Hand Rehabilitation and Telemonitoring through Smart Toys

We describe here a platform for autonomous hand rehabilitation and telemonitoring of young patients. A toy embedding the electronics required to sense fingers pressure in different grasping modalities is the core element of this platform. The system has been realized following the user-centered design methodology taking into account stakeholder needs from start: clinicians require reliable measurements and the ability to get a picture remotely on rehabilitation progression; children have asked to interact with a pleasant and comfortable object that is easy to use, safe, and rewarding. These requirements are not antithetic, and considering both since the design phase has allowed the realization of a platform reliable to clinicians and keen to be used by young children

Clinical usefulness of oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins in patients with carpal tunnel syndrome undergoing surgical treatment

We investigated the clinical usefulness of oral supplementation with a combination product containing alpha-lipoic acid, curcumin phytosome, and B-group vitamins in 180 patients with carpal tunnel syndrome (CTS), scheduled to undergo surgical decompression of the median nerve. Patients in Group A (n = 60) served as controls and did not receive any treatment either before or after surgery. Patients in Group B (n = 60) received oral supplementation twice a day for 3 months both before and after surgery (totaling 6 months of supplementation). Patients in Group C (n = 60) received oral supplementation twice a day for 3 months before surgery only. Patients in Group B showed significantly lower nocturnal symptoms scores compared with Group A subjects at both 40 days and 3 months after surgery (both P values < 0.05). Moreover, patients in Group B had a significantly lower number of positive Phalen's tests at 3 months compared with the other study groups (P < 0.05). We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve

Il trattamento conservativo precoce nella Camptodattilia = Camptodactyly : early nonoperative treatment

Scopo: Approfondimento delle classificazioni e dei protocolli conservativi utilizzati dalle unit\ue0 operative di chirurgia della mano e pubblicati negli ultimi 15 anni. Confronto con la classificazione ed il protocollo utilizzati nel nostro reparto. Materiali e metodi: Si sono analizzati i protocolli conservativi pubblicati e si \ue8 poi descritto il nostro protocollo attraverso l\u2019analisi di tre casi attualmente in trattamento. Risultati: Si \ue8 evidenziata una disomogeneit\ue0 nella classificazione delle camptodattilie e nell\u2019utilizzo dei tutori, sia per tipologia che per modalit\ue0 di utilizzo. Il nostro reparto si avvale della classificazione di Foucher per determinare la scelta del tipo di tutore. Conclusioni: Anche se la tipologia di tutore non \ue8 sempre la stessa, tutti gli autori concordano che, nella maggioranza delle camptodattilie sia importante cominciare con l\u2019approccio conservativo. Nel nostro reparto vengono confezionati tutori statici o dinamici in base al tipo di camptodattilia e viene monitorato costantemente l\u2019andamento tramite misurazioni goniometriche, con ottimi risultati.Purpose: To analyse the classifications and the conservative protocols used by hand surgery operative\u2019s units and published in the last 15 years. To draw a comparison between those classifications and protocols and the ones used in our unit. Material and Methods: The published conservative treatments have been analysed and then our protocol has been described through the analysis of three cases currently treated in our division. Results: It has been highlighted that camptodactyly classifications are not homogeneous. Moreover, in conservative treatment, different typology and posology of splints have been adopted. Our unit uses the Foucher\u2019s classification to define the type of splint that it is necessary. Conclusions: Despite the authors choose different types of splint, they agree that in the most cases of camptodactily the initial approach is conservative. In our unit static and dynamic splints are made directly on the patient\u2019s hand and they are monitored with goniometrical measurements, obtaining great results

Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence

The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered not defined. A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20\ub0 for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.usammenfassung Ziel der Konsensuskonferenz in Rom war es, eine Definition des Rezidivs bei Morbus Dupuytren festzulegen, die fur einen Vergleich der Ergebnisse unabhangig von der gewahlten Behandlung einsetzbar ist. 24 Handchirurgen aus 17 Landern kamen im Rahmen einer internationalen Konsensuskonferenz zusammen. Die Teilnehmer wendeten die Delphi-Methode an, um folgende Thesen zu bewerten: (1) die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren, das Rezidiv soll (2) auf die Stadieneinteilung nach Tubiana, (3) fur jedes einzelne behandelte Gelenk, oder (4) auf den Fingerstrahl angewandt werden. Jede These konnte auf einer Skala von 1 bis 5 bewertet werden: 1=stimme gar nicht zu; 2=stimme nicht zu; 3=stimme zu; 4=stimme sehr zu; 5=stimme vollstandig zu. Keine Zustimmung lag vor, wenn mindestens 66% der erfassten Antworten auf 1 und 2 entfielen und Zustimmung lag vor, falls mindestens 66 % der erfassten Antworten auf 3, 4 und 5 entfielen. Falls der Schwellenwert von 66% nicht erreicht wurde, wurde die jeweilige Aussage als "nicht definiert betrachtet. Die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren wurde mit dieser Methode festgestellt. Das Vorliegen von Knoten oder Sehnen ohne Kontraktur der Finger wurde nicht als Anzeichen eines Rezidivs gewertet. Die Stadieneinteilung nach Tubiana stellte sich als ungeeignet zur Beschreibung eines Rezidivs heraus. Ein Rezidiv bei Morbus Dupuytren ist besser durch die Messung eines spezifischen Gelenks als durch eine Messung der Beugekontraktur des gesamten Fingerstrahls bestimmt. Der Ausgangspunkt Null wurde definiert als Zeitraum zwischen 6 Wochen und 3 Monaten nach der primaren Behandlung. Ein Rezidiv wird dann definiert als eine passive Beugekontraktur von mehr als 20 degrees fur jedes behandelte Gelenk bei Vorliegen eines tastbaren Stranges, verglichen mit dem Ergebnis zum Zeitpunkt Null. Die Konferenz zeigte die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren und fuhrte zu einem Konsens in Bezug auf diese Definition. Bei Verwendung in nachfolgenden Publikationen wird sie es ermoglichen, verschiedene Techniken zu vergleichen und die Patienten beim Treffen einer informierten Entscheidung zu unterstutzen

L'esperienza di un approccio interdisciplinare al bambino con malformazione congenita all'arto superiore

Il contributo presenta un nuovo approccio interdisciplinare centrato sulla comunicazione chirurgo-piccolo paziente-famiglia che si propone di superare le difficoltà linguistiche, le percezioni sociali della salute e della medicina in relazione alle malformazioni, le spiegazioni implicite del senso comune, i ruoli sociali e in genere le dinamiche sociali che sul piano cognitivo ed emotivo influiscono in una relazione di cura

Un nuovo approccio al piccolo paziente malformato: l'aiuto dello psicologo

in relazione alle esperienze internazioniali, per nulla seguite nel nostro Paese, gli autori propongono un approccio alla malformazione che vada oltre l'aspetto strettamente tecnico chirurgico e riabilitativo per prendere in considerazione gli aspetti emotivi del bambino e dei suoi genitori. le loro aspettative, infatti sono determinanti nella relazione e nella comunicazione tra chirurgo e paziente, ma hanno bisogno del supporto dello psicologo per essere accolte e comprese

Congenital malformations and compliance to the treatment: influence of parents\u2019 personal perceptions of the relationship with the medical team

Congenital hand malformations can cause a traumatic stress condition and the trauma is the more severe if could not have been foreseen so that it requires the parents to elaborate strategies on adapting to the malformation experience. This process sometimes does not evolve spontaneously in an adaptive and physiological way both for the parents and the child. Parents personal feelings and their possibility to accept child malformation seem to be very important for child development, for the possibility to form a balanced relationship with parents, for the harmonic development of child personality and for his or her relationship with the social world in an unfamiliar environment, and for parents, and child, for the possibility to comply with the proposed treatment. Child possibility to accept the malformation can be determined by the analysis of parents expectations on the surgery. When a child with a hand malformation is born, parents experience a heavy sense of guilt because they feel they have given life to an "unfinished" child and they consequently want to repair their guilt as soon as possible. If parents can accept the limitations of the surgical procedure, they will accept child malformation. Whenever parents have deep unrealistic expectations and try to ignore what happened, they will inevitably be deluded. It seems very important to achieve a good interaction between the family and the medical team in order to support the parents; in this regard the psychologist is placed between parents' emotions in respect to the malformation and the treatment proposed by the team. The optimal solution is to devise a treatment based on parents and child needs and therefore work as team