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At least 775 records · Page 43Linked to original sources
PubMed1998

Recovery of arm function in patients with paresis after traumatic brain injury.

OBJECTIVE: To characterize the frequency of recovery of arm paresis in patients with traumatic brain injury (TBI) admitted to rehabilitation. DESIGN: Retrospective review identifying a cohort of patients with moderate or severe arm paresis after TBI followed at least 6 months postinjury. SETTING: Freestanding acute rehabilitation hospital TBI unit. PATIENTS AND METHODS: Forty-four patients with moderate to severe arm paresis were selected from 264 consecutive admissions and characterized by injury pathology subtype, injury severity (duration of unconsciousness [loss of consciousness, LOC] and posttraumatic amnesia [PTA]), age, and level of paresis according to Brunnstrom Stages of Recovery (BS 1 to 6). Patient groups with and without arm paresis were compared according to these variables (t tests and chi(2)). MAIN OUTCOME MEASURES: Recovery of arm paresis to isolated motor function (BS 5 or 6) and time to achieve recovery. Recovered and nonrecovered patients were compared (Mann-Whitney, t tests, and chi(2)) on injury severity, initial level of paresis, age, time to rehabilitation admission, and pathology subtype. Time to recovery was compared for patients at different levels of initial paresis, ranges of LOC, and pathology subtypes (Mann-Whitney and Kruskal-Wallis tests). RESULTS: Forty-four patients (17%) had moderate (BS 3 to 4) or severe (BS 1 to 2) paresis at rehabilitation admission. They were more severely injured than nonparetic patients based on longer LOC (p < .002) and PTA (p < .009). Thirty-six patients (82%) recovered by 6 months; 72% of these recovered by 2 months. If still paretic at 2 months, only 56% recovered. Mean recovery time was 6.9 weeks (SD, 6.1) from injury. Time to recovery was best predicted by initial level of paresis and injury severity (r2 = .48), but not age. Patients with diffuse injury tended towards a more protracted recovery (7.9 weeks, SD 6.5) than patients with focal injury (4.2 weeks, SD 3.9) (p = .08) and only those with diffuse injury showed further recovery after 3 months. CONCLUSIONS: Arm paresis after TBI is relatively infrequent. Most patients recover by 2 months but later recovery is possible, especially in patients with primarily diffuse brain damage. Recovery is highly related to initial impairment, injury severity, and distribution of brain injury.

Adolescent↗
PubMed2006

Observation of arm behaviour in healthy elderly people: implications for contracture prevention after stroke.

The purpose of this study was to observe normal arm movement in healthy older adults to determine the duration, frequency, and purpose of arm elevation and external rotation to guide clinical practice in the prevention of contracture. An observational study was undertaken in the homes and local community of 21 older people mean age 73 (SD 7) years. Participants' arm movements were observed for a median time of 254 (IQR 85) min during the day. The duration (min/hr) and frequency (movements/hr) which the arm spent in positions of 45 degrees to 90 degrees elevation, > 90 degrees elevation, and external rotation, as well as the purpose (manipulating, holding, reaching, pulling/pushing, or gesturing) for which these positions were adopted, were recorded. Participants' arms spent little time (3.6 min/hr) at 45 to 90 degrees elevation and almost no time (0.6 min/hr) at > 90 degrees elevation or external rotation (0.6 min/hr). Participants' arms moved to > 90 degrees elevation 13 times/hr and into external rotation 18 times/hr. Participants moved momentarily to elevation > 45 degrees and external rotation in order to reach for objects, while holding objects was the primary reason for maintaining positions for > 2 s. It may be possible to minimise the incidence of shoulder contracture in those patients with stroke who have regained some shoulder muscle activity by placing at-risk muscles in lengthened positions while replicating these features of everyday activities.

Activities of Daily Living↗
PubMed1999

Arm raising in humans under loaded vs. unloaded and bipedal vs. unipedal conditions.

The aim of the present experiment was to study the central organization of equilibrium control during arm raising in the frontal plane. Nine adult subjects (five seniors and four young adults) were asked to raise their right arm to a horizontal position in the frontal plane in two support conditions (bipedal vs. unipedal) and two load conditions (unloaded vs. a 3.5-kg load added on the moving hand). No instructions were given concerning the movement speed. The movements were performed at about half the maximum speed achievable under reaction time conditions. The final lateral center of mass (CM) position 1 s after the movement offset, and the time course of the CM shift during the movement were studied in the four experimental conditions, using a CM compensation index. The electromyographic (EMG) pattern of the main muscles involved in the movement performance and in the postural control were studied in three out of nine subjects during movements performed at two velocities (at the preferred speed and as fast as possible). The results indicate that (1) the CM shift remains minimized in the frontal plane during the time course of the arm movement and during the final stabilization of the arm regardless of the stance and load conditions; (2) the time course of the CM compensation index remains stable during the first 400 ms after the movement onset, decreasing late in the movement and increasing again at the end of the stabilization stage. A modelisation suggests that the time course is the result of the interaction of two controls: a first one, putative feedforward, starting early and decreasing with time and a second one, putative feedback, starting late in the movement and increasing with time; (3) both early and late index values are influenced by the support and load conditions, the highest index values being observed during unipedal stance and load conditions; (4) activation of quadratus lomborum (QL) contralateral to the raising arm is time locked with the deltoidus activation of the raising arm in both fast and slow movements: this contralateral QL activation corresponds to an anticipatory postural adjustment (APA) aimed at minimizing the CM shift.

Adult↗
PubMed2002

A real-time EMG-driven virtual arm.

An EMG-driven virtual arm is being developed in our laboratories for the purposes of studying neuromuscular control of arm movements. The virtual arm incorporates the major muscles spanning the elbow joint and is used to estimate tension developed by individual muscles based on recorded electromyograms (EMGs). It is able to estimate joint moments and the corresponding virtual movements, which are displayed in real-time on a computer screen. In addition, the virtual arm offers artificial control over a variety of physiological and environmental conditions. The virtual arm can be used to examine how the neuromuscular system compensates for the partial or total loss of a muscle's ability to generate force as might result from trauma or pathology. The purpose of this paper is to describe the design objectives, fundamental components and implementation of our real-time, EMG-driven virtual arm.

Arm↗
PubMed2001

Shoulder joint movement of the non-throwing arm during baseball pitch--comparison between skilled and unskilled pitchers.

The shoulder of a non-throwing arm during a baseball pitch must be in a constant position while the shoulder of the throwing arm moves in a nearly circular path around it. However, it has not been investigated whether a skilled pitch requires less shoulder-joint movement. It was hypothesized that pitchers with less shoulder movement of the non-throwing arm can be considered to have higher skill and to attain higher initial ball velocity. Nine baseball pitchers were used as subjects. The coach classified them into a skilled and an unskilled group. The pitching motions were recorded using two high-speed cameras. The time series of three-dimensional landmark coordinates of the shoulder joint of the non-throwing arm during the baseball pitch were calculated using the direct linear transformation method. The shoulder-joint movement (SJM) index, which expresses the movement (displacement) of the shoulder joint of the non-throwing arm quantitatively, was proposed to compare the SJM at different skill levels and investigate the relationship between SJM and initial ball velocity. The SJM of the skilled pitchers was smaller than that of the unskilled pitchers, and the smaller value of the SJM led to faster initial ball velocity. The data suggest that the less SJM of the non-throwing arm is required to attain a skilled pitch and higher initial ball velocity.

Adult↗
PubMed2003

Closed-loop multivariable system identification for the characterization of the dynamic arm compliance using continuous force disturbances: a model study.

This study presents a new multivariable closed-loop identification technique for estimating the dynamic compliance of the multijoint human arm during posture maintenance. The method is designed for the application of continuous force disturbances that facilitate interaction of the limb with the environment. The dynamic compliance of the arm arises from different physiological mechanisms and is important for maintaining stable postures and to suppress disturbances. Estimates can be useful to analyze the ability of the nervous system to adapt the arm compliance to different types of disturbances and environments. The technique is linear and requires no a priori knowledge of the system. Linear system behavior is justified for posture tasks where the hand position deviates slightly from a reference position. Interaction results in a closed-loop configuration of arm and environment. The problem with previous methods is the restriction to open-loop systems. With the current technique, the dynamic arm compliance is separately estimated from the closed-loop. The accuracy of the identification technique is tested by simulations for different values of the dynamic compliance of the arm and environment and for different methodological parameters. It is concluded that the identification technique is accurate, even for short observation periods and severe noise.

Arm↗
PubMed2001

An in vivo technique for determining 3D muscular moment arms in different joint positions and during muscular activation - application to the supraspinatus.

OBJECTIVE: To develop a 3D in vivo technique for determining the moment arm and insertion angle of muscles in different joint positions and under muscular activity. DESIGN: An open magnetic resonance imaging system and 3D processing techniques were used for determining the moment arm and insertion angle of the supraspinatus in healthy volunteers. BACKGROUND: Muscular moment arms are important parameters for the computation of joint forces, however, so far in vivo measurements have not considered the influence of muscle activity and were restricted to two dimensions. METHODS: 10 healthy shoulders were investigated in 30-150 degrees abduction with and without abducting muscular activity, using an open magnetic resonance imaging. The minimal distance between the midpoint of the humeral head and the line of action of the supraspinatus was determined in 3D. The insertion angle was derived by calculating the angle between the humerus and the supraspinatus. RESULTS: During elevation a significant (P < 0.001) increase of the supraspinatus moment arm was observed (19.9 mm (SD, 2.3 mm) at 30 degrees; 23.3 mm (SD, 2.5 mm) at 150 degrees ), being significantly larger at 90 degrees and 120 degrees under muscle activity. The insertion angle also increased significantly during elevation (P < 0.001), the values becoming larger under muscle activity at 60 degrees (P < 0.01) and at 90 degrees (P < 0.05). CONCLUSIONS: This 3D technique permits to determine the moment arm and insertion angle of muscles in vivo not only in various joint positions but also under in vivo muscle activity. For the supraspinatus, we observed a constant increase of both parameters during arm abduction. RELEVANCE: The technique and these data can be used for improved computation of joint forces in biomechanical model, and for precise diagnostics in patients with altered scapulohumeral motion patterns.

Adult↗
PubMed1999

Identification of optimal strategies for increasing whole arm strength using Karush-Kuhn-Tucker multipliers.

OBJECTIVE: The purpose of this study was to develop a computer model for identifying muscles critical to improving functional upper extremity strength. DESIGN: A three-dimensional biomechanical model of the upper extremity was developed, and the predictions were compared to maximal arm strength data collected from healthy volunteers. BACKGROUND: Although several optimization-based mathematical models of the shoulder have been developed, none have utilized the mathematical properties of the Karush-Kuhn-Tucker multipliers to efficiently estimate the effect of strengthening individual muscles on functional strength of the whole arm. METHODS: A static three-dimensional biomechanical model of the glenohumeral, radio-humeral, ulno-humeral and wrist joints was developed for predicting maximal hand exertion forces. The model was formulated as a linear program. Constraints consisted of moment equilibrium conditions and limits on maximum and minimum allowable muscle forces. Predicted arm strengths were compared to maximal pull strength measurements made on 10 subjects (5 male; 5 female). The task involved pulling toward the mid-sagittal plane of the body with the arm flexed 45 degrees. The Karush-Kuhn-Tucker variables associated with the maximal limits on muscle force were computed to estimate the effect of altering the strength of individual muscles on functional arm strength. RESULTS: Maximum pull strengths were predicted well by the model. Karush-Kuhn-Tucker values ranged from 0 (for muscles not at their upper force limits) to 0.11 for the flexor carpi radialis and pectoralis major muscles. Karush-Kuhn-Tucker multipliers were found to be insensitive to the assumed specific tension of muscle. CONCLUSIONS: Upper extremity strength can be predicted from musculoskeletal geometry and physiology using linear programming. RELEVANCE: Karush-Kuhn-Tucker multipliers associated with the muscle force upper limits give insight into the effect of strengthening individual muscles on whole arm exertion strength. Such an analysis may provide insight into the development of optimal rehabilitation protocols.

Adult↗
PubMed1997

Trajectory formation of the center-of-mass of the arm during reaching movements.

We attempted to identify the invariant kinematic properties of multijoint arm reaching movements in the horizontal plane to explore the planning variable(s) involved in their coordination. Different targets were placed near the perimeter of the workspace boundary, thereby causing variation of size and orientation of the hand stroke. We have a special interest in the trajectory characteristics of the most massive point within the arm system, the center-of-mass of the entire arm system, in addition to those of the hand or joints. The motion of the individual segments (the forearm plus hand and the upper arm) or joints (shoulder and elbow) was modulated in a different way depending on the tasks; thus, there was no invariance in the relationships between paired variables (displacement or velocity) for segment or joint motions. For relatively short hand strokes, the trajectory of the hand and the center-of-mass of the entire arm system were characterized by a nearly straight path, and a smooth, bell-shaped velocity curve along the path, symmetrical about the mid-portion of the movement, starting from nearly zero, growing to a single peak and declining again to nearly zero. However, in large hand strokes the hand path was highly curved and the velocity curve was asymmetric. Although the path of the center-of-mass of the entire arm system also tended to be curved with the increase of the hand stroke, a bell-shaped velocity curve along the path and its typical symmetry were preserved over a wide range of stroke sizes and orientations, and its peak was scaled in proportion to movement distance and movement time. Our findings indicate that it is not valid to postulate solely the joint- or hand-based planning strategies which have been proposed previously. Rather, the planning of the spatial aspects of the motion is largely dependent on the interaction of multiple variables, including those not analysed in this study. The bell-shaped pattern of the center-of-mass velocity profile represents a certain efficiency of movement, since it corresponds to a single accelerative and a decelerative phase of a mass over the movement, with no intermediate force reversals. The simple structure of the center-of-mass velocity profiles may reflect a fundamental organization principle underlying the temporal aspects of movement planning.

Adult↗
PubMed1999

Newborns spontaneous arm movements are influenced by the environment.

The spontaneous arm movements of 28 healthy full-term newborn infants were observed for 1 min in four different environmental conditions: each infant was placed in a vertical position in a bathtub filled with water with the water level up to her or his neck in a vertical position in water with the water level up to her or his waist in a supine position out of the water in a vertical position out of the water. It was hypothesised that these different environmental constraints would influence the infants spontaneous activity. From video recordings spontaneous arm movements were categorised according to the classifications of Hannan (Hannan TE. Young infant's hand and finger expressions: An analysis of category reliability. In: Field T, Fogel A, editors. Emotion and Early Interaction. New Jersey: Elbaum 1982;253-265). The statistical analyses showed, firstly, that the frequency of occurrence of various arm movements is greater out of the water than in the water. Secondly, for those out of the water the frequency of occurrence of various arm movements is greater in the vertical position in comparison to the supine position. Thirdly, the infants showed more active arm movements (more upward movements) in the vertical position out of the water in comparison to the two water and supine conditions. These findings lead to the conclusion that different environmental constraints influenced the spontaneous arm movements.

Arm↗
PubMed2003

Salvaging prosthetic dialysis fistulas with stents: forearm versus upper arm grafts.

OBJECTIVE: We compared results of angioplasty with those of concomitant stent placement to treat thrombosed forearm hemodialysis grafts with results for upper arm grafts. MATERIAL AND METHODS: Between October 1998 and July 2002, stents were deployed in 61 patients undergoing balloon angioplasty because of venous anastomotic stenosis causing graft thrombosis. Stents were used only in cases of inadequate angioplasty results. Twenty-three forearm grafts and 38 upper arm grafts were treated. All procedures were performed in an endovascular operating suite, with fistulography. Primary and secondary patency rates were analyzed and compared for graft location with the life table method. RESULTS: Grafts had undergone a mean of 1.56 previous revisions because of thrombosis (forearm: 1.52, upper arm: 1.58; P = NS). Excluding early thrombosis, a single graft infection was the only procedural complication. Cumulative primary patency rate at 3, 6, and 12 months (from stent placement) was 36.4%, 15.6%, and 0%, respectively, for forearm grafts, which was inferior to the 59.5%, 34.0%, and 17.0% primary patency rate observed for upper arm grafts (P =.0307) Secondary patency rate was 40.9%, 40.9%, and 30.7%, respectively, for forearm grafts, and 64.9%, 42.3%, and 19.7% for upper arm grafts (P = NS). CONCLUSION: Stent deployment can salvage thrombosed dialysis grafts. However, sustained patency occurs infrequently, with better results for upper arm grafts than for forearm grafts. Inasmuch as surgical revision of forearm grafts is usually straightforward, stenting should be reserved for use in high axillary grafts and other sites where surgical repair is difficult.

Adult↗
PubMedDate not supplied

Influence of arm positioning on rest/stress technetium-99m labeled sestamibi tomographic myocardial perfusion imaging.

BACKGROUND: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinely performed with patients' arms positioned above their heads to avoid potential attenuation artifact and reduced image quality. Currently no data are available to support the use of this practice using 99mTc SPECT MPI: METHODS AND RESULTS: Forty-one patients referred for routine rest/stress MPI were imaged using the standard protocol with arms positioned above their heads and again with their arms at their sides. The patients were injected with 10 to 45 mCi (370 to 1665 MBq) of 99mTc-labeled sestamibi (99mTc-sestamibi), and SPECT images were acquired 30 to 90 minutes later. Thirty patients were imaged on an ADAC Vertex dual-head camera and 11 patients on an ADAC Cirrus single-head camera. Images were interpreted by 3 nuclear cardiologists without knowledge of patient identity, arm position, or camera type using a 17-segment scoring model. No significant differences were noted in the percentage of abnormal study results, reversibility extent, or location of MPI defects between the 2 arm positions in the same patients. Image quality was also similar. CONCLUSION: Arm positioning does not influence the interpretation of 99mTc-sestamibi SPECT myocardial perfusion imaging with regard to image quality or defect location and extent.

Adult↗
PubMed2001

The validation of a quality of life scale to assess the impact of arm morbidity in breast cancer patients post-operatively.

This paper documents the validation of a quality of life scale (QOL) designed to assess the impact of arm morbidity on patients following breast cancer surgery. A four item arm subscale was developed to supplement a multi-dimensional, validated breast cancer QOL tool, the functional assessment of cancer therapy (FACT-B.) The new questionnaire, the FACT-B + 4, was validated on 279 women participating in a trial of sentinel node guided axillary therapy and 29 women attending a lymphoedema clinic. The subscale demonstrated good internal consistency (alpha co-efficient = 0.62 to 0.88) and stability (test-retest reliability = 0.97). Lymphoedema patients reported significantly greater arm problems than a matched sample of pre-operative trial participants. The lymphoedema group also scored lower than trial patients on the FACT-B + 4 indicating a poorer quality of life (p < 0.05). A subset of 66 trial patients who had completed three consecutive assessments was used to evaluate the sensitivity of the questionnaire to change over time. Scores on the FACT-B + 4 were found to decline significantly between the pre-operative assessment and post-operative assessment at 1 month. Arm problems significantly increased during this period. FACT-B + 4 score increased again from 1 month to 12 weeks post-surgery and symptoms reduced, as the extent of arm morbidity resolved. The FACT-B + 4 appears to be psychometrically robust and sensitive to patient rehabilitation, making it suitable for use in longitudinal surgical trials. Given the dearth of existing scales available to measure arm morbidity, we hope this new tool will prove useful to researchers.

Adult↗
PubMed2000

Peak and kinetic cardiorespiratory responses during arm and leg exercise in patients with spinal cord injury.

STUDY DESIGN: A paired comparison of the peak and submaximal responses of oxygen uptake and heart rate in patients with spinal cord injury (SCI) performing voluntary arm cycle exercise and functional electrical stimulation (FES) leg cycling exercise. OBJECTIVES: To test if the blunted heart rate response and slower rate of adjustment of oxygen uptake seen in patients with SCI performing FES leg cycle exercise are also characteristic of arm exercise in these patients. METHODS: Eight paraplegics performed incremental and constant work rate (CWR) exercise with the legs and arms. Mean response times (MRT) for Vo2 during exercise (on) and in recovery (off) were calculated from the breath-by-breath Vo2 profile. RESULTS: Peak heart rate was higher during incremental arm exercise, and uncorrelated with that observed during incremental FES leg cycling. For the same increase in Vo2, constant work rate arm exercise was associated with faster (and normal) Vo2 kinetics, greater increase in heart rate, and lower end-exercise blood lactate, compared to FES leg cycling. CONCLUSIONS: The consistently higher peak heart rate and Vo2, and faster Vo2 kinetics, for voluntary arm compared to FES leg cycle exercise suggest no intrinsic dysfunction of heart rate control in these paraplegics. Rather, these data suggest that during FES leg cycling the changes seen are due to some characteristic specific to the injury, such as reduced muscle mass and/or deconditioning of the remaining muscle. SPONSORSHIP: This research was supported by The Department of Veterans Affairs, Rehabilitation Research and Development Project #B603-RA. Spinal Cord (2000) 38, 340 - 345.

Adult↗
PubMed1996

Differences in mouth occlusion pressure and breathing pattern between arm and leg incremental exercise.

The aim of the study was to compare breathing pattern, mouth occlusion pressure, mean inspiratory flow and the ratio of mouth occlusion pressure to mean inspiratory flow at the same power output and carbon dioxide output during arm and leg incremental exercise. Mouth occlusion pressure was used as an index of inspiratory neuromuscular activity and its ratio to mean inspiratory flow as an index of the 'effective' impedance of the respiratory system. Eight normal subjects performed two incremental exercise tests, one with arms, the other with legs, on different weeks and in randomized order, and on two identical cycle ergometers. The power output was increased by steps of 25 W for arms and 50 W for legs every 4 min until exhaustion. At the same power output, oxygen consumption, carbon dioxide output, ventilation, mean inspiratory flow, mouth occlusion pressure, 'effective' impedance (P < 0.001) and respiratory frequency (P < 0.01) were higher during arm exercise than during leg exercise, whereas inspiratory time (P < 0.05) and expiratory time (P < 0.01) were lower. At the same carbon dioxide output, mouth occlusion pressure, ventilation, 'effective' impedance (P < 0.001) and respiratory frequency (P < 0.01) were higher and expiratory time (P < 0.05) was lower during arm exercise. In conclusion, the higher inspiratory neuromuscular activity and impedance of the respiratory system during arm exercise and the differences observed in ventilation and breathing pattern at equal carbon dioxide output seem related to the differences in exercising muscle afferents and the presence of an increased load due to contraction of rib cage muscles to stabilize posture.

Adult↗
PubMed1998

Reporting of 'hypotension' after epidural analgesia during labour. Effect of choice of arm and timing of baseline readings.

We studied 20 women in labour to see how reporting 'hypotension' after obstetric epidural analgesia is affected by position of the blood pressure cuff and baseline definition. Blood pressure was recorded from both arms simultaneously while the woman was semirecumbent and then in the left lateral position. Three readings were then taken after epidural bupivacaine, one left lateral and the remainder right lateral. Before the epidural, blood pressure in the dependent arm in the lateral position was similar to blood pressure in either arm in the semirecumbent position and an average of 10 mmHg (systolic) and 14 mmHg (diastolic) higher than blood pressure in the uppermost arm (p < or = 0.00005). This difference persisted in both lateral positions as epidural analgesia became established. Choosing different definitions of hypotension, baselines and arm to measure blood pressure resulted in 'hypotension rates' between 0% and 75%. For blood pressure measurement in the lateral position, the blood pressure cuff should be placed on the dependent arm.

Analgesia, Epidural↗
PubMed1999

The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body.

A study of melanocytic naevi was carried out in southern Spain to examine the relationship between numbers of naevi at different body sites as predictors of whole-body naevus count and to determine whether the naevus count on the arms is valid for identifying the risk factors for total naevi. Subjects were the control group from a case-control study on risk factors for cutaneous melanoma. They were selected from visitors to the University of Granada Hospital (southern Spain) between 1989 and 1993. Of 200 people invited to participate, 146 accepted (73%). Data were collected by personal interview, and melanocytic naevi were counted over the entire body surface by clinical skin examination performed by one dermatologist. Partial correlation coefficients (R) estimated by multiple linear regression were calculated. Comparisons between whole-body naevi and naevi on the arms, and their relationship with risk factors, were assessed by analysis of variance and covariance. Arms in men (adjusted R = 0.88) and thighs in women (adjusted R = 0.82) were the best predictors of total naevi after adjusting for age and sun exposure. Age, occupational and leisure sun exposure, and sunburns showed significant correlations with the total number of naevi. Similar results were found for the naevus count on the arms. In conclusion, the prediction of whole-body numbers of naevi by a naevus count on specific sites differs between men and women: arms in men and thighs in women are the best predictors. Nevertheless, naevus counts on the arms allowed us to study the risk factors for total naevi as well as whole-body naevus count: age and occupational sun exposure were the strongest determinants.

Adult↗
PubMedDate not supplied

Swelling, numbness, pain, and their relationship to arm function among breast cancer survivors: a disablement process model perspective.

The disablement process model proposed by Nagi in 1965 and subsequently expanded by Verbrugge and Jette was used heuristically to study the relationships among morbidities and arm/shoulder function limitations that breast cancer survivors experience in the period following treatment. A telephone survey was administered to 148 patients (67%) from among 222 breast cancer survivors who had undergone surgery in 1997 and 1998. Sixty-three percent of respondents reported experiencing some numbness, while 35% noticed swelling. Between 13% and 15% reported moderate to severe pain. Similar proportions said the occurrence of pain ranged from intermittent to constant. Between 1% and 4% reported problems with shoulder abduction and flexion and a decrease in arm strength and daily use of the arm. Swellings in the torso and arm tended to cluster into two different factors. Numbness followed a similar pattern. Apart from numbness in the arm, all the other factors had strong significant associations with one another. In multiple regression analyses, current pain intensity and swelling in the arm were independently related to current functional status of the arm/shoulder. The results suggest that it may be feasible to use patients' self-reports to develop a simple lymphedema-specific tool to monitor the functional status of women living with or at risk for lymphedema. Such a tool, if properly designed and implemented, would allow for the timely introduction of lymphedema or pain management strategies to improve arm function and ultimately the quality of life of breast cancer survivors.

Activities of Daily Living↗