Authors: (including presenting author): :
Chan HKT, Wu AYT, Lee JWK, Lee SKF, Wong TFY, Woo CW, Leung KKL
Affiliation: :
Physiotherapy Department, Kowloon Hospital
Keyword 1: :
Hip fracture patients
Keyword 2: :
Upper limb training
Keyword 3: :
Reaction time
Keyword 4: :
Improved function
Keyword 5: :
Smart training
Introduction: :
Conventional rehabilitation for elderly hip fracture patients prioritizes lower limb training to address pain, range of motion, strength, balance, and function, frequently neglecting upper limbs. Handgrip strength predicts favorable post-fracture outcomes, reflecting overall muscle strength, aiding mobility and daily activities. Upper limb reaction time and dexterity impairments are common, yet rapid responses are essential during balance perturbations to prevent falls. Given high recurrent fall risk, integrating upper limb reaction time training with smart indicators may enhance functional outcomes, safety awareness, and reduce fall recurrence.
Objectives: :
To evaluate the effectiveness of smart indicators and upper limb reaction time training on functional outcomes in elderly hip fracture patients. Outcome measures included functional mobility outcomes, upper limb reaction time, and hand function scores.
Methodology: :
Twelve elderly hip fracture patients were recruited. Tailored upper limb training was integrated into physiotherapy regimen alongside standard treatments, including strengthening exercises for upper extremity muscles and handgrip strength (HGS), alongside agility and functional tasks. Training utilized the Witty SEM (Microgate), a smart LED matrix that displays symbols and colours for cognitive-motor stimulation and reactivity. Discriminative response tasks challenged visual discrimination, attention, and upper limb reactivity. Functional outcomes were assessed pre- and post-intervention using validated measures: Modified Functional Ambulatory Category (MFAC), Elderly Mobility Scale (EMS), Numeric Pain Rating Scale (NPRS), HGS, upper limb reaction time, and Jebsen-Taylor Hand Function Test (JTHFT) Subtests 6 and 7.
Result & Outcome: :
Twelve elderly patients aged 72-98 completed this training programme within 26-70 days of rehabilitation. No adverse incident occurred, demonstrating elderly patients are able to comply and utilise new technology like Witty SEM despite consisting of complex tasks. Statistically significant improvement was demonstrated in the outcome measures of MFAC (p< 0.001), EMS (p< 0.001), NPRS (p< 0.001), HGS (p< 0.001), JTHFT (p< 0.001) and upper limb reaction time (p< 0.001). Furthermore, a significant negative and moderately strong correlation (r=-0.768, p =0.004) between patient’s age and HGS improvement was also displayed, reflecting that younger elderly may have greater grip strength and upper limb functional improvement in contrast to the older elderly. Additionally, moderately strong and positive correlations in patients’ improvement in HGS with MFAC (r=0.770, p =0.003) and EMS (r=0.636, p=0.026) were also found.
Handgrip strength (HGS) predicts favorable functional outcomes in post-hip fracture rehabilitation, reflecting overall muscle strength. Integrating upper limb training with smart indicators into lower limb rehabilitation significantly enhances grip strength, upper limb reaction time, motor skills, and functional performance in hip fracture patients. Improved reaction time promotes motor performance, attention, and environmental safety awareness, reducing recurrent falls and injuries in older adults. This approach is safe, effective, and feasible for improving hand motor function and mobility and enhances service care.
