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2018 Posters

Best Scientific Poster 

Kimberly Goldie Staines, OTR, CHT, Stacie Gorniak, Ph.D., Forrest Brooks, Ms, Evan D. Collins, MD.

Effects of Professional Musical Training on Strength, Force Control, and Between Hand Differences in String Musicians

In recent years, the impact of music and musical training on the mind and body has been of interest.  In most of these studies, researchers have learned more about how the brain reacts to listening to music, particularly classical music. The goal of this study is to assess the effects of professional musical instrument playing on measures of upper extremity strength and motor function via force production.   In addition to this goal, we are also interested in assessing kinetic performance differences between the two hands in professional musicians versus non-musician controls.
We hypothesized that: (1) musicians will exhibit larger maximal force values for both intrinsic and extrinsic muscles of the hand, and (2) that measures of force control (aka: steadiness) will be better in musicians versus controls.  No hypotheses regarding differences between hands were developed a priori, given the exploratory nature of this particular aim.  Our findings do not support the two primary hypotheses and suggest evidence of magnified between-hand performance differences in musicians versus controls.  

Best Clinical Poster

Molly Hudson, OTR, CHT, Jamie McGaha, OTD, OTR, CHT, Caroline Jansen Ph.D., PT, CHT, Kimatha Oxford Grice OTR, CHT, Sue Blackmore MS, OTR, CHT, COMT, UL.

Outcome Measures to Quantify HandTherapyy Outcomes for Patients with Thumb CMC Arthritis


The purpose of this study was to develop an efficient test battery to measure outcomes for patients with Carpometacarpal (CMC) osteoarthritis (OA). Specific aims: 1) determine measures with the largest effect sizes; 2) select measures with the highest correlations between patient perceived gains and clinician measured gains after hand therapy intervention. 

Methods included a multi-clinic, case series, repeated measures design. Fifteen right thumbs were analyzed. Subjects completed a 1x/week, 4-6 week program under licensed OT/CHTs; measurements were taken at baseline and discharge. Physical measures: grip, lateral pinch, palmar/radial abduction, opposition and the Colditz Tear test. Patient-centered measures: self-reported pain/stiffness, PRHWE, QuickDASH, PSFS, GROC. Statistical analysis completed with SPSS v. 25: descriptive statistics, paired t-test with Cohen’s effect sizes, Pearson’s correlation coefficients

Significant improvements (p < .05) were seen for: grip, pinch, tear test, palmar, radial abduction and all patient measures, except stiffness. Largest effect sizes were seen for PRHWE (d= 1.54), QuickDASH (d =1.52), palmar abduction (d=.77), tear test (d=.61) and pinch (d =.54). An inverse relationship indicated as pinch strength went up, stiffness scores decreased. GROC correlated with opposition from physical measures only.

Our study supports the value of patient-centered measures to quantify treatment outcomes and clinical measures that focus on CMC pathology, either by tolerating more loading (tear, pinch strength) or in mobility (palmar abduction). Our analysis supports findings from the literature that with targeted exercise and client-centered treatment, it is possible to improve functional strength, mobility, and the ability for patients with CMC OA.

Kimberly Goldie Staines, OTR, CHT, Bradley Elseman, MD, Morgan Norms, MD

The Critical Decision Making for the Design and Implementation of an LE Orthosis to Protect a Large Free Flap.

Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of extremities following trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). The multidisciplinary role of acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility is crucial to avoid the adverse impact on physical function and quality of life.  Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with limb salvage.
The purpose of this case study is to evaluate the critical decision making utilized for the design and implementation of an LS orthosis to protect a large free flap following limb salvage as a result of necrotizing fasciitis.
The orthotic trials and failures will be discussed as well as the final resolution and outcome for this patient. A detailed characterization of physiological biomarkers throughout the rehabilitation process may provide additional insight into the current understanding of disease processes and the orthotic considerations of these musculoskeletal injuries.

 

Kimberly Goldie Staines, OTR, CHT, Aida Galindo, OTR, CHT

The Use of Biceps Offloading Strap for Treating Secondary Bicep Tendinosis.

The impetus for the use of bicep offloading straps in the treatment of secondary bicep tendinopathy in has largely been based on empirical evidence related to use in patellar tendinopathy.  The hypothesis that bicep pain may be a result of high localized tendon strains that occur at smaller bicep tendon angles at the GH joint and anterior humeral head. The purpose of this study was to evaluate the clinical benefit of the use an offloading strap to manage this secondary bicep syndrome in rotator cuff insufficiency.
Overall, the authors found a lack of evidence to inform on the use of bicep offloading orthosis for treating secondary bicep tendinosis. There is, however, very low-quality evidence from this clinically heterogeneous trial using a bicep offloading strap [Count R Force, Northcoast]strap) that using a bicep strap did reduce shoulder pain or improve shoulder motion in the short term (under three months) in adults who were also undergoing an exercise program for treating rotator cuff injury. This points to the need for good-quality clinically-relevant research to inform on the use of commonly-available Elbow straps for treating secondary Bicep Tendonosis.

Kimatha Oxford Grice, OTD, OTR, CHT

Orthoses for CMC OA. A Therapist’s Personal Perspective as the Patient

This poster will compare and contrast 4-5 different hand based thumb orthoses that are typically used for CMC OA, based on the personal experience of the author in wearing them for her own CMC joint issues.  Qualities such as comfort, durability, functionality, and pain relief will be addressed.

Matthew Wymore OTR, CHT
Rehabilitation of a left elbow ulnar collateral ligament with Arthrex  fiber tape ligament augmentation repair-A case study


Internal bracing that forms an internal scaffold, has become a popular repair technique for many areas in the body.   Many cases have been reported nationally, but this is the first one we have seen in West Texas.   Many authors have shown highly active individuals to be able to return to high-level activities as soon as four weeks following this technique.  This case study will review the surgical reconstruction of a 53-year-old oil field worker who underwent a left lateral elbow ulnar collateral ligament repair using the Arthrex fiber tape with an internal brace ligament augmentation and the following accelerated rehabilitation that the surgeon and therapist agreed upon at the start of this patients therapy.  We will examine and discuss how the patient was doing with this accelerated progression, and how it had an overall impact on the function and early discharge that the patient had from therapy.

Dustin Blackington, OTR, Misty Fine, OTR, CHT

Electro-stimulation: A case-study with dry needling in the treatment of the post-stroke upper limb
All authors work at West Texas Rehabilitation Center in San Angelo, TX

Dry needling is the use of a thin monofilament needle, without the use of injectate, into muscles, ligaments, tendons, neural tissue, subcutaneous fascia and/or scar tissue. The purpose of dry needling is often used for the treatment of myofascial trigger points and neuromusculoskeletal syndromes. Dry needling is used to relieve pain and/or stimulate neural, muscular and connective tissues.
Electrical stimulation (E-stim) has long been used in the role of upper limb recovery post-stroke.  E-stim is a technique that uses electric current to stimulate muscle contraction via electrodes.  Similarly, electro-stimulation is a type of treatment that involves the use of thin monofilament needle directly into the affected tissue and is connected to cables of an electro-stimulation unit. The use of the needling with e-stim can be beneficial in improving the circulation of blood and nutrients to the tissue which aides in healing and pain recovery.
Dysfunction in the upper limb after post-stroke often involves spasticity.  Spasticity is experienced after there has been damage to the brain that blocks neuro-pathways Spasticity can cause a decrease in active tissue elongation, therefore causing daily activities to be more difficult.  Can the use of dry needling be used to decrease spasticity post-stroke in the upper limb and to improve active facilitation? The purpose of this single case study is to examine the effects of dry needling reducing spasticity in the upper-limb in conjunction with electrostimulation to facilitate active shoulder ROM to overall improve the patient’s functional independence.

 

Mary Beth Burkett, OTD, CHT

An Evidenced Based Approach for Orthotic Management of the PIP and DIP Joints.

The poster captures the components of my capstone project. The purpose of this capstone project was to develop a workshop to increase participant’s knowledge of current evidence related to the orthotic management of proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints by providing evidence from current studies regarding the effectiveness of finger orthoses. By the end of the workshop, participants demonstrated the ability to fabricate four different orthoses. In addition to understanding the need to incorporate evidence-based practice in orthotic interventions, it is also essential that occupational therapists have an understanding of the Occupational Therapy Practice Framework:  Domain and Process, 3rd Edition (American Occupational Therapy Association, 2014) and how outcome measures used in hand therapy must address participation.
The poster provides the background, literature, evidence, implications for occupational therapy, and findings for orthotic fabrication of swan neck and boutonniere deformities, DIP joint arthritis, and mallet finger injuries.  Conclusions drawn from the poster indicate that there is a lack of studies in the area of orthotic intervention for PIP and DIP joints, and future studies are needed. Also, traditional outcome measures used in hand therapy focus on body structures and functions, and the profession needs to shift focus on activity limitations and participation restrictions.

 

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