Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice

Abstract This clinical review discusses the organization, neuroanatomy, assessment, clinical relevance, and rehabilitation of sensorimotor (SM) control impairment after wrist trauma. The wrist SM control system encompasses complex SM pathways that control normal wrist active range of motion and medi...

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Bibliographic Details
Published in:Journal of hand therapy 2016-04, Vol.29 (2), p.154-165
Main Authors: Karagiannopoulos, Christos, MPT, PhD, Michlovitz, Susan, PT, PhD
Format: Article
Language:English
Subjects:
Assessment
Electromyography - methods
Fatigue
Feedback
Feedback, Sensory - physiology
Female
Hand Strength
Humans
Impairment
Ligaments
Male
Motor Skills - physiology
Neuroanatomy
Peripheral Nerve Injuries - etiology
Peripheral Nerve Injuries - physiopathology
Peripheral Nerve Injuries - rehabilitation
Peripheral Nervous System Diseases - etiology
Peripheral Nervous System Diseases - physiopathology
Peripheral Nervous System Diseases - rehabilitation
Physical Medicine and Rehabilitation
Physiology
Proprioception - physiology
Recovery of Function
Rehabilitation
Sensorimotor
Severity of Illness Index
Skin
Treatment Outcome
Wrist
Wrist Injuries - complications
Wrist Injuries - diagnosis
Wrist Injuries - rehabilitation
Wrist Joint - innervation
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Summary:Abstract This clinical review discusses the organization, neuroanatomy, assessment, clinical relevance, and rehabilitation of sensorimotor (SM) control impairment after wrist trauma. The wrist SM control system encompasses complex SM pathways that control normal wrist active range of motion and mediate wrist joint neuromuscular stability for maintaining joint function. Among various known assessment methods of wrist SM control impairment, the active wrist joint position sense test is determined to be a clinically meaningful and responsive measure for wrist SM control impairment after wrist fracture. Wrist trauma may involve significant soft tissue injury (ie, skin, ligament, muscle), which could disrupt the generation and transmission of adequate proprioceptive input from wrist mechanoreceptors, thus leading to significant joint SM impairment. Various clinical examples of wrist trauma (eg, distal radius fracture, scapholunate joint injury) along with known prognostic factors (eg, pain) that may influence wrist SM control impairment recovery are discussed to illustrate this point. This article proposes promising rehabilitation strategies toward restoring wrist joint conscious and unconscious SM control impairments, integrating current research evidence with clinical practice. These strategies require more rigorous evaluation in clinical trials. Level of Evidence 5.
ISSN:0894-1130
1545-004X
DOI:10.1016/j.jht.2015.12.003