Hand Evaluation and Intervention Plan

Frames of reference, models, and conceptual principles

Developmental

Motor control/motor learning

Rehabilitative

Biomechanical

Background information from child/caregiver interview, chart review, and clinical screening.

- Medical history

- Information regarding the child's overall health status

- Developmental history

- Information regarding other medical teams currently working with the child and the plan of

care of these teams

- Family concerns and priorities that have direct impact on the child's plan of care

assessment...

child's roles and occupations

Initial Screening and Assessment

- Thorough assessment of the child's overall health

- Specific impairment

- Past upper extremity surgery or injury

Congenital differences of the hand are a common feature of some childhood syndromes, such as

VACTERL which stands for 'vertebral defects, anal atresia,

cardiac defects, trachea-esophageal fistula, renal abnormalities, and limb abnormalities' and Fanconi anemia.

A child with congenital hand differences is also more likely to have

delays in fine motor, bilateral coordination, and/or functional mobility than a child who was otherwise healthy and sustained an injury to the hand. Therefore, a screening of early developmental milestones and fine motor skills is advised so that the occupational therapist may identify the need for additional therapy services (such as physical therapy).

Just as with congenital differences in the hand, it is common for children who are suffering from a systemic disease process that affects

their upper extremity, such as cerebral palsy (CP), to have delays in meeting early developmental milestones.

Acute Injury (Finger Fracture or Wrist Pain)

For children with acute injuries, the occupational therapist screens for the nature of the injury because certain types of trauma are more likely to develop secondary infection, for example, bite wounds.

Comprehensive Clinical Assessment

- Child's medical chart

- Interview the caregivers and child

- Examine (Pain, Tenderness, Skin, Edema, Sensation)

clinical observation

•How the child uses the arm and hand during functional tasks.

•Range of motion.

•Functional hand use and sensation.

Wrinkle Test

involves placing the child's hand in warm water for 30

minutes. When a child has peripheral nerve impairment, fingertip wrinkling is absent or diminished as compared with the unaffected hand. When sensory impairment improves, the typical wrinkling pattern returns. This is a particularly effective way to assess the presence of sensation in a child who is not able to report sensory symptoms.

Formal Assessment Tools

- Two-point discrimination testing

- Semmes Weinstein Monofilaments (SWM) to evaluate touch discrimination

muscle tone

Children who have an underlying neurologic disorder typically have abnormal muscle tone in their affected upper extremity. Muscle tone should be assessed through the function and feel of the upper extremity in all patients. The occupational therapist notes and describes the child's muscle tone.

- Hypotonicity

- Hypertonicity

Evaluation

- Range of motion

- Strength

Ongoing Assessment

- Ongoing assessment is a component of each therapy appointment.

- Assess the quality of hand function and grasping patterns.

- Patient-reported outcome measures and goal setting assessments are completed within the first one to two sessions and periodically through the duration of the intervention to assess progress toward goals.

Intervention Principles and Strategies

- Pain management

- Physical agent modalities

- Superficial thermal agents

- Upper extremity orthotics

- Casting

- Kinesiology tape

Child and Family Education: Activity Modification, Joint Protection, and Energy Conservation

Occupational therapists commonly use and educate the child and

family about... activity modifications, joint protection strategies, energy conservation.

Intervention

•Wound health and healing

•Scar management

•Edema control

•Desensitization and sensory re-education

•Range of motion exercises

•Strengthening

•Muscle tone

Intervention Plans: Build Fine Motor Skills and Bimanual Coordination

- Maximizing functional grasp patterns

- CIMT, HABIT, and sensory-based activities to promote increased awareness and use of the affected upper extremity

- Bimanual activity

- Mirror therapy

Interventions will be different for for Specific Conditions

●Congenital differences

●Upper extremity impairments caused by underlying disorder

●Cerebral palsy and traumatic brain injury

●Spinal cord injury

●Neurodegenerative conditions

●Rheumatic conditions

●Ehlers Danlos syndrome

●Upper extremity injury

●Brachial plexus birth palsy

●Upper extremity fractures

●Tendon and ligament injuries

●Nerve injuries

●Complex regional pain syndrome