Hand Therapists Research Articles

A current snapshot of the state of 3D printing in hand rehabilitation

3D printing is often discussed in the field of hand rehabilitation, yet many hand therapists are unaware of this technology and how it either is used or could potentially be used in rehabilitation. To shed some light on the state of 3D printing in hand rehabilitation, we sought insight from a rehabilitation engineer, occupational therapy educator, clinician, and hospital administrator to provide a comprehensive look at the state of 3D printing today.

Purdue manual dexterity testing: A cohort study of community-dwelling elderly

IntroductionThe Purdue Pegboard Test is a manual dexterity test that requires the manipulation of pegs, washers, and collars. Our population for this research study focused on the geriatric community owing to the lack of recent available normative data. Purpose of the StudyThe purpose of this study was to provide updated normative data for hand therapists to use in clinical practice to determine if seniors have dexterity deficits. Study DesignThis is a cohort study. MethodsThis study was completed through a convenience sample which included 128 participants. Participants were stratified into three age groups (60-69, 70-79, and 80+). Participants were asked to complete the Purdue Pegboard Test. Mean scores were analyzed using an independent-sample t-test and one-way analysis of variance to compare the mean scores of each designated age group. ResultsA one-way analysis of variance reported statistically significant differences between the 3 age groups (F = 15.03, P < .00). The results supported that those individuals who were younger (60-69) scored better on the assessment than those aged 80+ years. There was not a statistically significant difference between PPT mean scores of males and females. DiscussionMean scores for the PPT for community-dwelling seniors were established. ConclusionThe findings from this study support that dexterity may decline with age, which can affect occupational performance over time.

Mobilizing orthoses in the management of post-traumatic elbow contractures: A survey of Australian hand therapy practice

Study DesignMixed-methods survey. IntroductionElbow stiffness and contractures often develop after trauma. There is a lack of evidence on mobilizing orthoses and the factors guiding orthotic prescription. Purpose of studyTo investigate hand therapists' orthotic preferences for varying extension and flexion deficits, and describe the factors affecting orthotic choice for post-traumatic elbow contractures. Methods103 members responded to the electronic survey via the Australian Hand Therapy Association mailing list. Five post-surgical scenarios were used to gather information regarding orthotic preferences, reasons and orthotic protocol: (1) week 8 with 55° extension deficit; (2) week 12 with 30° extension deficit; (3) week 12 with 55° extension deficit; (4) week 8 with flexion limited to 100°; (5) week 12 with limited flexion. ResultsMost responders (89.9%) used mobilizing orthoses, predominantly for extension (88.5%). Orthotic preferences for scenarios 1 to 5 were (1) serial static (78.3%); (2) custom-made three-point static progressive (38.8%); (3) custom-made turnbuckle static progressive (33.8%); (4) “no orthosis” (27.9%); and (5) custom-made hinged (27.1%) and nonhinged (27.1%) dynamic. Choices were based on “effectiveness,” “ease for patients to apply and wear,” and “ease of fabrication/previous experience/comfortable with design.” The recommended daily dosage for extension was 6 to 12 hour. DiscussionThis is the first known study that reflects on the use of mobilizing orthoses in post-traumatic elbows in Australia. ConclusionsMobilizing orthoses are used routinely for post-traumatic elbows in Australia. Extension deficits are managed with serial static and static progressive orthoses at weeks 8 and 12, respectively. Research is needed to assess whether orthotic intervention before 12 weeks is beneficial in reducing contractures.

The study of the correlations between handgrip strength and some anthropometric characteristics of upper extremity of elite and sub-elite Olympic style weightlifting athletes

Background and Study Aim: Handgrip strength is widely used as a functionality parameter of the upper extremity and general health. The measurement of handgrip strength by dynamometry is a low cost, noninvasive method of simple applicability. The study aims to find out handgrip strength and its correlation with some anthropometric characteristics of the upper extremity and weightlifting performance of elite (international medalists) and sub-elite (national medalists) Olympic style weightlifting athletes. Material and Methods: We obtained anthropometric measurements of upper extremity of elite athletes (n=25 male, n= 20 female) and sub-elite athletes (n=25 male, n=29 female) in the study. Dominant and non-dominant handgrip strength measurements of the groups were obtained by a Jamar dynamometer, according to the recommendations of the American Association of Hand Therapists. Results:No statistically significant difference was observed in non-dominant handgrip strength of male elite and sub-elite weightlifting athletes. Similarly, no significant difference was observed in between some anthropometric characteristics of upper extremity and dominant and non-dominant handgrip strength of female elite and sub-elite weightlifting athletes. We didn’t find any asymmetry between dominant and non-dominant handgrip strength of study groups. We found a significant correlation between dominant and non-dominant handgrip strength of male and female elite athletes and their height, body weight, BMI and weightlifting performance. Conclusions: Consequently, we might explain that adding special exercises into the general trainings of athletes to develop handgrip strength might contribute to the weightlifting performance of the athletes.

Certified hand therapists membership in the American Society of Hand Therapists: A survey study

Study DesignSurvey research. MethodsA pilot tested survey was administered through an electronic mailing system to 5777 CHTs with email addresses on file at Hand Therapy Certification Commission. The survey was electronically distributed on two separate occasions to maximize the response rate. ResultsThe response rate was 53% (n = 1271). The majority of the respondents who were not members of ASHT, 49% (441), indicated that member fees are too expensive, and 35% (311) respondents selected other as the reason. They specified that they were members in another country, the expenses were too high, or that they were retired. Ten percent (93) of respondents answered that they did not know what member benefits were offered, and 4% (40) responded that they do not value the member benefits offered. Finally, 2% (14) of participants answered that they do not value membership in any other professional organization. DiscussionWhile ASHT membership cost is lower than the benefits the member receives, some do not believe that the costs outweighs the benefits. The combination of these factors accounts for approximately half of all CHTs choosing not to join ASHT. ConclusionMany established members value their membership and find it beneficial not only for themselves but also for furthering the profession as well. Many CHTs identified cost as the most apparent factor for not joining ASHT.

Do hand therapists have a role in workplace-based education to manage tennis elbow? Beliefs about effective treatments among Australian hand therapists and medical practitioners.

Lateral elbow tendinopathy (LET), commonly known as tennis elbow, is a prevalent work-related upper extremity musculoskeletal disorder. Medical practitioners and hand therapists manage LET with commonly available clinic-based treatments, despite no sound evidence to suggest long-term relief and functional restoration for workers with LET. Workplace-based rehabilitation is effective for injured workers with other health conditions, but no studies have investigated this rehabilitation approach in the management of LET. (i) Identify, compare, and contrast Australian hand therapists' and medical practitioners' perceptions about the effectiveness of common treatments for LET, and (ii) obtain their views towards a hand therapist delivered workplace-based education approach. In this cross-sectional study, 38 medical practitioners from Western Australia and 104 hand therapists around Australia completed online surveys. Independent t-tests were used to identify between-group differences in responses. Despite some between-group differences regarding the perceived effectiveness of common LET treatments, both groups believed education about LET pathology, activity modification, postures, and workplace recommendations were most effective. Most medical practitioners (81%) and hand therapists (71%) believed workplace-based education delivered by a hand therapist would be beneficial for patients with acute and chronic LET. Australian hand therapists and medical practitioners believed educational approaches were the most important component in the management of LET, and supported workplace-based educational interventions provided by hand therapists in the management of LET.

FUNCTIONAL STATUS AND ACTIVITY PARTICIPATION IN PATIENTS WITH DISTAL RADIUS FRACTURE: APPROACH WITH ICF FRAMEWORK

Objectives: Distal radius fracture (DRF) affects overall health status. The International Function Classification (ICF) based approach offered a different perspective on DRF management. The aim was to investigate the effectiveness of the rehabilitation program administered in patients with DRF from an ICF perspective. Methods: In this prospective study, 53 patients were divided into conservative and surgical groups and were admitted to 12-weeks supervised rehabilitation program. Body structure and functions were evaluated with pain assessment, range of motion and muscle strength measurement. Also, radiographic evaluations were done. Activity participation was assessed with Push-Off Test (POT), Michigan Hand Outcomes Questionnaire (MHOQ), Quick Disabilities of Arm-Shoulder and Hand (Q-DASH) and Jebsen-Taylor Hand Function Test (JTHFT). Measurements were made on the 2nd, 6th week and the 3rd, 6th months. Results: A total of 53 patients, 32 female (60.4%) and 21 male (39.6%) were included in the study. The mean age of the patients was 47,43±12,20 (23-60) years. 35 (66%) patients were treated conservatively and 18 (34%) patients were surgically treated. There was no difference between groups in pain level, range of motion, grip strength, POT, MHOQ, Q-DASH, JTHFT and radiologic measurements (p>0,05). Conclusion: Creating an ICF-based assessment and intervention plan for the activity participation of patients with DRF guides hand surgeons and hand therapists in achieving their goals.

Concurrent validity of handgrip strength between the jamar and bulb dynamometers in women with rheumatoid arthitis

Abstract Introduction: Rheumatoid arthritis (RA) is a progressive disease that causes deformation and constant joint damage. Handgrip strength (HGS) has been used by several health professionals in clinical practice as a mechanism for assessing muscle strength and overall performance. Objective: To perform the concordance analysis of handgrip strength measurements using a pneumatic dynamometer (Bulb) and a hydraulic dynamometer (Jamar) in women with rheumatoid arthritis. Method: The HGS measurements by the two dynamometers followed the norms of the American Society of Hand Therapists. The concordance between measurements was performed by the Bland-Altman method. Significance level was 5%. Results: In total, 41 women (60.63 ± 8.35 years) participated in the study. Analysis showed that the measures between the two dynamometers were not concordant (bias = 9.04, p &lt; 0.01), there was a linear relationship between the difference of the measures and the mean (r = 0.73, p &lt; 0.01), and the limits of agreement were very extensive (−2.74 to 20.81). Conclusion: Assuming that the rheumatoid arthritis compromises the hands, with a consequent decrease in HGS, further exploration of the subject is suggested in future studies to define the best measure for clinical practice at the different levels of health care. However, since there are many different dynamometers, we suggest to better explore the agreement between the measurements obtained by them in populations under different conditions.

Maximum voluntary muscle contraction and fatigue in multibacillary leprosy

Abstract Introduction: The impairment of muscle strength and fatigue in leprosy remains a problem that requires careful attention to avoid or minimize its progression, as well as prevention of disabilities and deformities. Objective: To investigate the maximum voluntary contraction and time to muscle fatigue in leprosy patients. Method: A total of 21 leprosy patients and 21 healthy subjects completed the sample. The method used to determine the maximum voluntary contraction (MVC) of the handgrip followed the recommendation of the American Society of Hand Therapists with the use of a hydraulic hand grip dynamometer. The test was performed three times with each hand, with a time interval of 60 seconds between successive trials. The subject was instructed to perform a maximal isometric force against the dynamometer for 5 seconds. The peaks were recorded and used for the fatigue test. For the fatigue test, we recorded the electromyogram of the forearm muscles to offline determine the onset time for the muscle contraction (14 bits, Miograph 2 USB®, Miotec, Brazil). Results: Leprosy patients had lower MVC compared with healthy subjects (p &gt; 0.05), both in the dominant and the non-dominant hands. The time to fatigue in the leprosy and control groups was similar (p &lt; 0.05). We observed that leprosy patients had more contractions than the healthy subjects (22.6 ± 11.8 contractions for the leprosy group vs. 12.3 ± 6.9 contractions for the control group, p &gt; 0.05). Conclusion: Multibacillary leprosy patients lost muscle force without modifying the resistance to fatigue.

The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial

ObjectiveTo assess the effect of upper limb exercise on hand function, daily activities performance and quality of life of patients with systemic lupus erythematosus (SLE).MethodsWe performed a pilot randomised, 24-week...

Maximum Palmar Abduction Angle of the Trapeziometacarpal Joint in Healthy Subjects Can Be Evaluated Accurately Using a Radiograph-Based Measurement Technique.

In carpal tunnel syndrome, the abductor pollicis brevis, which is the primary muscle for the palmar abduction of the thumb, is almost inevitably impaired. The active palmar abduction of the thumb may be a better indicator of thumb disability. The authors aimed to establish a simple and accurate method to measure the angle of active palmar abduction of the thumb and to determine the maximum angle values in healthy women. Twenty-five women 20 to 21 years old with no disorder of the hand participated in this study voluntarily. Three measurement methods were tested. The first method was designed according to the Japanese Orthopaedic Association and the second method was designed according to the American Society of Hand Therapists; both use photographs to perform measurement calculations. In the third method, 2 orthopedic surgeons measured the same angle as that described in the second method on hand radiographs. Intra- and interobserver reliability were assessed for each method and described as interclass correlation coefficients. The first and third methods had strong inter- and intraobserver reliability. The second method had strong intraobserver reliability but medium interobserver reliability. The measurement obtained with the first method was significantly different from the values obtained by the second and third methods (almost double). Therefore, the authors regarded the third method as the most appropriate approach for measuring active palmar abduction of the thumb, which, in healthy individuals, yielded maximum values of 45.3°±6.4° and 44°±7° for the left hand and the right hand, respectively. [Orthopedics. 2020; 43(2):e95-e101.].

Rééducation après arthroplastie prothétique de l’articulation interphalangienne proximale des doigts longs

PIP joint arthroplasty still remains an unsolved biomechanical challenge despite material advancements and new implant designs. This leads to a relatively high rate of complications. On the other hand, there is heterogeneity in postoperative management in the current literature. The present structured review aimed to examine the therapeutic strategies that could be used by the physiotherapist in order to help the patient recover a functional finger chain and prevent postoperative complications following PIP joint replacement. This review focused on patients undergoing primary total PIP joint arthroplasty of index, ring, middle and little fingers. Hand function and postoperative complications were the two variables studied. Therapeutic strategies were organized according to the parameters representing these variables. Literature searches were conducted between September 2018 and April 2019 on PUBMED. Research published from 2008 onwards, in French and English and reporting on PIP joint replacement and postoperative management were included. Details of surgical approaches, splint strategies, mobilization and strengthening and management of postoperative complications were recorded. In total, 48 studies including 3 articles providing description of surgical techniques were included. One study was found that mainly focused on rehabilitation strategies following PIP joint replacement. Nevertheless, in relation to hand function, most authors advocated joint mobilizations (n = 45) and some recommended strengthening (n = 4). Static (n = 43) and dynamic splints (n = 14) as well as buddy taping (n = 12) were frequently recommended to prevent and also to manage postoperative complications. On the other hand, few studies (n = 13) reported on wound assessment and postoperative swelling control. It is not possible to provide precise recommendations concerning therapeutic strategies that need to be adopted following PIP joint arthroplasty based on available knowledge. This is due to a lack of information on postoperative management and the use of different parameters in studies. Actual postoperative protocols do not allow the hand therapist to reproduce them in clinical practice. Hand function and complications following PIP arthroplasty might be influenced by the postoperative management therefore the methodological quality of studies might be questionable due to the lack of detail regarding postoperative protocols. Joint mobilization is one of the essential strategies in the postoperative management of PIP joint. However, specific protocols for rehabilitation following PIP joint replacement need to be clarified in future research. Hand and wrist musculoskeletal models could help surgeons and hand therapists in their clinical decisions in relation to surgical and therapeutic management.

Edema assessment and management practice patterns among hand therapists: Survey research

Study DesignSurvey research. IntroductionRecently, the lymphatic system's role in edema management has been reported; however, it is unclear how this evidence has translated into hand therapy practice. Purpose of the StudySurvey research was performed to explore edema education and management. MethodsA 22-question survey containing questions related to edema education and practice was administered to members of the American Society of Hand Therapists. Demographic data were obtained. Frequencies were examined using Chi-square and Fisher exact tests. ResultsA total of 436 members responded to the survey (92% occupational therapists [OTs]; 6% physical therapists [PTs]). Most hand therapists received edema education through on-the-job training and, or continuing education. PTs were more likely to learn the difference between acute, subacute, chronic edema (P < .01; 36% PTs, 17% OTs) and the role of the lymphatic system in edema management (P < .002; 36% PTs, 14% OTs) in entry-level education compared to OTs. OTs with an MS or OTD were more likely to learn the difference between acute, subacute, chronic edema (P < .001; 23% OTD, 24% MS, 10% BS) and the role of the lymphatic system in edema management (P < .004; 19% OTD, 19% MS, 7% BS) in entry-level education than BS-trained OTs. Duration and feel were common ways therapists assessed and identified differences in edema. Many therapists acknowledged the role of the lymphatic system in edema reduction, but responses lacked specificity. ConclusionThe survey results suggest most hand therapists learn edema management outside of academic programs, although this may be changing in OT with advancement of the entry-level degree.

The functional assessment and rehabilitation programme of the UK hand and upper limb transplant service

Introduction Hand and upper limb transplants are becoming internationally recognised as an effective treatment to improve function and quality of life in carefully selected patients. A comprehensive functional assessment and rehabilitation programme are an essential component of the multi-disciplinary assessment and treatment approach. Although there is an increasing body of published data on the surgical techniques and outcomes following hand transplant, little exists in the literature to guide the hand therapist. Method The pre-transplant functional assessments and rehabilitation programme provided for patients undergoing hand transplantation in the UK are described and critically analysed. The UK programme is based on that provided in Lyon, France, but adapted to suit the resources and structure of the UK National Health Service. Results Twelve patients have received a functional assessment as part of the multi-disciplinary hand transplant assessment process, with the loss of autonomy a key reason for patients seeking hand transplant. Six of these patients have received hand transplants, with patients more than one year post-transplant having achieved good and fair outcomes according to the Hand Transplantation Score System. Conclusions Although hand and upper limb transplant surgery is innovative, the therapy provided is based on the fundamental principles of good communication, accurate assessment and delivery of a bespoke rehabilitation programme; values which are common to all areas of hand therapy practice. A future study reporting the long-term outcomes of patients following hand transplant in the UK is needed to allow the effectiveness of the programme to be evaluated.

Psychosocial Influences in the Development of Cumulative Trauma Disorders

ABSTRACT Study Design This study is a single-phase, qualitative study using grounded theory methodology. Introduction Cumulative trauma disorders (CTDs) are musculoskeletal disorders that impact health and productivity. CTD risk factors are present in the workplace, home, and community. Occupational and physical therapists specializing in hand and upper extremity rehabilitation (hand therapists) are widely involved with this population. Hand therapists often employ a medical model in the assessment and treatment of these conditions; however, the medical model has not proven to be consistently effective in relieving symptoms or producing a durable return to daily living activities. Purpose of the Study The purpose of this study was to explore the lived experiences of individuals diagnosed with CTD, and investigate the psychosocial phenomena influencing CTD development as an impediment to occupational performance. Methods The principal investigator recruited 11 participants who met specific inclusion criteria, then used semi-structured interviews aimed at exploring the lived experiences of the participants while investigating the psychosocial phenomenon influencing CTD development. Interviews were transcribed and analyzed using a process of constant comparison, up until saturation occurred. Trustworthiness techniques were used in the data analysis phase and included peer reviews and member checking. Findings The findings suggest that many psychosocial factors contribute to the development and impact of CTDs, at both onset of symptoms and throughout the duration of the condition. A significant number of contextual factors influence participants’ function, behavior, relationships, and the course of medical care. Themes derived from the participants’ expressions, included the following: 1) an initial strategy of “work through the pain,” can be detrimental to symptom resolution and leads to progressive failure to meet role expectations, 2) a pervasive notion of CTDs as “an invisible disability,” leaving participants feeling isolated and frustrated when significant others fail to offer support or reject them, 3) participants often delayed reporting symptom development to employers, family members, and medical personnel, risking permanent injury and disability, 4) a “stigma” is attached to CTDs that encourages isolation; however, the social support of even one significant other in a person's life can facilitate adaptation. Discussion and Conclusion All participants experienced hardship because of their conditions; however, two of the eleven participants capably navigated the process, using past experience and support from family and employer to successfully adapt. These findings offer support that CTDs are adaptive disorders. The study's conclusion suggests a new model to describe CTD dysfunction and presents new ways of thinking for clinicians who treat the CTD population.

Varieties of Pediatric Brachial Plexus Pathogenesis and Treatment: Case Series

The purpose of this study is to describe the scope and distinct presentations of brachial plexus pathologies in children. Injury or obstruction to the brachial plexus in pediatric patients presents unique challenges. Literature is scarce in this area, with the exception of information pertaining to perinatal injury. In addition to knowledge of unique presentations in children, hand therapists must be aware of pediatric adaptations to motor and sensory testing and techniques to engage children and parents in therapy. More research is needed to explore the diversity of brachial plexus injury within the pediatric population and to reveal similarities and differences to existing guidelines for adult patients.

Occupation-Based Upper Extremity Rehabilitation: A Case Study

This case study quantifies and describes outcomes following occupation-based upper extremity (UE) rehabilitation for two patients with different UE conditions. Despite 85% of hand therapists being occupational therapists (OTs), biomechanical intervention and outcomes have predominated. Many OTs in this field have difficulty finding balance between using traditional biomechanical interventions to help improve physical function and focusing on occupation. A shift to occupation-based care focusing on functional performance is currently under way, returning to the foundation of the profession. Balancing both biomechanical and occupational interventions to optimize functional outcomes is exemplified in this case study.

Collaborative Curriculum - Advancing Ergonomics Education by Incorporating the Expertise of a Certified Hand Therapist

Dental professions are at a high risk of experiencing musculoskeletal disorders (MSDs), with estimates indicating that between 60% and 96% of the workplace is impacted. 1 The dental hygiene studies (DHS) program at Pacific University previously included standardized ergonomics education in their curriculum, however these principles were reinforced predominantly through passive techniques (posters and brochures). In 2017, Pacific adopted a plan for ergonomics curricular revision that incorporated the expertise of a faculty member in Pacific’s Physical Therapy (PT) program; this involved introducing the Core Four activity set to incoming DHS student cohorts by a PT who is a Certified Hand Therapist.

Purdue Manual Dexterity Scores: A Cohort Study of Community Dwelling Elderly

The Purdue Pegboard Test (PPT) is a manual dexterity test that requires the manipulation of pegs, washers, and collars. Our population for this research intervention focused on the geriatric community due to the lack of recent available normative data. Much of the existing data was collected using the Purdue Pegboard model 32020 which is no longer available for purchase. Our objective was to gather normative data for community-dwelling seniors. The purpose of this study was to provide updated normative data for hand therapists to use in clinical practice to determine if seniors have dexterity deficits.

Collagenase injections for Dupuytren disease: 3-year treatment outcomes and predictors of recurrence in 89 hands

Background and purpose — Few prospective studies have reported the long-term effect durability of collagenase injections for Dupuytren disease. We assessed the 3-year treatment outcome of collagenase injections and predictors of recurrence.Patients and methods — We conducted a single-center prospective cohort study. Indication for collagenase injection was palpable Dupuytren’s cord and active extension deficit (AED) ≥ 20° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. From November 2012 through June 2013, we treated 86 consecutive patients (92 hands, 126 fingers). A hand therapist measured joint contracture before, 5 weeks, and 3 years after injection. The patients rated their treatment satisfaction. Primary outcome was proportion of treated joints with ≥ 20° AED worsening between the 5-week and 3-year measurements. We analyzed predictors of recurrence.Results — 3-year outcomes were available for 83 of the 86 patients (89 hands, 120 treated fingers). Between the 5-week and 3-year measurements, AED worsened by ≥ 20° in 17 MCP (14%) and 28 PIP (23%) joints. At 3 years, complete correction (passive extension deficit 0–5°) was present in 73% of MCP and 35% of PIP joints. Treatment of small finger PIP joint contracture, greater pretreatment contracture severity, and previous fasciectomy on the treated finger were statistically significant predictors of recurrence. Treatment satisfaction was rated as very satisfied or satisfied in 59 of 87 hands. No long-term treatment-related adverse events were observed.Interpretation — 3 years after collagenase injections for Dupuytren disease, improvement was maintained and treatment satisfaction reported in two-thirds of the treated hands, with no adverse events. Complete contracture correction was achieved in 3 of 4 MCP joints, but in only a third of the PIP joints.