Hand Therapy
Hand therapy involves therapy for the hand, wrist and upper limb after injury, surgery or onset of disease
Hand Therapy includes:
- Guidance and Education
- Splinting
- Management of swelling (oedema) in the hand, wrist and upper limb
- Pressure Garments
- Active and Passive Mobilisation
- Muscle Strengthening
- Scar Management
- Assistive devices and adjusted techniques to compensate for the loss of functional ability
- Sensory re-education and Motor Imagery
Our therapy services include the following:
We actively engage with our patients to impart the necessary knowledge and insight about their hand, wrist or upper limb condition or injury and the aims of treatment. We also provide patients with the necessary tools and appropriate guidance to enable them to continue their therapy at home in-between their formal therapy sessions at the practice.
Certain conditions or injuries require splinting. Our experienced therapists have all completed their post graduate qualifications in splinting and therapy for the hand, wrist and upper limb. We make a whole range of splints that form an integral part of the rehabilitation and healing process. Such splints include the following:
Dynamic thermoplastic splints
Dynamic thermoplastic splints are used to:
- Realign joints where contractures have already started to develop.
- Compensate for the loss of function where muscles are currently not working optimally due to tendon or nerve injury.
Static thermoplastic splints
We provide patients with static custom-made thermoplastic splints in order to:
- Immoblise the hand, wrist or upper limb hand in the most functional position to allow for optimal healing. Regulate active movement without causing damage to repaired structures such as muscles, tendons or ligaments, thereby preventing stiffness of the limb.
- Prevent contractures of joints caused by injury, underlying neurological conditions or inflammatory conditions (such as arthritis) in the hand and forearm.
Functional splints
We also provide patients with custom made functional splints, which we manufacture from a variety of materials (e.g. thermoplastic and neoprene splinting material) to allow patients to perform their daily tasks with the support of a functional splint.
Examples of such splints include:
- Soft hand-based splints to support the thumb in daily tasks and prevent or limit pain and strain in patients with pain at the base of the thumb caused by osteoarthritis.
- Thermoplastic splints placing the fingers in the correct position to grip a pen or pencil and enable such a patient with impaired hand function to write effectively.
- Custom-made wrist splints keeping the wrist in extension to place the hand in the best position for task performance in cases where the wrist is injured, weak or lacks extension due to nerve injury.
Some conditions, injuries or surgical interventions cause swelling in the hand, wrist and upper limb. It is vitally important to manage such swelling as it could usually limit movement and could cause long term inflammation, stiffness and pain.
We manage swelling through various therapeutic principles to reduce the swelling as soon as possible, instead of waiting for it to gradually disappear by itself and causing long term discomfort and complications. These principles and techniques include:
- Compression
- Elevation
- Contrast baths
- Manual oedema mobilisation
- Active movement
By prioritising the reduction of swelling in the relevant limb, we facilitate faster healing and return to the performance of functional tasks.
Pressure garments form an essential part of our treatment. Such garments are custom made from a stretchy material that provides therapeutic pressure to achieve the following:
- Encourage circulation and reduce swelling in swollen digits and other parts of the hand, wrist or upper limb;
- Reduce the thickness, tightness and itchiness of a scar, improve appearance and pliability of a scar and prevent overgrowth and contracture of scar tissue in areas where scarring occur.
Pressure garments range from finger socks (to reduce the swelling in one specific finger), gloves for the fingers, hand and wrist, as well as various other pressure garments for areas of the body that could have been affected by burn scars.
Strengthening of the muscles in the hand, wrist and upper limb is an integral part of our rehabilitation process. Through muscle strengthening we aim to increase stability of the joints, improve grip and pinch strength and increase muscle endurance of the upper limb.
We focus on various types of strengthening exercises to support arthritic joints, stabilise weak wrists that are prone to ganglion formation, strengthen the muscles in the hand after an injury or nerve impingement (e.g. carpal tunnel syndrome) and improve the overall strength of the hand, wrist and upper limb after various other types of injury or surgery.
We treat post-surgical, post-injury and post-burn scars.
One of the biggest complications of scars in the hand and upper limb is that the soft tissue (nerves, muscles, ligaments and joint capsules) underneath the scar tissue gets stuck (adhered) to the scar causing tightness over the scar area, thereby limiting movement in the hand and upper limb and causing hypersensitivity of the scar tissue.
Another complication could also be overgrowth of scar tissue on the skin surface (hypertrophic scars or keloid scars) resulting in itchy, sensitive scars, with cosmetic disfigurement and skin or joint contracture (where the scar surface area extends over a joint).
We make it our priority to identify developing complications of scar tissue early and address them as a matter of priority to encourage optimal outcomes in terms of hand and upper limb function in post-surgery, post-injury or post-burn cases.
We use various techniques of scar management to ensure the best scar response. Such treatments include the use of the following:
- Heat
- Therapeutic scar massage
- Silicone gel scar sheeting
- Pressure garments
Research has shown that through application of silicone gel scar sheeting and pressure garments over scars, it is possible to facilitate an improvement of up to 70% in the appearance and pliability of the scar tissue.
As occupational therapists our aim is to enable our patients to perform their daily tasks effectively. In the process of doing so, we often use guidance on assistive devices and adjusted techniques of task performance to compensate for the loss of function in the hand, wrist and upper limb.
Through this we aim to prevent further injury (as in the case of permanent loss of sensation in a certain area of the hand or upper limb) and empower the patient with the necessary skills and tools to continue with their daily tasks.
Nerve regeneration is accompanied with pain (a dull ache, sharp shooting pain or pins and needles in the hand and upper limb) and sensory retraining aims to educate the patient on the management and reduction of such pain.
Motor imagery aims to simulate movement patterns of the hand and upper limb with the brain, although the individual is still unable to perform said movement patterns with the hand and upper limb.
This keeps the motor part of the brain, dedicated to the hand and upper limb, fit during phases of nerve injury and recovery where the neurofeedback between the brain and upper limb is disrupted and the motor cortex of the brain is therefore not activated otherwise.
To achieve these aims we use mirror box therapy as well as graded sensory and motor stimulation to improve the hand and upper limb function as the nerve supply recovers. This encourages early integration (communication) of the sensory and motor parts of the brain with the hand and upper limb and enables the individual to return to work, leisure and other daily tasks faster.