Abstract
Perfect for hand therapy specialists, hand therapy students, and any other professional who encounters clients with upper extremity issues, Fundamentals of Hand Therapy, 2nd Edition contains everything you need to make sound therapy decisions. Coverage includes hand anatomy, the evaluation process, and diagnosis-specific information. Expert tips, treatment guidelines, and case studies round out this comprehensive text designed to help you think critically about each clientâs individual needs.
... Scars can take several months to heal [21]. The alteration of sensitivity in scars must be treated with desensitization and the modeling of the scars may occur with compressive measures, for example, Coban, with cicatricial manual and vibrating massage [1], [21], as these are techniques that press the scarring tissue vertically, aiding in the cicatricial remodeling by reorganizing the collagen fibers [22]. ...
... Scars can take several months to heal [21]. The alteration of sensitivity in scars must be treated with desensitization and the modeling of the scars may occur with compressive measures, for example, Coban, with cicatricial manual and vibrating massage [1], [21], as these are techniques that press the scarring tissue vertically, aiding in the cicatricial remodeling by reorganizing the collagen fibers [22]. Therefore, the massaging of the scar on the forearm (graft) was executed in the direction opposed to the tension forces of the tendon. ...
... Chronic edema is one that persists for longer than 3 months, and it is harder and more difficult to work with. As a result of the prolonged contention of plasma in the interstitium, the tissue becomes fibrotic [21]. ...
The hand and the forearm are the main defensive organs and more than often they suffer serious traumatism in car accidents. Guiding these patients to rehabilitation areas is essential for the success of the process. The present case refers to a multiple trauma patient who suffered a car accident which had great impact on his upper left limb. The patient was treated at Hospital de São José, and later transferred for the Centro de Medicina e Reabilitação do Sul to start his rehabilitation. The complete description of the process in Occupational Therapy/Hand Therapy starts here, with the intention of evaluating the impact of this type of intervention on a multiple trauma patient, by assessing the evolution of the open wound, scar, edema, sensitiveness, joint range, muscular activation, limb functionality as well as Instrumental and Daily Life Activities. Despite improvements at motor and sensory levels, these were not as expected, as a result of the severity of the injuries and the late rehabilitation beginning. Nonetheless, at the functionality level the patient was able to achieve improvement levels that allowed a greater independence and a return to his job. A timely reference for treatment, in this case of multiple trauma in the upper limb, could have allowed for a greater success in the rehabilitation, at the same time, a more effective communication among all the structures involved in the case since the moment of the accident until rehabilitation would also have led to a faster closing of the wound, which would have a positive influence in the results. Although, and even with the late start, the Hand Therapy intervention was paramount for the patient’s independence.
... Pogosto se začnejo s pojavom neprijetnega občutka, okorelostjo, zbadanjem, odrevenelostjo, mravljinčenjem in bolečino. Nadaljujejo se z zmanjšanjem mišične moči zapestja, palčeve mišične kepe in prstov roke, zmanjšanim obsegom giba v zapestju in motnjami senzibilitete dlančne površine (Saunders idr., 2016;Cooper, 2014). Simptomi so značilno izrazitejši ponoči in zjutraj, kar vpliva na kakovost spanja. ...
... Pri SZP je najučinkovitejša preventiva. Tehnike za preventivo in izboljšanje simptomov SZP je smiselno uvesti še pred pojavom simptomov (Cooper, 2014). Ob blagi utesnitvi MŽ se uporabniku priporoči konzervativno zdravljenje, ki vpliva na zmanjšanje pritiska na živec in njegovo utesnitev (Moharić, 2014;Parish idr., 2020). ...
... Nekatere od nas zahtevajo velike fizične napore, kot je nošnja vrečke iz trgovine, druge od nas zahtevajo statične položaje zapestja, na primer uporaba telefona. Sleherna aktivnost lahko poslabša simptome SZP, vendar v različni meri (Cooper, 2014). Zato so tudi lažje aktivnosti v COPM-u manjkrat izpostavljene, npr. ...
Sindrom zapestnega prehoda je utesnitvena nevropatija. Povzroči jo mehanski dinamični pritisk živca na določenem mestu. Ob zgodnjem diagnosticiranju se težave odpravljajo s pomočjo konzervativnega zdravljenja. Med učinkovite delovnoterapevtskeintervencije spadajo: edukacija uporabnika o pravilni uporabi zgornjega uda med izvajanjem aktivnosti, spoznavanje ergonomskih načel in prilagoditev ter uporaba nočne opornice za zapestje. Članek predstavlja splošen pregled informacij, pomembnih tekom rehabilitacije sindroma zapestnega prehoda. Namen je bil ugotoviti, pri katerih dnevnih aktivnostih imajo uporabniki s sindromom zapestnega prehoda največ težav, ter jih seznaniti s pravilno rabo zgornjega uda in prilagojenim izvajanjem dnevnih aktivnosti. Na Univerzitetnem rehabilitacijskem inštitutu – Soča smo tekom ustaljene obravnave dodali edukacijski pristop. Izdelali smo navodila za prilagojeno uporabo zgornjega uda pri vsakodnevnih aktivnostih. Za preverjanje upoštevanja navodil smo izdelali vprašalnik upoštevanja navodil za preprečevanje simptomov sindroma zapestnega prehoda.
... Gelberman raportează că presiunea foarte mare pe nervul cubital apare atunci când cotul se găseşte în poziţia de flexie mai mare de 100-110º. Studiile au arătat că presiunea la nivelul nervului cubital creşte atunci când apare o tracţiune pe nerv concomitent cu abducţia umărului, iar extensia pumnului, pronaţia şi deviaţia radială sunt poziţii care cresc tensiunea pe nerv (6). ...
... Din punct de vedere motor, pacientul va prezenta scăderea forţei pe musculatura intrinsecă a mâinii (muşchii lumbricali mediali şi muşchii interosoşi palmari şi dorsali) şi rar va prezenta durere. În leziunile avansate, pot apărea atrofia musculară şi hipotonia progresivă, care determină deformări ale mâinii, cum ar fi semnul Duchenne şi semnul Wartenburg (când pacientul ţine degetul mic în abducţie, indicând slăbiciune pe interososul palmar, care realizează adducţia) (6,17). ...
... Pacientul nu va reuşi să prindă obiecte mari, din cauza dezechilibrului dintre musculatura extrinsecă şi cea intrinsecă a mâinii, ducând la aplatizarea arcului normal al mâinii şi nu va reuşi să cânte la pian sau să tasteze, din cauza afectării abducţiei şi adducţiei degetelor (6). ...
... belirtmek amacı ile kullanılır (1,2). Özellikle genç bireylerde daha sık görülmesi nedeniyle, iş gücü kaybına da neden olmaktadır (3,4). Tuzak ...
... Median sinirin el bileği seviyesinde karpal transvers bağ altında sıkışmasıdır (Şekil-2 (3,9). ...
... Median (3,9,12,13). Konservatif tedaviden başarı elde edilemezse, dekompresyon cerrahisine gidilir. ...
Tuzak nöropatiler periferik sinirlerin üzerindeki akut, intermittant, tekrarlayıcı veya devamlı baskı altında kalması sonucunda belli noktalarda ortaya çıkan, motor, duyu ve otonom bozuklukların eşlik ettiği tablodur. Tuzak nöropatiler, daha çok üst ekstremitede görülür; bunlar arasında da en sık görülenleri, median sinirin bilek seviyesinde sıkışması olan karpal tünel sendromudur. Tanıda doğru bir öykü, fizik muayene, özel testler(Tinel testi, Phalen testi), radyolojik incelemeler ve elektrofizyolojik incelemeler destekleyici yöntemler olarak kullanılmaktadır. Tuzak nöropati oluşumunda travma, vasküler patolojiler, inflamatuar ve otoimmün hastalıklar, endokrin ve metabolik bozukluklar, hormonal ve tümöral nedenler etkilidir. Tuzak nöropatilerde sinirin duysal alanına lokalize parestezi olması, yanma, karıncalanma, batma, kaşıntı, kas ağrısı bulunması, özellikle gece ağrısının fazla olması, kronik basıda kas güçsüzlüğü ve atrofisinin olması gibi klinik özellikleri bulunabilir. Tedavide splintleme, enjeksiyonlar, fizik tedavi modaliteleri ve cerrahi uygulamalar yer almaktadır.
... sık görülmesi nedeniyle, iş gücü kaybına da neden olmaktadır. [4,5] Sıkışma sonrasında ilgili periferik sinirin innerve ettiği alanda, motor, duyu ve otonom problemler ortaya çıkar. Ortaya çıkan problemin ciddiyeti, basıya maruz kalma süresi, şekli, şiddeti ve büyüklüğü ile doğru orantılıdır. ...
... Bu bölümde, kompresyon nöropatilerinde tanı konulmasına yardımcı yöntemlerden çok, hastadaki bozukluğu ortaya koyarak, rehabilitasyon programının oluşturulmasına katkıda bulunacak klinik test ve yöntemlerden bahsedilecektir. [4,6] Özellikle akut dönemde, pek çok hasta semptomları tanımlamada ve lokalize etmede güçlük yaşamaktadır; bu nedenle, bu dönemde açığa çıkan ağrı, karıncalanma ve yanma şikayetlerini objektif olarak değerlendirmek oldukça güçtür. Ağrının şiddeti, yeri, tipi, frekansı ve süresini değerlendirmek için, sözel yöntemlerin yanı sıra, görsel analog skalası ve ağrı değerlendirme anketleri (McGill ağrı skalası gibi) kullanılabilir. ...
... Özellikle, ağrının arttığı ve azaldığı pozisyonlar ve aktiviteleri öğrenmek önemlidir. [4,8] İlgili periferik sinirin dermatom alanında yapılacak duyu değerlendirmesi, basının oluşmaya başladığı ilk dönemden itibaren, hem basının şiddeti ve lokalizasyonunu belirlemede hem de bozukluğu ölçmede yararlı olacaktır. Özellikle hasta tarafından algılanan en düşük uyarıyı belirlemek için yapılan eşik testler, sinirin cevap oluşturabilmesi için gerekli minimum uyarıyı belirlemede önemlidir. ...
... Another limitation of the scope of disability duration guidelines is the absence of time-loss duration recommendations for specific -and critical -details on tendon and nerve lacerations 63 . Surgical and therapeutic management of these injuries often require specific and at times unique interventions depending on the type or level of structure injured 42,100 . As such, the outcomes associated with these varied injury characteristics may influence the time it takes to resume occupational performance 100 . ...
... Surgical and therapeutic management of these injuries often require specific and at times unique interventions depending on the type or level of structure injured 42,100 . As such, the outcomes associated with these varied injury characteristics may influence the time it takes to resume occupational performance 100 . The level of injury (i.e. ...
... While data reflecting injury characteristics, such as fracture type, were considered for this study, less than half of the sample had documentation specific to this fracture characteristic in the database. In clinical practice, case managers using Reed"s Disability Duration Guidelines 63 and therapists using clinical reasoning processes 17,100 , may need to address issues beyond the impairment or injury characteristics (e.g. type and extent of fracture displacement) to minimize time-loss duration. ...
... Das Ziel der Handrehabilitation ist es, den KlientInnen zu ermöglichen, dass sie ihre obere Extremität optimal und zu Ihrer Zufriedenheit im Alltag und Beruf einsetzen können [1] . Zu Beginn der Therapie wird der Klient befragt, wozu er seine obere Extremität im Alltag und Beruf wieder einsetzen will und/oder muss. ...
... Bei diesem Gütekriterium geht es um die Frage, ob ein Assessment dem Fokus der Intervention entspricht; d.h. ob es klientenzentriert ist [2] und ob seine Anwendung dazu beiträgt, dass die KlientInnen ihre Hand im Alltag wieder einsetzen können [1] . ...
L'objectif de la rééducation de la main est de permettre aux patients d'utiliser leur membre supérieur de manière optimale dans leur vie quotidienne. Diverses évaluations sont disponibles afin de contrôler les progrès du traitement. Elles sont conçues pour fournir des preuves convaincantes de l'état du patient ainsi que pour planifier, documenter et vérifier des traitements efficaces. Quels sont donc les bons instruments permettant d'évaluer l'efficacité des traitements? Des critères de qualité tels que la validité, la fiabilité, la praticabilité, l'accent mis sur l'intervention, la compatibilité avec la CIF et l'illustration de la qualité de vie et de la satisfaction servent de base au choix d'outils d'évaluation pertinents en rééducation de la main.
... Injury or disease within the wrist region of the hand, for any reason (involving the bones, muscles, and ligaments), can result in instability and pain. This causes functional disability in performing daily, leisure, and work related activities and ultimately reduces the individual's overall quality of life [1][2][3]. The ultimate goal of surgical treatment and hand rehabilitation is acquirement of the individual's independence in performing everyday activities. ...
... According to previous studies this questionnaire shows more sensitivity to distal radius fractures compared to evaluations of other upper limb structures (such as Disability of Arm, Shoulder and Hand questionnaire) that showed the functional capacity of the whole body as one functional unit [11]. The PRWE questionnaire shows an understanding of the patients' pain and disability in performing usual and specific activities by measuring 15 items and a numerical scale of 0-10 is reported by the patient [1]. This questionnaire assesses the intensity and frequency of pain. ...
Introduction: The following study was carried out in order to translate, cultural adaptation, and determine the content and face validity of the “Patient-Rated Wrist Evaluation” questionnaire with the aim of evaluating the two components of pain and disability in patients with wrist injuries.
Material and Methods: The methodology of this survey was non-experimental study. After translation and cultural adaptation according to the Beaton method (approved by the American Surgeon Association), the pilot test was performed on patients with wrist injuries (fractures of the distal radius, scaphoid fractures and carpal tunnel syndrome). To assess content and face validity, the questionnaire was given to 10 specialists (6 of whom were occupational therapists, 2 were physiotherapists, and 2 were orthopaedic surgeons), and 20 patients with wrist injuries.
Results: The qualitative content and face validity of the questionnaire for wrist injuries was appropriately reported good. Each item of the content validity ratio was slightly higher than 0.75 and this justified the necessity to include all items. Each item of the content validity index was slightly higher than 0.79. Therefore, all the items were approved in terms of their simplicity, clarity, and relevance. The impact score in order to evaluate the importance of each item was calculated and all were higher than 1.5. Therefore, in terms of face validity all the items were approved.
Conclusion: The results showed that the Persian version of the “Patient-Rated Wrist Evaluation” questionnaire for evaluating the pain and disability of wrist injuries was indeed satisfactory, in terms of it’s content and face validity, thus it can be used in patients by specialists and therapists.
... The encountered tendon lesions may be open since they frequently occur after a fracture or after touching a sharp object; they may also be closed since the tendons rub against a bony plane or within chronic diseases such as the rheumatoid polyarthritis [3]. ...
... After a traumatic lesion, some situations require a surgical treatment [9] that will have to be completed by recovery procedures, namely: electrical therapy (of low and average frequency), thermal water therapy, massage and kinetic therapy. As for the surgical repairs of the tendons, it is considered that the extensor tendons can be fixed more easily in comparison to the flexor tendons whereas the therapeutic attitude is different according to the location of the lesion [3,5,10]. ...
... To our knowledge there is no any other study that compared in between these flaps in terms of tendon gliding. The tendons of the hand pose a particular challenge for the hand therapist, as full hand function requires the tendon to glide long distances [13]. ...
... There are different methods of positioning patients during measurement and for calculating their grip strength from repeated measures, so the American Society for Surgery of the Hand and the American Society of Hand Therapists have standardized positioning, instruction, and calculation of grip strength [23,28]. Grip testing was undertaken using the secondand third-handle positions of hand dynamometer [29]. Most participants exhibited comfort and maximum HGS when using the third-handle position. ...
The present study aimed to determine gender differences in the hand grip strength (HGS) and to examine the relations between HGS, anthropometric characteristics, and physical activity (PA) in Greek young adults. A cross-sectional observational study of 276 students (21.5 ± 4.1 years, 122 men, 154 women) was conducted at the University of Patras, Greece. HGS was assessed via a hand-held grip strength dynamometer; body composition was determined by bioelectrical impedance analysis; and calf, mid-arm, and waist circumferences with inelastic tape. PA was assessed with the modified Baecke Questionnaire for Habitual Physical Activity (mBQHPA). The mean of HGS was 37.15 ± 11.2 kg. Men had significantly (p < 0.001) greater HGS than women. Statistically large correlation was detected between HGS and muscle mass (r = 0.73; p ≤ 0.001), gender (r = 0.6; p ≤ 0.001), mid-arm (r = 0.74; p ≤ 0.001), and calf circumference (r = 0.69; p ≤ 0.001). Results show that fat mass was a risk factor associated with HGS, found using regression analyses in both genders. However, PA was a significant associated factor only for women participants (ΟR = 0.77; 95% confidence interval [CI]: 0.17-1.38; p ≤ 0.05). In summary, the HGS of Greek physiotherapy students was associated with muscle mass, gender, mid-arm, and calf circumference.
... There are different methods of positioning patients during measurement and for calculating their grip strength from repeated measures, so the American Society for Surgery of the Hand and the American Society of Hand Therapists have standardized positioning, instruction, and calculation of grip strength [23,28]. Grip testing was undertaken using the secondand third-handle positions of hand dynamometer [29]. Most participants exhibited comfort and maximum HGS when using the third-handle position. ...
The present study aimed to determine gender differences in the hand grip strength (HGS) and to examine the relations between HGS, anthropometric characteristics, and physical activity (PA) in Greek young adults. A cross-sectional observational study of 276 students (21.5 ± 4.1 years, 122 men, 154 women) was conducted at the University of Patras, Greece. HGS was assessed via a hand-held grip strength dynamometer; body composition was determined by bioelectrical impedance analysis; and calf, mid-arm, and waist circumferences with inelastic tape. PA was assessed with the modified Baecke Questionnaire for Habitual Physical Activity (mBQHPA). The mean of HGS was 37.15 ± 11.2 kg. Men had significantly (p < 0.001) greater HGS than women. Statistically large correlation was detected between HGS and muscle mass (r = 0.73; p ≤ 0.001), gender (r = 0.6; p ≤ 0.001), mid-arm (r = 0.74; p ≤ 0.001), and calf circumference (r = 0.69; p ≤ 0.001). Results show that fat mass was a risk factor associated with HGS, found using regression analyses in both genders. However, PA was a significant associated factor only for women participants (ΟR = 0.77; 95% confidence interval [CI]: 0.17-1.38; p ≤ 0.05). In summary, the HGS of Greek physiotherapy students was associated with muscle mass, gender, mid-arm, and calf circumference.
... Occupational therapy, with a client-centered approach, calls for evaluation tools for evidence-based clinical decisions to maximize activity and participation in daily life [5,6]. The importance of patientreported outcome (PRO) measures is well-known [7,9] and they are classified into general, regional, and specific disease groups [10]. Numerous PROs have been designed in this regard, but most of them have time-consuming administration and scoring procedures [7,11]. ...
Objectives: The patient evaluation measure (PEM) evaluates the hand health profile. Having an appropriate measurement tool for the assessment of hand outcomes in Iranian individuals with wrist disorders is essential for clinical and research settings. The objective of the present study was to examine the psychometric features of the PEM in Iranian individuals with wrist disorders. Methods: Ninety individuals with wrist disorders were recruited. Hand outcome was evaluated with the PEM, quick-disabilities of the arm, shoulder, and hand (Q-DASH), visual analogue scale-pain (VAS-P), and JAMAR hand-grip dynamometer. The PEM was translated into Persian. Face, content, and convergent validity was examined. Also, acceptability, internal consistency, test-retest reliability, and absolute reliability were calculated. Results: All questions had an item impact score and CVR score of >1.5 and >0.42, respectively. All questions except for question 1 (CVI=0.76) and 10 (CVI=0.73) of section B had a CVI score of <0.79. After changes were applied, the CVI score for these questions (question 1=0.83; question 10=0.87) reached acceptable criteria. The total score of the PEM showed a significant moderate correlation with Q-DASH (ρ=0.51; P<0.001) and VAS-P (ρ=0.55; P<0.001) and an insignificant weak correlation with grip strength (ρ=-0.11; P>0.05). Floor and ceiling effects were 0% for the total PEM score. The Cronbach’s α and intra-class correlation values were 0.72-0.87 and 0.96-0.98, respectively. Discussion: The present study suggests that the PEM has acceptable validity and reliability for measuring performance and satisfaction in individuals with wrist disorders. This measure might contribute as an outcome measure in research and routine assessments in clinical practice.
... Since patients with OA tends to stay immobile for longer period due to pain and difficulty in functional movements, as a consequence, there is remarkable reduction in muscle strength and endurance. It is noteworthy, that the strength of quadriceps is essential in maintaining the alignment and joint tracking of knee and other associated joints like hip and ankle 16,17 . The data in this study has shown; as the strength of the quadriceps improves so does the balance, intensity of pain and ROM improve. ...
Background: Osteoarthritis is a combination of mechanical problems characterized by degradation of articular cartilage, articulating joints and subchondral space. Aim: To compare the effects of open chain kinetic exercises and closed kinetic chain exercises in improving dynamic balance and range of motion in patients with knee osteoarthritis. Study Design: Randomized controlled trial. Methodology: Study was conducted at Chugtai Medical center Lahore and sample of 46 patients were recruited and were randomly allocated in two groups. One group performed OKC exercises and the other group was asked to perform CKC exercises, while both of the groups received a common baseline treatment prior to corresponding intervention. Two session a week were given for a period of one month. Goniometry and Y-balance scale were used to assess ROM and dynamic balance pre and post treatment, respectively. Data was evaluated by using SPSS version 23. Results: In this study, the intra-group analysis illustrated that the increase in range of motion and improvement in dynamic balance was statistically significant in both groups with p-value<0.05. Whereas, the inter-group analysis showed that both interventions were clinically effective in treating knee osteoarthritis with p-value>0.05 during the treatment session of four weeks. Practical Implication: This study highlighted that physical training that includes open kinetic chain (OKC) and closed kinetic chain (CKC) exercises were found to be effective in improving balance and in increasing range of motion by reducing pain among osteoarthritis patients. Conclusion: It was concluded that patients with OKC exercises have shown equal improvement in ROM and dynamic balance compared to those who have been treated with CKC exercises. Keywords: Osteoarthritis, Exercises and Dynamic Balance.
... 3,4 Overload and/or repetitive microtrauma within physiological limits may cause tendon injury, leading to pain that significantly impairs patient's activities. 5,6 Tendon-related pain is referred to as tendinopathy, being a musculoskeletal disorder (MSD). 6,7 Each year, 33 million MSD are reported in the United States, 50% of which involving tendons and ligaments, costing approximately $30 billion. ...
Background: The purpose of this systematic review is to analyze the methodologies, utilized stimulation parameters, and the main cellular outcomes obtained by in vitro studies that apply a light source on tenocyte cultures.
Methods: The PubMed, Scopus, and Web of Science databases were searched up to December 9, 2019 for in vitro studies that used light sources on tenocyte cultures. A 13-item checklist was used to assess methodological quality of the studies and the risk of
bias was assessed using the Risk of Bias Assessment tool for Non-randomized Studies tool.
Results: Six studies were included. Tenocytes from the Achilles tendon were used by 83.3% of the studies, with 16.7% utilizing the deep digital flexor tendon, with cells in passage 2 to 5. Four studies used lasers and the other 2 used light-emitting diode or intense pulsed light, in wavelengths ranges from 530 to 1100 nm. The application of light to tenocytes resulted in positive effects reported by all studies, including an increase in cell proliferation and migration, and higher protein and gene expression of tendon biomarkers. Studies presented a lack of standardization on reporting light stimulation parameters and experimental methodologies, leading to low methodological quality. There was a high risk of selection, performance, detection, and reporting bias.
Conclusions: All studies showed positive effects after light stimulation on tenocytes, regardless of the light source used. However, the lack of standardized data on light stimulation parameters, experimental setup, and the studies’ main limitations hindered representative conclusions and comparisons amongst studies’ main outcomes.
... Every 2 week, 1-RM was assessed again. (14) Then, each subject was conducted to do an isotonic resistive quadriceps exercise by sitting on an NK table with the trunk and non-paretic lower extremity stabilized by a strap; a paretic lower extremity was given resistance on the dorsal aspect of the leg (tibia) with an intensity of 40% of 1 RM, did 3 sets of 25 repetitions exercise with 2 minutes of rest period between each set; and did 3 times a week for 8 weeks. ...
Objectives: To evaluate the efficacy of paretic side quadriceps resis-tive exercise on weight-bearing asymmetry and lean muscle mass of stroke patients. Study design: Experimental clinical study. Setting: Subjects: Patients with subacute stroke (2 weeks-6 months after the first stroke), aged 45-59 years old. Methods: All subjects were given paretic side quadriceps resistive exercise three times in a week, with the intensity of 40% 1 RM, 25 repetitions per set, 3 sets per time for 8 weeks. The lean muscle mass and the weight-bearing asymmetry were evaluated pre-and post-intervention. Results: Twelve patients (8 males and 4 females) with mean age of 55.5 (SD 5.1) years were recruited. The lean muscle mass assessed with bioelectrical impedance analysis was 9.09 (SD 2.81) in pre-and 8.87 (2.73) in post-intervention whereas the weight-bearing asymmetry was 9.52 (SD 5.63) in pre-and 5.98 (SD 5.445) in post-intervention. When comparing the pre-and post-intervention outcomes, there was a significant difference in the weight-bearing asymmetry. (p =0.034) but the lean muscle mass did not significantly change (p =0.146). Conclusion: The quadriceps resistive exercise of the paretic side was not effective in increasing the lean muscle mass but it reduced the weight-bearing asymmetry of subacute stroke patients. Therefore,a unilateral resistive exercise of a paretic side may be an effective intervention for stroke rehabilitation during subacute phase to improve weight-bearing symmetry.
... has haemostatic properties. They have also been suggested to promote healing via a direct modulatory effect on wound macrophages [62][63][64][65]. [59]. ...
The advancements in the development of wound dressings have seen tremendous growth in the past few decades. Wound healing approach has majorly shifted from dry healing to moist healing. There has been a significant advancement in our understanding of the underlying physiology involved in wound healing and the associated systemic factors having a direct or indirect influence on the healing. This has resulted in the development of wound dressings designed to treat specific types of wounds. The present review discusses the physiology of wound healing, followed by different factors that contribute to healing. The advancements in wound dressings with their merits and limitations, newer approaches in wound care i.e., hyperbaric oxygen, negative pressure therapy, skin substitutes and role of growth factors in wound healing, have been highlighted. In addition, more recent approaches for effective wound care like smart devices with sensing, reporting and responding functions are discussed.
... Thus, many hand therapists rarely prescribe any form of strengthening exercise for people with hand OA because they believe it exacerbates patients' symptoms, perhaps by subjecting the arthritic joint(s) to high loads. This view is reflected in several papers and hand therapy books (Cooper, 2014;Lefler & Armstrong, 2004;Rogers & Wilder, 2007), which suggest adapting exercises to avoid pain flares in hand OA patients. Even though pain levels should not necessarily guide exercise prescription in chronic musculoskeletal rehabilitation (Gardner et al., 2017;Rossettini, Carlino, & Testa, 2018), it would be useful to identify an alternative form of resistance training which did not utilise high intensities. ...
Symptomatic hand osteoarthritis (OA) affects twenty percent of people over the age of 70. Its socioeconomic burden is increasing and despite severe repercussions on people’s quality of life, it has not received as much scientific attention as OA at other joints such as the knee and hip. The need for effective conservative interventions for hand OA has been suggested by several authors. Moreover, in light of recent research at other joints, it is important to assess sensorimotor and muscle impairments and their relation to function to determine the primary needs of a conservative program of rehabilitation.
The first study compared selected measures of sensorimotor and muscle performance between people with hand OA and healthy controls. Furthermore, the relationship between these measures and function was assessed. People with hand OA were slower and less accurate in a hand left/right discrimination task and experienced neglect-like symptoms more frequently, suggesting they had a disrupted working body schema. However, no association was found between left/right discrimination performance and measures of hand function. While grip endurance was not different between groups, a significant loss of grip strength and a moderate relationship with self-reported function was identified in people with hand OA. We therefore hypothesised that improving grip strength may have beneficial effects in people with hand OA.
To test this hypothesis, we completed a review and meta-analysis of research papers assessing the effectiveness of resistance training interventions on grip strength, pain and function in people with hand OA (Study two). Five studies with 350 participants were included. The findings showed no improvements in grip strength or function and limited effects on joint pain. However, it was apparent that most studies utilised exercise regimes considered inadequate to induce strength changes. In some studies, fear of pain exacerbations or doing further damage to the affected joints led researchers to limit load during the prescribed exercise regimes. The findings suggested that a low intensity exercise alternative may be beneficial to improve muscle strength and function in people with hand OA, while reducing the risk of pain exacerbations and attenuating joint compressive forces.
After a subsequent search of the literature for low load strengthening programs, blood flow restriction training (BFR) appeared to be a viable treatment. This intervention has been shown to improve muscle strength and size in young, healthy people while utilising low exercise intensities. It was unclear however, if it was effective and safe in older people or individuals undergoing a period of disuse, as is common in OA. We therefore completed a systematic review and meta-analysis on this topic (Study three). Twenty-four studies, including a total of 485 individuals, were included. Findings suggested that BFR alone decreases the magnitude of strength loss associated with disuse. Furthermore, BFR training was found to be effective in improving strength and muscle size compared to matched low intensity exercise without BFR or a no intervention control. No difference was shown in treatment effects when comparing BFR to traditional high intensity strength training and there were few side effects associated with BFR.
Thus, study four assessed the feasibility of BFR training in people with hand OA and compared training effects to a traditional high intensity strength training program (HIT). A six-week intervention was trialled and feasibility issues regarding recruitment potential were identified. These included regional differences in recruitment as well as potential for greater involvement of surgeons in the recruitment process. In patients who joined the study, compliance with treatment was good in both groups and after six weeks of training, pre-exercise joint pain reduced significantly. Both BFR and HIT rarely led to acute exacerbations in joint pain. Pinch strength improved significantly in both groups, while grip strength improved significantly in the BFR group only.
The findings from this thesis suggest that people with hand OA present with both sensorimotor and muscle impairments but only grip strength was moderately associated with self-reported function. Both BFR and HIT appear effective in improving muscle strength and do not result in frequent pain exacerbations, with an overall decrease in pre-exercise joint pain intensity over the six-week training period, despite a progressive increase in training volume. Thus, in the future, an appropriately powered randomised controlled trial appears indicated and feasible, although additional strategies may be required to facilitate recruitment. Finally, although not explored in depth in this thesis, findings from study one suggest it is possible that interventions aiming at improving sensorimotor function may reduce symptoms and/or improve functional performance in people with hand OA. However, further research is required to explore these alternative treatment options.
... 15 Conservative treatment often includes education on the TD condition, resting of the affected digits through wearing of orthosis and activity modification to minimize aggravation of the condition. 16 Pain is managed with the use of thermal or electrical modalities, while massage over the palpable nodule is taught to increase flexibility of the thickened soft tissue and to decrease swelling. Passive range of motion and tendon gliding exercises are also taught to maintain joint range of motion and smooth tendon excursion. ...
Study design:
Patients with Green's classification grade 2 or 3 A1-pulley trigger digit (TD) were recruited and randomized to receive the proximal interphalangeal joint-blocking orthosis (PIPJ-BO) or metacarpophalangeal joint-blocking orthosis (MCPJ-BO).
Introduction:
TD is a common hand condition that can affect one's performance in activities of daily living. Conservative management of TD involves prescription of orthoses to facilitate recovery. No studies have evaluated the effectiveness of PIPJ-BO, optimal orthosis wear regime, and other factors affecting orthotic effectiveness.
Purpose of the study:
To compare the effectiveness of PIPJ-BO vs MCPJ-BO in TD management.
Methods:
Outcome measures included pain numerical rating scale, Green's classification grading, and Quick Disability of the Arm, Shoulder and Hand. Orthosis wear duration was also collated. Patients were followed up for 2 months, and changes between initial and final assessment score within each group and between both groups were analyzed.
Results:
Thirty-five patients with 43 TD were included in final analysis. Twenty-three TD were allocated PIPJ-BO while 20 with MCPJ-BO. Pain reduction was observed in both groups, but reduction was greater in PIPJ-BO group (P = .02). About 47.83% in PIPJ-BO group and 40% in MCPJ-BO group improved by at least 1 Green's classification grade. There was only significant improvement in Quick Disability of the Arm, Shoulder and Hand score for PIPJ-BO group (P = .0007), and duration of orthosis wear was significantly longer in the PIPJ-BO group (P = .0010). Advancing age was found to have higher rate of orthosis failure.
Discussion:
Findings suggest that both orthoses are effective in reducing pain and disability and improve in triggering symptoms, with PIPJ-BO being more superior. Moreover, PIPJ-BO is less restrictive, has better cosmesis and allowed better functional performance than MCPJ-BO.
Conclusion:
PIPJ-BO is more effective than MCPJ-BO in pain reduction and achieved better functional outcome. Orthosis wear of 24 hours for more than 8 weeks is recommended.
... Non-prehensile hand movements do not result in force or form closure. They might utilize the fingers or the hand in general, however, they do not result in an object acquisition or capturing by the hand 22 . Therefore, any hand movement which aimed at pushing (button press, moving objects on a surface by pushing them with an open palm, pushing a door to close it, etc.) or lifting (holding an item on a palm without achieving a form closure) were considered as push and lift grasp types, correspondingly. ...
This paper presents a grasping database collected from multiple human subjects for activities of daily living in unstructured environments. The main strength of this database is the use of three different sensing modalities: color images from a head-mounted action camera, distance data from a depth sensor on the dominant arm and upper body kinematic data acquired from an inertial motion capture suit. 3826 grasps were identified in the data collected during 9-hours of experiments. The grasps were grouped according to a hierarchical taxonomy into 35 different grasp types. The database contains information related to each grasp and associated sensor data acquired from the three sensor modalities. We also provide our data annotation software written in Matlab as an open-source tool. The size of the database is 172 GB. We believe this database can be used as a stepping stone to develop big data and machine learning techniques for grasping and manipulation with potential applications in rehabilitation robotics and intelligent automation.
... The extent of injury on the back of the hands and not on the palm may be a direct result of the lower vulnerability of palmar skin (7,8), and the (involuntary subconscious) wiping off of the causative self-mixed cream on the patient's own clothes. ...
A chemical alkali burn caused by ash and soot is quite rare, resulting from its high pH-value, and underestimated in its potential to cause injury. In folkloric medicine ash was purportedly used to relieve pain. We present an unusual case of a 27-year-old man who used a self-mixed cream of soot of wooden pellets, milking grease and baby oil to blacken his face and hands for a traditional Krampus procession.
... Hand orthoses, that are the main target of the present work, are indicated in the treatment of several pathologies and temporary or permanent disabilities, such as thumb instability, rheumatoid arthritis, carpal tunnel syndrome, bone fractures, hypertonicity, spasticity, etc. Intended outcomes of the use of such devices vary according to the pathology but, in general, the aim is to reduce pain and inflammation, improve function, prevent and correct deformity, protect healing structures, restrict motion and help the healing process, in support of therapeutic treatment (Fess et al. 2005, Bürge et al. 2008, Cooper 2013. Hand orthoses can differentiate each other for platform design (palmar or dorsal) and finger and thumb handling (or not) and possible finger positions. ...
In the field of rehabilitation, the 3D scanning of body parts can be considered a crucial starting point for subsequent 3D model design of customised devices, especially when additive manufacturing techniques are involved in their production. This study experimentally evaluates and identifies appropriate procedures to acquire and process 3D anatomic images of the hand, including fingers, for the design of customised orthoses. Hand scanning is a complex activity and requires solutions capable of solving problematic aspects, such as the difficulty in maintaining the hand in a steady position and the presence of motion artefacts due to involuntary movements. We addressed such issues by considering the use of two different kinds of optical scanning device. The acquisition process has been initially defined based on healthy subjects and then extended to patients affected by pathologies that compromise upper limb functionality. Quality anatomical models were produced thanks to the application of advanced geometry processing technologies for the automated alignment of multiple scans and the removal of artefacts due to involuntary movements. As a result, with distinctive pros and cons, both the proposed combinations of scanning procedures and dedicated geometry processing evidenced their suitability in producing complete and accurate enough 3D models to be exploited for the subsequent design and production of customised hand orthoses in a typical reverse engineering pipeline.
... The force required for flexion and extension of a human finger was found from literature, and it was reported in references [59] and [60] that the amount of safe force required for the hand is from 1 to 3 N. Some patients might need more power in their orthosis. ...
Several works have been reported in powered hand orthosis in the last ten years for assistive or rehabilitative purposes. However, most of these approaches uses conventional actuators such as servo motors to power orthosis. In this work, we demonstrate the recently reported twisted and coiled polymeric (TCP) muscles to drive a compact, light, inexpensive and wearable upper extremity device, iGrab. A 3D printed orthotic hand module was designed, developed and tested for the performance. The device has six 2-ply muscles of diameter 1.35 mm with a length of 380 mm. We used a single 2-ply muscle for each finger and two 2-ply muscles for the thumb. Pulsed actuation of the muscles at 1.8 A current for 25 s with 7% duty cycle under natural cooling showed full flexion of the fingers within 2 s. Modeling and simulation were performed on the device using standard Euler-Lagrangian equations. Our artificial muscles powered hand orthosis demonstrated the capability of pinching and picking objects of different shapes, weights, and sizes.
... Moving our bodies and using our hands is good for nerves. 5 Exercise ideas (must be done in pain-free way) ...
... The study used the third handle position of the Jamar Õ Hydraulic Hand Dynamometer. Grip testing is usually undertaken using the second and third handle positions of the Jamar Õ Hydraulic Hand Dynamometer, 34 but the participants in the present study exhibited comfort and maximum hand grip strength when using the third handle position. Because of the difference in hand size, women tend to exhibit their greatest grip strengths with the handle in the second position, whereas the third handle position is usually the most advantageous for men. ...
Objectives
To determine whether age, body mass index (BMI), hand length and forearm circumference were predictive of hand grip strength in healthy Saudi Arabian adult males.
Methods
This cross-sectional descriptive study recruited healthy adult male volunteers. Their anthropometric characteristics including age, BMI, hand length and forearm circumference were measured using routine techniques. Hand grip strength was assessed using a Jamar® Hydraulic Hand Dynamometer. The data were analysed using Pearson correlation coefficient (r) as well as by a stepwise multiple linear regression analysis.
Results
The study included 116 healthy males who satisfied the inclusion criteria. A Pearson correlation coefficient matrix demonstrated that all the four measures, age, BMI, hand length and forearm circumference, were significantly correlated with hand grip strength. Age had an inverse correlation with hand grip strength. The anthropometric measures of hand length, age and forearm circumference accounted for 44.2% (R² 0.442) of the variation of the hand grip strength.
Conclusion
Hand length, age and forearm circumference significantly impacted on hand grip strength in Saudi Arabian healthy adult males.
... From the functional bone-anatomy point of view, the force values in such experiments are strictly controlled by the process of deviation (i.e. excursion) of the extensor and flexor tendons to the figures inside the compartments of the rest (Cooper, 2013). This study is also confirming the previous research regarding the fact that the chuck and the lateral pinch grasp patterns are slightly tending to be equal (Dempsey and Ayoub, 1996). ...
... Hand orthoses, that are the main target of the present work, are indicated in the treatment of several pathologies and temporary or permanent disabilities, such as thumb instability, rheumatoid arthritis, carpal tunnel syndrome, bone fractures, hypertonicity, spasticity, etc. Intended outcomes of the use of such devices vary according to the pathology but, in general, the aim is to reduce pain and inflammation, improve function, prevent and correct deformity, protect healing structures, restrict motion and help the healing process, in support of therapeutic treatment (Fess et al. 2005, Bürge et al. 2008, Cooper 2013. Hand orthoses can differentiate each other for platform design (palmar or dorsal) and finger and thumb handling (or not) and possible finger positions. ...
... The dial reads the force in both kilograms and pounds with marking at intervals of 2 kg or 5 lb, allowing the assessment to the nearest 1 kg or 2.5 lb. The calibration accuracy was checked on new machines and the manufactures recommended annual or more frequent calibration [18,19]. The Jamar dynamometer consists of an adjustable handle to accommodate various size hands. ...
... Dominant hand-grip strength has been documented to accurately predict body strength, nutritional status, fatigue, and overall physical function (Waldo, 1996;Cooper, 2007). To assess grip strength, we used the Lafayette Hand Dynamometer with scores ranging from 0 to 100 kg. ...
"Positive health," defined as a state beyond the mere absence of disease, was used as a model to examine factors for enhancing health despite extreme trauma. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. Positive health was measured using a physical and a psychological composite score for each individual, based on 9 physical and 9 psychological variables. Physical and psychological health was correlated with optimism obtained postrepatriation (circa 1973). Linear regressions were employed to determine which variables contributed most to health ratings. Optimism was the strongest predictor of physical health (β = -.33, t = -2.73, p = .008), followed by fewer sleep complaints (β = -.29, t = -2.52, p = .01). This model accounted for 25% of the variance. Optimism was also the strongest predictor of psychological health (β = -.41, t = -2.87, p = .006), followed by Minnesota Multiphasic Personality Inventory-Psychopathic Deviate (MMPI-PD; McKinley & Hathaway, 1944) scores (β = -.23, t = -1.88, p = .07). This model strongly suggests that optimism is a significant predictor of positive physical and psychological health, and optimism also provides long-term protective benefits. These findings and the utility of this model suggest a promising area for future research and intervention. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
Background: Healthcare practitioners guide patients with metacarpal fractures to return to work without enough evidence that the hand has attained the strength that is required for the job. Measuring finger forces and grip strength may be valuable in informing and grading rehabilitation for patients with metacarpal fractures, to ensure safe return to work without disrupting bone healing.
Objective: To estimate normal values for grip strength and finger forces, so as to guide clinical practice in terms of assessing hand strength, for early return to work, of patients who sustained hand fractures.
Methods: Using a cross-sectional study, the grip strength and finger forces of six healthy adults, aged 20 to 59 years, were measured during 105 predetermined activities of daily living (ADLs), which were divided into five categories. The predominant grasp, i.e. the grasp that is most apparent for the longest time during each activity, was identified from the GRASP Taxonomy. Finger forces
were measured with 13 mm force-sensing resistors, glued to a glove attached to the dominant and non-dominant hands’ fingers. Grip strength was measured with a Jamar hydraulic dynamometer at the beginning of the test procedure, and after performing 25, 50, 75, and all 105 activities. Differences between grip-strength measurements at each data collection point were analysed using paired t-tests. Finger forces were analysed using descriptive statistics.
Results: There were no statistically significant differences in grip strength before and after testing for either the left or right hand. Maximum finger forces ranged from 1–25 Newton (N) for personal care, 1–9 N for transport and moving around, 1–41 N for home environment and inside, 1–26.5 N for gardening and outside, and 1–20 N for office and outside. The predominant grasp type for all ADLs was the thumb in the adducted position.
Conclusion: Grip-strength and finger-force measurements can be used by healthcare practitioners to assess when hand strength is optimal for resuming tasks required in the workplace, which will allow them to facilitate or gauge the appropriate time for a patient to return to work.
In the last decades, the continuous increase in the number of the vast cohort of chronic patients that constantly need medical assistance and supervision, and the widespread lack of therapist has brought to an increased interest in the role of medical technologies in rehabilitative programs and assistive scenarios. Current clinical evidence in rehabilitation demonstrates that there is an important and increasing demand for innovative therapeutic solutions to recover the hand functions to prevent patients to need assistance in performing daily life activities. This works describes the pathway from patent to TRL5 of a device to support hand grip actions and interaction with daily life objects. E-KIRO is based on the use of electromagnets, which are able to attach/detach interactive objects equipped with a ferromagnetic plate. Five end-users used the device and scored it with excellent usability based on the System Usability Scale.
Introduction: It is well-known that musculoskeletal conditions are related with pain and anxiety. Anxiety is a complex concept that involves a transient state caused by different factors, as well as a persistent mood.
Aim: The aim of the study is to reveal the associations between the discomfort caused by some musculoskeletal disorders and the emotionality (anxiety as a trait or a state) on the one hand and, on the other hand, the level of quality of life.
Material and method: The study was cross-sectional and was performed in a period of 6 months on an outpatient basis of 174 patients with musculoskeletal disorders. Thus, we have taken into consideration 5 groups of patients, according to the presented medical condition: low back pain, law back osteoporosis, hand osteoarthritis, knee osteoarthritis, coxarthrosis. We have administered two scales to all the patients: The State Trait Anxiety Inventory (STAI) form X1 (anxiety a s a state) and form X2 (anxiety as a trait) and the Quality of Life (QOL)
Results: For patients who were diagnosed with low back pain, quality of life was 60.71% of the maximum value. Anxiety by using the S.T.A.I. form X1 at an average value was 46.5, anxiety assessed by the STAI form X2 scale, indicates an average value of 39. In the case of osteoporosis, the value of their quality of life was 90.18%. Anxiety (form X1) was 36, and anxiety (form X2) was 52. For the patients diagnosed with hip osteoarthritis, respectively with knee osteoarthritis, the quality of life were 87.5% and 77.67%, anxiety (form X1) were 41 and 48, anxiety (form X2) were 47 and 61. For patients diagnosed with hand disorders, the quality of life was 81.25%, anxiety (form X1) was 62 and anxiety (form X2) was 47.
Conclusions: It was found that in the case of the low back pain, the quality of life had the lowest value (60.71% of the maximum value). In knee osteoarthritis it was found the highest value of anxiety as a trait was 61, and the highest value of anxiety as a condition was found in osteoarthritis of the hand as 62.
Snake venoms are substances mostly composed by proteins and peptides with high biological activity. Local and systemic effects culminate in clinical manifestations induced by these substances. Pain is the most uncomfortable condition, but it has not been well investigated. This review discusses Bothrops snakebite-induced nociception, highlighting molecules involved in the mediation of this process and perspectives in treatment of pain induced by Bothrops snake venoms (B. alternatus, B. asper, B. atrox, B. insularis, B. jararaca, B. pirajai, B. jararacussu, B. lanceolatus, B. leucurus, B. mattogrossensis, B. moojeni). We highlight, the understanding of the nociceptive signaling, especially in snakebite, enables more efficient treatment approaches. Finally, future perspectives for pain treatment concerning snakebite patients are discussed.
Background:
Grip strength is an essential component of physical fitness. The objective of this study was to develop normative handgrip strength data for Iranian healthy boys and girls comparing their handgrip strength with international reference values.
Methods:
Handgrip strength was measured in 2637 healthy children/adolescents (1391 boys and 1246 girls), aged 7-18 years, using a standard adjustable Jamar hand dynamometer (Model 5030 J1, Sammons Preston Rolyan, Bolingbrook, IL, USA). Body mass (kg) and stature (cm) were measured and body mass index was computed in kg/m2. The sample was stratified by gender, age, and hand preference.
Results:
Handgrip strength increased with age and was considerably higher in boys than in girls for all age groups (p < 0.001). Grip strength had a parallel and linear growth for both genders until the age of about 11 years and showed a steeper upward slope in boys than in girls thereafter. The findings of the current investigation were significantly different from those of the previously published normative data, especially for boys over the age of 12 years and girls in the age range of 7-18 years (p < 0.001). This difference was mainly in such a way that the Iranians had lower handgrip strength.
Conclusions:
The differences between present results and those of similar available in the literature in this field emphasize the significant role of using normative data specific to a particular population in research or clinical settings.
In chronic kidney disease (CKD), handgrip strength (HGS) is recommended as a surrogate measure of protein-energy status and functional status. However, it is not routinely used because of inconsistencies such as the optimal timing of the HGS measurement and unclear guidance regarding technique. We aimed to determine the extent of variation in the protocols and methods of HGS assessment. We aimed to identify clinical and epidemiological studies conducted on CKD that reported on the use of HGS as an outcome. A systematic literature search identified n = 129 studies with a total participant population of n = 35,192. We identified large variations in all aspects of the methodology including body and arm position, repetitions, rest time, timing, familiarization, and how scores were calculated. The heterogeneous methodologies used reinforce the need to standardize HGS measurement. After reviewing previously employed methodology in the literature, we propose a comprehensive HGS assessment protocol for use in CKD.
In an effort to improve rehabilitation devices, the applications of soft robotics technologies to prosthetics and physical therapy was explored, particularly due to the benefits of the inherent properties of soft materials. A conceptual design for a soft robotics device prototype is proposed to assist with physical therapy for wrist tendonitis and arthritis, carpal tunnel syndrome, fractures and sprains, and compromised motor skills due to chronic stroke. The device assists in four motions that are commonly performed in wrist therapy: flexion, extension, and rotation (clockwise and counterclockwise) using soft pneumatic actuators to guide movements. The distinct directions were achieved by varying the lateral and radial strain limiting layers. The device uses embodied intelligence to make the device dynamically adaptable in real time, allowing for a customizable recovery process. A detailed model of the device was developed and the viability of the design was assessed using a suite of state-of-the-art simulation tools and limited hardware prototyping. Simulations were performed through integration of Rhinoceros 3D, Grasshopper 3D, Firefly, an Arduino microcontroller, biosensors, Python scripting, and visual parametric programming. Pressure and materials were simulated and tested in Simulia Abaqus and Autodesk Fusion 360. Several parametric variations were tried using simulations and the predictions revealed that rubber silicone at a pressure of 10 kiloPascals is the optimal choice.
Antimicrobial resistance is one of the major causes for morbidity and mortality in sepsis patients. Trying to circumvent the challenge with newer antibiotics has led to the drug misuse and bacterial recalcitrance. Recently, polysaccharides have proffered inexplicable contributions in the field of antimicrobial drug delivery. Structural hierarchy and tunability in biochemical and mechanical properties make polysaccharides unique. Some of the polysaccharides in the naïve state itself pose antimicrobial properties in inhibiting bacterial colonization via blocking carbohydrate receptor associated with host–bacterial responses. While, rest of the saccharides upon modification delivers antibacterial drugs onto targeted sites with sustained or burst release depending upon the need. Ongoing research keeps pace in promoting polysaccharides for local as well as systemic therapy due to its attractive features, mainly biocompatibility, mechanical strength, stimuli responsiveness, protein affinity and reduced toxicity. This chapter presents the updates of prominent polysaccharides involved in the field of antimicrobial drug delivery.
Hände als frühzeitiger Ausdruck menschlichen Wesens und Handelns haben Forscher bestätigt, als sie 2014 die ältesten Handabdrücke eines Steinzeitmenschen auf der indonesischen Insel Sulawesi entdeckten.
The wrist is one of the most complex joints of the body. Wrist injuries are common in baseball, volleyball, gymnastics and in fighting sports. The falls on the hyperextended hand are the main risk factors in these injuries. Scapholunate joint injuries are complex issues that have controversies regarding both diagnosis and treatment. Scapholunate ligament injuries are usually responsible in dislocation of scapholunate joint. These injuries are often overlooked and commonly lead to chronic wrist pain. Early diagnosis of the scapholunate ligament damage is very important in planning the appropriate treatment regime. The diagnostic and treatment processes of scapholunate ligament injury in a boxer with chronic wrist pain are presented in this article.
Functional replantation relies on the success in the technical performance and intrinsic healing of all components of the injured extremity. The skeletal system forms the foundation upon which the remaining soft-tissue elements survive and act. Strictly adhering to the basic principles of fracture fixation and healing can optimize the initial outcome and can improve the likelihood of success in any revisional surgery. In most cases of extremity replantation, the musculotendinous units will be injured at the level of the tendon, leaving the motor innervation intact. Understanding tendon biology and careful attention to the resulting principles of repair will facilitate post-replant rehabilitation and increase the chance of functional success.
Following replantation at any level, successful return of function relies not only on survival of the extremity and healing of the tissues, but also on the dynamic return of motion. Integration of the hand therapist, surgeon, and patient will optimize outcomes. This chapter focuses on the rehabilitation process with suggested protocols and considerations for the various levels of upper extremity replantation. The hand therapist’s role is to collaborate with the treatment team while utilizing clinical reasoning and problem-solving skills to find the right balance between protecting healing structures and implementing early controlled motion in order to maximize the patient’s recovery and outcomes. The therapist also has a role in coaching the patient to use adaptive strategies to maintain function while awaiting motor and sensory return to improve use of the affected hand.
Introduction: Rheumatoid arthritis is a chronic systemic disease that most often affects smaller joints such as hands and wrists. It may cause deformities that jeopardize hand function, thus impacting the subject occupational performance. In order to assist the hand function restoration, occupational therapists often use orthosis to improve autonomy and/or independence to perform daily activities in patients with rheumatoid arthritis. Objective: This study aimed to identify the upper limb’s orthoses used in patients with rheumatoid arthritis, who were assisted by the Occupational Therapy, featuring the population, the type of research and the outcomes obtained. Method: This study is literature review and its selection criteria consists of publications in English, Spanish and Portuguese published within the last ten years, divided between experimental, observational and case studies, all with diagnosis of rheumatoid arthritis and assisted by an occupational therapist. Twelve articles were selected for review. Findings: The literature review points out the benefits achieved through the use of the orthosis to manual dexterity, grip strength, pain relief and aspects related to comfort and patient satisfaction. Conclusion: In this context, the orthosis appears
as an important assistive technology resource to keep function and restore compromised activities.
Fractures of the wrist are often highly traumatic, leading to significant pain and reduction in
an individual’s home, work and leisure roles for a considerable time. Among the studies on wrist fracture,
there is limited evidence which qualitatively explores the patient’s rehabilitation experiences of this condition, and the impact they feel it has on their daily lives. The aim of this study was therefore to explore the experiences of working age people with dominant side wrist fracture in terms of the impact on their lives from the resulting loss of hand function, and the role that hand therapy plays in the rehabilitation process.
Method. Using a qualitative approach, semistructured interviews were carried out with six participants who
were current or previous patients of an outpatient occupational therapy department and who had sustained
wrist fracture. Three key themes equated to the impact the fracture had on their lives: ‘functional ability’,
‘attitudes and expectations of self and others’ and ‘assessment and treatment in occupational therapy’.
Results. The main findings showed that the impact of reduced ability evoked negative reactions and dependence
on others. Lack of information on application and removal of plaster cast contributed towards early anxieties about the appearance and function of the hand. Patients’ attitudes generally reflected taking some responsibility for their own progress. Occupational therapy input increased motivation, and particularly for those who attended rehabilitation sessions in the department, the therapy was valued.
Discussion. The recommendations from this study are that early and continued patient education is provided by the therapist, engaging relatives where appropriate, to alleviate patient and family anxieties and to help determine realistic expectations of recovery. While patients generally engage with objective measurements, making assessment and treatment relevant to their activities of daily living is essential to ensure they are motivated for therapy.
ResearchGate has not been able to resolve any references for this publication.