Rehabilitation Strategies for Wrist Pain in a Patient With Thalassemia Major and Distal Ulnar Hypoplasia: A Case Report.

This case study examines the rehabilitation process of a 24-year-old female patient with thalassemia major (TM), a hereditary hemoglobinopathy, who also suffered from distal ulnar hypoplasia, a congenital anomaly that causes pain and affects the wrist joint's strength and range of motion. The patient underwent a comprehensive physical rehabilitation program that aimed to address the challenges posed by ulnar hypoplasia. This program included a combination of customized exercises, splinting, and orthotic interventions to improve hand and wrist function. By adopting a multidisciplinary approach, the patient experienced significant improvements in mobility, strength, and overall quality of life. This case highlights the significance of personalized rehabilitation strategies in managing complex medical conditions, demonstrating the potential for positive outcomes even in patients with dual diagnoses of TM and ulnar hypoplasia.

Can a structured home-based rehabilitation program reduce dorsal central wrist pain?

OBJECTIVES: Dorsal central wrist pain, often a consequence of peri-scapholunate ligament injury, can result in a decline in functional performance. There is a scarcity of clinical data evaluating the effectiveness of conservative management on peri-scapholunate ligament injury. Conservative management includes education, immobilization with orthotic devices, scapholunate-stabilizing muscle strengthening, and proprioception training. The identification of the ligamento-muscular reflex and scapholunate-stabilizing muscles formed the rationale for a rehabilitation training program. We have devised an innovative standardized 16-week treatment program for patients with dorsal central wrist pain associated with acute peri-SL ligament injury. We hypothesized that the program can effectively reduce dorsal wrist pain and improve functional performance. MATERIALS AND METHODS: Recruited subjects underwent the 16-week home-based program, which included immobilization and rehabilitation exercises, to improve their wrist stability. Follow-up was arranged every 4 weeks for progress monitoring. The Short-Form 12 item questionnaire version 2, power grip, pinch grip, wrist range of motion, total performance score and total pain score when performing activities of daily living were used to evaluate the effectiveness of the program. An exercise adherence questionnaire was used to evaluate adherence to the home rehabilitation program. RESULTS: Twenty-three subjects (26 wrists) completed the program. Pain on visual analog scale improved by 5.1 cm and total pain score improved from 14.4/20 to 19.5/20. Total performance score reached 39/40, which indicated near-normal wrist function. Power grip and pinch grip increased by 22.3% and 17.8%, respectively. The physical component scale of the Short-Form 12 item questionnaire showed significant improvement, while the mental component scale did not. Overall adherence was fair. DISCUSSION: Conservative management, including immobilization and rehabilitation training, can provide significant clinical improvement in patients with dorsal central wrist pain associated with acute peri-scapholunate ligament injury. CONCLUSION: Standardized wrist rehabilitation can be taken as a reference treatment modality. It is an evidence-based non-invasive treatment option for clinicians and therapists.

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.

Wrist weight-bearing tolerance in healthy adults.

STUDY DESIGN: Cross-sectional. INTRODUCTION: No information is available in the literature regarding the amount of weight-bearing tolerance in a normal human wrist. PURPOSE OF THE STUDY: To establish the normal limits of human wrist weight-bearing tolerance and to determine if gender, age and height are predictors of this weight-bearing tolerance. METHODS: A sample (N = 465) of healthy adults ages 18-64 completed a questionnaire indicating their gender, age range and height. Subjects were instructed in performing a wrist weight-bearing tolerance test using a calibrated analog scale. The amount of pressure that the subject was able to apply to the scale in 3 independent trials was recorded and analyzed. RESULTS: A strong positive correlation was found between average weight- bearing values achieved through the right and left hands for the subjects of this study, r(463)= .97, P < .001. A 2-way analysis of covariance revealed main effects for both gender (20.9, 95% CI [15.7, 26.0] pounds, P < .001) and age (F(4, 454) = 6.143, P < .001, partial η2 = .051). The highest weight-bearing tolerance was observed in males and individuals 25-34 years of age. Multiple regression analysis affirmed that gender, height and age categories of 45-54 and 55 to 64 were all statistically significant predictors of wrist weight-bearing tolerance, P < .01. DISCUSSION: These results establish normal wrist weight-bearing tolerance values and demonstrate that gender, age and height are predictors of this weight-bearing tolerance. CONCLUSION: These results could allow identification of pathologies associated with wrist instability.

Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial.

INTRODUCTION: During daily functions, our wrist moves through an oblique plane, named the dart-throwing motion (DTM) plane. This plane is considered a more stable plane because the proximal carpal row remains relatively immobile. However, rehabilitation programs that incorporate exercising in the DTM plane have yet to be explored. PURPOSE OF THE STUDY: The purpose of this study was to evaluate the rehabilitation outcomes after treatment in the DTM plane compared with outcomes after treatment in the sagittal plane after distal radius fracture. STUDY DESIGN: This is a pilot randomized controlled trial. METHODS: Subjects after open reduction internal fixation were assigned into a research group (N = 12; ages 48.7 ± 7.3) and a control group (N = 12; ages 50.8 ± 15). The control group activated the wrist in the sagittal plane, whereas the research group activated the wrist in the DTM plane. Range of motion, pain levels, functional hand motor skills tests, and satisfaction from self-training exercise were measured before and after a 12-session intervention. RESULTS: The outcome measures were similar between the treatment groups. The research group reported significantly higher satisfaction rates than the control group on topics such as general satisfaction (research group: 3.4 ± 0.7, control group: 2. 5 ± 1.2, P = .030), motivation to exert oneself (research group: 2.8 ± 1.0, control group: 2.3 ± 1.2, P = .009), progressed function (research group: 3.4 ± 0.7, control group: 2.4 ± 1.1, P = .012), and self-training contribution to the daily function (research group: 3.4 ± 0.7, control group: 2.5 ± 1.2, P = .030). DISCUSSION AND CONCLUSION: Pilot results do not favor one treatment method over the other. However, exercising in the DTM plane may contribute to the satisfaction of the client and increase self-training motivation.

Novel FMRI-Compatible wrist robotic device for brain activation assessment during rehabilitation exercise.

Magnetic Resonance Imaging (MRI) can be applied to study the effects of rehabilitation strategies for neuroscience research. An MRI-wrist robot is designed and used as a clinical tool to examine the process of the brain plasticity changes. In this robot, the patient actuation is accomplished with two standard air cylinders, located inside the MRI chamber with two degrees of freedom (flexion-extension and ulna-radial deviation) with pneumatic air transmission, consisting of simple mechanism converting rotary motion to linear independently. A pilot study of brain image aiming at revealing more effective therapeutic strategies carried out to confirm the technical aspects of the development and validation. In a healthy subject, both wrist movement of robot and subject demonstrated brain activity in the contralateral primary somatosensory cortex. Because the robot does not move during the patient's body, a stand was designed to allow the wrist robot and patient to fit comfortably within the MRI machine. While all the parts of the robot were carefully selected with strict MRI compatibility requirements, the robot was tested by presenting some pilot imaging data with null effects on the image quality, as well. Finally, the possible further development of the robot has been introduced for a rehabilitation assessment.

Does Object Height Affect the Dart Throwing Motion Angle during Seated Activities of Daily Living?

Complex wrist motions are needed to complete various daily activities. Analyzing the multidimensional motion of the wrist is crucial for understanding our functional movement. Several studies have shown that numerous activities of daily livings (ADLs) are performed using an oblique plane of wrist motion from radial-extension to ulnar-flexion, named the Dart Throwing Motion (DTM) plane. To the best of our knowledge, the DTM plane angle performed during ADLs has not been compared between different heights (e.g. table, shoulder and head height), as is common when performing day-to-day tasks. In this study, we compared DTM plane angles when performing different ADLs at three different heights and examined the relationship between DTM plane angles and limb position. We found that height had a significant effect on the DTM plane angles - the mean DTM plane angle was greater at the lower level compared to the mid and higher levels. A significant effect of shoulder orientation on mean DTM plane angles was shown in the sagittal and coronal planes. Our findings support the importance of training daily tasks at different heights during rehabilitation following wrist injuries, in order to explore a large range of DTM angles, to accommodate needs of common ADLs.

The Optimal Speed for Cortical Activation of Passive Wrist Movements Performed by a Rehabilitation Robot: A Functional NIRS Study.

Objectives: To advance development of rehabilitation robots, the conditions to induce appropriate brain activation during rehabilitation performed by robots should be optimized, based on the concept of brain plasticity. In this study, we examined differences in cortical activation according to the speed of passive wrist movements performed by a rehabilitation robot. Methods: Twenty three normal subjects participated in this study. Passive movements of the right wrist were performed by the wrist rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5 Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity accompanying the passive movements performed by a robot. The relative changes in oxy-hemoglobin (HbO) were measured in two regions of interest (ROI): the primary sensory-motor cortex (SM1) and premotor area (PMA). Results: In the left SM1 the HbO value was significantly higher at 0.5 Hz, compared with movements performed at 0.25 Hz and 0.75 Hz (p < 0.05), while no significant differences were observed in the left PMA (p > 0.05). In the group analysis, the left SM1 was activated during passive movements at three speeds (uncorrected p < 0.05) and the greatest activation in the SM1 was observed at 0.5 Hz. Conclusions: In conclusion, the contralateral SM1 showed the greatest activation by a moderate speed (0.5 Hz) rather than slow (0.25 Hz) and fast (0.75 Hz) speed. Our results suggest an ideal speed for execution of the wrist rehabilitation robot. Therefore, our results might provide useful data for more effective and empirically-based robot rehabilitation therapy.

The New Smartphone Application for Wrist Rehabilitation.

BACKGROUND: The rehabilitation after wrist surgery is extremely important. An instructed therapy in hospital is widely practiced. However, a dependent aging society and rush life style in younger generation have precluded patients to access to the frequent formal therapy. With the advancement in telecommunication technology, we have invented an application for smartphone for home-based wrist motion rehabilitation. METHODS: Twenty participants were included in four-week wrist motion rehabilitation programme after wrist surgery. Participants were instructed to use the application by physical therapist and informed details of home-based wrist rehabilitation. The feasibility of application was evaluated by satisfaction level in various aspects and the adherence to the therapy was monitored by function provided in the application. The degrees of motion were compared at the end of prescribed programme. RESULTS: Patient satisfaction was consistently high in every aspects. Also, the adherence to the therapy was high (90.42%). Ranges of motion significantly gained in every plane of wrist motion ([Formula: see text]). CONCLUSIONS: This novel smartphone application seems to be a promising and convenient alternative for patients who need to gain wrist motion without formal rehabilitation in the hospital. Adherence to the therapy is also easily traced with this application.

Development of wrist rehabilitation robot and interface system.

The authors have developed a practical wrist rehabilitation robot for hemiplegic patients. It consists of a mechanical rotation unit, sensor, grip, and computer system. A myoelectric sensor is used to monitor the extensor carpi radialis longus/brevis muscle and flexor carpi radialis muscle activity during training. The training robot can provoke training through myoelectric sensors, a biological signal detector and processor in advance, so that patients can undergo effective training of extention and flexion in an excited condition. In addition, both-wrist system has been developed for mirror effect training, which is the most effective function of the system, so that autonomous training using both wrists is possible. Furthermore, a user-friendly screen interface with easily recognizable touch panels has been developed to give effective training for patients. The developed robot is small size and easy to carry. The developed aspiring interface system is effective to motivate the training of patients. The effectiveness of the robot system has been verified in hospital trails.