The Arthritic Hand

The Arthritic Hand - a system to reduce pain and increase function

Eric E. Sabelman PhD; J. Beatrice Netter MFA; David L. Jaffe MS; Michael Ward MD

Objectives - People with arthritis in the hand/wrist are subject to loss of manipulative function essential to carrying out daily activities. We hypothesize that loss of function may be avoided, reduced or reversed by reducing pain during physical therapy. The objective of this project is to combine proven exercise and non-pharmacological pain reduction methodologies in a way that makes them easily useable and quickly convertible to a commercial product. The devices and end-user training techniques resulting from this project may be means for implementing therapies based on biomechanical models for preservation of bone and joint properties.

Approach - Based on the literature and on interviews with therapists, it is apparent that controlled exercise (i.e.: constrained to prevent pathologic motion of affected joints) shows promise for restoring or maintaining hand function, but is difficult for patients to consistently perform due to the pain involved. While it is possible to motivate patients to overcome joint pain in the clinic, long-term post-clinical compliance with the therapeutic regimen is rarely achieved, so that good outcomes are infrequent. Our goal of maintaining function and preventing further arthritic damage is complementary to other Center projects dealing with the ultimate consequences of joint degeneration.

The physical embodiment of the solution will include: (1) hot and cold water contrast baths, (2) a container for the contrast baths, (3) a heating system for the hot water, (4) a cooling system for the cold water, (5) water jets for pain reduction and possible gentle exercise resistance, (6) two temperature measurement gauges, (7) exercise assisting devices which may include: a variety of shapes and angles built into the basin (rubber stretch bands, gentle resistance and force devices, hand held paddles, etc.), (8) a force gauge, (9) a tool for recording results and progress.

Significance - Increasing numbers of veterans are entering the age at which arthritis affects their ability to care for themselves and /or remain usefully employed. Correct exercises can delay loss of function, but are seldom performed outside the clinic because of lack of motivation to overcome the pain involved. The devices to be developed will be applicable to this need both in clinical and home settings with minimal supervision.

Results/Status - Presently we are determining the best known exercise and pain relief techniques from the literature, evaluating existing tools, testing alternative pain reduction regimens to augment hot and cold water baths, and reviewing results with a clinical advisory team. In addition we are developing one function and appearance model (Fig. 1) which will culminate in a test with three primary end users. A second prototype employing warm and cool alternating mist jets has been built by a summer student (Fig. 2); it shows promise for rapid heat transfer to and from the hand with minimum weight and energy consumption. A larger scale project has been proposed to complete construction of three prototypes and evaluate the advantage of combined pain reduction and exercise over separate techniques.

Figure 1. Exercise assisting device for the arthritic hand.

In collaboration with other VA staff, the authors are developing "Working with Arthritis Workshops", at which the exercise/pain reduction concept is introduced. Workshop attendees can enroll as participants in expanded trials of the most efficacious of the prototypes. Workshops enhance the effectiveness of the device under development by providing users with information and techniques for assessment, goal setting, tracking progress, exercise, physiology, problem solving and support. Also, a collaboration has been established with the Extravehicular Systems Branch at NASA-Ames Research Center, which has expertise in design of both gloves for extreme conditions and for control of thermal flux in the extremities.

Figure 2. Prototype warm/cold wrist thermal applicator.

Republished from the 1996 Rehabilitation R&D Center Progress Report. For current information about this project, contact: Eric E. Sabelman.