|Year : 2020 | Volume
| Issue : 1 | Page : 24-28
Association between sensory, motor, and functional abilities among burned hand patients
Himani Kaushik1, Pragya Kumar2, Jaswinder Kaur3
1 Physiotherapist, Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
2 Assistant Professor, Physiotherapist, Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India
3 Senior Physiotherapist, Head of Department, Department of Physiotherapy, Dr. RML Hospital, New Delhi, India
|Date of Submission||16-Sep-2019|
|Date of Decision||01-Jun-2020|
|Date of Acceptance||02-Jul-2020|
|Date of Web Publication||21-May-2021|
Miss. Himani Kaushik
Bachelor of Physiotherapy, Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Context: Burn injuries are one of the most common health issues of the universe. Burn injuries in hand are very frequent, and in spite of appearance that the expanse of the hand represents < 3% of the total body surface area (TBSA) on each hand, burn injury may have major significance on the quality of the life of an individual. Although the studies have shown the association of burn with either functional, motor, or sensory functions, no such study was found which evaluated and related all the three aspects of hand function, i.e., sensory, motor, and functional activities.
Subjects and Methods: Individuals aged between 18 to 60 years satisfying the examination process were included for the study. Two groups were allocated, including 10 burned hand patients and 10 controlled subjects. All the 20 subjects were examined for sensory, motor, and functional abilities. Pain, temperature, and 2-point discrimination sensitivities were tested; motor functions were tested using Strickland method, Kleinert method, and Jamar hand dynamometer, and functional impairment was tested using Michigan Hand Questionnaire (MHQ).
Statistical Analysis Used: The descriptive data was analyzed using Microsoft Excel and Spearman's rank correlation test was applied using IBM SPSS Statistics for Windows, Version 16.0. Armonk, NY: IBM Corp.”
Result: TBSA was significantly related to the pain perceived on the Visual analog scale (VAS) (r = 0.509; P < 0.05). Significant correlation was seen with MHQ work (r = 0.611; P < 0.05), MHQ esthetics (r = 0.788; P < 0.05), and MHQ satisfaction (r = 0.654; P < 0.05) in relation to TBSA. Degree of burn was significantly related to the pain perceived on VAS (r = 0.907, P < 0.05), pain sensation, temperature, and 2-point discrimination (r = 0.59, P < 0.05). Significant correlation was seen with grip strength (r = 0.77, P < 0.05) and further, index finger flexion (r = 0.866), middle finger flexion (r = 0.949), ring finger flexion (r = 0.909), and little finger flexion (r = 0.910) were significantly related (P < 0.05) to degree of burn. MHQ was significantly related (P < 0.05) to degree of burn in terms of overall hand function (r = 0.836), ADL (r = 0.825), work (r = 0.790), pain (r = 0.574), esthetics (r = 0.86), and satisfaction (r = 0.884) in relation to degree of burn.
Conclusion: TBSA was significantly co-related with pain in terms of sensory function and showed significant relationship with functional abilities in terms of work, esthetic, and satisfaction. Degree of burn significantly related to the pain, temperature, and 2-point discrimination in terms of sensory abilities, grip strength, Strickland method, and Kleinert method in terms of motor abilities and MHQ in terms of functional capabilities. It also indicates that there was a statistically significant difference in sensory, motor, and functional abilities of the hand that were decreased in patients compared with the control group.
Keywords: Burn hands, functional abilities, motor functions, sensory functions
|How to cite this article:|
Kaushik H, Kumar P, Kaur J. Association between sensory, motor, and functional abilities among burned hand patients. Indian J Burns 2020;28:24-8
|How to cite this URL:|
Kaushik H, Kumar P, Kaur J. Association between sensory, motor, and functional abilities among burned hand patients. Indian J Burns [serial online] 2020 [cited 2021 Dec 8];28:24-8. Available from: https://www.ijburns.com/text.asp?2020/28/1/24/316574
| Introduction|| |
Burn injuries are one of the most common health issues of the universe. Burn injuries in hand are very frequent, and in spite of appearance that the expanse of the hand represents less than 3% of the total body surface area (TBSA) on each hand, burn injury may have major significance on the quality of the life of an individual. Hands are the direct means by which we pursue activities of daily living (ADLs) and prosecute for our environment or communicate with each other. Hands, because of its exposure and the importance of functions, are at high risk of injuries and the burn injury is too common.,
Burn patients' life is extremely elongated and challenging to return back to their ADLs and society, especially for those with psychological complications, dysfunctions, and cosmetic complications. Physiotherapy rehabilitation is an essential constituent of burn care to maximize and promote the physical, psychological well-being, and social integration of the patients with burn injuries. Physiotherapists may face very distinctive challenges for treating burn patients during the rehabilitation phase because of severe pain, psychological, and esthetic complications to patient recovery and ability to return to society and professional life. Accumulation, quantification, investigation, and comparison of patients' data and functional status with appropriate information are principles of functional diagnosis which help to design the treatment goals in the rehabilitation phase.
Holavanahalli et al. had concluded that even with the loss of extensor mechanics, the uninjured flexor muscles facilitate the function by permitting a modified grip and enabling patients to be free from most of the ADLs. An area of the study that has mostly escaped any sort of experimental attention is the dorsal area of the hand. The functional results, when the extensor mechanism is impaired, are discovered globally poor but have not been properly well defined. Chauvineau et al. had objectified that neurological skin dysfunctions and reduced functional hand activities were seen in burn patients compared to controls. In addition, there is a lack of a well-defined method to assess functional results.
Studies have shown the association for the burn with either functional, motor, or sensory functions, but no such study was found which evaluated and related all the three aspects of hand function, i.e., sensory, motor, and functional activities. The need of the present study was to find the relationship of sensory, motor, and hand functions of burn hand patients in terms of TBSA and degree of the burn. This will help physiotherapist to design better treatment protocols for their management, according to the patient's condition and level of impairment. Further focus can be laid on understanding what all measures need to be addressed to improve their overall health status.
The aim of the study was to determine the relationship between sensory, motor, and functional abilities in burned hand patients. The objectives were (a) to evaluate the sensory, motor, and functional abilities in burn hand patients and control group and (b) to elucidate the relationship of sensory, motor, and functional abilities in burn hand patients and control group.
| Subjects and Methods|| |
A cross-sectional correlation study was conducted. The study population included age group of 18 to 60 years and both males and females were included. Forty subjects were contacted for the study. Based on the inclusion criteria and exclusion criteria, twenty subjects were included in the study and conducted two focus groups, one with the burn hand patients (n = 10) and the second was the control group (n = 10) and informed consent was obtained from subjects individually. Type of sampling was convenience sampling. Inclusion criteria were subjects with subacute and chronic burns, subjects with either right- or left-hand dominance, cooperative individuals, understand both English and Hindi, and patients with burn hand and normal hand. Individuals under the age group of 18 years, acute burns cases, any infectious patients, alcoholic, cases of diabetic neuropathy, open wound cases, and unhealed burn cases were excluded from the study. Subjects were explained about the procedure of examination method of sensory, motor, and functional abilities.
All 20 subjects were examined for sensory, motor, and functional abilities. Pain, temperature, and 2-point discrimination sensitivities were tested; motor functions were tested using Strickland method, Kleinert method, and Jamar hand dynamometer and functional impairment was tested using Michigan Hand Questionnaire (MHQ) [Figure 1].
This research project was ethically approved by Non-Teaching Course Committee and ethical clearance was given by this committee.
| Results|| |
Relationship of total body surface area with sensory, motor, and functional abilities
TBSA was significantly related to the following: sensory abilities – pain perceived on the Visual analog scale (VAS) (r = 0.509; P < 0.05). Pain is psychological in nature following a burn injury. Motor abilities – TBSA has non-significant correlation between grip strength as well as range of motion (ROM) assessment. Broader surface area involvement in burn injuries doesn't involve all layers of skin and thus not essentially affect motor abilities. Functional abilities – Significant correlation was seen with MHQ work (r = 0.611; P < 0.05), MHQ esthetics (r = 0.788; P < 0.05), and MHQ satisfaction (r = 0.654; P < 0.05). The effect on appearance and satisfaction is a major complication of a burn injury which is significant because it affects body image and ability of the person.
Relationship of degree of burn with sensory, motor, and functional abilities
Degree of burn was significantly related to the following: sensory abilities – pain perceived on VAS (r = 0.907, P < 0.05), pain sensation, temperature, and 2-point discrimination (r = 0.59, P < 0.05). Degree of burn destroys all the layers of skin, which results in proprioception loss because of that the sensory functions of the patient get affected. Motor abilities – significant correlation was seen with grip strength (r = 0.77, P < 0.05). Further, index finger flexion (r = 0.866), middle finger flexion (r = 0.949), ring finger flexion (r = 0.909), and little finger flexion (r = 0.910) were significantly related (P < 0.05) to degree of burn, because depth of the burn involves the layers of the skin, tissues, and bones which affect the physical function and performance of the patient. Functional abilities – MHQ was significantly related (P < 0.05) to degree of burn in terms of overall hand function (r = 0.836), ADL (r = 0.825), work (r = 0.790), pain (r = 0.574), esthetics (r = 0.86), and satisfaction (r = 0.884). Burn injuries are challenging and patient may suffer with psychological and social factors which restricts the patients' physical activity.
| Discussion|| |
The aim of this study was to point out the relationship between sensory, motor, and functional abilities in burned hand patients. To elucidate the relationship of sensory, motor and functional abilities in burn hand patients and control group. A study shows that the most common cause of burn injuries is thermal burn. The burned hand represents the serious problems of an individual and it affects the physical factors as well as psychological factors also. Burn injury may be physically disabled and esthetic disfigurement to the person and therefore wallop on performance in rehabilitation, behavioral attributes, and activities and respond to social and professional life. Pain is also an important factor of burn cases because it also influences the psychological factors such as fear, anxiety, anger, and emotional distress which affect the patient recovery and functional activities. These all factors are lead to dissatisfaction with the patient. Hand burnt injuries frequently result in sensory loss and motor loss which is dependent on the depth of the burn. Loss of sensory functions and motor functions sometimes may require surgical interventions like skin graft and nerve grafting. Loss of sensory function may lead to a loss of pain sensation, proprioception, and temperature discrimination and so on. Loss of motor function may lead to functional limitation, contractures formation, and deformities. Other complications such as edema, hypertrophic scarring, and amputations. Application of physical therapy in burn hand injuries is very important to improve and prevent edema, contractures, scars, deformities, pain, functional activities and ROM, muscle strength, and psychological factors.
The main finding of this study is that the TBSA is mainly resulting in pain, cosmetic disfigurement, and psychological factors to the patient which leads to the individual work limitations, whereas the degree of burn defines the depth of burn, which has accordingly affected the patients' level of function, that is, sensory function, motor function, and functional capacity. According to the degree of burn, a patient may lead to a level of impairment like sensory loss, motor loss, and functional impairment.
Burns extremely jeopardize convulsive and drastically changes live within a second. It affects the life physically as well as psychologically. Esthetic appearance is never going to be same as in spite of best grafts applied on burnt area, scar will persist and lead to dire sequel of social isolation. The burn team focuses mostly on saving life physically and it does not focus on the entire picture. Although it is claimed that hand is an important part of the body, but its functionality is compromised at time of its management following injury .i.e., not seen as emergency. Future studies may include more number of subjects for the better understanding of the results. Future studies also find out association between sensory, motor and functional abilities among burned hand patients pre and post physiotherapy rehabilitation for the better knowledge of clinical outcomes.
| Conclusions|| |
TBSA was significantly co-related pain in terms of sensory function. TBSA showed a significant relationship to functional abilities in terms of work, esthetics, and satisfaction. The degree of the burn was significantly related to sensory abilities in terms of pain, temperature, and 2-point discrimination. The degree of the burn was significantly related to motor abilities in terms of grip strength, flexion, and extension ROM. The degree of the burn was significantly related to MHQ in terms of all six domains: overall hand function, ADLs, pain, work performance, aesthetics, and satisfaction.
The study suggested that in burnt hand cases, TBSA of the burn was significantly related to pain, cosmetic disfigurement, and psychological factors of the patient which limits the motor activities, whereas degree of burn defined by its depth significantly affects the patient's level of function in terms of sensory function, motor function, and functional capacity. Therefore, varying degrees of the burn will determine the level of impairment in terms of the patient's sensory, motor, and functional abilities rather than TBSA alone.
Financial support and sponsorship
No funding provided.
Conflicts of interest
There are no conflicts of interest.
| References|| |
O' Sullivan SB, Chui KK, Richard RL. Physical Rehabilitation. Examination of Sensory Function and Burns. 6th
ed.. New York: Jaypee Brothers; 2014. p. 87-123, 1090-121.
Dunpath T, Chetty V, Van Der Reyden D. Acute burns of the hands – Physiotherapy perspective. Afr Health Sci 2016;16:266-75.
Rrecaj S, Hysenaj H, Martinaj M, Murtezani A, Ibrahimi-Kacuri D, Haxhiu B, Buja Z. Outcome of physical therapy and splinting in hand injury. Our last four years' experience. Mater Sociomed 2015;27:372-5.
Liu MJ, Xiong CH, Xiong L, Huang XL. Biomechanical characteristics of hand coordination in grasping activities of daily living. J Pone 2016;11:1-16.
Chinese Burn Association, Chinese Association of Burn Surgeons, Cen Y, Chai J, Chen H, Chen J, et al
. Guidelines for burn rehabilitation in China. Burns Trauma 2015;3:20.
Holavanahalli RK, Helm PA, Gorman AR, Kowalske KJ. Outcomes after deep full-thickness hand burns. Arch Phys Med Rehabil 2007;88:S30-5.
Chauvineau V, Hardy E, Copello MF, Rezzoug N, Louis N, Gorce P, et al
. Burned hand: Is there a relationship between cutaneous sensory loss and functional ability? Ann Physical Rehabil Med 2014;57:E215.
Malenfant A, Forget R, Amsel R, Papillon J, Frigon JY, Choinière M. Tactile, thermal and pain sensibility in burned patients with and without chronic pain and paresthesia problems. Pain 1998;77:241-51.
Finnell JT, Knopp R, Johnson P, Holland PC, Schubert W. A calibrated paper clip is a reliable measure of two-point discrimination. Acad Emerg Med 2004;11:710-4.
Alsaeed S, Alhomid T, Zakaria H, Alwhaibi R. Normative values of two-point discrimination test among students of princess Noura Bint Abdulrahman University in Riyadh. Int J Adv Physiol Allied Sci 2014;1:42-52.
Salter M, Cheshire L. Hand Therapy – Principles and Practice. Functions of the Hand. 2nd
ed.. Oxford; Boston: Butterworth – Heinenann; 2000. p. 1-51.
Norkin CC, White DJ, Vij JP. Measurement of Joint Motion; A Guide to Goniometry. 3rd
ed.. FA Davis, Philadelphia: Jaypee Brothers; 2003. p. 3-54, 111-80.
Incel NA, Ceceli E, Durukan PB, Erdem HR, Yorgancioglu ZR. Grip strength: Effect of hand dominance. Singapore Med J 2002;43:234-7.
Richards LG, Olson B, Palmiter-Thomas P. How forearm position affects grip strength. Am J Occup Ther 1996;50:133-8.
Wind AE, Takken T, Helders PJ, Engelbert RH. Is grip strength a predictor for total muscle strength in healthy children, adolescents, and young adults? Eur J Pediatr 2010;169:281-7.
Kirkpatrick JE. Evaluation of grip loss: A factor of permanent disability in California. Indian Med Surg 1957;26:285-9.
Mathiowetz V, Kashman N, Volkand G, Weber K, Dowe M, Rogers S. Grip and pinch strength: Normative data for adults. Occupational Therapy Program, University of Wisconsin-Milwaukee. Milwaukee WI 53201. Archs Phys Rehabil 1985;66:69-72.
Firell JC, Crain GM. Which setting of the dynamometer provides maximal grip strength? J Hand Surg 1996;21A: 397-401.
Johansson CA, Kent BE, Shepard KF. Relationship between verbal command volume and magnitude of muscle contraction. Phys Ther 1983;63:1260-5.
Shauver MJ, Chung KC, The Michigan Hand Outcomes Questionnaire (MHQ) after 15 years of field trial. Plast Reconstr Surg 2013;131:e779-87.
Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg 1998;23:575-87.
Magee DJ. Orthopedic Physical Assessment. Forearm, Wrist and Hand. 6th
ed. Canada: Reed Elsevier; 2014. p. 429-91.
Lee KS, Jung MC. Ergonomic evaluation of biomechanical hand function. Saf Health Work 2015;6:9-17.