Hand Therapy Explained: What Happens After the Surgeon Finishes?

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every day, millions of Australians go about tasks so ordinary.
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We barely notice them.
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From preparing breakfast to tapping on a keyboard, but for patients recovering from an illness or injury that affects the use of their hand, even the simplest task can suddenly feel impossible.
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Today on Aussie Med Ed, we are exploring the world of hand therapy.
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In the profession of occupational therapy, the profession dedicated to restoring meaningful daily function.
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Now this work becomes even more specialized when we zoom in on the hand, one of the most intricate tools of the human body.
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Good day and welcome to Aussie Med Ed.
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The Aussie style Medical podcast a pragmatic and relaxed medical podcast designed for medical students and general practitioners where we explore relevant and practical medical topics with expert specialists.
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Hosted by myself, Gavin Nimon, an orthopaedic surgeon, this podcast provides insightful discussions to enhance your clinical knowledge without unnecessary jargon.
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I'd like to start the podcast by acknowledging the Kaurna people as the traditional custodians of the land on which this podcast is produced.
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I'd like to pay my respects to the elders, both past, present, and emerging, and recognizing their ongoing connection to land, waters, and culture.
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I'd like to remind you that all the information presented today is just one opinion, and there are numerous ways of treating all medical conditions.
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It's just general advice and may vary depending upon the region in which you're practicing or being treated.
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The information may not be appropriate for your situation or health condition.
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And you should always seek the advice from your health professionals in the area in which you live.
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Joining us today is Charlotte Nash, an experienced occupational therapist and accredited hand therapist, and the proprietor of full circle hand therapy.
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She's dedicated her career to upper limb rehabilitation, guiding patients through recovery from injury, surgery, and chronic conditions affecting the hand, wrist, and elbow.
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Through full circle hand therapy Charlotte leads a multidisciplinary team, that works closely with GP's, surgeons and other allied health professionals to deliver evidence-based patient-centered rehabilitation.
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it's great to have Charlotte Aussie Med Ed today.
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Part of full disclosure, one of the locations of Full Circle hand therapy is in my rooms here in Glenelg, and as such, we often work in collaboration caring for patients.
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Welcome, Charlotte.
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Thanks very much for coming on.
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Aussie Med Ed.
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Lovely to be here.
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Thank you for inviting me.
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I thought I'd start off, Charlotte, I really asking you to describe what actually is occupational therapy.
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perhaps from a patient's perspective, medical student's perspective, what does it involve and how will they encounter you in day-to-day life
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in day-to-day life?
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In a general OT sense, you would be, you'd usually see an OT in a hospital setting or be referred once you are starting to move through that rehabilitation process.
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I describe as OTs, as the person in your life when you've had anything that impacts how you were previously functioning in your life.
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And we help you create essentially a ladder to get over the wall.
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That is the thing that disrupted your life.
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So that could be anything from a mental health issue.
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It could be a spinal injury, it could be a brain injury, it could be just dealing with that transition As we age through life in children, it can be what some sort of diagnosis that may be preventing that child getting the best out of their life in their future.
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And OTs will look at how that person may be previously functioned, or that family or community functioned around that person, and try to find tools to create a scaffold to help you over the mountain that might be the incident you've had in your life, whether that's a physical, emotional, or a neurological type injury.
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And obviously for me, in our space that we work in, we are often dealing with the physical side of an injury.
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However, it's incredible how much we have to engage that person psychologically to get the best, get them back into their best function in life.
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So there's a real holistic approach to assessing and real function based approach.
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Is that correct?
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We really do and that's why a lot of our sessions, I always tell patients I'm very nosy.
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I ask lots of questions and it all sounds just like I'm just being distracting and everything.
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But what I'm really trying to ascertain is what makes this person tick and how am I going to get that person engaged in rehab to then get them the best outcomes and get them back into their life with as few complications as possible.
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So really that's the core philosophy behind occupational therapy.
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And how does it really work in real practice, perhaps when they patient comes along to see you, what does an assessment involve?
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Really we're looking at how that, we're trying to understand the trauma they've had from a medical perspective.
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Again, in my role, we're dealing with physical injuries and we're trying to assess how to best engage that person in the rehabilitation process, whether they're a young, 20-year-old football player or they're more elderly and looking at trying to get back into their sort of hobbies in retirement.
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We're trying to pick do they have children at home?
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Do they have a dog they like to take out running?
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We're trying to get an assessment of who the person is and how they function in their world, where the big sort of things that maybe we are gonna have to slow them down a bit.
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So if they're just had a distal radius ORIF (open reduction internal fixation) we are not gonna be really letting them back on to play football for the next few weeks and how to give that information carefully.
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But also looking at in that timeframe, what can they be doing to get back to that goal as quickly as possible.
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So we're trying to find the really small parts of any task that we can let them do to make sure they feel like they're getting back into things as quickly as possible.
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As opposed to the old adage of pop it in a sling and don't use it for six weeks or something like that.
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We are looking at, even if it's something tiny like they can.
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Play a little bit.
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And sometimes parents don't always like me.
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With the younger ones, I say, actually a bit of rehab with using your hand and playing some computer games is actually not the worst thing in the world because at least we're doing something engaging.
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Yeah.
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Of obviously any injury can take a long time to recover from.
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Yes.
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And you can't just wait for that to recover before you start the process.
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we'll start as early as medically viable for that person and for some injuries that could be the four days post-op.
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For some people we give more like 10, 10 days post-op, but we are trying to find even the smallest little hook of engagement and rehab that we can at the earliest possible opportunity.
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And certainly you guys fit under the allied health profession?
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Yes.
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of which probably the average listener will know the physiotherapist is probably the well, known allied health professional.
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How do you differ from physiotherapy
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in a basic OT and physio stance?
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Sort of when you're looking at the, those general cohorts of Allied health, I find that physio is very much about getting the muscle and the joint moving in a controlled setting.
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So you might be post hip surgery and we are looking at specifically getting certain goals of range of motion in a controlled environment.
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So that might be in the hospital on the ward, in the physio gym Once we're starting to look at occupational therapy getting involved, we are looking at what's the home environment we're trying to get that person home to?
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Do we need a different height chair, Do we need some help getting in and out of bed?
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And we are looking at how we are combining, what the physio's achieving with getting increased range of motion and increased strength.
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And we're looking at how we're going to put that into the home situation or into the community driving, all those sorts of different things.
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And we're also looking at how are they gonna engage in exercise.
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As well.
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Like how are we gonna get this medical environment where we've got someone pushing you three, four times a day, someone to be there.
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the patient has to take that on themselves and they have to go from patient to client and take control of their own rehabilitation process and put them back in the driving seat.
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Brilliant.
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In hand therapy.
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Little bit different as a subspecialty of occupational therapy 'cause you can be a physio or an OT to subspecialize into hand therapy.
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And at that point, once we have our accreditation as a hand therapist, we are performing a very similar role.
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Like I would interchange in and out with a physiotherapy quite easily.
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We are doing the same exercises, same splinting.
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The physios I find tend get a lot of their, their training when they're going through their accreditation process is sometimes looking more at what those OT skills are and how we get that engagement.
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And the OTs doing the accreditation process have to really drill down on their anatomy and their exercises and becoming, so we fill the gaps of each other in the hand therapy space to come together as an accredited hand therapist.
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And I'd say we are very interchangeable in that subspecialty, but yet in the community you'll see that we've got slightly different roles.
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Sure.
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So that obviously brings me into the idea that o Occupational therapy is a university degree you obtained.
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Yes.
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And does it vary between different countries and how many years would've been involved?
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Yeah, so it's generally a four year degree similar to physio in that regards because I think both physio and OT have got that prac component.
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So essentially in both of those degrees, there's essentially a year of that degree is prac.
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So we're out in the community learning those different roles.
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We have a international World Occupational Therapy Foundation, which is the accrediting board for all OT degrees.
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So anywhere that is accredited has to meet certain standards for the OT degree to be recognized as an OT degree or it doesn't get accreditation.
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So we have all our, have our different registration boards in different countries, however.
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They have to be an accredited degree.
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You can't just create an OT degree without that.
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International accreditation.
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Brilliant.
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And then the obviously different subspecialties you've mentioned hand therapy, which is your area.
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Yeah.
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What, how many other main subspecialties are there for occupational therapy?
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The ones I would think of at the top of my head, obviously pediatrics is a huge area.
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Then we've got geriatrics.
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So at each end of the age spectrum then you would have things like prescription, wheelchair fitting, vision, OTs, people who deal specifically with people with vision issues, low vision.
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Driving is a big one.
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So there is a whole group that is just on, competent to drive.
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And those driving assessors, we would then have neuro burns.
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Burns is a little bit hand therapy as well.
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Acquired brain injuries.
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Then we would have, Community OTs and home modifications is another and I'm talking more complex home modifications.
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We're all able to put a grab bar in, but I'm talking a full bathroom renovation hoist that complex.
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Home modifications
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Occupational therapists fit into occupational assessments as well following your work cover injury, for
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instance?
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Yes.
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Yeah.
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Occupational rehabilitation, that's actually where I started,
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right.
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Was in that occupational rehabilitation space where you're trying to understand a whole range of different types of employment and what effect that has on the body, and how different injuries will require a different pathway to get that person back to that working space.
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You've headed down the pathway of hand therapy.
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How much further training is that involved?
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It's probably one of the more involved ones we, in Australia, uk, US Europe, you have a sub specialty board.
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So in Australia it's called the Australian Hand Therapy Association.
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And essentially it takes two years worth of training, which you can spread out over five.
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But once you hit five years, you have to start redoing courses to become an accredited hand therapist.
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So you can join as an associate member so long as you've got sort of 12 months experience.
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And you've usually need a letter from an accredited hand therapist to say, yes, this person is good to join our association.
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And then once you're on that associate pathway, you're generally participating in that accreditation journey, which requires you must do certain.
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Accredited courses.
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So again, the A HTA has run through and accredited ISOs accredited courses to meet certain standards.
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There's four foundation courses.
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Then we have to do electives and you have to do so many hours of mentoring and practical experience within just hand therapy.
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So only the hours that you do, which are hand therapy related count to that.
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And once you've ticked those things off, then you go, you complete that accreditation process.
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In America, they have what's called the certified hand therapist exam.
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Right,
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which is a four hour exam.
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and you have to have done so many hours practical to be able to sit that exam.
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and that's made up part of my accreditation pathway with the Australian Hand Therapy Association.
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Excellent.
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And what took you down that path?
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Why did you decide to head down the path of hand therapy?
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I can remember and when I applied to do occupational therapy, like probably a lot of people didn't really understand a hundred percent of what was involved in the degree.
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And I can remember studying this degree going, this is good.
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But I hadn't quite found what made me tick.
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And then we started our semester in hand therapy and splinting.
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And I can remember coming out of my first anatomy lecture and it was like the moment I went, this is amazing.
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This is what I wanna do.
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I loved my anatomy labs, I love human biology and biochemistry, And that all coalesced into that first lecture on a hand therapy.
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And I was like, that's my pathway.
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So what are the main conditions you might see as a hand therapist?
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I know there's a large number.
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What are the main ones you come across?
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We would see, I tend to break them into what we would look at as a conservative group of injuries where we're trying to manage people and avoid having to go down that surgical pathway.
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And that would be a lot of tendinopathies overuse injuries.
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Yeah, anything that has a high inflammation background, like it's an, we are managing an inflammatory response to arthritises.
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Again, just trying to help people manage pain and discomfort.
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And then we've got our postoperative type conditions.
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Some of those are like if you've got carpal tunnel, we might do a bit conservatively to see if we can help that person.
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And then that might be a postoperative carpal tunnel as well.
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Lots of Orthopaedic things like the wrist fractures, distal radius, wrist fractures, Phalangeal fractures, metacarpal fractures, issues with the carpal bones, ligamentous repairs, and stabilizations, again, postoperatively.
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Then we would have looking into different soft tissues.
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Things like flexer tendon repairs, extensor tendon repairs, grafts, skin issues, flaps, things like that.
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Brilliant.
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So yeah, so We do tend to look at things, conservative or postoperative, and we have different ways of managing those different pathways.
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So deQuervain's (tenosynovitis) is quite common.
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pre and post, we've got tennis elbow, golfers elbow less common, the neuropathies, median nerve, radial nerve, ulnar nerve.
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Trying to help people manage those sorts of things.
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And these could be caused by cumulative type buildup or trauma, or they could be caused acutely by an incident depending on
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What about things like post-stroke recovery?
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Are you involved in that as well?
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Yes, definitely, because you'll get that hemiplegic effect.
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We would obviously be focused on the upper quadrant, same with like cerebral palsy anything like that where you've got loss of function in that upper quadrant.
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In our background.
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Obviously in hand therapy, we're obviously focused here, but then in the broader space of someone who has had a stroke, it would be looking at that whole person and how that whole person as an OT assists that person getting their function back and goes back into that home environment post rehab.
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One of the more common things I see that usually I think would be better be seen straight off with the hand therapist, be something like proximal interphalangeal injury, joint injury Are there other conditions too that you might see that a GP could really refer straight off to you first?
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certainly tennis elbow is one because we would like to try it.
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Try a lot of conservative measures with that prior to any sort of surgical intervention.
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deQuervain's again, that's another good one.
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If we catch things early and we've got a window where we are not getting into quite an entrenched pattern of injury, then the deQuervain's, carpal tunnels any sort of flexor or extensor tenosynovitis where we can try to rest and mobilize at the same time is quite useful.
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That works quite well in combination.
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If that person doesn't respond reasonably quickly then combining that with a cortisone injection and that rehabilitative process or the, while monitoring at what point we're like, we need to get that surgeon involved and take that next step.
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I sort of describe it to people as like the management ladder and if we check these things off, then We providing best care.
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Yeah, certainly trying non-operative measures and being supported by Allied Health like yourselves is a first line of treatment for most things that.
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Don't need urgent surgery, that's for sure.
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Are there things that worry you when you see them?
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that have really worried you and send 'em straight back to a surgeon or a general practitioner
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I think when looking at pain management, how that person is coping with the injury and how that initial response is being managed, and how that person psychologically is managing that injury.
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And that's where we might look at getting even psychology or adjustment to injury and counseling put in place really quickly so that person can just have a bit of that catastrophizing to settle down a little bit more.
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from a clinical perspective, if we're looking at something where we see.
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There's abnormal amounts of swelling or the pain is very acute.
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or trigger finger, if we've got locking happening, if we've got more significant factors than what we can think, we will manage, we'll get someone involved straight away.
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Because I do believe that getting people through that early intervention and getting things before they become chronic is really important.
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So I would be saying that, yeah there's that psychological profile, but there's also that immune response profile.
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Maybe if someone has got underlying conditions, do we have diabetes, do we have history of immune issues, cancers, anything like that, then we start to need to make sure that we're not missing anything.
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And obviously if we've got any concerns, things like making sure we're getting the radiology involved.
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So someone might come to me and they may have come from the trainer on the football field and they go, oh, just dislocated.
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Did it just dislocate?
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So I want to be making sure that I have not yet got my x-ray vision installed, so I need to make sure I've got radiology behind me.
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Have we got actual evidence that this is just a dislocation or do we have a fracture that we're actually dealing with as well?
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Anything where I see something with, if it's an acute injury, if I see really deep bruising, so it might not be extensive, but you'd have that really deep purple bruising coming out within 24 hours.
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I'm like, that's quite fracture risk.
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So I'm really looking at those acute and like very point tender, swollen immediately, deep bruising.
00:19:59.962 --> 00:20:05.812
I make sure I get that rechecked and scanned and that quick pathway might be a GP just to say, can we get a referral?
00:20:06.082 --> 00:20:16.882
If we know someone is down there and I'm only quite worried, I'll just reach out straight away and say, it may not always be the most right pathway, but my main thing is getting people the care they need really quickly.
00:20:17.122 --> 00:20:19.582
So what you're saying is of anything significant that.
00:20:19.597 --> 00:20:21.087
Is more than a minor trauma.
00:20:21.327 --> 00:20:23.097
You're always worried about a fracture being missed
00:20:23.097 --> 00:20:24.562
Even same with infection.
00:20:24.562 --> 00:20:37.327
Like you can have someone come in and then, but by the time they get to you 24, 48, 72 hours later, if there's an, there's a different type of redness that I always say is angry.
00:20:37.927 --> 00:20:50.467
If we've got any signs and that could, it could be anything from a cellulitis to someone having a hematoma that created an abscess or they've had surgery and it's six weeks later and something has gone amiss.
00:20:50.497 --> 00:20:54.787
And if I'm seeing angry signs of infection, I'm not missing a beat on that.
00:20:54.787 --> 00:21:02.167
I'm making sure that someone is checking that out really quickly because again, getting control of an infection is really important quickly.
00:21:02.437 --> 00:21:02.677
Yeah.
00:21:02.797 --> 00:21:03.937
And not letting it linger.
00:21:04.267 --> 00:21:06.277
So make sure we don't miss a fracture or infection.
00:21:06.887 --> 00:21:06.947
Yeah.
00:21:06.947 --> 00:21:15.137
And I think part of that is I was, I remember having a, this was more, probably more of a pain thing where you've got two cases.
00:21:15.137 --> 00:21:27.527
One is the football player on field does a fractured middle phalanx barely skips a beat, straps it up, trainer, put some of the magic cold spray on, put some tape on back on the field, plays the rest of the game.
00:21:27.557 --> 00:21:36.557
Then you've got the solo violinist about to go into her major concerto season for the year and she slams her finger in the car door as she gets out.
00:21:37.277 --> 00:21:41.267
Same fracture, completely different psychological management.
00:21:42.107 --> 00:21:42.197
Yeah.
00:21:42.827 --> 00:21:54.767
The anxiety, the stress and everything about a finger being injured for the violinist is completely acutely a different management pathway to the football player who's gone and played another 90 minutes of football with their broken finger.
00:21:54.887 --> 00:21:55.187
Yeah.
00:21:55.367 --> 00:21:58.457
And just how you manage those expectations can create Yep.
00:21:58.457 --> 00:22:02.507
The injury is the same, but the pathways of how we get to that end point can be quite different.
00:22:02.927 --> 00:22:03.167
Yeah.
00:22:03.407 --> 00:22:05.417
So you gotta assess the whole patient as we do.
00:22:06.437 --> 00:22:06.617
Yeah.
00:22:06.627 --> 00:22:09.807
obviously you can't really manage a patient with one consult.
00:22:10.197 --> 00:22:10.257
No.
00:22:10.307 --> 00:22:18.279
And obviously you have to assess a patient first, ascertain what their problem is, and coordinate a program for that individual.
00:22:18.519 --> 00:22:24.519
generally speaking where that first consultation, and often, this is what I say to my team of therapists.
00:22:25.269 --> 00:22:26.409
Things are getting tricky.
00:22:26.679 --> 00:22:30.489
So if that person has come in, that person needs to leave safe.
00:22:31.089 --> 00:22:32.259
So that's our first goal.
00:22:32.259 --> 00:22:40.539
So that first consultation, if there's a fracture, if there's a surgical intervention that's being done, we need to make that person safe to go home.
00:22:40.539 --> 00:22:46.624
So that will be, if you've taken a backslab off, usually there's an expectation we might be putting a splint back on.
00:22:46.894 --> 00:22:50.234
Have they got the right bandages to keep their dressing safe?
00:22:50.264 --> 00:22:51.314
is the person safe?
00:22:51.854 --> 00:22:52.814
And that's the first goal.
00:22:52.814 --> 00:23:00.814
So we'll be getting information on the op note from the operation note from the surgeon, or we'll be reviewing the referral that's been coming through.
00:23:01.054 --> 00:23:02.764
We will then review x-rays.
00:23:02.764 --> 00:23:10.204
And even though the person might say yeah, it's fractured, you'll often find us seeking the actual x-ray so that we can see exactly where it's fractured.
00:23:10.204 --> 00:23:17.344
Because a mid shaft metacarpal fracture is very different to a proximal metacarpal fracture and how we manage a distal metacarpal fracture.
00:23:17.884 --> 00:23:30.664
So we want to ideally be visualizing where a fracture is what zone a tendon has been lacerated in to be creating then the pathway for the type of splint we're choosing and the exercises that we're choosing.
00:23:31.084 --> 00:23:45.094
So typically you would see us, we would be reviewing those documentations, looking at the actual hand and seeing what that hand requires, seeing what the expectations are of the patient and how we match a splint and a rehab program to that person.
00:23:45.424 --> 00:23:54.694
You would usually go away from that initial consult with some sort of device if appropriate, and the first three to five exercises that we want you getting on with.
00:23:55.024 --> 00:23:58.924
Then we would have either weekly or fortnightly appointments depending on the injury.
00:23:59.674 --> 00:24:02.306
And obviously every injury depends on how quickly they recover.
00:24:02.516 --> 00:24:02.666
Yep.
00:24:02.906 --> 00:24:05.996
Tendonitis would normally take about three to four months to really settle down.
00:24:06.086 --> 00:24:06.386
Yep.
00:24:06.446 --> 00:24:09.536
While a fracture can often, we're talking about four to six weeks, depending on.
00:24:09.572 --> 00:24:10.142
location.
00:24:10.292 --> 00:24:10.622
Yep.
00:24:10.772 --> 00:24:10.982
Yeah.
00:24:11.072 --> 00:24:16.952
And different ways people, some people will regain their range of motion back at different rates to other people.
00:24:17.252 --> 00:24:22.622
Some people will have different swelling responses.
00:24:22.622 --> 00:24:24.902
Like some people you can't push as hard as other people.
00:24:24.932 --> 00:24:32.202
'cause if we get the swelling is problematic, then we're just creating more dramas and more problem how stable the fracture is.
00:24:32.292 --> 00:24:37.252
And that can be a tricky one on the operation report.
00:24:37.282 --> 00:24:43.012
'cause we want to be getting a feel for how stable we think the surgeon has been able to secure that fracture.
00:24:43.012 --> 00:24:51.662
do we need to slow that person down, keep things a bit more steady or have we got great screw fixation and we can move that pretty much normally from the get go.
00:24:52.142 --> 00:24:52.412
Yeah.
00:24:52.742 --> 00:24:53.282
Excellent.
00:24:53.582 --> 00:24:59.312
And the idea would be as we are only immobilizing what needs to be immobilized.
00:24:59.612 --> 00:25:02.792
So if we don't have to have a wrist involved, we won't include a wrist.
00:25:02.792 --> 00:25:05.477
If we don't have to have fingers splintered.
00:25:05.567 --> 00:25:07.607
We won't be splinting unnecessary joints.
00:25:07.607 --> 00:25:13.877
we want to be providing the most effective immobilization as possible so that everything else can be mobilized.
00:25:14.297 --> 00:25:14.537
Yeah.
00:25:14.537 --> 00:25:17.597
And obviously in the days gone by, but there used to be plaster of Paris.
00:25:17.602 --> 00:25:17.702
Yes.
00:25:17.772 --> 00:25:18.512
it never goes off.
00:25:18.857 --> 00:25:23.747
I've still got Plaster Paris, which I bought 20 years ago, which I still haven't got through because we hardly ever use it.
00:25:23.807 --> 00:25:24.827
Still a useful tool.
00:25:24.827 --> 00:25:29.057
I still for some conditions, still pull out the plaster of Paris.
00:25:29.267 --> 00:25:29.447
Right.
00:25:29.637 --> 00:25:30.897
Which is quite interesting.
00:25:30.927 --> 00:25:41.397
But yes, typically these days we are using the low temperature thermoplastics, which are strong light, durable remoldable, which I think is important.
00:25:41.607 --> 00:25:46.797
We don't, every time a person needs a change made to a splint, we are remolding the old splint.
00:25:47.327 --> 00:25:48.647
And we are trimming it down.
00:25:48.647 --> 00:25:55.562
So we might start with a. A wrist splint to the pip PJs down to the two thirds forearm.
00:25:55.892 --> 00:26:04.052
But every sort of week we're making it smaller and smaller so that as the injury heals, we're freeing the joints that don't need to be stabilized anymore.
00:26:04.172 --> 00:26:07.772
So these are those large sheets of plastic which heat up in a hot water.
00:26:07.822 --> 00:26:11.992
And then molded to the patient, perhaps you can show us a few on our little demonstration mat here.
00:26:12.022 --> 00:26:13.222
So I've got a few classics.
00:26:13.342 --> 00:26:25.152
So this one, this would be a classic splint that most graduates or university students are learning how to make at university level called a posi splint or position of safe.
00:26:25.202 --> 00:26:25.982
immobilization.
00:26:26.872 --> 00:26:33.462
This would be seen in neuro situations or in ICU where someone has a stroke and we're trying to prevent contracted.
00:26:33.927 --> 00:26:35.727
Down hands and fists like this.
00:26:35.727 --> 00:26:35.907
So
00:26:35.907 --> 00:26:46.167
this is a, this is for the listener is a one that's going over the forearm and on the Palmer side, what we call the volar side of the hand And then also incorporating the thumb in it in this particular one.
00:26:46.497 --> 00:26:46.737
Yep.
00:26:46.737 --> 00:26:48.777
So thumb is included.
00:26:48.777 --> 00:26:50.967
Fingers are slightly and comfortably extended.
00:26:51.627 --> 00:26:59.727
It's a bit of a workhorse in the OT world for splinting because it's got multiple different applications.
00:26:59.757 --> 00:27:09.017
Essentially it is immobilizing the DIPs PIPs, MCPs, wrist, and then similar joints like all the way to the tip of the thumb.
00:27:09.677 --> 00:27:10.667
And we would.
00:27:11.012 --> 00:27:16.772
Yeah, that might be used preventatively to prevent contractures, to prevent deformity, to maintain web spaces.
00:27:17.162 --> 00:27:23.272
Or it may be used if someone has had lots of extensor tendon injuries and we just need to get a bit of stillness and rest.
00:27:23.272 --> 00:27:24.322
It's a bit of a workhorse.
00:27:24.442 --> 00:27:27.772
And the ideal positioning for the MCPs and the PIPs in that scenario?
00:27:27.892 --> 00:27:33.492
In that scenario, we would say about 70 degree flexion at the MCPs.
00:27:33.532 --> 00:27:37.042
And we like to have our ips out reasonably straight.
00:27:37.042 --> 00:27:40.822
And then the thumb is slightly or comfortably positioned in opposition.
00:27:41.032 --> 00:27:44.932
Slight flexion at the mp, probably IP straight.
00:27:44.992 --> 00:27:48.532
But you're also wanting to balance, especially if someone has tone.
00:27:48.532 --> 00:27:56.812
So if they've had a. Injury that affects like stroke, a spinal injury or they've got a, some sort of neurological situation.
00:27:57.052 --> 00:28:07.462
If someone's really flexing down, if we put them into the position that we want and don't give any care for what the body's actually doing, you can get pressure injuries under the fingers.
00:28:07.462 --> 00:28:09.592
So it's sometimes it's not always the perfect position.
00:28:09.592 --> 00:28:18.622
You might have some flexion or not quite full wrist extension, but you want that balance between not having a thumb clenched inside a fist and not being able to get hygiene.
00:28:19.672 --> 00:28:28.552
But we want something sort of comfortable and open so that when that person gradually recovers, we are not having to deal with fixed flexion deformities and things like that.
00:28:28.822 --> 00:28:29.302
Excellent.
00:28:30.202 --> 00:28:34.912
So then we've got another workhorse in the OT world, which is called a thumb Spica.
00:28:35.632 --> 00:28:46.107
This is forearm based in this example and this immobilizes, the thumb and the wrist, again, different applications will require different.
00:28:47.267 --> 00:28:47.957
Positioning.
00:28:48.047 --> 00:28:55.187
So if we've got someone who's got a scaphoid fracture we will be making sure that the fractures aligned in the right position.
00:28:55.187 --> 00:29:01.187
If we are looking at more of a wrist issue, then we're changing the positioning of things ever so slightly.
00:29:01.187 --> 00:29:11.867
But key thing we're looking at is making sure we've got full range of motion in this instance of the fingers and in this splint we can mobilize the IP joints so someone's got reasonable function.
00:29:11.867 --> 00:29:15.827
We can actually oppose, we can use that hand quite freely.
00:29:15.827 --> 00:29:35.832
We're clearing the distal palm crease and it's easy to take on and off if that's what we want for the patient to be able to do for hygiene purposes so that we can take that splint off the shower, and that as well, the level of independence we give a patient will change at different points through someone's rehabilitation progress.
00:29:35.832 --> 00:29:44.682
So if someone has a flexer tendon laceration that's been repaired in zone two, we are managing that hygiene primarily until that tendon is safe enough to be moved.
00:29:45.192 --> 00:29:51.862
And so obviously with all these splints I always tell the patients that they shouldn't really be driving a car because they can't control it safely.
00:29:52.072 --> 00:30:01.592
Certainly with the, we have had a few conversations with different people of in law enforcement, both lawyers, police officers, detectives.
00:30:02.162 --> 00:30:08.852
but I definitely say that if you have your thumb in a splint and your wrist and a splint, then that's definitely not driving.
00:30:08.852 --> 00:30:12.122
It's usually as well, if they're wearing a splint it's not best for them.
00:30:12.542 --> 00:30:12.662
Yeah.
00:30:12.672 --> 00:30:18.192
Because I don't want them putting that tension or that load through that joint.
00:30:18.432 --> 00:30:26.412
So And we say it's, there was no point going through all this surgery only then to overload the joint and not let it heal correctly as we need to.
00:30:26.412 --> 00:30:30.342
And if we've seen them, if that's someone we might have seen conservatively, we'll prep them for that.
00:30:30.702 --> 00:30:33.282
We'll say you need a window of time leading up to surgery.
00:30:33.282 --> 00:30:36.702
Make sure you've got some people around you that can drive you different places.
00:30:37.092 --> 00:30:44.622
And that's where I always say as well, we try to have different locations in different aspects of OT so that your rehab is close to home.
00:30:44.832 --> 00:30:44.952
Yeah.
00:30:44.952 --> 00:30:45.402
It's great.
00:30:45.402 --> 00:30:51.792
Like with your surgeon, you go and see the surgeon that might not be super close to home 'cause you want that person doing that thing.
00:30:51.792 --> 00:30:55.062
But the touch points postoperatively may not be so high.
00:30:55.062 --> 00:30:56.862
So you might two weeks, six weeks.
00:30:57.492 --> 00:30:57.642
Yeah.
00:30:57.672 --> 00:30:58.302
So you make.
00:30:58.917 --> 00:31:03.777
A big drive to go and see a surgeon'cause that's the person that is doing all the work on the inside.
00:31:04.557 --> 00:31:07.197
But for rehabilitation, we try and make it close to home.
00:31:07.247 --> 00:31:08.537
So we try and make it convenient.
00:31:40.747 --> 00:31:47.347
So yes, smaller little splints that are less occlusive to the hand we say and we've checked that.
00:31:47.407 --> 00:31:49.297
That's not so problematic for driving.
00:31:49.297 --> 00:31:49.357
Yeah.
00:31:49.777 --> 00:31:58.137
And then at the right time, if they're safe to do I always say I like people to have a reasonable grip strength of 10 kilos, even though there's no rule for this.
00:31:58.142 --> 00:31:58.887
This isn't law.
00:31:58.887 --> 00:32:00.927
This is just my preferences.
00:32:01.377 --> 00:32:06.927
I like people to have at least 10 kilos of grip strengths so that they've got enough strength on a power steering vehicle to drive.
00:32:06.927 --> 00:32:11.037
I like them having an auto as well, and I like them.
00:32:11.727 --> 00:32:17.397
To be able to, at home, be able to do a three point turn and a reverse parallel park.
00:32:17.667 --> 00:32:17.727
Yeah.
00:32:17.757 --> 00:32:26.067
And once they can achieve that, I say, then you can get yourself in and out of the car park, being able to stop suddenly and stop and avoid an accident.
00:32:26.067 --> 00:32:28.467
That's where the stress comes in the hand with driving.
00:32:28.467 --> 00:32:30.677
So that's on top of the general rules.
00:32:30.677 --> 00:32:37.337
I get a little bit more specific about what I want people to be able to do before they're out driving.
00:32:37.577 --> 00:32:37.757
Yeah.
00:32:37.757 --> 00:32:38.657
I'm very cautious.
00:32:38.657 --> 00:32:43.667
I feel if a little lad runs out in front of the car with a chasing a ball and you haven't got perfect control of that
00:32:43.667 --> 00:32:46.627
vehicle, and that's what I say if I feel like someone is gonna be a bit.
00:32:47.167 --> 00:32:49.117
Not maybe listen to that so much.
00:32:49.117 --> 00:32:52.957
I say, this is not the time to have a little kid's life on your conscience.
00:32:53.137 --> 00:32:53.197
Yeah.
00:32:53.227 --> 00:32:55.117
Because you just wanted that shortcut.
00:32:55.117 --> 00:32:57.277
And I do come down pretty hard on that sometimes.
00:32:57.287 --> 00:32:59.327
I said, one of two things is gonna happen.
00:32:59.327 --> 00:33:01.937
You're gonna hurt yourself or you're gonna hurt someone else.
00:33:02.567 --> 00:33:03.137
Just don't do it.
00:33:03.797 --> 00:33:04.307
Brilliant.
00:33:04.907 --> 00:33:10.610
Okay, Charlotte obviously you provide this treatment and splints, but obviously it's a two-way process.
00:33:10.890 --> 00:33:15.510
What are your tips for collaborating with, say, surgeons or general practitioners who refer to you?
00:33:16.080 --> 00:33:21.240
So ultimately it starts with that referral to an occupational therapy provider.
00:33:21.240 --> 00:33:24.390
Similar to physio the client might reach out independently.
00:33:24.440 --> 00:33:32.000
if you're privately paying or using private health insurance, you don't technically need someone beyond that process to refer you to our service.
00:33:32.270 --> 00:33:33.560
So you can self-refer.
00:33:33.950 --> 00:33:40.660
Otherwise, typically someone goes to see their GP 'cause they have pain and a problem that GP may organize that referral for you.
00:33:40.660 --> 00:33:43.960
So typically they write a bit of a letter as to what might have happened.
00:33:44.285 --> 00:33:48.035
fallen outstretched hand or they might have had a baby and they've got to deQuervain's.
00:33:48.815 --> 00:33:50.315
Little bit of information.
00:33:51.095 --> 00:33:53.765
Please assess, give us your thoughts.
00:33:54.125 --> 00:33:56.375
So we'll meet that person, give them our thoughts.
00:33:56.375 --> 00:34:11.375
Sometimes we might say maybe it's intersection syndrome not deQuervain's, and We will try and feed that information back via another letter back and email or a phone call again from that surgical pathway is quite similar, but we might be utilizing that operative report.
00:34:11.825 --> 00:34:16.775
And on that operative report, there might just be a sentence like immobilize for six weeks in a splint.
00:34:16.985 --> 00:34:18.245
Take down bandages.
00:34:18.245 --> 00:34:21.065
Sutures out at 10 days, or a little bit of information.
00:34:21.065 --> 00:34:22.775
Just usually at the bottom of the op note.
00:34:24.035 --> 00:34:35.065
Referral can just be named detail phone number, and particularly if we are then reaching out to that patient And in terms of communication back, we try to find out what suits the person that's referring.
00:34:35.065 --> 00:34:41.394
Generally with gps, we're bouncing back with another letter that we're trying to get through quickly and efficiently.
00:34:41.394 --> 00:34:46.135
Most injuries have a very basic recipe book that we as beginner therapists learn.
00:34:46.135 --> 00:34:59.784
So we know like distal radius fracture is a splint for so many weeks, and at this week we do X, and at week four we do a bit more and we try to progress, but we learn what particular surgeons also like.
00:34:59.835 --> 00:35:13.005
Have, you've done your suspension arthroplasty and you've got the mini tightrope in as well, and how do you like to manage that versus if there's K wires and we grow our particular protocols and we use our track active program and we'll have Dr.
00:35:13.014 --> 00:35:16.545
Nimon's distal radius program that we like doing.
00:35:16.545 --> 00:35:28.545
Or even if it's things like, we try to have that information recorded so that the therapists can pick that information up, see what protocol someone likes to do and see how we move things along from there.
00:35:28.545 --> 00:35:37.264
So it's quite collaborative at that post-surgical level because everyone has developed their own slightly unique approach to managing these conditions.
00:35:37.625 --> 00:35:42.065
And we like to match our rehab protocols to suit what's happened surgically.
00:35:42.815 --> 00:35:53.510
When we are looking at conservatively managed, again, there's protocols, there's recommendations, but we're also trying to match that with a person themselves and we try to communicate what we're doing back as regularly as we can.
00:35:54.409 --> 00:35:54.679
Brilliant.
00:35:54.679 --> 00:36:03.849
On that process of the work cover, There's all these different scores and patient related outcome measures and things that they often are done as part of the assessment for work cover type injury or
00:36:03.940 --> 00:36:04.089
Yeah.
00:36:04.150 --> 00:36:05.170
Motor vehicle accident.
00:36:05.589 --> 00:36:11.049
What's the process that they demanded by legislation in Australia or they things that just help your recovery or
00:36:11.049 --> 00:36:15.579
They're not so demanded they're useful tools to try and quantify.
00:36:15.699 --> 00:36:18.460
A qualitative process is the way I describe them.
00:36:18.460 --> 00:36:22.269
Sometimes the quick dash is, or Quick Dash or the dash is a classic.
00:36:22.750 --> 00:36:26.019
and they're used as indicators.
00:36:26.394 --> 00:36:33.355
from a work cover perspective, I think they're trying to see those red flags as to how some, how is someone's pain tracking and how is this going?
00:36:33.684 --> 00:36:35.605
Are we gonna have issues returning to work?
00:36:36.054 --> 00:36:44.275
So sometimes they're used in that predictive sense, otherwise they're just used to track how well that person feels they're going with their injury.
00:36:44.694 --> 00:36:46.764
And we do them at rate.
00:36:46.795 --> 00:36:53.714
We don't do them all the time for, in our space, in the hand therapy space, we are really seeing what gives that person information.
00:36:53.714 --> 00:37:00.554
We're usually range of motion and grip strength are our big ones that we would use regularly as our reliable factors.
00:37:00.554 --> 00:37:01.424
And patients love it.
00:37:01.424 --> 00:37:06.884
They can, they can see their movements happening or they come in a week later, they go, I haven't really improved, but I've been doing everything.
00:37:06.884 --> 00:37:08.744
And I can say, no, you actually improved six degrees.
00:37:08.744 --> 00:37:09.554
That's fantastic.
00:37:09.944 --> 00:37:10.875
So it's quite motivating.
00:37:10.875 --> 00:37:12.525
They love seeing their strength go up.
00:37:12.525 --> 00:37:13.484
That's fantastic.
00:37:14.549 --> 00:37:20.719
Using the questionaires we might send that home as an email and then it, it builds information in a report.
00:37:20.719 --> 00:37:23.539
We can say, Hey, this person's tracking really well.
00:37:23.719 --> 00:37:28.170
Or if we're seeing those pain factors hanging around, we can say, this person's a bit stagnant.
00:37:28.170 --> 00:37:30.204
We need to put some more intervention in place.
00:37:30.204 --> 00:37:39.960
Maybe some adjustment to injury counseling, maybe some physio, even at that transition point, looking at getting an ep, an exercise physiologist involved is really useful.
00:37:40.500 --> 00:37:45.980
So they're not be all and end all measures, like they're useful.
00:37:46.009 --> 00:37:46.130
So
00:37:46.134 --> 00:37:46.264
it's a
00:37:46.264 --> 00:37:46.464
guide.
00:37:46.855 --> 00:37:47.144
Yeah.
00:37:47.364 --> 00:37:52.279
Guides to information as to what's going on and how we're tracking with progress
00:37:52.369 --> 00:37:52.960
Excellent.
00:37:53.639 --> 00:37:57.117
And what about Oedema I believe getting movement helps get the swelling out.
00:37:57.317 --> 00:38:02.326
I know traditionally that we talked about using Coban wrapping to try and get swelling out to help the movement.
00:38:02.326 --> 00:38:03.257
I presume it's a bit of both.
00:38:04.007 --> 00:38:04.306
Yeah.
00:38:04.516 --> 00:38:07.666
It's, again, it's picking the right modality for the right base.
00:38:07.766 --> 00:38:12.386
generally, if we're making a splint, we use the tubi grip for a few different things.
00:38:13.106 --> 00:38:15.956
The plastic itself is quite hot when it comes out of a pan.
00:38:15.956 --> 00:38:23.726
So if we're molding someone, we generally have a light tubi grip on place just to protect the skin it's not that hot, but you just need to protect someone.
00:38:24.306 --> 00:38:27.036
I don't like tuby grip too tight.
00:38:27.096 --> 00:38:29.556
The, my, one of my biggest things is when you see it leaving.
00:38:29.902 --> 00:38:30.922
Marks on the skin.
00:38:30.922 --> 00:38:31.851
It's too tight.
00:38:32.211 --> 00:38:32.362
Yeah.
00:38:32.541 --> 00:38:37.132
A light bit of compression with tubi grip, getting it moving, getting it elevated.
00:38:37.132 --> 00:38:41.541
I'm a big one with elevation for making sure that your elbow is straight.
00:38:41.721 --> 00:38:49.041
A lot of people just have their hand elevated with the kink in the elbow still, and I feel it slows the lymphatic system being able to drain.
00:38:49.431 --> 00:38:55.822
I like getting people draining the fluid back to the shoulder and moving the hand to pump the swelling out of the hand.
00:38:55.822 --> 00:39:01.612
That's my, probably my go-to initially, so long as nothing is too crazy.
00:39:02.451 --> 00:39:04.342
And ICE is another great one.
00:39:04.342 --> 00:39:07.971
So acutely postoperatively, people always say, do you use heat or do you use ice?
00:39:08.422 --> 00:39:10.641
But they're different tools, they're different things.
00:39:10.641 --> 00:39:17.842
I like acute swelling, so 24 to even a week after an injury or surgery, ICE is your best friend.
00:39:17.902 --> 00:39:19.612
We want that vasoconstriction.
00:39:19.612 --> 00:39:26.092
We want that pumping away from the peripheral back to, back to into that lymphatic system.
00:39:26.092 --> 00:39:33.652
So movement, a light cover of Tubi Grip, maybe to just help support the lymphatic system a little bit.
00:39:34.011 --> 00:39:45.451
I was taught, when I did a fair bit of work with lymphedema that if you are leaving white marks on the skin, you're compressing your lymphatic system so you can't be too tight.
00:39:46.411 --> 00:39:53.701
When we start to bring Coban and Handi Gores into the situation, we're looking at more entrenched and worrying edema.
00:39:53.911 --> 00:40:07.561
Someone has had a distal radius fracture, so they've had a fall with some force or some velocity, and the whole hand has puffed up and we've got that swollen look to the hand and the movement is restricted because the hand is so swollen they can't move.
00:40:07.951 --> 00:40:18.371
Then we have to activate things a little bit more intensely and my go-to with that style of swelling is actually handy Gores, which is a softer white wrap that.
00:40:18.692 --> 00:40:23.101
It goes on the fingers and then I might use Coban on the hand.
00:40:23.161 --> 00:40:25.172
Again, it's about the tension.
00:40:25.652 --> 00:40:32.961
So I say I'm opening the wave of the bandage, It can stretch up to 70% of its length, so you don't want it on that tight.
00:40:33.382 --> 00:40:50.902
Then what happens is, as their movement is so restricted from the swelling, this little bit of movement that they do have, the uneven surface of the bandaging and the spiral nature you've applied it on actually helps that lymphatic system to pump and get that fluid away.
00:40:52.072 --> 00:40:56.442
So if we're wrapping fingers, there's a very specific reason as to why we're doing that.
00:40:57.112 --> 00:41:09.422
And again, in most instances, Tubi Grip is not too tight, is supportive for the situation, comfort for the patient, wearing a splint, and is supposed to be working with you and not getting.
00:41:10.081 --> 00:41:12.601
tourniqueted off and creating those big divots.
00:41:13.051 --> 00:41:14.791
So yeah.
00:41:14.791 --> 00:41:17.822
But then the wrapping things that we do, were very specific.
00:41:17.822 --> 00:41:28.561
So I had a lady the other day, she crushed her back of her hand massive hematoma like it is, like you could hold the hematoma, but then the entire hand puffed up.
00:41:29.221 --> 00:41:41.581
So that was an instance where we're using this wrapping technique and mobilizing the hand a lot, and even using little devices to create an uneven surface to stimulate the lymphatic system.
00:41:41.701 --> 00:41:43.501
So that's just, that's.
00:41:43.936 --> 00:41:47.596
Different types of interventions for different types of situations.
00:41:47.866 --> 00:41:48.947
Brilliant, brilliant.
00:41:49.007 --> 00:41:53.467
Yeah, I've certainly there's always a importance to get the swelling out and get the movement back.
00:41:53.516 --> 00:41:58.007
The other thing too, that patients may not understand is the importance of desensitization as well.
00:41:58.317 --> 00:42:01.076
And particularly after surgery, but after any injury.
00:42:01.136 --> 00:42:01.436
Yeah.
00:42:01.547 --> 00:42:03.612
Perhaps you can explain that and what your role is in that scenario.
00:42:03.711 --> 00:42:16.297
So that's where you may have had someone who's again, had a trauma and their nerve has had some sort of injury to itself, whether it's been bruised lacerated, or even just the little postoperative bit of numbness that they get.
00:42:16.596 --> 00:42:21.606
And we start to get people giving some gentle feedback to those nerves that are, I always say they're just.
00:42:22.101 --> 00:42:26.612
They've gone out on strike And you have to grade how you get that nerve to respond.
00:42:26.612 --> 00:42:29.491
Again, if you go and give it too much feedback.
00:42:29.882 --> 00:42:39.931
So you too much scratchy material tapping too soon you can actually create more pain because it seems to disrupt the nervous system too much.
00:42:40.201 --> 00:42:40.322
Right?
00:42:40.351 --> 00:42:42.931
So we start with graded desensitization.
00:42:43.442 --> 00:42:46.021
Maybe we'll use the soft side of the Velcro.
00:42:46.442 --> 00:42:54.391
Just gentle touching, giving the nerve feedback constantly gives it a reason to come back, is the way I explain it.
00:42:54.781 --> 00:42:58.351
If you don't give the nerve any input, it's what we don't use, we don't need.
00:42:58.351 --> 00:43:02.181
So The body tends to not focus on trying to recover that sensation.
00:43:02.991 --> 00:43:15.652
But if we give it graded input as it can tolerate it, if some people just, they become very hypersensitive and they can't tolerate anything on there, and if you push them too hard, you'll just make the patient feel sick.
00:43:16.011 --> 00:43:17.391
They, and they'll start sweating.
00:43:17.391 --> 00:43:19.406
It's a really visceral response.
00:43:19.541 --> 00:43:23.862
You can see that they get to it, but so we grade it, we use soft textures.
00:43:23.891 --> 00:43:43.902
Light textures will start distal to the lesion and slowly work up so that we can really find where the problem is and just psychologically help that person through getting that sensation back and getting used to building up to things like tapping rougher textures, different inputs and stimulations
00:43:45.041 --> 00:43:46.301
on the other side of the coin where the nerve is hypersensitive.
00:43:46.991 --> 00:43:48.971
General touching can help desensitize
00:43:48.971 --> 00:43:49.301
Yeah.
00:43:49.301 --> 00:43:49.481
Yeah.
00:43:49.481 --> 00:43:52.391
So it's about just finding the right point.
00:43:52.391 --> 00:44:02.141
So sometimes we, you'll see the little mini massages that provide vibration stimulation, that can be, if you put that into soon, that can really upset someone.
00:44:02.382 --> 00:44:07.331
So it's just about finding the different point at which you introduce all these different things.
00:44:07.331 --> 00:44:15.041
You need the stimulation, you need to settle it down, and you just need to find the right type of input for that nerve to help.
00:44:15.041 --> 00:44:24.842
And it can be working, finding that point at which they're really like, there's usually almost a clear line you can draw around the boundary between what feels good and what doesn't.
00:44:25.711 --> 00:44:32.281
And up to a certain point you'll use one type of stimulus, but then over that area you'll use another type of stimulus.
00:44:32.281 --> 00:44:38.822
Sometimes this can be good and bad and you've got to really understand how your patient.
00:44:39.152 --> 00:44:40.231
Mind is ticking.
00:44:40.862 --> 00:44:53.851
We can put like a towel over where the injury is to dull the sensation slightly so that they're still touching it, but they're getting some stimulation back.
00:44:53.882 --> 00:44:57.511
So it's just about trying to find different ways of helping that person.
00:44:57.511 --> 00:45:05.011
Sometimes we say a person put a light bracelet on and that bracelet just helps constantly give a bit more feedback, or some people can't tolerate that.
00:45:05.521 --> 00:45:17.801
So it's just about finding those different little ways to constantly get little bits of stimulation back into it so that we don't create an entrenched hypersensitivity pattern where they don't use the hand.
00:45:18.011 --> 00:45:19.692
That's the big thing we want to avoid.
00:45:20.261 --> 00:45:20.531
Brilliant.
00:45:21.342 --> 00:45:26.592
So Charlotte, obviously you're quite passionate about providing good care and for these patients.
00:45:26.862 --> 00:45:29.652
Are there any barriers you come across that might affect recovery in.
00:45:29.697 --> 00:45:33.476
Is it important to really have a patient who's engaged in their own process as well?
00:45:33.567 --> 00:45:34.136
Yes.
00:45:34.136 --> 00:45:51.956
So I probably find, I'd say one of my biggest barriers is if we have late referral or an injury's been put to the back burner for a few months, I always say it's almost like the longer an injury's been present for that amount of time is what it's gonna take to recover from.
00:45:51.956 --> 00:46:03.866
So if we've been ignoring tennis elbow for 12 months and now it's raging and it's really unhappy and can't talk about, can't even think about it, we've got a longer journey ahead of us for that recovery timeframe.
00:46:04.467 --> 00:46:21.386
Similarly, if we've had a Boutonniere deformity and we've played the whole season and thought it would just get better and then nine months later we've got a nice little 45 degree plus a fixed flexion deformity, we are gonna be battleing for a while to get those to recover from those sorts of things.
00:46:21.686 --> 00:46:30.806
So that's where we do, and that engagement in rehab and finding what that person does, do they use a computer for a living?
00:46:30.806 --> 00:46:37.766
And if I make a few adjustments to their computer set up and get their finger moving on the top keyboard, are they an keen knitter?
00:46:37.797 --> 00:46:47.987
And I need to know how do I include those things into their rehab program as opposed to being told to do these little weird hand therapy exercises 16 times a day or whatever.
00:46:48.346 --> 00:46:57.496
I try to utilize the aspects of their life that are naturally the therapeutic or rehabilitative into their program.
00:46:57.496 --> 00:46:58.936
Or I tie things in with the day.
00:46:58.936 --> 00:47:02.666
I say pop this thera putty next to the kettle whilst you're waiting for the kettle.
00:47:02.846 --> 00:47:11.036
We're gonna do some putty squeezes so that we're trying to tag our intervention to fixtures that are already in their day.
00:47:11.487 --> 00:47:15.507
And we just asking like one little thing on top of that so that we are not creating.
00:47:16.001 --> 00:47:22.811
A huge, extensive programs, complicated programs that can be quite difficult for a patient to engage in.
00:47:23.112 --> 00:47:28.362
So I like to use what their natural things of hobbies and enjoyment are.
00:47:28.391 --> 00:47:29.951
Or I make things very specific.
00:47:29.951 --> 00:47:33.342
So how can someone wants to get back to lawn bowls?
00:47:33.911 --> 00:47:35.831
Maybe we need a bit of an adaptive equipment.
00:47:35.831 --> 00:47:37.842
You can get different little things to help bowl.
00:47:37.842 --> 00:47:46.931
So the person is still doing the thing they love, but they're able to now wear the splint that I want them to wear because they've had a fracture or something and we are combining the two things.
00:47:46.931 --> 00:47:48.342
I'm getting my rehabilitation.
00:47:48.371 --> 00:47:52.362
They're still participating in their thing that they love doing.
00:47:52.811 --> 00:47:53.231
Same.
00:47:53.471 --> 00:47:54.791
We take the same approach with work.
00:47:54.791 --> 00:47:56.981
What small aspect of work can be done?
00:47:57.011 --> 00:47:58.871
Can it be done in a different environment?
00:47:58.871 --> 00:47:59.711
Can we take that?
00:47:59.711 --> 00:48:01.211
Can someone do something from home?
00:48:01.601 --> 00:48:04.001
Can we adapt to the ergonomics to make sure someone is.
00:48:04.766 --> 00:48:07.226
Engaged and happy and feeling useful.
00:48:07.496 --> 00:48:09.896
And I think that really helps people's rehab.
00:48:09.967 --> 00:48:14.777
I try to not over medicalize things too much and Yep.
00:48:14.777 --> 00:48:23.056
You are there with them on the journey, but they're in control of how well their outcome is at the end of the day, and we make sure they don't feel lost along that pathway.
00:48:23.777 --> 00:48:23.866
Okay.
00:48:23.916 --> 00:48:24.306
Brilliant.
00:48:24.306 --> 00:48:27.246
So that's how we'd approach that side of things.
00:48:27.246 --> 00:48:27.697
I think.
00:48:27.886 --> 00:48:28.217
That basis.
00:48:28.396 --> 00:48:32.172
Are there new technologies or advances in the whole system?
00:48:32.172 --> 00:48:35.261
It makes people both more engaged but also helps the rehab as well.
00:48:35.692 --> 00:48:38.422
I think we're on the cusp of a few amazing things.
00:48:38.422 --> 00:48:40.521
I'm watching all the spaces as best I can.
00:48:40.521 --> 00:48:43.521
I do love little interactive apps on phones.
00:48:43.971 --> 00:48:46.672
that can just gamify exercises.
00:48:46.672 --> 00:48:54.771
So we've got a few script strength things that make a little action person move along a screen, make it a game, but they don't realize that they're actually doing their rehab at the same time.
00:48:54.771 --> 00:48:55.342
If that is.
00:48:55.717 --> 00:48:57.487
What we think is gonna engage that person.
00:48:57.487 --> 00:48:58.146
Then we'll do it.
00:48:58.717 --> 00:49:06.996
If we have different games that we can play with someone that is more engaging, that's fantastic.
00:49:06.996 --> 00:49:15.186
In terms of the technology, I think we will see at some point 3 d printing become part of our toolkit.
00:49:15.246 --> 00:49:16.626
At the moment, it's not quite there.
00:49:16.626 --> 00:49:18.396
It just takes too long to print.
00:49:18.396 --> 00:49:22.956
The printing a splint of this size, the timeframe would just be too long.
00:49:23.226 --> 00:49:24.306
They're not rem moldable.
00:49:24.786 --> 00:49:26.826
They're still a bit rough, but I think we're gonna get there.
00:49:26.856 --> 00:49:32.467
There's some really cool stuff happening in the Netherlands where they'll scan an image of your hand.
00:49:33.217 --> 00:49:34.987
It then goes to the Netherlands.
00:49:35.016 --> 00:49:42.217
This amazing, cool looking pearlescent, futuristic looking splint is then created and sent back.
00:49:42.636 --> 00:49:44.947
That's really great for things that are needed long term.
00:49:45.801 --> 00:49:54.592
So if someone needs, has a bit of arthritis, adamant they're not having surgery and we can create something like that's becoming more available.
00:49:54.641 --> 00:50:04.172
it's not quite available here as freely yet, and the splint isn't quite as cool or up there yet on top of what we've got available here in Australia.
00:50:04.172 --> 00:50:08.581
So I haven't gone down that path personally myself yet, but I think it's getting really close, which is great.
00:50:09.211 --> 00:50:26.902
And then looking at different things, Virtual reality, I think has got huge impact in returning to your work or tasks a lot quicker because suddenly you can be immersed in a world where you're doing the work thing.
00:50:27.201 --> 00:50:32.451
And I've seen these situations, they're filming like in real life.
00:50:32.451 --> 00:50:35.991
It's not a gamified cartoon environment.
00:50:35.991 --> 00:50:36.652
It's real.
00:50:36.652 --> 00:50:41.391
And you are walking down the street and your hand is there functioning beautifully and normally.
00:50:42.051 --> 00:50:49.942
In the vision, you might have a very injured hand in real life, but it's doing the things that you want your hand to be doing in real life.
00:50:49.942 --> 00:51:04.101
So I think in terms of a lot of pain management, a lot of getting people's brain, recognizing that their hand can do things sooner with the use of VR is going to become really, exciting in that space.
00:51:04.521 --> 00:51:16.442
And I think that will have a huge benefit to adjustment, to injury, to adjustment to, even in our prosthetics group where people have had amputations, it's going to, that I think is gonna be amazing to research as well.
00:51:16.831 --> 00:51:17.311
Brilliant.
00:51:17.311 --> 00:51:18.541
Sounds exciting times.
00:51:18.641 --> 00:51:26.382
So what do you, what advice would you give to the young medical student or young GP coming through the process about occupational therapy and hand therapy in particular
00:51:26.771 --> 00:51:55.871
I think it would be really interesting for someone who's learning that medical space once you're feeling like you've heading into a path that you like, if you can see a specialty you're heading towards, try to get to the spend a day in the life at the end of that rehab process, as much as you may be at the beginning of that process so that you are really creating that sort of 360 view of how that injury process looks to that person.
00:51:55.871 --> 00:51:58.211
I think we can get a bit stuck at our either end.
00:51:58.451 --> 00:52:04.692
Similarly, I tell my students and my young therapist to go and attend as many surgeries as possible.
00:52:04.692 --> 00:52:04.751
Yeah.
00:52:04.991 --> 00:52:06.672
So that they're seeing,'cause we see the end.
00:52:07.061 --> 00:52:07.181
Yeah.
00:52:07.211 --> 00:52:10.541
We see them all wrapped up neatly stitched up and looking beautiful.
00:52:11.051 --> 00:52:14.201
I said, go and see what's happened and then you'll understand the trauma.
00:52:14.201 --> 00:52:17.112
You'll understand why your PIP joint is so swollen afterwards.
00:52:17.141 --> 00:52:18.822
'cause you're gonna see what it's gone through.
00:52:19.152 --> 00:52:20.201
It's been through a lot.
00:52:20.501 --> 00:52:26.141
Similarly, I'd say to that new surgeon, that gp, that person try and spend a day.
00:52:26.757 --> 00:52:28.166
Half a day, whatever time you've got.
00:52:28.166 --> 00:52:29.547
No time is precious.
00:52:30.027 --> 00:52:34.766
Understanding what we are dealing with at our end and how we're engaging that person.
00:52:34.766 --> 00:52:44.666
The pain that we might be experiencing at six weeks, which they don't write about in the textbooks, and that isn't the common sort of standard and process.
00:52:44.697 --> 00:52:53.996
If you can see what it's like at the other end and how that person is going six weeks later and what we are putting them through and what we're trying to achieve with.
00:52:54.326 --> 00:53:02.726
I think sometimes splints are seen as just things that keep things still, and we love people understanding.
00:53:02.726 --> 00:53:04.616
It's no, this is helping us mobilize.
00:53:04.646 --> 00:53:10.317
I know it's a rigid piece of plastic, but we are doing this amazing stuff with this rigid piece of plastic.
00:53:10.706 --> 00:53:17.156
And as much as not splinting, yes, they're gonna move their hand more, but we're trying to overcome a few deficits at the same time.
00:53:17.156 --> 00:53:23.112
So seeing what we can do and the creativeness with which we are trying to get people moving and functioning.
00:53:24.281 --> 00:53:25.511
Would be really amazing.
00:53:25.511 --> 00:53:32.231
Even if someone's in a more medical space as opposed to surgical, seeing what's happening when that OT is trying to get that person home.
00:53:32.231 --> 00:53:34.871
What are we trying to achieve with medications?
00:53:34.871 --> 00:53:41.481
Like I had a, a few things where someone's got dementia but they've suddenly been given medication to take six times a day.
00:53:42.201 --> 00:53:43.822
And how are we making that happen?
00:53:43.822 --> 00:53:50.541
Because there's some huge, big functional things that we've gotta get through there and how we support that person through that process.
00:53:50.541 --> 00:53:58.761
So on both ends of that spectrum, I think it's, remember that it's this part of care is linked to this part of care over here.
00:53:59.121 --> 00:54:02.306
And trying to approach it from both ends to really understand that process.
00:54:03.246 --> 00:54:03.757
Brilliant.
00:54:04.266 --> 00:54:06.126
It's been fantastic having you come on.
00:54:06.286 --> 00:54:07.036
Aussie Med Ed today
00:54:07.092 --> 00:54:08.172
thank you for inviting us along.
00:54:08.521 --> 00:54:09.396
It's been great.
00:54:09.396 --> 00:54:13.717
So sharing your expertise and shed a light on both occupational and hand therapy.
00:54:14.016 --> 00:54:17.876
Your insights and patient centered rehab and collaborative practice are really useful.
00:54:18.246 --> 00:54:26.527
To our listeners, thanks for joining us and hopefully this podcast today will shed more light on another area of important part of rehab for a patient under your care.
00:54:26.916 --> 00:54:27.757
Thanks very much.
00:54:27.967 --> 00:54:28.237
Thank you.
00:54:28.717 --> 00:54:32.836
Thanks again for listening to the podcast and please subscribe to the podcast for the next episode.
00:54:33.226 --> 00:54:35.146
Until then, please stay safe.