ArticlesSplinting the hand in the functional position after brain impairment: A randomized, controlled trial☆
Abstract
Lannin NA, Horsley SA, Herbert R, McCluskey A, Cusick A. Splinting the hand in the functional position after brain impairment: a randomized, controlled trial. Arch Phys Med Rehabil 2003;84:297-302. Objective: To evaluate the effects of 4 weeks of hand splinting on the length of finger and wrist flexor muscles, hand function, and pain in people with acquired brain impairment. Design: Randomized, assessor-blinded trial. Setting: Rehabilitation center in Australia. Participants: Twenty-eight adults with acquired brain impairment, all within 6 months of the first injury. There was 1 withdrawal. Interventions: Subjects in both experimental (n=17) and control (n=11) groups participated in routine therapy[mdash ]motor training for upper-limb use and upper-limb stretches[mdash ]5 days a week. The experimental group also wore an immobilizing hand splint in the functional position (10[deg ][ndash ]30[deg ] wrist extension) for a maximum of 12 hours each night for the duration of the 4-week intervention period. Main Outcome Measures: The length of the wrist and extrinsic finger flexor muscles was evaluated by measuring the torque-controlled range of wrist extension with the fingers extended. Functional hand use was evaluated with the Motor Assessment Scale. Pain was evaluated with a visual analog scale. Results: The effects of splinting were statistically nonsignificant and clinically unimportant. At follow-up, estimates of treatment effects slightly favored the control group: range of motion at the wrist favored controls by 2[deg ] (95% confidence interval [CI], [minus ]7.2[deg ] to 3.2[deg ]), function favored controls by 0.2 points (95% CI, [minus ]2.7 to 2.3), and pain favored the experimental group by 1cm (95% CI, [minus ]4.6 to 2.2). Conclusions: An overnight splint-wearing regimen with the affected hand in the functional position does not produce clinically beneficial effects in adults with acquired brain impairment. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
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ExoMechHand prototype development and testing with EMG signals for hand rehabilitation
2024, Medical Engineering and PhysicsRehabilitation is a major requirement to improve the quality of life and mobility of patients with disabilities. The use of rehabilitative devices without continuous supervision of medical experts is increasing manifold, mainly due to prolonged therapy costs and advancements in robotics. Due to ExoMechHand's inexpensive cost, high robustness, and efficacy for participants with median and ulnar neuropathies, we have recommended it as a rehabilitation tool in this study. ExoMechHand is coupled with three different resistive plates for hand impairment. For efficacy, ten unhealthy subjects with median or ulnar nerve neuropathies are considered. After twenty days of continuous exercise, three subjects showed improvement in their hand grip, range of motion of the wrist, or range of motion of metacarpophalangeal joints. The condition of the hand is assessed by features of surface-electromyography signals. A Machine-learning model based on these features of fifteen subjects is used for staging the condition of the hand. Machine-learning algorithms are trained to indicate the type of resistive plate to be used by the subject without the need for examination by the therapist. The extra-trees classifier came out to be the most effective algorithm with 98% accuracy on test data for indicating the type of resistive plate, followed by random-forest and gradient-boosting with accuracies of 95% and 93%, respectively. Results showed that the staging of hand condition could be analyzed by sEMG signal obtained from the flexor-carpi-ulnaris and flexor-carpi-radialis muscles in subjects with median and ulnar neuropathies.
Nonsurgical Treatment Options for Muscle Contractures in Individuals With Neurologic Disorders: A Systematic Review With Meta-Analysis
2021, Archives of Rehabilitation Research and Clinical TranslationTo investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness.
Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020.
The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders.
Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°.
A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=−2 to 7°; I2=66%; P<.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=−8 to 9; I2=73%; P=.03). We found no effect of shockwave therapy (P=.56), physical activity (P=.27), electrical stimulation (P=.11), or botulinum toxin (P=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding.
We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.
Effect of chronic stretching interventions on the mechanical properties of muscles in patients with stroke: A systematic review
2020, Annals of Physical and Rehabilitation MedicineCitation Excerpt :Pooled analysis was not possible because of the heterogeneity of methods used across studies. Five of the studies measured joint angle at a standardized torque [7–9,42,43]. At the shoulder, the study of Turton and Britton [7] did not report changes in ROM at 1 kg of stretching (8 weeks; volume 2.5 hr/week; −1° [95% confidence interval (CI) −15° to 13°] in favour of stretching).
Muscle contractures are common after stroke and their treatment usually involves stretching. However, recent meta-analyses concluded that stretching does not increase passive joint amplitudes in patients with stroke. The effectiveness of treatment is usually evaluated by measuring range of motion alone; however, assessing the effects of stretching on the structural and mechanical properties of muscle by evaluating the torque-angle relationship can help in understanding the effects of stretching. Although several studies have evaluated this, the effects remain unclear.
A systematic review of the literature on the effectiveness of stretching procedures for which the outcomes included a measurement of torque associated with range of motion or muscle structure (e.g., fascicle length) in stroke survivors.
PubMed, ScienceDirect and PEDro databases were searched by 2 independent reviewers for relevant studies on the effects of chronic stretching interventions (> 4 weeks) that evaluated joint angle and passive torque or muscle structure or stiffness. The quality of the studies was assessed with the PEDro scale.
Eight randomized clinical trials (total of 290 participants) met the inclusion criteria, with highly variable sample characteristics (at risk/existing contractures), program objectives (prevent/treat contractures) and duration (from 4 to 52 weeks) and volume of stretching (1 to 586 hr). All studies were classified as high quality (> 6/10 PEDro score). Six studies focused on the upper limb. Many programs were less than 12 weeks (n = 7 studies) and did not change mechanical/structural properties. The longest intervention (52 weeks) increased muscle fascicle length and thickness (plantar flexors).
Long interventions involving high stretching volumes and/or loads may have effects on muscle/joint mechanical properties, for preventing/treating contractures after stroke injury, but need to be further explored before firm conclusions are drawn.
Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial
2019, Journal of PhysiotherapyIn adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture?
Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis.
Fifty adults undergoing rehabilitation after stroke who were unable to actively extend the affected wrist past neutral or were unable to flex the affected shoulder to 90 deg.
Three inpatient rehabilitation units in Australia.
Both groups received usual upper limb therapy 5 days a week for 5 weeks. In addition, the experimental group received up to 1 hour a day of active, intensive, repetitive upper limb training using the SMART Arm device 5 days a week for 5 weeks.
Measures were collected at baseline (Week 0), after intervention (Week 5) and at follow-up (Week 7). The primary outcomes were passive range of wrist extension, elbow extension, and shoulder flexion at Week 5. The secondary outcomes were: the three primary outcomes measured at Week 7; passive range of shoulder external rotation; arm function; and pain at rest, on movement and during sleep measured at Weeks 5 and 7.
Following an average of 2310 reaching repetitions, the mean effect at Week 5 on passive range of wrist extension was 1 deg (95% CI –6 to 8), elbow extension –6 deg (95% CI –12 to –1), and shoulder flexion 5 deg (95% CI –8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes.
In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles.
ACTRN12614001162606.
Orthotic Devices after Stroke
2015, Stroke Rehabilitation: A Function-Based ApproachIt takes two: Noninvasive brain stimulation combined with neurorehabilitation
2015, Archives of Physical Medicine and RehabilitationThe goal of postacute neurorehabilitation is to maximize patient function, ideally by using surviving brain and central nervous system tissue when possible. However, the structures incorporated into neurorehabilitative approaches often differ from this target, which may explain why the efficacy of conventional clinical treatments targeting neurologic impairment varies widely. Noninvasive brain stimulation (eg, transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS]) offers the possibility of directly targeting brain structures to facilitate or inhibit their activity to steer neural plasticity in recovery and measure neuronal output and interactions for evaluating progress. The latest advances as stereotactic navigation and electric field modeling are enabling more precise targeting of patient's residual structures in diagnosis and therapy. Given its promise, this supplement illustrates the wide-ranging significance of TMS and tDCS in neurorehabilitation, including in stroke, pediatrics, traumatic brain injury, focal hand dystonia, neuropathic pain, and spinal cord injury. TMS and tDCS are still not widely used and remain poorly understood in neurorehabilitation. Therefore, the present supplement includes articles that highlight ready clinical application of these technologies, including their comparative diagnostic capabilities relative to neuroimaging, their therapeutic benefit, their optimal delivery, the stratification of likely responders, and the variable benefits associated with their clinical use because of interactions between pathophysiology and the innate reorganization of the patient's brain. Overall, the supplement concludes that whether provided in isolation or in combination, noninvasive brain stimulation and neurorehabilitation are synergistic in the potential to transform clinical practice.
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