2,798,861 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
Control strategies for a multiple degree of freedom prosthetic hand
No full textSome of the traditional methods used to control a conventional prosthetic device are described alongside the current state of new control techniques and how they may progress. The review includes implantable myoelectric sensors and describes the potential of connecting directly to the peripheral nervous system. Control methods are then deduced for each technique, where the application is a six degrees of freedom hand having integral slip, force and temperature sensors
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
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
A comparative study on unconstrained hand biometrics
No full textBiometrics applied to mobile devices are of great interest for security applications. Daily scenarios can benefit of a combination of both the most secure systems and most simple and extended devices. This document presents a hand biometric system oriented to mobile devices, proposing a non-intrusive, contact-less acquisition process where final users should take a picture of their hand in free-space with a mobile device without removals of rings, bracelets or watches. The main contribution of this paper is threefold: firstly, a feature extraction method is proposed, providing invariant hand measurements to previous changes; second contribution consists of providing a template creation based on hand geometric distances, requiring information from only one individual, without considering data from the rest of individuals within the database; finally, a proposal for template matching is proposed, minimizing the intra-class similarity and maximizing the inter-class likeliness. The proposed method is evaluated using three publicly available contact-less, platform-free databases. In addition, the results obtained with these databases will be compared to the results provided by two competitive pattern recognition techniques, namely Support Vector Machines (SVM) and k-Nearest Neighbour, often employed within the literature. Therefore, this approach provides an appropriate solution to adapt hand biometrics to mobile devices, with an accurate results and a non-intrusive acquisition procedure which increases the overall acceptance from the final user
Ulnar collateral ligament injuries of the thumb- An overview of the injury and treatment
No full textComing 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
Secondary thumb reconstruction in a mutilated hand
No full textThe thumb plays an integral role in hand function. Traumatic amputation results in significant morbidity. With loss of the thumb, up to a 40% reduction in hand function may result. Thumb replantation must be attempted when possible. The goals of thumb reconstruction are to replicate normal function as closely as possible, minimize donor site morbidity, and expedite recovery. In the setting of a mutilated hand, the status of the remaining digits must be carefully assessed. Toe transfers, osteoplastic thumb reconstruction, and pollicization are commonly used. This article summarizes the indications and technical considerations in addressing the deficiencies after thumb amputation.No Full Tex
Regaining Motor Control in Musician's Dystonia by Restoring Sensorimotor Organization
No full textProfessional musicians are an excellent human model of long term effects of skilled motor training on the structure and function of the motor system. However, such effects are accompanied by an increased risk of developing motor abnormalities, in particular musician's dystonia. Previously we found that there was an expanded spatial integration of proprioceptive input into the hand area of motor cortex (sensorimotor organisation, SMO) in healthy musicians as tested with a transcranial magnetic stimulation (TMS) paradigm. In musician's dystonia, this expansion was even larger, resulting in a complete lack of somatotopic organisation. We hypothesised that the disordered motor control in musician's dystonia is a consequence of the disordered SMO.
In the present paper we test this idea by giving pianists with musician's dystonia 15 min experience of a modified proprioceptive training task. This restored SMO towards that seen in healthy pianists. Crucially, motor control of the affected task improved significantly and objectively as measured with a MIDI piano, and the amount of behavioural improvement was significantly correlated to the degree of sensorimotor re-organisation. In healthy pianists and non-musicians, the SMO and motor performance remained essentially unchanged. These findings suggest a link between the differentiation of SMO in the hand motor cortex and the degree of motor control of intensively practiced tasks in highly skilled individuals
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