Libby – Hand Therapy

Kenna Sullivan

Nadine Huang

Stacy Sellner

★55-year-old wife, mother,

grandmother

★Dog, gardening, granddaughter,

chess, Sunday service, cooking

★Clerical worker

Libby’s Background

Median Nerve Injury

★ Impaired fine sensory

and motor functions

★No guaranteed return of

tactile discrimination

★Nerve regeneration

depends on factors

★Cortical remapping

★Biomechanical

principles with

occupation-based,

client-centered

approach → improved

motivation & functional

gains

★Kirk Gober, OTR, MOT, CHT

4009 Bellaire Blvd. Ste. M

Houston, TX, 77025

(713) 839-7800

kirk@kirkgober.com

★Part of a PT unit

Large table top area where splints are made

Share exercise/strengthening activities

between PT

Houston Hand Therapy

Examples of Assessments

Examples of Assessments

★Course of Therapy

★Initial Evaluation

★Re-evaluation after 30 days

★Discharge (when appropriate)

★Work on: decreasing swelling, scar management

★Could be 7 months before full functional finger use

★Sensory follows motor

★Healing nerve process

Houston Hand Therapy

Course of Therapy

★ Fluidotherapy○ Desensitization, heat therapy

★ Ultrasound○ Deep heating agent

■ Contractures, scar adhesion, anti

inflammatory

★ Neurontin for nerve pain★ Low vibration, moving touch,

constant touch, higher vibration,

touch localization, 2 point

discrimination, stereognosis

Equipment and Techniques

http://e-current.com/fluidotherapy-units.aspx

Equipment and Techniques

http://www.fpnotebook.com/legacy/Sports/Pharm/Intphrs.htm

★ Iontophoresis with Dexamethasone○ Delivers water soluble, ionic drugs

○ Decreases pain and inflammation, improves

scar quality, decreases edema

★ Stretching○ Increases ROM, fluidity of movement

★ Hot Packs○ Decreases

muscle tone

★ Tinel’s test

http://www.cvs.com/drug/dexamethasone/solution-for-injection

★ Isotonic glove

○ Soothes pain to increase ROM

★ Electrical stimulation

○ Decreases pain, edema, increases

ROM

★ Massage

○ Reduces edema

★ H-wave

○ Electrical stimulation for fluid shift

Tools

http://www.kauaihandtherapy.com/splinting.html

http://www.abclawcenters.com/practice-areas/types-of-birth-injuries/birth-injuries/birth-

adv/cerebral-palsy/cerebral-palsy-faq

★ Static splint

○ Maintains correct/

therapeutic position

★ Silicone sheets

★ It takes 5 years to prepare for the CHT exam after

passing the NBCOT exam

★Patients may be discharged before reaching final stages

of regained hand functionality

★Schedules of CHT’s can be rather hectic

★CHT’s can remove sutures and work on decreasing scar

adhesion

★CHT’s don’t just work on the hand, they can work on

ROM/strength of forearm and even shoulder

★Hands on therapist-client time is 15-20 minutes, while a

whole session is about an hour

What We Learned about OT

★ Allen, L. (n.d.). Current Affairs. Retrieved November 12, 2014,

from http://occupational-therapy.advanceweb.com/Article/Current-

Affairs.aspx

★ Boyt Schell, B., Gillen, G., & Scaffia, M. (2014). Common

Conditions, Resources, and Evidence. Willard & Spackman’s

occupational therapy (12th ed., pp. 1145-1147). Philadelphia:

Wolters Kluwer Health/Lippincott Williams & Wilkins.

★ Early, M. (2013). Physical dysfunction practice skills for the

occupational therapy assistant (3rd ed.). St. Louis, Mo.:

Elsevier/Mosby.

★ Lundborg, G., & Rosén, B. (2007). Hand function after nerve

repair. Acta Physiologica, 189(2), 207-217.

References