Use of commercially produced elastic wrist orthoses in chronic arthritis: a controlled study.

ABSTRACT To examine the efficacy of wrist orthoses on pain, motion, and function of the wrist.
Consecutive patients were randomized to a treatment group using wrist orthoses or to a control group using no wrist orthoses, in a prospective, controlled, 6-month study.
Changes in wrist joint variables and general disease activity variables were not statistically different between the orthosis group (n = 36) and the control group (n = 33). Patients in the orthosis group had 25% and 12% improvements in grip strength and pinch grip and 50% reduction in pain while using the wrist orthosis.
Use of wrist orthoses improves function and reduces pain, but has no effects after 6 months, compared to a control group, on measures of local or general disease activity.

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    ABSTRACT: Objective: To evaluate the effectiveness of working wrist splints in people with rheumatoid arthritis. Data sources and study selection: This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Ten databases were searched from inception until September 2012 for quantitative and qualitative studies on the effectiveness of working wrist splints in rheumatoid arthritis. Data extraction: Data was extracted on participants, interventions, outcome measures and results. Experimental studies were evaluated using the van Tulder scale and the Cochrane Risk of Bias tool. Data was extracted by a single reviewer and all studies were reviewed by two blind reviewers. Data synthesis: Twenty-three studies were included in the review (n = 1,492), 13 experimental studies including 9 randomized controlled trials (RCTs) and 2 qualitative studies. Data was summarized using best evidence synthesis and a meta-ethnographical approach guided qualitative evidence synthesis. There is strong quantitative evidence (including 9 RCTs), supported by conclusions from qualitative literature, that working wrist splints reduce pain (d = 0.7-0.8), moderate evidence that grip strength is improved (d = 0.3-0.4) and dexterity impaired and insufficient evidence of their effect on function. Conclusions: Working wrist splints reduce pain and improve grip in rheumatoid arthritis. The effect of splints on function is not yet clear.
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    ABSTRACT: We describe the design of an active soft ankle- foot orthotic device powered by pneumatic artificial muscles for treating gait pathologies associated with neuromuscular disorders. The design is inspired by the biological musculoskele- tal system of a human foot and a lower leg, and mimics the muscle-tendon-ligament structure. A key feature of the device is that it is fabricated with flexible and soft materials that provide assistance without restricting degrees of freedom at the ankle joint. Three pneumatic artificial muscles assist dorsiflexion as well as inversion and eversion. The prototype is also equipped with various embedded sensors for gait training and gait pattern analysis. The prototype is capable of 12 dorsiflexion from a resting position of an ankle joint and a 20 dorsiflexion from plantarflexion. Results of early feedback control experiments show controllability of ankle joint angles. Ultimately, we envision a system that not only can provide physical support to improve mobility but also can increase safety and stability during walking, while enhancing muscle usage and encouraging rehabilitation. I. INTRODUCTION In patients with neuromuscular disorders, such as stroke, cerebral palsy (CP), amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), pathologies of the ankle-foot can result in abnormal gaits over time. Drop foot is one example. Due to the damage of the long nerves or of the brain/spinal
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    ABSTRACT: Rheumatic diseases and their resultant musculoskeletal and cardiopulmonary impairments are primary conditions limiting activity and function in older adults. Certain rheumatologic conditions such as polymyalgia rheumatica, degenerative spinal stenosis, and osteoporosis occur later in life. Other conditions such as rheumatoid arthritis, osteoarthritis (OA), and ankylosing spondylitis manifest at younger ages but their clinical manifestations may exacerbate with advancing age and concomitant changes in the musculoskeletal and sensory–motor systems, and with the coexistence of multiple comorbidities and polypharmacy. In fact, studies (Dunlop et al., Arthritis Rheum 44:212–221, 2001; Covinsky et al., J Am Geriatr Soc 56:23–28, 2008) indicate that older adults with arthritis are more limited in mobility and activities of daily living. Physical therapy interventions focus on restoration, maintenance, and promotion of maximal physical function (American Physical Therapy Association, Guide to physical therapist practice, 2003). The physical therapy model of practice is based on the International Classification of Function (ICF) [World Health Organization, International Classification of Functioning, Disability, and Health (ICF): ICF full version, 2001] and addresses patients’ needs at multiple levels across a continuum of care (Fig. 12.1). Physical therapy interventions for older adults with rheumatologic conditions aim to reduce pain; increase and maximize joint mobility; muscle strength; flexibility; aerobic capacity and to prevent functional loss. Interventions consist of exercise, physical modalities (e.g. heat, cold), skilled techniques such as joint mobilization/manipulation, and use of orthotics and assistive devices, combined with patient education. This chapter discusses the physical therapy management of six rheumatic conditions: polymyalgia rheumatica, spinal stenosis, osteoporosis, rheumatoid arthritis, OA, and ankylosing spondylitis. KeywordsPhysical therapy-Older adults-Arthritis-Polymyalgia rheumatica-Spinal stenosis-Osteoporosis-Rheumatoid arthritis-Osteoarthritis-Ankylosing spondylitis
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