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Abstract
Background: Elderly people with severe finger weakness may need assistive health technology interventions. Finger weakness impedes the elderly in executing activities of daily living such as unbuttoning shirts and opening clothes pegs. While studies have related finger weakness with ageing effects, there appears to be no research that uses an algorithmic problem-solving approach such as the theory of inventive problem-solving (TRIZ) to recommend finger grip assistive technologies that resolve the issue of finger weakness among the elderly. Using TRIZ, this study aims to conceptualise finger grip enhancer designs for elderly people. Methods: Several TRIZ tools such as the cause-and-effect chain (CEC) analysis, engineering contradiction, physical contradiction, and substance-field analysis are used to conceptualise solutions that assist elderly people in their day-to-day pinching activities. Results: Based on the segmentation principle, a finger assistant concept powered by a miniature linear actuator is recommended. Specific product development processes are used to further conceptualise the actuation system. The study concluded that the chosen concept should use a DC motor to actuate fingers through tendon cables triggered by a push start button. Conclusions: Finger pinch degradation worsens the quality of life of the elderly. A finger grip enhancer that assists in day-to-day activities may be an effective option for elderly people, not only for their physical but also their mental well-being in society.
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Affiliation(s)
- Dominic Wen How Tan
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
| | - Poh Kiat Ng
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
| | - Ervina Efzan Mhd Noor
- Faculty of Engineering and Technology, Multimedia University, Jalan Ayer Keroh Lama, Bukit Beruang, Melaka, 75450, Malaysia
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Blanquero J, Cortés-Vega MD, García-Frasquet MÁ, Sánchez-Laulhé PR, Nieto Díaz de Los Bernardos MI, Suero-Pineda A. Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial. J Physiother 2019; 65:81-87. [PMID: 30926400 DOI: 10.1016/j.jphys.2019.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022] Open
Abstract
QUESTION In people who have undergone surgical carpal tunnel release, do sensorimotor-based exercises performed on the touchscreen of a tablet device improve outcomes more than a conventional home exercise program prescribed on paper? DESIGN Randomised, parallel-group trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS Fifty participants within 10 days of surgical carpal tunnel release. INTERVENTION Each participant was prescribed a 4-week home exercise program. Participants in the experimental group received the ReHand tablet application, which administered and monitored exercises via the touchscreen. The control group was prescribed a home exercise program on paper, as is usual practice in the public hospital system. OUTCOME MEASURES The primary outcome was functional ability of the hand, reported using the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were grip strength, pain intensity measured on a 10-cm visual analogue scale, and dexterity measured with the Nine-Hole Peg Test. Outcomes were measured by a blinded assessor at baseline and at the end of the 4-week intervention period. RESULTS At Week 4, functional ability improved significantly more in the experimental group than the control group (MD -21, 95% CI -33 to -9) on the QuickDASH score (0 to 100). Although the mean estimates of effect on the secondary outcome also all favoured the experimental group, none reached statistical significance: grip strength (MD 5.6 kg, 95% CI -0.5 to 11.7), pain (MD -1.4 cm, 95% CI -2.9 to 0.1), and dexterity (MD -1.3 seconds, 95% CI -3.7 to 1.1). CONCLUSION Use of the ReHand tablet application for early rehabilitation after carpal tunnel release is more effective in the recovery of functional ability than a conventional home exercise program. It remains unclear whether there are any benefits in grip strength, pain or dexterity. TRIAL REGISTRATION ACTRN12618001887268.
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Affiliation(s)
- Jesús Blanquero
- Physiotherapy Department, University of Seville, Seville, Spain
| | | | | | | | | | - Alejandro Suero-Pineda
- Andalusian Public Foundation for the Management of Health Research of Seville FISEVI, Seville, Spain
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Reschechtko S, Wang H, Alendry K, Benson C, Hahn B, Zhang W. Effect of Sensory Deprivation on Maximal Force Abilities from Local to Non-local Digits. J Mot Behav 2019; 52:58-70. [PMID: 30848722 DOI: 10.1080/00222895.2019.1580670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study investigates the effect of sensory deprivation of the index and middle finger on motor function of all digits during maximal voluntary force production tasks. A total of 27 subjects performed maximal isometric pressing tasks by using different instructed finger combinations. Subjects completed the same tasks in two visits: a control visit when they had normal sensory feedback in all fingers, and an anesthesia visit when digital nerve blocks were performed on their right index and middle fingers. We evaluated three aspects of motor adaptation on both local (anesthetized) and non-local (non-anesthetized) digits during maximal force production: (1) task-relevant and overall force magnitude, (2) force directional application, and (3) digital individuation and force sharing. Our results indicate that selective digital anesthesia resulted in decreased maximal force magnitude, changed direction of force production, and significant changes extended to non-local digits. The motor weakness and inefficiency revealed in the non-local digits implies that sensory information from each digit can be shared across the digits to assist motor execution within the same hand.
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Affiliation(s)
- Sasha Reschechtko
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY, USA.,Department of Kinesiology, The Pennsylvania State University, State College, PA, USA
| | - Hu Wang
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY, USA
| | - Kerlin Alendry
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY, USA
| | - Cynthia Benson
- Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Barry Hahn
- Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | - Wei Zhang
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, NY, USA.,Ph.D. Program in Biology, Graduate School and University Center, City University of New York, New York, NY, USA
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Carteron A, McPartlan K, Gioeli C, Reid E, Turturro M, Hahn B, Benson C, Zhang W. Temporary Nerve Block at Selected Digits Revealed Hand Motor Deficits in Grasping Tasks. Front Hum Neurosci 2016; 10:596. [PMID: 27932964 PMCID: PMC5122577 DOI: 10.3389/fnhum.2016.00596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/09/2016] [Indexed: 01/04/2023] Open
Abstract
Peripheral sensory feedback plays a crucial role in ensuring correct motor execution throughout hand grasp control. Previous studies utilized local anesthesia to deprive somatosensory feedback in the digits or hand, observations included sensorimotor deficits at both corticospinal and peripheral levels. However, the questions of how the disturbed and intact sensory input integrate and interact with each other to assist the motor program execution, and whether the motor coordination based on motor output variability between affected and non-affected elements (e.g., digits) becomes interfered by the local sensory deficiency, have not been answered. The current study aims to investigate the effect of peripheral deafferentation through digital nerve blocks at selective digits on motor performance and motor coordination in grasp control. Our results suggested that the absence of somatosensory information induced motor deficits in hand grasp control, as evidenced by reduced maximal force production ability in both local and non-local digits, impairment of force and moment control during object lift and hold, and attenuated motor synergies in stabilizing task performance variables, namely the tangential force and moment of force. These findings implied that individual sensory input is shared across all the digits and the disturbed signal from local sensory channel(s) has a more comprehensive impact on the process of the motor output execution in the sensorimotor integration process. Additionally, a feedback control mechanism with a sensation-based component resides in the formation process for the motor covariation structure.
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Affiliation(s)
- Aude Carteron
- Department of Physical Therapy, College of Staten Island, City University of New York Staten Island, NY, USA
| | - Kerry McPartlan
- Department of Physical Therapy, College of Staten Island, City University of New York Staten Island, NY, USA
| | - Christina Gioeli
- Department of Physical Therapy, College of Staten Island, City University of New York Staten Island, NY, USA
| | - Emily Reid
- Department of Physical Therapy, College of Staten Island, City University of New York Staten Island, NY, USA
| | - Matt Turturro
- Department of Physical Therapy, College of Staten Island, City University of New York Staten Island, NY, USA
| | - Barry Hahn
- Emergency Medicine, Staten Island University Hospital Staten Island, NY, USA
| | - Cynthia Benson
- Emergency Medicine, Staten Island University Hospital Staten Island, NY, USA
| | - Wei Zhang
- Department of Physical Therapy, College of Staten Island, City University of New YorkStaten Island, NY, USA; Ph.D. Program in Biology, Graduate School and University Center, City University of New YorkNew York, NY, USA
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Hong CY, Guo LY, Song R, Nagurka ML, Sung JL, Yen CW. Assessing postural stability via the correlation patterns of vertical ground reaction force components. Biomed Eng Online 2016; 15:90. [PMID: 27485525 PMCID: PMC4969977 DOI: 10.1186/s12938-016-0212-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/24/2016] [Indexed: 12/16/2022] Open
Abstract
Background Many methods have been proposed to assess the stability of human postural balance by using a force plate. While most of these approaches characterize postural stability by extracting features from the trajectory of the center of pressure (COP), this work develops stability measures derived from components of the ground reaction force (GRF). Methods In comparison with previous GRF-based approaches that extract stability features from the GRF resultant force, this study proposes three feature sets derived from the correlation patterns among the vertical GRF (VGRF) components. The first and second feature sets quantitatively assess the strength and changing speed of the correlation patterns, respectively. The third feature set is used to quantify the stabilizing effect of the GRF coordination patterns on the COP. Results In addition to experimentally demonstrating the reliability of the proposed features, the efficacy of the proposed features has also been tested by using them to classify two age groups (18–24 and 65–73 years) in quiet standing. The experimental results show that the proposed features are considerably more sensitive to aging than one of the most effective conventional COP features and two recently proposed COM features. Conclusions By extracting information from the correlation patterns of the VGRF components, this study proposes three sets of features to assess human postural stability during quiet standing. As demonstrated by the experimental results, the proposed features are not only robust to inter-trial variability but also more accurate than the tested COP and COM features in classifying the older and younger age groups. An additional advantage of the proposed approach is that it reduces the force sensing requirement from 3D to 1D, substantially reducing the cost of the force plate measurement system.
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Affiliation(s)
- Chih-Yuan Hong
- Department of Mechanical and Electromechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Lan-Yuen Guo
- Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rong Song
- School of Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Mark L Nagurka
- Department of Mechanical Engineering, Marquette University, Milwaukee, WI, USA
| | - Jia-Li Sung
- Department of Mechanical and Electromechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chen-Wen Yen
- Department of Mechanical and Electromechanical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Physical Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Chen PT, Jou IM, Lin CJ, Chieh HF, Kuo LC, Su FC. Is the Control of Applied Digital Forces During Natural Five-digit Grasping Affected by Carpal Tunnel Syndrome? Clin Orthop Relat Res 2015; 473:2371-82. [PMID: 25690168 PMCID: PMC4457761 DOI: 10.1007/s11999-015-4189-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/03/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND The impaired sensory function of the hand induced by carpal tunnel syndrome (CTS) is known to disturb dexterous manipulations. However, force control during daily grasping configuration among the five digits has not been a prominent focus of study. Because grasping is so important to normal function and use of a hand, it is important to understand how sensory changes in CTS affect the digit force of natural grasp. QUESTIONS/PURPOSES We therefore examined the altered patterns of digit forces applied during natural five-digit grasping in patients with CTS and compared them with those seen in control subjects without CTS. We hypothesized that the patients with CTS will grasp by applying larger forces with lowered pair correlations and more force variability of the involved digits than the control subjects. Specifically, we asked: (1) Is there a difference between patients with CTS and control subjects in applied force by digits during lift-hold-lower task? (2) Is there a difference in force correlation coefficient of the digit pairs? (3) Are there force variability differences during the holding phase? METHODS We evaluated 15 female patients with CTS and 15 control subjects matched for age, gender, and hand dominance. The applied radial forces (Fr) of the five digits were recorded by respective force transducers on a cylinder simulator during the lift-hold-lower task with natural grasping. The movement phases of the task were determined by a video-based motion capture system. RESULTS The applied forces of the thumb in patients with CTS (7 ± 0.8 N; 95% CI, 7.2-7.4 N) versus control subjects (5 ± 0.8 N; 95% CI, 5.1-5.3 N) and the index finger in patients with CTS (3 ± 0.3 N; 95% CI, 3.2-3.3 N) versus control subjects (2 ± 0.3 N; 95% CI, 2.2-2.3 N) observed throughout most of the task were larger in the CTS group (p ranges 0.035-0.050 for thumb and 0.016-0.050 for index finger). In addition, the applied force of the middle finger in patients with CTS (1 ± 0.1 N; 95% CI, 1.3-1.4 N) versus the control subjects (2 ± 0.2 N; 95% CI, 1.9-2.0 N) during the lowering phase was larger in CTS group (p ranges 0.039-0.050). The force correlations of the thumb-middle finger observed during the lowering phase in the patients with CTS (0.8 ± 0.2; 95% CI, 0.6-0.9) versus the control subjects (0.9 ± 0.1; 95% CI, 0.8-1.0; p = 0.04) were weaker in the CTS group. The thumb-little finger during holding in the patients with CTS (0.5 ± 0.2; 95% CI, 0.3-0.7) versus the control subjects (0.8 ± 0.2; 95% CI, 0.6-0.9; p = 0.02), and the lowering phase in the patients with CTS (0.6 ± 0.2; 95% CI, 0.3-0.8) versus the control subjects (0.9 ± 0.1; 95% CI, 0.8-1.0; p = 0.01) also were weaker. The force variabilities of patients with CTS were greater in the CTS group than in the control subjects: in the thumb ([0.26 ± 0.11 N, 95% CI, 0.20-0.32 N] versus [0.19 ± 0.06 N; 95% CI, 0.16-0.22 N], p = 0.03); index finger ([0.09 ± 0.07 N; 95% CI, 0.05-0.13 N] versus [0.05 ± 0.03 N; 95% CI, 0.04-0.07 N], p = 0.03); middle finger ([0.06 ± 0.04 N; 95% CI, 0.04-0.08 N] versus [0.03 ± 0.01 N; 95% CI, 0.02-0.04 N], p = 0.02), and ring finger ([0.04 ± 0.03 N; 95% CI, 0.20-0.06 N] versus [0.02 ± 0.01 N; 95% CI, 0.02-0.02 N], p = 0.01). CONCLUSIONS Patients with CTS grasped with greater digit force associated with weaker correlation and higher variability on specific digits in different task demands. These altered patterns in daily grasping may lead to secondary problems, which will need to be assessed in future studies with this model to see if they are reversible in patients undergoing carpal tunnel release. CLINICAL RELEVANCE The current results helped to identify altered patterns of grasping force during simulated daily function in patients with CTS and to provide the clinician with potential information that might help guide the rehabilitation of grasp in these patients.
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Affiliation(s)
- Po-Tsun Chen
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan City, 701 Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Ju Lin
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan City, 701 Taiwan ,Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Feng Chieh
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan City, 701 Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan City, 701 Taiwan ,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan ,Musculoskeletal Research Center, National Cheng Kung University, Tainan, Taiwan
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Santello M, Lang CE. Are movement disorders and sensorimotor injuries pathologic synergies? When normal multi-joint movement synergies become pathologic. Front Hum Neurosci 2015; 8:1050. [PMID: 25610391 PMCID: PMC4285090 DOI: 10.3389/fnhum.2014.01050] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system’s ability to control movement.
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Affiliation(s)
- Marco Santello
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University , Tempe, AZ , USA
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine in St. Louis , St. Louis, MO , USA
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Li K, Evans PJ, Seitz WH, Li ZM. Carpal tunnel syndrome impairs sustained precision pinch performance. Clin Neurophysiol 2014; 126:194-201. [PMID: 24877682 DOI: 10.1016/j.clinph.2014.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/25/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate effects of carpal tunnel syndrome (CTS) on digit force control during a sustained precision pinch. METHODS Eleven CTS individuals and 11 age- and gender-matched healthy volunteers participated in the study. The subjects were instructed to isometrically pinch an instrumented apparatus for 60s with a stable force output. Visual feedback of force output was provided for the first 30s but removed for the remaining 30s. Pinch forces were examined for accuracy, variability, and inter-digit correlation. RESULTS CTS led to a decrease in force accuracy and an increase in amount of force variability, particularly without visual feedback (p<0.001). However, CTS did not affect the structure of force variability or force correlation between digits (p>0.05). The force of the thumb was less accurate and more variable than that of the index finger for both the CTS and healthy groups (p<0.001). CONCLUSIONS Sensorimotor deficits associated with CTS lead to inaccurate and unstable digit forces during sustained precision pinch. SIGNIFICANCE This study shed light on basic and pathophysiological mechanisms of fine motor control and aids in development of new strategies for diagnosis and evaluation of CTS.
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Affiliation(s)
- Ke Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
| | - Peter J Evans
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
| | - William H Seitz
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
| | - Zong-Ming Li
- Hand Research Laboratory, Departments of Biomedical Engineering, Orthopaedic Surgery, and Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
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Zhang W, Johnston JA, Ross MA, Sanniec K, Gleason EA, Dueck AC, Santello M. Effects of carpal tunnel syndrome on dexterous manipulation are grip type-dependent. PLoS One 2013; 8:e53751. [PMID: 23326498 PMCID: PMC3542366 DOI: 10.1371/journal.pone.0053751] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/03/2012] [Indexed: 12/31/2022] Open
Abstract
Carpal tunnel syndrome (CTS) impairs sensation of a subset of digits. Although the effects of CTS on manipulation performed with CTS-affected digits have been studied using precision grip tasks, the extent to which CTS affects multi-digit force coordination has only recently been studied. Whole-hand manipulation studies have shown that CTS patients retain the ability to modulate multi-digit forces to object mass, mass distribution, and texture. However, CTS results in sensorimotor deficits relative to healthy controls, including significantly larger grip force and lower ability to balance the torques generated by the digits. Here we investigated the effects of CTS on multi-digit force modulation to object weight when manipulating an object with a variable number of fingers. We hypothesized that CTS patients would be able to modulate digit forces to object weight. However, as different grip types involve the exclusive use of CTS-affected digits ('uniform' grips) or a combination of CTS-affected and non-affected digits ('mixed' grips), we addressed the question of whether 'mixed' grips would reduce or worsen CTS-induced force coordination deficits. The former scenario would be due to adding digits with intact tactile feedback, whereas the latter scenario might occur due to a potentially greater challenge for the central nervous system of integrating 'noisy' and intact tactile feedback. CTS patients learned multi-digit force modulation to object weight regardless of grip type. Although controls exerted the same total grip force across all grip types, patients exerted significantly larger grip force than controls but only for manipulations with four and five digits. Importantly, this effect was due to CTS patients' inability to change the finger force distribution when adding the ring and little fingers. These findings suggest that CTS primarily challenges sensorimotor integration processes for dexterous manipulation underlying the coordination of CTS-affected and non-affected digits.
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Affiliation(s)
- Wei Zhang
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, United States of America
- Department of Physical Therapy, College of Staten Island, City University of New York, Staten Island, New York, United States of America
| | - Jamie A. Johnston
- Faculty of Kinesiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Mark A. Ross
- Mayo Clinic Hospital, Phoenix, Arizona, United States of America
| | - Kyle Sanniec
- Mayo Clinic Hospital, Phoenix, Arizona, United States of America
| | | | - Amylou C. Dueck
- Mayo Clinic Hospital, Phoenix, Arizona, United States of America
| | - Marco Santello
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, United States of America
- * E-mail:
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