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Comparison of excursion-based approach with force-based approach in rehabilitation of repaired flexor tenons in zone ii and iiiCoates, Michelle Suzanne January 2017 (has links)
A dissertation submitted to the Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg
in fulfillment of the requirements for the degree of Master
of Science in Occupational Therapy
Johannesburg, June 2017 / This study explores the implementation of two different synergistic wrist motion
approaches in the treatment of flexor tendon injuries, the excursion-based
approach and the force-based approach. A prospective, quantitative, comparative
intervention research design was used to compare the two approaches and
determine their effectiveness in a public hospital in South Africa.
The five participants’ range of motion, independence in activities of daily living and
satisfaction levels were measured throughout the 12 week treatment programme.
The excursion-based group showed significant improvement in passive Strickland
and Glogovac scores over the rehabilitation period. The excursion-based group
also achieved better final place-and-hold and active Strickland and Glogovac
scores than the force-based group which showed a decline in these scores over
the 12 weeks. Both groups had a poor result for active movement at the final
session due to the development of adhesions, but were found to have an
improvement in their upper limb function measured on the Disabilities of the Hand,
Shoulder and Arm questionnaire in all activities except for those related to work.
These results were not statistically significant.
The poor results may be attributed to the unique challenges experienced by
patients with flexor tendon injuries, living in under-resourced South African
communities. The small sample and the fact that the excursion-based group
received isolated flexor digitorum profundus tendon repairs while the force-based
group received combined flexor digitorum profundus and flexor digitorum
superficialis repairs may also have had an impact on the results. The outcomes of
this study indicate that despite yielding successful results in research studies
performed in developed countries, it is unlikely that either of these approaches will
be suitable in the rehabilitation of patients with flexor tendon repairs in a public
hospital in South Africa. / MT2017
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Patient compliance and spontaneous movements while following an early active motion protocol after a flexor tendon repairSaleeba, Elizabeth Constance January 2010 (has links)
Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.
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Evidence-Based High-Loading Exercise as a Novel Therapeutic Training Approach in Achilles TendinopathyRadovanović, Goran 19 November 2024 (has links)
Sehnenverletzungen machen ca. 30 % der muskuloskelettalen Beschwerden aus. Repetitive Überlastung wird häufig als Ursache diskutiert. Dabei entstehende strukturelle Schäden können die Kapazität der Sehne, mechanische Belastung zu tolerieren, reduzieren. Das exzentrische Protokoll nach Alfredson sowie das „heavy slow resistance training“ sind häufig genutzte Formen der Trainingstherapie. Jedoch zeigen diese Protokolle bisher kaum Nachweise für strukturelle Anpassung. Eine trainingsinduzierte Zunahme der Sehnensteifigkeit könnte die Sehne widerstandsfähiger machen und vor Überlastung schützen, da die Beanspruchung (Sehnendehnung) bei gegebener Belastung reduziert wird. Bei gesunden Probanden führte das „high-loading“ Protokoll, das mit einer hohen Dehnungsmagnitude arbeitet, ausgelöst durch ca. 90 % der maximal willkürlichen Kontraktionskraft der Plantarflexoren, sowie einer Dauer von 3 Sek., zu positiven strukturellen Anpassungen. Die vorliegende Arbeit zeigt erstmals, dass sich tendinopathische Achillessehnen bei ausreichend hohem mechanischen Stimulus ähnlich gesunden Sehnen anpassen. Im Vergleich zum exzentrischen Training sowie passiver Therapie führte nur das high-loading Protokoll zu einer Hypertrophie der Sehne sowie einer Zunahme der Sehnensteifigkeit, während es in allen drei Gruppen gleichermaßen zu klinisch-funktionellen Verbesserungen kam. Das dabei angewandte mobile Trainingsgerät bewies in einer separaten Studie exzellente Reliabilität sowie Effektivität (Kraft/Sprunghöhe). Weiters wurden Asymmetrien zwischen der betroffenen/nicht-betroffenen Seite untersucht. Größtenteils zeigten sich im Vergleich zu Gesunden ähnlich ausgeprägte Asymmetrien. Die Effekte auf diese Asymmetrien durch Training waren eher gering. Eine Reduzierung der Asymmetrien ging nicht notwendigerweise einher mit einer klinisch-funktionellen Verbesserung. Insgesamt liefern die Ergebnisse wichtige Erkenntnisse bezüglich einer neuartigen Behandlungsmethode der Achillestendinopathie, die durch die hervorgerufene Verbesserung von Sehneneigenschaften sowohl für die Rehabilitation als auch Prävention zu empfehlen ist. / Tendon injuries account for approximately 30 % of musculoskeletal consultations. Repetitive overload is identified commonly as initial cause implicating structural impairments. Hence, the capacity of the tendon to tolerate mechanical load might be attenuated. In Achilles tendinopathy, Alfredsons ´eccentric exercise protocol and heavy slow resistance training are frequently applied exercise interventions both leading to clinical and functional improvements. However, evidence for eliciting structural adaptation is lacking. An exercise-induced increase in tendon stiffness might improve the tendon `s capacity to tolerate loading and thus reduce future damage as tendon strain at a given force is reduced. In healthy subjects, the high-loading protocol applying high tendon strain induced by highly intensive muscle contractions (i.e., at 90 % of maximum voluntary isometric contraction) with 3 seconds time-under-tension has led to positive adaptations (i.e., increased cross-sectional area and stiffness). This thesis first provides evidence that tendinopathic Achilles tendons do adapt comparable to healthy tendons given that an adequate mechanical stimulus was applied. High-loading led to tendon hypertrophy and an increase in tendon stiffness compared to eccentric exercise or passive therapy, while clinical/functional improvements have been detected in all the three groups. In a separate trial, the applied mobile training device showed excellent reliability and effectiveness (strength/jump height). Further, inter-limb asymmetries have been investigated showing comparable levels except for vascularization compared to healthy subjects. Therapeutic interventions had only small effects regarding pronounced asymmetry reductions whereas a reduction in asymmetry did not necessarily correlate with an improvement in tendon health.
In conclusion, the findings of the present thesis provide valuable evidence for high-loading as a novel exercise treatment in Achilles tendinopathy.
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