Deborah A. Schwartz

Aims: To test the long‐term efficacy, safety, and impact on quality of life (QoL) of an oral paediatric formulation of 320 μg/mL glycopyrronium in the 36‐week SALIVA (Sialanar plus orAl rehabiLitation against placebo plus oral rehabilitation for chIldren and adolescents with seVere sialorrhoeA and neurodisabilities) trial.Method: In the initial 12‐week blinded period, 87 children with neurodisabilities and severe sialorrhoea were randomized to 320 μg/mL glycopyrronium versus placebo. In the subsequent 24‐week open‐label study extension, 74 children received 320 μg/mL glycopyrronium (37 continued glycopyrronium, 37 switched from placebo).Results: The open‐label study extension population included 39 males and 35 females. The median age was 10 years 2 months (quartile 1, quartile 3: 7 years 5 months, 14 years 7 months; range: 3 years 5 months–17 years 8 months). Over 36 weeks, continued 320 μg/mL glycopyrronium resulted in a median 39‐point reduction in Drooling Impact Scale (DIS) score from baseline (quartile 1, quartile 3: −51, −21; p < 0.001), with an 81.1% response rate (DIS improvement ≥ 13.6 points) and a 70.3% good response rate (≥ 28 points). Improvements in the impact of drooling on QoL seen in the blinded period were sustained with continued glycopyrronium. Treatment‐related adverse events occurred most frequently during titration (0–4 weeks: 40.9%; 5–20 weeks: 32.4% in those who switched). Constipation was the most common adverse event.Interpretation: Long‐term treatment with 320 μg/mL glycopyrronium resulted in significant sustained improvements in drooling and QoL, with fewer adverse events after initial titration and overall good tolerability.

Since 2006 the Brooklyn Historical Society (BHS) has held a Public Perspectives Exhibition Series in its Independence Community Gallery, providing a forum for

Introduction: Carpometacarpal (CMC) joint osteoarthritis critically impacts activities of daily living. Pain is the main reason for a consultation to the hand therapy clinic as described in the literature, and conservative treatment, typically an orthosis, is the first intervention of choice. A thumb orthosis is a specific nonoperative palliative treatment for CMC joint osteoarthritis for improving function and comfort. A variety of thumb orthoses are described in the literature, but there is no supporting evidence highlighting the use of a specific orthotic design for short-time effect on pain and function. Purpose of the Study: The study was conducted to compare the short-term effect of 2 different thumb CMC orthoses on pain reduction as a primary outcome and improved hand function as a secondary outcome. Methods: A total of 66 patients were included in the study. One group of 33 patients received a Hybrid orthosis, immobilizing only the CMC joint, and the other group of 33 patients received a thumb orthosis called the “whale,” which immobilizes the CMC and metacarpophalangeal (MP) joints. Both orthotic designs were custom fabricated for each patient. Outcomes measures included the visual analogue scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH, Spanish version) for function. Results: Differences in pain scores and functional scores were found in both groups after the one-week washout period compared with baseline, but did not differ significantly between the two groups. Outcome for functional score demonstrated both clinically and statistically significant differences between the baseline and 1 week for outcome score for the both groups (p = .001). With respect to pain intensity, the mean pain score decreased from 7.69 to 5.51 for the CMC orthosis (p = .001) and from 7.78 to 5.45 for the CMC/MP “whale orthosis” (p = .001). Conclusion: The present study adds to our therapeutic knowledge base regarding the benefits of 2 different thumb orthotic designs on pain reduction and functional improvement in the first week using orthoses as an exclusive conservative treatment.

Purpose: The purpose of this research is to increase understanding of the current levels of evidence supporting the use of static progressive orthoses, and to provide clarity on appropriate diagnoses, outcome measures, and duration of use for this intervention. Rationale: Static progressive orthoses are an intervention commonly provided for clients with stiffness and/or limited range of motion (ROM) of upper extremity joints, due to trauma or injury. This type of orthosis incorporates nonelastic components to apply force to the stiff joint or tissue, holding it at end-range position to improve passive motion. There are only a limited number of studies on the use of static progressive orthoses for the upper extremity with a small number of clients enrolled. Design: A literature search of the current evidence supporting static progressive orthoses for treatment of stiff upper extremity joints was performed to identify information regarding common diagnoses of clients treated with this type of orthotic intervention, outcomes achieved, wearing schedules, and duration of orthotic use. Participants: This research examined the current levels of evidence supporting the use of static progressive orthoses for clients with limitations in ROM of the upper extremity following surgery or trauma (orthopedic pathologies). Analytic Methods: The current evidence supporting the use of static progressive orthoses is found in 11 studies on the elbow, 2 studies on the forearm, 3 studies on the wrist, 2 studies on stiff fingers, and 2 systematic reviews. The data provided in these 20 studies on client diagnoses, type of orthotic design, outcome measures, and duration of use are analyzed and described. Conclusions: Clients benefit from the use of static progressive orthoses by demonstrating increased ROM, increased function and grip strength, and decreased pain. The current evidence includes 20 studies that present information on appropriate client diagnoses, outcome measures, protocols of use, and average duration of wear.