Motion is lotion: the Importance of Hand and Face Exercises and Protection
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This session will discuss modalities and demonstrate exercises to improve movement and function in the hands, face and mouth. Suggestions will be also be provided on the use of assistive devices and alternate techniques to accomplish tasks of daily living to increase independence and protect the hands. This presentation was held on May 4, 2024 by the Scleroderma Foundation of Greater Chicago. For more information on the foundation and scleroderma, head to our website at www.stopscleroderma.org
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Motion is lotion: the Importance of Hand and Face Exercises and Protection
- 1. MOTION IS LOTION: THE IMPORTANCE OF HAND AND FACE EXERCISES AND PROTECTION Janet L. Poole, Ph.D., OTR/L OccupationalTherapy Graduate Program University of New Mexico jpoole@salud.unm.edu
- 2. The hand is the "tool of tools” Aristotle Our hands and fingers give us a powerful grip but also allows us to hold and manipulate small objects with great precision. Receptors on the skin respond to light and deep pressure, touch, pain and temperature for protection and identification of objects without vision.
- 3. Objectives •Discuss stretching exercises to maintain mobility in the hands and face •Discuss strategies to protect the hands and fingers through: • management of Raynaud’s • assistive device use • compensation for decreased hand function
- 4. General Guidelines for Stretching Exercises (range of motion) •Heat and massage can be done before exercises to warm up tissues •Range of motion/stretching exercises should be aggressive and started before obvious limitations in motion or deformities occur •Range of motion/stretching exercises should be done even with ulcers ALTHOUGH, modify the exercises
- 5. Modalities to Help Manage Pain and Increase Joint Motion* •Heat modalities Moist heat •Paraffin bath •Hot packs Dry heat •Fluidotherapy- done in OT or PT clinic •Massage •Connective tissue massage •Manual lymph drainage •Lymphatouch (Physiotouch) * Use heat and massage before doing the stretching exercises to warm up tissues
- 7. Paraffin increases tissue extensibility, decreases pain, and adds moisture to the skin – 120-130° degrees - do NOT use with open sores - place dipped hands in plastic bags -wrap in heavy towels or place in oven mitts - keep on 15-20 minutes Paraffin Wax
- 8. ConnectiveTissue Massage (a deep stretching massage) Manual Lymph Drainage (mobilizing massage, moves fluid)(used early in the edema stage) Massage Maddali Bongi, SM et al. ArthritisCare & Research, 2011; 63, 1134-41. Maddali Bongi S et al. Clinical & Experimental Rheumatology, 2009; 27:S44-S50 Lymphatouch (physiotouch) (negative pressure device that mobilizes tissue and can decrease edema) Murphy SL, Arthritis Rheumatoll, 2017; 69 (suppl 10):S2642-2643
- 9. Stretching Exercises •Purpose is to prevent or slow down development of contractures •Do frequently and beyond resistance •Maintain position of stretch 3-5 seconds even if skin blanches or turn white •Should be started before there is any noticeable loss of motion
- 10. Range of Motion Exercises for Flexion FOR the MCP joint Make a fist – palm of one hand may need to press on back of proximal phalanx of the other hand FOR the smaller finger joints Bend all the joints in one finger to touch the tip to the palm. Gently push with the other hand to stretch. Repeat with each finger
- 11. Range of Motion Exercises for PIP Joints Push hand flat Press fingers against each other Use three points of pressure PIP PIP PIP
- 12. Exercises to help spread fingers (stretch web spaces between fingers) •Interlace fingers and try to slide fingers all the way down so that web spaces are touching Webspaces • OR slide a smooth bottle cap between fingers
- 14. Dexterity Exercises Touch thumb to each finger quickly Lift and lower fingers one at a time quickly
- 15. Exercises for the Wrists Wrist extension Wrist flexion
- 16. Splints/Orthoses Ones with rubber bands may cause Raynaud’s Some are used to protect ulcers on fingers
- 17. How to monitor the motion in key hand joints Draw a hand out line to help monitor finger extension
- 18. How to monitor the motion in key finger joints Templates to monitor MCP flexion MCP joint
- 19. Thumb abduction Find the largest size object that will fit in the web space with all sides of web space touching object Gap; object too large
- 20. Exercises for other upper extremity joints Supination- palm up Shoulder Flexion Shoulder Extension External Rotation
- 21. Face andTemporomandibular Joint Exercises •Why mouth opening is important in scleroderma
- 22. Massage or Heat Massage to facial areas HEAT- warm towels on face, warm water from shower
- 23. Mouth and Face Exercises Big smile Open mouth wide Purse lips Puff up cheeks Curl lips over teeth Pull lips over teeth
- 24. Mouth Stretching Exercises (Naylor et al., 1984) Augmentation with tongue depressors Manual stretching of mouth and lips with fingers
- 25. How to monitor mouth opening (why is this important?) • Open mouth as wide as possible and measure from bottom front teeth to top. Make a card or find object (sterile) that is the same width to use as template OR • Open the mouth as wide as possible and mark the distance between the upper and lower teeth on an index card. The card can be held up to the teeth while standing in front of a mirror.
- 26. Oral Hygiene Regular visits to dentist/hygienist Electric tooth brushes, water jets Curved bristle brushes Children’s toothbrushes Large Handle Floss holder Electric flosser
- 27. PROTECTION: Management of Raynaud’s Phenomenon •Keep warm/avoid cold temperatures •Protect and insulate hands/fingers from cold, bacteria, pressure and trauma •Take care of skin • Keep skin moist •Management of stress Scleroderma & Raynaud’s UK www.sruk.co.uk Raynaud’s Association www.raynauds.org
- 28. Keep Warm • Dress warmly to insulate body- • Layers • Keep core warm – vests (heated); gloves, scarves/shawls • Chemical hand warmers • Avoid cold temperatures • Be prepared – have a kit in car or take with you with blankets, gloves, extra socks, scarves, hat, chemical hand warmers • Remember air conditioners in the summer (stores, work, concerts, arenas) • Electric throws, flannel sheets https://toastytouch.com
- 29. Protect hands and finger tips (and feet) • Insulate hands from cold, strong detergents, irritating chemicals, and bacteria in home and in yard/garden (wear rubber/garden gloves, use scrubbers) • Chemical hand warmers • Insulated mugs for cold drinks • Drink room temperature liquids • Take care of skin – keep skin moist • Avoid tight static grips and vibration • Use larger joints instead of gripping with fingers which reduces blood flow in fingers • Phone holders, head phones, ear buds, foam on handles, shoulder bags, back packs, cross body bags; carry bags on forearms not grip with fingers • Pad vibrating tools • Don’t go barefoot https://www.heatholders.com The writersglove.com
- 30. Avoid Static Positioning Causing Potential Compression Avoid resting phone/ipad on surface of finger/s
- 31. Use Assistive/Adapted Devices •Reduces pressure and stress to hands/fingers •independence •
- 32. 5 in 1 All purpose opener Dycem nonslip jar and bottle openers Medi-grip Bottle opener
- 33. Stress Reduction Positive Thinking • Positive self-talk • Gratitude journaling • Constructive worrying (no more than 20 minutes) Exercise • Any kind from yoga,Tai Chi to aerobic • Schedule time • Do what you like to do Relaxation Techniques • Mindfulness • Mediation • Guided imagery • Muscular relaxation • Body scan • Visualization
- 34. Heated Keyboard and mouse More Ideas for Raynaud’s Insert chemical heat packs in wrist sleeves
- 35. Possible Car Solutions Remote car starters Heated seats or covers or steering wheel covers Accessible parking or covered parking
- 36. Protection of Ulcers During ADLs • Insulate hands from cold, strong detergents, irritating chemicals, and bacteria (wear gloves) • Avoid tasks that risk fingertip trauma. • Protect fingertips or ulcers on fingers/tips Splints Jell pads, caps or finger sleeves From the American College of Rheumatology Image Bank
- 37. Keep Skin Moist • Use mild fragrance free and alcohol free soaps and moisturizers • Thick cream or ointment rather than lotion • Vitamin E • Put moisturizer on before bedtime at night and then put on cotton gloves • Humidifier • Stay hydrated
- 38. Conclusions •Heat and massage can be done before exercises to warm up tissues •Range of motion/stretching exercises should be aggressive and started before obvious deformities or loss of mouth opening. Monitor your hand and mouth motion •Exercise and stretch all hand joints but concentrate on the joints that are the tightest. •Range of motion /stretching exercises should be done even with ulcers ALTHOUGH, modify the exercises. •Take care of your hands (keep warm, protect skin).
- 39. RESOURCES self-manage scleroderma OR @selfmanagescleroderma https://www.selfmanagescleroderma.com/ BROCHURE: Stretching exercises for the face and hand. On the Scleroderma Foundation Website http://www.scleroderma.org/site/DocServer/Form_16c_low_res.pdf?docID=198 09&AddInterest=1281 Raynaud’s societies Scleroderma & Raynaud’s UK www.sruk.co.uk Raynaud’s Association www.raynauds.org