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Journal of NeuroEngineering and Rehabilitation

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Open Access 01-12-2018 | Research

Coactivation index of children with congenital upper limb reduction deficiencies before and after using a wrist-driven 3D printed partial hand prosthesis

Authors: Jorge M. Zuniga, Katsavelis Dimitrios, Jean L. Peck, Rakesh Srivastava, James E. Pierce, Drew R. Dudley, David A. Salazar, Keaton J. Young, Brian A. Knarr

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2018

Abstract

Background

Co-contraction is the simultaneous activation of agonist and antagonist muscles that produces forces around a joint. It is unknown if the use of a wrist-driven 3D printed transitional prostheses has any influence on the neuromuscular motor control strategies of the affected hand of children with unilateral upper-limb reduction deficiencies. Thus, the purpose of the current investigation was to examine the coactivation index (CI) of children with congenital upper-limb reduction deficiencies before and after 6 months of using a wrist-driven 3D printed partial hand prosthesis.

Methods

Electromyographic activity of wrist flexors and extensors (flexor carpi ulnaris and extensor digitorum) was recorded during maximal voluntary contraction of the affected and non-affected wrists. Co-contraction was calculated using the coactivation index and was expressed as percent activation of antagonist over agonist. Nine children (two girls and seven boys, 6 to 16 years of age) with congenital upper-limb deficiencies participated in this study and were fitted with a wrist-driven 3D printed prosthetic hand. From the nine children, five (two girls and three boys, 7 to 10 years of age) completed a second visit after using the wrist-driven 3D printed partial hand prosthesis for 6 months.

Results

Separate two-way repeated measures ANOVAs were performed to analyze the coactivation index and strength data. There was a significant main effect for hand with the affected hand resulting in a higher coactivation index for flexion and extension than the non-affected hand. For wrist flexion there was a significant main effect for time indicating that the affected and non-affected hand had a significantly lower coactivation index after a period of 6 months.

Conclusion

The use of a wrist-driven 3D printed hand prosthesis lowered the coactivation index by 70% in children with congenital upper limb reduction deficiencies. This reduction in coactivation and possible improvement in motor control strategies can potentially improve prosthetic rehabilitation outcomes.

Ervilha UF, Graven-Nielsen T, Duarte M. A simple test of muscle coactivation estimation using electromyography. Braz J Med Biol Res. 2012;45:977–81.CrossRefPubMedPubMedCentral

Gribble PL, Mullin LI, Cothros N, et al. Role of cocontraction in arm movement accuracy. J Neurophysiol. 2003;89(5):2396–405. https://doi.org/10.1152/jn.01020.2002. PubMed PMID: 12611935; eng.CrossRefPubMed

Hammond MC, Fitts SS, Kraft GH, et al. Co-contraction in the hemiparetic forearm: quantitative EMG evaluation. Arch Phys Med Rehabil. 1988;69(5):348–51. PubMed PMID: 3365115; engPubMed

Centomo H, Amarantini D, Martin L, et al. Muscle adaptation patterns of children with a trans-tibial amputation during walking. Clin Biomech (Bristol, Avon). 2007;22(4):457–63. https://doi.org/10.1016/j.clinbiomech.2006.11.005. PubMed PMID: 17222488; engCrossRef

Seyedali M, Czerniecki JM, Morgenroth DC, et al. Co-contraction patterns of trans-tibial amputee ankle and knee musculature during gait. J Neuroeng Rehabil. 2012;9(29) https://doi.org/10.1186/1743-0003-9-29. PubMed PMID: 22640660; PubMed Central PMCID: PMCPMC3480942. eng

Busse ME, Wiles CM, van Deursen RW. Co-activation: its association with weakness and specific neurological pathology. J Neuroeng Rehabil. 2006;3(26) https://doi.org/10.1186/1743-0003-3-26. PubMed PMID: 17116259; PubMed Central PMCID: PMCPMC1665451. eng

Eken MM, Dallmeijer AJ, Doorenbosch CA, et al. Coactivation during dynamometry testing in adolescents with spastic cerebral palsy. Phys Ther. 2016;96(9):1438–47. https://doi.org/10.2522/ptj.20140448. PubMed PMID: 26916928; engCrossRefPubMed

Osu R, Franklin DW, Kato H, et al. Short- and long-term changes in joint co-contraction associated with motor learning as revealed from surface EMG. J Neurophysiol. 2002;88(2):991–1004. PubMed PMID: 12163548; engCrossRefPubMed

Thoroughman KA, Shadmehr R. Electromyographic correlates of learning an internal model of reaching movements. J Neurosci. 1999;19(19):8573–88. PubMed PMID: 10493757; engCrossRefPubMed

10.

CDC. Facts about Upper and Lower Limb Reduction Defects 2014 [Acessed June, 2016; http://www.cdc.gov/ncbddd/birthdefects/ul-limbreductiondefects.html].

11.

Hadders-Algra M, Reinders-Messelink HA, Huizing K, et al. Use and functioning of the affected limb in children with unilateral congenital below-elbow deficiency during infancy and preschool age: a longitudinal observational multiple case study. Early Hum Dev. 2013;89(1):49–54. https://doi.org/10.1016/j.earlhumdev.2012.07.011. PubMed PMID: 22863184; engCrossRefPubMed

12.

Reilly KT, Sirigu A. Motor cortex representation of the upper-limb in individuals born without a hand. PLoS One. 2011;6(4) PubMed PMID: 21494663

13.

Meurs M, Maathuis CG, Lucas C, et al. Prescription of the first prosthesis and later use in children with congenital unilateral upper limb deficiency: a systematic review. Prosthetics Orthot Int. 2006;30(2):165–73. https://doi.org/10.1080/03093640600731710. PubMed PMID: 16990227; engCrossRef

14.

Bryant MH, Donahue JR, Sweigart JF, et al. A prosthesis to restore opposition in children with congenital absence of the hand. The Association of Children's prosthetic-orthotic. Clinics. 1979;17(6):5–10.

15.

Shim J-H, Lee Y-H, Lee J-M, et al. Wrist-driven prehension prosthesis for amputee patients with disarticulation of the thumb and index finger. Arch Phys Med Rehabil. 1998;79(7):877–8. https://doi.org/10.1016/S0003-9993(98)90373-2.CrossRefPubMed

16.

Zuniga JM, Peck J, Srivastava R, et al. An Open Source 3D-Printed Transitional Hand Prosthesis for Children. JPO. Journal of Prosthetics and Orthotics. 2016;28(3):103–8. https://doi.org/10.1097/jpo.0000000000000097. PubMed PMID: 00008526–201607000-00004CrossRef

17.

Zuniga JM, Peck JL, Srivastava R, et al. Functional changes through the usage of 3D-printed transitional prostheses in children. Disabil Rehabil Assist Technol. 2017:1–7. https://doi.org/10.1080/17483107.2017.1398279. PubMed PMID: 29116866; eng

18.

Bray JJ, University of California Los Angeles. Prosthetics-Orthotics Education Program. Prosthetic principles, upper extremity amputations : fabrication and fitting principles. Los Angeles: Prosthetics-Orthotics Education Program, Division of Orthopedic Surgery, University of California, Los Angeles; 1970.

19.

Scotland TR, Galway HR. A long-term review of children with congenital and acquired upper limb deficiency. J Bone Joint Surg Br Vol. 1983;65(3):346–9. PubMed PMID: 6841409; engCrossRef

20.

Davids JR, Wagner LV, Meyer LC, et al. Prosthetic management of children with unilateral congenital below-elbow deficiency. J Bone Joint Surg Am. 2006;88(6):1294–300. https://doi.org/10.2106/jbjs.e.00982. PubMed PMID: 16757763; engCrossRefPubMed

21.

Resnik L. Development and testing of new upper-limb prosthetic devices: research designs for usability testing. J Rehabil Res Dev. 2011;48(6):697–706. PubMed PMID: 21938656; engCrossRefPubMed

22.

Resnik L, Meucci MR, Lieberman-Klinger S, et al. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation. Arch Phys Med Rehabil. 2012;93(4):710–7. https://doi.org/10.1016/j.apmr.2011.11.010. PubMed PMID: 22464092; engCrossRefPubMed

23.

Zuniga JM, Katsavelis D, Peck J, et al. Cyborg beast: a low-cost 3d-printed prosthetic hand for children with upper-limb differences. BMC Res Notes. 2015;8(1):10. https://doi.org/10.1186/s13104-015-0971-9. PubMed PMID: 25601104; PubMed Central PMCID: PMCPMC4304188. EngCrossRefPubMedPubMedCentral

24.

Zuniga JM. Cyborg Beast. Available from: http://www.thingiverse.com/thing:261462. 2014.

25.

Hermens HJ, Freriks B, Merletti R, et al. Seniam 8: European recommendation for surface electromyography. Enschede, the Netherlands: Roessingh Research and Development; 1999.

26.

Steenbergen B, Meulenbroek RG. Deviations in upper-limb function of the less-affected side in congenital hemiparesis. Neuropsychologia. 2006;44(12):2296–307. https://doi.org/10.1016/j.neuropsychologia.2006.05.016. PubMed PMID: 16797611; engCrossRefPubMed

27.

Cheesborough JE, Smith LH, Kuiken TA, et al. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg. 2015;29(1):62–72. https://doi.org/10.1055/s-0035-1544166. PubMed PMID: 25685105; PubMed Central PMCID: PMCPMC4317279. engCrossRefPubMedPubMedCentral

28.

Postema SG, van der Sluis CK, Waldenlov K, et al. Body structures and physical complaints in upper limb reduction deficiency: a 24-year follow-up study. PLoS One. 2012;7(11):e49727. https://doi.org/10.1371/journal.pone.0049727. PubMed PMID: 23226218; PubMed Central PMCID: PMCPMC3511484. engCrossRefPubMedPubMedCentral

29.

Imamizu H, Miyauchi S, Tamada T, et al. Human cerebellar activity reflecting an acquired internal model of a new tool. Nature. 2000;403(6766):192–5. https://doi.org/10.1038/35003194. PubMed PMID: 10646603; engCrossRefPubMed

30.

Shumway-Cook A, Woollacott MH. Motor Control: Translating Research Into Clinical Practice. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2016.

31.

Huizing K, Reinders-Messelink H, Maathuis C, et al. Age at first prosthetic fitting and later functional outcome in children and young adults with unilateral congenital below-elbow deficiency: a cross-sectional study. Prosthetics Orthot Int. 2010;34(2):166–74. https://doi.org/10.3109/03093640903584993. PubMed PMID: 20298129; engCrossRef

32.

Sporns O, Edelman GM. Solving Bernstein's problem: a proposal for the development of coordinated movement by selection. Child Dev. 1993;64(4):960–81. PubMed PMID: 8404271; engCrossRefPubMed

33.

Ho ES, Clarke HM. Functional evaluation in children with congenital upper extremity malformations. Clin Plast Surg. 2005;32(4):471–83. https://doi.org/10.1016/j.cps.2005.05.006. PubMed PMID: 16139621; engCrossRefPubMed

34.

Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 2010;23(1):2–16; quiz 17. doi: https://doi.org/10.1016/j.jht.2009.09.008. PubMed PMID: 19963343; eng.

35.

Hagert E, Persson JK, Werner M, et al. Evidence of wrist proprioceptive reflexes elicited after stimulation of the scapholunate interosseous ligament. Journal of hand surgery. 2009;34(4):642–51. https://doi.org/10.1016/j.jhsa.2008.12.001. PubMed PMID: 19249163; engCrossRefPubMed

Title: Coactivation index of children with congenital upper limb reduction deficiencies before and after using a wrist-driven 3D printed partial hand prosthesis
Authors: Jorge M. Zuniga
Katsavelis Dimitrios
Jean L. Peck
Rakesh Srivastava
James E. Pierce
Drew R. Dudley
David A. Salazar
Keaton J. Young
Brian A. Knarr
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of NeuroEngineering and Rehabilitation / Issue 1/2018
Electronic ISSN: 1743-0003
DOI: https://doi.org/10.1186/s12984-018-0392-9

At a glance: The STEP trials

Springer Medicine

Coactivation index of children with congenital upper limb reduction deficiencies before and after using a wrist-driven 3D printed partial hand prosthesis

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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