Assessing Functional capacity in GVHD

 Myofascial involvement is one of the common problems faced by GVHD patients. RAHCT clinicians have developed what we believe is a more efficient way of measuring function in GVHD patients. 

 https://cgvhd.co.uk/rehab-pre-transplant 


This will allow clinicians to plan and design an efficient rehab program including functional capacity evaluations (FCE) for return to work or sports. 


The video here describes the variation in the AROM, extension of the wrist, while fingers are extended to while the fingers are closed. 

functional evaluation

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Wrist extension while fingers extended recorded as 12 degrees.

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Wrist extension while fingers flexed recorded as 51 degrees, a difference of 41 degrees.

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Another example while measuring the elbow extension with wrist neutral or flexion gives around 15 - 20 degrees of variation in reading when compared to wrist in flexion. 

Innovative Hand Splint

 Fasciitis or skin cGVHD often includes multi joint level involvement and hence the use of traditional splints for managing hand cGVHD appears to be extraneous .Here we present an innovative splinting technique which takes into account the fascia interconnection for the hand and forearm. 


This project was Lead by Jaleel Mohammed (PT, MSc)  from the RAHCT, Gloucester, UK  & 

Miss Elaf Moh. Al-Shaer (OTR/L,CHE, CKTP, LSVTP), Senior Occupational Therapist, KFSH&RC, Riyadh, KSA

References:

 [i] Oda K, Nakaseko C, Ozawa S, Nishimura M, Saito Y, Yoshiba F, Yamashita T, Fujita H, Takasaki H, Kanamori H, Maruta A. Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT. Bone marrow transplantation. 2009 Jan;43(2):159.

[ii] Martires KJ, Baird K, Steinberg SM, Grkovic L, Joe GO, Williams KM, Mitchell SA, Datiles M, Hakim FT, Pavletic SZ, Cowen EW. Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease. Blood. 2011 Oct 13;118(15):4250-7.

[iii]  Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D. Splinting after contracture release for Dupuytren's contracture (SCoRD): protocol of a pragmatic, multi-centre, randomized controlled trial. BMC musculoskeletal disorders. 2008 Dec;9(1):62. 

[iv]  Ebskov, Michel EH Boeckstyns, Allan Ibsen Sørensen, Niels Søe-Nielsen LB. Results after surgery for severe Dupuytren's contracture: does a dynamic extension splint influence outcome?. Scandinavian journal of plastic and reconstructive surgery and hand surgery. 2000 Jan 1;34(2):155-60.