Functional Recovery Of Hand Research Articles

Effect Of Thermal Stimulation And Mirror Therapy On Hand Functions In Patients With Stroke: An Interventional Study


 Background: Thermal stimulation can be used as an intervention to enhance sensory function. Activated areas by thermal stimulation are greater than those by tactile or mechanical stimulation. Mirror therapy creates the illusion of normal movement with the mirror image of the unaffected upper extremity. Thermal stimulation provides somatosensory stimulation that causes the forced use of the involved extremity as a protective response to heat which provokes volitional/reflexive motor activity. Somatosensory stimulation may induce brain plasticity.
 Purpose: This study was carried out to determine the effect of thermal stimulation and mirror therapy in the sensorimotor and functional recovery of hand in stroke patients with hand impairment.
 Methods: 18 stroke survivors were randomly assigned to Thermal Stimulation rehabilitation treatment and Mirror Therapy rehabilitation group (30 minutes daily for 3 weeks). Three measures, including Brunnstorm stage, Wolf motor Function Test, and Revised Nottingham Sensory Assessment scale was used as an outcome measure to assess the motor and sensory recovery.
 
 
 
 Results: The Thermal Stimulation group showed a potential trend for improved recovery stage as measured by Brunnstorm staging for motor recovery of hand as compared to the Mirror therapy group. The Thermal Stimulation group also showed a statistically significant and large improvement in tactile, proprioception and stereognosis score as measured by Revised Nottingham sensory assessment scale whereas Mirror Therapy group showed significant improvement in stereognosis score alone.
 
 
 
 Conclusion: Thermal stimulation has more positive effect in the sensorimotor and functional recovery of hand in acute stroke patients with hand impairment within 3 weeks in comparison to Mirror Therapy. Thermal stimulation protocol should be added in the clinical setting of rehabilitation in stroke patients with hand impairment on the basis of the result of this study.

Effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand

Objective: To observe the effects of functional training combined with self-made hand flexing training band in treatment of scar contracture after burn injury of dorsal hand. Methods: Forty-six patients with scar contracture after deep partial-thickness or full-thickness burn injury of dorsal hand hospitalized in our department from March 2013 to February 2015 were divided into routine training group (RT, n=18) and comprehensive training group (CT, n=28) according to their willingness. Two weeks after the wounds were healed, patients in group RT were treated with functional training of hands and self-made pressure gloves, while patients in group CT were treated with self-made hand flexing training band (consisting of nylon strap, flexing band, and velcro) on the basis of those in group RT. All patients were treated for 3 months. Before and after treatment, scar condition of affected hands was assessed with Vancouver Scar Scale (VSS). The range of motion of joints of affected hands was measured by Total Active Movement (TAM) Scale. The function of affected hands was evaluated by Carroll Upper Extremity Function Test. Data were processed with t test, chi-square test, and Mann-Whitney U test. Results: (1) The score of VSS in patients of group RT was (10.0±1.9) points before treatment and (4.4±1.4) points after treatment, with the improved score of (5.6±1.0) points. The score of VSS in patients of group CT was (10.5±1.8) points before treatment and (4.6±1.4) points after treatment, with the improved score of (5.9±1.2) points. There was no statistically significant difference in the improved score of patients between the two groups (t=0.834, P>0.05). The score of VSS in patients of groups RT and CT after treatment was significantly lower than that before treatment (with t values respectively 14.014 and 10.003, P values below 0.01). (2) Before treatment, the ratios of excellent and good results according to TAM were 2/9 in patients of group RT and 3/14 in group CT, with no statistical differences between them (χ(2)=2.140, P>0.05). After treatment, the ratio of excellent and good results according to TAM in patients of group CT (6/7) was higher than that in group RT (5/9, χ(2)=0.023, P=0.038). The ratios of excellent and good results according to TAM in patients of groups RT and CT after treatment were significantly higher than those before treatment (with Z values respectively -2.023 and -4.780, P values below 0.05). (3) The improved score of hand function in patients of group CT was (26±12) points, which was higher than (15±7) points in group RT (t=3.278, P=0.002). The score of hand function in patients of groups RT and CT after treatment was significantly higher than that before treatment (with t values respectively 2.628 and 6.125, P values below 0.05). There were no significant differences in grades of hand function of patients between the two groups before treatment (Z=-0.286, P>0.05). After treatment, the grade of hand function in patients of group CT was higher than that in group RT(Z=-1.993, P=0.046). The grades of hand function in patients of groups RT and CT after treatment were significantly higher than those before treatment (with Z values respectively -2.717 and -4.998, P values below 0.01). Conclusions: For patients with scar contracture after burn injury of dorsal hand, early functional training combined with hand flexing training band can improve the range of motion of hand joints and functional recovery of hand, and the result was better than functional training alone.