External therapeutic device to support rehabilitation of the hand following trauma or surgery

手功能的丧失将影响个人生活的方方面面。这包括养活和照顾自己的能力以及工作和参与家庭生活的能力。对于从创伤、烧伤或影响手部的手术等问题中恢复的人来说，手部康复的仔细管理可以显著影响患者的结果。为了减少发生活动困难的可能性，包括关节活动度丧失、肌肉和腱鞘粘连或非功能性瘢痕组织形成，通常需要持续被动活动（CPM）。此外，对于由于上肢瘫痪而导致手的活动性降低的人，例如颈脊髓损伤、中风、脑瘫或外周神经损伤的人，忽视对受影响的手的关节活动范围的维持的管理将导致挛缩和关节活动范围受限。这些综合征将降低已经受到瘫痪限制的手功能，并将对积极康复技术的潜在结果产生负面影响，例如肌腱转移手术和功能性神经肌肉刺激。因此，在这种情况下，CPM也是适用的。应用CPM的当前器械已被证明可有效减少上述综合征，这些结果总结在本提案所附的背景和研究计划中。不幸的是，临床医生并不总是规定使用这种设备。这主要是由于市场上这些设备的局限性。这些局限性包括缺乏安全的手指放置，缺乏便携性，无法为特定关节提供专门的治疗和不灵活的编程。本提案介绍了一种待开发的改进设备，这些改进构成了以下提案的目标。鉴于这种改进的装置，它可以克服目前的CPM机的许多问题，这是可能的，CPM的临床应用将实现更大程度的处方和应用在手部康复。这些改进应克服临床上对使用这些器械的沉默，并通过将其使用增加到科学文献所指出的水平来恢复平衡。该提案的总体目标是将该设备带入临床试验阶段。

The loss of hand function will affect every aspect of an individual’s life. This includes the ability to feed and care for themselves and the ability to work and participate in family life. For people recovering from problems such as trauma, burns or surgery affecting the hand, careful management of hand rehabilitation can influence the outcome for the patient significantly. In order to reduce the possibility of mobility difficulties occurring, including loss of joint range of motion, muscle and tendon sheath adhesions or non-functional scar tissue formation, continuous passive motion (CPM) is often indicated. Additionally, for people with reduced mobility of the hand due to upper limb paralysis, such as those with cervical spinal cord injury, stroke, cerebral palsy or peripheral nerve injury, disregard for management of the maintenance of the joint range of motion of the effected hand will result in contracture and limited joint range of motion. Such syndromes will reduce hand function, which is already limited by paralysis, and will negatively affect potential outcomes for aggressive rehabilitation techniques, such as tendon transfer surgery and functional neuromuscular stimulation. Therefore, in such cases, CPM is also indicated. Current devices applying CPM have shown to be effective in minimising the syndromes indicated above and these results are summarised in the Background and Research Plan attached to this proposal. Unfortunately, the use of such devices is not always prescribed by clinicians. This is due, mainly, to the limitations of these devices that are in the marketplace. These limitations include lack of secure finger placement, lack of portability, the inability to provide specialised therapy to specific joints and inflexible programming. This proposal introduces an improved device to be developed and these improvements form the proposal aims below. Given such an improved device, which can overcome many of the problems with current CPM machines, it is likely that that the clinical application of CPM will achieve the greater degree of prescription and application in hand rehabilitation. These improvements should overcome the clinical reticence to use these devices and restore a balance by increasing their use to the level that the scientific literature indicates they should have. The overall aim of the proposal is to take the device to a stage where it is ready for clinical trial.