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Skin sensitivity of the arm.

One hundred and sixty seven operating theatre personnel familiar with the practice of venous cannulation were asked to rank (in increasing order from one to five, corresponding to least to most painful) their opinion of the pain which they considered might accompany venous cannulation of each of five vein sites on the upper limb (dorsum of arm, dorsum of hand, cephalic, ventrum of arm and cubital fossa) which may be selected for this purpose. The skin sensitivity of each of the test sites of each volunteer was then assessed with a test device comprising a Tuohy needle and clamp, which together weighed 75.02 g. Following random application of the device to each of the test sites, the volunteer was asked to rank (in increasing order from one to five, corresponding to least to most painful) the actual pain felt. Analysis of pain expectations showed that there was no significant consensus view as to which site would be most tender. Following application of the test device the tenderness of the five sites was ranked (i) according to frequencies; dorsum of arm < dorsum of hand < cephalic < ventrum of arm < cubital fossa and, (ii) following statistical analysis: dorsum of arm = dorsum of hand = cephalic < ventrum of arm < cubital fossa. There was no correlation between expected and actual skin sensitivities. Knowledge of the different skin sensitivities of the upper limb may be useful when selecting a vein for venepuncture or the insertion of an indwelling venous catheter.

Adult↗

A comparison of the mid-arm circumference/head circumference ratio and ponderal index for the evaluation of newborn infants after abnormal intrauterine growth.

We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p = 0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p less than 0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.

Arm↗

Central and regional circulatory effects of adding arm exercise to leg exercise.

7 young, healthy, male subjects performed exercise on bicycle ergometers in two 20 min periods with an interval of 1 h. The first 10 min of each 20 min period consisted of arm exercise (38--62% of Vo2 max for arm exercise) or leg exercise (58--78% of Vo2 max for leg exercise). During the last 10 min the subjects performed combined arm and leg exercise (71--83% of Vo2 max for this type of exercise). The following variables were measured during each type of exercise: oxygen uptake, heart rate, mean arterial blood pressure, cardiac output, leg blood flow (only during leg exercise and combined exercise), arterio-venous concentration differences for O2 and lactate at the levels of the axillary and the external iliac vessels. Superimposing a sufficiently strenuous arm exercise (oxygen uptake for arm exercise greater than 40% of oxygen uptake for combined exercise) on leg exercise caused a reduction in blood flow and oxygen uptake in the exercising legs with unchanged mean arterial blood pressure. Superimposing leg exercise on arm exercise caused a decrease in mean arterial blood pressure and an increased axillary arterio-venous oxygen difference. These findings indicate that the oxygen supply to one large group of exercising muscles may be limited by vasoconstriction or by a fall in arterial pressure, when another large group of muscles is exercising simultaneously.

Adult↗

Ventilatory responses during arm and leg exercise at varying speeds and forces in untrained female humans.

1. Involvement of neural stimuli, central and/or peripheral in origin, in exercise ventilatory control was ascertained by examining the ventilatory responses to varying mechanical conditions of arm and leg cycle ergometries. Twelve untrained women underwent each of two modes of exercise at three levels of loading (0, 5 and 10 N), each at three levels of speed (30, 50 and 72 r.p.m.), during which steady-state values of minute ventilation (VE), tidal volume (VT), respiratory frequency (f) and CO2 excretion (VCO2) were measured. 2. Using the data obtained at the aerobic work intensities, the relationship of ventilatory responses (VE, VT and f) to the metabolic (VCO2) and mechanical (speed and load) variables were studied by multiple linear regression analysis. Coefficient of determination (r2) of the regression model was lowest (0.84) for f in the arm exercise and highest (0.99) for VE in the leg exercise. 3. Standardized partial regression coefficients of the model indicated that VE response is related to VCO2 at the rate of 94 +/- 3% (mean +/- S.E.M.) and to the pedal rate at 8 +/- 3% during the leg exercise, while it is closely related to VCO2 in the arm exercise. For f response, influence of the rate of limb movement was seen in the leg exercise but not in the arm exercise. The different effects of the rate of limb movement between the two exercise modes may be related to familiarity with the exercise modes, suggesting that a familiarity-related mechanism is involved in exercise ventilatory control. 4. A heavier load imposed on the limb muscles elicited a greater VT both in the arm and leg exercise and a lower f in the arm exercise. Postural control in the upper torso during increased limb muscle tension seems to affect VT and f.

Adult↗

Haemoglobin saturation during incremental arm and leg exercise.

There are few reports concerning the alterations in the percent of haemoglobin saturated with oxygen (%SO2) during non-steady state incremental exercise. Further, no data exist to describe the %SO2 changes during arm exercise. Therefore, the purpose of this study was made to assess the dynamic changes in %SO2 during incremental arm and leg work. Nine trained subjects (7 males and 2 females) performed incremental arm and leg exercise to exhaustion on an arm crank ergometer and a cycle ergometer, respectively. Ventilation and gas exchange measurements were obtained minute by minute via open circuit spirometry and changes in %SO2 were recorded via an ear oximeter. No significant difference (p greater than 0.05) existed between arm and leg work in end-tidal oxygen (PETO2), end-tidal carbon dioxide (PETCO2), or %SO2 when compared as a function of percent VO2 max. These results provide evidence that arterial O2 desaturation occurs in a similar fashion in both incremental arm and leg work with the greatest changes in %SO2 occurring at work rates greater than 70% VO2 max.

Arm↗

Mid-arm and chest circumferences at birth as predictors of low birth weight and neonatal mortality in the community.

In developing countries, where about three quarters of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. A study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight and those at risk. A study of 520 hospital births showed a strong correlation (p less than 0.001) between other anthropometric variables and birth weight, but the correlation was maximum for chest circumference (r = 0.8696) and mid-arm circumference (r = 0.8110). A mid-arm circumference of less than or equal to 8.7 cm and a chest circumference of less than or equal to 30 cm had the best sensitivity and specificity for identifying neonates with a birth weight of 2500 g or less. Measurements on 501 consecutive live births in the community were recorded and the infants followed up at specified ages. Mid-arm circumference was again significantly correlated to birth weight (r = 0.6918). Neonatal mortality showed an inverse relation but postneonatal mortality an inconsistent relation with mid-arm circumference. A mid-arm circumference of less than or equal to 8.7 cm and a birth weight of less than or equal to 2500 g were equally useful in predicting neonatal outcome. Mid-arm and chest circumferences are simple, practicable, quick, and reliable indicators for predicting low birth weight and neonatal outcome in the community and can be easily measured by paramedical workers in developing nations.

Abdomen↗

Comparison of arm and leg ergometry in patients with moderate chronic obstructive lung disease.

Exercise testing is traditionally performed with leg exercise on either a treadmill or a bicycle ergometer. Many of these tests are terminated before dyspnoea occurs because of leg fatigue, arthritic pain, or claudication. A study was carried out to determine whether arm ergometry testing might serve as an alternative method to leg testing in eight patients with chronic obstructive lung disease. The patients had mild to moderate dyspnoea on exertion and required bronchodilator treatment. They had smoked an average of 62 pack years and had a mean FEV1 of 1.88 l. Arm and leg ergometry yielded similar levels of maximum ventilation (arm 47.2, leg 48.6 l/min), maximum heart rates (126 v 124 beats/min), maximum tidal volume (1.5 v 1.6 l), and respiratory rate (30 v 29 breaths/min); but maximum oxygen consumption (1120 v 966 ml/min), maximum power output (62 v 26 w), and oxygen pulse (9.1 v 7.8 ml/beat) were all higher with leg than with arm ergometry. In addition, ventilation and heart rate at a given level of oxygen consumption were higher for arm than for leg work during both submaximal and maximal exercise. It is concluded that arm ergometry offers an alternative testing method to leg testing in patients with moderate chronic obstructive lung disease.

Arm↗

Possible contributions of CPG activity to the control of rhythmic human arm movement.

There is extensive modulation of cutaneous and H-reflexes during rhythmic leg movement in humans. Mechanisms controlling reflex modulation (e.g., phase- and task-dependent modulation, and reflex reversal) during leg movements have been ascribed to the activity of spinal central pattern generating (CPG) networks and peripheral feedback. Our working hypothesis has been that neural mechanisms (i.e., CPGs) controlling rhythmic movement are conserved between the human lumbar and cervical spinal cord. Thus reflex modulation during rhythmic arm movement should be similar to that for rhythmic leg movement. This hypothesis has been tested by studying the regulation of reflexes in arm muscles during rhythmic arm cycling and treadmill walking. This paper reviews recent studies that have revealed that reflexes in arm muscles show modulation within the movement cycle (e.g., phase-dependency and reflex reversal) and between static and rhythmic motor tasks (e.g., task-dependency). It is concluded that reflexes are modulated similarly during rhythmic movement of the upper and lower limbs, suggesting similar motor control mechanisms. One notable exception to this pattern is a failure of contralateral arm movement to modulate reflex amplitude, which contrasts directly with observations from the leg. Overall, the data support the hypothesis that CPG activity contributes to the neural control of rhythmic arm movement.

Arm↗

Comparison of arm versus leg work in induction of acute episodes of asthma.

The severity of exercise-induced asthma varies with the type of exercise performed. To determine whether such variation could be attributed to the use of different muscle groups, we exercised arms separately from legs using a bicycle ergometer. First, arms were exercised to exhaustion, then legs were exercised at the same load for the same duration. Arm work resulted in greater ventilation, heart rate, hydrogen ion concentration, and airway obstruction than did leg work. Later, legs were exercised to exhaustion using a load more than twice that of the arm work. Both the exhausting leg work and exhausting arm work resulted in significant bronchospasm and acidosis, whereas the nonexhausting leg work did not. These data suggest that, in arm and/or leg exercise, the relationship of work load to muscle mass is a determinant of airway obstruction.

Adult↗

Enhancement of arm exercise endurance capacity with dihydroxyacetone and pyruvate.

The effects of dietary supplementation of dihydroxyacetone and pyruvate (DHAP) on endurance capacity and metabolic responses during arm exercise were determined in 10 untrained males (20-26 yr). Subjects performed arm ergometer exercise (60% peak O2 consumption) to exhaustion after consumption of standard diets (55% carbohydrate, 15% protein, 30% fat; 35 kcal/kg) containing either 100 g of Polycose (placebo, P) or DHAP (3:1, treatment) substituted for a portion of carbohydrate. The two diets were administered in a random order, and each was consumed for a 7-day period. Biopsy of the triceps muscle was obtained immediately before and after exercise. Blood samples were drawn through radial artery and axillary vein catheters at rest, after 60 min of exercise, and at exercise termination. Arm endurance was 133 +/- 20 min after P and 160 +/- 22 min after DHAP (P less than 0.01). Triceps glycogen at rest was 88 +/- 8 (P) and 130 +/- 19 mmol/kg (DHAP) (P less than 0.05). Whole arm arteriovenous glucose difference (mmol/l) was greater (P less than 0.05) for DHAP than P at rest (0.60 +/- 0.12 vs. 0.05 +/- 0.09) and after 60 min of exercise (1.00 +/- 0.12 vs. 0.36 +/- 0.11), but it did not differ at exhaustion. Neither respiratory exchange ratio nor respiratory quotient differed between trials at rest, after 60 min of exercise, or at exhaustion. Plasma free fatty acid, glycerol, beta-hydroxybutyrate, catecholamines, and insulin were similar during rest and exercise for both diets. Feeding DHAP for 7 days increased arm muscle glucose extraction before and during exercise, thereby enhancing submaximal arm endurance capacity.

Adult↗

Left ventricular function during arm exercise: influence of leg cycling and lower body positive pressure.

The purpose of this study was to characterize left ventricular (LV) diastolic filling and systolic performance during graded arm exercise and to examine the effects of lower body positive pressure (LBPP) or concomitant leg exercise as means to enhance LV preload in aerobically trained individuals. Subjects were eight men with a mean age (+/-SE) of 26.8 +/- 1.2 yr. Peak exercise testing was first performed for both legs [maximal oxygen uptake (Vo(2)) = 4.21 +/- 0.19 l/min] and arms (2.56 +/- 0.16 l/min). On a separate occasion, LV filling and ejection parameters were acquired using non-imaging scintography using in vivo red blood cell labeling with technetium 99(m) first during leg exercise performed in succession for 2 min at increasing grades to peak effort. Graded arm exercise (at 30, 60, 80, and 100% peak Vo(2)) was performed during three randomly assigned conditions: control (no intervention), with concurrent leg cycling (at a constant 15% leg maximal Vo(2)) or with 60 mmHg of LBPP using an Anti G suit. Peak leg exercise LV ejection fraction was higher than arm exercise (60.9 +/- 1.7% vs. 55.9 +/- 2.7%; P < 0.05) as was peak LV end-diastolic volume was reported as % of resting value (110.3 +/- 4.4% vs. 97 +/- 3.7%; P < 0.05) and peak filling rate (end-diastolic volume/s; 6.4 +/- 0.28% vs. 5.2 +/- 0.25%). Concomitant use of either low-intensity leg exercise or LBPP during arm exercise failed to significantly increase LV filling or ejection parameters. These observations suggest that perturbations in preload fail to overcome the inherent hemodynamic conditions present during arm exercise that attenuate LV performance.

Adult↗

Influence of fingertip contact on illusory arm movements.

Recent evidence suggests that reaching movements are more accurate when end point contact occurs, suggesting that fingertip contact contributes to a final estimation of arm position. In the present study we tested two hypotheses: 1). that fingertip contact influences illusions of arm movement produced by muscle vibration and 2). that this influence depends on the a priori context of the stability of the contact surface. Subjects sat with their elbows on a table and eyes closed. They demonstrated the perceived orientation of the left (cue) arm by mirroring the location with the right (report) arm. We manipulated deep proprioceptive cues by vibrating the left biceps brachia, causing illusions of elbow extension, and tested whether these illusions were altered when the fingertip remained in contact with a stable external surface. The context at this point represents a prior assumption that the external contact surface is stable. Midway through the experiment, the context was changed by challenging the prior assumption that the contact surface was stable by demonstrating that it could move. Unbeknownst to the subject, the external contact surface remained stable during data collection throughout the experiment. As expected, without tactile cues, biceps vibration caused illusory elbow extension. Conditions with fingertip contact and biceps vibration in the stable context demonstrated that contact largely eliminated the overestimation of cue arm elbow angle. However, in the context of a possibly unstable (movable) contact surface, the reports of elbow extension returned. Thus a priori notions about the stability context of an external contact surface influence how this tactile cue is integrated with proprioceptive sensory modalities to generate an estimate of arm location in space. These findings support the notion that tactile cues are used to calibrate proprioception against external spatial frameworks.

Adult↗

Saccade adaptation in response to altered arm dynamics.

The delays in sensorimotor pathways pose a formidable challenge to the implementation of stable error feedback control, and yet the intact brain has little trouble maintaining limb stability. How is this achieved? One idea is that feedback control depends not only on delayed proprioceptive feedback but also on internal models of limb dynamics. In theory, an internal model allows the brain to predict limb position. Earlier we had found that during reaching, the brain estimates hand position in real-time in a coordinate system that can be used for generating saccades. Here we tested the idea that the estimate of hand position, as expressed through saccades, depends on an internal model that adapts to dynamics of the arm. We focused on the behavior of the eyes as perturbations were applied to the unseen hand. We found that when the hand was perturbed from stable posture with a 100-ms force pulse of random direction and magnitude, a saccade was generated on average at 182 ms postpulse onset to a position that was an unbiased estimate of real-time hand position. To test whether planning of saccades depended on an internal model of arm dynamics, arm dynamics were altered either predictably or unpredictably during the postpulse period. When arm dynamics were predictable, saccade amplitudes changed to reflect the change in the arm's behavior. We suggest that proprioceptive feedback from the arm is integrated into an adaptable internal model that computes an estimate of current hand position in eye-centered coordinates.

Adaptation, Physiological↗

Central resetting of neuromuscular steady states may underlie rhythmical arm movements.

Changing the steady-state configuration of the body or its segments may be an important function of central pattern generators for locomotion and other rhythmical movements. Thereby, muscle activation, forces, and movement may emerge following a natural tendency of the neuromuscular system to achieve the current steady-state configuration. To verify that transitions between different steady states occur during rhythmical movements, we asked standing subjects to swing one or both arms synchronously or reciprocally at approximately 0.8 Hz from the shoulder joints. In randomly selected cycles, one arm was transiently arrested by an electromagnetic device. Swinging resumed after some delay and phase resetting. During bilateral swinging, the nonperturbed arm often stopped before resuming swinging at a position that was close to either the extreme forward or the extreme backward arm position observed before the perturbation. Oscillations usually resumed when both arms arrived at similar extreme positions when a synchronous bilateral pattern was initially produced or at the opposite positions if the initial pattern was reciprocal. Results suggest that a central generator controls both arms as a coherent unit by producing transitions between its steady state (equilibrium) positions. By controlling these positions, the system may define the spatial boundaries of movement. At these positions, the system may halt the oscillations, resume them at a new phase (as observed in the present study), or initiate a new motor action. Our findings are relevant to locomotion and suggest that walking may also be generated by transitions between several equilibrium configurations of the body, possibly accomplished by modulation and gating of proprioceptive reflexes.

Acoustic Stimulation↗

Neurons in the primate superior colliculus coding for arm movements in gaze-related coordinates.

In the intermediate and deep layers of the superior colliculus (SC), a well-established oculomotor structure, a substantial population of cells is involved in the control of arm movements. To examine the reference frame of these neurons, we recorded in two rhesus monkeys (Macaca mulatta) the discharges of 331 neurons in the SC and the underlying mesencephalic reticular formation (MRF) while monkeys reached to the same target location during different gaze orientations. For 65 reach-related cells with sufficient data and for simultaneously recorded electromyograms (EMGs) of 11 arm muscles, we calculated an ANOVA (factors: target position, gaze angle) and a gaze-dependency (GD) index. EMGs and the activity of many (60%) of the reach-related neurons were not influenced by the target representation on the retina or eye position. We refer to these as "gaze-independent" reach neurons. For 40%, however, the GD fell outside the range of the muscle modulation, and the ANOVA showed a significant influence of gaze. These "gaze-related" reach neurons discharge only when the monkey reaches for targets having specific coordinates in relation to the gaze axis, i.e., for targets in a gaze-related "reach movement field" (RMF). Neuronal activity was not modulated by the specific path of the arm movement, the muscle pattern that is necessary for its realization or the arm that was used for the reach. In each SC we found gaze-related neurons with RMFs both in the contralateral and in the ipsilateral hemifield. The topographical organization of the gaze-related reach neurons in the SC could not be matched with the well-known visual and oculomotor maps. Gaze-related neurons were more modulated in their strength of activity with different directions of arm movements than were gaze-independent reach neurons. Gaze-related reach neurons were recorded at a median depth of 2.03 mm below SC surface in the intermediate layers, where they overlap with saccade-related burst neurons (median depth: 1.55 mm). Most of the gaze-independent reach cells were found in a median depth of 4.01 mm below the SC surface in the deep layers and in the underlying MRF. The gaze-related reach neurons operating in a gaze-centered coordinate system could signal either the desired target position with respect to gaze direction or the motor error between gaze axis and reach target. The gaze-independent reach neurons, possibly operating in a shoulder- or arm-centered reference frame, might carry signals closer to motor output. Together these two types of reach neurons add evidence to our hypothesis that the SC is involved in the sensorimotor transformation for eye-hand coordination in primates.

Algorithms↗

Antenatal nutritional assessment: the value of upper arm circumference.

Nutritional indicators such as prepregnant weight or weight increase during pregnancy are often difficult to use in developing countries. The value of the mid-upper-arm circumference was therefore analyzed in a study of 833 Mozambican gravidae, mainly seen at community level. Arm circumference was associated with both the estimated prepregnancy weight (p less than 0.0001) and the arm muscle circumference (p less than 0.0001). Of the studied women, 4% had an arm circumference below 23 cm, and 69% of these women had an estimated prepregnant weight for height below 85% of standard. An arm circumference below 25 cm was encountered in 24% of the studied group, and 11 out of these 24% were below 85% of estimated prepregnancy weight for height. In Mozambican gravidae a mid-upper-arm circumference below 25 cm is a warning of malnutrition and below 23 cm is a strong indicator of malnutrition.

Arm↗

End-expiratory lung volume during arm and leg exercise in normal subjects and patients with cystic fibrosis.

There are no reports concerning the regulation of end-expiratory lung volume (EELV) and flow-volume relationships during upper limb exercise in health and disease. We studied EELV during such exercise in 22 adults with cystic fibrosis (CF) and nine age-matched healthy control subjects. Subjects with CF were grouped according to the severity of their lung disease, as follows: mild = FEV1 > 80% predicted; moderate = FEV1 40 to 80% predicted, and severe = FEV1 < 40% predicted. EELV was calculated from measurements of inspiratory capacity (IC) made at each workload during an incremental arm and leg ergometer test to peak work capacity. In the control group, the decrease in EELV was significantly smaller for arm than for leg exercise at peak work (-0.13 L versus -0.53 L, p < 0.001) and for arm than for leg exercise at an equivalent submaximal ventilation (-0.13 L versus -0.46 L, p < 0.01). In the groups with moderate and severe CF, arm exercise resulted in an increase in EELV from resting levels (dynamic hyperinflation) that was not significantly different from the increase observed for leg exercise. For CF subjects there was a significant inverse relationship between FEV1 and changes in EELV from rest to peak arm exercise (r = -0.46, p < 0.05). In normal subjects, there was a difference in the EELV response for arm versus leg exercise. In CF subjects with airflow limitation, dynamic hyperinflation occurred with both forms of exercise.

Adolescent↗

Effects of morphologic restenosis, defined by MRI after coarctation repair, on blood pressure and arm-leg and Doppler gradients.

Ten years after coarctation repair, 36 adolescents and young adults were studied in order to evaluate the relationship of anatomy at the resection site to blood pressure and arm-leg and Doppler gradients. The patients underwent magnetic resonance imaging (MRI), exercise testing, and continuous wave (CW) Doppler echocardiography. On MRI, residual narrowing at the resection site was measured as 1-(phi anastomosis/ phi descending aorta) and expressed as percent stenosis. Residual stenosis on MRI was negatively correlated with the leg pressure at rest (P = 0.0003) and during exercise (P = 0.002). Residual stenosis correlated positively with the arm-leg gradient at rest (P < 0.0001) and during exercise (P < 0.0001) and with the peak CW Doppler gradient across the anastomosis (P < 0.0001). However, residual stenosis was not related to the systolic blood pressure of the arm at rest or during exercise. The systolic arm pressures did not differ between patients with residual stenosis of less than 30% (group I), patients with residual stenosis of equal to or greater than 30% but less than 45% (group II), and patients with residual stenosis of equal to or greater than 45% (group III). In conclusion residual anatomic stenosis influences blood pressure in the legs, the arm-leg gradient, and the Doppler gradient across the anastomosis. Arm hypertension late after coarctation repair seems not to be related to residual stenosis, and the benefit of reintervention in these patients remains questionable.

Adolescent↗