This study aims to investigate how temporary immobilization of the upper limb after injury affects brain activity and functional recovery. Participants with fractures or soft tissue injuries of the upper limb who require immobilization will be evaluated at three time points: at the beginning of immobilization, after removal of the immobilization, and four weeks later. Brain activity will be measured using electroencephalography (EEG), a non-invasive and painless technique that records electrical signals from the scalp. Functional outcomes such as pain, mobility, strength, and daily activity performance will also be assessed using validated questionnaires and clinical tests. The purpose of this study is to better understand how immobilization influences the brain and physical recovery, in order to improve rehabilitation strategies for patients with upper limb injuries. Participation is voluntary, and all participants will provide written informed consent.
Upper limb immobilization is commonly required after fractures and soft tissue injuries to promote healing. However, prolonged immobilization can lead to muscle weakness, sensory deficits, and changes in brain activity related to motor control. Previous research has shown that even short periods of limb disuse can induce neuroplastic changes in the sensorimotor cortex. These changes may contribute to persistent functional limitations after immobilization is removed. This prospective observational study aims to describe and quantify changes in sensorimotor cortical activity and functional outcomes associated with clinical immobilization of the upper limb. Adult patients requiring immobilization for upper limb fractures or soft tissue injuries will be recruited. Eligible participants will be evaluated at three time points: baseline (within five days of immobilization), post-immobilization (within 24-48 hours after removal), and follow-up (four weeks after post-immobilization). Brain activity will be recorded using a portable wireless electroencephalography (EEG) system following the international 10-20 electrode placement system. Resting-state and task-related recordings will be obtained. Spectral power in standard frequency bands and functional connectivity measures will be analyzed. Clinical and functional outcomes will include patient-reported questionnaires (PRWE, QuickDASH, MHQ, SPADI, TSK-11, PCS), range of motion, grip strength, and joint position sense. Statistical analyses will focus on longitudinal changes across time points using repeated-measures analysis of variance or mixed-effects models, depending on data distribution. Effect sizes and confidence intervals will be reported. This study has been approved by the local ethics committee, and all participants will provide written informed consent prior to participation. The results are expected to contribute to a better understanding of brain plasticity during immobilization and support the development of more effective rehabilitation strategies.
Study Type
OBSERVATIONAL
Enrollment
30
Standard orthopedic immobilization of the upper limb (wrist/hand) as part of routine clinical management following fracture or soft tissue injury.
Conventional wrist and hand rehabilitation provided according to clinical practice after immobilization removal.
Change in Sensorimotor Cortical Activity Measured by EEG
Changes in sensorimotor cortical activity measured using electroencephalography (EEG), including spectral power in mu (8-13 Hz) and beta (13-30 Hz) frequency bands over central regions (C3, C4 and adjacent electrodes), and functional connectivity between motor and somatosensory areas.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Upper Limb Pain and Disability (PRWE)
Patient-Rated Wrist Evaluation (PRWE) total score (0-100), assessing pain and functional disability of the wrist and hand. Higher scores indicate greater pain and disability.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Upper Limb Functional Status (QuickDASH)
Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), 11-item self-reported measure of upper limb disability (0-100). Higher scores indicate greater disability.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Hand Function (Michigan Hand Outcomes Questionnaire)
Michigan Hand Outcomes Questionnaire (MHQ) total score assessing hand function, activities of daily living, pain, work performance, aesthetics, and satisfaction. Scores range from 0 to 100 depending on domain.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Shoulder Pain and Disability (SPADI)
Shoulder Pain and Disability Index (SPADI), 13-item questionnaire assessing shoulder pain and disability. Scores range from 0 to 100, with higher scores indicating greater impairment.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Grip Strength
Grip strength measured in kilograms using a Jamar dynamometer under standardized positioning (shoulder adducted, elbow flexed 90°, forearm neutral). Bilateral measurements recorded.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Wrist Range of Motion
Active wrist range of motion (flexion, extension) measured in degrees using a goniometer under standardized positioning.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Joint Position Sense (Proprioception)
Joint Position Sense (JPS) error measured in degrees as the absolute difference between target and reproduced wrist position.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Pain Catastrophizing (PCS)
Pain Catastrophizing Scale (PCS), a 13-item self-reported questionnaire assessing rumination, magnification, and helplessness related to pain. Each item is scored from 0 to 4. Total scores range from 0 to 52, with higher scores indicating greater pain catastrophizing.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
Change in Kinesiophobia (TSK-11)
Tampa Scale for Kinesiophobia (TSK-11), an 11-item self-reported questionnaire measuring fear of movement and reinjury. Each item is rated on a 4-point Likert scale. Total scores range from 11 to 44, with higher scores indicating greater fear of movement.
Time frame: Baseline (within 5 days of immobilization), 24-48 hours after immobilization removal, and 4 weeks post-removal.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.