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Wrist arthritis can cause debilitating pain, weakness and decreased range of motion. When patients are first diagnosed, the condition can often be managed with activity modification and pain medication. However, as symptoms progress, patients eventually require surgery.

Surgeons typically perform a procedure called four-corner fusion to preserve wrist motion and provide pain relief.  This surgery involves removing one of the carpal bones and fusing four of the remaining carpal bones. Although this procedure is one of the most common treatments for wrist arthritis, it is not known how the position of the fusion of the wrist bones affects range of motion and joint contact.

Lawson associate scientist Dr. Nina Suh is leading a study with the goal of improving the surgical technique for four-corner fusion to maximize wrist function and symptom relief, and delay wrist arthritis progression.

Dr. Suh and her team will use a customized active-motion wrist simulator to create different carpal bone fusion positions. They will then assess how these positions affect wrist motion and joint contact area.

“We hope this research will lead to new surgical techniques that will help us to more effectively manage wrist arthritis with four-corner fusion,” says Dr. Suh, who is also an orthopaedic surgeon at the Roth McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London and an assistant professor at Western University’s Schulich School of Medicine & Dentistry. “The project will also advance our understanding of wrist biomechanics, providing a foundation for the development of enhanced patient-specific surgical tools, such as custom wrist fusion devices and implants.”

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The study is being funded through the Lawson Internal Research Fund (IRF), designed to allow scientists the opportunity to obtain start-up funds for new projects with exciting potential.

“The IRF program is valuable for scientists as external funding sources routinely require preliminary data to strengthen applications,” says Dr. Suh. “Particularly for new scientists such as myself, these grants provide seed funding that allows us to demonstrate the validity of our methodology and the clinical usefulness of our results.”

The IRF is designed to provide Lawson scientists the opportunity to obtain start-up funds for new projects with the potential to obtain larger funding, be published in a high-impact journal, or provide a clinical benefit to patients. Funding is provided by the clinical departments of London Health Sciences Centre and St. Joseph’s Health Care London, as well as the hospital foundations (London Health Sciences Foundation and St. Joseph’s Health Care Foundation).

Two new interventional studies have been brought to London, focused on improving quality of life for patients with Alzheimer’s disease and their caregivers. Both hope to improve upon standard approaches to treating agitation, a core symptom of Alzheimer’s.

Agitation is a significant source of stress for patients and caregivers. It is complex and difficult to treat. Often, families do not know about this particular symptom of Alzheimer’s and are not properly trained on how to manage care while dealing with agitation. 

“These studies are designed to have a direct impact on patients, families and care providers, to improve quality of life and function in those suffering from agitation due to Alzheimer’s,” says Dr. Amer Burhan, Associate Scientist at Lawson Health Research Institute (Lawson) and Geriatric Neuropsychiatrist, St. Joseph’s Health Care London (St. Joseph’s).

Parkwood Institute, a part of St. Joseph’s, is one of multiple sites participating in these studies across Canada and the United States.

One study aims to identify patients early in their diagnosis, while they are living at home or in the community, and apply a comprehensive psychosocial approach, with or without medication, to help with the management of agitation. “We hope to identify participants and have them participating in our program before they experience a crisis due to agitation,” explains Dr. Burhan.

Psychosocial intervention is a way of helping patients and caregivers understand the reasons for agitation. Agitation can develop due to a wide range of causes. For example, patients may just be bored and need help to find something meaningful to occupy their time, they could be upset about something in their current environment, or may be suffering from physical discomfort or pain.

Interventions can include communicating with patients in a manner that creates calm, scheduling meaningful activities, and maintaining routine and rhythm in life. The research team will connect with families early after diagnosis to give them the tools and support they need.

Initially, participants will be treated using structured psychosocial intervention to help reduce and manage their agitation. After three weeks, they will be reassessed and if significant agitation continues to persist, the patient will be randomly selected to receive either a placebo, or medication known as S-Citalopram to treat agitation while they continue to receive psychosocial care.

Sylvia Wilson is the wife of one of the study participants. By enrolling in this trial, she feels she has gained a much better understanding of her husband’s disease, and is grateful for the support that study participants receive.

“My husband typically does not like going to visit doctors, but Dr. Burhan and his team are great,” says Wilson. “They understand agitation, and other symptoms of the disease very well, and I notice a difference in his mood with the treatment he receives through the study.”

Participants are still able to receive care from their primary physician and care teams, with the study providing an added layer of support.

Another study is focused on Alzheimer’s patients who are admitted to hospital or living in long-term care. The aim is to standardize the approach to care for agitation related to Alzheimer’s. After baseline assessment, participants will be randomized to receive the current treatment as per usual, or an integrated care pathway derived from evidence-informed treatment guidelines. These include washing out medications that have not helped, adding individualized behavioral and environmental support, and if medications are needed, use a specific set of medications and dosages based on best evidence. 

“Better understanding agitation is a growing area of interest in geriatric research. The work being done locally is part of an international effort to create a paradigm shift in treating patients with Alzheimer’s disease and agitation,” explains Dr. Burhan.

Researchers are ready to offer these studies to patients and their families, hoping to make these treatment protocols an integral part of care for patients with agitation due to Alzheimer’s disease. Those interested in learning more about these studies can contact Dr. Burhan at @email or call 519-646-6100 x. 48170.

View the trial brochure

In the media: Study on 'agitation' in Alzheimer's patients seeks participants