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Overarm throws with the nondominant arm: kinematics of accuracy.

1. Overarm throws made with the nondominant arm are usually less accurate than those made with the dominant arm. The objective was to determine the errors in the joint rotations associated with this inaccuracy, and thereby to gain insight into the neural mechanisms that contribute to skill in overarm throwing. 2. Overarm throws from both left and right arms were recorded on different occasions as six right-handed subjects sat with a fixed trunk and threw 150 tennis balls at about the same speed at a 6-cm square on a target grid 3 m away. Joint rotations at the shoulder, elbow, wrist, and finger, and arm translations, were computed from recordings of arm segment orientations made with the magnetic-field search-coil technique. 3. All subjects threw less accurately in this task with the left (nondominant) arm. For throws made with the left arm, the height of ball impact on the target grid was related to hand trajectory length and to hand orientation in space at ball release, but not to hand trajectory height. 4. Two hypotheses were proposed to explain the decreased ball accuracy in the high-low direction during throwing with the nondominant arm: that it was caused by increased variability in the velocity or timing of onset of rotations at proximal joints (which determine the path of the hand through space) or increased variability in the velocity or timing of onset of finger extension (which determine the moment of ball release). 5. A prediction of the first hypothesis was that proximal joint rotations should be more variable in throws with the left arm. This was the case for the majority of proximal joint rotations in the six subjects when variability was examined in joint space. However, some proximal joint rotations were more variable in the right arm. 6. The first hypothesis was directly tested by determining whether hand angular position in space (which represents the sum of all proximal joint rotations) was related to ball impact height on the target grid at a fixed translational position in the throw. No relation was found between these variables for throws with the left arm in four subjects, whereas a weak relation was found for two subjects. It was concluded that, considering all subjects, the first hypothesis could not explain the results. 7. In contrast, in agreement with the second hypothesis, a strong relation (P < 0.001) was found in all subjects between ball impact height on the target grid and time of ball release for throws with the left arm, and with time of onset of finger extension. 8. Across all six subjects the timing precision (windows) for 95% of the throws was (for ball release) right arm, 9.3 ms; left arm, 22.5 ms; (for onset of finger extension) right arm, 13.7 ms; left arm, 26.7 ms. 9. Timing of onset of finger extension was no less accurate than timing of onset of other joint rotations for both left and right arms. However, simulations of throws showed that, for the same error in timing, finger extension had twice as large an effect on ball direction as any other joint rotation. Timing errors at the fingers have a greater effect than errors at other joints because finger errors are scaled by the higher angular velocity of the hand in space rather than by the smaller angular velocities of the individual joints. 10. It is concluded that although rotations were in general more variable at both proximal and distal joints of the nondominant (left) arm, the major cause of its decreased throwing accuracy was increased variability at the distal joints, i.e., in the timing of onset of finger extension. This may be due to a lack of precision in the commands from the right hemisphere to the left fingers in right-handed throwers.

Arm↗

The position of the arm during blood pressure measurement in sitting position.

OBJECTIVE: Determining the influence of the position of the arm on blood pressure measurement in the sitting position. METHODS: Blood pressure of 128 individuals (the majority being treated hypertensive patients) visiting the outpatient clinic was measured simultaneously on both arms with arms in two different positions. First, both arms were placed at the chair support level and blood pressure was measured three times on both arms after 10 min of rest. Subsequently, while still remaining in the same sitting position, five blood pressure measurements were made simultaneously at both arms with one arm placed on the desk and one arm placed and supported at heart level (mid-sternal). The arm placed at heart level served as the reference arm. The choice of which arm was placed at desk level and which arm was placed at heart level was randomized. RESULTS: Both at desk level and at chair support level, mean (+/-SD) systolic and diastolic blood pressures were higher than blood pressure at heart level by 6.1/5.7+/-4.6/3.1 and 9.3/9.4+/-5.4/3.4 mmHg, respectively. The effect of the height differences between the arm positions on the blood pressure readings was smaller than predicted (0.49 mmHg/cm systolic and 0.47 mmHg/cm diastolic). No significant correlation was found between blood pressure difference in the different arm positions (desk and heart level) and age, sex, weight or baseline blood pressure. CONCLUSIONS: Different arm positions below heart level have significant effects on blood pressure readings. The leading guidelines about arm position during blood pressure measurement are not in accordance with the arm position used in the Framingham study, the most frequently used study for risk estimations.

Adult↗

Activity of ventrolateral thalamic neurons during arm movement.

1. Monkeys were trained to maintain the handle of a manipulation within a small zone despite perturbations to the handle and to perform slow and rapid arm movements triggered by a visual stimulus. The activity of neurons in the region of the ventrolateral thalamus which projects directly to the arm area of the motor cortex (VL arm area) was then examined during performance of the task and while the animal's limb was passively manipulated. 2. Thalamic units related to arm movement were confined to the VL arm area. Microstimulation (less than 25 muA) in the VL arm area could, in some instances, evoke localized contractions of shoulder, arm, and hand musculature. Thalamic units whose discharge appeared to be related to jaw, tongue, and neck muscle activity occurred only medial to arm movement-related units, and units related to spontaneous leg movements occurred only laterally. 3. Most VL arm area neurons, although well related to active arm movements, were not influenced by gentle passive manipulation of the animal's limb. Few VL arm area neurons responded at short latency to perturbations applied to the handle of the manipulandum which the animal was holding. Thus, VL arm area neurons are unlike many motor cortex arm area neurons which are responsive to passive manipulation and are influenced at short latency by similar perturbations to the animal's limb. 4. Most arm movement-related VL neurons discharge during both fast and slow arm movements. Although a few neurons varied their discharge only during fast movements, none varied only in relation to slow movements. VL arm area neurons are, therefore, unlike the neurons in one source of its input, the globus pallidus, where some neurons are preferentially related to slow movements. 5. Some VL arm area neurons vary their discharge before any change in muscle activity during a fast and slow movement. Such neurons were recorded in VL regions which project to motor cortex areas representing proximal and distal musculature. This suggests that VL neurons might play a role in initiating activity in muscles concerned with controlling body posture, as well as those involved in discrete limb movements.20

Animals↗

Atracurium-induced neuromuscular block in the isolated arm.

A modification of the isolated arm technique was applied in 10 females under opioid-based i.v. anaesthesia for comparison of the offset of an atracurium-induced neuromuscular block in an isolated arm to an arm with maintained circulation. The neuromuscular blocking effect of a bolus dose of atracurium 0.5 mg.kg-1 was measured bilaterally using the integrated adductor pollicis EMG response (integrated T1 EMG response in % of baseline value and T4/T1 ratio) after bilateral ulnar nerve train-of-four (TOF) stimulation. At 10% T1 recovery, one arm was isolated from the general circulation for 20 min by means of a tourniquet cuff (isolated arm), while normal circulation was maintained in the other arm (control arm). In both arms, the TOF response, peripheral skin temperature, mixed peripheral venous pH and plasma concentrations of atracurium and laudanosine were then measured and compared. Core and peripheral skin temperatures in both arms remained stable and normal throughout the study, and mixed peripheral venous pH stayed within physiological limits in both arms in all subjects. In the isolated arm, recovery of the neuromuscular block was markedly delayed compared to the control arm, the integrated EMG T1 response and TOF ratio being significantly reduced in the isolated arm after 20 min of isolation. The decline in plasma concentration of atracurium was less in the isolated arm than in the control arm, whereas laudanosine levels increased in the isolated and decreased in the control arm. Normal peripheral circulation is of major importance for termination of an atracurium-induced neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗

Responses to submaximal and maximal arm cycling above, at, and below heart level.

It has been suggested previously that arm position may influence the cardiovascular and metabolic adjustments to arm cycling. Therefore, it was the purpose of this study to compare the responses to submaximal and maximal arm cycling with the arms positioned above, at, and below heart level. Five untrained subjects performed arm cycling at each of the three positions at 0, 29.6, 59.0, and 88.0 W. The work rate of 59.0 W was the highest work rate that could be maintained for 10 min by all five subjects. In addition, all subjects performed maximal cycling exercise at all three arm positions in order to determine arm VO2peak. A restraining harness and synchronous arm cycling were used to isolate the work to the arms as much as possible. Arm VO2peak averaged only 57% of leg VO2peak in the present study, due probably to the harness used to reduce the use of accessory muscles during arm exercise, as well as the use of synchronous arm cycling, which reduces trunk rotation. The present study found no significant difference in the responses to either submaximal or maximal arm cycling with the arms positioned above, at, or below heart level. These results suggest that possible changes in arm-muscle blood flow exert only negligible effects when rhythmic dynamic arm exercise is performed in an overhead position.

Arm↗

FluoroScan mini C-arm unit.

Mini C-arm units are very compact, mobile fluoroscopic imaging systems designed for real-time imaging of the extremities (e.g., fingers, arm, foot). As with conventional mobile C-arm units (such as those we evaluated in Health Devices 19[8], August 1990, and 22[3], March 1993), the standard environment in which mini C-arm units are used is the operating room; however, these units are compact enough to be used in emergency departments, physicians' offices, and, in some cases, locations outside of a healthcare facility (e.g., athletic playing field, work site). While mini C-arm units share many characteristics with conventional mobile C-arm units, their smaller size, simplicity of use, and lower cost can be significant advantages for certain procedures. In this study, we evaluated the FluoroScan, one of the two mini C-arm units currently available in the United States (and marketed worldwide). We tested this system against all relevant criteria from our earlier Evaluations of conventional mobile C-arm units and rated it Acceptable. Our ratings of C-arm units, in this and the previous studies, are based on the ability of a system to reliably produce the best possible image quality while (1) delivering the lowest possible radiation exposure to the patient and personnel and (2) minimizing operator effort and inconvenience. We discuss the purpose and use of mini C-arm units and describe the function of their major components in the Clinical and Technical Overview. In the Purchasing Guidance section, we highlight the differences between conventional and mini C-arm units and provide guidance for choosing the type of system that best meets a facility's needs. We also briefly describe the other currently available mini C-arm unit, the XiTec XiScan, and compare it with the evaluated unit. Issues of minimizing occupational radiation exposure resulting from scatter are discussed in the supplementary article, "Scatter Radiation from the FluoroScan Mini C-arm Unit." Readers are cautioned not to base purchasing and use decisions on our rating alone, but on a thorough understanding of our conclusions and the issues surrounding mini C-arm units, which can be gained by reading this study in its entirely. For additional perspectives on fluoroscopy and the operation of C-arm units, refer to our earlier Evaluations of conventional C-arm units.

Arm↗

Three-arm randomized study of two cisplatin-based regimens and paclitaxel plus gemcitabine in advanced non-small-cell lung cancer: a phase III trial of the European Organization for Research and Treatment of Cancer Lung Cancer Group--EORTC 08975.

PURPOSE: To compare the therapeutic efficacy of paclitaxel plus cisplatin (arm A) versus gemcitabine plus cisplatin (arm B) and arm A versus paclitaxel plus gemcitabine (arm C) in chemotherapy-naive patients with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients were randomly assigned to receive either paclitaxel 175 mg/m2 (3-hour infusion, day 1) or gemcitabine 1,250 mg/m2 (days 1 and 8) both combined with cisplatin 80 mg/m2 (day 1) or paclitaxel 175 mg/m2 (3-hour infusion, day 1) combined with gemcitabine 1,250 mg/m2 (days 1 and 8). Primary end point was comparison of overall survival for B versus A and C versus A. Secondary end points included response rate and duration, progression-free survival, toxicities, quality of life [QoL], and cost of treatment. RESULTS: Four hundred eighty patients (arm A, 159; arm B, 160; arm C, 161 patients) were enrolled; all baseline characteristics were balanced. Median survival times were as follows: arm A, 8.1 months; arm B, 8.9 months; arm C, 6.7 months. Response rates were 31.8% for arm A, 36.6% for arm B, and 27.7% for arm C. Other than myelosuppression (B v A, P <.005), no statistically or clinically significant differences were observed for secondary end points. The average treatment costs were 25% higher in arm C as compared with arms A and B. CONCLUSION: Gemcitabine plus cisplatin and paclitaxel plus gemcitabine do not increase overall survival in patients with advanced NSCLC as compared with paclitaxel plus cisplatin. Treatment was well tolerated, and most QoL parameters were similar, but costs associated with the nonplatinum arm were highest.

Adult↗

The effect of voluntary arm abduction on balance recovery following multidirectional stance perturbations.

The goal of this study was to investigate how voluntarily abducting one arm, 90 degrees at onset of a rotational perturbation of the support surface, influences the recovery of upright stance. Young adults were tested under four stance conditions: abducting one arm to the horizontal only (AO); perturbation of stance using a support surface rotation only (PO); combined support surface rotation and abduction of the downhill arm, ipsilateral to tilt (IPS); and fourth abduction of the uphill, contralateral arm (CON). Simultaneous auditory and visual trigger cues were used for arm raising. Perturbations consisted of six directions of combined support surface roll and pitch rotation (7.5 degrees and 60 degrees/s). Outcome measures were whole body centre of mass (COM) movements and body segment angular displacements recorded with a motion analysis system, as well as leg, trunk, and arm EMG responses. Arm raises contralateral and ipsilateral to the direction of support surface roll were more rapid than in the AO condition and significantly reduced or increased, respectively, COM lateral displacements relative to the PO condition. The changes in COM displacements and velocities during combined CON arm raise and perturbation were greater than expected from the sum of displacements for AO and PO conditions alone, but less for the IPS condition. Arm raising increased trunk roll in a direction opposite arm raising was more than for the AO and PO conditions. Robust effects were also observed for hip abduction but not for leg flexion. Early balance correcting activity was enhanced on the side opposite arm raising and later stabilising activity reduced bilaterally in lower trunk muscles compared to summed activity for the AO and PO conditions. Similar effects were observed in gluteus medius muscles but effects were weak in ankle muscles. EMG onsets in muscles of the raised arm were earlier than in the AO conditions. We conclude that triggered arm abduction, contralateral to the direction of support surface rotation, had significant stabilization benefits for young adults and ipsilateral arm movements had destabilizing effects. The arm raises could be simultaneously executed with balance corrections. These results provide insights into the integration of balance corrections and voluntary commands into one automatic reaction that may be useful in training fall avoidance.

Adaptation, Physiological↗

Is the high lactate release during arm exercise due to a low training status?

To determine whether arm lactate release during arm exercise is related to the training status of the arms, seven arm-trained athletes were studied during 30 min of continuous arm exercise (AE) or leg exercise (LE) of increasing intensities corresponding to 30%, 50%, and 80% of peak VO2 during AE and LE respectively. Blood vessels were catheterized for determination of regional blood flows and substrate exchanges. The respiratory exchange ratio was higher during AE than LE (P less than 0.01). The arteriovenous oxygen difference, [(A-V)O2], for the leg during LE was 11-19% higher than the (A-V)O2 for the arm during AE (P less than 0.01). At the highest intensity the (A-V)O2 was 170 +/- 6 ml O2l-1 during LE, vs. 143 +/- 9 during AE (P less than 0.01). Arm blood flow in relation to limb volume was 56-95% higher during AE (P less than 0.05). Arterial lactate concentrations were 27-60% higher during AE (P less than 0.01) and lactate release from the exercising limb was 2-4 times higher (P less than 0.05) during AE compared to LE. Adrenaline and noradrenaline rose 6- and 21-fold, respectively, during AE and did not differ from corresponding LE values. During AE the (A-V)O2 difference across the arm, arterial lactate concentration, and arm lactate release were of the same magnitude in arm-trained and relatively less arm-trained subjects. Lactate release in relation to O2 uptake by the exercising limb was 7-37% lower during AE in arm-trained subjects compared to AE in arm-untrained subjects but was 3-6 times higher than the corresponding relation during LE (P less than 0.01). We conclude that AE is associated with a larger lactate release compared to LE. This difference is only to a minor extent influenced by intense training of the arms. The high arm vs. leg lactate release appears to be associated with differences in regional circulatory adaptation by the exercising limb.

Adult↗

Disruption of coordination between arm, trunk, and center of pressure displacement in patients with hemiparesis.

To determine how arm movements influence postural sway in the upright position after stroke, interactions between arm, trunk, and center of pressure (CoP) displacements in the sagittal direction were investigated in participants with hemiparesis and healthy subjects. Participants swung both arms sagittally in either of 2 directions (in-phase, anti-phase) and at 2 speeds (preferred, fast) while standing on separate force plates. Variables measured included amplitude and frequency of arm swinging, shoulder and trunk range of motion, CoP displacements under each foot and of the whole body, and the relationships between the arm, trunk, and CoP displacements. CoP displacements under the non-paretic leg were greater than those under the paretic leg, which may in part be related to the larger amplitude of swinging of the non-paretic arm. CoP displacements under each foot were not related to arm swinging during in-phase swinging at the preferred speed in healthy subjects. When speed of arm swinging was increased, however, the CoP moved in a direction opposite to the arm movement. In contrast, in individuals with hemiparesis, CoPs and arms moved in the same direction for both speeds. During anti-phase swinging in healthy subjects, the trunk counterbalanced the arm movements, while in participants with hemiparesis, the trunk moved with the affected arm. Results show that stroke resulted in abnormal patterns of arm-trunk-CoP interactions that may be related to a greater involvement of the trunk in arm transport, an altered pattern of coordination between arm and CoP displacements, and an impaired ability of the damaged nervous system to adapt postural synergies to changes in movement velocity.

Adult↗

Interpreting spirometric data: impact of substitution of arm span for standing height in adults from North India.

STUDY OBJECTIVE: To evaluate if direct substitution of arm span for height during interpretation of spirometry data leads to any significant statistical or clinical differences in Indian adults, and to compare this method with the use of height estimated indirectly from arm span. DESIGN: Cross-sectional. SETTING: Respiratory laboratory of a tertiary referral hospital in North India. PARTICIPANTS: Two hundred twenty-eight subjects referred for spirometry. MEASUREMENTS AND RESULTS: Standing height and arm span were measured for all subjects. Spirometry measurements included FVC, FEV1, FEV1/FVC, peak expiratory flow, and maximal midexpiratory flow. Predicted values for each parameter were calculated separately for height, arm span, and height estimated from fixed height:arm span ratio. Results were classified into normal, obstructive, and restrictive defects for each height, arm span, and estimated height measurement, and any abnormality was categorized as mild, moderate, or severe. Arm span exceeded height in 182 (79.82%) subjects. Thirty-seven (16.2%) and 32 (14.0%) results were classified or categorized incorrectly when arm span and estimated height were substituted respectively, for actual height, with a kappa estimate of agreement 0.779 and 0.808, respectively; 17.4% and 11.0% normal results were classified, respectively, as restrictive defects using arm span and estimated height. Limits of agreement, which were almost equally wide for both sets of data, were more than the permissible intraindividual variability for FVC and FEV1. CONCLUSIONS: The substitution of arm span for height introduces statistically significant changes in spirometry results. Use of height estimated from arm span using fixed ratio also leads to misclassification of data, though less than that caused by use of arm span alone. Height estimated from arm span can be substituted for actual height in patients in whom height cannot be measured reliably. Where racial/ethnic norms for height and arm span correlation are not available, arm span is a reasonable surrogate for standing height.

Adolescent↗

Tumour features in the control and screening arm of a randomized trial of prostate cancer.

OBJECTIVE: To compare tumour characteristics at the time of diagnosis of cancers detected in the screening and control arm at the Rotterdam section of the European Randomized study of Screening for Prostate Cancer. METHODS: Data were retrieved from the Rotterdam section of the ERSPC. Men were randomized to the screening arm (n=21,210) or the control arm (n=21,166). Men randomized to screening were offered PSA testing every 4 years. Through linkage with the cancer registry, men randomized to the control arm were detected. The biopsy Gleason score was determined in 1,591 and 373 patients in the screening and control arm, respectively. TURP, radical prostatectomy (RP) and cystoprostatectomy were evaluated for Gleason score, pathological (p)T stage and tumour volume. RESULTS: More prostate cancers were detected in the screening arm (15.9 vs. 4.2 per 1000 man years, p<0.0001). Clinical stage distribution as well as biopsy and RP Gleason score distribution were significantly less favourable in the control arm. The incidence in man years of advanced disease (i.e. T4/N1/M1) was higher in the screening arm (6.0 per 100,000) as compared to the control arm (4.6 per 100,000). The 5-year PSA progression free survival after RP was 68% in the control arm and 89% in the screening arm (p<0.0001). The proportion of Incidental prostate cancers was 9.3% of all cancers detected in the control arm. CONCLUSIONS: Although the number of men with advanced prostate cancer is slightly higher in the screening arm, the proportion of prostate cancers with favourable features is increased in the screening arm as compared to that in the control arm.

Aged↗

MRI-derived moment-arms of the female and male spine loading muscles.

OBJECTIVE: Develop a comprehensive gender-specific database of trunk muscle moment-arms across multiple levels of the lower thoracic and lumbar spine, determine if gender differences exist across the different vertebral levels, and develop prediction equations for the moment-arms as a function of external anthropometric measures. DESIGN: This study quantified trunk muscle moment-arms relative to the spine from T(8) to S(1) of male and female spine loading muscles. BACKGROUND: Knowledge of trunk muscle geometry is important for biomechanical modeling of the low back and for understanding of spinal loading. However, there currently is a lack of comprehensive data regarding the moment-arms of the female spine loading muscles. Additionally, little is known regarding gender differences in moment-arms for the same muscles. METHODS: Magnetic resonance imaging scans through the vertebral bodies from T(8) through S(1) were performed on 20 females and 10 males. Moment-arms in the coronal and sagittal plane between the muscle centroid and vertebral body centroid were recorded at each vertebral level. Linear regression techniques taking into account anthropometric measures were utilized to develop prediction equations for the moment-arms for each muscle. RESULTS: Anthropometric measures were better predictors of coronal plane moment-arms than sagittal plane moment-arms for both genders. Measures consisting of height and weight were consistent predictors of female moment-arms. Measures about the xyphoid process and combinations of height and weight were consistent predictors of coronal plane moment-arms for males at several lower lumbar levels. Males exhibited larger moment-arms than for females, for most muscles at most levels. CONCLUSIONS: Trunk muscle moment-arms of females and males are different, and should be considered in the development of biomechanical models of the torso. Similar to other studies, external anthropometric measures were better predictors of coronal plane moment-arms than sagittal plane moment-arms.

Adult↗

Recovery of sliding ability in arm-depleted flagellar axonemes after recombination with extracted dynein I.

We compared sliding velocity between outer doublet tubules in demembranated axonemes of sea-urchin (Pseudocentrotus depressus) sperm flagella with that of arm-depleted axonemes recombined with extracted dynein I. The outer arm-depleted axonemes after extraction with 0.5 M NaCl had a velocity of 6.9 +/- I.0 micrometer/s, while the intact axonemes had a velocity of 14.3 +/- I.5 micrometer/s in the presence of I mM ATP and 2 microgram/ml trypsin at 25 degrees C. The sliding velocity was closely related to the number of remaining outer arms following the NaCl-extraction process. When the outer arm-depleted axonemes were recombined with dynein I, the sliding velocity increased to 11.3 +/- 1.3 micrometer/s. Electron microscopy confirmed the recovery of 94% of outer arms in the axonemes. After extraction with Tris-EDTA solution for 10 min, the axonemes lost their sliding ability completely, even in the presence of ATP and trypsin. Such axonemes lacked most of both inner and outer arms, although sometimes the basal segment of the arms appeared to remain. When the exogenous dynein I fraction extracted from other axonemes was added, the axonemes could extrude tubules, and both types of arms reappeared clearly and distinctly in the axonemes. The recombined axonemes with one-fold stoichiometric excess of dynein I recovered 58% of the total number of arms and had a velocity of 7.4 +/- 1.6 micrometer/s. Those with 2-fold stoichiometric excess had a velocity of 11.0 +/- 1.5 micrometer/s, up to 82% of the arms in these axonemes being restored. These results indicated that the exogenous dynein I fraction derived from the outer arms restored sliding ability to arm-depleted axonemes, recombining with th outer doublet tubules as inner and outer arms, and that the sliding velocity had a close relationship to the total number of arms in the axonemes, irrespective of their being inner or outer arms.

Adenosine Triphosphatases↗

Rhythmic arm cycling produces a non-specific signal that suppresses Soleus H-reflex amplitude in stationary legs.

Rhythmic arm cycling significantly suppresses Hoffmann (H-) reflex amplitude in Soleus muscles of stationary legs. The specific parameters of arm cycling contributing to this suppression, however, are unknown. Between the arms or legs, movement results in suppression of the H-reflex that is specifically related to the phase of movement and the locus of limb movement. We speculated that the effects of arm movement features on H-reflexes in the leg would be similar and hypothesized that the Soleus H-reflex suppression evoked by arm movement would therefore be specifically related to: (1) phase of the movement; (2) the locus of the movement (i.e., ipsilateral or contralateral arm); (3) range of arm motion; and (4) frequency of arm cycling. Participants performed bilateral arm cycling at 1 and 2 Hz with short and long-crank lengths. Ipsilateral and contralateral arm cycling was also performed at 1 Hz with a long-crank length. Soleus H-reflexes were evoked at four equidistant phases and comparisons were made while maintaining similar evoked motor waves and Soleus activation. Our results show that comparable suppressive effects were seen at all phases of the arm movement: there was no phase-dependence. Further, bilateral or unilateral (whether ipsi- or contralateral arm) cycling yielded equivalent suppression of the H-reflex amplitude. Cycling at 2 Hz resulted in a significantly larger suppression than with 1 Hz cycling. We conclude that a general, rather than a specific, signal related to the command to produce rhythmic arm muscle activity mediates the suppression of Soleus H-reflex during arm cycling.

Adult↗

Validation of the inverse water volumetry method: A new gold standard for arm volume measurements.

BACKGROUND: No consensus exists with respect to a commonly accepted and standardized method for measuring arm volumes in patients with lymphedema. Knowing the exact volume in (potential) lymphedemic arms and comparing this volume with healthy arms is important to detect the first signs of lymphedema and to study the effects of treatment. METHODS: A new apparatus, based upon the principle of measuring shortness of water, was developed to measure arm volumes. This measuring-method, inverse water volumetry, was prospectively validated in patients, suffering from lymphedema after complete or partial mastectomy for primary breast cancer. Healthy and lymphedemic arm were measured 3 times: twice by nurse A (A1 and A2) and once by nurse B (B). Subsequently, these differences in volumes were compared with differences in volumes obtained by the Herpertz method, which is based upon circumferential measurement. RESULTS: In every patient at every occasion volume of the lymphedemic arm was bigger than the corresponding volume of the control arm. Mean volumes of healthy arms were 3958(A1), 3966(A2) and 3961(B) ml respectively. Mean volumes of lymphedemic arms were 4721(A1), 4752(A2) and 4773(B) ml respectively, volume B being significantly different from volume A1. Volume difference of edemic arms minus control arms was not significant between measurements (A1 vs. A2 and A1 vs. B, respectively), while this difference was significant (A1 vs. B) using the Herpertz method. CONCLUSION: Inverse water volumetry is an easy measuring device with a high inter- and intra-observer agreement. The small but significant volume increase of lymphedemic arms in time compared to the constant volumes of control arms is as well indicative for the accuracy of the method as for the volume of lymphedemic arms to increase when no therapeutic garment is carried.

Aged↗

Influence of the arm position on intra-arterial blood pressure measurement.

The reference level for the measurement of blood pressure (BP) is the level of the right atrium. In practice this is regularly disregarded, as the patient's arm is usually placed lower than the right atrial level. The aim of the study was to determine the influence of first, different arm positions and second, different transducer positions on the intra-arterially (i.a.) recorded BP. In 16 healthy men (age 28.1 +/- 8.0 (s.d.) years), i.a. BP was recorded at the left arm in supine position, using a 5-7 cm long cannula. The baseline position was with the tip of the cannula placed precisely at the level of the right atrium. Subsequently, the following changes were made: 5, 10, 15 and 20 cm above and 5, 10, 15, and 20 cm below the baseline position. A 2-min rest period was allowed in each position before the BP was measured. The whole procedure was done either with the transducer connected to the arm at the place of the cannula (n = 7), or with the transducer placed next to the subject and continuously kept at the right atrial level during the BP measurement (n = 9). Simultaneously, baseline BP was measured indirectly, with a standard mercury sphygmomanometer, in the opposite arm maintained with the cubital fossa at the right atrial level during the whole procedure. This resulted in the first group of seven volunteers for both the i.a. systolic (SBP) and diastolic BP (DBP) values to significantly decrease (P < 0.001) when the arm together with the transducer were elevated above the level of the right atrium, and returned to the initial value when the arm and the transducer were placed back at the right atrial level. Intra-arterial SBP and DBP significantly (P < 0.001) increased as the arm, together with the transducer, were lowered below the right atrial level and returned to the initial value when the arm and the transducer were placed back at the right atrial level. In both directions, each 5 cm change in the arm level was accompanied by a 3-4 mm Hg change in the i.a. BP value. The baseline BP, measured sphygmomanometrically at the contralateral arm, remained constant during the whole duration of the procedure. The changes in the i.a. BP were minimal in the second group of nine subjects in which only the arm but not the transducer was placed at different levels. We conclude that small deviations in arm position above or below the 'gold standard', ie, the fossa cubiti at the right atrial level, will result in largely erroneous BP values. The correct positioning of the arm during BP measurement is therefore mandatory for the diagnosis and follow-up of hypertensive subjects.

Adult↗

Kinematic rules for upper and lower arm contributions to grasp orientation.

The purpose of the current study was to investigate the contribution of upper and lower arm torsion to grasp orientation during a reaching and grasping movement. In particular, we examined how the visuomotor system deals with the conflicting demands of coordinating upper and lower arm torsion and maintaining Donders' Law of the upper arm (a behavioral restriction of the axes of arm rotation to a two-dimensional "surface"). In experiment 1, subjects reached out and grasped a target block that was presented in one of 19 orientations (5 degrees clockwise increments from horizontal to vertical) at one position in a vertical presentation board. In experiment 2, target blocks were presented in one of three orientations (horizontal, three-quarter, and vertical) at nine different positions in the presentation board. If reach and grasp commands control the proximal and distal arms separately, then one would only expect the lower arm to contribute to grasp orientations and that Donders' Law would hold for the upper arm-independent of grasp orientations. Instead, as the required grasp orientation increased from horizontal to vertical, there was a significant clockwise torsional rotation in the upper arm, which accounted for 9% of the final vertical grasp orientation, and the lower arm, which accounted for 42%. A linear relationship existed between the torsional rotations of the upper and lower arm, which indicates that the components of the arm rotate in coordination with one another. The location-dependent aspects of upper and lower arm torsion remained invariant, however, yielding consistently shaped Donders' "surfaces" (with different torsional offsets) for different grasp orientations. These observations suggest that the entire arm-hand system contributes to grasp orientation, and therefore, the reach/grasp distinction is not directly reflected in proximal-distal kinematics but is better reflected in the distinction between these coordinated orienting rules and the location-dependent kinematic rules for the upper arm that result in Donders' Law for one given grasp orientation.

Adult↗