Corry K. van der Sluis

A prospective study on paediatric traffic injuries: health-related quality of life and post-traumatic stress

Objectives: To examine childrens reports of their health-related quality of life (HRQoL) following paediatric traffic injury, to explore child and parental post-traumatic stress, and to identify children and parents with adverse outcomes. Design: Prospective cohort study. Assessments: shortly after the injury, three months and six months post injury. Setting: Department of Traumatology, University Hospital. Subjects: Fifty-one young traffic injury victims aged 8-15 years. Main measures: TNO-AZL Childrens Quality of Life questionnaire and the Impact of Event Scale. Results: Short-term adverse changes in the childs HRQoL were observed for the childs motor functioning and autonomy. At three months, 12% of the children and 16% of the parents reported serious post-traumatic stress symptoms. Increased stress at three months, or across follow-up, was observed among hospitalized children, children with head injuries, and children injured in a motor vehicle accident. Parental stress was related to low socioeconomic status and the seriousness of the childs injury and accident (hospitalization, head injury, serious injury, motor vehicle involved, others injured). Conclusions: The children reported only temporary effects in their motor functioning and autonomy. Post-traumatic stress symptoms following paediatric traffic injury were not only experienced by the children, but also by their parents.

Determinants of return to work in patients with hand disorders and hand Injuries

Introduction Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries. Methods Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately. Results Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group. Conclusion Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job.

Determining skill level in myoelectric prosthesis use with multiple outcome measures

To obtain more insight into how the skill level of an upper-limb myoelectric prosthesis user is composed, the current study aimed to (1) portray prosthetic handling at different levels of description, (2) relate results of the clinical level to kinematic measures, and (3) identify specific parameters in these measures that characterize the skill level of a prosthesis user. Six experienced transradial myoelectric prosthesis users performed a clinical test (Southampton Hand Assessment Procedure [SHAP]) and two grasping tasks. Kinematic measures were end point kinematics, joint angles, grasp force control, and gaze behavior. The results of the clinical and kinematic measures were in broad agreement with each other. Participants who scored higher on the SHAP showed overall better performance on the kinematic measures. They had smaller movement times, had better grip force control, and needed less visual attention on the hand. The results showed that time was a key parameter in prosthesis use and should be one of the main focus aspects of rehabilitation. The insights from this study are useful in rehabilitation practice because they allow therapists to specifically focus on certain parameters that may result in a higher level of skill for the prosthesis user.

Learning to Control Opening and Closing a Myoelectric Hand

OBJECTIVE To compare 3 different types of myoelectric signal training. DESIGN A cohort analytic study. SETTING University laboratory. PARTICIPANTS Able-bodied right-handed participants (N=34) randomly assigned to 1 of 3 groups. INTERVENTIONS Participants trained hand opening and closing on 3 consecutive days. One group trained with a virtual myoelectric hand presented on a computer screen, 1 group trained with an isolated prosthetic hand, and 1 group trained with a prosthetic simulator. One half of the participants trained with their dominant side, and the other half trained with their nondominant side. Before and after the training period, a test was administered to determine the improvement in skill. Participants were asked to open and close the hand on 3 different velocities at command. MAIN OUTCOME MEASURES Peak velocity, mean velocity, and number of peaks in the myoelectric signal of hand opening and closing. RESULTS No differences were found for the different types of training; all participants learned to control the myoelectric hand. However, differences in learning abilities were revealed. After learning, a subgroup of the participants could produce clearly distinct myoelectric signals, which resulted in the ability to open and close the hand at 3 different speeds, whereas others could not produce distinct myoelectric signals. CONCLUSIONS Acquired control of a myoelectric hand is irrespective of the type of training. Prosthetic users may differ in learning capacity; this should be taken into account when choosing the appropriate type of control for each patient.

The i-LIMB hand and the DMC plus hand compared: A case report

The i-LIMB hand is a novel upper limb myoelectric prosthetic hand with several joints in the fingers and thumb. This study aimed to determine whether this new device had more functionality than a more conventional myoelectric prosthetic hand with only a single joint between the thumb and two fingers. Therefore, a 45-year-old man with a wrist disarticulation used the i-LIMB hand and the widely used Dynamic Mode Control hand (DMC plus hand) in a test procedure that covered all functional levels of the International Classification of Function (ICF). Functional outcomes of the i-LIMB seemed to be lower than or equal to the DMC plus hand. The patients satisfaction tended to be in favor of the i-LIMB. Compared to the DMC plus hand, the i-LIMB was more reliable when holding objects but had a lack of power and was less robust. We concluded that the i-LIMB hand has limited additional functionality compared to the DMC plus hand.

Postoperative hand therapy in Dupuytren's disease

Background. Postoperative hand therapy in patients after surgery for Dupuytrens contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery because of Dupuytrens disease were actually adhered to, and, to analyse differences in outcomes between patients who were referred according to the criteria (correctly referred) and those who were not referred but should have been (incorrectly not referred). Methods. Referral pattern was evaluated prospectively in 46 patients. Total active/passive range of joint motion (TAM/TPM), sensibility, pinch force, Disability Arm Shoulder Hand questionnaire (DASH) and Michigan Hand outcomes Questionnaire (MHQ) were used as outcome measures preoperatively and 10 months postoperatively. Results. In total 21 patients were referred correctly and 17 patients were incorrectly not referred. Significant improvements on TAM/TPM, DASH and MHQ were found at follow-up for the total group. No differences in outcomes were found between patients correctly referred and patients incorrectly not referred for postoperative hand therapy. Conclusion. Referral criteria were not adhered to. Given the lack of differences in outcomes between patients correctly referred and patients incorrectly not referred, postoperative hand therapy in Dupuytrens disease should be reconsidered.

Movement characteristics of upper extremity prostheses during basic goal-directed tasks

BACKGROUND After an upper limb amputation a prosthesis is often used to restore the functionality. However, the frequency of prostheses use is generally low. Movement kinematics of prostheses use might suggest origins of this low use. The aim of this study was to reveal movement patterns of prostheses during basic goal-directed actions in upper limb prosthetic users and to compare this with existing knowledge of able-bodied performance during these actions. METHODS Movements from six users of upper extremity prostheses were analyzed, three participants with a hybrid upper arm prosthesis, and three participants with a myoelectric forearm prosthesis. Two grasping tasks and a reciprocal pointing task were investigated during a single lab session. Analyses were carried out on the kinematics of the tasks. FINDINGS When grasping, movements with both prostheses showed asymmetric velocity profiles of the reach and had a plateau in the aperture profiles. Reach and grasp were decoupled. Kinematics with the prostheses differed in that the use of upper arm prostheses required more time to execute the movements, while the movements were less smooth, more asymmetric, and showed more decoupling between reach and grasp. The pointing task showed for both prostheses less harmonic movements with higher task difficulty. INTERPRETATION Characterizing prosthetic movement patterns revealed specific features of prosthetic performance. Developments in technology and rehabilitation should focus on these issues to improve prosthetic use, in particular on improving motor characteristics and the control of the elbow, and learning to coordinate the reach and the grasp component in prehension.

The Role of Order of Practice in Learning to Handle an Upper-Limb Prosthesis

OBJECTIVE To determine which order of presentation of practice tasks had the highest effect on using an upper-limb prosthetic simulator. DESIGN A cohort analytic study. SETTING University laboratory. PARTICIPANTS Healthy, able-bodied participants (N=72) randomly assigned to 1 of 8 groups, each composed of 9 men and 9 women. INTERVENTIONS Participants (n=36) used a myoelectric simulator, and participants (n=36) used a body-powered simulator. On day 1, participants performed 3 tasks in the acquisition phase. On day 2, participants performed a retention test and a transfer test. For each simulator, there were 4 groups of participants: group 1 practiced random and was tested random, group 2 practiced random and was tested blocked, group 3 practiced blocked and was tested random, and group 4 practiced blocked and was tested blocked. MAIN OUTCOME MEASURES Initiation time, the time from the starting signal until the beginning of the movement, and movement time, the time from the beginning until the end of the movement. RESULTS Movement times got faster during acquisition (P<.001). The blocked group had faster movement times (P=.009), and learning in this group extended over the complete acquisition phase (P<.001). However, this advantage disappeared in the retention and transfer tests. Compared with a myoelectric simulator, movements with the body-powered simulator were faster in acquisition (P=.004) and transfer test (P=.034). CONCLUSIONS Performance in daily life with a prosthesis is indifferent to the structure in which the training is set up. However, practicing in a blocked fashion leads to faster performance; in novice trainees, it might be suggested to practice part of the training tasks in blocks.

Birth prevalence for congenital limb defects in the northern Netherlands: a 30-year population-based study.

BackgroundReported birth prevalences of congenital limb defects (CLD) vary between countries: from 13/10,000 in Finland for the period 1964–1977 to 30.4/10,000 births in Scotland from 1964–1968. Epidemiological studies permit the timely detection of trends in CLD and of associations with other birth defects. The aim of this study is to describe the birth prevalence of CLD in the northern Netherlands.MethodsIn a population-based, epidemiological study we investigated the birth prevalences of CLD for 1981–2010. Data were collected by the European Surveillance of Congenital Anomalies in the northern Netherlands (EUROCAT-NNL). We excluded malpositions, club foot, and dislocation/dysplasia of hips or knees. Trends were analysed for the 19-year period 1992–2010 using χ2 tests, as well as CLD association with anomalies affecting other organs.ResultsThe birth prevalence of CLD was 21.1/10,000 births for 1981–2010. There was an overall decrease in non-syndromic limb defects (P = 0.023) caused by a decrease in the prevalence of non-syndromic syndactyly (P < 0.01) in 1992–2010. Of 1,048 children with CLD, 55% were males, 57% had isolated defects, 13% had multiple congenital anomalies (MCA), and 30% had a recognised syndrome. The upper:lower limb ratio was 2:1, and the left:right side ratio was 1.2:1. Cardiovascular and urinary tract anomalies were common in combination with CLD (37% and 25% of cases with MCA). Digestive-tract anomalies were significantly associated with CLD (P = 0.016).ConclusionsThe birth prevalence of CLD in the northern Netherlands was 21.1/10,000 births. The birth prevalence of non-syndromic syndactyly dropped from 5.2/10,000 to 1.1/10,000 in 1992–2010.

Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries.

PURPOSE Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of acute PTSD in hand-injured patients. METHODS Sixty-seven employed patients with hand injuries completed a number of questionnaires. The following factors were investigated: sociodemographic characteristics, injury severity, accident location, pain, satisfaction with hand functioning, aesthetics of the hand, social support, and coping styles. The primary outcome measure was the number of symptoms of PTSD. We analyzed factors that were univariately significantly associated with symptoms of PTSD using linear regression analysis, and explored interaction effects. RESULTS One patient met the criteria for PTSD; 44 patients experienced symptoms but did not meet the criteria (median, 1; interquartile range (IQR), 0-2); 22 patients experienced no symptoms of PTSD. Patients had a median pain score of 30 (IQR, 10-45), median satisfaction score of 60 (IQR, 45-70), median aesthetics score of 66.7 (IQR, 45.8-79.2), median palliative coping style score of 16 (IQR, 14.8-17.3), and median avoidance coping style of 15 (IQR, 13-16). Symptoms of PTSD were associated with pain (r, .530; p < .001), satisfaction with hand function (r, -.451; p < .001), aesthetics (r, -.320; p = .009), palliative coping style (r, .281; p = .022) and avoidance coping style (r, .283; p = .022). Pain and aesthetics remained significant after regression analysis. No interaction effects were significant. CONCLUSIONS Pain and aesthetics statistically predict symptoms of acute PTSD in patients with acute hand injuries. Patients with disproportionate pain or dissatisfaction with aesthetics should be evaluated for PTSD. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.