Scientific Session 2

This session will present cutting-edge hand and upper extremity therapy research you do not want to miss!

Asymmetrical Arm Swing During Gait in Children with Brachial Plexus Birth Injury

Purpose: Children with brachial plexus birth injury (BPBI) often report notable differences in arm movement between the affected and unaffected arm during sports activity, though this has not been investigated. We characterized abnormalities in arm swing during gait in children with BPBI, exploring asymmetry in arm movement and asynchrony with the lower extremities.

Methods: Patients between 5-17.99 years old with BPBI at a single children’s hospital were prospectively evaluated. We used an Inertial Measurements Unit system (XSENS, Movella Inc.) to collect bilateral shoulder and elbow three-dimensional kinematics and toe velocity during a 60-feet sprinting task. A custom-made MATLAB program was used to extract toe strike which defined each gait cycle start and end as well as peak shoulder and elbow flexion (positive) and extension (negative) angles during the gait cycles, and the time difference between toe strike and maximum shoulder and elbow flexion/extension of the opposing sides. Patient-reported outcomes including the Children’s Hand-Use Experience Questionnaire (CHEQ) and PROMIS Anxiety and Peer Relations modules were administered. Paired T-tests compared sides, and one sample Mann-Whitney tests evaluated CHEQ scores.

Results: Twenty-two patients were tested at an average age of 8.5 ± 3.2 years. Patients achieved less maximum shoulder extension (-1.83º versus -37.19º, p< 0.01) and less maximum elbow flexion (58.4º versus 79.1º, p< 0.01) on the affected side compared to the unaffected side (Figure 1). Although peak shoulder extension was reached at similar time point on both affected and unaffected side during gait cycle (mean 0.18 versus 0.12 seconds, p=0.3), there was more variation in timing of peak shoulder extension on the affected side (SD 0.12 versus 0.07, p=0.02), suggesting less consistency cycle-to-cycle, with similar findings regarding maximum elbow extension (mean 0.14(a) versus 0.09(u), p=0.50; SD 0.19(a) versus 0.12(u), p=0.04). On the mini CHEQ (ages 5-7.99, normal=4) and the CHEQ (age 8+, normal=100), patients reported significantly lower hand capacity during activities (mean 3.0, 58.9), longer average time to complete tasks (2.9, 63.6), and were more bothered by their arm function (mean 3.2, 69.5) than normal (p< 0.01 for all). Patients scored within normal limits on the PROMIS Peer Relations and Anxiety modules (mean 53.4 ± 7.3 and 50.5 ± 8.9, respectively).

Conclusion: Children with BPBI demonstrate less maximum shoulder extension and elbow flexion as well as decreased coordination with leg movements, ultimately reducing efficiency with sprinting. Children felt bothered by their arm function. BPBI causes arrhythmic arm swing in pediatric patients and worsens coordination with leg movements while sprinting.

Presenter: Meagan Pehnke, MS, OTR/L, CHT, CLT

Aquatics Therapy for Brachial Plexus Birth Injury

Purpose: The purpose of this case report is to describe a 12-week aquatics-based intervention for a 3 year-old boy with brachial plexus birth injury (BPBI) and discuss the benefits of aquatics therapy for children with BPBI. BPBI results in decreased functional use of the affected upper extremity (UE). A comprehensive review of the literature on rehabilitation interventions used for therapeutic management of BPBI identified numerous modalities  (Frade, 2019) but no research on the use of aquatics therapy for this population. While there is evidence that traditional techniques including sensory stimulation, passive and active range of motion (ROM), splinting, and other therapeutic modalities are beneficial in facilitating improved upper extremity function in children with BPBI, aquatics therapy may provide even greater benefits by facilitating repeated desired motor patterns while the weight of the arm is reduced by the water’s buoyancy, and by providing proprioceptive feedback and strengthening from the water’s viscosity, all while the child engages in a child centered, occupation-based environment.

Methods: This is a case report of a 3 year 3 month old child with history of right BPBI s/p nerve graft repair at 4 months of age. At the time of referral he was receiving consult OT services in preschool and had previously received weekly outpatient and early intervention OT. The child presented with the following limitations: 1) Decreased active shoulder flexion, abduction, internal and external rotation, and decreased elbow flexion, 2) Overuse of compensatory trunk movements to assist with UE ROM against gravity, 3) Decreased independence with dressing, 4) Decreased participation in play. The child participated in 11 60-minute aquatics therapy sessions in a therapy pool with adjustable height floor. Therapy focused on: 1) Range of motion activities: reaching for objects on and above pool surface and pool floor; 2) Strengthening activities: weightbearing on pool mat, swimming/paddling; 3) Dressing and undressing before and after entering the pool and donning/doffing shirt in the pool; 4) age appropriate play with therapist in the pool and family members and pool staff on the deck. See Table 1 for list of activities targeting therapy goals.

Results: 1. Improved scores on Active Movement Scale (AMS) for shoulder flexion, abduction, internal and external rotation, elbow flexion, forearm supination and pronation, and wrist extension (see Table 2). Finger and thumb movements were recorded at initial evaluation but were not recorded at discharge; however the child demonstrated improved ability to maintain grasp on objects indicating improved finger and thumb flexion.
2. Improved Mallet scores in all areas except internal rotation to bring hand to back, however the child demonstrated improved internal rotation to bring hand to waist at midline to reach/manipulate fasteners on his pants and made functional progress in pulling pants up and down. The Mallet Scale scores also confirm decreased use of compensatory trunk movements and shoulder trumpeting indicating improved kinematics/efficiency of UE motor patterns. 
3. Qualitative improvements in occupational performance and participation including increased spontaneous use of right arm during play and ADLs, increased independence with dressing and undressing (ability to don pullover shirt and bring hand to midline to reach fasteners and pull pants up and down), and increased confidence in social participation as reported by parents.

Conclusion: The outcome of this case report supports the use of aquatics OT as an effective modality to improve functional performance and participation for children with BPBI. The therapeutic properties of the water allowed the child to perform repeated movements using ranges of motion that were not available to him on land due to his decreased strength against gravity leading to improved active range of motion, strength, and use of efficient motor patterns. The temperature of the water helped loosen his shoulder girdle allowing for increased range of motion to reach for toys on the surface of the water at shoulder level and on the pool deck above shoulder level. Buoyancy of the water allowed the child access to new ranges of motion and to move repeatedly in these newly accessed planes without gravity related restrictions, enhancing his motor learning. Adjusting the water level to various heights such as shoulder, axilla, or sternal level facilitated various starting points to initiate range of motion at the shoulder and elbow. Moving his arm in these new ranges of motion against the resistance of the water served to improve the child’s strength, thus providing increased range of motion against gravity outside of the aquatics environment. The use of repetitive movements throughout the course of the intervention provided proprioceptive feedback and facilitated motor learning to reinforce improved movement patterns.

Presenter: Jennifer Wingrat

The Relationship Between Kinesiophobia and Disability in Persons with Thumb Carpometacarpal Osteoarthritis

Purpose: Kinesiophobia is linked to pain severity, disability, and rehabilitation outcomes for several musculoskeletal populations, however, the literature has not yet explored the impacts of kinesiophobia in upper limb osteoarthritis, particularly thumb carpometacarpal (CMC1) OA. Given its prevalence and how often persons with this condition are treated in hand therapy settings, there is a need to explore if these associations also exist in individuals with CMC1 OA.

The purposes of this study were to 1) explore rates of clinically significant kinesiophobia and 2) assess how kinesiophobia, when compared to other factors such as disease severity and pain severity, is related to self-reported disability persons with CMC1 OA.

Methods: We conducted a descriptive cross-sectional study where the Tampa Kinesiophobia Scale (TKS), Pain Numerical Rating Scale (NRS), Eaton-Littler radiographic staging, and the Thumb Disability Examination (TDX) were used to assess the constructs of kinesiophobia, pain severity, disease severity, and disability respectively. This data was supplemented by demographic data such as age, sex at birth, racial background, and ethnicity.

Participant demographics were reported via descriptive statistics. For project Aim 1, summary statistics (Means, SD) for TSK total, pain NRS, and TDX Total scores were reported. For Aim 2, tests of normality were conducted to determine if parametric or nonparametric statistical tests were required. It was determined that parametric tests were required, therefore Pearson’s’ R was used to evaluate the strength of associations between TDX, TSK, and Pain NRS. Test significance was set at p<.05. The strengths of relationships were assessed according to the criteria proposed by Cohen where correlation coefficients of 0.10, 0.30, and 0.50 are respectively ascribed to small, medium, and large effects.  A backwards stepwise multiple linear regression analysis was also conducted. All analyses were performed using SPSS ver. 27.

Results: Seventy-one adults with physician-confirmed CMC1 OA participated. Their characteristics are described in Table 1. Related to aim 1, forty percent of participants reported having clinically significant kinesiophobia (i.e., a score of 37 or higher). See Table 1. Related to aim 2, disability was moderately and strongly associated with kinesiophobia (r=.36, p<.001) and pain severity (r=.63, p<.001) respectively. While accounting for the effects of age, sex, and disease severity, pain severity (B=4.37, p<.001), kinesiophobia scores (B=.60, p=.03), and clinically-significant kinesiophobia (7.8, p=.03) were found to significantly predict disability. According to our findings, clinically-significant kinesiophobia and pain severity explain 50 percent of the variance (r-square = .50) in the self-reported disability experienced by patients with non-operative CMC1 OA.

Conclusion: 1Kinesiophobia is linked to pain severity and disability in CMC1 OA. Additionally, it, along with pain severity, are significant predictors of disability while disease severity, age, and sex are not. These findings support the premise that kinesiophobia is an important construct to consider when assessing, developing and implementing interventions in this population. However, it is not a construct that is explored in assessment tools commonly used within this population. As such, hand therapists may want to consider using the TSK to screen for the presence of kinesiophobia and clinical researchers who intend to develop any disease-specific scales should give consideration to incorporating this construct. Future study is recommended.

Presenter: Corey McGee, PhD, MS, OTR/L, CHT

Rehabilitation for Lateral Elbow Pain: A Comparative Effectiveness Pilot Randomized Controlled Trial (Preliminary Findings)

Purpose: Lateral elbow pain (LEP) affects approximately 3% of the population and contributes significantly to healthcare costs and disability. Current treatments focus on local pathology but often fail to address underlying mechanisms of overuse and regional contributors. The purpose of this pilot randomized controlled trial was to compare the effectiveness of a novel Regional Interdependence Model (RID-M) approach to standard therapy in reducing pain, improving function, and influencing structural outcomes in individuals with LEP. We hypothesized that ultra-sonagraphy testing would identify specific correlates (specifically the superficial branch of the radial nerve at the elbow) with the RID-M approach versus standard of care and that clinical and ultra-sonographic outcomes would demonstrate superior efficacy of RID-M over standard of care.

Methods: Participants diagnosed with LEP were randomized to either an RID-M intervention group or a control group receiving standard therapy. The RID-M intervention targeted multilevel contributors such as posture, radial nerve excursion, dynamic stability of the elbow, and muscle imbalances across the upper limb. Outcome measures included pain levels (Numeric Pain Rating Scale), grip strength, self-reported functional scores (Patient Rated Tennis Elbow Evaluation [PRTEE], Patient Specific Functional Scale [PSFS]), and ultrasound measures of superficial radial nerve morphology and extensor tendon characteristics were taken at baseline to compare the affected/nonaffected sides and pre/post treatment to compare the effects of the intervention versus the control (standard of care). Repeated measures ANCOVA assessed changes over time and between groups. Multivariable regression analyses were conducted to explore predictors of outcomes.

Results: Initial enrollment included 4/10 projected participants. Preliminary findings showed greater improvements in pain, grip strength, and function in the RID-M group compared to controls. Ultrasound imaging revealed differences in radial nerve position between the affected and unaffected side, and positive structural changes in radial nerve morphology and extensor tendon characteristics following RID-M intervention. Participants in the RID-M group demonstrated faster symptom resolution, requiring fewer treatment sessions compared to controls. Though the sample size is extremely limited, these early results may support the hypothesis that addressing regional interdependence mechanisms may improve clinical and structural outcomes in LEP.

Conclusion: Preliminary data suggest that a regional interdependence-based approach may be more effective than standard therapy for managing lateral elbow pain by targeting upstream contributors to overuse and dysfunction. Improvements were observed in both clinical outcomes and sonographic measures. These findings warrant further investigation with a larger sample to confirm efficacy and better identify predictors of successful outcomes. The study highlights the importance of expanding the therapeutic focus beyond local pathology to improve recovery trajectories in patients with LEP.

Presenter: Aviva Wolff,  EdD, OTR, CHT

Translation, Validity, and Reliability of the Thumb Disability Exam Questionnaire into Spanish

Purpose: This study assessed the validity and reliability of the Spanish translation of the Thumb Disability Exam Questionnaire (TDX-S). The translation seeks to enable Spanish-speaking individuals to self-report thumb-related function, pain, and satisfaction, increasing inclusivity in clinical assessments and research.

Methods: The translation followed Beaton’s cross-cultural adaptation guidelines. An expert committee composed of forward and back translators, a professional linguist, and a bilingual reviewer collaborated to produce a final version of the TDX-S for field testing. Participants were recruited through study flyers containing a QR code distributed in hand therapy and surgery clinics in Bogotá, Colombia, and San José, Costa Rica. The QR code linked to a REDCap survey, which included demographic questions, the TDX-S, a Visual Analog Scale for pain during activity (A-VAS), individual VAS items (best, worst, current pain), and the Spanish version of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH-S). Exclusion criteria included active infection of the hand or thumb, carpal tunnel syndrome, De Quervain’s tenosynovitis, and cognitive impairment. Forty native Spanish-speaking participants (35 females, 5 males) diagnosed with thumb carpometacarpal (CMC) osteoarthritis, aged 40 years or older (mean age = 63; range: 40–94 years), completed all survey questionnaires twice, five to seven days apart.

Results: The TDX-S demonstrated high internal consistency (Cronbach’s alpha = 0.95), indicating strong coherence among items. Test-retest reliability was good, with intraclass correlation coefficients (ICC 3,1) of 0.88 for the overall score, 0.83 for the function domain, 0.79 for pain, and 0.70 for satisfaction. Criterion validity was supported by strong correlations between the TDX-S and both the A-VAS and QuickDASH-S scores (Spearman’s rho = 0.61–0.77). All estimates included 95% confidence intervals, affirming statistical robustness.

Conclusion: The Spanish version of the TDX (TDX-S) is a valid and reliable tool for assessing thumb disability among Spanish-speaking populations. Its internal consistency is comparable to the original English, Brazilian Portuguese, and German versions. Although test-retest reliability was slightly lower than in previous validations, it remained within acceptable ranges and may have been influenced by early therapeutic intervention between testing intervals. Criterion validity of the TDX-S was stronger than that of the original English version, particularly in its associations with QuickDASH-S and VAS scores. Compared to the German version, the TDX-S showed slightly weaker correlation with QuickDASH-S but stronger correlation with VAS scores. These findings support the clinical and research utility of the TDX-S in Spanish-speaking settings.

Presenter: Olga Hincapie, PT, DPT, CHT

Casting Motion to Mobilize Stiffness Improves Range of Motion and Function in the Stiff Hand

Purpose: Stiffness of the hand or fingers is a common, yet challenging complication following trauma, immobilization, or surgery, often resulting in prolonged disability and reduced functional independence. Casting Motion to Mobilize Stiffness (CMMS) is a re-emerging therapeutic technique designed to correct maladaptive hand movement patterns using a series of non-removable plaster of Paris casts, selectively immobilizing proximal joints while directing active movement to distal joints where most needed.  This study evaluated the impact of CMMS on range of motion, pain, edema, strength, and functional outcomes in patients with stiff fingers treated in outpatient hand therapy settings.

Methods: A retrospective chart review was conducted of patients treated with Casting Motion to Mobilize Stiffness (CMMS) between January and December 2024 at two outpatient hand therapy clinics. Inclusion criteria consisted of patients with     documented by ICD-10 diagnosis codes     who underwent CMMS as part of their treatment. A total of 36 patients (56% female) were identified, and outcomes were analyzed for the whole hand and on a per-finger basis. For each patient, pre- and post-treatment measurements were extracted from the electronic medical record. These included active range of motion (AROM) at the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, wrist flexion and extension, pain scores at rest and with activity, grip strength, edema (measured circumferentially at the distal palmar crease with a tape measure), and functional outcomes assessed with the QuickDASH. Additional data collected included the number of CMMS casts applied, the number of therapy visits, and the duration of treatment from initial casting to discharge. All outcomes were compared using paired t-tests with statistical significance set at p < 0.05.

Results: A total of 115 fingers were treated across 36 patients (28 index, 25 middle, 28 ring, and 34 small fingers). Patients completed an average of 15.4 ± 9.5 therapy sessions over a treatment duration of 10.5 ± 8.1 weeks, receiving an average of 1.7 ± 1.1 CMMS casts. Significant improvements were observed in all measured domains. Total active motion (TAM) of digits improved from 136.8° ± 61.9 to 185.8°  ± 63.0 (p < 0.00001), representing a 36% increase. Each individual joint arc of motion of the MP, PIP, and DIP joints demonstrated statistically significant gains (p < 0.00001 for all). Pain at rest decreased from 1.9 ± 2.8 to 0.8 ± 1.8 (p = 0.00004), while pain with activity declined from 5.5 ± 3.4 to 2.7 ± 3.2 (p < 0.00001), reflecting statistically significant pain relief . Grip strength increased from 22.8 ± 18.3 lbs. to 44.4 ± 26.6 lbs. (p < 0.00001), nearly doubling by the end of treatment.  Circumferential edema measurement at the distal palmar crease decreased from 20.9 ± 3.9 cm to 18.7 ± 5.8 cm (p < 0.00001), and circumferential edema measurement at the proximal phalanx decreased from 6.6 ± 0.9 cm to 6.5 ± 1.0 cm (p = 0.00031). Functional outcomes measured by the QuickDASH improved from 66.4 ± 18.1 to 34.0 ± 27.1 (p < 0.00001), representing a 49% reduction in self-reported disability.  All improvements were statistically and clinically significant.

Conclusion: CMMS led to significant improvements in range of motion, pain relief, grip strength, edema reduction, and functional status in patients with hand stiffness. These findings support the use of CMMS as a highly effective intervention, particularly in cases where traditional therapy approaches are insufficient. Incorporating CMMS into clinical practice may enhance outcomes, reduce disability, and expedite functional recovery for patients with persistent stiffness in their hand.

Presenter: Kantessa Stewart, OTR/L, CHT

The Impact of Early ADL Participation on Functional Outcomes Post Distal Radius Fracture: A Pilot Study

Purpose: The purpose of this single blinded randomized controlled trial is to understand the effects of multimodal ADL education on pain, kinesiophobia, upper extremity function, digit ROM, hand dexterity, and hand strength.

Distal radius and ulnar fractures are the most common fractures in the upper extremity occurring in 16.2/10,000 persons. Multiple studies report that patients do not understand or feel uncertain about the activities they are allowed to perform post-distal radius fracture (DRF). There is no standard of care for education on activities of daily living (ADL) performance in the orthopedic clinic post-fracture. It is frequently reported the education currently being provided to patients is verbal education, which does not support health literacy initiatives as described in Healthy People 2030.

Methods: Study design: single blinded randomized controlled trial. This study has IRB approval from George Washington University and is registered on Clinical Trials.gov ID- NCT05650996 
Participants are recruited from the George Washington University Medical Faculty Associates Orthopedic Clinic. Individuals who have a conservatively treated distal radius fracture and who have met all inclusion and exclusion criteria are recruited for this study. After obtaining informed consent, participants are randomized to either the experimental or control group. The experimental group is provided a handout at 0-3 weeks post DRF describing early ADL performance and cast care. In addition, they watch a role-playing video in the physicianʼs office of an OT educating a mock patient on early ADL performance and cast care. The control group is provided a handout on cast care only at 0-3 weeks post DRF, and participants watch a video of an OT educating a mock patient on cast care in the physician's office, representing the standard education physicians typically provide during this time frame. Handouts for both the control and experimental groups, as well as a QR code to the video, are provided for the participants. Participants may access and watch their respective video at any time during their enrollment in the study. Participants are assessed at baseline (0-3 weeks), cast removal (6 weeks), 9 weeks, and 3 months. Subjective measures are performed at baseline and 6 weeks and include the Michigan Hand Outcomes Questionnaire, Visual Analog Scale, and Tampa Kinesiophobia Scale-11. At 6 weeks ROM of the digits is also assessed. At 9 weeks and 3 months all subjective measures are assessed along with objective measures of digit ROM, 9 hole peg board, lateral pinch, and grip strength.  
A Power Analysis was based on a prior RCT study and determined a sample size of 26 in each group. As of  May 2025 there are currently 40 participants enrolled in the study however only 15 have a complete data set. To examine the role of time and experimental group (control vs. experimental) on the dependent variables in the study, 15 subjects (ten control, five experimental) with complete data from baseline to 12 weeks were analyzed as part of this study using a mixed-measures ANOVA, with experimental condition as between-subjects and time as within-subjects. The objective was to measure changes over time as well as differences between the experimental and control groups.

Results: Results showed an interaction between time and experimental group for several dependent variables. Specifically, for the ADL subscale, satisfaction subscale, and total Michigan Hand Outcomes Questionnaire (MHQ) score (ps < .05), experimental participants improved over time moreso than control participants. In addition, main effects emerged for time on several dependent variables, where improvements occurred regardless of experimental condition on the work subscale of MHQ, hand function subscale of MHQ, digit ROM, VAS, and hand dexterity (9-hole) scores (ps < .05), consistent with positive hand outcomes, for both experimental and control participants.

Conclusion: Early pilot results from the full data set suggest that early ADL multimodal education significantly improves hand function in the experimental group between weeks between weeks 6, 9, and 12.​ This may suggest that early ADL education provided in the orthopedic clinic within 0-3 weeks in the conservatively treated DRF population improves hand function early in a patient's recovery.

Data collection is still ongoing in that the sample size with full data sets does not meet power requirements.,

No known complications have been identified in the participants receiving the intervention. ​

We launched our second clinical trial in August 2024 for surgical DRF and currently have 16 participants.​

Presenter: Sarah Doerrer, PhD, OTR/L, CHT, CLT

Effectiveness of Orthotic Devices After Cervical Spinal Cord Injury: A Systematic Review

Purpose: a. Clear purpose of study - This study primarily aims to assess the effectiveness of the use of traditional orthoses and myoelectric devices in adult patients with cervical spinal cord injury and significant impairments in upper extremity function.
b. Study rationale - Cervical spinal cord injury accounts for approximately 2-3% of trauma-related patients and 8.2% of trauma-related death. Spinal cord injury (SCI) from the third cervical level (C3) to the first thoracic (T1) vertebra can impact upper extremity function and subsequent performance of activities of daily living (ADLs).

Methods: c. Study design - This systematic review was conducted between June-November 2024, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines as specified by the American Occupational Therapy Association. A search of SCOPUS, Medline, CINAHL, CENTRAL, and PubMed was conducted to obtain articles relevant to the chosen topic. Keywords related to orthotic devices, cervical SCI, and myoelectric were used to search for articles detailing studies that examined the effectiveness of orthotics for use after cervical SCI. Titles and abstracts were initially screened by the research group to select articles for full review. Articles meeting the screening criteria were reviewed in full text formats to determine inclusion of the individual studies.
d. Participant recruitment and selection - The following inclusion criteria were established for this review: (1) human participants with cervical SCI; (2) upper extremity interventions using orthotic devices; (3) therapeutic outcomes related to occupational function. Studies were excluded if (1) the evidence was considered to be outdated, which the team defined as articles published before the year 1990; (2) included participants younger than 18 years old; (3) article not available in English; (4) contained not yet published results, (5) included use of neuroprosthetics; (6) included use of functional electrical stimulation (FES); (7) included use of neuromuscular electrical stimulation (NMES); (8) included use of transcutaneous electrical nerve stimulation (TENS); and (9) included lower extremity (LE) orthoses or gait retraining. The authors limited the scope to studies that utilized an orthotic intervention without electrically invoked training so that we could focus on the outcomes associated specifically with orthotic interventions. Therefore, any studies using FES, NMES, or TENS were excluded, while studies using EMG, which only detects electrical signals rather than transmitting, were included. 
e. Data collection and analysis - After detailed screening, discussion, and author consensus, 19 articles met the inclusion criteria. Articles ranged from level 1B (well-designed individual randomized controlled trials) to level 4 (case series and/or low-quality cohort and case-control studies). Outcomes included EMG outputs, handgrip force, and multiple batteries of tests to quantify hand function. Of the studies included, 12 utilized traditional orthotic devices and seven used myoelectric orthotic devices.

Results: f. Clear summary of findings - Strong evidence supports the effectiveness of orthotic devices for managing UE function in adults with cervical SCI to maximize participation in activities of daily living. Strong evidence supports the benefits of using traditional orthotic devices to improve ADL function, pinch strength, and overall hand function. Strong evidence supports myoelectric orthotic devices as an intervention to increase hand grip strength, range of motion, and pinch strength with some evidence supporting increases in muscle activation.

Conclusion: g. Recommendations based on findings - This review provides insight into the differences between types of orthotic devices for the management of the UE in adults post cervical SCI. The use of traditional orthotic devices versus myoelectrical orthotic devices may depend on the desired function of the UE or goals of the client and residual muscle activations may be required to move the hand and arm for use in ADLs.
h. Clearly stated clinical implication of the research/meaning of the study to the audience - Rehabilitation efforts after cervical SCI can be geared toward increasing function of the upper limb through the use of orthotic devices. A variety of orthotic devices can benefit the recovery of hand and arm function and facilitate the effectiveness of occupational therapy (OT) intervention for people with cervical SCIs. This review provides insight for OT practitioners to make clinical decisions as to whether or not to use traditional or myoelectric devices, after consideration of the client’s goals, desired activities of daily living, level of injury, zone of partial preservation, and current level of function.

Presenter: April Cowan, OTR, OTD, CHT

An Exploratory Study on the Predictors of Lifelong Participation in Adults with Upper Limb Musculoskeletal Differences

Purpose: Interventions for children with brachial plexus birth injury (BPBI) begin as early as 3 months of age, and primarily consist of surgical procedures and rehabilitation, with intent to restore function and enable occupational participation. Paediatric upper limb rehabilitation programs (0 to 18 years old) generally yield satisfactory outcomes in patients’ participation into early adolescence. However, recent literature indicates psychosocial health concerns remain undertreated relative to physical sequelae in youths with BPBI. During transitions to adulthood, BPBI experiences are contextualized by increasing independence and age-related milestones, illustrated by new social demands, education or career choices, and physical maturation. The underlying mental or physical factors that influence participation into adulthood remain unrecognized. Without insight into participation outcomes for adults living with BPBI, there remains a concerning gap in understanding of the long-term efficacy of childhood interventions, as well as the psychosocial and occupational wellbeing of adults in this population.  

The aim of this exploratory study was to identify how mental and physical factors relate to participation of adults with BPBI as measured by a battery of standardized patient reported outcome (PRO) measures. Specific research objectives included: 1) to describe participation restrictions and satisfaction (USER-P) in young adults with BPBI relative to a matched control group of peers without upper limb pathologies; and 2) to identify the relationship between participation (USER-P) and functional status (QuickDASH), mental health (MCS-12), physical health (PCS-12), and pain (BPI).

Methods: This exploratory observational study used a battery of PRO measures to compare participation between young adults with and without BPBI. Participants with BPBI were recruited through BPBI support organizations and word of mouth and visually verified via videoconference screening. Control participants were recruited through convenience sampling and verified through verbal confirmation of an absence of upper limb conditions. Participants 19 to 34 years of age were eligible.  Adults enrolled in high school or with cognitive or lower limb pathologies were excluded. Participation (primary outcome) was measured using the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). The QuickDASH (functional status), Short Form-12 Mental (MCS-12) and Physical (PCS-12) Components Scales, and Brief Pain Inventory (BPI) measures were also used. USER-P Participation restriction and satisfaction were compared between adults with and without BPBI using Mann Whitney U tests, followed by ANCOVA to determine effects of covariates. Spearman correlations were used to evaluate the relationship among the variables.

Results: The study included 26 young adults with BPBI aged 24.8 ± 3.1 years who were matched to 26 control participants aged 25.9 ± 4.0 years. The groups were matched for sex (F:M, 21:5), with close matching of BPBI (F:M:NB, 18:6:2) and control (F:M:NB, 21:5:0) group gender. The BPBI group included individuals with upper plexus palsy (n = 20, 77%), defined as no motor deficits in the hand, who resided in Canada (n = 15, 58%), USA (n = 8, 31%) and the UK (n = 3, 11%). After controlling for the MCS-12 and BPI, the BPBI group had significantly greater USER-P restrictions (ρ < 0.001) compared to the control group. However, having a BPBI did not have a main effect on USER-P satisfaction; rather, PCS-12 and MCS-12 were significant covariates of USER-P satisfaction. Within the BPBI group, USER-P participation restrictions showed moderate positive correlations with physical health (PSC-12, ρ = 0.7, ρ  < 0.001) and mental health (MSC-12, ρ = 0.5, ρ < 0.001), as well as moderate and negative correlations with functional status (QuickDASH, ρ = 0.6, ρ < 0.001) and pain interference (BPI, ρ = 0.6, ρ < 0.002).

Conclusion: After adjusting for mental health and pain influence, adults with BPBI reported greater participation restrictions than control-group peers. Severity of BPBI-correlated participation restrictions was significantly associated with decreased upper limb function and physical health, and greater pain interference. This indicates the importance of holistic rehabilitation in adults with BPBI, including mental health and pain management. Notably, outcomes related to participation satisfaction were associated with lower mental and physical health irrespective of BPBI. Therefore, measures of participation satisfaction may be clinically useful to screen for overall concerns with health-related quality of life, but less useful for interpreting upper limb participation outcomes.

Presenter: Emily Ho, PhD, OT Reg. (Ont.)

Observed Treatment and Patient Characteristics Associated with Carpometacarpal Osteoarthritis in an Outpatient Occupational Therapy Setting

Purpose: Thumb carpometacarpal (CMC) osteoarthritis is a prevalent degenerative condition that significantly impairs hand function, affecting grip, pinch strength, and fine motor tasks. It is a leading cause of upper extremity pain and disability, particularly among older adults and females. While conservative interventions—such as patient education, orthosis use, therapeutic exercise, manual therapy, and activity modification—are commonly employed, the optimal combination and sequencing of these strategies remain unclear. Despite existing clinical guidelines, there is limited data on the real-world application of rehabilitation approaches in outpatient settings. Previous studies have highlighted variability in musculoskeletal care across regions, providers, and practice environments; however, little is known about how these variations manifest in CMC osteoarthritis treatment specifically. Factors such as geographic location, clinician expertise, patient preferences, and insurance coverage likely influence intervention selection and intensity. This study aimed to describe and quantify current clinical practices for CMC osteoarthritis in outpatient occupational therapy, focusing on treatment duration, visit frequency, patient demographics, functional outcomes, and orthosis utilization. Understanding these patterns may help identify practice gaps, standardize care delivery, and optimize patient outcomes.

Methods: A retrospective cohort analysis was conducted using data from a large rehabilitation-focused Patient Outcomes Registry. Patients initiating care from January 2022 onward were included if an occupational therapist was the provider of record and CMC osteoarthritis was documented in at least one of four recorded ICD-10 codes. Extracted data included demographics, surgical history, visit utilization, subjective reports, and initial and final patient-reported outcomes (PROs). Orthosis interventions—custom or prefabricated—were identified through billed CPT codes. The Upper Extremity Functional Index (UEFI) and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) were used as PROs. To harmonize scoring, qDASH values were reversed (subtracted from 100), ensuring higher scores consistently reflected better function. Descriptive statistics were reported as counts (%), means (± standard deviation), and medians with 95% confidence intervals (CI). Comparative analyses of PRO changes and visit utilization were performed using analyses of covariance (ANCOVAs), adjusting for baseline characteristics. Statistical significance was set at α = 0.05.

Results: A total of 123 patients met inclusion criteria, with a majority being female (n = 94; 76%). The mean age was 63.6 ± 10.6 years. Surgical history was present in 34% of patients (n = 42). The average episode of care comprised 8.7 ± 10.3 visits. Orthosis use was incorporated in 24% of treatment plans, alongside range of motion, strengthening, and manual therapy interventions. Among patients with recorded PROs (n = 110; 89%), the UEFI was preferred, utilized in 68% of cases. ANCOVA analyses revealed significant main effects for surgical history on initial PRO (p < 0.001), final PRO (p = 0.024), and visit utilization (p = 0.004). Patients with surgical history exhibited lower baseline function (initial PRO: 37.3; 95% CI: 29.8, 44.9) but achieved higher terminal function (final PRO: 71.4; 95% CI: 61.9, 80.9) compared to non-surgical patients (initial PRO: 50.7; 95% CI: 44.9, 56.6; final PRO: 61.2; 95% CI: 53.0, 69.4). Surgical patients also utilized more visits (12.3; 95% CI: 8.3, 16.3) relative to non-surgical patients (6.7; 95% CI: 3.6, 9.7). Orthosis use demonstrated a significant association with improved final PRO scores (p = 0.020), with patients receiving orthosis achieving higher terminal function (72.2; 95% CI: 61.2, 83.2) compared to those without orthosis use (60.3; 95% CI: 53.2, 67.5).

Conclusion: This multi-center analysis of outpatient occupational therapy care for CMC osteoarthritis identified key treatment and patient characteristics associated with functional outcomes. Surgical history was consistently linked to lower baseline function, greater improvements in PROs, and higher visit utilization. Notably, the inclusion of orthosis perscription was independently associated with superior terminal function, regardless of surgical status. These findings suggest that orthotic management may provide additive benefits in the conservative and post-surgical treatment of CMC osteoarthritis. The observed variability in intervention use highlights opportunities to refine treatment protocols, inform clinical guidelines, and promote evidence-based standardization across practice settings. Further research is warranted to delineate optimal care strategies and enhance outcome predictability in this patient population.

Presenter: Michele Auch, OTD, OTR/L, CHT