Occupational therapy recognizes the power of occupations themselves in their ability to improve functioning by addressing the status of underlying client factors (e.g., body functions and structures) and skills (e.g., motor, process, and social; AOTA, 2020). Additionally, physical therapists can have a profound effect on people’s lives. They help people achieve fitness goals, regain or maintain their independence, and lead active lives. (APTA, n.d.) PTs and OTs address pain and dysfunction through biomechanical approaches, including orthoses, physical agent modalities, strengthening, and exercise, to increase ROM. Of utmost importance, a therapist empowers clients about their disease and instructs them in how to minimize its effects on their occupational performance. ● Pack handbags, briefcases, or luggage as light as possible. Use ergonomically designed carrying handles when carrying grocery or trash bags. ● For prolonged telephone use, use a headset that lessens pressure on the neck, shoulder, or elbow while talking. Consider a speakerphone for hands-free conversations. ● When cooking, use ergonomically friendly tools such as an electric can/jar opener, utensils with cushioned grips, and spring-activated scissors. ● When purchasing clothing, buy shirts with larger buttons that are easier to work. Buttonhooks with special grips are also available to make buttoning simpler, or try loose-fitting, pull- on clothing to avoid buttons and zippers. Principles of Joint Protection, Work Simplification, and Fatigue Management ● Reduce force and effort. Whenever possible, consider aids such as lamp switch enlargers, special doorknob/key turners, gas cap turning aids, zipper pulls, dressing sticks, long shoehorns, and sock pulls to make daily tasks easier or to change the position of the hand. ● Respect pain. Do not engage in activities that cause pain and swelling of the joints of the hand. ● If activities that cause pain must be completed, attempt them only if pain lasts less than one hour following the activity.
This course has examined the pathophysiology, anatomy, and causes of OA of the hand and wrist. It has outlined the diagnostic process and has highlighted various medical interventions, including surgical and conservative approaches. Therapists are important members of the healthcare team, working with individuals experiencing OA of the hand and wrist. Rehabilitation professionals are known for their skill and expertise in addressing the medical-based rehabilitation needs of both pre- and postsurgical clients. They are experts in providing education and training to clients about the disease itself and methods by which they can continue to participate in desired occupations, including daily activities, in a full and pain- free manner. ● Develop a light touch to decrease static pressure on thumb joints during activities such as writing. ● Use tools, adaptive implements and handles, and modified lifting techniques to decrease pain and stress during activities. ● Stop prolonged activities for at least 10 minutes per hour for rest or stretching exercises. ● Maintain muscle strength and range of motion through a program suggested by a healthcare provider. ● Avoid positions that put undue stress on arthritic joints and that could create deformities. ● Apply cold before, during, or after activity, depending on which method is most effective in reducing pain and inflammation. ● Use orthosis as recommended. ● Use the strongest joints available. For example, try to substitute the elbow for carrying a purse when hands show signs of arthritic changes. ● Avoid staying in one position for too long. ● Avoid starting an activity that cannot be stopped. Regular rest breaks take stress off delicate or painful joints. Adapted from Cooper (2020) Cleaning your Orthosis The plastic portion of your orthosis can be cleaned using soap and warm water. DO NOT wash orthosis in hot water, as it will melt. Stains can be removed from the orthosis with a scouring cleanser containing chlorine. Rinse and dry the orthosis, and be sure to dry the padding if needed. The straps and orthotic liners can be washed gently and line dried. These components need to be replaced for long-term orthosis usage. Orthosis with Attachments If your orthosis was fabricated with rubber bands or hardware to improve motion, be sure to follow the recommendations below: ● A light, steady pull is better than a hard or forceful pull. ● To achieve optimum comfort and benefit from your orthosis, the tension can be adjusted according to your therapist’s instructions. Please sign your name below to confirm your understanding of these instructions. Please retain this portion for your records. _________________________________________________________ I have been instructed in the care and use of my orthosis as described above and have been provided a copy of this information. Client __________________________________ Date __________
APPENDIX A
APPENDIX B SAMPLE ORTHOSIS CARE AND USE SHEET
Name _________________________________________________ Therapist _______________________________ Date __________ Type and purpose of orthosis: _____________________________ ________________________________________________________ ________________________________________________________ Wearing schedule: ______________________________________ Special considerations for application: ____________________ Precautions: ● Keep your orthosis away from open flames, as it will burn. ● Avoid exposing the orthosis to temperatures above 135 degrees Fahrenheit. ● Do not leave the orthosis in a car or near a heat vent. ● Do not adjust the orthosis. ● Contact your therapist (XXX-XXX-XXXX) for adjustments or if any of the following occur: ○ Reddened areas on your skin lasting longer than 20 minutes. ○ Additional swelling, pain, or stiffness. ○ Numbness.
Resources ● American College of Rheumatology http://www.rheumatology.org
● American Society for Surgery of the Hand: Goniometry/ Range of Motion Norm Values http://www.eatonhand.com/cht/cht044.htm
EliteLearning.com/Physical-Therapy
Book Code: PTOH1324
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