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1.
Eur J Med Res ; 29(1): 275, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38720374

RESUMO

BACKGROUND: Large skin lesions of the upper extremity tend to be ''long and narrow'' in shape, and the currently used repair and reconstruction protocols still have some drawbacks, including difficulty in closure of the donor area, poor cosmetic appearance of the donor and recipient areas, and low flap survival rates. The ilioinguinal flap has been more widely used for repair and reconstruction of various complex conditions. In order to improve the versatility of the flap design and to achieve better aesthetic results, we report a study on the improved design of Compound SCIP flap for repairing "long and narrow" large skin defects of the upper extremity by using a modified design of the ilioinguinal flap for the procurement of perforating blood vessels and flap excision. METHODS: From April 2005 to August 2015, a total of 12 patients underwent this modified design procedure, in which the anterior branch of the fourth lumbar artery or the posterior intercostal artery was selected to provide blood supply for the perforator flap together with the superficial branch of the superficial iliac artery to meet the blood supply needs of the flap for the one-time repair of a large "long and narrow" skin defect in the upper limb. Patient demographics, flap characteristics, and associated complications were retrospectively analyzed. RESULTS: 3 females and 9 males were included in this study, the mean age of the patients was 31.7 years (range, 22-44 years), the mean follow-up period was 15.3 ± 5.6 months (range, 7-24 months), and all patients had complete closure of the defect site and donor area, and all flaps survived. CONCLUSIONS: The Compound SCIP flap presents some advantages in repairing 'long and narrow' skin defects in the upper limb. While ensuring the survival rate of the elongated ilioinguinal flap, it amplifies the benefits of the ilioinguinal flap and enhances skin utilization. This can serve as a beneficial choice for repairing 'long and narrow' skin defects in the upper limb.


Assuntos
Procedimentos de Cirurgia Plástica , Extremidade Superior , Humanos , Feminino , Masculino , Adulto , Procedimentos de Cirurgia Plástica/métodos , Extremidade Superior/cirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Estudos Retrospectivos , Retalho Perfurante , Idoso , Adulto Jovem , Pele
2.
Medicine (Baltimore) ; 103(19): e37995, 2024 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-38728522

RESUMO

Breast cancer-related lymphedema (BCRL) occurs usually on the affected side, and its cause and pathophysiology are well known. However, the cause of edema of the upper extremity on the unaffected side is barely known. It is often considered to be chemotherapy-induced general edema, and clinical evaluation is rarely performed in these patients. This study aimed to present the clinical characteristics of unilateral breast cancer patients with edema of upper extremity on the unaffected side, and to emphasize the importance of early diagnosis and medical interventions. This study retrospectively analyzed the medical records of unilateral breast cancer patients complaining edema of upper extremity on the unaffected side, from January 2020 to May 2021. Lymphoscintigraphy was used to assist in confirming the diagnosis of lymphedema, and Doppler ultrasonography or 3D computed tomography angiography were performed to differentiate vascular problems. Fourteen patients were enrolled in the study. Seven, 3, and 4 patients had edema of both upper extremities, edema of the upper extremity on the unaffected side only, and edema of all extremities, respectively. None of the 4 patients with edema of all extremities showed abnormal findings on examination. In patients with edema in the upper extremity on the unaffected side alone, lymphatic flow dysfunction was seen in 2 patients, and deep vein thrombosis (DVT) was diagnosed in 1. In patients with edema of both upper extremities, lymphatic flow dysfunction was seen in 2 patients, and DVT was diagnosed in 3. One patient had DVT and accompanying lymphatic flow dysfunction. Lymphedema and DVT were diagnosed in a number of patients with edema of the upper extremity on the unaffected side, and lymphedema can occur without direct injury to the lymphatic flow system. Therefore, clinicians should not overlook the fact that diseases that require early diagnosis and treatment can occur in patients with edema of the unaffected upper extremity.


Assuntos
Neoplasias da Mama , Extremidade Superior , Humanos , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Extremidade Superior/fisiopatologia , Neoplasias da Mama/complicações , Adulto , Idoso , Linfedema/etiologia , Linfedema/diagnóstico , Edema/etiologia , Linfocintigrafia/métodos , Ultrassonografia Doppler/métodos , Linfedema Relacionado a Câncer de Mama/diagnóstico , Angiografia por Tomografia Computadorizada/métodos
3.
BMC Musculoskelet Disord ; 25(1): 374, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38730454

RESUMO

BACKGROUND: Shoulder pain is a leading cause of disability. Occupations requiring high upper extremity demands may put workers at greater risk of shoulder injury and resulting pain. We examined associations of occupation with shoulder pain and upper extremity disability in the Johnston County Osteoarthritis Project. METHODS: Work industry and occupational tasks for the longest job held were collected from participants. At follow-up ranging from 4-10 years later, participants were asked about shoulder symptoms (pain, aching, or stiffness occurring most days of 1 month in the last year) and given a 9-item, modified Disabilities Arm Shoulder and Hand (DASH) questionnaire to categorize disability from 0-4 (none-worst). Logistic regression and cumulative logit regression models were used to estimate associations with prevalent shoulder symptoms and with worse disability category, respectively. Models were adjusted for cohort, age, sex, race, education and time to follow-up. Sex- and race-stratified associations were evaluated. RESULTS: Among 1560 included participants, mean age was 62 years (standard deviation ± 9 years); 32% were men, and 31% were Black. Compared to the managerial/professional industry, higher odds of both shoulder symptoms and worse upper extremity disability were seen for most industrial groups with physically demanding jobs, particularly the service industry. Work that often or always required lifting/moving > 10 lbs. was associated with higher odds of shoulder symptoms. Work that sometimes or always required heavy work while standing was associated with higher odds of shoulder symptoms, and this association was stronger among men and White workers. CONCLUSION: Physically demanding occupations were associated with increased occurrence of shoulder pain and disability. Mitigating specific physical work demands may reduce shoulder-related disability.


Assuntos
Avaliação da Deficiência , Doenças Profissionais , Osteoartrite , Dor de Ombro , Extremidade Superior , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Dor de Ombro/epidemiologia , Dor de Ombro/etiologia , Dor de Ombro/diagnóstico , Doenças Profissionais/epidemiologia , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Extremidade Superior/fisiopatologia , Idoso , Osteoartrite/epidemiologia , Seguimentos , Inquéritos e Questionários
4.
Saudi Med J ; 45(5): 518-524, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38734426

RESUMO

OBJECTIVES: To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. METHODS: Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). RESULTS: A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). CONCLUSION: This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.


Assuntos
Extremidade Inferior , Doenças Musculoesqueléticas , Extremidade Superior , Humanos , Doenças Musculoesqueléticas/epidemiologia , Prevalência , Masculino , Feminino , Arábia Saudita/epidemiologia , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Adulto Jovem , Adolescente
6.
BMJ Open ; 14(5): e078104, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38719328

RESUMO

INTRODUCTION: Stroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb function, people who have had a stroke often employ abnormal 'compensatory' movements. In the short term, these compensatory movements allow the individual to complete tasks, though long-term movement in this manner can lead to limitations. Telerehabilitation offers the provision of rehabilitation services to patients at a remote location using information and communication technologies. 'EvolvRehab' is one such telerehabilitation system, which uses activities to assess and correct compensatory upper body movements, although the feasibility of its use is yet to be determined in National Health Service services. Using EvolvRehab, we aim to assess the feasibility of 6 weeks telerehabilitation in people after a stroke. METHODS AND ANALYSIS: A multisite feasibility study with embedded design phase. Normally distributed data will be analysed using paired samples t-tests; non-normally distributed data will be analysed using related samples Wilcoxon signed rank tests. Thematic content analysis of interview transcripts will be used to investigate the usability and perceived usefulness of the EvolvRehab kit. ETHICS AND DISSEMINATION: This study has received ethical approval from Solihull Research Ethics Committee (REC reference: 23/WM/0054). Dissemination will be carried out according to the dissemination plan co-written with stroke survivors, including academic publications and presentations; written reports; articles in publications of stakeholder organisations; presentations to and publications for potential customers. TRIAL REGISTRATION NUMBER: NCT05875792.


Assuntos
Estudos de Viabilidade , Reabilitação do Acidente Vascular Cerebral , Telerreabilitação , Humanos , Reabilitação do Acidente Vascular Cerebral/métodos , Telerreabilitação/métodos , Estudo de Prova de Conceito , Extremidade Superior/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia
7.
PLoS One ; 19(5): e0291279, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38739557

RESUMO

Upper limb robotic (myoelectric) prostheses are technologically advanced, but challenging to use. In response, substantial research is being done to develop person-specific prosthesis controllers that can predict a user's intended movements. Most studies that test and compare new controllers rely on simple assessment measures such as task scores (e.g., number of objects moved across a barrier) or duration-based measures (e.g., overall task completion time). These assessment measures, however, fail to capture valuable details about: the quality of device arm movements; whether these movements match users' intentions; the timing of specific wrist and hand control functions; and users' opinions regarding overall device reliability and controller training requirements. In this work, we present a comprehensive and novel suite of myoelectric prosthesis control evaluation metrics that better facilitates analysis of device movement details-spanning measures of task performance, control characteristics, and user experience. As a case example of their use and research viability, we applied these metrics in real-time control experimentation. Here, eight participants without upper limb impairment compared device control offered by a deep learning-based controller (recurrent convolutional neural network-based classification with transfer learning, or RCNN-TL) to that of a commonly used controller (linear discriminant analysis, or LDA). The participants wore a simulated prosthesis and performed complex functional tasks across multiple limb positions. Analysis resulting from our suite of metrics identified 16 instances of a user-facing problem known as the "limb position effect". We determined that RCNN-TL performed the same as or significantly better than LDA in four such problem instances. We also confirmed that transfer learning can minimize user training burden. Overall, this study contributes a multifaceted new suite of control evaluation metrics, along with a guide to their application, for use in research and testing of myoelectric controllers today, and potentially for use in broader rehabilitation technologies of the future.


Assuntos
Membros Artificiais , Eletromiografia , Humanos , Masculino , Feminino , Adulto , Desenho de Prótese , Extremidade Superior/fisiologia , Robótica , Movimento/fisiologia , Redes Neurais de Computação , Adulto Jovem , Aprendizado Profundo
8.
Jt Dis Relat Surg ; 35(2): 315-323, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38727110

RESUMO

OBJECTIVES: This study aims to investigate the influence of parents and children's psychological attributes and previous fracture history on upper extremity fractures in school-aged and adolescent children. PATIENTS AND METHODS: Between January 2022 and January 2023, a total of 194 participants consisting of 97 cases with upper extremity fractures (23 males, 74 females; median age: 10 years; range, 6 to 16 years) and 97 age-matched controls suffering from growing pains (47 males, 50 females; median age: 10 years; range, 6 to 16 years) were included in this case-control study. Both cases and controls were of school-age or over. The parents of the children were interviewed face-to-face using psychological scales including the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), the Autism-Spectrum Quotient (AQ), the Short Form of the Conners' Parent Rating Scale-Revised (CPRS-R:S), and the Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07). The results derived from these scales and the demographics of the participants were evaluated in terms of their association with the risk of upper extremity fractures. RESULTS: A household income below the official minimum monthly wage (MMW) and a previous fracture history showed a higher risk for upper extremity fractures (odds ratio [OR]=2.38, 95% confidence interval [CI]: 1.07-5.26 and OR=24.93, 95% CI: 3.27-189.98, respectively). In the univariate analyses, elevated scores on the hyperactivity subscale of CPRS-R:S (CPRS-R:SHS) were associated with a higher fracture risk (OR=1.14, 95% CI: 1.05-1.24). Furthermore, both a household income below MMW, a previous fracture history, and higher CPRS-R:S-HS scores were found as independent risk factors for upper extremity fractures in the multivariate regression analysis (OR=2.78, 95% CI: 1.13-6.86, OR=21.79, 95% CI: 2.73-174.03), and OR=1.11, 95% CI: 1.02-1.22, respectively). CONCLUSION: Our study results highlight the importance of known risk factors for upper extremity fractures such as lower monthly wage and the presence of previous fractures. The psychological states of parents and children should be evaluated together.


Assuntos
Fraturas Ósseas , Pais , Humanos , Masculino , Feminino , Criança , Adolescente , Estudos de Casos e Controles , Fraturas Ósseas/psicologia , Fraturas Ósseas/epidemiologia , Pais/psicologia , Fatores de Risco , Extremidade Superior/lesões , Ossos da Extremidade Superior/lesões , Inquéritos e Questionários
9.
Anesthesiol Clin ; 42(2): 203-217, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38705671

RESUMO

Upper extremity injuries are frequent in athletes which may require surgeries. Regional anesthesia for postoperative analgesia is important to aid recovery, and peripheral nerve blocks for surgical anesthesia enable surgeries to be performed without general anesthetics and their associated adverse effects. The relevant nerve block approaches to anesthetize the brachial plexus for elbow, wrist and hand surgeries are discussed in this article. There is very limited margin for error when performing nerve blocks and multimodal monitoring approach to reduce harm are outlined. Lastly, the importance of obtaining informed consent prior to nerve block procedures should not be overlooked.


Assuntos
Anestesia por Condução , Atletas , Bloqueio Nervoso , Extremidade Superior , Humanos , Anestesia por Condução/métodos , Extremidade Superior/cirurgia , Bloqueio Nervoso/métodos
10.
Clin Spine Surg ; 37(4): 188-197, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38706113

RESUMO

STUDY DESIGN: Retrospective analysis of a prospective, multicenter registry. OBJECTIVE: To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. METHODS: This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. RESULTS: Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). CONCLUSIONS: As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients' upper and lower extremity treatment expectations. LEVEL OF EVIDENCE: Level-III.


Assuntos
Vértebras Cervicais , Extremidade Inferior , Satisfação do Paciente , Espondilose , Extremidade Superior , Humanos , Extremidade Superior/cirurgia , Extremidade Superior/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Extremidade Inferior/cirurgia , Extremidade Inferior/fisiopatologia , Espondilose/cirurgia , Espondilose/fisiopatologia , Vértebras Cervicais/cirurgia , Resultado do Tratamento , Idoso , Estudos de Coortes , Doenças da Medula Espinal/cirurgia
11.
Semin Vasc Surg ; 37(1): 26-34, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38704180

RESUMO

Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.


Assuntos
Descompressão Cirúrgica , Síndromes de Compressão Nervosa , Músculos Peitorais , Extremidade Superior , Humanos , Resultado do Tratamento , Extremidade Superior/irrigação sanguínea , Extremidade Superior/inervação , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Síndromes de Compressão Nervosa/cirurgia , Recuperação de Função Fisiológica , Masculino , Feminino , Adulto
12.
Sci Rep ; 14(1): 9996, 2024 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-38693184

RESUMO

Tracking a moving object with the eyes seems like a simple task but involves areas of prefrontal cortex (PFC) associated with attention, working memory and prediction. Increasing the demand on these processes with secondary tasks can affect eye movements and/or perceptual judgments. This is particularly evident in chronic or acute neurological conditions such as Alzheimer's disease or mild traumatic brain injury. Here, we combined near infrared spectroscopy and video-oculography to examine the effects of concurrent upper limb movement, which provides additional afference and efference that facilitates tracking of a moving object, in a novel dual-task pursuit protocol. We confirmed the expected effects on judgement accuracy in the primary and secondary tasks, as well as a reduction in eye velocity when the moving object was occluded. Although there was limited evidence of oculo-manual facilitation on behavioural measures, performing concurrent upper limb movement did result in lower activity in left medial PFC, as well as a change in PFC network organisation, which was shown by Graph analysis to be locally and globally more efficient. These findings extend upon previous work by showing how PFC is functionally organised to support eye-hand coordination when task demands more closely replicate daily activities.


Assuntos
Córtex Pré-Frontal , Extremidade Superior , Humanos , Córtex Pré-Frontal/fisiologia , Masculino , Feminino , Extremidade Superior/fisiologia , Adulto , Adulto Jovem , Movimento/fisiologia , Desempenho Psicomotor/fisiologia , Movimentos Oculares/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho , Atenção/fisiologia
13.
Spinal Cord Ser Cases ; 10(1): 33, 2024 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-38704389

RESUMO

INTRODUCTION: Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered. CASE PRESENTATION: The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient's contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training. DISCUSSION: In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.


Assuntos
Traumatismos da Medula Espinal , Extremidade Superior , Humanos , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/complicações , Masculino , Fármacos Neuromusculares/uso terapêutico , Fármacos Neuromusculares/administração & dosagem , Adulto , Toxinas Botulínicas/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Toxinas Botulínicas Tipo A/administração & dosagem , Terapia Combinada
14.
J Neuroeng Rehabil ; 21(1): 75, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38734690

RESUMO

BACKGROUND: Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement. METHODS: This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments. RESULTS: Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs. CONCLUSION: This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.


Assuntos
Doenças do Sistema Nervoso , Extremidade Superior , Humanos , Extremidade Superior/fisiopatologia , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/métodos , Reabilitação Neurológica/instrumentação , Realidade Virtual , Terapia de Exposição à Realidade Virtual/métodos , Terapia de Exposição à Realidade Virtual/instrumentação
15.
MedEdPORTAL ; 20: 11399, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38736678

RESUMO

Introduction: Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques. Methods: We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness. Results: Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions. Discussion: CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.


Assuntos
Anatomia , Mama , Currículo , Educação de Graduação em Medicina , Avaliação Educacional , Aprendizagem Baseada em Problemas , Estudantes de Medicina , Extremidade Superior , Humanos , Educação de Graduação em Medicina/métodos , Estudantes de Medicina/estatística & dados numéricos , Aprendizagem Baseada em Problemas/métodos , Feminino , Mama/anatomia & histologia , Inquéritos e Questionários , Anatomia/educação
17.
Dev Neurorehabil ; 27(1-2): 44-56, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38600734

RESUMO

Reliability of joint motion and muscle length measurement in children with cerebral palsy was examined. Twenty-one studies of intraobserver and/or interobserver reliability were reviewed: joint motion of upper extremities in four and lower extremities in 13; muscle length of upper extremities in one and lower extremities in 15. Intraclass correlation coefficients for goniometric interobserver reliability varied widely for joint motion (range 0.38-0.92) and muscle length (range 0.20-0.95). Inclusion of an error measurement to provide clinicians with a value indicating true change was limited. Further research is required to determine intraobserver and interobserver reliability for these important pediatric clinical measurements.


Assuntos
Paralisia Cerebral , Extremidade Inferior , Músculo Esquelético , Amplitude de Movimento Articular , Extremidade Superior , Humanos , Paralisia Cerebral/fisiopatologia , Criança , Extremidade Inferior/fisiopatologia , Extremidade Superior/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Músculo Esquelético/fisiopatologia , Músculo Esquelético/diagnóstico por imagem , Variações Dependentes do Observador
18.
Sensors (Basel) ; 24(8)2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38676190

RESUMO

In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.


Assuntos
Hemiplegia , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior , Humanos , Hemiplegia/reabilitação , Hemiplegia/fisiopatologia , Masculino , Feminino , Extremidade Superior/fisiopatologia , Projetos Piloto , Pessoa de Meia-Idade , Idoso , Reabilitação do Acidente Vascular Cerebral/métodos , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/fisiopatologia
19.
BMJ Open ; 14(4): e086226, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38626967

RESUMO

INTRODUCTION: Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS: A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: NCT06082349.


Assuntos
Vasos Linfáticos , Linfedema , Neoplasias , Humanos , Adulto , Pessoa de Meia-Idade , Análise Custo-Benefício , Qualidade de Vida , Vasos Linfáticos/cirurgia , Linfedema/etiologia , Linfedema/cirurgia , Neoplasias/complicações , Neoplasias/cirurgia , Anastomose Cirúrgica/métodos , Extremidade Superior/cirurgia , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
20.
Trials ; 25(1): 254, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38605413

RESUMO

BACKGROUND AND PURPOSE: Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS: This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION: This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Terapia de Espelho de Movimento , Hemiplegia/diagnóstico , Hemiplegia/etiologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Extremidade Superior , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como Assunto
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