The use of braces in the rehabilitation treatment of the post-traumatic elbow

Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study

AIM

This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments.

DESIGN

The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey.

METHODS

Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis.

RESULTS

Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management.

CONCLUSION

Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.

Identifying Interaction Forces Via EMG Under Changing Motion Dynamics

Musculoskeletal injuries can severely inhibit performance of activities of daily living. In order to regain function, rehabilitation is often required. Assistive rehabilitation devices can be used to increase arm mobility by guiding therapeutic exercises or assisting with motion. Electromyography (EMG) may be able to provide an intuitive interface between the patient and the device if appropriate classification models allow smart systems to relate these signals to the desired device motion. Unfortunately, the accuracy of pattern recognition models classifying motion in constrained laboratory environments significantly drops when used for detecting dynamic unconstrained movements. The objectives of this study were to quantity how various motion factors affect arm muscle activations during dynamic motion, and to use these motion factors and EMG signals for detecting interaction forces between the person and the environment during motion. The results quantity how EMG features change significantly with variations in arm positions, interaction forces, and motion velocities. The results also show that pattern recognition models were able to detect intended characteristics of motion based solely on EMG signals. Prediction of force was improved from 73.77% correct to 79.17% accuracy during elbow flexion-extension by properly selecting the features, and providing measurable arm position and velocity information as additional inputs to a linear discriminant analysis model.

Design of a Smart Elbow Brace as a Home-Based Rehabilitation Device

Poststroke and traumatic elbow injuries are the most common cause of elbow stiffness, which results in loss of functional range of motion (ROM). Various studies support early mobilization of the elbow joint after injury or after surgery to reduce risks of elbow stiffness development. After hospitalization, patients are required to follow a long-term rehabilitation program during home recovery. Still, most patients do not adhere to their clinical therapy schedule due to either rehabilitation cost, social obligations, negligence, or lack of inspiration. Moreover, the numbers of therapists and assessment equipment are insufficient. This study introduces a smart elbow brace (SEB) as a home-based rehabilitation device that reduces regular in-patient rehabilitation costs and therapist workload and motivates patients to comply with the rehabilitation program that enhances the achievement of rehabilitation goals. Our device has two active degrees of freedom (2-DoF) that allow extension, flexion, pronation, and supination elbow motions. An extra sliding joint between forearm and wrist is added, which helps dump forces concentration at the elbow joint during extension-flexion movement. Mechanical design requirements, motion-tracking systems, and serious game development are described. The feasibility of a proposed SEB device is tested with five healthy subjects playing developed serious games with the device. The results show that subjects can attain maximum and minimum angles of flexion-extension and pronation-supination motion designed for elbow stiffness rehabilitation. The SEB device will be beneficial and be used at home as a complementary tool to support elbow stiffness rehabilitation during long-term home recovery.

The Influence of Perceptual-Motor Variability on the Perception of Action Boundaries for Reaching in a Real-World Setting

The ability to accurately perceive the extent over which one can act is requisite for the successful execution of visually guided actions. Yet, like other outcomes of perceptual-motor experience, our perceived action boundaries are not stagnant, but in constant flux. Hence, the perceptual systems must account for variability in one's action capabilities in order for the perceiver to determine when they are capable of successfully performing an action. Recent work has found that, after reaching with a virtual arm that varied between short and long each time they reach, individuals determined their perceived action boundaries using the most liberal reaching experience. However, these studies were conducted in virtual reality, and the perceptual systems may handle variability differently in a real-world setting. To test this hypothesis, we created a modified orthopedic elbow brace that mimics injury in the upper limb by restricting elbow extension via remote control. Participants were asked to make reachability judgments after training in which the maximum extent of their reaching ability was either unconstricted, constricted or variable over several calibration trials. Findings from the current study did not conform to those in virtual reality; participants were more conservative with their reachability estimates after experiencing variability in a real-world setting.

Open elbow arthrolysis for post-traumatic elbow stiffness: an update

Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article: Bone Joint Open 2020;1-9:576-584.