presentation 219 cindy ivy upper extremity orthosis use for als
TRANSCRIPT
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Upper Extremity Orthoses Use in ALS
Cynthia C. Ivy, OTD, M Ed, CHTNovember 7, 2014
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Occupational Therapy
“Occupational therapists and
occupational therapy assistants help people
across the lifespan participate in the things they
want and need to do through the therapeutic use
of everyday activities (occupations).”
AOTA website
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Maximize Level of Independence
• Appropriate exercises
• Hand orthoses
• Assistive devices
• Adaptive equipment
• Energy conservation/work simplification
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OT Evaluation
• Functional deficits
• MMT
• ROM (active vs passive, contractures)
• Sensibility
• Tone/spasticity
• Cognition
• Social
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Evaluation: Functional Deficits
• ADLS
• IADLS
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MMT
• 0-5 scale
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ROM
• Goniometry• Compare active to passive
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Sensibility
• Threshold/density
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Tone/Spasticity
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Cognition
• Safety
• Memory
• Follow through
• Helps to plan our interventions
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Social
• Family
• Working?
• Leisure activities
Purpose of Orthoses
• Help balance imbalance (of muscle strength)
• Improve independence in ADL
• Prevent contracture
• Relieve pain
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Problem: Weak Wrist Extensors
• Wrist in 10-30 = stronger, efficient grip
• Dorsal vs volar
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Problem: Intrinsic Wasting/Weakness
• Short Oppenens orthosis
• Night resting orthosis for comfort or for stretching in cases of extreme imbalance
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Problem: Proximal Weakness
• Mobile arm support
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Mobile Arm Support
Problem: Spasticity
• Soft orthoses for comfort and hygiene
• Night orthosis if painful or sensory problems
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Intrinsic Hand Weakness/Spastic Orthoses
Night Resting
Functional Finger Orthoses
Problem: Long Flexor Tightness
• Night resting WHFO
• Day resting WHO, FO or WHFO
• Functional day orthoses
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Problem: Intrinsic Tightness
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Functional Problem Solving
• Orthotic solutions based on functional needs alone
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Case Report
• 70 year old retired psychologist
• Slowly progressing ALS with spastic left hemiparesis
• 5 years from onset to death
• Adhesive capsulitis both shoulders
• Lacked motor control, fine motor
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Case Report
• 1 year post diagnosis difficulty grasping walker
• Weak intrinsics, inability to oppose thumb or extend fingers
• Could not encircle for grasp of walker
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•
Case Report
• Pinch strength increased by .25 kg with orthosis in place (.25 to .5 kg)
• Developed wrist drop (weak extensors)
• Developed sialorrhea
• Became socially isolated
• At 4 years after diagnosis completely wheelchair dependent
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Orthoses
• Prevent contractures
• Provide comfort
• Prevent overstretching of weakened muscles
• Promote function
References
• Dal Bello-Haas, V., Kloos, A. D., & Mitsumoto, H. (1998). Physical therapy for a patient through six stages of amyotrophic lateral sclerosis. Physical Therapy, 78(12), 1312-1324.
• Ivy, C. C., Smith, S. M., & Materi, M. M. H. (2014). Upper extremity orthoses use in amyotrophic lateral sclerosis/motor neuron disease: Three case reports. Hand.
• Lewis, M., & Rushanan, S. (2007). The role of physical therapy and occupational therapy in the treatment of amyotrophic lateral sclerosis. Neurorehabilitation, 22(6), 451-461.
• Morris, M. E., Perry, A., Bilney, B., Curran, A., Dodd, K., Wittwer, J. E., & Dalton, G. W. (2006). Outcomes of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease: a systematic review. Neurorehabilitation & Neural Repair, 20(3), 424-434.
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References• Pozza, A. M., Delamura, M. K., Ramirez, C., Valerio, N. I., Marino, L. H., &
Lamari, N. M. (2006). Physiotherapeutic conduct in amyotrophic lateral sclerosis. Sao Paulo Medical Journal = Revista Paulista de Medicina, 124(6), 350-354.
• Sinaki, M. (1987). Physical therapy and rehabilitation techniques for patients with amyotrophic lateral sclerosis. Advances in Experimental Medicine & Biology, 209, 239-252.
• Tanaka, K., Horaiya, K., Akagi, J., & Kihoin, N. (2013). Timely manner application of hand orthoses to patients with amyotrophic lateral sclerosis: A case report. Prosthetics and orthotics international. doi: 10.1177/0309364613489334
• Tanaka, K., Saura, R., Houraiya, K., & Tanimura, H. (2009). A simple and useful hand orthosis for patients with amyotrophic lateral sclerosis: a simple web spacer for thumb opposition weakness. [Case Reports]. Disability and rehabilitation: Assistive technology, 4(5), 364-366. doi: 10.1080/17483100902988946
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