Volum e 9 , I s s u e 4 www.handtherapy.com Oct - Dec 2008 4th Quarter
From The Editors Desk In This Issue
Exploring Hand Therapy is Thank you to our sponsors for making this A Patient’s Approach ..............................1 Activity Guidelines .................................11
dedicated to bringing you magazine possible. Please click on their Splinting Tips ...........................................3 Learn & Earn .........................................12
excellence in education. We ads (if viewing online) to learn more.
have excellent movie courses Political Corner ........................................6 New Releases .......................................13
EHT’s magazine is for informational
for fantastic prices. We are purposes only and is not intended to Quiz Corner. ............................................7 Arthritis Intervention Programs ..............14
adding courses regularly. be a substitute for professional medical
See page 13 for our new releases. We are Ergo Corner .............................................9 CHT Prep Material ................................16
advice, diagnosis or treatment. Content
looking for instructors primarily in the area is the opinion of the contributors and not
of pediatrics, neurological disorders, & necessarily of EHT.
elderly rehabilitation. If interested contact
Treatment2Go is a division of Exploring
Hand Therapy dedicated to providing
quality education for all rehabilitation
clinicians including OTs. PTs, ATCs, &
massage therapists to name a few. When
you see an EHT or Tx2go logo you know Susan Weiss Nancy Falkenstein
you are receiving excellence in education. OTR, CHT OTR, CHT
A Patient’s Approach to Home Exercises by David Rosen
Wrist Fusion: One the far side; one under On Deck Batting Practice
patient’s journey on the the other (pinky on the
long road to recovery bottom). Place your Purpose: Range of motion/muscle
thumb in the middle of figure 1 Gyroscope
memory -relearning how to
The exercises presented here are described the side of the gyroscope coordinate your fused hand to
by the journey of a patient as he traveled nearest to you (fig 2 and once again work effortlessly with
from surgery to function. These exercise 3). If you are working on your entire arm/shoulder/torso.
suggestions helped David overcome some your right hand then your Fig 1
of the obstacles faced in every day life hand should be forming Figure 2 Gyroscope
from basic ADLs to integrating into sports. a reversed letter “C”.
These exercises were developed to assist Fig 3
him in returning to maximal recovery. Note: Duration: Five minutes
many of these exercises are for late stage every other day. Technique: Being on
rehabilitation and should not be attempted Advance to daily with deck - swing baseball
during early recovery. Like any exercise Physicians or therapist Figure 3 Gyroscope bat as you would
protocol always get medical clearance. approval. “normally” (figs 1 - 4).
ENJOY! Tip: Increase time 1 minute every other day Precaution: Make sure you have sufficient
room around you/ wear a batting glove
Dyna-Flex Gyroscope Tip: Do not exceed 30 minutes per session (fused hand)
Purpose: Strengthening & Endurance Precaution: Read and follow product Tip: Use a bat that is a comfortable weight.
Technique: Wrap your hand around the directions and indications. You can work up to increasing the weight of
gyroscope placing your index finger on the the bat, but initiially begin with a light bat.
top far side of the gyroscope (fig 1). The
continued on page 3
three remaining fingers should be placed on
Exploring Hand Therapy
Splinting Tips by Nancy Falkenstein OTR, CHT
TIP: Obtaining end range PIPJ and DIPJ flexion have a tube. Bend finger as far as possible and
can be challenging. Presented here are a few slip on the finger. To increase tension double the
inexpensive ideas to elastic. I usually leave on 5 to 15 minutes. Figure
get that stubborn end C demonstrates final end range using coban®
range. Figure A displays or any tape. Patients can wrap the tape multiple
a commercially available times to increase tension. Wear 5 to 15 minutes.
final end range strap Note: Wearing time for A, can be longer than B & C
from 3PP. I like this strap because A is more comfortable & won’t roll creating
because it can be used a rope like seam on P1 like B and C tend to do.
& the patient TIP: When you choose to make a plaster of Paris
can increase finger splint a great tip is to dip the finger in paraffin
tension as wax before you construct the cast. This not only
tolerated. Figure allows easy cast removal by
B depicts one sliding the cast off the finger, it also
of my favorite protects the skin. Excellent when
techniques. Use you only need to hold the desired
an exam glove position a portion of the day or
to achieve final night (Dupuytren’s release). I have
end range. First cut the finger off the exam glove been using this tip for years and
and then cut the tip of the finger portion so you now find it invaluable.
Exploring Hand Therapy
One Armed Roundhouses (always with your stomach muscles pressed Duration: 2 sets of 15 reps, 3 to 4 days a
in) grip the dumbbell with the injured hand week. Don’t exceed 5 times a week.
Duration: 10-15 minutes (arm should be parallel with the same side
leg i.e.: right arm/ right leg) raise your back Precaution: Weight and ROM should not
Technique: Hold the cause pain during or after exercise.
bat in injured hand. up so that your triceps muscle (back of
Begin over your head arm) is pressed against the inside of your Tip: Practice first with no weight.
and swing the bat in a thigh (hamstring/inner thigh). The elbow
joint should be just below the hamstring Water Yo- Yo
(elbow joint should not be prevented from Purpose: muscle speed/reaction
Precaution: Make sure fFig 2
you have sufficient Technique: (figures 1 & 2)
room around you/ wear a batting glove • Throw and catch
(fused hand) • Bounce it
• Throw it
Tip: Do not choose a heavy bat.
Duration: 5 – 10 minutes daily
Dumbbell Isolation Curls
Tip: Exercise out doors, Yo Yos burst easily.
isolation of bicep and Fig 2 Fig 3 Tip: There is no wrong way to do this
secondary forearm muscles exercise.
bending by inner thigh). In one fluid motion
Technique: In a seated curl the dumbbell upward (fig 2) until
position (fig 1) with your dumbbell touches the chest and then lower
legs spread open and a the dumbbell (fig 3) back down away from
dumbbell between your feet you until it touches the ground. This is one
(approx 1.5 ft – 2ft space repetition.
Fig 1 Fig 1 Fig 2
between feet). Bend over
continued page 4
Exploring Hand Therapy
Nerf® Football Grip and Catch Hand Spider/Crab Stretch push with your fist through the webbing.
and Finger Flexion Duration (both exercises): 10 to 15 minutes 3
Purpose: Hand/finger/forearm isometric
strengthening coordination & ROM Purpose: Build up hand muscles and to 5 times a week
Technique: Grip a soft football (fig 1) fingers Tip: Increase 3 to 5 minutes on a weekly
over the laces (or however you prefer to Technique: Begin with your palm facing basis not to exceed a 30 minute session.
throw a football) Gripping and squeezing the down and fingers spread (fig 1), then simply
Tip: To save money I would recommend
football for 3-5 seconds at a time (fig 2). curl/flex the thumb and 4 fingers for 1-2
purchasing the red (med strength) power
seconds (fig 2). Your fingertips should touch
Duration: The soft football squeeze can be web. I personally found this strength to be
the underside of your hand. However the
done daily 2-4 sets with 10 reps. per set (fig most beneficial.
thumb knuckle will not touch the palm. Then
2). Initially start off doing 2 sets every other spread open your fingers and thumb (fig 3). Tip: You can perform both techniques in the
day. It is important to listen to your body. If
you have no pain or irritation during or after Duration: 30 reps. 5 to 10 times a day
this exercise then increase frequency to Precaution: Everyone is different. You
everyday. Eventually increase sets to four. should not have pain with this exercise.
Precaution: Do not continue if you Tip: Follow the manufacturer’s instructions
experience any irritation or pain. and indications when using this product.
Fig 1 Fig 2 Fig 3
Tip: Find a partner to throw & catch; start at Rubber band Thumb
a safe distance of no more than 25 ft. Precaution: This should be pain free
Flexion and Extension
and everybody’s range of motion will be Purpose: Thumb strength
different. Get comfortable performing these
movements before you worry about if your Technique: Loop rubber band (elastic band)
fingertips are touching your hand. around thumb tip (fig 1) then straighten
Individual Finger Flexion
Fig 1 Fig 2 Purpose:
Mini Rubber Ball (pinky) motion
Pitch Back /Catch Fig 1 & 2 thumb to each finger
Fig 1 Fig 2
Purpose: Catch/release the “O” sign by touching the thumb to each (extend) your thumb & fingers (fig 2).
hand/arm/ eye coordination finger tip (fig 1 & 2). Hold 2 seconds then
spread fingers wide apart ; repeat until you Duration: 5 minutes daily
Technique: Whether using
a pitch back, a stoop/curb touch each finger tip to your thumb. Tip: Double elastic band to increase
or a wall, simply grip the Duration: Daily resistance
rubber ball with the injured
Power Web Hand Strengthener Precaution: Do not over do this exercises or
hand and throw it and catch Fig 1
you may get tendonitis.
it only using injured hand.
Purpose: Stretch and strengthen joints
Perform over hand (fig 1)
and muscles: including flexion, extension, Chinese Metal Balls
and underhand (fig 2).
opposition, pronation and supination. Purpose: Massage and stimulate muscles
Duration: 15-30 minutes
2-4 times a week Technique: Injured hand palm is flush with Technique: Place one F
the Power Web. Then, weave the thumb metal ball in the palm of g
Tip: Begin using both Fig 2 and four fingers through the your hand and make a fist
hands and advance to using only the injured webbing (fig 1). Now, flex (squeezing the ball) for a 1
hand as tolerated and extend your fingers/ 3-5 seconds 5 reps/ set (fig 1).
thumb (motion is similar to
Tip: To save money bounce ball off a wall, waving hello - fig 2). Duration: Daily 3-5 sets.
curb or side of a building. Fig 1
Another Technique: While Tip: I found that rolling the i
metal ball gently over any g
Tip: You can also start using a large bouncy seated, place the Power
ball and advance to a small hand held ball or web horizontally between scar tissue helped (fig 2). 2
weighted ball. your legs. Then make a fist &
Fig 2 continued on page 5
Exploring Hand Therapy
Hand Putty Reverse Dumbbell Curl Reverse Grip Curls
Purpose: Hand and thumb strength Purpose: Strengthen hand/forearm Purpose: Rebuild & strengthen forearm and
Technique: Place putty in the palm of your Technique: Sitting or standing: Grip
hand (fig 1). With the putty in your hand & the dumb bell with your palm facing Technique: A curling bar (fig 1) is best. Grip
palm facing up (supinated), down in pronation hanging at your the bar with palms facing down (reverse
flex your thumb & move side (fig 1). In this position curl the curls). Start with arms extended (not locked
thumb into the putty (fig 2). dumb bell upwards toward your fig 1) curl the bar towards your chest as far
Place your fingers gently Fig 1 chest until your arm reaches full Fig 1 as you can (fig 2). Then slowly move the bar
around flexion (fig 2). Hold 2 seconds back towards the extended (starting position
the putty and then lower weight back (fig 3) this equals one repetition.
so they down to your side (starting point)
over lap in a smooth controlled motion.
the thumb Fig 2 Fig 3 Fig 4
Speed is not important.
(fig 3). Now that the thumb is buried in the
putty, straighten your thumb against the Duration: 3 times a week. (2
putty (fig 4). sets 15 reps) Fig 2 Fig 3
Duration: 5 minutes every other day. Do not Precaution: Start with a light weight. A can
Duration: 1 to 2 sets 15 reps/set palms
do more than 4x/week of soup is good. Increase as tolerated.
facing in and 1 to 2 sets 15 reps/set palms
Finger Roll Pulley Making a Fist and Extending into facing out.
a Full Jab
Purpose: Strengthen /coordinate finger/ Precaution: Begin with a light weight and
hand/forearm and UE muscles Purpose: Shoulder/arm/hand symbiosis and progress as tolerated or instructed by your
forearm rotation therapist.
Technique: With a plastic tube/ baseball bat
(fig 1), tape a rope (fig 2) to the bat. Attach Technique: Make a fist with your Metal Loop Thumb Swivel
a light weight to the end of the rope. Roll the injured hand, your shoulders are
square and the injured hand/fist Purpose: Rebuild flexibility and muscle
bat/pipe so the rope becomes collected on strength of thumb and hand coordination.
the bat as in figure 3. should be rotated inward so
fingers are touching your chin Technique: Holding a loop with the injured
Tip: Soup cans are good to use for your (fig 1). Thrust your fist forward, hand, wrap your fingers
weight. perpendicular to your torso and Fig 1 around the loop and press
parallel to the ground (fig 2). your thumb on the outside of
Duration: 3 sets 8 reps/set.
Once fully extended pull it right the loop (fig 1). Now begin
Precautions: Start with light or no weight back to the starting position. to move your arm/shoulder Fig 1
SPEED is key here. (with a slightly bent elbow),
Duration: 3-10 minutes daily back and forth horizontally, like a swivel (fig
Fig 2 3). This motion will engage thumb and hand
Precaution: Be careful not to hyper-extend muscles to reverse the atrophied muscle,
Fig 3 the elbow. increase flexibility and dexterity.
Fig 1 Purpose: Rebuild forearm
Ball Squeeze and release Fig 3
Technique: Bend at the waist Fig 1
Purpose: To get comfortable shaking hands and grip a light weight dumbbell
again. Duration: 3 to 5 repetitions 1x/day
with the injured hand allowing
your arm to dangle freely (Fig Precautions: There should be no pain when
Technique: Racquetball or any tennis size
1). Now rotate your arm moving performing this exercise. If pain is present,
ball that has some give is sufficient.
the weight in a clockwise then rest and attempt again in a few days.
Duration: Put it in your pocket counterclockwise movement (fig 2).
and squeeze a couple times a
Duration: Once a day 25 reps/set
Fig 1 continued on page 8
Exploring Hand Therapy
FINAL 2009 CHANGES TO were added on page 1438 of Time intervals for 1 through 8
PAYMENT POLICIES AND CMS 1403-FC. The ruling is very units are as follows:
RATES UNDER MEDICARE extensive and is close to 1,500 Units # of Minutes
PHYSICIAN FEE SCHEDULE pages. You can search the PDF 1 unit ≥ 8 minutes
by using key words such as through 22
OVERVIEW: Occupational therapy, Infrared minutes
On October 30, 2008, the therapy, and outpatient rehab to
Centers for Medicare & Medicaid 2 units ≥ 23 minutes
assist with finding information.
Services (CMS) issued a final through 37
This ruling is becomes part of
rule for the Medicare Physician minutes
the federal registry Nov 2009.
Fee Schedule (MPFS) for For specific changes affecting
calendar year CY 2009. The OTs and PTs visit your national 3 units ≥ 38 minutes
final rule establishes payment organizations at www.AOTA.org through 52
rates and policy changes that or www.APTA.org. Through minutes
will go into effect for services your national organizations you
furnished by physicians and non- can stay current. I encourage 4 units ≥ 53 minutes
physician practitioners (NPPs) to all to support their national through 67
people with Medicare on or after organizations as they help keep minutes
January 1, 2009. The final rule our professions “alive” on capital
also includes improvements to hill. 5 units ≥ 68 minutes
enrollment and billing rules. through 82
Counting Minutes in Times minutes
Regulation # CMS-1403-FC codes of 15 Minute Units
Medicare Program; Payment EHT has many questions relating 6 units ≥ 83 minutes
Policies Under the Physician Fee to actual time treating and how to through 97
Schedule and Other Revisions bill. The following is a summary minutes
to Part B for CY 2009; This of the Medicare rules:
ruling does include criteria for
7 units ≥ 98 minutes
payment of certain durable When only one service is through 112
medical equipment, Prosthetics, provided in a day, providers minutes
Orthotics, and Supplies should not bill for services
(DMEPOS). For additional performed for less than 8
information please visit: 8 units ≥ 113 minutes
minutes. For any single timed
CPT code in the same day
(measured in 15 minute units),
PhysicianFeeSched/PFSFRN/ providers should bill a single
itemdetail.asp?filterType=non More more information visit:
15 minute unit if treatment
is greater than or equal to 8
minutes through and including
22 minutes. If the duration of a
ge=10 single modality or procedure in a
day is greater than or equal to 23
CTP and HCPCS codes for minutes through and including 37
physical therapy, occupational minutes, then 2 units of the same
therapy, and outpatient speech- code should be billed.
language pathology services
Exploring Hand Therapy
Test Your Knowledge
1. Your Medicare patient was treated for 4 minutes of
u/s on continuous mode using a 3Mhz head @ .8
w/cm2. How would you bill this procedure?
2. What acronym did David Rosen use to describe his
3. What tip was provided to protect the skin and allow
easy removal of a plaster of Paris finger cast?
4. What was the name of the exercise in the featured
article warning you to exercise outside?
5. What was used to rub scar tissue in the featured
6. What is recommended by OSHA to
help residents/patients get out of bed?
7. OSHA states a patient/resident must
have cognitive capacity to operate a lift
8. According to the 2008 Physical
Activity Guidelines, what is the weekly
minimum amount of time an adult should exercise?
9. The 2008 Physical Activity Guidelines were designed
for the general public in mind. T/F.
10. List 2 types of injuries that would benefit from using a
mirror in therapy. Answers on page 12
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Exploring Hand Therapy
Featured Article continued
Ice is Your Friend Precautions: If you don’t have good work, labor and employment? Mr. Rosen
sensation to your hand then use a timer so was dedicated to improving his quality of life
Purpose: Pain relief. Icing helps soothe you don’t cause a cold injury. and he found theses exercises beneficial
overworked muscle and joints. in claiming control and ultimately achieving
Technique: If you have an ice pack secure success. Hard work and dedication are the
over the hand. Make sure you place a Mr. Rosen is a stand up comedian in NYC keys to a successful outcome. Mr. Rosen
barrier like a towel & was determined to return to functional wanted to share his exercises in hopes it
or pillow case and purposeful activities following his injury may help others. Our thanks to Mr. Rosen
between your skin which resulted in a wrist fusion. Initially, he and the many patient’s that have taught us,
and the ice pack. If was faced with life changing challenges from therapists, along our journey.
you purchased an Ice on hand secured with elastic hygiene, to dressing, to driving a car. Just
ice pack that has a going to the bathroom presented obstacles
barrier then you don’t need to add another let alone flossing & brushing his teeth,
one unless it is recommended by the eating, and drinking. These basic ADLs are
manufacturer. irrevocably changed or altered forever. Mr.
Rosen wanted to know how does a HWFR
Duration: 10-20 minutes (Hand Wrist Fusion Recipient) overcome
Tip: Always ice your hand after any exercise and/or adapt to, not only these mundane
activity. daily tasks, but also sports, heavy yard
Exploring Hand Therapy
Ergo Corner OSHA guidelines for Nursing Homes, ALFs and More
The following are OSHA recom- residents can weight to ensure resident is
mendations to prevent injury in the also use these supported. Ensure frame is firmly
workplace using good body me- Points to attached to the bed. If the device
chanics and ergonomic consider- Remember: To relies on a mattress support, ensure
ations. Although these guidelines reduce friction that the mattress is heavy enough to
are designed specifically for nursing and possible hold the frame. This simple device
homes, OSHA hopes that employers skin tears, can aid residents in achieving
with similar work environments, such use clothing independence.
as assisted living centers, homes for or material
the disabled, homes for the aged, between the resident’s skin and Transfer from Sitting to
and hospitals will also find this infor- the board. Can be used with a gait Standing Position
mation useful. or transfer belt and/or grab bars
to aid transfer. Back support and Description: Lift cushions and lift
Bathtub, Shower, and Toileting vinyl padded seats add to bathing chairs
Activities comfort. Look for devices that allow When to Use: Transferring patients/
for water drainage and have height- residents who are weight-bearing
Description: adjustable legs. May not be suitable and cooperative but need assistance
Toilet seat risers for heavy residents. If wheelchair is when standing and ambulating. Can
When to Use: used ensure wheels are locked and be used for independent residents
Designed for remove arms and foot rests from who need an extra boost to stand.
toileting partial wheelchairs before you transfer.
weight-bearing Ensure the transfer surfaces are at Points to Remember: Lift cushions
patients who can the same level for safety. Ensure use a lever that activates a spring
sit up unaided, use upper extremities the device is securely in place and action to assist
to get on and off the chair, can bend rated for the patient’s weight . The residents to rise
their hips, knees, and ankles can floor should be dry. up. Lift cushions
benefit from this device. may not be
Transfer from Sitting to appropriate
Points to Remember: Risers Standing Position for heavier
decrease the distance and amount residents.
of effort required to lower and Description: Stand-assist devices Lift chairs
raise residents. Grab bars and can be fixed to bed or chair or be are operated
height-adjustable legs add safety free-standing via a hand-held control that tilts
and versatility to the device. When to Use: Transferring forward slowly, raising the resident.
Ensure device is stable and can patient/residents who are weight- Residents need to have physical
accommodate resident’s weight and bearing and cooperative and can and cognitive capacity to be able to
size. Demonstrate to ensure safety. pull themselves up from sitting to operate lever or controls. Always
standing position. Can be used for ensure device is in good working
Bathtub, Shower, and Toileting independent residents who need order before use and is rated for the
Activities extra support to stand. resident weight to be lifted. Can aid
Description: Bath boards and Points to Remember: Check that
transfer benches the device is For more information please visit:
When to Use: When bathing stable before http://www.osha.gov/ergonomics/
patients/residents who are partial using with guidelines/nursinghome/final_nh_
weight bearing status, have good a patient. guidelines.html
sitting balance, can use upper Also ensure
extremities (have upper body the device is
strength), are cooperative, and can appropriately
follow instructions. Independent rated for
Exploring Hand Therapy
Surgery and Rehabilitation of the Hand:
With Emphasis on the Wrist
Paul C. LaStayo, PT, PhD, CHT
Terri L. Wolfe, OTR/L, CHT
Peter C. Amadio, MD
Richard A. Berger, MD, PhD
Marc Garcia-Elias, MD, PhD
Joseph F. Slade, III, MD
March 7-10, 2009
Terri M. Skirven, OTR/L, CHT
Susan M. Blackmore, MS, OTR/L, CHT
Jane M. Fedorczyk, PhD, PT, CHT, ATC
A. Lee Osterman, MD
(25 Contact Hours)
For more information please call
or visit our website at:
Exploring Hand Therapy
2008 Physical Activity Guidelines From the Center of Disease Control & Prevention
Be Active, Healthy, community organizations and is recommendations for adults,
& Happy designed to achieve the following older adults, children and
goals: adolescents, as well as people
The U.S. Department of Health • Raise awareness of physical with special considerations.
and Human Services (HHS) activity as a way to manage Science shows that for important
issues the Physical Activity arthritis pain and increase health benefits, most adults
Guidelines for Americans. The function. need:
content of the Physical Activity • Increase understanding of how • At a minimum, 150 minutes (2
Guidelines complements to use physical activity (types hours and 30 minutes) each
the Dietary Guidelines for and duration) to ease arthritis week of moderate-intensity
Americans, a joint effort of HHS symptoms and prevent further aerobic activity (such as brisk
and the U.S. Department of disability. walking);
Agriculture (USDA). Together, • Enhance the confidence of • or, 75 minutes (1 hour and
the two documents provide persons with arthritis in their 15 minutes) each week of
guidance on the importance ability to be physically active vigorous-intensity aerobic
of being physically active and • Increase physical activity activity (such as jogging or
eating a healthy diet to promote behaviors. running);
good health and reduce the risk • or, an equivalent mix of
of chronic diseases. The 2008 Physical moderate- and vigorous-
Activity Guidelines for intensity aerobic activity.
The primary audiences for the Americans provide specific • muscle-strengthening activities
Physical Activity Guidelines recommendations about the on 2 or more days each week
are policy-makers and health types and amounts of physical that work all major muscle
professionals. These Guidelines activity you need to do each groups
are designed to provide week and how hard you need
information and guidance on the to work to gain substantial These are just a few of the
types and amounts of physical health benefits. recommendations. Below are
activity that provide substantial a few of the many excellent
health benefits. This information These guidelines resource websites to learn
may also be useful to interested address physical about physical activity
members of the public. The main activity and health benefits.
idea behind the guidelines is from the very young
that regular physical activity over to the elderly. They CDC Arthritis Intervention:
months and years can produce provide excellent http://www.cdc.gov/arthritis/intervention/
long-term health benefits. tool for therapists index.htm
Realizing these benefits requires to educate their community and
physical activity each week. patients about the importance of 2008 Physical Activity Guideline
physical activity. I (nf), found the in PDF:
A health communications publication helpful to compliment
campaign promoting physical and add to my clinical knowledge
activity to Caucasians and base. Below are a few of the
Be Active, Healthy, and Happy:
African-Americans with arthritis highlights to the 2008 Guidelines: http://www.cdc.gov/Features/BeActive/
between the age of 45-70. This
campaign is intended for general How Much Physical Activity Do CDC A-Z index: Physical Activity
use by state health departments, You Need To Do? for Everyone:
their partners, and other The guidelines offer specific http://www.cdc.gov/physicalactivity/
Exploring Hand Therapy
Answers to Quiz (from page 7)
1. This procedure is not billable 4. Water Yo Yo uses water and health
according to the CMS balloons and they break professionals.
guidelines because your time easily 10. Mirror therapy
spent doing this procedure 5. Chinese Metal Balls or motor
did not meet the minimum 6. Stand assist devices imagery
criteria. Your set up of the 7. True therapy is
procedure is included in the 8. An adult should exercise: At advocated to
time. For this procedure to a minimum, 150 minutes (2 treat many
be billable hours and 30 minutes) each disorders, illness, or injuries.
you would week of moderate-intensity A few include:
need to aerobic activity (such as I. neruovascular injuries
document brisk walking); or, 75 minutes II. musculoskeletal injuries
treatment (1 hour and 15 minutes) III. pain injuries to include
took at least each week of vigorous- CRPS and phantom pain
8 minutes intensity aerobic activity
including set (such as jogging or running);
up. or, an equivalent mix of
2. HWFR = Hand Wrist Fusion moderate- and vigorous-
Recipient intensity aerobic activity.
3. Dip finger in paraffin wax 9. False. The primary audience
before fabricating plaster of for the Physical Activity
Paris cast. Guidelines are policy makers
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Exploring Hand Therapy
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Exploring Hand Therapy
Arthritis: Intervention of these new programs will be managing a variety of chronic
Programs promoted through state arthritis diseases. This program was
programs and other partners. developed at Stanford University.
Self-Management Education CDSMP workshops are held in
The CDC Arthritis Program Self-Management Education community settings and meet 2
recommends evidence-based Arthritis Foundation Self-Help 1/2 hours per week for 6 weeks.
programs that are proven Program (AFSHP) is an effective Workshops are facilitated by
to improve the quality of life self-management education two trained leaders, one or
of people with arthritis. The intervention both of whom are non-health
programs currently being for people professionals with chronic
promoted are: with arthritis. diseases themselves. This
Developed by program covers topic such
Three self-management Dr. Kate Lorig as: techniques to deal with
education programs. of Stanford problems associated with chronic
Four physical activity programs. University, disease, appropriate exercise,
Two health communications the course appropriate use of medications,
campaigns promoting physical helps people learn and practice communicating effectively
activity. the different techniques needed with family, friends, and health
A description of these programs to build an individualized self- professionals, nutrition, and,
is summarized below along with management program and gain how to evaluate
information about how to locate the confidence to carry it out. new treatments.
these programs in your state. The 6-week course consists of Participants who
weekly 2-hour sessions guided took CDSMP
There are by two trained instructors who demonstrated
currently two follow a detailed protocol. significant
physical activity There is a robust science base improvements
interventions that demonstrates the positive in exercise,
on our “Watch impacts of participation in the communication with physicians,
List” for possible Arthritis Foundation Self-Help self-reported general health,
recommendation Program: participants report health distress, fatigue, disability,
that are pending health a 20% decrease in pain, and and social/role activities
outcome data from evaluations a 40% decrease in physician limitations. To find out about
underway. The CDC’s Arthritis visits, even 4 years after course availability in your state, you can
Program is currently working participation. To find out about check with your state arthritis
to identify additional evidence- availability in your area you program.
based interventions that are can check with the Arthritis
safe and beneficial for people Foundation. To view the entire CDC
with arthritis. There is a self- http://www.arthritis.org recommendations and article
management education and two or to find an arthritis program in
physical activity interventions Chronic Disease Self- your state please visit:
with promising preliminary Management Program (CDSMP) http://www.cdc.gov/arthritis/
data that are developing the is an effective self-management intervention/
infrastructure to support wide- education program for people
spread dissemination. We with chronic health problems.
consider these interventions to The program specifically
be “Promising Practices”. The list addresses arthritis, diabetes,
of criteria used to screen each lung and heart disease,
intervention is available. Use but teaches skills useful for
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