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Aviva Wolff

Hospital for Special Surgery, Rehabilitation, Research Therapist

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Clinician Scientist with research interests in assessment, recovery, and improvement of upper extremity function and performance in individuals with musculoskeletal injury and impairment. Facilitator and leader of multidisciplinary collaborations between engineers, clinicians, and scientists with special interest in the underlying neurobiology of hand function and in combining biomechanics, neuroscience, technology, and clinical investigation to study impairment and recovery.

Founded Upper Extremity Clinical Movement Analysis Program at Leon Root Motion Analysis Laboratory at Hospital for Special Surgery to assess upper extremity movement dysfunction to inform surgery, therapy and performance.

Specialized expertise in design and testing of novel evidenced based therapy interventions and devices for pediatric and adult hand and upper extremity conditions .

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Macquarie University

Nazmi Bülent Alp

Istanbul University

Audrey L H van der Meer

Norwegian University of Science and Technology

Makerere University

International Journal of Kinesiology and Sports Science (IJKSS)

Srinath Kamineni MD, FRCS-Orth, FAAOS

University of Kentucky

University of Toronto

Emanual Maverakis

University of California, Davis

Universidade de São Paulo

Debashish Danda

Christian Medical College

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Papers by Aviva Wolff

HSS Research News

by Sherry I Backus, Howard Hillstrom, and Aviva Wolff

Rehabilitation for scapholunate injury: Application of scientific and clinical evidence to practice

Journal of Hand Therapy, 2016

In this article, the development of a rehabilitation approach is describe using scapholunate inju... more In this article, the development of a rehabilitation approach is describe using scapholunate injury as a model. We demonstrate how scientific and clinical evidence is applied to a treatment paradigm and modified based on emerging evidence. Role of the scapholunate interosseous ligament within the pathomechanics of the carpus, along with the progression of pathology, and specific rehabilitation algorithms tailored to the stage of injury. We review the recent and current evidence on the kinematics of wrist motion during functional activity, role of the muscles in providing dynamic stability of the carpus, and basic science of proprioception. Key relevant findings in each of these inter-related areas are highlighted to demonstrate how together they form the basis for current wrist rehabilitation. Finally, we make recommendations for future research to further test the efficacy of these approaches in improving functional outcomes.

The Relationship Between Functional Task Performance and Wrist Kinematic Parameters in Healthy and Midcarpal Arthrodesis Subjects

by Howard Hillstrom, Sherry I Backus, and Aviva Wolff

Performance of several upper extremity functional tasks was modeled with stepwise regression empl... more Performance of several upper extremity functional tasks was modeled with stepwise regression employing wrist kinematic variables. Models of Dart Throwing, Basketball Shooting, Hammering and Clubbing were formed from these wrist kinematic variables that explained between 27.7% to 61.6% of the variance in performance. INTRODUCTION Traditional outcome measures have described the wrist in isolated planes of motion (extension and flexion (EF), radial and ulnar deviation (RUD)). While practical and straightforward, these measures do not convey information concerning functional activities of the wrist. Most functional activities employ "coupled" wrist motion, a combination of EF and RUD [1]. In particular the "dart throwers motion" (DTM), radial-extension to ulnar-flexion, has been implicated as a common path of motion in many activities that require simultaneous force generation and targeted accuracy [2,3]. There is little information explaining the relationship betwee...

HSS Research News

Surgical Treatments for Scapholunate Advanced Collapse Wrist: Kinematics and Functional Performance

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

The Journal of Hand Surgery, 2015

The purpose of this investigation was to compare kinematic motion and functional performance duri... more The purpose of this investigation was to compare kinematic motion and functional performance during 2 tasks in patients following 4-corner fusion (4CF) or proximal row carpectomy (PRC) and to compare these data with those from healthy asymptomatic individuals. Twenty men (10 4CFs and 10 PRCs, ages, 43-82 y) were recruited for 3-dimensional wrist motion analysis testing. Kinematic coupling (the ratio of wrist flexion/extension to radial-ulnar deviation), kinematic path length (a measure of total angle distance), clinical measures, and performance measures were collected during 2 tasks: dart throwing and hammering. For each outcome, between-group comparisons employed a 1-way analysis of variance with post hoc analysis using the Fisher least significant difference test. All clinical measures (flexion-extension, radial-ulnar deviation, and grip strength) were decreased for 4CF and PRC patients compared with healthy subjects. Coupling, kinematic path length, and performance were all significantly reduced in 4CF and PRC patients compared with healthy subjects during both tasks. Reduced coupling and a shorter kinematic path length are indicative of less global and combined wrist motion. There were no differences identified in coupling patterns or performance between the surgical groups for the dart-throwing task. However, in hammering, the kinematic path length and performance (time and total strikes) were worse in 4CF than in PRC. Differences in wrist kinematics and performance were identified between the groups. PRC subjects performed better on kinematic and performance variables. As expected, both groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists. These results require confirmation and while they cannot be used to determine the benefits of one procedure over the other, they are an important step in quantifying differences in motion and function between procedures. Therapeutic II.

Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy

by Howard Hillstrom and Aviva Wolff

Research in Developmental Disabilities, 2015

Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first s... more Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first step in understanding hand posture differentiation. To quantify this ability and determine how hand posture evolves during reach toward various object shapes in children with unilateral spastic cerebral palsy (USCP), 2 groups of children (10 typically developing, and 10 USCP, ages 6-13) were studied in a single-session cross-sectional study. Subjects grasped rectangular, concave, and convex objects with each hand. Metacarpal and proximal interphalangeal joint finger flexion and finger abduction angles were calculated. The extent to which hand posture reflects object shape was calculated using a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;visuomotor efficiency (VME) index&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (a score of 100 reflects perfect discrimination between objects). A mixed design ANOVA with repeated measures on time was used to compare the VME between groups. Children with USCP demonstrated a lower VME than controls in the affected hand, indicating less effective hand-shaping; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01. There was also a difference between groups in the evolution of VME throughout reach; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01. No difference in hand-shaping in the less affected hand in USCP was observed. Analysis of joint angles at contact and VME throughout reach demonstrated that children with USCP differentiated their hand posture to objects of different shapes, but demonstrated deficits in the timing and magnitude of hand-shaping isolated to the affected side. The present study suggests it may be important to consider the quality of hand activity using quantitative approaches such as VME analyses. Rehabilitation approaches that target these deficits to improve joint mobility and motor control are worth testing.

American Association of Orthopedic Surgeons_Presentation 2011: Midcarpal arthrodesis, wrist coupling and performance

by Sherry I Backus and Aviva Wolff

Effects of midcarpal arthrodesis on Wrist Coupling, Kinematics and Performance: Analysis of six functional tasks

by Sherry I Backus and Aviva Wolff

An extension to the ISB wrist joint coordinate system: An in vitro accuracy study

by Sherry I Backus, Howard Hillstrom, and Aviva Wolff

Journal of Biomechanics, 2007

Effects of Midcarpal Arthrodesis on Wrist Coupling and Performance_ASB presentation

by Aviva Wolff and Sherry I Backus

Responsiveness of Three Patient Report Outcome (PRO) Measures in Patients with Hand Fractures: A Preliminary Cohort Study

Journal of Hand Therapy, 2015

Clinical measurement. Few studies describe the responsiveness of functional outcomes measures in ... more Clinical measurement. Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures. 1 - To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2 - To examine patients&#39; PRO preference. 60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported. Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p &lt; .001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98-1.23; SRM: 1.31-1.49) and T1 and T3 (effect size: 1.21-1.54; SRM 1.49-1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35-.64, SRM: .38-.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use. DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures. 2c.

SSc management – In person appointments and remote therapy (SMART): A framework for management of chronic hand conditions

by Aviva Wolff and Gwen Weinstock-Zlotnick

Journal of Hand Therapy, 2014

The changing health care climate poses unique challenges to managing a chronic and progressive di... more The changing health care climate poses unique challenges to managing a chronic and progressive disease like systemic sclerosis (SSc). At our institution, we employ a new model for SSc management that combines "in person" appointments and "remote" therapy (SMART). This program fosters an understanding of the disease process with the goal of improving skills and confidence for self-management and empowering individuals by providing a means of daily self-assessment. Technology is utilized as a means to remotely monitor and assess progress. We present our approach as a framework for long term management of chronic hand conditions. Evidence from a variety of disciplines is cited to support the design and parameters of this model.

Postoperative Management After Total Elbow Replacement

Techniques in Hand & Upper Extremity Surgery, 2000

Lateral Elbow Instability: Nonoperative, Operative, and Postoperative Management

Journal of Hand Therapy, 2006

The purpose of this article is to present a treatment approach that has been found to be effectiv... more The purpose of this article is to present a treatment approach that has been found to be effective in the early management of lateral elbow instability. Anatomy and joint mechanics related to stability of the elbow are reviewed. Operative and nonoperative treatment is outlined followed by a description of an innovative paradigm for the rehabilitation of elbow instability. Progression of the rehabilitation program as the elbow achieves greater stability is discussed. The authors hope that therapists and surgeons will find this method beneficial in beginning early range of motion for the unstable elbow, thus minimizing joint stiffness while preserving stability at the elbow joint.

The effect of simulated elbow contracture on temporal and distance gait parameters

by Mandi Gibbons, Aviva Wolff, Samir Trehan, Aaron Daluiski, and Howard Hillstrom

Gait & posture, Jan 28, 2015

Elbow contractures can be functionally debilitating. Extensive research has been published on tre... more Elbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters. Forty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials. All three fixed elbow conditions (120°, 90° and 30°) demonstrate...

Comparison of Wrist Kinematics and Functional Performance between Surgical Treatments for SLAC Wrist

by Aviva Wolff, Sherry I Backus, and Howard Hillstrom

The Journal of Hand Surgery, 2011

Differentiation of Hand Posture During Reach in Typically Developing Children and Children With Cerebral Palsy

by Aviva Wolff and Howard Hillstrom

Journal of Hand Therapy, 2012

Comparing the Responsiveness of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Dash), Michigan Hand Outcomes Questionnaire (Mhq), and Patient Rated Wrist/Hand Evaluation (Prwhe) for Hand Fractures

Journal of Hand Therapy, 2012

Wrist Kinematic Coupling and Performance During Functional Tasks: Effects of Constrained Motion

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

The Journal of Hand Surgery, 2014

Purpose To quantify the coupled motion of the wrist during selected functional tasks and to deter... more

Development of an Anatomical Wrist Joint Coordinate System to Quantify Motion During Functional Tasks

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

Journal of Applied Biomechanics, 2014

The purpose of this study was to develop a three-dimensional (3D) motion analysis based anatomica... more The purpose of this study was to develop a three-dimensional (3D) motion analysis based anatomical wrist joint coordinate system for measurement of in-vivo wrist kinematics. The convergent validity and reliability of the 3D motion analysis implementation was quantified and compared with manual and electrogoniometry techniques on 10 cadaveric specimens. Fluoroscopic measurements were used as the reference. The 3D motion analysis measurements (mean absolute difference [MAD] = 3.6°) were significantly less different (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .005) than manual goniometry (MAD = 5.7°) but not (P = .066, power = 0.45) electrogoniometry (MAD = 5.0°) compared with fluoroscopy. The intraclass correlation coefficient (ICC[2,1]) was highest for 3D motion analysis compared with manual and electrogoniometry, suggesting better reliability for this technique. To demonstrate the utility of this new wrist joint coordinate system, normative data from 10 healthy subjects was obtained while throwing a dart.

HSS Research News

by Sherry I Backus, Howard Hillstrom, and Aviva Wolff

Rehabilitation for scapholunate injury: Application of scientific and clinical evidence to practice

Journal of Hand Therapy, 2016

In this article, the development of a rehabilitation approach is describe using scapholunate inju... more In this article, the development of a rehabilitation approach is describe using scapholunate injury as a model. We demonstrate how scientific and clinical evidence is applied to a treatment paradigm and modified based on emerging evidence. Role of the scapholunate interosseous ligament within the pathomechanics of the carpus, along with the progression of pathology, and specific rehabilitation algorithms tailored to the stage of injury. We review the recent and current evidence on the kinematics of wrist motion during functional activity, role of the muscles in providing dynamic stability of the carpus, and basic science of proprioception. Key relevant findings in each of these inter-related areas are highlighted to demonstrate how together they form the basis for current wrist rehabilitation. Finally, we make recommendations for future research to further test the efficacy of these approaches in improving functional outcomes.

The Relationship Between Functional Task Performance and Wrist Kinematic Parameters in Healthy and Midcarpal Arthrodesis Subjects

by Howard Hillstrom, Sherry I Backus, and Aviva Wolff

Performance of several upper extremity functional tasks was modeled with stepwise regression empl... more Performance of several upper extremity functional tasks was modeled with stepwise regression employing wrist kinematic variables. Models of Dart Throwing, Basketball Shooting, Hammering and Clubbing were formed from these wrist kinematic variables that explained between 27.7% to 61.6% of the variance in performance. INTRODUCTION Traditional outcome measures have described the wrist in isolated planes of motion (extension and flexion (EF), radial and ulnar deviation (RUD)). While practical and straightforward, these measures do not convey information concerning functional activities of the wrist. Most functional activities employ "coupled" wrist motion, a combination of EF and RUD [1]. In particular the "dart throwers motion" (DTM), radial-extension to ulnar-flexion, has been implicated as a common path of motion in many activities that require simultaneous force generation and targeted accuracy [2,3]. There is little information explaining the relationship betwee...

HSS Research News

Surgical Treatments for Scapholunate Advanced Collapse Wrist: Kinematics and Functional Performance

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

The Journal of Hand Surgery, 2015

The purpose of this investigation was to compare kinematic motion and functional performance duri... more The purpose of this investigation was to compare kinematic motion and functional performance during 2 tasks in patients following 4-corner fusion (4CF) or proximal row carpectomy (PRC) and to compare these data with those from healthy asymptomatic individuals. Twenty men (10 4CFs and 10 PRCs, ages, 43-82 y) were recruited for 3-dimensional wrist motion analysis testing. Kinematic coupling (the ratio of wrist flexion/extension to radial-ulnar deviation), kinematic path length (a measure of total angle distance), clinical measures, and performance measures were collected during 2 tasks: dart throwing and hammering. For each outcome, between-group comparisons employed a 1-way analysis of variance with post hoc analysis using the Fisher least significant difference test. All clinical measures (flexion-extension, radial-ulnar deviation, and grip strength) were decreased for 4CF and PRC patients compared with healthy subjects. Coupling, kinematic path length, and performance were all significantly reduced in 4CF and PRC patients compared with healthy subjects during both tasks. Reduced coupling and a shorter kinematic path length are indicative of less global and combined wrist motion. There were no differences identified in coupling patterns or performance between the surgical groups for the dart-throwing task. However, in hammering, the kinematic path length and performance (time and total strikes) were worse in 4CF than in PRC. Differences in wrist kinematics and performance were identified between the groups. PRC subjects performed better on kinematic and performance variables. As expected, both groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists. These results require confirmation and while they cannot be used to determine the benefits of one procedure over the other, they are an important step in quantifying differences in motion and function between procedures. Therapeutic II.

Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy

by Howard Hillstrom and Aviva Wolff

Research in Developmental Disabilities, 2015

Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first s... more Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first step in understanding hand posture differentiation. To quantify this ability and determine how hand posture evolves during reach toward various object shapes in children with unilateral spastic cerebral palsy (USCP), 2 groups of children (10 typically developing, and 10 USCP, ages 6-13) were studied in a single-session cross-sectional study. Subjects grasped rectangular, concave, and convex objects with each hand. Metacarpal and proximal interphalangeal joint finger flexion and finger abduction angles were calculated. The extent to which hand posture reflects object shape was calculated using a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;visuomotor efficiency (VME) index&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (a score of 100 reflects perfect discrimination between objects). A mixed design ANOVA with repeated measures on time was used to compare the VME between groups. Children with USCP demonstrated a lower VME than controls in the affected hand, indicating less effective hand-shaping; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01. There was also a difference between groups in the evolution of VME throughout reach; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01. No difference in hand-shaping in the less affected hand in USCP was observed. Analysis of joint angles at contact and VME throughout reach demonstrated that children with USCP differentiated their hand posture to objects of different shapes, but demonstrated deficits in the timing and magnitude of hand-shaping isolated to the affected side. The present study suggests it may be important to consider the quality of hand activity using quantitative approaches such as VME analyses. Rehabilitation approaches that target these deficits to improve joint mobility and motor control are worth testing.

American Association of Orthopedic Surgeons_Presentation 2011: Midcarpal arthrodesis, wrist coupling and performance

by Sherry I Backus and Aviva Wolff

Effects of midcarpal arthrodesis on Wrist Coupling, Kinematics and Performance: Analysis of six functional tasks

by Sherry I Backus and Aviva Wolff

An extension to the ISB wrist joint coordinate system: An in vitro accuracy study

by Sherry I Backus, Howard Hillstrom, and Aviva Wolff

Journal of Biomechanics, 2007

Effects of Midcarpal Arthrodesis on Wrist Coupling and Performance_ASB presentation

by Aviva Wolff and Sherry I Backus

Responsiveness of Three Patient Report Outcome (PRO) Measures in Patients with Hand Fractures: A Preliminary Cohort Study

Journal of Hand Therapy, 2015

Clinical measurement. Few studies describe the responsiveness of functional outcomes measures in ... more Clinical measurement. Few studies describe the responsiveness of functional outcomes measures in patients sustaining hand fractures. 1 - To explore the responsiveness of three function-oriented Patient Report Outcome (PRO) measures with a cohort of hand fracture patients. 2 - To examine patients&#39; PRO preference. 60 participants with 74 hand fractures at an outpatient hospital-based hand therapy clinic consented to participate in this study. They completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) at three trials: T1 (evaluation), T2 (one month later), and T3 (two months later). Participants also identified which PRO they felt best reflected their hand use and which was easiest to complete. Descriptive statistics, analyses of variance (ANOVA), effect size, and standardized response mean (SRM) were employed to describe participants, determine functional change between trials, and examine and compare PRO responsiveness. Questionnaire preference at T1 was reported. Participants demonstrated functional improvement, as measured by the DASH, PRWHE, and MHQ. T1 scores: DASH = 41.85 (SD ± 22.78), MHQ = 50.13 (SD ± 18.36), and PRWHE = 48.18 (SD ± 22.07). T2 scores: DASH = 22.11 (SD ± 18.18), MHQ = 69.89 (SD ± 15.93), and PRWHE = 22.62 (SD ± 18.15). T3 scores: DASH = 17.56 (SD ± 18.01), MHQ = 75.37 (SD ± 19.19), and PRWHE = 22.40 (SD ± 19.04). Each PRO demonstrated significant test score differences between trials (p &lt; .001). Large responsiveness (≥.80) was noted between T1 and T2: (effect size: .98-1.23; SRM: 1.31-1.49) and T1 and T3 (effect size: 1.21-1.54; SRM 1.49-1.84). Smaller responsiveness effects were noted between T2 and T3 (effect size: .35-.64, SRM: .38-.81). No significant differences between questionnaire responsiveness were found. Patients reported PRWHE easiest to complete and MHQ best reflecting their hand use. DASH, MHQ, and PRWHE were each able to describe functional limitations in this cohort of patients with hand fractures. In capturing improvement over time they demonstrated comparable responsiveness in assessing change in patients with hand fractures. 2c.

SSc management – In person appointments and remote therapy (SMART): A framework for management of chronic hand conditions

by Aviva Wolff and Gwen Weinstock-Zlotnick

Journal of Hand Therapy, 2014

The changing health care climate poses unique challenges to managing a chronic and progressive di... more The changing health care climate poses unique challenges to managing a chronic and progressive disease like systemic sclerosis (SSc). At our institution, we employ a new model for SSc management that combines "in person" appointments and "remote" therapy (SMART). This program fosters an understanding of the disease process with the goal of improving skills and confidence for self-management and empowering individuals by providing a means of daily self-assessment. Technology is utilized as a means to remotely monitor and assess progress. We present our approach as a framework for long term management of chronic hand conditions. Evidence from a variety of disciplines is cited to support the design and parameters of this model.

Postoperative Management After Total Elbow Replacement

Techniques in Hand & Upper Extremity Surgery, 2000

Lateral Elbow Instability: Nonoperative, Operative, and Postoperative Management

Journal of Hand Therapy, 2006

The purpose of this article is to present a treatment approach that has been found to be effectiv... more The purpose of this article is to present a treatment approach that has been found to be effective in the early management of lateral elbow instability. Anatomy and joint mechanics related to stability of the elbow are reviewed. Operative and nonoperative treatment is outlined followed by a description of an innovative paradigm for the rehabilitation of elbow instability. Progression of the rehabilitation program as the elbow achieves greater stability is discussed. The authors hope that therapists and surgeons will find this method beneficial in beginning early range of motion for the unstable elbow, thus minimizing joint stiffness while preserving stability at the elbow joint.

The effect of simulated elbow contracture on temporal and distance gait parameters

by Mandi Gibbons, Aviva Wolff, Samir Trehan, Aaron Daluiski, and Howard Hillstrom

Gait & posture, Jan 28, 2015

Elbow contractures can be functionally debilitating. Extensive research has been published on tre... more Elbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters. Forty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials. All three fixed elbow conditions (120°, 90° and 30°) demonstrate...

Comparison of Wrist Kinematics and Functional Performance between Surgical Treatments for SLAC Wrist

by Aviva Wolff, Sherry I Backus, and Howard Hillstrom

The Journal of Hand Surgery, 2011

Differentiation of Hand Posture During Reach in Typically Developing Children and Children With Cerebral Palsy

by Aviva Wolff and Howard Hillstrom

Journal of Hand Therapy, 2012

Comparing the Responsiveness of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (Dash), Michigan Hand Outcomes Questionnaire (Mhq), and Patient Rated Wrist/Hand Evaluation (Prwhe) for Hand Fractures

Journal of Hand Therapy, 2012

Wrist Kinematic Coupling and Performance During Functional Tasks: Effects of Constrained Motion

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

The Journal of Hand Surgery, 2014

Purpose To quantify the coupled motion of the wrist during selected functional tasks and to deter... more

Development of an Anatomical Wrist Joint Coordinate System to Quantify Motion During Functional Tasks

by Howard Hillstrom, Andrew Kraszewski, Sherry I Backus, and Aviva Wolff

Journal of Applied Biomechanics, 2014

The purpose of this study was to develop a three-dimensional (3D) motion analysis based anatomica... more The purpose of this study was to develop a three-dimensional (3D) motion analysis based anatomical wrist joint coordinate system for measurement of in-vivo wrist kinematics. The convergent validity and reliability of the 3D motion analysis implementation was quantified and compared with manual and electrogoniometry techniques on 10 cadaveric specimens. Fluoroscopic measurements were used as the reference. The 3D motion analysis measurements (mean absolute difference [MAD] = 3.6°) were significantly less different (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .005) than manual goniometry (MAD = 5.7°) but not (P = .066, power = 0.45) electrogoniometry (MAD = 5.0°) compared with fluoroscopy. The intraclass correlation coefficient (ICC[2,1]) was highest for 3D motion analysis compared with manual and electrogoniometry, suggesting better reliability for this technique. To demonstrate the utility of this new wrist joint coordinate system, normative data from 10 healthy subjects was obtained while throwing a dart.