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

Trial Summary

What is the purpose of this trial?

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 routine hand therapy treatment versus routine hand therapy treatment and sensorimotor activities. Individuals who meet inclusion criteria at the facilities collecting data will be invited to participate. If they agree to participate, they will randomly and blindly (via concealed envelopes) be assigned to the control (routine treatment) or the sensorimotor treatment group. Data collection will occur at 3- and 6-weeks post initiation of skilled therapy and will include measurement of joint position sense, function via the Patient Rated Wrist and Hand, pain via the Numeric Pain Rating Scale, and range of motion at the digits and wrist.

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 data supports the effectiveness of the treatment Sensorimotor Training for wrist fractures?

Research shows that patients recovering from wrist surgery may experience faster sensorimotor improvements when using a comprehensive sensorimotor treatment protocol compared to standard care, although not all improvements were significant. This suggests that sensorimotor training could be beneficial in addressing sensorimotor deficits after wrist fractures. ^{1 2 3 4 5}

Is sensorimotor training safe for treating wrist fractures?

The research does not report any specific safety concerns related to sensorimotor training for wrist fractures, suggesting it is generally safe for use in humans. ^{3 6 7 8 9}

How does sensorimotor training differ from other treatments for wrist fractures?

Sensorimotor training for wrist fractures is unique because it focuses on improving the sensorimotor and proprioception (awareness of body position) functions that are often impaired after wrist surgery. Unlike standard treatments, this approach aims to enhance the feedback loops between the brain and wrist, potentially leading to faster recovery of wrist function. ^{3 4 6 10 11}

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 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]

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]

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]

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 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 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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

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

2. Austria pubmed.ncbi.nlm.nih.gov

Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Postoperative Treatment of Distal Radius Fractures Using Sensorimotor Rehabilitation. [2020]

4. United States pubmed.ncbi.nlm.nih.gov

Sensorimotor training and neural reorganization after stroke: a case series. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

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

6. United States pubmed.ncbi.nlm.nih.gov

Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. [2017]

7. England pubmed.ncbi.nlm.nih.gov

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

8. England pubmed.ncbi.nlm.nih.gov

Patient satisfaction after treatment of distal radial fractures in older adults. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Distal radius fractures: therapy practice patterns. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

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

11. England pubmed.ncbi.nlm.nih.gov

SITAR: a system for independent task-oriented assessment and rehabilitation. [2023]