Targeted sensorimotor retraining in the clinical setting: Improving patient outcomes following distal upper extremity injury.

BACKGROUND: Existing theoretical evidence indicates sensorimotor retraining is beneficial following wrist injury. However, there are no large cohort studies applying the knowledge in a clinical setting. PURPOSE OF THE STUDY: To Determine the clinical benefits of sensorimotor rehabilitation following distal upper extremity injury. STUDY DESIGN: Prospective cohort study. METHODS: A sensorimotor rehabilitation program was evaluated following distal upper extremity injury. A battery of clinical and patient-rated outcome measures (PROM) were taken before and after group completion. RESULTS: Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures. However, improvements in 11 of the clinical measures only had a small effect size (<0.5). Joint position sense had the greatest clinical change with a median improvement of 4° on the left and 3.9° on the right, and these had moderate effect sizes of 0.5 and 0.7, respectively. There were statistically significant improvements in all PROMs. PRWE had a median improvement of 21 (ES = 1.2). UEFI showed median improvements of 19.7 (ES = 1.4) and NRS (pain) median improved 2.5 (ES = 1.2). All PROM improvements had mean change greater than associated MCIDs. DISCUSSION: These results indicate the benefits of sensorimotor group rehabilitation and supports existing literature regarding the importance of sensorimotor control for JPS accuracy and function. Group based sensorimotor programs present an efficient and low-cost opportunity to provide intervention to patients following upper extremity injury. CONCLUSION: A sensorimotor group rehabilitation program may improve patient outcomes following distal upper extremity injury. LEVEL OF EVIDENCE: Level 2b prospective cohort.

Cumulative incidence of carpal instability 12-24 months after fall onto outstretched hand.

STUDY DESIGN: Descriptive Epidemiological Study. INTRODUCTION: Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. PURPOSE OF THE STUDY: Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. METHODS: We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson's) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. RESULTS: Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. DISCUSSION AND CONCLUSION: This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. LEVEL OF EVIDENCE: II.

Effects of repeated exposure on liking for a reduced-energy-dense food.

BACKGROUND: Reduced-energy-dense diet foods are often formulated to match the sensory characteristics of their regular-energy-dense counterparts. However, the extent to which attitudes toward a reduced-energy-dense food remain constant, even after repeated ingestion, remains to be explored systematically. OBJECTIVE: The objective was to determine whether liking, "expected satiety," and "expected satiation" change after repeated exposure to a familiar food that has been reduced in energy density. Expected satiety and expected satiation refer to the extent to which foods are expected to stave off hunger and to deliver "fullness," respectively, when compared on a calorie-for-calorie basis. DESIGN: Participants (n = 36) consumed either reduced-energy-dense (374 kcal) or standard-energy-dense (567 kcal) spaghetti Bolognese for lunch over 5 test sessions. During each test session, liking for the spaghetti Bolognese was assessed, together with measures of expected satiety and expected satiation. RESULTS: Participants in the reduced-energy-dense condition reported a decrease in liking for the spaghetti Bolognese over the test sessions ( approximately 30%), whereas liking in the standard condition remained constant [condition (reduced/standard) x session (1-5) interaction, P < 0.008]. By contrast, both expected satiation and expected satiety remained similar across conditions and test sessions. CONCLUSIONS: Over time, the pleasantness of a reformulated low-energy-dense food can decrease, and this may undermine its efficacy as a weight-loss product. It remains to be determined whether a longer period of "flavor-nutrient learning" is needed for shifts in expected satiety and expected satiation to be observed.

Attentional bias training and cue reactivity in cigarette smokers.

AIMS: Attentional bias for drug-related cues has been associated with drug maintenance and relapse. We investigated whether attentional bias for smoking-related stimuli could be altered using a modified visual probe task in cigarette smokers. We also sought to determine whether changes in attentional bias were associated with changes in subsequent craving and cue reactivity. PARTICIPANTS: Male and female (n=54) current smokers (>or=5 cigarettes per day), aged between 18 and 40 years, were recruited from staff and students of the University of Bristol, and from the general population. DESIGN: Participants attended a single test session and completed an attentional training procedure in which they were either trained to attend to smoking-related pictorial stimuli (attend group) or to neutral pictorial stimuli (avoid group). Group allocation was randomized. MEASUREMENTS: Following attentional training, participants underwent a smoking cue exposure procedure in which they were exposed to smoking-related stimuli. Subjective measures of mood and craving were taken at baseline and before and after cue exposure. Participants then smoked a cigarette and smoking topography was measured. FINDINGS: Attentional training increased attentional bias among participants in the attend group, and decreased attentional bias among those in the avoid group. There were also differences between the attend and avoid groups in post-training changes in craving during exposure to in vivo smoking cues, reflecting greater increases in craving in the attend group, although these effects were observed in males only. CONCLUSIONS: These data are the first to show alterations in attentional bias for smoking-related stimuli following a modified visual probe training procedure. Furthermore, post-training group differences in subjective craving suggest potential clinical utility of training procedures, although these effects may operate only in males. Future research should investigate whether multiple training sessions enhance post-training reductions in craving and cue reactivity, and the longer-term persistence of training effects.