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Featured Article by Nancy Falkenstein,OTR/L,CHT

Nancy Falkenstein OTR, CHT

Susan Weiss OTR, CHT

The PURPLE BOOK 3rd editon - NEW

•New illustrations•New questions•New chapters•NEW 3rd edition is

hereHand & Upper Extremity Rehabilitation: A Quick Reference Guide and Review”. Studying for the

CHT© exam See Purple Book (pages 8, 11) for details.As always EHT/Tx2go strives to bring you valuable education and products. Please visit our sponsors websites. If viewing online just click and go. Thank you to our sponsors for making this newsletter possible.This newsletter is for informational purposes only and is not intended to be a substitute for professional advise, diagnosis, or treatment. Opinions are that of the authors and not necessarily of EHT/Tx2go.

continued on page 3

In This Issue

1

Exploring Hand Therapy

Treatment2gowww.handtherapy.com

Featured Article CRPS Vitamin C ............1

Hand Care 2014 ......................................2

Therapist In Your Pocket .........................4

Ergo Corner .............................................6

2014 Philly Hand Conference ..................7

New Releases ......................................5,8

Purple Book ......................................8, 11

Learn & Earn FREE CEU ........................8

Activity Guideline .....................................9

Quiz .......................................................10

Volume 15, Issue 1 January - March 2014

CRPS treated with Vitamin C??

We all know Complex Regional Pain Syndrome (CRPS) has been described and researched since the American Civil War until today. There have been

many names given to this syndrome such as, shoulder hand pain, pre-operative pain, post-operative pain, Sudeck’s atrophy,causalgia,reflexsympathetic dystrophy (RSD) and most recently CRPS. The large number of references tells us that this syndrome has always been and still is, to an extent, a puzzle to many clinicians and researchers.

CRPS remains a puzzling and complicated neuropathic pain involving sensory, motor and autonomic changes which can be a source of frustration for clinicians,

patients, and loved ones. The primary goals for CRPS patients are to have less pain with increased function, return to work and return to everyday life activities.

We all know the best approach is a comprehensive interdisciplinary functional approach to include medications, psychological,

behavioral techniques and OT/PT but all too often we have a piecemeal approach to

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treating CRPS. This piecemeal approach, although is not ideal and often frustrating, is all too often a “common place” situation. We as clinicians must learn to workefficientlyandeffectivelywithin our constraints.

There is a plethora of medications used to treat CRPS despite the lack of randomized controlled trails/research. However, It is a good idea to become familiar with the medications that may be administered to your CPRS

clients. One quick reference is our 3rd edition “Hand and Upper Extremity Rehabilitation: A Quick Reference Guide and

Review” found within the drug appendix. Some common categories include:

•Antiepileptic Drugs, Antidepressants

•Opioids•Anti-inflammatorydrugs•Bisphosphonates•Sodium channel blockers•Adrenergic drugs•Topical agents•Thalidomide•N-methyl-D-aspartate

antagonists

Recently high dose Vitamin C (antioxidant) has been suggested to help decrease neuropathic pain.

Although there is controversy surrounding high dose Vitamin C, it is appropriate to look at what is currently know.

Antioxidants have been researched in the burn patient with suggested success which has led to trying antioxidants in the prevention of post-traumatic dystrophy. Matsuda et el found that high dose vitamin C stops the progression of vascular permeability after burns and therefore reduces microvascular leakageoffluidandprotein.There is a complex of activity occurringinthefluid.Highdosevitamin C is a natural antioxidant that can savage radicals, stopping free-radical reactions and can prevent the propagation of a painful chain reaction. High dose vitamin C protects the capillary endothelium and erythrocytes and leukocytes. It was found that there are few substances that have such an impact on wounds after burns and the signs of inflammationasvitaminC.

From these studies vitamin C has been used as a prophylaxis for CRPS. Zollinger et el reported treating CRPS with a high dose of 500 mg vitamin C daily has shown favorable results. Note healthy individuals need only about 60mg daily (National Research Council of the USA). The 500 mg daily is considered

far below the overdose level.

Zollinger et el looked at wrist fractures treated with cast immobilization after reduction and hypothesized that post-traumatic CRPS would be lower in the group receiving vitamin C vs the placebo group. The results showed that administering high dose antioxidant vitamin C 500 mg daily with wrist fractures was associated with lower frequency of CRPS compared to the matched placebo group. They concluded that vitamin C used as prevention could also be used as a prophylaxis not only in CRPS but also with other injuries to include trauma of the foot and ankle.

Chen et el reported that plasma vitamin C is lower in postherpetic neuralgia (PHN) patients, therefore administering high dose vitamin C may reduce spontaneous pain. Many studies have shown that vitamin C decreases the prevalence of CRPS I, which is a form of PHN.

Zollinger et el studied vitamin C and developing CRPS I after surgery for basal joint arthritis of the thumb. They concluded and advised the use of high dose vitamin

C as prophylaxis against CRPS in trapeziometacarpal joint replacement showed favorable results.

continued page 4




4

As with many approaches to treating CRPS, there is controversy and it is no different relating to the effectiveness of administering high doses of the antioxidant vitamin C as a prophylaxis. Therefore, it is concluded that more research is needed in this area. However, it is exciting to learn that a simple and cheap approach, such as vitamin C, can help decrease the onset of CRPS or to assist with decreasing pain associated with CRPS.

References:•Mackey, S., Feinberg, S.,

Pharmocologic therapies for complex regional pain syndrome paper

•Zollinger, et el., Clinical results of 40 consecutive

basal thumb prostheses and no crps type 1 after vitamin c prophylaxis, The Open Orthopaedic Journal 2010, 4,6366

•Asaad, B. & Glass P., Perioperative management for patients with complex regional pain syndrome. Pain Manage, 2012 2(6), 561-567

•Harden, N.R., Pharmacotherapy

•“Letters to the Editor, The Vitamin C Controversy. Clinical J pain. Volume 26, number 6, July/August 2010

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Brachial Plexus: Secrets of Treating TOS

.40 AOTA CEUs or 5 NBCOTcontact hours

Brachial Plexus: Secrets to Treating Thoracic Outlet Syndrome (TOS) is an often under-diagnosed, over-diagnosed or misdiagnosed nerve compressionthatoftencreatesdifficultiesinmanagement.Thepurposeof this course is to provide the reader with clarity in understanding the structures involved, the use of provocative testing alone with a systemized plantotreatandimprovetheidentifiabledysfunctionsintheupperquadrant.You will understand Brachial Plexus TOS when you complete this course. Must have for everyone!. Manual includes worksheets, labeling/matching, & identifying coursework of brachial plexus, dermatomes, anatomy and more. EXCELLENT study material for exam for the CHT!

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Flexor Tendons: Get Your Glide On (Interactive movie)


This interactive .60 CEU (6 contact hours) course is in movie format either streaming or DVD. This is an intermediate (mixed level learning) AOTA APP course which teaches the learner how to evaluate and treat flexor tendons. The learner will learn a variety of treatment programs to enable them to pick and choice appropriate programs for their patients. Instructional methods include: lecture, hands on demonstration, power point presentation, live surgical viewing. Upon Successful completion of the examination (80%) your certificate will be sent via email.





ERGO Corner

6

The following are OSHA recom-mendations to prevent injury in the workplace using good body me-chanics and ergonomic consider-ations. Although these guidelines aredesignedspecificallyfornursinghomes, OSHA hopes that employers with similar work environments, such as assisted living centers, homes for the disabled, homes for the aged, andhospitalswillalsofindthisinfor-mation useful.

Bathtub, Shower, and Toileting Activities

Description: Toilet seat risersWhen to Use: Designed for toileting partial weight-bearing patients who can sit up unaided, use upper extremities to get on and off the chair, can bend their hips, knees, and ankles can benefitfromthisdevice.

Points to Remember: Risers decrease the distance and amount of effort required to lower and raise residents. Grab bars and height-adjustable legs add safety and versatility to the device. Ensure device is stable and can accommodate resident’s weight and size. Demonstrate to ensure safety.

Bathtub, Shower, and Toileting Activities

Description: Bath boards and transfer benchesWhen to Use: When bathing patients/residents who are partial weight bearing status, have good sitting balance, can use upper extremities (have upper body

strength), are cooperative, and can follow instructions. Independent residents can also use these

Points to Remember: To reduce friction and possible skin tears, use clothing or material between the resident’s skin and the board. Can be used with a gait or transfer belt and/or grab bars to aid transfer. Back support and vinyl padded seats add to bathing comfort. Look for devices that allow for water drainage and have height-adjustable legs. May not be suitable for heavy residents. If wheelchair is used ensure wheels are locked and remove arms and foot rests from wheelchairs before you transfer. Ensure the transfer surfaces are at the same level for safety. Ensure the device is securely in place and rated for the patient’s weight . The floorshouldbedry.

Transfer from Sitting to Standing Position

Description: Stand-assist devices canbefixedtobedor chair or be free-standingWhen to Use: Transferring patient/residents who are weight-bearing and cooperative and can pull themselves up from sitting to standing position. Can be used for independent residents who need extra support to stand.

Points to Remember: Check that the device is stable before using with a patient. Also ensure the device is appropriately rated for resident’s weight to ensure resident issupported.Ensureframeisfirmlyattached to the bed. If the device relies on a mattress support, ensure

that the mattress is heavy enough to hold the frame. This simple device can aid residents in achieving independence.

Transfer from Sitting to Standing Position

Description: Lift cushions and lift chairs

When to Use: Transferring patients/residents who are weight-bearing and cooperative but need assistance when standing and ambulating. Can be used for independent residents who need an extra boost to stand.

Points to Remember: Lift cushions use a lever that activates a spring action to assist residents to rise up. Lift cushions may not be appropriate for heavier residents. Lift chairs are operated via a hand-held control that tilts forward slowly, raising the resident. Residents need to have physical and cognitive capacity to be able to operate lever or controls. Always ensure device is in good working order before use and is rated for the resident weight to be lifted. Can aid resident independence.

For more information please visit:https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html



Surgery and Rehabilitation of the HandWith Emphasis on Tendon and Nerve

One day pediatric pre-course on Friday, March 21, 2014

Contact Information:

www.handfoundation.org

Email: [email protected]

Phone: 610-768-5958

Honored Professors:

Birgitta N. Rosén, OT, PhD

William W. Walsh, MBA, MHA, OTR/L, CHT

James P. Higgins, MD

Michael Sandow, FRACS

John G. Seiler, III, MD

Robert M. Szabo, MD

Chairmen:

Terri M. Skirven, OTR/L, CHT

Susan M. Blackmore, MS, OTR/L, CHT

Jane M. Fedorczyk, PT, PhD, CHT

Jenifer M. Haines, MS, OTR/L, CHT

A. Lee Osterman, MD

March 22-25, 2014

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Hand & UE Rehabilitation: A Quick Reference Guide and Review, 3rd ed

A Quick Reference Guide& Review | Falkenstein & Weiss

3rdEdition

Upper ExtremityRehabilitation

Hand&


Hand&

A Quick Reference Guide& Review

3rdEdition

Nancy Falkenstein, OtR/l, CHt

President

Susan Weiss, OtR/l, CHt

Chief executive Officer www.handtherapy.com

isBn: 978-0-9884606-0-7 $249.00

tHis One-OF-a-kind guide provides a comprehensive, easy-to-followoverview of hand and upper extremity rehabilitation. Questions with detailed answers and explanations provide the reader with the essentials of hand re-habilitation. The reader will also appreciate the “Clinical Gems” throughout the text which provide additional useful tips or hints about key topics.

This book is ideal for those studying for specialty certification including the CHT® exam. This is a reference book that can’t be missed by anyone in the hand therapy industry as its values are limitless for the hand care practitioner.

Most treasured new features:

• 5 New chapters have been added to this edition: Psychosocial Aspects of Impairment, Ergonomics/Return to work, Spinal Cord/CNS/Brachial Plexus, Ligamentous and Muscular Injuries, and Edema/Lymphedema/Vascular Disorders.

•Every chapter has been completely revised with new questions, content, clinical gems and references to allow previous readers to enjoy an up-to-date resource book.

•More than 550 illustrations/photos—most of them new or updated.•The convenient Quick Reference Guide in the beginning of the

book has been updated. • Reviews the latest rehabilitation advances and techniques are ad-

dressed.•Includes a NEW appendix to practice labeling anatomical structures.• Fresh new perspectives from a diverse set of contributors.•Interactive vendor list.

Occupational Therapy Physical Therapy

Hand Rehabilitation

3rdEdition

Hand U

pper Extrem

ity Rehabilitation

&

A Quick Reference

Guide& Review

Falkenstein & Weiss

Exp l

oring Hand TherapyEx

p lorin

g Hand Therapy

Treatment 2 Go®

w w w . h a n d t h e r a p y . c o m

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Activity Guidelines

o

Be Active, Healthy, & Happy

The U.S. Department of Health and Human Services (HHS) issues the Physical Activity Guidelines for Americans. The content of the Physical Activity Guidelines complements the Dietary Guidelines for Americans, a joint effort of HHS and the U.S. Department of Agriculture (USDA). Together, the two documents provide guidance on the importance of being physically active and eating a healthy diet to promote good health and reduce the risk of chronic diseases.

The primary audiences for the Physical Activity Guidelines are policy-makers and health professionals. These Guidelines are designed to provide information and guidance on the types and amounts of physical activity that provide substantial healthbenefits.Thisinformationmay also be useful to interested members of the public. The main idea behind the guidelines is that regular physical activity over months and years can produce long-termhealthbenefits.Realizingthesebenefitsrequiresphysical activity each week.

A health communications campaign promoting physical activity to Caucasians and African-Americans with arthritis between the age of 45-70. This campaign is intended for general use by state health departments, their partners, and other community organizations and is designed to achieve the following goals:

•Raise awareness of physical activity as a way to manage arthritis pain and increase function.

•Increase understanding of how to use physical activity (types and duration) to ease arthritis symptoms and prevent further disability.

•Enhancetheconfidenceofpersons with arthritis in their ability to be physically active

•Increase physical activity behaviors.

The Physical Activity Guidelines for Americans provide specific recommendations about the types and amounts of physical activity you need to do each week and how hard you need to work to gain substantial health benefits.

These guidelines address physical activity and health from the very young to the elderly. They provide excellent tool for therapists to educate their community and patients about the importance of physical activity. I (nf), found the publication helpful to compliment and add to my clinical knowledge

base. Below are a few of the highlights to the Guidelines:

How Much Physical Activity Do You Need To Do?

Theguidelinesofferspecificrecommendations for adults, older adults, children and adolescents, as well as people with special considerations. Science shows that for important healthbenefits,mostadultsneed:

•At a minimum, 150 minutes (2 hours and 30 minutes) each week of moderate-intensity aerobic activity (such as brisk walking);

•or, 75 minutes (1 hour and 15 minutes) each week of vigorous-intensity aerobic activity (such as jogging or running);

•or, an equivalent mix of moderate- and vigorous-intensity aerobic activity.

•muscle-strengthening activities on 2 or more days each week that work all major muscle groups

These are just a few of the recommendations. Below are a few of the many excellent resource websites to learn about physicalactivitybenefits.

CDC Arthritis Intervention:• http://www.cdc.gov/arthritis/interventions.htmPhysical Activity Guideline in PDF: • http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf

• http://www.health.gov/paguidelines/pdf/paguide.pdfCDC A-Z index: Physical Activity for Everyone:• http://www.cdc.gov/physicalactivity/

9

http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf

http://www.cdc.gov/physicalactivity

http://www.cdc.gov/arthritis/interventions.htm

http://www.health.gov/paguidelines/pdf/paguide.pdf



10

Quiz

Quiz: Test your knowledge

1. Vitamin C is believed to help with ______, associated with _________?

2. VitaminCisclassifiedasa_________?

3. What is the recommended dose of vitamin C for a healthy adult?

4. Vitamin C is proposed to stop free radicals in the blood to help prevent CRPS1. True or False

5. What is “Therapist in Your Pocket”?

6. A sliding bath board may not be appropriate for what population?

7. Hand Care 2014 is when?

8. Most adults need a minimum of how many minutes each week to be Active, Healthy, & Happy?

9. How many minutes each week if adults participate in vigorous intensity or high intensity is needed?

10. The Philadelphia Meeting 2014 focus is on what topics?

1. Pain and CRPS 1

2. Antioxidant

3. 60 mg/day

4. False

5. Trademark of Exploring Hand Therapy® and is geared for self instructional assistance in the area of OT/PT.

6. Obese. Check manufacturers specifications

7. May 8 - 10 2014 in Indiana.

8. 150 minutes of moderate intensity

9. 75 minutes of vigorous intensity

10. Surgery and Rehabilitation of the Hand with Emphasis on Tendon and Nerve. Meeting March 22-25, 2014 Philadelphia, PA.

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11

Order the Purple Book now and $ave!!

3rd Edition:“Hand & Upper Extremity Rehabilitation: A Quick Reference Guide and Review” 3rd edition is a question/answer book with referenced explanations. Every chapter in the 3rd edition has new content, revised content, new photos and drawings. Also we added:

5 Amazing New Chapters •Spinal Cord/CNS/Brachial

Plexus•Ergonomics/Return to Work•Psychosocial Aspects of

Impairment•Ligamentous and Muscular

Injury•Edema/Lymphedema and

Vascular Disorders

4 Fantastic Appendixes:•Anatomy Labeling•Vendor Listing•Drugs in Hand Therapy•Practice Exams

Chapters:•Clinical Anatomy •Evaluation •Neuroanatomy/Nerve Injury/

Sensory Reeducation •Physical Agent Modalities •Assorted Treatment

Techniques •Orthotics: Design/

Fabrication/Training •Edema/Lymphedema/

Vascular Disorders •Wounds/Infection/Grafts/

Burns •Fractures/Dislocations/

Subluxations •Ligamentous and Muscular

Injuries •Arthritis and Related

Disorders •CRPS/Fibromyaligia •Tendon Injuries and

Conditions •Complex Traumatic Hand/

Tendon Transfers •Cumulative Trauma

Disorders •Tumors/Cysts/Dupuytrens •Congenital Anomalies/

Amputations/Prosthetics •Sports Injuries •Wrist •Elbow •Shoulder •Spinal Cord/CNS/Brachial

Plexus •Ergonomics/Return to Work •Psychosocial Aspects of

Impairment •Professional Practice

Management

A Quick Reference Guide& Review | Falkenstein & Weiss

3rdEdition


Hand&


Hand&

A Quick Reference Guide& Review

3rdEdition

Nancy Falkenstein, OtR/l, CHt

President

Susan Weiss, OtR/l, CHt

Chief executive Officer www.handtherapy.com

isBn: 978-0-9884606-0-7 $249.00

tHis One-OF-a-kind guide provides a comprehensive, easy-to-followoverview of hand and upper extremity rehabilitation. Questions with detailed answers and explanations provide the reader with the essentials of hand re-habilitation. The reader will also appreciate the “Clinical Gems” throughout the text which provide additional useful tips or hints about key topics.

This book is ideal for those studying for specialty certification including the CHT® exam. This is a reference book that can’t be missed by anyone in the hand therapy industry as its values are limitless for the hand care practitioner.

Most treasured new features:

• 5 New chapters have been added to this edition: Psychosocial Aspects of Impairment, Ergonomics/Return to work, Spinal Cord/CNS/Brachial Plexus, Ligamentous and Muscular Injuries, and Edema/Lymphedema/Vascular Disorders.

•Every chapter has been completely revised with new questions, content, clinical gems and references to allow previous readers to enjoy an up-to-date resource book.

•More than 550 illustrations/photos—most of them new or updated.•The convenient Quick Reference Guide in the beginning of the

book has been updated. • Reviews the latest rehabilitation advances and techniques are ad-

dressed.•Includes a NEW appendix to practice labeling anatomical structures.• Fresh new perspectives from a diverse set of contributors.•Interactive vendor list.

Occupational Therapy Physical Therapy

Hand Rehabilitation

3rdEdition

Hand U

pper Extrem

ity Rehabilitation

&

A Quick Reference

Guide& Review

Falkenstein & Weiss

Exp l

oring Hand TherapyEx

p lorin

g Hand Therapy

Treatment 2 Go®

w w w . h a n d t h e r a p y . c o m

Order the3rd edition

of “Hand and Upper Extremity Rehabilitation:

Quick Reference Guide and Reveiw”

forOnly $224.00

Order now and Save $25.00

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Exploring Hand Therapy - LiveConferences.com · As always EHT/Tx2go strives to bring you valuable education and products. Please visit our sponsors websites. If viewing online just