I would also teach retrograde massage techniques and educate regarding
parrafin bath and maybe a few other ideas to facilitate decreased
edema and gentle movement. Edema can definitely impair your fine motor
coordination, and it will not always go away just by using your hands.
There are times when you have so much edema that you can't actively
use your hands enough to decrease the edema and then increase the
movement. Vicious cycle, but see what I mean?
I've also had guys that have shops and like handwork and building/
remodeling to just work on tightening/loosening varying size nuts and
bolts both with their hands and with tools. I know that is not the
ultimate goal but it is a piece of the goal. Sometimes I find that
patients feel like they are doing themselves more good if it feels
like an exercise program. You can also use that as a way to get in
multiple reps of a needed activity that might only need to be done a
few times in the course of one "real" project. There's no harm, and if
it helps, everybody wins.
I will tell you that I learned a lot about edema and decreased
sensation in hands and arms over the past 1 1/2 years from personal
experience. I had to have major surgery and ended up having some
sensation return that I didn't know was lost. It really surprised me
because I thought, as an OT, that I would know if I had an obvious
impairment like that. Nope! Not a clue! I was so shocked when I had to
have an infusion for the first time post-op, and it was like someone
had sharpened all the needles! I used to never mind if it took a while
for them to find a good vein. Didn't hurt, didn't bother me. Well,
that's not cause I'm tough. It's cause I couldn't feel a damn thing!
Very strange. I still have neuropathy to varying degrees throughout
each day and day to day and find myself compensating all the time.
It's very interesting to switch the roles now and then. Enlightening
experience. I am now using my new Wii Fit to see if I can help improve
my static and dynamic balance. I'll tell you the results if anyone is
interested.
Ciao for now!
Mary Alice in Texas
Mary Alice Cafiero, MSOT/L, ATP
m...@mac.com
972-757-3733
Fax 888-708-8683
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On Jan 19, 2009, at 8:45 PM, Ron Carson wrote:
Evaluated a man last week who is s/p hospitalization for multi-organ
failure. Basically, the man died but recovered. During the eval, the
patient's primary c/o was bi-lateral hand swelling, decreased
sensation, decreased gross and find motor strength/coordination. He
reported that about the only thing he couldn't do was buttoning. But,
he also said that "things are getting much better". I instructed him
to keep doing what he was doing, use his hands as much as possible to
get back to "work". I told him I would be back in one week.
Today, the man's hand were minimally improved. He stated that
yesterday he couldn't open a set of jumper cables and had to call his
wife. She said that he was literally crying. The patient seemed
frustrated at his situation, but still said things were getting
better. I asked him to show me the cables that he couldn't open. So,
we walked outside and he showed me the difficulty he had.
Once again, I suggested that he get in his shop (he's building an
ultra-light aircraft) and that he get busy using his hands. I again,
said I'd be back in one week.
I don't know what is wrong with this man's hands. I'm sort of torn
because he is able to do so much, but is then somewhat limited. I
strongly believe that if he will increase the use of his hands, they
will improve.
But, it seems that my suggestions were met with some skepticism. The
patient's wife wanted to buy an exercise ball, the social worker, who
just happened to be there, suggested hand exercises. I just sort of
shook my head and reiterated that the best exercise was using his
hands.
Am I wrong in my approach? Not to bring up the PT ~vs~ OT thing, but
the PT wrote "OT can address all the patient's needs". I always feel a
double-edged sword when PT dismisses UE patients.
Ron
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Ron Carson MHS, OT
www.OTnow.com
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