Electromyographic and Functional Analysis of Neuromuscular Rehabilitation Methods in Individuals With Scapholunate Instability: A Comparison of Conventional and Virtual Reality-Supported Interventions
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 36
- 试验地点
- 2
- 主要终点
- Wrist Proprioception
研究概览
简要总结
Scapholunate instability is a common form of carpal instability that can cause wrist pain, weakness, and functional limitations during daily activities. Conservative rehabilitation approaches are frequently recommended in the early stages; however, there is no standardized rehabilitation protocol, and the effects of different neuromuscular rehabilitation methods have not been sufficiently investigated.
The primary aim of this study is to comparatively examine the effects of conventional physiotherapy approaches and virtual reality-supported neuromuscular rehabilitation on forearm muscle activation patterns assessed using surface electromyography, wrist proprioceptive function (joint position sense), pain intensity, and functional improvement in individuals with scapholunate instability, and to identify clinically applicable rehabilitation protocol approaches for this population.
In this single-blind randomized controlled trial, participants with pre-dynamic or dynamic scapholunate instability will be randomly assigned to either a conventional rehabilitation group or a virtual reality-supported rehabilitation group. Both groups will receive an 8-week rehabilitation program administered twice per week. Primary outcome measures will include electromyographically assessed forearm muscle activation and wrist proprioception. Secondary outcome measures will include pain intensity, grip strength, wrist muscle strength, and upper extremity functional outcomes assessed using validated clinical instruments. All outcome assessments will be performed before and after the intervention period by an assessor blinded to group allocation.
详细描述
Scapholunate instability is the most common form of carpal instability and is characterized by disruption of the scapholunate interosseous ligament, leading to altered wrist kinematics, pain, reduced grip strength, proprioceptive deficits, and functional limitations. In the early (pre-dynamic and dynamic) stages of the condition, conservative management is recommended; however, standardized, evidence-based rehabilitation protocols are lacking. In particular, the neuromuscular mechanisms underlying wrist stabilization, muscle activation patterns, and proprioceptive control have not been sufficiently investigated using objective measurement methods.
This randomized, single-blinded controlled trial is designed to compare the effects of conventional physiotherapy and virtual reality-supported neuromuscular rehabilitation in individuals with scapholunate instability. Participants diagnosed with pre-dynamic or dynamic scapholunate instability will be randomly allocated to either a conventional rehabilitation group or a virtual reality-supported rehabilitation group. Both groups will receive an 8-week intervention program consisting of two supervised sessions per week. The conventional rehabilitation program will focus on strengthening "scapholunate-friendly" wrist and forearm muscles, improving neuromuscular control, and enhancing wrist proprioception through progressive strengthening and proprioceptive exercises. The intervention group will receive the same conventional program supplemented with virtual reality-based rehabilitation games designed to promote task-oriented movement, sensorimotor integration, and real-time feedback.
Outcome assessments will be conducted before and after the intervention by a blinded evaluator. Primary outcome measures will include wrist proprioception (joint position sense) and forearm muscle activation patterns assessed using surface electromyography. Secondary outcome measures will include pain intensity, grip strength, wrist muscle strength, pressure pain threshold, and upper extremity functional performance assessed using validated clinical outcome measures.
The study aims to objectively evaluate neuromuscular and proprioceptive changes associated with different rehabilitation approaches and to determine whether virtual reality-supported rehabilitation provides additional benefits over conventional physiotherapy alone. The findings of this study are expected to contribute to the development of clinically applicable, evidence-based rehabilitation protocols for individuals with scapholunate instability and to provide insight into muscle activation strategies involved in wrist stabilization.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Aged between 18 and 65 years
- •Diagnosed with scapholunate instability (pre-dynamic or dynamic instability) by a physician and referred for conservative treatment
- •A score of ≤6 on the Beighton Hypermobility Scale
- •Presence of clinical instability symptoms, including pain, a sense of instability, and functional limitation
- •Willingness to participate in the study and high motivation to comply with the intervention protocol
排除标准
- •History of previous surgery involving the hand or wrist
- •Presence of any neurological or cardiovascular disorder
- •Presence of additional orthopedic pathology affecting the shoulder, elbow, or wrist other than scapholunate instability
- •History of surgery involving the ipsilateral upper extremity within the past 6 months
- •Presence of visual or hearing impairments that may interfere with participation in the rehabilitation program
- •Participation in sensory- or function-oriented rehabilitation of either hand within the past 6 months
- •A score below 26 on the Montreal Cognitive Assessment (MoCA)
- •Inability to read or write
研究组 & 干预措施
Conventional Physiotherapy Group
Participants assigned to this arm will receive a structured conventional physiotherapy program focusing on wrist and forearm stabilization. The intervention will include strengthening exercises targeting scapholunate-friendly muscles, neuromuscular control exercises, and proprioceptive training aimed at improving wrist stability and functional movement patterns. The program will be delivered under supervision twice per week for 8 weeks.
干预措施: Conventional Physiotherapy Group (Other)
Virtual Reality-Supported Neuromuscular Rehabilitation Group
Participants assigned to this arm will receive the same conventional physiotherapy program as the control group. In addition, they will participate in virtual reality-supported neuromuscular rehabilitation using sensor-based interactive therapeutic games designed for upper extremity rehabilitation. The virtual reality component will consist of four different game-based tasks targeting wrist and forearm motor control, proprioceptive feedback, and functional task performance. These games will be selected to promote controlled movement, coordination, and task-oriented motor training. The intervention will be administered twice per week for 8 weeks under physiotherapist supervision.
干预措施: Conventional Physiotherapy Group (Other)
Virtual Reality-Supported Neuromuscular Rehabilitation Group
Participants assigned to this arm will receive the same conventional physiotherapy program as the control group. In addition, they will participate in virtual reality-supported neuromuscular rehabilitation using sensor-based interactive therapeutic games designed for upper extremity rehabilitation. The virtual reality component will consist of four different game-based tasks targeting wrist and forearm motor control, proprioceptive feedback, and functional task performance. These games will be selected to promote controlled movement, coordination, and task-oriented motor training. The intervention will be administered twice per week for 8 weeks under physiotherapist supervision.
干预措施: Virtual Reality-Supported Neuromuscular Rehabilitation (Other)
结局指标
主要结局
Wrist Proprioception
时间窗: Baseline and after 8 weeks of intervention
Wrist proprioception will be assessed by evaluating joint position sense using both a universal goniometer and an electrogoniometer. Assessments will be performed in a standardized sitting position with the forearm supported. Predetermined wrist joint angles will be set by the assessor, and participants will be asked to actively reproduce the target positions without visual feedback. Wrist joint angles will be recorded using both measurement tools, and the absolute angular error between the target angle and the reproduced angle will be calculated to determine proprioceptive accuracy.
Forearm Muscle Activation
时间窗: Baseline and after 8 weeks of intervention
Forearm muscle activation will be assessed using surface electromyography during standardized wrist and forearm tasks. Electromyographic activity of selected forearm muscles involved in wrist stabilization will be recorded and analyzed to evaluate neuromuscular activation patterns.
次要结局
- Pain Intensity(Baseline and after 8 weeks of intervention)
- Pressure Pain Threshold(Baseline and after 8 weeks of intervention)
- Grip Strength(Baseline and after 8 weeks of intervention)
- Wrist Muscle Strength(Baseline and after 8 weeks of intervention)
- Upper Extremity Function (QuickDASH)(Baseline and after 8 weeks of intervention)
- Wrist Pain and Disability (PRWE)(Baseline and after 8 weeks of intervention)