Rehabilitation of the upper extremity following nerve and tendon reconstruction: when and how.
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ABSTRACT:
SUBMITTER: Novak CB
PROVIDER: S-EPMC4317280 | biostudies-other | 2015 Feb
REPOSITORIES: biostudies-other
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Project description:Introduction Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications. Results On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations. Conclusion There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.
| S-EPMC8041497 | biostudies-literature
Project description:BACKGROUND Both spinal cord stimulators (SCS) and interdisciplinary chronic pain rehabilitation program (CPRP) are evidence-based treatments for chronic pain but differ on treatment foci. SCS focuses on decreasing the subjective pain experience as a means of improving function and quality of life. CPRP focuses on addressing the cognitive, emotional, and behavioral factors associated with chronic pain to improve function. Due to experimental constraints, these 2 treatment options are difficult to compare; however, this case report offers a unique opportunity to examine outcomes for both interventions in a sequential manner for changes in pain, function, and mood. CASE REPORT This single case study examined the separate and sequential outcomes of SCS and CPRP in a 26-year-old patient with a work-related injury resulting in chronic upper extremity pain. This patient was treated within an interdisciplinary CPRP following failure and removal of an SCS. Outcomes were measured by psychological assessments and return-to-work through a 6-month post-CPRP follow-up. CONCLUSIONS Pain intensity decreased following SCS placement and CPRP, while pain-related distress, pain interference, and overall affect improved only after CPRP, with sustained improvements at 6-month follow-up. Patient evidenced improvement following treatment with SCS and CPRP. SCS resulted in improvement in subjective pain and modest improved self-reported activity. CPRP demonstrated marked improvement in pain, self-reported function, and mood with patient eventually returning to work and maintaining most of these gains 6-months after completing CPRP treatment.
| S-EPMC6253559 | biostudies-other
Project description:Reconstruction of tendons following complex trauma to the upper limb presents unique clinical and research challenges. In this article, the authors review the principles guiding preoperative assessment, surgical reconstruction, and postoperative rehabilitation and management of the upper extremity. Tissue engineering approaches to address tissue shortages for tendon reconstruction are also discussed.
| S-EPMC4317277 | biostudies-other
Project description:Robotic rehabilitation is a promising approach to treat individuals with neurological or orthopedic disorders. However, despite significant advancements in the field of rehabilitation robotics, this technology has found limited traction in clinical practice. A key reason for this issue is that most robots are expensive, bulky, and not scalable for in-home rehabilitation. Here, we introduce a semi-passive rehabilitation robot (SepaRRo) that uses controllable passive actuators (i.e., brakes) to provide controllable resistances at the end-effector over a large workspace in a manner that is cost-effective and safe for in-home use. We also validated the device through theoretical analyses, hardware experiments, and human subject experiments. We found that by including kinematic redundancies in the robot's linkages, the device was able to provide controllable resistances to purely resist the movement of the end-effector, or to gently steer (i.e., perturb) its motion away from the intended path. When testing these capabilities on human subjects, we found that many of the upper-extremity muscles could be selectively targeted based on the forcefield prescribed to the user. These results indicate that SepaRRo could serve as a low-cost therapeutic tool for upper-extremity rehabilitation; however, further testing is required to evaluate its therapeutic benefits in patient population.
| S-EPMC5980770 | biostudies-literature
Project description:Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain-computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as "responders" (<1 = "non-responders") and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotal score at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p = 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors. Clinical Trial Registration: ClinicalTrials.gov, NCT02098265.
| S-EPMC6235950 | biostudies-literature
Project description:Spinal cord injury (SCI) is a profoundly debilitating condition with no effective treatment to date. The complex response of the central nervous system (CNS) to injury and its limited regeneration capacity pose bold challenges for restoring function. Cervical SCIs are the most prevalent and regaining hand function is a top priority for individuals living with cervical SCI. A promising avenue for addressing this challenge arises from the emerging field of regenerative rehabilitation, which combines regenerative biology with physical medicine approaches. The hypothesis for optimizing gains in upper extremity function centers on the integration of targeted neurorehabilitation with novel cell- and stem cell-based therapies. However, the precise roles and synergistic effects of these components remain poorly understood, given the intricate nature of SCI and the diversity of regenerative approaches. This perspective article sheds light on the current state of regenerative rehabilitation for cervical SCI. Notably, preclinical research has yet to fully incorporate rehabilitation protocols that mimic current clinical practices, which often rely on neuromodulation strategies to activate spared circuits below the injury level. Therefore, it becomes imperative to comprehensively investigate the combined effects of neuromodulation and regenerative medicine strategies in animal models before translating these therapies to individuals with SCI. In cases of severe upper extremity paralysis, the advent of neuromodulation strategies, such as corticospinal tract (CST) and spinal cord stimulation, holds promise as the next frontier in enhancing the effectiveness of cell- and stem cell-based therapies. Future preclinical studies should explore this convergence of neuromodulation and regenerative approaches to unlock new possibilities for upper extremity treatment after SCI.
| S-EPMC10791849 | biostudies-literature
Project description:Background: Medical malpractice accounts for more than $55 billion of annual health care costs. Updated malpractice risk to surgeons and physicians related to upper extremity peripheral nerve injury has not been published. Methods: A comprehensive database analysis of upper extremity nerve injury claims between 1995 and 2014 in the United States was conducted using the Medical Professional Liability Association Data Sharing Project, representing 24 major insurance companies. Results: Nerve injury in the upper extremity accounted for 614 (0.3%) malpractice claims (total of 188 323). Common presenting diagnoses included carpal tunnel syndrome (41%), upper extremity fractures (19%), and traumatic nerve injuries to the shoulder or upper limb (8%). Improper performance (49% of total claims) and claims without evidence of medical error (19%) were the most common malpractice suits. Orthopedic surgeons were the most frequently targeted specialists (42%). In all, 65% of nerve injury claims originated from operative procedures in a hospital, 59% of claims were dismissed or withdrawn prior to trial, and 30% resulted in settlements. Thirty-three percent of claims resulted in an indemnity payment to an injured party, with an average payout of $203 592 per successful suit. Only 8% of claims resulted in a completed trial and verdict, and verdicts were overwhelmingly in favor of the defendant (83%). Conclusions: Most malpractice claims from peripheral nerve injuries in the United States arise from the management of common diagnoses, occur in the operating room, and allege improper performance. Strategies to reduce malpractice risk should emphasize the management of common conditions and patient-physician communication.
| S-EPMC8283106 | biostudies-literature
Project description:Applications related to virtual reality are a rapidly growing area. Thus, these technologies are also increasingly used in the field of medicine and rehabilitation. The primary objective of this prospective pilot study was to investigate the feasibility, user experience and acceptance of a virtual-reality-based system for upper extremity rehabilitation. The study was conducted as a single-center trial over 16 weeks. The eligibility criteria included rehabilitants with upper extremity injuries of at least 18 years of age who were fluent in spoken and written German. After detailed instruction, each participant was asked to complete daily 30 min exercises over 15 training sessions with the virtual reality system consisting of three different training modules. Outcomes were assessed pre-study and post-study using standardized clinical measures. In addition, qualitative interviews with rehabilitants as well as therapists regarding user experience and acceptance were conducted. Six participants were recruited for the pilot study, of which five underwent virtual-reality-based rehabilitation. Overall, the clinical measures showed a positive tendency over the course of the study, even if the results were not significant. Furthermore, the virtual-reality-based training was well accepted by the participants as well as therapists. Given these findings, it will be beneficial to evaluate virtual reality for rehabilitation in further research.
| S-EPMC10218592 | biostudies-literature
Project description:ObjectiveTo present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial.DesignLiterature review and expert opinion.SettingSingle academic center.ResultsPeripheral nerve stimulation has recently become popular with the development and availability of peripheral nerve stimulators with an external pulse generator. Here, we describe ultrasound anatomy and technical details for peripheral nerve stimulation in the upper extremity for three major nerves: median, ulnar, and radial.ConclusionsUpper extremity peripheral nerve stimulation can be considered as an option for refractory neuropathic upper extremity pain.
| S-EPMC7828604 | biostudies-literature
Project description:Rehabilitation therapy plays an essential role in assisting people with stroke regain arm function. Upper extremity robot therapy offers a number of advantages over manual therapies, but can suffer from slacking behavior, where the user lets the robot guide their movements even when they are capable of doing so by themselves, representing a major barrier to reaching the full potential of robot-assist rehabilitation. This is a pilot clinical study that investigates the use of an electromyography-based adaptive assist-as-needed controller to avoid slacking behavior during robotic rehabilitation for people with stroke. The study involved a convenience sample of five individuals with chronic stroke who underwent a robot therapy program utilizing horizontal arm tasks. The Fugl-Meyer assessment (FM) was used to document motor impairment status at baseline. Velocity, time, and position were quantified as performance parameters during the training. Arm and shoulder surface electromyography (EMG) and electroencephalography (EEG) were used to assess the controller's performance. The cross-sectional results showed strong second-order relationships between FM score and outcome measures, where performance metrics (path length and accuracy) were sensitive to change in participants with lower functional status. In comparison, speed, EMG and EEG metrics were more sensitive to change in participants with higher functional status. EEG signal amplitude increased when the robot suggested that the robot was inducing a challenge during the training tasks. This study highlights the importance of multi-sensor integration to monitor and improve upper-extremity robotic therapy.
| S-EPMC10566685 | biostudies-literature