Journal of Hand Therapy最新文献

Study design: Retrospective service evaluation INTRODUCTION: Therapist-led clinics are evidenced to be safe, effective alternatives to consultant-led outpatient clinics for musculoskeletal conditions.

Purpose of study: To evaluate the impact of an occupational therapist (OT)-led hand clinic in one acute hospital in Ireland.

Methods: Referrals received by Plastic and Reconstructive Surgeons were redirected to the OT-led hand clinic at the initial point of triage. Patients were scheduled for clinic appointments according to clinical priority and were evaluated using diagnosis-specific assessment proformas. Assessment included detailed history taking, investigating activities which worsen symptoms, and provocative testing where appropriate. When a diagnosis was unclear, further imaging/investigations were ordered. Following comprehensive assessment, patients were either discharged to the referring doctor, scheduled to the consultant-led clinic for further clinical assessment/surgery booking, or continued with hand therapy. Hand therapy interventions were multi-modal, and incorporated injection therapy (commenced 2022, 1-year after the service began). Outcomes included patient wait times, correlation of referred versus treated condition, patient satisfaction, outcome of assessment/treatment and patient perception of change using Global Rating of Change (GROC).

Results: A total of 1072 patients were referred to the service from March 2021 to September 2024. Of those, 973 (91%) were scheduled and 99 (9%) declined an appointment. Approximately 91% of patients were seen within 6 months, compared to a previous average wait of 12-15 months. More than 31% of patients were treated for a different complaint than their referred complaint. Over 65% of patients did not require consultant plastic surgeon review and their full episode of care was managed by a single OT. Patients expressed high satisfaction and 97% reported improvements in their symptoms on GROC completion.

Conclusion: This OT-led clinic successfully reduced patient wait times, yielded high patient satisfaction and was an effective way to treat subacute/chronic wrist/hand pathology.

Background: Normal hand function relies on a finely tuned interaction between the sensory and motor systems within the central and peripheral nervous systems. The central nervous system continuously adapts to changed activity, environmental changes, learning, and injury - a phenomenon known as neuroplasticity. The neuroplasticity is a life-long ability and presents opportunities for therapeutic intervention; by directing it, lost or impaired functions can be improved through a process called "guided plasticity".

Purpose: To give an overview of methods of guided plasticity used in hand rehabilitation STUDY DESIGN/METHOD: Expert review RESULT: This overview highlights the cortical process for neuroplasticity, sensory-motor synergy, and its implications for hand function and rehabilitation. Sensory and motor training should commence as early as possible after an injury due to the rapid cortical changes following input changes - a cortical preparation.

Conclusion: As research progresses, we can expect further refinements in rehabilitation techniques and neuro engineering, potentially leading to improved outcomes for patients with hand injuries.

Background: Nerve transfers are increasingly used to restore upper limb function in infants and toddlers with brachial plexus birth injuries (BPBI). However, standardized, pediatric-specific rehabilitation protocols remain lacking. Adult-focused approaches are often developmentally inappropriate, and the absence of tailored rehabilitation may contribute to high failure rates, particularly for complex transfers.

Purpose: To present a structured, milestone-based rehabilitation protocol adapted from the Donor Activation Focused Rehabilitation Approach (DAFRA) for infants and toddlers undergoing nerve transfers for BPBI and to report functional outcomes using a case-series design.

Study design: Therapeutic, case series METHODS: Following IRB approval, infants and toddlers undergoing nerve transfers for BPBI at a single institution were enrolled. Procedures included spinal accessory nerve to suprascapular nerve (SAN-SSN), medial pectoral to axillary nerve (MPN-AxN), ulnar nerve fascicle to musculocutaneous branch (Oberlin), and double fascicular nerve transfers. All pati three-phase rehabilitation protocol was implemented, emphasizing donor-recipient muscle re-education through play-based functional activities, co-activation, and caregiver participation. Outcomes were assessed using the Active Movement Scale (AMS).

Results: Fourteen patients underwent SAN-SSN transfer at a mean age of 7.0 months; 71.4% achieved full external rotation against gravity (AMS 7). Twenty-one underwent MPN-AxN transfer at a mean age of 8.9 months, demonstrating significant improvements in abduction (median AMS 5, IQR 3-6) and flexion (median AMS 6, IQR 5-6) (both p < 0.001). Thirteen patients underwent double fascicular nerve transfers for elbow flexion at a mean age of 10.1 months, with significant gains in elbow flexion (median AMS 6, IQR 6-7) and forearm supination (median AMS 5, IQR 3-7) (both p = 0.002). Biceps improved from median MRC 0 (IQR 0-1) preoperatively to MRC 4 (IQR 3-5) postoperatively (p = 0.002). Meaningful recovery occured in 100% for elbow flexion 62% for supination, and 70% for biceps strength.

Conclusions: A structured, milestone-based, play-integrated DAFRA protocol yields promising outcomes in infants and toddlers undergoing nerve transfers for BPBI. Developmentally appropriate rehabilitation may reduce failure rates and supports broader adoption of pediatric-specific protocols.

Background: Free functional muscle transfer surgery requires supervised rehabilitation to optimize motor re-education, yet guidelines regarding orthotic use and therapeutic exercises are lacking.

Purpose: To present an overview of the rehabilitation protocol for a patient who underwent free functional muscle transfer after brachial plexus injury.

Study design: Case report.

Methods: A 49-year-old male with complete brachial plexus injury began outpatient hand therapy 2 weeks after free functional muscle transfer. Rehabilitation included a dedicated orthosis program and exercises based off the Donor Activation Focused Rehabilitation Approach. Donor muscle activation is first coupled with passive elbow and finger flexion, followed by active-assisted, antigravity, and then resisted motion.

Results: The case obtained a 4 cm distal palmar crease distance, an elbow arc of 30-100 degrees, and the elbow could withstand moderate (4/5) resistance. Elbow and finger flexion strength was greater with co-contraction of the donor trapezius muscle.

Conclusions: Good strength and range-of-motion outcomes were obtained using Donor Activation Focused Rehabilitation Approach as a framework to model free functional muscle transfer rehabilitation.

Background: Handgrip strength has been proposed as an indicator of overall body strength. Low handgrip strength in older ages is associated with a number of health-related outcomes.

Purpose: This study was aimed to investigate the prevalence of low handgrip strength and associated factors among individuals age 50 years and above.

Study design: A population-based cross-sectional study.

Methods: This study was conducted among 3007 participants with the mean age of 62.1 ± 7.8, between 2020 and 2022. Low handgrip strength was defined as a handgrip strength of <28 kg for men and <18 kg for women. A chi-square and independent sample t-test was used for comparing categorical and quantitative variables. A multivariable logistic regression analysis was used to determine the factors associated with low handgrip strength.

Results: The prevalence of low handgrip strength was 16.8%. In multivariable regression analysis of men age (OR = 1.09 (95%CI: 1.07, 1.11)), wrist circumference (OR = 0.91 (95%CI: 0.83, 0.99)), and iron deficiency anemia (OR = 1.9 (95%CI: 1.1, 3.4)) remained significantly associated with low handgrip strength. Whereas, in women, age (OR = 1.05 (95%CI: 1.03, 1.08)) showed a significant association.

Conclusions: Low handgrip strength showed a high prevalence; and was associated with age, wrist circumference, and iron deficiency anemia in men, while with age in women.

Background: Phantom limb pain (PLP) is a condition that affects an estimated 80% of the 2 million amputees in the United States. Historically, therapists have utilized various interventions including desensitization, mirror therapy, graded motor imagery (GMI) and virtual reality (VR) to address phantom limb pain. Unfortunately, despite these treatment strategies, limitations in current therapeutic interventions result in suboptimal outcomes.

Purpose: To determine if Targeted Brain Rehabilitation (TBR), a treatment designed to prevent and treat maladaptive cortical reorganization through a VR platform, enhances the individual experience while having a positive impact on PLP. We hypothesize that a single session guided by a therapist of Targeted Brain Rehabilitation (TBR), delivered via a structured virtual reality protocol, would reduce phantom limb pain (PLP) intensity as measured by the Numeric Pain Rating Scale (NPRS).

Study design: Case Series.

Methods: This single-session feasibility and usability study of TBR included 18 patients with upper extremity amputations. The TBR system comprises four sequential phases: (1) laterality recognition, (2) guided motor imagery, (3) virtual mirror feedback, and (4) guided motor execution. Each phase is designed to target specific cortical regions and mechanisms implicated in PLP.

Results: Participants reported overall high comfortability (8.8±1.1) and high levels of satisfaction (8.9±1.2) with their VR experiences for TBR. The TBR system demonstrated high usability (System Usability Scale: 86.8±11.8) and minimal simulator sickness (Simulator Sickness Questionnaire: 10.5±26.3). Levels of pain reduced significantly following TBR use (Numeric Pain Rating Scale: decreased from 4.9±2.9 to 2.4±2.1, p=0.0013, CI=1.13-3.87).

Conclusion: This pilot case series highlights the promising potential of Targeted Brain Rehabilitation in managing phantom limb experiences and reducing PLP intensity. Ongoing research aims to establish TBR's long-term effectiveness in pain management, prosthetic utilization, and improving patients' participation in meaningful daily activities.

Background: Hand edema is common complication following stroke that can significantly impair quality of life. Despite its prevalence, there is no established consensus on optimal management.

Purpose: The objective of this review is to identify and evaluate the range of interventions studied for poststroke hand edema, synthesize their reported effects on edema reduction, and examine their accessibility and application across diverse stroke populations.

Study design: Scoping review METHODS: A systematic search was conducted in five databases following methodology criteria outlined by the Joanna Briggs Institute for scoping reviews. Two independent reviewers screened titles, abstracts, and full texts for inclusion, and performed data extraction with a third reviewer resolving conflicts.

Results: In total, 19 studies with 653 patients were included. Three groupings of interventions were created based on mechanism of action: physical and mechanical modalities, neuromodulatory therapies, and pharmacologic or alternative therapies. Most interventions showed some degree of hand edema reduction. Among these, physical and mechanical modalities, particularly compressive wrapping, wrist hand orthoses (WHO), and fluidotherapy, demonstrated positive results in multiple studies. Neuromodulatory and pharmacologic/alternative therapies showed inconsistent or limited evidence with interventions often assessed in single studies. Methodological heterogeneity, small sample sizes, and short follow-ups limited the ability to compare and draw conclusions. Accessibility of interventions also varied, but compressive wrapping and WHOs stood out as offering potential for home use and reduced clinic visits.

Conclusions: The included studies were heterogeneous and lacked strong evidence for any specific intervention. Treatment should be individualized and emphasize accessible approaches that may improve adherence. Further research should focus on larger sample sizes, longer follow-up, standardized outcome measures, and clearly defined stroke chronicity to inform clinical practice.

Background: Trapeziometacarpal osteoarthritis (TMC OA) is a common degenerative condition, characterized by pain and functional limitations, predominantly affecting older women. While conservative treatments are the primary approach, functional outcomes are highly variable, and the predictive factors influencing these outcomes remain uncertain.

Purpose: This systematic review aims to identify demographic, clinical, and psychological factors that predict functional outcomes following conservative management of TMC OA.

Study design: Systematic Review.

Methods: The protocol was prospectively registered in PROSPERO (CRD42024626957). A systematic literature search was conducted in MEDLINE, PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, following PRISMA guidelines. Eligible studies included longitudinal observational studies and randomized controlled trials reporting on functional outcomes of conservative treatments within 3-12 months. Functional outcomes were assessed using validated tools such as the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Michigan Hand Outcomes Questionnaire (MHQ), and the Functional Index for Hand Osteoarthritis (FIHOA). Data synthesis focused on predictive factors including pain levels, radiographic severity and psychosocial variables.

Results: Six studies (n=1040 patients) met the inclusion criteria. The most consistently reported patient factors included baseline pain levels (5/6 studies), radiographic severity (3/6 studies), gender (3/6 studies), and psychosocial factors such as depression and treatment expectations (2/6 studies). Radiographic staging was associated with functional outcomes in a complex manner: advanced stages predicted poorer outcomes, while early stages were linked to acute impairments due to synovitis. Biopsychosocial factors, such as psychological health and education level, accounted for substantial variance in functional outcomes.

Conclusion: Individual demographic, clinical, and psychosocial factors predict functional outcomes following conservative TMC osteoarthritis treatment. Clinicians should take into account baseline pain levels, radiographic severity, gender, and psychological factors when counseling patients and setting realistic treatment expectations. Future prospective studies are needed to confirm these predictive factors, followed by research to determine which specific interventions may be most effective for patients with different predictor profiles.

Background: Pediatric patients with congenital upper limb differences often experience challenges in performing daily activities such as bike riding. This skill supports physical activity, social participation, and independence, yet adaptive devices are often costly and lack personalization.

Purpose: This case study describes the impact of a custom 3D-printed adaptive device on bike riding skills, muscular strength and endurance, and motivation in a child with a congenital upper limb difference.

Study design: Case study.

Methods: A single case study was conducted with a pediatric patient with a right congenital upper limb difference. The adaptive device was designed using 3D printing software and lightweight polylactic acid (PLA) filament based on the patient's needs and bike handle dimensions. The participant completed pre- and post-assessments surrounding a two-week bike riding protocol (5 sessions per week, 30 minutes each). Motivation toward bike riding was assessed using the intrinsic motivation subscale of the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3), and perceived competence was evaluated with the Pictorial Scale of Perceived Movement Skill Competence. Core muscular endurance was measured using the FitnessGram curl-up and trunk extension tests, and shoulder strength was measured via handheld dynamometry (flexion, abduction, horizontal abduction, and adduction). Bike riding ability was analyzed using observational criteria from the Special Olympics Cycling Manual.

Results: Post-assessment results demonstrated increased motivation (BREQ-3: 4.67 to 5.0), improved core endurance (curl-ups: 33 to 39; trunk lift: 11.5 to 12.5 in.), and bilateral shoulder strength gains, most notably in right abduction (+8.6 lbs) and left horizontal abduction (+8.1 lbs). Observable skill gains included improved stopping, dismounting, and steering.

Conclusion: A personalized 3D-printed adaptive device enhanced motivation, perceived competence, strength, and bike riding ability in a child with a congenital upper limb difference. Future studies with larger samples are recommended to validate these findings.

Background: The Stroke Upper Limb Capacity Scale (SULCS) is a practical and useful performance-based tool designed to assess upper limb functional capacity, including both basic and advanced movement.

Purpose: The aim of this study was to investigate the psychometric properties of the Turkish version of the SULCS in post-stroke patients.

Study design: Cross-Cultural Translation Study METHODS: A total of 56 patients with upper limb hemiparesis participated in the study. The Turkish SULCS was administered twice by the same researcher, with a one-week interval between assessments to determine intra-rater reliability. Additionally, the Fugl-Meyer and ABILHAND instruments were used to assess convergent validity.

Results: The Turkish SULCS demonstrated strong intra-rater reliability, with an intraclass correlation coefficient (ICC) of.97 (95% confidence interval:.95-.98). For the total SULCS-Turkish score, the standard error of measurement (SEM) was calculated to be 0.61 (SEM% = 9.76), and the minimum detectable change (MDC) was 1.69. Excellent correlations were also found between the Turkish SULCS and both Fugl-Meyer and ABILHAND scales (r = 0.77 and r = 0.86, respectively).

Conclusions: The findings suggest that the Turkish SULCS has strong intra-rater reliability and excellent convergent validity, supporting its use in clinical settings to assess upper limb functional capacity in post-stroke patients.