255,626 research outputs found
Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study
No full textIntroduction
There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR.
Methods
We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round.
Results
There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5–14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers.
Conclusion
Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients
The effectiveness of origami on overall hand function after injury: A pilot controlled trial
No full textThis pilot study measured the effectiveness of using origami to improve the overall hand function of outpatients attending an NHS hand injury unit. The initiative came from one of the authors who had used origami informally in the clinical setting and observed beneficial effects. These observed effects were tested experimentally. The design was a pilot non-randomised controlled trial with 13 participants. Allocation of the seven control group members was based on patient preference. The experimental group members attended a weekly hour of origami for six weeks, in addition to their conventional rehabilitation.
Hand function of all participants was measured using the Jebsen-Taylor Hand Function Test before and after the six-week period, and additional qualitative data were gathered in the form of written evaluations from patients. The quantitative data were analysed using the Mann Whitney U test or Fisher’s exact test. Themes were highlighted from the qualitative data.
The results show that there was a greater difference in the total score of the experimental group using the impaired hand between pre- and post-intervention of 11.8 seconds, compared with 4.3 seconds in the control group, but this was not statistically significant at the 5% level (p=0.06). Additionally, differences in the sub-test scores show a markedly larger improvement in the experimental group. Qualitative data indicate that the experimental group experienced the origami sessions as being enjoyable and beneficial. Further research with a larger sample and randomised group allocation is recommended to verify and expand these preliminary findings
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Real time hand gesture recognition including hand segmentation and tracking
No full textIn this paper we present a system that performs automatic gesture recognition. The system consists of two main components: (i) A unified technique for segmentation and tracking of face and hands using a skin detection algorithm along with handling occlusion between skin objects to keep track of the status of the occluded parts. This is realized by combining 3 useful features, namely, color, motion and position. (ii) A static and dynamic gesture recognition system. Static gesture recognition is achieved using a robust hand shape classification, based on PCA subspaces, that is invariant to scale along with small translation and rotation transformations. Combining hand shape classification with position information and using DHMMs allows us to accomplish dynamic gesture recognition
Advanced clinical practice in closed hand trauma: Codevelopment of a hand therapist--led fracture clinic.
No full textBACKGROUND: Closed hand trauma is prevalent, and its management is healthcare service intensive. In the United Kingdom, persistent healthcare austerity and challenges of providing care compliant with national guidance are driving innovation in practice. Increasingly, advanced clinical practice hand therapists work in the fracture clinic performing assessment of closed hand trauma and deciding on surgical or nonsurgical treatment options. PURPOSE: Reported is the codevelopment of a hand therapist--led closed hand trauma clinic, aiming to promote practice development internationally. STUDY DESIGN: Service evaluation. METHODS: With "Innovate at Imperial," charity funding the Enhanced Pathway for Injuries that are Closed and Complex (EPIC) was developed. This article describes the pathway and reports on (i) the codevelopment using focus groups with patients; (ii) a quantitative evaluation of the pathway; and (iii) a qualitative exploration of patient experience of EPIC using satisfaction questionnaires and a focus group. RESULTS: Initial focus groups revealed that patients valued early intervention, expert opinion, kindness, personalized care, and being included in the treatment decision-making. They trusted therapists to deliver care. Of the 212 patients assessed in the first 9months, 75% were referred to hand therapy, 22% were discharged, and 4% referred for surgery. Active range of motion at discharge was excellent or good in 79% of patients, pain absent or minimal in 81%, and Patient-Rated Wrist and Hand Evaluation score 25 or lower in 59%. Patients referred to hand therapy required two appointments (median). Therapists attained clinical proficiency over 3-6months, assessed by the number of cases queried with hand surgeons. Patient satisfaction with the pathway was high and no patients requested to see a hand surgeon instead of a therapist. CONCLUSIONS: Therapists can safely and efficiently lead closed hand trauma clinics. This codeveloped pathway can serve as a model for other centers
Coming clean on hand hygiene
No full textIntroduction: Hand hygiene is universally recognized as one of the most effective ways to reduce the cross-transmission of hospital acquired infections. Successful strategies to improve hand hygiene compliance require a baseline knowledge of hand hygiene practices. Methodology: A direct observational method was used to collect data about hand hygiene practices amongst medical doctors by a group of trained medical students during their clinical assignments. To prevent any bias during the observation, the purpose of the study was not disclosed to the doctors; they only knew that they were being observed for infection control practices. A structured data collection sheet was used to direct the observations. Data on hand hygiene practices was collected during routine clinical work over a number of weeks. Observers recorded the professional grade of physician observed, speciality, location, activity performed, method used, and facilities available. Results: A total of 898 observations were recorded. Overall compliance before and after doctor-patient contact was 22.7% and 33.5% respectively. Within specialties, hand hygiene practices were lowest in obstetrics and gynaecology and highest in specialized surgical units. Poorest compliance was evident in house officers before patient contact, while the most compliant was the registrar group, following examination. Alcohol hand rub was the preferred method in the wards whilst hand washing was mainly utilised in the outpatient setting. Conclusion: Hand hygiene amongst doctors in St Luke's Hospital is low and could be a factor in the high MRSA endemicity.peer-reviewe
The development of hand preference in children: The effect of task demands and links with manual dexterity
No full textLateralisation of hand preference and manual dexterity are known to develop over childhood, while in
adulthood strength of hand preference has been shown to interact with extrinsic task demands. Some
evidence exists to suggest that strength of hand preference and motor skill may be related. In the current
study a handedness inventory, midline crossing (QHP) and peg-moving tasks were used to investigate:
(1) the development of hand preference between 4 and 11 years; (2) whether extrinsic task demands
affect strength of hand preference, and (3) whether strength of hand preference was associated with
manual dexterity. Younger children (4–5 years) showed weak hand preference in comparison to older
children (8–11 years), and extrinsic task demands influenced willingness to cross the body’s midline with
the preferred hand. Age and peg-moving speed were associated with midline crossing in certain task conditions. Overall, results suggest a coupling between manual dexterity and brain maturation in typical
development
Post-operative rehabilitation after PIP joint arthroplasty with early active motion: A retrospective review of outcomes
No full textWe present a retrospectively review of outcomes of the first fifteen patients who underwent proximal interphalangeal (PIP) joint arthroplasty and were treated using the same early active motion rehabilitation regime introduced by the therapy department at Mount Vernon Hospital. The regime utilises early motion of the PIP joint while protecting the arthroplasty with a small static splint and digit strapping to reduce lateral forces on the joint.
The notes of fifteen patients were reviewed and their outcomes presented. To evaluate the outcomes in more detail the patients were divided into three groups according to their diagnostic reason for the procedure (rheumatoid arthritis, osteoarthritis and trauma). The overall mean arc of motion at the PIP joint on discharge from therapy was 54 improved from 28 pre operatively.
The patients with the osteoarthritic PIP joints gained the largest improvement in the PIP joint arc of motion and required the least rehabilitation intervention. Patients with rheumatoid arthritis required intense rehabilitation to gain less overall PIP joint motion but still reported satisfaction with their outcome. All 15 patients experienced an improvement in their pain level and subjectively reported increased function in their affected hand.
Following this retrospective review of cases the team continue to use this regime for metal and silastic prosthesis but now routinely provide additional written information pre operatively to assist patients’ understanding of the procedure and the extent of the rehabilitation required
Simplified Hand Configuration for Object Manipulation
No full textThis work is focused on obtaining realistic human hand models that are suitable for manipulation tasks. Firstly, a 24 DOF kinematic model of the human hand is defined. This model is based on the human skeleton. Intra-finger and inter-finger constraints have been included in order to improve the movement realism. Secondly, two simplified hand descriptions (9 and 6 DOF) have been developed according to the constraints predefined. These simplified models involve some errors in reconstructing the hand posture. These errors are calculated with respect to the 24 DOF model and evaluated according to the hand gestures. Finally, some criteria are defined by which to select the hand description best suited to the features of the manipulation task
Hand gesture recognition for multimedia applications
No full textHand gesture is potentially a very natural and useful modality for human-machine interaction. It is considered to be one of the most complicated and interesting challenges
in computer vision due to its articulated structure and environmental variations. Solving such challenges requires robust hand detection, feature description, and viewpoint invariant classification.
This thesis introduces several steps to tackle these challenges and applies them in a hand-gesture-based application (a game) to demonstrate the proposed approach.
Techniques on new feature description, hand gesture detection and viewpoint invariant methods are explored and evaluated. A normal webcam is used in the research as input
device. Hands are segmented using pre-trained skin colour models and tracked using the CAMShift tracker. Moment invariants are used as a shape descriptor.
A new approach utilising the Zernike Velocity Moments (ZVMs, first introduced by Shutler and Nixon [1,2]), is examined on hand gestures. Results obtained using the
ZVMs as spatial-temporal descriptor are compared to an HMM with Zemike moments (ZMs). Manually isolated hand gestures are used as input to the ZVM descriptor which generates vectors of features that are classified using a regression classifier. The performance of ZVM is evaluated using isolated, user-independent and user-dependent data.
Isolating (segmenting) the gesture manually from a video stream for gesture recognition is a research proposition only and real life scenarios require an automatic hand
gesture detection mechanism. Two methods for detecting gestures are examined. Firstly, hand gesture detection is performed using a sliding window which segments sequences of frames and then evaluates them against pre-trained HMMs. Secondly, the set of class-specific HMMs is combined into a single HMM and the Viterbi algorithm is then used to find the optimal sequence of gestures.
Finally, the thesis proposes a flexible application that provides the user with options to perform the gesture from different viewpoints. A usable hand gesture recognition
system should be able to cope with such viewpoint variations. To solve this problem, a new approach is introduced which makes use of 3D models of hand gestures (not postures) for generating projections. A virtual arm with 3D models of real hands is created. After that, virtual movements of the hand are simulated using animation
software and projected from different viewpoints. Using a multi-Gaussian HMM, the system is trained on the projected sequences. Each set of hand gesture projections is
marked with its specific class and used to train the single multi-class HMNI with gestures across different viewpoints
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