Coupled bilateral movements and active neuromuscular stimulation: intralimb transfer evidence during bimanual aiming. Hyperextension injuries of the PIP finger joint. Comparison of early motion and immobilization.
Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor recovery protocols according to group assignments: (1) coupled bilateral involved concurrent wrist/finger movements on the unimpaired limb coupled with active stimulation on the impaired limb; (2) unilateral/active stimulation involved neuromuscular electromyogram-triggered stimulation on the impaired wrist/fingers; and (3) no protocol (control group). During the pretest and posttest, subjects performed transverse plane target aiming movements (29 cm) with vision available. The coupled bilateral group showed positive intralimb transfer post-treatment when both arms moved simultaneously. During the posttest, the coupled bilateral group displayed improved movement time, higher peak limb velocity, less variability in peak velocity, and less percentage of total movement time in the deceleration phase than during the pretest. The evidence confirms that within-limb transfer from distal joint training to proximal joint combinations is viable and generalizable in chronic stroke rehabilitation. Moreover, these intralimb transfer findings extend the evidence favoring motor improvements for coupled bilateral protocols during chronic stroke. In a prospective study of traumatic lesions of the volar fibrocartilage of the PIP joint, 56 patients were randomized to treatment by immobilization for 3 weeks and 56 patients, to purely analgetic treatment without immobilization. Seventy-eight patients were reexamined 6 months later and 77 patients, in a follow-up study 2-3 years after the injury. No difference was found between the two groups with respect to subjective complaints or objective signs.
There is insufficient evidence from trials testing the need for, and the extent and duration of, immobilisation to inform on the key conservative management decisions for treating hyperextension injuries of the proximal interphalangeal joints.