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Background Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol. Literature review A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016. BFR therapy was performed with a restrictive tourniquet applied to the upper brachium, performing the same strengthening exercises as the control group but with the restrictive tourniquet in place. Clinical assessment was conducted at 6, 10, and 14 weeks from the date of initial cast immobilization. Outcome measures collected included wrist range of motion; grip strength; pinch strength; visual analogue scale for pain with activity and at rest; patient-rated wrist evaluation (PRWE) scores; and disabilities of the arm, shoulder, and hand scores. Results Thirteen patients were enrolled and randomized between the BFR (n = 6) and control (n = 7) groups. The BFR group noted significantly greater reduction in pain with activity compared to the control group after 8 weeks of therapy (Δ −4.0 vs. −2.3, p = 0.03). Similarly, patients in the BFR group displayed greater reduction in PRWE scores compared to the control group after 8 weeks of BFR therapy (Δ −57.9 vs. 30.8, p = 0.01). The two groups did not demonstrate any significant difference in radiographic outcomes at any time point or throughout the course of the study. All patients tolerated the BFR therapy program and there were no complications. Clinical relevance The addition of BFR therapy to the rehabilitative program after closed management of a distal radius fracture is safe, well tolerated by patients, without any deleterious effects on radiographic outcomes. This pilot study noted that BFR therapy in patients with nonoperative distal radius fractures may result in a larger reduction in pain with activity and greater improvement in overall self-perceived function.

Purpose: To present population data on standardized measures of dexterity, activity performance, disability, health-related quality of life (HRQoL) and community integration for persons with upper limb amputation (ULA), compare outcomes to normative values, and examine differences by prosthesis type and laterality (unilateral vs. bilateral amputation). Materials and methods: Multi-site, cross-sectional design, with in-person evaluations, functional performance, and self-report measures. Descriptive and comparative analyses were performed by amputation level and prosthesis type, data were compared for unilateral and bilateral amputation. Results: One hundred and twenty-seven individuals participated; mean age 57 years, 59% percent bodypowered prostheses users. All measures of dexterity differed (p < 0.05) by amputation level and by laterality. All measures of activity differed by amputation level with the best scores in transradial (TR) amputation groups. Comparisons of body-powered users with TR amputation found that dexterity was better for those with bilateral compared to unilateral amputation. Conclusions: Dexterity is markedly impaired in persons with ULA. Individuals with more proximal ULA levels are most impacted. HRQoL and community participation are less impacted and more equivalent to unimpaired persons. Further research is needed to examine differences by terminal device type and determine how best to match persons with ULA to the optimal prosthesis type and componentry, based on individual characteristics. ä IMPLICATIONS FOR REHABILITATION This study provides population-based, comparative data on dexterity, activity performance, disability, quality of life, and independence in upper limb prosthesis users. The study provides preliminary analyses comparing the effectiveness of body-powered devices, myoelectric devices with single degree of freedom and multi-degree of freedom terminal devices. The data presented in this study can be used to benchmark outcomes in patients who are upper limb prosthesis users. The data will also be useful to inform comparative evaluations of existing and emerging prosthetic technology.

IntroductionEMG pattern recognition control (EMG-PR) is a promising option for control of upper limb prostheses with multiple degrees of freedom (DOF). The purposes of this study were to 1) evaluate outcomes of EMG-PR and inertial measurement units (IMU) control of the DEKA Arm as compared to personal prosthesis; and 2) compare outcomes of EMG-PR to IMU control of DEKA Arm.MethodsThis was a quasi-experimental, multi-site study with repeated measures that compared non-randomized groups using two types of controls: EMG-PR and IMUs. Subjects (N = 36) were transradial (TR) and transhumeral (TH) amputees. Outcomes were collected at Baseline (using personal prosthesis), and after in-laboratory training (Part A), and home use (Part B). Data was compared to personal prosthesis, stratified by amputation level and control type. Outcomes were also compared by control type.ResultsThe EMG-PR group had greater prosthesis use after Part A, but worse dexterity, lower satisfaction, and slower activity performance compared to Baseline; the IMU group had slower activity performance. After Part B, the EMG-PR group had less perceived activity difficulty; the IMU group had improved activity performance, improved disability and activity difficulty, but slower performance. No differences were observed for TH group by control type in Part A or B. The TR group using EMG-PR had worse dexterity (Parts A & B), and activity performance (Part A) as compared to IMU users.Discussion/ConclusionFindings suggest that for the TR group that IMUs are a more effective control method for the DEKA Arm as compared to the EMG-PR prototypes employed in this study. Further research is needed to refine the EMG-PR systems for multi-DOF devices. Future studies should include a larger sample of TH amputees.Trial registrationClinicalTrials.gov NCT01551420.