Exploration of outcome measures for assessing orthotic intervention in upper extremity peripheral nerve injuries: 2 case reports.

In upper extremity peripheral nerve injuries, orthotic intervention has been used as a valuable device to restore function. However, there is lacking evidence to support it. The purpose of this study was to explore the application of body function's outcome measures for orthotic intervention evaluation in patients with peripheral nerve injury. Two participants sustaining a peripheral nerve injury who underwent orthotic intervention were assessed: subject 1 was a 25-year-old man with ulnar and median nerve injury presenting with a composite claw; subject 2, a 28-year-old man with radial nerve injury presenting with a dropped wrist. Strength, range of motion, and electromyography were measured in 2 conditions: wearing the orthosis and without it. The Jamar, Pinch Gauge, a 3D motion capture system (Optitrack-NaturalPoint), and surface electromyography (Trigno Wireless System, Delsys) were the chosen instruments. Both subjects presented differences in grip and pinch strength. In both tasks, subject 1 reached higher wrist extension while wearing the orthosis. Subject 2 reached higher wrist extension and radial deviation while wearing the orthosis. There were marked differences in both tasks for subject 2, especially the maintenance of wrist extension when wearing the orthosis. Electromyographic assessment showed higher root-mean-square values for all muscles, in both tasks for subject 1. For subject 2, a higher root-mean-square value was found for flexor carpi ulnaris during the execution of task 1 wearing the orthosis. Outcome measures of body function can quantify the impact of orthotic intervention in patients sustaining peripheral nerve injury, and therefore, they are feasible for evaluating it.

Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework.

STUDY DESIGN: Case report. INTRODUCTION: Radial nerve injury can cause severe functional impairment due to paralysis of wrist and digit extensors. Various orthotic designs have been described, including static, dynamic, and tenodesis. All provide wrist stabilization or extension assistance. Some, but not all, also provide extension assistance to the wrist, thumb, and fingers. PURPOSE AND METHODS: This article tells the story of Max, a 27-year-old male university student, who sustained a radial nerve injury after a left humeral shaft fracture. He was treated at a Brazilian tertiary hospital, where the choice of thermoplastics and dynamic components resulted in limited options for orthotic fabrication. Max was provided with custom-molded static wrist orthosis and a bulky, older style, high-profile dynamic forearm-based wrist-finger-thumb assistive-extension orthosis. RESULTS AND DISCUSSION: Grip strength and functional status improved, and Max was completely satisfied because with the dynamic orthosis, he could play the guitar again, which was his favorite activity. CONCLUSION: Max's story illustrates that a convenient functionally oriented orthotic intervention can be performed even in resource-limited environments by following the client-centered bio-occupational orthotic framework proposed by McKee and Rivard. This framework addresses the client's biological needs (addressing paralyzed muscles and maintaining length of soft tissues) and occupational/functional needs.

Student perceptions and effectiveness of an innovative learning tool: Anatomy Glove Learning System.

A trend in anatomical education is the development of alternative pedagogical approaches to replace or complement experiences in a cadaver laboratory; however, empirical evidence on their effectiveness is often not reported. This study aimed to evaluate the effectiveness of Anatomy Glove Learning System (AGLS), which enables students to learn the relationship between hand structure and function by drawing the structures onto a worn glove with imprinted bones. Massage therapy students (n = 73) were allocated into two groups and drew muscles onto either: (1) the glove using AGLS instructional videos (3D group); or (2) paper with palmar/dorsal views of hand bones during an instructor-guided activity (2D group). A self-confidence measure and knowledge test were completed before, immediately after, and one-week following the learning conditions. Self-confidence of hand anatomy in the 3D group gradually increased (3.2/10, 4.7/10, and 4.8/10), whereas self-confidence in the 2D group began to decline one-week later (3.2/10, 4.4/10, and 3.9/10). Knowledge of hand anatomy improved in both groups immediately after learning, (P < 0.001). Students' perceptions of AGLS were also assessed using a 10-pt Likert scale evaluation questionnaire (10 = high). Students perceived the AGLS videos (mean = 8.3 ± 2.0) and glove (mean = 8.1 ± 1.8) to be helpful in improving their understanding of hand anatomy and the majority of students preferred AGLS as a learning tool (mean = 8.6 ± 2.2). This study provides evidence demonstrating that AGLS and the traditional 2D learning approach are equally effective in promoting students' self-confidence and knowledge of hand anatomy.

Using model hands for learning orthotic fabrication.

Trainees could benefit from practicing orthotic fabrication on simulated hands with joint deformities. As a first step toward such training, we explored the use of a nonpathological model hand. Twenty-one participants were randomized into one of two groups that practiced using a person's right hand or a model right hand. One week later, all participants returned for a transfer test in which they made one orthosis on a person's left hand. All participants' performance and orthoses were evaluated using a validated checklist and a global rating scale (GRS). Fabrication time for each orthosis also was recorded. The GRS score and fabrication time changed significantly over the course of practice. Trainees who practiced with the model hand made better orthoses during practice and on the transfer test, as measured with the checklist's final product subscore. Instructional and contextual factors that may affect trainees' performance and learning are discussed.

Development and validation of tools for evaluation of orthosis fabrication.

This study is the first phase of research aimed at developing new educational approaches to enhance occupational therapy students' orthosis fabrication skills. Before the effectiveness of training can be determined, a method for evaluating performance must be established. Using the Delphi method, we developed a global rating scale and checklist for evaluating technical competence when fabricating metacarpophalangeal (MCP) joint-stabilizing orthoses. To determine the reliability and validity of these tools, three evaluators used them to assess and score orthotic fabrication performance by experienced and student occupational therapists. The results suggest that these measurement tools are valid and reliable indicators of the technical skills involved in fabricating an MCP joint-stabilizing orthosis. Future studies should focus on building on these tools to evaluate communication skills, technical skills for making other types of orthoses, and effectiveness of training programs.

Orthotic considerations for dense connective tissue and articular cartilage--the need for optimal movement and stress.

Orthotic intervention is an essential component of hand rehabilitation, addressing biological factors that affect activity and participation. Functional, pain-free joint mobility requires skeletal stability, healthy articular cartilage, and appropriate extensibility of periarticular dense connective tissues (DCTs). This article addresses basic science underlying clinical reasoning when considering orthoses to maintain or restore structural integrity, mobility and function of DCT structures, and articular cartilage. However, these tissues often have different and sometimes conflicting requirements for the maintenance and restoration of integrity and health. The duration of immobilization, especially at end range, should be carefully considered, as it impairs nutrition of tissues and adversely compresses articular cartilage, causing injury that may not be reversible. Immobilization also reduces extensibility of DCT. Thus, an intermittent orthotic wearing schedule is suggested, allowing movement wherever possible to promote tissue health. To optimize benefits and minimize harmful effects of orthotic intervention, further research on physiological responses of human tissues to immobilization and tension is needed.

Malt liquor marketing in inner cities: the role of neighborhood racial composition.

In response to anecdotal reports that African American neighborhoods are targeted for high-alcohol malt liquor advertising, the authors observed alcohol ads on off-premise alcohol outlets, billboards, and transit structures in 10 U.S. cities over 3 years. Malt liquor ads were prevalent on storefronts, but rare on billboards. Using Poisson regression, the authors found that storefront malt liquor ads were more common in neighborhoods with higher percentages of African Americans, even after controlling for social and physical disorder. Results suggest that policymakers attempting to reduce malt liquor-related harms may do well to consider regulations that limit storefront advertising exposure.

Biopsychosocial approach to orthotic intervention.

Orthotic intervention should be individualized and patient or client centered. The best outcomes occur when orthotic interventions are designed with patient involvement and holistic consideration of the individual's unique personal attributes, context, and environment. The authors discuss Shelley's story, which illustrates an approach to orthotic intervention that is based on Engel's biopsychosocial model and the International Classification of Functioning, Disability and Health. Fifteen guiding principles for the biopsychosocial orthotic approach are presented. Orthoses that are thoughtfully designed with patient input, carefully constructed and monitored, and modified as needed, can make a difference in a person's life by relieving pain, providing joint stabilization, protecting vulnerable tissues and enabling valued activity and participation. This, in turn, promotes physical and emotional well-being.

Alcohol and malt liquor availability and promotion and homicide in inner cities.

We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.

Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report.

Radial nerve injury is a relatively common occurrence and recovery depends on the level of injury and extent of connective tissue damage. Orthoses (splints) are often provided to compensate for lost motor power. This article chronicles the recovery, over 27 months, of a 76-year-old woman who sustained a high radial nerve injury of her dominant arm during surgery for total shoulder replacement (Delta Reverse). Customized, low-profile dynamic splints, unlike any previously published design, were developed to address her goals for functional independence and the biological needs of the tissues. Dynamic power was provided to the wrist, fingers, and thumb by elastic cords and thin, flexible thermoplastic, without the need of an outrigger, thus avoiding the need for wire bending and cutting. At the outset, the splint was forearm-based and when wrist extension power was recovered, a hand-based splint was designed. Eventually, a circumferential hand-based thumb-stabilizing splint fulfilled most of the remaining orthotic requirements.

Orthoses as enablers of occupation: client-centred splinting for better outcomes.

BACKGROUND: Orthotic intervention (splinting) may have become an end unto itself in the minds of therapists and clients rather than the means to enable optimal occupational performance. Some policy makers and payers seem to hold the belief that orthoses/splints are mere technical aids and as such do not require professional skill and expertise. NARRATIVES: Three client stories demonstrate how iterative collaboration and follow-up help achieve client-identified objectives. DISCUSSION: Client input is an important component of the process and an orthosis must fit into the person's lifestyle, especially if required for long-term use. Six essential considerations when providing orthoses to meet occupational goals are emphasized: client-centredness, comfort, cosmesis, convenience, less is more and follow-up. Use of the Canadian Occupational Performance Model for intervention planning and as an outcome measure is demonstrated. PRACTICE IMPLICATIONS: Orthoses that are thoughtfully designed with client input and carefully constructed can make a difference in a person's life by relieving pain, providing protection and joint stabilization and enabling valued occupations.

The needs and experiences of injured workers: a participatory research study.

This paper reports on the findings of a participatory research study in which 290 injured workers in Ontario, Canada responded to a survey that was developed and administered by a group of university researchers in partnership with injured worker peer researchers. The objectives of the study were to gain a broad view of the needs and experiences of injured workers and to develop strategies for change. Findings indicated that many injured workers experience undue financial, emotional and physical hardship during the compensation, treatment and rehabilitation process. These hardships are experienced due to perceived lack of respect, insufficient information concerning rights and the return-to-work process, and limited opportunities for input into the medical or rehabilitation process. Recommendations for increasing the power of workers and creating a more supportive climate are included.