Hand Therapy helps patients with Rheumatoid Arthritis achieve significant improvements in hand function

Treating patients with rheumatoid arthritis improved dramatically since introduction of the first biologic agent, etanercept (Enbrel). However, adjunctive modalities, such as hand exercises and occupational therapy, which were used aggressively by rheumatologists in the pre-biologic era, are no longer used extensively.

In this multicenter study, researchers evaluated 490 U.K. patients who had received stable medical regimens for ≥3 months. Patients were randomized to usual care or to usual care plus a hand-strengthening and hand-exercise program. The intervention involved six sessions with a therapist who promoted patient-directed goal-setting and instructed participants in mobility and strength-and-endurance exercises that were to be performed at home daily. At 4 and 12 months, the exercise group achieved significant improvements in overall hand function, activities of daily living, satisfaction, and confidence to self-manage symptoms (especially in the first 4 months), compared with the usual-care group.

An editorialist notes that the feasibility of strengthening regimens for RA patients has been questioned. In this U.K. study, only 20% of patients were receiving biologic disease-modifying antirheumatic drugs (DMARDs); in many U.S. centers, at least twice that percentage receives DMARDs. However, appropriate hand therapy should become more of a standard of care, even in the U.S., as it provides clear benefits at marginal cost.

Source: Coblyn, Jonathan S . NEJM Journal Watch. General Medicine (Oct 30, 2014).

Australian Bureau of Statistics data shows that workers compensation claims are falling, News Mail reports. Sales people are the top category to have reduced claims in the Central QLD Bay region, with a 33 per cent drop in 2011-2013. Managers reduced their claim rate over the same period by 28 per cent, while community and personal service workers’ claims dropped by 13 per cent. “Overall, the rate of injury is a bit over four per cent and figures confirm that work-related injury rates have continued to fall,” said ABS labour force director Stephen Collett. “We’ve seen a fall of just over two percentage points – it was 6.4 per cent in 2005-06 and it’s now down to 4.3 per cent.”

(Ref: http://www.rtwmatters.org/article/news.php)

The potential benefits of Pre Employment Assessments

The decision on whether to adopt pre-employment medicals should start with a discussion on “why do we want to do pre-employment medicals”? and “to which roles should they apply”?

Answering these questions will go a long way towards developing the rationale for a business case for adoption. The inherent physical component of pre-employment medicals because this is really where the employee health discussion typically commences.

A decade ago, there was the common notion within an organisation that if we don’t know about the health of a worker, we cannot be held accountable for it. It is safe to say that this has now proven not to be the case and that employers are expected to, at a minimum, have involvement in the protection of the health of a worker and ideally to be promoting better health. As a consequence, with greater involvement comes greater responsibility and accountability.

Health and wellbeing is rapidly developing away from what was considered a ’nice to have’ for a few more benevolent employers, into a much more far reaching discussion around productivity and profitability for most organisations. Keeping workers fit for longer should now be seen in the context of an ageing workforce, the cost of worker retention and training and the loss of corporate knowledge. For any organisation that is interested in improving the health and wellbeing of its workforce, understanding and managing the health risks that come in to the business through the recruitment process is a key step and pre-employment medicals offer a way to achieve this.

(Ref: www.hcamag.com/opinion/the-potential-benefits-of-utilising-preemployment-medicals-129812.aspx).

Once the crisis has passed, the road to recovery lies ahead. Recovering from a stroke can be a lengthy process that requires patience, hard work and commitment. In most cases, recovery can begin after doctors have treated any life-threatening conditions and taken steps toward preventing further complications and another stroke. This means that rehabilitation may start during your initial hospital stay. Starting the recovery process as early as possible can increase your chances of regaining lost brain and body function.

Early evaluation and treatment by and entire rehabilitation team is critical to achieving maximum quality of life after a stroke. The team should include physical therapists who work to help the patient achieve maximal motor control and strength for walking and balance. Occupational therapists help the patient regain hand and arm functionality to manage daily activities, such as bathing, dressing, writing or cooking. They can also address safety issues in the home by suggesting changes or proper home equipment. Finally, speech-language pathologists assess cognitive and communication difficulties and help the patient regain speaking, listening and writing abilities as well as comprehension. They also assist patients who may have difficulty swallowing after a stroke.

Source: http://www.palmbeachpost.com/lifestyles/health/the-keys-surviving-and-thriving-after-stroke/63x4cNJ3rNfjWvOFNFVHrM/

The prognosis and speed of peripheral nerve recovery depend very much on the level of injury, severity of injury, the surgical intervention and the subsequent rehabilitative process. Many high level injuries may take years or months for the affected peripheral nerve to recover. Prolonged muscle imbalance causes joint contractures and over-stretching of denervated muscles. Without proper care, hand function recovery may be limited even the nerve regenerated afterwards. During the nerve regeneration period, splinting is one of the most useful modality to minimise deformities, prevent joint contractures and substitute loss motor control. Proper splinting encourages early use of the injured hand in daily activities. There are different types of splinting design for median nerve palsy, ulnar nerve palsy and radial nerve palsy. Dynamic splinting techniques are frequently employed to allow early prehension activities. Other therapeutic techniques, including pressure garment and sensory re-education are useful to enhance better functional return after nerve repair.

Source: https://www.ncbi.nlm.nih.gov/pubmed/12596288

There is increasing evidence that successful optimization of electrode position, amplitude and frequency parameters in a dynamically changing pattern may well be the key critical to successful therapeutic outcomes. The InterX is a device that provides such non-invasive interactive neurostimulation (NIN), optimizing all three stimulation parameters in a high amplitude, high density manner without penetrating too deeply into the tissue and without soliciting uncomfortable muscle contractions.

The InterX device operates by scanning the tissue to determine its impedance and to use the electrical characteristic of the skin to identify and target optimal treatment points. As stimulation is performed, the impedance of the skin under the electrode changes and is sensed by the device through the completed electrical circuit which in turn automatically varies the waveform parameters. Different preset stimulation patterns are selected in subsequent therapy sessions to prevent physiological accommodation and each of these presets automatically delivers a varying frequency to ensure optimal effects. The presets in this study varied the frequency from 15-360 pulses per second using a mixture of burst, variable and amplitude modulated parameters.

The delivery of NIN through the Flexible Array Electrode is effective for the management of pain in this population of patients, supporting previous literature pertaining to the handheld application of NIN in the post-surgical setting. The InterX is designed to optimize treatment point location, amplitude and frequency to ensure better clinical results and this technological aspect is maintained in this application. The clinical benefit of NIN therapy with the InterX device as a supplement to the standard in-house rehabilitative protocol allows patients suffering pain to regain function quicker, especially if their pain levels are particularly high. Even though subjects with more severe pain and more ROM-restriction were randomly assigned to the InterX group, the subjects receiving NIN therapy with InterX fared much better clinically with significantly reduced pain levels and improvements in ROM compared to control subjects. The implications of these findings are that patients suffering severe pain following TKR struggle to get sufficient relief from the standard of care of medications and that the inclusion of NIN therapy into the standard of care will offer greater and more consistent pain control, without the need for increased medication even with the worst cases.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182948/