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Upper Extremity: The region of the upper limb in animals, extending from the deltoid region to the Hand, and including the Arm; Axilla; and Shoulder.

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

1Program in Physical Therapy, Washington University School of Medicine, 2Program in Occupational Therapy, Washington University School of Medicine, 3Department of Neurology, Washington University School of Medicine, 4Mallinckrodt Institute of Radiology, Washington University School of Medicine, 5Department of Biomedical Engineering, Washington University

JoVE 55673


 Medicine

Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms

1Department of Biomedical Engineering, Seoul National University College of Medicine, 2Department of Rehabilitation Medicine, Chungnam National University Hospital, 3Interdisciplinary Program for Bioengineering, Seoul National University Graduate School, 4Department of Rehabilitation Medicine, Seoul National University Hospital, 5Seoul National University College of Medicine, 6Institute of Medical and Biological Engineering, Seoul National University

JoVE 54521


 Bioengineering

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

1Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 2Center for Brain Health, Cleveland Clinic Foundation, 3Quantitative Health Sciences, Cleveland Clinic Foundation, 4Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation

JoVE 51318


 Medicine

Motor Exam II

JoVE 10095

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

There are two main types of reflexes that are tested on a neurological examination: stretch (or deep tendon reflexes) and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1). DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTR examination is using a stick figure diagram. The DTR test can help distinguish upper and lower motor neuron problems, and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2). Superficial reflexes are segmental ref


 Physical Examinations III

Peripheral Vascular Exam Using a Continuous Wave Doppler

JoVE 10123

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Peripheral vascular disease (PVD) is a common condition affecting older adults and includes disease of the peripheral arteries and veins. While the history and physical exam offer clues to its diagnosis, Doppler ultrasound has become a routine part of the bedside vascular examination. The video titled "The Peripheral Vascular Exam" gave a detailed review of the physical examination of the peripheral arterial and venous systems. This video specifically reviews the bedside assessment of peripheral arterial disease (PAD) and chronic venous insufficiency using a handheld continuous wave Doppler. The handheld Doppler (HHD) is a simple instrument that utilizes continuous transmission and reception of ultrasound (also referred to as continuous wave Doppler) to detect changes in blood velocity as it courses through a vessel. The Doppler probe contains a transmitting element that emits ultrasound and a receiving element that detects ultrasound waves (Figure 1). The emitted ultrasound is reflected off of moving blood and back to the probe at a frequency directly related to the velocity of blood flow. The reflected signal is detected and transduced to an audible sound with a frequen


 Physical Examinations I

Peripheral Vascular Exam

JoVE 10122

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

The prevalence of peripheral vascular disease (PVD) increases with age and is a significant cause of morbidity in older patients, and peripheral artery disease (PAD) is associated with cardiovascular and cerebrovascular complications. Diabetes, hyperlipidemia, hypertension, and tobacco use are important disease risk factors. When patients become symptomatic, they frequently complain of limb claudication, defined as a cramp-like muscle pain that worsens with activity and improves with rest. Patients with chronic venous insufficiency (CVI) often present with lower extremity swelling, pain, skin changes, and ulceration. While the benefits of screening asymptomatic patients for PVD are unclear, physicians should know the proper exam technique when the diagnosis of PVD is being considered. This video reviews the vascular examination of the upper and lower extremities and abdomen. As always, the examiner should use a systematic method of examination, though in practice, the extent of the exam a physician performs depends on their suspicion of underlying PVD. In a patient who has or is suspected to have risk factors for vascular disease, the vascular exam should be thorough, beginning with inspection, fo


 Physical Examinations I

A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

1Christian Doppler Laboratory for Restoration of Extremity Function, 2Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, 3Department of Neurorehabilitation Engineering, Bernstein Focus Neurotechnology Göttingen, 4University Medical Center Göttingen, Georg-August University, 5University of Applied Sciences FH Campus Wien, 6Research & Development, Otto Bock Healthcare Products GmbH

JoVE 52968


 Behavior

Motor Exam I

JoVE 10052

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes the patient's ability to walk unassisted and the speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and help to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.


 Physical Examinations III

Lymph Node Exam

JoVE 10061

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA

The lymphatic system has two main functions: to return extracellular fluid back to the venous circulation and to expose antigenic substances to the immune system. As the collected fluid passes through lymphatic channels on its way back to the systemic circulation, it encounters multiple nodes consisting of highly concentrated clusters of lymphocytes. Most lymph channels and nodes reside deep within the body and, therefore, are not accessible to physical exam (Figure 1). Only nodes near the surface can be inspected or palpated. Lymph nodes are normally invisible, and smaller nodes are also non-palpable. However, larger nodes (>1 cm) in the neck, axillae, and inguinal areas are often detectable as soft, smooth, movable, non-tender, bean-shaped masses imbedded in subcutaneous tissue. Lymphadenopathy usually indicates an infection or, less commonly, a cancer in the area of lymph drainage. Nodes may become enlarged, fixed, firm, and/or tender depending on the pathology present. For example, a soft, tender lymph node palpable near the angle of the mandible may indicate an infected tonsil, whereas a firm, enlarged, non-tender lymph


 Physical Examinations II

Orthotopic Hind Limb Transplantation in the Mouse

1Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, 2Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, 3Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and School of Medicine, 4Department of General, Visceral and Transplant Surgery, Charite Berlin

JoVE 53483


 Medicine

Creation and Transplantation of an Adipose-derived Stem Cell (ASC) Sheet in a Diabetic Wound-healing Model

1Diabetic Center, Tokyo Women's Medical University School of Medicine, 2The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 3The Department of Anatomy and Developmental Biology, Tokyo Women's Medical University School of Medicine

JoVE 54539


 Medicine

Sensory Exam

JoVE 10113

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration, and joint position sense. Sensation of the face is discussed in the videos Cranial Nerves Exam I and II, as are the special senses of smell, vision, taste, and hearing. The spinothalamic tract mediates pain and temperature information from skin to thalamus. The spinothalamic fibers decussate (cross over) 1-2 spinal nerve segments above the point of entry, then travel up to the brainstem until they synapse on various nuclei in thalamus. From the thalamus, information is then relayed to the cortical areas such as the postcentral gyrus (also known as the primary somatosensory cortex). Afferent fibers transmitting vibration and proprioception travel up to medulla in the ipsilateral posterior columns as fasciculus gracilis and fasciculus cuneatus, which carry information from the lower limbs and upper limbs, respectively. Subsequently, the afferent projections cross over and ascend to the thalamus, and from there to the primary somatosensory cortex. The pattern of a


 Physical Examinations III

Procedure for Human Saphenous Veins Ex Vivo Perfusion and External Reinforcement

1Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, 2Laboratory of Experimental Medicine, Department of Medicine, CHUV University Hospital, 3Department of Vascular Surgery, Pellegrin Hospital, University of Bordeaux, 4Department of Thoracic and Vascular Surgery, CHUV University Hospital

JoVE 52079


 Medicine

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

1Johns Hopkins University School of Medicine, 2Burn and Complex Wound Center, 3Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, 4Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, 5Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 6Vascularized Composite Allotransplantation (VCA) Lab, Johns Hopkins University School of Medicine

JoVE 53442


 Medicine

Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss

1Department of Integrative Physiology, National Institute for Physiological Sciences, 2Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, 3Department of Otorhinolaryngology, Kansai Rosai Hospital, 4Institute for Biomagnetism and Biosignalanalysis, University of Muenster, 5Institute for Epidemiology and Social Medicine, University of Muenster, 6Sokendai Graduate University for Advanced Studies

JoVE 53264


 Behavior

An Objective and Child-friendly Assessment of Arm Function by Using a 3-D Sensor

1Data Science, Roche Pharmaceutical Research and Early Development Informatics, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., 2Translational Technologies and Bioinformatics, Pharmaceutical Sciences, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., 3Biomarker Experimental Medicine, Neuroscience, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd., 4Division of Neuropediatrics, University of Basel Children's Hospital, 5Department of Neurology, University of Basel Hospital, 6Translational Medicine, Neuroscience and Rare Diseases, Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche, Ltd.

Video Coming Soon

JoVE 57014


 JoVE In-Press

Proper Adjustment of Patient Attire during the Physical Exam

JoVE 10147

Source: Jaideep S. Talwalkar, MD, and Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

In order to optimize the predictive value of the physical examination, the provider must perform maneuvers correctly. The proper use of drapes is an important component of correctly performing physical examination maneuvers. Skin lesions are missed when "inspection" occurs through clothing, crackles are erroneously reported when the lungs are examined through a t-shirt, and subtle findings on the heart exam go undetected when auscultation is performed over clothing. Accordingly, the best practice standards call for examining with one's hands or equipment in direct contact with the patient's skin (i.e., do not examine through a gown, drape, or clothing). In addition to its clinical value, the correct draping technique is important for improving the patient's comfort level during the encounter. Like all other aspects of the physical exam, it takes deliberate thought and practice to find the right balance between draping, which is done to preserve patient modesty, and exposure, which is necessary to optimize access to the parts that need examination. Individual provider styles in the use of gowns and drapes vary consider


 Physical Examinations I

Engineering 3D Cellularized Collagen Gels for Vascular Tissue Regeneration

1Laboratory for Biomaterials and Bioengineering, Department Min-Met-Materials Eng & CHU de Québec Research Center, Canada Research Chair I for the Innovation in Surgery, Laval University, 2NSERC CREATE Program for Regenerative Medicine (NCPRM), Laval University, 3Department Electronics, Information and Bioengineering, Politecnico di Milano, 4Department of Chemical and Materials Engineering, University of Alberta, 5National Institute for Nanotechnology, National Research Council (Canada), 6Department of Chemical and Biochemical Engineering, University of Western Ontario

JoVE 52812


 Bioengineering

Bioelectric Analyses of an Osseointegrated Intelligent Implant Design System for Amputees

1Department of Veteran Affairs, 2Department of Bioengineering, University of Utah, 3Scientific Computing and Imaging Institute , University of Utah, 4Department of Physical Medicine and Rehabilitation, University of Utah, 5Department of Orthopaedics, University of Utah

JoVE 1237


 Biology

Establishment of Cancer Stem Cell Cultures from Human Conventional Osteosarcoma

1Department of Surgery and Translational Medicine (DCMT), University of Florence, 2Neurofarba Department, University of Florence, 3Department of Traumatology and General Orthopedics, Azienda Ospedaliera Universitaria Careggi

JoVE 53884


 Cancer Research

Peripheral Venous Cannulation

JoVE 10200

Source: Sharon Bord, MD, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA

Placement of an intravenous (IV) catheter is one of the key procedures in medicine. The IV catheter allows patients to receive critical medications, including pain medicine, insulin, antibiotics, blood products, and fluids for rehydration. Additionally, placing an IV catheter allows for blood samples to be obtained, which can be sent to the laboratory for testing and evaluation. A majority of peripheral IV lines are placed in the superficially located veins of the upper extremities. IV catheters can be placed in any superficial vein from the upper arm to the hand (though the veins in the antecubital fossa are larger than those in the hand). IV catheters can be placed in the lower extremities as well; however, this procedure should be performed with caution in patients with a history of diabetes or poor peripheral circulation.


 Emergency Medicine and Critical Care

Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet

1Surgical Research Lab, Marie Lannelongue Hospital, 2Department of Pathology, Marie Lannelongue Hospital, 3Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital, 4Thoracic and Cardiovascular Surgery, University Hospital of Rennes, 5INSERM U999 Paris-Sud University

JoVE 53133


 Medicine

Large-Scale Purification of Porcine or Bovine Photoreceptor Outer Segments for Phagocytosis Assays on Retinal Pigment Epithelial Cells

1INSERM, U968, 2Sorbonne Universités, UPMC Paris 06, UMR_S 968, Institut de la Vision, 3CNRS, UMR_7210, 4Department of Biological Sciences, Center for Cancer, Genetic Diseases and Gene Regulation, Fordham University

JoVE 52100


 Immunology and Infection

Vision Training Methods for Sports Concussion Mitigation and Management

1Neurology and Rehabilitative Medicine, University of Cincinnati, 2Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati, 3Department of Athletics, University of Cincinnati, 4Department of Neurosurgery, University of Cincinnati, 5College of Education, Criminal Justice, and Human Services, University of Cincinnati, 6Division of Sports Medicine, Cincinnati Children's Hospital Medical Center

JoVE 52648


 Behavior

Human Dupuytren's Ex Vivo Culture for the Study of Myofibroblasts and Extracellular Matrix Interactions

1Department of Molecular Cell Biology, Cancer Genomics Centre and Centre for Biomedical Genetics, Leiden University Medical Center, 2Department of Orthopedic Surgery, Academic Medical Center, 3Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, 4Department of Orthopedic Surgery, Mayo Clinic, 5Department of Biochemistry and Molecular Biology, Mayo Clinic, 6Department of Dermatology, Leiden University Medical Center

JoVE 52534


 Medicine

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