Objective: To show whether a difference in fine motor control exists between patients with chronic, undiagnosed wrist pain (CUWP) and healthy controls. Furthermore, a method to assess fine motor function of the wrist is evaluated.
Design: A case–control study.
Setting: The Academic Medical Center in Amsterdam, the Netherlands.
Subjects: Twenty-seven CUWP patients were compared with 50 healthy control subjects.
Interventions: Subjects performed horizontal stroke patterns on a digital writing tablet connected to a computer. The control subjects were tested twice to obtain test–retest reliability. A visual analogue scale was used to assess subjective pain.
Main outcome measures: Fluency of movement and average velocity were measured. Intraclass correlation, ANOVA repeated measures statistics and Pearson correlation were calculated.
Results: There is a significant difference in fluency of motion between patients and controls, possibly due to a disturbed motor control, since there is no relationship between pain and test score, nor do CUWP patients have any abnormality in the wrist that can explain the disturbance in motor function. The test method is reliable (ICC = 0.78) and valid.
Conclusions: The disturbed fine motor control in CUWP patients is suggested to maintain chronic wrist pain through ‘strain injury, causing’ pain evasive adaptation of the motor control system. This might lead to new perspectives regarding treatment of CUWP patients.
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References
1.
Mulder ThW. A process-oriented model of human motor behavior: towards a theory-based rehabilitation. Phys Ther1991; 71: 157–164.
2.
Mulder ThW, Hochstenbach JBH. Motor control and learning: implications for neurological rehabilitation. In: Ward CD ed. Handbook of neurological rehabilitation. Hillsdale: Erlbaum Publishers, in press.
3.
Mulder ThW, Nienhuis B, Pauwels J. The assessment of motor recovery: a new look at an old problem. J Electromyogr Kin1996; 6: 137–145.
4.
Mulder ThW, Berndt H, Pauwels J, Nienhuis B. Sensorimotor adaptability in the elderly and disabled. In: Stelmach GE, Homberg V eds. Sensorimotor disorders in the elderly. The Hague: Kluwer Academic Publishers: 413–426.
5.
Merzenich MM, Jenkins WM, Reorganization of cortical representations of the hand following alterations of skin inputs induces by nerve injury, skin island transfers and experience. J Hand Ther1993; 6: 89–104.
6.
Geurts ACH, Mulder ThW. Reorganization of postural control following lower limb amputation: theoretical considerations and implications for rehabilitation. Physiother Theory Pract1992; 8: 145–157.
7.
Mulder ThW, Geurts ACH. Recovery of motor skill following nervous system disorders: a behavioral emphasis. Clin Neurol1993; 1: 1–13.
8.
De Visser E, Pauwels J, Duysens J, Mulder ThW, Veth RPH. Gait adaptations during walking under visual and cognitive constraints. Am J Phys Med Rehabil1998; 77: 1–7.
9.
Videler AJ, Kreulen M, Brandsma W. An exercise program for patients with chronic, undiagnosed wrist pain. [In Dutch]. Fysiopraxis1998; 7: 10–13.
10.
Byl NN, Melnick M. The neural consequences of repetitions: clinical implications of a learning hypothesis. J Hand Ther1997; 10: 160–174.
11.
Altman DG. Practical statistics for medical research. London: Chapman & Hall, 1991.
12.
Teulings HL, Schomaker LRB. Invariant properties between stroke features in handwriting. Acta Psychol1993; 82: 69–88.
13.
Philips JG, Bradshaw JL, Chiu E, Bradshaw JA. Characteristics of handwriting of patients with Huntington’s disease. Mov Disord1994; 9: 521–530.
14.
Philips JG, Martin KE, Bradshaw JL, Iansek R. Could bradykinesia in Parkinson’s disease simply be compensation?J Neurol1994; 241: 439–447.
15.
Teulings HL, Contreras-Vidal JL, Stelmach GE, Adler CH. Parkinsonism reduced coordination of fingers, wrist and arm in fine motor control. Exp Neurol1997; 146: 159–170.
16.
Hogan N. An organizing principle for a class of voluntary movements. J Neurosci1984; 4: 2745–2754.
17.
Hogan N, Flash T. Moving gracefully: quantitative theories of motor coordination. Trends Neurosci1987; 10: 170–174.
18.
Wing AM. Response timing in handwriting. In: Stelmach GE ed. Information processing in motor control and learning. New York: Academic Press, 1978: 153–172.
19.
Pienimäki TT, Kauranen K, Vanharanta H. Bilaterally decreased motor performance of arms in patients with chronic tennis elbow. Arch Phys Med Rehabil1997; 78: 1092–1095.
20.
Viikari-Juntura E, Hietanen M, Kurrpa K, Huuskonen M, Kuosma E, Mutanen P. Psychomotor capacity and occurrence of wrist tenosynovitis. J Occup Med1994; 36: 57–60.
21.
Huskisson EC. Measurement of pain. Lancet1974; 9: 1127–1131.
