ABSTRACT
We investigated the efficacy of the supination-external rotation ('Sup-ER') orthosis, designed as a non-operative treatment to maintain normal anatomical growth of the shoulder, on the progression of glenohumeral dysplasia in patients with brachial plexus birth injuries. The Sup-ER orthosis was fabricated for 20 infants diagnosed with glenohumeral dysplasia after brachial plexus birth injuries and its success in correcting glenohumeral dysplasia was confirmed by objective calculations of the alpha angle on serial ultrasound findings and improvement in Active Movement Scale scores. Of the 20 patients, 14 had successful resolution of glenohumeral dysplasia, confirmed by shoulder abduction, shoulder flexion, external rotation and supination, Active Movement Scale scores and improving alpha angle measurements. Failure to rectify glenohumeral dysplasia, evidenced by worsening ultrasound findings and Active Movement Scale scores, necessitated a change to operative management in six patients.Level of evidence: IV.
ABSTRACT
BACKGROUND: Pulley injuries are common among rock climbers, which is a growing population. Hand therapists need a therapeutic intervention which promotes healing and enables participation. PURPOSE: The purpose of this case series is to detail the functional outcomes of a 12-week protocol using a pulley ring orthosis (PRO) among rock climbers with a grade I, II, or III pulley injury. STUDY DESIGN: A prospective repeated measures case series followed the healing timeline of four participants who rock climbed while wearing the invervention device, the PRO, with weekly measurements to monitor healing METHODS: Participants with a grade I, II, or III A2 pulley injury were custom fitted for a PRO, which they wore while rock climbing a minimum of 3 times per week for 12 weeks. Weekly check-ins were scheduled for subjective and objective measurements. RESULTS: All participants demonstrated indicators of full healing, which, in this study, is defined as progressive improvement in strength, function, and pain, without interruption of their typical rock climbing schedules. CONCLUSIONS: Providers should consider the use of a PRO as a protective orthosis for rock climbing patients with a low-grade A2 pulley injury who want to continue rock climbing while they are healing.
ABSTRACT
The purpose of this study was to develop a scale that identifies hospitalized patients in need of physical therapy (PT) and/or occupational therapy (OT) assessments. Preliminary scale items were tested for reliability among 52 patients and remaining items were then administered to 299 patients and items that were associated with the concept of 'need for an assessment' on multivariate analyses were selected as final scale items. The concept of need was based on the clinical judgment of physical and occupational therapists. Receiver operator characteristic (ROC) curves were constructed to determine a cut-off score and the predictive ability of this score in determining length of stay and utilization of services was evaluated among 200 patients. The final scale contains two components. The PT component addresses ambulation, falls, breathing, and activities of daily living (ADL). The OT component addresses swallowing, ADL and instrumental activities of daily living (IADL). The area under the ROC curves of the PT and OT components were 0.71 and 0.72, respectively. Both components predicted length of stay and utilization (p < 0.05). In summary, this scale provides a mechanism for targeting patients for early PT and OT assessment and provides a basis for testing the effectiveness of early PT and OT interventions.