Comparison between patient-reported and physician-estimated pain and disability in hand and wrist disorders

Background Pain and disability are important components of the assessment of hand problems, but it is unknown how physician estimates compare to patient self-reports. Objective To analyse differences between patient-reported and physician-estimated pain and disability in patients with hand or wrist disorders and to analyse factors influencing these differences. Methods Observational study of patients with hand or wrist disorders seen during multidisciplinary outpatient consultations. Patients, rehabilitation medicine (RM) consultants, RM trainees and plastic surgeons completed visual analogue scales (VASs) to rate the level of self-reported (patients) or estimated (physicians) pain and disability. Multilevel analyses were performed to evaluate differences in VAS-pain and VAS-disability scores between patients and physicians and to evaluate the influences of diagnosis, physician experience and medical specialty. Results Complete data were obtained for 250 patients. Levels of pain and disability estimated by physicians were lower compared to patient self-reports. Ratings differed among medical specialties. Pain was underestimated to a greater extent by plastic surgeons compared to RM consultants. Disability was underestimated to a greater extent by RM consultants compared to plastic surgeons. Estimates of pain and disability did not differ between consultants and trainees in RM. Type of diagnosis did not influence the degree of underestimation of pain and disability. Conclusions Physicians underestimate pain and disability compared to self-reports in patients with hand or wrist disorders. Ratings differ among medical specialties: plastic surgeons underestimate pain more, while RM consultants underestimate disability more. Physician experience and diagnosis do not influence the degree of underestimation of pain and disability

Stump sensibility in children with upper limb reduction deficiency

Objectives: To compare stump sensibility in children with upper limb reduction deficiency with sensibility of the unaffected arm and hand. In addition, to evaluate the associations between stump sensibility, stump length and activity level.Design: Cross-sectional study.Subjects: Children and young adults aged 6-25 years with upper limb reduction deficiency.Methods: Threshold of touch was measured with Semmes-Weinstein monofilaments, stereognosis was measured with the Shape-Texture Identification test and kinaesthesia and activity level was measured with the Child Amputee Prosthetics Project Functional Status Inventory and the Prosthetic Upper Extremity Functional Index.Results: A total of 31 children with upper limb reduction deficiency (mean age 15 years, 3 prosthesis wearers) were investigated. The threshold of touch of the stump circumference was lower (indicating higher sensibility) than of the unaffected arm (p=0.006), hand (p=0.004) and stump end-point (p=Conclusion: Threshold of touch, stereognosis and kinaesthesia of the affected sides were excellent. Threshold of touch of the stump circumference was lower (indicating higher sensibility) than of the unaffected arm and hand. High stump sensibility may clarify good functioning in the children without prostheses and contribute to prosthesis rejection.</p

Effects of asymmetrical support on lower limb muscle activity during Lokomat guided gait in persons with a chronic stroke:an explorative study

BACKGROUND: The Lokomat, one of the most popular robotic exoskeletons, can take the asymmetry in the gait pattern of unilaterally affected patients into account with its opportunity to provide unequal levels of movement support (or 'guidance') to each of the legs. This asymmetrical guidance may be used to selectively unburden limbs with impaired voluntary control and/or to exploit the interlimb couplings for training purposes. However, there is a need to explore and understand these specific device opportunities more broadly before implementing them in training. AIM: The aim of this study was to explore the effects of (a)symmetrical guidance settings on lower limb muscle activity in persons with post stroke hemiparesis, during Lokomat guided gait. DESIGN: A single group, dependent factorial design. SETTING: Rehabilitation center; a single session of Lokomat guided walking. POPULATION: A group of ten persons with post stroke hemiparesis. METHODS: Participants walked in the Lokomat in eight conditions, consisting of symmetrical and asymmetrical guidance situations, at both 0.28 m/s and 0.56 m/s. During symmetrical conditions, both legs received 30% or 100% guidance, while during asymmetrical conditions one leg received 30% and the other leg 100% guidance. Surface electromyography was bilaterally measured from: Biceps Femoris, Rectus Femoris, Vastus Medialis, Medial Gastrocnemius and Tibialis Anterior. Statistical effects were assessed using Statistical Parametric Mapping. RESULTS: The provision of assymetrical guidance did not affect the level of lower limb muscle activity. In addition, no effect (except for Vastus Medialis in the affected leg during 1.5-2.4% of the gait cycle) of symmetrical guidance on muscle amplitude could be observed. CONCLUSIONS: The results show no evidence that either symmetrical or asymmetrical guidance settings provided by the Lokomat can be used to manipulate activity of lower limb musculature in persons with post stroke hemiparesis. CLINICAL REHABILITATION IMPACT: This study provides insights for the use of specific opportunities provided by the Lokomat for training purposes post stroke

Lokomat guided gait in hemiparetic stroke patients:the effects of training parameters on muscle activity and temporal symmetry

Purpose: The Lokomat is a commercially available robotic gait trainer, applied for gait rehabilitation in post-stroke hemiparetic patients. Selective and well-dosed clinical use of the Lokomat training parameters, i.e. guidance, speed and bodyweight support, requires a good understanding of how these parameters affect the neuromuscular control of post-stroke hemiparetic gait. Materials and methods: Ten stroke patients (unilateral paresis, 7 females, 64.5 ± 6.4 years, >3months post-stroke, FAC scores 2–4)) walked in the Lokomat under varying parameter settings: 50% or 100% guidance, 0.28 or 0.56m/s, 0% or 50% bodyweight support. Electromyography was recorded bilaterally from Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius, and Tibialis Anterior. Pressure sensors placed under the feet were used to determine the level of temporal gait symmetry. Results: Varying guidance and bodyweight support had little effect on muscle activity, but increasing treadmill speed led to increased activity in both the affected (Biceps Femoris, Medial Gastrocnemius, Tibialis Anterior) and unaffected leg (all muscles). The level of temporal symmetry was unaffected by the parameter settings. Conclusions: The Lokomat training parameters are generally ineffective in shaping short term muscle activity and step symmetry patients with hemiparetic stroke, as speed is the only parameter that significantly affects muscular amplitude. Trial Registration: d.n.a.IMPLICATIONS FOR REHABILITATIONThe Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients.This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking.Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters.Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training. The Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients. This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking. Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters. Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training.</p

Determinants of Return to Work in Patients with Hand Disorders and Hand Injuries

Introduction Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries. Methods Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately. Results Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group. Conclusion Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job

Development and sensibility assessment of a health-related quality of life instrument for adults with severe disabilities who are non-ambulatory

Background Insight in health-related quality of life (HRQoL) of adults with severe disabilities who are non-ambulatory is important, but a measure is lacking. The aim was to develop a HRQoL measure for this group. Method The developmental process consisted of the adaptation process of a proxy HRQoL measure for children with severe disabilities who are non-ambulatory and the assessment of the sensibility of the developed instrument. A three-step process was used: focus groups, e-survey and interviews. Results In total, 72% of the items remained unchanged. Three new items and one element to an existing item were added. In ten items, the formulation of the items was adapted to the target group. Concerning the sensibility, respondents suggested minor changes to the instruction and the output scales. Conclusions This study has yielded a proxy HRQoL measure for adults with severe disabilities who are non-ambulatory, the CPADULT, with good sensibility

Preliminary study of the Southampton Hand Assessment Procedure for Children and its reliability

Background: The Southampton Hand Assessment Procedure (SHAP) is currently used in the adult population for evaluating the functionality of impaired or prosthetic hands. The SHAP cannot be used for children because of the relatively larger size of the objects used to perform SHAP tasks and unknown clinimetric properties. The aims of this study were to adapt the SHAP for use in children (SHAP-C), to determine norm values for the SHAP-C, and to analyze the reliability of the SHAP-C. Methods: The SHAP-C was adapted based on the SHAP protocol. Some objects were downsized, and the timing of tasks was performed by the rater instead of the participant. Intra-and inter-rater reliability were assessed in 24 children (5 [0.54] y/o) with unimpaired hands. The repeatability coefficients (RCs) were calculated. An RC Results: Participants were able to perform all SHAP-C tasks. The means of the SHAP-C tasks ranged from 0.75 to 1.21 seconds for abstract objects and from 0.64-19.13 seconds for activities of daily living. The RCs of a single assessor did not exceed 75% in 17/26 SHAP-C tasks, displaying a relatively good intra-rater reliability, whereas the RCs for the inter-rater reliability exceeded 75% in 22/26 SHAP-C tasks, thus displaying poor reliability. Conclusion: In this first study that adjusted the SHAP for pediatric use, we found that all SHAP-C objects and tasks could be performed by children. The intra-rater reliability was better than the inter-rater reliability. Although the SHAP-C appears to be a promising instrument, the protocol requires further modifications to provide reliable measurements in children

Changes in the Content of Pediatric Physical Therapy for Infants:A Quantitative, Observational Study

AIMS: The aim of our observational longitudinal study is to evaluate changes over time in standard pediatric physical therapy (PPT) for infants at risk of neurodevelopmental disorders. METHODS: Treatment sessions in two time periods (2003-2005 [n = 22] and 2008-2014 [n = 16]) were video recorded and analyzed quantitatively in five categories: neuromotor actions, educational actions, communication, position, and situation of treatment session. Differences in percentages of time spent on therapeutic actions between periods were tested with Mann-Whitney U and Hodges Lehmann's tests. RESULTS: No significant changes appeared in the main categories of neuromotor actions. Time spent on not-specified educational actions toward caregivers (median from 99% to 81%, p = .042) and not-specified communication (median from 72% to 52%, p = .002) decreased. Consequently, time spent on specific educational actions (caregiver training and coaching; median from 1% to 19%, p = .042) and specific communication (information exchange, instruct, provide feedback; median from 21% to 38%, p = .007) increased. Infant position changed only minimally: time spent on transitions-that is, change of position-decreased slightly over time (median from 7% to 6%, p = .042). Situation of treatment session did not change significantly over time. CONCLUSIONS: Neuromotor actions in PPT remained largely stable over time. Specific educational actions and communication increased, indicating larger family involvement during treatment sessions

Learning effects of repetitive administration of the Southampton Hand Assessment Procedure in novice prosthetic users

Objective: The Southampton Hand Assessment Procedure (SHAP) evaluates the functionality of normal, injured or prosthetic hands. The aim was to evaluate the learning effects of SHAP tasks and the appropriateness of the time limits applied per task in novice prosthetic users. Methods: Right-handed unimpaired volunteers (n=24, mean age 21.8 years) completed 8 SHAP sessions over 5 consecutive days using a prosthetic simulator. The execution times of SHAP tasks were transformed into 6 prehensile patterns, the functionality profile, and the index of function, a general functionality score. Learning effects in task times were analysed using multilevel analysis. Results: Learning effects occurred in all SHAP tasks. Tasks, sex, sessions, tasks-sessions interaction, and the first session of the day contributed (p25% of participants in at least the first 3 sessions, which affected the calculation of the functionality profile and index of function scores. Conclusion: The learning effects of SHAP in novice prosthetic users require consideration when conducting a reliability study. SHAP scores in novice prosthetic-hand users are confounded by learning effects and exceeded time limits

LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy:neuromotor, cognitive, and behavioral outcome

Contains fulltext : 229748.pdf (Publisher’s version ) (Open Access)Purpose: Evidence for efficacy of early intervention in infants at high risk of cerebral palsy (CP) is limited. We compared outcome of infants at very high risk of CP after receiving the family centered program COPing with and CAring for infants with special needs (COPCA) or typical infant physiotherapy.Materials and methods: Forty-three infants were randomly assigned before the corrected age of 9 months to 1 year of COPCA (n = 23) or typical infant physiotherapy (n = 20). Neuromotor development, cognition, and behavior was assessed until 21 months corrected age. Video-recorded physiotherapy sessions were quantitatively analyzed for further process analyses. Outcome was evaluated with nonparametric tests and linear mixed effect models.Results: During and after the interventions, infant outcome in both intervention groups was similar [primary outcome Infant Motor Profile: COPCA 82 (69-94), typical infant physiotherapy 81 (69-89); Hodges Lehman estimate of the difference 0 (confidence interval -5;4)]. Outcome was not associated with contents of intervention.Conclusions: One year of COPCA and 1 year of typical infant physiotherapy in infants at high risk of CP resulted in similar neurodevelopmental outcomes. It is conceivable that combinations of active ingredients from different approaches are needed for effective early intervention.IMPLICATIONS FOR REHABILITATIONFor infants at very high risk of cerebral palsy, 1 year of intervention with the family-centred programme Coping with and Caring for infants with special needs resulted in similar infant outcome as 1 year of typical infant physiotherapy.Infant's neuromotor, cognitive, and behavioural outcome was not associated with specific interventional elements, implying that the various elements may have a similar effect on developmental outcome.We suggest that a specific mix of ingredients of different approaches may work best, resulting in comprehensive care including both infant and family needs