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Kim T, Lohse KR, Mackinnon SE, Philip BA. Patient Outcomes After Peripheral Nerve Injury Depend on Bimanual Dexterity and Preserved Use of the Affected Hand. Neurorehabil Neural Repair 2024; 38:134-147. [PMID: 38268466 PMCID: PMC10922924 DOI: 10.1177/15459683241227222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life. OBJECTIVE To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes. METHODS Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand. RESULTS The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand. CONCLUSION After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.
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Affiliation(s)
- Taewon Kim
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin A. Philip
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Akbari H, Saraee A, Mirzaei L, Abolfazli M, Bagheri H, Akbari P. Comparison of Functionality Level, Disability and Quality of Life in Subjects with Peripheral Nerve Repair in the Upper Extremity. World J Plast Surg 2024; 13:68-73. [PMID: 39193248 PMCID: PMC11346686 DOI: 10.61186/wjps.13.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/24/2024] [Indexed: 08/29/2024] Open
Abstract
Background Peripheral nerve damage is a very important factor in patients' quality of life and functionality for various reasons. We aimed to compare the functionality level, disability and quality of life in subjects with peripheral nerve repair in the upper extremity. Methods This cross-sectional study was conducted on patients with nerve injuries in 2019. Among those patients, Eighty-five were selected as the sample. The instruments used in this study included the health-related quality of life standard questionnaire (SF-36), and the disability of the arm, shoulder and hand questionnaire (DASH-38). Data were analyzed by SPSS software version 22 and one-way ANOVA and Kruskal-Wallis statistical tests. Results Results of the Kruskal-Wallis test showed that the disability score in the groups of patients was not significant. In addition, according to the results of the one-way ANOVA test, the quality of life score was not significant among the patient groups. Conclusion Considering that peripheral nerve damage has a significant impact on patients' quality of life and functionality, apart from more research on the subject, it is necessary to provide support for patients to improve their quality of life.
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Affiliation(s)
- Hossein Akbari
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Amir Saraee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Leila Mirzaei
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahsa Abolfazli
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Hossein Bagheri
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Peyman Akbari
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Prevalence of Comorbid Psychiatric Conditions and Chronic Pain in Patients Seeking Peripheral Nerve Surgery. Plast Reconstr Surg Glob Open 2022; 10:e4434. [PMID: 35923982 PMCID: PMC9287277 DOI: 10.1097/gox.0000000000004434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
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Kawai H, Ito A, Wang T, Xu S, Kuroki H. Investigating the Optimal Initiation Time of Ultrasound Therapy for Peripheral Nerve Regeneration after Axonotmesis in Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:304-312. [PMID: 34740495 DOI: 10.1016/j.ultrasmedbio.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
This study was aimed at identifying the optimal initiation time of ultrasound (US) therapy for peripheral nerve regeneration after axonotmesis. Thirty-six rats with sciatic nerve crush injury were divided into four groups that received US irradiation initiated 1, 7 or 14 d after injury, or sham stimulation for 4 wk. Motor function analysis was conducted weekly; however, there was no significant improvement attributed to US treatment. Four weeks after injury, compound muscle action potential amplitude values of the group in which US irradiation was initiated 1 d after the injury exhibited significant improvement compared with the sham stimulation group. In addition, myelin sheath thickness was significantly greater in the 1-d group than in other groups. These results indicate that US treatment initiated 1 d after peripheral nerve injury promotes maximum regeneration.
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Affiliation(s)
- Hideki Kawai
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
| | - Akira Ito
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Tianshu Wang
- Department of Development and Rehabilitation of Motor Function, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shixuan Xu
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Cochrane SK, Calfee RP, Stonner MM, Dale AM. The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions. J Hand Ther 2022; 35:24-31. [PMID: 33250395 PMCID: PMC8985319 DOI: 10.1016/j.jht.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. PURPOSE OF THE STUDY This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. STUDY DESIGN This is a retrospective cohort study of patients from one orthopedic center. METHODS Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. RESULTS Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). CONCLUSIONS Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
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Affiliation(s)
- Shannon K. Cochrane
- Washington University School of Medicine in St. Louis, Program in Occupational Therapy, St. Louis, MO, USA
| | - Ryan P. Calfee
- Washington University School of Medicine in Saint Louis, Orthopedic Surgery, Saint Louis, MO, USA
| | - Macyn M. Stonner
- Washington University School of Medicine in St. Louis, Milliken Hand Rehabilitation Center, Center for Advanced Medicine, St. Louis, MO, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA,Corresponding author. Department of Medicine, Washington University School of Medicine in St. Louis, 4523 Clayton Ave., CB 8005, Saint Louis, MO 63110, USA. Tel.: 314-454-8470; fax: 314-454-5113. (A.M. Dale)
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Heinzel JC, Dadun LF, Prahm C, Winter N, Bressler M, Lauer H, Ritter J, Daigeler A, Kolbenschlag J. Beyond the Knife-Reviewing the Interplay of Psychosocial Factors and Peripheral Nerve Lesions. J Pers Med 2021; 11:jpm11111200. [PMID: 34834552 PMCID: PMC8624495 DOI: 10.3390/jpm11111200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 01/12/2023] Open
Abstract
Peripheral nerve injuries are a common clinical problem. They not only affect the physical capabilities of the injured person due to loss of motor or sensory function but also have a significant impact on psychosocial aspects of life. The aim of this work is to review the interplay of psychosocial factors and peripheral nerve lesions. By reviewing the published literature, we identified several factors to be heavily influenced by peripheral nerve lesions. In addition to psychological factors like pain, depression, catastrophizing and stress, social factors like employment status and worker's compensation status could be identified to be influenced by peripheral nerve lesions as well as serving as predictors of functional outcome themselves, respectively. This work sheds a light not only on the impact of peripheral nerve lesions on psychosocial aspects of life, but also on the prognostic values of these factors of functional outcome. Interdisciplinary, individualized treatment of patients is required to identify patient at risk for adverse outcomes and provide them with emotional support when adapting to their new life situation.
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Affiliation(s)
- Johannes C. Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
- Correspondence: ; Tel.: +49-7071-6061038
| | - Lucy F. Dadun
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Natalie Winter
- Department of Neurology, Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Michael Bressler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Henrik Lauer
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Jana Ritter
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Schnarrenbergstraße 95, 72076 Tuebingen, Germany; (L.F.D.); (C.P.); (M.B.); (H.L.); (J.R.); (A.D.); (J.K.)
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El-Haj M, Ding W, Sharma K, Novak C, Mackinnon SE, Patterson JMM. Median Nerve Compression in the Forearm: A Clinical Diagnosis. Hand (N Y) 2021; 16:586-591. [PMID: 31540555 PMCID: PMC8461194 DOI: 10.1177/1558944719874137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Median nerve entrapment in the forearm (MNEF) without motor paralysis is a challenging diagnosis. This retrospective study evaluated the clinical presentation, diagnostic studies, and outcomes following surgical decompression of MNEF. Methods: The study reviewed 147 patient medical charts following MNEF surgical decompression. With exclusion of patients with combined nerve entrapments (radial and ulnar), polyneuropathy, neurotmetic nerve injury, or median nerve motor palsy, the study sample included 27 patients. Data collected include: clinical presentation and pain, strength, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The study included 27 patients (mean follow-up = 7 months), and 13 patients had previous carpal tunnel release (CTR). Clinical presentation included pain (n = 27) (forearm, n = 22; median nerve innervated digits, n = 21; and palm, n = 21) and positive clinical tests (forearm scratch collapse test, n = 27; pain with compression over the flexor digitorum superficialis arch/pronator, n = 24; Tinel sign, n = 11). Positive electrodiagnostic studies were found for MNEF (n = 2) and carpal tunnel syndrome (n = 11). Primary CTR was performed in 10 patients and revision CTR in 7 patients. Postoperatively, there were significant (P < .05) improvements in strength, pain, quality of life, and DASH scores. Conclusions: The MNEF without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent forearm pain and median nerve symptoms (especially after CTR) should be evaluated for MNEF. Surgical decompression provides satisfactory outcomes.
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Affiliation(s)
- Madi El-Haj
- Washington University School of Medicine, St. Louis, MO, USA
| | - Wei Ding
- Shanghai Ninth People’s Hospital, China
| | - Ketan Sharma
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - J. Megan M. Patterson
- University of North Carolina School of Medicine, Chapel Hill, USA
- J. Megan M. Patterson, Department of Orthopaedics, University of North Carolina School of Medicine, 3135 Bioinformatics Building, Campus Box 7055, Chapel Hill, NC 27599-7055, USA.
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The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications. Diagnostics (Basel) 2020; 10:diagnostics10060366. [PMID: 32498404 PMCID: PMC7345276 DOI: 10.3390/diagnostics10060366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. METHODS Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. RESULTS The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). CONCLUSIONS The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function. The review of the literature yielded multiple studies employing inconsistent metrics and terminology to define order or innervation.
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Philip BA, Kaskutas V, Mackinnon SE. Impact of Handedness on Disability After Unilateral Upper-Extremity Peripheral Nerve Disorder. Hand (N Y) 2020; 15:327-334. [PMID: 30417700 PMCID: PMC7225876 DOI: 10.1177/1558944718810880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Impairment of the dominant hand should lead to greater disability than impairment of the nondominant hand, but few studies have tested this directly, especially in the domain of upper-extremity peripheral nerve disorder. The aim of this study was to identify the association between hand dominance and standardized measures of disability and health status after upper-extremity peripheral nerve disorder. Methods: An existing database was reanalyzed to identify the relationship between affected-side (dominant vs nondominant) on individuals with unilateral upper-extremity peripheral nerve disorder (N = 400). Primary measure of disability was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: We found no differences in standardized measures of disability or health status between patients with affected dominant hand and patients with an affected nondominant hand. However, a post hoc exploratory analysis revealed that patients with an affected dominant hand reported substantially reduced ability to perform 2 activities in the DASH questionnaire: "write" and "turn a key." Conclusions: Following unilateral upper-extremity peripheral nerve disorder, impairment of the dominant hand (compared with impairment of the nondominant hand) is associated with reduced ability to perform specific activities, but this reduced ability is not reflected in standardized measures of disability and health status. To adequately identify disability following unilateral impairment of the dominant hand with the DASH, individual items must be used instead of the total score. New or alternative measures are also recommended.
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Affiliation(s)
- Benjamin A. Philip
- Washington University School of Medicine, St. Louis, MO, USA,Benjamin A. Philip, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108, USA.
| | - Vicki Kaskutas
- Washington University School of Medicine, St. Louis, MO, USA
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Berlet L, Kaskutas V. Developing occupation kits in a Hand Therapy Student Experiential Learning Clinic. HAND THERAPY 2020. [DOI: 10.1177/1758998320912680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Combining occupation-based and biomechanical approaches is effective to increase function after hand injury. This project developed and evaluated occupation kits as a means to increase occupation-based practice. Methods Descriptive study that utilized existing Disabilities of the Arm, Shoulder and Hand data from 642 patients treated by hand surgeon and patients in our Hand Therapy Student Experiential Learning Clinic (HTSELC) to identify difficult activities. These data informed the selection of occupational areas to address with the kits. Biomechanical demands of each kit developed were quantified by 10 student therapists using the Abilities Questionnaire. Fourteen occupational therapists reviewed and rated the usefulness of each kit by survey. Kits were piloted in the HTSELC, and student therapists documented the percentage of time delivering each intervention type: activity/occupation, preparatory methods and tasks, education, advocacy, and group. The degree of occupation-based practice was compared using intervention type percentages before and after introduction of the kits. Results Ten kits were created to address most occupation categories within occupational therapy’s scope of practice. Kits include procedures, safety precautions, and a standardized scale to objectively measure performance. Clinicians noted that kits reflected each occupation well (3.7/5) and 45% reported they were likely to use the kits. After the kits became available in the HTSELC, the percentage of interventions at the occupation/activity level increased from 19% to 26% and biomechanical interventions, including preparatory methods and tasks, decreased from 61% to 49%. Conclusion This research suggests that occupation kits can be a first step to help therapists deliver occupation-based interventions in hand therapy settings.
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Affiliation(s)
- Logan Berlet
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Vicki Kaskutas
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
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Zink PJ, Philip BA. Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review. Am J Occup Ther 2020; 74:7401205030p1-7401205030p15. [PMID: 32078514 DOI: 10.5014/ajot.2020.036665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. Study Selection and Data Collectio : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.
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Affiliation(s)
- Patrick J Zink
- Patrick J. Zink, MSOT, is Occupational Therapist, Select Physical Therapy, Kansas City, MO. At the time of the study, he was Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Takata SC, Wade ET, Roll SC. Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. J Hand Ther 2019; 32:1-9. [PMID: 28647322 PMCID: PMC5740027 DOI: 10.1016/j.jht.2017.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/08/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Mapping review. INTRODUCTION Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice. PURPOSE OF THE STUDY The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research. METHODS A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice. RESULTS Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status. DISCUSSION Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions. CONCLUSIONS More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Sandy C Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Emily T Wade
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
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Vikström P, Björkman A, Carlsson IK, Olsson AK, Rosén B. Atypical sensory processing pattern following median or ulnar nerve injury - a case-control study. BMC Neurol 2018; 18:146. [PMID: 30231852 PMCID: PMC6145124 DOI: 10.1186/s12883-018-1152-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Due to brain plasticity a transection of a median or ulnar nerve results in profound changes in the somatosensory areas in the brain. The permanent sensory deprivation after a peripheral nerve injury might influence the interaction between all senses. The aim of the study was to investigate if a median and/or ulnar nerve injury gives rise to a changed sensory processing pattern. In addition we examined if age at injury, injured nerve or time since injury influence the sensory processing pattern. METHODS Fifty patients (40 men and 10 women, median age 43) operated due to a median and/or ulnar nerve injury were included. The patients completed the Adolescent/Adult Sensory Profile questionnaire, which includes a comprehensive characterization on how sensory information is processed and how an individual responds to multiple sensory modalities. AASP categorizes the results into four possible Quadrants of behavioral profiles (Q1-low registration, Q2-sensory seeking, Q3-sensory sensitivity and Q4-sensory avoiding). The results were compared to 209 healthy age and gender matched controls. Anova Matched Design was used for evaluation of differences between the patient group and the control group. Atypical sensory processing behavior was determined in relation to the normative distribution of the control group. RESULTS Significant difference was seen in Q1, low registration. 40% in the patient group scored atypically in this Quadrant compared to 16% of the controls. No correlation between atypical sensory processing pattern and age or time since injury was seen. CONCLUSION A peripheral nerve injury entails altered sensory processing pattern with increased proportion of patients with low registration to sensory stimulus overall. Our results can guide us into more client centered rehabilitation strategies.
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Affiliation(s)
- Pernilla Vikström
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital and Lund University, Jan Waldenströms gata 5, SE-205 03, Malmö, Sweden
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital and Lund University, Jan Waldenströms gata 5, SE-205 03, Malmö, Sweden
| | - Ingela K Carlsson
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital and Lund University, Jan Waldenströms gata 5, SE-205 03, Malmö, Sweden
| | - Anna-Karin Olsson
- Department of Psychiatry, NU Health Care, Trollhättan and Department of Psychology, Karlstad University, Karlstad, Sweden
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital and Lund University, Jan Waldenströms gata 5, SE-205 03, Malmö, Sweden.
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