Instructional Concurrent Session I
Beyond Exercises: Functional Dexterity Assessments and Purposeful Activity
Human movement requires integration of the musculoskeletal, sensorimotor and cortical systems to accomplish a functional task. Dysfunction in any system will reduce task performance proficiency. Dexterity is defined as skill and ease in performing tasks, especially with the hands.1 Synonyms include efficiency, delicacy, proficiency and finesse. As clinicians, we recognize dexterity or the lack of dexterity, but how do we measure it, document it and improve it following musculoskeletal or neurological injuries? This presentation will explore dexterity assessments of function and how they can be used to measure intervention outcomes. Integrative therapeutic activities beyond rote exercises will be demonstrated in order to address dexterity deficits and expand the clinicians’ toolbox.
- Attendees will describe the role of dexterity in hand function.
- Attendees will identify the best available dexterity assessment tools, their limitations and how to document the results.
- Attendees will understand the role of directed, purposeful activity in restoring dexterity and improving functional outcomes.
- Attendees will identify creative purposeful activities for improving dexterity and incorporate them into their clinical repertoire to improve functional outcomes.
Demystifying Boutonniere and Pseudo-Boutonniere Deformities
Boutonniere or pseudo boutonniere deformity is the term used to describe flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. It can result from pathology due to trauma, disease process or iatrogenic causes (i.e. post-surgical) at the PIP, DIP, or metacarpal-phalangeal (MCP) joints, resulting in increased tension on the flexor system and flexion at the PIP joint. This will subsequently produce hyperextension at the DIP joint. This results into the displacement of the conjoined lateral bands volar to the midline axis at the PIP joint, resulting into a boutonniere deformity. Boutonniere deformities are classified into three categories based on underlying etiology: extrinsic, associated with increased flexor tendon force at the PIP joint; intrinsic, due to reinforced action of the intrinsic muscle acting at the PIP joint; or articular, linked to changes in the PIP joint instability. Boutonniere deformities can be identified as correctable or fixed deformities, the latter potentially requiring surgical correction. The purpose of this instructional course is to assist participants in identifying early signs of boutonniere deformities, designing rehabilitation strategies to prevent fixed deformities, and explore post-operative therapeutic management.
- Understand the pathophysiology, biomechanical implications and classification of boutonniere deformities
- Explore therapeutic strategies to address boutonniere deformities, focusing on preventing fixed deformities
- Comprehend post-operative management of boutonniere deformities
Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
Many people who have been treated with chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN) that interferes with their activities of daily living and negatively impacts their overall quality of life. The seriousness of this problem is evident in that CIPN is the primary reason for patients to have to reduce or discontinue their chemotherapy treatment. This reduction or discontinuation of treatment can cause shortening of lifespans. As more aggressive pharmacological agents are developed and survival rates increase in the future, the number of people affected by CIPN is projected to grow. This presentation will 1) define CIPN; 2) demonstrate hand therapy evaluation techniques that focus on the unique characteristics of CIPN; and 3) present evidence-based interventions targeting the neuromuscular system. Suggestions for hand therapy home programs including therapeutic exercise, manual therapy, and sensory stimulation will be provided. Recommendations will be offered for program development including marketing strategies.
- Describe chemotherapy-induced peripheral neuropathy (CIPN) and its impact on hand function, life roles and overall quality of life
- Distinguish between signs of sensory pain and sensory impairment and apply this distinction to your clinical reasoning in treating CIPN
- Demonstrate 3 evidence-based hand therapy interventions for sensory impairment or sensory pain due to CIPN
- Provide a home program for symptom management that includes a client’s family member or significant other as appropriate
The Complexities of Upper Extremity Trauma: A Case by Case Examination of Individuals with Blast and Crush Injuries
This course will discuss the complexities and decision making processes when treating individuals following a blast or a crush injury. Participants will learn about the most recent evidenced based practices for wound care, early active range of motion, and edema and orthotic management. Additionally, topics will include the use of smart technologies and Telehealth programs to complement in-person treatment. Individuals will be able to identify the early signs of Post Traumatic Stress Disorder and will learn about screening tools available for their practices. A case by case examination will be used throughout this course to discuss complex injuries, and is intended for intermediate and advanced practitioners.
- Identify evidence based practices for wound care, early active motion protocols, and edema and orthotic management.
- Discuss the importance of using smart technologies and Telehealth programs to improve patient compliance and outcomes.
- Recognize the risk factors and identify the early signs of Post Traumatic Stress Disorder.