Post on 29-Dec-2015
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Occupational Therapy Interventions that Yield the Greatest Overall Improvement to
Hand Function in Persons with R.A
Ryan RhodesSpalding University
Auerbach School of Occupational Therapy
Hand Function: An Occupational Therapy
Cornerstone
“Man, through the use of his hands, as they are energized by mind and will can influence the state of his own health”
-Mary Reilly
What is Rheumatoid Arthritis?
R.A. is a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility.
Manifests as synovitis, inflammation of the synovial membrane that lines the joint capsule.
Symptoms of Rheumatoid Arthritis
Pain
Decreased ROM
Decreased Strength
Decreased Functional Mobility
Swelling
Joint Instability
Decreased Physical Endurance
Stiffness
Decreased Sensation
Numbness and Tingling
Common Interventions
All interventions are determined by the client’s occupational profile, goals, disease activity and inflammatory stage. Rest Physical Agent Modalities (PAMs) –
Contraindications? Therapeutic Exercise and Activity Splinting Occupational Performance training Client Education
Finding the Right Balance Between Activity and Rest.
Rest: “Active” means of reducing inflammation and swelling.
During active systemic inflammation: Pt. requires 8 – 10 hours of sleep/night.
30 min – 1 hour of rest during the morning and evening.
Avoidance or Modification of Activity.
Splinting?
Physical Agent Modalities
Once again, dependent on stage & activity level of disease.
Modality use alone shows no sustained benefits in treating R.A.
Most common modalities: Thermotherapy and Cryotherapy Benefits? Contraindications?
Therapeutic Exercise
Maintain strength, prevent atrophy from disuse, & improving/maintaining ROM.
Variables: Isotonic vs. Isometric; High Intensity vs. Low Intensity.
Pain Rule of Thumb?
Where is the Universal Exercise Program?
Therapeutic Activity: What makes us OTs
Physical & Psychological Benefits.
Activity Analysis is useful for observation of functional limitations and goal setting.
Like Exercise, Activities should be non-resistive, avoid patterns of deformity & not overstress joints.
Avoid prolonged static use of hands.
Integration of Splints?
Splinting: A Combo of Science and Art.
Indications: Reduce
Inflammation Decrease Pain Support Unstable
Joints Properly Position
Joints Limit Undesired
Motion Increase ROM
Splints
Considerations: Splint weight. Transferred
forces. Skin tolerance. Splint strapping
Are Splints always beneficial?
Splinting Options: Rigid Hand Splint
Max immobilization/stability
Soft Splint More ROM
freedom Semi-rigid Splint:
Provides elements of both.
Patient Education
Disease Process
Symptom Management
Joint Protection & Fatigue Management
Principles: Respect Pain! Maintain Muscle
Strength and ROM Stable positions
for jts Avoid positions of
deformity. Use Strongest
Joints Available
References
Adams, J., Burridge, J., Mullee, M., Hammond, A., & Cooper, C. (2008). The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial. Rheumatology, 47, 1548-1553. Doi: 10.1093/rheumatology/ken292.
Dogu, B., Sirzai, H., Yilmaz, F., Polat, B., & Kuran, B. (2013). Effects of isotonic and isometric hand exercises on pain, hand functions, dexterity and quality of life in women with rheumatoid arthritis.
Rheumatology International, 33, 2625-2630. Doi: 10.1007/s00296-013-2787-z Formsma, S.A., van der Sluis, C.K., & Dijkstra P.U. (2008). Effectiveness of an mp-blocking splint and
therapy in rheumatoid arthritis: a descriptive pilor study. Journal of Hand Therapy, 21, 347-53. Doi: 10.1197/j.jht.2008.06.001
Hammond, A., Young, A., & Kidao, R. (2004). A randomized controlled trial of occupational therapy for people with rheumatoid arthritis. Annals of the Rheumatic Diseases, 63, 23-30. Doi: 10.1136/ard. 2002.001511
Niedermann, K., Buchi, S., Ciurea, A., Kubli, R., Steurer-Stey, C., Villiger, P.M., & De Bie, R.A, (2012). Six and 12 months’ effects of individual joint potection education in people with rheumatoid arthritis: A randomized control trial. Scandinavian Journal of Occupational Therapy, 19, 360-369. Doi: 10.3109/11038128.2011.611820
Ronningen, A., Kjeken, I. (2008). Effect of an intensive hand exercise programme in patients with rheumatoid arthritis. Scandinavian Journal of Occupational Therapy., 15, 173-183. Doi: 10.1080/11038120802031129
Silva, A.C., Jones, A., Silva, P.G. & Natour, J. (2008). Effectiveness of a night-time hand positioning splint in rheumatoid arthritis: A randomized controlled trial. Journal of Rehabilitation Medicine, 40(9), 749-54. Doi: 10.2340/16501977-0240