Journal of Hand Therapy最新文献

Background

Proprioception is an essential sensory function of the body. Proprioception is defined as one’s awareness of their body’s position and movement through space. It contributes to both the conscious and unconscious awareness of limb and trunk position and movement. The purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity.

Purpose

The purpose of this review is to provide an evidence-based review of proprioception and conditions that interfere with proprioceptive acuity.

Study Design

This narrative literature review examines studies that determine proprioceptive systems and their implication for rehabilitation.

Methods

Relevant study data were extracted as part of this review.

Results

Types of proprioceptive interventions can include active or passive movement training, somatosensory stimulation training, force reproduction, and somatosensory discrimination training. Joint position sense error is the most widely used objective measure of proprioception.

Conclusions

Therapists should consider using a standardized measure to ascertain proprioceptive deficits in their patients following upper extremity injury or disease to determine the deficits and measure change. There are a variety of interventions that can be used in hand rehabilitation to restore proprioceptive acuity, and active movement interventions have been found to be the most effective.

Background

Little is known about how hand therapists assess proprioception and treat deficits in clinical practice and what types of diagnoses they see most often. To our knowledge, no survey has been completed regarding proprioception practice patterns among hand therapists.

Purpose

The purpose of this study was to examine current practice patterns related to the treatment and assessment of proprioception deficits by hand therapists in the United States.

Study Design

This was a cross-sectional study using a survey instrument.

Methods

The survey was sent to occupational and physical therapists identified as certified hand therapists or members of the American Society of Hand Therapists. The Checklist for Reporting Results of Internet E-Surveys was used in reporting results.

Results

Members of American Society of Hand Therapists (n=152) responded to the survey. The participants were asked if they provided rehabilitation services to people who have proprioceptive deficits, and 122 (82%) responded yes, and 27 (18%) responded no. Most therapists use a standardized technique for assessing proprioceptive deficits. Hand therapists' mean confidence level in treating proprioception deficits was 7.2 out of 10 compared to the mean confidence level reported evaluating them, which was 6.1 out of 10.

Conclusions

Most hand therapists evaluate and treat proprioception deficits across a variety of diagnoses. While the frequency and duration of proprioception treatment varies, most hand therapists reported high use of open- and closed-chain exercises and activities along with elastic taping as part of their intervention approach.

Background

Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception.

Purpose

The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects.

Methods

Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT).

Results

No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p=0.286), nor between pre and post-intervention (p=0.111). For wrist joint position sense, a statistically significant effect (p< 0.05) was found at 30º of extension between the control and experimental group in favor of the control group.

Conclusions

The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered.

Hand therapist should take into consideration the importance of hand proprioception in long-term functional outcomes and its potential impairment due to various factors. Rehabilitation programs should focus on proprioceptive training for hand injuries but also consider broader aspects such as global proprioception, plantar support, posture, and balance.

Patient's experience after a significant hand and forearm injury resulting from a sports accident, multiple surgeries, and the challenges of recovery emphasizes the importance of holistic approaches to rehabilitation, considering both physical and mental aspects, and praises the role of the physiotherapist in providing comprehensive support and building confidence.

Background

Proprioception of the elbow is necessary for daily activities. Proprioception can be impaired with injury or pathology, and rehabilitation efforts seek to improve proprioception for improved upper extremity functioning. In clinical practice, joint position sense (JPS) testing is often utilized to assess conscious proprioception; however, varying methods exist with little evidence of psychometric properties, especially for the elbow.

Purpose

The primary aim of this study was to create a standardized elbow JPS test protocol using goniometry measurement to determine the most reliable testing position. The secondary aim was to determine if the elbow JPS test had acceptable test-retest reliability in healthy adults.

Study Design

This was a cross-sectional study using a convenience sample of healthy adults.

Methods

Three elbow positions (45°, 60°, and 75° of elbow flexion) were measured twice on the same day by a single rater using a universal goniometer. We calculated the absolute error in degrees between each position and reposition and the intraclass correlation coefficient (3,1) for relative reliability. We also calculated the standard error of the measurement and visually inspected Bland-Altman plots for absolute reliability.

Results

Sixty-eight healthy adults (mean age 27.9 years, standard deviation 8.59) were assessed. The mean absolute error for all positions for test and retest was 5.7°. The intraclass correlation coefficients were moderate to good (0.57-0.75), and the standard error of the measurement was 2° (rounded) for all positions. The limits of agreement were moderately narrow, and the Bland-Altman plots showed a random distribution of errors for each position, indicating clinically acceptable measurement error.

Conclusions

The joint position reproduction test for JPS using goniometry demonstrated moderate to good test-retest reliability and acceptable measurement error in healthy adults. The elbow joint angle of 60° flexion was the most reliable for JPS testing, providing insight for JPS assessment in clinical practice.

Background

Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons.

Purpose

The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint.

Study Design

This was a cross-sectional study of a convenience sample of healthy adults.

Methods

Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated.

Results

Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (−0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions.

Conclusions

The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults.

Background

Chronic joint hypermobility has been attributed to repetitive ligamentous microtrauma, benign joint hypermobility syndrome (BJHS), or genetic connective tissue disorders that lead to pain and functional impairment, especially among females. Chronic wrist hypermobility (CWH) prevalence, etiology, and effects on proprioception, strength, and function have yet to be established.

Purpose

This pilot study aimed to determine the CWH prevalence among adults; its effects on proprioception, strength, and function; and whether these effects are gender based.

Study Design

This was a quasi-experimental cross-sectional study.

Methods

Ninety wrists (55 participants, mean age 27.46 years) with no wrist range of motion (ROM) restrictions or previous trauma for ≥6 months were screened for CWH based on an exploratory set of diagnostic criteria. Fifty-eight wrists (34 adults) were allocated to a CWH group, and 32 wrists (21 adults) were allocated to a healthy control group. Twenty-five CWH and 25 healthy control matched (gender, age, and handedness) participants were compared. Assessment included the active wrist joint position sense test, hand-held dynamometry for wrist extension and grip strength, and the patient-rated wrist evaluation for function. Testers were blinded to group allocation.

Results

A 64.4% CWH prevalence existed among CWH participants, who were mostly asymptomatic females (74%). Frequent etiologic factors were midcarpal (96.5%) and scapholunate (39%) instabilities and BJHS (37%), which was higher among females (30%) than males (8%). Independent t-tests showed statistically significant (p < 0.05) group differences in wrist proprioception, wrist isometric extension, grip strength, and function with moderate-high (0.41-0.75) effect size. No significant gender differences existed in proprioception and function.

Conclusions

CWH is very prevalent among functional independent young adults with atraumatic midcarpal and intercarpal ligamentous laxities and BJHS. CWH prevails among women and adversely affects wrist proprioception, strength, and function. The study’s specific CWH diagnostic criteria may be useful for clinicians to identify and timely manage impacted individuals by CWH.

Background

Taping stimulates the mechanoreceptors, increases sensory information to the central nervous system, and improves sensorimotor synchronization, resulting in improved motor control. However, the efficacy of taping on elbow proprioception is not clear.

Purpose

This study aimed to evaluate the immediate effects of taping on elbow proprioception in healthy individuals.

Study design

This study was a two-arm, parallel-group, randomized, controlled, single-blinded study with a sham application.

Methods

Fifty six healthy adults were randomized 1:1 to kinesio taping (n = 27) or sham taping (n = 29). Active joint position sense error (JPSE) was used to quantify proprioception using a universal goniometer at three-time points: baseline (BS), immediately after taping (IA), and 30 minutes after taping (30MA), with the tape still in place at 70° and 110° of elbow flexion. Participants were blinded to group assignments. The Friedman analysis assessed differences between evaluations within groups, and the Mann-Whitney U test determined differences between groups.

Results

The study was completed with 56 participants and there were no dropouts. No skin reaction or adverse effect was observed in the participants and no test trial was excluded. The baseline scores of the groups were similar (p > 0.05). A significant difference was detected in the study group after kinesio taping at 70° (MD = −1.22; CI = (−2.33: −0.10; p < 0.005; d = 0.653) and 110° of elbow flexion (MD = −1.34; CI = 2,47: −0,21; p < 0.005; d = 0.73). This statistically significant difference was observed even at the 30MA evaluations at 70° (p < 0.05). Also, there was a statistically insignificant tendency to decrease in JPSE of both groups at both degrees following taping.

Conclusions

Elbow proprioception may be enhanced by kinesio taping, and this effect could last up to 30 minutes at 70° of elbow flexion. In contrast, sham taping did not produce such an improvement. Based on the differences in JPSE, kinesio taping proved more effective and had a longer-lasting impact than the sham application. The statistically insignificant tendency to decrease in JPSE may indicate that the 30-minute application period is inadequate to create a statistically significant effect on elbow proprioception. Longer usage periods can better reveal the effects of orthoses on proprioception.

Background

Sensorimotor impairment following distal radius fracture (DRF) has been associated with a significant decline in function. Joint position sense (JPS) testing is a meaningful and responsive way to assess sensorimotor impairment for individuals who have sustained a DRF; however, there are factors that may influence the results of JPS testing, including kinesiophobia and pain intensity.

Purpose

This study aimed to evaluate the influence kinesiophobia may have on wrist JPS testing and if pain intensity impacts kinesiophobia and JPS in individuals with a DRF.

Study Design

This was a cross-sectional study.

Methods

Participants referred from two medical centers with a diagnosis of DRF treated with at least 3 weeks of immobilization were enrolled in the study. Data were collected at 1 week and 6 weeks postimmobilization period. Demographics were summarized with descriptive statistics, and linear relationships between kinesiophobia, pain intensity, and wrist JPS were examined using Pearson correlation coefficient.

Results

Forty-eight participants were included in this study (mean age 42.9 years). Significant positive correlations were found between the Tampa Scale for Kinesiophobia (TSK) and Numeric Rating Scale (NRS; r = 0.951, p < 0.001), TSK and JPS error (r = 0.942, p < 0.001), as well as NRS and JPS error (r = 0.898, p < 0.001). These correlations indicate that higher levels of kinesiophobia are associated with increased pain intensity and greater JPS error. T-tests reveal no significant difference between male and female for the TSK, NRS, or JPS scores.

Conclusions

There is an association for individuals with high levels of kinesiophobia and both greater pain and errors with JPS testing.