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Gulley Cox LI, Dias N, Zhang C, Zhang Y, Gorniak SL. Effects of Type II Diabetes on Proprioception during a Reach to Pinch Task. J Mot Behav 2023; 56:263-274. [PMID: 37997260 PMCID: PMC10957313 DOI: 10.1080/00222895.2023.2285888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Older adults with type II diabetes (T2D) are at risk of developing nerve disorders that result in functional impairment. Most work in proprioceptive dysfunction in older adults with T2D has focused on functional deficits of the lower limb. The purpose of this study was to examine proprioceptive effects of T2D on the upper limb in older adults. Kinematic performance of a reach-to-pinch action toward a virtual target was assessed in a T2D group (60+ years old with T2D) and a healthy age- and sex-matched control group. Tactile and vibratory thresholds did not differ between T2D and controls. Task accuracy via mean pinch location was significantly worse for persons with T2D (pwT2D) with differences in wrist extension/flexion (ex/fl), wrist abduction/adduction (ab/ad), 1st carpometacarpal (CMC) ab/ad, 2nd metacarpophalangeal (MCP2) ex/fl, MCP2 ab/ad, and digit 1 and hand transport trajectories. Group differences persisted with consideration of body mass index; sex differences in task accuracy emerged. Findings indicate that proprioception of the upper extremity is altered in pwT2D such that they exhibit a unique aperture position and aiming strategy during a reach-to-pinch action. These findings characterize functional sensorimotor impairment of the upper limb in pwT2D with respect to workspaces without visual or tactile feedback.
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Affiliation(s)
- Lauren I. Gulley Cox
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
| | - Nicholas Dias
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Stacey L. Gorniak
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
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Behm P, Marks M, Ferguson SJ, Brodbeck M, Herren DB. Intraoperative Load Tolerance of the Thumb Carpometacarpal Joint After Resection-Suspension-Interposition Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:40-44. [PMID: 35415590 PMCID: PMC8991452 DOI: 10.1016/j.jhsg.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The objective was to measure the intraoperative load tolerance of the thumb carpometacarpal (CMC) joint after trapeziectomy, tendon suspension, and interposition. Methods In this single-center prospective study, preoperative pinch grip, thumb mobility, and hypermobility of the thumb CMC joint were determined by 2 hand surgeons. Patients completed the brief Michigan Hand Outcomes Questionnaire. During surgery and upon removal of the trapezium, the surgeon subjectively rated the degree of thumb CMC load tolerance as “stable,” “medium stable,” or “unstable.” A measurement system with an integrated force sensor was used to measure intraoperative thumb CMC load tolerance. The thumb ray was displaced manually by 10 mm toward the scaphoid, and the counteracting force was measured over the entire displacement. The objective load tolerance was determined as the maximal measured force after trapezium resection, tendon suspension, and interposition. Analysis of variance was used to test for the differences in load tolerance between the surgical steps. Spearman’s coefficient was used to find correlations between load tolerance and clinical or patient-reported variables. Results Twenty-nine patients with a mean age of 70 years (SD, 8.1 years) were available for analysis. The measured intraoperative load tolerance after trapeziectomy was 15.5 N (SD, 5.4 N) and significantly increased to 18.7 N (SD, 5.5 N) after suspension. Load tolerance only slightly increased after tendon interposition, increasing the force to 20.3 N (SD, 6.7 N). Neither the surgeon’s subjective stability rating nor the clinical or patient-reported variables correlated with the measured load tolerance after trapeziectomy. Conclusions Our results show that tendon suspension leads to the highest increase in thumb CMC load tolerance during resection-suspension-interposition arthroplasty. Clinical relevance Tendon suspension appears to be the most important step in stabilizing the metacarpal base after trapeziectomy, whereas tendon interposition does not seem to have a relevant additional effect regarding load tolerance, at least immediately after surgery.
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Liu M, Wilder S, Sanford S, Saleh S, Harel NY, Nataraj R. Training with Agency-Inspired Feedback from an Instrumented Glove to Improve Functional Grasp Performance. SENSORS (BASEL, SWITZERLAND) 2021; 21:1173. [PMID: 33562342 PMCID: PMC7915039 DOI: 10.3390/s21041173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/01/2022]
Abstract
Sensory feedback from wearables can be effective to learn better movement through enhanced information and engagement. Facilitating greater user cognition during movement practice is critical to accelerate gains in motor function during rehabilitation following brain or spinal cord trauma. This preliminary study presents an approach using an instrumented glove to leverage sense of agency, or perception of control, to provide training feedback for functional grasp. Seventeen able-bodied subjects underwent training and testing with a custom-built sensor glove prototype from our laboratory. The glove utilizes onboard force and flex sensors to provide inputs to an artificial neural network that predicts achievement of "secure" grasp. Onboard visual and audio feedback was provided during training with progressively shorter time delay to induce greater agency by intentional binding, or perceived compression in time between an action (grasp) and sensory consequence (feedback). After training, subjects demonstrated a significant reduction (p < 0.05) in movement pathlength and completion time for a functional task involving grasp-move-place of a small object. Future work will include a model-based algorithm to compute secure grasp, virtual reality immersion, and testing with clinical populations.
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Affiliation(s)
- Mingxiao Liu
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Samuel Wilder
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Sean Sanford
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Advanced Rehabilitation Neuroimaging Laboratory, Kessler Foundation, East Hanover, NJ 07936, USA;
| | - Noam Y. Harel
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA;
- Departments of Neurology and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Raviraj Nataraj
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA; (M.L.); (S.W.); (S.S.)
- Movement Control Rehabilitation (MOCORE) Laboratory, Altorfer Complex, Stevens Institute of Technology, Hoboken, NJ 07030, USA
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Ma'touq J, Hu T, Haddadin S. Sub-millimetre accurate human hand kinematics: from surface to skeleton. Comput Methods Biomech Biomed Engin 2018; 21:113-128. [PMID: 29374973 DOI: 10.1080/10255842.2018.1425996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A highly accurate human hand kinematics model and identification are proposed. The model includes the five digits and the palm arc based on mapping function between surface landmarks and estimated joint centres of rotation. Model identification was experimentally performed using a motion tracking system. The evaluation of the marker position estimation error, which is on sub-millimetre level across all digits, underlines model quality and accuracy. Noticeably, with the development of this model, we were able to improve various modelling assumptions from literature and found a basic linear relationship between surface and skeleton rotational angles.
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Affiliation(s)
- Jumana Ma'touq
- a Institute of Automatic Control , Leibniz Universität Hannover , Hannover , Germany
| | - Tingli Hu
- a Institute of Automatic Control , Leibniz Universität Hannover , Hannover , Germany
| | - Sami Haddadin
- a Institute of Automatic Control , Leibniz Universität Hannover , Hannover , Germany .,b Center for Systems Neuroscience , Hannover , Germany
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Nataraj R, Audu ML, Li ZM. Digit mechanics in relation to endpoint compliance during precision pinch. J Biomech 2015; 48:672-680. [PMID: 25596633 DOI: 10.1016/j.jbiomech.2014.12.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/16/2014] [Accepted: 12/18/2014] [Indexed: 11/18/2022]
Abstract
This study investigates the mechanics of the thumb and index finger in relation to compliant endpoint forces during precision pinch. The objective was to gain insight into how individuals modulate motor output at the digit endpoints and joints according to compliance-related sensory feedback across the digits. Thirteen able-bodied subjects performed precision pinch upon elastic resistance bands of a customized apparatus instrumented with six degree-of-freedom load-cells. Compliance levels were discretely adjusted according to the number of bands connected. Subjects were provided visual feedback to control the rate of force application. Fifteen repetitions of low-to-moderate force (<20N) pinches were analyzed at each of five compliance levels, during which force and motion data were collected. Joint angles and moments normalized by pinch force magnitude were computed. Second-order polynomials were used to characterize joint mechanics as a function of compliance. The joint degrees-of-freedom (DOFs) at the finger showed greater dependence on compliance for angular position while the thumb joint DOFs demonstrated greater dependence for normalized joint moment. The digits also adjusted coordination of their endpoint forces according to compliance. Overall, the finger may be altering its position to increase load to the joints of the thumb with changing compliance. These findings describe naturally emergent changes in digit mechanics for compliant precision pinch, which involves motor execution in response to endpoint sensory feedback. Identifying and understanding these motor patterns may provide theoretical basis for restoring and rehabilitating sensorimotor pathologies of the hand.
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Affiliation(s)
- Raviraj Nataraj
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
| | - Musa L Audu
- Motion Study Laboratory (Louis Stokes VAMC), Department of Biomedical Engineering, Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
| | - Zong-Ming Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
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Nataraj R, Evans PJ, Seitz WH, Li ZM. Pathokinematics of precision pinch movement associated with carpal tunnel syndrome. J Orthop Res 2014; 32:786-92. [PMID: 24536036 PMCID: PMC4010872 DOI: 10.1002/jor.22600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/24/2014] [Indexed: 02/04/2023]
Abstract
Carpal tunnel syndrome (CTS) can adversely affect fine motor control of the hand. Precision pinch between the thumb and index finger requires coordinated movements of these digits for reliable task performance. We examined the impairment upon precision pinch function affected by CTS during digit movement and digit contact. Eleven CTS subjects and 11 able-bodied (ABL) controls donned markers for motion capture of the thumb and index finger during precision pinch movement (PPM). Subjects were instructed to repetitively execute the PPM task, and performance was assessed by range of movement, variability of the movement trajectory, and precision of digit contact. The CTS group demonstrated shorter path-length of digit endpoints and greater variability in inter-pad distance and most joint angles across the PPM movement. Subjects with CTS also showed lack of precision in contact points on the digit-pads and relative orientation of the digits at contact. Carpal tunnel syndrome impairs the ability to perform precision pinch across the movement and at digit-contact. The findings may serve to identify deficits in manual dexterity for functional evaluation of CTS.
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Affiliation(s)
- Raviraj Nataraj
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation; Cleveland Clinic; Cleveland Ohio
| | - Peter J. Evans
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation; Cleveland Clinic; Cleveland Ohio
| | - William H. Seitz
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation; Cleveland Clinic; Cleveland Ohio
| | - Zong-Ming Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation; Cleveland Clinic; Cleveland Ohio
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Nataraj R, Evans PJ, Seitz WH, Li ZM. Effects of carpal tunnel syndrome on reach-to-pinch performance. PLoS One 2014; 9:e92063. [PMID: 24632925 PMCID: PMC3954882 DOI: 10.1371/journal.pone.0092063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) compromises fine sensorimotor function during activities of daily living. Reach-to-pinch for a small object requires not only dexterity of the grasping digits, but also coordinated transport of the hand to the target. This study examined the effects of CTS on the kinematic performance of reach-to-pinch maneuver. Methods Eleven CTS subjects and 11 able-bodied (ABL) controls donned markers for motion capture of the hand, thumb and index finger during reach-to-pinch. Subjects were presented with a virtual target they could see without seeing their reaching upper-extremity. Subjects were instructed to reach to and grasp a virtual object as accurately and precisely as possible. Performance was assessed by variability of the movement trajectories of the digits and hand, the accuracy relative to the target, and precision of pinch contact over repetitive trials. Findings The CTS group demonstrated significantly increased movement variability in inter-pad distance, joint angles, and transport of the hand compared to ABL controls (p<0.01). CTS subjects also exhibited reductions in accuracy (41%) and precision (33%) of their pinch contact location (p<0.05). Interpretation CTS adversely affects the ability to execute the reach-to-pinch maneuver. Reduced performance was shown in terms of increased variability for both grasp and transport and the ability to locate the grasping digits relative to a target-object. These performance indices could be used for diagnostic and evaluative purposes of CTS.
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Affiliation(s)
- Raviraj Nataraj
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Peter J. Evans
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - William H. Seitz
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zong-Ming Li
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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