Importance of hand therapy

Howdy Folks

One of the first patients I encountered on my current placement in an acute neuro ward was a 80-ish year old man who presented with left-sided weakness, UL>LL and dysarthira following a R sided LACS. The main aim of treatment for him to was to increase the function of his left wrist, hand and fingers. He is L hand dominant. Until then he had been treated with exercises to facilitate wrist extension, finger extension, different grip positions and finger opposition, as well as FES for 30 mins a day to improve his L wrist extensor function. Exercises for him included picking up different sized blocks of foam, using a pincer grip to pick up cone-shaped objects and squeezing putty given to him by the OT. Further examination revealed that grasping and picking up and glass and bringing it to his mouth was a functional task that needed rehabilitating, on top of the manipulation defecits.

As you guys know, the UL was not something we spent a great deal of time on in our studies of neuro rehabiliation, particularly on the practical side of things. As such I felt quite unprepared to treat this man, and particularly how to progress treatment according to his level of recovery. On top of this, a number of physio's at the hospital have pointed out that, as we know, the hand and fingers represent a huge area in out sensory and motor homunculus, and therefore require a lot of cortical activation for there movement and re-training. Thus hand therapy is a tiresome job for patients and should be the priority of treatment if a number of impairments or functional tasks need attention and time is limited. This information has definately changed the way I think about sructuring my treatment sessions (if relevant to the patient).

Of course I made sure to read about treatment options for the hand, including sensory and motor re-training, and felt confident to being treating the man and offer suggestions for progression. This experience, and others, have really opened my eyes to some of the world of knowledge and treatment options that exists beyond our 2 year study at uni so far. With regard to the hand, I would love to hear what others have encountered on their neuro pracs, including occurence of presentation, treatment options and how patients have responded to such therapy. With regard to this man, I went in to treat him the following day, armed with my aresenal of awesome treatment options only to find he had been discharged! Bugger! But at least I feel more confident should I have to provide hand therapy in the future.