Sensorimotor Training for Wrist Fractures

Overseen By Kristen Valdes, OTD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Hand Surgery Associates LLC

Disqualifiers: Prior wrist surgery, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 6 weeks

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial evaluates the effectiveness of sensorimotor training for individuals who have undergone wrist surgery for a fracture. It compares regular hand therapy to a combination of hand therapy and sensorimotor exercises, which aim to improve coordination and movement. The goal is to determine if sensorimotor training provides better pain relief, function, and movement than hand therapy alone. Individuals who have had wrist surgery with a volar plate and can attend therapy at least once a week may be suitable candidates for this study. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance recovery options for future patients.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that sensorimotor training is safe for wrist fracture rehabilitation?

Research has shown that sensorimotor training is generally safe for people recovering from wrist fractures. This training has successfully helped patients regain movement and strength in their wrists. Reports indicate that the exercises, which sometimes include techniques like vibration, are safe and usually don't cause serious side effects.

One study found that using a robot to assist with this treatment was as effective and safe as traditional methods, suggesting that the exercises themselves are unlikely to cause harm.

Although specific data on negative effects for sensorimotor training isn't provided, its regular use in rehabilitation supports its safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about sensorimotor training for wrist fractures because it offers a new approach to rehabilitation. Unlike traditional hand therapy, which mostly focuses on strengthening and range of motion, sensorimotor training integrates exercises that improve coordination and sensory feedback. This method could enhance the brain's connection with the wrist and hand, potentially speeding up recovery and improving function. By addressing both motor and sensory components, this technique may lead to more comprehensive rehabilitation outcomes.

What evidence suggests that sensorimotor training is effective for wrist fractures?

Research has shown that sensorimotor training can aid recovery after wrist fractures. One study found that patients who underwent this training after wrist surgery experienced better movement and function than those who did not. Another study demonstrated clear improvements in several health measures for patients who completed a sensorimotor rehabilitation program. In this trial, the experimental group will receive both sensorimotor intervention and traditional hand therapy, while the control group will receive only hand therapy. These findings suggest that adding sensorimotor activities to regular hand therapy might enhance recovery after a wrist fracture. ^{1 3 4 6 7}

Are You a Good Fit for This Trial?

This trial is for English-speaking adults over 18 who've had wrist surgery with a volar plate to fix a broken distal radius. They must be able to attend weekly occupational therapy sessions.

Inclusion Criteria

Understand English

I had surgery to fix a broken wrist with a plate on the palm side.

I can go to occupational therapy sessions at least once a week.

Exclusion Criteria

Cognitive impairment

I have a broken wrist that was treated with a cast or other method.

I have had surgery on my wrist or hand before.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either traditional hand therapy or traditional hand therapy with sensorimotor activities

6 weeks

Regular visits for therapy sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Sensorimotor Training

Trial Overview The study compares routine hand therapy alone versus hand therapy plus sensorimotor activities in healing after wrist surgery. Participants are randomly assigned to either the control group or the experimental group and evaluated at 3 and 6 weeks.

How Is the Trial Designed?

Group I: Experimental Group Experimental Treatment 1 Intervention

The experimental group will receive sensorimotor intervention and traditional hand therapy

Group II: Control Group Experimental Treatment 1 Intervention

Control Group will receive Hand Therapy only

Who Is Running the Clinical Trial?

Hand Surgery Associates LLC

Lead Sponsor

Trials

1

Recruited

50+

Touro University Nevada

Collaborator

Trials

4

Recruited

200+

Orthopaedic Specialty Group PC, Fairfield

Collaborator

Trials

2

Recruited

120+

Published Research Related to This Trial

In the WRIST trial, which involved patients aged 60 and older with distal radial fractures, grip strength and wrist motion were found to be key indicators of patient satisfaction, with optimal recovery thresholds identified at 59% strength and 79% motion.

At 12 months post-treatment, patients achieved an average grip strength of 82% and wrist motion of 88% of normal, suggesting that further therapy beyond these recovery points may not significantly enhance patient satisfaction and could waste healthcare resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient satisfaction after treatment of distal radial fractures in older adults. Chung, KC., Sasor, SE., Speth, KA., et al.[2021]

A study involving 60 patients recovering from distal radius fractures showed that those treated with a sensorimotor therapy protocol experienced better sensorimotor and functional improvements compared to those receiving standard postoperative care.

Despite the improvements, the study did not find significant efficacy in addressing proprioceptive deficits, indicating a need for further research to refine treatment protocols and evaluation methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Rehabilitation. Wollstein, R., Harel, H., Lavi, I., et al.[2020]

A novel 2-week upper extremity sensorimotor training program showed feasibility for improving hand function in stroke survivors, with both participants demonstrating enhanced performance on the Wolf Motor Function Test after training.

While one participant showed no change in sensory function, the other experienced improvements in touch perception and proprioception, alongside evidence of neural reorganization, suggesting potential benefits of targeted sensory training post-stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sensorimotor training and neural reorganization after stroke: a case series. Borstad, AL., Bird, T., Choi, S., et al.[2021]

The active wrist joint position sense test is highlighted as a key assessment tool for measuring sensorimotor control impairment after wrist trauma, making it clinically relevant for evaluating recovery.

Wrist trauma can significantly disrupt proprioceptive input due to soft tissue injuries, leading to sensorimotor impairments, and the article suggests rehabilitation strategies that need further clinical trial evaluation to restore wrist function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. Karagiannopoulos, C., Michlovitz, S.[2017]

Recent advancements in understanding wrist proprioception highlight its complexity, emphasizing the need to consider the entire hand and arm in rehabilitation and surgical approaches, rather than just the wrist joint itself.

An updated four-stage rehabilitation protocol is proposed for wrist trauma and surgery, focusing on reducing pain and edema, enhancing proprioception awareness, and promoting both conscious and unconscious neuromuscular rehabilitation to improve recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Wrist proprioception-An update on scientific insights and clinical implications in rehabilitation of the wrist. Hagert, E., Rein, S.[2023]

The SITAR system is a novel, sensor-based tool designed for independent assessment and rehabilitation of upper limb function, allowing patients to engage in task-oriented training with minimal therapist involvement.

Pilot studies show that patients can effectively use SITAR for various upper limb tasks, such as reaching and sensory resolution, and they find the system motivating, indicating its potential for enhancing rehabilitation outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

SITAR: a system for independent task-oriented assessment and rehabilitation. Hussain, A., Balasubramanian, S., Roach, N., et al.[2023]

Wearable motion sensors can provide detailed, real-time data on mobility-related activities, allowing for continuous monitoring of patients' walking speed, distance, and movement quality outside of laboratory settings.

The use of these mobile health devices in neurorehabilitation can enhance personalized therapy by providing immediate feedback, improving patient engagement, and enabling more accurate tracking of rehabilitation progress in real-world environments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Wearable motion sensors to continuously measure real-world physical activities. Dobkin, BH.[2022]

In a study of 61 patients with distal radius fractures, combined physical and occupational therapy significantly improved grip strength compared to physical therapy alone, with a notable increase of 67% versus 53% after 12-16 weeks.

While the combined therapy showed better grip strength outcomes, it did not demonstrate a significant difference in the Disabilities of Arm, Shoulder and Hand (DASH) score, indicating that while grip strength improved, overall functional disability may not have changed as much.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial. Filipova, V., Lonzarić, D., Jesenšek Papež, B.[2018]

A survey of 242 therapists revealed that over 75% used upper extremity range-of-motion exercises and compressive wrap with retrograde massage during the immobilization phase of distal radius fracture management.

Post-immobilization, more than 90% of therapists incorporated range-of-motion exercises and heat/cold modalities, indicating a strong focus on restoring movement and function after immobilization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Distal radius fractures: therapy practice patterns. Michlovitz, SL., LaStayo, PC., Alzner, S., et al.[2019]

A study involving 42 individuals with unilateral wrist disorders revealed a wide range of functional difficulties in daily activities, highlighting the impact of such disorders on both gross and fine motor tasks.

Participants commonly used compensatory mechanisms, such as relying on others or using their other hand, to adapt to their limitations, indicating a need for more comprehensive wrist outcome instruments that reflect these challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Difficulties associated with wrist disorders--a qualitative study. Bialocerkowski, AE.[2017]

A systematic review of 59 articles found that early active motion protocols and splinting are the most effective occupational therapy interventions for improving functional outcomes in adults with musculoskeletal disorders of the forearm, wrist, and hand.

There is a lack of research on occupation-based interventions, highlighting a gap in evidence that could inform future occupational therapy practices and research efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review. Roll, SC., Hardison, ME.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6358444/

Postoperative Treatment of Distal Radius Fractures Using ... There was documented sensorimotor and functional improvement in both groups with treatment. The clinical results were better in the group treated with the ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06299228

Is Sensorimotor Training Effective Following a Distal ... The purpose of this study is to compare the short-term outcomes of individuals who have surgery (volar plate) for a wrist (distal radius) fracture who have ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10584051/

Clinical evaluation of a wrist sensorimotor rehabilitation ... This study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0894113020302118

Improving patient outcomes following distal upper extremity ... Ninety-three patients, 49 males (53%) and 44 females (47%), completed the program. There were statistically significant improvements in 12 clinical measures ...

5. jospt.org jospt.org/doi/10.2519/jospt.2024.0301

Distal Radius Fracture Rehabilitation The AAOS CPG states that there are no significant differences in radiographic or long-term patient-reported outcomes between fixation techniques ...

6. rehand.net rehand.net/en/distal-radius-fracture-rehabilitation-sensorimotor-system/

Distal Radius Fracture | Rehabilitation Evidence-Based An exercise program based on the latest evidence about the Sensorimotor System, involving both the central (Nervous System) and peripheral (the wrist) levels, ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8406564/

Efficacy of wrist robot-aided orthopedic rehabilitation The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions.