Low frequency oscillations during hand laterality judgment task with and without personal perspectives: a preliminary study.

Sense of personal perspective is crucial for understanding in attentional mechanisms of the perception in "self" or "other's" body. In a hand laterality judgment (HLJ) task, perception of perspective can be assessed by arranging angular orientations and depths of images. A total of 11 healthy, right-handed participants (8 females, mean age: 38.36 years, education: 14 years) were included in the study. The purpose of this study was to investigate behavioural and cortical responses in low-frequency cortical rhythms during a HLJ task. A total of 80-visual hand stimuli were presented through the experiment. Hand visuals were categorized in the way of side (right vs. left) and perspective (1st vs. 3rd personal perspective). Both behavioural outcomes and brain oscillatory characteristics (i.e., frequency and amplitude) of the Electroencephalography were analysed. All reaction time and incorrect answers for 3rd person perspective were higher than the ones for 1st person perspective. Location effect was statistically significant in event-related theta responses confirming the dominant activity of theta frequency in spatial memory tasks on parietal and occipital areas. In addition, we found there were increasing in delta power and phase in hand visuals with 1st person perspective and increasing theta phase in hand visuals with 3rd person perspective (p < 0.05). Accordingly, a clear dissociation in the perception of perspectives in low-frequency bands was revealed. These different cortical strategy in the perception of hand visual with and without perspectives may be interpreted as delta activity may be related in self-body perception, whereas theta activity may be related in allocentric perception.

Investigation of grip strength, pain threshold, pain tolerance and function in smartphone users.

PURPOSE/AIM OF THE STUDY: Few studies have demonstrated the effects of smartphone use on grip strength and upper extremity function. The present study was purposed to compare smartphone users' grip/lateral pinch strength, pain threshold/tolerance and upper limb function. MATERIALS AND METHODS: A prospective cross-sectional study was conducted with 241 individuals. Participants were divided into three groups with the cut-off values of the Smartphone Addiction Scale (SAS). The Edinburgh Handedness Inventory (EHI) was used to determine the dominant side. Thumb pain threshold and tolerance were evaluated with the algometer. A hand dynamometer measured the grip and lateral pinch strength. Upper extremity functions were evaluated with the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick-DASH). RESULTS: Handgrip strength of the dominant/non-dominant extremities and Quick-DASH scores were higher in low-level smartphone users (p < 0.05). There was no significant difference between the groups on lateral pinch strength and pain threshold/tolerance (p > 0.05). Smartphone usage significantly affected dominant and non-dominant hand grip strength (Standardized ß1 = -0.15, ß2 = -0.15, p < 0.05). In addition, the smartphone use level negatively affected dominant lateral pinch strength (Standardized ß = -0.12, p = 0.05). On the other hand, smartphone use positively affected upper extremity function (Standardized ß = 0.17, p < 0.05). CONCLUSIONS: As smartphone addiction increases, standard handgrip strength and functionality decrease. Pain threshold/tolerance is not affected by smartphone use. Future studies should focus on fine motor skills to present a more comprehensive upper limb function evaluation.

Effect of Painful Electrical Stimuli on Readiness Potential in the Human Brain.

The readiness potential (RP), which is a slow negative electrical brain potential that occurs before voluntary movement, can be interpreted as a measure of intrinsic brain activity originating from self-regulating mechanisms. Early and late components of the RP may indicate clinical-neurophysiological features such as motivation, preparation, intention, and initiation of voluntary movements. In the present study, we hypothesized that electrical pain stimuli modulate the preparatory brain activity for movement. The grand average evoked potentials were measured at sensory motor regions with EEG during an experimental protocol consisting of painful and nonpainful stimuli. Our results demonstrated that painful stimuli were preceded by an enhanced RP when compared to non-painful stimuli at the Cz channel (p < 0.05). Furthermore, the mean amplitude of the RP at the early phase was significantly higher for the painful stimuli when compared to the non-painful stimuli (p < 0.05). Our results indicate that electrical painful stimuli, which can be considered as an unpleasant and stressful condition, modulate the motor preparation at sensory motor regions to a different extent when compared to non-painful electrical stimuli. Since early component of the RP represents cortical activation due to anticipation of the stimuli and the allocation of attentional resources, our results suggest that painful stimuli may affect the motor preparation processes and the prediction of the movement at the cortical level.

Fear of movement-related pain disturbs cortical preparatory activity after becoming aware of motor intention.

Fear of movement-related pain is known to disturb the process of motor preparation in patients with chronic pain. In the present study, we aimed to clarify the neural mechanisms underlying the influence of fear movement-related pain on motor preparatory brain activity using Libet's clock and electroencephalography (EEG). Healthy participants were asked to press a button while watching a rotating Libet's clock-hand, and report the number on the clock ("W time") when they made the "decision" to press the button with their right index finger. Immediately after pressing the button, a painful electrical stimulus was delivered to the dorsum of the left hand, causing participants to feel fear of movement (button press-related pain). We found that fear of movement-related pain caused the W time to be early, and that the amplitudes of readiness potentials (RPs) increased after awareness of motor intention emerged. In addition, fear of movement-related pain caused over-activation of the medial frontal cortex, supplementary motor area, cingulate motor area, and primary motor cortex after participants became aware of their motor intention. Such over-activation might result from conflict between the unrealized desire to escape from a painful experience and motivation to perform a required motor task.

Classification of motor imagery and execution signals with population-level feature sets: implications for probe design in fNIRS based BCI.

OBJECTIVE: The aim of this study was to introduce a novel methodology for classification of brain hemodynamic responses collected via functional near infrared spectroscopy (fNIRS) during rest, motor imagery (MI) and motor execution (ME) tasks which involves generating population-level training sets. APPROACH: A 48-channel fNIRS system was utilized to obtain hemodynamic signals from the frontal (FC), primary motor (PMC) and somatosensory cortex (SMC) of ten subjects during an experimental paradigm consisting of MI and ME of various right hand movements. Classification accuracies of random forest (RF), support vector machines (SVM), and artificial neural networks (ANN) were computed at the single subject level by training each classifier with subject specific features, and at the group level by training with features from all subjects for ME versus Rest, MI versus Rest and MI versus ME conditions. The performances were also computed for channel data restricted to FC, PMC and SMC regions separately to determine optimal probe location. MAIN RESULTS: RF, SVM and ANN had comparably high classification accuracies for ME versus Rest (%94, %96 and %98 respectively) and for MI versus Rest (%95, %95 and %98 respectively) when fed with group level feature sets. The accuracy performance of each algorithm in localized brain regions were comparable (>%93) to the accuracy performance obtained with whole brain channels (>%94) for both ME versus Rest and MI versus Rest conditions. SIGNIFICANCE: By demonstrating the feasibility of generating a population level training set with a high classification performance for three different classification algorithms, the findings pave the path for removing the necessity to acquire subject specific training data and hold promise for a novel, real-time fNIRS based BCI system design which will be most effective for application to disease populations for whom obtaining data to train a classification algorithm is not possible.

Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial.

STUDY DESIGN: Single-blinded randomized controlled trial. INTRODUCTION: Pain management is essential in the early stages of the rehabilitation of distal radius fractures (DRFx). Pain intensity at the acute stage is considered important for determining the individual recovery process, given that higher pain intensity and persistent pain duration negatively affect the function and cortical activity of pain response. Graded motor imagery (GMI) and its components are recent pain management strategies, established on a neuroscience basis. PURPOSE OF THE STUDY: To investigate the effectiveness of GMI in hand function in patients with DRFx. METHODS: Thirty-six participants were randomly allocated to either GMI (n = 17; 52.59 [9.8] years) or control (n = 19; 47.16 [10.5] years) groups. The GMI group received imagery treatment in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 8 weeks. The assessments included pain at rest and during activity using the visual analog scale, wrist and forearm active range of motion (ROM) with universal goniometer, grip strength with the hydraulic dynamometer (Jamar; Bolingbrook, IL), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire, and the Michigan Hand Questionnaire. Assessments were performed twice at baseline and at the end of the eighth week. RESULTS: The GMI group showed greater improvement in pain intensity (during rest, 2.24; activity, 6.18 points), wrist ROM (flexion, -40.59; extension, -45.59; radial deviation, -25.59; and ulnar deviation, -26.77 points) and forearm ROM (supination, -43.82 points), and functional status (Disability of the Arm, Shoulder and Hand Questionnaire, 38.00; Michigan Hand Questionnaire, -32.53 points) when compared with the control group (for all, P < .05). CONCLUSION: The cortical model of pathological pain suggests new strategies established on a neuroscience basis. These strategies aim to normalize the cortical proprioceptive representation and reduce pain. One of these recent strategies, GMI appears to provide beneficial effects to control pain, improve grip strength, and increase upper extremity functions in patients with DRFx.

Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature.

OBJECTIVE: To provide an overview of rehabilitation for patients who underwent first carpometacarpal joint (CMC-1) arthroplasty, with emphasis on early active mobilization. DATA SOURCES: PubMed/MEDLINE, Embase, CINAHL, and Cochrane were searched. STUDY SELECTION: Articles written in English that described the postoperative regimen (including immobilization period/method and/or description of exercises/physical therapy, follow-up 6wk) on CMC-1 arthroplasty were included. DATA EXTRACTION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as guidance in this review, and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale. DATA SYNTHESIS: Twenty-seven studies were included consisting of 1015 participants, in whom 1118 surgical procedures were performed. A summary of the components of postoperative rehabilitation used in the included studies of CMC-1 osteoarthritis is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of range of motion and strength exercises) provides positive outcomes for pain, limitations in activities of daily living, and grip and pinch strength, but comparative studies are lacking. Furthermore, 3 postoperative exercises/therapy phases were identified in the literature-the acute phase, the unloaded phase, and the functional phase-but again comparative studies are lacking. CONCLUSIONS: Early active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation for CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high-quality comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.

Validity and Reliability of Visual Analog Scale Foot and Ankle: The Turkish Version.

The present study tested the reliability and validity of the Turkish version of the visual analog scale foot and ankle (VAS-FA) among healthy subjects and patients with foot problems. A total of 128 participants, 65 healthy subjects and 63 patients with foot problems, were evaluated. The VAS-FA was translated into Turkish and administered to the 128 subjects on 2 separate occasions with a 5-day interval. The test-retest reliability and internal consistency were assessed with the intraclass correlation coefficient and Cronbach's α. The validity was assessed using the correlations with Turkish versions of the Foot Function Index, the Foot and Ankle Outcome Score, and the Short-Form 36-item Health Survey. A statistically significant difference was found between the healthy group and the patient group in the overall score and subscale scores of the VAS-FA (p < .001). The internal consistency of the VAS-FA was very good, and the test-retest reliability was excellent. Adequate to good correlations were found between the overall VAS-FA score and the Foot Function Index, Foot and Ankle Outcome Score, and Short-Form 36-item Health Survey scores in the healthy and patient groups both. The Turkish version of the VAS-FA is sensitive enough to distinguish foot and ankle-specific pathologic conditions from asymptomatic conditions. The Turkish version of the VAS-FA is a reliable and valid method and can be used for foot-related problems.

Effects of Corrective Taping on Balance and Gait in Patients With Hallux Valgus.

BACKGROUND: Taping is an effective temporary therapy for improving hallux valgus (HV) in adults. Although HV has been demonstrated to impair postural balance, there is a lack of information about how corrective taping affects balance and gait patterns in adults with HV deformity. METHODS: Eighteen middle-aged female patients (average age, 53.5 years) with HV were included. Corrective tape was applied to correct HV angulation. A series of balance and gait stability tests were performed before applying tape and 1 hour after the tape was applied with a Balance Master computerized posturography device. The study involved the following tests: modified clinical test of sensory interaction and balance (mCTSIB), unilateral stance (US), limit of stability (LoS), step up/over (SUO), and walk across (WA) tests. RESULTS: No significant difference was found between the no-tape and taped condition in the static balance mCTSIB and US tests ( P > .05). The taping intervention resulted in significant improvement in the dynamic balance measures for the LoS test's backward reaction time and left maximum excursion ( P < .05), a significantly higher impact index bilaterally in the SUO assessment ( P < .05), and an increase in step width mean and variability in the WA test ( P < .05). CONCLUSIONS: Taping for correcting HV angulation had negative acute effects on dynamic balance in the SUO and WA tests and positive effects in the LoS test. CLINICAL RELEVANCE: Corrective taping, although a form of conservative treatment for hallux valgus, has been insufficiently studied in terms of effects on balance. Our results show that taping, as an acute effect, may impair balance in middle-aged adults when walking or ascending and descending stairs.

Effect of a spinal brace on postural control in different sensory conditions in adolescent idiopathic scoliosis: a preliminary analysis.

BACKGROUND: Despite the positive effects of spinal braces on postural stability, they may constrain movement, resulting in poor balance control in patients with adolescent idiopathic scoliosis (AIS). Therefore, assessment of postural dynamics may aid in designing new less-constraining braces. OBJECTIVES: The effects of a spinal brace on postural stability and Cobb angle were investigated in this study. METHODS: Thirteen pediatric patients (10 females, three males) with AIS were recruited to participate in the study. Cobb angle was assessed by X-ray analyses, and postural stability was tested by computerized dynamic posturography in braced and unbraced conditions. A polyethylene underarm corrective spinal brace was fabricated for the subjects. RESULTS: Thoracic and lumbar curvature decreased to 18.88 ± 11.73° and 17.70 ± 10.58°, respectively, after bracing (p < 0.05). Lower equilibrium scores were observed in the "eyes closed" condition and higher scores in the "eyes closed with a swaying support" condition; higher composite equilibrium scores were also observed for the sensory organization test (p < 0.05) in the braced condition. Lower scores were observed for the "toes-up adaptation test" in the braced condition (p < 0.05). In the braced condition, the reaction time was slower in the right-backward direction and movement velocity was higher in the right-front direction on the limits of stability test (p < 0.05). Furthermore, lower on-axis velocity during forward/backward dynamic balance control was observed in the braced condition (p < 0.05). CONCLUSIONS: Wearing a spinal brace improved postural stability in terms of increased proprioception, equilibrium performance, and rhythmic movement ability in patients with AIS.

Progressive cervical length changes versus single cervical length measurement by transvaginal ultrasound for prediction of preterm delivery.

BACKGROUND: To evaluate cervical length changes as predictors of preterm delivery. METHODS: Two hundred and fifty-seven pregnant women underwent transvaginal ultrasound examination at 16 and 24 weeks of gestation. Cervical length was measured and the difference between the 2 measurements was calculated. The sensitivity, specificity, positive predictive value and negative predictive value of cervical length and cervical length changes were calculated and these methods were compared by receiver-operating characteristic (ROC) curve analysis. RESULTS: Preterm delivery (before 37 weeks of gestation) occurred in 19 patients (7.4%). The mean cervical length was shorter in the preterm group, the area under the ROC curve for prediction of preterm delivery was 0.914, ultrasound had a sensitivity of 84.2% to predict preterm delivery with a false-positive rate of 18.5%, and the relative risk was 4.56 at the 34.3-mm cutoff value at 24 weeks of gestation. In contrast, a cervical length change on transvaginal ultrasound had a sensitivity of 73.3% to predict preterm delivery with a false-positive rate of 18.1%, and the relative risk was 4.08 at the 6.6-mm cutoff value. CONCLUSION: A single cervical length measurement obtained at 24 weeks of gestation can predict preterm delivery as accurately as cervical length change.