||Assessment and Intervention for the Hands with Sensorimotor Deficits Based on Functional Perspectives
||Department of BioMedical Engineering
The biomechanical advantage of an opposed thumb combined with the mechanoreceptors in the glabrous skin of grasping digits provide the capacity of optimizing and maintaining precision grip. Our previous efforts have proved that there was significant correlation between tactile sensibility and fingertip force control in a pinch-holding-up activity. For the tight coupling between sensory and motor in hand coordination, the ability of adjusting pinch force when executing functional task has been defined as “functional sensibility” for nerve injury patients. However, the sensitivity and validity of the previously designed pinch apparatus have not been established. As well as, the measuring apparatus required for such a sophisticated precision pinch performance assessment is not readily available in most clinical settings. Moreover, there was no appropriate equipment for restoring sensorimotor function for patients with impaired sensibility in clinics. Therefore, there were three specific purposes in this dissertation. The first purpose was to assess the feasibility of a “functional sensibility test” as an assisted examination for determining precision pinch performance in patients with carpal tunnel syndrome. In addition, the second purpose was to develop a new “manual tactile test” and understand the clinical and functional merits of the new test for determining sensorimotor deficit for peripheral nerve injury patients. And, the third purpose was to develop a computerized re-education system to enhance hand coordination for clinical use.
We examined the validity, sensitivity and accuracy of the functional sensibility tests and manual tactile test by analyzing the differences between carpal tunnel syndrome (CTS) patients and healthy controls. The relationship between the results of manual tactile sensibility, traditional sensibility test and the precision pinch performance for the carpal tunnel syndrome patients has also been analyzed. In addition, the training effects of a computerized evaluation and re-education biofeedback system on the hand coordination of the sensory stroke patients were also analyzed. The anticipated achievement of the dissertation will be to analyze and enhance neuromuscular control of the hands with functional perspectives to assist the clinicians to make a precise diagnosis and arrange appropriate treatments after injury.
List of Tables IX
List of Figures XI
Chapter 1 General Introduction 1
1.1 Research Background 1
1.2 Our previous Efforts 5
1.3 Clinical Relevance 7
1.4 Motivations 7
1.5 Specific Aims 8
1.6 Dissertation Outline 10
Chapter 2 Precision Pinch Performance in Patients with Sensory Deficits of the Median Nerve at the Carpal Tunnel 12
2.1 Feasibility of a Novel Functional Sensibility Test as an Assisted Examination for Determining Precision Pinch Performance in Patients with Carpal Tunnel Syndrome 12
2.1.1 Introduction 12
2.1.2 Materials and methods 15
18.104.22.168 Subjects 15
22.214.171.124 Ethics statements 16
126.96.36.199 Instruments 16
188.8.131.52 Procedures of the PHUA Test 18
184.108.40.206 Data Processing and Analysis 18
220.127.116.11 Experimental Protocol. 19
18.104.22.168 Statistical Analysis. 20
2.1.3 Results 21
2.1.4 Discussion 25
2.2 Precision Pinch Performance in Patients with Sensory Deficits of the Median Nerve at the Carpal Tunnel 28
2.2.1 Motivation and Specific Purposes 28
2.2.2Materials and Methods 28
22.214.171.124 Subjects 28
126.96.36.199 Ethics Statements 30
188.8.131.52 Instruments 30
184.108.40.206 Procedures of the PHUA Test 30
220.127.116.11 Data Processing and Analysis 30
18.104.22.168 Statistical Analysis 32
2.2.3 Results 33
2.2.4 Discussion 36
2.3 Sensorimotor Control in Hand: a Functional Outcome Indicator to Represent the Treatment Effect for Carpal Tunnel Syndrome 39
2.3.1 Motivation and Specific Purposes 39
2.3.2 Materials and Methods 39
22.214.171.124 Subjects 39
126.96.36.199 Instruments 40
188.8.131.52 Procedures of the PHUA Test 40
184.108.40.206 Experimental Procedures 40
220.127.116.11 Statistics Analysis 40
2.3.3 Results 41
2.3.4 Discussion 45
2.4 Conclusion 48
Chapter 3 Usefulness of Manual Tactile Test for Predicting Precision Pinch Performance and Severity in Carpal Tunnel Syndrome 49
3.1 Establishment of a Proper Manual Tactile Test for Hands with Sensory Deficits 49
3.1.1 Introduction 49
3.1.2 Materials and Methods 52
18.104.22.168 General Design. 52
22.214.171.124 Participants. 52
126.96.36.199 Manual Tactile Test (MTT). 53
188.8.131.52 Traditional Sensibility Tests. 55
184.108.40.206 Exp Protocol. 55
220.127.116.11 Statistics Analysis. 56
3.1.3 Results 57
3.1.4 Discussion 62
3.2 Diagnosis from Functional Perspectives: Usefulness of a Manual Tactile Test for Predicting Precision Pinch Performance and Disease Severity in Subjects with Carpal Tunnel Syndrome 64
3.2.1 Motivation and Specific Aims 64
3.2.2 Materials and Methods 65
18.104.22.168 Participants, MTT, Traditional Sensibility Tests, Nerve Conduction Study and Pinch Apparatus 65
22.214.171.124 The Grading for CTS hands 65
126.96.36.199 Statistical Analyses. 65
3.2.3 Results 66
3.2.4 Discussion 70
3.3 Conclusion 72
Chapter 4 Clinical Application of Computerized Evaluation and Re-education Biofeedback Prototype for Sensorimotor Control of the Hand in Stroke Patients 73
4.1 Introduction 73
4.2 Materials and methods 76
4.2.1 Participants 76
4.2.2 Instrumentation 77
4.2.3 Traditional Sensory Test 79
4.2.4 Hand Function Test 80
4.2.5 Experimental Procedures 80
4.2.6 Data Analysis 81
4.3 Results 81
4.4 Discussion 86
Chapter 5 Summary and Future Work 90
5.1 Summary of the Present Work 90
5.2 Dissertation Limitation 96
5.3 Suggestion for Future Work 97
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