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Volume 5, Issue 2 www.exploringhandtherapy.com July 2005 In This Issue Featured Article...............1 In The Spotlight ..............3 Penelope.........................7 Splinting Tips & Tricks... 8 Ergo Tips and Tricks......11 Hand Exam Tips ...........13 In The Web ...................14 POP Quiz.......................14 Quiz Answers............... 16 Pssst Did You Know......16 Ask the Expert...............19 EHT’s Modality Course..20 From the Editors’ Desk: Susan Weiss Nancy Falkenstein Exploring Hand Therapy, Inc (EHT) continues to provide you with excellence in education at afford- able prices. We have great cours- es you can watch with kids on lap, coffee in hand - in your PJ’s... any- time day or night. Soon to be Released Courses: * Static Splinting Made Simple * Therapeutic Taping of the Upper Extremity *Carpal Tunnel You Have Control Newly Released Courses: * MODALITIES: Four or five part PAM course. EHT’s Physical Agent Modalities course meets most state requirements with 34 contact hours & up to 40 hours in some states. A BIG hit is EHT’s HAND CLUB! Join today to receive a free course. Visit: www.exploringhandtherapy.com EHT’s magazine is for information- al purposes only and is not intend- ed to be a substitute for profes- sional medical advice, diagnosis or treatment. Always consult your supervisor before implementing ideas. Order our courses at: www.exploringhandtherapy.com or www.treatment2go.com Thank you to our sponsors for making this magazine possible. Please click their ad (if viewing on- line) or visit their website. Lessons of a Grateful Hand Therapist By Tracey Airth-Edblom, OTR/CHT Have you ever used a therapeu- tic tool that allows you to: reduce edema decrease pain increase ROM reduce scarring diminish the effects of the injury on sur- rounding tissue increase strength in functional and work activities during the healing process Wouldn't you appre- ciate such a tool in your therapy tool- box? I have been a prac- ticing OT for 17 years and a CHT for 11 of these 17 years. I have worked with a wide variety of orthopaedic patients from geriatrics to infants, from fractures to burns, skiers, musicians, athletes and working folk. Along the way I've tried many toys and tools to help me do my job better. In 1994 I was introduced to Kinesio Tex tape and more recently to Balance Tex tape by Sammons Preston. These tapes have changed the way I see, as well as the way I treat my patients. It has been an exciting 11 years of watching my clients leave the clinic with Tex tape on their bod- ies, knowing that it is acting like my hands, helping their tissue to continue to heal, to prevent unwanted tension, & relieve pain. Taping allows them to achieve their rehab goals sooner, and continue to advance their rehab continue page 3 1 Balancing Tex Tape® by Sammons Preston

From the Editors’ Desk - Exploring Hand TherapyEHT’s Modality Course..20 From the Editors’ Desk: Susan Weiss Nancy Falkenstein Exploring Hand Therapy, Inc (EHT) continues to

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Page 1: From the Editors’ Desk - Exploring Hand TherapyEHT’s Modality Course..20 From the Editors’ Desk: Susan Weiss Nancy Falkenstein Exploring Hand Therapy, Inc (EHT) continues to

Volume 5, Issue 2 www.exploringhandtherapy.com July 2005

In This IssueFeatured Article...............1In The Spotlight ..............3Penelope.........................7Splinting Tips & Tricks... 8Ergo Tips and Tricks......11Hand Exam Tips ...........13

In The Web ...................14POP Quiz.......................14Quiz Answers............... 16Pssst Did You Know......16Ask the Expert...............19EHT’s Modality Course..20

From the Editors’ Desk:

Susan Weiss Nancy Falkenstein

Exploring Hand Therapy, Inc (EHT)continues to provide you withexcellence in education at afford-able prices. We have great cours-es you can watch with kids on lap,coffee in hand - in your PJ’s... any-time day or night.

Soon to be Released Courses: * Static Splinting Made Simple * Therapeutic Taping of the

Upper Extremity *Carpal Tunnel You Have Control

Newly Released Courses:* MODALITIES: Four or five partPAM course. EHT’s PhysicalAgent Modalities course meetsmost state requirements with 34contact hours & up to 40 hoursin some states.

A BIG hit is EHT’s HAND CLUB!Join today to receive a free course.Visit: www.exploringhandtherapy.com

EHT’s magazine is for information-al purposes only and is not intend-ed to be a substitute for profes-sional medical advice, diagnosis ortreatment. Always consult yoursupervisor before implementingideas.

Order our courses at:www.exploringhandtherapy.comor www.treatment2go.com

Thank you to our sponsorsfor making this magazine possible.Please click their ad (if viewing on-line) or visit their website.

Lessons of a Grateful HandTherapist

By Tracey Airth-Edblom,OTR/CHT

Have you ever used a therapeu-tic tool that allows you to: • reduce edema• decrease pain• increase ROM • reduce scarring• diminish theeffects of theinjury on sur-rounding tissue • increasestrength in functional and workactivities during the healingprocess

Wouldn't you appre-ciate such a tool inyour therapy tool-box?

I have been a prac-ticing OT for 17years and a CHT for 11 of these17 years. I have worked with awide variety of orthopaedicpatients from geriatrics to infants,from fractures to burns, skiers,musicians, athletes and workingfolk. Along the way I've triedmany toys and tools to help medo my job better.

In 1994 I was introduced toKinesio Tex tape and morerecently to Balance Tex tape by

SammonsPreston.

These tapeshavechanged theway I see,as well asthe way I treat my patients. Ithas been an exciting 11 years ofwatching my clients leave theclinic with Tex tape on their bod-ies, knowing that it is acting likemy hands, helping their tissue tocontinue to heal, to preventunwanted tension, & relieve pain.Taping allows them to achievetheir rehab goals sooner, andcontinue to advance their rehab

continue page 3

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Balancing Tex Tape®by Sammons Preston

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goals through self-taping evenafter discharge.

As soon as I started to use Textape, I noticed a difference.Clients reported less pain. I sawlarge, dark bruises disappear in 2days while patients asked for"that magic tape". I obligedthough I still wasn't sure how orwhy the tape was working.

In the beginning, I was unsure,so I was using the tape as a lastresort, primarily on the 'train-wrecks'. You know who I'm refer-ring to: the patients who respondpartially to every other tool inyour bag and still leave youstruggling for the next way to tryto help them. So I studied, tooksome continuing educationcourses and became an instruc-

tor. First I learned how to applythe tape to quiet an over-used orover-stimulated muscle. Restingand decongesting the musclesrelieved the patient's pain andmade ROM and functional activi-ties easier more quickly.

Then I noticed that patients whowere post-op had diminishedscarring weeks earlier thanexpected, less reddened scars,softer, and less hypersensitivescars. Patients who had had sur-gery in the past began to ask meif I could tape their old scars -and they were pleased with thoseresults as well.

I have had great success treatingmild cases of breast cancer lym-phedema, so I applied taping topost-op edema. We began to

treat post-op clients for edema, tohelp diminish their pain andincrease their ease of ROM exer-cises earlier in their treatment.Let's face it, a hand full ofswollen sausage fingers doesn'tmove well.

On a more personal note, Ibegan taping my own back 9years ago after 2 pregnanciesleft me with unstable SI jointsbilaterally. I have taped my ownskating injuries to reduce localedema immediately after injurythereby minimizing collateral tis-sue damage from pre-inflamma-tory cellular activity.

Taping with Tex tape hasenhanced my ability to treat thelayers of tissue affected by an

Continued page 4

Q: What school did you attend? A: I received my bachelors degreein OT from the University ofSouthern Indiana in 1997.

Q: In what state do you current-ly practice hand rehabilitation?A: I work in the rolling hills ofsouthern Indiana.

Q: What type of setting do youwork in? A: Currently, I work in a small hos-pital and see about 2/3 outpatients,1/3 inpatients. My outpatients arelargely referred from nurse practi-tioners and internal medicine doc-tors. It's hand therapy but not asmuch orthopedic as I'd like.

Q: How long have you beendoing hand therapy?A: Almost 6 years now.

Q: What do you find is the mostchallenging diagnosis youtreat? A:That would have to be thosechronic tennis elbows that show noimprovement no matter how manythings you try. It just drives mecrazy to have to give a tennis

elbow patient backto the orthopedicdoctor for surgery.

Q: What is your favorite diagno-sis to treat?A: I really like the patients withwrist pain that has no acute cause.My skills go into full gear as Imake my educated guess as towhat the diagnosis might be.There are so many possibilitieswith all of thosebones, ligaments,muscles, nerves,etc. I just love itwhen my diagno-sis matches theorthopedic’s diagnosis.

I also like to work with nerve

In The Spotlight ....Chad Royer OTR/L, CHT

3

continued on page 6

Chad Royer OTR/L, CHT

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injury differently. I've learnedthere is a certain artistry to tapingthat incorporates your depth ofknowledge as well as the depthof the tissue. It helps, a lot, toknow your anatomy, and to beclear in your own mind what youare taping, and how you intendyour tape application to affectthat particular layer of tissue.

There is clearly a science, butthere is art in the fingertips asthere is in myofascial techniquesor in palpating for a problem.This is a tool that responds topractice and has the flexibility torespond to the skill of the user.Because of it's flexibility, the tapeis friendly to the new user, thenew therapist, and even the layperson with a little extra instruc-tion.

Here it is several years later andI still find Tex tape is one of themost powerful therapeutic toolsas well as the most versatile.Tex tape is the one tool that Icould easily apply to 99% of thepatients that stroll into our clinic.Though I choose more judiciouslythan this, they could all benefitfrom at least one application ofTex tape at some point in theirrehabilitation.

I couldn't be more grateful for theinvention of Tex tape. It willremain in my therapeutic reper-toire for many years to come.The only thing more satisfyingthan seeing my patient's improvewith the tape is seeing anothertherapist's satisfaction when theyrealize what they can do with thistape…and then I think of all the

grateful patients they will treat.

Tracey Airth-Edblom, OTR, CHT received aBachelor of Arts in Gerontology and a Bachelorof Science in Occupational Therapy at theUniversity of Alberta in Canada. She worked atthe University of Calgary (Foothills) Hospital for3 years in general orthopaedics, and rheumatol-ogy. She then moved to California to join inopening The Arthritis Center in San Mateo, CA.She has been a Hand Therapist at KentfieldHand Center in Kentfield, CA since March,1993. Throughout her career, she has alwaysbeen an educator and a program developer.Tracey has presented at 6 national conferencesin Canada and the US, taught seminars acrossthe US including guest lectures at the Universitylevel in Rheumatology and Hand Therapy.Tracey is currently an Adjunct Instructor forSamuel Merritt College’s Hand Therapy pro-gram in Oakland, CA.

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entrapments. Especially the timeswhen the symptoms fade so quick-ly with something so simple aswearing a brace at night or anelbow pad during the day. Then,your patent thinks your are agenius!

Q: What area of hand and upperextremity rehab do you want toexpand your expertise in? A: Right now, I'm interested in cer-vical conditions. That's alwaysbeen a confusing area for me andyet it's so important for differentialdiagnosis. I also, like wound care. Ithink I've got the basics but theresure is a lot to know and keep cur-rent with.

Q: What do you do when youare not consumed with handtherapy?A: I live in the country with my wifeand two boys (8 and 6 years old).We do a lot of outside things likeriding dirt bikes, playing in the

woods, and catch-ing frogs (yes, mywife does all thesethings, too). Weenjoy church activi-ties, and I'm tryingto get my wife hooked on golf!

Q: Do you have an area of clini-cal expertise that you can sharea tip or trick with us, that we cantry in our clinical practice?A: I modified a PIP/DIP flexion andextension splint I saw in theSammons Preston catalog. Theoriginal splint worked on a pulleysystem with fishing line and wasmade out of foam/cloth. I madethe same thing out of thermoplas-tic, lined with 1/8 inch closed cellfoam for grip and comfort and itworked much better. I was able toget more motion before the twopieces touched in the middle andwas also able to get more force.

Q: How did you find EHT and

what do you like about EHT?A: I was using the purple book tostudy for my CHT exam (which Ipassed on the first try thanks toyou guys) and loved it. So Ithought I'd try the website andloved the education you offer. I'vebeen utilizing those courses for 21/2 years now. But probably thebest thing about EHT is how helpfuland friendly Nancy and Susan havebeen. I couldn't believe how quicklyyou all respond to questions.Actually, I expected a generic, briefreply about 1-2 weeks later the firsttime I emailed a question; butSusan replied within probably 1-2hours (and has been answering allof my questions ever since).

Thankyou

CHAD!

In the Spotlight (continued)

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An Automated Helping Hand

Penelope™, is a one-armed robotic scrub technician. Dr. Michael R. Treat MD conceived of the ideafor Penelope in March 2001. Shortly after, he formed Robotic Surgical Tech, Inc., a spin-off company ofNewYork-Presbyterian Hospital and Columbia University.

Penelope currently performs some of the tasks of a scrubtechnician. "In the operating room, the scrub technician isresponsible for dispensing and retrieving surgical instrumentskept on a tray called the Mayo stand. Penelope can do thosebasic functions," says Dr. Treat. " What makes our robot trulyunique is that it is autonomous. Most surgical robots availabletoday are run by the surgeon. Penelope is a stand-alone co-worker."

Dr. Treat is particularly excited about Penelope's future advances. "Right now Penelope is configured asa server of instruments, but we have already developed innovations that will create a much more capablesystem down the line. In addition to dispensing instruments, the robot will be able to keep track of theinstruments and count them," he explains. "Penelope is also the first surgical robot to have artificial intel-ligence; the computer's brain directs the robot's autonomous actions. Using this technology, Penelopewill one day be able to learn the surgeon's preferences and keep track of them—even predicting whatkinds of instruments the surgeon may want and keeping a data file of the surgeon's requests. Nothinglike this has ever been seen in the OR."

A longtime proponent of surgical technology, Dr. Treat believes Penelope will one day be regarded as asignificant historical device. "Penelope is the first of her kind, but won't be the last. This robot embodiesthe future of surgery. I'm confident that someday descendants of this machine will be performing surgery,not just assisting." If Penelope proves to be clinically viable during the investigational stage, Dr. Treathopes to offer the robot commercially in 2006.

To learn more visit their website:

http://www.columbiasurgery.org/news/si/2005_penelope.html

An article in the N.Y. times also featured Penelope™ and you might enjoy reading it

http://www.nytimes.com/2005/01/18/technology/18nurse.html?ex=1263790800&en=b9306bea1ba78c40&ei=5088&partner=rssnyt

Scrub Techs going HIGH TECH

Penelope handing an instrument to Dr. Treat

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Splinting for the elderly requiresmeticulous attention to detail. Youshould be aware of the elders cog-nitive, sensory, and physical statusto determine usefulness and appro-priateness of a splint. Below aresome considerations when splint-ing the elderly.

• Always think safety. Never allow a

splint to prevent safe grasp, especial-ly when they use a cane or walker.

• Be careful not to exacerbate a pre-

existing condition such as BJOA, byputting strain on the thumb when fab-ricating a resting hand splint.

• It is important to give the elderly a

simple and clear written splint instruc-

tion sheet. Illustrations are a benefitas well. Always explain the purpose ofthe splint and demonstrate propersplint application. Have your patientdemonstrate with 100% accuracysplint application. LISTEN to yourpatient’s complaints and adjust thesplint accordingly.

• Protect skin integrity by providing

good sanitary instructions to clean thesplint with isopropyl alcohol and/orchlorine for stain removal.

• Try the new Sammons Preston

antimicrobial stockinette to absorbperspiration. Powder is also a goodway to control moisture.

• Your patient can use an athletic

sock to create a thick stockinette. Cut

the foot part off ofthe sock & cut athumb hole.

• Some tips for

splinting OA jointsin the elderly. ~ The DIPJ’s may

benefit from thermo-plastic circumferentialimmobilization splints to decrease pain.

~ The thumb IP joint is often enlarged and

may be deformed in the elderly; Use a coat-ed material which allows the thermoplasticmaterial to “pop off” when it cools.

~ Another option for splinting the thumb is

to use a neoprene splint/sleeve. You cancut the edge if the material if too tightaround the thumb IPJ. Plus the neoprene isnot rigid and it can slip over an enlarged IPJeasily.

Splinting Tips and Tricks (splinting the elderly)

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Problem:Pain in the thumb and ulnar wristfrom pointer/mouse use:

Solution:Some Quick Tips for safer mouseuse:

• Keep the mouse close to thekeyboard.

• Position the mouse to allow youto maintain a straight, neutral wristposture. This may involve adjust-ments in your chair, desk, key-board tray, etc.

• If the keyboard tray/surface isnot large enough to accommodateboth the keyboard and mouse, tryone of the following to limit reach-ing:

~ Use a mouse platform posi-tioned over the keyboard. Thisdesign allows the mouse to beused above the 10-key pad.~ Install a mouse tray next to thekeyboard tray.~ Use a keyboard that has a point-ing device, such as a touchpad,incorporated into the keyboard.~ Use a keyboard without a ten-key pad, which leaves more roomfor the pointer/mouse.~ Install keyboard trays that arelarge enough to hold both the key-board and mouse.

~ Use a mouse pad with awrist/palm rest to promote neutralwrist posture.

• Alternate hands with which youoperate the pointer/mouse.

• Use keyboard short cuts toreduce extended use. ~ Substitute keystrokes for mousing

tasks, such as • Ctrl+S to save, • Ctrl+A for highlight all• Ctrl+P to print.

Ergo Tips and Tricks

The FIRST and ONLY CLUB ded-icated to the

Hand Therapy Community

YOUR EXCLUSIVE MEMBERSHIP IS JAM PACKED WITH BENEFITS!

JOIN TODAYwww.exploringhandtherapy.com

MEMBERSHIP INCLUDES all this and MORE...

* Free DVD or CD-ROM course with Annual Membership * Club member discounts* Interactive Discussion Board * Case studies presented for open discussion * Q and A on the discussion boards * Live Chat* 20 page magazine mailed to your home quarterly* Network with other therapists * Prepare for the hand exam by networking and MORE.

Information from OSHA ergonomic solutions

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HOW DID THEY DO IT!!

Last issue EHT gave you sometips from recent CHT’s. By popu-lar demand we are includingmore. This section is devoted tointerviewing recently CertifiedHand Therapists and how theyDID IT!! EHT will include com-ments from recently certifiedhand therapists as they sharetheir advice to help you studyfor the big day.

The practice exams were a bighelp. I took each of them twice, onetwo months ahead of time, to get in'exam mode.' Then, I took one eachweek the last three weeks beforethe test. The practice test questionswere more factual than the actualexam, which was moresituation/treatment-oriented.

However, the exercise took theedge off the fear of the test, whichis invaluable. Thanks for doing it.Barb

When did you begin preparationsfor the exam?

Formalized studying 6 monthsbefore the exam. However, I havebeen preparing for a career inhands and the CHT even back tomy MPT coursework in graduateschool, 5+ years ago. I took anelective course in hand and upperextremity the last semester of myprogram. I also completed a clinicalaffiliation at the Curtis Hand Centerin Baltimore. I had the privilege ofworking at a very busy hand centerwith a strong resident/fellow pro-gram. We were able to attendweekly lectures/case presentations

offered bythe chief of thehand/upperextremity divi-sion.

How manyhours did you put into studyingfor the exam?

Approximately 5 hours per weekuntil Sept. and then it was 10-12hours per week from Sept. up untilthe exam.

Did you participate in a studygroup? If yes was this helpful?

No, I did not participate in a studygroup.

Tell Me Some Secrets..... PLEASE!

Continue on page 15

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1. Elbow flexion is best assessedwith elbow flexed to 90 degrees andforearm in neutral rotation? T/F

2. The mobile wad of Henry consistsof the BR, ECRB, ECRL and formsthe lateral margin of what structure?

3. Acute olecranon bursitis is a com-mon clinical manifestation of gout.T/F

4. A Clamp sign is indicative of what?

5. In referenceto thumbCMCJ sublux-ation in OA;the protrudingappearance of the CMCJ is referredto as _____________.

6. A syndrome of the hand and wristassociated with bicycling known ascyclist palsy or handlebar palsy is acompression of what nerve & where?

7. Tex tapingis the sameas athletictaping. T/F

8. The Kinesio Taping Method isapplied over muscles to reduce painand inflammation, relax overusedtired muscles, and to support mus-cles in movement on a 24hr/daybasis. It is non-restrictive type of tap-ing which allows for full range ofmotion. T/F

9. Tape of any kind may be an effec-tive and inexpensive choice for scarremodeling. T/F

10. According to thePalmar classification,the TFCC has twotypes of tears;Traumatic and Degenerative tear.Name 2 of the 5 stages of degenera-tive TFCC tears.

IN THE WEB

Test Your Knowledge... POP Quiz!

Answers on page 16

Learn about tapinghttp://www.kinesio-tape.com/KinesioTex1.html

How people agehttp://occupationaltherapy.advanceweb.com/common/Editorial/Editorial.aspx?CC=53239

Getting ready to take the the hand exam... now that you have studiedwith all of our great courses and content go to http://www.htcc.organd register to take your exam.

California readers please note we have 20 courses that are approved foradvanced hand therapy education and/or modalities. Visithttp://www.bot.ca.gov/advanced.htm to view the EHT approved courses.

Excellent Information Sheets--check them outhttp://www.pncl.co.uk/~belcher/information/Menu.html

Are you in Maryland, Kentucky or another state that has just addedmore hours to your modality requirements? If so we have up-to-date modalityeducation on CD's and DVD's. Visit www.treatment2go.comto learn more.

Get the Newly Revised "PURPLE BOOK!" Signed by the Authors!

Hand Rehabilitation a QuickReference Guide and Review,

2nd Edition by Weiss & Falkenstein

Order Now at www.treatment2go.com

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What study resources did youuse?° Rehabilitation of the Hand;

Hunter, MD, Etc.°Hand Secrets; Jebson, MD,

Kasdan, MD°Hand Rehabilitation A Quick

Reference Guide and Review; Falkenstein and Weiss (Exploring Hand Therapy)

°Practice Exams offered by Exploring Hand Therapy

°Self Assessment exams offered byAmerican Society forSurgery of the Hand

°In-services given by my CHT colleagues

° CD offered by ASHT° Attending the Philadelphia

Meeting ° Clinical Affiliation at The Curtis

Hand Center in Baltimore° EXPERIENCE in the clinic

What resources were most helpful?

° EXPERIENCE!° Rehab of the Hand for knowledge

on extensor/flexor tendons.°Hand Rehab Quick Reference

Guide and Review (Purple book)

° Exploring Hand Therapy’s practice exams

Did you feel prepared for theexam?

Actually, yes. That is until I com-pleted the exam.

What else would have been help-ful for preparation of the exam?

For this particular exam, a bit morestudying about modalities. (Note fromEHT: We have a great modalities course atwww.treatment2go.com ).

What other suggestions do youhave for future students prepar-ing for the hand examination?

Research, explore, and gain accessto every resource possible. This isespecially true for those clinicianswho are not treating hands for themajority of their case load.

Jennifer Thompson MPT, CHTPlace of employment: PRO PhysicalTherapy - Hand and Upper ExtremityCenter, Delaware.

When did you begin preparationsfor the exam?

May 2004

How many hours did you put intostudying for the exam?

400 hours

Continued page 18

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1. True2. Antecubital fossa3. True4.Clamp sign may indicatescaphoid fracture. This sign is demon-strated when the patient grasps the volarand dorsal aspects of the scaphoid whenasked.. Where is the pain?5. “Squaring” or “Shoulder” sign and adiagnosis may be made based on thisappearance, grind test and/or X-rays.6. Ulnar nerve at Guyon’s canal7. False8. True9. True10. Degenerative TFCC tears (stages)

Answers to Test Your Knowledge

Did you know Exploring HandTherapy has a booth at theAnnual ASHT meeting in SanAntonio Texas in Sept. from the22-24th? We are at thefront entrance of the vendors byMosby. Please visit us and get afree DVD!

Did you know that PoweringAthletics has a great new devicefor wrist exercise. This piece ofequipment is great for retrainingwrist muscles after fracture orinjury. It is easy to use andportable too! See ad above fordetails and website info.

Did you know that SammonsPreston now has antimicrobialstockinette as well as material?NO MORE STINKY SPLINTS and

just in time for a HOT summer. Itis new and worth checking out.EHT demos the use of this in ourSplinting Made Simple video.Visit. www.sammonspreston.comfor more info or samples.

Pssst! Did you Know.........

I. TFCC wearII TFCC wear and chondromalaciaIII. TFCC perforation and chondroma-laciaIV. TFCC perforation, + chondromala-cia, + lunotriquetral ligament tearV. TFCC perforation, + ulnocarpalarthritis

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Did you participate in a studygroup? If yes - was this helpful?

Yes, informally. It was very helpfulto collaborate with a few other peo-ple and discuss topics/chapters/cur-rent issues.

What study resources did youuse?

Practice tests, rehab of the hand,EHT test prep guide of questions,current journal articles, weeklyhand grand rounds at the localorthopedic residency program, andother people.

What resources were most help-ful?

The practice tests and being able togo back on wrong answers andresearch based on my mistakes. Itprepared me to understand whatmy current weaknesses and

strengths were to more customizemy study program

Did you feel prepared for theexam?

So-so, but then do we ever?

What else would have been help-ful for preparation of the exam?

More access on the ASHT websiteto journal articles, etc.

What other suggestions do youhave for future students prepar-ing for the hand examination?

Start studying early and takeadvantage of every opportunity to

grow! Gretchen Kaiser OTR/L, CHT!Place of employment: Hand TherapyProfessionals

Dear Susan and Nancy,I just wanted to thank you so much

for putting together that compre-hensive CD-ROM -The Basics andBeyond! I used it to help study forthe CHT exam and I passed...firsttime!!!!!!!!! I will recommend it toothers studying for the exam.Again...thank yousoooo much, it wasvery helpful.

Dawn HentschkeOTR/L, CHT : )

EHT wishes 2005 test takers success. Visit us at:www.exploringhandtherapy.com

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Question: How long does one appli-cation of Tex tape last on the patient?Answer: This depends on where thetape is on the body. Generally 3-4days, but on sweaty hands/feet, or onsweaty athlete, it might only last 1-2days.

Question: Can Tex tape get wet? Ifyes, do you recommend the patientput the taped area in a plastic bagduring a shower?Answer: The tape is designed to getwet and to breathe. It dries after ashower in about 20 minutes, faster ifyou take the time to use a hair dryer onlow or cool setting (too much heat acti-vates the glue and removal maybecome difficult/painful)

Question: Are there any tricks tokeep the Tex tape in place?Answer: Skin preps such as those weall use for tens applications or the onesused for ostomy supplies work well,especially on palms or on oilier skin.

Question: Do you have the patientbuy a roll of their own for self appli-cation? If yes, how often do youhave them change their Tex tape? Ifno, do you change at each clinicalvisit?Answer: Usually, the first taping is doneto check that the patient benefits, asexpected. Once this is established, Iteach the patient or their family memberto tape and they buy a roll or 2.

Question: How long should one rollof TEX tape last? Answer: One roll lasts for several tap-ing, especially since patients’ who are

taping as part of their home mainte-nance program will typically tape onceor twice a week.

Question: What diagnosis do youfavor with using Tex Tape?Answer: There really isn't one diagno-sis I favor. I utilize Tex Tape early onwhen I expect to make a difference inedema, which is very effective, to relaxmuscles, or to decrease pain. So asyou can see, this is just about everyonewe see in the clinic.

Question: Do you use Tex Tape inconjunction with splinting? Or inconjunction with scar gel sheets?Answer: Tape and splinting combina-tions are very common such as with 1stCMC OA, deQuervains, LRTI's, carpaltunnel, etc... There are other considera-tions when using the tape to affectscars. If the scar is in the palm ofsomeone who needs to frequently washtheir hands, I'd choose scar gel at nightand leave their hand free during theday. However, if that same scar was onthe back of the hand, I'd likely chooseTex Tape. It can stay in place longer,without reapplication, and it providessome sun protection (as evidenced bythe interesting suntans) for those youngscars.

Question: When do you know to d/cusing Tex Tape? Answer: Some goals are achieved veryquickly, such as decreased edema andpain. Other symptoms arise and thetape may be used again in a differentway. Some patient’s wear the tapeonce in a while, while others use it onlyonce a month (such as when their job

has a financial 'close' week every monthwhich is very busy). Those patients willkeep a roll of tape in the medicine cabi-net like the rest of us keep Tylenol orIbuprofen.

Question: Do you feel the patient’scan be good at self application of Textape; since there is a technique tothe application?Answer: Some patients actuallybecome very proficient at taping them-selves and even at 'tweaking' their owntaping according to how they feel. Thisdoes take practice, and it's true that noteveryone becomes proficient. Clinicpractices usually take care of it, but forsome, this option is abandoned.

Question: Any tips, tricks or tech-niques that you can share would beappreciated.Answer: The most important aspect ofhaving the tape stay in place for a fewdays is to have the patient wash theirskin in the clinic before you apply. If thetape works but doesn't stick well the firsttime, then the second time, utilize a skinprep after washing. Excess hair keepsthe tape away from the skin making thetape relatively ineffective. So, use hairclippers (such as commonly availablegroomer) to clip hair above the skinrather than razoring it which increasesthe disturbance of the epidermis andincreases the likelihood that the tapewill be irritating. Happy taping!!

From the Experts!This month’s featured expert...Tracey Edblom

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