HAND REHABILITATION – OCCUPATIONAL THERAPY APPROACH
HAND AND WRIST THERAPY
Hands and wrists are complex parts of the body made up of bones, tendons, muscles, nerves, veins, ligaments and connective tissues. They make it possible to perform movements, and provide the dexterity and strength needed to carry out everyday tasks at home and at work. We often take the ability of our hands for granted, unless they are limited by pain or injury.
We use our hands for almost everything we do from morning until night. Because of their constant use, hands and wrists are often injured. Any direct trauma or laceration to the hand can result in serious consequences if one or more tissues are damaged. An injury to the area will therefore affect a person’s ability to do simple and complex tasks. Ensuring appropriate diagnosis, assessment and rehabilitation for injuries to hands and wrists is essential to preventing long-term adverse effects and possible disability.
Hand therapy is a type of rehabilitation provided by an occupational therapist for patients suffering from a condition affecting their hands and upper limbs.
Occupational therapy is the healthcare profession that aims to restore a patient’s functional capacity. Using specific assessment and treatments skills, occupational therapists specializing in hand therapy offer therapeutic approaches to restore function, limit the progression of a pathology or prevent upper limb dysfunction in order to help patients resume their everyday tasks at home and at work, and their recreational activities.
The most common types of hand or wrist injuries are sprains, tendinopathy and fractures. Sprains and fractures are very common, given our natural tendency to use our hands to protect ourselves when we fall, slip, tumble or trip. Overuse and repetitive movements have been linked to a variety of hand and wrist injuries, the most common of which is carpal tunnel syndrome.
An appropriate hand and wrist assessment is needed before choosing a treatment option. Occupational therapists assess deformity, swelling, difference in colour, sensitivity and change in overall function, i.e. movement, strength and dexterity, which are very important in determining the scope, limitations and severity of an injury.
The following are a few examples of hand/wrist pre- or post-operative conditions:
·            Fractures
·            Tendinitis
·            Lacerations (lesions) or tears: skin / nerve / tendon / muscle / ligament
·            Sprains / trauma
·            Wounds
·            Hyposensitivity or hypersensitivity
·            Complex regional pain syndrome (CRPS)
·            Amputation (finger)
·            Arthrosis / arthritis
Occupational therapy treatment options for the hand and wrist include:
·            Orthosis manufacturing
·            Education and treatment for healing scars related to hand injuries
·            Exercises to increase range of motion and improve hand and upper limb strength
·            Pain management
·            Edema / muscle massage
·            Sensitization and desensitization
·            Education about the condition
·            Advice for adapting the task or the environment
·            Motor imagery rehabilitation
ORTHOSIS MANUFACTURING
Orthosis manufacturing requires occupational therapists to demonstrate dexterity and creativity, and to apply the knowledge they have acquired in a number of areas (e.g. anatomy, biomechanics, diagnostics and the healing process). Occupational therapists use their analysis skills to determine what type of orthosis to manufacture, its function and the materials required in order to optimize the useful life and comfort of the orthosis. Orthosis manufacturing takes the following into account.
1.   Main types of orthoses
Static orthoses are used to partially or completely immobilize joints. In the case of partial immobilization, a patient can perform active movements in one direction, but is restricted in the opposite direction. A semi-dynamic orthosis immobilizes and exerts a force on the joints to increase passive range of motion. A dynamic orthosis exerts a passive force in one direction, while allowing active resisted movement in the opposite direction.
2.   Primary functions of orthoses
One of the functions of an orthosis is to protect (through immobilization) from sources of pain, injury, deformity or stress (e.g. carpal tunnel syndrome or fracture) that interfere with the healing process. Orthoses are also used to correct a deformity (e.g. rheumatoid arthritis, Dupuytren’s fracture) or support weak, paralyzed or spastic muscles in order to improve joint mobility. Depending on a patient’s goal or condition, an orthosis can be worn on a short- or long-term basis, or for a specific activity.
3.   Materials used
Occupational therapists use mostly low-temperature thermoplastic, which becomes malleable when immersed in warm water. The temperature is comfortable enough so that the plastic can be applied directly to the patient’s skin for custom manufacturing. There is, however, a range of prefabricated products available.
Low-temperature thermoplastics are divided into two categories: clear or opaque when warm. Each one has varying degrees of compliance. The clear plastic retains 100% of its memory, that is, it will return to its original shape (size and flatness) when reheated. The opaque plastic has different degrees of (partial) memory. The more flexible the material, the less it retains its original shape.
Working time refers to the cooling time during which the occupational therapist can work the material before it hardens. This characteristic is largely affected by the thickness and degree of perforation of the plastic. The thinner or more perforated plastic requires less working time. For example, a plastic that is 1/8 inch (3.2 mm) thick has a working time of approximately 3 to 5 minutes. Thickness varies from 1/32 inch (0.8 mm) to 6/32 inch (4.8 mm). Perforation provides ventilation, decreases weight and increases the compliance and flexibility of the orthosis, but complicates the finishing (rough edge).
As a general rule, the thinnest material that provides appropriate support and sufficient working time is used to manufacture orthoses. Usually, thinner plastics are used for small orthoses, but occupational therapists can decide otherwise if they notice complications or limitations during a patient’s visit.
Par Thermoplastics can also be used for other purposes, such as adapting the length of utensil handles, pencils or tools in order to improve a patient’s autonomy in carrying out his or her activities of daily living.
Feel free to contact us for more information on hand therapy, our related services and the location of our six clinics.
REFERENCE
McKee, P. & Morgan, L. (1998). Orthotics in Rehabilitation: Splinting the Hand and Body. Philadelphia, PA: F.A. Davis.
AUTHORS
Marie-France St-Pierre, M.Sc. A. OT, occupational therapist, Forcephysio multidisciplinary medical and rehabilitation clinic
Shang Yuan (Lily) Teng, M.Sc., B.Sc. OT, occupational therapist, multidisciplinary rehabilitation coordinator, Forcephysio multidisciplinary medical and rehabilitation clinic