Joints involved in deep burn often result in joint contracture, limb dysfunction, psychological disorder, or even loss of living and working abilities. The management of post-burn joint contracture will directly orientate the functional recovery of the patients. Comprehensive intervention may prevent the contracture process of the affected joints. Orthoses application is an important measure and should be maintained throughout the whole process of burn care, from positioning the joints at the early stage to maintaining the range of joint motion at the late stage. Orthoses should be used on the premise of protecting the joint functions. In order to maintain the tissue tension while enhancing the joint mobility and muscle strength, the static orthoses and the dynamic orthoses are often alternately used. It is showed in clinical practice that orthoses are designed and applied on the basis that biomechanics will lead to a better outcome.
Burns ; complications ; rehabilitation ; Cicatrix ; etiology ; rehabilitation ; Contracture ; etiology ; rehabilitation ; Humans ; Orthopedic Procedures ; instrumentation ; Orthotic Devices

Patients with deep burns are prone to suffer cicatrix hyperplasia or contracture, leading to problems including dysfunction in limbs, which impacts patients' life quality and makes it difficult for them to return to society. Thereby, the rehabilitation treatment after deep burns is particularly important. Currently, exercise therapy plays an important role in burn rehabilitation, which is mainly based on therapies such as continuous manual assistance training and manual stretching practice to provide patients with physical exercise to limbs and to correct the functional dysfunction of limbs in patients. With the continuous progress in technology, functional training robots have been developed to meet the needs. The emergence of functional training robots saves manpower and provides patients refined and standardized functional exercise treatment. From the aspects of production technology and multi-technology integration, this paper mainly introduces the recent innovation and development of functional training robots and the advantages of the application of functional training robots in the field of burn rehabilitation.
Burns/rehabilitation* ; Cicatrix ; Contracture ; Exercise Therapy ; Humans ; Robotics

Orthotic technology has developed rapidly in recent decades m western countries. Korea has been confronted with the problems of purchasing the appropriate orthotic materials, training of orthotists and financial expense. The introduction of new materials and lamination technology for orthotic appliance will enable such problems to be solved. Fiberglass reinforced plastic (FRP), which was laminated with Korean made plastic resins and fiberglass, was superior to the mechanical properties of other plastic materials, such as acrylic, polypropylene and thermoplast. Lamination of the orthotic devices with FRP was introduced and it should be technically possible for an orthotist in a small workshop or a member of the house staff of a hospital to make an appliance on the premises.
Braces ; Burns/*rehabilitation ; Contracture/*rehabilitation ; *Glass ; Human ; *Orthotic Devices ; Support, Non-U.S. Gov't ; Tensile Strength

OBJECTIVETo study the effects of ultrashort wave combined with sequential pressure treatment on the functional recovery of deeply burned hands in the early stage of healed wounds in hands.

METHODSSixty-five patients with burn of unilateral hand were hospitalized from July 2012 to June 2013 in our center. Injured hands of 35 patients were treated with active movement, ultrashort wave, sequential pressure therapy, and pressure gloves, and the other 30 patients were treated with active movement and pressure gloves 10-31 days after the wounds were healed according to the will of patients. The former 35 patients were regarded as comprehensive treatment (CT) group, and the latter 30 patients were regarded as routine treatment (RT) group. Before treatment and 4 weeks after treatment, the appearance of injured hands was observed; the circumference of the proximal segment of thumb, index, and middle fingers and that of the palmar crease and wrist crease were measured to evaluate swelling of injured hand; score and grade of function of injured hands were evaluated with a Carroll Upper Extremity Functional Test. Data were processed with t test and rank sum test.

RESULTS(1) Four weeks after treatment, appearance of 30 injured hands in group CT was improved, which was close to that of the normal hand of each patient, while contracture deformity of metacarpophalangeal joints and interphalangeal joints was observed in the other 5 injured hands. Four weeks after treatment, no obvious change in the appearance of 17 injured hands in group RT was observed compared with that before treatment, while hyperextension of metacarpophalangeal joints, flexion of interphalangeal joints, and adduction deformity of thumb were observed in the other 13 hands. (2) Four weeks after treatment, the circumferential values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands in group CT were respectively lower than those before treatment (with t values 3.26-4.24, P values below 0.01), and the circumferential values of the proximal segment of thumb and middle fingers and the wrist crease of injured hands in group RT were respectively lower than those before treatment (with t values 2.02-2.44, P values below 0.05). The difference values of circumference values of the proximal segment of thumb, index, and middle fingers and the palmar crease and wrist crease of injured hands between before treatment and 4 weeks after treatment were respectively (0.491 ± 0.022), (0.583 ± 0.089), (0.486 ± 0.021), (1.100 ± 0.076), (0.751 ± 0.053) cm in group CT, which were significantly higher than those in group RT [(0.306 ± 0.021), (0.277 ± 0.022), (0.320 ± 0.027), (0.700 ± 0.052), (0.483 ± 0.048) cm, with t values respectively 5.94, 3.11, 5.02, 4.22, 3.68, P values below 0.01]. (3) Four weeks after treatment, scores of function of injured hands in groups CT and RT were respectively higher than those before treatment (with t values respectively 14.40 and 4.00, P values below 0.001), and the grades of function of injured hands were respectively improved (with u values respectively 6.93 and 3.29, P values below 0.01). The difference value of scores of function of injured hands between before treatment and 4 weeks after treatment was (51.1 ± 2.2) points in group CT, which was significantly higher than that of group RT [(32.5 ± 4.8) points, t = 3.52, P < 0.001].

CONCLUSIONSUltrashort wave combined with sequential pressure and routine rehabilitation treatment of deeply burned hands in the early stage after wounds in hands are healed can obviously reduce the swelling of injured hands, which provides a favorable condition for active movements and systematic rehabilitation treatment later.

Burns ; rehabilitation ; therapy ; Contracture ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Pressure ; Recovery of Function ; Treatment Outcome ; Wound Healing

OBJECTIVE: To propose a kind of robotic ankle-foot rehabilitation system for children with cerebral palsy and to preliminarily verify its feasibility in clinical application. METHODS: A robot assisted ankle-foot rehabilitation system was specially designed and developed for children with cerebral palsy and a preliminary clinical study was conducted in Department of Rehabilitation Medicine, Peking University First Hospital. Modified Tardieu Scale and joint biomechanical properties (ankle plantar flexion resistance torque under different ankle dorsiflexion angles) were measured to analyze the muscle tone and soft tissue compliance of the ankle plantar flexors pre- and post-robotic training intervention. Six children with cerebral palsy (4 girls and 2 boys, mean age: 7 years) were recruited in this study. Each subject received 5 session robotic training and each session included 10-cycle passive stretching and static hold. SPSS 19.0 software was used for data statistical analysis. RESULTS: Both R1 and R2 angles of Modified Tardieu Scale for ankle plantar flexors after training were significantly higher than those before the treatments (Gastrocnemius: P_R1=0.003, P_R2=0.029; Soleus: P_R1=0.002, P_R2=0.034). The difference between R2 and R1 was of no statistical difference before and after the training (P=0.067 and P=0.067, respectively). After training, the ankle plantar flexion resistance torque under different dorsiflexion angles (0°, 10°, 20°, 30°) were significantly reduced than those before training (P=0.001, P=0.001, P=0.014, P=0.002, respectively). CONCLUSION The robot assisted ankle-foot rehabilitation system can improve the contracture and soft tissue compliance of cerebral palsy children's ankle plantar flexors. All the children in the study were well tolerated and interested with the training, easy to accept and cooperate with it. This device may be suitable for application in the rehabilitation of children with cerebral palsy. However, further randomized clinical trials with larger sample size are still needed to verify the long term efficacy of this device.
Ankle ; Ankle Joint/physiopathology* ; Cerebral Palsy/rehabilitation* ; Child ; Contracture/rehabilitation* ; Female ; Humans ; Male ; Muscle, Skeletal ; Robotics

Extensor tendon adhesion and joint contracture after crushing injury of the hand are common complications that affect finger motion and hand function. The development of stiff joint can be associated with significant morbidity and had a profound influence on the patient's ability to function. Metacarpophalangeal joint capsulectomy is a surgical procedure used to treat patients with joint stiffness and disabling contractures. Seventeen patients with metacarpophalangeal joint contracture underwent capsulectomy with or without tenolysis from June 1997 to December 1998. The procedures were done after conservative methods had failed. The follow-up period was from 2 to 21 months(mean 12 months). After metacarpophalangeal capsulectomy and immediate postoperative exercise, an average gain of 28 degree of metacarpophalangeal flexion was achieved. In conclusion, when indicated, capsulectomy is a useful procedure for the treatment of contracture of the metacarpophalangeal joint. It is imperative for the treating physician to stress prevention in the form of timely appropriate splintage, early rehabilitation, and aggressive intervention if necessary.
Contracture ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Joints ; Metacarpophalangeal Joint* ; Rehabilitation ; Tendons

PURPOSE: To evaluate the therapeutic effects of chevron olecranon osteotomy and bilateral reconstruction plate as operative treatment for distal humerus intercondylar fracture. MATERIALS AND METHODS: Among patients operated for distal humerus intercondylar fracture in our hospital from June, 1997 to October, 2005, 26 patients were selected who could be followed-up for more than one year. The average follow-up period was 15 months. All olecranon osteotomies were chevron osteotomy and all fractures were treated with internal fixation using bilateral reconstruction plate. The ulnar nerve was checked in all cases. Three patients in which case the plate might irritate the ulnar nerve, received with ulnar nerve anterior transposition. Cassebaum's classification and Mayo elbow performance score were used to evaluate at three, six and twelve months. RESULTS: Mean bone union period was 11.7 weeks. There were 9 excellent cases, 11 good cases, 4 fair cases and 2 poor cases. Mean flexion contracture was 11° and further flexion was 126° at last follow-up. CONCLUSION: Bilateral reconstruction plate internal fixation using chevron olecranon osteotomy showed strong fixation and good clinical results and it is possible for early rehabilitation treatment.
Classification ; Contracture ; Elbow ; Follow-Up Studies ; Humans ; Humerus* ; Olecranon Process ; Osteotomy ; Rehabilitation ; Therapeutic Uses ; Ulnar Nerve

Chronic low back pain (CLBP) is a complicated clinical condition related with pathologic pain generators in the spinal column, weakened and deconditioned muscles in the trunk and extremities that control the motion and stability of the spine and pelvis, faulty biomechanics caused by connective tissue contractures, and behavioral problems such as fear-avoidance beliefs and emotional distress. Since it is initiated and maintained by these complicated causal factors, CLBP could not be successfully treated by one or two specific rehabilitative treatment options. A multidisciplinary approach with an appropriate individualization to each patient is known to be more successful than simple and passive physical therapeutic agents. Among the rehabilitative therapeutics, sustained exercise for 2 to 3 months appears to be the most effective, providing CLBP patients with significant pain relieves and functional improvements that last for a long-term period. There have been several different types of low back exercises including strengthening, flexibility training, aerobic exercise, lumbar flexion exercise, and McKenzie's extension exercise, with which favorable outcomes were reported. Recent advances in the field of spine biomechanics introduced a principle, the core stabilizing exercise, to stabilize the spine and pelvis by strengthening and improving the control of the several specific truncal muscles. Although supported by some reports showing excellent results, the core stabilizing exercise in itself may not be the most effective therapeutic exercise for CLBP. Instead, it could be a useful adjunctive measure to the exercises that have been used to date. A novel rehabilitative therapeutic modality is anticipated to be developed in the near future to theat the spine more specifically, addressing its particular pathologic conditions.
Connective Tissue ; Contracture ; Exercise ; Extremities ; Humans ; Low Back Pain* ; Muscles ; Pelvis ; Pliability ; Rehabilitation ; Spine

PURPOSE: To analyze the final results of a two-stage flexor tendon reconstruction in the hand with the early postoperative combined protocol of controlled motion, and to identify the prognostic factors associated with the final results. MATERIALS AND METHODS: Nine cases of two-stage flexor tendon reconstructions in 9 patients, who had been unable to flex their digits due to old flexor tendon injury, were examined. Using the modified Boyes' injury severity classification, the digits were classified as grades 1, 2 and 3 in 1, 5 and 3 patients, respectively. The average follow-up period was 1 year and 8 months and the final results are expressed using the Buck-Gramcko assessment system. RESULTS: Eight out of nine hands were graded as excellent and one patient whose injury severity had been graded 3 was graded as good. Excellent results were found in patients with a more than 10-year interval between the injury and the stage I procedure. Of the 3 patients who had undergone contracture release two were excellent and one was good. All 5 patients with a pulley reconstruction had excellent results. Complications involved one infection at the distal incision site, one tendon rupture and four flexion contractures. CONCLUSION: A two-stage flexor tendon reconstruction with an early postoperative combined protocol of controlled motion is a useful procedure for restoring the flexor performance in old badly scarred digits. The excellent or good results might be due to following: the early protected rehabilitation incorporating two protocols, a pulley reconstruction and protection, flexion contracture release, an initial injury with less than moderate grade and the young age of the patients.
Cicatrix ; Classification ; Contracture ; Follow-Up Studies ; Hand* ; Humans ; Rehabilitation ; Rupture ; Tendon Injuries ; Tendons*

PURPOSE: To describe long-term clinical results and serial changes in the postoperative range of motion (ROM) after arthroscopic treatment for a limitation of motion (LOM) of the elbow. MATERIALS AND METHODS: Sixty-three patients with LOM of the elbow were treated with arthroscopic procedures. The follow-up period averaged 42.5 months. RESULTS: The total ROM was 79.3degrees C preoperatively. From the first and second week after the operation, the ROM showed a progressive increase up to six months postoperatively (mean 109.2degrees C at 3 months and mean 118.4degrees C at 6 months follow-up). Then the ROM continued to increase slowly for a total of 1 year after the operation (mean 121.5degrees C). However, after one year postoperative, the ROM showed little further increase. The ROM acquired during surgery (mean 121.9degrees C) was usually the same range achieved by patients during the rehabilitation period (mean 122.8degrees C at an average of 42.5 months follow-up). Patients with post-traumatic stiffness had more severe flexion contracture and decreased total ROM (73.1degrees C) than those with degenerative stiffness (85.7degrees C) preoperatively. But no significant difference existed in the postoperative total ROM (post-traumatic stiffness, 122.8degrees C and degenerative stiffness, 120.5degrees C). CONCLUSION: Based on our experience, 94% of the patients obtained functional ROM after arthroscopic procedures. The minimally invasive nature of elbow arthroscopy is a safe, reproducible and effective procedure for LOM of the elbow with minimal morbidity.
Arthroscopy ; Contracture ; Elbow Joint* ; Elbow* ; Follow-Up Studies ; Humans ; Range of Motion, Articular ; Rehabilitation