Passive stiffness of coupled wrist and forearm rotations.

Coordinated movement requires that the neuromuscular system account and compensate for movement dynamics. One particularly complex aspect of movement dynamics is the interaction that occurs between degrees of freedom (DOF), which may be caused by inertia, damping, and/or stiffness. During wrist rotations, the two DOF of the wrist (flexion-extension and radial-ulnar deviation, FE and RUD) are coupled through interaction torques arising from passive joint stiffness. One important unanswered question is whether the DOF of the forearm (pronation-supination, PS) is coupled to the two DOF of the wrist. Answering this question, and understanding the dynamics of wrist and forearm rotations in general, requires knowledge of the stiffness encountered during rotations involving all three DOF (PS, FE, and RUD). Here we present the first-ever measurement of the passive stiffness encountered during simultaneous wrist and forearm rotations. Using a wrist and forearm robot, we measured coupled wrist and forearm stiffness in 10 subjects and present it as a 3-by-3 stiffness matrix. This measurement of passive wrist and forearm stiffness will enable future studies investigating the dynamics of wrist and forearm rotations, exposing the dynamics for which the neuromuscular system must plan and compensate during movements involving the wrist and forearm.

Position-dependent characterization of passive wrist stiffness.

Because the dynamics of wrist rotations are dominated by stiffness, understanding wrist rotations requires a thorough characterization of wrist stiffness in multiple degrees of freedom. The only prior measurement of multivariable wrist stiffness was confined to approximately one-seventh of the wrist range of motion (ROM). Here, we present a precise nonlinear characterization of passive wrist joint stiffness over a range three times greater, which covers approximately 70% of the functional ROM of the wrist. We measured the torque-displacement vector field in 24 directions and fit the data using thin-plate spline smoothing optimized with generalized cross validation. To assess anisotropy and nonlinearity, we subsequently derived several different approximations of the stiffness due to this multivariable vector field. The directional variation of stiffness was more pronounced than reported previously. A linear approximation (obtained by multiple linear regression over the entire field) was significantly more anisotropic (eigenvalue ratio of 2.69 ± 0.52 versus 1.58 ± 0.39; ) though less misaligned with the anatomical wrist axes (12.1 ± 4.6° versus 21.2 ± 9.2°; ). We also found that stiffness over this range exhibited considerable nonlinearity-the error associated with a linear approximation was 20-30%. The nonlinear characterization over this greater range confirmed significantly greater stiffness in radial deviation compared to ulnar deviation. This study provides a characterization of passive wrist stiffness better suited to investigations of natural wrist rotations, which cover much of the wrist's ROM. It also provides a baseline for the study of neurological and/or orthopedic disorders that result in abnormal wrist stiffness.

UK guidelines for the management of pituitary apoplexy.

Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving. It is a clinical syndrome characterized by the sudden onset of headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage and/or infarction of the pituitary gland. It is associated with the sudden onset of headache accompanied or not by neurological symptoms involving the second, third, fourth and sixth cranial nerves. If diagnosed patients should be referred to a multidisciplinary team comprising, amongst others, a neurosurgeon and an endocrinologist. Apart from patients with worsening neurological symptoms in whom surgery is indicated, it is unclear currently for the majority of patients whether conservative or surgical management carries the best outcome. Post apoplexy, there needs to be careful monitoring for recurrence of tumour growth. It is suggested that further trials be carried out into the management of pituitary apoplexy to optimize treatment.