Featured Article By - Exploring Hand Therapy

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Featured Article By - Exploring Hand Therapy Powered By Docstoc
					   Volum e 7 , I s s u e 4                                                www.handtherapy.com                                                            October - December 2007


 From The Editors Desk                                                                                                                    In This Issue
 As we head into the cold months and          rehabilitation clinicians including OTs.     Featured Article .......................................1     Political Corner ......................................10
 approach the new year, EHT will continue     PTs, ATCs, massage therapists to name a      Splinting Tips ...........................................4   Ask The Expert ......................................12
 to provide our exceptional educational       few. Go to www.treatment2go.com and
 opportunities. Check out our most            register to win a FREE course.               What’s Hot ...............................................4   Newly released courses ........................13
 recent popular movie courses on page         Thank you to our sponsors for making this    Quiz Corner. ............................................5    Ergo Corner ...........................................14
 13. As always we have a great interactive    magazine possible. Please click on their
 website for your learning enjoyment. Visit                                                Learn & Earn ........................................10       Modalities ..............................................16
                                              ads (if viewing online) to learn more.
 www.handtherapy.com
                                              EHT’s magazine is for informational
 EHT is excited to announce                   purposes only and is not intended to
 TREATMENT2Go. This is a division             be a substitute for professional medical
 of Exploring Hand Therapy dedicated          advice, diagnosis or treatment. Content
 to providing quality education for all       is the opinion of the contributors and not
                                              necessarily of EHT.
                                              ENJOY!


                                                                                                                                                         Susan Weiss                    Nancy Falkenstein
                                                                                                                                                          OTR, CHT                      OTR, CHT, CEES

Featured Article                                                                                                                  By: George LeCour OTR/L, CHT
Less Is More in Sports                                           When many people think of                                                      The first lesson therapists
Rehab                                                            sports medicine and rehab                                                      have to learn is that sports
                                                                 they usually associate it with                                                 rehab involves any person
I have recently noticed many                                     college level or professional                                                  who plays competitive sports.
therapists practicing today                                      athletes. Anyone who
have become bored and                                            watches sports on television,
complacent. They often feel                                      reads game statistics in the
as though they are no longer                                     newspaper, or even plays
challenged in their practice                                     fantasy football (or any sport)
and their once sharp clinical                                    has a basic understanding of
skills have become rather                                        sports medicine. For most
dull. Personally, I feel the                                     people sports medicine is
truth be known, is that with                                     when an athlete goes down
all the treatment gadgets                                        during the game, a trainer                                                     This can be someone who
and specialty certifications                                     comes in to assess the                                                         plays high school sports, little
available today therapists                                       athlete, and they are carted                                                   league baseball, or even is a
are relying more on what                                         off the field. For many this is                                                league bowler. Just because
those things promise to                                          sports medicine but behind                                                     there is not a trainer in the
deliver rather than using their                                  the scenes it involves so                                                      locker room, a mascot on
own expertise and instincts.                                     much more.                                                                     the field, or a high profile
Sports rehab is a very                                                                                                                                                     continued on page 3
different area of practice.

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      coach present does not mean the                   trainers, physicians, coaches,         competition.
      individual playing a competitive                  parents, and the injured athlete.      So how is sports rehab so much
      sports is not considered (or                      Care is very coordinated between                         different from
      treated) as an “athlete”. Athletes                individuals and communication is                         say regular
      come in many different sizes,                     essential; however, the common                           orthopedic
      ages, and backgrounds. One                        goal of all the individuals involved                     rehab? The
      one common dominator is they                      in the process is to return the                          biggest
      are all competing for something.                  athlete to competitive play as                           difference is
                                                        quickly and safely as possible.                          TIME!
      Another lesson therapists in
      sports rehab learn is that there                  Rehabilitation of an injured                                 In sports
      can be a number of people                         athlete is a very challenging area     rehab the name of the game is to
      involved as part of the rehab                     of practice. Therapists must           return an athlete to competitive
      team. Often the therapist does                    have sound clinical skills and         play as quickly and safely as
      not carry the weight of returning                 be confident in all decisions. In      possible. What this means is that
      the athlete to competition solely                 addition, therapists must stay         even though an athlete has an
                             on their                   current on new techniques and          injury it does not mean they will
                              shoulders.                changing surgical procedures           not continue to play. Of course,
                              Instead,                  and treatment protocols. Athletes      if the injury is serious enough or
                              therapists                are driven to attain some sort         certain surgical procedures are
                              work in                   of prize and therapists should         required the athlete may not be
                              conjunction
                 FW_adult_therapy_ad0407 Color.pdPage       driven by the satisfaction
                                                        be4/17/07 10:29:26 PM
                                                        1
                                                                                                              continued on page 5
                              with athletic             of returning an athlete to




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                                                                                                                                    3
Splinting Tips and Tricks                                               by: Susan Weiss OTR/L, CHT
Mallet Finger: Tiny Splint -             to understand that continuous           is lax and hyperextends (swan-
Tough To Make                            splinting is needed for the joint       neck deformity), then splinting the
                                         to maintain extension. You must         PIPJ in partial flexion for the first
Mallet injuries, whether bony            teach them to maintain extension        half of treatment is appropriate.
or tendinous, usually do alright         even while cleaning the finger.         Various types of splints used:
with closed treatment and do             They can’t take a shower and
not need surgical intervention.          leave the splint on the counter or
Splinting of the DIPJ in full            all gains made will be lost.
extension will allow for healing         Remember, the DIPJ should be
of the injured structure and for         immobilized in full extension so
restoration of excellent function        that the finger is straight do not
and appearance if used properly.         put the finger in hyperextension.
Patient education and compliance         Sustained hyperextension of the
are critical in order for the patient    DIPJ may cause ischemia to the
to end up without a significant          skin over the dorsum of the joint
lag/deformity. Extension splinting       and contribute to the development
should be maintained without             of pressure sores.                      Premolded plastic splints are
any lapse for the prescribed                                                     available commercially. These
treatment time. Tendinous injuries       Various methods have been used          are called stax splints and
require 6-8 weeks of splinting,          to splint the DIPJ in extension.        many clinics have a variety
and bony injuries require 4-5            Splinting is usually isolated to the    of sizes on hand in the clinic.
weeks. It is critical for your patient   distal joint. However, if the PIPJ                           Continued on page 6

What’s Hot
How Much Time                            time.”                                  the old routine of skipped lunches
Do You Spend                             Total patient time, of course,          and extra hours seems like a
Documenting?                             includes time spent with the patient    more comfortable solution. Those
                                         and time spent documenting the          therapists who have taken the leap
After speaking with hundreds of          encounter. For example, if you          with a JTECH system, tell us that
hand therapists, JTECH found             have 20 minutes to spend with a         the time necessary to learn and
they all share one challenge…            patient and you need 10 minutes         integrate the system is minimal and
time. While situations and needs         for documentation, that leaves          pales in comparison to the efficiency
vary from one clinic to another          only 10 minutes devoted to patient      enjoyed on a daily basis. And, once
and one region to another, all the       care. So how do you get more            the system is up and running, they
hand therapists we met said they         time for patient care without writing   also find the JTECH system is easily
faced the daily demand of trying to      documentation during non-treatment      customized to their clinical needs
evaluate and treat as many patients      time? Ideally, most therapists would    and style.
as possible during treatment hours.      like to document as they go. But that
Sadly, most therapists report that       requires evaluation instruments that    The JTECH system works for hand
providing appropriate patient            interface directly with documentation   therapists because we make it our
care requires them to catch up on        software that is easy, efficient,       business to know what challenges
documentation during non-treatment       flexible and comprehensive enough       they face so we can provide optimal
hours, which frequently means            to handle an entire evaluation.         solutions. We consider all of the
skipping lunches, arriving at work       Naturally, when you are already         hand therapists we work with to
early and leaving the clinic late.       pressed for time, who wants to          be our consultants because they
And, in many cases, therapists           spend more time learning a new          provide input and ideas that make
are not accounting for this extra        software program? For many hand         our products more useful.
documentation time as “patient           therapists the old equipment and                            Continued on page 11


 4
able to play, but if at all possible   athlete will not miss any playing     Now, let us take a moment and
the athlete will play. Because of      time unless motion is severely        consider differences between
this one factor, this is why less      affected or their performance is      treatment approaches for
is more in sports rehab.               significantly limited by pain. The    different needs of the athlete.
                                       therapist must assess the athlete     Each athlete is unique. They
Consider someone with a rotator        to determine the pathology,           play different sports, different
cuff impingement for example.          consider biomechanics,                positions, and have different
If the person is not an athlete        analyze the athlete’s sport           physical
then time is only a concern in         and position, and formulate a         demands. For
terms of insurance or physician        treatment plan. Treatment for         example, a
instructions. Therapists usually       the athlete may include ice or        quarterback
follow a similar rehabilitation        heat, ultrasound, laser, manual       with a shoulder
protocol with impingement              therapy, therapeutic exercises        injury on the
pathologies which may include          specific to the identified problem,   throwing arm
moist heat, electrical stimulation,    and equipment or biomechanical        is approached differently than a
ultrasound, and therapeutic            modification. Aside from therapy,     linebacker with a shoulder injury.
exercises. This group of patients      the athlete may perform certain       An injury to an athlete has to be
are often seen in the clinic 3x a      treatment activities independently    considered within its individual
week for a period of weeks to try      or may receive additional             context.
and return the person to normal        treatment daily by an athletic
daily activities without pain. Now     trainer.                              The treatment arsenal of a sports
if this person is an athlete, well,                                          rehab therapist often consists of
time is a factor. Most likely the                                                            continued on page 7



                                                      Test Your Knowledge

                                                     1. In reference to treating an athlete; what is one of
                                                         the biggest differences compared to the “general”
                                                         orthopedic population?
                                                     2. To speed up healing most athletes will “rest” (no
                                                         sports) during healing. T/F
                                                     3. In reference to sports rehab an athlete is only
                                                         considered college and professional players? T/F
                                                     4. JTECH is a computerized documentation system
                                                         customized to the clinician’s needs? T/F
                                                     5. Ergonomics is considered a growing field for OT
                                                         and PT. T/F
                                                     6. The geriatric population, for the most part, does
                                                         not benefit from ergonomics. T/F
                                                     7. What therapeutic intervention is considered
                                                         effective and efficient when treating an athlete?
                                                     8. What position do you want to splint a mallet
                                                         deformity for conservative intervention?
                                                     . List three (3) types of mallet finger splints?
                                                     10. List 2 concerns a therapists must address when
                                                         treating an athlete.

                                                                                                Continued on page 15


                                                                                                                   5
 Splinting Tips and Tricks Continued                                            by: Susan Weiss OTR/L, CHT
Unfortunately, these often do             However with the volar approach,          patient. I teach them that this
not fit the finger sufficiently           the aluminum precludes any                splint may be one of the toughest
close to maintain the joint in full       tactile feedback from the digital         splints they will ever make!
extension. These splints have the         pulp for light activities. Also
added disadvantages of entirely           aluminum splints are often bulky,         The Cochrane Reviews (research
covering the fingertip from tactile       large and often extend the length         grading system) reveals that there
sensation and they also prevent           of the finger. You can cut the            is not enough evidence about
evaporation of moisture from the          aluminum but then the edges               the best way to treat a mallet
enclosed skin. You can modify             are sharp and can pose a safety           finger injury. The report says:
them by cutting the material to fit       concern.                                  Four trials were included. These
better and/or adding a lining to                                                    involved a total of 278 patients,
the splint.                               A multitude of custom                     mainly adult, participants with
                                          thermoplastic/casting splints have        283 mallet finger injuries. All
Aluminum foam splints can be              been described. Clinicians will           four trials were methodologically
applied the the finger either             use coban® or straps to hold a            flawed, including inadequate
dorsally or volarly. These are                           thermoplastic splint       outcome assessment. The
                                                         in positon. Other          author of this review concluded:
                                                         clinicians will apply      There was insufficient evidence
                                        Volar Splint
                                                         a quick cast out of        from comparisons tested
                                                         casting material.          within randomized controlled
                                          This design will hold the finger in       trials to establish the relative
                                          extension prohibiting the patient         effectiveness of different, either
                                          from removing the cast except for         custom-made or off-the-shelf,
                                          in the clinic (to apply a new cast        finger splints used for treating
                                          or inspect the finger).                   mallet finger injury.

                                           Fabricating a mallet finger splint       So guess what gang... you got it...
                                                      can provide a great           this is a great area to do a study!
applied using tape to keep                            challenge for the clinician
the splint in place. Dorsal                           to achieve the proper fit     The following website provides
splinting allows the digital pulp                     and position. I believe it    excellent diagrams on mallet
to be partially exposed for             Dorsal splint depends on the individual     finger pathology.
keyboarding and other daily                           patient as to what splint     http://www.eatonhand.com/hw/
activities. In addition, dorsal            will work best. For patients who         hw015.htm
splints are found by many to               need the tactile feedback a dorsal
               be more effective at        splint is indicated. For patients
               maintaining the joint       who will overcome a dorsal splint
               in full extension. It is    with force, a volar splint is easier
 3 point strap best to use 2 strips of     to apply and less likely to fail. It
 fixation
               tape to allow a 3-point     is funny when students come in
fixation. Volar splinting requires         and think a mallet finger splint is
only one band of tape around               a breeze only to have a patient
the finger at the level of the distal come back because it is falling
joint to achieve 3-point fixation.         off or they keep looking at the
Therefore, a volar splint using            finger to see if it is straight. I
a single strip of tape is slightly         then remind them of my initial
easier to apply and maintain.              teachings when we first saw the
 6
selected modalities, therapeutic      5.  3.5cm x 2.0cm Plastazote         7. Two (2) layers may be
exercises, manual therapy             Now lets look at taping                 applied for more rigid fixation
techniques, athletic taping, and      techniques.
splinting/bracing. Therapists
usually select the intervention       Instructions for LT taping:
which will accomplish the desired     1. The forearm is pronated,
goal most effectively in order to         wrist in neutral, and the hand
save time. For example:                   is relaxed. Athlete should not
Modalities may be selected                be in a fisted position.
to manage symptoms versus             2. The plastazote piece is
eliminating symptoms.                     placed on the palmar surface
Symptoms managed with                     to provide a “lift” to the
modalites may be:                                                          Precautions for Taping:
• inflammation                                                             • Monitor for skin sensitivity
• pain and/or                                                              • Watch for redness, itching, or
• swelling                                                                   blisters in the area of the tape.
                                                                           • Do not shave the area to be
Conservative treatment is often                                              taped.
used to manage an athlete’s                                                • Tape should not be worn for
injury until the completion of the                                           more than 2 days consecutively.
season when further medical                                                • The skin should be cleansed
management can be performed              pisiform.                           thoroughly with rubbing alcohol
unless the severity of the injury     3. Make sure the skin has been         in between taping.
warrants otherwise.                      prepped before applying the       • If the patient complains of
                                         tape.                               numbness in the fingers or the
Athletic taping is a treatment        4. Apply the hypafix first             hand “feels cold” then remove
intervention that epitomizes the         and use it to secure the            the tape and reapply monitoring
less is more concept of sports           plastazote insert in place.         placement of the plastazote
rehab. Taping can be used for            No tension should be applied        insert and tension of the tape.
a variety of injuries and for a          to the hypafix. It is the base
number of reasons. The practice          for your taping.                  This is just a synapse of sports
of taping has evolved over the        5. Starting on the volar surface     rehab. There is so much more
years with newer techniques                                                to this area of rehabilitation. In
and tapes being developed each                                             general, sports rehab relies on
year.                                                                      strong clinical assessment skills
                                                                           and quick, effective decision
To demonstrate how taping can                                              making. It is a great and growing
be used effectively, here is an                                            area in rehabilitation.
example of taping of a wrist for
an athlete with lunotriquetral (LT)
instability. Below is a list of the
items used:                              of the wrist, apply the
                                         leukotape. The tape should
1. Skin prep spray                       begin at the radius, cross the
2. Skin prep using Milk of               ulna, and an upward lift is
   Magnesia can also be used             applied.
3. Leukotape                          6. The tape is then secured on                        continued on page 8
4. Hypafix                               the dorsal wrist at the radius.

                                                                                                                  7
 Featured article (continued)
To learn more about rehabing the    If you do not treat sports medicine
athlete check out....               patients then hopefully this article
                                    will challenge you to go back to
Sports Injuries: Off the Sideline   your roots as a therapist. Treat
and Into the Game                   all patients individually and avoid
Getting Off the Sideline and Into   getting into a rut. Be selective
the Game is an interactive 7.75     with treatment interventions and
contact hours (.775 AOTA CEU)       choose tools which will benefit
movie course that will introduce    each specific patient and are not
the rehab professional to the       simply a billable unit.
world of sports medicine & assist
in discovery                        Order Sports Rehabilitation go to
of the unique                       http://www.live-conferences.
treatment of                        com/product.asp?cid=140
the athlete . At
the completion                      Thank you George
of this course                      George’s Bio on page15
the participant
will feel more
confident to
“take the field”
in sports rehab.

 PHOENIX ARIZONA -- ASHT Annual Conference                                  Want To Be a STAR?
Exploring Hand Therapy wants to     for helping us and ensuring            We want to share
extend a thank you to everyone      everything ran smoothly.               your ideas.
that stopped by our booth at
the ASHT annual conference in       EHT is growing and we continue         Please write a
Phoenix this October. Although      to give you quality education at       feature article for us. We do not
the exhibit hours were limited      a great price. If you didn’t get a     require lots of references but
this year we managed to meet        chance to stop by our booth you        are interested in a great find or a
almost 75% of the participants.     can check out all of our courses       wonderful story. Share your tips/
                                    and interactive website at             tricks. This is a great way for you
                                    www.handtherapy.com                    to communicate to over 11,000
                                                                           clinicians. Your clinical pearls are
                                                                           valuable.

                                                                           Please email us and share
                                                                           susan@handtherapy.com
Marleen Phillip, Susan, Nancy
and Carolyn
                                      Marleen, Susan and Caroyln
We had a great time and wanted
to thank our booth helpers,
Marleen, Carolyn, and Phillip


 8

Political Corner
OTs and PTs call to action. We          AOTA members, staff, and              (two Senators and one member
must act now. It is that time of year   consumers were successful in          of the House of Representatives)
again, we must stop the therapy         getting language extending the cap    and ask them to support extending
caps. Congress must address             exceptions process and preventing     the Medicare Part B therapy cap
the Medicare therapy caps and           the fee schedule cuts included in     exceptions process for two years.
the fee schedule cuts. Unless           the Children’s Health Insurance
Congress acts by December 31,           Program (CHIP) legislation that       AOTA has created a very easy
2007, the therapy caps will return      passed the House in July. However,    email link for you to send the
and occupational therapy, physical      the Senate passed a CHIP bill that    message to Congress. Please Visit
and speech therapy practitioners        differed from the House version       AOTA today and get involved.
will face cuts in                       and the two bodies compromised        http://capwiz.com/aota/issues/
Medicare Part                           on a bill that included no Medicare   alert/?alertid=10410596
B payments on                           provisions.
January 1, 2008.
                                        Now, the House and Senate
Congress must                           will have to address the therapy
hear from YOU                           caps, fee schedule cuts and other
to understand                           Medicare provisions in another bill
the importance of                       prior to December 31, 2007. AOTA
getting legislation                     needs your help to urge Congress to
passed that will extend the therapy     take action.
cap exceptions process for 2008
and 200, and prevent cuts the fee      Grassroots action is still needed.
schedule.                               Contact your members of Congress

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                                        opportunity by reading this jam packed publication.
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                  Course Title: LEARN AND EARN Volume 6 Sports


10
Christine Clements,                             JTECH: What made you decide                    JTECH: How were you able to
OTR, CHT and                                    to purchase a JTECH?                           justify a (computerized) system
a long-time user                                                                               in your budgeting process?
                                                Christine: We looked at Greenleaf and
of JTECH’s
                                                another system which actually has a            Christine: It saves time so the therapist can
Computerized
                                                computerized medical record as well.           see more patients. It shaved off a significant
Comprehensive
                                                In the end, we chose JTECH because             amount of dictation and transcription time.
Hand Evaluation
system, provided                                it was specific, easy to use, had AMA          JTECH: How much documentation
a great deal of input on our new                normative data and an FCE program.             time are you saving with the
Tracker Version 5 software. She                                                                computerized system?
                                                JTECH: How has the computerized
was also kind enough to share some              system benefited your clinic?                  Christine: I’m saving 50-75% in written and
of her experiences with using the
                                                Christine: It saves time, money and            dictation time with the JTECH CHE system.
JTECH system.
                                                transcription costs. It has professional
JTECH: How did you know you                     documentation and allows immediate
                                                                                               We’re very pleased with Christine’s
needed to make the investment                                                                  results and now, with our wireless
in a computerized system?                       feedback, especially when the patient has
                                                                                               technology, we anticipate that
                                                a doctor appointment the same day. I can
                                                                                               therapists will be able to shave still
Christine: With multiple joints to measure      write a note at the treatment session and      more time from their evaluations
and record in the hand and upper                send it with the patient to the appointment.   because of the portability of the
extremities, it took too much time to
                                                JTECH: What is your favorite                   system and greater ease of use. As
compare and report to the MD. I loved           feature of the JTECH CHE system?               we continue to consult with hand
the graphs. I thought a computerized                                                           therapists to provide innovative and
system would save time, increase accuracy,      Christine: The goniometer, it measures         practical solutions, we welcome your
justify intervention and put clinicians in      quickly and accurately as multiple joints      feedback and can be reached at
front of the patient more, which it does.       take longer to document. I love the            (800) 85-8324.
                                                graphs for tracking gains and losses.




            “I’m saving 50-75% in
            written and dictation
            time with the JTECH
            CHE system.”
            “I love the graphs for tracking gains and losses.
            Providing immediate feedback to MD’s has also
            been a great benefit, especially when they’re
            scheduled to see the patient the same day.”
            Christine Clements, OTR, CHT, Saginaw, MI

                                                                                                                               MM202-B
      Rental and monthly payment programs available.


                      CHE          Call for a FREE
                     Your
                                   demonstration
                     helping       (800) 985-8324,
                     hand          (801) 478-0680

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                                                                                                                                          11
Ask the Expert                                                        Our featured expert ... George LeCour OTR/L, CHT
1. How does a therapist get a position                                  3. What settings do therapists perform
working in sport rehabilitation?                                        sports rehabilitation?
In order to obtain a position in sports-specific rehabilitation         Most sports rehab clinics are outpatient in nature but some
therapists need to locate an outpatient clinic that targets an          therapists may be located within an athletic organization
orthopedic, athletic, or wellness population. Many of these             (university athletics) or the offices of an orthopedic practice.
clinics will be active sponsors of wellness events or athletic
organizations. Probably the easiest way to seek out employment
is to talk with schools, universities, or athletic organizations in     4. Are athletes allowed to play sports in casts or splints?
the area to find out who provides the care for their athletes.           Yes. Certain conditions permit an athlete to continue competitive
                                                                        play without interruption with the use of a cast or splint. In
                                                                        order for casts or splints to be permitted they must meet certain
2. Does a therapist require advance certification
to perform sport rehabilitation?                                        requirements. They must protect the injured area, be easily
                                                                        removed, and be well-padded to prevent injury to other players.
Not necessarily. Many therapists may be certified athletic              Of course, the final approval is granted by the officiating crew.
trainers (ATCs) but most just receive some advanced training in
orthopedic treatment or specialized techniques. A successful
sports rehab therapist has a love for sports and often a                5. How do you learn taping techniques
competitive nature. It is that competitive nature which drives          to use for athletic injuries?
them to obtain advanced training to be a successful therapist.          Most sports rehab taping consists of basic athletic taping; however,
                                                                        there are more advanced taping techniques used today which

                                                                                                                           continued on page 15


12
                                    Newly Released and Popular CEU Courses
                        Wrist pathology     you view this section you will feel         intrinsics, edema, joint mobilization
                        is commonly         confident in your exam skills and have      and splinting is beneficial when
                        encountered         a broader knowledge of the mysteries        viewing this course. The instructor
                        in the clinic       of the wrist.                               discusses basic joint kinesology,
                        both directly                                                   anatomy, and pathology. Stiff joints
                        and indirectly.     Gary Schwartz, MD walks you through         are a common diagnosis therapists
                        To provide          the Physicians Wrist Secrets (Part          are faced with daily. This course will
                        the highest         3) in this 3.25 AOTA CEU movie              help you get ‘em movin.
                        quality of care                              course. The
                        for patients                                 MD’s approach      Every practicing rehab professional
                        with wrist                                   is part 3 of the                          has been faced
                        dysfunction                                  Wrist Secrets                             with a dilemma
                        thorough                                     trilogy. Dr.                              at some point
knowledge is needed. Wrist Secrets                                   Schwartz                                  in their career
(Part 1) is a 4.0 hour AOTA CEU                                      teaches                                   concerning
movie course designed to provide you                                 with ease                                 assistants and
with a comprehensive understanding                                   on various                                techs. Who
of wrist evaluation and treatment.                                   challenging                               can supervise
The therapist will learn the pertinent                               wrist                                     a PTA? Can
anatomy and biomechanics as it                                       pathologies to                            a tech provide
applies to evaluation and treatment.                                 intervention.                             treatment?
Emphasis will be on proper                  Dr. Schwartz addresses many                                        Is it legal?
interpretation of special tests, manual     questions you may have had about            How should assistants and techs
therapy, connective tissue healing          the physicians approach. Dr. Schwartz       be utilized? Assistants & Techs:
and treatment techniques. Part 1            leads you down the path of wrist            The Good, The Bad, & The Ugly
is presented by Richard Montmeny            pathology and with his knowledge            is a fantastic movie CEU course
PhD,PT,CHT,CEA.                             teaches you clinical gems that will         designed to answers your ethical and
                                            assist your clinical reasoning skills.      legal questions regarding therapy
                         Wrist Secrets      He answers questions about wrist            assistants and techs.
                         (Part 2),          pathology in an easy to understand
                         presented by       fashion.                                    Have you ever had an athlete referred
                         Susan Weiss,                                                   to your clinic and felt as though your
                         OTR/L, CHT            NOTE: Save $$$ and purchase                                       treatment was
                         is a 4.0 hour          WRIST SECRETS the trilogy                                        inadequate?
                         AOTA CEU                       package.                                                 Have you
                         movie course.                                                                           ever felt that
                         Susan will bring   Stiffness: Suggestions and                                           your treatment
                         you up close       Solutions is a 3.5 AOTA CEU                                          approach is
                         and personal       movie course presented by Nancy                                      stale?
                         during this in                           Falkenstein,                                   Sports
                        depth study                               OTR/L, CHT.                                    Rehabilitation:
of the wrist. You will see a detailed                             Excellent                                      Getting Off
clinical examination up close and                                 dynamic                                        the Sideline
have the ability to watch rewind and                              interactive                                    and Into the
replay. In the palpation lab you will                             course                Game is a course that will introduce
learn how to find the carpal bones with                           designed              the rehab professional to the world
ease and the structures surrounding                               to give you           of sports medicine and discuss the
them. After the detailed examination                              suggestions           unique treatment of the athlete.
Susan will lecture on wrist fracture,                             and solutions
stiff hand treatment, TFCC care,                                  to treating
carpal bone fractures, dislocations                               the stiff hand.        For a complete listing of
and instabilities. Learn skills you can     Intermediate to advanced movie               EHT’s courses visit
use in your clinics immediately. After      course. Basic knowledge in wounds,           www.handtherapy.com

                                                                                                                             13
Ergonomic Corner
Ergonomics and Aging                     as well as the older customer         Skin Changes
                                         in mind. One example Jacobs           Ergonomic Intervention:
We all hear about the baby               quotes is in the banking industry.    • Improve hydration (drink water)
boomers coming of “age”. We              “Now banks are redesigning            • Avoid work in extremes of hot or
have heard that the aging                service carrels with sit-stand          cold temperatures
population will have specific            chairs, adjustable height counter,    • Improve work/rest schedules
needs and OTs and PTs are                and adjustable keyboards that         • Avoid work with chemicals with
going to be in demand as the             enable the bank employees and           de fatting properties
population ages. We, as                  the customer to sit or stand while
therapists, must keep in mind            banking”.                             These are just a few of the many
that treatment interventions             Jacobs lists a few ergonomic          ergonomic considerations when
and daily activities are more            suggestions relating to the effects   working with the elderly. Of
challenging to the aging patient.        of aging. Listed are a some of her    course, we as therapists or dual
There are numerous pathological          suggestions:                          role of therapists and ergonomist,
                   conditions                                                  must educate the community
                   that exist and        Vision Changes                        in the special consideration for
                   determining the       Ergonomic intervention:               the aging worker and customer.
                   treatment that        • Brighter lighting                   There are many areas to
                   fits the patient is   • Reduce or eliminate glare           address when treating the
                   both rewarding        • Use special purpose lighting        elderly or planning an ergonomic
                   and challenging.      • Use high contrast materials         intervention for the community
                   Working with                                                or work force. There is much
                   older people          Hearing Changes                       written about the aging body
forces therapists to re-evaluate,        Ergonomic Intervention:               which will assist therapists in
integrate, and update his/her            • Avoid high frequency noise          relevant intervention. Therapists
knowledge base to effectively            • Reduce background noise             can provide a vital role in making
and efficiently best serve the           • Use equipment with adjustable       the transition into geriatric
geriatric population. Aging poses          noise levels                        ergonomics.
challenges in many areas such            • Combine noise based systems
as biological, physiological,              with visual and perceptual
psychological, and sociological            features
areas. Some define an “older             Muscle Changes
person” as anyone                        Ergonomic
over 50 years of                         Intervention:
age.                                     • Reduce work
                                           with static
As the baby                                muscle effort
boomers age,                             • Increase use of                     References:
the older worker                           mechanical lifts or automation      *Jacobs, Karen, Ergonomics for
(for monetary                            • Keep work in the “neutral zone”     Therapists 3rd ed., St. Louis,
compensation)                            • Eliminate twisting                  Mosby 2008
will continue to increase.               • Stretch upper body throughout       *Cole, Marilyn, Volunteering for
Ergonomics in the subcategory of           the day                             Older Adults, Special Interest
geriatrics ergonomics is growing.        • Regular exercise                    Gerontology, Vol 30 No.1 March
Many workspaces are being                                                      2007 AOTA, Inc
redesigned with the older worker

14
 Ask the Expert (continued)                                                     GEORGE LaCour, OTR, CHT
are often taught in orthopedic site-specific                                         to develop effective strategies
courses or manual therapy courses. In order                                          for staff development, fiscal
for taping to be effective proper equipment                                          planning, and human resource
must be used and the therapist must fully                                            management. George has
understand the purpose of using the tape                                             successfully designed and
prior to use. When used correctly, athletic                                          implemented computer software
taping is a valuable asset to therapy.                                               for clinical documentation. In
6. What is the best sport rehab                                                      addition, he has experience in
course on the market?                                                                JCAHO and HCFA compliance.
                                                  George LaCour, OTR, CHT            Currently, George has moved into
There are many orthopedic courses on the
                                                  graduated with a B.S. degree       the private sector where he works
market but for the most comprehensive
                                                  in Occupational Therapy from       in a busy orthopaedic and sports
course in sports rehab there is only one.
                                                  Louisiana State University         medicine clinic. He devotes his
Sports Rehab: Off the Sidelines and Into
the Game offers insight into sports rehab in
                                                  Medical Center in 17. In 2003, career to patient care, research,
addition to providing valuable information for
                                                  he received his Certification in   and education
assessment and treatment of specific injuries.    Hand Therapy. George worked
This course is loaded with pictures in addition   for  years at a state-funded                Thank you George
to video demonstrations which makes the           charity hospital where he served
learning process much more interactive.           as Director of Rehabilitation. It
                                                  was during this time that he faced
                                                  the many challenges of being
                                                  a manager which allowed him

  Answers to Quiz (from page 5)
    1. Time. This is so critical in                    considered an ideal area for    10. Concerns when treating an
       sports rehab. because the                       our expertise.                  athlete may include:
       athlete needs to return                    6.   False. The aging population
       safely to his/her sport.                        can greatly benefit from           I. Protecting the injury
    2. False. Athletes are unique                      ergonomics. The work               II. Team approach to
       in that they will most likely                   force and the customer                  treating the athlete from
       return to their sport prior to                  are aging and companies                 the coach, to the trainer
       being healed.                                   are seeking advice from                 to the parent
    3. False. In reference to                          ergonomic specialists to           III. Time is critical when
       sports rehab. an athlete is                     redesigning the workstation             dealing with the athlete
       any person playing a sport                      to accommodate the aging           IV. Managing the
       regardless of age or level of                   population.                             symptoms
       play.                                      7.   Taping the injured athlete is      V. Return to play
    4. True.                                           a great way to protect and
    5. Ergonomics is a growing                         allow continuation of play.
                 field and OTs                    8.   Full extension of the DIPJ.
                  and PTs are                          Avoid hyper-extension as
                  taking advantage                     this may cause ischemia.
                  of this area of                 .   Mallet finger splints:
                  growth. With our                     I. Dorsal/volar custom
                  background and                       II. Aluminum
                  knowledge it is                      III. STAX splint.

                                                                                                                       15
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