DRAFT: This module has unpublished changes.
23 September 2010
1:30-4:30pm 3 hours
Accumulated Hours: 9
Today I worked with Nicole and Anne in the hand therapy clinic at Physiotherapy Associates. After a few more sessions, I plan to pick either hand therapy (generally occupational therapy) or the other side with all around therapy without a specific focus (mostly physical therapy). Anne’s patient and my first encounter today was a middle aged man who cut off his middle finger just above the middle knuckle/joint with a band saw. He also cut his ring finger below where the nail starts completely off. The surgeon was able to reattach the middle finger however was not able to revive the tip of the ring finger. After surgery, physical therapy first attempts to reduce swelling and return motion through strength NOT force. Due to the injury, there are no longer working nerves within the middle finger, causing difficulty with adapting to grasping anything. As time progresses, therapy will allow for forced stretching, however in order to insure proper healing, no pressure can be applied as of today.
Nicole’s next patient had a joint replacement surgery in her middle finger in the middle joint. After surgery, she was placed in a splint to allow healing. The lack of motion over an extended period of time along with the general stiffness created by the new joint has caused the joint to lock, disabling the patient to bend her finger. Therapy at first involves bending from voluntary strength and power without any force from the therapist. Nicole created a tool out of splint material that allows the patient to exercise and the finger on her own.
Nicole’s last patient was a very interesting and unique case. After losing feeling in her arm, doctor’s discovered the patient had an extra bone in her neck attached to the breast bone and first rib (located near the breast bone). This bone pinched the nerve, tendon, and artery bundle near the shoulder. From there, a part of the artery flaked off and caused a blockage near the elbow, causing lack of nerve feeling in the lower arm and minimized blood flow. Doctor’s removed the extra bone by breaking it off the breast bone and rib, removing a muscle in the neck, and re-figuring the bundle of nerves, tendons, and arteries. Due to the fraying of nerve endings, the patient experienced false feelings with touch. For example, touching cotton balls felt like hot nails, and a towel felt like sand paper. The patient has received extensive physical therapy on her lower arm to regain strength and train her nerves. For nerve work the patient was given exercises including using rice and towels. She had to also stretch each finger and wrist as the lack of blood flow due to the bone caused tenseness and stiffness throughout the entire arm.
hand therapy uses a lot of repetition and is very tedious, which causes the patient to run through their charts by memorization. Heat seems to be used before therapy to loosen the region where ice is used at the end to reduce swelling. I think I might stick with occupational hand therapy.