Evaluation of the Hand Flashcards
Hand therapy as a specialty area
- Grown as specialty area for both OT and PT.
- Many of the treatments have evolved from the profession’s specialties (both OT and PT).
- Requires additional training beyond entry level
- A more thorough understanding of thermal modalities, wound care and protocols is required.
- CHT: Certified Hand Therapist (after 3 years experience, 4000 documented hours and certification exam 50% pass rate)
hand therapy
primarily
- private therapy offices- SERC, select therapy
- Outpatient rehab clinics
- Hospitals- adult and pediatric
- job sites- Harley Davidson
Secondarily in
- Nursing homes
- Home health care
- Schools
clinical assessment
- Must have an understanding of the functional anatomy of the hand and upper extremity.
- Must have knowledge of tissue and bone healing in a healthy person and be able to identify factors that would affect the normal rate and use good clinical judgment in choosing evaluations and interventions.
What do we address during an evaluation
- Occupational Profile: Includes client and their occupational history (prior and current level of function, context, supports and barriers)
- History and mechanism of injury
- Past medical history
- Symptom interview
- Physical assessment
- Functional assessment
- Psychological/cognitive assessment
History of Injury
- Mechanism of injury: Trauma, gradual onset, insidious
- Environmental conditions at the time of injury
- Date of injury
- Previous treatment including immediate care (ER, ice etc.). Did they receive therapy or require surgery?
- If the diagnosis was not due to trauma then document the length of time the individual has experienced the symptoms and what effects the intensity.
- Medications or injections
- Infections
General Medical History/Co-morbidities
- Cardiac or respiratory problems, allergies, high blood pressure, arthritis, diabetes, circulatory problems. Other co-existing diagnoses
- It is especially important to document allergies, pacemaker, fractures, diabetes and history of cancer.
- looking at patient’s hear health is vital.
occupational Profile
Develop an understanding of the client’s occupational history and experiences, patterns and routines of daily living, interests, values, and needs. The client’s problems and concerns about performing occupations and daily life activities are identified, and the client’s priorities are determined”
Informal Clinical Observations
-Evaluation of the upper extremity begins as soon as you meet the patient and escort them to the treatment area.
- Notice whether the patient’s upper extremity has a normal swinging motion when walking.
-Does the patient spontaneously use their arm?
-Does the patient cradle the arm, guard or try to protect the arm
by keeping in locked into their chest? - Are the shoulders symmetrical?
-Does the patient spontaneously place the arm or does he/she
use the uninjured hand to assist?
evaluation of pain
- Is there pain?
- Describe it
- When does it occur?
- What makes it better/worse?
- How does it affect occupational performance?
pain assessment options
- Questionnaires
- Body Diagrams
- Rating Scales (verbal or visual)
skin evaluation
Color, tone, moisture Skin creases- make sure doctor makes a good z-plasty Edema Deformities Thenar/hypothenar atrophy Contractures
wounds
Location Size – ruler or saran wrap method Color: Red Yellow Black Drainage
creases of the hand
Creases of the Normal Hand. Distal palmar crease and thenar crease important in splinting.
arches of the hand
Observe the arches. Nerve injuries, muscular diseases, stroke, spinal cord injuries and arthritis are example of thing that can effect the normal arches of the hand and impair function. The distal transverse arch, The proximal transverse arch and the longitudinal arch are important to keep in mind during splint fabrication.
Volar Surface Anatomy
Volar surface starting from the thumb side of the hand: Radial artery, FCR, median nerve, palmaris longus, FDS, ulnar artery and FCU
