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Pilot Study Focuses on Hand Function

Michelle A. James, MD 2012 OREF/POSNA Research Grant in Pediatric Orthopaedics
Research Summary

Research topic:
Studying the maximum range of thumb motion in patients diagnosed with congenital thumb deficiency as well as those with no history of deficiency

Research results: Validated clinical tests, using motion analysis techniques that quantify the volume of motion—how the thumb interacts with the fingers to enable a child to perform activities

Patient care application of results: More precise assessment of surgical and nonsurgical treatment options for children with impairments and malformations affecting prehension

Simplified patient care application: The groundwork for the development of clinical tests that allow children with hand differences to be assessed for treatment options, resulting in better care

Pilot Study Focuses on Hand Function
OREF grant recipient leads effort to advance treatment for children with hand anomalies
Sharon Johnson

If Michelle A. James, MD, and her research team are successful, pediatric orthopaedic surgeons who treat children with hand differences will soon have a better way to help them understand the functional workspace of the thumb, and inform clinical decision-making. 

The team’s work is supported by a 2012 research grant provided by the Orthopaedic Research and Education Foundation (OREF) in partnership with the Pediatric Orthopaedic Society of North America (POSNA). 

 “The OREF/POSNA grant is huge for us,” Dr. James said. “This is a study that could fall between the cracks with other funding sources. It’s not a large multicenter outcome study. It’s a pilot that, hopefully, will eventually yield a highly useful tool that will help kids.”

 The research is underway at the Motion Analysis Laboratory of Shriners Hospitals for Children—Northern California, in Sacramento, where Dr. James is chief of orthopaedics. She is also chief, Division of Pediatric Orthopaedics at the UC Davis School of Medicine, also in Sacramento, and deputy editor of The Journal of Bone and Joint Surgery.

Hands = connection + expression
“Our hands connect us to our world,” Dr. James said. “We use our hands to open doors, tie our shoes, comb our hair and perform a multitude of basic tasks that get us through each day. They are also our instruments of expression as we use our hands to design, create, repair and touch.”

Today, Dr. James said, it’s difficult to perform a comprehensive clinical evaluation of children with abnormal or impaired thumbs. Better testing would help pediatric orthopaedic surgeons evaluate patients for invasive procedures, such as index pollicization by which the index finger is shortened and rotated to act as a thumb for children who don’t have thumbs.

 “Currently, there is no validated clinical test that quantifies the volume of motion—how the thumb interacts with the fingers to enable a child to perform activities,” Dr. James explained. 

Beyond better decision-making for treating patients with congenital thumb deficiency, she sees an opportunity to help orthopaedists more precisely assess surgical and nonsurgical treatment options for children with impairments and malformations affecting prehension, including those stemming from cerebral palsy, arthrogryposis and thumb polydactyly. 

Three subject groups
Three groups of 10 male and 10 female subjects ages 5 to 18 years will help the team establish a continuum of thumb opposition volume. Results for a control group with no history of surgery or injury to the hand will be compared with those for two additional groups: children with previously diagnosed congenital thumb deficiency who have undergone surgical thumb reconstrution; or an index pollicization procedure.
All subjects will perform a series of trials to measure maximal range of motion and will be monitored while picking up different-sized objects, buttoning a shirt, and grasping a measuring tape. Six standardized clinical tests, modified for the third group to account for one less digit, will assess the subjects’ dominant and non-dominant hands. 

There’s an app for that
In addition to the OREF-funded study, the team will use funding from other sources to apply the design of the kinematic model to mobile technology and create an inexpensive and reliable tool for testing thumb/finger function in children. The study will yield at least a first-generation smart phone app.

“We envision little balloons that the kids pop or something like that,” Dr. James said. “We’ll translate the data back and make sure the results compare with those that would be captured through our kinematic analysis.”

 The app also offers promise for lowering the age at which pediatric orthopaedists are able to test function in children.

“Today, below roughly age 5, it’s hard to get consistent performance,” Dr. James said.
“My goal is to have a valid test for a 2-year-old or, even better, a 1 1/2-year-old because that’s the age at which we want to intervene—the age at which we start thinking about doing surgery but can’t, as of yet, measure results either pre- or post-procedure.”

Bigger steps for better patient care
“We have to figure out through research which assessment and treatment works best so we can tell parents the best alternative when we’re talking about doing surgery on their child. Doing research in little bits and pieces in your free time doesn’t get us very far. OREF and other funding organizations help by giving us time. We can take a bigger step.”

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