Rehabilitation Of Hand Injuries Research Articles

Early Daily Activity: Development and description of an occupation-based intervention for surgically repaired distal radius Fractures.

To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture. The Early Daily Activity (EDA) intervention uses the performance of strategically selected daily activities as the primary rehabilitative strategy. Occupation-based interventions are recommended for hand injury rehabilitation but are often poorly described and lack explicit theoretical underpinnings. The EDA-intervention was developed from exploratory research that informed the theory and structure. The theoretical principles are that daily activity performance is (i) safe within defined parameters (ii) appropriately self-determined (iii) produces high ranges and amounts of therapeutic movement, and (iv) builds psychosocial competencies. The EDA-intervention is designed to be commenced within 2 weeks of surgery. There are three key components. The first is activity-specific education to emphasise the safety, benefits, and therapeutic actions of activity performance. A set of parameters for defining safe activities is described to support education. The second component is patient-therapist collaboration to select a range of daily activities that provide a 'just-right' challenge. Collaboration occurs at regular intervals throughout the rehabilitation period to incrementally increase the challenge of activities. The third component is performance of activities at-home targeted at improving range of movement and function. The EDA-intervention can be used by hand therapists, but it has not yet undergone effectiveness evaluation. A planned study will explore clinician readiness to adopt the EDA-intervention, inform iterative changes to the protocol and the design of feasibility and effectiveness studies.

Early practice of use of video consultations in rehabilitation of hand injuries in children and adults: Content, acceptability, and cost-effectiveness

BackgroundVideo consultation was implemented as a new service in a hospital hand therapy setting. PurposeTo describe the first year’s practice of video consultations in the rehabilitation of upper extremity injuries, evaluate the acceptability, and investigate economic effects. Study DesignIterative design including economic evaluation. MethodsUsing the framework early health technology assessment, 13 hand therapists described characteristics of 99 video consultations, under predefined headlines: the patients’ municipally, adult vs child, time use, technical, content, and usefulness compared to physical consultations. The text was coded and categorized according to 22 techniques or tools used by hand therapists, and challenges were identified. Acceptability was assessed on a three-graded adjectival scale. To illustrate the costs associated with video vs physical consultations, we drafted different scenarios based on the data and stakeholder insights. ResultsOf 99 planned video consultations (16 with children), 88 were completed. Techniques or tools most frequently used were the performance of exercises (n = 55), orthoses (n = 26), and daily activities (n = 23). Technical challenges were common, and observation of children could be difficult. Eleven of the completed consultations were rated as not acceptable and 77 as acceptable and as either useful (n = 28) or very useful (n = 49). Four drafted scenarios showed cost savings of video consultations for the health institution and society, highest at longer travel distances and in other cases where the patient could claim refunds related to travel and time away from work and home. ConclusionsThe results show therapeutic possibilities and points to areas for improvements and illustrate settings where the use of video may save costs for the health institution and society.

A Low-Cost Soft Robotic Hand Exoskeleton for Use in Therapy of Limited Hand–Motor Function

We present the design and validation of a low-cost, customizable and 3D-printed anthropomorphic soft robotic hand exoskeleton for rehabilitation of hand injuries using remotely administered physical therapy regimens. The design builds upon previous work done on cable actuated exoskeleton designs by implementing the same kinematic functionality, but with the focus shifted to ease of assembly and cost effectiveness as to allow patients and physicians to manufacture and assemble the hardware necessary to implement treatment. The exoskeleton was constructed solely from 3D-printed and widely available off-the-shelf components. Control of the actuators was realized using an Arduino microcontroller, with a custom-designed shield to facilitate ease of wiring. Tests were conducted to verify that the range of motion of the digits and the forces exerted at the fingertip coincided with those of a healthy human hand.

Rehabilitation of the hand

This article outlines the general principles that are considered to provide successful rehabilitation of hand injuries and following hand surgery. It includes a broad summary of assessment and treatment techniques and the clinical reasoning behind therapeutic interventions. It contains information regarding exercise, mobilization, splinting and rehabilitation regimes.

The application of data gloves in the evaluation of patients with hand injuries

Objective To develop a data glove evaluation system to assist rehabilitation physicians and therapists in assessing the degree of rehabilitation of hand-wounded patients. Methods A data glove containing 13 6-axis inertial sensors was designed and produced. It was tested on 10 healthy subjects and 3 hand trauma patients admitted to the Department of Rehabilitation Medicine at Run Run Shaw Hospital. The glove transmitted acceleration and angular velocity components in the X, Y and Z directions to a computer terminal, allowing the bending angles of the subject′s finger joints to be calculated. Traditional protractor measurements were used to verify to what extent the data glove accurately reflected the hand and joint activity. Results Compared with the traditional protractor measurement method, the data glove quickly gave accurate maximum bending angles both in healthy and hand-wounded subjects . Such data can facilitate the rehabilitation of hand injuries. Conclusions The data glove produced in this study can effectively assist rehabilitation doctors and therapists in assessing the recovery of hand-injured patients. Key words: Data gloves; Inertial sensors; Hand injury

Integration of Injured Hands

The inhibition of the gesture of thinking has been the most revealing sign for the diagnosis of a disintegration of an injured hand. Explanation: The involuntary inhibition to recognize and use an injured hand causes and implicates the alienation of the rested hand. Information by hand surgeons and hand therapists. Creative hand therapy guides the attention to complex and pleasing activities. In complex disintegrations after hand injuries the hand as well as the person need help. Designation: Hypotheses: Posttraumatic Proportionate Regional Disintegration while the tissues heal. Posttraumatic Complex Regional Disintegration, if the disintegration overruns the healing of tissues or if the person suffers. The Complex Regional Pain Syndrome is distinguished as a rare exception of a biopsychosocial disintegration. Posttraumatic regional disintegration seems to be proportionate while the tissues are healing. If the mentioned sensations of the patients and the visible signs of disintegration persist, the disorder spreads onto the biopsychosocial unit of the person. This disorder of hand and person may be designated as a complex disorder. The impact of a proportionate posttraumatic disintegration as well as the formation and exacerbation of a complex posttraumatic disintegration may be prevented by the facilitation of the integration of an injured hand. Scientific prove is needed for: the guiding impact of the healthy hand for physiotherapy; the impact of the gesture of thinking to diagnosis and treatment of disintegrations; the effectivity and the economic efficiency of a biowpsychosocial integrating rehabilitation and creative hand therapy.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial

Study designRandomized Controlled Trial (RCT). IntroductionEngagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PurposeThe purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. MethodA single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. ResultsFollowing a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. ConclusionThis study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients. Level of evidence1b.

Occupation-based intervention in hand injury rehabilitation: Experiences of occupational therapists in Malaysia

Introduction: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists’ experiences of providing OBI in hand injury rehabilitation in Malaysia. Methods: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. Results: Definition of “Occupation as a means”, and “Occupation as an end” was broadened after data analysis of interviews to include two new themes: “Rewarding yet challenging” and “Making OBI a reality”. Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. Conclusion: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients’ maximum level of functioning both can be used for successful rehabilitation of hand injuries.

(iv) Acute flexor tendon injury and rehabilitation of hand injuries

Abstract This article details the anatomy of the flexor tendons of the hand and the treatment when they are severed. The common techniques and pitfalls of flexor tendon repair are discussed along with a broad overview of the rehabilitation following the injury.

Occupational Therapy Rehabilitation of Post Operative Hand Injury Cases using Modified Low Cost Splints and Home Based Exercises: A Rural Indian Experience

Objective : Kleinert (active extension, passive flexion) is basic early motion program for rehabilitation of hand injuries. There have been significant innovations in therapy programme at different zones of tendon injuries in past. The aim of this study was to analyze the functional improvement after a postoperative regimen with use of modified splints and home base activities in combination with Occupational Therapy. Design : Twenty eight patients with different tendon injuries were retrospectively enrolled in this study from one and a half year of routinely collected data. Gross grip, fine grip and range of motion were measured using JAMAR, pinch O meter and finger goniometer respectively. Result : Statistically and clinically significant improvement was observed in muscle strength (gross and fine) and range of motion in these patients' hands after modified kleinert splint, custom made splint and home base exercise in all patients (p <0.001 ). Conclusion : The outcome of the current study i.e. making the patients functionally independent with the use of low cost modified splints and home based exercises, are at par with the other studies that have used standard splints. However postoperative occupational therapy programme is not much documented in literature, although realised and practiced at some places in the western world. This attempt is to produce some evidence of the utility of combination of simple techniques and devices to get optimum results in hand injury cases.

Design and development of a hand exoskeleton for rehabilitation of hand injuries

Hand injuries are common problems. In order to adapt to fingers of different sizes and avoid secondary injuries, a hand exoskeleton for rehabilitation is proposed. The exoskeleton is designed as a wearable device and each finger has three joints named the metacarpophalangeal (MCP) joint, the proximal interphalangeal (PIP) joint and the distal interphalangeal (DIP) joint which all employ a novel mechanism called “circuitous joint”. Adopting a symmetrical pinion and rack with a parallel sliding mechanism, the circuitous joint can cover a wide workspace of the finger and adapt to fingers of different thicknesses. And the parallel sliding mechanism ensures that the contact force between the exoskeleton and the finger is perpendicular to the finger's bone, which can minimize the secondary injuries. Moreover, the Bowden cable driving method reduces the burden on the fingers by placing the driving and control system on the forearm. Lastly, hand fitness test and contact force experiment are conducted and the results verify the rationality and effectiveness of the exoskeleton.

A conductive polymer sensor for measuring external finger forces

This paper describes the construction and use of a durable and thin force sensor that can be attached to the palmar surface of the fingers and hands for studying the biomechanics of grasp and for use in hand injury rehabilitation. These force sensors were constructed using a modified commercially available conductive polymer pressure sensing element and installing an epoxy dome for directing applied forces through a 12 mm diameter active sensing area. The installation of an epoxy dome was effective for making the sensors insensitive to contact surfaces varying from 25 to 1100 mm 2 and a 16 mm radius surface curved convex towards the finger. The completed sensors were only 1.8 mm thick and capable of being taped to the distal phalangeal finger pads. They were calibrated on the hand by pinching a strain gage dynamometer. The useful range was between 0 and 30 N with an accuracy of 1 N for both static loading and normal dynamic grasp activities. The sensor time constant was 0.54 ms for a step force input. Because of varying offset voltages every time the sensors were attached, these sensors should be calibrated on the hand before each use. The sensors were used for measuring finger forces during controlled pinching and lifting tasks, and during ordinary grasping activities, such as picking up a book or a box, where the useful force range and response for these sensors were adequate.

Rehabilitation of Hand Injuries in Athletes

This article outlines and stresses the importance of proper rehabilitation of hand injuries in athletes. Rationale for guidelines in splinting, modalities, and appropriate progression of various types of exercise is discussed.