Alessio Murgia

Case studies to Demonstrate the Range of Applications of the Southampton Hand Assessment Procedure.

The Southampton Hand Assessment Procedure (SHAP) was devised to assess quantitatively the functional range of injured and healthy adult hands. It was designed to be a practical tool for use in a busy clinical setting; thus, it was made simple to use and easy to interpret. This paper describes four examples of its use: before and after a surgical procedure, to observe the impact of an injury, use with prostheses, and during recovery following a fracture. The cases show that the SHAP is capable of monitoring progress and recovery, identifying functional abilities in prosthetic hands and comparing the capabilities of different groups of injuries.

The use of kinematic and parametric information to highlight lack of movement and compensation in the upper extremities during activities of daily living

A problem that is common to the study of upper limb kinematics and gait analysis is the translation of the evidence from kinematic measurements into easily interpretable information on the status of the patient, such as the amount of compensation or lack of motion. In this study parameters that can be helpful in the rapid and clear identification of limited wrist motion and compensation were derived from kinematic data. A group of six subjects (group A) with no hand impairment, average age 32.5 ys SD 10.7 ys, and another group of five subjects (group B), average age 34.2 ys SD 16.8 ys, having suffered from distal radius fracture were tested during a cyclic activity of daily living. The activity simulated page turning. Thorax, shoulder, elbow and wrist angles were measured during this task using a motion capture system. Corresponding angle ranges were also calculated. The active range of motion (AROM) found for Group B was generally lower than that of Group A, particularly for elbow supination and wrist movements, with wrist flexion/extension statistically smaller for group B (P=0.02). Additional parameters that took into account lack of movements at the wrist and compensation from shoulder elevation, rotation and elbow pronation/supination proved to be more useful at identifying those subjects of group B outside the normative range and can provide clinicians with a rapid and efficient tool that can shorten the analysis process and help make more informed decisions on therapeutic treatments.

Communicating Eye Gaze across a Distance without Rooting Participants to the Spot

Eye gaze is an important conversational resource that until now could only be supported across a distance if people were rooted to the spot. We introduce EyeCVE, the worldpsilas first tele-presence system that allows people in different physical locations to not only see what each other are doing but follow each otherpsilas eyes, even when walking about. Projected into each space are avatar representations of remote participants, that reproduce not only body, head and hand movements, but also those of the eyes. Spatial and temporal alignment of remote spaces allows the focus of gaze as well as activity and gesture to be used as a resource for non-verbal communication. The temporal challenge met was to reproduce eye movements quick enough and often enough to interpret their focus during a multi-way interaction, along with communicating other verbal and non-verbal language. The spatial challenge met was to maintain communicational eye gaze while allowing free movement of participants within a virtually shared common frame of reference. This paper reports on the technical and especially temporal characteristics of the system.

Rocking the boat: Does perfect rowing crew synchronization reduce detrimental boat movements?

In crew rowing, crew members need to mutually synchronize their movements to achieve optimal crew performance. Intuitively, poor crew coordination is often deemed to involve additional boat movements such as surge velocity fluctuations, heave, pitch, and roll, which would imply lower efficiency (eg, due to increased hydrodynamic drag). The aim of this study was to investigate this alleged relation between crew coordination and boat movements at different stroke rates. Fifteen crews of two rowers rowed in a double scull (ie, a two‐person boat) at 18, 22, 26, 30, and 34 strokes per minute. Oar angles (using potentiometers) and movements of the boat (using a three‐axial accelerometer‐gyroscope sensor) were measured (200 Hz). Results indicated that crew synchronization became more consistent with stroke rate, while surge, heave, and pitch fluctuations increased. Further, within each stroke rate condition, better crew synchronization was related to less roll of the boat, but increased fluctuations regarding surge, heave, and pitch. Together this demonstrates that while better crew synchronization relates to enhanced lateral stability of the boat, it inevitably involves more detrimental boat movements and hence involves lower biomechanical efficiency.

Assessing the effectiveness of robot facilitated neurorehabilitation for relearning motor skills following a stroke

A growing awareness of the potential for machine-mediated neurorehabilitation has led to several novel concepts for delivering these therapies. To get from laboratory demonstrators and prototypes to the point where the concepts can be used by clinicians in practice still requires significant additional effort, not least in the requirement to assess and measure the impact of any proposed solution. To be widely accepted a study is required to use validated clinical measures but these tend to be subjective, costly to administer and may be insensitive to the effect of the treatment. Although this situation will not change, there is good reason to consider both clinical and mechanical assessments of recovery. This article outlines the problems in measuring the impact of an intervention and explores the concept of providing more mechanical assessment techniques and ultimately the possibility of combining the assessment process with aspects of the intervention.

A Tool for Replay and Analysis of Gaze-Enhanced Multiparty Sessions Captured in Immersive Collaborative Environments

A desktop tool for replay and analysis of gaze-enhanced multiparty virtual collaborative sessions is described. We linked three CAVETM-like environments, creating a multiparty collaborative virtual space where avatars are animated with 3D gaze as well as head and hand motions in real time. Log files are recorded for subsequent playback and analysis using the proposed software tool. During replaying the user can rotate the viewpoint and navigate in the simulated 3D scene. The playback mechanism relies on multiple distributed log files captured at every site. This structure enables an observer to experience latencies of movement and information transfer for every site as this is important for conversation analysis. Playback uses an event-replay algorithm, modified to allow fast traversal of the scene by selective rendering of nodes, and to simulate fast random access. The toolpsilas analysis module can show each participantpsilas 3D gaze points and areas where gaze has been concentrated.

Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy: A pilot study

BACKGROUND Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and occupational therapy program for patients recovering from NA. OBJECTIVE Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. METHODS We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week period. PRIMARY OUTCOME MEASURES The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). SECONDARY OUTCOME MEASURE Disability of Arm Shoulder and Hand (DASH). RESULTS Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9-3.7) and +1.4 (0.4-2.4) points, respectively and the SRQ +14.8 (7.4-22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. CONCLUSION The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation.

A portable device for the clinical assessment of upper limb motion and muscle synergies

We present a device for recording and analyzing upper limb movements and muscle activities in a single unit. The devices outputs are related to aspects of clinical assessment such as joint coordination, fatigue and muscle synergies. A comparison with an optoelectronic motion capture system was also carried out during a hand to mouth and a hand to contralateral shoulder task. High correlation was found for the elbow angles, while analysis of the root mean square errors indicated that the angular outputs of the device were overestimated compared to the angles calculated using the optoelectronic system. Biceps and triceps co-contraction patterns were also observed during the hand to mouth task. Applications to the clinical assessment and monitoring of neurological disorders are discussed.

A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis

Hand exercises are often part of the treatment of hand rheumatoid arthritis; however, it is still unclear whether and what type of exercises is effective in the treatment of this condition. Therefore, a systematic review into the effectiveness of hand exercises in the treatment of hand rheumatoid arthritis has been performed. Studies were identified in the literature databases by predefined search criteria. The eight included studies are peer-reviewed studies published between 2000 and 2014. Hand exercises differed between studies, but always included resistance and/or active range of motion exercises. Grip strength in various grip types (power grip, key pinch, precision pinch and tripod pinch) was found to improve by hand exercise therapy without having adverse effects on pain or disease activity. Adaptations in the range of motion in response to hand exercise therapy were less pronounced. There appears to be some transfer from the improvements on the body functioning level to the level of daily functioning, with the largest improvements found on grip ability. With regard to the intervention content, there was some evidence in favour of a longer therapy duration and a higher therapy intensity. No conclusions could be drawn on the effectiveness of the different types of exercises. Collectively, the studies indicate that hand exercises may have positive effects on strength and some aspects of daily functioning without aggravating disease activity or pain, although caution should be taken for subjects in the exacerbation period.

Upper Extremity Kinematics and Muscle Activation Patterns in Subjects With Facioscapulohumeral Dystrophy

OBJECTIVE To compare the kinematics and muscle activity of subjects with facioscapulohumeral dystrophy (FSHD) and healthy control subjects during the performance of standardized upper extremity tasks. DESIGN Exploratory case-control study. SETTING A movement laboratory. PARTICIPANTS Subjects (N=19) with FSHD (n=11) and healthy control subjects (n=8) were measured. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Kinematic data were recorded using a 3-dimensional motion capturing system. Muscle activities, recorded using electromyography, were obtained from 6 superficial muscles around the glenohumeral joint. Shoulder elevation and elbow flexion angles, and maximum electromyographic activity during the movements as a percentage of maximum voluntary contraction (MVC) were calculated. RESULTS Kinematic differences between the FSHD group and the healthy control group were found in the shoulder elevation angle during single shoulder movements and both reaching tasks. In general, subjects with FSHD had higher percentages of muscle activation. The median activity of the trapezius was close to the MVC activity during the single shoulder movements. Moreover, deltoid and pectoralis muscles were also highly active. CONCLUSIONS Higher activation of the trapezius in subjects with FSHD indicates a mechanism that could help relieve impaired shoulder muscles during arm elevation around shoulder height. Compared with healthy subjects, persons with FSHD activated their shoulder muscles to a greater extent during movements that required arm elevation.