Interventions for hand impairments
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| Interventions during the inflammation phase of tissue healing | rest is advised, edema management, pain control, and positioning
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| Interventions during the fibroplasia phase of tissue healing | starts at 4 days to 6 weeks. Formation of scar tissue. Begin AROM, splint
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| interventions during the maturation phase of tissue healing | gentle resistive activity, avoid inflammation, dynamic or static splinting, scar tissue management
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| hand position to avoid | wrist flexed, MP joints stiffen in hyperextension, and DIP's flexed, adducted thumb
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| Describe the Intrinsic Plus position | wrist in neutral or extension, MP's in flexion, IP's in extension (flexor and extensor tendon repair not conducive to these positions
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| PROM precautions | can be injurious to delicate tissues, can incite inflammation and trigger CRPS, can cause inflammation if PROM is done after heat application
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| Guidelines for PROM | gentle and pain-free
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| may be more effective than PROM | low load-long duration splinting
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| heat precaution | do not use on inflamed or edematous extremity, may degrade collagen and contribute to microscopic tears, can have rebound effect, with stiffening following its use
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| Guidelines for use of heat | use aerobic exercise to warm up tissue, elevate the extremity in conjunction with heat, monitor frequently for signs of inflammation
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| benefits of purposeful activity fro hand therapy | produces coordinated movement patterns in multiple planes, leads to better movement quality
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| Benefits of occupation as means for therapy | improved quality of movement and return to occupation
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| wound color: red | revascularizing
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| wound color: yellow | exuidate--needs cleansing and debridement
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| wound color: black | necrotic--needs debriedment
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| Describe a mature scar | flat and softer, has neutral color, does not blanch to touch
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| Interventions for edema | elevation, compression, manual edema mobilization, lymphedema pumps
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| interventions for scar management | compression, silicone gel
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| interventions | edema control, scar management, tendon gliding, blocking exercises, place and hold, end feel and splinting
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| types of splinting | blocking, buddy strapping, dynamic vs static
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| Intervention for stiff hand (as result of fx) | decrease PROM/AROM if painful or swollen, static splinting during acute inflammatory phase, dynamic when joint has soft end feel
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| Intervention for tendonitis (more than half of occupationsl illnesses) | RICE, splinting @ night, gradual mobilization balanced w/rest, prevent re-injury thru education
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| Intervention for lateral epicondylitis | proximal conditioning and scapular stabilizing, built up handles, splinting, counterforce strap
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| intervention for medial epicondylitis | proximal conditioning, avoid end range, built up handles, splinting, counterforce strap
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| Intervention for DeQuervains Disease (common type of tendonitis) | avoid wrist deviation (esp w/pinching), forearm thumb spica
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| Intervention for nerve injuries | steroid injection, night splinting in neutral, exercises for tendon gliding, aerobic exercises, proximal conditioning, ergonomic modification, postural training
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| Management of CRPS | medications, sympathetic blocks, modalities; vaso motor challenge thru stress loading (scrubbing); change positions, temperature feedback, contrast, vibration, desensitization, water aerobics; Pt. directed therapy
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| Interventions for OA | splinting, pain mgmt, jt. protection
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| Interventions for RA | reduce inflammation, jt. protection, splinting, energy conservation
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