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| Name | Class |
|---|---|
| Shepherd Center, Atlanta GA | OTHER |
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The purpose of this study is to determine if tetraplegic individuals with incomplete spinal cord injury (SCI) who remain unable to move their arms normally 1 year after their SCIs are able to sense and move the affected arm(s) better after 10-13 weeks of treatment with a new robotic therapy device.
The hypothesis is that using the AMES device on the arm(s) of chronic tetraplegic subjects with incomplete SCI will result in improved strength, sensation, and functional movement in treated limb(s).
Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA, with several thousand new injuries each year. Most recovery, following SCI, occurs in the six months following surgery. Further recovery after 12 months is unusual.
In this study 13 subjects, more than 1 year post injury, were enrolled to test the safety and efficacy of a new type of robotic therapy device known as the AMES device. The aim of this Phase I/II study is to investigate the use of assisted movement and enhanced sensation (AMES) technology in hand rehabilitation of incomplete SCI subjects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AMES treatment | Experimental | The subject will receive 25 treatment sessions, conducted 2-3 times per week on the AMES device. Each session will consist of testing followed by 30 minutes of wrist and finger rehabilitation using the AMES device. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AMES treatment | Device | The AMES device rotates the fingers-thumb or the wrist in the flexion-extension directions over a range of 30 degrees while vibrators stimulate the tendons attached to muscles that are lengthened by the thumb-finger or hand movement. A treatment consists of 20 minutes of fingers-thumb movement, followed by 10 minutes of wrist movement. The subject's task is to assist the motion of the device. |
| Measure | Description | Time Frame |
|---|---|---|
| Grasp Release Test | The task involves picking up, transporting, and placing six objects (i.e., peg, paperweight, fork, block, can, and videotape). Movement of each of the 6 objects is scored based on the number of times the participant can move the object in 30 seconds, with a minimum score of zero if no objects are successfully moved. A cumulative score is based on the sum of all completed movements for all 6 objects. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| Measure | Description | Time Frame |
|---|---|---|
| ASIA Motor Key Muscles | ISNCSCI Assessment of motor function (upper limb only). Scores on a scale ranging from 0 (i.e., total paralysis) - 5 (i.e., full range of motion) for each of 5 upper limb muscle groups. Total score represents the overall level of the upper limb impairment and represents the sum of the 5 scores from the 5 upper limb muscle groups. Accordingly, the total score has a range of 0-25, with 0 representing a completely paralyzed upper limb and 25 representing a normally functioning upper limb. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Paul J. Cordo, Ph.D | Oregon Health and Science University | Principal Investigator |
| Deborah Backus, PhD, PT | Shepherd Center, Atlanta GA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shepherd Center | Atlanta | Georgia | 30309 | United States | ||
| Oregon Health and Science University |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18645190 | Result | Cordo P, Lutsep H, Cordo L, Wright WG, Cacciatore T, Skoss R. Assisted movement with enhanced sensation (AMES): coupling motor and sensory to remediate motor deficits in chronic stroke patients. Neurorehabil Neural Repair. 2009 Jan;23(1):67-77. doi: 10.1177/1545968308317437. Epub 2008 Jul 21. |
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| ID | Title | Description |
|---|---|---|
| FG000 | AMES Treatment | The subject will receive 25 treatment sessions, conducted 2-3 times per week on the AMES device. Each session will consist of testing followed by 30 minutes of wrist and finger rehabilitation using the AMES device. AMES treatment: The AMES device rotates the fingers-thumb or the wrist in the flexion-extension directions over a range of 30 degrees while vibrators stimulate the tendons attached to muscles lengthened by the finger or wrist movements. A treatment consists of 20 minutes of fingers-thumb movement, followed by 10 minutes of wrist movement. The subject's task is to assist the motion of the device. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Enrolled 13 subjects. Three subjects dropped out. Of the remaining 10 subjects, 15 limbs were tested, both limbs in 5 of the subjects.
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| ID | Title | Description |
|---|---|---|
| BG000 | AMES Treatment | The subject will receive 25 treatment sessions, conducted 2-3 times per week on the AMES device. Each session will consist of testing followed by 30 minutes of wrist and finger rehabilitation using the AMES device. The AMES device rotates the fingers-thumb or the wrist in the flexion-extension directions over a range of 30 degrees while vibrators stimulate the tendons attached to muscles that are lengthened by the thumb-finger or hand movement. A treatment consists of 20 minutes of fingers-thumb movement, followed by 10 minutes of wrist movement. The subject's task is to assist the motion of the device. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Grasp Release Test | The task involves picking up, transporting, and placing six objects (i.e., peg, paperweight, fork, block, can, and videotape). Movement of each of the 6 objects is scored based on the number of times the participant can move the object in 30 seconds, with a minimum score of zero if no objects are successfully moved. A cumulative score is based on the sum of all completed movements for all 6 objects. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Error | Objects moved | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Arms | Arms |
|
Time of enrollment until completing the 3-month follow-up evaluation (i.e., 5-6 months)
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | AMES Treatment | The subject will receive 25 treatment sessions, conducted 2-3 times per week on the AMES device. Each session will consist of testing followed by 30 minutes of wrist and finger rehabilitation using the AMES device. AMES treatment: The AMES device rotates the fingers-thumb or the wrist in the flexion-extension directions over a range of 30 degrees while vibrators stimulate the tendons attached to muscles lengthened by the finger or wrist movements. A treatment consists of 20 minutes of fingers-thumb movement, followed by 10 minutes of wrist movement. The subject's task is to assist the motion of the device. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Liver disease requiring hospitalization | Hepatobiliary disorders | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Urinary tract infection | Renal and urinary disorders | Non-systematic Assessment |
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Paul Cordo | Oregon Health & Science University | 503 418 2520 | cordop@ohsu.edu |
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| ID | Term |
|---|---|
| D013119 | Spinal Cord Injuries |
| D011782 | Quadriplegia |
| D010291 | Paresis |
| D010243 | Paralysis |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020196 | Trauma, Nervous System |
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|
| Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| ASIA (ISNCSCI) Sensory/Key Sensory Points/ Light-Touch | Measures the subject's sensory perception, with eyes closed, of a light touch by the tester on 9 key sensory points of the hand, arm, shoulder and neck. Sensation at each key point is rated as a number on a scale from 0 (no feeling) to 2 (normal feeling), with a score of 1 representing partly diminished feeling. The overall sensation of the upper limb and nearby areas is represented as the sum of all 9 individual key point scores and, therefore, has an overall range of 0-18, with higher scores representing better sensation. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| ASIA (ISNCSCI) Sensory/Key Sensory Points/Pin-Prick | Measures the subject's sensory perception, with eyes closed, of a light prick of a safety pin produced by the tester on 9 key sensory points of the hand, arm, shoulder and neck. Sensation at each key point is rated as a number on a scale from 0 (no feeling) to 2 (normal feeling), with a score of 1 representing partly diminished feeling. The overall sensation of the upper limb and nearby areas is represented as the sum of all 9 individual key point scores and, therefore, has an overall range of 0-18, with higher scores representing better sensation. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| Van Lieshout Hand Function Test for Tetraplegia- Short Version | Measures the functional movement in the upper limb of people with cervical spinal cord injury. The short version of this test includes a total of 10 different functional tasks to be performed by the subject with the upper limb. For example, one task is to reach and pick up a filled Coke bottle, set it down, and then replace it in its original position. Each task is scored on a scale of 0-5, 0 representing inability to perform the task and 5 representing normal movement. A single, total score is calculated as the sum of the scores on the 10 tasks, and therefore, has an overall range of 0-50, with higher scores representing better performance. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| Modified Ashworth Scale | Measurement of joint stiffness (tone/spasticity). Score is based on sum of MAS value for 4 muscle groups: (1) Wrist/finger flexors, (2) Wrist/finger extensors, (3) elbow flexors, and (4) elbow extensors. Each muscle group and direction is score on a scale of 0 (no increase in muscle tone) to 5 (rigid), with a score of 2 used instead of 1+. A single overall score representing the sum of all 4 muscle groups and directions is used and has a range of 0-20 with higher scores representing more severe impairment. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| Capabilities of Upper Extremity Instrument | Subjective questionnaire of participants' self-perceptions of upper limb function that contains 17 questions relating to the use of the right upper limb, the same 17 relating to the use of the lower upper limb, plus two additional questions relating to bimanual function. Responses to each item of the questionnaire has a range of 1 (i.e., "totally limited") to 7 (i.e., "not at all limited"). A total cumulative score used for the study is based on the sum of the responses to all 34 questions (i.e., 16 right arm, 16 left arm, 2 both arms), and therefore has a cumulative score range of 32 - 224, with higher scores indicating more function. | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training |
| Strength Test - Thumb/Finger Extension | Maximum strength of thumb-and-fingers in extension. Pre-training score is average of a total of 3 scores, including 1 score from each of the first 3 days of training. Post-training score is average of a total of 3 scores, including 1 score from each of the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Strength Test - Thumb/Fingers Flexion | Maximum strength of Thumb/fingers in Flexion Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Strength Test - Wrist Extension | Maximum wrist strength in extension Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Strength Test - Wrist Flexion | Maximum strength in flexion direction Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Active Motion Test - Fingers/Thumb | Tracking task for the thumb and finger, i.e., opening and closing the hand. The participant tracks a target box on a video screen by actively moving the thumb and fingers, first in the opening direction, then closing, and finally opeining again. The participant's thumb-and-finger position is represented on the video screen by a vertical line that he/she attempts to keep in the the target box. Performance on this task is scored as the amount of time, in seconds, that the participant keeps the line in the target box. The maximum total score in this test is 60 seconds. The "Pre-training Score" is the average score obtained during the first 3 days of training, and the Post-training Score" is average score obtained during the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Active Motion Test - Wrist | Tracking task for the wrist, i.e., flexing (i.e., pull with the front of the hand) and extending (i.e., pushing with the back of the hand). The participant tracks a target box on a video screen by actively moving the hand at the wrist, first in the extension direction, then flexion, and finally extension again. The participant's wrist position is represented on the video screen by a vertical line that he/she attempts to keep in the the target box. Performance on this task is scored as the amount of time, in seconds, that the participant keeps the line in the target box. The maximum total score in this test is 60 seconds. The "Pre-training Score" is the average score obtained during the first 3 days of training, and the Post-training Score" is average score obtained during the last 3 days of training. | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) |
| Portland |
| Oregon |
| 97006 |
| United States |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Age at time of injury | Mean | Standard Deviation | years |
|
| ASIA Motor Key Muscles | Measures the level of impairment of key muscles controlling the upper limb, including: elbow flexors (spinal level C5), wrist extensors (spinal level C6), elbow extensors (spinal level C7), finger flexors (spinal level C8), and finger abductors (spinal level T1). The scale range is 0 (total paralysis) to 5 (normal active movement), but also includes a scale category "NT," which indicates that muscle group was not testable. Total score is the sum of the scores from all 5 spinal levels ranging from 0-25. A higher score means less upper limb impairment. | Mean | Standard Deviation | units on a scale |
|
| Time since injury | Mean | Standard Deviation | years |
|
|
|
|
| Secondary | ASIA Motor Key Muscles | ISNCSCI Assessment of motor function (upper limb only). Scores on a scale ranging from 0 (i.e., total paralysis) - 5 (i.e., full range of motion) for each of 5 upper limb muscle groups. Total score represents the overall level of the upper limb impairment and represents the sum of the 5 scores from the 5 upper limb muscle groups. Accordingly, the total score has a range of 0-25, with 0 representing a completely paralyzed upper limb and 25 representing a normally functioning upper limb. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | ASIA (ISNCSCI) Sensory/Key Sensory Points/ Light-Touch | Measures the subject's sensory perception, with eyes closed, of a light touch by the tester on 9 key sensory points of the hand, arm, shoulder and neck. Sensation at each key point is rated as a number on a scale from 0 (no feeling) to 2 (normal feeling), with a score of 1 representing partly diminished feeling. The overall sensation of the upper limb and nearby areas is represented as the sum of all 9 individual key point scores and, therefore, has an overall range of 0-18, with higher scores representing better sensation. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | ASIA (ISNCSCI) Sensory/Key Sensory Points/Pin-Prick | Measures the subject's sensory perception, with eyes closed, of a light prick of a safety pin produced by the tester on 9 key sensory points of the hand, arm, shoulder and neck. Sensation at each key point is rated as a number on a scale from 0 (no feeling) to 2 (normal feeling), with a score of 1 representing partly diminished feeling. The overall sensation of the upper limb and nearby areas is represented as the sum of all 9 individual key point scores and, therefore, has an overall range of 0-18, with higher scores representing better sensation. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Van Lieshout Hand Function Test for Tetraplegia- Short Version | Measures the functional movement in the upper limb of people with cervical spinal cord injury. The short version of this test includes a total of 10 different functional tasks to be performed by the subject with the upper limb. For example, one task is to reach and pick up a filled Coke bottle, set it down, and then replace it in its original position. Each task is scored on a scale of 0-5, 0 representing inability to perform the task and 5 representing normal movement. A single, total score is calculated as the sum of the scores on the 10 tasks, and therefore, has an overall range of 0-50, with higher scores representing better performance. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Modified Ashworth Scale | Measurement of joint stiffness (tone/spasticity). Score is based on sum of MAS value for 4 muscle groups: (1) Wrist/finger flexors, (2) Wrist/finger extensors, (3) elbow flexors, and (4) elbow extensors. Each muscle group and direction is score on a scale of 0 (no increase in muscle tone) to 5 (rigid), with a score of 2 used instead of 1+. A single overall score representing the sum of all 4 muscle groups and directions is used and has a range of 0-20 with higher scores representing more severe impairment. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Capabilities of Upper Extremity Instrument | Subjective questionnaire of participants' self-perceptions of upper limb function that contains 17 questions relating to the use of the right upper limb, the same 17 relating to the use of the lower upper limb, plus two additional questions relating to bimanual function. Responses to each item of the questionnaire has a range of 1 (i.e., "totally limited") to 7 (i.e., "not at all limited"). A total cumulative score used for the study is based on the sum of the responses to all 34 questions (i.e., 16 right arm, 16 left arm, 2 both arms), and therefore has a cumulative score range of 32 - 224, with higher scores indicating more function. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | units on a scale | Prior to training (baseline), after 25 training sessions (about 8 weeks), 3 months post-training | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Strength Test - Thumb/Finger Extension | Maximum strength of thumb-and-fingers in extension. Pre-training score is average of a total of 3 scores, including 1 score from each of the first 3 days of training. Post-training score is average of a total of 3 scores, including 1 score from each of the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Newton*meters | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
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|
|
| Secondary | Strength Test - Thumb/Fingers Flexion | Maximum strength of Thumb/fingers in Flexion Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Newton*meters | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Strength Test - Wrist Extension | Maximum wrist strength in extension Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Newton*meters | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Strength Test - Wrist Flexion | Maximum strength in flexion direction Pre-training score is average of a total of 9 efforts, including 3 efforts from the first 3 days of training. Post-training score is average of a total of 9 efforts, including 3 efforts from the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Newton*meters | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Active Motion Test - Fingers/Thumb | Tracking task for the thumb and finger, i.e., opening and closing the hand. The participant tracks a target box on a video screen by actively moving the thumb and fingers, first in the opening direction, then closing, and finally opeining again. The participant's thumb-and-finger position is represented on the video screen by a vertical line that he/she attempts to keep in the the target box. Performance on this task is scored as the amount of time, in seconds, that the participant keeps the line in the target box. The maximum total score in this test is 60 seconds. The "Pre-training Score" is the average score obtained during the first 3 days of training, and the Post-training Score" is average score obtained during the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Seconds | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
|
|
|
| Secondary | Active Motion Test - Wrist | Tracking task for the wrist, i.e., flexing (i.e., pull with the front of the hand) and extending (i.e., pushing with the back of the hand). The participant tracks a target box on a video screen by actively moving the hand at the wrist, first in the extension direction, then flexion, and finally extension again. The participant's wrist position is represented on the video screen by a vertical line that he/she attempts to keep in the the target box. Performance on this task is scored as the amount of time, in seconds, that the participant keeps the line in the target box. The maximum total score in this test is 60 seconds. The "Pre-training Score" is the average score obtained during the first 3 days of training, and the Post-training Score" is average score obtained during the last 3 days of training. | Analysis population is "arms." Three subjects dropped out. Five of the remaining subjects were tested for both arms. | Posted | Mean | Standard Deviation | Seconds | Prior to training (baseline), after each of 25 training sessions (about 3 times/week) | Upper Limbs | Upper Limbs |
|
|
|
|
| 2 |
| 13 |
| 5 |
| 13 |
| Suicide | Psychiatric disorders | Non-systematic Assessment | Presumed due to depression |
|
| Reduction in tenodesis | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Strength gain in finger flexors reduced ability to use tenodesis |
|
| Bleeding | Blood and lymphatic system disorders | Non-systematic Assessment | Subject accidentally pricked on ear lobe during sensory testing producing 1 drop of blood. |
|
| Skin abrasion | Skin and subcutaneous tissue disorders | Non-systematic Assessment | Abrasion from vibrator probe |
|
| Fall | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Tripped over dog and fractured shoulder |
|
| Muscular soreness | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | After first training session |
|
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| D014947 | Wounds and Injuries |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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