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PubMed1977

Oxygen uptake transients at the onset and offset of arm and leg work.

The halftimes (t1/2) of the VO2 on-and off-responses have been determined on 4 moderately active subjects (1) in arm cranking (VO2 congruent to 1 1/min). (2) in leg pedaling at 4 graded submaximal (VO2 congruent to 0.8 to 2.51/min) work loads, and (3) when superimposing arm cranking on preexisting leg pedaling, both in the supine and in the upright position. In supine experiments the mean t1/2 of the VO2 on-response was longer for arm cranking than for leg pedaling (64 vs 44-49 sec) at equal VO2; however, at the same percentage of arm and leg VO2 max the respective t1/2 were similar. In sitting experiments all t1/2 of the VO2 on-response were shorter than when supine, but the t1/2 for the arms were still slightly longer than those for the legs. When arm cranking was superimposed on preexisting leg pedaling, the t1/4 for arms was reduced both in supine (from 64 to 35-38 sec) and in the sitting position (from 44 to 40 sec). The halftime of the VO2 off-response were much shorter (20-32 sec) than those of the on-response and similar in all experiments. In all conditions the O2 deficits at work onset were considerably larger than the fast component of the corresponding O2 debts during the first minutes of recovery. The difference was totally accounted for by anaerobic glycolysis occurring early during the VO2 on-response, particularly in arm exercise. It is concluded that at submaximal work loads the O2 deficit is accounted for the fast component of the O2 debt plus the O2 equivalent of the early lactate production.

Adult↗
PubMed1996

Kinetics of oxygen uptake and cardiac output at onset of arm exercise.

Pulmonary oxygen uptake (V O2) kinetics at onset of exercise is reported to be slower for arm than for leg exercise. This could be attributed to reduced cardiac output (Q) or reduced arteriovenous O2 content difference or both. To test this, V O2 mean tissue oxygen consumption (V O2T) and Q kinetics in arm cranking were compared with corresponding values found in leg cycling. The increase in V O2 during phase 1 (abrupt increase after onset of exercise) was less in arm than in leg exercise, suggesting that immediate Q adjustments to arm exercise were less pronounced. Mean response times (MRT, the relative rates at which a steady state was attained) for V O2, V O2T, and Q were prolonged during arm exercise. The MRT of VO 2 in arm exercise at a given blood lactate increase was higher than in leg exercise. The delayed V O2 kinetics in arm exercise might be due to delayed Q kinetics and higher anaerobic glycolysis occurring early during arm exercise.

Adult↗
PubMed1986

Edema of the arm as a function of the extent of axillary surgery in patients with stage I-II carcinoma of the breast treated with primary radiotherapy.

Edema of the arm can be a significant complication following treatment of breast cancer. To determine the risk of arm edema and factors associated with this risk in patients treated with primary radiotherapy, we reviewed the records of 475 women with early breast cancer treated between 1968 and 1980. During this period, the use of axillary surgery prior to radiation gradually increased, and all patients received full axillary irradiation until late in the series. Based on the surgeon's report, the extent of axillary surgery was classified as either a sampling, a lower dissection, or a full dissection. Edema of the arm was scored on clinical grounds and ranged from mild hand swelling to an increased arm circumference of 8 cm. At 6 years, the actuarial risk of developing arm edema was 8% for the entire study population. This risk was 13% for 240 patients who had axillary surgery and 4% for 235 patients not undergoing axillary surgery (p = 0.006). For patients undergoing axillary surgery, the risk of arm edema was 37% with full dissection compared to 5% with sampling (p = 0.0003), and 8% with lower dissection (p = 0.03). The risk of arm edema at 6 years was 28% if more than ten nodes were removed, and 9% if one to ten nodes were removed (p = 0.03). However, the extent of axillary dissection was stronger predictor of subsequent edema than was the number of nodes obtained. The role of axillary irradiation could not be evaluated since 91% of patients received axillary irradiation. The use of chemotherapy, the site or size of the primary tumor, clinical nodal status, patient age and weight, type of suture, the use of a drain, and subsequent local or distant failure did not appear to be significant risk factors. We conclude that the combination of full dissection and full axillary irradiation results in an unacceptably high risk of arm edema.

Arm↗
PubMed1994

Increased arterial inflow demonstrated by Doppler ultrasound in arm swelling following breast cancer treatment.

Doppler ultrasound was used to estimate the mean arterial flow in the arms of 50 patients with arm oedema following breast cancer treatment (oedema group). They were compared with 26 treated breast cancer patients with no arm swelling (control group). Flows on the treatment side were expressed as a percentage of the flow in the contralateral normal arm. Mean percentage blood flow was 68% higher in the swollen arms than the contralateral normal arms compared to a mean increase of 38% on the breast cancer treatment side in the control group. In both groups there was a significantly higher proportion of patients with increased (> 150%) rather than decreased (< 50%) flow on the treatment side. The ratio of increased to decreased flow was 27:4 in the oedema group and 6:0 in the control group. A neurological deficit on the treatment side was associated with an increased incidence of higher flow on the same side in the oedema group. These findings demonstrate that breast cancer treatment results in a significant increase in arterial flow in the arm on the treatment side, and that this increase is even higher in those patients with swelling. Increased blood flow is likely to contribute to arm swelling. One explanation for increased flow would be neurological deficit with loss of sympathetic vasoconstrictor control.

Adult↗
PubMed2005

Three-dimensional scapulothoracic motion during active and passive arm elevation.

BACKGROUND: Scapulothoracic muscle activity is believed to be important for normal scapulothoracic motion. In particular, the trapezius and serratus anterior muscles are believed to play an important role in the production and control of scapulothoracic motion. The aim of this study was to determine the effects of different levels of muscle activity (active versus passive arm elevation) on three-dimensional scapulothoracic motion. METHODS: Twenty subjects without a history of shoulder pathology participated in this study. Three-dimensional scapulothoracic motion was determined from electromagnetic sensors attached to the scapula, thorax and humerus during active and passive arm elevation. Muscle activity was recorded from surface electrodes over the upper and lower trapezius, serratus anterior, anterior and posterior deltoid, and infraspinatus muscles. Differences in scapulothoracic motion were calculated between active and passive arm elevation conditions. FINDINGS: Scapular motion was observed during the trials of passive arm elevation; however, there was more upward rotation of the scapula, external rotation of the scapula, clavicular retraction, and clavicular elevation under the condition of active arm elevation. This was most pronounced for scapular upward rotation through the mid-range (90-120 degrees) of arm elevation. INTERPRETATION: The upper and lower trapezius and serratus anterior muscles have an important role in producing upward rotation of the scapula especially throughout the mid-range of arm elevation. Additionally, it appears that capsuloligamentous and passive muscle tension contribute to scapulothoracic motion during arm elevation. Assessment of the upper and lower trapezius and serratus anterior muscles and upward rotation of the scapula should be part of any shoulder examination.

Adolescent↗
PubMed2006

The contribution of non-digital afferent signals to grip force adjustments evoked by brisk unloading of the arm or the held object.

OBJECTIVE: Earlier studies suggest that grip force adjustments evoked by mechanical perturbations result more from cutaneous signals from the fingertips, than from afferent signals from the supporting limb. Generally an increase in tangential load at the fingertips induces an increase in grip force, whereas a decrease in load induces the opposite reaction. Some data suggest that prior knowledge and experience influences the magnitude of grip force adjustments. METHODS: This study examines the relative contribution of digital and arm afferent signals in the context of brisk involuntary upward flexions obtained either by unloading the arm (ARM) or the held object (OBJECT). Following the perturbation, the tangential load at the fingertips increased in ARM, but decreased in OBJECT. A subsidiary goal was to compare the performance of naive subjects with the performance of trained and informed subjects. RESULTS: When the perturbation was completely unexpected, grip force increased sharply after OBJECT and ARM unloading. By contrast, when subjects had prior knowledge and experience with the upcoming perturbation, grip responses were clearly differentiated; grip force increased after ARM, but decreased after OBJECT. CONCLUSIONS: These results challenge the view that cutaneous signals of the fingertips are the driving signals of grip force responses. Instead, afferent signals from the flexed arm would account well for the lack of difference between grip force responses in ARM and OBJECT under unpredictable conditions. These data provide clear evidence that prior knowledge and experience influences reactive grip force control, since subjects became able to repress unnecessary grip force modulation in OBJECT. SIGNIFICANCE: These data have implications for understanding the initiation and the modulation of grip force adjustments.

Adult↗
PubMed2006

Arm constraint and walking in healthy adults.

The aim of the present study was to examine the functional adaptations in inter-segmental coordination when constraining one arm in healthy adults during treadmill walking at different velocities. Subjects were instructed to walk on a motorized treadmill at different walking velocities (range: 0.22-1.52 m/s) during three experimental conditions, i.e.: (1) no arm constraint, (2) dominant arm constrained, and (3) non-dominant arm constrained. Movements of body segments were recorded with a 3D motion analysis system. A comparison between walking with one arm constrained and normal walking revealed decreased, transverse pelvic, thoracic, and trunk rotation, however there were slight increases in non-constrained arm movement amplitude. Reduced arm movement amplitude did result in altered frequency and phase relations between the arm and leg. Persons with upper extremity movement dysfunction may walk slower due to atypical coordination between upper and lower body movement at higher walking velocities. Future studies should focus on examining the underlying dynamics of adaptations in inter-limb and trunk coordination during walking in both healthy adults and persons with upper extremity movement disorders.

Adult↗
PubMed2005

The effect of arm swing on lower extremities in vertical jumping.

Although it is known that an arm swing can enhance the performance in vertical jumping, the mechanisms through which this enhancement occurs are not yet clearly described. The purpose of this study was to examine how arm swing affects the lower extremity torque, power and work in vertical jumping and to gain an insight into the mechanisms that enable the arm swing to increase jump height. Five subjects maximally performed two types of vertical squat jumps with (SJA) and without (SJ) an arm swing from a force platform. All performances were videotaped with a high-speed video camera (200 Hz). The jump heights, joint torques, power and work were calculated by combining kinematic and kinetic data. It was confirmed that arm swing enhanced the jump height significantly (p<0.01). The work by the hip and by the ankle was significantly augmented by arm swing (p<0.05 and p<0.01, respectively). However, the work by the knee was significantly smaller in SJA (p<0.05). The total work by the three lower extremity joints (ankle, knee and hip) was significantly larger in SJA (p<0.05). The increase of the lower extremity work by the arm swing (31.4 J) was about twice as large as the work done by the shoulder and elbow in SJA (16.3 J). It was concluded that the increment of jump height resulted mainly from the increase of the lower extremity work, which is considered to have been brought about by the additional load on the lower extremity due to the arm swing.

Adult↗
PubMed2006

A kinematic model of the shoulder complex to evaluate the arm-reachable workspace.

Upper-arm evaluation including shoulder motion in physiotherapy has no three-dimensional tool for an arm-functioning evaluation, which hampers an uniform, objective comparison. Human shoulder complex models suffer from lack of shoulder girdle kinematic data. A kinematic shoulder-complex model with six degrees of freedom is proposed as the composition of the inner joint representing the shoulder-girdle joints and outer joint representing the glenohumeral joint. The outer shoulder joint has three perpendicular rotations: adduction/abduction, retroflexion/flexion and internal/external rotation of the humerus. The inner shoulder joint has two rotations, depression/elevation and retraction/protraction, and one translation, which are all dependent on the elevation angle of the humerus. The human arm-reachable workspace that represents the area within reach of the wrist is calculated on the basis of the shoulder-complex model and the additional elbow-joint direct kinematics. It was demonstrated that cross-sections of the calculated workspace are in agreement with the measured arm-reachable workspace in all three anatomical planes. The arm-reachable workspace volume and graphics were calculated and a comparison of the arm's workspaces during a patient's shoulder treatment was made. The obtained numerical and graphical arm-reachable workspaces can be used for arm-functioning evaluations in rehabilitation and ergonomics.

Arm↗
PubMed2005

Fetal upper arm volume in predicting intrauterine growth restriction: a three-dimensional ultrasound study.

As fetuses with intrauterine growth restriction (IUGR) may have increased risks with perinatal morbidity and mortality, prenatal diagnosis of IUGR is a very important issue in perinatology. To assess the efficacy of fetal upper arm volume in predicting IUGR, we undertook a prospective, cross-sectional study using quantitative three-dimensional (3D) ultrasound (US). In total, 40 fetuses with IUGR and 442 fetuses without IUGR were included for the upper arm volume assessment in utero by 3D US. All the fetuses were singletons and were followed up to delivery to establish whether they were complicated with IUGR or not. Our results showed that fetal upper arm volume assessed by 3D US can differentiate fetuses with IUGR from fetuses without IUGR well. The best predicting threshold for IUGR is at the 10th percentile by upper arm volume. Using the 10th percentile as the cutoff, the sensitivity of fetal upper arm volume in predicting IUGR was 97.5%, with specificity 92.8%, predictive value of positive test 54.9%, predictive value of negative test 99.8% and accuracy 93.1%. Furthermore, upper arm volume is the best parameter for detecting IUGR among the common fetal biometric indices, such as biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). In conclusion, fetal upper arm volume assessed by quantitative 3D US can be used to predict fetuses with IUGR antenatally. We believe fetal upper arm volume assessment by 3D US would be a useful test in detecting fetuses with IUGR.

Arm↗
PubMed1977

A comparison of the response to arm and leg work in patients with ischemic heart disease.

An exercise test based on arm work was evaluated in a series of 33 male patients, mean age 52 years, with ischemic heart disease. The responses to arm exercise on a modified table-mounted bicycle ergometer and to standard bicycle exercise were compared. Twenty six of 33 patients (79 per cent) had identical end-points with both tests. Three patients had an ischemic response, i.e., significant ST abnormality and/or angina pectoris during leg work only, and four patients during arm work only. 41 per cent of the peakload during leg exercise. Mean values were 181 and 439 kpm./min. (p less than 0.001). Comparison of individual data on peak load demonstrated only a weak correlation between arm and leg work capacity (r = 0.37, p less than 0.05). Peak heart rate was slightly higher during leg work, 129 compared to 122 beats/min. (p less than 0.05) but the mean heart rate-systolic blood pressure products were not significantly different. A subgroup of seven patients had a history of angina pectoris preferentially precipitated by arm work but their physiological responses did not differ significantly from those of patients without a history of arm work sensitivity. The data indicate that arm work is a satisfactory alternate diagnostic test method with respect to myocardial ischemia, but measurements of physical work capacity defined as aerobic capacity, cannot be based on arm work.

Adult↗
PubMed2001

Arm complications after radial artery procurement for coronary bypass operation.

BACKGROUND: Radial arteries are being used frequently for coronary artery bypass conduits, and surgeons are appropriately concerned about the risks of ischemia, infection, and neurologic dysfunction of the "donor" arm. We present our record of donor site complications, with emphasis on the safety of radial usage in patients older than 65 years of age. METHODS: A total of 343 radial arteries were removed from 217 patients, aged 37 to 83 years. Forty-nine (23%) of the patients were women; 126 of the radial arteries were from patients aged 65 years or older. Four patients died. In the remaining 213 patients, 338 donor arms were examined for at least 6 weeks postoperatively for evidence of infection, ischemia, hematoma, seroma, or paresthesia. RESULTS: No donor arms developed symptoms of 'ischemia or motor dysfunction. Two of 338 (0.6%) arms developed hematomas requiring operative drainage. Relatively minor complications of stitch abscesses, skin dehiscence, superficial infection, and small hematomas or seromas affected another 14 arms (4.1%). Cutaneous paresthesias in the radial distribution of the lateral antebrachial cutaneous nerve or superficial branch of the radial nerve were noted postoperatively in 36 arms (10.7%). The risk of any arm complication occurring was 13% in the 65 and older group and 17% in those less than 65 years old (p = NS). CONCLUSIONS: The risk of a major arm complication from radial artery harvesting for coronary bypass is low, even in patients of advanced age.

Adult↗
PubMed2003

Arm positioning alters lung volumes in subjects with COPD and healthy subjects.

Subjects with chronic obstructive pulmonary disease (COPD) have difficulty performing arm exercise, particularly if the arms are unsupported and elevated. The purpose of this study was to evaluate the effect of arm position on static lung volumes in COPD and healthy subjects. Lung volumes were measured by plethysmography in nine COPD subjects (mean age +/- SD = 67.3 +/- 10.3 years; % pred FEV1 +/- SD = 39.7 +/- 10.9%) and nine healthy subjects (mean age +/- SD = 55.8 +/- 8.8 years; % pred FEV1 +/- SD = 102.9 +/- 12.2%) with the arms below 90 degrees shoulder flexion, at 90 degrees shoulder flexion and above 90 degrees shoulder flexion. In all subjects a significant increase in functional residual capacity (FRC) and reduction in inspiratory capacity (IC) was shown with arms above 90 degrees shoulder flexion when compared with both arms below 90 degrees shoulder flexion (mean increase in FRC (95% CI) was 0.17 L (0.06 to 0.27) for COPD and 0.29 L (0.11 to 0.47) for healthy subjects; mean reduction in IC (95% CI) was 0.24 L (0.1 to 0.38) for COPD and 0.45 L (0.22 to 0.68) for healthy subjects) and arms at 90 degrees shoulder flexion (mean increase in FRC (95% CI) was 0.15 L (0.01 to 0.29) for COPD and 0.22 L (0.11 to 0.34) for healthy subjects; mean reduction in IC (95% CI) was 0.14 L (0.01 to 0.26) for COPD and was 0.29 L (0.17 to 0.42) for healthy subjects). These changes may alter lung mechanics and, in COPD subjects, may affect their ability to perform arm exercise above shoulder height

Adult↗
PubMedDate not supplied

Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease.

Prior studies demonstrate the ability of upper extremity training to increase arm strength and endurance when incorporated into a pulmonary rehabilitation program. However, patients with severe chronic obstructive pulmonary disease (COPD) may have transportation or mobility problems that make it difficult to travel to a rehabilitation site to obtain this training. This pilot study was designed to determine whether a home-based, upper-arm exercise program could increase arm strength and endurance, and decrease perceptions of breathlessness and fatigue during five activities of daily living. Twenty patients with severe COPD (FEV1 0.80 +/- 0.42) were randomized to an experimental (n = 10) or control group (n = 10). The experimental-group training included three upper arm exercises five times a week for 8 weeks, with training level incremented during weekly home visits. Control-group subjects were contacted weekly to equalize attention from health care providers. During the upper-extremity endurance test for number of rings moved, no significant differences between groups were seen for interaction or treatment. However, there was a significant interaction between treatment and time for perceived fatigue (p = 0.0012), with the experimental group perceiving less fatigue during upper arm work than did the control group. No change was seen in perceived breathlessness. Findings of this study suggest that a home-based, upper-arm exercise program can reduce perceptions of fatigue for patients with severe COPD during activities involving upper arm work. Testing in a larger sample is indicated to determine whether this training can also improve ability to perform unsupported arm work.

Arm↗
PubMed1999

Does the oculo-manual co-ordination control system use an internal model of the arm dynamics?

The hypothesis that during self-moved target tracking, the eye-arm co-ordination control system uses an internal model of the arm dynamics was tested. The contribution of arm proprioception to this model was also assessed. Subjects (nine healthy adults and one deafferented subject) were requested to make forearm movements and visually track an arm-driven target. Unexpected changes in mechanical properties of the manipulandum were used to modify the dynamical conditions of arm movement. The smooth pursuit gain (SPG) was computed before and during the perturbation. Results showed a decrease of SPG during perturbation in control subjects only. We propose that an internal model of the arm dynamics may be used to co-ordinate eye and arm movements, and arm proprioception may contribute to this internal model.

Adult↗
PubMed2002

Oxygen uptake kinetics during high-intensity arm and leg exercise.

The purpose of the present study was to examine the oxygen uptake kinetics during heavy arm exercise using appropriate modelling techniques, and to compare the responses to those observed during heavy leg exercise at the same relative intensity. We hypothesised that any differences in the response might be related to differences in muscle fibre composition that are known to exist between the upper and lower body musculature. To test this, ten subjects completed several bouts of constant-load cycling and arm cranking exercise at 90% of the mode specific V(O(2)) peak. There was no difference in plasma [lactate] at the end of arm and leg exercise. The time constant of the fast component response was significantly longer in arm exercise compared to leg exercise (mean+/-S.D., 48+/-12 vs. 21+/-5 sec; P < 0.01), while the fast component gain was significantly greater in arm exercise (12.1+/-1.0 vs. 9.2+/-0.5 ml min(-1) W(-1); P < 0.01). The V(O(2)) slow component emerged later in arm exercise (126+/-27 vs. 95+/-20 sec; P < 0.01) and, in relative terms, increased more per unit time (5.5 vs. 4.4% min(-1); P < 0.01). These differences between arm crank and leg cycle exercise are consistent with a greater and/or earlier recruitment of type II muscle fibres during arm crank exercise.

Adult↗
PubMed2001

Effectiveness of arm supports during typing for adults with neurological disorders.

Four computer-typing accommodations were evaluated to determine if arm supports would enhance typing performance and/or comfort of adults with neurological disorders. Each of 12 adults (6 females and 6 males) participated in 7-min typing tasks under the following conditions: 1) without arm support, 2) Ergo Rest arm support, 3) custom arm support in fixed mode, and 4) custom arm support with movable mode. The objective dependent variables were speed, errors, and type of errors. The subjective dependent measures were reported body part discomfort, and arm support ratings. The data were found to be nonparametric in nature. Therefore, nonparametric techniques were employed to analyze the data. Only one of the objective dependent measures were statistically significant; Type of error (additional key). This result may be attributed to the wide range of disability manifestations among participants. Subjective dependent measures were found to be statistically significant, leading to the conclusion that typing with an arm support was more comfortable and easier than without an arm support.

Adult↗
PubMed2000

An upper arm model for simulated weightlessness.

This investigation examined the effects of 4 weeks of non-dominant arm unloading on the functional and structural characteristics of the triceps brachii muscle of six normo-active college-age males (age: 23 +/- 1 years, height: 176 +/- 4 cm, weight: 76 +/- 6 kg). The primary intention of this study was to determine if arm unloading is an effective analogue for simulating the effects of weightlessness on human skeletal muscle. Subjects were tested 2-3 days preceding unloading in a standard arm sling and following removal of the sling. The sling was worn during waking hours to unload the arm. Subjects were allowed to remove the sling during sleep and bathing. Torque production (Nm) during maximal isometric extension at 90 degrees significantly declined (P < 0.05) in response to unloading (53.93 +/- 5.07 to 47.90 +/- 5.92; 12%). There was no significant change (P > 0.05) in the force-velocity attributes of the triceps over the other measured velocities (1.05, 1.57, 2.09, 3.14, 4.19, 5.24 rad.s-1). Cross-sectional muscle area (CSA) of the upper arm was smaller (44.3 +/- 2.7 to 42.4 +/- 2.5 cm2; 4%) following 4 weeks of unloading (P < 0.05). Histochemical analysis of individual muscle fibres demonstrated reductions in fibre CSA of 27 and 18% for type I and type II fibres, respectively. However, these changes were not statistically significant. Electrophoretic analysis of muscle samples revealed a significant increase (40 +/- 7 to 58 +/- 4%, pre- and post-, respectively) in myosin heavy chain (MHC) type II isoforms following unloading. Reductions in type I MHC isoform composition failed to reach statistical significance (P < 0.08). Amplitude of the integrated electromyographic (IEMG) signal during maximal isometric contraction of the long head of the triceps decreased by 21% in response to the 4-week unloading period (P < 0.05). The changes in triceps, muscle structure and function found with arm unloading are similar in magnitude and direction to data obtained from humans following exposure to real and simulated weightlessness. These findings demonstrate that arm unloading produces some of the effects seen in response to weightlessness in muscles of the upper arm and provides potential for an additional model to simulate the effects of microgravity on human skeletal muscle.

Adult↗