Instructional Concurrent Session II
Cross-Education: Current Evidence and Potential Applications in Upper Limb Rehabilitation
‘Cross-education’ is the term commonly used to describe unilateral resistance training of a limb for the purpose of strengthening the contralateral limb. Cross-education has also been used to prevent atrophy associated with limb immobilization (e.g., casting) via resistance training of the uninjured limb. This technique has been widely studied and applied in the kinesiology field, but less is known about its effects in rehabilitation. This instructional session will present the principles underpinning cross education, and current evidence for cross-education based on a recent systematic review of the literature. Populations, exercise dosing, training duration, and targeted outcomes will be addressed. Specific recommendations will be made to incorporate cross-education with persons after hand and upper limb injury, including considerations for adverse events and important modifiers for treatment response. Novice to advanced therapists will benefit from the focus on application of evidence for both planning services for individual clients and to advocate for developing the evidence-based in the arena of hand rehabilitation.
- Participants will be able to define and describe cross-education, including the potential mechanisms, risks and benefits for different populations
- understand the current evidence base for cross-education, including the gaps
- consider the opportunities to incorporate cross-education into hand rehabilitation interventions
- develop and utilize tailored cross-education programs for individual clients
Kinesiophobia: Clinical Implications from a Surgeon and Therapist Perspective
Kinesiophobia is the fear of movement. This psychological construct has gotten more attention recently for its impact on functional outcomes. This session will discuss the history of kinesiophobia and how it was first studied in individuals with low back pain. The Tampa Scale of Kinesiophoia will be examined and its use in clinical practice will be discussed. Evidence will be presented on how both kinesiophobia and catastrophic thinking negatively effect individuals with upper extremity injuries. Case studies will be presented and surgeon and therapist collaboration will be discussed. Clinical intervention will be provided from both the surgeon and therapist perspective including how the use of occupation-based interventions are important for this population.
- Attendee will understand what kinesiophobia is and how it can impact functional outcomes in individuals with upper extremity injuries.
- Attendee will be able to interpret the Tampa Scale of Kinesiophobia and understand its use in clinical practice.
- Attendee will be able to describe interventions for individuals with kinesiophobia.
Talking to the Hand: Application of Pain Neuroscience Education Principles to Management of Upper Extremity Chronic Pain Conditions
Chronic pain conditions in the upper extremity are complicated and challenging to treat. The Biopsychosocial Model addresses this complexity by accounting for the intricate interactions between biological, psychological and social factors. Pain Neuroscience Education (PNE), a component of the biopsychosocial model, is designed to help patients understand their pain from a neurobiological and neurophysiological perspective. There is a growing body of evidence to support the use of PNE for a range of chronic musculoskeletal disorders to reduce pain and improve patient’s knowledge of pain. Studies demonstrate a positive effect of PNE on additional factors such as function, disability, motion, and psychosocial factors. In this course, we review the neurophysiology of pain, and the evidence to support the use of PNE for musculoskeletal conditions. We will discuss the elements of a biopsychosocial model to pain and demonstrate how to incorporate PNE principles into hand therapy treatment of upper extremity chronic pain conditions. We will review how to screen and identify patients appropriate for PNE. Finally, we will present practical strategies to incorporate into treatment plans. We will conclude with 1-2 case studies that demonstrate the effective use of PNE in patients with hand and arm pain. Aviva Wolff, EdD, OT, CHT is an occupational therapist, clinician-scientist with a particular focus in upper extremity rehabilitation. She has a strong background in motor control and movement analysis with extensive experience working with performing artists and individuals with neuromuscular conditions and musculoskeletal injuries. She currently consults for the Julliard School, and runs the upper extremity clinical movement analysis programs and hand and wrist biomechanics research at the Leon Root, MD Motion Analysis Laboratory at Hospital for Special Surgery. Aviva regularly incorporates principles of pain neuroscience education into her practice and treatment of patients with chronic upper extremity pain. She is a national and international lecturer and has lectured extensively on this topic. She will be presenting with an esteemed panel of experts in chronic pain at the IFSHT Triennial Conference in Berlin this June. Scott Siverling, has been practicing physical therapy in an orthopedic setting for twenty years. He has been a board-certified specialist in the area of orthopedics since 2006 and is a fellow of the American Academy of Orthopedic Manual Physical Therapists. Scott regular treats and advises patients with chronic spinal and extremity pain. He continues to practice daily in New Jersey at an outpatient regional clinic of the Hospital for Special Surgery and has given several lectures on the topic of the neuroscience of pain.
- To describe the neurophysiology of pain, and pain mechanisms
- To discuss the current evidence regarding pain neuroscience education (PNE)
- To identify patients, appropriate for PNE
- To apply the principles of PNE to the treatment of chronic UE pain conditions such as complex regional pain syndrome, thoracic outlet syndrome, nerve compression, and arthritic conditions
Wound and Scar Management for the Advanced Practitioner
This 1-hour instructional course will address advanced wound physiology and topical management of wounds. The presentation will include acute and chronic wounds, delayed or complicated healing of post-op wounds, and burns. Topical treatment, lasers, and skin substitutes will be reviewed as well as live clinical scenarios to assist hand therapists in choosing the most appropriate wound dressing for cases presented.
- Describe wound stages and characteristics to determine optimal management by the hand therapist
- Differentiate between alginates, antimicrobials, hydrocolloids, foams, and other skin products to promote optimal healing and wound closure
- Determine best practice management of skin substitutes and use of laser therapy in wound healing and scar