Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review.

PURPOSE: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures. METHOD: Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence. RESULTS: Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast). CONCLUSIONS: Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures. IMPLICATIONS FOR CANCER SURVIVORS: There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.

Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging.

Background: Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC). Methods and Results: Retrospective three-dimensional surface imaging (3D-SI) of 100 breasts taken before or after breast conserving surgery for breast cancer were retrieved for reliability analysis. Three assessors followed a standardized measurement technique using two software programs, Vectra® 3D Analysis Module (VAM) and Breast Sculptor®. Mean breast volume was 489.9 ± 206 cc using VAM and 480.1 ± 229.1 cc using Breast Sculptor. Lin's concordance showed poor agreement between programs (0.81-0.88). Measurements using VAM had excellent intra- and inter-rater reliability with SEM = 4.1% for one assessor and 8.7% for multiple assessors. Breast Sculptor also had excellent intra-rater and substantial inter-rater reliability but the SEM was much larger at 14.5% (intra-rater) and 19.1% (inter-rater). The SDC value was lowest for VAM and a single rater with 56 cc indicating a meaningful change beyond measurement error. Conclusion: Breast volume measurements captured with 3D-SI using VECTRA-XT are highly reliable, but the volumes, SEM, and SDC varied between the two software programs. Measurement error was lowest with VAM software. Although the usefulness of VECTRA-XT and VAM software to detect change in breast volume is promising, further solutions to reduce measurement error are required to improve clinical utility to measure breast lymphedema.

Safety and Feasibility of a Kinesiotape Application for Secondary Hand Lymphedema: A Case Series.

Background: The safety and feasibility of using kinesiotape as a short-term alternative treatment to compression garments or gloves for hand lymphedema have not been examined. The aim of this study was to examine if kinesiotape could maintain size and extracellular fluid (ECF) volume of the hand and forearm, as well as upper limb function and quality of life for women with secondary hand lymphedema. Methods and Results: Six women with secondary hand lymphedema underwent pretreatment measurements, including hand and digit size using a tape measure; ECF volume using bioimpedance spectroscopy; and patient-reported outcome measurements of upper limb function and quality of life. Kinesiotape was then applied to the dorsum of the hand and left for 48 h, during which participants were asked not to wear compression garments. Posttreatment measurements were completed after kinesiotape removal. Changes in measurements were compared to the smallest detectable change (SDC). Hand size did not change more than the SDC; however, a single affected digit increased in circumference by more than the SDC. Changes of the whole arm ECF volume were less than the SDC. The ECF volume of the dorsum of the hand increased in one and decreased in another participant. The forearm ECF volume decreased in two participants. Upper limb function and quality of life did not change. No adverse event was reported. Conclusion: Short-term kinesiotape use appears to be safe in maintaining the physical presentation of hand lymphedema. However, these results should be examined in a larger sample. The feasibility of using kinesiotape as an alternative treatment to compression requires further investigation. Clinical Trial Registration number: ACTRN12618001232224p, July 23, 2018 retrospectively registered.

Reliability and Validity of Physical Tools and Measurement Methods to Quantify Hand Swelling: A Systematic Review.

OBJECTIVE: Hand swelling may result from injury or trauma. Various physical assessment tools and measurement methods can be used to quantify the volume or size of the hand or fingers; however, the reliability and validity of each tool and measurement method have not been evaluated. The purpose of this study was to evaluate the reliability and validity of physical assessment tools and methods used to quantify hand and finger volume orsize. METHODS: MEDLINE, CINAHL, EMBASE, Web of Science, and Scopus were searched using key terms related to swelling, edema, volume, size, hand, measures, reliability, and validity. Cross-sectional or longitudinal studies that assessed reliability and/or validity of physical assessment tools or measurement methods to quantify hand swelling were included. Two examiners independently extracted data from the included articles and appraised the articles' quality using the Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Data extracted from studies analyzing reliability and validity were grouped by type of assessment tool and measurement method. RESULTS: Five physical assessment tools used for quantification of hand swelling were evaluated, including tape measure, water volumeter, bioimpedance spectroscopy, ring gauge, 3-dimensional techniques. All assessment tools had good to excellent reliability (ICC = 0.74 - 0.99), and moderate to high validity (Pearson coefficient = 0.58 - 0.99), for quantification of the volume or size of the hand or fingers. CONCLUSION: All measurement methods with these tools had good to excellent reliability and moderate to high validity. The evidence underpinning the figure-of-eight technique, which uses a tape measure, was the highest. Because these physical assessment tools and measurement methods assess different aspects and regions of the hand, which one is selected depends on the region of interest for assessment and the availability of tools. IMPACT: Reliable tools and measurement methods are available to measure the size or volume of the hand and fingers, either together or separately. The best tool will depend on the aim of assessment and tool availability. LAY SUMMARY: Hand swelling can occur with injuries, burns, or lymphedema. This review shows that tools are available to accurately measure swelling in any part of thehand.

The functional connectivity in the motor loop of human basal ganglia.

Basal ganglia interact in a complex way which is still not completely understood. The model generally used to explain basal ganglia interactions is based on experimental data in animals, but its validation in humans has been hampered by methodological restrictions. The time-relationship (partial correlation) of the fluctuations of the blood-oxygen-level-dependent signals recorded in the main basal ganglia was used here (32 healthy volunteers; 18-72 years of age; 16 males and 16 females) to test whether the interaction of the main basal ganglia in humans follows the pattern of functional connectivity in animals. Data showed that most basal ganglia have a functional connectivity which is compatible with that of the established closed-loop model. The strength of the connectivity of some basal ganglia changed with finger motion, suggesting that the functional interactions between basal ganglia are quickly restructured by the motor tasks. The present study with the motor cortico-BG loop centers supports the circling dynamic of the basal ganglia model in humans, showing that motor tasks may change the functional connectivity of these centers.

The functional connectivity of intralaminar thalamic nuclei in the human basal ganglia.

Projections of the centromedian-parafasicularis neurons of the intralaminar thalamus are major inputs of the striatum. Their functional role in the activity of human basal ganglia (BG) is not well known. The aim of this work was to study the functional connectivity of intralaminar thalamic nuclei with other BG by using the correlations of the BOLD signal recorded during "resting" and a motor task. Intralaminar nuclei showed a marked functional connectivity with all the tested BG, which was observed during "resting" and did not change with the motor task. As regards the intralaminar nuclei, BG connectivity was much lower for the medial dorsal nucleus (a thalamic nucleus bordering the intralaminar nuclei) and for the default mode network (although intralaminar nuclei showed a negative correlation with the default mode network). After the "regression" of intralaminar nuclei activity (partial correlation), the functional connectivity of the caudate and putamen nuclei with other BG decreased (but not with the primary sensorimotor cortex). Present data provide evidence that intralaminar nuclei are not only critical for striatal activity but also for the global performance of human BG, an action involving subcortical BG loops more than cortico-subcortical loops. The high correlation found between BG suggest that, similarly to that reported in other brain centers, the very-slow frequency fluctuations are relevant for the functional activity of these centers.

Mu-rhythm changes during the planning of motor and motor imagery actions.

Motor imagery is a mental representation of motor behavior which has been widely used to study the cognitive basis of movement. The assumption that real movements and motor imagery (virtual movements) use the same neurobiological basis has been questioned by functional magnetic resonance data. The functional similarity in the planning of real and virtual movements was studied here by analyzing event-related EEG recordings of the Mu-activity in the sensitive-motor cortex, pre-motor cortex and supplementary motor cortex. A visual stimulus (an arrow) which displayed the information needed for planning a motion (which can be executed or imaged later after the display of a second stimulus) induced a short-lasting phase-locked Mu-response (PLr) which was wider and more widespread when it was used for the motor planning of real or virtual movements than when it was passively watched. The phase-locked Mu-response was accompanied by a persistent decrease of the Mu-rhythms which were not phase-locked to stimuli (NPLr), a response which also was more marked and generalized when stimuli were used for motor planning than when they were passively observed. PLr and NPLr were similar during motor testing and imagery testing, suggesting that both tasks activated the Mu rhythms to a similar degree. This congruency between real and virtual movements was observed in the three cortical areas studied, where the amplitude, latency and duration of the phase-locked and non-phase-locked Mu response was similar in both cases. These noticeable similarities support the idea that the same cortical mechanisms are recruited during the planning of real and virtual movements, a fact that can be analyzed better when an event-related paradigm and a high time-resolution method are used.

Mu rhythm, visual processing and motor control.

OBJECTIVE: The Mu-rhythm has been proposed as both an inhibitor ("idling hypothesis") and as a promoter ("processing hypothesis") of information processing in the primary sensory-motor cortex (SM-C). We tested these possibilities by analyzing the phase-locked and non-phase-locked Mu response during the execution of a visual-motor task. METHODS: EEG was recorded in 13 subjects during the visual presentation of an arrow which indicated the direction of the finger motion to be executed after the presentation of a second stimulus. The EEG activity in the α-range (Mu-α) and ß-range was evaluated by a method which segregated the phase-locked and the non-phase-locked response. The event-related Mu-response observed during this task was compared with that computed when the subjects saw the same arrow-stimuli but did not perform any task (passive test). RESULTS: Visual stimuli induced a phase-locked α-oscillation which began ≈50ms after the stimulus onset and persisted for about 150-200ms. This response was much higher when stimuli were used for motion planning than when they were passively observed, and was more marked in the α-range than in the ß-range. The phase-locked response was followed by a persistent decrease of the non-phase-locked Mu-activity similar to that previously reported with the event-related desynchronization/synchronization method. CONCLUSIONS: The Mu-wave is not a single phenomenon. It was segregated here into two components, one with an early and short-lasting phase locked-response to visual stimuli, which increased during the task execution, and the other without phase-locked responses which persistently decreased during the task execution. SIGNIFICANCE: Present data suggest that Mu-activity performs a double action, increasing the information processing of one task (according to the "processing hypothesis") and decreasing the computation of other potentially interfering tasks (according to the "idling hypothesis"), with task selection being achieved by choosing their phase-association to the Mu-wave.

The kinematics of motor imagery: comparing the dynamics of real and virtual movements.

Motor imagery (MI) is a key tool for studying the cognitive functions of movement. These studies assume that movements and their MI (virtual movements) involve the same cognitive functions. The real-virtual isochrony and isometry of movements of different complexity and accuracy, and the kinematics of real and virtual movements (real-virtual spatial homology and partial isometry) were studied to test this hypothesis. Isochrony was high in complex attention-demanding tasks but not in simple or inaccurate tasks, with isometry and spatial homology also being different for different motor patterns. These data suggest that movements and their MI do not always involve the same cognitive functions, and are particularly different in simple motor tasks requiring low attention levels.

How similar are motor imagery and movement?

It has been suggested that motor imagery (MI) has the basic components of real motion. This possibility was tested here in 17 healthy volunteers studied while performing or imaging a fast sequence of finger movements of progressive complexity, a fast and precise extension of the arm to touch a small circle with the tip of a pencil, a periodic repetitive flexion-extension of the index finger at a specified rate, and a velocity-regulated continuous rotary movement of the right hand. Motor sequences of 4 to 5 fingers showed a real-virtual congruency similar to that previously reported with other equivalent tests, but it decreased in the simplest sequences performed with 1 to 2 fingers. A more marked decrease of real-virtual congruency was found in the experimental paradigm aimed at producing movements with a pre-specified velocity, which was low for rhythmic movements of the index finger and practically absent in the continuous rotary movements of the hand. Present data show that the ability of MI to produce "realistic" simulations of motion is not the same for all motor tasks.

Integration of auditory and kinesthetic information in motion: alterations in Parkinson's disease.

The main aim in this work was to study the interaction between auditory and kinesthetic stimuli and its influence on motion control. The study was performed on healthy subjects and patients with Parkinson's disease (PD). Thirty-five right-handed volunteers (young, PD, and age-matched healthy participants, and PD-patients) were studied with three different motor tasks (slow cyclic movements, fast cyclic movements, and slow continuous movements) and under the action of kinesthetic stimuli and sounds at different beat rates. The action of kinesthesia was evaluated by comparing real movements with virtual movements (movements imaged but not executed). The fast cyclic task was accelerated by kinesthetic but not by auditory stimuli. The slow cyclic task changed with the beat rate of sounds but not with kinesthetic stimuli. The slow continuous task showed an integrated response to both sensorial modalities. These data show that the influence of the multisensory integration on motion changes with the motor task and that some motor patterns are modulated by the simultaneous action of auditory and kinesthetic information, a cross-modal integration that was different in PD-patients.