The use of video games combined with conventional physical therapy in children with upper limb fractures: An exploratory study

Arrebola, Lucas Simões; Liu, Yi; Oliveira, Vanessa Gonçalves Coutinho de

doi:10.3233/prm-170529

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…The distress associated with pain can impact negatively on patients’ physical and psychological outcomes including limiting their ROM during ULI therapy [ 44 ], increasing their risk of Post-Traumatic Stress Disorder after a burn injury [ 45 ] or reducing confidence in the care team [ 7 ]. These physiotherapists instead reported increased ROM in all children using HMD-VR, a finding consistent with other work [ 46 ].…”

Section: Discussionsupporting

confidence: 90%

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study

Phelan

Furness

Dunn

et al. 2021

PRM

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PURPOSE: Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain. This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs. METHODS: Ten children aged 9–16 in one UK Children’s hospital trialled HMD-VR during one rehabilitation session. They, their parents (n = 10), and hospital physiotherapy staff (n = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings. RESULTS: Inductive thematic analysis of interview data generated three themes, ‘Escape through Engagement’; ‘Enhanced Movement’; and ‘Adaptability and Practicality’. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards. CONCLUSION: Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials.

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Section: Discussionsupporting

confidence: 90%

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study

Phelan

Furness

Dunn

et al. 2021

PRM

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“…Several authors did not report any benefit from a short course of PT on elbow function or motion. 44 – 46 Recently, two pilot trials 47 , 48 analyzed the benefits of video gaming in restoring normal elbow function and in reducing pain after conservative or surgical treatment. In particular, tennis, boxing, and bowling gaming could shorten recovery time, 48 and should be considered in the holistic management of elbow injuries.…”

Section: Discussionmentioning

confidence: 99%

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Pavone

Vescio

Accadbled

et al. 2022

Journal of Children's Orthopaedics

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Purpose: The purpose of this study was to evaluate the current trends in the treatment of supracondylar humerus fractures as well as the preferred post-operative follow-up protocol among members of the European Paediatric Orthopaedic Society. Methods: The survey was composed by four main domains and 26 items: (1) surgeon information (3 items); (2) treatment (8 items); (3) post-operative treatment (3 items); and (4) factors influencing the outcome (12 items). All active members of European Paediatric Orthopaedic Society were invited by email to answer an electronic questionnaire. Results: The survey was submitted to 397 European Paediatric Orthopaedic Society active members; 184 members answered (46.3%) the questionnaire. Among respondents, 64.1% declared >10 years of experience and 55.4% declared to treat >20 supracondylar humerus fractures per year. Closed reduction, percutaneous pinning, and supine position were the preferred treatment option for Gartland type II and III supracondylar humerus fractures by 79.9%, 95.5%, and 84.8% of respondents, respectively. Supracondylar humerus fractures are treated within 24 h from trauma by 33.2% of respondents. Pins are removed 4 weeks from index procedure by 58.2% of respondents. Fracture type (72.3%), surgeon experience, and (71.2%) are of “crucial importance” for expected outcome of supracondylar humerus fractures treatment. Conclusion: Surgeon experience, type of fracture, treatment modality, and pins configuration were considered the main factors potentially influencing the outcome of supracondylar humerus fractures. European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal. Other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated. Level of evidence: level II.

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“…This period can lead to elbow or wrist stiffness after cast removal and consequently to limitations in a child's daily activities. [ 20 21 22 23 ] Despite this risk, the use of physical therapy after removal of the cast is still on debate, because of strong evidence of autonomous complete functional recovery in children forearm fractures. In contrast, recent studies demonstrated that an upper limb immobilisation, longer than 2 weeks, can produce thinning of its corresponding region on the primary sensory-motor cortex, known as homunculus, and so following physical therapy was strictly recommended.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, recent studies demonstrated that an upper limb immobilisation, longer than 2 weeks, can produce thinning of its corresponding region on the primary sensory-motor cortex, known as homunculus, and so following physical therapy was strictly recommended. [ 20 24 ] Furthermore Colaris et al ., on 2013, reported that long cast immobilisation, in children with both bone forearm fractures, could result in higher limitation of pronation/supination because of severe interosseous membrane contracture and in those cases, physiotherapy was associated with a better functional outcome. [ 23 ] Therefore we believe that immobilisation should be reduced to the minimum, so that early mobilisation could minimise cortical alterations, reduce the risk of joint stiffness, avoiding the need of physiotherapy and granting a faster return to all daily activities.…”

Section: Discussionmentioning

confidence: 99%

Elastic Stable Intramedullary Fixation Using Epibloc versus Crossed Kirschner Wires Fixation for Distal Forearm Fractures in Children

Vitis¹,

D’Orio²,

Passiatore³

et al. 2022

African Journal of Paediatric Surgery

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Background: Childrens' distal forearm fractures (DFFs) could be treated conservatively with closed reduction and immobilisation, but post-reduction displacements often occur. Displaced DFF should be surgically fixed, to avoid further displacement. Nevertheless, immobilisation after surgery is recommended. Epibloc system (ES), a system of stable elastic nail fixation, is widely used to stabilise adults extra-articular distal radius fractures, with advantages to not requiring post-surgical immobilisation. The present investigation represents a retrospective analysis of paediatric patients with DFF treated with ES applied with a minimal technical variation, to fix both ulna and radius fractures using a unique device. Materials and Methods: A retrospective analysis was performed on 44 children (age 6–11 years) who underwent closed reduction and internal fixation because of DFF (both ulna and radius). Group A (21 patients): ES fixation. Group B (23 patients): K-wires and short arm cast fixation. The primary outcome was the subsistence of reduction monitored through X-rays. The secondary outcome was the measurement of active range of motion (AROM) and the time of recovery. Results: No differences were observed comparing Group A and B in terms of the maintenance of reduction ( P > 0.05). Seven days after the implant removal, patients in Group A reached significantly better results compared to patients in Group B in terms of AROM ( P < 0.05). No differences were revealed in terms of complications between the two groups. Conclusion: ES applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.

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The use of video games combined with conventional physical therapy in children with upper limb fractures: An exploratory study

Cited by 11 publications

References 24 publications

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study

Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society

Elastic Stable Intramedullary Fixation Using Epibloc versus Crossed Kirschner Wires Fixation for Distal Forearm Fractures in Children

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