Dependence of safety margins in grip force on isometric push force levels in lateral pinch

Pinch Grip per SE Is Not an Occupational Risk Factor for the Musculoskeletal System: An Experimental Study on Field

Introduction: Some ergonomic evaluation methods define pinch grip as a risk factor independent of the exerted force. The present experimental study was performed with the main aim of objectively measuring the muscle engagement during the execution of pinch grip. Methods: the participants of the study were healthy workers occupationally involved in a high-intensity repetitive job related to the sorting of letters and small packages. Surface electromyography (sEMG) was used to study the activity of the abductor pollicis brevis and first dorsal interosseous fibers related to the execution of the required working tasks, while the force exerted during voluntary muscle contraction for pinch grip was measured by a portable acquisition system. The subjects were specifically asked to exert the maximum voluntary isometric contraction (MVIC) and further voluntary isometric contractions with a spontaneous force (SF) equal to 10%,20% and 50% of the MVIC; finally, the workers were asked to hold in pinch grip two types of envelopes, weighing 100 g and 500 g, respectively. Results: The force required to pinch 100 and 500 g envelopes by the fifteen subjects of the study corresponded to 4 and 5% MVIC, respectively. The corresponding sEMG average rectified values (ARV) were approximately 6% of that at MVIC for first dorsal interosseus (FDI) fibers and approximately 20–25% of MVIC for abductor pollicis brevis (ABP) fibers. Bivariate correlation analysis showed significant relationships between force at MVIC and FDI ARV at MCV. Conclusions: The obtained results demonstrate that muscle recruitment during pinch grip varies as a function of the SF: not only the position but also the exerted force should be considered when assessing the pinch grip as risk factor for biomechanical overload of the upper limb.

Effect of novel training to normalize altered finger force direction post-stroke: study protocol for a double-blind randomized controlled trial

BACKGROUND

Functional task performance requires proper control of both movement and force generation in three-dimensional space, especially for the hand. Control of force in three dimensions, however, is not explicitly treated in current physical rehabilitation. To address this gap in treatment, we have developed a tool to provide visual feedback on three-dimensional finger force. Our objective is to examine the effectiveness of training with this tool to restore hand function in stroke survivors.

METHODS

Double-blind randomized controlled trial. All participants undergo 18 1-h training sessions to practice generating volitional finger force of various target directions and magnitudes. The experimental group receives feedback on both force direction and magnitude, while the control group receives feedback on force magnitude only. The primary outcome is hand function as measured by the Action Research Arm Test. Other outcomes include the Box and Block Test, Stroke Impact Scale, ability to direct finger force, muscle activation pattern, and qualitative interviews.

DISCUSSION

The protocol for this clinical trial is described in detail. The results of this study will reveal whether explicit training of finger force direction in stroke survivors leads to improved motor control of the hand. This study will also improve the understanding of neuromuscular mechanisms underlying the recovery of hand function.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03995069 . Registered on June 21, 2019.

Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke

Background

Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone.

Methods

A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication.

Discussion

This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden.

Trial registration

NCT04569123. Registered on September 29, 2020

Anaphylaxis treatment: ergonomics of epinephrine autoinjector design

Epinephrine administration is a critical component of individualized emergency action plans for patients at risk for anaphylaxis. Fundamental ergonomic principles can be used to facilitate rapid and effective use of an epinephrine autoinjector when appropriate. Specific patient characteristics, including age and strength, that impact physical and cognitive capabilities, should be considered when choosing an epinephrine autoinjector. Considerations in the optimal functioning of an autoinjector include the device being portable, identifiable, safe, and effective. Size, shape, coloring, and labeling of the device all contribute to the device being portable and identifiable. Trigger-lock features, designs resistant to physical perturbations, and safety technology to prevent injury after use contribute to safety and reliability. Optimal grip designs, tailored in size and/or shape to specific patient types, contribute to reliability and effectiveness. After selection of the most appropriate autoinjector, hands-on training, practice, and drills should be implemented.

Pursue or shoot? Effects of exercise-induced fatigue on the transition from running to rifle shooting in a pursuit task

To investigate to what degree exercise-induced fatigue influences behavioural choices, participants' transition from running to rifle shooting in a pursue-and-shoot task was assessed. Participants ran on a treadmill and chased a target in a virtual environment and were free to choose when to stop the treadmill and shoot at the target. Fatigue increased progressively throughout the 20-minute test. Results indicated that shooting accuracy was not affected by fatigue. However, the distance to the target at which participants decided to shoot showed a U-shaped relationship with fatigue, R(2) = 0.884, p = 0.013. At low fatigue levels (ratings of perceived exertion [RPE] < 6.5), the distance to the target at which participants shot decreased, whereas at higher fatigue levels (RPE > 6.5) shooting distance increased again. At high levels of fatigue, participants stopped running sooner, aimed at the target longer and shot less often. Findings indicate that physiological parameters influence not only perception but also actual transitions between different actions.

Hand grip function assessed by the box and block test is affected by object surfaces

STUDY DESIGN

N/A.

BACKGROUND

One of the hand function assessment tools is the Box and Block Test (BBT).

PURPOSE

To examine if the BBT score is affected by grip surfaces.

METHODS

Thirteen adults performed the BBT with wooden, rubber-covered, and paper-covered blocks. The BBT scores and time for seven movements (finger closing, contact to lift-off, transport before barrier, transport after barrier, release, return, and reach) were compared across the three block types.

RESULTS

The mean BBT score was 8% higher for the rubber blocks than the paper and wooden blocks (p<0.01) due to the reduced time for contact to lift-off (when the finger touches a block until the block is lifted).

CONCLUSIONS

Hand function assessments should be controlled for object surfaces. Therapists may vary grip difficulties by changing object surfaces. Redesigning daily objects with high-friction surfaces may increase grip function.

LEVEL OF EVIDENCE

N/A.

Effect of elliptic handle shape on grasping strategies, grip force distribution, and twisting ability

A generic torque model for various handle shapes has been developed and evaluated using experimental data. Twelve subjects performed maximum isometric torques using circular and elliptic cylinders in medium and large sizes (circular: r = 25.4, 38.1 mm; elliptic: semi-major/minor axes = 30.9/19.3, 47.1/27.8 mm) finished with aluminium and rubber, in two opposite directions. Torque, grip force distribution, and finger position were recorded. Maximum torques were 25%, 7%, and 31% greater for the elliptic, large-size, and rubber-finished cylinders than for the circular, medium-size, and aluminium-finished cylinders, respectively. Greater torque for the elliptic cylinders was associated with 58% greater normal force that the subjects could generate for the elliptic than circular cylinders. The model suggests that greater torques for the large-size and rubber cylinders are related to long moment arms and greater frictional coupling at the hand-cylinder interface, respectively. Subjects positioned their hands differently depending on torque direction to maximise their normal force and torque generation. STATEMENT OF RELEVANCE: Desirable handle features for torque generation may be different from those for grip only. Design of handles per advantageous handle features (e.g., shape, size, and surface) may help increase people's torque strength and contribute to increased physical capacity of people.

State estimation bias induced by optimization under uncertainty and error cost asymmetry is likely reflected in perception

It is well known from numerous studies that perception can be significantly affected by intended action in many everyday situations, indicating that perception and related decision-making is not a simple, one-way sequence, but a complex iterative cognitive process. However, the underlying functional mechanisms are yet unclear. Based on an optimality approach, a quantitative computational model of one such mechanism has been developed in this study. It is assumed in the model that significant uncertainty about task-related parameters of the environment results in parameter estimation errors and an optimal control system should minimize the cost of such errors in terms of the optimality criterion. It is demonstrated that, if the cost of a parameter estimation error is significantly asymmetrical with respect to error direction, the tendency to minimize error cost creates a systematic deviation of the optimal parameter estimate from its maximum likelihood value. Consequently, optimization of parameter estimate and optimization of control action cannot be performed separately from each other under parameter uncertainty combined with asymmetry of estimation error cost, thus making the certainty equivalence principle non-applicable under those conditions. A hypothesis that not only the action, but also perception itself is biased by the above deviation of parameter estimate is supported by ample experimental evidence. The results provide important insights into the cognitive mechanisms of interaction between sensory perception and planning an action under realistic conditions. Implications for understanding related functional mechanisms of optimal control in the CNS are discussed.

Gender differences in hand stability of normal young people assessed at low force levels

To examine gender differences in hand stability, finger position and force holding tasks at low force levels were conducted with 30 male and 30 female young adults. Total fluctuation was defined as the standard deviation of measured data and fluctuation and the 10-Hz component of the physiological tremor were compared between maleand female subjects. In all tasks, the total fluctuation and the 10-Hz tremor were significantly larger in male subjects than females. On average, the fluctuation was 1.3 times larger and the 10-Hz tremor was 1.6 times larger. The results of this study suggest that women have superior hand stability compared with men at low force levels. Finger length, maximal voluntary contraction and surface electromyography were also measured and factors related to gender differences in hand stability are discussed. STATEMENT OF RELEVANCE: Hand stability is crucial for precise manual operations. This study demonstrated gender differences in hand steadiness at low force levels. Though hand dexterity cannot be explained only by hand stability, the results of this study are useful not only for occupational aptitude tests but also for neuropsychological tests.