Health & Wellness by Adirondack Physical & Occupational Therapy
Health & Wellness The Newsletter About Your Health And Caring For Your Body
IN REHABILITATION OF THE HAND The Unique Role of Occupational Therapy
INSIDE: • Rehabilitation Of The Hand • The Role Of OT In Managing Post-Concussion Syndrome
• Relieve Hand Pain In Minutes • Patient Success Spotlight
Hand therapy, a specialty practice area of occupational therapy, is typically concerned with treating orthopedic-based upper-extremity conditions to optimize the functional use of the hand and arm. Conditions seen by the occupational therapy practitioner specializing in this area include fractures of the hand or arm, lacerations and amputations, burns, and surgical repairs of tendons and nerves. Acquired conditions such as tendonitis, rheumatoid arthritis and osteoarthritis, and carpal tunnel syndrome also are treated by occupational therapy practitioners specializing in hand rehabilitation. Practitioners who treat clients with conditions of the hand or arm can do so without additional formal education in most states. However, many practitioners choose to gain several years of experience before treating hand clients, and therapists may choose to become specially certified through the Hand Therapy Certification Commission (Hand Therapy Certification Commission, n.d.). Occupation-Based Hand Therapy Hand therapy typically addresses the biomechanical issues underlying upper-extremity conditions. However, occupational therapy practitioners bring an added dimension to this specialty area. They use an occupation- based and client-centered approach that identifies the participation needs of the client—what he or she wants to be able to do in daily life that is fulfilling, necessary, and/or meaningful—and emphasizes the performance of desired activities as the primary goal of therapy. The Benefits of Occupation-Based Hand Therapy Evidence indicates that clients view themselves in relation to their occupational abilities and roles. Injuries and conditions that interfere with life roles, habits, time use, activity patterns, occupational experiences, and
full participation will create a sense of dysfunction and yearning for normalcy (Custer, Huebner, & Howell, 2014). Incorporating “usual and customary” occupational activities into treatment and focusing goals on enabling performance of those activities provides benefits to clients, including: • Preserving roles and habits, as well as related psychological well- being, through attention to details of day-to-day functioning early in the rehabilitation process. • Increasing motivation for therapy and more cost-effective rehabilitation because clients can see a direct relationship between their occupational therapy intervention and being able to resume normal participation in their activities. • Making the client a partner in his or her rehabilitation. Not all intervention can or should be completed within the clinic. Consulting with the client about what he or she can and should not do outside the clinic as well as giving “homework” assignments can address occupational goals that go beyond clinical staff time and budget constraints. What Does an Occupation-Based Approach to Hand Therapy Look Like? The client–therapist relationship is key to an occupation-based approach. Occupational therapistsbegin interventionwithaclient-centeredassessment tool, such as the Canadian Occupational Performance Measure (Law et al., 2005).This type of tool will provide an occupational profile of the client that highlights functional deficits and desired occupational goals rather than focusing solely on the physical components of function. (continued inside)
https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/hand-therapy.aspx
www.adirondacktherapy.com
REHABILITATION OF THE HAND
Occupations (activities) may not be designed to assist with healing the injury itself; they may be used as a means of helping clients return to psychological and social well-being while waiting for their bodies to heal. Adaptations will be made to occupations as appropriate to allow for immediate engagement if that is the desire of the client. For example, an occupational therapy practitioner can support a mother with a tendon repair of her dominant hand in her desire to bake a cake for her child’s birthday by showing her adaptive techniques to compensate for her limited hand mobility. These techniques might include making cupcakes, which can be much easier than baking a cake because the paper-lined tins can be filled by scooping out batter instead of pouring it from the bowl, and using canned frosting and colored sugar sprinkles to avoid the need to forcefully grip a decorating bag. When possible, occupational therapy practitioners provide splints and adaptive equipment that facilitate rather than inhibit early participation in daily activities such as dressing or driving. Outcomes The ultimate goal of occupation-based hand therapy is to ensure that the rehabilitation process promotes healing while also enabling clients to performmeaningful activities both in the clinic and in their daily lives. This approach fosters positive outcomes for clients, including enhancing their satisfaction with the therapy experience and results, maintaining their ability to engage in desired roles within their family and the community, and most importantly, experiencing quality of life as they define it. Call Adirondack Physical and Occupational Therapy today to discuss your condition and see how we can help you regain a pain-free life.
(continued from outside) Laying a strong groundwork through the initial evaluation focuses intervention in two ways. First, the therapist will know immediately what things the client values and enjoys, and what he or she needs to “get back to.” This groundwork enables the therapist and client to collaboratively set goals that reflect what the client needs and wants to do. Second, the client will understand that therapy is addressing his or her whole body, mind, and lifestyle—including any psychological and social issues—and not just an isolated injury. The practitioner may begin with preparatory methods (e.g., range of motion, muscle strengthening, physical agent modalities) or purposeful activities (e.g., simulated occupations, components of occupations or other meaningful activities). As the client progresses, the intervention expands to address actual performance of desired life tasks and occupations (e.g., self-care, kitchen tasks, work activities). The therapist chooses activities carefully, to be sure they relate to components or actual activities that the client will be doing during or after rehabilitation and links preparatory methods to the ultimate end goal—which is to resume active participation to the extent possible.
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They are a congenial and caring group; I highly recommend them! Patient Success Spotlight
Our Occupational Therapists
Shellie Taylor, OTR/L Shellie is a 1998 graduate of Utica College with a BS in Occupational Therapy. She has experience in school and preschool based pediatrics, short term rehabilitation, and home care. Shellie also trained under a Developmental Optometrist and provides OT services for visual deficits impacting concussion rehabilitation. When not working, Michelle King, MS, OTR/L FCE Michele is a 2004 graduate of Russell Sage College with a Masters Degree in Occupational Therapy. Over 15 years of education with a specialty in hand and stroke treatment. Michele is a resident of Oswego, NY, soccer mom to 2 boys and enjoys fishing with her husband on Lake Ontario. Clark Wolf, OTR/L Clark is a 2001 graduate from Dominican College, New York with a Masters Degree in Occupational Therapy. Over 16 years of experience in the field. Clark enjoys hunting, hiking and chasing around his 3 children.
Shellie enjoys hiking and biking local trails with her family.
“ The entire staff is professional and extremely competent. The therapists make you a partner in your recovery while guiding you back to health. They are a congenial and caring group; I highly recommend them!” – Macklin M.
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THE ROLE OF OT IN MANAGING POST-CONCUSSION SYNDROME
Evaluation Vision evaluation: Following an accident, the patient had difficulty following moving objects with her eyes, difficulty shifting her focus from one distance to another, burning eyes, difficulty seeing clearly without squinting, difficulty concentrating, daily eyestrain and headaches, and dizziness that worsened when in crowded, visually stimulating environments. She also displayed difficulty with saccadic eye movement, and initially she was only able to focus (converge) at 10 inches from her nose (normal is 2 to 4 inches). The DEM findings indicated a horizontal score of 45.28 seconds (below norm), with complaints of nausea, dizziness, and eyestrain after performing. Sensory evaluation: The patient’s primary sensory issues included increased sensitivity to noise, light, and movement, specifically when riding the subway, walking on a crowded sidewalk, or being in crowded or loud spaces. She also noted difficulty concentrating when talking on the phone, sorting mail, and listening to voicemail. Subjective symptoms: She reported nausea, dizziness, headache, fatigue, tearfulness, and occasional outbursts of anger. Functional evaluation: She performed all self-care activities with minimal difficulty and increased time. Interventions Occupational therapy intervention focused on improving the patient’s pursuits, saccades, accommodation, and functional convergence.
Treatments began with basic visual scanning activities with simple information and were eventually graded up to be more complex, where she was required to scan in multiple directions and integrate more complex visual information. Scanning activities included word searches, copying phone numbers, and doing word cancellation worksheets At the time of the occupational therapy evaluation, she avoided reading and computer use as they made her nauseous and dizzy, and increased the frequency of her headaches. Conclusion Concussion management and rehabilitation are gaining increased attention and focus in the medical community. Referrals to occupational therapy will increase as more people with concussion and mild traumatic brain injury are identified. There is also a growing need for further education on preventing concussion, as well as managing symptoms following concussion. Occupational therapists are instrumental in providing holistic rehabilitation and facilitating return to routine self-care, work, and leisure activities for clients who have sustained a concussion. They play an important role on the interdisciplinary team in the comprehensive management of clients following concussion, and they can facilitate improved functional and cognitive outcomes in this population.
https://www.nyit.edu/files/box/profile_images/SoHP_AOTASpecialInterestSectionQuarterly
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