Assessment Of Hand Function Research Articles

Constraint Induced Movement Therapy Camp for Children with Hemiplegic Cerebral Palsy Augmented by Use of an Exoskeleton to Play Games in Virtual Reality

Aim To determine the acceptability and effects of a pediatric constraint induced movement therapy (P-CIMT) camp for children with hemiplegic cerebral palsy (hCP) augmented by use of an exoskeleton to play games in virtual reality (VR). Method 31 children with hCP attended a P-CIMT camp 6 hours per day for 10 days over 2 successive weeks (60 hours) that included 30 minutes of unilateral training with the Hocoma Armeo®Spring Pediatric that combines the assistance of an exoskeleton and VR games. The primary outcome measure was the Assisting Hand Assessment (AHA); secondary outcome measures were the Melbourne Assessment of Uni-lateral Hand Function (MUUL), and the Canadian Occupational Performance Measure (COPM). Assessments were completed at pre-intervention, post-intervention, and 6 months following intervention. Results Participants demonstrated clinically and statistically significant improvement in bimanual performance (AHA) (p < .001) and COPM Performance (p < .001) and Satisfaction with performance (p < .001). Improvement in unilateral performance (MUUL) was statistically (p < .001) but not clinically significant. Conclusions A P-CIMT camp augmented by the Hocoma Armeo®Spring Pediatric was feasible and accepted by participants. Bimanual hand function and occupational performance improved immediately following intervention, and the treatment effects persisted 6 months following intervention.

Patient-reported outcome measures for patients with hand-specific impairments—A scoping review

BackgroundPatient-reported outcome measures (PROMs) are increasingly used to provide evidence for treatment effects and to guide rehabilitation. To our knowledge, no disease-specific PROM exists for the assessment of patients with flexor tendon lesions of the hand. We believe that PROMs used to assess hand function, regardless of diagnosis, contain relevant items for patients with flexor tendon lesions of the hand. PurposeThe aim of our study was to identify and collect items from pre-existing PROMs used by clinical experts to assess the health status and function in patients with reduced hand function. Study DesignA scoping review searching for PROMs with hand-specific content was conducted to ensure face validity. As these items are assumed to have been through an evaluation process by the clinical specialists, they have the advantage and likelihood of being useful. MethodsWe searched five bibliographic databases. All PROMs with hand-specific content used to assess hand function were considered for inclusion. Questionnaires written in English, Danish, Swedish, and Norwegian were included. An analysis of content redundancy was conducted, and items were grouped according to The World Health Organization’s International Classification of Functioning, Disability and Health. ResultsSeventy-three PROMs were included with a total of 1,582 items. The majority of the items were redundant across measurement instruments, and redundant items were consolidated, resulting in 179 nonredundant items. All nonredundant items were classified according to the International Classification of Functioning, Disability and Health components. ConclusionsThis review presents a collection of 179 items ensuring face validity for patients with hand-related disease/injury.

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.

Hand function assessment in peritoneal dialysis patient: a pilot study.

There is variability among centres regarding the utilization of assisted peritoneal dialysis (PD). Functional impairment is one of the leading causes of assisted PD. Tools to assess the patient's ability to manipulate PD devices are required. The objective of this study was to evaluate the feasibility of hand function evaluation in PD patients and to test the association between hand function estimation and assisted PD. This was a pilot study of adults treated with PD in a dialysis unit in January 2019. Hand function was evaluated by Purdue Pegboard, Jebsen, Jamar and pinch tests. Relative risks were calculated with a Cox model to evaluate the association between each test and assisted PD. Among the 43 PD patients included, 16 were autonomous and 27 were assisted in performing dialysis. The Jebsen and Purdue Pegboard tests were completed by 41 patients (95.3%). All patients succeeded in performing the Jamar and pinch tests. The median time to complete all tests was 22min. After adjustment based on the Charlson comorbidity index, the assembly test of the Purdue Pegboard (RR 0.92 [95% confidence interval (CI) 0.86-0.98]), total Jebsen (RR 1.01 [95% CI 1.00-1.01]) and Jamar test (RR 0.94 [95% CI 0.90-0.99] with the dominant hand; OR 0.94 [95% CI 0.88-0.98] with the non-dominant hand) scores were associated with assisted PD. The evaluation of hand function of PD patients is feasible in daily practice using the Jebsen, Purdue Pegboard, pinch and Jamar tests and may support choosing the appropriate utilization of assisted PD.

Hand Kinematics Characterization While Performing Activities of Daily Living Through Kinematics Reduction.

Improving the understanding of hand kinematics during the performance of activities of daily living may help improve the control of hand prostheses and hand function assessment. This work identifies sparse synergies (each degree of freedom is present mainly in only one synergy), representative of the global population, with emphasis in unveiling the coordination of joints with small range of motion (palmar arching and fingers abduction). The study is the most complete study described in the literature till now, involving 22 healthy subjects and 26 representative day-to-day life activities. Principal component analysis was used to reduce the original 16 angles recorded with an instrumented glove. Five synergies explained 75% of total variance: closeness (coordinated flexion and abduction of metacarpophalangeal finger joints), digit arching (flexion of proximal interphalangeal joints), palmar-thumb coordination (coordination of palmar arching and thumb carpometacarpal flexion), thumb opposition, and thumb arch. The temporal evolution of these synergies is provided during reaching per intended grasp and during manipulation per specific task, which could be used as normative patterns for the global population. Reaching has been observed to require the modulation of closeness, digit arch and thumb opposition synergies, with different control patterns per grasp. All the synergies are very important during manipulation and need to be modulated for all the tasks. Finally, groups of tasks with similar kinematic requirements in terms of synergies have been identified, which could benefit the selection of tasks for rehabilitation and hand function assessments.

EARLY COMPLEX REHABILITATION TREATMENT OF PATIENTS WITH FRACTURE OF DISTAL METAEPIPHYSIS OF THE RADIUS

Relevance. Fractures of the distal metaepiphysis of the radial bone among all fractures range from 11% to 30%. Unsatisfactory results of treatment in patients over 70 years old are found in 44% of cases. Timely and adequate rehabilitation treatment is important for obtaining good results in the treatment of such patients.&#x0D; Objective: to improve the results of the treatment of patients with fractures of the distal metaepiphysis of the radial bone based on early comprehensive individual rehabilitation treatment.&#x0D; Materials and methods. 97 patients with displaced fractures of the distal metaepiphysis of the radius were observed. Among them, 67 are women (69.1%), over 50 years old – 64 (66%). Used conservative treatment with a sparing technique of one-stage reduction. Upon completion of the correction, according to the indications, measures were prescribed for the prevention of neurodystrophic syndrome, depending on the likelihood of its development (according to the temperature gradient of the fingers of the extremities) in the form of drug therapy. Massage, kinesiotherapy, and physiotherapy began on the second day. The pain intensity was determined using a visual analog scale. The nature of pain was determined by the DN4 questionnaire (questionnaire for the diagnosis of neuropathic pain). For subjective unified assessment of hand function in the long term after a hand injury, I used a specific questionnaire DASH (Disability of the Arm, Shoulder and Hand Outcome Measure) – a questionnaire of outcomes and disability of the hand and hand.&#x0D; Results. Rehabilitation treatment at admission and at the early outpatient stage was complex, individual, taking into account the periods of illness. The debris correction was painless, low-traumatic, rational fixing bandages were used. The volume of drug therapy was determined by the value of the temperature gradient of the fingers.&#x0D; Conclusion. The proposed method for the rehabilitation of patients with fractures of the distal metaepiphysis of the radius is highly effective: good and satisfactory (according to the DASH scale) results were obtained in 97.8% of cases, unsatisfactory – in 2.2%.

Single Assessment Numeric Evaluation (SANE) in Hand Surgery: Does a One-Question Outcome Instrument Compare Favorably?

Patient-reported outcome measures are increasingly used to measure patient status, impairments, and disability, but often require lengthy surveys and place a considerable burden on patients. We hypothesized that the Single Assessment Numeric Evaluation (SANE), composed of a single question, would be a valid and responsive instrument to provide a global assessment of hand function. The SANE, Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE), and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) data are routinely collected electronically in our hand and upper-extremity center. To identify our cohort, we used Current Procedural Terminology codes to query our electronic medical record research data repository for the 7 most common hand surgery procedures performed over 2 years from December 2016 to 2018. These procedures included carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, wrist arthroscopy, distal radius fracture fixation, first dorsal compartment release, and cubital tunnel release. Patients undergoing a single isolated procedure with questionnaires obtained in the preoperative and/or postoperative period were included in the analysis. Convergent validity, coverage, and responsiveness for each instrument were assessed. We identified 214 patients for inclusion. The SANE score had a moderate to strong correlation with the QuickDASH and PROMIS-UE. Floor and ceiling effects for the SANE were less than 10% at baseline and follow-up. Overall, the QuickDASH was the most responsive, followed by SANE and PROMIS-UE; all 3 instruments exceeded the acceptable thresholds for responsiveness and demonstrated significant changes before to after surgery. Responsiveness of the SANE varied by procedure and was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release. The single-item SANE is a reasonable measure of global function in patients undergoing common hand procedures and demonstrates psychometric properties comparable to those of the PROMIS-UE and QuickDASH outcome scores. The SANE score is a reasonable outcome measure of global hand function that may have utility in demonstrating response to treatment in a practice setting and may provide a useful adjunct to multiple-item measures in clinical research studies.

Hand Function at 18-22 Months Is Associated with School-Age Manual Dexterity and Motor Performance in Children Born Extremely Preterm

To determine associations between hand function at age 18-22months (early) and scores on the Movement Assessment Battery for Children, 2nd edition (MABC) at 6-7years of age (school age) in extremely preterm children. Prospective multicenter cohort of 313 extremely preterm children with early hand function assessment and school-age MABC testing. Early hand function was compared with "definite deficits" (MABC <5th percentile) and MABC standard scores. Early hand function was categorized as "no deficit" vs "any deficit." Mixed-effects regression models were used to evaluate the association of early hand function with MABC deficits, controlling for multiple demographic, neonatal, and childhood factors. Children with early hand function deficits were more likely to have definite school-age deficits in all MABC subtests (Manual Dexterity, Aiming and Catching, and Balance) and to have received physical or occupational therapy (45% vs 26%; P<.001). Children with early hand function deficits had lower Manual Dexterity (P=.006), Balance (P=.035), and Total Test (P=.039) scores. Controlling for confounders, children with early hand function deficits had higher odds of definite school-age deficits in Manual Dexterity (aOR, 2.78; 95% CI, 1.36-5.68; P=.005) and lower Manual Dexterity (P=.031) and Balance (P=.027) scores. When excluding children with cerebral palsy and those with an IQ <70, hand function deficits remained significantly associated with manual dexterity. Hand function deficits at age 18-22months are associated with manual dexterity deficits and motor difficulties at school age, independent of perinatal-neonatal factors and the use of occupational or physical therapy. This has significant implications for school success, intervention, and rehabilitative therapy development.

Soft tissue reconstruction of low voltage electric burn injuries of the thumb and first web space by the first dorsal metacarpal artery island flap: a three-year study from Eastern India

Background: Complex soft tissue defects of thumb and first web space are a reconstructive challenge. Low voltage electric burns of the hand commonly result in localised and deep soft tissue destruction. The first dorsal metacarpal artery flap (FDMA) is an attractive local flap option to reconstruct these. This study illustrates our experience with the same.Methods: Between March 2014 and February 2017, 16 patients with complex soft tissue defects of thumb and first web space resulting from low voltage electric burns underwent reconstruction with the FDMA flap and subsequent structured hand therapy. In the follow up visits objective assessment of hand function included tests of mobility using Kapandji Score, sensory evaluation with static 2 point discrimination and cortical reorientation. The Subjective Satisfaction Score was used to ascertain the patient’s overall perception of aesthetic and functional outcome.Results: Majority (43.75%) of the patients had defects involving the thumb IP joint. No case of complete flap failure was noted. In a mean follow-up of 11.5 months the reconstructed thumb showed return of good protective sensation as well as mobility. Though cortical reorientation was complete in only 18.75 %, it did not substantially impede hand functioning. All patients were satisfied with the functional and aesthetic result.Conclusions: In cases of low voltage electric burn injuries the FDMA flap is a reliable reconstructive option for small to moderate sized complex defects of thumb and first web space. It has minimal donor site morbidity and can be accomplished in a relatively simple single stage procedure.

Novel Assembled Sensorized Glove Platform for Comprehensive Hand Function Assessment by Using Inertial Sensors and Force Sensing Resistors

This study proposed a novel assembled sensorized glove combining nine-axis inertial measurement units (IMUs) and force sensing resistors (FSRs) to simultaneously measure hand kinematics and fingertip force. The sensorized glove was designed to have high flexibility and extensibility. The accuracy and reliability of the hand kinematics measurements were verified using four-finger flexion–extension tasks. The results reveal that the mean absolute errors (MAEs) of the joint angles of fingers are all <5°, thus indicating that the glove can precisely measure hand kinematics. The MAE of the fingertip force prediction was 1.47 N, thus revealing that the FSRs can accurately measure the fingertip force. Moreover, comprehensive evaluation was conducted to prove that the sensorized glove can not only simultaneously measure the hand kinematics and fingertip force but also distinguish between the subjects with distinct hand functions. Therefore, the sensorized glove proposed in this study is reliable and has a strong potential for application in practical rehabilitation settings.

Multidimensional evaluation is necessary to assess hand function in patients with Charcot-Marie-Tooth disease type 1A.

Charcot-Marie-Tooth (CMT) disease type 1A (CMT1A) is the most common hereditary neuropathy. Several studies have assessed the relation between axonal loss and grip strength; however, the functional impact on dexterity and health-related quality of life (HRQoL) is unknown. We hypothesized that the severity of axonal loss will be correlated with loss of function and HRQoL. The purpose of this study was to evaluate the relation between severity of electroneuromyography impairment and its impact on function and HRQoL in adults with CMT1A. Grip and lateral pinch strength were evaluated with specific dynamometers: the Jamar and the Pinch Gauge. Dexterity was explored with the Sollerman, Jebsen, and Nine-hole Peg tests. The CMT impact on well-being was assessed by the validated Medical Outcomes Study Short Form 36 (SF-36), Beck Depression Inventory, and Fatigue Severity Scale, and disease severity by the CMT neuropathy score and Inflammatory Neuropathy Cause and Treatment sensory sum score. Finally, axonal loss and demyelination process was assessed by electroneuromyography. We included 33 participants with CMT1A (23 females, mean [SD] age 47.0 [4.7] years). We found lack of correlation between severe electroneuromyography impairment (frequency of abnormal results >80%), significant distal amyotrophy (70%) and quality of life (mean [SD] scores for physical and mental SF-36 36.4 [10.0] and 48.4 [11.5]), autonomy for activities of daily living, and hand function that remains relatively preserved. We found a correlation between lateral pinch and dexterity according to the Sollerman test (r=0.52, p<0.05) but a lack of correlation among the other parameters. Electrophysiological follow-up seems to be of little relevance to follow HRQoL in individuals with CMT1A and manual function related to functional objectives for everyday physical medicine and rehabilitation practice. The manual function is complex and requires an overall, quantitative, qualitative and multidisciplinary assessment. Each tool (Pinch Gauge, Jamar, Sollerman, Jebsen, Nine-hole Peg) measures a specific element of manual function and is necessary when performing a grip function analysis.

Assessment of hand function using the functional dexterity test after opponensplasty in young children with Blauth type 2 hypoplastic thumb.

The functional dexterity test (FDT) is a timed pegboard test based on the manipulation of each peg and suitable for young children as it is both simple and quick to perform. We assessed the postoperative FDT values for children with Blauth type 2 hypoplastic thumbs after opponensplasty. We evaluated hand function using FDT for 12 hands of 11 patients with Blauth type 2 hypoplastic thumbs. Opponensplasty was performed in all hands following by Huber's procedure. All patients were evaluated from 6 to 12 months after surgery for hand function using three types of FDT scores: time in seconds to complete the test (FDT time), combined total time with penalty seconds added to the initial time (FDT total), and the number of pegs per second to complete the task as a percentage against normative values (FDT speed). We compared the postoperative FDT scores with those for Blauth type 1 or 2 hypoplastic thumb patients without surgical treatment. FDT time and FDT total for the patients postoperatively were both significantly shorter than those in the type 2 patients without surgical treatment. FDT speed was significantly higher than that for the patients without surgical treatment. There were no significant differences in the three FDT scores between the postoperative patients and the type 1 patients. There were several limitations including small sample size, large ranges of the data, and high number of variables. FDT reflected postopponensplasty improvement in hand dexterity in young children with Blauth type 2 hypoplastic thumb.

A Horticultural Therapy Program Focused on Succulent Cultivation for the Vocational Rehabilitation Training of Individuals with Intellectual Disabilities.

We aimed to develop a horticultural therapy program for the vocational rehabilitation of individuals with intellectual disabilities and examine its effects. Individuals with intellectual disabilities (n = 28, average age: 33.23 ± 4.9 years) were recruited from a welfare center in Jecheon, South Korea. They participated in eight weekly sessions of a horticultural therapy program consisting of common succulent cultivation techniques at a specialized succulent cultivation farm located in Jecheon, South Korea. Before and after the program, we assessed hand function (grip strength, pinch force, and hand dexterity, evaluated using a hand dynamometer, Jamar hydraulic pinch gauge, and grooved pegboard, respectively), emotional behavioral strategies (evaluated using the emotional behavioral checklist), and social skills (evaluated using the social skill rating system-teacher form). After participation in the horticultural therapy program, individuals with intellectual disabilities displayed significantly improved hand function, emotional behavior, and social skills (all p < 0.05). This study demonstrates the potential of horticultural therapy focused on succulent cultivation for the vocational training of individuals with intellectual disabilities. Future studies should investigate the effects of the program in a larger cohort.

Assessment of hand functions in patients with idiopathic cervical dystonia.

Cervical dystonia (CD) is the most common form of focal dystonia characterized by involuntary contractions of the neck muscles, causing abnormal rotation of the head into specific directions. Studies report that idiopathic dystonia is a developmental disorder of the sensorimotor circuits, involving both the cortico-striatal and thalamo-cortical pathways. It is also suggested that enhanced cortical plasticity extends beyond the clinically affected region and may also be detected in the unaffected upper limbs of the patient with CD. In the present study, we aimed at exploring if patients with CD had hand motor dysfunctions. Forty patients with idiopathic CD and 40 healthy controls were included in this study. Dystonic symptoms were assessed by means of The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Stanford Health Assessment Questionnaire (HAQ) was used to assess functional status. Quality of life (QoL) was assessed by using the Medical Outcomes Study Short Form 36-Item Health Survey (SF 36). Grip strength was assessed by using hand dynamometers. Tip pinch, lateral pinch and chuck pinch of the hand were assessed by using a pinchmeter. Fingertip dexterity and hand coordination was assessed using Purdue Pegboard. Duruoz Hand Index (DHI) was used for the assessment of hand functions. There were no significant differences between the groups in grip and pinch strengths of hands and fingers. As to the fingertip dexterity, patients with CD had a mean Pin 1 and Pin 2 test score of 10.6±2.8 and 10.8±3.2 respectively and a mean assembling test score of 5.2±2.0. These results were significantly worse than those of the healthy controls. As to the SF 36 sub-scores, there were significant differences between the groups in all SF 36 sub-scores (p<.001). This study indicates that patients with CD suffer a deteriorated fine motor coordination of hands without dystonic involvement of upper extremities. Furthermore, lower SF 36 scores in patients with CD suggest poorer health-related quality of life.

Functional outcomes after flexor tendon repair of the hand.

This study aims to evaluate the hand function after flexor tendon repair (FTR) and to investigate factors associated with functional outcomes. Between January 2013 and September 2015, a total of 126 patients (84 males, 42 females; mean age 31 years; range, 15 to 62 years) who underwent FTR due to flexor tendon injuries (FTIs) were included. The hand function was assessed using the Jebsen Hand Function Test (JHFT) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) at three and six months following FTR. Of the patients, 94 (75%) and 72 (56%) completed the three-month and six-month assessment visits, respectively. A total of 65 patients (51.1%) had both three and six-month follow-up data. The patients regained a fair amount of power grip strength and more than half of their pinch grip strength compared to the unaffected hand. The results of assessment of hand function at activity and participation levels (JHFT and Quick DASH) showed slightly higher levels of disability. Of 41 patients who were employed prior to injury, 29 (71%) returned to work at six months after surgery. Zone IV injury and language barrier were associated with poor functional outcomes at six months. Our study results showed that the JHFT and Quick DASH scores of the patients were less than the established norms, although functional outcomes improved over time. Based on these results, we suggest that the presence of zone IV FTI and language barrier are associated with poor functional outcomes.

Clinical Assessments of Hand Function in 1st Carpometacarpal Osteoarthritis: Do They Correlate With Radiographic Findings?

Clinical Assessments of Hand Function in 1st Carpometacarpal Osteoarthritis: Do They Correlate With Radiographic Findings?

P.190Feasibility, reliability and convergent validity for digital biomarkers captured via a smartphone application (app) to assess motor behaviors in individuals with spinal muscular atrophy (SMA) in the JEWELFISH trial

Frequent visits to the clinic to complete assessments impose a large burden on individuals with spinal muscular atrophy (SMA) and their caregivers. New tools may complement or improve regular assessment of symptom severity and progression. Smartphones enable remote patient monitoring through widely accepted platforms and have previously demonstrated value in disorders such as Parkinson's disease. We developed a smartphone application (app) comprising nine tests for the assessment of finger, hand, arm and lung functions via tapping, tracing, squeezing, sustained-phonation and phone-turning games. Using the app, we are assessing the feasibility, reliability and convergent validity of potential digital biomarkers captured via smartphone in patients with Type 2 or 3 SMA from the JEWELFISH trial (NCT03032172)—an ongoing, multicenter, open-label study evaluating the safety, tolerability and PK/PD relationship of risdiplam (RG7916/RO7034067) in non-naïve patients with SMA (who have previously received olesoxime, AVXS-101 or therapies targeting SMN2-splicing). Risdiplam is an investigational, orally administered, centrally and peripherally distributed small molecule that modulates SMN2 pre-mRNA splicing to increase survival of motor neuron (SMN) protein levels. Patients perform daily active tests at home and data features are computed from sensor data. We are using the aggregated sensor data features over all tests to quantify convergent validity relative to clinical assessment of disease severity (determined by motor function measurement and forced vital capacity). Smartphones may enable long-term, frequent, reliable, low-burden and disease-relevant monitoring for individuals with type 2 or 3 SMA. We will present data from JEWELFISH exploring the validity of this approach.

The burned hand - innovations and current research

Hand function is crucial for everyday and professional life. Even small burns can have a great impact on hand function, either from the injury itself or from scar contractions. Preservation and restoration of hand function are essential for mental and physical well-being of burn survivors. Reduced hand function can lead to social isolation and occupational invalidity. Even though one hand represents only 3 % of the total body surface area, hand burns are categorized as severe burn injuries and are a primary indication for treatment in a dedicated burn center. Hands are involved in more than 80 % of all severe burn injuries, making them the most affected body part. Independent of the severity of the overall burn, hand injuries need to be treated with highest priority.Novel approaches in acute and long-term care of burned hands should aim for long-term improvement in functional and aesthetic outcomes. All burn patients with hand involvement should be able to be reintegrated into society, perform activities of everyday life and return to their profession. The purpose of this review is to highlight recent advancements in research of the burned hand and to identify areas in which further research is needed. We summarized all relevant and recent original and review articles on hand burns; including acute treatment, aftercare, reconstruction, injuries due to E-cigarettes and methods for assessment of hand function. These findings were put into context of established methods in order to provide an outlook on possible future innovations.

Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, andM-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study.

Occupation-based hand therapy in a baker with monomelic amyotrophy (distal segmental spinal muscular atrophy or Hirayama disease)

The aim of this case report is twofold: the very rare Hirayama disease is discussed, including the impact on the patient’s functioning. The unique way to solve an orthesis problem is described, by observing patient’s performance meticulously. Various hand function assessments were used to cover every level of the International Classification of Functioning model. An occupation-based approach was followed by performing a working visit during which the essence of his treatment problem became apparent. The development of a new adjustable brace is described. Combining two sorts of wrist positions in one splint is a novel approach that could be helpful for patients with other conditions. A work visit was helpful to focus on the participation level. The occupation-based intervention resulted in the patient’s ability to resume work.