34 of the 60 ROM measured. The maximum mean difference between sides for all ROM measured was 7.5 degrees . CONCLUSION: The results of this show that some ROM are different between body sides and that when these differences exist they are minimal and may not be clinically insignificant. These results support the practice of using the opposite side of the body as an indicator of preinjury or normal extremity ROM.

Upper extremities flexibility comparisons of collegiate "soft" martial art practitioners with other athletes.

The aim of this study was to compare the flexibility of the upper extremities in collegiate students involved in Aikido (a kind of soft martial art attracting youth) training with those involved in other sports. Fifty freshmen with a similar frequency of exercise were divided into the Aikido group (n = 18), the upper-body sports group (n = 17), and the lower-body sports group (n = 15) according to the sports that they participated in. Eight classes of range of motion in upper extremities were taken for all subjects by the same clinicians. The Aikido group had significantly better flexibility than the upper-body sports group except for range of motion in shoulder flexion (p = 0.22), shoulder lateral rotation (p > 0.99), and wrist extension (p > 0.99). The Aikido group also had significantly better flexibility than the lower-body sports group (p < 0.01) and the sedentary group (p < 0.01) in all classes of range of motion. The upper-body sports group was significantly more flexible in five classes of range of motion and significantly tighter in range of motion of wrist flexion (p < 0.01) compared to the lower-body sports group. It was concluded that the youths participating in soft martial arts had good upper extremities flexibility that might not result from regular exercise alone.

Total Elbow Arthroplasty after Failed Surgical Treatment for Elbow Fracture or Dislocation

PURPOSE: The current study reports the clinical results of total elbow arthroplasties (TEA) which were Performed on patients with poor clinical and radiological results after initial surgeries for elbow fractures or dislocations. MATERIALS AND METHODS: The clinical outcomes of twelve consecutive patients who underwent TEA after failed surgeries for elbow fractures or dislocations from january, 1995 to December, 2005 were evaluated. The initial diagnoses were distal humeral fractures in 8 cases and fracture-dislocations in 4 cases. The Mean period from the initial operations to the TEAs was 12 months. The mean folloow up period after TEA was 43 months. RESULTS: The mean range of motion, in terms of active extension, activeflexion, supination, and pronation, improved from 14.2degrees, 96.7degrees, 50.8degrees and 53.3degrees to 5.4degrees, 122.1degrees, 63.3degrees and 67.5degrees, respectively (p<0.05).RAdiolucent lines were found in 3 cases, which were 1 case of type 3, and 2 cases of type 4. All three loosening cases underwent revision TEAs. The mean postoperative Mayo elvow performance score was 79 point. There were 6 cases of excellent, 2 cases of good, and 4 cases in poor. CONCLUSION: Good clinical results were obtained after TEA performed in failed surgeries for elbow fractures of dislocations.

An osteopathic approach to performing arts medicine.

An osteopathic approach to the performing artist is a complete approach. It involves spending adequate time with the performing artist to obtain a complete history and evaluation. It requires attention to the performer's lifestyle, practice habits, exercise routine, nutrition, stress level, and coexisting medical problems. Because an injury to a performing artist can be physically, emotionally, and financially devastating, these patients deserve a comprehensive treatment plan to allow for the best opportunity for recovery.

Using motor imagery in the rehabilitation of hemiparesis.

OBJECTIVE: To examine the effectiveness of using motor imagery training in the rehabilitation of hemiparesis. DESIGN: A before-after trial with clinical and behavioral analyses of single cases. SETTING: Academic-affiliated rehabilitation hospital. PARTICIPANTS: Two survivors of embolic middle cerebral artery stroke that resulted in chronic hemiparesis. INTERVENTION: A motor imagery training program consisting of imagined wrist movements (extension, pronation-supination) and mental simulations of reaching and object manipulation making use of a mirror box apparatus. Twelve 1-hour experimental sessions were delivered, 3 times a week for 4 consecutive weeks. MAIN OUTCOME MEASURES: Two clinical assessments, grip strength, 4 wrist functionality measurements, and 3 timed performance tests. All outcome measures were recorded before training began, at 3 times during the intervention month, with 2 additional long-term measurements. RESULTS: Performance of the paretic limb improved after the imagery intervention, indicated by increases in assessment scores and functionality and decreases in movement times. The improvements over baseline performance remained stable over a 3-month period. CONCLUSIONS: These results demonstrate the potential for using motor imagery as a cognitive strategy for functional recovery from hemiparesis. The intervention targets the cognitive level of action processing while its effects may be realized in overt behavioral performance.

Impairment of pronation, supination, and body co-ordination in reach-to-grasp tasks in human Parkinson's disease (PD) reveals homology to deficits in animal models.

Animal (monkey, rat, mouse) models are widely used to investigate degenerative processes and potential therapeutic treatments for human Parkinson's disease (PD). One task that has proved useful in these investigations is a reach-to-grasp task (skilled reaching) in which an animal reaches for a piece of food that it then consumes. Rats with extensive unilateral Dopamine depletions are impaired in using the contralateral limb. The qualitative features of posture, lifting and advancing the limb, pronating the paw to grasp food, and in withdrawing and supinating the paw to place the food in the mouth are impaired, as is reaching success. Humans with PD are often described as having poor manual dexterity that worsens as the disease progresses. As there have been no detailed comparisons of reaching movements in the animal models and in PD subjects, the following descriptive analysis was performed. Ten subjects with PD, eight age matched controls and 14 young normal subjects were studied as they used a natural movement of reaching for a small piece of food that they then placed in the mouth to eat. The reaching movements were described using Eshkol-Wachman Movement Notation (EWMN), supplemented with kinematic analyses. From this description, a 21-point rating scale was devised to describe the component movements of the reach. Movements included: orienting the head and eyes to the target, adjusting posture, lifting the hand, shaping and aiming the digits to the target, pronating the hand to grasping the food with a pincer grip, lifting and supinating the hand to transporting the food to the mouth, and further supinating the hand and opening the digits to place food in the mouth, and finally returning the hand to the starting position. Analysis indicated that most aspects of the reaching movements of the PD subjects were significantly different relative to both young control subjects and old control subjects. As compared to the control groups, postural and reaching components of the movements were fragmented, movements were achieved using more proximal segments of the body, and rotatory movements of the hand were limited. The PD subjects did use a pincer grasp to obtain the food, but the grasp was less independent of other digit movements than was observed in the control subjects. These results are discussed in terms of a homology to impairments displayed animal models of PD.

A modified technique of harvesting tibial cancellous bone and its use for sinus grafting.

Autogenous bone is the gold standard graft for sinus augmentation. The harvest of autogenous bone grafts from intraoral sites does often not provide sufficient bone volume and quality. A modified technique of harvesting a tibial cancellous graft is presented. With a micro-bone saw, a bony lid is prepared at the medial condyle of the tibia. The lid stays attached to the tendinous pes anserinus. Following the harvest, the lid is repositioned accurately. This method offers some distinct advantages. A sufficient amount of biologically highly valuable cancellous bone may be harvested for sinus grafting and possibly other surgeries with bone augmentation. The procedure may be performed under local anaesthesia and does not require hospitalisation. Neither major complications nor serious postoperative morbidity were observed.

[Orthopedic treatment of fifth metacarpal neck fractures: prospective study]. / Traitement orthopédique des fractures du col du cinquième métacarpien: étude prospective.

Many methods of treatment have been proposed for the metacarpal neck fractures of the little finger, from early mobilisation to open or closed surgical techniques. A prospective studies of 20 cases treated by a non surgical technique is presented. The reduction was performed by manipulation under local anesthesia according to the Jahss technique and a modified Thomine brace was applied for four weeks. All patients were reviewed for follow-up at 30, 60, and 180 days. The fracture displacement was initially 34 degrees. It was reduced by manipulation to 12 degrees. All fractures healed with an average final displacement of 20 degrees. At 6 months for final examination, average T.A.M. was 245 degrees, T.P.M. was 276 degrees, grip strength reached 96% of the other hand. There were 19 excellent and one bad results. In conclusion, ambulatory non surgical treatment by reduction and local immobilisation of the fractures of the fifth metacarpal provide a good final result with a low cost.

Conservative chiropractic care of lateral epicondylitis.

OBJECTIVE: To discuss the management of a patient with lateral epicondylitis refractory to previous medical and conservative interventions. CLINICAL FEATURES: A 45-year-old woman had difficulty in supinating her left elbow because of pain from activities at work. Standard tests demonstrated and reproduced pain at the lateral epicondyle with resisted extension of the wrist and fingers. INTERVENTION AND OUTCOME: Specific joint manipulation for relief of lateral epicondylitis was performed. Immobilization of the elbow joint after manipulation was accomplished by means of a sugar tong plaster splint. Follow-up joint manipulation with a progressive rehabilitation program was effective in providing relief of symptoms. CONCLUSION: Resolution of pain and limited elbow motion was demonstrated after Mills' manipulation.

A static dynamometer measuring simultaneous torques exerted at the upper limb.

The majority of available dynamometers are designed to measure force or torque in one specific direction, one joint at a time. For the quantification of motor incoordination in neurological patient populations, these dynamometers provide limited information about the global behavior of the limb under investigation. This report describes the potential use and function of a static dynamometer measuring torques exerted simultaneously at the shoulder (flexion-extension, abduction-adduction, internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). Orthogonal forces were measured at the arm and wrist using strain gauge transducers interfaced with a laboratory computer. The lever arms were specified to a software program and the joint torques were calculated in real time according to static equilibrium equations. The use of the dynamometer is illustrated by characterizing for one hemiparetic subject, the joints torques recorded at the shoulder, elbow, and forearm during isolated submaximal grip exertions at different force levels on both sides. The torques generated at the shoulder, elbow and forearm during the hand grip tasks on the affected side were significantly higher than those obtained on the nonaffected side and increased with the grip force level. These differences probably reflect the loss of movement selectivity observed following a lesion in the central nervous system. Further studies are currently being undertaken in neurological patient populations to characterize and quantify motor deficits using this dynamometer. As a long term goal, we hope that the method and technologies described here will contribute to the evaluation and rehabilitation of these populations.