Therapist Track
7:45 - 9:45 AM
HT-IC34
An Anatomical and Biomechanical Analysis of Orthotic Fabrication
Audience Level: Basic
Chair: Rebecca L. von der Heyde, PhD(c), OTR/L, CHT, St. Louis, MO
Please note this course has a limit of 60 registrants.
Objectives:
• Describe and discuss the musculoskeletal anatomy of the forearm and hand
• Integrate relevant kinesiology and biomechanics
• Compare and contrast options for the fabrication of orthoses based on foundational science constructs
• Identify common errors in immobilization
• Examine their own clinical practice for integration of presented concepts
Description:
As the profession of hand therapy advances towards evidence-based practice, comprehensive knowledge of the anatomy and biomechanics of the forearm will become increasingly imperative as rationale for clinical interventions. Incorporation of such foundational science as a means to analyze the custom fabrication of orthoses will prove beneficial as our profession defends our unique role for patients with upper extremity conditions. This course will specifically identify the anatomic and kinesiological constructs that inform decision-making for multiple diagnoses of the wrist and hand, including CMC osteoarthritis, proximal phalanx fractures, distal radius fractures, and flexor tendon injuries.
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HT-IC35
Working Hand-in-Hand — Volunteerism in Developing Countries
Audience Level: Intermediate
Chair: Nancy Chee, OTR/L, CHT, San Francisco, CA
Faculty: Douglas Hutchinson, MD, Salt Lake City, UT; Nancy Kelly, MHS, Washington, DC
Description:
Presentations are on the experiences of a hand surgeon and hand therapist with working as volunteers in developing countries. Discussion on how programs have developed, through surgeries done, post op care, therapy and teaching with local personnel have helped people and the countries underserved. And a final speaker will present about looking into opportunities available for those interest in volunteering overseas.
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7:45 - 11:15 AM
HT-IC36
Clinical Reasoning and Physical Agents: Employing an Evidence-based Approach
Audience Level: Intermediate
Chair: Ginny Gibson, MS, OTR/L, CHT, Oakland, CA
Faculty: Michelle Cameron, MD, PT, OCS, Portland, OR; Jennifer Chisar, MS, PT, CHT, Walnut Creek, CA; Jane Fedorczyk, PhD, PT, CHT, ATC, Philadelphia, PA
Objectives:
• Justify use or non-use of thermotherapy to increase soft tissue extensibility using an evidenced-based approach
• Justify use or non-use of cryotherapy to reduce edema associated with inflammationusing an evidenced-based approach
• Justify use or non-use of ES for strengthening of innervated and denervated muscle using an evidenced-based approach
• Justify use or non-use of ultrasound and low-level LASER for tissue healing using an evidenced-based approach
• Describe appropriate utilization of therapeutic ultrasound in pediatrics
Description:
The therapeutic application of physical agents requires knowledge of the mechanism of action for the agent, skill to apply the agent, and an understanding of the effectiveness of an agent for a defined purpose. Effectiveness of specific agents, as described in basic science and clinical research studies, will be reviewed. The presenters will describe and define the studies using levels of evidence as defined by Sackett (2000)and using the PICO format(patientpopulation, intervention, comparison, outcomes). Case studies will be presented to provide the participants with opportunity to utilize research in their clinical decision making processes.
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8:00 - 9:30 AM
HT-IC37
Applying Basic Science to Clinical Practice: Using the Wrist as a Model
Audience Level: Advanced
Chair: Susan Michlovitz, PhD, PT, CHT, Ithaca, NY
Faculty: Marc Garcia-Elias, MD, PhD, Barcelona, Spain; Elisabet Hagert, MD, PhD, Stockholm, Sweden; Paul LaStayo, PhD, PT, CHT, Salt Lake City, UT
Objectives:
• Describe selected basic science models that have been used to study wrist proprioception and mechanics
• Describe and analyze clinical and therapeutic applications of basic science as related to wrist proprioception and biomechanics
• Discuss how basic science principles have been incorporated into therapy regimens and evaluation principles
Description:
Clinical strategies for managing wrist and distal radio-ulnar joint problems are often derived from work done in basic science. The hand professional should be up-to-date on this information utilize this information when designing therapy programs and understanding rationale for surgical interventions. Presenters in this course discuss the role that basic science models apply to clinical practice and will use work done on the wrist as a model. The presenters and participants will have the opportunity to brainstorm new or modified therapy paradigm for managing problems of wrist instability and other selected problems affecting the wrist.
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HT-IC38
Therapeutic Evidence of Principles and Management of Tendon Transfers in the Hand
Audience Level: Intermediate
Chair: Shrikant Chinchalkar, OTR, CHT, London, ON, Canada
Faculty: Saba Kamal, OTR, CHT, San Jose, CA
Objectives:
• Understand the principles of tendon transfer
• Indication and Contra-indication of tendon transfers
• Peripheral nerve injury, RA and traumatic hand conditions requiring transfers
• Consideration of musculo tendinous unit retraining pertaining to specific transfers used in these conditions
• Pre/ post surgical management of tendon transfer
Description:
Post-operative surgical outcome of tendon transfers for irreparable nerve lesions, tendon ruptures in RA &/or traumatic conditions is dependent upon the close communication between the patients, therapists & the surgeons. Muscle imbalance is usually evident after traumatic injuries, resulting into a functional loss producing an additional progressive neuromuscular impairment. Maintaining a mobile extremity without deforming contracture demands a planned & persistent rehabilitation program before tendon transfer is performed. Primary indications for tendon transfers is based on the understanding of principles of tendon transfers that results in balanced functional performance done by redistributing assets rather than creating new ones. A number of tendon transfers used in nerve palsies treated with early mobilization have demonstrated therapeutic evidence of level III & VI. The presentation highlights the indications & contraindication of tendon transfers & discuss the techniques of transfer re-education for various transfers used for (such as pulvertaft or end to end ) for nerve injuries, RA, & traumatic hand conditions. The participants will learn the process of muscle re-education to regain motor power & function that teaches coordinated synchronized movement, relearning motor control of the new muscle by cortical re-training. Cortical plasticity occurs in the primary motor & sensory cortex in response to a variety of experiences, (from learning a new piano piece to losing a leg in an accident). Plasticity contributes in some still-mysterious way to enhance patients' abilities to acquire & use newly reconstructed movements. A better understanding of the mechanisms underlying cortical plasticity holds with it the possibility of establishing more effective recovery strategies after neuromuscular injury in humans. Finally, the participants will learn the pre/ post op surgical management of tendon transfer with specific ADLs & use of EMG triggered E-stim to maximize the function of the hand as adaptive brain changes in cortical representations in its association with motor skill relearning & of basic movements.
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9:45 - 11:15 AM
HT-IC39
Static Progressive Splinting
Audience Level: Advanced
Chair: Karen Schultz-Johnson, MS, OTR, CHT, FAOTA, Edwards, CO
Please note this course has a limit of 60 registrants.
Objectives:
• To define static progressive splinting and contrast it with other splinting approaches
• To identify to advantages of static progressive splinting
• To clarify indications and contra-indications for static progressive splinting
• To discuss clinical critical thinking with regard to specifying splint regimen and dose of static progressive splint wear
• To have the “hands on” experience of fabricating a static progressive splint
Description:
Static-progressive splinting (SPS) is the use of inelastic components to apply torque to a joint in order to statically position it as close to end-range as possible. It maximizes total end range time thus increasing PROM. As tissue lengthens in response to this carefully applied stress, the clinician or wearer adjusts the joint position to progress tissue at the new maximum tolerable length. SPS combines precision in joint position and torque application with patient-controlled stress to create an approach powerful enough to succeed when no other treatment approach does.
This instructional course discusses the rationale and physics behind static progressive splinting. In addition, it presents indications contra-indications, advantages, as well as guidelines for splint regimen. It offers many SPS examples and makes clear that this approach can be used with any mobilizing splint design. The unique mechanics of this splint approach are described and the various methods of achieving SPS are compared. Offering high levels of patient satisfaction and compliance, SPS has come to the forefront of clinical practice.
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HT-IC40
A Practical How-to Approach to Choosing an Appropriate Outcome Measure to Measure Meaningful Change in Hand Patients
Audience Level: Intermediate
Chair: Kristin Valdes, OTD, OTR, CHT, Venice, FL
Faculty: Gretchen Kaiser Bodell, OTD, OTR/L, MBA, CHT, Phoenix, AZ; Tambra Marik, OTD, OTR/L, CHT, Gig Harbor, WA
Objectives:
• Choose an appropriate patient-centered outcome measure to use in their practice
• Understand when change measured is clinically significant
• Discuss the variety of patient centered outcomes measures that are available to measure change
• Score the various patient centered outcome measures
• Start utilizing patient centered outcome measures in their clinical setting
Description:
There is an ever-increasing demand upon hand therapists to use outcome measurements to validate the interventions that they use in patient treatment. Participants will gain an understanding of the psychometric properties of the outcome measurements used to determine the initial status of a patient, detect change, and enhance clinical decision making using an evidence-based framework. The concept of minimally clinically important difference (MCID) will be discussed to allow therapists to make informed decisions regarding therapeutic interventions. This course is designed to provide hand therapists with the tools needed to improve clinical decision by using an evidence-based framework in the application of patient centered outcome measures.
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HT-IC41
ASHT International Panel
Audience Level: Intermediate
Chair: Martin Walsh, OTR/L, CHT, Sacramento, CA
Description:
The International Hand Therapy Panel is designed to feature therapists from countries outside of North America who will discuss research and treatment techniques that are unique to their respective countries. This session will encourage audience participation in a discussion regarding differences in approaches and medical systems.
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HT-IC42
Joint Replacement in the Upper Extremity: Surgical Advances and Innovations in Rehabilitation Techniques
Audience Level: Intermediate
Chair: William H. Seitz, Jr, MD, Cleveland, OH
Faculty: Ernest Michaud, OTR/L, CHT, Cleveland, OH; Monica Van Niel, OTR/L, Beachwood, OH;
Patty Shimko, OTR/L, Beachwood, OH
Objectives:
• Obtain a clear insight into the decision making process including implant choice for a wide variety of arthropathic conditions involving the wrist, elbow and shoulder
• Identify the mechanics of joint replacement in the framework of a variety of pathological conditions to provide the foundation for the ability to develop a rehabilitation program designed at maximizing outcome in patients undergoing wrist, elbow and shoulder replacement arthroplasty
Description:
Joint replacement in the wrist, elbow and shoulder is an evolving science. New surgical implants, techniques and strategies have expanded the scope of indications and broadened the patient population to include a wider array of patients with a variety of arthritic and post-traumatic conditions. More physiological and kinematic designs for primary arthroplasty has provided tools to better restore normal joint mechanics. Innovative engineering has also resulted in the development of unconventional, but effective implant designs for conditions previously precluding effective arthoplasty. As surgical techniques have evolved, so too have techniques in rehabilitation designed at preparing patients for surgery as well as helping them maximize a functional outcome following surgery. This symposium will address new technology in total and partial wrist replacement surgery, elbow replacement surgery and shoulder replacement surgery. Specific applications for patients with rheumatoid disease, osteoarthritis, post traumatic arthropathy and cuff tear arthropathy will be discussed. Indications for partial and total wrist replacement arthroplasty, total elbow arthroplasty, total shoulder arthroplasty (including reverse shoulder arthroplasty and cup resurfacing arthroplasty) will be presented.
Rehabilitation Strategy:
Rehabilitation strategies including pre-operative preparation, innovative approaches to phased post-operative rehabilitation (including return to work and sports rehabilitation) will be detailed. Use of a variety of modilities, splinting, therapeutic exercise regimens and water therapy will be discussed at each level of rehabilitation specific for each involved joint arthroplasty. The panel will share their extensive experience in surgical decision making while optimizing outcomes through a carefully designed and individually detailed rehabilitation program based on careful communication from the first stages of pre-operative planning to the ultimate goal of return to function. Specific case presentations will be provided, demonstrating application of the principals discussed. The target audience is surgeons and therapists engaged in the care and treatment of patients with arthritis involving the wrist, elbow and shoulder.
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