Hand Injury Patients Receiving Different Rehabilitation Programs
Condition: Hand Injury
MeSH terms: Wounds and Injuries; Hand Injuries
Study type: Interventional

Summary: 
      Hand injury is one of common occupational or traumatic injury at outpatient clinic of
      rehabilitation department. The motor or sensory deficits after hand trauma including bony
      fracture,tendon / nerve injury, joint stiffness, motion restriction, sensory impairment, or
      pain lead to impaired upper extremity function, ability for daily activity, or quality of
      life. Rehabilitation is a kind of therapy for disability after hand trauma. It could provide
      pain control, improvement of joint motion, stiffness reduction, preventing secondary trauma.
      The investigators consider that there are some deficits in hand function and range of motion,
      pain after injury, and some attenuation of brain functional MRI (fMRI) for hand motor
      control. Therefore, optimal and early intervention of rehabilitation programs may have some
      benefits for their hand functional outcome and improve the brain activities in fMRI images
      for the hand motor control.

      The aims of this study are to compare the differences in hand motor control area of brain
      functional MRI (fMRI) between normal subjects and hand injury patients before treatment and
      to investigate the improvement in brain fMRI activity and functional outcome after early
      rehabilitation in hand injury patients.

      The investigators will collect 40 patients with hand trauma after operation and 10 normal
      subjects in this study. The 10 normal subjects were allocated in the control group. These 40
      patients were randomly divided into 2 experimental groups: 20 patients in group A and 20
      patients in group B.

      In group A and B, the patients will perform immobilization and Kleinert programs
      respectively. All patients will perform rehabilitation regimen with 2-3 sessions per week for
      3-6 months. Before and after rehabilitation, all patients will receive physical examinations,
      brain fMRI, and DASH questionnaire for daily activity.
    

Detailed description: 
      Rehabilitation regimen is a noninvasive therapy for hand injured patients after operation.
      Protected active/passive motion is the mostly used method. Rehabilitation therapy could
      provide pain control, improvement of joint motion, stiffness reduction, preventing secondary
      trauma. The investigators will collect 40 patients with hand trauma after operation and 10
      normal subjects in this study. These 40 patients were divided into 2 experimental groups: 20
      patients in group A ( immobilization program) and 20 patients in group B (Kleinert program).

      A.The immobilization program 0-4 week: dorsal prospective splint in the wrist and MCP joint
      flexion and IP joint full extension.

      3-4 weeks: Hourly: 10 repetitions of passive digital flexion and extension with wrist at
      10ﾟextension. Hourly: 10 repetitions of active tendon gliding exercises.

      4-6 weeks: dorsal blocking splint discontinued. Gentle blocking exercises initiated 10
      repetitions, 4-6 times daily added to passive flexion and tendon gliding.

      6-8 weeks: gentle resistive exercise being and progresses gradually. B.The Kleinert program
      0-3 day: dorsal protective splint applied with wrist and MCP joints in flexion and IP joints
      in full extension; elastic traction from fingernail, through palmar pulley, to volar forearm.
      Velcro strap to allow night release of elastic traction, splinting IPs in full extension.

      0-4 weeks: hourly active extension to limits of splint, followed by flexion with elastic
      traction only. Wound and scar management and education. 4-6 weeks: dorsal protective splint
      discontinued, sometimes replaced with wrist cuff and elastic traction. Night protective
      splint to prevent flexion contracture. Active wrist and gentle active fisting initiated
      unless signs of minimal adhesions. At 6 weeks blocking exercises begin.

      6-8 weeks: progressive resistive exercises begin. The investigators will perform the physical
      examination, brain fMRI, and QuickDASH questionnaire for each patient before the program, 3
      and 6 months later. Functional magnetic resonance imaging (fMRI) will be also performed in
      normal participants.

      All patients will perform rehabilitation with 2-3 sessions per week. The investigators will
      perform the physical examination, brain fMRI, and QuickDASH questionnaire for each patient
      before the program, 3 and 6 months later. Functional magnetic resonance imaging (fMRI) will
      be also performed in normal participants.
    

Intervention name(s): custom-made dynamic hand splint; custom-made protective hand splint; physical therapy and occupational therapy
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): custom-made dynamic splinting with more early active exercises intervention.; Immobilization splint with gentle ROM exercises; both the immobilization and Kleinert programs including physical therapy and occupational therapy for 2-3 times per week.
Other intervention name(s): Dynamic splint; resting hand splint
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: rehabilitation; functional MRI