edema

residual limb wrapping

four inch ACE bandage. 2 2 links together sewn. start at the middle of the limb than start making a 8 shape.

massage (soft tissue mobility improvement)

gentle to firm massage of the scarred are with a thick aintment such as lnolin deep prep, or aliprep deep tissue massage cream will rapidly soften scar tissue and should be followed immediately with active hand use so the tendons will glide against the softened scar. VABRATION: to the area with a small, low-intensity vibrator will have a similar effect. both technique may be stared 4 weeks afer the injury.

elevation

hand above the heart. -avoided slings reduce blood flow b/c of elbow flexion. -resting the hand on pillows while seated or lying down is effective. -resting hand on top of the head or using devices that elevate the hand with the elbow in extension have been suggested.

manual edema mobilization

hands-on-technique for stimulating the lymphatic system to remove the excess large plasma proteins that cause sustained edema leading to fibrotic tissue and stiffness. is use in cases where the lymph system is temporary (edema) rather that caused by damage to the lymphatic system (lymphedema). -knowledge of the anatomy and physiology of lymphatic system is needed. -hand-on continuing education courses to become skilled in this massage technique.

hand massage

Massage helps to promote the circulation and movement of blood back to the heart. It also decreases the chances of joint stiffness

1+

Mild pitting edema. 2mm depression that disappears rapidly

Physical Agent Modalities (PAMs)

Neuromuscular electrical stimulation (NMES) and high-voltage pulsed current stimulation (HVPC). Both modalities are applied in such a way as to facilitate a muscle contraction, there by improving the muscle's ability to pump. -may be used only by an occupational therapist with documented competency.

retrograde massage

-Edema reduction technique -Assists the return of blood and lymphatic fluids to the venous system -Stroking is applied in centripetal direction -Massage should be performed with the extremity elevated -start the massage distally and stroke smoothly and lightly in a proximal direction with the extremity in elevation. -follow by AROM. severe: 2 stage procedure. 1. it begins proximally (midforearm) or empty the proximal body part. 2. the hand or distal part, is massage so that fluid may be emptied into a available space.

contrast baths

-Edema reduction technique -Move hand from warm (104-110 F) to cold (50-64 F) water -Begin in warm water (typically for 10 minutes), then transfer to cold water (typically for one minute). Then warm for typically 4 minutes -In the case of severe edema, some therapists suggest ending in cold water for one minute -Duration of this intervention can vary. The most common is 15 to 30 minutes. litter evidence that this approach is effective for edema or ROM.

string wrapping

1) Use a soft cord about ¼" thick and approximately 12-14" long for each finger involved. 2) Start from distal (fingertip) to proximal (toward wrist). 3) Starting with one end of the cord, lay the end of the cord at the tip of the finger, making a loop at the base of the finger. 4) Starting at the finger tip, begin coiling the cord closely but firmly around the finger until the entire finger is wrapped. If the hand is swollen, continue to wrap it also and stop at the wrist. Wrapping must be done evenly. 5) Elevate the hand for five minutes. 6) Remove the cord and make a fist ten times to allow the blood to return and circulate. 7) Repeat this procedure three times a day for five minutes each or as instructed by your occupational therapist.

string wrapping (do not use if you have )

1) circulatory disorders or problems 2) decreased sensations (numbness)

Coban Wrap (how to do it)

1. Begin wrapping at the tip end of the finger, wrap in a spiral fashion towards the base of the finger. 2. Do not pull the wrap to tight. 3. Wrap all the fingers, then continue wrapping the rest of the hand.

edema (DON'TS)

1. DON'T put your hand in hot water: dependency + heat = edema 2. DON'T overuse your hand. This will only increase the edema. Balance rest and activity. 3. DON'T exercise past the point of pain! Pain is a warning sign and is usually accompanied by edema. If the pain lasts more than one hour following exercise, then you have done too much. 4. DON'T wrap your splint too tightly. Straps and splints should be loose enough so that one finger can be placed between the fingers and the skin

edema (DO's)

1. Keep your hand elevated! One way to remember this is to imagine that a drop of water is rolling from your fingertip, down your arm to your heart. So...in a car, use an arm rest, while walking, use banister rails, while standing, put your hand up against a wall or rest it on top of your head, in the shower, hold it up! 2. DO your exercises every hour as directed by your occupational therapist. This way edema will be pumped out of your hand by your own muscles 3. DO use your hand in and elevated position during activity. For example, read with your hand on a table, rather than in your lap. 4. DO sleep with your arm on top of two or three pillows at night. 5. DO massage from your fingertips down to the palm of your hand and beyond to squeeze the edema out.

hand massage (instruction)

1. Support your elbow on the table. 2. Put a small amount of lotion over the area that is to be massaged. 3. Starting at the fingertip, place the "good" thumb on the backside of the injured finger and the index finger on the palmer side of the injured finger. 4. Slowly, but firmly "squeeze" the fluid from the fingertip moving toward the palm. Do this for each finger involved. 5. With the "good" thumb over the back of the hand, slightly conform the rest of the fingers in the palm of the hand and firmly stroke the fluid from the hand toward the wrist. (Like putting on a glove.) 6. Starting from the fingertip again, repeat steps 2,3,4, & 5. Do these ten times a day.

compression pumps for lymphedema

2 phases: 1. the patient receives manual lymph drainage therapy (when the vessel are stimulated and drained to eliminate or limit any possible damage by the tissue.) 2. the pump is placed and adjusted to be sure the right amount of pressure is being applied. this should be followed by the application of a compression garment to make sure the fluid released doesn't return to the affected limb.

compression pump

2 types: 1.sequential gradient pump: this pump is automated and it pushes airs into the channels of the garment on the patient. gently imitates the flow of the lymph starting from the hand or/and the foot moving towards the center of the body. 2. flexitouch: preparatory and the treatment phase are handled by the pump. with he pump properly positioned, the system will complete both stages of the process for you and this means everything is done at one time. (less time )

AROM and PAMs (reduce scar)

AROM provide an internal stretch against a resistant scar, and its value cannot be overstated, when the patient can not achieve active range because of scar adhesion or weakness, and OT may use NMES to assist the motion. High-voltage, direct-current ultrasound and a continuous passive motion machine may also be judiciously used by the therapist.

coban wrap

Digit is wrapped distal to proximal. - Effective for decreasing edema in a digit - Avoid too much tension - Individual can exercise and do activities while wearing

Active Range of Motion (AROM)

IS THE BEST WEAPON TO COMBAT EDEMA. active motion does no mean wiggling the fingers but rather maximum available ROM done firmly and with purpose -shoulder and elbow should be moved several times a day. -the importance of AROM for edema control, tendon gliding, and tissue nutrition canot be overemphasize. PROM-give information about noncontractile structures such as ligaments surrounding he joing. AROM-gives information about contractile units moving the joint. -to improve limited AROM: modalities to improve tissue elasticity, joint mobilization techniques to restore joint play, PROM to the involved joint, and dynamic or static progressive splinting.

Coban wrap (precaution)

If your fingers become cold or change color, remove the Coban immediately!

pressure (reduce scar)

Is the principal technique used to modify a scar is the application of _____. similar to the technique used in burn rehabilitation. a hypertrophic scar, or a scar that is randomly laid down and thickened, cannot glide properly and therefore may restrict AROM, contribute to deformity, or be cosmetically unacceptable. types of products: Otoform, Silastic Elastomer, and prosthetic foam. this products areheld in place with pressure devices such as Coban wrap, Isotoner gloves, Ace bandage, or pressure elastic garments. -pressure should be applied 24 hours period and removed for bathing and exercises.

Pneumatic Pressure

Pressure of air or another gas. Think of them as air splints that, instead of inflating all at once, inflate gradually, starting distally and working back towards the body

string wrapping (precaution)

Remove immediately if there is pain or hand turns blue or discolored.

stump wrapping

Smooth and even, firm but not tight, wrap distal to proximal to keep fluids out of stump. shrinking and shaping the limb to forma tapered-shape limb to tolerate a prosthesis. elastic ace bandage, a tubular bandage, or a shrinker sock applied to the residual limb. figure 8 method is used when a elastic bandage is applied to the limb. pt is instructed to wrap the stump when is not wearing the postoperative prosthesis.

5% goal

So, if the goal is to decrease swelling by 5%, if the swollen hand is 450 ml and we want it decreased by 5% then we multiply 450 ml x .05 and we get 22.5 ml. Subtract 22.5 from 450 to find our target goal of 427 ml. We need to get that swelling down to this value in 2 weeks! But how did your OT arrive at 5%. Did she just pull that value of of her, um, I mean, out of thin air? No, she measured the non-swollen hand and used that information to set the goal. Here's how I did it: (Actual measured value - norm value)/ the norm value I measured the swollen hand at 450 ml and the non swollen hand at 413 ml, so I considered the 413 as my "norm". So, plugging in the values: 450-413=37 37/413=.089 move the decimal two spaces right and you have 8.9%. Right now, the swollen hand is almost 9% more swollen than the non affected hand. So, a goal of 5% reduction seems about right.

edema (described by Bunnell)

When a hand remains swollen, from whatever cause, the movable parts are bathed in serofibrinous (water and fibrin) exudate. Fibrin is deposited between the various tissue layers and the folds of the joint capsules, between the tendons and their sheaths, throughout the ligamentous tissue itself and between and within the muscles. While soaked in the exudate, all of these tissues swell and become shorter and thicker. The fibrin seals them in this condition and the folds of synovial membrane, the joint capsules, the tendon and tendon sheaths become plastered together with organized adhesions.

Serofibrinous exudate

a fluid that contains both serum and fibrin.

edema (swelling)

an abnormal infiltration and excess accumulation of serous (watery-like) fluid in connective tissue or in a serous cavity.

tape measure

can be used to measure parts of the hand or forearm. around the distal palmar crease, around the ulnar styloid of the wrist, or over the joints or phalanges. make sure to note the exact site and time of day of the measurement so that meaningful comparison can be made in repeat assessment.

Complex Regional Pain Syndrome (CRPS)

characterized by an overactive sympathetic nervous system; typically follows an insult (no matter how minor) to a nerve. that causes hypersensitivity in the UE or LE.

desensitization

hypersensitive after surgery, with extreme discomfort in response to normal tactile stimulation. treatment aims to decrease hypersensitivity. graded stimuli are introduced; materials are graded form soft to hard, and force of application is graded form light touch to rubbing to tapping to prolonged pressure. the patient should carry out a desensitization program so that tolerance is increased without pain.

thermal heat (reduce scars)

in the form of a paraffin bath, or packs, or fluidotherapy immediately followed by stretching wile the tissue cools with provide stretch to scar tissue. HEAT SHOULD NOT BE USED WITH INSENSATE AREAS OR IT SWEELING PERSISTS.

fibrin

is deposited int eh spaces surrounding he joints, tendons, and ligaments, resulting in reduced mobility, flattening of the arches of the hand, tissue atrophy, and father disuse.

Pitting Edema

is present early and can be recognized as a bloated swelling tat "pit" when pressed by the examiner's finger.

edema

is usually caused by injury or by disease. After injury, the blood vessels constrict for a few minutes, then they dilate, causing increased blood flow, and increased permeability of the capillaries. Because the capillaries become more permeable this allows fluid to leak into the interstitial spaces. The fluid that leaks in is referred to as edema.

elevation retrograde massage string wrapping coban wrapping contrast bath air splints

methods for decreasing edema.

2+

moderate pitting edema. 4 mm depression that disappears 10-15 seconds.

3+

moderately severe pitting edema. 6 mm depression that may last more than 1 min.

0+

no pitting edema

4+

severe pitting edema. 8 mm depression that can last more than 2 minutes.

lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

Volumeter

tips: 1. remove any jewerly. 2. avoid any errative movemtns that might splash water in or out of the measured quantity. 3. be prepared to physically guide the person's hand into the water if they are not able to do so themselves. 4. if the hand is really swollen it could displace more water then the cylinder will hold.

volumeter

used to measure volume of both hands for comparison, increased volume indicate edema. has been shown to be accurate to 10 ml when used in the prescrived manner. variables that decrease accuracy. 1. the use of a faucet or hose that introduces air into the tank during filling. 2. movement of the arm within the tank. 3.inconsistent pressure on the top rod. 4. the use of a volumeter in a variety of place, the same level surface should always be used.

pressure wraps

used to prevent swelling after surgery on a fracture Coban elastic: may be used to reduce edema, start distally, the finger is wrapped snugly to proximally until the wrap is proximal to the edema. -5 min than is removed. -active exercise while fingers are wrapped or immediately afer. -measurement before and after treatment to document an increases in ROM and a decrease in edema. -use Bet Wrap instead of Coban Wrap is cheaper comes in colors and is wider. Elastic Ace bandages may be used for larger areas -3 or 4 inches in width for entire hand and forearm. Tubular Gauze and Digisleeves provide compression to a specific finger.