The Efficacy of Tele-Rehabilitation Program for Improving Upper Limb Function among Adults Following Elbow Fractures: A Pilot Study

Background: Active mobilization post-elbow fractures reduces the incidence of complications. Occupational therapists use tele-rehabilitation, incorporating technology into their practices. There is a lack of evidence-based trials regarding the integration of tele-rehabilitation during treatment. We therefore aimed to compare tele-rehabilitation treatment outcomes with conventional rehabilitation in improving the upper limb function post-elbow fractures. Methods: Eighteen participants post-elbow surgery due to fracture were divided into two groups according to age and fracture type. The groups received one month of treatment: the tele-rehabilitation group (N = 9, median age 33.0 ± 27.9 years, range 18.5–61.0) received 1–2 tele-rehabilitation treatments per week via a biofeedback system of elbow motion (the ArmTutor and 3D Tutor systems, MediTouch Ltd., Netanya, Israel) and 1–2 treatments in an outpatient clinic, and the control group (N = 9, median age 60.0 ± 37.0 years, range 20.5–73.0) received 3–4 treatments per week in the clinic. Both groups were instructed to self-practice at home. Four evaluations were performed: before and after the intervention, and 3 months and 1 year from surgery. The outcome measures included the Jebsen–Taylor hand function test; the disabilities of the arm, shoulder, and hand questionnaire; the patient-rated elbow evaluation; satisfaction; passive and active range of motion (ROM); and strength measurements. Results: Findings demonstrated a significant improvement in the ROM and in functional assessments in both groups. No statistically significant differences were found between the groups. The subjects in the tele-rehabilitation group reported a higher level of satisfaction and needed less help from a family member during practice. Conclusions: Tele-rehabilitation programs could be incorporated in the framework of treatment following elbow fractures. Tele-rehabilitation is a cost-effective treatment, suitable for patients with accessibility difficulties or who have difficulty arriving at the clinic

Key Strike Forces and Their Relation to High Level of Musculoskeletal Symptoms

Background: This study aimed to investigate the relation between key strike forces and musculoskeletal symptoms (MSS). Moreover, this study presents a key strike force measurement method to be used in a workplace setting. The correlation between key strike force characteristics and MSS was previously studied, but the measurement methods used either a single-key switch or force platforms applied under the keyboard. Most of the studies were conducted in a laboratory setting. The uniqueness of measurement methods in the current study is their ability to measure forces applied to a specific key in a workplace setting and to provide more information about specific key strike forces during typing. Methods: Twenty-four healthy computer workers were recruited for the study. The demographic questionnaire, and self-reported questionnaires for psychosocial status (General Nordic Questionnaire for Psychological and Social Factors at Work) and for detecting MSS were filled up, which later helped in dividing the participants into two groups (12 participants with pain and 12 without pain). Participants typed a predetermined text that utilized the instrumented keys multiple times. The dynamic forces applied to the keys were recorded and collected, using four thin and flexible force sensors attached to the preselected keys according to their location. Results: The results demonstrated that participants with high levels of MSS, specifically in the back and neck, in the last year exerted significantly higher key strike forces than those with lower levels of symptoms (p<0.005). Conclusion: The key strike force exerted while typing on a keyboard may be a risk factor for MSS, and should therefore be considered in ergonomic evaluations and interventional programs

Internal Mechanics of a Subject-Specific Wrist in the Sagittal versus Dart-Throwing Motion Plane in Adult and Elder Models: Finite Element Analyses

Introduction: Most of the wrist motions occur in a diagonal plane of motion, termed the dart-throwing motion (DTM) plane; it is thought to be more stable compared with movement in the sagittal plane. However, the effect of the altered carpus motion during DTM on the stress distribution at the radiocarpal joint has yet to be explored. Aim: To calculate and compare the stresses between the radius and two carpal bones (the scaphoid and the lunate) in two wrist positions, extension and radial extension (position in DTM), and between an adult and an elder model. Methods: A healthy wrist of a 40-year-old female was scanned using Magnetic Resonance Imaging in two wrist positions (extension, radial extension). The scans were transformed into three-dimensional models and meshed. Finite element (FE) analyses in each position of the wrist were conducted for both adult and elder models, which were differentiated by the mechanical properties of the ligaments. The distal surfaces of the carpal bones articulating with the metacarpals were loaded by physically accurate tendon forces for each wrist position. Results: The von Mises, shear stresses and contact stresses were higher in the extension model compared with the radial-extension model and were higher for the radius-scaphoid interface in the adult model compared with the elder model. In the radius-scaphoid interface, the stress differences between the two wrist positions were smaller in the elder model (11.5% to 22.5%) compared with the adult model (33.6–41.5%). During radial extension, the contact area at the radius-lunate interface was increased, more so in the adult model (222.2%) compared with the elder model (127.9%), while the contact area at the radius-scaphoid was not affected by the position of the wrist in the adult model (100.9%) but decreased in the elder model (50.2%) during radial extension. Conclusion: The reduced stresses during radial extension might provide an explanation to our frequent use of this movement pattern, as the reduced stresses decrease the risk of overuse injury. Our results suggest that this conclusion is relevant to both adults and elder individuals