Ring orthosis design and production by rapid prototyping approach.

STUDY DESIGN: In this study, ring orthosis design and manufacturing was performed by using rapid prototyping technology. INTRODUCTION: Swan neck and boutonniere deformities may occur because of various reasons such as tendon injuries, sharp object injuries, or rheumatic diseases. Although the ring orthoses are the most commonly used conservative treatment method for swan neck and buttonhole deformities, they cannot be widely used because they are both difficult to produce and esthetically unsatisfied with the patients. PURPOSE OF THE STUDY: In this study, it was aimed to manufacture with an orthosis design that is fully compatible, more esthetic, faster, and easily produced. METHODS: 3D printing technologies are used in design and manufacturing. The 3D scanner is used in the measurement process, and the 3D printer is used in the manufacturing process. RESULTS: As a result of the study, a more esthetically pleasing and comfortable orthosis was made faster. DISCUSSION AND CONCLUSIONS: As a result of the study, the thickness of the material should not be less than 5 mm.

Congenital thumb anomalies and the consequences for daily life: patients' long-term experience after corrective surgery. A qualitative study.

PURPOSE: The aim of the study was to explore patients' long-term experience of a congenital hand problem, and the consequences for daily life. METHOD: Fifteen participants with a median age 24 years (17-55 years), born with thumb hypoplasia/aplasia or thumb duplication were interviewed using a semi-structured interview guide. The interviews were subjected to qualitative content analysis. RESULTS: Although the mobility and strength in the thumb/hand(s) varied within the group, hand function was generally described as good. Compensatory strategies were used to overcome practical obstacles. The emotional reactions to being visibly different from peers in early life varied from total acceptance and a sense of pride in being special, to deep distress and social withdrawal. Support from parents, teachers and others was important in facing emotional challenges and practical consequences. CONCLUSION: The present study highlights the importance of healthcare professionals addressing appearance-related concerns which may have long-term emotional and social consequences for patients born with a thumb anomaly. Implications for Rehabilitation Appearance-related concerns and need for emotional support should be fully considered throughout the rehabilitation process to prevent distress and social withdrawal. Effective problem-solving strategies, such as compensation, change in occupational performance and support from others may reduce activity limitations and participation restriction.

Severe camptodactyly: A systematic surgeon and therapist collaboration.

INTRODUCTION: Although common, the treatment of camptodactyly is controversial. PURPOSE: Our purpose is to delineate a logical stepwise treatment plan based on corresponding components of the pre-operative and intraoperative evaluation of camptodactyly. In addition, describe structure rehabilitation plan utilizing the same stepwise evaluation. METHODS: With the use of a retrospective cohort study design, we reviewed 18 consecutively operated digits in twelve patients with camptodactyly affecting the proximal interphalangeal (PIP) joint. There were five girls and eight boys, averaging eight years of age (range: 9 months to 15 years) at surgery. RESULTS: Surgery corrected flexion contractures with mean post-operative flexion contracture of 3° (range 0-25°) at mean follow-up of 11 months (range 3-32 months). 15 of 18 digits achieved full active PIP extension. DISCUSSION: By employing a detailed clinical assessment to guide surgical treatment followed by focused therapy, we have markedly improved flexion contractures in digits with moderate to severe camptodactyly. CONCLUSIONS: Hand therapy is essential to maintain and further surgical improvement of passive extension and to regain active extension following surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[Splints in occupational therapy of the hand in an Austrian central hospital--current status]. / Die ergotherapeutische Schienenversorgung der Hand in einem österreichischen Zentralkrankenhaus--eine Bestandsaufnahme.

Ergotherapeutic splinting is essential in the treatment of diseases, injuries and innate deformities of the hand. However due to its high material and staff costs, a definitely diagnosed indication is a prequisite for prescription. A retrospective study was performed using the Krankenhausinformationssystem (KIS) to establish the total number of hand splints prescribed by the Department of Physical Medicine and Rehabilitation of the General Hospital of Vienna from 1/1992 until 8/1998, as well as referring doctors/departments and diagnoses leading to referral were recorded and descriptively evaluated. The total number of patients was 1972. 1236 (63%) of the cases were referred by surgical departments/branches, 410 (20%) by internal departments, 151 (8%) by the neurological department and 175 (9%) by other departments. The diagnosis leading to referral were rheumatoid arthropathies (542 = 26%), peripheral nerve lesions (458 = 22%), tendon lesions (201 = 10%), Dupuytren' contractures after surgery (184 = 8%), degenerative joint diseases (82 = 4%), conditions after fractures (55 = 2.5%), patients after amputations (50 = 2.3%), disorders of the central nervous system (53 = 2.5%), focus removals (40 = 2%) and tendovagintis (35 = 1.7%). The remaining 19% were referred due to surgical repositionings, soft tissue injuries, local infections and various other diagnoses. The majority of ergotherapeutic splintings was prescribed due to forms of rheumatic or rheumatoid diseases, peripheral nerve lesions as well as hand surgery. In this study documenting the clinical practice of a medical center was primarily aimed at providing the basis for further discussion of both factual and economic aspects of future developments in splinting.

[The spastic hand. Postoperative rehabilitation]. / Die spastische Hand. Grundlagen der postoperativen Rehabilitation.

Postoperative rehabilitation starts with preoperative evaluation of the patient. The outcome of rehabilitation measures is strongly dependent on the surgeon's ability to define a realistic rehabilitation aim, i.e., a goal the patient can achieve with a high degree of probability. Therefore, knowledge of the patient's individual basic situation and status as well as of the autonomic development of the different categories of cerebral palsy is of great importance. The operative procedures used are well established in cerebral palsy surgery. They are accepted as standard procedures. The decisive question is to whom they are offered. The same conditions pertain to the postoperative rehabilitation period. During that time a combination of functional bracing and physiotherapy plus occupational therapy is offered after primary cast immobilization. This period is finished when the specific aim has been achieved, i.e., integration of the gained function into everyday life.

A method for shortening instruments using the Rasch model. Validation on a hand functional measure.

BACKGROUND: Many measurement instruments, particularly measures of hand functional ability, frequently comprise a large number of items. Reduced versions of these instruments can facilitate their use. This work proposes a new method for shortening an instrument. METHODS: The method proposed was based on a scale of item difficulty calculated using the Rasch model. It was applied on a hand functional measure comprising 67 tests. The sample included 194 patients with hand lesions. The shortened instrument obtained was compared with those provided by classic methods used in the literature, with item random choice, and with shortened versions proposed by four independent experts, two rehabilitation physicians and two occupational therapists, who are clinicians familiar with the tool. All the statistical analyses were carried out on a random sub-group of two-thirds of the sample. A cross validation was then carried out on the remaining third. RESULTS: The reduction obtained had score non significantly different from that of the original instrument. In addition, the intra-class correlation coefficient and the Cronbach alpha coefficient were high. Among the different degrees of reduction investigated, the 12-item version seemed to be appropriate. Our method appeared to provide better results in terms of discriminant validity and internal validity than the choices of the four experts. The reductions produced were also better than those obtained by classic methods based on principal component analysis and multiple linear regression, as well as those obtained by random choices of items. CONCLUSION: The method presented is pertinent and useful. The reduction obtained appeared to be better than the choices of experts and the reductions provided by classic methods. The method could be used in other fields.

Strength measurements of the lumbrical muscles.

This study was designed to measure the strength of the lumbrical muscles in the index and long fingers in patients with ulnar nerve paralysis. A hand-held dynamometer was used. The results show that in ulnar nerve damage the index and long fingers have a mean metacarpophalangeal (MCP) joint flexion strength of 0.8 kg (range 0.3-1.5), compared with 6.4 kg (range 4.6-7.9) in the noninvolved hand. Thus, the damaged fingers have only about 12% of the strength of those of the noninvolved hand. In the hand with ulnar paralysis, the loss of intrinsic strength (dorsal and palmar interosseous muscles) is considerable (almost 90%). The contribution of the interosseous muscles in maintaining the intrinsic position is considerably greater than that of the lumbricals. Comparing the Medical Research Council (MRC) scale (0-5) with the dynamometry measurements shows that MRC grade 3 correlates with about 0.8 kg, while grade 5 correlates with about 6.5 kg of MCP joint flexion strength.

The use of synthetic plaster casting tape for hand and wrist splints.

In a prospective study, 40 patients were fitted with synthetic plaster splints to assess the use of such material for hand and/or wrist splints. Factors assessed in both splint fabrication and use included molding properties, elastic traction fixation, weight, ventilation, durability, patient comfort, effectiveness, practicability, time, and cost. The patients were divided into three groups according to basic pathology: tendon/nerve injuries; bone and joint disorders; and rheumatoid disease deformities. Recovery of 50-100% of active range of motion was considered a good result. Good results were obtained in 37 patients (92.5%), whereas in the remaining three patients (7.5%) the results were poor. It is suggested that synthetic plaster is a suitable material for the fabrication of splints in hand rehabilitation.

Surgical treatment and postoperative splinting of recessive dystrophic epidermolysis bullosa.

Digital contractures and pseudosyndactyly, common manifestations in recessive dystrophic epidermolysis bullosa, cause significant functional impairment. The deformities progress with time, although surgery may delay the progression. The role of surgical intervention, hand therapy, and the use of prolonged splinting was examined in seven children (nine hands) with recessive dystrophic epidermolysis bullosa with an average age of 5 years, 8 months (range, 1 year, 10 months to 16 years, 4 months). The technique of surgery, postoperative regimen, and splinting differ from those previously reported. Surgery includes "de-cocooning" the hand and fingers, manipulating contracted joints, and full-thickness skin grafting to dermal defects. Surgery and the postoperative regimen of rigid night splints and web-retaining gloves for day wear has allowed arrest or minimal progression of contractures in complaint patients in short-term follow-up study of an average of 17 months (range, 12-28 months). An interdisciplinary team of physicians and surgeons, therapists, and nurses makes this care regimen possible and influences family compliance.

Aparato de compresión-distracción modelo 1 (ACD-1) en el tratamiento de la sindactilia. Informe de 2 casos / Compression-distraction device model 1 (ACD-1) for treatment of syndactily. report of 2 cases

El objetivo de este artículo es demostrar la utilidad del empleo del ACD-1 en la formación de piel como primera etapa, por un proceso de distracción dosificada en el tratamiento quirúrgico de la sindactilia. Se estudiaron 2 hombres sanos mayores de 20 años que acudieron voluntariamente quirúrgico basado en el uso del ACD-1. A cada paciente fueron montados 3 apartas ACD-1, en las falanges proximal, media y distal de cada uno de los dedos afectados, para inmediatamante después llevar a cabo un proceso de distracción en cada uno de los aparatos a razón de 1 mm diario, hasta obtener la suficiente piel para llevar a cabo la plástica. En los dos casos el resultado fue satisfactorio, conservándose la actividad de los dedos durante el proceso de distracción, evitando de esta manera complicaciones postoperatorias como contracturas, necrosis o desgarros

Ranges of joint motion of the adult hand.

Norms of the motion of the joints of the adult hand are presented. Examined were 100 males and 100 females aged 20-25 years. All of them were university students in whom the hand was not affected by work or other one-sided activities and so its motion could be considered as the optimal (left-handed students were not included in this series). The passive and active flexions and hyperextensions were measured in all fingers of both hands as well as in the wrist. In the latter were measured in addition both active ductions. The results may serve for an assessment of deviations in joint motion of the hand in inborn malformations and other diseases, sequelae of injuries, during rehabilitation and evaluation of the effect of working and other manual activities etc. Differences in motion of the individual joints of the same type and differences between the right and the left side and both sexes were assessed as well.