Angie Prock, M.S., OT/L, hand therapist, with Banner Physical Therapy recently made a presentation to members of Banner High Country Seniors about the occupational therapy services available.
She explained Occupational Therapy, or OT, helps people across the lifespan to do the things they want and need to do through the use of daily activities (occupations) and exercise. OT practitioners enable people of all ages to live life to its fullest by helping them promote health and prevent — or live better with — injury, illness or disability.
How can OT help?
OT services at Banner Physical Therapy typically include:
• Hand, wrist, elbow and shoulder rehab due to injury, disability, or post- operatively
• Hand/wrist splint fabrication/fitting
• Stroke and neurological rehabilitation
• Adaptive equipment training
• Client/family/caregiver training
“OT helps people get back to what they need and want to do after an injury or surgery, by doing movements that you usually do in your every-day life in addition to therapeutic exercises and modalities. We use activities a lot to improve your ability to do what you need to do. I focus from the shoulder to the hand (hand, wrist, shoulder). Others may focus in other areas. We’re across from the hospital on East Main Street. There are three physical therapists in the office; I’m currently the only one for OT outpatient,” Prock said.
Prock makes splints for trigger finger, anything with the thumb, wrist, hand or arm. She’s been in Payson about 12 years doing OT. As part of OT, adaptive equipment training is included. This teaches patients to use tools to help them to adapt — utensils and tools to use or to learn to do things differently.
Additionally caregiver training is offered. If a patient needs the help of a caregiver to do transfers, bathe, etc. this training helps the caregiver function more safely.
As a separate service, Banner Home Health Care Services can do an assessment and make recommendations regarding caring for a patient in the home as they go through OT.
The therapists at Banner Physical Therapy provide individualized care. When a patient comes for therapy, the licensed occupational therapist, physical therapist, or physical therapy assistant treats them, not by a therapy aid.
“We provide individualized care. I follow your treatment all the way through. Our clinic feels this is important,” Prock said.
After an individualized evaluation, the therapist develops a plan based on the patient’s goals.
Treatment can include:
• Daily functional activities designed to improve function;
• Exercises and stretches designed to improve comfort, motion and strength;
• Modalities (various means of treatment) can include ultrasound, paraffin, electrical stimulation, Kinesio Tape and others
“We need a doctor’s order to do therapy. The initial appointment takes about an hour and involves the OT doing an assessment, developing a plan, and starting treatment usually during the first visit,” she said.
The work focuses on daily functional activities: pinch grasp, turning, twisting, placing things into a cabinet, etc., until the patient is better. She uses several tools during treatment that improve wrist movement, shoulder strength, finger strength, hand strength. She also uses hot packs, cold packs and different things for therapy as it frequently is a strength issue.
Ice vs. Heat
• In general, ice is better for the first 48-72 hours after an acute injury and when you have “over done it.” Ice helps to constrict blood vessels and this numbs pain, relieves inflammation and limits bruising, it also decreases swelling. Ice is great for an acute injury within 2-3 days of an injury or if you have swelling.
• In general, heat is better for arthritis discomfort and injuries older than 3 weeks, it relaxes tight muscles, increases blood flow, and relieves aching joints, helping you to move better.
“This is a very general statement,” Prock cautioned, adding if you have received other recommendations by your doctor, follow their advice.
Additionally — do not use heat for acute injuries. It increases inflammation and can delay healing.
Prock uses massage and gives patients stretches looking at the big picture. She said pain could be reduced through exercises and stability given to an unstable, painful joint. “If you perform exercises to strengthen those muscles, you develop the strength needed and then may not experience as much pain,” Prock said.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome results from pressure on the median nerve at the wrist. The median nerve and tendons of the finger flexor muscles share a common tunnel at the wrist.
Any process that decreases the space in the tunnel may result in the symptoms associated with carpal tunnel syndrome.
The following suggestions are intended to decrease stress on the carpal tunnel area and lessen the symptoms you may have:
• Sleep with your wrists held straight, a splint could facilitate this;
• Keep your wrists straight when using tools, typing, computer work;
• Decrease repetitive/strong grasping with the wrists in a flexed (curled) position;
• Take frequent rest breaks from repetitive activities;
• Perform conditioning and stretching exercises before and after activities;
• Avoid activities that produce hand vibration such as using power tools like a drill or jackhammer; if necessary wear padded gloves or pad the tool handle to absorb the vibration;
• Pinching or writing activities may irritate the area and should be avoided or performed for short periods of time; if necessary, adapt activity by enlarging the size of the object.
If symptoms worsen or persist, consult a physician and inquire about occupational or physical therapy. Early treatment usually results in faster relief.
Prock sees a lot of patients for carpal tunnel syndrome. She said if you have had symptoms three months or less, physical therapy might help. Therapy is most successful if therapy is sought within the first three months of the onset of symptoms.
Tennis elbow is a painful condition that occurs when tendons in your elbow area are overloaded, usually by repetitive motion of the wrist and arm. Despite its name, athletes aren’t the only people who develop this.
If overused, the tendons get inflamed, Prock said. Some people may wear a cuff brace to deal with the issue — it can reduce the strain on the joint. These are available from a drug store. Sometimes doctors will do a steroid shot. She has patients that have injured themselves using the really large Yeti cups, as they are so heavy. Handles are made for them that make it less likely to develop tennis elbow.
To help decrease symptoms and improve the condition:
• Always pick up an object with a palm-up grip, if unable to use a thumbs-up grip;
• Never grasp or pick up an object with a palm-down grip; if you must, use other arm;
• Avoid picking up an object with involved elbow locked completely and try to avoid any forceful or sudden extension (straightening) of the involved elbow;
• Avoid forceful power-gripping or extended gripping an object; if you must lift or carry object use a hook grip instead of a full fist;
• Another motion which can greatly increase discomfort is supination; rotating your forearm from a palm-down to palm-up position as in grasping and opening a doorknob or tightening a screw with a manual screwdriver; try to use uninvolved arm for these tasks;
• Use a counterforce brace (tennis elbow brace) to minimize the stress to the tendon;
• Use ice three times a day for 10 to 20 minutes each time for acute symptoms (in the first 48 hours); after the first 48 hours, it may be helpful to alternate ice and heat, for 10 minutes at a time, ending with heat several times per day to help with healing
• Friction massage: rubbing the area that is painful (tendon) up and down and side to side with as much pressure as can tolerate for up to two minutes, at least three times per days can help with healing.
It’s always good to speak with your doctor prior to attempting any of these recommendations. Specifically if you have:
• Burns or healing wounds
• Deep vein thrombosis
• Unhealed fractures
• Severe osteoporosis
• Severe thrombocytopenia
• Bleeding disorders or taking blood-thinning meds
• Active cancer