PF is one of the most common foot and ankle problems. People with PF experience mild to severe pain that interferes moderately with activities of daily living (ADL). Due to chronic pain that interferes with ADL, people with PF often use non-steroidal anti-inflammatory medications and/or acetaminophen. These medications alleviate pain but cannot eliminate it. Additionally, with chronic use, these medications can cause well-known adverse side effects. The purposes of this study were to investigate the effect of Korean Hand Therapy (KHT) in (1) treating the pain experienced in patients with plantar fasciitis (PF), (2) evaluating its impact on functionality, and (3) assessing participants' self-adherence to treatment. A pre-post mixed methods pilot study was conducted with 28 participants. Baseline measures included a demographic questionnaire, height and weight, a 10-point pain scale, the foot function index (FFI), and measurement of the plantar fascia via ultrasound. As a group, participants were taught about KHT and how to self-administer it. Participants then self-administered KHT for four weeks. Three weekly electronic surveys were sent asking participants about their pain and use of KHT. After four weeks, participants returned for final data collection, including a focus group. Baseline measures, except the demographic questionnaire and height and weight, were repeated. Thickness of PF was not correlated with pain at baseline (r = -0.14, p = 0.47). Compared to baseline, pain was significantly reduced after the initial KHT treatment on the first visit (4.875 vs 2.625, p < 0.00) and at the 4-week follow up (4.875 vs 2.528, p < 0.05). On average for all four weeks, participants reported 5.48 (SD 1.50) days of self-guided KHT per week. PF thickness was not significantly reduced at the follow up session at 4 weeks (t =1.16, p = 0.26). FFI scores were significantly improved between baseline and four weeks: Pain (t = 3.80, p < 0.00), Activity Limitation (t = 2.64, p = 0.02), and Disability (t = 4.74, p < 0.00) and overall FFI (t = 4.83, p < 0.00). Findings suggest KHT may reduce pain and increase functionality for people who experience PF. While the sample was small, KHT is low-risk, low-cost, and easily self-administered. Further investigation is needed on the long-term effects of KHT and its ability to generally alleviate all types of pain.

Introduction Allodynia is a type of neuropathic pain defined as pain due to a stimulus which does not normally provoke pain. There is little research and conflicting advice. The purpose of this thesis is to provide a summary of the current state of hand therapy knowledge. To accomplish this, a review of the hand therapy literature related to allodynia was conducted, along with the collection of expert opinion utilizing the Delphi survey technique. Methods International hand therapy experts were invited to participate in a classical Delphi study. Mixed methods were used to summarize each round and inform any subsequent questioning. Thematic analysis was used to look for patterns of meaning within the written responses. A consensus level of 75% was decided upon a priori for all final recommendations. Results Forty-three hand therapists from 15 countries contributed to the fourth and final round. Through the consensus process definitions related to allodynia, and assessments and treatments for allodynia, were explored and recommendations generated. Two themes were identified 1) assessment and treatment decisions depend on the client’s presumed underlying mechanisms contributing to the allodynia as well as psychosocial and functional status, and 2) whether the area of allodynia should be touched or not. Discussion and conclusions The literature and our survey results are mixed on whether it is beneficial to touch an area of allodynia. Other aspects related to allodynia such as functional or psychosocial impact are rarely addressed in the literature but were highlighted in our survey. This thesis contributes to the knowledge by presenting: 1) a summary of the current literature, 2) a new consensus definition of hypersensitivity, 3) experts’ recommendations for assessment and treatment of allodynia of the hand and factors to consider when utilizing these, and 4) recommendations for future research, practice, and education. / Thesis / Master of Science Rehabilitation Science (MSc) / Allodynia is when pain is caused by something that would normally not be painful such as a light touch or mild temperatures. It occurs when nerves become overly sensitive, and if this happens in the hand, it can limit how people use their hand and cause distress. There is little research to guide therapists and conflicting advice in textbooks on how to treat this. To help fill this gap, we conducted four online surveys with hand therapy experts. We found that expert therapists recommended assessments and treatments that look at how the person with allodynia is functioning and managing the pain. However, they disagreed on whether the painful area should be touched or not. This is important as it influences the advice given to clients and how treatment is delivered. More research is needed to compare approaches and to figure out what factors may influence how people with allodynia may respond to different treatments.

The purpose of this study was to describe the therapeutic interventions used for people with limited function of the hand due to osteoarthrtis or rheumatoid arthritis. The study was accomplished through a literature studie. Data were collected through a search of databases considering the criteras for inclusion or exclusion that were established by the authors before the search. Twelve articles were included in the study and analysed through a qualitative content analysis. Fivedifferent categories of occupational interventions were revealed through the analysis. The categories are orthotics, heat and cold treatment, information and education, strength and range of motion exercises and training in activity of daily life. The result of the analysis continued with an interpretation of OTIPM to furher iluminate the occupational focus of activity. A minority of the occupational interventions used as treatment of clients with a limited function of the hand due to osteoarthrits or rheumatoid arthritis correspond to the focus of activity described in OTIPM. / Validerat; 20110607 (anonymous)

A fratura da extremidade distal do rádio é o tipo de lesão mais comum encontrada nos departamentos de emergência ortopédica. Requer reabilitação efetiva que pode ser feita com contribuições de tecnologias atuais. Para isto foi construído um sistema mecatrônico móvel e interativo a partir de conhecimentos de especialistas na área da saúde e engenharia. O sistema foi testado em trinta pessoas saudáveis, sendo eles profissionais das áreas citadas e a população mais acometida: homens jovens e mulheres pós-menopausa. Os dados obtidos foram analisados, assim como as pistas sociais apresentadas pelos participantes. Após os testes todos responderam um questionário para avaliar o sistema. Os resultados mostraram que o sistema cumpre grande parte dos requisitos necessários para a reabilitação, mas precisa de melhorias. / Distal radius fracture is the most common type of injury found in emergency of orthopedic department. It requires effective rehabilitation that can be made with contributions of current technologies. For this, a mobile and interactive mechatronic system was built from the expertise of specialists in healthcare and engineering. The system was tested in thirty healthy people, the professionals of these areas and the population most affected: young men and postmenopausal women. The data and the social cues presented by the participants were analyzed. They answered a questionnaire to evaluate the system. The results showed that the system meets many rehabilitation requirements, but improvements are necessary.

A fratura da extremidade distal do rádio é o tipo de lesão mais comum encontrada nos departamentos de emergência ortopédica. Requer reabilitação efetiva que pode ser feita com contribuições de tecnologias atuais. Para isto foi construído um sistema mecatrônico móvel e interativo a partir de conhecimentos de especialistas na área da saúde e engenharia. O sistema foi testado em trinta pessoas saudáveis, sendo eles profissionais das áreas citadas e a população mais acometida: homens jovens e mulheres pós-menopausa. Os dados obtidos foram analisados, assim como as pistas sociais apresentadas pelos participantes. Após os testes todos responderam um questionário para avaliar o sistema. Os resultados mostraram que o sistema cumpre grande parte dos requisitos necessários para a reabilitação, mas precisa de melhorias. / Distal radius fracture is the most common type of injury found in emergency of orthopedic department. It requires effective rehabilitation that can be made with contributions of current technologies. For this, a mobile and interactive mechatronic system was built from the expertise of specialists in healthcare and engineering. The system was tested in thirty healthy people, the professionals of these areas and the population most affected: young men and postmenopausal women. The data and the social cues presented by the participants were analyzed. They answered a questionnaire to evaluate the system. The results showed that the system meets many rehabilitation requirements, but improvements are necessary.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference while remaining rooted in an occupational therapy perspective. Hand function is important for participation in daily occupations. The current focus in assessment and treatment of clients in occupational therapy remains on body structure and function which is also true in South Africa. The gap in the literature about the effects of OBHT indicates that there is a need for a study in a South African context. This research was conducted to examine the influences of an OBHT among clients with hand injuries within occupational therapy practice in a South African context.

Physical injuries to the upper extremity can have a drastic impact on an individual’s daily functioning affecting their psychological well-being, social participation, and ability to perform valued activities such as self-care, work, and leisure tasks. Due to the wide range of factors affecting a person who is recovering from an upper extremity injury, therapists treating these individuals must understand, help identify, and address the areas impacting function to support and maximize participation in and performance of valued occupations. However, often psychosocial aspects of care go unaddressed when biomechanical interventions are prioritized, which is primarily attributed to therapists’ lack of knowledge, confidence, or skills in this area. Unlocking Biopsychosocial Hand Therapy is a continuing education unit (CEU) course aimed at filling therapist gaps in knowledge and service provision, specifically regarding psychosocial factors, when treating clients with upper extremity injuries or conditions. The long-term goals of this innovative program are to improve client outcomes and to increase therapist prioritization of psychosocial factors on par with biological factors.

Damage to the brain can lead to different types of long-term motor impairments like hemiplegia. Children with hemiplegia have difficulties performing everyday activities that rely on the coordinated use of both hands, such as feeding or dressing. Therefore, arm-hand therapy is important to improve the child’s motor skills to gain more independence in their daily life activities.  Specialists usually recommend additional home therapy to maintain the skills and extend the therapeutic benefits. However in many cases, there is a lack of continuity of progress in the home environment. The problem with therapy is that it consists of repetitive exercises that a lot of kids may stop doing out of boredom. This project was approached with a user-centered design perspective to understand the field of rehabilitation in children with hemiplegia motor disabilities and explore how design can spark motivation and playfulness in this context. The solution was developed through extensive research including field research, observations, literature research and interviews with specialists from Sweden and Argentina as well as with parents.  Several different design directions took shape during the process, they were then evaluated and validated with specialists, parents and tested with kids.  The result of this project is a hybrid therapeutic toy composed of physical controllers and digital therapeutic games. By interacting with the controllers, children can improve their hand motor skills while playing different digital games designed to allow the repetition of hand movements with therapeutic effect. By turning repetitive training into playful therapy exercises, hemi makes long-term home therapy possible for children without thinking they are exercising.

Hand therapy (HT) is a specialty area of occupational therapy (OT) practice that focuses on rehabilitation for individuals with hand and upper extremity related conditions with aim to return to performance of daily activities required for life. As with other health professionals, occupational therapy practitioners (OTPs) have a duty to the public to ensure that services rendered are safe and use evidence-based best practices to improve patient health-outcomes. In HT clinics, OTPs face numerous challenges implementing evidence-based practice (EBP) including a lack of time, skills, and misperceptions of EBP (Scurlock-Evans et al., 2014), as well as reimbursement and funding models which incentivize high productivity over time to evaluate the evidence and integrate into clinical practice. The cost of OTPs not implementing EBP into their clinical decisions negatively impacts health outcomes of the patients under their care. The Hand Therapy with Evidence Based Practice (HT-EBP) program aims to enhance patient care through enhancing private HT clinics adoption of up-to-date research evidence into clinical practice. The HT-EBP program is designed for use in community-based private HT clinics that typically have less than 10 OTPs employed. A commitment of two OTPs, preferably one seasoned and one entry level, coming together in a mentor-mentee relationship is needed to implement the program. This program requires the participating clinics and OTPs to actively engage in the development of clinical care plans through review of research evidence on selected clinical diagnoses. Resulting from the HT-EBP program, the HT clinic will be able to provide evidence-based quality care while the OTP participants will develop professionally in the field of HT, gaining firm knowledge in clinical topics and building clinical confidence at the same time. This program will be further enhanced through 1) access to high quality research databases from clinic affiliated universities, 2) professional organization’s focus on continuing education courses that develop research knowledge and analytic skills for OTPs, and 3) collaborating with clinic managers to facilitate more time for clinicians to engage in acquiring and creating knowledge in chosen clinical topics of interests. The HP-EBP will first be piloted at the author’s private HT clinic prior to recruiting other private HT clinics to adopt the program. The HT-EBP program will aim to address the challenges that OTPs face when implementing EBP by working with universities, professional organizations. With time, it is anticipated that a significant volume of evidence-based clinical care plans would be compiled and shared among OTPs in HT, thus enhancing care for patients with hand conditions. Successful implementation of the HT-EBP program may have the potential to serve as a template for other healthcare specialties to deploy EBP.

Introduction: Dexterity impairments are common and disabling. Measuring the extent of these impairments is important for care and service provision. Despite this, dexterity is poorly operationalized in the management of persons with hand and wrist conditions (HWC). Thesis purpose: To understand: 1) how dexterity is defined in the management of persons with HWC and 2) how therapists working with persons with HWC perceive/understand the concept and measurement of dexterity and use of performance-based outcome measures of dexterity (PBOMD). Methods: In study one, Interpretive Description was used to understand the perceptions and measurement practices of occupational therapists working with persons with HWC in Singapore. Study two involved a content analysis of the literature outlining the constructs measured by PBOMD that were validated for use in persons with HWC. Results: Both studies highlighted the lack of conceptual clarity around ‘dexterity’ that is reflected in therapists’ and tool developers’ discourse. Many of the therapists we interviewed, perceive PBOMD to lack clinical value. Studies from this thesis suggest that identified PBOMD do not adequately cover dexterity. Conclusion: Findings highlight the challenges surrounding the construct of dexterity and provide clinical practice recommendations. / Thesis / Master of Science Rehabilitation Science (MSc) / Dexterity is the ability to do tasks, successfully, quickly and accurately. Loss of dexterity is common and affects our ability to do our tasks of daily life and work. Unfortunately, there is a lack of agreement on the best way to measure dexterity. Our study aims to explore what dexterity means to health professionals. We focused on occupational therapists seeing persons with hand and arm injuries. In the first study, we interviewed therapists to understand how they measured dexterity. In the second study, we searched for dexterity tests used with persons with hand injuries. Then, we compared the tests we found to dexterity theories. We found that dexterity is measured in different ways. Therapists faced many barriers to using dexterity tests. Current dexterity tests are an incomplete reflection of a person’s dexterity. The information gained from these studies could be used to inform future research on the measurement of dexterity.