Hand Exercise Research Articles

Robotic hand system design for mirror therapy rehabilitation after stroke

This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.

Remotely Supervised Transcranial Direct Current Stimulation (RS-tDCS) Paired with a Hand Exercise Program to Improve Manual Dexterity in Progressive Multiple Sclerosis: A Randomized Sham Controlled Trial (P5.6-009)

Remotely Supervised Transcranial Direct Current Stimulation (RS-tDCS) Paired with a Hand Exercise Program to Improve Manual Dexterity in Progressive Multiple Sclerosis: A Randomized Sham Controlled Trial (P5.6-009)

Use of paraffin instead of lukewarm water prior to hand exercises had no additional effect on hand mobility in patients with systemic sclerosis: A randomized clinical trial

Introduction Systemic sclerosis is a connective tissue disease associated with significantly impaired hand mobility, which may hamper activities of daily living. The aim of the present study was to investigate the effect on hand mobility and health status of patients with systemic sclerosis of warming up hands with paraffin compared with warming up hands in lukewarm water prior to hand exercises. Methods Patients were allocated to receive either warm-up treatment with water or paraffin prior to hand exercises for a period of six months. Primary outcome was Hand Mobility in Scleroderma (HAMIS), while secondary outcomes included SF-36 and measurements of fingertips to proximal and distal palmar crease. Follow-up assessments were conducted 3, 6 and 12 months post baseline. Results Ninety patients were enrolled in the study and 56 patients completed. No statistically significant differences were observed between groups regarding hand mobility post intervention. Within both groups, hand mobility improved on the HAMIS six months post baseline with −2.6 points (95% CI: −4.4; −0.8) in the paraffin group and −3.3 points (95% CI: −5.2; −1.5) in the water group. Improvements were maintained at 12-month follow-up. Conclusions Our findings suggested that warm-up with paraffin compared to lukewarm water prior to hand exercises in patients with systemic sclerosis had no additional effect on hand mobility. Results may have been affected by the high dropout rate and statistical errors underestimating a possible effect.

Dupuytren's disease: limited fasciectomy, night splinting, and hand exercises-long-term results.

Dupuytren's contracture (DC) is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits. There is currently no gold standard operative and postoperative protocol for reducing recurrence rates. We propose a combination of surgical intervention, night splinting, and home hand exercises as a treatment protocol. Thirty patients were included in our study, diagnosed with DC Tubiana grade II-IV. Our treatment protocol was limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for eightweeks. The outcomes were recurrence, QuickDASH score, extension or flexion deficit, and grip strength. The mean follow-up was 4.9years (range 2-11years). Recurrence of DC occurred in two patients (7%), who had discontinued the use of the splint within twomonths postoperatively. All other patients had complied with the postoperative protocol. The mean QuickDASH score improved from 61.5 (SD 2.1) to 8.6 (SD 2) postoperatively (p < 0.001). Grip strength did not differ significantly in the operated hands (37.9kg, SD 1.3) when compared to the healthy hands (40.2kg, SD 1.3, p = 0.035). The recurrence was not significantly correlated either with the Tubiana grade (p = 0.7), or with the patients' age (p = 0.27). This study shows that limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for at least eightweeks, is a viable protocol which reduces the rates of recurrence of DC.

Effects of Hand Exercise on Eating Action in Patients With Alzheimer's Disease.

We aim to investigate whether a popular hand exercise could be used to improve the action of eating in patients with Alzheimer's disease (AD). A 6-month intervention was conducted in 60 patients with AD who live in a nursing home. They were divided into hand exercise and control groups. Patients of the control group maintained their daily routine. The improvement of Edinburgh Feeding Evaluation in Dementia scale in hand exercise group was significantly greater than in the control group ( P = .003). Significant differences in time of autonomous eating and time of simulated eating between patients in the hand exercise and control groups ( P < .05) were noted. The improvements in accuracy of eating action and coordination of eating action from baseline were significant in hand exercise group compared to the control group ( P = .020 and .014, respectively). Hand exercise is a safe and effective intervention to improve the feeding and eating of people with AD.

Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis

To update the evidence on efficacy and safety of non-pharmacological, pharmacological and surgical interventions for hand osteoarthritis (OA), a systematic literature review was performed up to June 2017, including (randomised)...

Effect of exercise on shoulder function and morbidity following mastectomy with axillary dissection in patients with breast cancer: a prospective randomized clinical study

Background: There are no guidelines for the exercises performed in physical rehabilitation after breast cancer surgery and, specifically, for how to minimize these postoperative complications. Hence this study was conducted to study the effect of exercise intervention on upper extremity range of motion, strength, lymphedema, pain and activities of daily living (ADL).Methods: A total of 75 patients were included in the study in accordance to inclusion criteria. They were randomized into exercise group (n=38) and no exercise group (n=37). Patients in the exercise group were given a set of 19 active or active assisted range of motion exercises and strengthening exercises with frequent follow up. The other group were did not receive any strict exercise, they were given a few free hand exercise when they had some shoulder complaints based on treating physician discretion. Apart from demographic data other parameters studied were pain, numbness, active shoulder range of motion, muscle strength, lymphedema and ADL. These were evaluated before surgery, 24 hours after drain removal and 3 weeks /6 weeks/ 3 months of post-surgery.Results: Demographic parameters were comparable between the groups. Pain score, shoulder ROM were better in the exercise group compared to no exercise group and this difference was found to be significant (p &lt;0.001). More patients in no exercise group experienced numbness. There was no statistically significant difference in the grip strength between the two groups. The incidence of lymphedema was higher in no exercise group compared to exercise group and this was extremely significant. (p &lt; 0.001). Patients in no exercise group had higher disability scores for ADL which was significant compared to exercise group.Conclusions: Exercise interventions resulted in significantly reduced pain, improved shoulder ROM and lowered ADL impairment. Exercise intervention significantly reduced the incidence of lymphedema, but there was no effect on strength.

Validation of a precision tremor measurement system for multiple sclerosis

BackgroundTremor is a debilitating symptom of Multiple Sclerosis (MS). Little is known about its pathophysiology and treatments are limited. Clinical trials investigating new interventions often rely on subjective clinical rating scales to provide supporting evidence of efficacy. New MethodWe present a novel instrument (TREMBAL) which uses electromagnetic motion capture technology to quantify MS tremor. We aim to validate TREMBAL by comparison to clinical ratings using regression modelling with 310 samples of tremor captured from 13 MS participants who performed five different hand exercises during several follow-up visits. Minimum detectable change (MDC) and test-retest reliability were calculated and comparisons were made between MS tremor and data from 12 healthy volunteers. ResultsVelocity of the index finger was most congruent with clinical observation. Regression modelling combining different features, sensor configurations, and labelling exercises did not improve results. TREMBAL MDC was 84% of its initial measurement compared to 91% for the clinical rating. Intra-class correlations for test-retest reliability were 0.781 for TREMBAL and 0.703 for clinical ratings. Tremor was lower (p = 0.002) in healthy subjects. Comparison with Existing MethodsSubjective scales have low sensitivity, suffer from ceiling effects, and mitigation against inter-rater variability is challenging. Inertial sensors are ubiquitous, however, their output is nonlinearly related to tremor frequency, compensation is required for gravitational artefacts, and their raw data cannot be intuitively comprehended. ConclusionsTREMBAL, compared with clinical ratings, gave measures in agreement with clinical observation, had marginally lower MDC, and similar test-retest reliability.

A randomised controlled trial of wax baths as an additive therapy to hand exercises in patients with systemic sclerosis

ObjectiveThe musculoskeletal features of systemic sclerosis (SSc) are a major cause of disability, causing limitations to movement and function. The study aim was to compare the effects of daily hand exercises with or without daily home wax bath hand treatment in patients with SSc. DesignAssessor-blinded randomised controlled trial of parallel group design. SettingSingle participating centre, undertaken in secondary care and in participants homes. Participants36 participants with hand skin tightening of SSc, two participants lost to follow up. InterventionsParticipants were randomised into wax bath versus no wax bath groups. Both groups in addition performed regular hand exercises as part of standard care. The study period was 9weeks, with further measures of outcome undertaken at 18weeks. Main outcome measuresThe primary outcome measure was the Hand Mobility in Scleroderma test (HAMIS). Secondary outcomes measures were the Scleroderma Health Assessment Questionnaire, grip and pinch strength and the Cochin Hand Function Scale. ResultsBetween group comparisons of HAMIS scores showed no evidence of effectiveness of the wax bath treatment at 9-week follow up (adjusted difference in means (95% CI) experimental-control −1.47 (−3.55 to 0.61), P=0.16) or at 18-week follow up (adjusted difference in means (95% CI) experimental-control 1.94 (−1.07 to 4.95), P=0.20). Analysis of secondary outcomes also showed no evidence for effectiveness of the wax bath treatment at either 9 or 18weeks. ConclusionOur findings suggest that the addition of regular wax bath treatment confers no additional beneficial effect to standard care with daily home exercises. Trial registrationISRCTN registry (http://www.isrctn.com) ISRCTN 66736089.

Exercise for rheumatoid arthritis of the hand.

Exercise for rheumatoid arthritis of the hand.

An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing.

BackgroundThe Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults.ObjectiveWe have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues.MethodsWe developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website.ResultsA preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises.ConclusionsmySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences.

Commentary: An interactive videogame for arm and hand exercise in people with Parkinson's disease: A randomized controlled trial.

Commentary: An interactive videogame for arm and hand exercise in people with Parkinson's disease: A randomized controlled trial.

Reverse Cholesterol Transport: Molecular Mechanisms and the Non-medical Approach to Enhance HDL Cholesterol.

Dyslipidemia (high concentrations of LDL-c and low concentrations of HDL-c) is a major cause of cardiovascular events, which are the leading cause of death in the world. On the other hand, nutrition and regular exercise can be an interesting strategy to modulate lipid profile, acting as prevention or treatment, inhibiting the risk of diseases due to its anti-inflammatory and anti-atherogenic characteristics. Additionally, the possibility of controlling different training variables, such as type, intensity and recovery interval, can be used to maximize the benefits of exercise in promoting cardiovascular health. However, the mechanisms by which exercise and nutrients act in the regulation of cholesterol and its fractions, such as reverse cholesterol transport, receptors and transcription factors involved, such as PPARs and their role related to exercise, deserve further discussion. Therefore, the objective of this review is to debate about non-medical approaches to increase HDL-c, such as nutritional and training strategies, and to discuss the central mechanisms involved in the modulation of lipid profile during exercise, as well as that can be controlled by physical trainers or sports specialists in attempt to maximize the benefits promoted by exercise. The search for papers was performed in the databases: Medline (Pubmed), Science Direct, Scopus, Sport Discus, Web of Science, Scielo and Lilacs until February 2016.

Recommendations for exercises in hand osteoarthritis: a systematic review protocol of clinical guidelines and consensus recommendations

Background: Individuals with hand Osteoarthritis (OA) often experience pain, finger joint stiffness and reduced handgrip strength, which can affect daily functional task performance. There is a need to evaluate current and emerging evidence-based rehabilitation strategies that aim to lessen the burden and improve the quality of life of people living with the disease.Objectives: This proposed systematic review aims to: (1) critically appraise all available published guidelines on hand OA to ascertain whether hand exercises are recommended as part of the current best practice for people with hand OA; (2) identify the type and dosage of exercises recommended regarding frequency, intensity and duration; (3) provide a summary of hand exercise recommendations for the management of hand OA.Methods: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols (PRISMA-P) guidelines. A comprehensive search of seven published databases and 19 grey literature sources will be conducted from January 1997 to December 2017. All relevant guidelines will be critically appraised with the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Extracted hand exercise recommendations will be categorized and synthesized based on the levels of evidence and strength of recommendations using a narrative approach.Conclusions: The proposed systematic review seeks to establish whether hand exercises are recommended as best practice for the management of hand OA. It will provide a comprehensive summary of recommendations on the type and dosage of hand exercises. This information will help develop future research questions on the clinical applicability of these exercises.

An instrumented object for hand exercise and assessment using a pneumatic pressure sensor.

Measurement of grip force is important for both exercise training and assessment of the hand during physical rehabilitation. The standard method uses a grip dynamometer which measures the force between the fingers and opposing thumb. The primary limitation of the grip dynamometer is the restriction of measurement to cylindrical grasps. Any deformation of the hand due to muscular or skeletal disease makes the grip dynamometer difficult or impossible to use. An alternative to the grip dynamometer is a sealed pneumatic object that can be gripped by the hand. Measurement of the internal pressure in the object can be related to the grip force. In this paper, we analyze such a pneumatic pressure sensing object for hand grip assessment and also describe an easy fabrication of the grip sensor. The instrumented object presented in this paper is designed to assess both the maximal voluntary grip forces and continuous grip force to monitor control of hand function during exercise under instruction from a therapist. Potential uses of such a pneumatic pressure sensing object for hand grip are in physical rehabilitation of patients following paralysing illnesses like stroke and spinal cord injury.

Improved Hand Function, Self-Rated Health, and Decreased Activity Limitations: Results After a Two-Month Hand Osteoarthritis Group Intervention.

To evaluate the effects on hand function, activity limitations, and self-rated health of a primary care hand osteoarthritis (OA) group intervention. Hand OA causes pain, impaired mobility, and reduced grip force, which cause activity limitations. OA group interventions in primary care settings are sparsely reported. Sixty-four individuals with hand OA agreed to participate; 15 were excluded due to not fulfilling the inclusion criteria. The 49 remaining (90% female) participated in an OA group intervention at a primary care unit with education, paraffin wax bath, and hand exercise over a 6-week period. Data were collected at baseline, end of intervention, and after 1 year. Instruments used were the Grip Ability Test (GAT), the Signals of Functional Impairment (SOFI), dynamometry (grip force), hand pain at rest using a visual analog scale (VAS), the Patient-Specific Functional Scale (PSFS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH), and the EuroQol VAS (EQ VAS). Data were analyzed using nonparametric statistics. Hand function, activity limitation, and self-rated health significantly improved from baseline to end of intervention, grip force (right hand: P < 0.001; left hand: P = 0.008), SOFI (P = 0.011), GAT (P < 0.001), hand pain at rest (P < 0.001), PSFS (1: P = 0.008, 2: P < 0.001, and 3: P = 0.004), Quick-DASH (P = 0.001), and EQ VAS (P = 0.039), and the effects were sustained after 1 year. The hand OA group intervention in primary care improves hand function, activity limitation, and self-rated health. The benefits are sustained 1 year after completion of the intervention.

I072 The contribution of occupational therapy in the care of people with musculoskeletal diseases

Musculoskeletal conditions (MSCs) are a heterogeneous group of conditions, which affect the musculoskeletal system and are linked to bodily pain, impaired physical function and lead to decline in the performance of activities of daily living (ADLs). Their prevalence is widespread in the general population and is predicted to increase with the ageing population. Due to their unique focus on understanding occupation and its impact on health, and their biopsychosocial approach to assessment, rheumatology occupational therapists have a key role to play within the multi-disciplinary teams (MDTs) providing care for people with MSCs. Rheumatology occupational therapists’ input could range from providing practical advice on overcoming everyday difficulties (e.g. recommending strategies to help with household tasks and cooking); to help to manage mood and stress; teach joint protection and hand exercises to help improve movement and grip; provide splints or arthritis gloves to rest or support joints and help reduce hand pain; to the delivery of psychological interventions to increase motivation, self-efficacy and coping skills to self manage chronic symptoms of MSCs. Again, due to their inherent skills to assess individual’s capacity and performance to work, occupational therapists are best placed within the MDT to provide work rehabilitation, such as job retention or return-to-work interventions. Considering the growing impact of MSCs on work participation, this important aspect of occupational therapy is more often than not under utilised in the NHS. Occupational therapists in the UK may work within the NHS, Social Services, and charities or in private practice. Nevertheless, unlike other health professionals commonly involved in the care of people with MSCs (e.g. physiotherapists and nurses) they are not commonly placed in Primary Care settings. Consequently, people with MSCs may not be accustomed to being seen by/referred to occupational therapy services. Therefore, this presentation will briefly touch upon the growing evidence-base underpinning the rheumatology occupational therapy practice, and highlight ongoing challenges to maximise the people with MSCs' access to the specialist rheumatology occupational therapy services within the MDT in the NHS.

The Effect of Hand Exercise on Reducing the Symptoms in Hemodialysis Patients with Carpal Tunnel Syndrome.

Context:Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies, and there is no consensus on the preferred method of treatment.Aims:The aim of this study is to determine the effects of hand exercise performed with a ball on symptoms and to evaluate the results in hemodialysis (HD) patients with CTS.Settings and Design:This study was conducted in patients with HD who were treated in dialysis centers and state hospitals in Turkey between 2011 and 2012.Subjects and Methods:This study included 19 patients (28 hands) that were diagnosed as CTS. For exercise treatment, a hand and finger exercise ball that consists of two parts: a foam body and flexible rubber cords was used. Patients placed their fingers through each cord, squeezed it for 1 s, and then opened their fingers against the cord for 1 s. Patients repeated this exercise for 30 s to 1 min/day.Statistical Analysis Used:The McNemar, Friedman ANOVA, and the Wilcoxon test with a Bonferroni correction were used on SPSS 20.0 software package program. P < 0.05 was considered statistically significant.Results:Results showed that recovery was performed from physical examination results, grip strength, and Boston questionnaire scores. About 21.4% of patients’ electrophysiological results were negative at the end of the 1st month and 32.1% of them at the end of the 3rd month.Conclusion:Due to the slowed progress of CTS and detection of slight improvement in evaluation parameters, this self-applicable and practical exercise can be used as an alternative treatment of mild CTS in patients with HD.

The Effects of Hand Exercise on Function and Physical Impairments in Patient with Hand Osteoarthritis

The Effects of Hand Exercise on Function and Physical Impairments in Patient with Hand Osteoarthritis

Osteoarthritis of the hands and muscle strengthening exercises: na integrative update and review of the literature

ABSTRACT BACKGROUND AND OBJECTIVES: Osteoarthritis of the hands is a highly prevalent disease that can lead to significant deformity and disability. The therapeutic approach in the management of osteoarthritis of the hands is based on pharmacological and non-pharmacological approaches. However, none of these treatments demonstrated a reduction of joint damage, and it presents itself in a purely symptomatic way. Yet, expert practitioners strongly recommend and use hand muscle strengthening in patients with hand osteoarthritis, but there is no consensus for such conduct. The objective of the study was to review the concepts about hand osteoarthritis as well as to bring the current evidence on muscle strengthening as a non-pharmacological treatment for this disease. CONTENTS: The study reviewed the United States National Library of Medicine database (Pubmed). The words used were: hand osteoarthritis, exercises, physiotherapy and rehabilitation. We included 5 articles in English, published in the last 10 years, focused on muscle strengthening exercises for osteoarthritis patients. CONCLUSION: There is no consensus, nor a more effective exercise protocol, although exercises and physiotherapy are still recommended. We suggest conducting randomized controlled clinical trials to improve the evidence on this subject.