Conventional and Virtual Reality-Based Neuromuscular Rehabilitation in Scapholunate Instability

Condition(s) studied

Investigational drug(s) / intervention(s)

Conventional Physiotherapy Group: Participants assigned to the conventional physiotherapy group will receive a structured neuromuscular rehabilitation program focusing on wrist and forearm stabilization. The intervention will include supervised strengthening exercises targeting scapholunate-friendly muscles, neuromuscular control exercises, and proprioceptive training aimed at improving wrist stability and functional movement patterns. Progressive resistance and task-oriented exercises will be used according to individual tolerance. The rehabilitation program will be administered twice per week for 8 weeks by a licensed physiotherapist.

Virtual Reality-Supported Neuromuscular Rehabilitation: Participants in the virtual reality-supported rehabilitation group will receive the same conventional physiotherapy program as the control group. In addition, this group will participate in virtual reality-based therapeutic exercises delivered through sensor-based interactive games designed for upper extremity rehabilitation. These exercises will aim to enhance wrist and forearm motor control, proprioceptive feedback, and functional task performance by promoting controlled and task-oriented movement patterns. Virtual reality sessions will be supervised by a physiotherapist and integrated into the rehabilitation program with the same frequency and duration as the conventional intervention, administered twice per week over an 8-week period.

Study summary

Scapholunate instability is a common form of carpal instability that can cause wrist pain, weakness, and functional limitations during daily activities. Conservative rehabilitation approaches are frequently recommended in the early stages; however, there is no standardized rehabilitation protocol, and the effects of different neuromuscular rehabilitation methods have not been sufficiently investigated.

The primary aim of this study is to comparatively examine the effects of conventional physiotherapy approaches and virtual reality-supported neuromuscular rehabilitation on forearm muscle activation patterns assessed using surface electromyography, wrist proprioceptive function (joint position sense), pain intensity, and functional improvement in individuals with scapholunate instability, and to identify clinically applicable rehabilitation protocol approaches for this population.

In this single-blind randomized controlled trial, participants with pre-dynamic or dynamic scapholunate instability will be randomly assigned to either a conventional rehabilitation group or a virtual reality-supported rehabilitation group. Both groups will receive an 8-week rehabilitation program administered twice per week. Primary outcome measures will include electromyographically assessed forearm muscle activation and wrist proprioception. Secondary outcome measures will include pain intensity, grip strength, wrist muscle strength, and upper extremity functional outcomes assessed using validated clinical instruments. All outcome assessments will be performed before and after the intervention period by an assessor blinded to group allocation.

Eligibility

Primary outcome measure(s)

• Wrist Proprioception — Baseline and after 8 weeks of intervention
  Wrist proprioception will be assessed by evaluating joint position sense using both a universal goniometer and an electrogoniometer. Assessments will be performed in a standardized sitting position with the forearm supported. Predetermined wrist joint angles will be set by the assessor, and participants will be asked to actively reproduce the target positions without visual feedback. Wrist joint angles will be recorded using both measurement tools, and the absolute angular error between the target angle and the reproduced angle will be calculated to determine proprioceptive accuracy.
• Forearm Muscle Activation — Baseline and after 8 weeks of intervention
  Forearm muscle activation will be assessed using surface electromyography during standardized wrist and forearm tasks. Electromyographic activity of selected forearm muscles involved in wrist stabilization will be recorded and analyzed to evaluate neuromuscular activation patterns.

Trial sites (1)

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