Faculty Bibliography

BACKGROUND:Holt-Oram syndrome (HOS) is a rare, genetic condition characterized by the combination of congenital heart defect and hypoplasia in one or both upper extremities. Children with HOS commonly present with varied joint and limb involvement including radial longitudinal deficiency impacting hand function. Evidence-based guidelines regarding orthotic wear and therapeutic techniques are lacking. PURPOSE/OBJECTIVE:The aim of this case report was to present the results of a long-term occupational therapy program for a patient with HOS pre and postpollicization. STUDY DESIGN/METHODS:Case report. METHODS:A 4-month-old patient with bilateral radial longitudinal deficiencies began outpatient occupational therapy for custom orthosis fabrication and treatment which included long term clinic and home-based intervention. Techniques included passive range of motion, orthosis wear, therapeutic taping, and modified constraint induced movement therapy. Longitudinal assessment of musculoskeletal alignment and functional hand use was performed using goniometry for passive and active range of motion, the Assisting Hand Assessment (AHA), and The Thumb Grasp and Pinch Assessment (T-GAP). RESULTS:Improvement in passive and active range of motion was achieved as well as improved activity level function as measured by the AHA and T-GAP postpollicization and intervention. CONCLUSIONS:A combined clinic and home-based therapeutic approach can be effective for children with HOS to improve alignment and function pre and postpollicization to further enhance hand function. Comprehensive, long-term assessment is necessary to fully evaluate and communicate improvement.

Objective/UNASSIGNED:To delineate healthcare disruption for individuals with (ABI) during the peak of the pandemic, and to understand the impact of healthcare disruption on health-related quality of life (HRQoL). Design/UNASSIGNED:Cross-sectional survey. Setting/UNASSIGNED:General community. Participants/UNASSIGNED:N=207. Volunteer sample of adults with traumatic brain injury (TBI, n=33), stroke (n=66), and healthy adults (n=108) with access to the internet and personal technology. Interventions/UNASSIGNED:NA. Main Outcome Measures/UNASSIGNED:NA. Results/UNASSIGNED: = 0.148). Conclusion/UNASSIGNED:Individuals with and without ABI experienced pronounced disruption in healthcare utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental healthcare were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but, limitations included difficulty with technology, difficulty with comprehensive exam, and decreased rapport with providers.

PURPOSE/UNASSIGNED:To address the gap in the literature and clarify the expanding role of wearable sensor data in stroke rehabilitation, we summarized the methods for upper extremity (UE) sensor-based assessment and sensor-based treatment. MATERIALS AND METHODS/UNASSIGNED:The guideline outlined by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews was used to complete this scoping review. Information pertaining to participant demographics, sensory information, data collection, data processing, data analysis, and study results were extracted from the studies for analysis and synthesis. RESULTS/UNASSIGNED:We included 43 articles in the final review. We organized the results into assessment and treatment categories. The included articles used wearable sensors to identify UE functional motion, categorize motor impairment/activity limitation, and quantify real-world use. Wearable sensors were also used to augment UE training by triggering sensory cues or providing instructional feedback about the affected UE. CONCLUSIONS/UNASSIGNED:Sensors have the potential to greatly expand assessment and treatment beyond traditional clinic-based approaches. This capability could support the quantification of rehabilitation dose, the nuanced assessment of impairment and activity limitation, the characterization of daily UE use patterns in real-world settings, and augment UE training adherence for home-based rehabilitation.IMPLICATIONS FOR REHABILITATIONSensor data have been used to assess UE functional motion, motor impairment/activity limitation, and real-world use.Sensor-assisted treatment approaches are emerging, and may be a promising tool to augment UE adherence in home-based rehabilitation.Wearable sensors may extend our ability to objectively assess UE motion beyond supervised clinical settings, and into home and community settings.

The aim of this study was to examine the effects of instruction adherence on upper extremity motor outcomes after highly structured intervention. A secondary data analysis was completed using mixed linear modelling design. Thirty chronic stroke survivors with moderate-to-severe arm impairment were assigned explicit movement instructions and completed 12 robotic therapy sessions over four weeks. Instruction adherence was measured weekly using the Manipulation Check Questionnaire (MCQ). Motor outcomes were measured at baseline, discharge, and at 4-week follow-up using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS). There were no effects of adherence-related variables on upper extremity motor outcomes (p values > .2). Participant scores improved for both FMA-UE and WMFT-FAS from baseline to follow-up (p values < .001). Participants improved motor function after 12 weeks of robotic training, however, instruction adherence did not affect motor improvement. Adherence to explicit information may play a limited role in motor learning for stroke survivors with moderate-to-severe arm impairment during highly structured training protocols.

IMPORTANCE/OBJECTIVE:Effective treatment of the affected hand after stroke is crucial for improved functional independence and recovery. OBJECTIVE:To determine the feasibility and clinical utility of an electromyography-triggered hand robot. DESIGN/METHODS:Single-group repeated-measures design. Participants completed training 3×/wk for 6 wk. Feasibility data included participant feedback, adverse events, and compliance rates. Upper extremity outcomes were collected at baseline, discharge, and 6-wk follow-up. SETTING/METHODS:Outpatient clinic. PARTICIPANTS/METHODS:Twelve stroke survivors at least 6 mo poststroke living in the community. INTERVENTION/METHODS:Eighteen sessions of intensive robotic hand therapy over 6 wk. Each 60-min treatment session was personalized to match the participant's ability. OUTCOMES AND MEASURES/UNASSIGNED:Arm Motor Ability Test (AMAT), Stroke Impact Scale Hand subscale (SIS-H), Stroke Upper Limb Capacity Scale (SULCS), Fugl-Meyer Assessment, Box and Block Test, and dynamometer. RESULTS:All participants completed the training phase. Mild skin pinching or rubbing at dorsal proximal interphalangeal joint and proximal arm fatigue were the most common adverse events. Improvements in raw scores were achieved from baseline to discharge for all outcome measures, except the SULCS. Participants significantly improved from baseline to discharge on the AMAT and the SIS-H, and improvements were maintained at 6-wk follow-up. CONCLUSION AND RELEVANCE/UNASSIGNED:Robotic hand training was feasible, safe, and well tolerated. Participants reported and demonstrated improvements in functional use of the affected arm. Thirty percent of participants achieved clinically significant improvements on the AMAT. We recommend further study of the device in a larger study using the AMAT as a primary outcome measure. WHAT THIS ARTICLE ADDS/UNASSIGNED:It is feasible and safe to implement a robotic hand training protocol for people with moderate to severe arm impairment in an outpatient setting. Robotic training may provide a viable option for this group to actively participate in intensive training of the distal hand.

OBJECTIVE: To compare the long-term effects of external focus (EF) versus internal focus (IF) of attention after 4-weeks of arm training. DESIGN: Randomized, repeated measure, mixed ANOVA. SETTING: Outpatient clinic. PARTICIPANTS: 33 individuals with stroke and moderate-to-severe arm impairment living in the community (3 withdrawals). INTERVENTIONS: 4-week arm training protocol on the InMotion ARM robot (12 sessions). MAIN OUTCOME MEASURES: Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up. RESULTS: There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment [Jt indep-EF, F(1.6, 45.4) = 17.74, p<.0005, partial eta2=.39; Jt indep-IF, F(2, 56)= 18.66, p<.0005, partial eta2=.40; FMA, F(2, 56) = 27.83, p<.0005, partial eta2=.50 ; WMFT, F(2, 56) =14.05, p<.0005, partial eta2=.35]. CONCLUSION: There were no differences in retention of motor skills between EF and IF participants four weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

OBJECTIVE: To investigate the feasibility of a combined clinic-home intervention using a robotic elbow brace and, secondarily, to collect preliminary data on the efficacy of this clinic-home intervention. DESIGN: Nonrandomized pre-/postinterventional study. SETTING: Outpatient clinic and participants' homes. PARTICIPANTS: Individuals at least 6 months after stroke (N=11; 5 women and 6 men; mean age, 51.7y; mean time since stroke, 7.6y; mean Fugl-Meyer Assessment of the Upper Extremity [FMA-UE] score, 22 of 66) were enrolled from the community. INTERVENTIONS: Participants received training in an outpatient clinic from an experienced occupational therapist to gain independence with use of the device (3-9 sessions) followed by a 6-week home program using the device at home. MAIN OUTCOME MEASURES: Five instruments were administered before and after the study intervention: Modified Ashworth Scale, Box and Blocks test, FMA-UE, Arm Motor Ability Test, and Motor Activity Log-Amount of Use and Motor Activity Log-How Well subscales (MAL-AOU, MAL-HW). RESULTS: Nine participants completed the study. Participants used the device on average 42.9min/d, 5.3d/wk. The FMA-UE (t=3.32; P=.01), MAL-AOU (t=4.40; P=.002), and MAL-HW (t=4.02; P=.004) scores showed statistically significant improvement from baseline to discharge; the MAL-AOU (t=2.61; P=.035) and MAL-HW (t=2.47; P=.043) scores were also significantly improved from baseline to 3-month follow-up. CONCLUSIONS: This combined clinic-home intervention was feasible and effective. Participants demonstrated improvements in arm impairment and self-reported use of the arm from baseline to discharge; they continued to report significant improvement in actual use of the arm at 3-month follow-up.