Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty

Background This study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA. Methods We randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters. Results There was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain. Conclusions The application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors

Objective. Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. Approach. In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30-minute treatment of continuous passive motion (CPM) using a robotic glove. Main results. On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. Significance. This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.

Effect of Kinesiology Tape on Muscle Activation of Lower Extremity and Ankle Kinesthesia in Individuals With Unilateral Chronic Ankle Instability

Background: The purpose of the study was to determine the effect of kinesiology tape (KT) on lower limb muscle activation during computerized dynamic posturography (CDP) tasks and ankle kinesthesia in individuals with chronic ankle instability (CAI).Methods: Thirty-five men with CAI participated in this study. The experimental procedure followed a repeated measures design. Muscle activation of lower extremity and ankle kinesthesia of participants were measured using four taping treatments, namely, KT, athletic tape (AT), sham tape (ST), and no tape (NT) in a randomized order. Muscle activation was assessed using surface electromyography (sEMG) synchronized with CDP tests from seven lower extremity muscles of the unstable limb. Ankle kinesthesia was measured by using a threshold to detect the passive motion direction of the unstable ankle. Parameters were analyzed by using a one-way repeated measures ANOVA and followed by pairwise comparisons with a Bonferroni correction.Results: No significant difference was observed among different taping treatments for the majority of parameters during CDP. Except for condition 4 with open eyes, sway-referenced surface, and fixed surround in the sensory organization test (SOT), gastrocnemius medialis root mean square (RMS) was 28.19% lower in AT compared with NT (p = 0.021, 95% CI = 0.002–0.039), while gastrocnemius lateralis RMS was 20.25% lower in AT compared with KT (p = 0.038, 95% CI = 0.000–0.021). In forward-small sudden translation from motor control test (MCT), for peroneal longus (PL), RMS was 24.04% lower in KT compared with ST (p = 0.036, 95% CI = 0.000–0.018). In toes-down sudden rotation from adaption test (ADT), for PL, RMS was 23.41% lower in AT compared with ST (p = 0.015, 95% CI = 0.002–0.027). In addition, no significant difference was observed for a threshold to the detection of passive motion direction among different taping treatments.Conclusion: This study indicated that KT had minimal effect on the muscle activation of the unstable lower limb during static stance, self-initiated, and externally triggered perturbation tasks from CDP and ankle kinesthesia among individuals with CAI, suggesting that the benefit of KT was too small to be clinically worthwhile during application for CAI.

Continuous Passive Motion Not Affect the Knee Motion and the Surgical wound Aspect After Total Knee Arthroplasty

Background. This study aimed to assess whether use of continuous passive motion (CPM) can improve range of motion in patients after total knee arthroplasty (TKA). Moreover, the relationship between the use of CPM with the surgical wound aspect (SWA) and pain management after TKA was analysed.Methods. We randomized 210 patients, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain was measured before surgery, on the 1s, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 hours after surgery. This scale analyses swelling, erythema, haematoma, blood drainage and blisters. Results. There was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for haematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain. Conclusions. The application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in haematoma appearance.

Perkutane, antegrade K-Draht-Osteosynthese bei Fingergrundgliedfrakturen: Vergleich zwischen frühfunktioneller und statischer Nachbehandlung

Zusammenfassung Ziel Diese retrospektive Studie vergleicht die klinischen Ergebnisse der frühfunktionellen Nachbehandlung mit den Ergebnissen mittels 6-wöchiger Schienenruhigstellung nachbehandelter Fingergrundgliedfrakturen nach perkutaner, antegrader K-Draht-Osteosynthese. Patienten und Methoden Von insgesamt 90 Patienten, die zwischen 2010 und 2017 aufgrund einer isolierten Fingergrundgliedfraktur nach geschlossener Reposition mittels perkutaner, antegrader K-Draht-Osteosynthese operativ versorgt wurden, konnten 46 (17 Frauen und 29 Männer mit einem mittleren Alter von 42,8 Jahren) im Mittel nach 18,5 Monaten nachuntersucht werden. Bei 28 Patienten war eine frühfunktionelle, bei 18 eine statische Nachbehandlung erfolgt. Beide Gruppen unterschieden sich nicht statistisch signifikant bzgl. des Alters, der Geschlechtsverteilung, der Frakturlokalisation und -morphologie, des Unfallmechanismus und der Dauer der Operation. Bei der Nachuntersuchung wurde die aktive und passive Beweglichkeit des operierten Fingers (total active motion [TAM] und total passive motion [TPM], Fingerkuppen-Hohlhand-Abstand [FKHA], Nagelrand-verlängerter-Handrückenebenen-Abstand [NHREA]) und des korrespondierenden, unverletzten Fingers der Gegenseite gemessen und in Relation zueinander gesetzt (TAMrel, TPMrel). Des Weiteren wurde die Kraft bei verschiedenen Griffformen bestimmt und in Relation zur Kraft der unverletzten Gegenseite gesetzt. Intra- und postoperative Komplikationen, der DASH-Score und die Zeit bis zur Wiederaufnahme der Arbeitstätigkeit wurden erfasst. Ergebnisse Keine signifikanten Unterschiede zwischen den beiden Gruppen konnten bzgl. der Häufigkeit von Komplikationen und notwendiger Revisionen, der Fingerbeweglichkeit und Kraft festgestellt werden. Patienten mit aktiver Nachbehandlung kehrten im Vergleich zu Patienten mit statischer Nachbehandlung jedoch signifikant früher an ihre Arbeitsplätze zurück (2,5 vs. 9,0 Wochen nach operativer Versorgung, p = 0,035). Der DASH-Score in der Gruppe mit aktiver Nachbehandlung war mit 1,7 Punkten etwas niedriger als in der Gruppe mit statischer Nachbehandlung mit 2,5 Punkten (p = 0,269). Schlussfolgerung Patienten mit frühfunktioneller Nachbehandlung waren signifikant kürzer arbeitsunfähig. Zum Nachuntersuchungszeitpunkt fand sich kein Unterschied in der globalen Fingerbeweglichkeit beider Gruppen. Bei gegebener Compliance kann auf eine postoperative Ruhigstellung verzichtet werden.