Physical Therapy UpdatePhysical Therapy for Hand Rehabilitation |
Gary M. Souza, P.T.
|
Suite 100Physical Therapy for Functional Hand Rehabilitation
Hand and upper extremity function are important for human expression and are central to most occupational tasks and activities of daily living. Thus, it is not surprising that hand injuries account for a greater number of lost work days than any other occupational injury, including low back injuries. Over 400,000 hand and arm injuries occur each year, accounting for 16million missed days of work. Specifically, cumulative trauma disorders (CTDs) are a major cause of decreased productivity in many hand intensive industries.
Occupational risk factors include poor posture, repetitive or forceful exertion, mechanical stress, vibration, and extreme temperatures in the work environment. Occupational injuries are often complicated by the chronic nature of many conditions and the specialized tasks that many workers perform. Thus, it is easy to understand why the most successful and efficient recovery often requires the expertise of a specialist.
Certified hand therapists (CHTs) are physical or occupational therapists with specialized and extensive training in hand rehabilitation. To become certified as a hand specialist, a therapist must possess both extensive clinical experience and a strong scientific knowledge base. These skills are attained through advanced continuing education, clinical experience, independent study, and passing a board examination. These specialized skills facilitate optimal functional recovery while minimizing potential complications.
Successful Treatment
Successful treatment at Gary M. Souza Physical Therapy begins with a detailed physical evaluation. This includes an assessment of the patient's deficits and rehabilitation potential. An individualized treatment plan is then formulated, which includes a range of treatment procedures designed to optimize functional outcomes. Crucial factors in successful hand rehabilitation include the patient's understanding of his/her diagnosis, ergonomic training to minimize the likelihood of re-injury, and active patient involvement.
Evaluation
Initial patient evaluation at Gary M. Souza Physical Therapy addresses patient history, physical status, range of motion, strength, sensation, function, and goals. These objective measures help the physical therapist determine the factor(s) contributing to the loss of function. The anatomical and biomechanical structure of the hand requires range of motion measurements be taken not only at individual joints, but compositely with all joints moving together. Range of motion measurements are taken both passively and actively, helping to differentiate between structural dysfunction and strength deficits. An injury may also require isolated manual muscle testing to assess the strength of individual muscles with the hand. Larger muscles and groups of muscles can also be tested using computerized strain gauges.
At Gary M. Souza Physical Therapy, we utilize the Blankenship System, which is a computerized system for performing Functional Capacity Evaluations. This system contains components such as Myotest, which allows accurate and objective assessment of functional strength including grip and pinch force. In addition, the Blankenship System contains a repetitive measure format to determine validity, which can assist in the identification of patients putting forth submaximal effort.
Light touch and deep pressure sensation can be measured using Semmes-Winstein monofilament testing. Research shows monofilament testing to be the most effective and cost efficient form of sensation testing. In addition, it does not result in the patient discomfort associated with electrodiagnostic testing. Objective information gained from monofilament testing can be used to monitor return of sensation following peripheral nerve injuries, determine when protective sensation is absent, and serve as a guide for beginning sensory reeducation programs.
Developing a Treatment Program
At Gary M. Souza Physical Therapy, we pride ourselves on delivering quality care. To ensure the highest standard of care, our patients receive one on one treatment with a physical therapist at every visit. The development of a treatment program is tailored to the needs of each patient and their stage in the rehabilitation process. Hand therapy intervention often begins within days of injury or surgery. Treatment can consist of wound care, dressing changes, splinting, edema reduction, and pain management. Gentle therapeutic exercise can often be initiated early to reduce edema, retain motion in uninvolved joints, decrease stiffness, and prevent adhesion formation, thus shortening the overall rehabilitation time.
Splinting
Fabrication of custom splints is often necessary in hand rehabilitation to maximize outcomes. Custom splints are often more effective and cost efficient than over-the-counter splints because they can be modified as patients gain range of motion or their treatment needs change. Post operative splinting may be necessary to maintain tissue length and/or to protect surgical repairs. Static splinting is often used for immobilization and prevention of deformity, whereas dynamic splinting may be indicated to increase range of motion or protect healing tissues. At Gary M. Souza Physical Therapy, we are experienced in the fabrication of splints and are able to fit and modify splints on the day of evaluation. Our therapists have undergone graduate training and continuing education in the area of hand therapy and splint fabrication techniques, and possess years of clinical experience.
Patient Involvement
Active patient involvement is crucial to achieving good outcomes in hand rehabilitation. The patient must have confidence in their physical therapist and be willing to work together towards functional and meaningful goals. We believe that patient education leads to patient involvement in treatment, and thus strive to provide our patients with an understanding of their diagnosis and benefits of physical therapy treatment.
Return to Function
As patients near their return to work, there are several options for facilitating a smooth transition to the work environment. The patient's tolerance for activities such as computer data-entry, repetitive manipulation tasks, and lifting objects can be objectively measured. An evaluation of the work environment can be performed and recommendations for modifying postures and biomechanical constraints can be made to decrease the incidence of re-injury.
In Summary...
Certified hand therapists provide specialized care designed to maximize functional outcomes and cost effectiveness of care. At Gary M. Souza Physical Therapy, we provide a broad range of services such a patient evaluation, wound care, acute and chronic care, dynamic and static splinting, patient education, occupational testing, Functional Capacity Evaluations, on-site job assessment, and follow up care to assure optimal recovery in the safest and most cost effective manner.
Gary M. Souza, DPT, OCS
Liz Souza, DPT, CHT
www.gmspt.com
Member:
- American Physical Therapy Association
- Hand Rehabilitation Section
- Private Practice Section
- Orthopedic Section
- California Chapter, APTA
- California Private Practice Special Interest Group
