Improvement of hand function in children with cerebral palsy via an orthosis that provides wrist extension and thumb abduction

Background

The present study examines the hand movements of children with cerebral palsy during functional tests and compares the childrens' performance with and without the aid of an orthosis that provides wrist extension and thumb abduction.

Methods

The range of motion of the trapeziometacarpal joint was assessed for 32 participants via a reflexive markers image system. Observed motions included flexion–extension and abduction–adduction motions performed in the course of four tests for manual ability; the rest position, lateral and tripod pinches and cylindrical grasp. Muscle strength and manual ability were evaluated using dynamometry and the Jebsen–Taylor test.

Findings

The range of motion tests for the rest position, lateral and tripod pinches and cylindrical grasp demonstrated improvements from 17% to 42% (P < 0.001) for flexion/extension and from 36% to 54% for abduction/adduction (P < 0.001) with the use of the orthosis. Dynamometry measurements showed that the improvement in muscle strength obtained through use of the orthosis was 50% (P < 0.001). Improvements in the time required to perform the movements as determined using the Jebsen–Taylor test varied from 13% to 24% (P < 0.01) for the four considered tests of manual ability.

Interpretation

The orthosis improved the range of motion of the trapeziometacarpal joint, muscle strength and manual ability. The combination of the three techniques may provide the basis for a quantitative assessment of hand dysfunction/improvement in cerebral palsy that will ultimately guide health professionals in their clinical interventions.     

Peroneal reaction time measurement in unipodal stance for two different destabilization axes

Background

The variability of peroneal reaction time measurements is a major problem when using this parameter to control rehabilitation or proprioceptive training processes. In order to control peroneal reaction time values, some extrinsic factors should be considered. The purpose of this study was to measure peroneal reaction time in unipodal stance for two different destabilization axes.

Methods

The peroneal reaction time of 10 healthy subjects was measured from kinematic and electromyograhic data in an experimental study using an ankle destabilization device.

Findings

In a preliminary analysis, results showed that the destabilization axis orientation did not affect peroneal reaction time values (68.5 ms, standard deviation = 9.5 ms and 71.5 ms, standard deviation = 8 ms for destabilizations in the frontal plane and around the Henke's axis, respectively). However, the inter-trial variance of inversion velocity peaks explained between 40% and 49% of the peroneal reaction time variance. When trials were selected on the basis of homogeneous inversion velocity peaks, results showed that peroneal reaction time values for the peroneus brevis were shorter during inversion movements performed around the physiological Henke's tilting axis (63 ms, standard deviation = 9 ms vs. 71 ms, standard deviation = 8 ms).

Interpretation

Our findings evidenced that tilting axis orientation must be considered as an extrinsic factor that may influence peroneal reaction time. Moreover it also seems necessary to consider inversion speed values to adequately compare peroneal reaction time values.     

Patient satisfaction with the CMC controller: A cohort study

Study DesignCohort study.IntroductionThe evidence specific to understanding patient satisfaction, preference and the effects on occupational performance using a CMC orthosis is sparse.Purpose of the StudyThe main purpose of this study was to determine patient satisfaction, aspects of the orthotic preference, and the effect on pain and function of the CMC Controller Plus neoprene orthotic device.MethodsThis research was conducted at two outpatient clinics located in Pennsylvania and Florida during 2019. The subjects of this study included any individuals referred to one of two participating hand therapy facilities with either a primary or secondary diagnosis of thumb CMC joint arthritis or present with this diagnosis as a comorbidity. The CMC Controller Plus orthosis (Hely & Weber) was provided to each patient by the treating therapist at no cost to the patient after the patient agreed to take part in the study. None of the patients received hand therapy treatment for the CMC pain; the only intervention provided was the CMC Controller Plus.ResultsThe CMC Controller Plus orthosis improved the patients' functional status and reduced their pain. The effect size for the change in function was large (1.29) compared to the effect size for the reduction in pain which approached moderate at 0.49.DiscussionThe CMC Controller Plus orthosis improved the patient's functional status by 52% and reduced their pain by 29%.ConclusionThe results were both statistically and clinically significant.     

儿童功能性膝关节疼痛病因探求

目的：通过对195例反复发作性膝关节疼痛患儿的行走步态进行临床观察,找出其发病原因和有效治疗方法。方法方便选取2005年1月—2015年8月把该院收治的195例门诊膝关节疼痛患儿,随机设置为观察组(A)95例和对照组(B)100例两组,A组进行步态分析,找出尖足和外翻足等异常步态,并予矫形器包括矫形足托和矫形足弓垫穿戴矫正,并进行正常步态练习3个月；B组予口服钙剂3个月；观察两组病例疼痛缓解情况。结果经过3个月的治疗,观察组的膝关节疼痛得到明显的缓解和减轻,获得了98.9%的有效率；对照组的膝关节疼痛改善相对不明显,有效率为63%,两者比较差异有统计学意义。结论功能性膝关节疼痛是尖足、外翻足等步态异常所致的疲劳性疼痛,不是正常的生长性疼痛,穿戴矫形足托或足弓垫,改善异常步态是治疗此类疼痛的有效方法之一。     

Evaluation of gait,relapse and compliance in clubfoot treatment with custom-made orthoses

Relapse after successful initial correction of idiopathic clubfoot with the Ponseti method is often related to poor compliance with the foot abduction orthosis (FAO). The aim of this study was to evaluate treatment with custom-made dynamic orthoses. Twenty children with idiopathic clubfoot (30 feet) who had been treated with dynamic orthoses after the correction phase according to the Ponseti casting technique were evaluated. Relapse rates during orthotic treatment were registered. A Vicon gait analysis system was used to measure gait parameters at the age of seven years. The overall gait quality was estimated with the Gait Deviation Index (GDI). Data were analyzed with a nested mixed model and compared with a control group of 16 healthy children. No relapse occurred during the orthotic treatment. High compliance with the orthoses was observed based on parents’ self report and physiotherapist observations. Gait analysis showed decreased ankle power and moment, increased internal foot progression, decreased dorsiflexion during stance, and increased plantar flexion at initial contact compared with the control group. Hip and shank rotations were normal. No calcaneus or equinus gait was observed. The mean GDI was 89.7 (range 71.6–104). The gait analysis outcomes and frequency of relapse were comparable to those of previous studies. Internal foot progression originated primarily from the foot level and was not, as frequently found after FAO treatment, compensated by external rotation at knee or hip level. In children exhibiting poor compliance with an FAO, this dynamic model is considered an effective alternative.     

可调式功能支具在小儿手部瘢痕植皮术后功能恢复的作用

目的:观察小儿手部瘢痕植皮术后使用可调式功能支具畸形对手功能康复的临床疗效.方法:2005年6月～2007年5月,通过对52例(52只手)小儿手部畸形患者,行瘢痕松解白体中厚皮或全厚皮移植术后予以佩戴可调式低温热塑功能锻炼支具6个月～24个月.结果:随访6个月～24个月,52例行皮片移植术的畸形手患者未发牛再次挛缩,手指关节伸屈自如,对指,对掌,握拳功能改善明显,皮片柔软.结论:小儿手部瘢痕植皮术后常规佩戴可调式低温热塑功能锻炼支具对手部功能恢复疗效显著,且简便易行.     

Proximal femoral focal deficiency. Results of conservative and surgical treatment,critical analysis and indications

The treatment of proximal focal femoral deficiency (PFFD) has always been a challenge for the pediatric orthopaedic surgeon. Multiple conservative and surgical approaches have been recommended with frequently unsatisfactory results. We reviewed the medical records of 22 patients seen between 1981 and 1990, and evaluated the results and complications of 3 different treatments administered according to the extent of leg length discrepancy. Of the 22 patients, 5 with the greatest leg length discrepancy were treated with hip stabilization (group A), 14 patients had leg lengthening (group B) and 3 patients had conservative treatment and orthosis (group C). The average follow-up period was16.8 years (range, 10–22 years). Mean age of the patients at treatment was 5.8 years (range, 1–12 years) in group A, 8.4 years (range, 4–16 years) in group B and 3.3 years (range, 1-6 years) in group C. Roentgenograms showed stable hips (Fixsen and Lloyd-Robert's type I) in only 2 of 5 patients from group A and 7 of 14 patients of group B. The remaining were unstable hips (Fixsen and Lloyd-Robert's types II and III). In group B the Wagner apparatus was used in 12 cases, Orthofix in 1 case and Lazo-Cañadell in 1 case. 6 patients in group B underwent more that one lengthening. The mean residual shortenings in groups A, B and C were, respectively, 12.2 cm (range, 2–27), 11.5 cm (range, 1–20) and 18.1 cm (range, 4–27). The patients were evaluated in reference to gait, range of motion at knee and hip levels, stability of the hip and knee and residual shortening on an original scoring scale. Group A showed 60.0% of good results (3 of 5 cases), group B 64.3% (9 of 14 cases) and group C 66.6% (2 of 3 cases). Among patients who sustained to femoral lengthening (group B), complications were osteitis (6 cases), angular deformity (3 cases), pseudoarthrosis (1 case), and fracture (1 case); group A presented 2 cases of pseudoarthrosis while group C had no complications. This experience confirms that the treatment of the patient must be individualized with reference to age, presence or absence of stable hip and other anomalies of the limb. The contribution we make for further evaluations is a proposed new scoring system.     

A simple and useful hand orthosis for patients with amyotrophic lateral sclerosis: A simple web spacer for thumb opposition weakness

Purpose. To evaluate the clinical efficacy of simple web spacer for thumb opposition weakness in patients with amyotrophic lateral sclerosis (ALS).

Method. Observational survey.

Setting. Hospital in Japan.

Results. The average grip strength with and without the web spacer was 8.25 ± 1.74 kg and 8.13 ± 1.91 kg, respectively. The lateral pinch strength was 0.83 ± 0.45 kg and 0.93 ± 0.47 kg. The palp pinch strength was 0.37 ± 0.24 kg and 0.22 ± 0.16 kg. In observation of activities of daily living (ADL) the movements of fingers required for palp pinching such as grasping buttons, flipping the pages of a book, and picking up small things were more easily carried out when wearing.

Conclusions. The simple web spacer, which improves precision hand motion and facilitates grasping, should be considered in the treatment of patients with ALS.     

1例骨盆矫正治疗耻骨联合分离症临床报道

耻骨联合分离是女性生产必须经历的过程,临床上多数产科及骨科医生不够重视,严重影响患者的生活质量。目前多采用止痛药、骨盆带固定等治疗,效果不理想。治疗时应整体评估患者骨盆状态,调整耻骨上下错合、旋转等,再闭合耻骨联合,从而个性化地制定治疗方案。本文报道1例骨盆矫正治疗耻骨联合分离症。