[3D-printed hand prostheses function in adolescents with congenital hand amputation: A case series]. / Funcionalidad de prótesis de mano impresa en 3D en adolescentes con amputación congénita parcial de mano: Una serie de casos.

OBJECTIVE: To describe the effect of the 3D-printed Cyborg Beast prosthesis on upper limbs function in adolescents with congenital hand amputation. CLINICAL CASES: Five patients aged between 12 and 17 years, with congenital hand amputation were selected. All patients were from the Teletón Institute in Santiago, Chile. The patients were trained for prosthesis use in four sessions. Hand function was evaluated without prosthesis, at 1 and 4 months of use with the modified Bilan 400 points scale, and upper limb function perception was evaluated with the 'Upper Extremity Functional Index (UEFI)'. At 1 month and 4 months of use, the percentage change for hand functionality for the unaffected limbs was between -11% and -4%; and -9% and -2% for the affected limb. The percentage change for the upper limbs perceived function was -62%. CONCLUSIONS: The use of the 3D-printed Cyborg Beast prosthesis was not a functional solution for the 5 patients included in this study. Future research is needed to improve the functionality of these types of 3D-printed hand prostheses.

Funcionalidad de prótesis de mano impresa en 3D en adolescentes con amputación congénita parcial de mano: una serie de casos / 3D-printed hand prostheses function in adolescents with congenital hand amputation: a case series

Resumen: Objetivo: Describir el efecto de la prótesis impresa en 3D Cyborg Beast en la funcionalidad de miembros superiores (MMSS) en adolescentes con amputación congénita parcial de mano. Casos Clínicos: Se seleccionaron 5 pacientes entre 12 y 17 años con amputación congénita parcial de mano en el Instituto Teletón Santiago. Los pacientes fueron entrenados en el uso de la prótesis por 4 sesiones. Se evaluó la función basal (sin prótesis), al mes y los 4 meses de uso de la prótesis con la pauta Bilan 400 points modificada y la percepción de funcionalidad de MMSS sin y con prótesis con la "Upper Extremity Function Index (UEFI)". Al mes y 4 meses de uso, el porcentaje de cambio para funcionalidad de mano fue de -11% y -4% para la extremidad no afectada y de -9% y -2% para la afectada. El porcentaje de cambio para la percepción de funcionalidad de MMSS fue de -62%. Conclusiones: El uso de la prótesis de mano Cyborg Beast no fue una solución funcional para los 5 pacientes incluidos en este estudio. Futuras investigaciones son necesarias para poder mejorar la funcionalidad de estos diseños de prótesis impresa en tecnología 3D.

Abstract: Objective: To describe the effect of the 3D-printed Cyborg Beast prosthesis on upper limbs function in adolescents with congenital hand amputation. Clinical Cases: Five patients aged between 12 and 17 years, with congenital hand amputation were selected. All patients were from the Teletón Institute in Santiago, Chile. The patients were trained for prosthesis use in four sessions. Hand function was evaluated without prosthesis, at 1 and 4 months of use with the modified Bilan 400 points scale, and upper limb function perception was evaluated with the 'Upper Extremity Functional Index (UEFI)'. At 1 month and 4 months of use, the percentage change for hand functionality for the unaffected limbs was between -11% and -4%; and -9% and -2% for the affected limb. The percentage change for the upper limbs perceived function was -62%. Conclusions: The use of the 3D-printed Cyborg Beast prosthesis was not a functional solution for the 5 patients included in this study. Future research is needed to improve the functionality of these types of 3D-printed hand prostheses.

Is short-term hand therapy effective in a child with congenital radioulnar synostosis? A case report.

STUDY DESIGN: Case report. INTRODUCTION: Congenital radioulnar synostosis (CRUS) is a rare malformation that causes the restriction of the rotational movements of the forearm, and it is common in congenital elbow anomalies. PURPOSE OF THE STUDY: The aim of this case report was to present the results of physiotherapy in a patient with CRUS who did not undergo surgery. METHODS: A 7-year-old male patient with CRUS began outpatient physical therapy. The child underwent a physiotherapy program for a total of 10 weeks in the presence of a physiotherapist, 2 days per week, and with a home schedule at other times. Observational posture assessment, range of motion measurements of the upper extremities, the Jebsen-Taylor Hand Function Test, finger and hand grip strength, and Canadian Occupational Performance Measure were used to evaluate the patient before and after the physiotherapy program. RESULTS: An increase in Jebsen-Taylor Hand Function Test, Canadian Occupational Performance Measure, and grip strengths were found; however, there was no change in the range of motion values for our patient. DISCUSSION: This report contains physiotherapy results of a patient with CRUS who did not undergo surgery. Further short- and long-term follow-up studies are needed to demonstrate the effects of physiotherapy on surgical and nonsurgical patients with CRUS. CONCLUSIONS: Physiotherapy can be effective in the functional use of the upper extremities in patients with CRUS who do not undergo surgery; long-term follow-up would demonstrate whether functional changes are permanent over time.

Applying the Patient-Reported Outcomes Measurement Information System to Assess Upper Extremity Function among Children with Congenital Hand Differences.

BACKGROUND: Few studies have evaluated self-assessment tools among children with congenital hand differences. The authors compared three upper extremity disability instruments with the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Upper Extremity Item Bank. METHODS: Thirty-three children (aged 6 to 17 years) with congenital hand differences completed the Pediatric Outcomes Data Collection Instrument; the Michigan Hand Outcomes Questionnaire; the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the PROMIS Upper Extremity short form and computerized adaptive test. Hand function was also assessed, and construct validity and feasibility were examined. RESULTS: PROMIS demonstrated good construct validity. Short form and computerized adaptive test were highly correlated with Disabilities of the Arm, Shoulder, and Hand questionnaire scores (r = 0.80, p < 0.001) and Pediatric Outcomes Data Collection Instrument domains (r = 0.70, p < 0.001). PROMIS was moderately correlated with the Michigan Hand Outcomes Questionnaire (r = 0.40, p < 0.05). PROMIS scores also correlated with grip (r = 0.60, p < 0.001) and pinch strength (r = 0.50, p < 0.001). Compared with the Pediatric Outcomes Data Collection Instrument and the Disabilities of the Arm, Shoulder, and Hand and Michigan Hand Outcomes questionnaires, PROMIS required the least time to complete with fewer children requiring assistance. CONCLUSION: The Patient-Reported Outcomes Measurement Information System is highly correlated with both functional assessment and self-reported function among children with congenital hand differences.

Test-retest reliability and rater agreements of assessment of capacity for myoelectric control version 2.0.

The Assessment of Capacity for Myoelectric Control (ACMC) is an observation-based tool that evaluates ability to control a myoelectric prosthetic hand. Validity evidence led to ACMC version 2.0, but the test-retest reliability and minimal detectable change (MDC) of the ACMC have never been evaluated. Investigation of rater agreements in this version was also needed because it has new definitions in certain rating categories and items. Upper-limb prosthesis users (n = 25, 15 congenital, 10 acquired; mean age 27.5 yr) performed one standardized activity twice, 2 to 5 wk apart. Activity performances were videorecorded and assessed by two ACMC raters. Data were analyzed by weighted kappa, intraclass correlation coefficient (ICC), and Bland-Altman method. For test-retest reliability, weighted kappa agreements were fair to excellent (0.52 to 1.00), ICC2,1 was 0.94, and one user was located outside the limits of agreement in the Bland-Altman plot. MDC95 was less than or equal to 0.55 logits (1 rater) and 0.69 logits (2 raters). For interrater reliability, weighted kappa agreements were fair to excellent in both sessions (0.44 to 1.00), and ICC2,1 was 0.95 (test) and 0.92 (retest). Intrarater agreement (rater 1) was also excellent (ICC3,1 0.98). Evidence regarding the reliability of the ACMC is satisfactory and MDC95 can be used to indicate change.

Superimposed electrical stimulation improves mobility of pre-stiff thumbs after ulnar collateral ligament injury of the metacarpophalangeal joint: a randomized study.

OBJECTIVE: This study aimed at testing the ability of the superimposed electrical stimulation technique to restore the mobility of pre-stiff thumbs after operative repair for rupture of the ulnar collateral ligament. MATERIAL AND METHODS: Eight patients demonstrating a pre-stiff metacarpophalangeal joint were involved in two rehabilitation sessions of a counterbalanced design. In the voluntary contraction session, they performed 20min of repeated active flexions of the impaired metacarpophalangeal joint. In the superimposed electrical stimulation session, they performed 20min of percutaneous neuromuscular electrical stimulations which were superimposed to voluntary flexion. RESULTS: Mean active range of motion improvement from pre- to post-session was significantly greater in the superimposed electrical stimulation condition compared to the voluntary contraction condition (11±5 deg versus 3±4 deg; P<0.01). CONCLUSION: Superimposing electrical stimulation to voluntary contractions is an efficient technique to improve active range of motion of the pre-stiff metacarpophalangeal joint of the thumb.

Avaliação do tratamento da camptodactilia: análise retrospectiva de 22 pacientes, em um total de 39 dígitos

Camptodactilia é uma deformidade congênita caracterizada por uma postura em flexão na IFP, geralmente encontrada no dedo mínimo. Afeta aproximadamente 1% da população. A causa primária para esta deformidade é ainda motivo de discussão, não havendo consenso na literatura mundial. Se não for tratada haverá uma piora progressiva em cerca de 80% dos casos. Essa patologia, de aparência relativamente simples, não é fácil de ser tratada. O problema reside no fato da existência de várias formas de apresentação clínica, o que faz com que não haja um modelo único de tratamento efetivo. O objetivo deste estudo é avaliar, retrospectivamente, os resultados dos casos tratados no serviço de Cirurgia da Mão do INTO-MS-RJ, a partir de um protocolo pré estabelecido; e realizar uma análise crítica dos resultados alcançados, separando os casos em seus respectivos subgrupos. Foram avaliados 22 pacientes, num total de 39 dígitos, de janeiro de 2004 a dezembro de 2012. Relacionamos as estruturas anatômicas alteradas encontradas nos casos que foram submetidos a procedimento cirúrgico e seus resultados, tanto no tratamento conservador, como para os cirúrgicos, enfatizando suas principais indicações. Os resultados foram analisados pelo método de Sierget e col da clínica Mayo. Observamos que os casos de camptodactilia isolada do dedo mínimo na forma flexível, >60º, que foram submetidos a tratamento cirúrgico, de maneira uniforme apresentaram resultados excelentes. Nas formas rígidas, nossas observações indicam benefícios com ganho de extensão e correção da deformidade, entretanto o arco de movimento com flexão ativa na IFP é sempre parcial. Com o tempo de evolução alguns casos apresentaram alguma perda de ganho previamente alcançado, o que corrobora a permanente vigilância necessária no acompanhamento, com uso sistemático de órteses, até a fase final do crescimento esquelético.

Pollicization: the concept, technical details, and outcome.

Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.

Pollicization: The Concept, Technical Details, and Outcome

Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.

Pollicization: The Concept, Technical Details, and Outcome

Pollicization substitutes a functioning finger for a deficient thumb. The most indication is thumb hypoplasia with absence or instability of the carpometacarpal joint. However, there are additional causes that may negate thumb function, such as trauma, macrodactyly, multi-fingered hand, and a mirror hand. The technique of pollicization represents a consolidation of contributions from surgeons over the last 100 years. A meticulous stepwise approach from incision to closure is necessary to optimize outcome. Following pollicization, cortical plasticity and motor relearning play a pivotal role in function following pollicization with connections and adjacent sprouting from nearby cortical and/or subcortical territories. Occupational therapy is necessary to encourage large object acquisition followed by smaller objects and ultimately fine pinch. Pollicization is more reliable in patients with isolated thumb hypoplasia and a mobile index finger with robust extrinsic and intrinsic muscle-tendon units compared to and patients with radial forearm deficiencies and diminished index mobility.

Effect of passive stretching on simple camptodactyly in children younger than three years of age.

PURPOSE: To present the effectiveness of passive stretching as a treatment for camptodactyly, without any other form of physiotherapy or splinting. METHODS: From May 2003 to August 2008, 61 digits of 22 patients were treated conservatively using passive stretching exercises. All children were less than 3 years old and had no other anomalies. Flexion contractures before and after treatment in mild, moderate, and severe groups were measured and changes were analyzed statistically. The correlations between various clinical factors and treatment outcome were also analyzed statistically. The average follow-up period was 26 months (range, 12-47 mo). RESULTS: Mean flexion contracture improved from 20° to 1° in the mild group (p < .001), from 39° to 12° in the moderate group (p < .001), and from 75° to 28° in the severe group (p < .001). Of the clinical factors examined, only initial flexion contracture was found to be significantly correlated with treatment outcome (r = -0.287, p = .0025). CONCLUSIONS: Passive stretching can effectively improve flexion deformity in camptodactyly in infants and young children. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Hand therapy for children with congenital hand differences.

Children with congenital hand anomalies benefit from a surgeon's partnership with a hand therapist, who can help the child and their family achieve goals of independence and improved self-esteem. Topics are addressed by age group and include evaluation of children with hand anomalies, splinting the child's hand after injury or surgery, treatment plans geared specifically for children, achieving increased independence with activities of daily living, and a discussion of how to support families as they adjust to life with a child who has a congenital hand anomaly.

Resultados funcionales de la simbraquidactilia tratada quirúrgicamente / Functional results of surgery treated symbrachydactyly

La agenesia digital es una malformación congénita, también conocida como simbraquidactilia. Clínicamente varía desde aplasia de una o varias falanges intermedias hasta fragmento de mano con adactilia. El objetivo final del tratamiento es la funcionalidad de la mano, realizar pinza fina, permitiendo la integración escolar, familiar y social del niño. Mostramos los resultados funcionales de algunos casos tratados en nuestro Servicio de Rehabilitación tras ser intervenidos por el Departamento de Cirugía Plástica, y analizamos algunos aspectos como función de la mano, edad de la cirugía, función del pie/marcha, factores psicológicos y estética de la mano(AU)

Digital agenesia is a congenital malformation also known as symbrachydactyly. Clinical features may vary from one o more medium phalanx aplasia to one hand fragment with adactyly. The final goal of the treatment is to achieve hand function with grasp improving thus permitting the child academic, family and social integration. We show the functional results archieved by the cases treated in our Rehabilitation Unit after surgery repair has been done by Plastic Surgery department, and we have analysed several aspects such as: hand function, age of surgery, toe function/walking, psychological factors and appearance of the hand(AU)

Hand function in cerebral palsy. Report of 367 children in a population-based longitudinal health care program.

PURPOSE: To describe aspects of hand function in a total population of children with cerebral palsy (CP). METHODS: Upper extremity data were collected for 367 children who were born between 1992 and 2001 and were registered in a population-based health care program for children with CP. Hand function was classified according to the Manual Ability Classification System (MACS), the House functional classification, and the Zancolli classification. The type of spastic thumb-in-palm deformity was evaluated according to House. RESULTS: In the total population of children with CP aged 4 to 14 years, 60% had more than minor problems with hand function (>MACS I). Independence in age-relevant, daily manual activities (MACS I-II) was noted in 87% of children with spastic unilateral CP and in 63% of children with spastic bilateral CP, but in only 20% of children with dyskinetic CP. According to the House functional classification, both hands were spontaneously and independently used in 55% of children (House 7-8), whereas 5% did not use either of their hands (House 0). Minor increase of flexor muscle tone (Zancolli level 1) was found in 69% of all children. Only 2% were in level 3 in both hands. Spastic thumb-in-palm deformity in 1 hand was found in 25% and in both hands in another 15%. CONCLUSIONS: Limitations in hand function are common in all types of CP, but characteristics of the disability vary considerably between different CP subtypes. The MACS classification is useful to evaluate how well children can handle objects in daily activities. The House functional classification describes grip function in each hand separately; the Zancolli classification of finger and wrist extension and the classification of thumb-in-palm deformity according to House give an estimate of dynamic spasticity. All these classifications were shown to be useful in a population-based health care program, but further studies of the psychometric properties are required.

Evaluation of the driving ability in disabled persons: a practitioners' view.

PURPOSE AND METHODS: The purpose of this paper is to present, on the basis of four genuine cases from the Rehabilitation Research Unit of Oulu University, the theoretical frame in which evaluations of driving ability of disabled persons can be made. RESULTS: First, it is not the operations with the control devices but the correct mental actions which the driver carries out with the help of the control devices which are crucial for safe driving. Second, driving ability is only partly a biomedical object of research and one ought to avoid an excessive medicalisation of an evaluation of driving ability. Third, the driver meets traffic situations not by his or her separate biological or psychological functions, such as vision, attention, memory, thinking, motives, but as an integrated whole, as a personality. CONCLUSIONS: By its complexity an evaluation of driving ability can be compared to an evaluation of working capacity where often a multidisciplinary team is needed. When evaluating driving ability we have to take a step from low-level motor operations towards high-level mental actions, from the measurement of acuity of eyesight towards the testing of the flexibility of perception, from the diagnosis-based evaluation to the patient-based evaluation, from using the common pencil-paper tests towards the traffic-related task-specific tests and from the testing of separate single general non-driving-related factors towards an evaluation of the theoretically based driving performance as whole.

Radial club hand deformity--the continuing challenges and controversies.

The records of 27 patients with Radial club hand deformity attending the Hospital and Rehabilitation Centre for Disabled Children (HRDC) were reviewed. This longitudinal intercalary deficiency of forearm growth has a varied clinical presentation and the goals of management are both improved function and cosmesis. We present the results of our treatment and review the current world literature on this challenging orthopaedic deformity.

Arthrogryposis wrist deformities: results of infantile serial casting.

Arthrogryposis multiplex congenita involving the upper extremity can be associated with significant contractures of major joints. Treatment options to maximize upper extremity motion and function include passive joint stretching, serial casting, or surgical intervention. This study reviewed all patients at Carrie Tingley Hospital with arthrogrypotic wrist flexion contractures treated with passive stretching, serial casting, and custom wrist orthotics to determine the effect on wrist position and function. Seventeen infant patients with distal and classic arthrogryposis used this regimen. Average follow-up was 6 years. The greatest gain in wrist motion occurred after the first casting session for both groups. Patients with distal arthrogryposis had the largest improvement in passive wrist motion, were more functionally independent at final follow-up, and had no recurrence of deformity. Patients with classic arthrogryposis had rigid wrist flexion contractures and a 75% incidence of deformity recurrence after casting. At final follow-up, these patients remained functionally dependent, requiring >50% assistance with activities of daily living, and had less improvement in wrist motion. The authors recommend early casting of infant wrist deformities for both forms of arthrogryposis. If the wrist deformity recurs, repeat serial casting is unlikely to improve wrist extension. Other treatment options may be considered in the older child.

[Holt-Oram syndrome. 3 case reports and their physical therapy, occupational therapy and technical orthopedic treatment]. / Das Holt-Oram-Syndrom. Drei Fallbeispiele und deren krankengymnastische, ergotherapeutische und orthopädie-technische Behandlung.

The combination of organ and skeletal malformation as well as the fact that Holt-Oram syndrome appears in many forms with related functional disturbances and makes it mandatory that the therapy for these patients be determined on an individual basis. Supportive statomotoric therapy of young patients plays a particularly central role, as do development-synchronized treatment aids. Physiotherapy, ergotherapy, and technical orthopedic support oriented toward functionality are all part of the therapeutic concept.