Modalities of Wrist Rehabilitation Lynne Pringle Cape Town
Modality:  mode/form/manner <ul><li>Aim of treatment </li></ul><ul><li>Modalities </li></ul>
The wrist in function <ul><li>Flexion  </li></ul><ul><li>Extension </li></ul><ul><li>Radial deviation </li></ul><ul><li>Ul...
Muscles of the wrist <ul><li>EDC  -  extension </li></ul><ul><li>EPL  -  ext + rad deviation </li></ul><ul><li>FPL  -  fle...
Dynamic  <ul><li>rhythmic alternation </li></ul><ul><li>force </li></ul><ul><li>compress </li></ul><ul><li>pumps blood out...
Static <ul><li>prolonged </li></ul><ul><li>postural stance </li></ul><ul><li>greatest force at beginning </li></ul><ul><li...
Considerate static effort: <ul><li>High level of effort  -  10 sec </li></ul><ul><li>Moderate level  -  1min or more </li>...
Function of wrist demands: <ul><li>stability </li></ul><ul><li>posture </li></ul><ul><li>positioning </li></ul><ul><li>sup...
Therapeutic exercises <ul><li>passive exercise  -  external force…… </li></ul><ul><li>-gravity, CPM, another individual/ p...
Therapeutic exercises <ul><li>active exercise:  </li></ul><ul><li>active contract muscle crossing joint </li></ul><ul><li>...
Therapeutic exercise <ul><li>resistive exercise  </li></ul><ul><li>-muscles contracting against resistance </li></ul><ul><...
 
Thermal  <ul><li>Cryotherapy:  ice packs </li></ul><ul><li>acute inflammation + pain </li></ul><ul><li>Precautions:  </li>...
Thermal  <ul><li>Superficial heating agents:  heatpacks </li></ul><ul><li>-elevate tissue temp – reduce pain </li></ul><ul...
Thermal  <ul><li>Paraffin baths </li></ul><ul><li>Warm whirlpools </li></ul><ul><li>Fluidotherapy </li></ul><ul><li>Ultras...
 
Thermal  <ul><li>Precautions: </li></ul><ul><li>-vascular insuffiency </li></ul><ul><li>-edema </li></ul><ul><li>-malignan...
Edema  <ul><li>   Elevation </li></ul><ul><li>   Active range of motion </li></ul><ul><li>   Rest </li></ul><ul><li>  ...
Splints  <ul><li>Prevent deformity </li></ul><ul><li>Immobilise/stabilise </li></ul><ul><li>Protect + support </li></ul><u...
 
Splinting protocol <ul><li>light tension over prolonged period </li></ul><ul><li>PROM limitations with ‘hard end feel’ </l...
<ul><li>Scaphoid fractures  - longer splinting </li></ul><ul><li>Kienbocks  -  thermoplastic and soft </li></ul><ul><li>CT...
Avoidance/adaptations <ul><li>The wrist absorbs a tremendous amount of stress during normal activities </li></ul><ul><li>U...
 
 
Tichauer, ER  (1976) <ul><li>wire cutters </li></ul><ul><li>12 weeks </li></ul><ul><li>normal pliers: unnatural grip </li>...
 
<ul><li>Moderate work may produce fatigue </li></ul><ul><li>Repeated static load </li></ul><ul><li>Arthritis </li></ul><ul...
<ul><li>Reversible musculoskeletal: </li></ul><ul><li>Localised </li></ul><ul><li>Pains of muscle weariness </li></ul><ul>...
Vibration  <ul><li>powertools </li></ul><ul><li>eyesight and efficiency </li></ul><ul><li>energy consumption and fatigue <...
Avoidance/adaptations <ul><li>minimise/abolish need to hold +grasp </li></ul><ul><li>avoid unnatural postures </li></ul><u...
Keyboards  <ul><li>unnatural position of wrist </li></ul><ul><li>increased keys </li></ul><ul><li>flat design </li></ul><u...
 
Tools  <ul><li>weight of tool itself </li></ul><ul><li>sharp </li></ul><ul><li>larger handles </li></ul><ul><li>protective...
Conclusion  <ul><li>The powerful wrist muscles are able to place the hand in almost infinite number of spatial orientation...
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Hand Therapy - Treatment Modalities Of The Wrist

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Hand therapy rehabilitation - Treatment Modalities of the wrist: splints, braces, range of motion, muscle strengthening, positioning, ergonomic workstations and function

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Hand Therapy - Treatment Modalities Of The Wrist

  1. 1. Modalities of Wrist Rehabilitation Lynne Pringle Cape Town
  2. 2. Modality: mode/form/manner <ul><li>Aim of treatment </li></ul><ul><li>Modalities </li></ul>
  3. 3. The wrist in function <ul><li>Flexion </li></ul><ul><li>Extension </li></ul><ul><li>Radial deviation </li></ul><ul><li>Ulnar deviation </li></ul><ul><li>Rotation </li></ul><ul><li>motion, stability, position </li></ul>
  4. 4. Muscles of the wrist <ul><li>EDC - extension </li></ul><ul><li>EPL - ext + rad deviation </li></ul><ul><li>FPL - flexion </li></ul><ul><li>FDS - flexion </li></ul><ul><li>FDP - flexion </li></ul><ul><li>BR - extensor, supinator </li></ul><ul><li>ECU </li></ul><ul><li>ECRL - ulnar deviation </li></ul><ul><li>ECRB </li></ul>
  5. 5. Dynamic <ul><li>rhythmic alternation </li></ul><ul><li>force </li></ul><ul><li>compress </li></ul><ul><li>pumps blood out </li></ul><ul><li>subsequent relaxation </li></ul><ul><li>retains energy-rich sugar + oxygen </li></ul><ul><li>removes waste products </li></ul>
  6. 6. Static <ul><li>prolonged </li></ul><ul><li>postural stance </li></ul><ul><li>greatest force at beginning </li></ul><ul><li>muscle shortens </li></ul><ul><li>power declines </li></ul><ul><li>recuperation </li></ul><ul><li>no sugar or oxygen </li></ul><ul><li>no waste products excreted </li></ul><ul><li>acute pain </li></ul><ul><li>muscle fatigue </li></ul>
  7. 7. Considerate static effort: <ul><li>High level of effort - 10 sec </li></ul><ul><li>Moderate level - 1min or more </li></ul><ul><li>Slight level - (1/3 of max) 4min or more </li></ul><ul><li>Static needs more rest periods </li></ul>
  8. 8. Function of wrist demands: <ul><li>stability </li></ul><ul><li>posture </li></ul><ul><li>positioning </li></ul><ul><li>support </li></ul><ul><li>motion </li></ul>
  9. 9. Therapeutic exercises <ul><li>passive exercise - external force…… </li></ul><ul><li>-gravity, CPM, another individual/ pt. </li></ul><ul><li>-pain prevents AROM </li></ul><ul><li>-joint mobilisation </li></ul><ul><li>-tissue mobility </li></ul><ul><li>-stretching </li></ul><ul><li>-early wound healing </li></ul><ul><li>-RA </li></ul>
  10. 10. Therapeutic exercises <ul><li>active exercise: </li></ul><ul><li>active contract muscle crossing joint </li></ul><ul><li>-maintain mobility </li></ul><ul><li>-tendon glide </li></ul><ul><li>-elasticity + contractability </li></ul><ul><li>-bone integrity </li></ul><ul><li>-reduce edema </li></ul><ul><li>-active assist </li></ul>
  11. 11. Therapeutic exercise <ul><li>resistive exercise </li></ul><ul><li>-muscles contracting against resistance </li></ul><ul><li>-amount of stress – muscle strength </li></ul><ul><li>LLPS </li></ul><ul><li>Minimise muscle co-contraction </li></ul>
  12. 13. Thermal <ul><li>Cryotherapy: ice packs </li></ul><ul><li>acute inflammation + pain </li></ul><ul><li>Precautions: </li></ul><ul><li>-underlying joint stiffness </li></ul><ul><li>-wound tensile strength </li></ul>
  13. 14. Thermal <ul><li>Superficial heating agents: heatpacks </li></ul><ul><li>-elevate tissue temp – reduce pain </li></ul><ul><li>-visco-elastic properties </li></ul><ul><li>-reduce stiffness </li></ul><ul><li>Warren et al </li></ul>
  14. 15. Thermal <ul><li>Paraffin baths </li></ul><ul><li>Warm whirlpools </li></ul><ul><li>Fluidotherapy </li></ul><ul><li>Ultrasound </li></ul>
  15. 17. Thermal <ul><li>Precautions: </li></ul><ul><li>-vascular insuffiency </li></ul><ul><li>-edema </li></ul><ul><li>-malignancy </li></ul><ul><li>-infection </li></ul><ul><li>-sensation </li></ul><ul><li>-acute stages </li></ul><ul><li>-infants and geriatrics </li></ul>
  16. 18. Edema <ul><li> Elevation </li></ul><ul><li> Active range of motion </li></ul><ul><li> Rest </li></ul><ul><li> MEM </li></ul>
  17. 19. Splints <ul><li>Prevent deformity </li></ul><ul><li>Immobilise/stabilise </li></ul><ul><li>Protect + support </li></ul><ul><li>Correct deformity </li></ul><ul><li>Substitute for dysfunctional use </li></ul><ul><li>Exercise </li></ul>
  18. 21. Splinting protocol <ul><li>light tension over prolonged period </li></ul><ul><li>PROM limitations with ‘hard end feel’ </li></ul><ul><li>static nocte </li></ul><ul><li>unobstructive use of hand </li></ul><ul><li>patient independent compliance </li></ul>
  19. 22. <ul><li>Scaphoid fractures - longer splinting </li></ul><ul><li>Kienbocks - thermoplastic and soft </li></ul><ul><li>CTS - functional position </li></ul><ul><li>- avoid/modify pressure Med N, sustained flexion/ulnar dev, repetitive flex/ext combined with distal gripping + pinching </li></ul><ul><li>Carpal fractures – muscle strengthening once healed. Prolong splinting with heavy uncontrolled activities. </li></ul><ul><li> pain free motion>maximum range </li></ul>
  20. 23. Avoidance/adaptations <ul><li>The wrist absorbs a tremendous amount of stress during normal activities </li></ul><ul><li>Unnatural postures </li></ul><ul><li>Hand in line of forearm </li></ul><ul><li>Proximal stabilisation + support </li></ul><ul><li>Significantly more powerful when in pronation </li></ul><ul><li>More forceful when pushing than when pulling </li></ul><ul><li>more powerful when pulling downwards </li></ul>
  21. 26. Tichauer, ER (1976) <ul><li>wire cutters </li></ul><ul><li>12 weeks </li></ul><ul><li>normal pliers: unnatural grip </li></ul><ul><li>25 or 40 workers showed morbid symptoms of tendinitis </li></ul>
  22. 28. <ul><li>Moderate work may produce fatigue </li></ul><ul><li>Repeated static load </li></ul><ul><li>Arthritis </li></ul><ul><li>Tendinitis or peritendinitis </li></ul><ul><li>Inflammation attachment points </li></ul><ul><li>Arthrosis </li></ul><ul><li>Painful muscle spasms </li></ul><ul><li>Inter-joint malalignment </li></ul>
  23. 29. <ul><li>Reversible musculoskeletal: </li></ul><ul><li>Localised </li></ul><ul><li>Pains of muscle weariness </li></ul><ul><li>Persistent troubles: </li></ul><ul><li>trauma, pathology, inflammatory + degenerative processes. </li></ul>
  24. 30. Vibration <ul><li>powertools </li></ul><ul><li>eyesight and efficiency </li></ul><ul><li>energy consumption and fatigue </li></ul><ul><li>degenerative- bones, joints, tendons </li></ul><ul><li>bone atrophy, risk of fracture </li></ul><ul><li>high frequency may affect circulation and decrease sensation </li></ul><ul><li> damping </li></ul>
  25. 31. Avoidance/adaptations <ul><li>minimise/abolish need to hold +grasp </li></ul><ul><li>avoid unnatural postures </li></ul><ul><li>outstretched arm – forwards or sideways </li></ul><ul><li>sitting down </li></ul><ul><li>arms in opposition </li></ul><ul><li>work level – natural posture </li></ul><ul><li>hands 25-30cm from eye </li></ul><ul><li>elbows 90°-120° </li></ul><ul><li>pulling 50cm and pulling grasp 70cm </li></ul>
  26. 32. Keyboards <ul><li>unnatural position of wrist </li></ul><ul><li>increased keys </li></ul><ul><li>flat design </li></ul><ul><li>rest wrists </li></ul><ul><li>move on desk </li></ul><ul><li>ergonomic design </li></ul><ul><li>split keyboard </li></ul><ul><li>brace with ulnar stay </li></ul><ul><li>large forearm/wrist support </li></ul>
  27. 34. Tools <ul><li>weight of tool itself </li></ul><ul><li>sharp </li></ul><ul><li>larger handles </li></ul><ul><li>protective gloves </li></ul><ul><li>correct tool </li></ul><ul><li>shaped to fit hand, in line forearm </li></ul><ul><li>incorrect seat height </li></ul><ul><li>free rhythm, correct speed </li></ul>
  28. 35. Conclusion <ul><li>The powerful wrist muscles are able to place the hand in almost infinite number of spatial orientations. </li></ul><ul><li>Forms of treatment must be selected to achieve position, muscle strength, stability, reduce pain and edema, and range of motion. </li></ul><ul><li>Functional wrists are vital in order for the hand to perform coordinated manipulations, power grip, and strong rotative actions. </li></ul>

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