Geometrical adaptation in ulna and radius of cerebral palsy patients: measures and consequences

The Effects of Extracorporeal Shock Wave Therapy on Spastic Muscle of the Wrist Joint in Stroke Survivors: Evidence From Neuromechanical Analysis

Background: This study combined neuromechanical modeling analysis, muscle tone measurement from mechanical indentation and electrical impedance myography to assess the neural and peripheral contribution to spasticity post stroke at wrist joint. It also investigated the training effects and explored the underlying mechanism of radial extracorporeal shock wave (rESW) on spasticity.

Methods: People with first occurrence of stroke were randomly allocated to rESW intervention or control group. The intervention group received one session of rESW therapy, followed by routine therapy which was the same frequency and intensity as the control group. Outcome measures were: (1) NeuroFlexor method measured neural component (NC), elastic component (EC) and viscosity component (VC), and (2) myotonometer measured muscle tone (F) and stiffness (S), (3) electrical impedance myography measured resistance (R), reactance (X) and phase angle (θ); (4) modified Asworth scale; (5) Fugl Meyer Upper limb scale. All outcome measures were recorded at baseline, immediately post rESW and at 1-week follow-up. The differences between the paretic and non-paretic side were assessed by t-test. The effectiveness of rESW treatment were analyzed by repeated-measures one-way analysis of variance (ANOVA) at different time points.

Results: Twenty-seven participants completed the study. NC, EC, and VC of the Neuroflexor method, F and S from myotonometer were all significantly higher on the paretic side than those from the non-paretic side. R, X, and θ from electrical impedance were significantly lower on the paretic side than the non-paretic side. Immediately after rESW intervention, VC, F, and S were significantly reduced, and X was significantly increased. The clinical scores showed improvements immediate post rESW and at 1-week follow-up.

Conclusions: The observed changes in upper limb muscle properties adds further support to the theory that both the neural and peripheral components play a role in muscle spasticity. ESW intervention may be more effective in addressing the peripheral component of spasticity in terms of muscle mechanical properties changes. The clinical management of post stroke spasticity should take into consideration of both the neural and non-neural factors in order to identify optimal intervention regime.

Boccia as a Rehabilitation Intervention for Adults With Severe Mobility Limitations Due to Neuromuscular and Other Neurological Disorders: Feasibility and Effects on Upper Limb Impairments

Purpose

Scant research exists regarding the effects of playing Boccia as a rehabilitation strategy for people with severe mobility limitations due to neuromuscular and other neurological disorders. This study is aimed at identifying the feasibility and effects of playing Boccia on the upper limb impairments of people with severe mobility limitations due to neuromuscular and other neurological disorders.

Materials and Methods

Seven people played Boccia three times per week for 20 weeks as part of the rehabilitation process, while other seven kept up with their usual rehabilitation schedule. Attrition, adherence, adverse effects, participation and completion rate were registered to assess feasibility. The effects of the program on grip, pinch strength and upper-limb active range of motion were assessed by means of a dynamometer and a goniometer.

Results and Conclusions

The program was feasible, although no effects were observed after its completion on variables assessed, except for hand flexion and ulnar deviation active range of motion. In a group of people with severe disability due to neuromuscular and other neurological disorders, playing Boccia as part of a multidisciplinary rehabilitation program was shown to be a feasible therapy. However, practicing this game did not lead to significant improvements in upper limb impairments, except for wrist flexion and ulnar deviation active range of motion.

Maturation Disparity between Hand-Wrist Bones in a Chinese Sample of Normal Children: An Analysis Based on Automatic BoneXpert and Manual Greulich and Pyle Atlas Assessment

OBJECTIVE

To assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China.

MATERIALS AND METHODS

Our study included 229 boys and 168 girls aged 2-14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed.

RESULTS

In 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups.

CONCLUSION

Obvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups.