Download PDF
J Wrist Surg 2019; 08(01): 002-009
DOI: 10.1055/s-0038-1672151
Special Review: Revolution in Wrist Rehabilitation
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Rehabilitation

Ronit Wollstein
1   Department of Orthopedic Surgery, New York University, School of Medicine, Huntington Station, New York
,
Hani Harel
2   Carmel Lady Davis Medical Center Occupational Therapy, Haifa, Israel
,
Idit Lavi
3   Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
,
Raviv Allon
4   Department of Orthopedic Surgery, School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
,
Dafna Michael
2   Carmel Lady Davis Medical Center Occupational Therapy, Haifa, Israel
› Author Affiliations Funding None.
Further Information

Publication History

22 March 2018

02 August 2018

Publication Date:
27 September 2018 (online)

   Permissions and Reprints

Abstract

Background Sensorimotor and specifically proprioception sense has been used in rehabilitation to treat neurological and joint injuries. These feedback loops are not well understood or implemented in wrist treatment. We observed a temporary sensorimotor loss, following distal radius fractures (DRF) that should be addressed postsurgery.

Purpose The purpose of this prospective therapeutic study was to compare the outcomes of patients following surgery for DRF treated using a sensorimotor treatment protocol with those patients treated according to the postoperative standard of care.

Patients and Methods Patients following surgery for DRF sent for hand therapy were eligible for the study. Both the evaluation and treatment protocols included a comprehensive sensorimotor panel. Patients were randomized into standard and standard plus sensorimotor postoperative therapy and were evaluated a few days following surgery, at 6 weeks, and 3 months postsurgery.

Results Sixty patients following surgery were randomized into the two treatment regimens. The initial evaluation was similar for both groups and both demonstrated significant sensorimotor deficits, following surgery for DRF. There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the sensorimotor-proprioception protocol mostly in the wrist; however, not all of the differences were significant.

Conclusion Patients after surgery for DRF demonstrate significant sensorimotor deficits which may improve faster when utilizing a comprehensive sensorimotor treatment protocol. However, we did not demonstrate efficacy of the protocol in treating proprioceptive deficits. Further study should include refinement of functional outcome evaluation, studying of the treatment protocol, and establishment of sensorimotor therapeutic guidelines for other conditions.

Level of Evidence This is a level II, therapeutic study.

Keywords

distal radius fracture - postoperative - proprioception - rehabilitation - sensorimotor therapy
 

  • References

  • 1 Edgerton VR, Courtine G, Gerasimenko YP. , et al. Training locomotor networks. Brain Res Brain Res Rev 2008; 57 (01) 241-254
    CrossrefPubMedSearch in Google Scholar
  • 2 Guillery RW. Anatomical pathways that link perception and action. Prog Brain Res 2005; 149: 235-256
    PubMedSearch in Google Scholar
  • 3 Baert IA, Mahmoudian A, Nieuwenhuys A. , et al. Proprioceptive accuracy in women with early and established knee osteoarthritis and its relation to functional ability, postural control, and muscle strength. Clin Rheumatol 2013; 32 (09) 1365-1374
    CrossrefPubMedSearch in Google Scholar
  • 4 Biel A, Dudziński K. Rehabilitation outcome in patients recovering from reconstruction of the anterior cruciate ligament: a preliminary report. Ortop Traumatol Rehabil 2005; 7 (04) 401-405
    PubMedSearch in Google Scholar
  • 5 Rios JL, Gorges AL, dos Santos MJ. Individuals with chronic ankle instability compensate for their ankle deficits using proximal musculature to maintain reduced postural sway while kicking a ball. Hum Mov Sci 2015; 43: 33-44
    CrossrefPubMedSearch in Google Scholar
  • 6 Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport 2015; 18 (03) 238-244
    CrossrefPubMedSearch in Google Scholar
  • 7 Smith TO, King JJ, Hing CB. The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis. Rheumatol Int 2012; 32 (11) 3339-3351
    CrossrefPubMedSearch in Google Scholar
  • 8 da Silva KN, Teixeira LE, Imoto AM, Atallah AN, Peccin MS, Trevisani VF. Effectiveness of sensorimotor training in patients with rheumatoid arthritis: a randomized controlled trial. Rheumatol Int 2013; 33 (09) 2269-2275
    CrossrefPubMedSearch in Google Scholar
  • 9 Hagert E. Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist. J Hand Ther 2010; 23 (01) 2-17
    CrossrefPubMedSearch in Google Scholar
  • 10 Aimonetti JM, Morin D, Schmied A, Vedel JP, Pagni S. Proprioceptive control of wrist extensor motor units in humans: dependence on handedness. Somatosens Mot Res 1999; 16 (01) 11-29
    CrossrefPubMedSearch in Google Scholar
  • 11 Marini F, Squeri V, Morasso P, Masia L. Wrist Proprioception: Amplitude or Position Coding?. Front Neurorobot 2016; 10: 13
    PubMedSearch in Google Scholar
  • 12 Patterson RW, Van Niel M, Shimko P, Pace C, Seitz Jr WH. Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am 2010; 35 (01) 52-56
    PubMedSearch in Google Scholar
  • 13 Karagiannopoulos C, Michlovitz S. Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. J Hand Ther 2016; 29 (02) 154-165
    CrossrefPubMedSearch in Google Scholar
  • 14 Röijezon U, Faleij R, Karvelis P, Georgoulas G, Nikolakopoulos G. A new clinical test for sensorimotor function of the hand - development and preliminary validation. BMC Musculoskelet Disord 2017; 18 (01) 407
    CrossrefPubMedSearch in Google Scholar
  • 15 Bearne LM, Coomer AF, Hurley MV. Upper limb sensorimotor function and functional performance in patients with rheumatoid arthritis. Disabil Rehabil 2007; 29 (13) 1035-1039
    CrossrefPubMedSearch in Google Scholar
  • 16 Park JH, Kim D, Park H, Jung I, Youn I, Park JW. The effect of triangular fibrocartilage complex tear on wrist proprioception. J Hand Surg Am 2018 Doi: 10.1016/j.jhsa.2018.01.022
    PubMedSearch in Google Scholar
  • 17 Leung PC. Sensory recovery in transplanted toes. Microsurgery 1989; 10 (03) 242-244
    CrossrefPubMedSearch in Google Scholar
  • 18 Fedrizzi E, Pagliano E, Andreucci E, Oleari G. Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence. Dev Med Child Neurol 2003; 45 (02) 85-91
    PubMedSearch in Google Scholar
  • 19 Connell LA, Lincoln NB, Radford KA. Somatosensory impairment after stroke: frequency of different deficits and their recovery. Clin Rehabil 2008; 22 (08) 758-767
    CrossrefPubMedSearch in Google Scholar
  • 20 Herold F, Orlowski K, Börmel S, Müller NG. Cortical activation during balancing on a balance board. Hum Mov Sci 2017; 51: 51-58
    CrossrefPubMedSearch in Google Scholar
  • 21 Herwig A, Prinz W, Waszak F. Two modes of sensorimotor integration in intention-based and stimulus-based actions. Q J Exp Psychol (Hove) 2007; 60 (11) 1540-1554
    PubMedSearch in Google Scholar
  • 22 Vlaar MP, Solis-Escalante T, Dewald JPA. , et al; 4D-EEG consortium. Quantification of task-dependent cortical activation evoked by robotic continuous wrist joint manipulation in chronic hemiparetic stroke. J Neuroeng Rehabil 2017; 14 (01) 30
    CrossrefPubMedSearch in Google Scholar
  • 23 Taube W, Mouthon M, Leukel C, Hoogewoud HM, Annoni JM, Keller M. Brain activity during observation and motor imagery of different balance tasks: an fMRI study. Cortex 2015; 64: 102-114
    CrossrefPubMedSearch in Google Scholar
  • 24 Wilk KE, Macrina LC. Nonoperative and postoperative rehabilitation for glenohumeral instability. Clin Sports Med 2013; 32 (04) 865-914
    CrossrefPubMedSearch in Google Scholar
  • 25 Valdes K, Naughton N, Algar L. Sensorimotor interventions and assessments for the hand and wrist: a scoping review. J Hand Ther 2014; 27 (04) 272-285 , quiz 286
    CrossrefPubMedSearch in Google Scholar
  • 26 Avanzino L, Pelosin E, Abbruzzese G, Bassolino M, Pozzo T, Bove M. Shaping motor cortex plasticity through proprioception. Cereb Cortex 2014; 24 (10) 2807-2814
    CrossrefPubMedSearch in Google Scholar
  • 27 Kavounoudias A, Roll JP, Anton JL, Nazarian B, Roth M, Roll R. Proprio-tactile integration for kinesthetic perception: an fMRI study. Neuropsychologia 2008; 46 (02) 567-575
    CrossrefPubMedSearch in Google Scholar
  • 28 Wollstein R, Michael D, Harel H. A protocol for evaluation and rehabilitation of distal radius fractures using sensorimotor input: a case series. J Hand Surg Asian Pac Vol 2017; 22 (02) 150-155
    PubMedSearch in Google Scholar
  • 29 Li XM, Yang Y, Hou Y. , et al. Diagnostic accuracy of three sensory tests for diagnosis of sensory disturbances. J Reconstr Microsurg 2015; 31 (01) 67-73
    PubMedSearch in Google Scholar
  • 30 Jerosch-Herold C. A study of the relative responsiveness of five sensibility tests for assessment of recovery after median nerve injury and repair. J Hand Surg [Br] 2003; 28 (03) 255-260
    PubMedSearch in Google Scholar
  • 31 Van Dokkum LEH, Mottet D, Laffont I. , et al. Kinematics in the brain: unmasking motor control strategies?. Exp Brain Res 2017; 235 (09) 2639-2651
    CrossrefPubMedSearch in Google Scholar
  • 32 Merians AS, Poizner H, Boian R, Burdea G, Adamovich S. Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke?. Neurorehabil Neural Repair 2006; 20 (02) 252-267
    CrossrefPubMedSearch in Google Scholar
  • 33 Enke AM, Poskey GA. Neuromuscular re-education programs for musicians with focal hand dystonia: a systematic review. Med Probl Perform Art 2018; 33 (02) 137-145
    CrossrefPubMedSearch in Google Scholar
  • 34 Gutiérrez-Espinoza H, Rubio-Oyarzún D, Olguín-Huerta C, Gutiérrez-Monclus R, Pinto-Concha S, Gana-Hervias G. Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study. J Hand Ther 2017; 30 (03) 242-252
    CrossrefPubMedSearch in Google Scholar
  • 35 James MA, Bagley A, Vogler IV JB, Davids JR, Van Heest AE. Correlation between standard upper extremity impairment measures and activity-based function testing in upper extremity cerebral palsy. J Pediatr Orthop 2017; 37 (02) 102-106
    CrossrefPubMedSearch in Google Scholar
  • 36 Karagiannopoulos C, Sitler M, Michlovitz S, Tucker C, Tierney R. Responsiveness of the active wrist joint position sense test after distal radius fracture intervention. J Hand Ther 2016; 29 (04) 474-482
    CrossrefPubMedSearch in Google Scholar
  • 37 Lutsky K, Kim N, Medina J, Maltenfort M, Beredjiklian PK. Hand dominance and common hand conditions. Orthopedics 2016; 39 (03) e444-e448
    CrossrefPubMedSearch in Google Scholar
  • 38 Kachooei AR, Moradi A, Janssen SJ, Ring D. The influence of dominant limb involvement on DASH and QuickDASH. Hand (NY) 2015; 10 (03) 512-515
    CrossrefPubMedSearch in Google Scholar
  • 39 Leduc A, Lievens P, Dewald J. The influence of multidirectional vibrations on wound healing and on regeneration of blood- and lymph vessels. Lymphology 1981; 14 (04) 179-185
    PubMedSearch in Google Scholar
  • 40 Mridha M, Odman S, Oberg PA. Mechanical pulse wave propagation in gel, normal and oedematous tissues. J Biomech 1992; 25 (10) 1213-1218
    CrossrefPubMedSearch in Google Scholar
  • 41 Wang JH, Sun T. Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome. Arch Med Sci 2017; 13 (01) 163-173
    PubMedSearch in Google Scholar
  • 42 Puchalski P, Zyluk A. Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors. J Hand Surg [Br] 2005; 30 (06) 574-580
    CrossrefPubMedSearch in Google Scholar
  • 43 Dijkstra PU, van der Schans CP, Geertzen JH. Risk perception of developing complex regional pain syndrome I. Clin Rehabil 2003; 17 (04) 454-456
    CrossrefPubMedSearch in Google Scholar
  • 44 Dilek B, Yemez B, Kizil R. , et al. Anxious personality is a risk factor for developing complex regional pain syndrome type I. Rheumatol Int 2012; 32 (04) 915-920
    CrossrefPubMedSearch in Google Scholar
  • 45 Niekel MC, Lindenhovius AL, Watson JB, Vranceanu AM, Ring D. Correlation of DASH and QuickDASH with measures of psychological distress. J Hand Surg Am 2009; 34 (08) 1499-1505
    CrossrefPubMedSearch in Google Scholar
  • 46 Bot AG, Souer JS, van Dijk CN, Ring D. Association between individual DASH tasks and restricted wrist flexion and extension after volar plate fixation of a fracture of the distal radius. Hand (NY) 2012; 7 (04) 407-412
    CrossrefPubMedSearch in Google Scholar