Hi, I am an NHS Community Occupational Therapist that is seeing an increased number of referrals for elderly clients, often with Dementia, and or in care homes with severe contractures of the hand. The referrals are made, generally, too late for palm protectors/ passive/ active ROM exercises/ Thera putty etc. I am looking for advice that I can pass onto the care homes a) to prompt earlier therapy intervention b) promote good hand hygiene/ tissue viability regimes (often when the clients are reluctant to engage with staff) and c) how to best manage the complex scenarios: such as poor hand hygiene/ severe pain and pressure sores to palm/ fingers/ thumb with dignity. Many thanks to OT Hub for sharing.
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Managing Severe Hand Contractures in the Older Person.
Managing Severe Hand Contractures in the Older Person.
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Helen you said that surgical release wasn’t possible in this case - is that due to a concern regarding use of GA? If so discuss with surgeons regarding use of regional block. A number of our patients would also be risky GA patients but have managed really well with the regional block! If hands have spasticity, contracture and nails are digging into palm +\- pressure areas then surgery is definitely the way forward if botulinum toxin has been tried with no success. Pain relief to enable handling also really important.
Hi Helen, it sounds like you are describing Dupuytren's disease, which would make sense in the population you are serving. Check out eatonhand.com, it will confirm that this is indeed what you are seeing. This is not a condition that responds to conservative care (any pre-op therapy has been shown to not make ANY difference on the disease process). So the good news first- these are not "late referrals" to OT. The not so good news- surgical intervention and then formal hand OT therapy is vital to a good outcome. Hope this helps. Feel free to reach out to me if you would like additional information. Lynn Festa OTR, CHT, CDWF
Don’t know where my original post disappeared to but let’s try again.
I work in a spasticity mgt team and see this problem a lot - either due to a Neuro condition - dementia, stroke etc or through Dupytren, or arthritic changes. we carried out an education programme including identification of the problem, handling hands, analgesia, and basics such as hand hygiene and nail care, with nursing home care staff which was successful in the short term but difficult due to staff turn over. We published a paper in nursing times. We developed the SCIN an assessment tool to monitor . Now we also have a joint surgical assessment clinic with. A hand and plastic surgeon which has made a fantastic difference. But prevention is always better than cure so we have a long way to go. Contact me if you want more info.
Thanks for engaging with the community here @helencartin. Are you happy for us to raise this post to Members' attention via our social media network? This should prompt a faster response to your query.