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1.
Am J Occup Ther ; 75(1): 7501205110p1-7501205110p10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399059

RESUMO

IMPORTANCE: Children with arthrogryposis multiplex congenita are often delayed in their development of reaching and object exploration, which can place them at risk for associated delays in motor and cognitive development. OBJECTIVE: To evaluate the longitudinal assistive and rehabilitative effects of the Playskin Lift™ (hereinafter Playskin), a novel exoskeletal garment, on reaching and object exploration abilities in children with arthrogryposis. DESIGN: Single-case ABA design with a 1-mo baseline, 4-mo intervention, and 1-mo postintervention. SETTING: Home environment. PARTICIPANTS: Seventeen children with arthrogryposis (ages 6-35 mo at first visit; 5 boys). INTERVENTION: Participants used the Playskin daily for 30 to 45 min while participating in structured intervention activities to encourage reaching for objects across play spaces larger than they were typically able to. OUTCOMES AND MEASURES: Participants were tested biweekly throughout the study with and without the Playskin using a systematic reaching assessment. Coding of reaching and object exploration behavior was performed using OpenSHAPA software; statistical analyses were conducted using Hierarchical Linear and Nonlinear Modeling software. Feasibility of the Playskin for daily home intervention was evaluated with a parent perception questionnaire. RESULTS: Positive assistive effects (improved performance when wearing the Playskin within sessions) and rehabilitative effects (improved independent performance after the Playskin intervention) were observed with increased active range of motion, expanded reaching space, improved grasping with the ventral side of the open hand, and greater complexity and multimodality and intensity of object exploration. CONCLUSIONS AND RELEVANCE: The Playskin may be a feasible, effective assistive and rehabilitative device to advance object interaction and learning in young children with arthrogryposis. WHAT THIS ARTICLE ADDS: The novel exoskeletal Playskin garment improves reaching and object exploration in young children with arthrogryposis.


Assuntos
Artrogripose , Adolescente , Adulto , Criança , Pré-Escolar , Vestuário , Comportamento Exploratório , Mãos , Força da Mão , Humanos , Masculino , Adulto Jovem
3.
Am J Occup Ther ; 75(1): 7501205020p1-7501205020p11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33399050

RESUMO

IMPORTANCE: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN: Randomized, crossover-controlled, assessor-blinded study. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS: RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.


Assuntos
Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Mãos , Humanos , Recuperação de Função Fisiológica , Extremidade Superior
4.
J Appl Microbiol ; 130(1): 25-39, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32794646

RESUMO

Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.


Assuntos
Higiene das Mãos/instrumentação , Higiene das Mãos/métodos , Eletricidade , Mãos/microbiologia , Humanos , Papel
5.
J Hosp Infect ; 107: 5-11, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32949629

RESUMO

BACKGROUND: Disinfection of gloves can be used during a pandemic situation when performing various procedures on the same patient or when removing personal protective equipment. If performing glove disinfection, there is a need to check the compatibility of gloves with the disinfectant product used. AIM: To test the resistance of nitrile gloves to various disinfectant solutions. METHODS: One hundred percent powder-free nitrile gloves, composed of nitrile butadiene rubber compounds, were exposed to various disinfectants to analyse resistance. The seven most commonly used disinfectant solutions in the healthcare field were selected for testing. The effects of each disinfectant were analysed in comparison with the control group (untreated glove). For tensile testing, the thickness of each test specimen was measured with a micrometer. FINDINGS: Bleach solution decreased the breaking load of gloves, although to a lesser extent than disinfectants that contained ethanol. CONCLUSION: Disinfectants that contain alcohol decrease the breaking load of nitrile gloves.


Assuntos
/prevenção & controle , Desinfetantes/farmacologia , Desinfecção/métodos , Luvas Cirúrgicas/virologia , Mãos/virologia , Clareadores/farmacologia , Etanol/farmacologia , Luvas Cirúrgicas/normas , Humanos , Nitrilos/química
6.
J Surg Oncol ; 123(1): 110-116, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33125739

RESUMO

BACKGROUND AND OBJECTIVES: Describe patient-reported functional outcomes for hand and foot sarcoma survivors treated with limb-sparing surgery and radiation therapy (LSS + RT). METHODS: Fifty-four patients with hand/wrist and foot/ankle sarcomas treated with LSS + RT from 1991 to 2015 were identified. Survivors ≥18 years old without subsequent amputation completed self-assessed functional surveys: Toronto upper extremity salvage score (TESS-UE) and Michigan hand outcomes (MHQ) surveys for hand; TESS lower extremity (TESS-LE) and Foot and Ankle Outcomes (FAOS) surveys for foot. Scoring scales: 0-100, MHQ and TESS; -26 to 56 and 25-59, FAOS core and shoe comfort, respectively. Higher scores denote superior function. RESULTS: Five-year local tumor control was 88%. Fourteen of 24 hand (58%) and 14/18 foot (78%) survivors completed surveys. Mean TESS-UE and MHQ scores were 89.4 and 72.8, respectively. Mean TESS-LE, core FAOS, and shoe comfort scores were 92.4, 46.19, and 53.1, respectively. No factors correlated with outcomes. TESS-UE and MHQ scores strongly correlated (r = .87). TESS-LE and FAOS scores were associated with a poor correlation (r = .02 and r = .69). CONCLUSIONS: The largest patient-reported functional outcomes analysis for hand and foot sarcoma survivors treated with LSS + RT demonstrates excellent local tumor control and acceptable functional outcomes. Further exploration of optimal functional assessment tools is needed given the potential scope differences.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Doenças do Pé/terapia , Mãos/efeitos da radiação , Mãos/cirurgia , Salvamento de Membro/métodos , Medidas de Resultados Relatados pelo Paciente , Sarcoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Terapia Combinada , Feminino , Seguimentos , Doenças do Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radioterapia , Estudos Retrospectivos , Sarcoma/patologia , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 30(1): 105447, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33188953

RESUMO

BACKGROUND: Hand motor function is often severely affected in patients with hemorrhagic stroke. The present study aimed to investigate the feasibility of predicting hand function recovery after hypertensive intracerebral hemorrhage using diffusion tensor imaging (DTI). METHODS: A total of 75 patients with hypertensive intracerebral hemorrhage were prospectively included. DTI of the corticospinal tract (CST) connecting the hand knob area of the precentral gyrus and the cerebral peduncle was performed at around 3 weeks after stroke. Integrity of the CST was evaluated as no disruption, partial disruption, and complete disruption. Hand function was compared by the Brunnstrom recovery stage of hand (BRS-H) at post-stroke 3 weeks and 3 months. RESULTS: Degrees of integrity of the corticospinal cord was negatively correlated with the BRS-H at both post-stroke 3 weeks (r = -0.77, p < 0.01) and 3 months (r = -0.75, p < 0.01). Patients with intact CST or completely disrupted CST shown by DTI did not show significant improvement in the BRS-H at post-stroke 3 months. However, those with partially disrupted CST showed significant improvement in the BRS-H at post-stroke 3 months compared to 3 weeks (3.79 ± 1.36 vs 2.53 ± 1.58, p = 0.012). CONCLUSIONS: DTI can be used to visualize the damage to the hand fibers of the CST. Patients with partially disrupted CST may benefit most from rehabilitation therapy for hand function recovery after hypertensive intracerebral hemorrhage.


Assuntos
Imagem de Tensor de Difusão , Mãos/inervação , Atividade Motora , Córtex Motor/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , /fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo , Resultado do Tratamento
9.
Acta Psychol (Amst) ; 212: 103192, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33137614

RESUMO

The sense of self is a complex phenomenon, comprising various sensations of bodily self-consciousness. Interestingly, the experience of possessing a body - 'embodiment' - and locating the body within space may be modulated by the Rubber Hand Illusion (RHI). Measures of the RHI include proprioceptive drift (PD), the extent to which the hand is mis-localised towards the rubber hand, and subjective questionnaires. Although these measures often correlate, research from the visual RHI suggests that they reflect separate underlying processes. We investigated whether increasing the duration of tactile stimulation would affect PD and questionnaires differently during the somatic RHI. Participants experienced 30 s, 2 min, or 5 min of synchronous or asynchronous tactile stimulation. Increasing duration affected only PD, with increased drift following 5 min vs 30 s of stimulation. Our findings suggest that PD and questionnaires are not proxies for one another, but reflect separate underlying processes of the somatic RHI.


Assuntos
Transtornos Dissociativos , Ilusões , Percepção do Tato , Percepção Visual , Imagem Corporal , Emoções , Mãos , Humanos , Propriedade , Propriocepção
10.
Br J Dermatol ; 184(1): 141-150, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32779733

RESUMO

BACKGROUND: There are two distinctive acral manifestations of COVID-19 embodying disparate clinical phenotypes. One is perniosis occurring in mildly symptomatic patients, typically children and young adults; the second is the thrombotic retiform purpura of critically ill adults with COVID-19. OBJECTIVES: To compare the clinical and pathological profiles of these two different cutaneous manifestations of COVID-19. METHODS: We compared the light microscopic, phenotypic, cytokine and SARS-CoV-2 protein and RNA profiles of COVID-19-associated perniosis with that of thrombotic retiform purpura in critical patients with COVID-19. RESULTS: Biopsies of COVID-19-associated perniosis exhibited vasocentric and eccrinotropic T-cell- and monocyte-derived CD11c+ , CD14+ and CD123+ dendritic cell infiltrates. Both COVID-associated and idiopathic perniosis showed striking expression of the type I interferon-inducible myxovirus resistance protein A (MXA), an established marker for type I interferon signalling in tissue. SARS-CoV-2 RNA, interleukin-6 and caspase 3 were minimally expressed and confined to mononuclear inflammatory cells. The biopsies from livedo/retiform purpura showed pauci-inflammatory vascular thrombosis without any MXA decoration. Blood vessels exhibited extensive complement deposition with endothelial cell localization of SARS-CoV-2 protein, interleukin-6 and caspase 3; SARS-CoV-2 RNA was not seen. CONCLUSIONS: COVID-19-associated perniosis represents a virally triggered exaggerated immune reaction with significant type I interferon signaling. This is important to SARS-CoV-2 eradication and has implications in regards to a more generalized highly inflammatory response. We hypothesize that in the thrombotic retiform purpura of critically ill patients with COVID-19, the vascular thrombosis in the skin and other organ systems is associated with a minimal interferon response. This allows excessive viral replication with release of viral proteins that localize to extrapulmonary endothelium and trigger extensive complement activation.


Assuntos
/complicações , Pérnio/diagnóstico , Livedo Reticular/diagnóstico , Púrpura/diagnóstico , /imunologia , Adolescente , Fatores Etários , Idoso , Biópsia , /imunologia , Caspase 3/imunologia , Caspase 3/metabolismo , Pérnio/imunologia , Pérnio/patologia , Diagnóstico Diferencial , Feminino , , Mãos , Humanos , Interferon Tipo I/imunologia , Interferon Tipo I/metabolismo , Interleucina-6/imunologia , Interleucina-6/metabolismo , Livedo Reticular/imunologia , Livedo Reticular/patologia , Livedo Reticular/virologia , Masculino , Pessoa de Meia-Idade , Proteínas de Resistência a Myxovirus/análise , Proteínas de Resistência a Myxovirus/metabolismo , Púrpura/imunologia , Púrpura/patologia , Púrpura/virologia , RNA Viral/isolamento & purificação , /isolamento & purificação , Índice de Gravidade de Doença , Pele/imunologia , Pele/patologia , Pele/virologia , Glicoproteína da Espícula de Coronavírus/imunologia , Glicoproteína da Espícula de Coronavírus/isolamento & purificação
11.
Acta Psychol (Amst) ; 212: 103209, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33197642

RESUMO

An embodied sense of self allows individuals to acquire moment-to-moment insight regarding the relationship between themselves and their environment. Fundamental to this experience is information regarding body ownership and self-location, which can inform both intrapersonal and interpersonal functioning. Although it is well documented that variation in mental health symptoms can impact the accuracy of bodily self-perception, little research has, to date, explored the influence of social anxiety on the embodied self. To address this issue, here we propose to examine the impact of social anxiety on the rubber hand illusion (RHI), a procedure which can distort perceptions of body location and ownership. Related literature points to competing predictions relative to how symptoms of social anxiety potentially impact susceptibility to the RHI. In the current manuscript we present the results of a pilot study indicating a positive relationship between the strength of the RHI and social anxiety, and detail a proposed registered report that seeks to replicate and extend this experiment.


Assuntos
Ilusões , Percepção do Tato , Percepção Visual , Ansiedade , Imagem Corporal , Mãos , Humanos , Projetos Piloto , Propriocepção
12.
Acta Psychol (Amst) ; 212: 103214, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33217698

RESUMO

Several studies have reported that proactive motor control in a cued four-finger choice reaction task proceeds more efficiently with a 2-hands motor set (two fingers on each hand) than with a 1-hand motor set (four fingers on one hand). According to the Grouping Model, this is because the 2-hands motor set recruits distinct left and right hand representations located in separate cerebral hemispheres, whereas the 1-hand motor set recruits partially overlapping neural areas grouped together in one hemisphere. The latter neural organization increases neuromotor noise, thereby complicating proactive motor selection. The present study examined the effect of older age on the 2-hands motor selection advantage. A group of young and a group of older adults performed two proactive motor tasks-the procue task and the anticue task-with two motor sets: a 2-hands and 1-hand set. Predictive cues preceded the target signal at five different time intervals (100-850 ms), allowing advance selection of 2 out of 4 fingers. Older adults showed longer reaction times and smaller cueing benefits compared to younger adults. Overall, cueing benefits were greater, and accrued faster, with the 2-hands than with the 1-hand motor set, reflecting the beneficial impact of the neuroanatomical hand distinction. Importantly, the 2-hands advantage was substantially greater in the older age group, suggesting that the hand distinction might abate age-related neural dedifferentiation. These findings highlight the impact of cortical representational distinctiveness in proactive motor control, especially in older age.


Assuntos
Sinais (Psicologia) , Mãos , Idoso , Dedos , Lateralidade Funcional , Humanos , Tempo de Reação
13.
Med Clin North Am ; 105(1): 187-197, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246518

RESUMO

Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. Useful physical examination techniques are described. The history and physical examination are usually sufficient to diagnose these conditions without the need for more advanced testing. All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.


Assuntos
Doenças do Pé/diagnóstico , Doenças do Pé/terapia , Mãos , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/terapia , Fasciíte Plantar/diagnóstico , Fasciíte Plantar/terapia , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/terapia , Articulação da Mão , Humanos , Anamnese , Neuroma Intermetatársico/diagnóstico , Neuroma Intermetatársico/terapia , Onicomicose/diagnóstico , Onicomicose/terapia , Osteoartrite/diagnóstico , Osteoartrite/terapia , Educação de Pacientes como Assunto , Exame Físico , Autogestão
14.
PLoS One ; 15(12): e0242625, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33270681

RESUMO

BACKGROUND: Patients treated in hand surgery (HS) belong to different demographic groups and have varying impairments related to different pathologies. HS outcomes are measured to assess treatment results, complication risks and intervention reliability. A one-dimensional and linear measure would allow for unbiased comparisons of manual ability between patients and different treatment effects. OBJECTIVE: To adapt the ABILHAND questionnaire through Rasch analysis for specific use in HS patients and to examine its validity. METHODS: A preliminary 90-item questionnaire was presented to 216 patients representing the diagnoses most frequently encountered in HS, including distal radius fracture (n = 74), basal thumb arthritis (n = 66), carpal tunnel syndrome (n = 53), and heavy wrist surgery (n = 23). Patients were assessed during the early recovery and in the late follow-up period (0-3 months, 3-6 months and >6 months), leading to a total of 305 assessments. They rated their perceived difficulty with queried activities as impossible, difficult, or easy. Responses were analyzed using the RUMM2030 software. Items were refined based on item-patient targeting, fit statistics, differential item functioning, local independence and item redundancy. Patients also completed the QuickDASH, 12-item Short Form Survey (SF-12) and a numerical pain scale. RESULTS: The rating scale Rasch model was used to select 23 mostly bimanual items on a 3-level scale, which constitute a unidimensional, linear measure of manual ability with good reliability across all included diagnostic groups (Person-Separation Index = 0.90). The resulting scale was found to be invariant across demographic and clinical subgroups and over time. ABILHAND-HS patient measures correlated significantly (p<0.001) with the QuickDASH (r = -0.77), SF-12 Physical Component Summary (r = 0.56), SF-12 Mental Component Summary (r = 0.31), and pain scale (r = -0.49). CONCLUSION: ABILHAND-HS is a robust person-centered measure of manual ability in HS patients.


Assuntos
Grupos Diagnósticos Relacionados , Mãos/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Calibragem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
15.
Ned Tijdschr Geneeskd ; 1642020 11 05.
Artigo em Holandês | MEDLINE | ID: mdl-33331733

RESUMO

Because of COVID-19 outbreak people wash more often their hands and use more often and longer disposable gloves. The natural skin barrier function is damaged by washing hand or using disinfectants, because of this allergic and irritative hand eczema develops. Allergic hand eczema can be caused by materials which people work with, and by ingredients of creme and soap, but also by wearing gloves. To prevent hand eczema, good protection of the hands is essential. It is very important to have knowledge about different gloves to inform (health) worker about wearing gloves in the proper way.


Assuntos
Eczema , Luvas Protetoras , Desinfecção das Mãos/métodos , Higienizadores de Mão/efeitos adversos , Prevenção Primária/métodos , Sabões/efeitos adversos , /epidemiologia , Eczema/etiologia , Eczema/prevenção & controle , Luvas Protetoras/efeitos adversos , Luvas Protetoras/classificação , Mãos , Humanos , Inquéritos e Questionários
16.
Nat Commun ; 11(1): 6386, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318484

RESUMO

Eye contact is among the most primary means of social communication used by humans. Quantification of eye contact is valuable as a part of the analysis of social roles and communication skills, and for clinical screening. Estimating a subject's looking direction is a challenging task, but eye contact can be effectively captured by a wearable point-of-view camera which provides a unique viewpoint. While moments of eye contact from this viewpoint can be hand-coded, such a process tends to be laborious and subjective. In this work, we develop a deep neural network model to automatically detect eye contact in egocentric video. It is the first to achieve accuracy equivalent to that of human experts. We train a deep convolutional network using a dataset of 4,339,879 annotated images, consisting of 103 subjects with diverse demographic backgrounds. 57 subjects have a diagnosis of Autism Spectrum Disorder. The network achieves overall precision of 0.936 and recall of 0.943 on 18 validation subjects, and its performance is on par with 10 trained human coders with a mean precision 0.918 and recall 0.946. Our method will be instrumental in gaze behavior analysis by serving as a scalable, objective, and accessible tool for clinicians and researchers.


Assuntos
Comunicação , Aprendizado Profundo , Olho , Redes Neurais de Computação , Transtorno do Espectro Autista , Pré-Escolar , Feminino , Mãos , Humanos , Lactente , Aprendizado de Máquina , Masculino , Modelos Teóricos
17.
BMC Surg ; 20(1): 306, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33256710

RESUMO

BACKGROUND: Complex regional pain syndrome (CRPS) is a rare but feared complication in hand surgery. Although multimodal therapy concepts are recommended, there is only low evidence on efficacy of such approaches. Furthermore, recommendations regarding therapy duration are lacking. Aim of this study was to validate the efficacy of an International Classification of Functioning, Disability and Health (ICF)-based multidisciplinary rehabilitation concept for treatment of CRPS of the hand and to find correlations between therapy duration and outcome measures. METHODS: Patients with CRPS of the hand after occupational trauma that underwent an ICF-based rehabilitation program between 2010 and 2014 were included in this retrospective study. Besides demographic data, outcomes included pain (VAS), range of motion assessed by fingertip-to-palm-distance (PTPD) and fingernail-to-table-distance (FTTD) as well as strength in grip, 3-point pinch and lateral pinch. All measures were gathered at admission to and discharge from inpatient rehabilitation therapy as well as at follow-up. Statistical analysis included paired t-test, ANOVA and Pearson's correlation analysis. RESULTS: Eighty-nine patients with a mean age of 45 years were included in this study. Duration of rehabilitation therapy was 53 days on average. All outcomes improved significantly during rehabilitation therapy. Pain decreased from 6.4 to 2.2. PTPD of digit 2 to 5 improved from 2.5, 2.8, 2.6, and 2.3 cm to 1.3, 1.4, 1.2, and 1.1 cm, respectively. FTTD of digit 2 to 5 decreased from 1.5, 1.7, 1.5, and 1.6 cm to 0.6, 0.8, 0.7, and 0.7 cm, respectively. Strength ameliorated from 9.5, 3.7, 2.7 kg to 17.9, 5.6, 5.0 kg in grip, lateral pinch, and 3-point pinch, respectively. Improvement in range of motion significantly correlated with therapy duration. 54% of patients participated at follow-up after a mean of 7.5 months. Outcome measures at follow-up remained stable compared to discharge values without significant differences. CONCLUSION: The ICF-based rehabilitation concept is a reliable and durable treatment option for CRPS of the hand. Range of motion improved continuously with therapy duration and thus may serve as an indicator for optimum length of therapy.


Assuntos
Síndromes da Dor Regional Complexa/reabilitação , Duração da Terapia , Mãos/fisiopatologia , Adulto , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
18.
Med Hypotheses ; 144: 110261, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33254560

RESUMO

The contribution of various modes of transmission of SARS-CoV-2 has been the subject of recent intensive debate. The predominant route of the viral transmission is via exhaled droplets of different sizes which can be inhaled by nearby exposed individuals or deposited on peoples and surfaces. Touching contaminated surfaces followed by hand to facial transfer has been identified as a potential infection route. As humans involuntarily touch their faces over 20 times per hour a hand washing with soap and water is recommended to avoid hands to face transmission. To date however, there is no clear explanation how the viruses arrive form the face into the nose and the lung. Our hypothesis is that during the physiological nasal air inspiration the virion particles attached on the face close to the nose are resuspended in the air and then are inhaled into the nose. Our preliminary fluid dynamics simulations confirm our hypothesis. Further experimental and computational studies are warranted.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/métodos , Face , Desinfecção das Mãos , Mãos , Aerossóis , Simulação por Computador , Humanos , Hidrodinâmica , Modelos Teóricos , Nariz , Resistência ao Cisalhamento , Carga Viral , Vírion
19.
PLoS One ; 15(12): e0242961, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351819

RESUMO

Presurgical hand asepsis is part of the daily routine in veterinary medicine. Nevertheless, basic knowledge seems to be low, even among specialised veterinary surgeons. The major objectives of our study were to assess current habits for presurgical hand preparation (phase 1) among personnel in a veterinary hospital and their effectiveness in reducing bacteria from hands in comparison to a standardised protocol (phase 2). Assessment of individual habits focused on time for hand washing and disinfection, the amount of disinfectant used, and the usage of brushes. The standardised protocol defined hand washing for 1 min with liquid neutral soap without brushing and disinfection for 3 min. All participants (2 surgeons, 8 clinic members, 32 students) used Sterillium®. Total bacterial counts were determined before and after hand washing, after disinfection, and after surgery. Hands were immersed in 100 ml sterile sampling fluid for 1 min and samples were inoculated onto Columbia sheep blood agar using the spread-plate method. Bacterial colonies were manually counted. Glove perforation test was carried out at the end of the surgical procedure. Differences in the reduction of relative bacterial numbers between current habits and the standardised protocol were investigated using Mann-Whitney-Test. The relative increase in bacterial numbers as a function of operation time (≤60 min, >60 min) and glove perforation as well as the interaction of both was investigated by using ANOVA. Forty-six and 41 preparations were carried out during phase 1 and phase 2, respectively. Individual habits differed distinctly with regard to time (up to 8 min) and amount of disinfectant (up to 48 ml) used both between participants and between various applications of a respective participant. Comparison of current habits and the standardised protocol revealed that the duration of hand washing had no significant effect on reducing bacteria. Contrary, the reduction in bacterial numbers after disinfection by the standardised protocol was significantly higher (p<0.001) compared to routine every-day practice. With regard to disinfection efficacy, the standardised protocol completely eliminated individual effects. The mean reduction in phase 1 was 90.72% (LR = 3.23; right hand) and 89.97% (LR = 3.28; left hand) compared to 98.85% (LR = 3.29; right hand) and 98.92% (LR = 3.47; left hand) in phase 2. Eight participants (19%) carried MRSA (spa type t011, CC398) which is well established as a nosocomial pathogen in veterinary clinics. The isolates could further be assigned to a subpopulation which is particularly associated with equine clinics (mainly t011, ST398, gentamicin-resistant). Glove perforation occurred in 54% (surgeons) and 17% (assistants) of gloves, respectively, with a higher number in long-term invasive procedures. Overall, bacterial numbers on hands mainly increased over time, especially when glove perforation occurred. This was most distinct for glove perforations on the left hand and with longer operating times. Our results demonstrate that standardised protocols highly improve the efficacy of hand asepsis measures. Hence, guiding standardised protocols should be prerequisite to ensure state-of-the-art techniques which is essential for a successful infection control intervention.


Assuntos
Mãos , Cavalos , Hospitais Veterinários/normas , Controle de Infecções/normas , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Animais , Luvas Cirúrgicas , Desinfecção das Mãos/normas , Humanos , Controle de Infecções/estatística & dados numéricos , Padrões de Referência
20.
Med Probl Perform Art ; 35(4): 202-207, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33257922

RESUMO

AIMS: Although the significance of upper-body posture in relation to piano performance has often been highlighted, the role of experience remains unclear. The aim of this study was to examine selected upper body posture parameters in adolescent piano students of different performance level (beginners vs advanced). METHODS: Thirteen (13) adolescent piano students (14.7±0.5 yrs; 7 beginners and 6 advanced) volunteered. They all performed two specific major scales (G-major and E-major) in five octaves in two predetermined different tempi (slow and fast). An upper body biomechanical model consisting of 27 reflective markers was applied on specific bony landmarks. A 10-T camera Vicon system running Nexus 2 was employed to capture upper body motion--a) sway of the trunk in relation to the instrument, b) finger/hand sway over the keyboard, c) overall hand movement, and d) spinal angles--at selected moments of four different performances. RESULTS: Beginners demonstrated more trunk sway than their advanced counterparts (p<0.05), more finger/hand sway (p<0.05), more overall hand movement (p<0.05), and more flexed spinal angles at the start of their performance (p<0.05). Most of these differences appeared in the G-fast performances, whereas the G-slow equivalents revealed no differences. CONCLUSION: Less-experienced piano players are characterized by more movement in their trunk posture and more upper limb activity than their more advanced colleagues. Future research should examine whether interventional programs designed to alter upper-body posture would have beneficial effects in piano performance.


Assuntos
Mãos , Postura , Adolescente , Fenômenos Biomecânicos , Estudos Transversais , Humanos , Movimento , Tronco
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