Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage.

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

Effects of an early intervention with Hyperbaric Oxygen Treatment on arm lymphedema and quality of life after breast cancer-an explorative clinical trial.

PURPOSE: Lymphedema (LE) is a common complication after breast cancer treatment, which negatively affects the quality of life (QOL). Hyperbaric Oxygen Treatment (HBOT) is an established treatment for radiation-induced tissue injury, but evidence of effect on breast cancer-related LE is inconclusive. We aimed to explore effects of HBOT on early breast cancer-related LE and the implications for QOL. METHODS: We invited women with breast cancer treated with surgery, axillary dissection and radiotherapy, who had participated in a randomized controlled trial and who presented with LE 1 year after surgery. In a prospective observational study design, change in LE was assessed with perometry, dual-energy X-ray absorptiometry (DXA) and lymphoscintigraphy, and QOL by validated self-report scales. Participants were offered 40 sessions of HBOT on every weekday for 8 weeks and were followed for 6 months. RESULTS: Out of 50 eligible participants, 20 women accepted participation. Nineteen women initiated and completed treatment and follow-up. None of the objective measures of LE severity showed consistent changes during the study period, but participants reported significant improvements in QOL (physical functioning, fatigue, insomnia and breast and arm symptoms), with improvements peaking at 6-month follow-up. CONCLUSION: Participants receiving HBOT experienced improved QOL without consistently significant changes in arm mass, volume or lymphatic drainage. These results call for studies into differential effect in patient sub-groups, and a large-scale, randomized placebo-controlled trial with long-term follow-up to assess the effect of HBOT in patients with soft tissue radiation injuries after breast cancer seems warranted. TRIAL REGISTRATION: Danish Health and Medicines Authority, EUDRACT no. 2015-000,604-25 Ethical committee of the Capitol Region, No. R96-A6604-14-S22.

Effects of Functional Electrical Stimulation Cycling Combined With Arm Cranking Exercise on Cardiorespiratory Fitness in People With Central Nervous System Disorders: A Systematic Review and Meta-analysis.

OBJECTIVE: To examine the evidence regarding the potential of hybrid functional electrical stimulation (FES) cycling for improving cardiorespiratory fitness for people with a mobility disability related to a central nervous system (CNS) disorder. DATA SOURCES: Nine electronic databases: MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo, SPORTDiscus, Pedro, Cochrane, and Scopus, were searched from inception until October 2022. STUDY SELECTION: Search terms included multiple sclerosis, spinal cord injury (SCI), stroke, Parkinson's disease, cerebral palsy, synonyms of FES cycling, arm crank ergometry (ACE) or hybrid exercise, and V̇o2. All experimental studies, including randomized controlled trials that included an outcome measure related to peak or sub-maximal V̇o2 were eligible. DATA EXTRACTION: From a total of 280 articles, 13 were studies included. The Downs and Black Checklist was used to assess study quality. Random effects (Hedges' g) meta-analyses were undertaken to determine whether there were differences in V̇o2peak during acute bouts of hybrid FES cycling vs other modes of exercise and changes resulting from longitudinal training. DATA SYNTHESIS: During acute bouts of exercise, hybrid FES cycling was moderately more effective than ACE (effect size [ES] of 0.59 (95% CI 0.15-1.02, P=.008) in increasing V̇o2peak from rest. There was a large effect on the increase of V̇o2peak from rest for hybrid FES cycling compared with FES cycling (ES of 2.36 [95% CI 0.83-3.40, P=.003]). Longitudinal training with hybrid FES cycling showed a significant improvement in V̇o2peak from pre to post intervention with a large, pooled ES of 0.83 (95% CI 0.24-1.41, P=.006). CONCLUSIONS: Hybrid FES cycling produced higher V̇o2peak compared with ACE or FES cycling during acute bouts of exercise. Hybrid FES cycling can improve cardiorespiratory fitness in people with SCI. Additionally, there is emerging evidence that hybrid FES cycling might increase aerobic fitness in people with mobility disability related to CNS disorders.

Wireless Peripheral Nerve Stimulation for The Upper Limb: A Case Report.

Peripheral neuro-stimulation (PNS) has been proved to be effective for the treatment of neuropathic pain as well as other painful conditions. We discuss two approaches to PNS placement in the upper extremity. The first case describes a neuropathic syndrome after the traumatic amputation of the distal phalanx of the fifth digit secondary to a work accident with lack of responsiveness to a triple conservative therapy. An upper arm region approach for the PNS was chosen. The procedure had a favorable outcome; in fact, after one month the pain symptoms were absent (VAS 0) and the pharmacological therapy was suspended. The second case presented a patient affected by progressive CRPS type II in the sensory regions of the ulnar and median nerve in the hand, unresponsive to drug therapy. For this procedure, the PNS device was implanted in the forearm. Unfortunately, in this second case the migration of the catheter affected the effectiveness of the treatment. After examining the two cases in this paper, we changed our practice and suggest the implantation of PNS for radial, median and/or ulnar nerve stimulation in the upper arm region, which has significant advantages over the forearm region.

Conservative management of distal bicipital tendinopathy with lateral antebrachial nerve entrapment: A case report.

INTRODUCTION: Kettlebell snatches are an efficient and effective exercise. If the kettlebell being utilized is too heavy or too many repetitions are executed, this can lead to an overuse injury such as a tendinopathy. Multiple orthopedic tests exist to evaluate for a distal biceps tendon rupture. At present, there are no publications utilizing shockwave and active rehabilitation to treat distal bicipital tendinopathy with Lateral Antebrachial Cutaneous Nerve (LABCN) entrapment. Currently, no published manuscripts are reporting distal bicipital tendinopathy with LABCN nerve entrapment being treated successfully with shockwave and active rehabilitation over the course of 5 weeks. METHODS: The objective of this case report is to examine the conservative management of a 37-year-old male with a diagnosis of distal bicipital tendinopathy and LABCN entrapment. The patient presents with discomfort originated weeks prior after an intense block of kettlebell training. The patient was diagnosed with brachioradialis tendinopathy due to the specifics of his injury. Following the initial evaluation, the patient was unable to supinate the forearm past 45° actively, yet he can passively achieve 90°, although this is done with minor discomfort. DISCUSSION: The patient's rehab began with the execution of wrist, elbow, and shoulder controlled articular rotation (CARS). The concept of CARs is to train the joint and soft tissues to respond to full range activity. A progressive approach utilizing isometric to eccentric exercise with extracorporeal shockwave was used. The authors studied forty-eight patients with chronic distal biceps tendinopathy. After five shockwave therapy treatments over three months, there was a significant decrease in symptomology without complications (Furia et al., 2017). CONCLUSION: This case report demonstrates that active rehabilitation and shockwave therapy effectively resolved the patient's symptoms with no adverse reactions. Additionally, the case report can be a suggested management protocol for successful conservative management for patients with suspected distal bicipital tendinopathy with LABCN entrapment going forward.

Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review.

QUESTION: What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Adults after stroke. INTERVENTION: Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy. OUTCOME MEASURES: Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale. RESULTS: Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD -1.07, 95% CI -1.59 to -0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD -0.18, 95% CI -0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD -1.08); however, this estimate had substantial uncertainty (95% CI -3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD -7.84, 95% CI -12.99 to -2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain. CONCLUSIONS: After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score. REGISTRATION: PROSPERO CRD42021251630.

The complex impedance phase angle of dominant arm: a useful parameter in bone mineral density (BMD) assessment of group 1 post-menopausal women.

For widespread osteoporosis (OP) screening, portable and cost-effective screening devices are needed. With 45 menopaused women, when body mass index was below 30 kg.m- 2, the phase angle (PhA) of complex bioimpedance at 5 kHz, measured from the dominant arm, was correlated with dual-energy X-ray absorptiometry (DEXA) measured central bone mineral densities (BMD), for total hip r = 0.493 and for total lumbar r = 0.411, P< 0.05, and the strength of correlation decreased with increasing measurement frequencies. ANOVA tests showed that, below 15 kHz, PhA was a descriptive marker for bone mineral deficiency. By correlating to hip and lumbar bone mineral densities simultaneously, the dominant arm segment PhA was superior to the characteristic frequency fc of the body impedance spectroscopy (BIS) and the PhA of whole-body impedance measurements, of the earlier research works. Due to its medium correlation strength with central BMDs, a PhA measuring device could be considered as a complementary tool to the gold standard (DEXA), for OP screening of group 1 post-menopausal women only. For group 2, with 44 subjects with body mass indices over 30 kg.m- 2, i.e., obese population, the PhA was not correlated with BMD and was no longer a descriptive marker for reduced BMD.

Effects of motor imagery training on skeletal muscle contractile properties in sports science students.

Background: Studies on motor imagery (MI) practice based on different designs and training protocols have reported changes in maximal voluntary contraction (MVC) strength. However, to date, there is a lack of information on the effects of MI training on contractile properties of the trained muscle. Methods: Forty-five physically active sport science students (21 female) were investigated who trained three times per week over a 4-week period in one of three groups: An MI group conducted MI practice of maximal isometric contraction of the biceps brachii; a physical exercise (PE) group physically practiced maximal isometric contractions of the biceps brachii in a biceps curling machine; and a visual imagery (VI) group performed VI training of a landscape. A MVC test of the arm flexors was performed in a biceps curling machine before and after 4 weeks of training. The muscular properties of the biceps brachii were also tested with tensiomyography measurements (TMG). Results: Results showed an interaction effect between time and group for MVC (p = 0.027, η 2 = 0.17), with a higher MVC value in the PE group (Δ5.9%) compared to the VI group (Δ -1.3%) (p = 0.013). MVC did not change significantly in the MI group (Δ2.1%). Analysis of muscle contractility via TMG did not show any interaction effects neither for maximal radial displacement (p = 0.394, η 2 = 0.05), delay time (p = 0.79, η 2 = 0.01) nor contraction velocity (p = 0.71, η 2 = 0.02). Conclusion: In spite of MVC-related changes in the PE group due to the interventions, TMG measurements were not sensitive enough to detect concomitant neuronal changes related to contractile properties.

Data-Based and Opportunistic Integral Concurrent Learning for Adaptive Trajectory Tracking During Switched FES-Induced Biceps Curls.

Hybrid exoskeletons, which combine functional electrical stimulation (FES) with a motorized testbed, can potentially improve the rehabilitation of people with movement disorders. However, hybrid exoskeletons have inherently nonlinear and uncertain dynamics, including combinations of discrete modes that switch between different continuous dynamic subsystems, which complicate closed-loop control. A particular complication is the uncertain muscle control effectiveness associated with FES. In this work, adaptive integral concurrent learning (ICL) motor and FES controllers are developed for a hybrid biceps curl exoskeleton, which are designed to achieve opportunistic and data-based learning of the uncertain human and electromechanical testbed parameters. Global exponential trajectory tracking and parameter estimation errors are proven through a Lyapunov-based stability analysis. The motor effectiveness is assumed to be unknown, and, to help with fatigue reduction, FES is enabled to switch between multiple electrodes on the biceps brachii, further complicating the analysis. A consequence of switching between the different uncertain subsystems is that the parameters must be opportunistically learned for each subsystem (i.e. each electrode and the motor), while that subsystem is active. Experiments were performed to validate the developed ICL controllers on twelve healthy participants. The average (± standard deviation) position tracking errors across each participant were 1.44 ± 5.32 deg, -0.25 ± 2.85 deg, and -0.17 ± 2.66 deg across biceps Curls 1-3, 4-7, and 8-10, respectively, where the average across the entire experiment was 0.28 ± 3.53 deg.

Age-related asymmetry in anticipatory postural movements during unilateral arm movement and imagery.

Reaching movements of the arms are accompanied by anticipatory (APM) and compensatory postural motion (CPM) that counteract the resulting perturbations to body stability. Recent research has shown that these postural actions are also observable in the context of imagined arm movements. As motor imagery (MI) shares many neurophysiological and behavioral characteristics with physical movements, and MI training can affect subsequent performance, MI tasks provide a good setting for studying the anticipatory aspects of postural control. This study investigated APMs and CPMs of the head and hip of healthy young and older adults in the temporal vicinity of physical and imagined forward raises of the dominant and non-dominant arm. When MI of the dominant arm was self-initiated, both age groups showed APM in the anteroposterior plane. When the self-initiated MI was of the non-dominant arm, only the older group showed anteroposterior APM. The older group did not show APM when an expected arm movement (or MI) was made to an external signal. This suggests an age-related deficit in coordinating postural preparation with external events. Only the older group showed mediolateral APM, and only for dominant arm MI, indicating sensitivity to potential perturbation to the weaker, non-dominant side of the body. Overall, the older group showed more anticipatory postural motion at the head. Systematic APM for manual MI suggests that MI training may be an effective intervention for anticipatory postural control. An integrated model of postural support for executed and imagined limb movements is suggested.

Arm Movement Analysis Technology of Wushu Competition Image Based on Deep Learning.

In order to improve the recognition accuracy of action poses for athletes in martial arts competitions, it is considered that a single frame pose does not have the temporal features required for sequential actions. Based on deep learning, this paper proposes an image arm movement analysis technology in martial arts competitions. The motion features of the arm are extracted from the bone sequence. Taking human bone motion information as temporal dynamic information, combined with RGB spatial features and depth map, the spatiotemporal features of arm motion data are formed. In this paper, we set up a slow frame rate channel and a fast frame rate channel to detect sequential motion of images. The deep learning model takes 16 frames from each video as samples. The softmax classifier is used to get the classification result of which action category the human action in the video belongs to. The test results show that the accuracy and recall rate of the arm motion analysis technology based on deep learning in martial arts competitions are 95.477% and 92.948%, respectively, with good motion analysis performance.

Biomechanical Analysis of Arm Manipulation in Tai Chi.

In order to explore the kinematics and muscle force characteristics of competitive Taijiquan arm manipulation, and solve the problems of arm trajectory and control in the process of manipulation, this study puts forward the sports biomechanical analysis of arm manipulation in competitive Taijiquan. The technical characteristics and muscle force characteristics of 15 athletes from the competitive Taijiquan team of Xi'an Institute of physical education were studied. Use Excel 2007 and SPSS17.0 to statistically analyze and process the original data. According to the actual needs, the data indicators are summarized. The combined movements of competitive Taijiquan arm manipulation are captured through high-speed photography, and the kinematic data are statistically analyzed, mainly from the two aspects of action amplitude change and action braking. The results show the action track length, relative track length, and action track length of each plane of the two combined hands. The order of the two combined action tracks is: combination 1 > combination 2, in which the action track in the sagittal plane is the longest in combination 1, and it can also be considered that the motion amplitude in the sagittal plane is the largest in combination 1. The average acceleration of group A in the first beat is 0.51 m/s2 smaller than that of group B, and the value is 0.22 m/s2 smaller. Therefore, the deceleration of group A is larger than that of group B, and the braking capacity of group A is slightly stronger than that of group B. In the second beat, the average acceleration of group B is 1.5722 m/s2 larger than that of group A, and the value is 0.210 m/s2 larger. The average acceleration of group A in the third, fourth, fifth, and sixth beats is 0.9, 3.728, 0.57, and 0.837 m/s2 smaller than that of group B, and the values are 0.466, 0.174, 0.250, and 0.003 m/s2 smaller, indicating that the braking capacity of group A in the third, fourth, fifth, sixth, and eighth beats is slightly stronger than that of group B. In the braking of each beat in combination 1 and combination 2 of group AB, the braking ability of arm manipulation of group A is stronger than that of group B. In competitive Taijiquan, the movement techniques of manipulation include: bouncing technology, braking technology, and control technology. For arm manipulation, athletes should have the ability of "braking" technology. In the correlation analysis of movement track length, RMS and I EMG, the score of athletes in group A is high, and there is no correlation between movement track length and RMS. There is a significant correlation between RMS and movement track length in group B, and the correlation degree is moderate. This shows that when the movement of group B athletes is completed, the muscles are in a state of tension, the movement skills are not mastered well, and the energy saving is not achieved. During training, we should pay more attention to the proprioception of muscles and form a correct way of muscle exertion.

Short-term arm immobilization modulates excitability of inhibitory circuits within, and between, primary motor cortices.

Previous research has suggested that short-term immobilization of the arm may be a low-cost, non-invasive strategy to enhance the capacity for long-term potentiation (LTP)-like plasticity in primary motor cortex (M1). Short-term immobilization reduces corticospinal excitability (CSE) in the contralateral M1, and interhemispheric inhibition (IHI) from ipsi- onto contralateral M1 is increased. However, it is unclear whether reduced CSE and increased IHI are associated with changes in intracortical inhibition, which has been shown to be important for regulating neuroplasticity in M1. The current study used transcranial magnetic stimulation to evaluate the effects of short-term (6 h) arm immobilization on CSE, IHI, and intracortical inhibition measured bilaterally in 43 neurotypical young adults (23 immobilized). We replicated previous findings demonstrating that immobilization decreased CSE in, and increased IHI onto, the immobilized hemisphere, but a significant change in intracortical inhibition was not observed at the group level. Across individuals, decreased CSE was associated with a decreased short-interval intracortical inhibition, an index of GABAA -ergic inhibition, within the immobilized hemisphere only in the immobilization group. Previous research has demonstrated that decreases in GABAA -ergic inhibition are necessary for the induction of LTP-like plasticity in M1; therefore, decreased intracortical inhibition after short-term arm immobilization may provide a novel mechanism to enhance the capacity for LTP-like plasticity within M1 and may be a potential target for strategies to augment plasticity capacity to enhance motor learning in health and disease.

The effect of motor imagery on quality of movement when performing reaching tasks in healthy subjects: A proof of concept.

INTRODUCTION: The use of motor imagery (MI) has been shown to offer significant improvements in movement performance in sports, and is now receiving a lot of attention as a relatively new therapeutic approach which can be applied in rehabilitation. However, the effects of MI on the quality of movement is still unclear. This study explored the immediate effect of MI on reaching tasks in healthy subjects. METHODS: 17 healthy individuals (33 ± 8.2 years) participated in the study. Surface electromyography (sEMG) and inertial measurement units (IMU) were used to identify muscle activity and angular velocity in both upper limbs. Participants performed a reach task using their dominant and non-dominant arms at their most comfortable speed, they were then asked to imagine themselves performing the same reaching task, and finally they were asked to repeat the reaching task. RESULTS: Significant decreases were seen in the muscle activity between pre and post MI for Biceps Brachii, Anterior Deltoid and Triceps Brachii. In addition, a significant increase was seen in extension angular velocity post MI. DISCUSSION: The results indicate that the use of MI just after physical practice appears to have an immediate effect on the muscle activity and kinematics during a reaching task, which may suggest an improved quality of movement. CONCLUSION: This proof of concept study shows the potential for MI to improve the quality of performing reaching task and offers a possible therapeutic option for Stroke survivors and other neuromuscular disorders.

Cardiorespiratory and metabolic demand of the 6-minute pegboard and ring test in healthy young adults.

OBJECTIVE: To determine the cardiorespiratory and metabolic demand of the Six-Minute Pegboard and Ring Test (6PBRT) in healthy young adults and its association with maximal arm cycle ergometer test (arm CET). METHODS: Volunteers were randomized to performed the 6PBRT test or arm CET. The second test was performed after 48 h. Oxygen consumption (VO2), heart rate (HR), dyspnea and upper limb fatigue were assessed during the tests. Demographic data, body composition, level of physical activity, arm strength and endurance were also evaluated. RESULTS: During 6PBRT, VO2 values increased from 5.8 to 11.1 mL kg-1.min-1 (p < 0.001). VO2peak, HR Mean and HRmax at 6PBRT were 47.2% and close to 65% respectively of those achieved during the arm CET. There was a positive correlation between the score on 6PBRT and VO2mean and VO2peak achieved at arm CET (r = 0.268; p = 0.003 and r = 0.247; p = 0.046 respectively). No correlation was found between the HRmean, HRpeak, level of physical activity or strength with 6PBRT (p > 0.05). Handgrip endurance had a positive correlation with score on 6PBRT (r = 0.237; p = 0.054). Body Mass Index, body fat and fat mass were negatively correlated with the score on 6PBRT (r = 0.301; p = 0.014, 0.329; p = 0.007 and r = 0.427; p = 0.001). CONCLUSIONS: The 6PBRT test showed a moderate cardiorespiratory and metabolic demand in healthy individuals in comparison of arm CET. BMI, body fat and fat mass correlated with the score on 6PBRT.

Manual Lymph Drainage With Progressive Arm Exercises for Axillary Web Syndrome After Breast Cancer Surgery: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to determine the effectiveness of a physical therapist-designed program tailored to axillary web syndrome (AWS) in women after breast cancer surgery. METHODS: A prospective, single-center, assessor-blinded, randomized controlled trial was conducted at the Physiotherapy in Women's Health Research Unit of the Alcalá University (Madrid, Spain). Ninety-six women with AWS were assigned to the physical therapy group (manual lymph drainage [MLD] using resorption strokes and arm exercises as if performing median nerve neurodynamic glide exercises with no neural loading; n = 48) or the control group (standard arm exercises; n = 48), with both groups receiving treatment 3 times a week for 3 weeks. Both interventions included an educational component. RESULTS: Compared with the control group, the physical therapy group showed significant and clinically relevant improvements in the primary outcome (self-reported pain intensity) at the primary and 3-month follow-ups. Significant and clinically relevant differences between groups were also found in the secondary outcomes (shoulder active range of motion, shoulder disability, and physical and functional aspects of health-related quality of life) at the primary follow-up and in the secondary outcomes as well as the trial outcome index at the 3-month follow-up. No significant differences were found at the 6-month follow-up in either primary or secondary outcomes. CONCLUSION: The physical therapy program tailored to AWS was found to be effective for AWS symptoms in women after breast cancer surgery, both immediately after the program and after 3 months. IMPACT: To our knowledge, this is the first appropriately designed study to demonstrate the effectiveness of MLD with progressive arm exercises for AWS. Clinicians and health service providers should consider how to provide survivors of breast cancer with AWS the opportunity to participate in physical therapy programs, including MLD with progressive arm exercises. LAY SUMMARY: For axillary web syndrome following breast cancer surgery, a physical therapist can design a treatment program including manual lymph drainage and progressive arm exercises, which has been shown to result in reduced pain and improved motion compared with standard arm exercises.

Improving the Learning Rate, Accuracy, and Workspace of Reinforcement Learning Controllers for a Musculoskeletal Model of the Human Arm.

Cervical spinal cord injuries frequently cause paralysis of all four limbs - a medical condition known as tetraplegia. Functional electrical stimulation (FES), when combined with an appropriate controller, can be used to restore motor function by electrically stimulating the neuromuscular system. Previous works have demonstrated that reinforcement learning can be used to successfully train FES controllers. Here, we demonstrate that transfer learning and curriculum learning can be used to improve the learning rates, accuracies, and workspaces of FES controllers that are trained using reinforcement learning.

Smoothness Discriminates Physical from Motor Imagery Practice of Arm Reaching Movements.

Physical practice (PP) and motor imagery practice (MP) lead to the execution of fast and accurate arm movements. However, there is currently no information about the influence of MP on movement smoothness, nor about which performance parameters best discriminate these practices. In the current study, we assessed motor performances with an arm pointing task with constrained precision before and after PP (n = 15), MP (n = 15), or no practice (n = 15). We analyzed gains between Pre- and Post-Test for five performance parameters: movement duration, mean and maximal velocities, total displacements, and the number of velocity peaks characterizing movement smoothness. The results showed an improvement of performance after PP and MP for all parameters, except for total displacements. The gains for movement duration, and mean and maximal velocities were statistically higher after PP and MP than after no practice, and comparable between practices. However, motor gains for the number of velocity peaks were higher after PP than MP, suggesting that movements were smoother after PP than after MP. A discriminant analysis also identified the number of velocity peaks as the most relevant parameter that differentiated PP from MP. The current results provide evidence that PP and MP specifically modulate movement smoothness during arm reaching tasks. This difference may rely on online corrections through sensory feedback integration, available during PP but not during MP.

Rehabilitation of high upper limb amputees after Targeted Muscle Reinnervation.

STUDY DESIGN: This is a Delphi study based on a scoping literature review. INTRODUCTION: Targeted muscle reinnervation (TMR) enables patients with high upper limb amputations to intuitively control a prosthetic arm with up to six independent control signals. Although there is a broad agreement regarding the importance of structured motor learning and prosthetic training after such nerve transfers, to date, no evidence-based protocol for rehabilitation after TMR exists. PURPOSE OF THE STUDY: We aimed at developing a structured rehabilitation protocol after TMR surgery after major upper limb amputation. The purpose of the protocol is to guide clinicians through the full rehabilitation process, from presurgical patient education to functional prosthetic training. METHODS: European clinicians and researchers working in upper limb prosthetic rehabilitation were invited to contribute to a web-based Delphi study. Within the first round, clinical experts were presented a summary of recent literature and were asked to describe the rehabilitation steps based on their own experience and scientific evidence. The second round was used to refine these steps, while the importance of each step was rated within the third round. RESULTS: Experts agreed on a rehabilitation protocol that consists of 16 steps and starts before surgery. It is based on two overarching principles, namely the necessity of multiprofessional teamwork and a careful selection and education of patients within the rehabilitation team. Among the different steps in therapy, experts rated the training with electromyographic biofeedback as the most important one. DISCUSSION: Within this study, a first rehabilitation protocol for TMR patients based on a broad experts' consensus and relevant literature could be developed. The detailed steps for rehabilitation start well before surgery and prosthetic fitting, and include relatively novel interventions as motor imagery and biofeedback. Future studies need to further investigate the clinical outcomes and thereby improve therapists' practice. CONCLUSION: Graded rehabilitation offered by a multiprofessional team is needed to enable individuals with upper limb amputations and TMR to fully benefit from prosthetic reconstruction. LEVEL OF EVIDENCE: Low.