Background

Hand rehabilitation, also called hand therapy, is a group of assessments and interventions aimed at testing and restoring hand function after injury. This video series explains and demonstrates how the occupational therapy (0T) practitioner can assess hand range of motion, strength, and sensation as well as how to treat deficits in these areas. These videos also cover how to recognize and treat edema in the hand.

Previously, you learned how to measure range of motion, strength, and sensation as individual concepts, but now you are able to practice them together in a way that allows you to treat a specific condition. Many occupations rely heavily on hand use; thus, the OT’s goal is to help clients engage more fully in their desired occupations. Understanding how to apply these concepts to hand therapy is vital to helping our future clients succeed.

Hand Functional Testing

This video demonstrates how the OT practitioner can administer common hand-function assessments.

Hand Functional Testing Video Transcript

Hand Performance Assessment Tips

• Purdue Pegboard Test
  • Have your client preform the test by placing as many pegs as possible in the holes within 30 seconds. Your client will perform two trials.
    • For the first trial, have your client use their dominant hand.
    • For the second trial, have your client use their nondominant hand.
  • Have your client perform an assembly trial using both hands, timed for one minute.
    • Have your client assemble in this order: peg, washer, collar, washer.
    • Score the number of assembled pegs, and multiply that by the number of correctly placed pieces.
• Quick DASH
  • Ask your client assessment questions that reflect their self-reported perceptions of their shoulder, arm, and hand disability.
  • Note: The minimally clinically important difference equals scoring 9-11.3

Hand Strength and ROM Testing

This video demonstrates how the OT practitioner can measure hand-specific range of motion (ROM) and strength.

Hand Strength and ROM Testing Video Transcript

Hand Range of Motion Tips

• Goniometry
  • Align the goniometry’s stationary arm with your client’s joint.
  • Have your client bend the joint that is being measured.
  • Move the goniometer’s adjustable arm to match your client’s movement.
  • Add MCP, PIP, and DIP measurements together to calculate your client’s total hand and finger active range of motion.
• Distance
  • Measuring Grasp
    • Use a tape measure.
    • Measure from the distal palmar crease to the fingertips.
  • Measuring Opposition
    • Use a tape measure.
    • Measure the distance between the pad on the pinky and the pad of the thumb.

Hand Strength

• Manual Muscle Testing
  • See OER 1140 1150 Physical Dysfunction I, Chapter One: Strength Assessment and Intervention for details on manual muscle testing.
• Dynameter and Pinch Gauge
  • Have your client sit with their elbow unsupported at 90 degrees.
  • Test the affected side first, then compare it to the nonaffected side.
  • Test three different types of pinches—lateral pinch, pincer grasp, and three-jaw chuck.
  • Measure pinch strength three times for each pinch type.
  • Take the average of the three pinch measurements, for example, the average of three lateral pinch measurements, etc.

Hand Sensation and Edema Testing

This video explains how the OT practitioner can assess hand sensation and how to measure edema.

Hand Sensation and Edema Testing Video Transcript

Hand Sensation Tips

• See OER 1140 1150 Physical Dysfunction I, Chapter 5: Sensation Assessment and Intervention for details on sensation testing.

Edema

• Measuring Pitting
  • Push down on an edema area, which will create a depression or pit in the skin.
  • Measure the depth of the depression and the time it takes for the skin pit to rebound.
    • 2mm depression—barely detectable, immediate rebound (+1).
    • 4mm deep pit—a few seconds to rebound (+2).
    • 6mm deep pit—10-12 seconds to rebound (+3).
    • 8mm very deep pit—> 20 seconds to rebound (+4).

• Volumetric Measurement
  • Fill a measuring basin with water.
  • Place a measuring cup beneath the basin’s water spout.
  • Place your client’s hand in the water basin and hold the basin’s handle.
  • Wait until water stops flowing out of the basin’s spout.
  • Record how much water is in the measuring cup.

• Figure-Eight Circumferential Measurement
  • Use a tape measure.
  • Measure across the distal palmar crease around the back of your client’s hand and around. Create an X on the dorsal aspect of the hand, and create two parallel lines on the palmer aspect of the hand.
  • Record your measurements.

Hand Interventions

This video teaches and demonstrates techniques that the OT practitioner can use to increase range of motion (ROM) and strength in their client’s hands.

Hand Interventions Video Transcript

Range of Motion Interventions Tips

• Joint Blocking
  • Block all of your client’s joints except the one you’re working on so that you can focus on movement at one joint.
  • Joint blocking helps train muscles to work independently of one another.
• Tendon Glides
  • Move the joints of your client’s hand through full range of motion.
  • Perform the following positions in any order as long as you use all the positions.
    • Open Hand
    • Loose Grasp
    • Full Fist
    • Half Fist
    • Tabletop
    • Flat-Finger Fist
• Place-and-Hold
  • Place your client’s hand in a position such as the closed fist, and have them hold it until they fatigue, then relax.
  • Place-and-hold is an isometric strengthening exercise.
• Functional Tasks
  • Gentle gripping, reaching, turning, and manipulating objects.
  • Functional tasks are everyday tasks for your client to practice.

Edema Interventions and Scar Massage

This video explains and demonstrates interventions that the OT practitioner can employ to perform scar massage and to reduce their client’s edema.

Edema Interventions and Scar Massage Video Transcript

Edema Interventions and Scar Massage Tips

• Manual Edema Mobilization—this helps send extra fluid to the heart.
  • Start squeezing upstream, working proximal to distal.
  • Create a space by the heart, then move fluid into that space away from the extremity and towards the heart.
  • Apply pressure in a circular motion on either the anterior or posterior surface of the extremity.
  • The skill here is to move the skin; it’s not the same as massaging the muscles.
• Scar Massage
  • Move the scar in all planes such as forward and back, side to side, and in circles.
  • Be aware of hypersensitivity.
  • Perform the massage for about five minutes, as tolerated.

Resources

• e-Hand.com:  The Electronic Textbook of Hand Surgery by Charles Heaton, MD
• Resources on hand anatomy and conditions by American Society for Surgery of the Hand