The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study

Objective For patients with De Quervain syndrome using thumb spica orthosis is restricting, so many patient are dissatisfied with using static model. The aim of this study is to compare the effect of modified dynamic and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. Method In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient’s satisfaction of orthoses, were evaluated after using modified dynamic and conventional static orthosis in two groups. Results Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement (p?>?0.05). However, the satisfaction level of the patients who had used dynamic orthosis was higher (p?Conclusion It seems, adding a joint to the static thumb spica leads to patient’s relief and consequently to their satisfaction.

• Implications for Rehabilitation

• The dynamic thumb spica, is easier to use and patients satisfaction is higher than static thumb spica.

• Therefore, it can be used for conservative treatment of De Quervain syndrome.

     

Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis

Abstract

Purpose: The purpose of this study was to conduct a current review of randomized controlled trials regarding the effect of conservative interventions on pain and function in people with thumb carpometacarpal (CMC) osteoarthritis (OA), perform a meta-analysis of the findings and summarize current knowledge. Method: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to May 2014. Reference lists of relevant literature reviews were also searched. All published randomized trials without restrictions to time of publication or language were considered for inclusion. Study subjects were symptomatic adults with thumb CMC OA. Two reviewers independently selected studies, conducted quality assessment and extracted results. Data were pooled in a meta-analysis, when possible, using a random-effects model. Quality of the body evidence was assessed using GRADE approach. Results: Sixteen RCTs involving 1145 participants met the inclusion criteria. Twelve were of high quality (PEDro score?>?6). We found moderate quality evidence that manual therapy and therapeutic exercise combined with manual therapy improve pain in thumb CMC OA at short- and intermediate-term follow-up, and from low to moderate quality evidences that magneto therapy improves pain and function at short-term follow-up. Orthoses (splints) were found to improve function at long-term follow-up and pinch strength at short-term follow-up. Finally, we found from very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. Conclusions: Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain. Additional research is required to determine the efficacy of other therapeutic interventions that are performed with patients with thumb CMC OA.

• Implications for Rehabilitation

• Manual therapy and exercise are an effective means of improving pain and function at short-term follow-up by patients with thumb CMC OA.

• Magneto therapy, manual therapy, manual therapy and exercise and Orthoses (splints) were found to have clinically significant results.

• Very few of the included studies showed a clinically significant effect size in favor of treatment.

     

How kinematic disturbance in the deformed rheumatoid thumb impacts on hand function: a biomechanical and functional perspective

Purpose This study investigates the effects of kinematic disturbances in rheumatoid thumb on patient’s hand functions via objective and patient-perceived measurements. Method Twenty-one patients with rheumatoid arthritis (RA) and 21 healthy age- and gender-matched individuals were recruited to receive the objective evaluations, including the Purdue Pegboard Test, Jamar dynamometer, pinch-meter, Permanent Impairment Scale and self-administrated measurements, including the Health Assessment Questionnaire (HAQ) and Manual Ability Measure-36 (MAM-36). An electromagnetic tracking system was used to measure thumb kinematics. The differences in the measures between the RA and control groups and the dominant and non-dominant hands of the RA group were examined. The relationships between the thumb kinematics and hand functional capabilities, as well as impairment levels, were also explored. Results The RA group showed significantly smaller thumb movement capabilities and hand strength, as well as worse scores in hand dexterity, MAM-36 and HAQ than healthy controls. The movement workspace of the RA thumb showed moderate correlations with the factors of hand strength, dexterity, impairment scale, MAM-36 and HAQ scores. Conclusions The findings indicate deficits related to the movement capability of the RA thumb may negatively influence hand dexterity and functional hand performance, as well as life quality, for the patients with RA.

• Implications for Rehabilitation

• A deformed rheumatoid thumb might limit the movement workspace of the thumb and consequently impair the hand performance as well as the life quality.

• The dominant thumb of the RA patients might have greater structural and functional deterioration than the non-dominant side.

• Suitable joint protection strategies, exercises and orthotics should be early applied to the RA patients for preserving hand functions.

     

An overview of robotic/mechanical devices for post-stroke thumb rehabilitation

Purpose: This article aims to clarify the current state-of-the-art of robotic/mechanical devices for post-stroke thumb rehabilitation as well as the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion.

Methods: A systematic literature search was conducted to identify robotic/mechanical devices for post-stroke thumb rehabilitation. Specific electronic databases and well-defined search terms and inclusion/exclusion criteria were used for such purpose. A reasoning model was devised to support the structured abstraction of relevant data from the literature of interest.

Results: Following the main search and after removing duplicated and other non-relevant studies, 68 articles (corresponding to 32 devices) were left for further examination. These articles were analyzed to extract data relative to (i) the motions assisted/permitted – either actively or passively – by the device per anatomical joint of the thumb and (ii) mechanical-related aspects (i.e., architecture, connections to thumb, other fingers supported, adjustability to different hand sizes, actuators – type, quantity, location, power transmission and motion trajectory).

Conclusions: Most articles describe preliminary design and testing of prototypes, rather than the thorough evaluation of commercially ready devices. Defining appropriate kinematic models of the thumb upon which to design such devices still remains a challenging and unresolved task. Further research is needed before these devices can actually be implemented in clinical environments to serve their intended purpose of complementing the labour of therapists by facilitating intensive treatment with precise and repeatable exercises.

• Implications for Rehabilitation

• Post-stroke functional disability of the hand, and particularly of the thumb, significantly affects the capability to perform activities of daily living, threatening the independence and quality of life of the stroke survivors. The latest studies show that a high-dose intensive therapy (in terms of frequency, duration and intensity/effort) is the key to effectively modify neural organization and recover the motor skills that were lost after a stroke. Conventional therapy based on manual interaction with physical therapists makes the procedure labour intensive and increases the costs.

• Robotic/mechanical devices hold promise for complementing conventional post-stroke therapy. Specifically, these devices can provide reliable and accurate therapy for long periods of time without the associated fatigue. Also, they can be used as a means to assess patients? performance and progress in an objective and consistent manner.

• The full potential of robot-assisted therapy is still to be unveiled. Further exploration will surely lead to devices that can be well accepted equally by therapists and patients and that can be useful both in clinical and home-based rehabilitation practice such that motor recovery of the hand becomes a common outcome in stroke survivors.

• This overview provides the reader, possibly a designer of such a device, with a complete overview of the state-of-the-art of robotic/mechanical devices consisting of or including features for the rehabilitation of the thumb. Also, we clarify the anatomical characteristics and motions of the thumb that are crucial for the development of any device that aims to support its motion.

• Hopefully, this?combined with the outlined opportunities for further research?leads to the improvement of current devices and the development of new technology and knowledge in the field.

     

Long-term functional outcome of patients with longitudinal radial deficiency: cross-sectional evaluation of function,activity and participation

Purpose: To evaluate all functional aspects of patients with longitudinal radial dysplasia and to clarify the relationship between body functions on the one hand and limitations in activity and participation on the other hand. Methods: Thirty-one arms of seventeen adult patients with longitudinal radial dysplasia were analysed. Body function was assessed by measuring grip and pinch strength and active range of motion (ROM) of the hand. Activities were measured using the “Sequential Occupational Dexterity Assessment “, to measure perceived restrictions in participation the “Impact on Participation and Autonomy questionnaire” was used. Relationships between severity of dysplasia, body function, participation and activity were determined. Results: Patients with a severe type scored significantly lower in body function scores than patients with a mild form. Patients with limited active finger joint motion performed worse on activities. We found no significant differences in activity and participation between mild or severe types and found no correlation in participation scores. Conclusion: Although considerable restrictions in joint mobility and strength were revealed, little or no limitations on the activity and participation level were found. Limitations in body functions hardly influenced capacity on activity level and did not influence participation in societal roles.

Implications for Rehabilitation

• People with LRD learn to accomplish many of the everyday tasks without great difficulty and do not report a low quality of participation in major life activities.

• Professionals working in rehabilitation medicine should focus on activity and participation rather than on body structure or functions. Therapy focused solely on increasing joint motion or strength does not lead to further improvement.

• For parents it will be reassuring to know that children with severe radial deficiencies can satisfactory fulfill social roles in later life.

     

Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis

Objective

The purpose of this study is to evaluate whether neurodynamic mobilization of the median nerve improves pressure pain threshold (PPT) and pinch and grip strength in patients with secondary thumb carpometacarpal osteoarthritis (TCOA).

Method

Fifteen patients with secondary TCOA (13 women and 2 men) between 70 and 90 years old were received by neurodynamic therapy. All patients received median nerve mobilization of the dominant hand by sliding technique during 4 sessions over 2 weeks. The outcome measures of this case series were monitored by using PPT measured by algometry as PPT at the trapeziometacarpal (TM) joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone. Tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. These variables were measured at pretreatment, 5 minutes posttreatment, 1 week (first follow-up [FU]) and 2 weeks after treatment (second FU).

Results

Pressure pain threshold in the TM joint was 3.54 ± 0.04 kg/cm². After treatment, it increased to 4.38 ± 0.04 kg/cm² (P < .01) and maintained in the first FU (4.27 ± 0.04 kg/cm², P < .02) and second FU (4.08 ± 0.04 kg/cm², P < .02). In contrast, we found no differences in PPT in the other studied structures after treatment. Similarly, tip and tripod pinch strength remained without change after treatment. Grip strength was 10.77 ± 0.18 kg, and after treatment, it increased to 11.55 ± 0.16 kg (P < .05) and maintained in first FU (11.73 ± 0.18 kg, P < .02) and second FU (11.2 ± 0.17 kg, P < .05).

Conclusions

Median nerve mobilization decreased pain in the TM joint and increased grip strength in this group of patients with TCOA.     

The applicability of four clinical methods to evaluate arm and hand function in all stages of spinal muscular atrophy type II

Abstract

Aim: To evaluate the ability of four clinical methods to reflect arm and hand function at impairment and activity level and to determine their ability to discriminate among SMA II patients of all ages and in all stages of the disease. Methods: Fifty-two patients with SMA II (age range: 8–73 years) were assessed by means of the Egen Klassifikation 2 (EK2 scale), the Motor Function Measure Scale (MFM D3), the Manual Muscle Test (MMT) and Hand-Held Dynamometry (HHD) in full fist grip and lateral pinch grip. Patients were classified into six levels of upper limb function by means of the Brooke Upper Limb Scale, and the four methods’ ability to differentiate among patients within these levels was calculated. Modified versions of the EK2 scale (EK Upper Limb) and the MFM D3 (MFM D3 Upper Limb) were assessed in the same manner. Results: The patients’ physical abilities were best described by the MMT and EK2 while the “EK Upper Limb”, MFM D3 and MMT were best at discriminating among patients across the range of upper limb function. Quantitative muscle tests as measured by Citec? HHD were less applicable to weak patients; full fist grip could discriminate among patients at Brooke levels 3–5, and lateral pinch grip among the strongest patients. Conclusion: At the impairment level, MMT is the superior measure of muscle function in very weak patients in whom HHD cannot reflect capacity. At the activity level, the EK 2 represents daily activities whereas the MFM D3 measures motor functions. In differentiating among SMA II patients of all ages and in all stages of the disease, the ability of abbreviated versions of scales targeting upper limb function is superior to unabridged versions of these scales.

• Implications for Rehabilitation

• Evaluation of upper limb function in spinal muscular atrophy II

• Even very weak patients with SMA II have some residual upper limb function that is measurable if the right method is chosen.

• The Manual muscle test is applicable to all patients with SMA II and is useful to determine possible interventions – such as methods to drive a wheelchair or operate a computer.

• Abbreviated versions of the EK2 scale and the MFM are useful as methods to evaluate subtle changes in upper limb function resulting from disease progression or interventions.

     

Evaluation of hand orthoses in Duchenne muscular dystrophy

Abstract

Purpose: The purpose of this study was to evaluate whether treatment of boys with Duchenne muscular dystrophy using hand orthoses could benefit joint mobility, grip strength, or fine motor function.

Method: Eight boys with Duchenne muscular dystrophy were provided with individually customised rest orthoses. The results were analysed using single-subject design. The study included a baseline and an intervention phase. A follow-up examination was also performed.

Results: Boys with less than 50° passive wrist extension mobility were included. Wrist extension of the dominant hand increased in four and was maintained in four. Wrist extension in the non-dominant hand increased in five, was maintained in two and decreased in one. Thumb abduction in the dominant hand increased in six and two remained stable. In the non-dominant hand five increased and three remained stable. Grip strength and fine motor function showed also positive results.

Conclusions: This study indicates that the use of hand orthoses in Duchenne muscular dystrophy can delay development of contractures and improve passive wrist extension and thumb abduction. Hand orthoses can therefore be recommended for boys who start to develop contractures in the long finger flexors. Due to small sample size further studies are needed to confirm this result.

• Implications for rehabilitation

• Evaluation of hand orthoses in Duchenne muscular dystrophy.

• Preserved hand function is of uttermost importance for performance of activities in the late stages of Duchenne muscular dystrophy.

• Contractures of long finger flexors affect hand function and limit performance of daily activities.

• Hand orthoses can delay development of contractures and preserve hand function and give prerequisites for independence.

• The occupational therapists should measure wrist joint mobility regularly to be able to find the right time for intervention with hand orthoses in this progressive disorder.

     

Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit. They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p < 0.0001). Patients experienced only moderate knee pain during the strength training exercises, but knee pain at rest and knee joint effusion (p < 0.0001) were unchanged or decreased over the six training sessions. Isometric knee-extension strength and maximal walking speed increased by 147 and 112%, respectively. Conclusion: Progressive strength training initiated immediately after TKA seems feasible, and increases knee-extension strength and functional performance without increasing knee joint effusion or knee pain.

Implications for Rehabilitation

• Rehabilitation with progressive strength training initiated early after total knee arthroplasty (TKA) seems feasible.

• Rehabilitation with progressive strength training increases knee-extension strength and maximal walking speed without increasing knee joint effusion and knee pain during the first 2 weeks after TKA.

• During the progressive strength training exercises, patients with TKA may experience moderate knee pain, which seems to decrease over time. Resting knee pain before and after each training session is none to mild.

• The results of this pilot study are encouraging, but a larger randomized controlled trial, which compares rehabilitation with or without progressive strength training, is needed to confirm our findings.

     

The effects of a new designed forearm orthosis in treatment of lateral epicondylitis

Purpose: This paper reports on the design and testing of a new designed forearm orthosis and explores its efficacious in comparison to the standard counterforce orthosis in patients with lateral epicondylitis. Method: Twenty-four patients were enrolled in this assessor-blinded clinical trial and randomly assigned to two parallel treatment groups. The measures of pain and function, the pain threshold and grip strength were compared using patient rated tennis elbow evaluation (PRTEE) form, algometer and dynamometer respectively at baseline and 4 weeks after treatment. Paired and independent t-test statistical methods recruited for within and between groups comparisons respectively. Results: The both orthoses, counterforce and new-designed, significantly relieved pain, and improved function, pain threshold and grip strength of all patients after 4 weeks application. The new-designed orthosis seemed to be more effective than the counterforce orthosis in pain relief, but there was not any significant difference in efficacious of two types of orthoses regarding function. Conclusions: The new-designed orthosis can significantly relieve pain, improve function, increase pain threshold and grip strength after application. This orthosis seemed to be more effective than counterforce orthosis in relieving pain and increasing the pain threshold probably due to the limitation of forearm supination.

Implications for Rehabilitation

• Several orthoses have been prescribed in the literature to decrease pain and inflammation of the lateral epicondylitis.

• The new-designed forearm orthosis is composed of wrist and below elbow counterforce straps that are connected by a non flexible middle part.

• The new-designed orthosis was better than counterforce orthosis in relieving pain and increasing pain threshold.

     

Muscle power is an important measure to detect deficits in muscle function in hip osteoarthritis: a cross-sectional study

Purpose: To investigate between-leg differences in hip and thigh muscle strength and leg extensor power in patients with unilateral hip osteoarthritis. Further, to compare between-leg differences in knee extensor strength and leg extensor power between patients and healthy peers.

Methods: Seventy-two patients (60–87 years) with radiographic and symptomatic hip osteoarthritis not awaiting hip replacement and 35 healthy peers (63–82 years) were included. Hip and thigh muscle strength and leg extensor power were measured in patients and knee extensor strength and leg extensor power in healthy.

Results: The symptomatic extremity in patients was significantly (p?t-test) weaker compared with the non-symptomatic extremity for five hip muscles (8–17%), knee extensors (11%) and leg extensor power (19%). Healthy older adults had asymmetry in knee extensor strength (6%, p?Conclusions: Patients had generalized weakening of the affected lower extremity and numerically the largest asymmetry was evident for leg extensor power. In contrast, healthy peers had no asymmetry in leg extensor power. These results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with hip osteoarthritis.

• Implications for Rehabilitation

• Even in patients with mild symptoms not awaiting hip replacement a generalized muscle weakening of the symptomatic lower extremity seems to be present.

• Between-leg differences in leg extensor power (force?×?velocity) appears to be relatively large (19%) in patients with unilateral hip osteoarthritis in contrast to healthy peers who show no asymmetry.

• Compared to muscle strength the relationship between functional performance and leg extensor power seems to be stronger, and more strongly related to power of the symptomatic lower extremity.

• Our results indicate that exercise interventions focusing on improving leg extensor power of the symptomatic lower extremity and reducing asymmetry may be beneficial for patients with mild symptoms not awaiting hip replacement.

     

Congenital thumb anomalies and the consequences for daily life: patients’ long-term experience after corrective surgery. A qualitative study

Purpose: The aim of the study was to explore patients’ long-term experience of a congenital hand problem, and the consequences for daily life.

Method: Fifteen participants with a median age 24 years (17–55 years), born with thumb hypoplasia/aplasia or thumb duplication were interviewed using a semi-structured interview guide. The interviews were subjected to qualitative content analysis.

Results: Although the mobility and strength in the thumb/hand(s) varied within the group, hand function was generally described as good. Compensatory strategies were used to overcome practical obstacles. The emotional reactions to being visibly different from peers in early life varied from total acceptance and a sense of pride in being special, to deep distress and social withdrawal. Support from parents, teachers and others was important in facing emotional challenges and practical consequences.

Conclusion: The present study highlights the importance of healthcare professionals addressing appearance-related concerns which may have long-term emotional and social consequences for patients born with a thumb anomaly.

• Implications for Rehabilitation

• Appearance-related concerns and need for emotional support should be fully considered throughout the rehabilitation process to prevent distress and social withdrawal.

• Effective problem-solving strategies, such as compensation, change in occupational performance and support from others may reduce activity limitations and participation restriction.

     

Higher pain sensitivity and lower muscle strength in postmenonpausal women with early rheumatoid arthritis compared with age-matched healthy women – a pilot study

Purpose: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA. Methods: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed. Results: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups. Conclusions: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.

Implications for Rehabilitation

• Difference in muscular strength between postmenopausal women with and without (rheumatoid arthritis) RA is present in early disease despite low disease activity.

• Women with RA have decreased pressure pain thresholds and hyperalgesia, but no dysfunction of segmental and plurisegmental pain inhibitory mechanisms.

• The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity in this group of patients.

     

Are the mental representations of people with osteoarthritis consistent with the International Classification of Functioning Disability and Health?

Purpose: This study examined whether the mental representations of people with osteoarthritis (OA) were consistent with the International Classification of Functioning Disability and Health (ICF) model. Methods: A geographical cohort of 202 people with OA about to have joint replacement surgery completed postal questionnaires. Mental representations were measured by asking participants what they were hoping for from their joint replacement. Two expert judges classified these illness representations to the main ICF constructs of Impairment (I), Activity Limitation (A) and Participation Restriction (P). Results: There was strong agreement between the expert judges. There were a similar number of illness representations for each of the ICF constructs. The primary biomedical route of the ICF model was suggested by the ordering of the participants’ illness representations i.e. I to A to P. Conclusions: The mental representations of people with OA were consistent with the ICF theoretical framework with all three ICF constructs of importance. It appeared that people with OA implicitly apply a biomedical causal model of disability, suggesting that treatments and interventions aimed at reducing impairment may only affect P indirectly, through A. Additionally, the methods provide a novel way of exploring the potential causal relationships between constructs of the ICF model.

Implications for Rehabilitation

• People with disabling conditions describe their health condition in terms that are consistent with the ICF model of functioning, disability and health

• All three ICF constructs (impairment, activity and participation) were found to be of importance to people with OA.

• People waiting for joint replacement surgery have mental representations that match a biomedical model describing impairment followed by activity limitations followed by restrictions in social participation

• The results suggest that for people with osteoarthritis, treatments and interventions aimed at reducing impairment may only affect participation indirectly, through activity.

     

A kinematic and electromyographic study of grip in extension in a clinical setting

Aim: Grip, including grip in extension, is an essential element in human beings. The functional evaluation scales of the hand require a greater number of objective variables in order to offer an overall perspective. Devices such as surface electromyography and inertial sensors can be used in evaluation and tasks. Such equipment can lead to new variables for analysis and offer different approaches for treatment. Methods: Six participants were selected randomly from a sample of healthy population. Each participant made the grip in extension, which was parameterized in real time. This movement was analyzed and recorded in a synchronized manner with surface electromyography and accelerometer-type inertial sensors in the hand. Results: After analyzing and processing the data, it was possible to detect five phases within the movement thanks to in-depth analysis of the module vector of the index finger along with electromyography of the musculature of the first dorsal interosseous. Conclusions: Parameterization is possible in real time for the grip in extension based on surface electromyography and accelerometer, offering new analysis variables on hand operation while providing a suitable complement to standardized assessments.

• Implications for Rehabilitation

• The use of surface electromyography and accelerometry in the arm synchronously, allows clinicians to identify new intervention and treatment variables.

• The protocol developed can be used in clinical practice because it is non-invasive, the enabled devices do not cause damage on the subject.

• According to the results, the muscles of the hypothenar region and the first dorsal interosseous have greater activation in the hand during grip extension.

• The wrist extensor muscles and flexor carpi ulnaris have more activation during the approach phase to grip. These are the muscles that should be prioritized for rehabilitation.

• The variation of the acceleration allows you to differentiate between the phases of rest and movement of the hand. If the variation of the acceleration at rest is higher than 0.3g, this could indicate the presence of abnormal movements or tremor.

     

Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase

Purpose: The aim of this study was to understand the living experiences of middle-aged Taiwanese adults with early knee osteoarthritis (OA). Methods: A qualitative research design was used in this study. Participants (n?=?17) were recruited by purposive sampling from orthopedic clinics at two medical centers in northern Taiwan. Data were collected through in-depth interviews from July to December 2010. The data were transcribed verbatim and summarized by content analysis. Results: The results indicated that the lived experiences could be grouped into 4 main themes: awareness; surmise of causes; acquisition of strategies; and the search for confirmative diagnosis. Conclusions: This study found that patients’ knowledge is insufficient for recognition of the presence of early OA. There is a need for clinicians to integrate knowledge of OA into the health education system and to develop interventions for early knee osteoarthritic patients. Patients’ disease cognition must be promoted so that their ability to process early symptoms of this disease will improve.

Implications for Rehabilitation

• Awareness, surmise of causes, and acquisition of strategies are repetitive circles. Patients pursue the true cause for their knee joint disease and seek confirmative diagnosis when the symptoms do not improve or when they became worse.

• The information patients have is insufficient to know the presence of degenerative osteoarthritis disease.

• There is a need for clinical practitioners to integrate knowledge of osteoarthritis into the health education system to increase awareness and to develop appropriate interventions for patients with early knee OA.

     

The three-dimensional analysis of three thumb joints coordination in activities of daily living

Background

Presently, the angular movements of the three thumb joints during activities of daily living are limited as a result of their static position and lack of the required thumb range of motion information during motion. The purpose of this study was to investigate the three thumb joints' motion required in activities of daily living.

Methods

Sixteen healthy subjects were recruited for this study. A three-dimensional motion analysis system was used, with 14 retroreflective markers attached to each subject's thumb for motion data collection. Three joints including interphalangeal joint, metacarpophalangeal joint and carpometacarpal joint of the thumb were analyzed. The distal segment orientation relative to the proximal segment was defined the joint angle. The styloid process of radial bone orientation when quantifying the carpometacarpal joint movement was indirectly calculated from the third metacarpal bone.

Findings

The results showed that each type of activity involved significant interphalangeal flexion. The metacarpophalangeal joint mainly showed abduction motion, cylinder grip and spherical grip with the largest angle. For the carpometacarpal joint, the cylinder grip and spherical grip showed a relatively larger rotational range of motion. The interphalangeal joint in the three thumb joints was primary in flexion.

Interpretation

These results may provide more information to precisely describe the thumb function in daily life activities and also provide a reference when assessing thumb impairment or for constructing an index used for evaluating the recovery of an injured thumb in clinic. It also could help in designing hand-related instruments for use in activities of daily life.     

Effects of hand-training in persons with myotonic dystrophy type 1 – a randomised controlled cross-over pilot study

Abstract

Purpose: To investigate the effects of a hand-training programme on grip, pinch and wrist force, manual dexterity and activities of daily living, in adults with myotonic dystrophy type 1 (DM1). Method: In this randomised controlled trial with a crossover design, 35 adults with DM1 were, after stratification for grip force, assigned by lot to two groups. Group A started with 12 weeks of hand training, while group B had no intervention. After a wash-out period of 12 weeks, where none received training, the order was reversed. The Grippit® was used as primary outcome measure and the hand-held Microfet2? myometer, the Purdue Pegboard, the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS) were secondary outcome measures. Assessments were performed before and after training and control periods, i.e. four times altogether. Results: Ten persons dropped out and 13 had acceptable adherence. Intention-to-treat analyses revealed significant intervention effects for isometric wrist flexor force (p?=?0.048), and for COPM performance (p?=?0.047) and satisfaction (p?=?0.027). On an individual level, improvements were in general showed after a training period. Conclusion: The hand-training programme had positive effects on wrist flexor force and self-perception of occupational performance, and of satisfaction with performance. No evident detrimental effects were shown.

• Implications for Rehabilitation

• Myotonic dystrophy type 1 (DM1) is a slowly progressive neuromuscular disease characterised by myotonia and muscle weakness and wasting.

• People with DM1 are often concerned about their ability to carry out ADL and to participate in, e.g. work, sports and hobbies when they gradually become weaker.

• This pilot study showed that a hand-training programme improved wrist flexor force and self-perception and satisfaction of occupational performance.

• Resistance training of hand muscles with a silicon-based putty can be a therapy option for people with DM1 in clinical practise.

     

Changes in self-reported disability after performance-based tests in obese and non-obese individuals diagnosed with osteoarthritis of the knee

Abstract

Purpose: The purposes of this study are three-fold: (1) To examine whether the WOMAC questionnaire should be obtained before or after performance-based tests. (2) To assess whether self-reported disability scores before and after performance-based tests differ between obese and non-obese individuals. (3) To observe whether physical activity and BMI predict self-reported disability before and after performance based tests. Methods: A longitudinal study included thirty one participants diagnosed with knee osteoarthritis (OA) using the Kellgren-Lawrence Scale by an orthopedic surgeon. Results: All WOMAC scores were significantly higher after as compared to before the completion of performance-based tests. This pattern of results suggested that the WOMAC questionnaire should be administered to individuals with OA after performance-based tests. The obese OA was significantly different compared to the non-obese OA group on all WOMAC scores. Physical activity and BMI explained a significant proportion of variance of self-reported disability. Conclusion: Obese individuals with knee OA may over-estimate their ability to perform physical activities, and may under-estimate their level of disability compared to non-obese individuals with knee OA. In addition, self-reported physical activity seems to be a strong indicator of disability in individuals with knee OA, particularly for individuals with a sedentary life style.

• Implications for Rehabilitation

• Osteoarthritis is a progressive joint disabling condition that restricts physical function and participation in daily activities, particularity in elderly individuals.

• Obesity is a comorbidity commonly associated with osteoarthritis and it appears to increase self-reported disability in those diagnosed with osteoarthritis of the knee.

• In a relatively small sample, this study recommends that rehabilitation professionals obtain self-report questionnaires of disability after performance-based tests in obese individuals with osteoarthritis of the knee as they are more likely to give an accurate representation of their level of ability at this time.

     

Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial

Purpose: To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH). Methods: A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n?=?8) or sham (n?=?7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen–Taylor test (JTT). Results: Both groups improved JTT over time (p?p?=?0.025). However, this difference was attenuated at one-week follow-up. There was a non-significant tendency for greater improvement in JTT in the anodal group compared with the sham group, from baseline to post-assessment (p?=?0.158). Conclusions: Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH.

• Implications for Rehabilitation

• Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone.

• tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.