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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