HandTherapyfortheNonHandTherapistKristine对于非手手疗法治疗师克里斯蒂娜.ppt

Hand Therapy for the Non Hand Therapist Kristine Milliron OTR/L,CHT,Quick DASH,Disabilities of the Arm, Shoulder and Hand,Every Day Module,Work & Sports / Performing Arts Module,55,11,- 1,x 25 = 100,Total Summary # ?s answered,- 1 x 25 = ?,Ex.) Ms. Pane has Medicare Since MC does not recognize work or leisure, only page 1 was completed.,Evaluation,Quick, Efficient & Complete,Clinical Assessment,1) History of Injury & Functional Status (Prior & Current) 2) Organized Examination 3) Knowledge of Disease process,S: Subjective,Pt. is a _ YOM/F with Dx of _. Pt is R/L hd dominant. Pts occupation : _ . DOI _ DOS_ . SPS = _ location of pain_. Functional Status (prior) = _ (Current) Functional Status = _ Pts. functional goal = _,O: Objective,A/PROM of involved joints - Finger Hyperextension documented as (+) positive value. Incomplete extension documented as (-) negative value. ASHT Guidelines : Document extension/flexion Index (IF) Middle (MF) Ring (RF) Small (SF),ASHT Recommendations,How to measure TAM,MP PIP DIP (TAM) IF +20/90 0/100 0/90 (300) MF +20/80 0/75 0/45 (220) RF -10/60 0/70 -5/30 (145) SF -20/50 +10/20 -10/30 (80),Thumb ROM,Th MP ext/flex Th IP ext/flex Th Radial Abduction Th Palmar Abduction Th Opposition Th Adduction,Wrist/Forearm ROM,Extension/Flexion RD/UD Pron/Sup,Grip Testing (20lbs required for I ADL),Jamar Dynamometer Test position - Forearm in neutral, elbow flexed to 90, sh adducted, wrist 0-30 extension and 15 degree UD. ASHT recommends 3 trials & average. Use 2nd handle position if only one handle space is used.,Grip Testing continued,Bell Curve test - test 1 x each handle space. Be sure to test to eliminate fatigue. Test hands alternately. Full effort will produce a curve with 1st & 5th handle producing lowest scores & greatest in the middle. Intrinsic minus hand is exception to the rule. Grip will increase from I-V due to extrinsic flexion are at a better mechanical position with wider handle positions.,Pinch Testing (4-7 lbs) required for independent ADL,Same arm position as grip test Lateral or Key Pinch Tip Pinch 3 Jaw Chuck Pinch or Palmar pinch,Edema,Circumferential measurements: measure landmarks - IPs, MPs, DPC, Wrist, Elb jt. Volumetric displacement Equipment Needed: plastic hand volumometer, graduated. Cylinder 500 ml, small bucket or container, elevated Wooden support for volumometer, chair.,Procedure: 1) Position volumeter & cylinder on elevated wooden support. Pour H2O in volumeter until water overflows & discontinues dripping into cylinder. 2) Empty Cylinder thoroughly. 3) Instruct patient to sit with back against the chair, feet flat on floor. 4) Position hand in anatomical position. Instruct pt to lower hand until the stop dowel rests between the web of the mi & ring fingers. 5) Hold this position until the water no longer flows from the spout. Remove cylinder, then have pt remove hand from the water. 6) Read water level in the cylinder on a flat surface. 7) Repeat on opposite hand.,Wound & Scar Assessment,Location, Size, Depth, Description of exudate Exudate: Bloody or Sanguinous Serous - clear/yellowish liquid Serosanguinous - Serous fluid & blood Purulent - pus Deep dark red - old blood,Sensibility Testing,Semmes Weinstein Monofilament Test Weber Static 2 Point Discrimination Test Dellon Moving 2 Point Discrimination Test,Dexterity Testing,Minnesota Rate of Maniputlation Test Purdue Pegboard Crawford Small Parts Test Jebsen Taylor Hand Function Test,Common Hand Injuries,Also occurs when shutting trunk of car,Wrist Fractures,Loss of Radial Tilt Less functional impact than other anatomic parameters Decreased Grip strength Dorsal Angulation Silverfork Deformity - will look deformed Decrease in pronation and flexion Midcarpal instability Ulnar sided wrist pain,Wrist Fractures Continued,Radial Shortening Decrease in flexion, ulnar deviation and pronation Decreased grip strength Shortening of 6 mm or more affects forearm rotation Intraarticular involvement with step offs of as little as 1-2 mm (can cause risk of post traumatic arthritis).,Keep It Simple Stupid,Strategies for Regaining wrist ROM,Wrist extension with simultaneous finger flexion needs to be restored. This affects power grip Overcome the substitution pattern of fingers extending wrist. ECRB, ECRL & ECU need to “work alone” NMS to extensors (flexion wrap to hand) Reverse curl bar,Wrist ROM Strategies Continued,Pron/Supination - perform with elbow at side to prevent sh substitution. Hammer Velcro Board Modified PNF pattern,Wrist ROM Strategies continued,Wrist Flexion Stretch long extensors (composite fist with wrist flexion) US over dorsal wrist ligament Curl bar,Finger Stiffness,TERT stretches Hook fist position isolates digital extensors & helps stretch the intrinsics with IP flexion. Bunnell blocking/Active Lumbricale stretches IP extension ex with MPs flexed (A/PROM),Edema Control,Edema fluid & hematoma surround interroseous muscles - leads to intrinsic hand contractures. Venous drainage impeded from cast, bandages etc. Edema decreases mobility, impedes circulation & leads to fibrosis if not addressed early.,Edema control,Distal to proximal massage. Skin surface massage is an important part of early tx because the lymphatics rely on local tissu