Results of using PABLO As A New Method For Evaluation And Therapy For Hand Pathology

Key-words : Hand Pathology; Hand Evaluation and Therapy; ,,PABLO”device; Virtual Reality; Functional Rehabilitation Introduction The Pablo system from Tyromotion represents a new medical method for assessment and therapy for the patients with pathology that affects the whole upper limb and especially the hand. The device has very sensitive sensors that can measure the hand grip strenght and the pinch force, also the ROM (range of motion) for all the joints of the upper limb (shoulder, elbow, wrist). These measurements allows the doctor to have an objective evaluation of joint mobility and muscular strenght of the entire upper limb, with better clinical and functional diagnosis for specific pathologies and with better evaluation during rehabilitation programs. We started to use Pablo in our Clinique of National Institute of Rehabilitation for patients hospitalised here for upper limb pathology, especially CNS affection (stroke) and with plastic surgeries for various hand traumas (burns, amputations, electric lessions, work-related accidents). Our purpose was to demonstrate that Pablo can be useful as an assessment tool for hand pathology ( instead of classic goniometry and dynamometry) also, that it can be part of the classic rehabilitation program for these patients (together with other specific therapeutic methods). Material and Method We tested 20 stroke patients and 40 postsurgical hand injury patients. At the beginning and at the end of each 15-days rehabilitation sessions in our Clinique, all of them were assessed clinical, goniometric and dynamometric (Jamar hand test) and also, using Pablo. The functional measurements consists in DASH scale (Disability of Arm-Shoulder-Hand). The rehabilitation program consisted in daily physical procedures for each patients, with kinesitherapy, ergotherapy, therapeutical massage, electrostimulations for hypotrophic muscles (the classic program), but also a half of hour per day with Pablo therapy module for 10 stroke patients and 28 postsurgical hands. Results The patients with hand pathology showed improvement of all the tested parameters, in the general group but in the group with Pablo therapy, the results were better. DASH score decreased from 96.5 points (at the beginning of the study) to 70.9 points (at the second testing) and 61.9points (at the end of the study), demonstrating a decrease in upper limb disability. The DASH score in Pablo patients showed better results: from 92.8 points at the beginning to 53.4 points at the end of the study. Also, all the mobility and prehension force scores at all ten pinch or grip types (policis-fingers, interdigital, lateral, tripulpar, grip force) showed improvement in all the patients, but the results were better for those who used Pablo as a supplement therapy. Conclusions: 1. Pablo can represent a modern option for evaluation of hand deficits and dysfunctions, as a measurement replacement possibility of classic goniometry and dynamometry, with time-sparing for clinical examination and data-based results and objectively monitoring the progression in time of the recovery process. 2. Pablo game therapy sessions, based on Virtual Reality concept, can be integrated in the classic occupational therapy program, to adapt the game parameters to the realistic status of the patient and to be performed also by the patient himself, at home. 3. All the grip and pinch scores and the DASH functional score showed statistical significant improvement for the patients who worked with Pablo.