Scientific Posters

Scientific posters summarize hand therapy-related research in an electronic format. The author provides an overview of the study background, purpose, results and conclusions in the e-poster format. In addition, a subset of e-posters present critically appraised papers and critically appraised topics. In these e-posters, the authors highlight their structured approach to addressing clinical questions and assessing research evidence. All scientific posters can be viewed on site on the kiosks in the Exhibit Hall or through the ASHT on-demand platform.

CRITICALLY APPRAISED PAPER: Tauqeer S, Arooj A, Shakeel H. Effects of manual therapy in addition to stretching and strengthening exercises to improve scapular range of motion, functional capacity and pain in patients with shoulder impingement: An RCT. BBMC Musculoskeletal Disorders. 2024;25(1). doi:10.1186/s12891-024-07294-4

Purpose: This level II randomized controlled trial focused on improving scapular range of motion (ROM), function, and pain in individuals with shoulder impingement syndrome (SIS) in an outpatient hospital setting. It specifically examined the benefits of manual therapy associated with exercise therapy. This article is clinically relevant because incorporating manual therapy in conjunction with exercise therapy provides practitioners with a low-cost addition to SIS treatment plans that improves pain and ROM, thereby improving functional performance.

Methods: Participants with chronic SIS were recruited via convenience sampling. Participants had a history of non-traumatic onset shoulder pain, pain with palpation of rotator cuff tendons and 150 degrees of arm elevation, pain during passive or isometric resisted external rotation of the arm at 90 degrees of abduction, 1 or more positive SIS tests, or positive painful arc during active elevation. Exclusion criteria was previous rotator cuff surgery, paresthesias reproduced by a cervical compression test, had a history of clavicle, humerus, or scapular fracture, positive arm drop test, positive sulcus or apprehension test, systemic illness or corticosteroid injection within 3 months before intervention or physiotherapy within 6 months before intervention.
A total of 32 participants were included 16 participants in each group, using a computer-generated randomization process. Participants were assessed prior to intervention and at week 4. Interventions were provided by 1 therapist for both groups.
Group A received manual treatment with stretching and strengthening. Sessions consisted of exercise and 45 minutes of manual therapy. They received 3 sessions/week for 4 weeks. Manual therapy was individualized for each patient. This included mobilizations intended to reduce movement resistance and increase ROM. Each mobilization was performed for 30 seconds with 1 mobilization every 1 to 2 seconds, followed by 30 seconds of rest, for 5 sets. Mobilizations were performed at Grade I-II or Grade III-IV, depending on the pain report. The exercise regime was the same as described for the control group below.
Group B, the control group, received only exercise therapy for both sides, lasting 25-30 minutes. Strength exercises were performed in max shoulder external rotation, initiating elbow flexion at 90 degrees in the scapular plane. Shoulder extension in the prone position for lower trapezius. Wall push-ups for pectoralis minor. Each exercise was initially performed 5 times for 3 sets. Stretches were based on increased activation of pectoralis minor and upper trapezius muscles and posterior shoulder tightness associated with shoulder pain and limited ROM. Initially performed 7 times for 3 sets. Exercise frequency increased with progression and resistance was added.

Results: The outcome measures included Disability of the Arm, Shoulder, and Hand (DASH) questionnaire to evaluate function, the Numeric Pain Rating Scale (NPRS), and a goniometer for scapular ranges. Each outcome measure was conducted pre and post intervention, and has strong psychometric properties.
Results from the DASH demonstrated higher shoulder function after treatment. Pain levels improved significantly for Group A. Scapular protraction (p = 0.001) and upward rotation (p = 0.001) significantly improved post-treatment in both groups and when compared between groups. The use of independent sample t-tests were used for analysis and was appropriate because the Shapiro-Wilk test verified that a parametric test would be suitable. The effect size for pain in this study was 0.89, demonstrating a high effect of the treatment compared to the control.

Conclusion: Limitations that should be considered was there was no blinding of patients and therapists, which could increase the risk of measurement, detection, and selection bias. Performance bias may exist due to the variation between treatment and control groups. External validity may be questioned because only pain was measured with no report of improved range. An apriori power analysis was performed which determined that 64 participants were required. Because the sample was half, there is risk of type II error. Findings suggest superior improvements in pain, function, and shoulder ROM after adding manual therapy with exercise therapy in patients with SIS. To determine the long term effects of this treatment protocol, further studies are warranted.

Author(s): McCauley Medlin | Brooke Piazza | Gretchen Bachman

CRITICALLY APPRAISED PAPER: Teo, S. H., Ng, D., C., L. & Wong, Y., K., Y. (2019). Effectiveness of proximal interphalangeal joint-blocking orthosis vs metacarpophalangeal joint-blocking orthosis in trigger digit management: A randomized clinical trial. Journal of Hand Therapy, 32(4), 444-451.

Purpose: This was a Level 1B quantitative, randomized clinical trial study. The objective was to evaluate the effectiveness of proximal interphalangeal joint-based orthosis (PIPJ-BO) vs. metacarpophalangeal joint-based orthosis (MCPJ-BO) in reducing pain, trigger digit grading, and disability for individuals with grade 2 or 3 A1 pulley trigger digits. A secondary aim was to identify other factors affecting orthosis effectiveness for trigger digits. The outcomes of this study can impact clinical decisions on orthosis design for patients referred to an outpatient clinic with A1 pulley trigger digits with grade 2 and 3 in Green’s classification rating for optimal outcomes of the therapy.

Methods: Convenience sampling was used to recruit patients who were diagnosed with trigger digit and referred for outpatient hand therapy in Tan Tock Seng Hospital in Singapore between July 2011 and June 2013.  The inclusion criteria were patients diagnosed with grade 2 or 3 A1 pulley trigger digit using the Green classification system, and who did not receive steroid treatment within the last 6 months before recruitment. Patients with other repetitive stress or musculoskeletal injuries on the affected hand, third annular pulley trigger digits, diabetes or rheumatoid arthritis, only with trigger thumb, or who had undergone trigger release surgery, were excluded from the study. Informed consent was obtained before the orthosis assignment. A total of 35 participants were included in the data analysis; 16 patients were assigned to the MCPJ-BO group, and 19 patients were randomly assigned to the PIPJ-BO group. Each participant received the prescribed orthosis, and all participants attended four sessions of occupational therapy fortnightly.

Results: Both the MCPJ-BO and PIPJ-BO showed a significant improvement in pain score post-treatment. However, the PIPJ-BO group (-2.65, SD 2.08) had greater overall pain reduction than the MCPJ-BO group (-1.25, SD 1.83). Both groups showed improved Quick DASH scores, which indicates improvement in function. Still, only the PIPJ-BO group’s improvement was statistically significant posttreatment (P=.0007), as the statistical significance level was set at 0.05. PIPJ-OB group had a higher average duration of orthosis wear with an average of 13.3 hours per day compared to 9.6 hours in the MCPJ-OB group.  For the severity of symptoms, 40% of the MCPJ-BO group and 47.8% of the PIPJ-BO group had improvements of at least 1 Green’s classification grade (P=.606), which marked orthosis treatment as successful in this study. Thirty patients were considered successful and had a mean age of 58.87 (SD 6.93), whereas five who failed had a mean age of 65.80 (SD 5.54), which indicated age as an associated factor for orthosis failure.

Conclusion: This study had several limitations, with the first being the small sample size (35 participants) secondary to excluding patients with diabetes mellitus, rheumatoid arthritis, trigger thumb, and other tendinopathies, which are often associated factors of trigger finger. The study also suggests PIPJ-BO may have had a higher compliance rate due to having better cosmesis and being less restrictive, allowing functional use of the hand. However, this assumption is not supported by evidence, as there was no qualitative data collection from the participants to identify the factors for higher compliance. The data was collected in the span of 5 years, from 2011 to 2016, and the intervention was conducted with data collection by the therapist on duty. The number of participating therapists is not indicated in the study. Although the study's authors believed the outcome measurements were objective and without bias, various therapists providing the treatment may indicate intervention bias.

Based on the outcome measure, PIPJ-BO was more effective than the MCPJ-BO-based orthosis in reducing pain, reducing the severity of trigger symptoms, and improving functional outcome using Quick DASH. PIPJ-BO also had higher compliance with the orthosis wearing schedule. Therefore, PIPJ-BO is recommended to be worn for at least 8 weeks, 24 hours a day, in treating patients with grade 2 or 3 A1 pulley trigger digit with Green’s classification. Age factor also contributes to conservative treatment outcome, with patients more than 60 years of age having a higher failure rate with trigger digit treatment using orthosis.

Author(s): Jee Yoon Chong

CRITICALLY APPRAISED PAPER: Jiménez-Barrios M, González-Bernal J, Santamaría-Peláez M, et al. Impact of a dynamic orthosis on manual dexterity among people with Parkinson’s disease: a randomized trial. Am J Occup Ther. 2025;79(1):7901205110. doi:10.5014/ajot.2025.050723

Purpose: Clinical Bottom Line:
This randomized controlled trial (RCT) provides Level 1b evidence supporting the use of a dynamic elastomeric fabric orthosis (DEFO) worn daily for two months to improve manual dexterity in the most affected upper limb of individuals with Parkinson’s disease (PD). The DEFO showed measurable improvements in upper limb function during wear, enhancing performance in daily activities. However, benefits did not persist after removal. Occupational therapy practitioners (OTPs) should educate clients on the temporary nature of effects and consider integrating DEFOs into home-based, client-centered interventions. Additional training may be necessary for OTPs to implement this intervention effectively.

Research Objectives, Design Type, and Level of Evidence:
The study aimed to assess the effectiveness of a DEFO in improving manual dexterity in people with PD. It used an unblinded, longitudinal RCT design with 80% statistical power, representing Level 1b evidence.

Methods: Participant Selection:
A consecutive non-probability sample of 60 individuals with PD was recruited from Burgos University Hospital (Spain) between September and October 2021. Inclusion required a PD diagnosis with upper limb motor symptoms. Exclusion criteria included cognitive impairment (MoCA ≤ 26) and other neurological tremor disorders. Ethical approval and informed consent were obtained.

Interventions and Control Groups:
Participants were randomly assigned to either the experimental group (n = 40) or control group (n = 20). The experimental group received a custom DEFO for their most affected arm, worn daily (except during sleep and bathing) for two months. The orthosis was fitted by trained occupational therapists and used at home during daily and instrumental activities. Adherence was monitored via phone follow-ups. The control group received no orthosis and continued standard care (Levodopa only). Both groups maintained their existing pharmacological treatment.

Results: Outcome Measures:
Manual dexterity was assessed using the Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and the Square Test (ST). Each measure is standardized, reliable, and valid, with testing conducted at baseline and after two months, during both on- and off-medication states. On-medication typically improves motor symptoms and dexterity, while off-medication is associated with greater impairment. Assessing both states allows for a clearer understanding of how the intervention performs across the full range of motor symptom variability.

Results:
Paired t-tests with Bonferroni correction showed statistically significant improvements in the DEFO group while the orthosis was worn. Significant changes were seen in the first subtest of the PPT (on-medication, baseline: p = .012; post-intervention: p = .008) and the MMDT Placing test (on-medication: p = .001; off-medication: p = .005). No significant improvements were seen when the orthosis was not worn or in between-group comparisons post-intervention (ANCOVA, p > .05). No participants dropped out.

Conclusion: Limitations:
Limitations include the unblinded design, limited intervention duration (2 months), and self-reported adherence without objective tracking. Winter seasonality may have influenced DEFO use due to thermal comfort. Unequal group sizes and limited demographic data collected also reduce generalizability. The Bonferroni correction may have limited statistical sensitivity.

Conclusion:
The DEFO temporarily improved upper limb dexterity in individuals with PD during wear, offering a promising, nonpharmacological tool for occupational therapy. However, effects did not persist post-use, highlighting the need for continued DEFO wear or integration with other interventions. The results support further exploration of DEFOs in broader, long-term clinical applications and emphasize the need for specialized training among OTPs.

Author(s): Kasey Donaldson | Sarah Doerrer | Laurie Rogers

CRITICALLY APPRAISED PAPER:  Kamel FAH, Basha MA. Effects of virtual reality and task-oriented training on hand function and activity performance in pediatric hand burns: A randomized controlled trial. Arch Phys Med Rehabil. 2021;102(5):889-895. doi:10.1016/j.apmr.2021.01.087

Purpose: This study evaluated whether adding Xbox Kinect or Task-Oriented Training (TOT) to traditional rehabilitation (TR) would improve hand function, activity performance, and satisfaction in children with partial- or full-thickness hand burns compared to TR alone. Interventions included motion-sensing games or functional tasks combined with TR, delivered three times a week for eight weeks. Tasks were tailored by adjusting complexity, materials, and repetitions. Findings support that when added to TR, Xbox Kinect and TOT enhance outcomes more than TR alone. These approaches align with the Occupational Therapy Practice Framework (OTPF) by promoting client-centered, meaningful, repetitive, and goal-directed tasks that improve engagement and recovery. The interventions are suitable for hospital, outpatient, and pediatric OT settings. While the internal validity rating is moderate due to limitations such as small sample size (n=50), short duration, and lack of blinding, the clinical benefits suggest value in exploring these methods further in practice. The objective aimed to assess whether adding hands-free, motion-sensing gaming or TOT to TR enhances outcomes in pediatric burn rehabilitation. A randomized controlled trial was conducted in an outpatient setting and is classified as Level 1b evidence. The study achieved 80% statistical power with a moderate effect size (0.45), indicating an adequate sample size to detect meaningful differences between groups.

Methods: Fifty children aged 7–14 years with hand burns affecting over 50% of the hand/wrist and less than 30% total body surface area were recruited from burn units in Cairo, Egypt. Children with complicating conditions or pre-existing disorders were excluded. Participants were randomly assigned to one of three groups by a blinded physical therapist: TR only (n=17), TR + Xbox Kinect (n=17), or TR + TOT (n=16).

The control group received 40-minute TR sessions three times a week for 8 weeks, consisting of paraffin treatment, massage, ROM exercises, mobilization, strength training, desensitization, home programming, and OT interventions. Intervention groups participated in 50-minute sessions, three times a week for 8 weeks. The TOT+TR group completed functional hand tasks using materials like putty, bands, and buttons. Difficulty was adjusted via task variation and repetitions. The Xbox Kinect+TR group played motion-based games targeting occupational goals, chosen through the Canadian Occupational Performance Measure (COPM). These games promoted hand coordination and precise movement.

Results: Assessments were completed at baseline and post-intervention by a blinded assessor. Primary measures included the Jebsen-Taylor Hand Function Test (JTHFT), Duruoz Hand Index (DHI), and COPM. The JTHFT evaluated hand function across seven tasks (reliability r = 0.97–0.98). The DHI measured activity limitations via an 18-item scale (0–90), although reliability was unreported. The COPM assessed perceived performance and satisfaction in meaningful tasks; clinically meaningful changes were ≥1.4 (performance) and ≥1.9 (satisfaction). Secondary outcomes included total active ROM (via steel finger goniometer), grip strength (Jamar dynamometer), and pinch strength (pinch dynamometer). Strength was measured three times with 30-second rests.

Descriptive statistics and ANOVA confirmed no baseline differences among groups. A mixed-model MANOVA with Bonferroni correction showed significant post-intervention improvements in hand function, performance, and satisfaction in both the Xbox Kinect+TR and TOT+TR groups compared to TR alone (P < .05). The Xbox group outperformed the TOT group in DHI, COPM satisfaction, and palmar pinch strength (P < .05). No significant differences were found between the intervention groups in JTHFT, COPM performance, ROM, grip strength, or tip/lateral pinch strength. All groups showed significant within-group improvements (P < .001), except the control group’s tip pinch strength (P = .06).

Conclusion: This study had several limitations impacting generalizability. Home programs during traditional rehab were not monitored, possibly introducing bias. The small sample size (n=50) and 8-week follow-up limit the strength and long-term applicability of results. Participants were not blinded, potentially affecting performance bias. Factors like socioeconomic status, burn severity, and developmental differences (ages 7–14) were not analyzed. Despite this, baseline characteristics were similar, and dropout was low. The study supports that adding Xbox Kinect or TOT to traditional rehab may improve hand function and performance in children with hand burns. Future studies should include larger, diverse samples with longer follow-up.

Author(s): Nicole Tran | Sarah Doerrer | Laurie Rogers

CRITICALLY APPRAISED PAPER: Khoramdel F, Ravanbod R, Akbari H. Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: a randomized controlled trial. J Hand Ther. Published online 2025. doi:10.1016/j.jht.2025.02.009.

Purpose: This randomized, sham-controlled trial examined whether adding high-intensity laser therapy (HILT) to mirror therapy (MT) improves outcomes in adults with post-traumatic complex regional pain syndrome type I (CRPS-I) of the hand. For occupational therapists working in hand therapy or neurorehabilitation, findings suggest that integrating six HILT sessions immediately followed by MT over two weeks may accelerate pain relief, reduce swelling, and improve ROM and motor control—ultimately enhancing participation in self-care and functional hand use. The intervention targets both peripheral inflammation and maladaptive neuroplasticity. Research objectives included assessing pain, hand edema, AROM, motor function, and muscle activity. This single-blind, randomized, sham-controlled clinical trial (n = 24) meets Oxford CEBM Level 1B criteria. Limitations include a small sample size, short intervention duration, and absence of a HILT-only arm, which constrain generalizability and mechanism attribution.

Methods: Twenty-four adults with post-traumatic CRPS-I of the hand were randomly assigned via concealed envelopes to an intervention (n=12) or control group (n=12). Both groups received six sessions over two weeks. The same physiotherapist administered all treatments, while outcome assessments (EMG and motion tests) were performed by a blinded evaluator. The intervention group received high-intensity laser therapy (HILT) using a 5W Eltech k-laser applied to the volar hand and fingers in three phases: fast scanning, stationary application (25 J), and slow scanning. Treatment intensity was customized using a 1x1 mm grid based on hand size. Each session was immediately followed by mirror therapy (MT), which included guided bilateral hand movements (e.g., wrist flexion/extension, finger ab/adduction) with progressive repetition (3x8 to 3x12). The control group received sham HILT (no irradiation) followed by the identical MT protocol in frequency, duration, and progression.

Results: Participants were assessed at pre-treatment, mid-treatment, and 48 hours post-treatment using the Visual Analog Scale (VAS), Fugl-Meyer hand subscale, figure-of-eight method for edema, active range of motion (AROM) for the wrist and MCP joints, and surface electromyography (EMG). Within-group analyses showed statistically significant improvements in all outcome measures for both the HILT+MT and Sham+MT groups (p < .05). In the HILT+MT group, pain measured by VAS decreased from 7.0 to 2.7 (mean difference −4.2 ± 1.2, p < .001), exceeding the minimal clinically important difference (MCID = 2.0), while the Sham+MT group showed a smaller reduction from 6.9 to 5.5 (p < .001), not meeting the MCID. Range of motion improved in both groups, but gains were larger in the HILT+MT group—for example, MCP-3 flexion increased by +8.9° compared to +3.8° in the Sham+MT group. Similarly, hand edema decreased by 2.2 cm in the HILT+MT group versus 0.7 cm in the Sham+MT group. Muscle activation measured by surface EMG increased significantly in both groups, with the HILT+MT group showing greater gains (e.g., FDS peak RMS increased by +4.2 μV vs. +2.6 μV; p = .03). Grip strength also improved more in the HILT+MT group (+1.0 kg) compared to the Sham+MT group (+0.3 kg; p = .002). Between-group comparisons confirmed that the HILT+MT group achieved significantly greater improvements than the Sham+MT group across all outcome domains (p < .05), indicating a stronger effect of the combined intervention. No participants dropped out of the study, and baseline characteristics were comparable between groups, supporting the internal validity of the results.

Conclusion: This single-site RCT found that combining HILT with mirror therapy led to significantly greater improvements in pain, ROM, muscle activation, and hand function in adults with CRPS-I compared to mirror therapy with sham laser. By session three, the HILT+MT group achieved a clinically meaningful reduction in pain, with continued improvement by 48 hours post-treatment. Limitations include a small sample size (n=24), short intervention duration (2 weeks), lack of long-term follow-up, and absence of CRPS-specific patient-reported outcome measures. Performance bias was possible due to an unblinded therapist, and generalizability may be limited by the single-site design. Despite these limitations, findings suggest HILT enhances MT outcomes through both central and peripheral mechanisms and may serve as a promising, noninvasive early intervention in occupational therapy for upper limb CRPS-I.

Author(s): Emma Screws | Sarah Doerrer 

CRITICALLY APPRAISED PAPER: Li Y, Lian Y,Chen X,et al.Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: A randomised controlled trial. J Neuroeng Rehabil.2024;21(1):77–3.doi:10.1186/s12984-024-01372-3.

Purpose: Stroke remains a leading global cause of mortality and often results in hand dysfunction, limiting daily activities such as grasping, dressing, and grooming. A 2024 single-blind RCT study aimed to assess the effectiveness of combining task-oriented training with the SEM™ Glove, a force-feedback hand rehabilitation robot, on finger grasping function in stroke patients with hemiplegia. Participants engaged in therapeutic sessions, receiving either robotic or therapist-assisted task-oriented training plus conventional upper extremity (CUE) occupational therapy (OT). The robot-assisted group demonstrated greater improvements in grip strength, active range of motion, and hand motor function. Real-time tactile feedback during functional tasks such as grasping, drinking, and peg insertion was shown to enhance outcomes in the robotic group. Although limited by a small sample size and short intervention period, the study provides level 2B evidence supporting the integration of wearable robotics in stroke rehabilitation to promote functional hand use. These findings suggest that force-feedback training, when combined with CUE therapy in inpatient settings, can enhance client-centered, occupation-based recovery of hand function.

Methods: Participants were recruited from the Department of Rehabilitation Medicine at the First Hospital of Jilin University in China. Of 65 individuals screened, 44 met criteria and were randomized (22 per group); four were excluded, and 40 completed the four-week protocol. Inclusion criteria: age 20–80, first-time stroke ( level 2, minimal depression, and intact vision, speech, and cognition. Exclusion: neurological, orthopedic, or rheumatoid history; sensory deficits in digits; significant finger pain; severe organ disease/infection; or involvement in other UE rehab studies. The experimental group (n=20) received CUE OT (40 min, 5x/week) and task-oriented training (TOT) with the SEM™ Glove (20 min, 5x/week). TOT included placing a ball, a drinking task, and peg insertion, with grasp patterns simulated using the non-affected hand. The control group (n=20) received similar CUE therapy and TOT with manual guidance from an occupational therapist, without robotic assistance.

Results: Outcome measures were assessed at baseline and after the 4-week intervention for both groups. The Fugl-Meyer Assessment for Hand (FMA-Hand), Action Research Arm Test (ARAT), Grip Strength Test, Modified Ashworth Scale (MAS), range of motion (ROM), Brunnstrom Recovery Stages of the Hand (BRS-H), and Barthel Index (BI) were used. The FMA-Hand and ARAT demonstrated good reliability and validity in assessing motor function and hand grasp in stroke patients. MAS, ROM, BRS-H, and BI were used to assess muscle tone, joint mobility, motor recovery, and daily activity performance, though their reliability and validity were not reported. Within-group analysis resulted in significant improvements in motor function, hand grasping, grip strength, active ROM, and ADL performance in both groups after four weeks (p < 0.05). Between-group analysis showed that the experimental group had significantly greater motor function, grip strength, and ROM improvements than the control group (p < 0.05). No significant differences were found between MAS, BRS-H, or BI groups. Although cylindrical and spherical grasp scores were slightly higher in the experimental group (p = 0.031 and p = 0.015), these differences did not reach statistical significance after Bonferroni correction.

Conclusion: The authors acknowledge several limitations of the study. A short intervention period, lack of follow-up, and small sample size limit generalizability and understanding of long-term outcomes for stroke populations. Additional limitations include the frequency of task-oriented training exercises, limited power for subgroup analysis, and the SEM™ Glove's inability to detect finger extension or sensorimotor activity related to grip release or assist the index and pinky fingers, potentially affecting fine motor manipulation. Although improvements were observed, statistical significance was not maintained following Bonferroni correction. Despite these limitations, task-oriented training assisted by the force-feedback hand rehabilitation robot improved grasping function, grip strength, and hand motor function compared to therapist-assisted training in stroke patients with hemiplegia. Integrating this technology into OT practice may enhance client-centered care in hand function recovery. Further research with larger sample sizes, longer interventions, alternative protocols, and objective measures is needed to validate and optimize these findings.

Author(s): Shani Marcelle | Sarah Doerrer

CRITICALLY APPRAISED TOPIC: Treating the Hypermobile Individual and Hand: A Multimodal Approach

Purpose: a. Background/Clinical Scenario
 Wrist hypermobility often leads to joint instability, pain, and poor proprioception, which impair hand function and increase injury risk. These issues affect daily tasks requiring fine motor control or weight bearing. Instability from hypermobility or ligament injury disrupts neuromuscular function and joint positioning. Research shows that dynamic stability and proprioceptive training can restore control by targeting stabilizing muscle groups. Wrist orthoses also aid by reducing pain and enhancing proprioception. Together, exercise and external support may restore wrist function in hypermobile individuals.
b. Evidence-Based Question (PICO)
In individuals with hypermobility disorders, do dynamic stability and proprioceptive training (with or without bracing) improve wrist function, stability, and pain more than rest and bracing alone?

Methods: c. Search Strategy and Study Selection
•    Databases: PubMed, CINAHL, Cochrane, Google Scholar
•    Keywords: “wrist proprioception,” “joint hypermobility,” “EDS,” “dynamic stability,” “wrist instability,” “orthoses”
•    Inclusion: Human studies (2005–2024), English, interventions on dynamic stability, proprioception, or bracing; study types: RCTs, case series, systematic reviews, and cadaver studies.
d. Data Extraction:
•    Four studies were selected and assessed for population, intervention, outcomes (proprioception, pain, function), and quality using the PEDro scale.

Results: Study 1: 
Findings: This retrospective review displays that occupational therapy and bracing had 70% improvement rates for symptom control and alleviation for EDS populations. 
Interpretation: This data displays evidence to support multimodal occupation-based interventions with external supports
Study 2:
Findings: This case series reported functional improvements in patients with carpal instability after participating in a structured exercise program focused on dynamic neuromuscular control and proprioceptive retraining.
Interpretation: Although not hypermobility-specific, these results suggest that proprioceptive exercises can benefit wrist control and function, potentially applicable to hypermobile populations
Study 3: 
Findings: This RCT evaluated proprioception changes following two interventions: wrist-stabilizing exercises and orthotic support. While both groups showed improved function, only the exercise group demonstrated improvements in proprioception, suggesting neuromuscular training's specific benefit on sensory-motor control.
Interpretation: This study offers the most direct evidence that dynamic wrist exercises can enhance proprioception in individuals with hypermobility.
Study 4: 
Findings: This study directly compared proprioception in individuals with chronic wrist hypermobility (CWH) to healthy controls. It found that those with CWH had significantly poorer proprioception, strength, and functional performance.
Interpretation: Chronic hypermobility negatively affects proprioception, highlighting a need for targeted interventions to address these deficits.

Conclusion: g. Limitations
•    Limited High-Level Evidence: Many studies were case series or biomechanical, reducing generalizability.
•    Non-Specific Populations: Some studies focused on general wrist instability, not specifically hypermobility.
•    Small Samples: Several studies had small participant numbers, increasing bias risk.
•    Variable Measures: Differing outcome tools limited data comparison across studies.
•    Short-Term Follow-Up: Most studies lacked long-term tracking of functional gains. 
h. Conclusion: Evidence supports a multimodal approach for treating wrist hypermobility. Proprioceptive and dynamic stability training can improve neuromuscular control, while bracing may reduce pain and support function. Combined, these strategies show promise for restoring wrist performance. While encouraging, more rigorous studies with hypermobility-specific groups and standardized outcomes are needed to refine best practices.

Author(s): Savannah Olsen

SHOULDER CONTRACTURE IN BRACHIAL PLEXUS BIRTH INJURY: A RETROSPECTIVE CHART REVIEW

Purpose: Purpose: 1) determine the rate of shoulder contracture in infants with brachial plexus birth injury (BPBI) seen at a regional multidisciplinary brachial plexus clinic; 2) compare the rate of shoulder contracture for infants who began care with a specialty team before 2 months of age to those who began care with a specialty team after 2 months of age
Rationale: Injury to the brachial plexus occurs in up to 1/1000 live births (DeFrancesco, 2019). Most infants with BPBI have a full spontaneous recovery but up to 30% have lifelong upper extremity paralysis or weakness causing decreased functional use of the affected arm (Chauhan et al., 2014, Koshinski et. al, 2022) with internal rotation contracture being the most common deformity (Immerman et al., 2013). Due to the high rate of spontaneous recovery, oftentimes a “wait and see approach” is taken, resulting in delayed referral to specialists and delayed initiation of intervention. Early intervention for BPBI including occupational therapy, typically includes a primary goal of improving and/or maintaining shoulder range of motion due to the known risk of developing shoulder contracture within the first year of life. Children who develop shoulder contracture are at risk for subsequent surgeries throughout their lives with shoulder joint deformities such as contracture, being the most common reason for surgery in this population (Cornwall, 2020; Ulmann et al., 2022). Results of a pilot study by Wingrat and Elrick (2023) suggest that among infants with BPBI who began conservative therapy with a specialty BPBI team including daily PROM starting before 2 months of age were less likely to develop shoulder contracture than those who received PROM inconsistently and/or starting after 2 months, indicating that there may be a critical window during the first 2 months of life where initiating specialty care including daily PROM is integral for preventing shoulder contractures in infants with BPBI.

Methods: Retrospective chart review of infants seen in a regional multidisciplinary brachial plexus clinic in which the standard of care includes daily PROM, who continued to return for follow-up visits for at least 18 months. Medical records of all patients seen at the clinic during two time periods, 2007-2014 and 2019-2025 were screened. Records from the interim time period were located on another electronic medical system that was not available for review. Informed consent was not required and the study was approved as exempt from the appropriate Institutional Review Board. Inclusion criteria included all infants with documented BPBI whose first visit to the clinic occurred before age 12 months and who were followed until at least one year of age with the following data documented in their medical record: age at first visit, age of diagnosis, age at which PROM was initiated, and Active Movement Scale (AMS) scores for shoulder flexion, abduction, and internal rotation at initial evaluation and all subsequent follow-up visits up to 18 months of age. Exclusion criteria included infants seen in brachial plexus clinics without diagnosis of BPBI, first clinic visit after age 1, no/missing AMS scores, history of primary nerve surgery in the first year of life.

Results: Forty-two patients met the inclusion criteria with 21 seen for their initial visit at or before 2 months of age, and 21 seen for their first clinic visit after 2 months of age. At least 4 of the infants who were seen after 2 months of age had received previous therapy but not with a BPBI specialist. The overall rate of contracture was 19% (8/42), as indicated by a statement in the medical record documenting contracture at or after 12 months of age. Only two patients whose care was initiated at or before 2 months had documented contracture (rate = 9%) while 6 whose care began after 2 months had a contracture (rate = 28%) (See Table and Figure). Using Chi-square analyses the difference in rates of contracture was not statistically significant (p = 0.23); however, calculations of relative risk (3.01) and odds ratio (3.81) suggest that infants with early initiation of conservative care with a specialty team including daily PROM by 2 months of age, have a decreased likelihood and lower odds of developing shoulder contracture compared to those with delayed initiation of care with a specialty team.

Conclusion: While the difference in rate of contracture was not statistically significant, the findings related to relative risk and the odds ratio are clinically significant and support the recommendation that any infant with a known or suspected BPBI should be referred to a specialist and/or specialty team such as a multidisciplinary brachial plexus clinic as early as possible, and no later than 2 months of age. Research is needed on efficacy of frequency of PROM needed to prevent or reduce contracture as well as on efficacy of other interventions such as static splints.

Author(s): Jennifer Wingrat | Matt Elrick

THE USE OF OCCUPATIONAL-BASED INTERVENTION FOR MANAGING HAND INJURIES: A SCOPING REVIEW

Purpose: Hand injuries are complex injuries that can have devastating impacts on physical, psychological, and social aspects of life, affecting the quality of life. Clients with hand injuries often must deal with consequences such as persistent stiffness, pain, and loss of function for years. The management of hand injuries includes range-of-motion exercise, stretching, use of modalities, joint mobilization, and strengthening. These management components have existed in hand therapy for years and are based on the medical model. The medical model's intervention may fail to improve the client's occupation. There is a growing need for Occupation-Based Intervention (OBI) in hand therapy because it provides holistic care to the client, but the credibility of OBI is often questioned; hence, the study's purpose was to know the extent of evidence in OBI and to identify the research gaps for further research.

Methods: The scoping review was registered under the open science framework. Two methodological frameworks were used in the scoping review. They are as follows: 1) Arksey and O'Malley (2005) and 2) Joanna Briggs Institute (JBI, 2005). The PRISMA extension for scoping reviews. (PRISMA-ScR) was used as a reporting guideline for this scoping review. Five databases, PubMed, CINAL, Scopus, and ProQuest, were used to search the articles about OBI in hand injuries. PRISMA guidance was used to select the articles for the review.

Results: The initial search resulted in 4765 articles, of which 143 are from PubMed, 230 are from CINAL, 4261 are from Scopus, and six are from Google Scholar. The records removed before screening are 4738. The 2300 articles were removed because of duplicate records, and 2438 were removed because they were unrelated to the upper extremity. This resulted in 27 articles for screening, so 27 articles were screened, out of which 12 articles were removed because it was not related to the study purpose, which led to 15 articles being retrieved for screening. Upon screening the 15 articles, one article was removed because of the case study. Fourteen articles that met the inclusion criteria were selected for the review. 
The data from the 14 articles were extracted by using the JBI guidance. The Quantitative analysis was performed using Power BI, and the Qualitative analysis was performed using content analysis. The content analysis was done using the following steps: familiarization of data, inductive extraction and analysis, open coding, framework development, extraction and organization of initial themes, modification of themes, and development of final themes.

Conclusion: The study found evidence to support the use of OBI in hand injuries and that OBI can improve occupational performance when combined with a biomechanical frame of reference and can improve client satisfaction. The objective measurements used by the therapists, such as range of motion and strength, have little impact on clients' occupations. The occupation-based intervention tends to improve the client's occupational performance and satisfaction. In addition, it helps improve the client's motivation and retention of the occupational performance gained with OBI.

Author(s): Sudhagar Gangatharam | Christopher Eidson

A RELIABLE, VALID, AND EFFICIENT GONIOMETRIC TECHNIQUE TO MEASURE SCAPULAR PROTRACTION AND RETRACTION

Purpose: To analyze the reliability and validity of goniometry to measure scapular protraction and retraction.

Methods: Two experienced raters (OT/CHTs) measured the resting, protracted, and retracted positions of the scapulae of a sample of healthy young adults using a 6-inch goniometer aligned with the superior angle (axis), frontal plane (static arm), and acromion (moving arm). The Dartfish motion analysis system was then used by a blinded researcher to place digital angles on photos taken of the participant’s shoulders, using reflective stickers that were placed on anatomical landmarks as a guide. Upon Institutional Review Board (IRB) approval, a convenience sample of students, staff, and faculty at a university in the southwest region of the United States were recruited for the study. Inclusion criteria required participants to be 18 years of age or older, affiliated with the university, and without shoulder pathology or injury that would limit mobility. Individuals that were under the age of 18, not affiliated with the university, or those with shoulder impairment limiting scapular mobility were excluded. Descriptive (mean, SD) statistics and reliability analysis (ICC, SEM) were used to analyze inter-rater reliability. Additional statistics including Pearson’s r, limits of agreement (LOA), and Bland-Altman plots were used to assess criterion validity as a measure of validity.

Results: Measures obtained by both raters for the neutral, protracted, and retracted positions of the scapula (n=50) demonstrated excellent inter-rater reliability (ICCs = .89-.99; SEM=.63-1.9) with MDCs and MDC% ranging from 1.7 - 5.3° and 7-20%, respectively. See Table 1 for details. The mean variance between goniometric measurements and Dartfish was less than 1° with very strong correlation (r = .84-.92). See Table 2 for details.

Conclusion: Goniometric measurement of scapular protraction and retraction using the superior angle and acromion as anatomical landmarks appears to be a reliable and valid technique that can be efficiently implemented in clinical practice and used for education and research.

Author(s): Nathan Short | Donna Walls | Corey McGee

CASE REPORT OF A 54-YEAR-OLD LINE SPECIALIST FOLLOWING SURGICAL RECONSTRUCTION OF A COMPLETE CHRONIC PECTORALIS MAJOR MUSCLE TEAR

Purpose: Pectoralis major muscle (PMM) tears are rare, but injury rate has increased in the last 30 years (Magone et al., 2021). Injury is most common in athletes (Butt et al., 2015; Magone et al., 2021) & active military personnel (Chan et al., 2019) with surgical & non-surgical treatment options. Surgical approach (repair or reconstruction) depends on several factors, including chronicity of injury, i.e. 6 weeks or longer (Gupton & Johnson, 2019). Majority of the literature on surgical and rehabilitation outcomes are for acute, primary repairs in young males (20 to 30 years). There are varying rehabilitation guidelines (duration of sling wear, passive ROM limits) in the limited studies that describe therapy following reconstruction of PMM tears in the general population (Giordano et al., 2023). 
The purpose of this case study is to add to the literature on post-operative rehabilitation, complications, and relevant clinical findings following PMM tear reconstruction with an Achilles allograft in a 54-year-old line specialist.

Methods: Consensus-based clinical case reporting guideline, the CARE checklist (Gagnier et al., 2013), was referenced for writing the case report. The Institutional Review Board (IRB) at the surgery center and university were consulted. IRB approval was not required given the nature of this single case report. Therapist and surgeon’s notes were extracted, patient-specific information was de-identified, and relevant clinical findings, interventions, protocol, and outcomes during the post-surgical period were reviewed. Surgeon was consulted on post-operative guidelines.

Results: Duration of revascularization of an allograft guided first 6 weeks of rehabilitation. This included 6 weeks of sling wear, no shoulder external rotation and abduction past neutral, and passive flexion limited to 90°. ROM restrictions were lifted at 6 weeks, isometrics initiated at 8 weeks, and full strengthening at 12 weeks. Challenge of the first 2 weeks was compromised axillary skin integrity due to chafing. Capsular tightness although anticipated was not experienced. Full AROM was restored by 11 weeks, 5/5 strength by 18 weeks, and return to full duty at 19 weeks with QuickDASH score of 0%, Shoulder Pain and Disability Index score of 7.6%, and Single Assessment Numerical Evaluation (SANE) at 80%.

Conclusion: This case study highlights lack of capsular tightness post immobilization in the shoulder following chronic PMM tear reconstruction. Skin breakdown at the surgical incision was the only complication in the post-operative period. The client had a good outcome with minimal perceived disability and ability to return to work with no restriction as a linesman in 4.4 months post-surgery. 
Clinical implications: Graded therapeutic intervention can maximize outcomes post-reconstruction of PMM tear in a 54-year-old male with moderate to heavy job demands.

Author(s): Priya Bakshi | Amy Jassman | Grace Aubry | Grace Willman | Nardos Gebreyohannes | Caitlin Wyrick

OBSERVED PREVALENCE OF THUMB METACARPOPHALANGEAL COLLAPSE BY OCCUPATIONAL AND PHYSICAL THERAPISTS [Preliminary Findings]

Purpose: The purpose of this study was to determine the prevalence of thumb metacarpophalangeal (MP) collapse during pinch testing as observed by occupational and physical therapists to inform future research and practice guidelines.

Methods: This prospective observational prevalence study was announced via email by the American Society of Hand Therapists (ASHT) by asking therapists to take a survey about thumb MP collapse, which included a post-test to assess their competency in identifying thumb MP collapse through photo observation. Therapists who received a score of 80% or higher on the post-test were invited to participate in phase two, which involved tracking thumb MP collapse on an excel sheet each time they administered a pinch test. Each pinch observation included the following datapoints: a unique non-identifiable patient code, current gender, hand dominance, pinch type, whether MP collapse was observed, and diagnoses when relevant for each hand. A total of 106 therapists took the survey. Each phase two therapist was eligible to participate in four weeks of data collection, receiving a $75 Amazon gift card after each week. Participants were not required to complete their four weeks of data collection consecutively, but were told that all data must be submitted to research team by the end of May 2025; at the time of this submission, over 2,000 data points have been obtained by 20 therapists. Analyses included descriptive statistics to determine MP collapse by pinch type, gender, diagnosis, and hand dominance. The effects of therapist experience level, score on the post-test, and productivity status were examined. Logistic regression was used to understand the effects of gender, diagnosis, pinch type, and therapist. Prevalence is reported in frequencies and prevalence ratios. We will consider the use of modeling with paired data using general estimating equation and McNemar test for correlated samples for within-subjects analysis of left and right hands. Multinomial regression modeling will analyze differences in gender and diagnosis after transforming the MP collapse condition into four categories: 1. No MP collapse bilaterally, 2. MP collapse in dominant hand only, 3., MP collapse in nondominant hand only, and 4. MP collapse bilaterally.

Results: Based on preliminary data: On the first trial of any pinch test (including three-point, two-point, and lateral), only 34% of people had thumb MP collapse, but when provided with 2 or 3 trials, collapse was observed on at least one trial in 50% of cases. On the first trial of lateral pinch, 57% of people collapsed, but when provided with 2 or 3 trials, collapse was observed on at least one trial in 78% of cases. Of all females performing pinch tests, 39.13% demonstrated thumb MP collapse compared to 24.04% of males, no matter the pinch type. When looking at lateral pinch only, 81.54% of females collapsed compared to 68.93% of males. There is a significant difference in observed collapse between diagnoses. Based on logistic regression, people with thumb carpometacarpal (CMC) osteoarthritis are 4.1 times more likely to present with thumb MP collapse during lateral pinch testing than people without a thumb diagnosis. Notably, 73% of people without thumb diagnoses present with MP collapse during lateral pinch, whereas 91% of people with CMC osteoarthritis present with MP collapse during lateral pinch.

Conclusion: Preliminary findings suggest that three trials of pinch testing can increase therapists' detection of thumb metacarpophalangeal (MP) collapse. As suspected, thumb MP collapse occurs most frequently during lateral pinch. Prior studies have shown that the carpometacarpal (CMC) joint is more unstable during lateral pinch than other pinch types (e.g. Halalij et al., 2014) and that females have less CMC joint congruity than males (Ateshian et. al, 1992). This study provides further evidence that people with CMC OA present with MP collapse under load at a significantly higher rate than people without conditions. This supports people with CMC osteoarthritis seeking hand therapy services for joint protection, activity modification, and thumb posture re-training. There is a high prevalence of thumb collapse during lateral pinch in people without a thumb diagnosis. This may support the need for increased community and patient education about the risks associated with thumb MP collapse. Further research is needed to determine standard management of thumb MP collapse by hand therapists. Due to the limited control in this observational study, these pilot findings should be considered with caution. Future research may further examine inter-rater reliability of therapists' detection of thumb MP collapse by observation.

Author(s): Nicole Hoover 

EMPOWERING FUTURE HAND THERAPISTS: ENHANCING STUDENT CONFIDENCE IN UPPER EXTREMITY REHABILITATION

Purpose: This study sought to assess and improve occupational therapy student confidence in performing upper extremity (UE) evaluation and intervention techniques. Evidence suggests that many students lack a firm grasp of these essential skills, which diminishes their confidence and hinders their Level II Fieldwork performance. Compounding this issue, limited hand therapy content in occupational therapy curricula often leaves students feeling unprepared for Level II Fieldwork and Doctoral Capstone experiences, and entry-level practice in this specialized setting. Given that only a small percentage of occupational therapy and physical therapy practitioners specialize in hand therapy and achieve the Certified Hand Therapist credential, and that the number of new practitioners pursuing this specialization continues to decline, targeted, faculty-led seminars during graduate education will increase student interest in this career path, prepare students for Level II Fieldwork and Doctoral Capstone experiences in hand therapy and foster successful experiences, facilitate the transition to hand therapy entry-level practice, and contribute to a sustainable workforce.

Methods: Hand Therapy fieldwork educator feedback informed the development of a faculty-led, upper extremity seminar. Secondary analysis of this data was used to identify key areas in which students would benefit from additional hand therapy evaluation and intervention preparation. Second-year Doctor of Occupational Therapy students scheduled for Level II Fieldwork in hand therapy settings were recruited to participate in the study. Participant confidence in eight identified UE evaluation and intervention techniques was assessed before and after the seminar using a survey. Data was analyzed using descriptive statistics. Secondary analysis of Doctoral Capstone experience application data provided qualitative information supporting participants interest in hand therapy as a future career.

Results: Identified areas of need included range of motion norms and stretching, orthosis selection and fabrication, manual muscle testing, goniometry, grip and pinch strength testing, and special testing for differential diagnosis. Following the seminar, one-third of student participants improved their confidence in all eight techniques, while the remaining two-thirds reported improvements in five or more areas. All seminar attendees had successful hand therapy fieldwork experiences. Additionally, half of the study participants applied to be placed at a hand therapy Doctoral Capstone experience and expressed interest in hand therapy as a career upon graduation.

Conclusion: Incorporating structured learning opportunities focused on setting-specific knowledge and techniques prior to Level II Fieldwork can enhance student confidence when performing essential assessments and interventions by providing a low-stakes environment conducive to focused skill development and refinement, augmentation of foundational knowledge, and additional hands-on practice. These opportunities increase exposure to hand therapy content, generating interest in this specialty practice area for future entry-level occupational therapists and provide a supplement to the limited hand therapy didactic content found in some occupational therapy programs. This study highlights a viable approach to sustainable hand therapy practice by enhancing student preparedness and confidence and equipping students with essential skills required for Level II Fieldwork and Doctoral Capstone experiences, and entry-level practice opportunities in hand therapy.

Author(s): Sarah Donley | Brenda Bodine 

HAND ACUTE TRAUMATIC ALLODYNIA OF CHILDHOOD (ATAC): A CASE SERIES

Purpose: Hand surgeons and therapists commonly treat acute hand injuries in the pediatric population. A key component of assessing children with hand injuries is the physical examination, particularly the localization of tenderness, since radiographs may not always reveal obvious injuries in the immature skeleton. However, such assessment can be challenging when the child presents with diffuse pain and tenderness, especially if the pain seems out of proportion to the injury. In this case series, we describe a clinical entity consisting of acute onset allodynia following blunt trauma, which we term Hand - Acute Traumatic Allodynia of Childhood (Hand ATAC), that we have observed in the pediatric population.  We describe the clinical presentation and the outcomes following a collaborative surgeon and therapist treatment approach.

Methods: Institutional board approval was granted for this retrospective chart review which included records from January 2013 to December 2023. The electronic medical records (EMR) of children 5-21 years old were included for patients who presented with a history of an acute blunt trauma and documented allodynia who had no radiographic evidence of fractures. One researcher extracted demographic variables from the EMR with oversight from the lead investigator. All diagnostic data was extracted by the lead investigator who is a pediatric orthopaedic surgery fellow. The investigator who is a pediatric hand therapist extracted data regarding therapy intervention. Descriptive statistics were performed in Microsoft Excel to describe the cohort.

Results: Five patients (4 Female, 1 Male; median age 13 years old, range 10-13) met inclusion criteria (Table 1). Patients were a median of 7 days (range 5-19) from date of injury (DOI) at the time of their initial clinic visit. All were experiencing allodynia following a blunt trauma to the hand that prevented a full clinical exam. Two patients had radiographic evidence of soft tissue edema, both of whom were the only two patients who were noted to hold their affected hand in protected posture, and three had normal radiographs. Vasomotor symptoms were absent in all patients. The median Numeric Rating Scale (NRS) pain score at presentation was 7 (range 4-8). Pediatric Outcomes Data Collection Instrument (PODCI) Pain and Upper Extremity (UE) Function scores were available for 4 patients.  Median PODCI Pain score was 15 (range 6.75 – 41) and PODCI UE Function score was 31.33 (range 12.67 – 58.33).

All patients were referred to occupational therapy (OT) with a pediatric hand therapist and initiated care with OT on the date of presentation. Initial therapy intervention included active range of motion and desensitization exercises with tactile stimulation to the symptomatic region of the upper extremity with instruction in performing these exercises three or more times each day. Additional therapy interventions utilized during the episode of OT care included activity modifications, joint protection strategies, and grip and pinch strengthening exercises with theraputty. For the only patient with allodynia lasting greater than 3 weeks, mirror therapy was utilized.

Patients had a resolution of their allodynia within a median of 14 days (range 11-126). At repeat clinical exam with the hand surgeon (median 12.5 days, range 7-21 days), one patient had a suspected occult scaphoid fracture and continued with care beyond the resolution of allodynia for fracture care. No other patients had the diagnosis of additional pathology, as tenderness had resolved completely with resolution of the allodynia. Patients received OT on a weekly to every other week frequency until the hand surgeon or OT determined their allodynia was resolved, pain was resolved/controlled, and premorbid level of function resumed. Patients had a median of 2 OT visits (range 1-5) with a median length of OT treatment lasting 14 days (range 1-63) and 3 visits with the hand surgeon (1-5) and median length of hand surgeon treatment lasting 32 days (range 14-126) until discharge from care.

At discharge from care, median NRS score was 0 (range 0-1). Final PODCI scores were available for 2 patients and reflected improvements in pain (PODCI Pain range 74-100) and upper extremity function (PODCI UE Function range 91.67 – 100).

Conclusion: This descriptive case series highlights a clinic entity, Hand ATAC, in the pediatric population and outlines an effective collaborative treatment approach to the clinical presentation. In this case series, immediate hand therapy intervention was effective in decreasing the child’s allodynia within a few weeks allowing the surgeon to perform a full clinical evaluation for other underlying injuries. This characterization of Hand ATAC allows for hand surgeons to identify children who may benefit from same day referral to hand therapy, potentially avoiding evolution of the allodynia into chronic symptoms such as complex regional pain syndrome.

Author(s): Jenny Dorich | Stephanie Lamer | Kaitlynn Jackson | Sierra Richardson | Roger Cornwall

OCCUPATIONAL THERAPY STUDENT EDUCATION ON HAND THERAPY

Purpose: Despite a national shortage of Certified Hand Therapists (CHTs), occupational therapy (OT) programs are currently not required by ACOTE to include hand therapy specific content into their curriculum. This has led to a decline in the number of practicing CHTs due to an imbalance between the rate of retiring clinicians and the entry of newly credentialed practitioners into the field. Currently, less than 7% of CHTs are under the age of 35, and over 25% of current CHTs are expected to retire in the next 10 years. CHTs' willingness to supervise students or mentor novice therapists is negatively impacted by the limited baseline knowledge these practitioners and learners possess in the specialized area of hand therapy. This study, which was conducted within a Master's of Occupational Therapy program in a private university on the east coast, assessed whether hand therapy specific content increased students’ knowledge, confidence, and interest levels in hand therapy.

Methods: The study utilized a quasi-experimental single group pre-/post-test design, utilizing a quantitative measurement tool. The tool measured the constructs of knowledge, confidence, and interest levels using a 1-10 ordinal scale. This study design was the most appropriate as it allowed for the measurement of changes in knowledge, confidence, and interest in the hand therapy specialization before and after the intervention. Eligible participants of this study were recruited through email, canvas announcements, and in-person at the private university. Participants in this study participated in the intervention of a six week specialization course on hand therapy on Canvas through the private university. The modules of this course included: assessments, protocol management and clinical decision making, inflammatory upper extremity injuries, nerve upper extremity injuries, upper extremity deformities, and upper extremity flexor tendon injuries. This study utilized criterion sampling. The sample size of this population was determined by the number of participants willing to participate in the study.  All analyses were performed using RStudio, a statistical software engine and graphic user interface for R.

Results: Of the 28 OT students who participated, 22 reported no prior experience in hand therapy, with the remainder having experience as COTAs or rehabilitation aides. Descriptive and frequency statistics were used to measure attribute variables and to measure central tendencies of ordinal scale responses.  Wilcoxon signed rank tests of difference were performed to evaluate within groups differences between pre-test and post-test scores. Overall, concepts of knowledge (Pre-Mean: 3.29, SD 1.54; Post-Mean: 6.07, SD: 1.71) and confidence (Pre-Mean: 2.57, SD: 1.71; Post-Mean: 5.21, SD: 1.23) increased from pre- to post-program (W = 18.0, p < 0.001; W = 40.5, p < 0.001, respectively). Interest level remained relatively unchanged (Pre-Mean: 4.5, SD: 2.08; Post-mean: 4.46, SD:219). Wilcoxon was performed to evaluate within groups differences between pre-test and post-test scores. Confidence (W = 40.5, p < 0.001) and knowledge (W = 18.0, p < 0.001) were statistically significant. Interest was not statistically significant (W = 181.0, p = 0.85).

Conclusion: These findings suggest that integrating hand therapy content into occupational therapy curricula enhances students’ confidence and knowledge in upper extremity evaluation, clinical reasoning, and biomechanical intervention planning. Furthermore, incorporating hand therapy-focused coursework at the entry-level supports the development of foundational clinical skills, potentially increasing the capacity of CHTs to accept and mentor students in fieldwork placements. The results of this study have the potential to influence future educational initiatives by supporting the development of experiential learning opportunities, increasing students’ knowledge and awareness of the CHT credential, and guiding strategies to strengthen CHT mentorship practices.

Author(s): Madeline Ritenour | Jill Yannick 

STRATEGIES FOR SUCCESSFUL IMPLEMENTATION OF MYOELECTRIC PROSTHESES FOR UPPER EXTREMITY AMPUTEES: A CLINICAL CASE STUDY

Purpose: Individuals who have suffered distal traumatic upper extremity amputation injuries experience a profound degree of functional disability combined with psychological distress. Evidence demonstrates unless individuals suffering traumatic amputation are not prepared to accept a prosthesis within the first six months of injury, they will likely not accept utilizing any type of prosthesis. With current technology, myoelectric prostheses offer patients vast improvements in the ability to perform fine motor manipulation tasks and enhance confidence due to improved cosmesis. It is imperative therapists understand strategies to prepare and transition patients in the use of a myoelectric prosthesis. The purpose of this retrospective clinical study is to demonstrate the successful use of strategies to prepare patients for use of a prosthesis and follow through with appropriate personalized functional training.

Methods: Individuals who have suffered distal traumatic upper extremity amputation injuries experience a profound degree of functional disability combined with psychological distress. Evidence demonstrates unless individuals suffering traumatic amputation are not prepared to accept a prosthesis within the first six months of injury, they will likely not accept utilizing any type of prosthesis. With current technology, myoelectric prostheses offer patients vast improvements in the ability to perform fine motor manipulation tasks and enhance confidence due to improved cosmesis. It is imperative therapists understand strategies to prepare and transition patients in the use of a myoelectric prosthesis. The purpose of this retrospective clinical study is to demonstrate the successful use of strategies to prepare patients for use of a prosthesis and follow through with appropriate personalized functional training.

Results: Both subjects were seen for a total of 16 weeks. The first subject demonstrated fair tolerance to his prosthesis but still demonstrated preference to using his uninvolved, dominant hand for most activities. His DASH score improved from 88.7 to 53.2. This second subject responded exceptionally well to the application of his prosthesis being able to perform highly complex skills including painting, writing, and playing musical instruments. His DASH score improved from 80.3 to 33.6.

Conclusion: In order for patients who have suffered traumatic distal upper extremity amputation to achieve optimal functional restoration using a prosthesis, it is imperative that therapists understand how to address psychological, sensory, and motor processes to prepare them for this transition. Using preliminary desensitization, graded motor imagery, and neuromuscular reeducation with biofeedback provides a positive foundation for the transition to utilization of myoelectric prostheses resulting in positive functional outcomes.

Author(s): Christine Eddow

MEASURING WHAT MATTERS: VALIDATING THE HANDFULS HAND OUTCOME TOOL IN PEDIATRIC BURN SURVIVORS

Purpose: The aim of this study was to validate the Hand Accumulation and Dexterity Functional Limits- Shriners (HANDFULS) in children recovering from hand burns during the first two years after injury and compare their performance to that of non-injured children. The newly developed HANDFULS outcome tool is an easy-to-administer test that measures two critical constructs of hand function that are often impaired after burn or other injury to the hands. The first, palmar workspace volume (PWV), is the functional space created within the palm and fingers and is represented by the number of marbles held in the hand with knuckles turned downward. The second, in-hand manipulation, is the active collection and repositioning of items within the hand. The HANDFULS test captures the two constructs: the number of marbles that fit in the hand determines the PWV, and the timing of how long it takes to collect and position those marbles in the hand quantifies in-hand manipulation.

Methods: The aim of this study was to validate the Hand Accumulation and Dexterity Functional Limits- Shriners (HANDFULS) in children recovering from hand burns during the first two years after injury and compare their performance to that of non-injured children. The newly developed HANDFULS outcome tool is an easy-to-administer test that measures two critical constructs of hand function that are often impaired after burn or other injury to the hands. The first, palmar workspace volume (PWV), is the functional space created within the palm and fingers and is represented by the number of marbles held in the hand with knuckles turned downward. The second, in-hand manipulation, is the active collection and repositioning of items within the hand. The HANDFULS test captures the two constructs: the number of marbles that fit in the hand determines the PWV, and the timing of how long it takes to collect and position those marbles in the hand quantifies in-hand manipulation.

Results: A total of 119 patients with 165 hand burns were enrolled in the study.  Subjects had a mean age of 8.5 (SD=+5.4) years, 56% male, and 56% white. The mean TBSA burned was 12.7% (SD=+17.5%), and surgery was performed on 48 (40.3%) subjects. The least squares mean for PWV was 6.6 marbles (SE=0.29) for all subjects at 2 months (baseline).  Statistically significant improvements were found in PWV over time (p-value<.001), with an increase of 1.5 (SE=0.52) units (marbles held in hand) over the course of the study period. The recovery interval with the largest PWV change was between 2 and 6 months, with an increase of 0.96 (SE=0.36) units (P=.008), representing an increase in functional volume within the palm and fingers. Patients' HANDFULS scores also changed significantly over time, with a decrease of 0.95 seconds per marble over the course of follow-up (P=.0012), representing an improvement in in-hand manipulation. Similar to PWV, the largest change occurred between 2 and 6 months with a decrease of 0.60 seconds per marble (P=.009). Patients did not change significantly between 6 and 12 months or between 12 and 24 months (P values = 0.22 and 0.95, respectively). Compared to non-injured children, 45% of children with burns achieved age-typical PWV and 32% age-typical HANDFUL scores by 2 months after injury. These percentages increased to 78% and 78%, respectively, by 24 months after injury.

Conclusion: The HANDFULS outcome tool demonstrates sensitivity to change in key, problem-specific aspects of hand function in children following hand burn injury. These findings support the clinical use of HANDFULS as a valid outcome measure to track early functional recovery of patients with hand burns and can help guide early intervention for return to age-typical hand function recovery.

Author(s): Ingrid Parry | Sandra Taylor | David Greenhalgh | Michelle James

COMPREHENSIVE PHYSICAL EXAMINATION AND PATIENT REPORTED OUTCOME ASSESSMENT FOR CHILDREN WITH BRACHIAL PLEXUS BIRTH INJURY: BENEFITS AND CHALLENGES

Purpose: Brachial plexus birth injury (BPBI) is the most common cause of pediatric upper extremity (UE) paralysis. Up to forty percent of children with BPBI have incomplete recovery, experiencing permanent musculoskeletal sequelae and functional impairments that affect many aspects of health-related quality of life (HRQoL). The relative impact of these factors on overall HRQoL remains unknown; thus, clinicians lack clarity in focusing interventions on the factors most relevant to individual patient’s overall HRQoL. Comprehensive assessment of all factors affecting HRQoL for each patient at the point of care (POC) is one way to individualize treatment. However, tolerance of this approach and feasibility is unknown. A recent multicenter study (Growing Up with a Plexus Injury – GUPI) used such an approach to prospectively assess patients at the POC, assessing clinician-, patient-, and parent-reported outcomes to capture the scope of HRQoL across the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). The current study surveys the assessors (i.e., clinicians and researchers) who administered these assessments to determine benefits and challenges of implementing comprehensive physical examination (PE) and patient-reported outcome (PRO) assessments in 8-18 year-olds with BPBI.

Methods: In the prospective multicenter GUPI study, the impact of BPBI on HRQoL was comprehensively investigated using PE measures and PROs. The PE measures were guided by the iPLUTO coreset for children with BPBI. The iPLUTO coreset included the Mallet global shoulder function scale, individual joint active and passive range of motion (A/PROM), and the Semmes-Weinstein (SW) sensation assessment. The ICF-informed PRO assessments included both patient- and caregiver-PROs of UE function, pain, stigma, activity participation and global health. In the current study, the GUPI study assessors were subsequently surveyed with closed- and open-ended questions about assessor confidence, and the clinical value, ease, length, and accuracy of the assessments, and assessor perceptions of the patients’/caregivers’ assessment experience. Close-ended responses were analyzed with descriptive statistics, and open-ended responses were evaluated qualitatively to expand on close-ended responses.

Results: Surveys were sent to 16 assessors at the 4 North American BPBI centers involved in the GUPI study. We achieved a 69% response rate (n = 11). Ten of 11 (91%) respondents had > 1 year of study experience; 7 (64%) had completed assessments in > 20 patients. Overall, assessor confidence performing the assessments was strong (Figure 1A,D). Although, qualitative data revealed that assessor confidence with specific measurements decreased in children with cognitive limitations and those with more complex injuries/sequalae. Regarding PE assessments (Figure 1B), clinical value was rated highly overall, with more variability in the perceived value of SW testing than the Mallet and A/PROM. The Mallet was rated most favorably and A/PROM least favorably respective to ease, length and accuracy. Qualitatively, A/PROM were valued for guiding clinical decisions about treatment interventions but perceived to be limited in assessing patients’ functional capabilities. Furthermore, PE assessments were found to emphasize the child’s physical limitations over functional capabilities. Open-ended responses also revealed assessors perceived patient age, cognition, and tolerance for handling to impact accuracy and ease of performing the PE. Regarding assessors’ perceptions of patient/parent experience with the PE (Figure 1C), the Mallet was rated most favorably and AROM/PROM the least favorably. However, qualitative data indicated that all PE assessments were perceived to create patient/caregiver concern by highlighting functional limitations. Regarding PROs (Figure 1E), clinical value, ease and accuracy were rated favorably, but the administration time was rated unfavorably. Open-ended responses revealed concerns for survey fatigue and survey accuracy. Nonetheless, PROs were valued for revealing HRQoL concerns not found with the PE and for providing the patient/parent “a voice.”

Conclusion: As we move towards a more holistic and comprehensive assessment of HRQoL outcomes in children with BPBI, we must carefully consider the impact of these assessments on patients and families, in addition to assessor and clinic burden.

Author(s): Jenny Dorich | Kristen Davidge | Amelia Brawner | Roger Cornwall

UNDERSTANDING HEALTH LITERACY RELATED TO CMC ARTHROPLASY: EXPLORING CLIENT PERCEPTIONS

Purpose: This study aimed to assess the perspectives of clients on the perceived benefit of a preoperative educational session focusing on postoperative recovery following carpometacarpal arthroplasty (CMC) surgery.  The study addressed two questions. 1) Do clients perceive themselves as well prepared for CMC arthroplasty surgery and understand how long it will take to return to normal activities? 2) What are the perspectives of clients regarding an occupational therapy consultation pre-operatively focusing on enhancing comprehension of post-operative treatment?

Methods: The study utilized a quantitative survey methodology to examine client perceptions of the perceived benefits of enhanced preoperative education. Descriptive statistics were used to analyze survey responses to Likert-scale items evaluating participants' understanding of the recovery process and their perceptions of the value of preoperative educational sessions. The application of this methodology enabled the investigation of participants’ opinions within the Facebook Group, CMC- hand joint arthritis suffers United, utilizing a representative subset of the group.

Results: Statistical analysis was conducted using Qualtrics crosstabulation tools.  Analyses concluded statistically significant (p < 0.1) between: (1) misunderstanding of activity resumption and increased concern; (2) perceived preparedness and understanding of recovery; and (3) perceived understanding after their first therapy visit and their belief that therapy improved understanding and reduced concerns. Out of a sample of 25 participants (n=25), a majority of 72% (n=18) indicated either strong agreement or somewhat agreement regarding their understanding of the recovery process prior to undergoing CMC arthroplasty. While more than half of the participants reported having a solid understanding before the procedure, 33% (n=8) later expressed a lack of understanding regarding the duration required to resume normal activities. Additionally, 88% of participants (n=22) agreed or somewhat agreed that a therapist-led educational session would improve understanding of the surgical procedure and subsequent recovery.  These findings reinforce the critical need to strengthen health literacy within this population to alleviate client concerns, improve confidence in recovery, and promote more informed participation in care.

Conclusion: While clients may initially perceive themselves as having a comprehensive understanding of CMC arthroplasty and the recovery process, they may still lack clarity on critical aspects of the postoperative timeline, specifically regarding the expected return to normal activities. Occupational therapists have the responsibility of facilitating individuals' preparedness for occupational performance, encompassing an obligation to adequately prepare clients before and following hand surgery. This study reveals a gap in the current research regarding the role of prehabilitation in hand therapy and represents a call to action for further investigation into the impact of how improving health literacy and setting realistic recovery expectations for those undergoing outpatient hand procedures may affect overall satisfaction and decrease client frustrations.

Author(s): AJ Mullholand | Shirley O'Brien

AT WHAT AGE IS THE MUSICGLOVE AN EFFECTIVE TOOL FOR HAND THERAPY WITHIN THE PEDIATRIC AND ADOLESCENT POPULATIONS?

Purpose: The MusicGlove is a hand therapy tool that utilizes a music-based "video game" interface to engage patients during rehabilitation. A similar platform to the video game Guitar Hero is used, however patients are encouraged to use various finger pinches to play "notes" to the songs. Younger patients are often hesitant to mobilize their fingers in the various pinch patterns necessary for fine motor skills. This interactive tool may provide them with an interesting game to gain interest in therapy. This device has been utilized among chronic stroke and traumatic brain injury patients in the adult population, but has yet to be used with the pediatric and adolescent populations. The purpose of this study is to establish the efficacy of the MusicGlove within the pediatric population and determine at what age this device is most appropriate for use.

Methods: Study design and recruitment: A prospective study was performed to enroll patients and siblings of patients ages 2-17 years. Additionally, children and adolescents from personal contacts were also recruited for participation. Patients who may be in cast or splint that does not permit hand use were recruited for participation with their unaffected extremity. The MusicGlove device was modified using Velcro to accommodate the variety of hand sizes within the population of interest.

Data collection: The same song was used for all participants. Two trials were performed on each hand per participant, resulting in four total trials. The participants then completed a brief satisfaction survey at the conclusion of their session, with the aid of a parent as appropriate. Patient demographics, the percentage of “notes” correctly played, and the Likert scale responses to the satisfaction survey were recorded. Simple statistical analysis was performed to determine percent accuracy and interest within gender and age groups.

Results: 52 participants completed the MusicGlove testing and satisfaction questionnaire. The average age of participants was 8.3 years (Range: 2-16 years). The overall percentage of notes accurately played among all participants was 67.5% (Range: 6.4%-100.0%). The percentage of notes accurately played increased with age, and participants 9 years and older were able to complete the testing with 77.4% accuracy or greater (Range: 77.4%-100.0%) (Figure 1). The majority  (37, 71.2%) of participants completed all trials; however, 15 (28.8%) participants, aged 2-9 years, did not complete all four trials due to disinterest and/or refusal. All but one participant (aged 2 years), still completed the satisfaction survey. Responses to survey questions are presented in Figure 2.

Given that we were utilizing an adult small sized glove for a variety of ages and hand sizes, glove fit was an issue for patients on either end of the spectrum. Younger patients struggled with the glove being too loose and/or falling off, while some older patients experienced issues with the glove being too tight. This is reflective of our limited available sizes as well as the lack of pediatric sizing in MusicGloves.

Conclusion: The MusicGlove device is an effective hand therapy tool within the pediatric and adolescent population from age 9 years and older. This tool may aid in increasing patient engagement, compliance with hand therapy, and potentially improve outcomes. Further investigation of this device in comparison to traditional hand therapy is warranted to assess its utility as a therapeutic tool.

Author(s): Ritu Goel | Joshua Abzug | Julia Conroy

THE INFLUENCE OF ACADEMIC: CLINICAL PARTNERSHIPS IN HAND THERAPY

Purpose: The purpose of this study is to understand the workflow of creating an academic-clinician partnership to perform research in hand therapy. There are considerable barriers for academics to partner with clinicians to perform research, including IRB application requirements and creating proper agreements to allow for data collection. There is also a lack of accessibility for clinicians interested in research that do not have the resources available to perform research at their institutions. This study aims to bridge this gap and increase access to academics and clinicians to further research within the realm of hand therapy.

Methods: This is a descriptive research study. An education session on what an academic and clinician partnership involves was disseminated through the Capital Hand Therapy Association over zoom by an academic at George Washington University (GWU). Clinicians were given the opportunity to ask questions and if they were interested in partnering with GWU they gave their contact information. Clinician research partners represented CHTs from private practice, therapist owned, corporate, and hospital-based outpatient clinics. Over 6 months, clinicians and the GWU academic worked on a clinical study protocol together through brainstorming and literature review. After a protocol was developed, the IRB and onboarding process began with each site. GWU served as the overarching IRB and sites were onboarded to collect data; various documentation was required for each site, such as data use agreements and one site specific IRB application. After the site was onboarded, a GWU OTD student trained the clinician onsite on use of the REDCap software for data collection. Descriptive analysis was used to evaluate the onboarding process and compliance with data collection as sites were onboarded.

Results: The two research questions and results for this study are as follows:
1. For a research team completing academic-clinician partnered research in an IRB exempt study, what are the methods of creating an agreement between parties to allow data collection?
- As seen in Table 1, methods for creating a data collection agreement included meetings with supervisors (i.e., heads of research and clinic managers), data use agreements, and an additional IRB application for one site with an IRB. These methods of agreements have taken anywhere from two weeks to 9 months for the separate IRB application.
2. What is the data collection compliance rate of data collectors at sites that include corporate, hospital based, and private practice?
- As seen in Table 2, the compliance rate for data collectors with study participants is 100% as of May 2025, showing that clinical research partners collected the required data at each visit. Table 2 also includes other outcomes for this study, including onboarding 100% of sites, which has yet to be completed as of May 2025, and completing at least 1 full data set from each site, which has not been completed. There are currently 3 study participants as of May 2025.

Conclusion: Academic-clinician partnerships are an effective method of increasing research accessibility for clinicians, students, and faculty members. When partnering for research, it is recommended to submit for IRB approval early on in the process, utilize student researchers to ensure clinician compliance and train clinicians in data collection software, have clinicians advocate for themselves to perform research, and be aware of the length of time needed for additional IRB approval and partnership agreements, which may take up to a year to complete.

Author(s): Natalie Sipes |  Sarah Doerrer

OCCUPATIONAL THERAPY USING PROXIMAL INTERPHALANGEAL JOINT BLOCK ORTHOSIS FOR CONSERVATIVE TREATMENT OF TRIGGER FINGER: A RETROSPECTIVE STUDY

Purpose: Trigger finger (TF), also known as flexor stenosing tenosynovitis, is a common hand condition with a prevalence rate of 2.6% in the general population. It is characterized by clinical symptoms of pain, swelling, and clicking or locking of a digit during flexion or extension. TF can cause functional limitations when using the involved hand during daily activities. Despite the prevalence of TF and its impact on the functional use of the hand in individuals with this condition, a limited number of studies have analyzed the effectiveness of conservative treatment for TF. Traditionally, the metacarpophalangeal joint (MCPJ) block orthosis has been effective in prior research. However, recent studies support using the proximal interphalangeal joint (PIPJ) block orthosis for single-digit TF. The primary objective of this research study was to investigate the effectiveness of occupational therapy (OT) using a PIPJ block orthosis in reducing pain, triggering symptoms, and improving function for individuals with TF. The findings from this study can support practitioners' clinical decisions on trigger finger orthosis design. They can be used in developing standardized protocols for conservative hand therapy treatments in individuals with TF.

Methods: This research was a quantitative, retrospective study using a pre- and post-test, one-group design to examine the benefits of the PIPJ block orthosis for the conservative treatment of TF in an outpatient occupational therapy (OT) setting. Subjects were selected based on inclusion and exclusion criteria, and data were retrieved from the electronic medical record system. Three outcome measures were used to assess the effects of the OT intervention. The numeric Rating Scale (NRS) is the most frequently used patient-reported outcome measure of pain in clinical practice. Green's classification grading system (see Table 1) addresses the second objective of monitoring outcome changes in the severity of triggering symptoms. The last objective was measured using the QuickDASH to assess patients' reported changes in function and perceived severity of impairment. Paired t-tests were used to determine changes in pain and QuickDASH outcome measures, and the Wilcoxon signed-rank test for the trigger finger grade changes. The alpha value of p ≤ 0.05 was used to test for statistical significance.

Results: A total of 38 subjects and 45 involved digits were included in the final data analysis. Twenty-five subjects were females (66%), and 13 were males (34%). The average age of subjects was 64.2 years, ranging from 42 to 84 years (See Table 2). Pain scores were analyzed using a one-tailed paired t-test. The p-value was <.0001, demonstrating that the changes in pain level before and after OT treatment were highly statistically significant. For the QuickDASH score before and after OT treatments, the p-value for the tailed t-test was 0.075, and the change was not statistically significant. Five out of 45 digits had entirely resolved symptoms of triggering. The p-value was <.0001, less than p < .05, indicating that the trigger finger grading from pre- to post-treatment was highly statistically significant. The PIPJ block orthosis effectively reduced pain and triggering symptoms for individuals with TF, at least after six weeks of wearing time (see Table 4).

Conclusion: This retrospective study demonstrated the benefits of PIPJ block orthosis for conservative TF management. Twenty-five out of 45 digits (55%) showed one or more grades of improvement in Green’s classification grading in this study. Subjects with multiple involved joints (n = 7) showed significant improvement in pain and trigger finger symptoms. Teo et al. (2019) suggest that the superior results of the PIPJ block orthosis were due to a higher compliance rate than the MCPJ block orthosis. PIPJ block orthosis is smaller in size, lighter, and less restrictive. The findings of this study show positive improvements in pain, triggering symptoms, and function, with statistically and clinically significant improvements in pain and the severity of triggering symptoms using the PIPJ block orthosis. These findings support current literature on using an orthosis program for trigger finger patients and assist outpatient clinicians in making evidence-based decisions on the orthosis design when treating trigger finger patients conservatively. This study concludes that the PIPJ block orthosis is effective for individuals with isolated TF, multiple TF, or trigger thumb. For the maximum benefits of using the PIPJ block orthosis in reducing trigger finger symptoms, a wearing duration of 6 to 10 weeks is recommended.

Author(s): Jee Yoon Chong

A PILOT STUDY TO RE-NORM THE COMPLETE MINNESOTA DEXTERITY TEST

Purpose: This pilot study aimed to establish up-to-date normative data for the Complete Minnesota Dexterity Test (CMDT). The CMDT includes five subtests that evaluate eye-hand coordination, gross motor control, and fine motor skills in the upper body. While the test has been shown to be reliable (Walter et al., 2024), the normative data hasn’t been updated since 1957. The original norms were mostly based on young adult men who were in the workforce at that time (Layfayette, 1998) which doesn’t reflect today’s population. According to current recommendations, standardized tests like the CMDT should have their norms updated every 15 to 20 years to stay valid and ethical (Tulsky & Price, 2003). Because of this, our study focused on taking the first steps toward re-norming the CMDT so it can remain useful and accurate in modern clinical practice.

Methods: After obtaining Institutional Review Board approval at Jacksonville University, participants were recruited using paper flyers posted in the Health Sciences Building. Participants were also recruited verbally as they walked past the evaluation tables in the main entranceway. Inclusion criteria were anyone over the age of 18 who was able to read and understand English. Individuals with a current upper extremity injury or back pain were excluded due to the fact that the test was administered in standing position. After written consent was obtained, participants completed the five subtests of the CMDT in accordance with the administration manual. In an attempt to control for confounding factors such as practice and fatigue, the sequence of the subtests was varied (for example, participant 1 completed subtests 1-2-3-4-5, participant 2 completed subtests 2-3-4-5-1, etc.). The average time to complete each subtest was then calculated for the participants in each of the following age ranges: 18-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, 71+ years. Additional demographic information was also collected including gender, handedness, as well as occupational and leisure pursuits. A G*power33 analysis determined that 1140 individuals will be needed to re-norm the CMDT.

Results: A total of 25 participants completed the study. Most participants were aged 18–30 (n=16), and none were in the 71+ age group. The sample was 72% female and 28% male, with 96% right-handed and 4% left-handed. Future analysis will explore whether or not handedness, occupation, and hand-related leisure activities may influence CMDT subtest scores. Please see Tables 1, 2, and 3 for our results.

Conclusion: This pilot study showed that re-norming the CMDT is feasible and important for updating its scores. Having current norms will help occupational therapists better assess client performance, set goals, and track progress. Future research will continue in order to achieve the targeted number of participants needed.  Continuing to add participants will also ensure more diverse participants from various age ranges.  Additional data may also allow us to look at whether or not other factors such as gender, handedness, occupational pursuits, and leisure pursuits affect CMDT results.

Author(s): Jacqueline Walter | Diamonique Carroll | Brooke English | Crystal Fields | Shakara Johnson | Mark McGary | Eryn Owenby | Sarah Doerrer | Brandon Powers | Victoria Priganc

ADAPTATION OF THE BRIEF ACTIVITIES MEASURE FOR UPPER LIMB AMPUTEES: A DELPHI METHOD APPROACH

Purpose: This research project aims to enhance and adapt the Brief Activities Measure for Upper Limb Amputations (BAM-ULA) by identifying two new occupation-based tasks using the Delphi Method. BAM-ULA is a performance-based outcome measure designed to assess functional abilities in individuals with upper limb amputations who use a prosthetic device.

Methods: The Delphi Method is a structured communication technique that gathers expert consensus through multiple rounds of questionnaires and focus groups. This study involved three focus groups—rehabilitation specialists, individuals with shoulder disarticulations, and individuals with partial hand amputations—comprising a total of nine expert panelists. Participants were recruited using convenience sampling to ensure demographic diversity across the United States.
Each focus group initially met independently for the first two rounds to discuss and identify relevant tasks based on their unique perspectives and experiences. In the final round, all groups convened collectively to reach a consensus on the proposed modifications to the BAM-ULA. Throughout the process, the student researcher and a faculty advisor conducted qualitative coding of emerging themes and patterns from each session. These findings were then presented in subsequent meetings for participant validation and refinement.
During the first round, participants explored the functional role of prosthetic devices in daily activities, emphasizing that prostheses are primarily used for stabilization rather than for executing complex tasks. In the second round, participants identified specific tasks and activities that should be incorporated into the BAM-ULA, drawing from their lived experiences and considering their applicability in clinical settings. The final consensus meeting resulted in the addition of two new task items, the development of revised scoring metrics, and the removal of certain tasks deemed less relevant or impractical for individuals with upper limb amputations.

Results: After the final focus group meeting, the participants reached a consensus on adding two new tasks to BAM-ULA: donning and doffing a prosthetic device and opening and closing a prescription bottle. These tasks were identified as critical activities that individuals with upper limb amputations frequently encounter in their daily lives. Additionally, the participants suggested removing the task of taking a wallet out of one’s back pocket and tucking in a shirt, as this action is not typically performed by individuals with a unilateral upper limb amputation who would use their functioning arm to complete this specific task. The rehabilitation team also proposed conducting a detailed activity analysis for each task item and introducing a partial scoring system to more accurately capture functional performance and the nuances of task completion.

Conclusion: The inclusion of these new tasks in BAM-ULA will provide a more comprehensive assessment of functional performance for individuals with upper limb amputations. By incorporating bilateral occupation-based tasks that reflect real-life activities, the enhanced BAM-ULA will better capture the challenges and capabilities of these individuals, leading to improved rehabilitation outcomes. The findings of this study revealed that most prosthetic users primarily utilize their devices to perform bilateral tasks, highlighting the need for the BAM-ULA to incorporate a greater number of bilateral activities to more accurately reflect functional use. This project successfully utilized a modified Delphi method approach to identify and reach a consensus on new occupation-based tasks for BAM-ULA. The addition of donning and doffing a prosthetic device and opening and closing a prescription bottle, along with the removal of taking a wallet out of one’s back pocket and tucking in a shirt, will enhance the measure's accuracy and inclusivity. This research contributes to the field of occupational therapy by providing a more robust tool for assessing functional performance in individuals with upper limb amputations. Future research should focus on piloting the adapted BAM-ULA across all levels of upper limb loss, with particular attention to bilateral amputees, whose needs are especially critical in prosthetic training and assessment.

Author(s): Alexis Clapper | Sarah Doerrer | Michelle Intintoli

HAND THERAPISTS' PERCEPTION OF PREFABRICATED ORTHOSIS USE FOR CONSERVATIVE MANAGEMENT OF TFCC INJURIES

Purpose: Prefabricated orthosis use has become more prominent as a quick and less restrictive intervention to address pain, ROM, and functional use of the upper extremity for clients with TFCC injuries. While these orthoses are being used, limited research exists to study their use and efficacy in practice. The purpose of this survey study is to examine hand therapists’ preferences of prefabricated orthoses in the conservative management of TFCC injury and therapists’ perception of prefabricated orthoses’ effectiveness in patient outcomes, specifically pain, weightbearing capacity, and functional outcomes.

Methods: A 29-item mixed-method survey was administered, identifying perceived outcomes and prevalence of use for prefabricated orthoses in the conservative management of TFCC lesions. Questions were designed as either multiple-choice responses, Likert-style questions, or open-ended responses. The survey was peer-reviewed by the ASHT Research division. Following IRB approval, the survey was administered to all active ASHT members via email starting 10/8/2024. The survey remained open until 11/8/2024. Inclusion criteria included eighteen years or older, active members of ASHT at survey distribution, and be OT, PT, OTA, or PTAs.

Results: 167 ASHT members completed the survey. Results demonstrate that 57.0% prefer to issue a patient with a TFCC injury a prefabricated orthosis and 34.3% choose to issue the patient a custom orthosis (n=158). 
For the question related to prefabricated orthosis preference, results reveal that 68.2% state the WristWidget® is the most frequently preferred prefabricated orthoses for managing TFCC injuries followed by the Bullseye 16.2%, 6.10% who preferred prefabricated wrist cockups, 4.1% prefer the Comfort Cool® Ulnar Boost™, and 4.8% preferred other prefabricated orthoses (n=148). 
The survey consisted of four Likert-style questions regarding the WristWidget®, the Bullseye, and Comfort Cool® Ulnar Boost™ examining therapists' beliefs regarding the prefabricated orthoses ability to reduce pain, improve functional weightbearing, and improve performance in ADL and IADL tasks.
For improvements in pain,  90.3% (n=144) of respondents replied either “strongly agree” or “agree” the WristWidget may improve pain in conservative management of TFCC injuries, compared to 49.6% (n=142) for the Bullseye orthosis, and 24.5% (n=143) for the Comfort Cool® Ulnar Boost™.
For improvements in functional weight-bearing,  84.0% (n=144) of respondents replied either “strongly agree” or “agree” the WristWidget may improve functional weight-bearing in conservative management of TFCC injuries, compared to 45.5% (n=143) for the Bullseye orthosis, and 22.4% (n=143) for the Comfort Cool® Ulnar Boost™.
For improvements in ADLs, 83.3% (n=144) of respondents replied either “strongly agree” or “agree” the WristWidget may improve ADL function in conservative management of TFCC injuries, compared to 45.1% (n=142) for the Bullseye orthosis, and 23.9% (n=142) for the Comfort Cool® Ulnar Boost™.
For improvements in IADLs, 88.7% (n=142) of respondents replied either “strongly agree” or “agree” the WristWidget may improve IADL function in conservative management of TFCC injuries, compared to 48.3% (n=143) for the Bullseye orthosis, and 23.9% (n=142) for the Comfort Cool® Ulnar Boost™.
The survey included one qualitative, open-ended prompt  “In your professional experience, how has the use of prefabricated orthoses in managing TFCC injuries impacted patient outcomes and treatment approaches?”. Four themes were extracted, including 1) Easy to use and subjectively improve patient compliance, 2) Pain reduction and improve functional outcomes, 3) Prefabricated orthosis use is dependent on severity of injury, and 4) The WristWidget ® is easy to utilize, and it improves patient outcomes in mild cases of TFCC injuries.
Finally, the survey included one multi-select question posed as “Why do you prefer prefabricated orthoses for the conservative management of TFCC injuries? Select all that apply.”  Highest frequencies of responses include 18.3% reporting “ease of use”, 16.2% reporting “pain reduction”, 14.7% reporting "better patient satisfaction”, and 13.8% reporting “cost” (n=557).

Conclusion: This study demonstrates hand therapists report a preference for prefab orthoses compared to custom fabricated for conservative TFCC treatment.  Survey results identified the WristWidget® as the preferred prefabricated orthosis. Therapists report prefabricated orthoses  reduce pain, improve functional weightbearing, and improve ADL and IADL performance. Hand therapists commonly state prefabricated orthoses are easy to use, reduce pain, and improve functional outcomes. However, the use of prefabricated orthoses depends upon severity of injury. Results will be used for further efficacy studies for the use of prefabricated orthoses for TFCC injuries.

Author(s): David Plutschack | Megan Plantikow | Jonah Lewis | Tucker Aeschliman | John Levis