Hand Therapy in Pediatrics: Collaboration for Best Outcomes for Pain-related and Neurological Conditions – Minimizing Impairment and Maximizing Function
Pediatric pain conditions, such as Complex Regional Pain Syndrome and Ehlers-Danlos Syndrome, can be challenging for therapists to evaluate and treat. Similarly, children with upper extremity neuromotor impairment resulting from disorders of the central nervous system often present with complex treatment needs. Both populations benefit from a multidisciplinary approach to limit detrimental impact on participation in activities of daily living, education, social and leisure activities and maximize function. The hand therapists’ role in managing pain conditions and children with upper extremity neuromotor impairment can be enhanced by collaborating with the patient and family on goal setting and home exercise/activity programs, as well as by facilitating self-management of their condition. In addition, children with neuromotor impairment may seek consultation with hand specialists to maximize their upper extremity function and/or quality of life. For this population, presenters will highlight the collaboration between the hand therapist and surgeon in a multidisciplinary evaluation aimed at identifying client goals and the client’s upper limb function to guide the plan of care. For both populations, presenters will discuss the evidence-based interventions hand therapists utilize to enhance function. Additionally, for children with neuromotor impairment, the common surgical interventions for this population along with the post-operative rehabilitation protocols will be discussed. Throughout this session, elected case studies will be used to illustrate the application of session content and participants.
- Discuss current evidence in the management of pediatric pain conditions, including Complex Regional Pain Syndrome (CRPS), Ehlers-Danlos Syndrome (EDS) or joint hypermobility, and chronic wrist pain.
- Describe applying relevant outcome measures, such as the Canadian Occupational Performance Measure (COPM) as a method to facilitate collaborative goal setting, family centered care, self-management.
- Discuss the benefits to and strategies for a collaborative care plan for children with upper limb neuromotor impairment or chronic pain conditions seeking improved function and/or quality of life.
- Verbalize understanding of evidence-based surgical and therapy interventions to enhance upper extremity function in individuals with upper limb neuromotor impairment.
- Demonstrate understanding of the hand therapist’s role in post-operative rehabilitation of children and young adults with upper limb neuromotor impairment who pursue reconstructive surgery.
Hands On Orthotics - Simplifying Static Progressive Orthoses
The ASHT Education Division presents an orthosis fabrication course focusing on static progressive orthoses for the hand and wrist. Orthosis material will be provided so all clinicians will get hands on practice with fabrication of static progressive MP flexion, PIP extension, PIP flexion, and wrist extension orthoses. The focus is to simplify the fabricating process and create orthoses without expensive outriggers so practitioners of all levels can fabricate orthoses efficiently and cost effectively. This course will provide clinical pearls that can be valuable to patient care immediately. Indications and contraindications will also be reviewed to ensure safety and proper use.
- Interpret a hand therapy evaluation to determine the appropriate use of a static progressive orthosis
- Describe contraindications of static progressive orthoses
- Discuss the importance of a 90* angle of pull
- Demonstrate ability to fabricate static progressive orthoses to improve hand and wrist function
Head in Hand: Blending Pain Science into Our Daily Practice to Optimize Outcomes
Pain science is primarily discussed with chronic pain and is often perceived as a hands-off paradigm that rejects structural pathology and conflicts with traditional therapy approaches. However, its principles are relevant even in the presence of tissue healing and can enhance and be enhanced by standard techniques, such as manual therapy and therapeutic exercise. Routine integration of pain science principles into daily practice can increase the value of hand therapy by addressing or preventing persistent pain or disability and decreasing the costs and utilization of health care services. This intermediate session will present an evidence-informed perspective that blends pain science with traditional assessments and interventions for clients across the spectrum of upper extremity pain, from acute to persistent. We will present strategies to identify individuals who may particularly benefit from this collaborative approach, including the use of meaningful measures that extend beyond numerical ratings of pain. In addition, we will discuss practical techniques to incorporate pain science interventions—such as pain neuroscience education and graded activity—in ways that are relevant for a range of conditions and compatible with fast-paced treatment environments. Learning will be enhanced through the use of case studies, demonstrations, and interactive polling.
- Describe the advantages of blending pain science with traditional therapy approaches in the management of acute or subacute hand injury or surgery
- Identify the colored psychosocial flags associated with higher disability and health care costs in relation to upper extremity rehabilitation
- Discuss evaluation strategies that are consistent with both pain science and tissue healing models
- Compare and contrast education from a biomedical approach with a pain science approach
- Apply integrated intervention techniques to optimize the value of care after acute hand injury or surgery
Manual Therapy for Management of Painful Diagnoses
Painful diagnoses, such as thumb CMC arthritis, lateral epicondylitis, and tendinitis are amenable to treatments that fall under the description, manual therapy. An eclectic manual therapy approach to these complex and chronic sequelae can be extremely successful in reducing both moderate to severe pain, and the muscle energy imbalances that contribute to them. Some methods demonstrated will include trigger point release, joint mobilization, muscle energy and strain counter strain, and myofascial release. This presentation is designed to offer tools to evaluate postural deficits, and treat muscle imbalance that contribute to them through well-established osteopathic methods. Participants will be introduced to methods of assessment for postural imbalance, the presence of trigger and tender points, and the presence of hyper tonicity. Participants will be shown effective methods to treat these deficits through demonstration, and will have the opportunity to practice exercises and treatment methods. The demonstrations will serve as introductory methods for the advanced techniques listed above. Mastery of these skills requires many hours of training and clinical practice. Precipitants with all levels of manual skills will take something away from the class. A moderate experience level will benefit the most. Experienced therapists will be able to hone medium to expert skills.
- Paricipants will review anatomical basis of postural deficits
- Paricipants will interpret postural and joint manual therapy assessment
- Participants will appliy manual treatment techniques for lateral epicondylitis, CMC arthritis, and carpal tunnel syndrome