1963 - Improving Hand Function in Childhood Scleroderma using Continuous Passive Motion

Kimberly A. Wesdock1, Harry L. Gewanter1, Sejal M. Shah2, George H. Masiello1, Chester H. Sharps1. 1Children's Hospital, Richmond, VA; 2West End Orthopaedic Therapy Services, Richmond, VA
Presentation Number: 1963

Purpose: A dearth of demonstrable evidence supports interventions in scleroderma with questionable efficacy of Continuous Passive Motion (CPM). We evaluated the effectiveness of CPM to improve hand function in an adolescent with scleroderma using traditional measures as well as three-dimensional kinematic analysis.
Methods: A single-case A-B experimental design was used with a 13-year-old female who had long-standing localized scleroderma with significant hand/wrist limitations. Her disease had been treated with a variety of state-of-the-art medication regimens plus aggressive hand therapy utilizing dynamic splinting and serial casting. Despite these regimens, limitations persisted as documented by her hand therapist, and hand function remained unchanged during the 1-year baseline phase. For the 13-month intervention phase, medications and hand therapy intensity were kept constant, and CPM was added to her regimen. Data collection occurred 3 more times during the intervention phase: pre-CPM, after 2, and 13 months. A CPM machine customized for the hand was used consistently for 30 minutes, twice daily for 13 months. Data included active/passive range of motion (AROM/PROM) of forearm, wrist and all finger joints; grip/pinch strength; wrist and finger kinematics; and self-reported activity performance.
Results: Statistically significant improvements in all aspects of hand/wrist functioning were found post-CPM. Increases in AROM/PROM of MCP, PIP and DIP finger joints as well as grip/pinch strength were noted using the two standard deviation band method for single case data (p<.05), in addition to changes in trend, slope and level data using the split-middle technique. Comparative kinematics demonstrated significant improvements in finger joint excursion with repeatable movements across multiple trials. Clinically meaningful changes included increased speed and endurance without pain or joint swelling during handwriting, keyboarding, violin and piano playing (with improved octave stretch). Among the new abilities achieved during the CPM phase included learning to knit and performing push-ups in P.E. class.
Conclusions: Hand/wrist function in a highly motivated adolescent with localized scleroderma improved with the addition of CPM to her therapeutic regimen. With CPM, functional improvements persisted in contrast with previous intervention attempts. This concert pianist/violinist demonstrated improved dexterity, endurance and hand function across different conditions after using CPM. Post-CPM kinematic changes added another dimension by illustrating consistency of dynamic finger movements not provided by conventional clinical measurements. Kinematic analysis afforded additional objective measurements to document treatment outcomes, and may prove useful in individuals with scleroderma as well as joint contractures.

 K.A. Wesdock, None.