Rochelle Mendonca

The effectiveness of orthoses in the conservative management of thumb CMC joint osteoarthritis: An analysis of functional pinch strength

STUDY DESIGN The study was a retrospective cohort analysis for a 19-month period from May 2013 to December 2014. INTRODUCTION Although the use of orthoses has long been a staple of conservative treatment measures for individuals with osteoarthritis of the thumb carpometacarpal (CMC) joint, there remains little evidence exploring its effectiveness in improving functional outcomes for this client population. PURPOSE OF THE STUDY The purpose of this study was to assess the effectiveness of 3 frequently used orthoses in improving the functional pinch strength of adults with a diagnosis of thumb CMC joint osteoarthritis. METHODS A retrospective cohort analysis was conducted to determine whether pinch strength improved after orthotic fabrication, and fitting in patients referred to a hand therapy clinic. RESULTS Patients who received a Colditz design orthosis had a mean increase of 2.64 lb with regard to functional pinch strength after orthotic fabrication and fitting. Patients who received a Comfort Cool orthosis (North Coast Medical, Morgan Hill, CA) had a mean increase of 2.47 lb, whereas patients who received a Thumb Spica orthosis had a mean increase of 3.25 lb. There was no evidence of any statistically significant difference in the average improvements in pinch strength between the Colditz design orthosis and the Comfort Cool orthosis. CONCLUSIONS Results from this study demonstrate that orthosis wear consistently increases the functional pinch strength of individuals with thumb CMC joint osteoarthritis. Large-scale multisite research studies comparing various orthotic designs are necessary to help therapists determine best practice interventions for the conservative management of thumb CMC joint osteoarthritis. LEVEL OF EVIDENCE 2(c).

Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym

Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-in-one robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.

Assessing human-human therapy kinematics for retargeting to human-robot therapy

In this paper, we present experiments examining the accuracy of data collected from a Kinect sensor for capturing close interactive actions of a therapist with a patient during stroke rehabilitation. Our long-term goal is to map human-human interactions such as these patient-therapist ones onto human-robot interactions. In many robot interaction scenarios, the robot does not mimic interaction between two or more humans, which is a major part of stroke therapy. The Kinect works for functional tasks such as a reaching task where the interaction to be retargeted by the robot is minimal to none; though this data is not good for a functional task involving touching another person. We demonstrate that the noisy data from Kinect does not produce a system robust enough to be for remapping to a humanoid robot a therapits movements when in contact with a person.

Reliability of the Bulb Dynamometer for Assessing Grip Strength

Background: Hand function is an overall indicator of health and is often measured using grip strength. Hand-held dynamometry is the most common method of measuring grip strength. The purpose of this study was to determine the inter-rater and test-retest reliability, the reliability of one trial versus three trials, and the preliminary norms for a young adult population using the Baseline® Pneumatic Squeeze Bulb Dynamometer (30 psi). Methods: This study used a one-group methodological design. One hundred and three healthy adults (30 males and 73 females) were recruited. Six measurements were collected for each hand per participant. The data was analyzed using Intraclass Correlation Coefficients (ICC) two-way effects model (2,2) and paired-samples t-tests. Results: The ICC for inter-rater reliability ranged from 0.955 to 0.977. Conclusion: The results of this study suggest that the bulb dynamometer is a reliable tool to measure grip strength and should be further explored for reliable and valid use in diverse populations and as an alternative to the Jamar dynamometer. Comments The authors report no conflicts of interest to disclose.

Impact of an Activity-Based Program on Health, Quality of Life, and Occupational Performance of Women Diagnosed With Cancer

OBJECTIVE. We evaluated the impact of a 1‐wk activity program on the health, quality of life (QOL), and occupational performance of community‐living women diagnosed with cancer. METHOD. A one‐group pretest‐posttest repeated‐measures design was used. Participants completed a functional health measure (36‐Item Short Form Health Survey [SF‐36]), a QOL measure (World Health Organization Quality of Life‐Brief version [WHOQOL‐BREF]), and an occupational performance and satisfaction measure (Canadian Occupational Performance Measure [COPM]) before and 6 wk after program completion. The COPM was also administered on Day 5. RESULTS. Paired t tests for the SF‐36 and WHOQOL‐BREF showed no significant differences, except for the WHOQOL‐BREFs Social Relationships subscale (p < .008). Repeated‐measures analyses of variance showed a significant difference in COPM performance and satisfaction scores (p < .001). CONCLUSION. The activity program effectively improved occupational performance and satisfaction and social relationships of community‐living women diagnosed with cancer.

Towards quantifying dynamic human-human physical interactions for robot assisted stroke therapy

Human-Robot Interaction is a prominent field of robotics today. Knowledge of human-human physical interaction can prove vital in creating dynamic physical interactions between human and robots. Most of the current work in studying this interaction has been from a haptic perspective. Through this paper, we present metrics that can be used to identify if a physical interaction occurred between two people using kinematics. We present a simple Activity of Daily Living (ADL) task which involves a simple interaction. We show that we can use these metrics to successfully identify interactions.

Evaluating a computer-training program for individuals with physical disabilities

Purpose As increasing numbers of people with disabilities return to the community, it is necessary to equip them with skills to succeed in this technological world. The purpose of this paper is to evaluate the effect of attendance, satisfaction, goal achievement, and transportation on a goals-based computer-training program for people with physical disabilities (n=130). Design/methodology/approach Regressions, distribution comparisons, and correlations were retrospectively conducted on data from a computer-training program for people with disabilities. Participants were aged 20-100 and were diverse in terms of education, diagnoses, and living situation. Findings Results indicated that people with physical disabilities from diverse demographic and -contextual backgrounds could participate in a goals-based computer-training program. Factors that affected the computer-training program included method of transportation (p=0.034), perception of goal achievement (p=0.000), and attendance rates (p=0.001). A strong correlation was found between support available for computer use and continued computer use (p=0.000). Research limitations/implications Goals-based computer-training approaches that are client-centered may lead to increased perceptions of goal achievement and program satisfaction for people with disabilities, which could be used as outcomes to monitor success of such programs. It is also important to consider the effect of transportation and attendance rates on computer-training programs. However, results of this study were limited by its retrospective nature. Originality/value This study provides empirical data on factors that affect goals-based computer-training programs and evidence for the efficacy of such programs for individuals with disabilities. This can be used for program development and future research.

Impact of a Fieldwork Experience on Attitudes Toward People With Intellectual Disabilities

OBJECTIVE. The objective of this study was to describe the effects of curriculum activities on changing attitudes of health professional students toward people with intellectual disabilities (IDs). METHOD. A nonrandomized, pretest‐posttest design was used. Participants were college students assigned to one of three groups: two groups of students from different years in the occupational therapy program and one group of public health students. Each group completed the Attitudes Toward Intellectual Disabilities Questionnaire before and after each intervention. RESULTS. No significant differences were found in change of attitude after a lecture on the effects of stigma on people with disabilities. Length of time in program, age, and amount of experience with people with IDs affected changes in attitude for occupational therapy students after a fieldwork intervention. CONCLUSION. Level I fieldwork significantly improved the attitudes of occupational therapy students toward people with IDs, whereas a lecture did not.