Common Occupational Therapy Issues
Management of Complex Regional pain Syndrome (CRPS)
We have a special interest in the management of CRPS in upper and lower limbs. Our approach is based on David Butler’s work in Adelaide and internationally on sensitisation of the nervous system. Our techniques vary with each patient to ensure the treatment is customised to meet the individual’s needs and rate of progress.
When symptoms such as pain, swelling and stiffness beyond what you would expect at that stage of recovery, hypersensitivity and temperature / colour changes in the skin start occurring, refer ASAP. We can often divert the course of this syndrome with the right education and handling.
Our treatment "tools" include:
- Patient education to help them to better understand their pain and how to manage it
- Use of imagined movements, laterality images and mirror therapy to “run the pathways” and refresh the homunculus
- Address the issues that impair function e.g. splinting one area to increase function
- Mobilisation techniques and soft tissue treatment
- Oedema management
- Desensitisation techniques
- Use of modalities such as ultrasound, low level laser therapy, ECell, TENS
- Graded return to home, work and leisure activities – e.g. using an FCE to determine physical restrictions for work, a worksite assessment to determine suitable duties and education regarding pacing and techniques to manage pain
:: back to top
Worksite Assessments (WSA)
Our therapists can design and monitor a suitable duties program (SDP) for an injured worker following:
- Functional assessment of the worker's capacities and limitations (either in our rooms or onsite)
- Discussion with the employer
- Liaising with the treating doctor/s and rehab providers
The SDP specifies the recommended duties, restrictions, hours and how the programme will be progressed over the specified time frame. The aim is to optimise safety during the return to work process, assist the worker to progress at a rate suited to their rehab needs and recommend modification to equipment, workstation or techniques if required.
:: back to top
Hand Therapy for Trigger fingers
Trigger finger is a painful condition that affects the bending and straightening of the finger or thumb. Trigger finger can feel like the finger / thumb is clicking or popping when it is moving as the tendon develops a lump / nodule, which makes it hard for the tendon to glide smoothly.
One of the first symptoms may be pain and tenderness at the base of the finger or thumb. The most common symptom however is the ‘triggering’ or ‘catching’ feeling when the finger or thumb is bent.
Our Occupational Therapists with a specialisation in Hand and UL Therapy can provide conservative treatment using:
- Task modification to reduce forceful repetitive movements
- Splinting to promote rest and altered use patterns
- Reducing the inflammation / irritation using massage, gentle stretches and therapy modalities such as ultrasound and low level laser
:: back to top
DVA Homefront Assessments
Do you look after any DVA clients?
The focus of DVA's Homefront program is to ensure that each veteran receives a visit from a health care professional in their home at least once every year.
- DVA White and Gold Card holders are entitled to a free Homefront home falls risk assessment every year
- DVA makes a financial contribution (approx $200 in October 2010) towards any recommended aids, minor home maintenance / modifications that will help reduce the risk of a fall – make sure your patients don’t miss out. The kinds of things this funding can be used for include hose reels, cordless large button phones, night lights, touch lamps, sensor lights, non-slip mats etc.
During a Homefront assessment it may be identified that the veteran is eligible for equipment e.g. grab rails, shower chair, overtoilet frame via the RAP (Rehabilitation Appliance Progam). The therapist will then contact the GP seeking a D904 or referral on the GPs letterhead so these recommendations can be facilitated. You can of course send this type of referral from the outset and we can organise the full range of options.
Helping you prevent falls and accidents at home...
:: back to top
Splints and Braces
- We have an extensive range of well fitting ready to wear braces which cater to injuries such as wrist ligament sprains, overuse injuries of the wrist and OA of the thumb CMC joint.
- We custom make a variety of splints (e.g. using thermoplastic, lycra or neoprene) if the ready to wear options are not going to meet the need.
- Thermoplastic splints can be immobilising (such as a wrist splint for a distal radius fracture) or mobilising / dynamic (for a stiff finger that needs prolonged stretch).
- We do not sell splints or braces over the counter (without a consult) as they are just one aspect of the treatment that is needed in most cases. Therefore we ask that people are referred for an initial assessment and the need for splinting / bracing is determined during the consult.
- The splint / brace can be fitted or custom made at the time of the appointment in the majority of cases.
Some of the common conditions we can splint and provide treatment for include:
- Wrist pain
- Fractured distal radius
- Ulnar collateral ligament strain of the thumb - "Gamekeeper’s Thumb"
- Tone management / positioning for hands with or at risk of contractures
- DeQuervain’s Tendinosis
- Carpal tunnel syndrome
- Trigger finger
- Mallet finger
:: back to top
Joint Protection for Arthritis of the Hands
Joint protection means just that – strategies used to protect the joints. Joint protection aims to reduce pain and swelling, maintain and improve function and help keep the joint intact.
Joint Protection Principles
We teach client joint protection principles such as:
- Respect Pain – Let pain be your guide
- Use larger joints and muscles – spread the strain
- Avoid staying in one position for too long and aim to be in a neutral position
- Avoid gripping too tightly
- Balance activity and rest – take breaks and pace yourself
- Keep the joints movin
- Use a splint or brace (and we have a great range of these)
- Change the way you do things to make them easier and less painful
- Use assistive equipment – for example:
- Button Hook
- Jar and Bottle Opener
- Built up Cutlery
- Lever and tap Turner
- Key Turner
- Modified Chopping Boards
- Self opening Scissors
- Modified Knife Handle
Some of the common conditions we can splint and provide treatment for include:
- Wrist pain
- Fractured distal radius
- Ulnar collateral ligament strain of the thumb - "Gamekeeper’s Thumb"
- Tone management / positioning for hands with or at risk of contractures
- DeQuervain’s Tendinosis
- Carpal tunnel syndrome
- Trigger finger
- Mallet finger
:: back to top
Tennis Elbow
What are the Occupational Therapy / Hand Therapy treatment options?
- Educating the patient re task modification, e.g. avoid doing tasks with the forearms pronated as this tends to overwork the wrist extensors when reaching and gripping.
- Treatment of the inflammation / degenerative changes - we may use heat / cold, ultrasound, E-Cell, myofascial release – lessening the pull from the chronically tight muscle lessens the aggravation at the tendon.
- Fabricating / fitting wrist splints to decrease the use of the wrist extensors and helps with retraining more appropriate ways to perform everyday tasks at home and work.
- Fitting a Counterforce Brace - only used occasionally, but can be useful for redirecting the wrist extensor's line of pull away from the lateral epicondyle, allowing the inflamed / irritated tissues to rest. Needs to be used in conjunction with other techniques.
- Worksite assessment - may be beneficial to identify the aggravating activities, make recommendations regarding suitable duties programs and / or modifications to the workplace environment or worker's technique.
For more information, please email mail@cairnsot.com.
:: back to top
Carpal Tunnel Syndrome in Pregnancy
During pregnancy, weight gain, the effect of the hormone relaxin and fluid retention can decrease the amount of space available in the carpal tunnel, placing increased pressure on the median nerve. This can cause bilateral pain, weakness / clumsiness and tingling or numbness in the thumb, index, middle and half of the ring finger. Pregnancy related CTS occurs in up to 35% of expectant mums. Onset is most commonly in the third trimester and continues until after delivery. A study by Turgut et al (2001) showed 23.9% of women who developed CTS in pregnancy had persisting symptoms at three months post partum and 10.9% of women found their symptoms persist for six months.
Pregnancy related CTS has been shown to respond well to therapy management prior to delivery and in the period following birth.
Cairns OT therapists can help relieve the symptoms of Carpal Tunnel Syndrome by:
- Reducing swelling by teaching retrograde massage and prescribing and fitting compression gloves
- Providing a lightweight splint or brace to keep the wrist in a neutral position and relieve pressure on the median nerve
- Providing information of task modification and pacing to help reduce the force and repetition of finger movement that exacerbates CTS
- Teaching exercises to help the median nerve to slide better in the surrounding tissues
Expectant mums often find treatment helps their sleep and their hands can function better during the day.
For more information, please email mail@cairnsot.com.
:: back to top
DeQuervain’s in New Mothers
Do you know any new mothers with pain in the radial (thumb) side of the wrist or base of the thumb? Does it hurt when they pick up the baby or when they move their thumb or wrist?
They may have DeQuervain’s Tendinosis. It is very common in new mothers, grandparents and child carers.
So what can you do… refer them to Cairns Occupational Therapy so we can:
- Teach them how to modify their daily activities and pace their tasks to reduce the use of the thumb. There are lots of ways to do this – we have detailed handouts for mums to take home.
- Help them to manage swelling and pain using heat, cold, ultrasound, soft tissue release etc.
- Fit a splint / brace that limits the movement of the thumb and wrist. This will make it easier to rest the area and stop the aggravating movements.
We know lots about this condition... Kerry has had first hand experience and has presented on the “Management of DeQuervain’s in New Mums” at the Australian Hand Therapy Conference and OT State Conference.
For more information, please email mail@cairnsot.com.
:: back to top
Rheumatoid Arthritis
Occupational therapists have a very important role in the treatment of RA, however it is very rare that our clinic receives referrals for this relatively common condition. So what can we do for your patients with RA?
- Give them practical advice on how they can overcome everyday problems e.g. to teach task modification and prescribe adaptive equipment.
- Discuss their condition, how it affects them and what they can do to help themselves e.g. energy conservation, joint protection.
- Fabrication of splints to rest or support painful or damaged joints
- Provide exercises and activities to help improve / maintain strength or movement
- Teach techniques to help the client cope with pain
- Offer a workplace advice to help people with arthritis work as comfortably as possible. We can visit the workplace and recommend options and resources for people remaining at, or returning to work once diagnosed with arthritis. We can also discuss with employers how they can best support their employee with RA.
- Offer a home assessment to provide advice on everyday activities that they might be having difficulty completing.
Referrals for RA are best to occur soon after diagnosis so that advice can be provided before significant damage to the joints. However, anybody with RA would benefit from a referral to review their current condition and prevent further damage to joints. These patients may be able to be funded under the Medicare EPC program.
For more information, please email mail@cairnsot.com.
:: back to top
Hand strength
Grip strength is affected by many conditions. Many factors such as hand dominance, fatigue age, state of nutrition, time of day, pain, sensory loss, restricted motion, and cooperation of the patient can influence the strength of the grip.
If your patients are experiencing:
- Decreasing hand strength
- Frequent dropping of items or
- Difficulty manipulating objects such as buttons, jars etc.
We can assist them with these issues by:
- Providing an in-depth assessment of their hands, to identify the causes of their symptoms. We may use the Jamar dynamometer to give an accurate measure of grip strength. A Pinch gauge is used to assess the various types of pinch grip. This is an important component for hand rehabilitation. It assesses the patient’s initial limitations and provides a quick reassessment of patient’s progress.
- Prescribing the ideal equipment to assist them in increasing their hand strength such as:
- Digiflex
- Theraputty
- Theraband
- Wrist cuffs
- Free weights
- Functional tasks
For more information, please email mail@cairnsot.com.
:: back to top
Scar Management
Do you have a patient with a post surgical scar that is hypersensitive, restrictive or simply making your patient self conscious? No matter how big or small, scars can have a big impact on how the patient feels about the success of their surgery, whether it be removal of a simple skin cancer or more invasive surgery.
We regularly help clients to optimise the scars that have occurred as a result of surgery, burns, lacerations, slow healing wounds and all manner of injury.
The cornerstone of scar management is to hasten wound healing, manage the oedema and utilise massage, compression and silicone mediums to speed up remodelling of the scar.
At Cairns Occupational Therapy we specialise in scar management. Our scar management program can include:
- The use of various silicon based products on keloid and hypertrophic scars. Silicone has been shown to minimise these types of scars by improving the texture and colour, reducing itching, softening and flattening the scar.
- Design of an exercise program to improve flexibility, through stretching. Stretching is very important if the scar covers a joint. Stretching can also help to reduce contraction as the force applied in the stretch opposes that of the contracting tissue.
- Scar massage to help the scar tissue grow back in a more similar way to its original state. This increases the flexibility, range of movement and also decreases itching. Massage should be dry skin on dry skin before moisturiser is applied.
- Deep tissue massage and myofascial releases
- Low level laser, heat and therapeutic ultrasound to reduce adhesions and density
- Compression garments – including arm sleeves, finger sleeves, leg garments (ready-to-wear and custom made)
- Prescription of silicone sheeting / gels
- Pressure therapy eg. compression garments, ear splints for ear-piecing scars
- Desensitisation programs and techniques for hypersensitivity
- Education for self management and help with regaining self-confidence for noticeable scars.
Monitoring of scars can be required over many months / years and changes are often implemented as scar remodelling occurs.
For more information, please email mail@cairnsot.com.
:: back to top
Home Assessment
Our Occupational Therapists can improve your safety and independence
OT home assessments address:
- Management of ADL including all transfers and mobility
- Manual handling skills/equipment for carers
- Falls risk assessment
- Prescription of assistive equipment, home modifications and personal alarms
Target groups:
- DVA gold card holder
- DVA white card holders –conditions apply
- Privately insured and Self funded
- Compensable patients e.g. WorkCover Qld, CTP claimant
Referrals:
These are via a GP using either a D904 or doctor’s letterhead including personal and clinical details.
For more information, please email mail@cairnsot.com.
:: back to top
Post Mastectomy Intervention
Cairns Occupational Therapy can help:
- Improving arm movement and prevent stiffness and tight muscles affecting everyday tasks.
- Improving the appearance of scars, +/- implants and reducing the impact of scarring on lymphatic drainage and shoulder movement.
- Teaching how to improve lymphatic drainage and reducing the risks of developing chronic oedema / lymphoedema.
- Teaching self-management of lymphoedema, if it does occur, via massage, exercises, compression bandaging / garments if necessary.
Patients can be referred by GPs, Specialists, allied health providers or themselves. Often treatment is best implemented pre-op or in the first few weeks after surgery, but it is never too late.
For more information, please email mail@cairnsot.com.
:: back to top
Pre Employment Screenings
A pre-employment functional screening (PES) is an adjunct to a pre-employment medical assessment. It provides an objective measure of a person’s ability to physically perform a job. It is based on a task analysis that examines the critical physical demands of a specific role.
Our Occupational Therapists conduct an assessment of an individual's ability to complete the physical tasks inherent to a specific job. The PES report provides the employer with a clear indication of an individual’s suitability to perform the physical demands of a job and thus minimise the risk of them sustaining a physical injury.
A pre-employment screening is often seen by employers as an integral component of a job seeker’s employment application and costs the employer approximately $150 (excl GST) per person.
For more information, please email mail@cairnsot.com.
:: back to top
Getting comfortable at your desk
This info sheet is designed to help you be more comfortable at work. Whether you spend five minutes or five hours using your keyboard, mouse, or trackball, these suggestions can help you and your staff stay comfortable and productive.
Adjust Your Chair
When was the last time you adjusted your chair? Is it set up the right way for you? Follow these steps for an immediate increase in comfort and support.
Adjust the height of your chair: Your chair should be at a height that facilitates good upper limb use. The height of the chair is often determined by the height of the desk that you are using. Try and position yourself so that the keyboard, mouse, or trackball are at or below elbow height. Do your feet feel well supported? If not, you may need a foot rest (an old phone book works well!)
Adjust the height of your back rest: Most desk chairs have a lumbar support – but is yours in the correct position? A good way to ensure that the position is supporting the natural curves of the back is to run your fingers horizontally from the top of your hips around to your spine. Where your fingers meet should be where the middle of the lumbar support sits. If you are tall you may find comfort from a back support which supports both your lumbar and thoracic spine.
Adjust the tilt of your back rest: How often do you find yourself leaning forward to type or write leaving the back rest behind? Most chairs have a lever to adjust the tilt of your back rest, so if you tend to lean forward set the back rest on a forward tilt. Try different positions until you find one which is both comfortable and supportive.
Adjust the tilt of your seat: If possible, slope the seat slightly forward to facilitate proper knee position.
Reposition Your Screen
Your computer monitor should be arms length away (finger tips should touch screen when elbow is extended) with the top of the screen at eye level or slightly lower
Reposition Your Materials
Have a look around your desk. Are you constantly reaching for books and stationary? Try and position items depending on their frequency of use. Put materials you use the most closest to you. Put materials that you use occasionally no further than an arm’s length away to avoid over-reaching. Put your most infrequently used materials further away, but consider convenience.
Do you use a wrist rest? Avoid planting your wrist on it, particularly when you are typing. Glide your wrist over it and use it only as a reminder to keep your wrists straight.
Still not comfy? An individual ergonomic assessment can find the solution for you and your staff. Give us a call.
For more information, please email mail@cairnsot.com.
:: back to top
