Passive Wrist Research Articles

Negative emotions reduce sensorimotor cortex activity during proprioceptive modulation of rolandic ∼20HZ beta rhythm in typically developing children and those with neurodevelopmental conditions

BackgroundThe Rolandic ∼20-Hz beta rhythm of the sensorimotor cortex is associated with motor function and perception. However, the modulation of this rhythm by different emotional stimuli is an innovative area of research. AimsThis study aims at investigating the impact of affective pictures (positive, negative, and neutral) on the proprioceptive modulation of the Rolandic ∼20 Hz beta rhythm in typically developing children and children with neurodevelopmental disorders (i.e. cerebral palsy and autism). Methods and proceduresEEG was recorded while participants experienced passive wrist movements during the simultaneous viewing of affective pictures. Time-frequency analysis of the sensorimotor oscillatory activity was performed. Outcomes and resultsOur findings revealed that pictures with negative emotional valence notably diminish event-related synchronization (ERS) amplitude during the perception of hand movement in all groups of children. Conclusions and implicationsThese findings suggest that emotional stimuli, particularly the negative ones, could significantly influence brain's processing of proprioception, adding knowledge to the interaction of common comorbidities, such as sensorimotor disorders and emotional dysregulation, in children with neurodevelopmental disabilities.

Design and Analysis of VARONE a Novel Passive Upper-Limb Exercising Device

Robots have been widely investigated for active and passive rehabilitation therapy of patients with upper limb disabilities. Nevertheless, the rehabilitation assessment process is often ignored or just qualitatively performed by the physiotherapist implementing chart-based ordinal scales or observation-based measures, which tend to rely on professional experience and lack quantitative analysis. In order to objectively quantify the upper limb rehabilitation progress, this paper presents a noVel pAssive wRist motiOn assessmeNt dEvice (VARONE) having three degrees of freedom (DoFs) based on the gimbal mechanical design. VARONE implements a mechanism of three revolute passive joints with controllable passive resistance. An inertial measurement unit (IMU) sensor is used to quantify the wrist orientation and position, and an encoder module is implemented to obtain the arm positions. The proposed VARONE device can also be used in combination with the previously designed two-DoFs device NURSE (cassiNo-qUeretaro uppeR limb aSsistive dEvice) to perform multiple concurrent assessments and rehabilitation tasks. Analyses and experimental tests have been carried out to demonstrate the engineering feasibility of the intended applications of VARONE. The maximum value registered for the IMU sensor is 36.8 degrees, the minimum value registered is −32.3 degrees, and the torque range registered is around −80 and 80 Nmm. The implemented models include kinematics, statics (F.E.M.), and dynamics. Thirty healthy patients participated in an experimental validation. The experimental tests were developed with different goal-defined exercising paths that the participant had to follow.

Medical Rehabilitation in Patient with Post ORIF et causa Neglected Epiphyseal Fracture Distal Radius-Ulna Sinistra: A Case Report

Distal radius-ulna fracture is one of the most common human osseous injuries, with incidence rate increasing worldwide. There are two peaks of prevalence: the first around the 10th and the second around the 60th year of life. During childhood, they are among the most common pediatric fractures accounting for 19.9 to 35.8% of all pediatric fractures. We reported a case of a boy 13 years old diagnosed as post open reduction internal fixation distal radius ulna et causa epiphyseal fracture. He came to rehabilitation outpatient clinic with chief complaint pain on his left forearm. He underwent a surgery two weeks ago at the distal radius ulna. The surgeon did osteotomy on ulna and then fixated with plate and screw. On physical examination, there were pain and range of motion limitation mainly on the forearm and wrist joint. The patient was treated with low level laser therapy at the surgical wound to promote healing and decrease edema, initial digital motion exercise along with active range of motion of the uninvolved joints. He was also educated about icing and medicamentation if pain still persisted. Once adequate bony healing had occurred, active, active-assisted, progressive passive wrist motion, and strengthening exercise using resistance were performed to maximize the result. At the end of rehabilitation program, there was great improvement on pain and also range of motion improvement. Albeit, there was still a slight range of motion limitation on ulnar deviation and wrist extension by 5 degrees. In conclusion, rehabilitation program is very beneficial in treating post-surgery patient using modalities and exercises to improve functional function. Keywords: epiphyseal fracture; radius-ulna; medical rehabilitation

Passive wrist deviation to increase the ultrasound identified procedural safe zone in carpal tunnel syndrome: A retrospective cohort study.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated. To identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS. Retrospective cohort study. Quaternary medical center multidisciplinary outpatient hand clinic. Twenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment. Ultrasound-identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial-ulnar deviation as well as in passive ulnar and radial deviation. The ultrasound-identified safe zone distance with the wrist in each of the three positions. The interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs. This study demonstrates that the ultrasound-measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound-guided injections.

Closing the loop: Novel quantitative fMRI approach for manipulation of the sensorimotor loop in tremor

Tremor is thought to be an effect of oscillatory activity within the sensorimotor network. To date, the underlying pathological brain networks are not fully understood. Disentangling tremor activity from voluntary motor output and sensorimotor feedback systems is challenging. To better understand the intrinsic sensorimotor fingerprint underlying tremor, we aimed to disentangle the sensorimotor system into driving (motor) and feedback/compensatory (sensory) neuronal involvement, and aimed to pinpoint tremor activity in essential tremor (ET) and tremor-dominant Parkinson's disease (PD) with a novel closed-loop approach.Eighteen ET patients, 14 tremor-dominant PD patients, and 18 healthy controls were included. An MR-compatible wrist manipulator was employed during functional MRI (fMRI) while muscle activity during (in)voluntary movements was concurrently recorded using electromyography (EMG). Tremor was quantified based on EMG and correlated to brain activity. Participants performed three tasks: an active wrist motor task, a passive wrist movement task, and rest (no wrist movement).The results in healthy controls proved that our experimental paradigm activated the expected motor and sensory networks separately using the active (motor) and passive (sensory) task. ET patients showed similar patterns of activation within the motor and sensory networks. PD patients had less activity during the active motor task in the cerebellum and basal ganglia compared to ET and healthy controls. EMG showed that in ET, tremor fluctuations correlated positively with activity in the inferior olive region, and that in PD tremor fluctuations correlated positively with cerebellar activity.Our novel approach with an MR-compatible wrist manipulator, allowed to investigate the involvement of the motor and sensory networks separately, and as such to better understand tremor pathophysiology. In ET sensorimotor network function did not differ from healthy controls. PD showed less motor-related activity. Focusing on tremor, our results indicate involvement of the inferior olive in ET tremor modulation, and cerebellar involvement in PD tremor modulation.

Implications of providing wrist-hand orthoses for children with cerebral palsy: evidence from a randomised controlled trial

Purpose To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy. Methods A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5–15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles. Results The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81–25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20–33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings. Conclusion The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population. Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572 IMPLICATIONS FOR REHABILITATION There may be incremental benefit, for children with cerebral palsy, at 6 and 12 months on passive wrist range from wearing a rigid wrist-hand orthosis designed according to this protocol. The rigid-wrist-hand orthosis evaluated in this study, which allowed for some tailoring for individual children’s presentations, differed in design from past recommendations for “resting hand” positioning. Longitudinal follow up of children with cerebral palsy prescribed a rigid wrist-hand orthosis is essential to monitor any benefit. Minor adverse events were commonly experienced when wearing the orthosis and should be discussed prior to prescription of a rigid wrist-hand orthosis.

Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Isolated Lunotriquetral Interosseous Ligamentous Injury: A Retrospective Case Series of 22 Patients.

Background: The literature is scarce regarding isolated tears of lunotriquetral interosseous ligament (LTIL). The purpose of this study was to present mid-term clinical and functional results of arthroscopic dorsal ligamentocapsulodesis in the treatment of isolated LTIL tears. Methods: Twenty-two patients (8 females, 14 males; mean age: 31 years; age range: 18-42) with isolated LTIL tears verified by wrist arthroscopy were retrospectively reviewed and included in the study. The mean follow-up was 55 months (range: 24-84). The modified Mayo wrist score, visual analog scale (VAS), flexion and extension deficits of passive wrist range of motion (ROM), pain-free ROM with forced wrist extension and grip strength were measured in all patients preoperatively and at final follow-up. Results: The mean modified Mayo wrist score significantly improved from 50 ± 10.29 preoperatively (range: 30-65) to 86 ± 11.61 (range: 60-100) at the final follow-up (p < 0.001). The mean VAS score significantly improved from 7.1 ± 0.83 (range: 6-8) preoperatively to 2.2 ± 1.35 (range: 0-6; p < 0.001) at the final follow-up. At the final follow-up examination, the forced wrist extension was painless in all but three patients who developed pain at 70º, 75º and 80º of extension, respectively. The mean strength of hand grip significantly increased from 38.6 ± 9.68 (range: 24-54) kg to 49.5 ± 12.36 (range: 33-66) kg at the final assessment (p < 0.001). No major complications were observed during or after the procedure. Conclusions: With the encouraging mid-term outcomes and a lower complication rate, arthroscopic LTIL dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in improving functional outcomes and reducing pain in patients with isolated LTIL tears. Level of Evidence: Level IV (Therapeutic).

Design of Transverse Brachiation Robot and Motion Control System for Locomotion between Ledges at Different Elevations.

Bio-inspired transverse brachiation robots mimic the movement of human climbers as they traverse along ledges on a vertical wall. The constraints on the locomotion of these robots differ considerably from those of conventional brachiation robots due primarily to the need for robust hand-eye coordination. This paper describes the development of a motion control strategy for a brachiation robot navigating between wall ledges positioned on a level plane or at different elevations. We based our robot on a four-link arm-body-tail system performing a four-phase movement, including a release phase, body reversal phase, swing-up phase, and grasping phase. We designed a gripper that uses passive wrist joint motion to grasp the ledge during the tail swing. We also developed a dynamic model by which to coordinate the swing-up movement, define the phase switching conditions, and time the grasping action of the grippers. In experiments, the robot proved highly effective in traversing between wall ledges of the same or different elevations.

Real-life Wrist Movement Patterns Capture Motor Impairment in Individuals with Ataxia-Telangiectasia.

Sensitive motor outcome measures are needed to efficiently evaluate novel therapies for neurodegenerative diseases. Devices that can passively collect movement data in the home setting can provide continuous and ecologically valid measures of motor function. We tested the hypothesis that movement patterns extracted from continuous wrist accelerometer data capture motor impairment and disease progression in ataxia-telangiectasia. One week of continuous wrist accelerometer data were collected from 31 individuals with ataxia-telangiectasia and 27 controls aged 2–20 years old. Longitudinal wrist sensor data were collected in 14 ataxia-telangiectasia participants and 13 controls. A novel algorithm was developed to extract wrist submovements from the velocity time series. Wrist sensor features were compared with caregiver-reported motor function on the Caregiver Priorities and Child Health Index of Life with Disabilities survey and ataxia severity on the neurologist-performed Brief Ataxia Rating Scale. Submovements became smaller, slower, and less variable in ataxia-telangiectasia compared to controls. High-frequency oscillations in submovements were increased, and more variable and low-frequency oscillations were decreased and less variable in ataxia-telangiectasia. Wrist movement features correlated strongly with ataxia severity and caregiver-reported function, demonstrated high reliability, and showed significant progression over a 1-year interval. These results show that passive wrist sensor data produces interpretable and reliable measures that are sensitive to disease change, supporting their potential as ecologically valid motor biomarkers. The ability to obtain these measures from a low-cost sensor that is ubiquitous in smartwatches could help facilitate neurological care and participation in research regardless of geography and socioeconomic status.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12311-022-01385-5.

HP03: Abnormal Dynamic Neuronal Connectivity in children with dystonia

Dystonia is a network disorder resulting from dysfunction of, or abnormal connectivity within, the cortico-basal ganglia-cerebellar network. Despite the dynamic nature of the disorder, stimulus-related changes in connectivity have not been studied. We investigate modulation of neuronal connectivity by a proprioceptive stimulus in dystonia. Methods: Sixteen young people with dystonia and eight controls participated (age 6-20years, mean 12.5). A robotic wrist interface delivered passive wrist extension movements, producing a brief stretch of the right wrist flexors. Scalp EEG (10-20 system) was sampled at 2500Hz. Wrist position was monitored and movement onset synchronised with EEG. Data were segmented into epochs (1 second pre- and 3.5 seconds post-stimulus). Up to 160 epochs were averaged per subject to produce a Stretch Evoked Potential (StretchEP). Event-related network dynamics were estimated using the imaginary part of Wavelet Transform Coherency, excluding volume conduction, with bootstrapping to test for significance against random coupling between brain areas. The overall engagement of cortical areas into short-lived stimulus-related networks (global microscale nodal strength - GMNS) was estimated for each subject. Results: Clear StretchEPs were evoked over contralateral sensorimotor cortex. Individual dynamic connectivity maps revealed particularly strong event-related connectivity in the theta (4-8Hz) band in dystonia. At group level, theta band GMNS was significantly higher in dystonia than controls (p=0.045). The spatial extent of the networks was also stronger in dystonia than controls (non-significant trend). Conclusion: Young people with dystonia show an exaggerated dynamic network response to proprioceptive stimuli, displaying excessive, widespread theta-band synchronisation and over-recruitment across the sensorimotor network.

A portable low-cost 3D-printed wrist rehabilitation robot: Design and development

This article proposes a two-degrees-of-freedom robot for wrist rehabilitation, referred to as MOCH. The MOCH mechanism comprises a remote center of motion (RCM) mechanism with a rotation center outside of the robot structure. When the patient holds the robot end-effector, coinciding the RCM of the robot with the rotation axis of the wrist allows pure rotational motion of the hand. As the rotation point lies out of the robot structure, there is less risk of interference between the patient and the robot. Furthermore, MOCH benefits a novel actuation that enables the actuators to be grounded, reducing the inertia and the size of the robot, and eliminating difficulties with feeding power to actuators on moving linkages. The optimal design of MOCH is provided considering the mechanical criteria and requirements of the wrist rehabilitation robot. Based on the proposed design, a prototype of the robot is developed with a mass of 1.3 kg using 3D printing. To validate the efficacy of MOCH in practice, a trajectory tracking control strategy is implemented for passive wrist rehabilitation.

Effects of Dry Needling on Connectivity of Corticospinal Tract, Spasticity, and Function of Upper Extremity in People with Stroke: Study Protocol for a Randomized Controlled Trial

Spasticity is a common motor disorder in adult stroke patients. Injury to the corticospinal tract (CST) is associated with spasticity. Dry needling (DN) has positive impacts on spasticity reduction and improvement in the range of motion (ROM) in stroke patients. This study aims to investigate the effectiveness of DN on the connectivity of the CST and the level of spasticity in adult stroke patients. This double-blind randomized controlled trial will enroll and randomly assign stroke patients to either the experimental group, for receiving three sessions of DN for the spastic wrist flexors, or the control group, for sham needling. The primary outcome measures will be diffusion tensor imaging and the Modified Modified Ashworth Scale score to assess CST connectivity and wrist flexor spasticity, respectively. The Box and Block Test and standard goniometry are the secondary outcome measures to assess hand dexterity and active and passive wrist ROM, respectively. Measurements will be taken both before and after the intervention. The results of this study will provide important evidence of the effects of DN on CST connectivity, spasticity, and arm function in adult stroke patients. This trial is registered in the Iranian Registry of Clinical Trials (IRCT) (https://www.irct.ir; IRCT20191208045649N1).

Evaluation of Restricted Motion Area of the Median Nerve in Patients with Carpal Tunnel Syndrome: A New Measurement Method Using an Ultrasonographic Video Image.

Background: The precise etiology of carpal tunnel syndrome (CTS) remains unclear. One of the accepted factors for CTS is the restriction of the median nerve. Previous reports using ultrasound had only observed and measured the movement of parts of the median nerve. In this study, we aimed to elucidate the difference in the movement of the entire median nerve in patients with CTS (before and after surgery) and healthy volunteers using a new measurement method. Methods: We expressed the amount of movement of the entire nerve by a new method creating the motion area of the median nerve (MAMn) from an ultrasonographic video image on the computer. We compared the MAMn, the real MAMn (RMMn) (the value obtained by subtracting the nerve cross-sectional area from the MAMn), and mobile ratio (MR) (the value obtained from dividing the MAMn by the nerve cross-sectional area) between six wrists of six cases of CTS (before and at an average of 3.5 months after surgery) and six wrists of six healthy volunteers. Results: During passive wrist flexion, the average MAMn, RMMn, and MR of healthy cases were 23.1 mm2, 16.4 mm2, and 3.52, respectively. The average MAMn, RMMn, and MR of cases of CTS were respectively 11.8 mm2, 5.4 mm2, and 1.86 preoperatively; and 16.2 mm2, 7.3 mm2, and 1.87, postoperatively. The MAMn, RMMn, and MR decreased more significantly in patients with CTS than in healthy volunteers (p < 0.01). The MAMn and RMMn increased postoperatively (p < 0.05), but the MR remained low. Conclusions: The new measurement method revealed that the mobility of the entire median nerve was significantly restricted in cases of CTS compared to healthy participants. However, after surgery, nerve restriction was not restored despite improvements in symptoms, suggesting that decreases in nerve mobility contribute to CTS but are not a direct cause of symptoms.

Quantifying neural and non-neural components of wrist hyper-resistance after stroke: Comparing two instrumented assessment methods

Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexor®) with an experimental EMG-based device (Wristalyzer) in 43 patients with chronic stroke. Spearman's rank correlation coefficients (r) between components, modified Ashworth scale (MAS) and range of passive wrist extension (PRoM) were calculated with 95% confidence intervals. Neural as well as elastic components assessed by both devices were associated (r = 0.61, 95%CI: 0.38-0.77 and r = 0.53, 95%CI: 0.28–0.72, respectively). The neural component assessed by the NeuroFlexor® associated significantly with the elastic components of NeuroFlexor® (r = 0.46, 95%CI: 0.18–0.67) and Wristalyzer (r = 0.36, 95%CI: 0.06–0.59). The neural component assessed by the Wristalyzer was not associated with the elastic components of both devices. Neural and elastic components of both devices associated similarly with the MAS (r = 0.58, 95%CI: 0.34–0.75 vs. 0.49, 95%CI: 0.22–0.69 and r = 0.51, 95%CI: 0.25–0.70 vs. 0.30, 95%CI: 0.00–0.55); elastic components associated with PRoM (r = -0.44, 95%CI: -0.65- -0.16 vs. -0.74, 95%CI: -0.85- -0.57 for NeuroFlexor® and Wristalyzer respectively). Results demonstrate that both methods perform similarly regarding the quantification of neural and elastic wrist hyper-resistance components and have an added value when compared to clinical assessment with the MAS alone. The added value of EMG in the discrimination between neural and non-neural components requires further investigation.

Outcomes of Arthroscopic Lunate Core Decompression Versus Radial Osteotomy in Treatment of Kienböck Disease

The purpose of the study was to evaluate the functional and radiographic outcomes of arthroscopic lunate decompression versus radial osteotomy in the treatment of Kienböck disease (KD). In a prospective cohort design, we enrolled 82 patients with KD with Lichtman stages I to IIIb. Participants assigned themselves to groups by choosing either arthroscopic lunate core decompression and synovectomy (group A; n= 54) or radial osteotomy (group B; n= 28). For radial osteotomy, a distal radius volar approach was used and a shortening osteotomy (in negative and neutral ulnar variance) or lateral closing wedge osteotomy (in positive ulnar variance) was performed. Arthroscopic lunate core decompression was performed under direct visualization from the 3-4 portal using a shaver (through the 6R portal) and a cutting burr (through the trans-4 portal). The shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, visual analog scale (VAS) score for pain, wrist passive flexion/extension, grip strength, and radiographic assessments (Lichtman classification, radioscaphoid angle, carpal height ratio) were recorded before surgery and at the final follow-up. Sixty-four patients were included in the final analysis (44 in group A and 20 in group B). The mean ages of participants were 33 ± 11 years in group A and 31 ± 8 years in group B. The mean follow-up periods were 44 ± 20 months in group A and 37 ± 23 months in group B. The QuickDASH score, VAS score, and passive wrist movements significantly improved in both groups. Grip strength showed a significant increase in group A only. The postoperative functional analysis between the 2 groups showed no significant difference, except for the wrist passive extension, which was higher in group A. Lichtman staging remained the same in 79.5% and 73.6% of patients in groups A and B, respectively. An arthroscopic lunate core decompression and wrist synovectomy has comparable midterm results to radial shortening osteotomy in the treatment of KD. Therapeutic II.

High-resolution ultrasound demonstrates in vivo effects of wrist movement on the median nerve along the forearm.

High-resolution ultrasound (HRUS) is the imaging method of choice to visualize peripheral nerve size, structure, and biomechanical performance. The purpose of this study was to show and quantify the effects of active and passive wrist alignment on median nerve (MN) cross-sectional area (CSA) along the forearm in a healthy population. Sixteen healthy volunteers underwent HRUS of their dominant forearm (n=16, 10 males, 6 females, 18-55 y of age). Median nerve's CSA was assessed at four defined areas on the forearm in relation to active and passive wrist alignment. Changes in wrist alignment were significantly associated with MN CSA (P < .001), regardless if the wrist was moved actively or passively. MN CSA was lowest during passive extension of the wrist joint and highest during passive flexion of the wrist joint (range: 4.5-23.2 mm2 ). The elasticity of nerve tissue, the loose connective tissue between the fascicles, and the paraneurium allow peripheral nerves to adapt to longitudinal strain. HRUS enables the demonstration of significant median nerve CSA changes along the forearm during active and passive wrist movement in healthy volunteers.

The effect of botulinum toxin-A on neural and non-neural components of wrist hyper-resistance in adults with stroke or cerebral palsy.

BackgroundBotulinum toxin‐A (BoNT) is widely used to manage focal upper limb spasticity and is effective in reducing resistance to passive movement, as measured with the modified Ashworth scale. Discrimination and quantification of the underlying neural and non‐neural components of hyper‐resistance may further improve understanding of the effect of BoNT.ObjectiveTo explore the effects of BoNT on neural (NC), non‐neural elastic (EC), and viscous (VC) components of resistance to passive wrist extension in adults with stroke or cerebral palsy and the association between the effects on wrist hyper‐resistance components and clinical spasticity, pain and motor function scales.DesignPre‐experimental study with pre‐ and post‐intervention measurements at 6 and 12 weeks.SettingAn outpatient clinic of a hospital.ParticipantsAdults with chronic stroke or cerebral palsy indicated for BoNT treatment for hyper‐resistance in the wrist (N = 18).InterventionsBoNT injections in the wrist and/or finger flexor muscles.Main Outcome MeasuresWrist hyper‐resistance components, using the NeuroFlexor, and clinical scales (modified Ashworth scale, Tardieu scale, passive wrist extension, pain, Fugl‐Meyer motor assessment of the upper extremity, and action research arm test).ResultsNC was significantly reduced 6 and 12 weeks post‐intervention (median −11.96 Newton, P < .001 and median −9.34 Newton, P = .001, respectively); non‐neural EC and VC showed no change. NC reduction 6 weeks post‐intervention correlated significantly with BoNT dose (Pearson correlation coefficient r p = −0.56). No significant correlations were found between change scores in wrist hyper‐resistance components and clinical scales.ConclusionsBoNT affected the neural component of resistance to passive wrist extension, while leaving the non‐neural elastic and viscous components unaffected. This instrumented approach to quantify the effects of BoNT in the wrist and finger flexor muscles on the components of wrist hyper‐resistance may have an added value for BoNT treatment evaluation in clinical practice.

Determining the Effectiveness of a New Device for Hand Therapy (The FEPSim Device): Feasibility Protocol for a Randomized Controlled Trial Study.

BackgroundImpairments of the forearm, wrist, and hand affect a sizable proportion of individuals and impose a significant economic burden on health care systems. FEPSim is a medical device for hand and wrist rehabilitation. The FEPSim device could be part of the standard of care for upper extremity rehabilitation during therapeutic activities to increase range of motion, dexterity, and strength. FEPSim has not yet been tested in a health care setting; therefore, a trial of the effectiveness of FEPSim in upper extremity rehabilitation is warranted.ObjectiveThis study aims to assess the feasibility of conducting a definitive trial in terms of recruitment, eligibility criteria, the type and number of diagnoses included, the length and dosage of the intervention, and data collection methods. This study also aims to gather clinical and statistical information as well as information related to the cost and usability, which allows for an economic evaluation of the device.MethodsThe trial will use a randomized controlled design comprising 47 intervention participants and 47 control group participants. Participants will be adults (age≥18 years) attending outpatient rehabilitation with limitations in their forearm, wrist, or hand function due to distal radial or ulnar fractures, stroke, or osteoarthritis. This study’s primary outcome variables are related to patients’ range of motion and strength, specifically active and passive wrist flexion and extension range of motion; active and passive forearm pronation and supination range of motion; grip strength; and pinch strength. The secondary outcome variables are related to patients’ perceived wrist pain and disability in activities of daily living. The patients’ perceived wrist pain and disability in activities of daily living will be measured using the patient-rated wrist evaluation questionnaire. The control group will receive the standard of care at each of the 2 hospital facilities (Glenrose Rehabilitation and Royal Alexandra Hospitals). The intervention group will receive the same standard of care as the control group at each facility and will use the FEPSim device for therapeutic activities to increase strength, range of motion, resistance, and dexterity. All the participants will be assessed at baseline (week 0); weeks 2, 4, and 8; and postintervention (week 10).ResultsThe FEPSim study was launched in April 2020. This study is currently on hold because of the global COVID-19 pandemic. The recruitment process is expected to resume by September 2020, and the primary impact analysis is expected to be conducted by December 2020.ConclusionsThis study will provide valuable information on the measurement of comparative intervention effects, technology acceptance by hand therapists, and how associated treatment and product costs will contribute to the evidence planning process, which will be crucial for the future adoption of FEPSim.Trial RegistrationInternational Standard Randomized Controlled Trial Number Registry ISRCTN13656014; https://www.isrctn.com/ISRCTN13656014International Registered Report Identifier (IRRID)PRR1-10.2196/22145

Comparison of functional outcome of extra-articular distal radius fractures treated by volar locking plate versus percutaneous pinning in adults-a retrospective study

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Distal radius fractures are one of the most common fractures in an adult population and accounts for 17.5% of all the fractures. The management of distal radius fractures remains debatable despite the availability of different methods of treatment. The aim of this study is to assess the functional outcomes of extra-articular distal radius fractures treated with percutaneous pinning or internal fixation with volar locking plate in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study of 40 patients diagnosed with distal radius fracture with AO classification were treated either with percutaneous pinning (n=20) or open reduction and internal fixation with volar locking plate (n=20) were included in study. DASH score and radiographs at 6&lt;sup&gt;th&lt;/sup&gt; month was assessed for functional outcome and radiological union.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age in plate group was 40 and 45 years in K wire group. The mean passive wrist ROM at the final follow-up evaluation in plate group was 63.8&lt;sup&gt;o&lt;/sup&gt; extension and 70.5&lt;sup&gt;o &lt;/sup&gt;flexion, 81.7&lt;sup&gt;o&lt;/sup&gt; supination and 79&lt;sup&gt;o&lt;/sup&gt; pronation, compared with 56.75&lt;sup&gt;o&lt;/sup&gt; extension and 65.25&lt;sup&gt;o&lt;/sup&gt; flexion, 74.7&lt;sup&gt;o&lt;/sup&gt; supination and 85.5&lt;sup&gt;o&lt;/sup&gt; pronation in patients treated with K wire group. Patients with plate group and K wire group had DASH score of 19.85 and 18.49 respectively (p=0.07) at 6 months follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The use of ORIF with plate resulted in stable fixation of the unstable extraarticular fractures, allowing early post-surgical wrist motion and has good radiological outcome whereas K wire also has advantages of being minimal invasive, reduced hospital stay and minimal cost.&lt;/p&gt;

A Double-blind Randomized Controlled Trial for the Effects of Dry Needling on Upper Limb Dysfunction in Patients with Stroke

Spasticity is one of the main complications of a stroke. This double-blind, randomized controlled trial aimed to compare the result of three sessions of dry needling (DN) versus sham DN on the affected upper limbs in post-stroke survivors. We recruited 24 patients (age 57.0 ± 9.6 years; male 71%). Patients were randomly allocated to two groups: a DN group and a sham DN group. The primary outcome measures were the Modified Modified Ashworth Scale (MMAS) and the Box and Block Test (BBT). Secondary outcome measures included active and passive wrist range of motion (AROM and PROM). All assessments were measured at baseline, immediately after the last session of the intervention, and one month later. Patients in the DN group had improved upper limb spasticity and passive wrist range of motion compared to control group (P &lt; 0.05). There were no between-group differences in other outcome measures (P &gt; 0.05). Dry needling is a useful method for improving muscle spasticity in the upper limbs of patients with stroke.