Hand Therapy - Influence on Rehabilitation Outcome

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Study on how patients not performing home exercises gain strength and functional range of motion, however not full ROM. This results in a weakeness in the full function

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Hand Therapy - Influence on Rehabilitation Outcome

  1. 1. Competition: Influence on Rehabilitation Lynne Pringle Cape Town
  2. 2. Research problem: <ul><li>From injury/condition to restored function </li></ul><ul><li>Expectations – ROM & Muscle strength </li></ul><ul><li>Full spectrum of therapy regimes – wound healing, education, support, splinting, home programmes, modalities, exercise devices </li></ul><ul><li>1960’s: Jim Hunter: ‘..specific therapeutic regimes consistently applied by dedicated therapists’ </li></ul>
  3. 3. <ul><li>‘ how & why’ of muscles </li></ul><ul><li>Treatment sessions + home exercise programs </li></ul><ul><li>Individual compliance & motivation </li></ul><ul><li>Full ROM vs Functional ROM </li></ul><ul><li>Progress - ↓/delayed </li></ul><ul><li>Stiffness prolonged: </li></ul><ul><li>- pts skip exercise sessions </li></ul><ul><li>- ↓ repetitions </li></ul><ul><li>- half-hearted muscle contractions </li></ul>
  4. 4. Purpose: <ul><li>Prospective </li></ul><ul><li>Competition – motivation, success, compliance, cooperation </li></ul><ul><li>Daily exercise programme </li></ul><ul><li>Rehab process/progress </li></ul><ul><li>Balance: rest & motion </li></ul><ul><li>Success – patient cooperation </li></ul><ul><li>Functional arc sufficient – weakness, ↓fx </li></ul><ul><li>Full ROM↑ » muscle strength↑ » ADL↑ </li></ul>
  5. 5. Method: <ul><li>Random </li></ul><ul><li>Entered into competition </li></ul><ul><li>Weekly & monthly winner - % ROM gained </li></ul><ul><li>Subjects and control groups ->heat pack modality </li></ul><ul><li>Measurements: goniometer, TAM </li></ul><ul><li>Treatment sessions </li></ul><ul><li>Home exercise program </li></ul><ul><li>Exercise devices </li></ul>
  6. 6. ROM home program exercises - phases of wound healing <ul><li>Inflammatory phase: gentle motion, edema & pain control, avoid stress </li></ul><ul><li>Fibroplasia phase: controlled stress, ↑ & maintain jt & tissue mobility </li></ul><ul><li>Remodeling phase: ↑ controlled stress/tension to healing tissues = decrease adherence, influence collagen formation, focus strengthening </li></ul>
  7. 7. <ul><li>Biomechanical: </li></ul><ul><li>Full ROM requires: </li></ul><ul><li>- max stretch of </li></ul><ul><li>muscle-tendon-unit </li></ul><ul><li>M-T-U in shortened position </li></ul><ul><li>+ tissue inflammation – </li></ul><ul><li>tendon adherent entire path </li></ul><ul><li>Scars – normal skin adapts </li></ul><ul><li>ends to stretched position </li></ul><ul><li>K Flowers (1984): repetitive prolonged stretch at Total End Range Time (TERT) produces full ROM in flex & ext. </li></ul>
  8. 8. <ul><li>Elftman H 1966: relationship </li></ul><ul><li>between fibre length, tension </li></ul><ul><li>and excursion of muscle -> </li></ul><ul><li>fibre length proportional </li></ul><ul><li>to potential excursion. </li></ul><ul><li>Tension/strength – related to </li></ul><ul><li>cross-sectional area of fibres </li></ul><ul><li>& excursion (distance strength </li></ul><ul><li>used & work capacity) </li></ul><ul><li>Strength also depends – </li></ul><ul><li>amount fibre contraction </li></ul><ul><li>˃ initial length of muscle ˃ tension/contractability ˃ exert greater tension & sustain heavier loads; decrease reinjury </li></ul>
  9. 9. <ul><li>Brand, Paul et al, 1981: table relative mean muscle fibre resting lengths forearm and hand. </li></ul><ul><li>Whether short fibres + large mass = powerful over short distances, or </li></ul><ul><li>Long fibres + small mass, move longer distances, little strength, </li></ul><ul><li>All require contraction from max length – joints full ROM </li></ul>
  10. 10. Result: <ul><li>Interest +++ </li></ul><ul><li>90% in first 2 weeks - then decline </li></ul><ul><li>Reasons: no prize, isolated, ↓ treatment sessions, ↓ reinforcing stimulus </li></ul><ul><li>Checklist: education  </li></ul><ul><li>support  </li></ul><ul><li>pain + edema mx  </li></ul><ul><li>modalities  </li></ul><ul><li>exercise devices ? </li></ul>
  11. 11. 1. Exercise putty: <ul><li>Graded resistance </li></ul><ul><li>- variety of colours X </li></ul><ul><li>Flexion & extension </li></ul><ul><li>End range </li></ul><ul><li>Prolonged stretch </li></ul><ul><li>Oily, colour residue, </li></ul><ul><li>sticks skin, fragments X </li></ul><ul><li>Collects dirt X </li></ul><ul><li>No blocking X </li></ul><ul><li>Requires degree initiative/invention X </li></ul><ul><li>Mainly flexion X </li></ul>
  12. 12. <ul><li>Rubber bands/elastics: </li></ul><ul><li>Visco-elastic properties – soft tissue </li></ul><ul><li>Breger-Lee + Buford: various lengths & thicknesses -> tendon creep over time. </li></ul><ul><li>Shorter and thicker bands = larger tension & limited excursion </li></ul>
  13. 13. 2. Stress ball: <ul><li>Flexion </li></ul><ul><li>Extension X (new) </li></ul><ul><li>Graded resistance X </li></ul><ul><li>Full ROM to end range X </li></ul><ul><li>Repetitive </li></ul><ul><li>Precaution: overwork X </li></ul><ul><li>Egg-shaped/foam better X </li></ul><ul><li>Easy to clean </li></ul>
  14. 14. 3. Handigym <ul><li>Ext & flexion </li></ul><ul><li>wrist </li></ul><ul><li>Full ROM to end </li></ul>
  15. 15. <ul><li>Repetitive </li></ul><ul><li>Graded resistance </li></ul><ul><li>Precaution: overwork X </li></ul>
  16. 16. <ul><li>Prolonged stretch </li></ul><ul><li>FDS glide </li></ul><ul><li>Blocking </li></ul><ul><li>Intrinsic stretches </li></ul>
  17. 17. <ul><li>Easily adjustable </li></ul><ul><li>Easy to clean </li></ul>
  18. 18. 4. Handi <ul><li>Individual digits </li></ul><ul><li>IP extension stretches </li></ul>
  19. 19. <ul><li>Intrinsic stretches </li></ul><ul><li>Flexion & extension </li></ul><ul><li>Blocking </li></ul>
  20. 20. Conclusion: <ul><li>Competition - positively affect participation motivation. </li></ul><ul><li>Prompt/stimulus – consistent application </li></ul><ul><li>Small study - correct exercise devise(s) – requirements ↑ROM & ↑muscle strength - repetitive stimulus/prompt..... </li></ul><ul><li>Positive measurable functional outcome. </li></ul>
  21. 21. <ul><li>Thank you! </li></ul>www.lynnepringle.com www.linkedin.com/in/lynnepringle

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