Upper limb joint coordination preserves hand kinematics after a traumatic brachial plexus injury.

Background: Traumatic brachial plexus injury (TBPI) causes a sensorimotor deficit in upper limb (UL) movements. Objective: Our aim was to investigate the arm-forearm coordination of both the injured and uninjured UL of TBPI subjects. Methods: TBPI participants (n = 13) and controls (n = 10) matched in age, gender, and anthropometric characteristics were recruited. Kinematics from the shoulder, elbow, wrist, and index finger markers were collected, while upstanding participants transported a cup to their mouth and returned the UL to a starting position. The UL coordination was measured through the relative phase (RP) between arm and forearm phase angles and analyzed as a function of the hand kinematics. Results: For all participants, the hand transport had a shorter time to peak velocity (p < 0.01) compared to the return. Also, for the control and the uninjured TBPI UL, the RP showed a coordination pattern that favored forearm movements in the peak velocity of the transport phase (p < 0.001). TBPI participants' injured UL showed a longer movement duration in comparison to controls (p < 0.05), but no differences in peak velocity, time to peak velocity, and trajectory length, indicating preserved hand kinematics. The RP of the injured UL revealed altered coordination in favor of arm movements compared to controls and the uninjured UL (p < 0.001). Finally, TBPI participants' uninjured UL showed altered control of arm and forearm phase angles during the deceleration of hand movements compared to controls (p < 0.05). Conclusion: These results suggest that UL coordination is reorganized after a TBPI so as to preserve hand kinematics.

Kinematic Changes in the Uninjured Limb After a Traumatic Brachial Plexus Injury.

Background: Traumatic brachial plexus injury (TBPI) typically causes sensory, motor and autonomic deficits of the affected upper limb. Recent studies have suggested that a unilateral TBPI can also affect the cortical representations associated to the uninjured limb. Objective: To investigate the kinematic features of the uninjured upper limb in participants with TBPI. Methods: Eleven participants with unilateral TBPI and twelve healthy controls matched in gender, age and anthropometric characteristics were recruited. Kinematic parameters collected from the index finger marker were measured while participants performed a free-endpoint whole-body reaching task and a cup-to-mouth task with the uninjured upper limb in a standing position. Results: For the whole-body reaching task, lower time to peak velocity (p = 0.01), lower peak of velocity (p = 0.003), greater movement duration (p = 0.04) and shorter trajectory length (p = 0.01) were observed in the TBPI group compared to the control group. For the cup-to-mouth task, only a lower time to peak velocity was found for the TBPI group compared to the control group (p = 0.02). Interestingly, no differences between groups were observed for the finger endpoint height parameter in either of the tasks. Taken together, these results suggest that TBPI leads to a higher cost for motor planning when it comes to movements of the uninjured limb as compared to healthy participants. This cost is even higher in a task with a greater postural balance challenge. Conclusion: This study expands the current knowledge on bilateral sensorimotor alterations after unilateral TBPI and should guide rehabilitation after a peripheral injury.

Congelamento da marcha e de membros superiores na doença de Parkinson / Freezing of gait and upper limbs in Parkinson's disease

O fenômeno do congelamento é considerado um sintoma incapacitante para indivíduos acometidos pela doença de Parkinson, gerando impactos negativos na mobilidade, funcionalidade e qualidade de vida. O congelamento pode acometer membros inferiores (congelamento da marcha) e/ou membros superiores, sendo caracterizado por súbita incapacidade de iniciar ou manter a amplitude dos movimentos. A fisiopatologia do congelamento ainda não é compreendida, porém atribui-se às alterações em diferentes estruturas neuroanatômicas, tais como: núcleo pedúnculo-pontino, locus ceruleus, circuitaria dos núcleos da base, pedúnculo cerebelar e córtices cerebrais e sistema límbico. Fatores que contribuem para o surgimento do congelamento são: tempo de duração da doença, idade avançada, subtipo acinético-rígido da doença, ansiedade ou depressão, perfil de tratamento farmacológico. Sugere-se que o congelamento da marcha e dos membros superiores compartilhem das mesmas características espaço-temporais. A avaliação clínica do congelamento da marcha é melhor estabelecida quando comparada com a avaliação do congelamento dos membros superiores. Estratégias para minimizar o fenômeno do congelamento são descritas no presente artigo.

The phenomenon of freezing is a disabling symptom for subjects with Parkinson's disease, causing impairment in mobility, functionality and quality of life. Freezing may affect lower limbs (freezing of gait) or upper limbs, and is characterized by sudden inability to initiate or maintain range of motion. The pathophysiology of freezing is not yet understood, but it is attributed to changes in different neuroanatomical structures, such as: pedunculopontine nucleus, locus ceruleus, basal ganglia circuitry, pedunculocerebellar and cerebral cortices and limbic system. Factors that contribute to the appearance of freezing are: advanced age, akinetic-rigid subtype of the disease, anxiety or depression, pharmacological treatment strategies. It is suggested that the freezing of gait and upper limbs share the same spatiotemporal characteristics. The clinical evaluation of freezing of gait is better established when compared to the freezing of upper limbs. Strategies to minimize the phenomenon of freezing are described in this article.

Avaliação dos membros superiores na doença de Parkinson: implicações para a Reabilitação Física / Assessment of upper limbs in Parkinson's disease: implications for Physical Rehabilitation

A doença de Parkinson é uma desordem neurológica com impacto negativo na motricidade e qualidade de vida dos pacientes. O comprometimento motor inclui dificuldades para a marcha, equilíbrio e atividades de vida diária. Contudo, pouca atenção é dada aos aspectos de avaliação e reabilitação física dos membros superiores na doença de Parkinson. Sendo assim, o presente artigo apresenta instrumentos de avaliação no contexto da Classsificação Internacional de Funcionalidade, Incapacidade e Saúde que são relatados na literatura e que podem servir como desfechos clínicos para verificar a evolução dos pacientes com DP na reabilitação física.

Parkinson's disease is a neurological disorder with a negative impact on motor function and quality of life of patients. The motor impairment includes diffulites in walking, balance and daily activities. However, little attention is paid to aspects of evaluation and physical rehabilitation for upper limbs in Parkinson's disease. Therefore, this paper presents assessment tools in the context of the International Colassification of Functioning, Disability and Health that are reported in the literature and which can serve as clinical outcomes to verify the evolution of Parkinson's disease patients in physical rehabilitation.