Upper extremity amputations and prosthetics.
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ABSTRACT:
SUBMITTER: Ovadia SA
PROVIDER: S-EPMC4317270 | biostudies-other | 2015 Feb
REPOSITORIES: biostudies-other
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Project description:Individuals with upper extremity (UE) amputation abandon prostheses due to challenges with significant device weight-particularly among myoelectric prostheses-and limited device dexterity, durability, and reliability among both myoelectric and body-powered prostheses. The Modular Prosthetic Limb (MPL) system couples an advanced UE prosthesis with a pattern recognition paradigm for intuitive, non-invasive prosthetic control. Pattern recognition accuracy and functional assessment-Box & Blocks (BB), Jebsen-Taylor Hand Function Test (JHFT), and Assessment of Capacity for Myoelectric Control (ACMC)-scores comprised the main outcomes. 10 participants were included in analyses, including seven individuals with traumatic amputation, two individuals with congenital limb absence, and one with amputation secondary to malignancy. The average (SD) time since limb loss, excluding congenital participants, was 85.9 (59.5) months. Participants controlled an average of eight motion classes compared to three with their conventional prostheses. All participants made continuous improvements in motion classifier accuracy, pathway completion efficiency, and MPL manipulation. BB and JHFT improvements were not statistically significant. ACMC performance improved for all participants, with mean (SD) scores of 162.6 (105.3), 213.4 (196.2), and 383.2 (154.3), p = 0.02 between the baseline, midpoint, and exit assessments, respectively. Feedback included lengthening the training period to further improve motion classifier accuracy and MPL control. The MPL has potential to restore functionality to individuals with acquired or congenital UE loss.
| S-EPMC7806748 | biostudies-literature
Project description:Background and objectivePrediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis.DesignProspective cohort study.Methods140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures.ResultsThe participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'.ConclusionsRecovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.
| S-EPMC4431803 | biostudies-literature
Project description:PURPOSE:The Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test (UE CAT) was recently updated to version 2.0 (v2.0). We hypothesized that the PROMIS UE CAT v2.0 would exhibit improved performance characteristics compared with the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) when administered to a nonshoulder upper extremity patient population. METHODS:The UE CAT v2.0, Physical Function (PF) CAT v2.0, and the QuickDASH were each prospectively administered via tablet computer to all patients presenting to a tertiary hand and upper extremity clinic between April 2017 and October 2017. Patient responses were analyzed, and the mean, range, floor and ceiling effect, and correlations between instruments were calculated. RESULTS:Among 825 patients, the mean UE CAT v2.0 score was 38.3 (SD 10.7) with a range of 15 to 61 and interquartile range of 15.4. The UE CAT v2.0 had a strong correlation with the QuickDASH (r = -0.749) and the PF CAT v2.0 (r = 0.719). No patient scored between 56 and 60, indicating a gap in scoring in that range. The UE CAT v2.0 demonstrated a floor effect of 1%, a ceiling effect of 6.9%, and a high internal consistency with a Cronbach alpha of 0.99. CONCLUSIONS:The PROMIS UE CAT v2.0 demonstrated improved ceiling effects, range, and a decreased gap in scoring compared with prior versions. Limitations of the PROMIS UE CAT v2.0 are still present, but updates have led to an incremental improvement over prior versions, demonstrating the ability to influence PROMIS instrument performance through upgrades. CLINICAL RELEVANCE:The updated PROMIS UE CAT v2.0 still demonstrates a ceiling effect and gap in scores at the upper end of the instrument, both of which may limit discrimination between different levels of upper extremity function for high-functioning patients.
| S-EPMC6450736 | biostudies-literature
Project description:OBJECTIVE:Upper extremity (UE) transplantation is the most commonly performed composite tissue allotransplantation worldwide. However, there is a lack of imaging standards for pre- and posttransplant evaluation. This study highlights the protocols and findings of UE allotransplantation toward standardization and implementation for clinical trials. METHODS:Multimodality imaging protocols for a unilateral hand transplant candidate and a bilateral mid-forearm level UE transplant recipient include radiography, computed tomography (CT), magnetic resonance (MR) imaging, catheter angiography, and vascular ultrasonography. Pre- and posttransplant findings, including dynamic CT and MR performed for assessment of motor activity of transplanted hands, are assessed, and image quality of vessels and bones on CT and MR evaluated. RESULTS:Preoperative imaging demonstrates extensive skeletal deformity and variation in vascular anatomy and vessel patency. Posttransplant images confirm bony union in anatomical alignment and patency of vascular anastomoses. Mild differences in rate of vascular enhancement and extent of vascular networks are noted between the 2 transplanted limbs. Dynamic CT and MR demonstrate a 15° to 30° range of motion at metacarpophalangeal joints and 90° to 110° at proximal interphalangeal joints of both transplanted hands at 8 months posttransplant. Image quality was slightly better for CT than for MR in the first subject, while MR was slightly better in the second subject. CONCLUSION:Advanced vascular and musculoskeletal imaging play an important role in surgical planning and can provide novel posttransplantation data to monitor the success of the procedure. Implementation of more standardized protocols should enable a more comprehensive assessment to evaluate the efficacy in clinical trials.
| S-EPMC3716341 | biostudies-literature
Project description:Background: Functional upper extremity (UE) motion enables humans to execute activities of daily living (ADLs). There currently exists no universal language to systematically characterize this type of motion or its fundamental building blocks, called functional primitives. Without a standardized classification approach, pooling mechanistic knowledge and unpacking rehabilitation content will remain challenging. Methods: We created a taxonomy to characterize functional UE motions occurring during ADLs, classifying them by motion presence, temporal cyclicity, upper body effector, and contact type. We identified five functional primitives by their phenotype and purpose: reach, reposition, transport, stabilize, and idle. The taxonomy was assessed for its validity and interrater reliability in right-paretic chronic stroke patients performing a selection of ADL tasks. We applied the taxonomy to identify the primitive content and motion characteristics of these tasks, and to evaluate the influence of impairment level on these outcomes. Results: The taxonomy could account for all motions in the sampled activities. Interrater reliability was high for primitive identification (Cohen's kappa = 0.95-0.99). Using the taxonomy, the ADL tasks were found to be composed primarily of transport and stabilize primitives mainly executed with discrete, proximal motions. Compared to mildly impaired patients, moderately impaired patients used more repeated reaches and axial-proximal UE motion to execute the tasks. Conclusions: The proposed taxonomy yields objective, quantitative data on human functional UE motion. This new method could facilitate the decomposition and quantification of UE rehabilitation, the characterization of functional abnormality after stroke, and the mechanistic examination of shared behavior in motor studies.
| S-EPMC6710387 | biostudies-literature
Project description:IntroductionWe assessed the potential use of quantitative ultrasound (QUS) in the evaluation hand muscles affected by upper extremity mononeuropathies.MethodsThe gray scale levels (GSLs) of abductor pollicis brevis (APB), abductor digiti minimi (ADM), and first dorsal interosseous (FDI) of 30 healthy and 30 upper extremity mononeuropathy patients were measured and compared with standard electrophysiological values.ResultsMean GSL was elevated in 34 APBs of carpal tunnel syndrome patients and 18 FDIs of ulnar neuropathy patients (e.g., FDI mean GSL (interquartile range) 31.5 (27.3~43.8) arbitrary units for patients and 24.0(23.0~29.0) for healthy subjects (P = 0.020)). GSL correlated with motor response amplitudes (Spearman's rho (ρ) = -0.39, P = 0.002 in APB, ρ = -0.72, P = 0.002 in FDI, and ρ = -0.43, P = 0.013 in ADM). The APB GSL correlated with electromyographic severity and disease duration (ρ = 0.46, P < 0.001 and ρ = 0.45, P = 0.003).ConclusionsMuscle QUS may serve as a useful tool in upper extremity mononeuropathy evaluation. Further study of this concept is recommended.
| S-EPMC6579675 | biostudies-literature
Project description:Background: Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. Methods: Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed. Results: Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits. Conclusions: Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.
| S-EPMC6900692 | biostudies-literature
Project description:Introduction Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications. Results On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations. Conclusion There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.
| S-EPMC8041497 | biostudies-literature
Project description:PurposeStatistical literacy is the ability of a patient to apply basic statistical concepts to their health care. Understanding statistics is a critical component of shared decision making. The purpose of this investigation was to define levels of statistical literacy in an upper-extremity (UE) patient population. We aimed to determine if patient demographics would be associated with statistical literacy.MethodsAn electronic survey was administered to a consecutive series of UE patients at a single institution. We recorded baseline demographics, Single Assessment Numeric Evaluation scores, the Berlin Numeracy Test (BNT), and General Health Numeracy Test. We also included a surgical risk question, which asked: "Approximately 3% of patients who get carpal tunnel surgery develop an infection. If 100 patients get this surgery, how many would you expect to develop an infection?" A covariate-controlled adjusted odds ratio reflecting the association between each statistical literacy outcome measure and patient characteristics was reported.ResultsA total 254 surveys were administered, 148 of which were completed and included. Fifty percent of respondents had a high-school education or less. For the BNT, 78% scored in the bottom quartile, and 52% incorrectly answered all questions. For the General Health Numeracy Test, 34% answered 0 or 1/6 questions correctly. For the surgical risk question, 24% of respondents answered incorrectly. Respondents who had a college or graduate degree had 2.62 times greater odds (95% confidence interval, 1.09-6.32) of achieving a BNT score in a higher quartile than patients who did not have a college or graduate degree.ConclusionsOverall levels of statistical literacy are low for UE patients.Clinical relevanceWhen engaging in management discussions and shared decision making, UE surgeons should assume low levels of statistical literacy. Consideration of alternative formats, such as frequencies, video-based materials, and pictographs, may be warranted when discussing outcomes and risks of surgical procedures.
| S-EPMC10721529 | biostudies-literature
Project description:Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae. To date, there have been no randomized trials to define the optimal management strategy for patients presenting with UEDVT, so many conclusions are drawn from smaller, single-center studies or from LEDVT research. In this article, the authors describe the evidence for the currently available treatment options and an approach to a patient with acute UEDVT.
| S-EPMC5334483 | biostudies-other