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Decoding brain intention from noninvasively measured neural signals has recently been a hot topic in brain-computer interface (BCI). The motor commands about the movements of fine parts can increase the degrees of freedom under control and be applied to external equipment without stimulus. In the decoding process, the classifier is one of the key factors, and the graph information of the EEG was ignored by most researchers. In this paper, a graph convolutional network (GCN) based on functional connectivity was proposed to decode the motor intention of four fine parts movements (shoulder, elbow, wrist, hand). First, event-related desynchronization was analyzed to reveal the differences between the four classes. Second, functional connectivity was constructed by using synchronization likelihood (SL), phase-locking value (PLV), H index (H), mutual information (MI), and weighted phase-lag index (WPLI) to acquire the electrode pairs with a difference. Subsequently, a GCN and convolutional neural networks (CNN) were performed based on functional topological structures and time points, respectively. The results demonstrated that the proposed method achieved a decoding accuracy of up to 92.81% in the four-class task. Besides, the combination of GCN and functional connectivity can promote the development of BCI.

Hybrid Brain–Computer Interfaces (BCIs) for upper limb rehabilitation after stroke should enable the reinforcement of “more normal” brain and muscular activity. Here, we propose the combination of corticomuscular coherence (CMC) and intermuscular coherence (IMC) as control features for a novel hybrid BCI for rehabilitation purposes. Multiple electroencephalographic (EEG) signals and surface electromyography (EMG) from 5 muscles per side were collected in 20 healthy participants performing finger extension (Ext) and grasping (Grasp) with both dominant and non-dominant hand. Grand average of CMC and IMC patterns showed a bilateral sensorimotor area as well as multiple muscles involvement. CMC and IMC values were used as features to classify each task versus rest and Ext versus Grasp. We demonstrated that a combination of CMC and IMC features allows for classification of both movements versus rest with better performance (Area Under the receiver operating characteristic Curve, AUC) for the Ext movement (0.97) with respect to Grasp (0.88). Classification of Ext versus Grasp also showed high performances (0.99). All in all, these preliminary findings indicate that the combination of CMC and IMC could provide for a comprehensive framework for simple hand movements to eventually be employed in a hybrid BCI system for post-stroke rehabilitation.

The prognosis and speed of peripheral nerve recovery depend very much on the level of injury, severity of injury, the surgical intervention and the subsequent rehabilitative process. Many high level injuries may take years or months for the affected peripheral nerve to recover. Prolonged muscle imbalance causes joint contractures and over-stretching of denervated muscles. Without proper care, hand function recovery may be limited even the nerve regenerated afterwards.

During the nerve regeneration period, splinting is one of the most useful modality to minimise deformities, prevent joint contractures and substitute loss motor control. Proper splinting encourages early use of the injured hand in daily activities. There are different types of splinting design for median nerve palsy, ulnar nerve palsy and radial nerve palsy. Dynamic splinting techniques are frequently employed to allow early prehension activities. Other therapeutic techniques, including pressure garment and sensory re-education are useful to enhance better functional return after nerve repair.

Driving with an arm protruding through a window can result in limb threatening injury. A series of seven upper limb injuries sustained during motor vehicle accidents (MVAs) with a limb protruding from the vehicle window is described. The severity and complexity of these injuries are related to the ultimate functional recovery for the limb. This study serves to highlight the severity of injury and morbidity following these modalities of trauma, which although rarely fatal, carry extensive consequences and could be easily prevented with appropriate education programmes and legislation.

A retrospective analysis of 227 patients undergoing ultrasonography (US) of the hand/wrist over a three-year period in a district general hospital trust was performed. The usefulness in each case was assessed by two independent reviewers using a qualitative rating system, as (A) Useful: determines management, (B) Useful: contributory, (C) Not useful: not misleading, or (D) Not useful: misleading/potentially harmful. US was useful in 74.8% of cases but misleading/potentially harmful in 13.1%. Misleading rates exceeding 10% in sub-categories including tendinopathy, carpal tunnel syndrome, foreign body and lumps, where US findings may influence the decision to operate or not, are particularly worrying. There were a number of cases where US led to unnecessary operations or suggested operating on the wrong structures, and also cases where US findings wrongly suggested that surgery was unnecessary. Various recommendations aimed to improve the usefulness of US in the Hand and Wrist, including mandatory/formal musculoskeletal US training, are made.

Acute spontaneous compartment syndrome of the forearm is rarely reported in the literature. It is typically associated with trauma or thromboembolism in the acute setting and repetitive exertional stress in the chronic setting. However it is rare for it to present bilaterally with no apparent underlying cause.

We report the case of a young 31-year-old lady who presented to our Emergency Department with bilateral compartment syndrome of the forearm. Her presenting complaints included acute severe pain and swelling of the forearms bilaterally, with a decreased range of movement of the wrist and fingers. She also complained of numbness in all fingers.

She had no history of recent trauma and ultrasound scans showed no evidence of vascular compromise. Past medical history was notable only for idiopathic hypertension and coeliac disease.

The patient was taken to theatre urgently where flexor and extensor compartments and carpal tunnel were decompressed. Pronator Teres was found to be dusky initially but turned pink after decompression. All other muscles were normal.

An interesting fact of this case was that combination of the high compartment pressures and anaesthetic related hypotension caused the forearm pulses to become impalpable at induction, these returned intra-operatively.

The patient has been seen in the outpatient department following discharge. She is well apart from some mildly reduced grip strength in her right hand likely due to carpal tunnel decompression. No cause was found for the scenario after extensive medical investigation.

The Oberg, Manske and Tonkin (OMT) Classification of congenital anomalies of the hand and upper limb uses dysmorphological terminology, placing conditions in one of three groups: Malformations, Deformations and Dysplasias. The main group, Malformations, is further subdivided according to whether the whole of the limb is affected or the hand plate alone, and whether the primary insult involves one of the three axes of limb development and patterning or is non-axial. The common surgical diagnoses, such as thumb duplication and thumb hypoplasia, are then placed within this framework. Recently the International Federation of Societies for Surgery of the Hand Scientific Committee for Congenital Conditions approved the OMT Classification as a timely and appropriate replacement of the previously accepted Swanson Classification. This review charts the development of and modifications to the OMT Classification and its current status.

Purpose: In recent years, ownership and usage of cell phones have become widespread, especially amongst young people. The increasing use of text messaging on mobile phones has focused concern on possible musculoskeletal disorders for the users. Hence the purpose of this study was to find the prevalence of cumulative trauma disorders (CTDs) of the upper limb in cell phone users. Methods: A questionnaire-based survey was undertaken to detect the prevalence of CTDs in 1500 college students. Results: The response rate of the survey was 91.9%. Overall prevalence of CTD in the upper limb was found to be 18.5%. Maximum symptoms were noted in thumb (52%). Pain (61.7%) and fatigue (44.3%) were the two most common symptoms reported by the respondents. Conclusions: Mild form of CTD is present in students using cell phones and mainly depends on the pattern of phone usage.

Poultry slaughtering reports a high prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs). The main risk factors associated with upper limb and neck work-related musculoskeletal disorders are repetitiveness, high frequency of action, excessive force, awkward posture, insufficient recovery time and exposure to cold temperature. The purpose of this study was to identify and describe the prevalence of upper limb and neck symptoms among poultry slaughter workers in Iran, using the Nordic standardized questionnaire and occupational repetitive action (OCRA) checklist method. The study subjects consisted of 68% male and 32% female with a mean age 28.88 ± 0.56. Two hundred twelve poultry slaughter workers were interviewed. Out of every 20 workers, in the last 12 months, 12 reported pain in the upper limb and neck. Statistical analysis showed a significant association between the OCRA level of risk and UP-WMSD symptom (ρ < 0.05). The results of this study revealed that upper limb and neck symptoms occurred in high rates among poultry slaughter workers. This study provides information for the prevalence of upper limb and neck symptoms among poultry slaughter workers in Iran, and the results suggest interventions for hands/wrist, elbow, shoulder and neck pain should be important and major priority.

Fibrous dysplasia (FD) is a congenital skeletal disorder characterized by the replacement of the bone marrow with fibrous tissue. FD may occur in isolation or association with endocrinopathies, and in that case, labeled McCune–Albright syndrome (MAS). FD can cause bone deformities or/and limb length discrepancies. The surgical intervention aims to correct limb deformities and length discrepancies while improving regional aesthetics.

We report a case of a 14-year-old girl with FD that had affected her upper limbs. More characteristic had been the shortening of the right humerus (10 cm discrepancy from the left humerus) and the gun-stock deformity of the elbow. On the X-ray, a prominent feature was the shortening of the humerus and the valgus deformity of its distal end. The lengthening and correction of the deformity of the right humerus had been performed using the Taylor spatial frame (TSF) system. The software program had provided us with the estimated minimum correction time of 143 days for 7 cm humeral lengthening. A total of 157 days had been needed to lengthen and correct the deformity.

The TSF system allows the simultaneous lengthening and correction of all the components of a multiplanar malformation of a limb and minimizes the required time.

The reliable knowledge that model-based three-dimensional (3D) fluoroscopy can provide about in vivo joints kinematics is essential to diagnose orthopedic pathologies, develop new prosthesis, and evaluate clinical procedures. To exploit 3D fluoroscopy for the analysis of elbow kinematics, its use was evaluated considering a single model for the forearm or two different models for the ulna and radius. Active elbow flexion-extension and prono-supination motor tasks of a healthy male subject were acquired by means of fluoroscopy. The 3D bone models were automatically aligned to the relevant projections. The pose estimation algorithm sought the tangency condition of the projection rays with the model surface, minimizing a cost function and exploiting an adaptive distance map. Five iterative guided alignments were performed to avoid the final convergence to a local minimum. The results highlighted the critical alignment of the ulna/radius model, particularly when prono-supination is performed. From the physiological motion patterns and given the values of the cost function, 3D fluoroscopy was proven to be applicable to the analysis of the elbow kinematics when single bone models for the ulna and radius are used.

In the conventional upper-limb rehabilitation process, patients have to be relying on therapists to do the exercise and assessments. Using robotic rehabilitation devices, patients can practice independently and intensively with their upper paretic limb. In this study, we hypothesized that a multi-DOF passive mechanism coupled with multi-DOF 3D sensory feedback could provide: (1) safe and nature active exercise; (2) various combinations of degrees of freedom (DOF) for the training of different specific joints; (3) the possibility to realize ideal trajectory. In order to test the hypothesis, we designed a seven-DOF passive exoskeleton-based system for the upper extremity, integrated with virtual reality (VR) technology based 3D feedback. An experiment was done on six healthy subjects and three subjects with upper-limb impairment. All subjects did not experience any problems when handling the device during the intervention. Moreover, Fugl–Meyer Score of the upper extremity Assessment (FMA) scale showed that the three patients have increased the score by 19, 23 and 14, respectively. Wolf Motor Function Test (WMFT) scale showed that the three patients have increased their scores by 22, 22 and 14, respectively.

Patients who suffer from stroke have motion function disorders. They need rehabilitation training guided by doctors and trainers. Nowadays, robots have been introduced to help the patients regain their motion function in rehabilitation training. In this paper, a novel multi degree of freedom (DOF) exoskeleton robot, with light weight, including (6$+$1) DOFs, named as Rehab-Arm, is proposed and developed for upper limb rehabilitation. The joints of the robot are equipped with micro motors which are capable of actuating each DOF respectively and simultaneously. The medial/lateral rotation of shoulder is realized by a semi-circle guide mechanism for convenience consideration and safety. The robot is used in sitting posture which is attached to a custom made chair. Hence, the robot can be used to assist patients in passive movement with 7 DOFs of the upper limb for rehabilitation. Five adult healthy male subjects participated in the experiment to test the joint movement accuracy of the robot. Finally, subjects can wear Rehab-Arm and move their upper limb, led by micro motors of the robot, to perform task assigned with specific trajectory.

Current clinical services are struggling to provide the most favorable rehabilitation treatment for patients with stroke, which inspired researchers to investigate and explore the use of rehabilitation devices suitable for the patients and rehabilitation therapy. This review paper addresses the importance of biomechanical features in patients who experienced stroke to the upper limb. First and foremost, a review was done on general biomechanical description associated with motor control, shoulder, elbow, wrist and fingers joint. This included the ability of the patients to move their affected arm and the affect on peak joint torque, range of motion, joint forces, grip strength and muscle activities during the activities of daily living. In addition, we also reviewed the material properties and geometrical condition of tissue in stroke patient. The repercussions of post-stroke patient regarding the bone density, stiffness of muscle as well as the thickness of cartilage are described in this review. Based on the findings, the movement of affected stroke hand is associated with the motor control and material properties of tissue. To strengthen the motor control and maintaining tissue properties, early physical training on patients should be conducted in two to four weeks after stroke. In conclusion, this report suggests a new approach for future biomechanical studies in order to enhance the quality of physiotherapy rehabilitation peculiarly for post-stroke patients.

Background: Range of motion (ROM) asymmetry between sides is one indicator of a positive neurodynamic test, but this has been less well studied for the ulnar nerve.

Objective: The purpose of this study was to investigate side-to-side variation in elbow ROM during an ulnar neurodynamic test sequence, including contralateral cervical side flexion, in 40 asymptomatic subjects.

Methods: A traditional goniometer was used to measure elbow flexion ROM at two end points, onset of resistance ($R$1) and symptom onset ($P$1). Two repeated measures of $R$1 and $P$1 were taken on each side.

Results: Reliability for $R$1 and $P$1 was found to be good (ICC $\ge 0.83$, SEM $\le 5.37$) with no significant difference in mean ROM between sides. A significant relationship between sides was seen ($r$ values $\ge 0.48$) and $R^2$ values $>0.23$; this indicates at least 23% of the variance observed in one limb was accounted for by range in the opposite limb. This relationship was slightly stronger for $R$1 than $P$1. Lower bound scores indicate that intra-individual ROM difference $>23^{°}$ for $R$1 and 22^° for $P$1 would exceed normal ROM asymmetry.

Conclusion: These findings provide clinicians with background information of ROM asymmetry during the ulnar neurodynamic test.

Background: A small number of patients develop intractable peripheral nerve pain following injury or surgery to the upper limb that is refractory to pharmacological treatment. This study reports our results of using transcutaneous peripheral nerve stimulation (TPNS), a non-invasive form of neuromodulation, to treat this difficult problem.

Methods: Seventy-two patients were treated for intractable pain in the upper limb using this technique. Electrical current was delivered transcutaneously through a handheld probe, placed on the skin overlying the affected peripheral nerve proximal to the site of pain. Pain severity was determined before and immediately after treatment by subjective patient self-assessment using a visual analogue pain scale. Pre-post treatment changes in pain severity were analysed by Student's test for paired data. Outcome in respect of overall effectiveness of this treatment, was graded according to the maximum duration of pain relief achieved.

Results: Overall, TPNS reduced pain intensity from 8.4 (SD 1.6) before treatment to 4.2 (SD 3.5) immediately after treatment, a highly significant effect ($p<0.001$). The treatment achieved cure in 8/72 (11%) of our patients and a useful therapeutic outcome (pain relief ≥ 1 day) in 27/72 (38%). The treatment failed in 37/72 (51%).

Conclusions: TPNS warrants consideration as a therapy for neuropathic pain in the upper limb after drug treatment has failed and before offering surgery or spinal root stimulation.

Background: Management of upper limb spasticity remains challenging. Selective peripheral neurectomy (SPN) is a relatively recent intervention for cases refractory to medical therapy. The aim of this study was to conduct a systematic review looking at the efficacy and outcomes of SPN, in order to clarify the patient selection criteria and surgical technique.

Methods: A search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Open Grey and CINAHL was conducted. Inclusion criteria included studies comparing pre- and post-operative outcomes for SPN, neurectomy, fasciculotomy and upper limb spasticity.

Results: Only case series were reported with no randomised controlled trials found. 7 studies met the inclusion criteria with a total of 174 patients. A meta-analysis was not possible due to the degree of baseline heterogeneity. All studies had no control arm for comparison of outcomes, with a high risk of bias due to poor internal and external validity, as well as design and performance bias. Surgical techniques differ vastly between studies, with percentage of fascicles ablated between 30–80% and length of neurectomy between 5–10 mm. Some advocated removing end branches while others performed fascicular SPN proximally. 13 patients underwent orthopaedic or neurosurgical procedures, which are both confounding factors. All studies reported an improvement in spasticity although functional outcomes were reported with non-standardized measures. Recurrence rates were reported to be 0–16.1% (mean 3.72%).

Conclusions: From this systematic review, SPN appeared to be a useful technique in selected cases, but overall no firm conclusions can be drawn regarding the best surgical technique, or the extent of functional improvement.