Electronic Thesis and Dissertation Repository

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Dr. Joy MacDermid

Abstract

Currently, there is weak evidence on the effectiveness of different rehabilitation regimens following distal radius fracture (DRF). This thesis evaluated sensory and vascular effects of exercise, thermal and ultrasound interventions that can be used in the mobilization phase (cast removal) after DRF.

Methods

  • This thesis includes 3 studies. The first study compared responses to Immersion in Cold water Evaluation (ICE) in the DRF and uninjured hands. Skin blood flow (Sbf), skin temperature (temp.) and sensory perception thresholds (sPT) at 2000Hz for A –beta fibres and at 5 Hz for C fibres were obtained before, immediately after ICE and 10 min later.
  • The second study assessed Sbf, temp., and sPT before and after 3 conditions: control, 1 MHz continuous and 3 MHz pulsed US in healthy subjects.
  • The third study assessed Sbf and sPT before and after 3 conditions: control, 5 min of high intensity and low intensity hand exercises in healthy subjects.
  • Differences in these were analyzed using General Linear Models.

Results

  • In the DRF hand, Sbf increased (Mean Difference (MD) = -42.2 A.U.) immediately, at 1 min (MD= -35 A.U.), and 10 min after ICE (MD= -1 A.U.). There was a decrease in temp. for the index and little fingers immediately after ICE (MD=9. 9 & 9.1 o C) and these did not return to baseline by 10 min (MD= 4.4 & 4 o C). ICE had no effect on sPT at 5 Hz (p>0.05). There was no difference between the DRF and uninjured hand on all measures(p>0.05) except for the sPT at 2000Hz, which remained high on the DRF side for up to 10 min( MD= -1.8 m. A.).
  • Both pulsed and continuous US caused small to moderate reductions in Sbf (MD= 2.8 A.U. & 3.9 A.U.), temp. (MD = 2.5 0 C & 1.1 0 C) and sPT at 5 Hz (MD=1.3 m. A. & 1 m. A.). US had no effect on sPT at 2000Hz (p>0.05).
  • Both type of exercises were insufficient to alter Sbf and sPT at 2000Hz and 5 Hz (p>0.05).

Conclusions

  • Normal thermo-physiological responses were observed after ICE in both hands. A-beta fibres on the DRF side became less sensitive after ICE.
  • Minor changes can occur in Sbf, temp., and sPT at 5 Hz following 3 to 5 min exposure to US in healthy subjects.
  • Hand grip exercises had minimal impact on Sbf or sPT in healthy subjects.
  • The changes seen with ICE and US are presumed to help with tissue healing and pain modulation which needs further investigation.