Journal of Hand Therapy最新文献

Background: Turkey has a high rate of average daily phone usage time.

Purpose: The study was planned to investigate the effect of smartphone addiction on upper extremity function in healthy adults in Turkey.

Study design: The study was designed as a cross-sectional study.

Methods: The study was conducted between January to May 2025 with university students studying at a university in Turkey. Addiction level was evaluated using the Smartphone Addiction Scale-Short Version (SAS-SV); muscle strength was evaluated using Hydraulic Hand Dynamometer and Mechanical Pinch Gauge; and hand-eye coordination was evaluated using Minnesota Manual Dexterity Test (MMDT). Quick Disabilities Of The Arm, Shoulder, and Hand Questionnaire (Quick-DASH) was used for upper extremity functioning and Neck Disability Index (NDI) was used for neck disabilities.

Results: Our study was completed with 213 participants. 79.7% (n = 166) of the participants were female with a mean age of 20.99 ± 3.95 years. Smartphone addiction was 47.9%. In the turning test of the sub- dimension of the MMDT, participants with smartphone addiction demonstrated lower performance (p < 0.05). In addition, Quick-DASH and NDI scores were significantly higher among addicts compared to non-addicts (p < 0.05). Correlation analysis revealed a positive correlation between SAS-SV scores and the turning test, daily smartphone usage time, Quick-DASH, and NDI scores (p = 0.014, r = 0.17; p < 0.001, r = 0.31; p < 0.001, r = 0.28; and p < 0.001, r = 0.35, respectively). Furthermore, as cervical flexion posture increased during phone use, both Quick-DASH and NDI scores also increased (p < 0.05).

Conclusions: Smartphone addiction and increased flexion posture in the cervical region negatively affect hand-eye coordination, upper extremity and cervical spine health in users. Physiotherapists should take the lead in developing healthy posture habits and body awareness in adults who use smartphones intensively.

Background: Stiffness of the proximal interphalangeal joint is a common and disabling condition often managed conservatively with orthoses applying low-load prolonged stretch. The key therapeutic variable in these interventions is Total End Range Time, but the clinical impact of the initial orthotic regimen (continuous vs intermittent) remains unclear.

Objective: To compare the efficacy of an early continuous high-dose (20-22 h/day) regimen vs an initial intermittent low-dose (10-14 h/day) regimen-later escalated to high-dose-in improving passive extension of the proximal interphalangeal joint in patients with joint stiffness using an elastic tension digital neoprene orthosis.

Methods: Fifty patients (57 affected proximal interphalangeal joint) were randomized to group A (continuous high-dose) or group B (intermittent low-dose, converted to high-dose after week 3). Passive range of motion was measured goniometrically at baseline, week 1, week 3, and final follow-up. Treatment compliance and patient-reported discomfort were also assessed.

Results: At week 1, group A showed significantly greater passive range of motion improvement than group B (18.6° ± 6.97 vs 12.6° ± 5.23; p < 0.001; Cohen's d: 0.87). Although group B switched to the continuous regimen after week 3, it never reached the levels of improvement achieved by group A at any follow-up. Effect sizes remained large at week 3 and final follow-up, consistently favoring the early continuous regimen. The continuous protocol was also better tolerated during initial adaptation.

Conclusions: Early initiation of a continuous high-dose orthotic regimen yields superior short- and long-term recovery of proximal interphalangeal joint extension compared to starting with an intermittent protocol, even if the regimen is intensified later. Delayed optimization of Total End Range Time does not compensate for early treatment deficits. These findings emphasize the importance of maximizing Total End Range Time from the outset in conservative management of proximal interphalangeal joint flexion contractures.

Background: The extensor pollicis longus is the principal extensor of the thumb and is typically evaluated in clinical examination with the hand placed flat on a surface. As the hand is commonly immobilized or functions in 20-30 degrees of wrist extension (the functional position), it is important to understand extensor pollicis longus function in both positions.

Purpose: To establish normative reference values for extensor pollicis longus extension force measured with the hand in flat and functional positions and assess normative values for lift-off height and extensor pollicis longus tendon gliding amplitude.

Study design: Cross-sectional study.

Methods: Two hundred healthy individuals (100 males, 100 females; aged 18-85 years, median age 46 years) were included. A custom-made device capable of measuring isolated finger force and recording electromyographic activity was used. Lift-off test height and extensor pollicis longus tendon gliding amplitude were documented.

Results: Extensor pollicis longus force peaked in the third decade of life and declined thereafter. In the flat position, the median extension force was 9.3 N (range: 1.1-18.8 N) for females and 15.8 N (range: 6.4-33.0 N) for males. In the functional position, the median values were 14.0 N (range: 3.8-35.2 N) for females and 21.2 N (range: 6.4-50.6 N) for males. Lift-off height was comparable between the sexes, with median values from 46 to 48 mm (range: 10-75 mm). Likewise, gliding amplitude exhibited no differences between the sexes, with a median of 30 mm (range: 5-50 mm).

Conclusions: Reference values for extensor pollicis longus extension force, lift-off height, and tendon gliding amplitude were established. Maximal force occurs at 30 degrees wrist extension, peaks in the third decade, and declines after the fourth. On average, force values in females were approximately 60% of those observed in males.

Background: Certified hand therapists commonly experience thumb pain as they utilize their thumbs daily to perform treatment interventions. Research available on this topic is limited.

Purpose: To examine current thumb pain experienced by certified hand therapists practicing in the United States and Canada.

Study design: Descriptive.

Methods: ASHT members with self-reported thumb pain were recruited via email to participate in a 31-question survey (based on established surveys) related to thumb pain, aggravating tasks, and treatment options. An ordinal logistic regression model was utilized to interpret the coefficients and the relationship between variables. Free-response qualitative data were coded and themed.

Results: A total of 197 certified hand therapists with current thumb pain met the inclusion criteria for the study (92% occupational therapists, 8% physical therapists). Most participants had bilateral carpometacarpal joint thumb pain with 39% of certified hand therapists (n = 77) reporting daily pain. Various activities of daily living and instrumental activities of daily living were reported as difficult to perform due to thumb pain. Manual massage was the most reported work-related task to contribute to pain. Joint protection techniques, orthoses, and taping were commonly reported interventions to self-treat pain.

Conclusions: Certified hand therapists' thumb pain impacts both their work and daily lives. Future research is needed to explore the effectiveness of joint protection techniques and adaptations to determine how to decrease thumb pain for certified hand therapists and to promote longevity of the therapists' careers.

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.