Hand Therapy

What is Hand Therapy?

Hand therapy is a specialty practice area of Occupational Therapy, typically concerned with treating orthopaedic, plastics and neurological upper-extremity conditions, optimising the functional use of the hand and arm. At Hand Works, we offer our patients an added dimension to their treatment, by identifying their unique needs through an occupation-based and patient-centred approach. Our ultimate goal is to give our patients a rehabilitation process that promotes healing so they can return to their meaningful activities, thus enhancing their quality of life.

 

What to expect?

Assessments

Pain levels / functional
movement / swelling /
wound and scar

Splinting

Custom made
Thermoplastic Orthosis
to immobilize and protect
your injury or condition

Treatment

Education
Pain Management
Swelling Management
Wound and scar Management
Exercise Prescription

Rehabilitation

Stretching
Strengthening
Conditioning
Getting you back to work,
sport and daily tasks!

Discharge

You are ready to return
to your desired
activities without
any further help!
 
 
What we Treat

What we Treat

Orthosis / splint fabrication

Choosing the right type of material for our orthoses is an important factor in providing the best possible outcome for our patients. You may have noticed that at Hand Works Occupational Therapy our material of choice is low temperature thermoplastic material. This material has the ability to be remoulded, is lightweight, waterproof, removable, comes in a variety of colours, and is strong enough to immobilise any affected area of the upper limb. Though not commonplace, staff at Hand Works Occupational Therapy are also able to fabricate custom made orthoses using Plaster of Paris and fibreglass material. If you prefer using these materials over thermoplastic, please make note in your referral, or simply contact the therapist directly.

Return to work recommendation

Hand Works care for many patients who have sustained work related injuries, and are progressing through the workers compensation system. A large part of their rehabilitation is their gradual return to work programs. Work Site Assessments As Occupational Therapists, we are skilled to assess and provide ergonomic recommendations due to our background of task analysis and anatomical knowledge. We will include return to work recommendations in our initial and progress reports. Therapists at Hand Works can be available to undertake work site assessments for workers who have sustained hand or upper limb injuries (whether in an office or at an industrial site), and are in the unique situation of assessing the worker’s physical capabilities, as well as having a depth of knowledge of their upper limb injury or disability. We can assess the ergonomics of a workstation and recommend changes to enhance the injured workers return to work (e.g. vertical mouse, keyboard alterations, postural considerations, or tool usage recommendations). Recommendations We are able to assess the patients’ improvements at every treatment session and adjust their return to work recommendations as appropriate. We will work with doctors and vocational rehabilitation providers to support the worker during their return to work in a suitable role including appropriate hours/tasks. As much as possible, we will tailor our exercise regime to mirror the work tasks that are required of the injured worker. Our work recommendations will take into consideration the injury, anatomy, and psychosocial situation of the worker.

Activity modification and work simplification

The team of Occupational Therapists at Hand Works have specialised knowledge and skills to help restore function after an injury, surgery or the onset of a disabling condition. Intervention has a particular emphasis on providing education and modifications related to specific tasks and the environment. The ultimate goal of this is to enable maximal functional performance in daily activities, i.e. to enable people to do the things they want and need to do despite their injury or condition. The therapists at Hand Works are well equipped in evaluating how one interacts with his or her environment, and the manner in which they perform particular tasks. This is all viewed with a thorough understanding of anatomy, pathology, biomechanics and the physical and psychosocial demands that daily activities place on the body. Education and recommendations on activity modification and work simplification are tailored to the individual, and can significantly vary depending on individual, occupational and environmental factors. To find out the right activity modifications and recommendations, please contact us for a consultation.

Scar management

Why do we have scars? Scarring is the process by which wounds are repaired. Following an accident/surgery, our body responds to the injury by forming a collagenous ‘glue’. This glue is called granulation scar tissue which holds all structures together while healing occurs. Importance of scar management We at Hand Works Occupational Therapy value the importance of appropriately managing your scars. Scars can cause joint stiffness, tendon adhesions and may become cosmetically unacceptable if not managed correctly. Proper scar management is vital and the earlier the intervention the better the outcome. Flags for us to review your scars includes: Scaring of aesthetic concern regions to patient especially face, décolletage, hand etc History of keloid or hypertrophic scarring Risk of adhesions affecting mobility i.e. over bony prominences or joints where movement places tension over healing wound- hand, elbow, knee Other risk factors for poor healing e.g. Wound infection, poor nutrition or vitamin E, C and protein deficiencies, smoking and nicotine substitution, UV light exposure and occupational/environmental considerations We offer a range of services and products to assist you with your scars. This includes and not limited to: Scar massage Compression therapy including bandaging and pressure garments Topical treatments e.g. silicone gel Movement and exercise prescription Splinting and casting to address scar related contractions Managing pain and hypersensitivity e.g. desensitisation exercises Assessing and managing sensory changes e.g. sensory mapping and re-education If you have any queries regarding our scar management program, please contact us on 1300 887 798.

K-wire and suture removal

Your surgeon will likely utilise several stitches, or ‘sutures’, to secure wound edges together. Combinations of dissolvable and non-dissolvable sutures are often used. Once the wound has closed, your hand therapist will remove your sutures, usually between 10-14 days post operatively as requested by your doctor. This is generally a simple and non-invasive procedure. Kirschner wires, otherwise known as ‘K-wires’ are stainless steel wires commonly used in orthopaedic or plastic surgery to secure a fracture, or to hold a joint in a good position. The k-wire can be inserted into a bone directly through the skins surface (leaving the head protruding through the skin) or buried under soft tissue. This type of fixation is commonly utilised for hand or finger injuries, as it is a relatively non-invasive method, and can provide adequate stability with minimal soft tissue exposure. Your k-wire will be required to stay in place for a period of time following surgery to allow structures to heal. The length of time will be decided by your surgeon, though is usually between 4-6 weeks. It will then need to be removed. Your Hand Works therapist can do this for you if requested by your surgeon. Removal is typically straight forward. An orthosis is often recommended to be worn to protect the k-wires from being knocked, and to protect the healing structure. It is extremely important to keep the k-wires clean to prevent infection. Your therapist will discuss hygiene and care techniques with you. If you have concerns regarding your sutures or k-wires being removed, please let your therapist know.

Oedema Management

What is Oedema? Oedema, also known as swelling, is an excess accumulation of fluid in the interstitium (the spaces between cells of bodily tissues). Because one sixth of the body consists of spaces between cells, the interstitium provides a great deal of room for expansion when filled with oedema. The injured hand commonly develops oedema as a result of increased capillary permeability, which allows leakage of fluid and protein into the tissue spaces. The presence of mild oedema post injury or surgery is part of the normal healing process; however excessive amounts of oedema can destroy the continuity of wound healing and affect the integrity of healing structures. The lymphatic system – what is it? The lymphatic system is one of the most vital systems in the body, and its prime role is to remove excess fluid from bodily tissues. The lymphatic system is an intricate network of lymphatic channels that drains excess fluid and other substances including cells, proteins, lipids, microorganisms, and debris, from the tissues to maintain homeostasis. When the lymphatic system is overwhelmed by the rate of capillary filtration it cannot carry the volume of fluid as fast as it is produced, and oedema develops. The movement of lymph fluid through the system is aided greatly by external forces: adjacent muscle contraction, tissue compression (e.g. massage, bandaging), and general stimulation (e.g. body movement, breathing). If healing progresses without complication, oedema begins to subside and motion is regained. However, if oedema persists beyond the normal healing period it can cause adverse effects, such as delayed healing, increased scar tissue, joint stiffness, pain, and consequently loss of function. How is oedema managed? At Hand Works we are specially trained in the use of techniques and tools to help reduce oedema rapidly and efficiently. Oedema control is of prime concern post injury or surgery to the hand and arm. The particular technique or tool used to help control oedema will depend on various factors, such as the type and location of oedema, the severity of oedema and how long oedema has been present for, as well as other personal factors including general health and presenting injury. Contact us should you need further assistance in managing your swelling.

Exercise Program

Movement is an important part of keeping all of our joints healthy and functional. In some instances a joint and surrounding tissues may need rest or immobilisation after an injury or surgery. An exercise program developed by Occupational Therapists at Hand Works can be an effective way to regain movement in a joint and maintain gliding between structures in the hand. Depending on the symptoms/injury a graded exercise program may be required to assist healing and remodelling as well as to regain movement. At Hand Works Occupational Therapy, therapists are highly trained in creating an exercise program which focuses on maintaining a balance between movement and rest. A tailored exercise program will be structured to promote an optimum recovery of your condition. To find out more about exercise programs, please contact us on 1300 887 798.

Lower limb casting

On recent discussion with our referring GP’s, the question as to whether we can provide casting for the lower extremity was raised. The answer is YES! The team at Hand Works Occupational Therapy can provide the option for either a waterproof or a standard fibreglass cast for the lower extremity. If you require the cast to be weight bearing, we can also provide a cast shoe at the time of consultation. So, instead of sending your patients to the ED to get a foot cast, why not send them down to one of our six easily accessible clinics?

Manual Oedema Mobilisation

Oedema is defined as an accumulation of excessive fluid in intercellular spaces. It is a natural byproduct of the healing process that changes as an injury advances through the stages of healing. Decreasing or managing oedema, especially in the sub acute or chronic stage, is of great importance to the therapists at Hand Works Occupational Therapy. Subacute and chronic oedema is high in protein and represents an overload of the lymphatic system. If left untreated it can contribute to fibrosis, stiffness and limited range of motion (ROM), all of which can directly impact on your patients’ recovery and functional outcomes. MEM is a specific treatment theory/technique that targets the lymphatic system through gentle stimulation to facilitate the flow of excessive tissue fluid and plasma proteins away from an area of oedema. The MEM technique consists of diaphragmatic breathing, light skin-traction massage, exercise, pump point stimulation and a self-management program. Techniques that utilise the same principles of MEM such as chip bags, low-stretch bandaging and Kinesiotaping may also be used in conjunction with MEM. MEM is only one type of oedema reduction technique that is offered at Hand Works Occupational Therapy. If you have a patient suffering chronic or subacute oedema, please feel free to refer them to Hand Works for assessment and treatment.

Strengthening

Strengthening programs are a routine aspect of a comprehensive treatment plan for most diagnostic groups seen at Hand Works. Strengthening may be targeted to a specific muscle group which was injured, or be a broader program applied to target multiple muscle groups or joints. Hand Works use specific exercises and integrate these during the therapy process as appropriate. Your therapist may begin strengthening exercises early in your therapy process, or they may need to be commenced later in your rehabilitation cycle, depending on your diagnosis and progression. Concentric, eccentric, and isometric exercises may be prescribed to a patient during their recovery, and graded or adapted as needed following evaluation by the therapist. A multitude of tools may be used when developing a resistive exercise program, including specialised tools used only in treatment sessions, as well as objects such as free weights, theraband or tubing, resistive sponges, theraputty, hand grippers, power balls, hand bars, and slosh pipes, which we can provide patients with to use at home or work, as part of their home exercise program. Common everyday items that patients have at home can also be integrated into their exercise schedules, to allow easy access to materials and increase adherence to therapy schedules. Research on proprioceptive rehabilitation is an emerging aspect in hand therapy in recent years, and Hand Works specifically integrate exercises which focus on proprioception rehabilitation when developing treatment plans. The overall aim of a strengthening program is to ensure that the patient reaches their pre-injury functional level to their best ability. Hand Works see patients from all walks of life and strengthening programs are developed to target their individual needs.

Sensory Re-education

Following an injury where nerves have been damaged, sensory re-education is a vital aspect of the rehabilitation process. Four major areas of sensory sensibility include touch, proprioception, pain, and temperature. Sensory re-education is a multimodal process, where the cortical integration of sensory re-education is an ongoing and ever changing process. Sensory re-education allows the hand to be a functional unit to recognise shapes, textures, pain stimuli, and modify grip force accordingly. Hyper or hypo-sensitivity may occur following injury, and sensory re-education may be targeted to one or both of these issues concurrently. If hypersensitivity occurs, then a desensitisation program is developed to gradually allow the patient to progressively tolerate more challenging stimuli. At Hand Works Occupational Therapy, we have an array of treatment modalities to perform sensory re-education tasks. The goal of sensory re-education is to normalise sensory input, improve processing of sensory pathways to the hand, and ultimately to regain optimum hand function. Throughout the rehabilitation process, we are also able to perform an array of sensory assessments which may be used as an outcome measure and to track nerve recovery. Some of the common sensory assessments that we use at Hand Works include the Semmes Weinstein Monofilament Test, the STI Test and the 2 point discrimination test.

Desensitisation

After an injury or surgery, an area of skin (commonly around the scar) can become extra sensitive or ‘hypersensitive’. Hypersensitivity in this context refers to a reaction of extreme discomfort or pain in response to a stimulus that is usually non-threatening and does not normally provoke pain. This is a common problem encountered in rehabilitation, particularly in the skin of the hands and fingers, and can stop the person from using their hand in everyday tasks as it is too painful or uncomfortable. Desensitisation is a treatment that involves exposing the skin and scar to many different textures to decrease sensitivity and encourage the person to use their hand or other affected body parts as normal again. It is common for people to protect the hypersensitive area; however it is important to expose the area to normal sensations in order to decrease sensitivity. The goal of desensitisation therapy is to decrease the painful and uncomfortable response that occurs when the hand is used or exposed to different textures, and to allow the person to return to using their hand for functional tasks. At Hand Works Occupational Therapy, we are able to form desensitisation programs to assist with your hypersensitive upper limbs and scars. We will be able to monitor your condition closely, recording progress and customising programs based on your symptoms. If you would like to know more about desensitisation and the treatments that we offer, please contact us on 1300 887 798.

Pain Management

The experience of pain is different for everyone, and at Hand Works we ensure that we listen to our patients and their individual needs, particularly if their presenting condition is centred around pain management. A thorough clinical evaluation of pain, including both subjective and objective methods, is completed at each appointment by our therapists. This will help formulate an appropriate treatment plan to manage both acute and chronic pain. Pain may be due to an acute injury, chronic injury, or the sequela of prior injury where pain develops as a secondary complication (e.g complex regional pain syndrome). Some physical treatment techniques that are used at Hand Works to manage pain include the following: Early mobilisation Stretches Heat (heat packs, paraffin wax) Soft tissue treatment Transcutaneous electrical nerve stimulation (TENS) InterX dynamic neuro-stimulation Desensitisation/resensitisation Mirror box therapy Functional use To find out more about our pain management program, do contact us on 1300 887 798.

Soft Tissue Therapy

As previously discussed under soft tissue conditions (myofascial trigger points can develop within our muscle groups, and cause patterns of both localised and referred pain. These trigger points can be released to decrease symptoms, and increase your overall muscle function. At Hand Works, we are able to complete soft tissue treatment to loosen up the involved muscle groups. If appropriate, your therapist will also introduce a stretching program for you, which will assist in the release of a trigger point. Stretching will also help to lengthen the muscle after the trigger points have been released, and allow you to use your muscle more efficiently to achieve greater movement of a joint. Soft tissue treatment assists with reducing pain, and allows tightly contracted muscles to lengthen, therefore increasing your flexibility and range of motion of a joint.

CPM

A Continuous Passive Motion (CPM) device allows controlled continuous passive range of motion in a reciprocal fashion to a joint. CPM has proven to be clinically effective in reducing post-operative pain, joint stiffness and oedema. At Hand Works, therapists may use the CPM to assist patients to increase, maintain and restore passive mobility, maintain gliding, simulate nutrient diffusion and decrease oedema and pain so that patients can return to their pre-injury leisure and work duties.

InterX

What is InterX Therapy? InterX Therapy is the targeted application of Interactive Neurostimulation to manage and relieve the symptoms of pain and injury. The procedure involves applying a hand held device directly to the skin over the injured or painful area. The sensation from the device resembles a tingling or vibrating sensation and is tailored to individual needs. InterX is different to TENS as the stimulation has an interactive nature guided by the machine’s ability to sense changes in the tissues being treated. The benefits may be experienced long term. Due to the machine’s ability to constantly adjust the waveform, there is much lower chance of the effectiveness of treatment decreasing over time as with TENS. Benefits of InterX Therapy includes: o Non-drug pain relief o Comfortable o Non-invasive application…no messy gel or stick on electrodes. o Easily combined with other therapies. o For some patients a home InterX unit can be arranged for treatment between clinic visits. o Can help with pain, swelling, bruising, muscle tightness and joint stiffness from chronic and acute conditions e.g. sports injuries, tendon injuries and conditions (eg overuse), nerve injuries and conditions, arthritis , fractures, complex Regional Pain Syndrome. InterX Therapy is safe when used by a trained professional. The equipment carries the European CE mark and is 510(k) cleared by the US FDA and Australian TGA as a pain management device. The therapists at Hand Works Occupational Therapy are trained in using InterX as a treatment modality and are happy to provide you with further information if you wish to know more about the device. Treatment sessions usually last 30 mins to 1 hr.