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Hand Therapy for Carpal Tunnel Syndrome

The Carpal Tunnel is a narrow passage in the wrist that is made of small bones and tissues which houses the flexor tendons of the hand and the median nerve responsible for some movement of the fingers. Carpal Tunnel Syndrome (CTS) may cause numbness, pain and tingling in the forearm, hand, wrist and fingers. These symptoms arise when the carpal tunnel becomes restricted causing a compression of the median nerve.

Risk Factors

There are some lifestyle practices and medical conditions which may predispose persons to this condition. These include:

  • Repetitive hand and wrist movements, or poor positioning of hands and wrist while working; known as incorrect ergonomics.
  • Health conditions that cause swelling in the soft tissue in the forearm/hands or reduce the blood flow to the hands such as: Rheumatoid Arthritis, Obesity, Diabetes, Multiple Sclerosis. This can also occur during pregnancy.
  • Smoking may restrict blood flow to the median nerve.
  • Broken wrist bones, dislocated bones, and new bone growth might add pressure on the median nerve

Difficulties Associated with Carpal Tunnel Syndrome

In addition to pain and numbness in the hand and forearm, persons with Carpal Tunnel Syndrome may experience reduced grip strength in the hand which may cause cramping and pain whenever they engage in activities such as writing, driving, typing on a keyboard, preparing meals especially using knives, opening bottles or doors; washing and dressing.

Treatment – Hand Therapy

Fortunately hand therapy, which is a specialty practice area done by an occupational therapist or a trained physiotherapist, can help patients with Carpal Tunnel Syndrome to recover successfully. A hand therapist can teach you how to avoid provoking and worsening the symptoms by introducing you to these treatment options:

  • Relative resting– through discussion, the hand therapist will advise you on how best to incorporate rest in your daily routine to relieve some of the symptoms.
  • Splinting provides support for the affected hand by positioning the median nerve in its most open position, relieving the pressure of the nerve and allowing for a restoration of blood circulation which reduces pain and discomfort.
  • Hand Therapy Exercise will increase the strength of the muscles in your hand, wrist and shoulder.

On average, most patients with CTS see improvement in their condition within the first 6 weeks of hand therapy, however this is dependent on several factors which include: the severity of the compression in the carpal tunnel, the patient’s compliance with the treatment program and treatment of the existing medical conditions or lifestyle practices which caused the carpal tunnel syndrome in the first place as mentioned earlier.

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One of the Secret Weapons for Neck Pain

Neck pain affects just about anyone, even healthy people in the prime of their lives. This should not be surprising since the neck works in balancing the head, which on average weighs 10 pounds. Neck pain can be triggered by improper sleeping positions, poor posture or injury to the spine. Now one of the secret weapons for common neck pain is isometric neck exercise.

What is an isometric neck exercise?

This is a type of neck strengthening exercise performed with the neck held in a non-moving position in the midline and the hands are used to apply force to the head at the front, back and sides, so the neck muscles contract without changing its length and position. The neck is held in this non-moving position to isolate and build the resistance of the neck muscle; repeating this activity will strengthen the neck muscles and help with neck stability.

Once there are no contraindications, the goal of isometric neck exercise is to reduce muscle stiffness and ease the pain for persons experiencing neck discomfort from most conditions. They are quick, neck strengthening exercise that can be performed at your convenience, at any time. However, it is best to speak with your medical doctor, physical therapist or occupational therapist before performing these exercise.

4 Isometric Neck Exercise in 60 seconds done without changing the position of the head.

  • Strengthening Muscles on the Right Side of the Neck

Place your right hand on the right side of your head, above your ear. Tilt your head to the right against your hand while pressing your hand against your head, without moving the neck and hand. Hold for 5- 8 seconds and then repeat twice.

  • Strengthening Muscles on the Left Side of the Neck

This is same as above however you are using your left hand on the left side of the neck.

  • Strengthening Muscles at the back of the neck

Place the fingers on one hand between the fingers of the other hand (interlocking them) then place both hands on the back of your head, just above your neck. Press your head backwards without moving position against your hands while pressing your hands against your head. Do not lean the head backward. Hold for 5-8 seconds and repeat this exercise twice.

  • Strengthening Muscles at the front of the neck

Place the palms of both hands on your forehead above your eyebrows. Press your hands against your forehead while pressing the forehead against your hands, without leaning the forehead forward. Hold for 5-8 seconds and repeat this exercise twice. Remember to consult with a medical doctor and then a physical or occupational therapist before performing basic, isometric neck exercise. If done incorrectly, this will lead to injury or permanent damage to your neck.

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Non-Surgical Treatment for Lower Back Pain

According to the American Academy of Physical Medicine and Rehabilitation (AAPMR), lower back pain is a commonly diagnosed physical ailment, identified in up to 84 percent of adults at some time in their lives. Lower back pain may be acute, i.e. comes on suddenly and lasts no longer than about 4-6 weeks; or chronic, lasting greater than 3-6 months.

What are some effective, non-surgical treatment options for lower back pain?

Physical Therapy

The goal of physical therapy is to decrease back pain while increasing function. Physical therapy exercise for lower back pain includes specific back stretching and strengthening exercise to increase the patient’s rate of recovery. Additionally, the physical therapist will prescribe a specific maintenance program for the patient to prevent future back problems.

Pain Medication

Pain medication is prescribed after an assessment by the medical doctor and may include, an anti-inflammatory such as ibuprofen or diclofenac; or analgesic such as acetaminophen or codeine; a neuropathic or nerve pain medication; or a muscle relaxant; or vitamins such as Vitamin B complex.

Heat or Ice Application

Applying a heat or cold pack may relieve pain and/or inflammation.

Therapeutic Massage

Therapeutic massages decrease muscle tension. When the muscle relaxes, it becomes more flexible thereby reducing pain intensity and allowing more mobility.

Fluoroscopic-guided (x-ray) intervention spine injection

A medical doctor who specializes in spine treatment such as a Physiatrist (rehabilitation medical doctor) may use x-ray or fluoroscopic-guided tools to identify where the pain originates, isolate that area and then inject therapeutic medications into the specific area. This procedure offers optimal care for patients with acute or chronic back pain because the rehabilitation doctor targets the source of the pain.

Spine Manipulation

Spine manipulation is sometimes used to relieve pain and improve physical function by using the hands or a device to apply controlled force to the spine. The amount of force applied depends on the form of manipulation used.

Cognitive Behavioural Therapy

For patients with chronic pain, the goals of cognitive behavioural therapy are to modify the patient’s view of their pain, and change the physical and/or psychological response that may contribute to how they perceive the pain. Cognitive behavioural therapy is usually combined with other methods of pain management.

If the pain intensity increases after multidisciplinary medical intervention, surgery may be required.

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How to Achieve the Best Life Outcomes after a Stroke

The best way to get better after a stroke is to start stroke rehabilitation. The American Heart Association/American Stroke Association (AHA/ASA) highly recommends an intensive, multidisciplinary approach to stroke rehabilitation.

This simply means a team effort to rehabilitation which may include physiatrists, neurologists, rehabilitation nurses, physical and occupational therapists, speech, language and swallow pathologists and psychologists.

The first step is a detailed examination performed by the physiatrist (a rehabilitation medical doctor) to identify functional deficits caused by the stroke.

Then, the team of medical specialists meet to develop a comprehensive program to ensure the patient is able to regain his/her independence in regular, everyday activities.

What is the role of each medical specialist on a stroke rehab team?

  • Physiatrist (Rehabilitation medical doctor)

Manages and coordinates the care and rehabilitation of stroke patients including:

  1. Management of current medical conditions to include the cause of the stroke; decrease complications, minimize impairment and maximize function
  2. Prevent recurrence of stroke
  • Physiotherapist (Physical Therapist)

The Physiotherapist helps to improve muscle strength, coordination, sitting or standing balance, and the ability to walk. He/she also helps patients regain independence and recover from any impairment caused by the stroke that may influence weakness and unsteadiness.

  • Occupational Therapist

The occupational therapist provides rehabilitation for stroke patients to improve the ability to care for themselves including: bathing, grooming, toileting, dressing, feeding and other self-care activities with the aim towards independence. Additionally, the occupation therapist facilitates hand function rehabilitation and preparation so that patients are able to return to work or independent living.

  • Speech, Language and Swallow Therapist

The speech, language and swallow therapist conducts swallow screening for Dysphagia (difficulty swallowing) and begins treatment to prevent choking while the patient is eating or drinking.

  1. He/she also evaluates and treats the patient’s ability to communicate which includes speech problems such as slurred speech and language problem such as comprehension, expression of words and in some cases memory.
  • Neuropsychologist

Patients are given a neuropsychological assessment to establish their current conditions and abilities. Once assessment is done, patients are started on a comprehensive program of cognitive training- coordinated care for changes in thinking, behaviourand emotions, as well as the application of biofeedback techniques for managing some conditions.

  • Nutritionist

The nutritionist works along with the swallow therapist to recommend the best ways to prepare food for stroke patients to ensure they are chewing or swallowing without the risk of aspiration (choking) which may occur when food or liquid enters the windpipe to lungs (trachea) instead of stomach.

Do you have other questions about stroke rehabilitation?

Book an appointment today!

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Will I get Osteoporosis?

You’re possibly reading this article from the comfort of your office desk, bed or couch. And if we’ve guessed right, you’ve probably been sitting for at least two hours. It’s a good time to stand up and walk around the room. Don’t worry about the peering eyes, let them look! You’re doing wonders for your bones when you move!

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PUBLISHED: Neurolytic Injection of Botulinum Toxin Type A and Phenol for Spasticity a Patient with Traumatic Brain Injury

Objective
To evaluate the effects of Botulinum Toxin Type A (BTX-A) and 7% Phenol injection in the management of spasticity in a patient with traumatic brain injury at the University Hospital of the West Indies (UHWI).

Method
This is a case report of a patient treated at the Physiatry clinic at UHWI and who had Physiotherapy/Occupational therapy at UHWI and Sir John Golding Rehabilitation Center. The patient was functional only at a wheelchair level and had increased flexion at the right elbow and wrist. He received BTX-A injection to his right elbow flexors and wrist flexors. He continued therapy and was seen for follow up at six (6) weeks, ten (10) weeks and then seven (7) months after the BTX-A injection. He thereafter received 7% phenol to the right flexor carpi radialis. Any change in range of motion (ROM) of the joints was measured using a goniometer and spasticity was assessed using the Modified Ashworth Scale (MAS).

Results
The patient had improvement in the ROM with right elbow extension from 130° to 160° at six (6) weeks, then to 170 ° at ten (10) weeks however at seven (7) months the ROM decreased to 130° despite continuing therapy. He was treated with 7% phenol injection to his right flexor carpi radialis and had improvement in ROM of elbow extension to 165°. Wrist extension range of motion improved from -10o to neutral at six (6) and ten (10) weeks but then decreased to -5o at seven (7) months, but overall showed a +5° improvement. Additionally, he had Berg Balance improvement from 3 to 15 and Barthel Index from 13 to 72, and subsequently was able to walk using a roll walker, with assistance, for the first time after his injury.

Conclusion
Botulinum Toxin Type A and 7% phenol were effective in treating this patient with spasticity secondary to traumatic brain injury. Keywords: Botulinum Toxin Type A, 7% Phenol Injection, Spasticity, Traumatic Brain Injury, Physical Medicine & Rehabilitation.

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PUBLISHED: Sports medicine experts analyse ISSA proposed changes for ‘Champs’

With ISSA expected to announce its decision on Friday regarding proposed changes to protect athletes at Boys and Girls ‘Champs’, two local sports medicine experts have added their voices to the growing debate.

Speaking on Eye on Sports, Dr Paula Dawson and Dr Winston Dawes gave their own recommendations for the protection of athletes from overwork at ‘Champs’.

“Now that we are pushing our athletes a little bit more, most schools should move towards having a check system where athletes are continuously evaluated before problems come and that’s one of the fundamental things we should look at,” said Dr Dawson.

According to Dr Dawes: “We need a team together and parents can get involved to monitor what the athletes do outside of the sight of the coach”.

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PUBLISHED: Physical Medicine and Rehabilitation

Physiatry was first introduced at University Hospital of the West Indies/UWI in August 2008, with the appointment of Dr. Paula Dawson, Consultant Physiatrist and Lecturer. The University Hospital now offers clinical care and academic education in many areas of the field.

Overview 

The goal of the field medicine is to assist people who have experienced traumatic injury, disabling diseases or following surgery, to regain control of their lives by restoring function. Treatment is aggressive, nonsurgical management of body’s musculoskeletal system, which includes bones, joints, muscles, ligaments, tendons, and nerves. This is done in conjunction with a team which includes nurses, physiotherapists, occupational therapists, speech and language pathologists, psychologist and other rehabilitation specialists. A holistic approach to patient care is adapted to maximize patients’ function and adding quality to life. Although all clinical areas in Physiatry are done at University of the West Indies, the main areas of focus are:

  • Musculoskeletal Rehabilitation
  • Sports Medicine Rehabilitation
  • Interventional Spine Rehabilitation
  • Spasticity Management

Musculoskeletal Rehabilitation

Treatment of painful musculoskeletal conditions of the spine, muscles, nerves and joints; Trigger point injection or peripheral joint injections of the hips, knees, shoulder; Diagnosis and treatment of nerve entrapment, radiculopathy, plexopathy, neuropathy, myopathy

Sports Medicine Rehabilitation

Diagnosis and comprehensive non-operative treatment of acute or chronic overuse sports injuries; Peripheral joint injections.

Interventional Spine Rehabilitation

Lumbar: Fluoroscopically guided epidural steroid injections (transforaminal, interlaminar and caudal); Lumbar selective nerve root blocks; Lumbar zygapophyseal (facet) joint injections; Sacroiliac joint injection

Cervical: Fluoroscopically guided epidural steroid injections; (transforaminal, interlaminar); Cervical selective nerve root blocks; Cervical zygapophyseal (facet) joint injections

Spasticity Management

Spasticity management in children with cerebral palsy or adults with neurological disease, with medications and injection of Botulinum Toxin and Phenol injection.

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PUBLISHED: Dr. Paula Dawson Pioneering Physical Medicine and Rehabilitation in Jamaica and the Caribbean

For others, she is seemingly imbued with Florence nightingale type characteristics, that of a ministering angel, who finds a way for those who feel there is no hope to alleviate their pain or some physical disability. a case in point, a sixteen year old boy, who was confined to a wheelchair for more than a year due to a brain injury and was not able to walk. “i examined this little boy and i said there was no reason why
this boy should not be walking,” she recounts. nearly seven months later, after assembling a multi-disciplinary team (which is what a physiatrist does), including a physiotherapist, occupational therapist and psychiatrist and designing a treatment plan that is tailor made to maximize his independence and quality of life, he is able to walk with a roll walker. Welcome to the world of Dr Paula Dawson, who not only holds the distinction of being Jamaica’s only physiatrist but is also one of only two such persons in the English- speaking Caribbean.
“When i see persons debilitated by pain that are now free of it through my work that excites me,” she says proudly. Her work involves examining the musculoskeletal and neurological problems of patients and finding ways of treating them so they are able to maximize as much treatment as possible without surgery.

Read More on Page 24 of the University of the West Indies, Mona Magazine 

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