Search

Studies on functional recovery after pediatric forearm fractures are scarce. Outcome measures are usually (retrospectively) incorporated to compare treatments. How these parameters recover has only rarely fallen within the scope. Aim was to provide insight into "normal recovery" by evaluating how limitations, post-traumatic symptoms, range of motion (ROM) and dexterity recuperate. Prospective observational study regarding children 4 and 18 years with a reduced forearm fracture. Limitations, post-traumatic symptoms, ROM, and dexterity were evaluated 6 weeks, 3 and 6 months post-trauma. ROM of the unaffected side was used as a baseline. Of 54 participants 25.9% and 5.9% perceived limitations after 3 respectively 6 months. Pain, swelling and hypertrichosis were common symptoms. Movements distal from the elbow were restrained 6 weeks post-trauma. Supination and palmar flexion were most affected, followed by dorsal flexion and pronation. Palmar flexion and pronation were still affected after 3 months and associated with treatment invasiveness. Dexterity was diminished at 6 weeks only. Mild limitations are common. Further investigation of the association between pain, reduced sensitivity and hypertrichosis with treatment invasiveness is warranted. Regarding ROM supination, pronation, palmar and dorsal flexion should be incorporated in future studies. Dexterity is an unsuitable outcome measure. This study relates to monitoring recovery from pediatric forearm fractures. Physicians ought to realize that one in four children experience limitations preceding 3 months post-trauma, in which case involvement of a hand therapist should be considered. Pain, swelling and especially hypertrichosis are common post-traumatic symptoms in children and should on itself not immediately raise concerns for complex regional pain syndrome (CRPS). To assess recovery of range of motion measuring pronation, supination, dorsal, and palmar flexion is sufficient. [ABSTRACT FROM AUTHOR]

The measurement of physical fitness of lower limb amputees is difficult, as the commonly used ergometer tests have limitations. A combined arm-leg (Cruiser) ergometer might be valuable. The aim of this study was to establish the repeatability and validity of the combined arm-leg (Cruiser) ergometer. Thirty healthy volunteers carried out three incremental exercise tests, once on the bicycle ergometer and twice on the Cruiser ergometer. The repeatability of the Cruiser ergometer was assessed by studying the mean values of the test-retest and the validity by studying the mean values of the bicycle and the two Cruiser ergometer tests. The intraclass correlation coefficient for repeated measurements on the Cruiser ergometer was 0.84 for the maximal oxygen consumption (V[subscript O2max]), and 0.71 for the maximal heart rate (HR[subscript max]). The intraclass correlation coefficient for the measurements on the bicycle ergometer and the Cruiser ergometer was 0.86 for the V[subscript O2max] and 0.73 for HR[subscript max]. Bland and Altman plots for V[subscript O2max] and HR[subscript max] showed a bias close to zero and a great accuracy. The conclusion of this study is that the Cruiser ergometer provides a repeatable and valid measurement of physical fitness in healthy volunteers. Its value in clinical practice for lower limb amputees needs to be further established.

This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting. A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth. Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered. Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered. Differences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance. When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences. From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required. It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans. During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants. [ABSTRACT FROM AUTHOR]

In persons with a hip or knee flexion contracture ≥25°, fitting a prosthesis is said to be difficult. This systematic review aims to assess the evidence for fitting of a prosthesis in persons with a severe contracture (≥25°) after a lower limb amputation. PubMed, Embase, Scopus, CINAHL, and Orthotics & Prosthetics Virtual Library databases were searched from inception to December 2019, using database specific search terms related to amputation, prosthesis, and contracture. Reference lists of included studies were checked for relevant studies. Quality of the included studies was assessed using the critical appraisal checklist for case reports (Joanna Briggs Institute). In total, 13 case studies provided evidence for fitting of a prosthesis in more than 63 persons with a transtibial amputation and three with a transfemoral amputation, all of whom had a hip or knee flexion contracture ≥25°. Some studies found a reduction in contractures after prosthesis use. Several techniques for fitting a prosthesis in case of a flexion contracture ≥25° were found. Contracture reduction occurred in some cases and was possibly related to prosthesis use. Fitting a transtibial or transfemoral prosthesis in persons with a lower limb amputation with a severe flexion contracture is possible. This study provides information on prosthesis prescriptions and adaptations for persons with a transfemoral and transtibial amputation with a flexion contracture ≥25°. The fitting of bent prostheses is not limited by prosthetic components and techniques. Parallel to the use of bent prostheses, it is also important to treat the contracture. [ABSTRACT FROM AUTHOR]