Optimizing Physical Function Following Distal Radius Fracture

Distal Radius Fracture (DRF) is one of the most frequent of all human bone fractures. Wrist and/or finger range of motion (ROM) and grip strength are standard outcome measures used by clinicians to evaluate recovery after a hand injury. ROM is considered to be an important component of joint mobility and relates to measures of functional impairment and disability. Impaired wrist and hand ROM are related to a decrease in grip strength, grasp ability, fine manipulation, and hand function. The relationship between ROM and other physical impairments as they relate to patient-rated outcomes after DRF have not been well identified. The thesis includes three studies. The first study (Chapter 2) is a systematic review and meta analysis of existing literature on the effects of laser irradiation on bone regeneration, suggesting that low power laser can enhance biomechanical indicators of bone during fracture healing in animal models. The second study (Chapter 3) explores the intra-rater, inter-rater, and inter-instrument reliability and construct validity of two digital electro goniometers to measure active wrist and active/passive index finger ROM in patients with limited wrist and/or hand. The results of this study demonstrate that digital goniometry is highly reliable for all measures across occasions, raters and instruments. The moderate correlation between individual joint motions and patient-rated self-reported function suggests that joint motion impairments contribute to functional disability. The third study (Chapter 4) has a specific focus on the relationship between physical impairment outcome measures and patient-rated wrist pain and function in early and late stages after distal radius fracture. Wrist flexion, extension, supination, pronation, grip strength, age and gender, were found to contribute significantly with wrist pain and function. Good wrist arc of motions (close to normal) and moderate grip strength must be recovered to have optimal wrist functional outcomes after distal radius fracture. The thesis concludes with a discussion of the next steps required toward understanding effective mechanisms to promote bone healing and earlier function after DRF, which may lead to more effective patient-centered treatment protocols. Keywords: Bone Healing, Distal Radius Fracture, Physical Impairment, Patient-Rated Wrist Evaluation

Effects of Short-term Whole Body Vibration Training on Knee Proprioception in Healthy Adults and People with Knee Osteoarthritis

Introduction: many researches have studied the short and long term effects of whole body vibration on muscle strength and proprioception. The effect of this modality in athletes and healthy population have been studied by several researchers; however, to accept it as a therapeutic procedure, it needs more studies.  In knee osteoarthritis, muscle weakness and joint instability can affect proprioception. Since some researchers reported the effect of whole body vibration on kinematic and neuromuscular control and some others have rejected this effect, the purpose of this study is to investigate the short term effect of whole body vibration on proprioception of the knee joint in patients with knee osteoarthritis and healthy individuals. Materials and Methods: In this experimental study, two groups of the same size (21 in healthy and patient groups) went through whole body vibration ( 60 Hz frequency, low amplitude and 25 Hz frequency , high amplitude) and the knee joint properioception accuracy was assessed ( by joint angle replication test) and was compared with the no-vibration baseline results. Results The joint angle reconstruction error was different between two groups and also before and after whole body vibration. Whole body vibration with 25Hz frequency and high Amplitude was ineffective in improvement of knee properioception in osteoarthritis patients (p=0.09). But the vibration with 60 Hz and low amplitude was effective significantly in properiception improvement and decrease of joint angle reconstruction error in healthy (p=0.01) and patients groups. (p=0.02). Discussion: This study shows that the whole body vibration with proper frequency and amplitude (60 Hz and low amplitude) can have immediate effect on the knee joint properioception in patients with knee osteoarthritis and healthy people.Key words: Whole Body Vibration; Knee; Osteoarthritis; Properioceptio

Effects of High-Power Diode Laser Irradiation Combined with Electrical Stimulation on Wrist Pain and Function Following Carpal Tunnel Syndrome

Introduction: Carpal Tunnel Syndrome (CTS) is the most common and most well-known compression neuropathy which may manifest as mild, moderate, or severe and lead to various degrees of disability in people. The present study aimed to compare the effect of high-power diode laser beam and Transcutaneous Electrical Nerve Stimulation (TENS) separately and in combination on improvement of wrist pain and function in patients with CTS. Method and Materials: The study was designed as a randomized trial. A total of 45 patients (7 men and 38 women) were randomly divided into three groups of high-power laser (n=15), TENS (n=15), and high-power laser with TENS (n=15). The TENS group received conventional TENS on pain site for two weeks as 5 sessions per week and 30 minutes per session. The high-power laser group received 6.5 J/cm2 laser for two weeks, 5 sessions per week. The group of high-power laser with TENS received conventional TENS and then 6.5 J/cm2 laser for two weeks as 5 sessions per week and 30 minutes per session. The Persian McGill Pain Questionnaire, Visual Analogue Scale (VAS), and the 5-point scale of pain severity of McGill Pain Questionnaire (pain severity) were used to assess pain and the Persian version of the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was administered to evaluate hand function before and after treatment. All the patients filled a demographic questionnaire including age, height, and weight prior to the intervention. Results: The mean scores of McGill, VAS, pain severity, and DASH questionnaires reduced significantly in high-power laser and high-power laser with TENS groups; however, these variables had no significant difference in the TENS group. Conclusions: High-power laser diode (808 nm, 6.5 j/cm2) can reduce pain and improve hand function in patients with mild to moderate CTS. Laser-induced anti-inflammatory effects and blood flow improvement are possible causes of decreased pain and sensory signs followed by improvement in hand function.Key words: Carpal Tunnel Syndrome, High-Power Laser, Hand, Pain, Transcutaneous Electrical Nerve Stimulatio

Effects of low power laser irradiation on bone healing in animals: a meta-analysis

<p>Abstract</p> <p>Purpose</p> <p>The meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage.</p> <p>Methods</p> <p>We searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis.</p> <p>Results</p> <p>Studies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 - 1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.</p

Effects of Low-Level Laser Therapy and Transcutaneous Electrical Nerve Stimulation on Pain and Hand Function Following Carpal Tunnel Syndrome

Introduction: This study aimed to compare the short-term effects of Low-Level Laser Therapy (LLLT) and Transcutaneous Electrical Nerve Stimulation (TENS) on hand pain and function in patients with low or moderate levels of Carpal Tunnel Syndrome (CTS). Materials and Methods: Twenty-four patients with confirmed mild to moderate CTS were recruited for this study. The eligible patients were randomly divided into two groups: LLLT and TENS. Patients in the LLLT group were exposed to GaAlAs diode laser, 808 nm with 6.5 J/cm2 for two points perpendicularly over the carpal area. Patients in the TENS group were treated daily by conventional TENS with 80 µs duration for a period of 30 minutes per day. All patients were treated daily, five days per week for a period of two weeks. The researchers performed clinical assessment using visual analogue scale and McGill Pain questionnaire for pain rating and Disabilities of the Arm, Shoulder and Hand questionnaire for functional scales. For statistical analysis, paired t-test was used in each group, and analysis of variance was used for comparison between groups. Results: All outcome measures in the LLLT group were substantially improved while the TENS group provided better pain sensation. Conclusion: This study documented that LLLT might be effective in reducing pain and improving function in patients with mild to moderate CTS. Electrical stimulation might have been effective (short term) in controlling pain in these patients.Keywords: Carpal Tunnel Syndrome; Function; Low-level Lasers; Pain; TEN