Injured Hand Research Articles

Evaluation of the clinical and radiological outcome of hemi-hamate arthroplasty in the reconstruction of proximal interphalangeal Joint fracture-dislocations.

Background: Hemi-hamate arthroplasty, a new attractive method for treatment of unstable Proximal Interphalangeal (PIP) joint fracture-dislocations, offers several advantages over the previous methods. This study was designed to evaluate the clinical and radiological outcome of this procedure. Methods: In this study, 14 patients and 15 fingers with PIP joint fracture-dislocations were evaluated, including 8 acute and 7 chronic injuries. The mean age and follow-up of the patients were 35.3 years and 29.7 months, respectively. The mean PIP joint involvement was 56.6%. Objective assessment of the outcome was performed by joint alignment, motion, stability, and grip and pinch strength. Subjective evaluation of the outcome was performed using the Visual Analogue Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Statistical analysis was performed using SPSS for Windows (version 16). Independent sample t test or Mann-Whitney U test were used for statistical comparison of the mean values. A p value of < 0.05 was considered significant. Results: At the final follow-up, 14 out of 15 PIP joints were clinically stable. Grip and pinch strength of the injured hand averaged 87.6% and 88% of contralateral hand, respectively. The mean PIP joint flexion, arch of motion, and flexion contracture were 82.6, 63.6, and 19 degrees, respectively. The mean DASH score was 20.33±21.87 in acute and 7.25±11.71 in the chronic group (p=0.181). The mean VAS was 2.87±2.29 in acute versus 0.42±0.78 in chronic patients (p=0.022). The degenerative joint disease was observed in 5 cases. Conclusion: Although hemi-hamate arthroplasty is a promising method for the reconstruction of severe PIP joint fracturedislocations, it is associated with minimal functional limitation and high rate of osteoarthritis.

The results of the treatment of hand - Outcomes of the treatment of hand degloving injuries with greater omentum flaps.

Degloving injury consists in tearing out the soft-tissue integument from skeleton of the hand, with accompanied nerves and vessels. The whole hand degloving has bad reputation and one of worst prognosis, even worse than total hand amputation. The range of possible salvage procedures in these cases is limited and their outcomes are unsatisfactory. One of the suitable methods is wrapping the skinned hand with pedicled or free greater omentum flap, retrieved from the abdominal cavity. The article reports outcomes of the treatment of 5 patients at a mean of 8 years after total degloving of their hands and coverage with omental flaps. All flaps healed uneventfully, but in none of the patients the whole length of the fingers was preserved. Division of stumps of 3 fingers was possible in one patient, two others had three-digital hands and remaining two had only separated thumb. Dexterity of injured hands was limited with a mean of score DASH questionnaire of 43 points. Quality of life as measured by SF-36 questionnaire was fair (58 and 53 points in physical and mental domain, respectively). Regardless this, all patients were satisfied with achieved outcomes and all returned to work, which was a confirmation of the effectiveness of the method used in their treatment.

Application of accelerated rehabilitation surgery concept in the treatment of metacarpal fractures with absorbable rods

Objective To explore the clinical efficacy of absorbable rod in the treatment of metacarpal fractures under the guidance of accelerated rehabilitation surgery concept. Methods From August 2016 to August 2018, 53 patients with long oblique and spiral metacarpal fractures were treated with absorbable rod by fixation perpendicular to the fracture line. The patients were divided into observation group and control group according to whether they were treated with the concept of accelerated rehabilitation surgery during perioperative period or not. There were 24 cases in the observation group (28 places) and 29 cases in the control group (31 places). The visual analogue scale (VAS) on the first day after operation, the time when the active range of motion of metacarpophalangeal joint returned to normal, the time of fracture healing and the functional evaluation results of the injured hand at the last follow-up were compared between the two groups. Results All the patients were follow-up for 1 to 12 months with an average of 9.2 months. All the incisions achieved primary healing and all the fractures were healed. On the first day after operation, VAS and the recovery time of metacarpophalangeal joint activity in the observation group were (2.64±0.81) points and (19.35±2.12) days, respectively, which were significantly lower than those in the control group (3.42±1.13) points and (28.63±1.31) days. The differences were statistically significant (t=-2.920, -14.665, P 0.05). There was no significant difference in hand function evaluation between the two groups at the last follow-up (χ2=0.045, P>0.05). Conclusion The technique of absorbable rod by fixation perpendicular to the fracture line for long oblique or spiral metacarpal fractures is a safe and effective surgical method. With the guidance of accelerated rehabilitation surgery concept, hand function can be better restored and satisfactory clinical efficacy can be obtained. Key words: Metacarpal bones; Fractures,bone; Absorbable rod; Accelerated rehabilitation surgery

Rehabilitation of the burnt hand

Injuries to the hands occur disproportionately more frequently in thermal accidents. The aim of ICF-oriented rehabilitation of burn injured hands is to return as much sensory and gripping functionality as possible or to develop everyday practical compensation mechanisms. Often the expectations of functionality and aesthetics for the burn injured are clouded by the clinical picture of edema, epithelial defects, contractures and hypertrophic scarring but, multimodal therapy options and interdisciplinary thinking are the means by which the rehab team can address and alleviate these concerns.

Radial Half of the Second Metacarpal Bone and the First Dorsal Interosseous Muscle Composite Flap for Treating the First Metacarpal Bone Defect: A Case Report

Traumatic bone defect is a challenging problem for both patient and doctor. The goal of treatment is the restoration of hand function with acceptable appearance of an injured hand. Especially in the injury of the thumb, length and stability are very important to achieve good holding and pinching functions. We reported a 23-year-old patient with traumatic first metacarpal bone loss after a motor vehicle accident treated with vascularized radial half of the second metacarpal bone and the first dorsal interosseous muscle composite flap.

Outcomes of the Hemi-Hamatum Arthroplasty.

Background: Multi-fragmental intra-articular middle phalanx base fractures mostly occur in young adults during sports or work-related activities. If left untreated properly proximal interphalangeal joint (PIPJ) instability and pain persists, thus impairing the hand's function and the patient's quality of life. Joint surface reconstruction with hamate osteochondral graft can be used for multi-fragmental middle phalanx base reconstruction. Methods: A retrospective study was conducted. The technique was used for 17 patients. Follow-up was performed at least 6 months after the surgery. Patients were asked to fulfil multiple surveys: Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Modern Activity Subjective Survey 2007 (MASS07). Objective measurements included strength of the power and pinch grip, range of motions (ROM) in both proximal interphalangeal and distal interphalangeal (DIPJ) joints. All measurements were taken on both hands, on operated and contralateral fingers. Results: Out of 17 patients 5 were females and 12 males, mean age 40 (ranged 22-65 years) Eleven patients agreed to participate in the follow-up. All patients were right-handed, 8 patients had injured their right hand. The injuries' aetiologies were sports (n = 3), fighting (n = 2) and work-related (n = 4). Six patients were treated with immobilisation before the surgery, which was performed on average 45 days after the injury (ranged 1-184 days). Two patients developed arthrosis post-operatively and received synthetic joints. Mean DASH score was 6.9, PRWE score was 5.2 and mean MASS07 score was 6.8. Patients achieved on average 90% of power grip and 100% of pinch grip with their injured hand compared to their healthy hand. Average ROM in PIPJ was 82.2° and in DIPJ 68.9°. No patients experienced joint instability or chronic pain. Conclusions: Hemi-hamate arthroplasty provides satisfactory results in patients with both acute and chronic dislocated intra-articular middle phalanx base fractures.

High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement

High-pressure injection injuries to the fingers resulting from the introduction of a foreign substance, such as oil or paint, through a minor puncture wound are rare but can have serious clinical consequences. The objective of this article was to examine the long-term outcomes after surgical debridement of these injuries. We present a retrospective case series of 8 adults who had a high-pressure injection injury to their hand and underwent surgical debridement in our facility. Data were extracted from our outpatient registry. Assessment included a full physical examination, grip strength, range of motion, two-point discrimination and Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. We followed 8 male patients for an average of 12.7 years. Their average age was 37 at time of injury and all had injured their right dominant hand. Seventy-five percent of the injuries were to the index finger. Seven out of the 8 patients returned to their pre-injury occupation, 4 out of 8 patients had reduced range of motion of the affected digit. Injury sequelae adversely affected activities of daily living (ADL) with an average QuickDASH score of 26. Grip strength in the injured hand was reduced by an average of 35% in 6 out of 8 patients compared with the uninjured hand. Sensation was also reduced in the affected digit in 7 out of 8 patients. All patients suffered from some level of neuropathic pain and/or cold intolerance. High pressure injection injury to the fingers is a serious event found amongst industrial laborers. In most patients, this injury will lead to long-term disability along with a negative impact on ADL. However, most patients eventually return to their pre-injury occupation. Extensive, single or repeat debridement of high-pressure injection injuries remains a valid treatment option with good long-term results.

Clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area

Objective: To explore the clinical effects of dorsal perforator fascia pedicle flap of the deep palmar arch in the repair of skin and soft tissue defects of finger web area. Methods: Eleven patients (7 males and 4 females, aged from 18 to 73 years) with soft tissue defects of finger web area in distal dorsal side were admitted to Xinhua Hospital (Chongming) of Shanghai Jiao Tong University School of Medicine from October 2010 to September 2018. The sizes of skin and soft tissue defects ranged from 2.5 cm×1.5 cm to 6.0 cm×2.5 cm. According to the origin, course, branches, and distribution of the dorsal perforator of deep palmar arch, and the anatomical characteristics with vascular network of dorsal carpal and dorsal metacarpal, dorsal perforator fascia pedicle flaps of the deep palmar arch from the back of the injured hands were designed and transferred to repair the wounds of finger web area in distal dorsal side. The sizes of the flaps of patients ranged from 3.5 cm×2.0 cm to 6.5 cm×3.0 cm. The donor sites were sutured directly or covered with free forearm full-thickness skin graft. The clinical effects and swelling degree of flaps in early and late stages were evaluated during the follow-up of 3 to 36 months post surgery. Results: All the flaps survived in 11 patients, the incisions in donor and recipient sites were healed. During the follow-up of 3 to 36 months post surgery, the survival of flaps was good, and the appearance, color, and elasticity were close to normal skin, with two-point discrimination distance of 7 to 10 mm and sensory function recovery of grade S(3). The wounds in donor site had small scar without infection. The efficacy was evaluated as satisfactory in 8 patients, general in 3 patients, and dissatisfactory in no patient. Flap swelling rating in early stage was 1st degree in 7 patients, 2nd degree in 2 patients, and 3rd degree in 2 patients. Flap swelling rating in late stage was 1st degree in 8 patients, 2nd degree in 2 patients, and 3rd degree in 1 patient. The extension and flexion of the metacarpal and interphalangeal joints were basically normal and the patients were satisfied with the outcomes. Conclusions: Based on the dorsal perforator of deep palmar arch, dorsal perforator fascia pedicle flap of the deep palmar arch is reliable to transfer to repair skin and soft tissue defects of finger web area in distal dorsal side, which is worthy of promotion in clinic.

Applying EMG technology in medial and lateral elbow enthesopathy treatment using Myo motion controller

Electromyography (EMG) is a diagnostic technique allowing for the detection of signals generated by changes in electrical potentials of striated muscles. The application of this technology is becoming an increasingly popular subject of scientific research. With the appearance of new devices retrieving EMG data, novel methods of its processing for various purposes are being developed. One such device is the Myo movement controller, produced by Thalmic Labs (now North). The device has been used for the analysis of muscle activation levels in patients with "tennis elbow" and "golfer’s elbow"—conditions of upper limbs which usually result from occupational injuries. The process of their rehabilitation is complex and requires a continuous monitoring of its progress. The data obtained by means of the Myo controller was used for pattern recognition of an injured hand with relation to the healthy one. The study involved examining ten subjects, including five controls. The results indicate that the muscle activation force is considerably lower in injured individuals. The arithmetic mean for the 6 analyzed motions in the injured group is 38.54% lower. The SmartEMG application (https://www.smartemg.com) enables the implementation of procedures performed during an examination as well as those involved in the management of the collected recordings. The study produced satisfactory results, which indicates the possibility of using the Myo controller in the treatment of elbow enthesopathy.

Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand.

Background: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms. Methods: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation. Results: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci. Conclusions: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons.

Spinal cord injury transiently alters Meissner's corpuscle density in the digit pads of macaque monkeys.

Meissner's corpuscles (MCs) are cutaneous mechanoreceptors found in glabrous skin and are exquisitely sensitive to light touch. Along with other receptors, they provide continuous sensory feedback that informs the execution of fine manual behaviors. Following cervical spinal deafferentation injuries, hand use can be initially severely impaired, but substantial recovery occurs over many weeks, even when ~95% of the original input is permanently lost. While most SCI research focuses on central neural pathway responses, little is known about the role of peripheral receptors in facilitating recovery. We begin to address this by asking the following: (1) What is the normal pattern of MCs in the distal pads of all five digits in the macaque monkey (with hands similar to humans)? (2) What happens to these receptors 4-5 months following either a dorsal column lesion (DCL) or a combined dorsal root/dorsal column lesion (DRL/DCL), when functional recovery is largely complete? (3) What happens chronically, 12-14 months later? Our findings show that in normal monkeys, MCs are densest in the distal pads of the opposing thumb and index finger, with the greatest concentration on the thumb. This reflects a close functional relationship between receptor density and precision grip. At 4-5 months post-injury, there was a (~30%) loss of MCs on the deafferented digits of the injured hand compared with the contralateral side. However, 12-14 months after a DRL/DCL, receptor densities had returned to normal levels. Our findings indicate a complex peripheral response and highlight the importance of the periphery in shaping central changes.

Orthofix mini external fixator combined with lever technique for minimally invasive prying reduction and limited internal fixation in the treatment of metacarpal and phalangeal fractures at joint sites

Objective To investigate the clinical efficacy of Orthofix mini external fixator combined with lever technique for minimally invasive prying reduction and limited internal fixation in the treatment of metacarpal and phalangeal fractures at joint sites. Methods From October 2014 to June 2017, we applied mini external fixator technique to pull and restore joint alignment, then lever technique for minimally invasive prying reduction to restore articular surface, and limited internal fixation to treat 36 metacarpal and phalangeal fractures at joint sites in 34 cases. Fracture healing and hand function recovery were assessed. Results All the patients obtained short-term follow-up for 6 to 10 months, of which 21 cases obtained long-term follow-up for 10 to 30 months. All the fractures healed after operation. The healing time was 5 to 12 weeks, with an average of 7.3 weeks. According to TAM criteria, the excellent and good rate of short-term follow-up was 82.4%, and the excellent and good rate of long-term follow-up was 90.5%. 5 patients had moderate finger activity during short-term follow-up, of which 2 were reoperated after 10 months and had good long-term follow-up function. One patient was unable to cooperate with functional exercise, and the follow-up showed poor finger activity. Conclusion The method is effective in the treatment of metacarpal and phalangeal fractures at joint sites. This technique is minimally invasive, which does not increase the soft tissue adhesion of joint. The reliable fixation can meet the needs of early functional exercise. The injured hand has good appearance without obvious surgical scar at joint sites and the incidence of hand joint stiffness is low. Key words: Metacarpal bones; Finger phalanges; Fractures,bone; Mini external fixator

Reconstruction of digit planer injuries using component transfer of double second toes: A case report

The purpose of this report is to show that customized component second-toe transfers may improve functional and aesthetic outcomes following bone, soft tissue, and joint destruction of traumatically injured digits. A 22-year-old male sustained a planer injury resulting in loss of the distal volar soft tissues of the middle, ring, and small fingers, along with variable destruction of middle phalanges and distal interphalangeal joints. Simultaneous vascularized second-toe transfers were performed with customized joint and pulp reconstruction of middle and small fingers. The ring finger was salvaged using non-vascularized autologous bone graft and acellular dermal matrix. The patient had an uncomplicated postoperative course. Five-year strength, sensory and patient reported outcomes represent overall satisfactory results. Strength testing revealed the injured hand to perform within 90% strength of the uninjured side. Sensory outcomes showed present but diminished sensory perception in each of the injured digits. The patient's upper extremity function, physical health, quality of life, and foot health were overall acceptable, and he returned to using his hand for typing, writing, weight-lifting, and woodworking.

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.

How does simulation of an observed external body state influence categorisation of an easily graspable object?

Several works have provided evidence of a resonant motor effect while observing a hand interacting with painful stimuli. The aim of this work is to show that participants are sensitive to the observation of an injured hand when they have to categorise an easily graspable object with their own hand. In Experiment 1, participants indicated whether or not photographs of objects (graspable or non-graspable, left or right oriented) could be grasped with their dominant hand, by tapping a key on a keyboard. Target objects were preceded by primes consisting of photographs of hands (injured vs healthy) in a grasping posture (power grasp). Experiment 2 consisted of two phases: In the first phase, participants had to categorise square or circle shapes. After their response (Group 1: tapping a key vs Group 2: constricting a hand grip), photograph of two types of hand (injured vs healthy) was displayed on the computer screen. In the second phase, participants had to indicate whether objects could be easily grasped with their dominant hand. Target objects were preceded by primes (square and circle) as shown in the first phase. Results show that response times were slower when the graspable target objects were right oriented and preceded by the photograph or a geometric shape associated with an injured hand. This response delay was accentuated in the handgrip condition. These results highlight that the view of an injured hand activates motor programme and pain mechanisms associated with participants relative to the consequences of the simulated grasping action.

Can mirror visual feedback improve sensory relearning outcomes following median/ulnar nerve repair?

Background/Aims: Mirror visual feedback is an intervention that focuses on watching the movements of the intact hand in the mirror to restore the movements of the injured hand. This method is developed based on the concept of the central reflection of the amputated or injured limb. This study aims to determine the effect of mirror visual feedback as a complementary method on the outcomes of sensory relearning in patients following median/ulnar nerve repair. Methods: This randomised clinical trial was conducted on 20 patients with median/ulnar nerve damage who were selected through convenience sampling and were then randomly assigned to a treatment and a control group. Both groups received traditional rehabilitation in three 40-minute sessions a week. In addition, the treatment group received mirror visual feedback 15 minutes a day, 5 days a week, for 8 weeks. The patients' sensory status was assessed using Semmes-Weinstein Monofilaments and two-point discrimination tests and their sensory function was assessed using stereognosis both before and after the intervention. Findings: The final analysis was performed on a total of 20 patients. The Semmes-Weinstein Monofilaments test and two-point discrimination scores obtained showed significant improvements following therapy in both groups. The changes in Semmes-Weinstein Monofilaments test (P=0.000], two-point discrimination (P=0.000) and stereognosis (active: P=0.001, passive: P=0.000) scores were significantly greater in the mirror therapy group compared to the controls. Conclusions: Mirror visual feedback in conjunction with traditional sensory retraining programmes led to greater improvements in superficial sensation and touch discrimination of the hand in the first phase of the sensory relearning programme. This may be due to the use of the neuroplasticity potential, the stimulation of the somatosensory areas and motor networks, the adjustment of early cortical reorganisation and the prevention of further changes.

First dorsal metacarpal artery flap for hand cover tissue defects reconstruction

The aim — to increase the efficiency of the defect’s reconstruction of the hand cover tissues considering the functional and aesthetic aspects.Materials and methods. 12 patients with soft tissue defects of the hand were undergoing a surgery with the flap on the first dorsal metacarpal artery and its modification during the period from 2015 to 2018. To assess the effectiveness of treatment, the level of complications and the level of aesthetic and functional state of the hand in 6 months after treatment, the questionnaire «Assessing the level of daily life and quality of life of patients with the injured hand» were used.Results and discussion. The treatment helped to restore the anatomical integrity and function of the hand. According to the questionnaire, the level of everyday life and quality of life of patients with hand disorders in 6 months after treatment was from 23 to 27 points (median — 26.0 ± 1.3 points, which corresponds to a high level of satisfaction with the treatment result.Conclusions. One­stage reconstruction of the soft tissue defects of the hand with the first dorsal metacarpal artery flap plasty allows to increase the efficiency of surgical treatment (provides for the initial closure of the soft tissue defect and the early restoration of the hand function, as well as the restoration of the lost skin without the contours of the hand distortion and deformation of the donor area) and a high level of satisfaction with the treatment results in patient.

Outcomes After Revision Amputation or Replantation in FRANCHISE (Finger Replantation and Amputation Callenges in Assessing Impairment, Satisfaction, and Effectiveness) Study

Outcomes After Revision Amputation or Replantation in FRANCHISE (Finger Replantation and Amputation Callenges in Assessing Impairment, Satisfaction, and Effectiveness) Study

Intelligent Object Grasping With Sensor Fusion for Rehabilitation and Assistive Applications.

This paper presents the design and control of the intelligent sensing and force-feedback exoskeleton robotic glove to create a system capable of intelligent object grasping initiated by detection of the user's intentions through motion amplification. Using a combination of sensory feedback streams from the glove, the system has the ability to identify and prevent object slippage, as well as adapting grip geometry to the object properties. The slip detection algorithm provides updated inputs to the force controller to prevent an object from being dropped, while only requiring minimal input from a user who may have varying degrees of functionality in their injured hand. This paper proposes the use of a high dynamic range, low cost conductive elastomer sensor coupled with a negative force derivative trigger that can be leveraged in order to create a controller that can intelligently respond to slip conditions through state machine architecture, and improve the grasping robustness of the exoskeleton. The improvements to the previous design are described while the details of the controller design and the proposed assistive and rehabilitative applications are explained. Experimental results confirming the validity of the proposed system are presented. Finally, this paper concludes with topics for future exploration.

Psychometric properties of the goniometric assessment of the Dart Thrower’s Motion

Introduction The Dart Thrower’s Motion is an important movement for hand function. A goniometric clinical measure of Dart Thrower’s Motion has been developed. However, its validity and reliability in people with wrist and hand injury is not known. This study investigated the inter-rater and test–retest reliability and criterion validity of the Dart Thrower’s Motion measure. Methods A cross-sectional design was used. Thirty-five participants with hand or wrist injury completed the goniometric assessment of the Dart Thrower’s Motion and goniometric wrist active range of motion assessment three times in a hand clinic. Two assessors and a reader to record the results were involved. Participants also completed the patient-rated wrist and hand evaluation. Results The intraclass correlation coefficients were 0.70–0.83 and 0.91–0.92, respectively for inter-rater and test–retest reliability in the injured hands indicating moderate to high reliability. The Pearson correlation coefficients between the Dart Thrower’s Motion measure and wrist active range of motion assessment ranged from 0.45 to 0.73, and with patient-rated wrist and hand evaluation ranged from −0.36 to −0.53. The results indicate that goniometric assessment of the Dart Thrower’s Motion has acceptable criterion validity. Conclusion The goniometric assessment of Dart Thrower’s Motion can be considered a valid and reliable clinical measure for measuring the impact of the injury to one’s hand and wrist range of motion and function. It shows its clinical utility in people with hand and wrist injury. It is hoped this simple measure can be eventually implemented in clinical settings, allowing for an increased understanding of an individual’s functional use of the hand and wrist.