Hand Injury Clinical Trial
Official title:
The Functional Outcome and Brain Functional MRI of Hand Injury Patients After Different Rehabilitation Programs
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.
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.
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