FingerPrint (AHTA News) - Issue111

NEWSLETTER OF THE

Issue 111, Apr - Jun 2017

Hand Therapy Awareness Week

FEATURES Early Active Vector Adjustable Skin Traction for Phalangeal Fractures Use of Upper Limb Mobilisation Splinting Following Traumatic Forearm Injury Orthosis use for Osteoarthritis of the Trapeziometacarpal Joint of the Thumb

UPDATES AHTA 2017 Conference - Connecting Pathways...Firing up your nerve potential Portfolio Reports IFSHT Update www.ahta.com.au l 1

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In this issue...

PUBLISHED BY

Australian Hand Therapy Association Incorporated ABN 72 874 453 636 PO Box 5111 West Busselton WA 6280 T: +61 8 9755 0416 E: info@ahta.com.au www.ahta.com.au EDITOR Julia Wild E: communications@ahta.com.au ADVERTISING SALES Veronica Dullens T: 0400 449 100 E: events@ahta.com.au

DISCLAIMER While every effort has been made to ensure the accuracy of information, the Australian Hand Therapy Association Inc. (AHTA) will not accept any responsibility for errors or omissions or for any consequences arising from reliance on information published.

Views expressed are those of the writers and are not necessarily the opinions of, or are endorsed by the AHTA unless otherwise stated.

Copy in this newsletter cannot be reproduced without the written authorisation of the AHTA. The AHTA welcomes contributions but reserves the right to accept or reject any material.

FEATURES

6 8 14 20 23

Report: Early Active Vector Adjustable Skin Traction (EAVAST) for Phalangeal Fractures Case Study: Use of Upper Limb Mobilisation Splinting Following Traumatic Forearm Injury Literature Review: Orthosis Use for Osteoarthritis of the Trapeziometacarpal Joint of the Thumb Myers Team Orthopaedic Outreach Lautoka Hospital Fiji Update: Indigenous Allied Health Association

REGULARS

4 5 32 33 34 35 36

National Conference Update From the Editor Practice Profiles Mentor List Product Profiles - Dressings IFSHT Update Contact Us

REPORTS

24 25 26 27 28 29 29 30

President Advocacy Membership Education Research and Scholarships Communications Marketing and Promotions States and Territories

Cover image supplied by Southern Hand Therapy. www.ahta.com.au l 3

Australian Hand Therapy Association National Conference 22 - 24 Sept 2017 • Stamford Grand, Glenelg SA Be part of an AHTA First!

Look inside - live fresh UL cadaveric dissection and demonstration The 2017 AHTA conference committee are delighted to be offering registrants the opportunity to be involved in a live fresh UL cadaveric dissection and demonstration, allowing the rare opportunity for to look inside and visually explore what we usually only see on the outside.

The American Society of Hand Therapy offered a similar session last year’s conference. This was a highlight of the conference for me, and I was eager to see if we could offer something similar to AHTA members and conference registrants this year.

What is it that you would like to see? Muscle transfer, tendon repair..?

We will be screening the live sessions from the University of South Australia. The dissection session will be followed by an AHTA Members only Workshop, where we will encourage participants to request the surgeon show / demonstrate what they wish to see.

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Dr. Paul van Minnen has kindly offered to carry out our dissection and demonstrations.

For more information about the conference please visit www.ahtaconference.com.au.

Come and join us in Adelaide, and be part of this rare and exciting learning opportunity to look beyond the skin and see what we usually only feel from the outside!

To keep up to date with the conference follow the conference via the website and/or our Facebook page. If you have any questions please email ahta@yrd.com.au.

Jo Marsh Conference Committee

SURGEON PROFILE Dr. van Minnen is a plastic and reconstructive surgeon with a special interest in hand and wrist surgery.

He studied medicine, obtained his PhD and completed Plastic, Reconstructive and Hand Surgery training at Utrecht University in The Netherlands. He qualified as a Netherlands Board (NVPC) and European Board (EBOPRAS) certified plastic surgeon before arriving in Australia in 2012.

In Adelaide, he completed three years of advanced fellowship training in Reconstructive Microsurgery, Burns Surgery and Hand and Wrist Surgery at the Royal Adelaide Hospital and Flinders Medical Centre. In 2015, he was awarded Fellowship of the Royal Australasian College of Surgeons (FRACS) as a plastic and reconstructive surgeon.

He holds a consultant staff specialist position in the Royal Adelaide Hospital where he treats patients with severe and complex hand trauma.

He also consults in his private practice.

From the editor FINGERPRINT is our newsletter title. Thank you to Vera Tse for her suggestion.

She will have $100.00 towards her conference fee!

We have Hand Therapy Awareness week next week. Get planning and send those photos to Amy at marketing@ahta.com.au. I wonder who will win the prize for promoting our profession?

It is great to see the National Conference programme on nerves developing with Tim Cocks from the NOI group as our guest speaker. We are also lucky to have a great live dissection as part of the programme. See you there.

A big thank you for all our contributors with articles, volunteer work and committee workers. Let us know what is going on in your area and we’d love to have a review on meeting, courses, books, websites etc.

We will welcome back Kate Noller, Executive Assistant from maternity leave in June. I wish to thank Veronica for helping with all her extra hours whilst Kate has been away.

Hand Therapy Around the World Manhattan barber, Jed Mosher’s stroke left him without the use of his hand and with slurred speech, forcing him into early retirement.

With the help of an OT, Jed has regained function in his hand, allowing him to return to work.

For the full article visit: http://ksnt. com/2017/04/14/manhattan-barberovercomes-stroke/

Julia Wild AHTA Communications Officer Letters to the editor are welcome and may be emailed to communications@ahta.com. au. Letters should not be more than 300 words and must be accompanied by the therapist’s name (published) and contact information.

Health & Safety Alert FLOODING ALERT Don’t leave washing machine on when no one is in the practice. If the hose comes loose you can flood your suite and any nearby.

UNPACK YOUR CLEAN LINEN Fresh laundry that has had massage oils should be unpacked on the day they are delivered. Otherwise the warm towels and oil can lead to self-ignition.

AHTA 2-day course

Mastering Handwriting in Hand Therapy Sat 24 & Sun 25 June 2017, Melbourne This course will provide participants with the theoretical and practical knowledge required to competently assess handwriting skills, and provide appropriate intervention strategies for children through to adults who have presented to hand therapy.

Visit the Online Store at www.ahta.com.au to book your place today www.ahta.com.au l 5

FEATURE

REPORT

Early Active Vector Adjustable Skin Traction for Phalangeal Fractures Jason Fairclough Practice Principal, Hills Family PhysioCentre

Phalangeal fractures, especially those involving the proximal interphalangeal joint can be complex to treat and may involve disruption of the static and dynamic bone and soft tissue apparatus.1 Various surgical options are available including Kirschner wires, screw fixation, hemi-hamate replacement, Suzuki frames, volar plate arthroplasty, however complications such as neuropathic pain, post-operative stiffness, pin loosening and infection are reported.2 The use of ligamentotaxis, whether via skeletal or skin traction, has been documented in the literature stemming from initial work pioneered by Schenk3 and the original Southampton technique described by Fitzgerald and Khan4.

These techniques have been modified over time, and utilise tensioning the soft tissue envelope to reduce fracture fragments, prevent peri-articular adhesions, and allow early motion. They are minimally invasive.

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FEATURE

The Early Active Vector Adjustable Skin Traction (EAVAST) method was developed in Nepean Hospital, Sydney, Australia and initial results of a retrospective study were published in the journal Hand5 and presented at the International Federation of Societies for Surgery of the Hand (IFSSH) Conference in Argentina in 2016.

The technique involves the following components: 1. Application of adhesive tape to the finger to apply with a hole cut in the end with a holepunch.

2. Threading of elastic thread into the hole in the tape to provide a dynamic traction component.

Forces applied can be from 50 to 500 grams. The elastic can be secured via a hook onto the volar aspect of a hand based splint.

3. Measurement of traction force utilising a plastic tube and a tension gauge.

4. Application of blocks using luxafoam, neoprene straps and adjustment of the angle of the splint to assist fracture reduction.

5. Early motion under traction towards the scaphoid tubercle.

Motion may be passive, active assisted or active. Repetitions are usually 10 motions, five times a day.

References 1. Chinchalkar S and Gan BS. Management of Proximal Interphalangeal Joint Fractures and Dislocations. Journal of Hand Therapy.

2003; 3: 117-128.

2. Blazer PE, Steinberg DR. Fractures of the proximal interphalangeal joint. J Am Acad Orthop Surg. 2000; 8(6): 383-90.

3. Schenk RR. The Dynamic Traction Method – combining movement and traction for intra-articular fractures of the phalanges.

Hand Clinics. 1994b; 10: 187-198.

4. Fitzgerald J and Khan M. The conservative management of shafts of the phalanges of the fingers by combined-traction splintage.

Journal of Hand Surgery. 1984; 9B: 303-306.

5. Dowd M, Fairclough J, Lam J, Chan Q, Wood S and Diab J. Early Active Vector Adjustable Skin Traction (EAVAST) for Phalangeal Fractures. Hand. 2016; 61S.

This research work is supported by

About the author

A case series of 54 finger phalanges traction cases treated with EAVASST demonstrated mean TAM of 227.50; excellent outcomes in 37 cases, good in 14 cases and poor outcomes in 3 cases, under Belsky’s criteria. Grip strength averaged 32.3kg and was 99.3% of the unaffected limb. 5 Mild malrotation was observed in two cases, in another case where surgery was combined with the traction scar adhesion were observed but these did not require surgical intervention.

The following pre- and post-traction radiographs show the potential for the EVAST technique to provide good radiological outcomes.

Jason Fairclough is a Physiotherapist and Certified Hand Therapist, and is the Practice Principal of Hills Family Physio in Sydney, Australia. His current research interests are in the areas of traction methods for management of fractures; competency and education for hand specialisation; and the efficacy of electrotherapy agents and biometric devices.

He is contactable at info@ hillsfamilyphyio.com.au. Updates on the skin traction method will be available at hault.net.au and hillsfamilyphysio.com.au. www.ahta.com.au l 7

FEATURE

CASE STUDY

Use of Upper Limb Mobilisation Splinting Following Traumatic Forearm Injury Amanda MacKillop

This case study focuses on the type and design of mobilisation splinting used to regain upper limb range of motion and functional mobility, following traumatic injury to the forearm. Conjunctive therapeutic modalities is also briefly discussed.

Background information C.H. is 21 year old male, who sustained a traumatic injury to his left forearm in a motor vehicle accident on 5th February 2014. He underwent the following surgical procedures:

• 6 February 2014 - - -

Mid shaft radius and ulnar ORIF. Distal radius ORIF. VAC dressing in preparation for skin graft.

• 10 February 2014 - washout + VAC dressing.

• 14 February 2014 - split skin graft to forearm.

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C.H. was discharged from hospital and commenced hand therapy at Advance Therapy Solutions on 27 February 2014. C.H. experienced a number of functional limitations of the left upper limb due to a number of factors, including the type and nature of his injuries, multiple surgeries, delay in commencing hand therapy and period of immobilisation, He presented with poor active and passive wrist extension, reduced wrist flexion, DIP joint flexion of middle, ring and little fingers with wrist extension, ongoing pain and discomfort and difficulty regaining upper limb strength.

Skin graft and surgical scarring had become severely adhered to the flexor muscles in C.H.’s forearm, most notably flexor digitorum profundus (FDP) of middle, ring and small fingers. This limited soft tissue and muscle (belly and tendon) glide. Muscle shortening had occurred. This contributed to

reduced active and passive wrist extension, reduced active DIP joint flexion, and causing the DIP joints to flex with composite wrist extension. Adhesions, reduced skin tensibility at the graft site, muscle shortening from immobilisation also contributed to ROM deficits.

C.H. underwent further surgery on 20 August 2014. This involved:

• Left wrist arthroscopy.

• Removal of distal radius ORIF hardware.

• Flexor release from skin graft scar.

• Tenolysis of middle, ring and little finger FDP. C.H. recommenced hand therapy the following day. The following was noted:

• Large surgical wound at preexisting skin graft on volar forearm, sutures in-situ.

• Mild to moderate diffuse oedema of the forearm, hand and fingers.

FEATURE

• Active wrist extension: - -

Isolated: 45 degrees.

Composite: 45 degrees.

• Passive wrist extension: 55 degrees, springy end-feel.

• Active wrist flexion: 70 degrees, full passive.

• Full forearm rotation.

• Flexion of middle, ring and small DIP joints with composite wrist and digit extension – hard end-feel with passive ROM.

• Reduced active isolated middle, ring and small DIP joint flexion: approx. 60 degrees, full passive.

• Nil sensory deficits.

• Grip strength (1 September

• To increase muscle length and extensibility to improve wrist extension, and middle, ring and small DIP joint flexion and extension.

• Improve muscle glide and minimise adherence/tethering to scarring which would further limit wrist and finger ROM.

• Protect wound strength and enable healing without comprimsing its integrity.

• Optimise functional use of the upper limb by restoring and improving upper limb strength and work hardening for patient’s goal to return to normal duties as a delivery driver.

Assessment and clinical considerations for splint prescription and design, and treatment plan With knowledge gained from the AHTA Upper Limb Orthotic/Splint Fabrication-Mobilisation Course, the following treatment plan was developed and actioned.

Patient goals for therapy C.H. worked as a delivery driver for an outdoor furniture company.

His duties included delivery and set up of furniture. It was his goal to return to normal work duties.

C.H. also hoped to return to playing football. These goals were considered realistic considering his age, motivation, social support, employer support, and insurance body funding treatment.

Objectives for therapy

• To correct ROM deformity and improve tissue and muscle mobility which had become tethered/adhered to surgical scarring.

passive composite wrist middle, ring and small DIP joint extension.

• Commenced in the acute stage of tissue healing, and continued through the fibroplasia stage – phases in which applying gentle forces/loads will have the most influence on the laying down of collagen fibres (Wilton, 2013). Mechanical manipulation of wound contraction by way of the serial static splint, combined with other movement modalities, enabled differential glide between tissue structures and prevent further contracture (Wilton, 2013).

• Splint dose:

2014): L=14kg, R=46kg.

As instructed by the treating surgeon, C.H. was prescribed regular active and passive wrist and finger ROM exercises to complete daily. He was also provided a serial static composite finger and wrist extension splint to wear overnight (see figures 1 and 2).

• Purpose of splint: to increase

Weeks 0-2: Serial static composite wrist and finger extension splint – fabricated on 21 August 2014, 1 day post-op:

• Materials: 3.2mm Orfit Eco thermoplastic, with a wide velcro loop strap proximally.

Splint length was from the proximal third of the forearm to the finger tips, contoured to the limb. Proximal edge of the splint was curved away from the skin to prevent a sudden change in pressure gradient at the edge of the splint.

• The splint was moulded in position of end range passive composite wrist and finger extension.

-

-

-

Force: Applied at lightmoderate tension to enable desired wear time (patient rated pain scale 3-4/10i).

Daily end range time (DERT): Daily wear, 1 to 2 hours 2 to 4 times per day, 6 to 8 hours total.

Total end range time (TERT): 17 weeks post op, or until ROM plateau reached (Wilton, 2013).

As passive end range feel of MF, RF and LF DIP joint extension (with composite wrist extension) was ‘hard’, a serial static splint was chosen (Wilton, 2013). Staticprogressive orthosis correct contractures by apply force that keeps the shortened soft tissue at a constant length, thereby inducing stress relaxation in the tissues under tension, and muscle lengthening occurs (McKee et. al., 2012).

As C.H. was not able to functionally use his left hand whilst in the splint, consideration as to whether or not it was appropriate to wear for 6 to 8 hours during the day. C.H. was not working and spending most of his time at home. It was therefore www.ahta.com.au l 9

FEATURE

considered a realistic expectation to wear the splint as prescribed.

Effort was made to ensure C.H. understood the wearing regime, and agreed to comply.

Figures 3, 4 and 5: Dynamic wrist splint Figure 6: Use of Haldex tension gauge to set force of dynamic traction

Figure 1 and 2: Serial static composite wrist and finger extension splint. considered a realistic expectation to wear the splint as prescribed.

Effort was made to ensure C.H. understood the wearing regime, and agreed to comply.

• Commenced in fibroplasia

Dynamic wrist extension splint fabricated on 1 September 2014, 12 days post-op.

• Splint dose:

• Materials: 2.5mm Orfilight thermoplastic, and string elastic for the dynamic component.

The splint length was from the proximal third of the forearm to the distal palmar crease in the palm. The splint was contoured to the limb, and hinges built-up away from the skin so to avoid areas of pressure and rubbing.

The proximal edge of the splint was curved away from the skin to prevent a sudden change in pressure gradient at the edge of the splint (see figures 3-5).

• Purpose of splint: to increase passive wrist extension. End range passive wrist extension felt ‘springy’, and further ROM with therapist application of increased stretch was achieved.

On this basis, dynamic splint design was chosen (Wilton, 2013).

10 l AHTA NEWSLETTER l APR - JUN 2017

stage of tissue healing to ensure maximum effect on the laying down of collagen fibres (Wilton 2013).

- Force: Dynamic traction was measured with a Haldex tension gauge, and 500grams of force was applied (see figure 5).

- DERT: overnight, 6 to 8 hours total.

- TERT: 17 weeks post op, or until ROM plateau reached. (Glasgow et. al., 2012; Wilton, 2013).

The dyamic splint was designed to provide a mobilising force on the wrist and finger joints, and wrist and finger flexors. Dynamic traction ensure the tissues are kept under the same constant tension, which induces creep (and lengthening) in tissues (McKee et. al., 2012).

FEATURE

Figure 6: Use of Haldex tension gauge to set force of dynamic traction

aware of how it was designed to sit and fit. Pictures were taken of him wearing the splint and sent to his phone to use as a reference, if needed.

Consideration for wound healing and splint prescription:

• As discussed above, serial

ROM exercises - In addition to splinting, regular tendon glides and active and passive ROM exercises of the fingers and wrist were prescribed on day 1. Particular focus on ROM deficits, i.e. isolated wrist extension; composite wrist, middle, ring and small DIP joint extension; and active middle, ring and small DIP joint flexion. Frequent daily ROM exercises were advised. C.H. was encouraged to use the hand and arm for light functional tasks.

Wound and oedema management – Regular wound care was undertaken in therapy and at home by C.H., with the assistance of his mother.

He was fitted with a custom-made Second Skin full compression arm sleeve.

Patient education - Time was spent with C.H. explaining the principles of wound/tissue healing, regaining ROM and tissue lengthening, purpose and presciption of splint wear and importance of adherance and active participation in therapy.

Exercises and splint wearing timeframes were written out (often including diagrams) to minimise misunderstanding and ensure his compliance. C.H.’s mother also attended his therapy appointments, and her understanding was also ensured so to provide C.H. support and clarification at home if required.

Splint don and doff was practiced with C.H. to ensure he was able to put on the splint correctly, and was

static splinting was commenced during inflammation phase of wound healing, and dynamic splinting commenced during the fibroplasia phase.

• The surgical wound was located in the proximal volar forearm, it was considered at minimal risk of damage from shearing forces as it did not span a joint.

Wound healing was closely monitored until the wound closed.

• Increased oedema was also monitored as an indication of loads being applied through splinting and exercise too forceful.

Weeks 2 to 6:

appropriate. According to principles of stress relxation inviscoelastic material that is held at a constant displacement for a period of time, will have a decrease in retractive force of material (Wilton, 2013).

Essentially, over time, tension will decrease as tissues respond to force and the muscle lengthens.

• Graduated strengthening commenced at 2 weeks postop. This included use of putty, free weights, theraband, and flexbars. Once the wound was closed and grip strengthii improved beyond 20kg, supervised gym sessions with an exercise physiologist (in consultation with hand therapist) were commenced for work hardening purposes. C.H. also attended physiotherapy for left shoulder pain complaints.

• C.H. returned to work on a graduated suitable duties plan at 4 weeks post op. He was provided time during the day for splint wear, and to adjust his work duties accordingly.

• C.H. attended for twice weekly therapy for the first 4 weeks post op. for wound, scar and oedema management, ROM monitoring and upgrades, and splint upgrades. Appointment frequency was reduced to weekly between weeks 4 to 6.

Weeks 6 to 12:

• Hand therapy appointment frequency reduced to fortnightly.

• Splint wearing regime – as per above.

• As passive ROM increased, serial static splint was remoulded, and the elastic component of the dynamic splint shortened and remeasured each time to ensure 500 grams of force was continually provided. This ensured that the level of tension applied (in response to stress relaxation and subsequent lengthening of tissue) remained

Week 12 to 14:

• C.H. resumed normal work duties around 14 weeks post op. He was medically discharged at this time.

• C.H. was advised to continue with splint regime until 17 weeks post-op, or until plateau in ROM is reached.

www.ahta.com.au l 11

FEATURE

• C.H. was to continue with home

• Return to work as a delivery

exercise and gym strengthening programs, unsupervised.

driver at 2 weeks post-op greatly impeded CH’s ability to wear the serial static splint during the day, as well as his ability to complete prescribed exercises. His employer was contacted and C.H. was provided time during the day to periodically complete onehanded tasks and enabled him to wear the splint.

Objective measures at 20 November 2014, 12 weeks postop:

• Wound healed.

• Scar softened and flattened with mild scar adherence/ tethering.

• Mild oedema of upper limb.

C.H. continued to wear his gauntlett compression sleeve during the day.

• Improved active wrist extension: - -

Isolated: 60 degrees (versus 75 degrees right hand).

Composite (wrist and fingers): 55 degrees.

Considerations for alternatives to splint design: Serial static splint: The splint design was chosen for the following reasons:

• Ease of patient don and doff.

• Ease of splint adjustment to accommodate increased passive ROM

• Improved passive wrist extension: 70 degrees.

• Active wrist flexion: 80 degrees .

• Nil resting pressure or shearing

• DIP joint flexion with composite wrist extension nearly full.

Wilton, J. Hand Splinting Orthotic Intervention – Principles of Design and Fabrication 2nd Edition, Western Australia: Vivid Publishing, 2013.

• Orfilight 2.5mm plastic was chosen due to its lightweight nature, good adhesion of straps and ability to stick to itself. A 3.2mm plastic was not chosen as it was considered too bulky for the splint design.

L=31kg, R=52kg.

• No issues regarding the

McKee, P., Hannah, S., Priganc, V. W., Orthotic Considerations for Dense Connective Tissue and Articular Cartilage – The Need for Optimal Movement and Stress.

Journal of Hand Therapy, 2012, 233-43.

Dynamic splint:

• Increased grip strength:

Issues pertaining to splint design, fabrication, and implementation:

Glasgow, C., Fleming, J., Tooth, L. R., The Long-term Relationship between Duration of Treatment and Contracture Resolution Using Dynamic Orthotic Devices for the Stiff Proximal Interphalangeal Joint: A prospective Cohort Study. Journal of Hand Therapy, 2012, 25: 38-47.

over the surgical wound (on volar surface of forearm).

• Full active middle, ring and small isolated DIP joint flexion.

REFERENCES

• Thin black elastic loop (doubled over) was used for dynamic traction component of the splint. A wider hat elastic type strap, requiring only a single length, would have been a suitable alternative.

dynamic splint. It worked exceptionally well, with no complaints from C.H. He was able to tolerate the splint all night.

• Initially not included, finger straps were later added to the serial static splint to minimise DIP joint flexion as passive wrist extension increased. This occurred due to flexor tightness which pulled the DIP joints into flexion as wrist extension increased.

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Patient rated pain scale 0-10 (0=no pain, 10=extreme pain).

Grip strength was measured with a Jaymar Dynamometre, and used as an objective measure for upper limb strength.

i

ii

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WWW.ROCKTAPE.COM.AU www.ahta.com.au l 13

FEATURE

LITERATURE REVIEW

Orthosis use for Osteoarthritis of the Trapeziometacarpal Joint of the Thumb Mikaela Foy

Objectives

Background

This literature review aims to appraise and synthesise the existing evidence regarding the use of orthoses for osteoarthritis of the thumb. The research question under consideration is the following: What is the most effective orthosis to relieve symptoms of osteoarthritis of the thumb? This literature review will begin with a summary of the condition and anatomical considerations, followed by a description of the literature search undertaken. Methodological quality of randomised controlled trials and systematic reviews have been appraised using the PEDro scale and AMSTAR checklist respectively to inform the results and conclusions (Shea et al., 2007; The Physiotherapy Evidence Database, 1999).

Osteoarthritis is the most common joint disorder in the world (Arden & Nevitt, 2006). It is commonly referred to as ‘wear and tear’ arthritis because it results from the breakdown of cartilage between bones. Over time, bones may develop spurs and segments of bone may chip off, thus increasing the degeneration of the joint (Cooper, Javaid & Arden, 2014).

Recent research suggests that the disease processes of osteoarthritis are more complex than once believed and are not limited to articular cartilage, but also affect subchondral bone, synovium and ligaments (Berenbaum, 2016; Cooper, Javaid & Arden, 2014). The primary symptoms of osteoarthritis are joint pain, inflammation, reduced strength and reduced range of motion (Grenier, Mendonca & Dalley, 2016). Disease progression is usually slow, but over time can cause significant functional

14 l AHTA NEWSLETTER l APR - JUN 2017

limitations for individuals affected by the condition (Dillon et al., 2007).

Osteoarthritis can affect joints all over the body. This literature review will focus on osteoarthritis of the thumb. Osteoarthritis of the thumb is a common condition which can have a significant effect on function of the hand and subsequently occupational performance. The thumb is often described as the most important digit of the hand, due to its opposition and prehension capabilities (Hamaan et al., 2014).

The carpometacarpal joint, also known as the trapeziometacarpal joint, is considered the most important joint of the thumb (Neumann & Bielefeld, 2003).

This is also the thumb joint most commonly and severely affected by osteoarthritis (Dillon et al., 2007).

Anatomically, osteoarthritis occurs at the trapeziometacarpal joint due to an insufficiency of the anterior oblique ligament of the joint and

FEATURE

the cartilage between the first metacarpal and trapezium gradually deteriorating (Grenier, Mendonca & Dalley, 2016) . These changes lead to reduced joint space, irregular movement of the joint’s articulating surfaces and dorsoradial sublaxation of the base of the first metacarpal (Grenier, Mendonca & Dalley, 2016).

The prevalence of osteoarthritis of the thumb is estimated at 7% of adult males and 15% of adult females (Haara et al., 2004).

Osteoarthritis is strongly associated with aging, thus its prevalence is expected to increase dramatically with the current aging society (Kjeken, Smedsland, Moe et al., 2011). Symptoms generally develop between the ages of 50 and 70 (Grenier, Mendonca & Dalley, 2016).

Research indicates that females are affected by osteoarthritis of the thumb more frequently than males, particularly post-menapausal women (Davenport, 2009). Research suggests that females may be at higher risk for osteoarthritis of the thumb because their trapezium bone is shallower and has a thinner lining of articular cartilage which may increase joint instability and subsequent osteoarthritis (Neumann & Bielefeld, 2003). Risk factors for osteoarthritis of the thumb include previous trauma and repetitive joint use (Fontana, Neel, Claise, Ughetto, & Catilina, 2007).

Diagnosis of osteoarthritis of the thumb generally begins with a client self-reporting symptoms, followed by a physical examination and provocative testing. This is often followed by examination of radiographic images (Grenier, Mendonca & Dalley, 2016).

Treatment options include splinting, activity modification, assistive devices, analgesics and surgery (Grenier, Mendonca & Dalley, 2016).

This literature review will appraise and synthesise existing evidence

regarding the use of orthoses as an occupational therapy intervention for osteoarthritis of the thumb.

the volume of research in this area and restricts this literature review to the highest levels of evidence.

Exclusion criteria:

Search strategy The databases AMED, CINAHL and MEDLINE were searched for the purpose of this literature review. A list of synonyms for the population and intervention was produced, as shown in Table 1. The population has two components, the first being a diagnosis of osteoarthritis and secondly the thumb being the affected joint. Keywords were then searched with ‘OR’ combining synonyms and ‘AND’ combining keywords describing the population and intervention.

Table 1. Search terms Population

Intervention

Osteoarthritis

orthos*

degenerative joint disease

splint*

wear and tear arthritis

brace

degenerative arthritis OA AND Thumb Pollex first digit

Methods of review Study selection criteria Inclusion criteria:

• Orthosis as primary intervention • Participants diagnosed with osteoarthritis of the thumb

• Available in English language • Full text accessible • Peer reviewed

• Orthosis was not the primary intervention

• Studies investigating postsurgical use of orthosis

• Participants did not have a diagnosis of osteoarthritis of the thumb

• Not available in English language

• Full text not accessible • Article not peer reviewed • Study design other than systematic review or randomised controlled trial Assessment of study quality Initially, the titles and abstracts of all identified literature were reviewed to determine their relevance. Then selected studies were read in full and appraised using a relevant evaluation tool. Randomised controlled trials were appraised using the PEDro scale which is designed to facilitate critical appraisal of experimental research (The Physiotherapy Evidence Database, 1999). The PEDro scale enables rapid evaluation of the internal validity and sufficiency of statistical information of studies.

Results of the PEDro scale are summarised in Table 2.

The systematic review was appraised using the AMSTAR checklist (Shea et al., 2007). The AMSTAR checklist is a reliable and valid measurement tool commonly used to evaluate systematic reviews.

Results of the AMSTAR checklist are summarised in Table 3.

• Research design of systematic review or randomised controlled trial. This inclusion criterion was added due to www.ahta.com.au l 15

FEATURE

Y

Y

Y

Y

Y

Y

Y

Y

N

N

N

Y

Y

Y

Y

Y

Y

Y

N

N

N

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

N

Y

Y

Y

Y

Y

least one key outcome

Y

included studies

N

measures of variability for at

Provides point measures and

Measure of key outcomes

N

systematic review and all

Blinding of all assessors

statistical outcomes reported

Blinding of all therapists

Y

Results of between-group

Blinding of all subjects

Y

allocated to

Groups similar at baseline

treatment they were initially

Concealed allocation

Y

Subjects received the

Random allocation

Y

participants

Eligibility criteria specified Wajon

obtained from >85% of initial

Table 2. Assessment of study quality using PEDro scale

& Ada (2005) Rannou et al (2009) Hermann et al (2014) Carreira, Jones & Natour, (2010)

Y

Y

N

Y

Y

Brousseau

Y

N

Not

Stated onflict of interest of

publication bias

Assessed likelihood of

combine findings

Appropriate methods to

form conclusions

used appropriately to

Scientific quality of studies

documented

studies assessed and

Scientific quality of

included studies provided

Charactereristis of

studies specified

Included and excluded

as inclusion criteria

Status of publication used

search

N

Comprehensive literature

Y

and data extraction

Duplicate study selection

Egan &

‘a priori’ design specified

Table 3. Assessment of systematic review quality using the AMSTAR checklist

N

specified

(2007)

Five studies satisfied the selection criteria. One systematic review was included and four randomised controlled trials. Systematic reviews are considered the highest level of filtered evidence and randomised controlled trials are the highest level of unfiltered evidence according to the commonly accepted hierarchy of evidence (Ho, Peterson & Masoudi, 2008).

A common strength of the included studies is using multiple outcome measures. For example, Rannou et al., (2009) assessed the efficacy of the orthosis on five key outcomes, 16 l AHTA NEWSLETTER l APR - JUN 2017

including pain, hand disability, global perceived disability, pinch strength, thumb mobility and angle of closure of first web space.

Another common strength of the studies was utilising the study design of a randomised controlled trial with clear specification of eligibility criteria and concealed random allocation to groups.

A common limitation of studies is the use of co-interventions. For example, Wajon and Ada (2005) compared a splint and exercise program to another splint and exercise program. The inclusion

of hand exercises makes it difficult to isolate the effectiveness of the orthosis design. Another common limitation of the studies was lack of blinding of participants, therapists and assessors. Due to the overt nature of orthoses, it is difficult to blind participants and therapists to the allocation of interventions. It is possible to blind assessors to group allocation. Two studies achieved this by having the experimental group remove orthosis prior to assessments (Hermann et al., 2014; Wajon & Ada, 2005). Another study overcame this by constructing splints for the control group to wear

only during assessments (Carreira, Jones & Natour, 2010). The use of placebos in orthosis studies is continuing to be investigated (White, Donovan-Hall, Kislop, Boucas & Adams, 2013). Another limitation of the included studies is the large proportion of female participants. The studies ranged from 74% of participants being female up to 95%. Osteoarthritis of the thumb is more common in females, however not to this extent, which limits generalisation to the wider population.

Figure 3. Thermoplastic stabilising splint

Figure 3. Thermoplastic stabilising splint.

Reprinted from “Assessment of the effectiveness of a functional splint for osteoarthritis of the trapeziometacarpal joint of the dominant hand: A randomized controlled study”, by A, Carreira., A, Jones., & J, Natour, 2010, Journal of Rehabilitation Medicine, 42(5), 469-474.

Data extraction

Figure 4. Prefabricated soft orthosis

The included studies are summarised in Table 4. Data extracted includes the study design, sample size and characteristics, intervention, outcome measures and results.

Images of orthoses Figure 1. Thumb strap splint

Figure 1. Thumb strap splint. Reprinted from “No difference between two splint and exercise regimens for people with osteoarthritis of the thumb: A randomised controlled trial”, by A,Wajon & L, Ada, 2005, Australian Journal of Physiotherapy, 51(4),

Figure 4. Prefabricated soft orthosis.

Reprinted from “Effects of a soft prefabricated thumb orthosis in carpometacarpal osteoarthritis”, by M, Hermann et al., 2014, Scandinavian Journal of Occupational Therapy, 21(1), 31-39.

245-249.

Results

Figure 2. Rigid rest neoprene splint

Orthosis design

Figure 2. Rigid rest neoprene splint.

Reprinted from “Splint for base of thumb osteoarthritis: A randomized trial”, by F, Rannou et al., 2009, Annals of Internal Medicine, 150(10), 661-669

Orthoses are a common intervention used by occupational therapists to relieve symptoms of osteoarthritis of the thumb. All of the studies included in this literature review focused on osteoarthritis of the trapeziometacarpal joint of the thumb. This is the joint of the thumb most commonly and severely affected by osteoarthritis (Dillon et al., 2007). The orthoses varied in design and materials used, but

all shared the common factor of stabilising the trapeziometacarpal joint. It is a commonly accepted practice to stabilise the affected joint when designing an orthosis (Egan & Brousseau, 2007; Hermann et al., 2014). Orthosis designs differed in the range of motion they allowed at surrounding joints. The orthoses studied by Rannou et al.

(2009) and Wajon and Ada (2005) only covered the radial aspect of the hand, with a thin band around the wrist securing its position. In contrast, the orthoses investigated

by Carreira, Jones and Natour (2010) and Hermann et al. (2014) covered a larger area of the hand.

Two of the experimental studies investigated orthoses made from soft, elastic materials, such as neoprene or fabrifoam (Hermann et al., 2014; Rannou et al., 2009).

The remaining two randomised controlled trials examined orthoses constructed from thermoplastic materials (Carreira, Jones & Natour, 2010; Wajon & Ada, 2005). The systematic review explored orthoses made from a variety of materials (Egan & Brousseau, 2007). Three of the randomised controlled trials investigated custom made orthoses (Carreira, Jones & Natour, 2010; Rannou et al., 2009; Wajon & Ada, 2005). The remaining experimental study examined a prefabricated orthosis available in three different sizes (Hermann et al., 2014).

Key outcomes All four randomised controlled trials found that orthosis wear reduced pain at the base of the thumb.

Similarly, Egan and Brousseau’s (2007) systematic review reported that there is evidence to suggest that orthoses are effective in relieving pain. Egan and Brousseau (2007) suggest that the pain relieving quality of orthoses is still somewhat unclear due to the potentially confounding effect of analgesics during studies and the www.ahta.com.au l 17

FEATURE

Table 4. Data extraction Authors & year of publication

Study design

Sample size & characteristics

Intervention

Outcome measures

Results

Wajon & Ada (2005).

Randomised controlled trial

N= 40 -mean age of 59.7 years -74% of participants were female -diagnosed with thumb CMC OA -excluded if had another hand condition or steroid injection in 6 weeks prior

Experimental group: Thumb strap splint worn full time and abduction exercise regimen (refer to Figure 1).

Control group: Current clinical practice of short opponens splint and pinch exercises.

-pain using visual analogue scale -pinch strength using pinch gauge dynamometer -hand function using Sollerman Test of Hand Function

After 6 weeks of splint wear, both groups improved in all outcomes, but there was no significant difference between groups.

Egan & Brousseau (2007).

Systematic review

-7 articles included in review -inclusion criteria: experimental or observational study that investigated the effect of orthosis use in CMC OA of adults -exclusion criteria: language other than English or French, studies reporting splinting as postsurgical intervention or alongside another medical intervention

NA

NA

Some evidence to suggest pain relieving quality of orthoses. However this evidence came solely from pretest-posttest studies, thus internal validity of results may have been influenced by the placebo effect or co-interventions.

Rannou et al., (2009).

Randomised controlled trial

N=112 -90% of participants were female -diagnosed with base of thumb OA -excluded if posttraumatic OA, other hand condition or previous hand surgery

Experimental group: Custom made rigid rest neoprene splint for night time wear (refer to Figure 2).

Control group: Usual care at discretion of general practitioner

-pain using visual analogue scale -hand disability using the Cochin Hand Functional Scale -global perceived disability using visual analogue scale -pinch strength using an electronic dynamometer -thumb mobility using Kapandji index thumb opposition scale -angle of closure of the first web space using photograph and goniometer

After 12 months wearing splint, the experimental group reported reduced pain and disability of hand.

Splints had no effect on the radiographic progression of OA.

Carreira, Jones, A & Natour (2010).

Randomised controlled trial

N= 40 -mean age of 65.1 years -95% of participants were female -diagnosis of painful CMC OA of the thumb -exclusion criteria were severe deformities of hand that prevented gripping, other hand conditions and incapacity to respond to a questionnaire.

Experimental group: Custom made thermoplastic splint stabilising CMC with thumb in functional position (refer to Figure 3).

Control group: Also had custom splint made for them, but only wore for the evaluations for the first 90 days. Splints were then given to participants for use at home from day 90 to day 180.

-pain using visual analogue scale -functional capacity using Disability of Arm Shoulder and Hand questionnaire -grip strength using Jamar dynamometer -pinch strength using pinch gauge dynamometer

Reduced pain when wearing splint for activities of daily living. Improvement in pain was reported by control group only after day 90 when they began wearing splints for daily activities.

No change in function, grip or pinch strength.

Hermann et al., (2014).

Randomised controlled trial

N=59 -mean age of 70.5 years -diagnosed with thumb CMC OA -exclusion criteria were previous thumb surgery, cortisone injection in 2 weeks prior, cognitive deficits and presence of other diseases that could impact hand function

Experimental group: Prefabricated soft, elastic orthosis that covers wrist, and CMC and MCP joints of thumb and hand exercises (refer to Figure 4).

Control group: Hand exercises

-pain using a numeric rating scale -grip and pinch strength using Grippit electronic instrument -self report hand symptoms and activity performance using Australian Canadian Hand Index -participant experience of orthosis use using interview

Reduced pain when wearing orthosis. No significant difference between groups on longer term pain measures, strength, symptoms or activity performance.

18 l AHTA NEWSLETTER l APR - JUN 2017

FEATURE

majority of evidence coming from studies that were not adequately controlled. Further research is required in this area.

Hand function, activity performance, pinch strength, grip strength and thumb mobility were other key outcomes investigated.

Participant’s reported reduced disability of the hand after wearing a rigid rest orthosis overnight for 12 months (Rannou et al., 2009). Wajon and Ada (2005) found improvement in pinch strength and hand function in both the newly designed thumb strap splint and the short opponens splint groups. Due to the nature of the study designs, it is possible that these improvements could be attributed to the Hawthorne or placebo effects (Makenbach, 2005; ver Stappen et al., 2004). The remaining randomised controlled trials and systematic review report no evidence of improvement on any key outcomes except pain (Carreira, Jones & Natour, 2010; Egan & Brousseau, 2007; Hermann et al., 2014). There is currently insufficient evidence to suggest one splint design is more effective than others.

Wearing regimen and adherence The studies differed significantly in the orthosis wearing regimen.

Wearing regimens ranged from full time wear with removal only for personal care tasks (Wajon & Ada, 2005), to daytime wear (Carreira, Jones & Natour, 2010) to nighttime wear (Rannou et al., 2009). One study did not describe the wearing regimen instructed to participants (Hermann et al., 2014).

Two of the randomised controlled trials asked participants to keep an adherence diary (Hermann et al., 2014; Rannou et al., 2009). In both cases, adherence varied significantly between participants.

Conclusions Implications for practice The evidence is currently insufficient to determine the most effective orthosis for relieving symptoms of osteoarthritis of the thumb.

The existing literature suggests that orthoses can relieve pain of osteoarthritis at the base of thumb (Carrieria, Jones & Natour, 2010; Egan & Brousseau, 2007; Hermann et al., 2014; Rannou et al., 2009; Wajon & Ada, 2005). Current practice for orthoses varies in design, material used and wearing regimen. There is currently no gold standard for any of these variables. Occupational therapists are encouraged to provide a client centred approach when designing orthoses (Egan & Brousseau, 2007).

Occupational therapists should aim to achieve a balance between stability of joints and functionality of the hand (Hermann et al., 2014). The client’s occupations and preferences should be considered when choosing the most appropriate orthosis (Egan & Brousseau, 2007; Wajon & Ada, 2005).

common limitation of existing research is the lack of blinding of participants and therapists. The use of a placebo orthosis was recently studied and clinicians reported anxieties regarding its use as well as practical concerns (White et al., 2013). Additional research is needed to determine the feasibility of a placebo orthosis. Researchers should ensure assessors are blinded to group allocation. It is also suggested that researchers consider including a qualitative aspect to their research to investigate the client experience of orthosis wear (Hermann et al., 2014).

Implications for research Further research is required in this area. Additional high quality randomised controlled trials would increase the body of evidence available (Egan & Brousseau, 2007). Stratified random sampling should be considered as an option to enable the gender ratio of participants to be in proportion with that of affected adults in the general population. This would enhance the generalisability of findings (Carreira, Jones & Natour, 2010). Further research is required regarding co-interventions, such as hand exercises and analgesics (Rannou et al., 2009; Wajon & Ada, 2005). Further research is also necessary to determine the optimal wearing regimen of orthoses for osteoarthritis of the thumb. A

For the full list of references for this article please click here. www.ahta.com.au l 19

FEATURE

7-13 APRIL 2017, FIJI

Myers Team Orthopaedic Outreach Lautoka Hospital Adrian Jollow Newtown Hand Therapy

It was a privilege to return to Lautoka Hospital Fiji as part of the Myers Orthopaedic Team in April 2017 with Orthopaedic Outreach.

hand therapy patient. It was great to catch up with some familiar faces and to have such a warm Fijian welcome.

After completing all the required paperwork and making sure all my shots were up-to-date, there was a moment at Fijian Customs when the X-ray of my bags caught the attention of local staff, and I thought there may be trouble.

Luckily I had my letter explaining the bag of plaster, bandages and plastic were donations for the hospital, and Bula Vinaka, I was away (thanks Emilie Myers).

Donations of thermoplastic and fibreglass from Australian suppliers and pre-loved thermoplastic splints from Royal Prince Alfred Hospital were added to the Lautoka Physiotherapy Department. And thank you Mr Ward for the heat gun! I also brought over an electric fry pan for the department as heating splints in a hydrocollator bath was tricky (with several splints lost in it’s depths last year). No wonder Customs were a little intrigued on my arrival.

In addition to the Lautoka Hospital staff, physiotherapists from Nadi and Sigatoka (smaller centres not too far from Lautoka) had been organised for the week and they were enthusiastic to learn more about splinting and care of the 20 l AHTA NEWSLETTER l APR - JUN 2017

I’d been looking forward to returning to Fiji as I was keen to catch up with many patients from the 2016 trip. It was pleasing that quite a few patients from 2016

attended the clinic this year, and to see the results of therapy with these petients by the local staff.

This lady presented in 2016 with a right Galleazzi fracture malunion, EPL rupture and DRUJ impaction.

She underwent surgery for removal of hardware, EIP to EPL transfer and removal of ulnar head during the 2016 trip. The local therapists managed her well and now she has considerably more function compared to twelve months ago.

FEATURE

Restricted motion, ulnar sided wrist pain and decreased thumb control main presenting problems in 2016

Range of motion significantly better, good thumb extension, and only mild discomfort around hypnothenar eminence with lifting basket of washing reported at 2017 review The cases that we encountered were as complex as those seen during the last visit, with perhaps more wrist fractures requiring attention compared to the case load in 2016, which was more top heavy with flexor tendon and nerve repairs.

The severity of injuries presenting over such a short time frame in Lautoka was astounding - and I don’t think it was just because we were in town. Surgical cases performed during the week included fixation of distal radius fractures, corrective osteotomies, tendon repairs, nerve repairs, joint releases, pulley reconstructions, and tendon transfers. The local mining

industry contributed quite a bit to our caseload again this year, with significant trauma cases resulting from mining accidents.

The local therapists assisted with the fabrication of splints, patient education and exercises throughout the week, and we discussed things to watch for at different times throughout the different phases of healing. Many of the patients seen at Lautoka required follow up in Nadi or Sigatoka, so it was excellent having these therapists at Lautoka to discuss, treat and be involved with planning future therapy.

In the Physiotherapy Department, I gave a few ‘formal’ presentations,

on Clinical Reasoning in PostOperative Management of the Complex Trauma Patient, Manual Oedema Management Technique (MEM) for Sub-acute & Chronic Swelling, Post-operative Management of Extensor Tendon Repairs Zones I-VI, Post-Operative Management of Flexor Tendon Repairs. The local therapists practised making the splints required for extensor tendon repairs Zones I-VI, and were able to demonstrate sound clinical reasoning regarding this.

Adding to the educational information provided from previous trips, double sided laminated hand-outs with essential information

www.ahta.com.au l 21

FEATURE

(‘cheat sheets’) regarding postop extensor tendon repairs, and metacarpal fracture management with pictures of the appropriate splints were given to the outpatient department.

We were able to fabricate template splints which could be used for immediate post-op splinting of extensor tendon injuries and splints for flexor tendon injuries. These were labelled for ease of use by the orthopaedic team. We emphasised the need for early referral to hand therapy, particularly for these cases, which seem to be in abundance at Lautoka. Local therapists were encouraged to use the donated splinting material liberally and as needed because more donations

are forthcoming.

Encouragement of the physiotherapy department to liaise with the orthopaedic team regularly to identify new cases requiring hand physiotherapy would no doubt improve the outcomes of patients, and by catching these patients earlier, would make the hand therapy needs less involved.

The mantra that every hand case needs to see hand physiotherapy is particularly apt in this environment.

Since returning to Sydney I have put together a few videos outlining the basics of tendon transfer rehab and central slip injury management so the team at Lautoka can refer to this easily. To have a look at the outline of tendon transfer

ADVANCE YOUR SKILLS & KNOWLEDGE IN HAND THERAPY

BY ATTENDING THESE AHTA TRAINING COURSES • Quality post-graduate education programs • Developed and accredited by the Australian Hand Therapy Association (AHTA) • Delivered by competent and dynamic hand therapy clinicians • Meet and network with other clinicians in hand therapy • Ask questions specific to your practice • Earn Continuing Professional Development (CPD) points FUNDAMENTALS OF HAND THERAPY 4 - 6 Aug 2017

Melbourne, VIC

3 - 5 Nov 2017

Gold Coast, QLD

HAND & UPPER LIMB ORTHOTIC FABRICATION IMMOBILISATION

29 - 30 Jul 2017

Sydney, NSW

MOBILISATION

21 - 22 Oct 2017

Perth, WA

For full course details and to book your place visit the Online Store on the AHTA website at www.ahta.com.au or email events@ahta.com.au

22 l AHTA NEWSLETTER l APR - JUN 2017

(following Pronator Teres to ECRB, FCR to EDC and Palmaris Longus to EPL) you can go to https:// youtu.be/Z1aOCxbHFSQ. The aim is to provide ongoing support for the local staff to promote the field of hand therapy, and use the technology available to assist with this.

Thanks again to Emilie Myers, whose hard work over many years co-ordinating all aspects of the trip and liaising closely with local staff, makes a trip like this possible, fun and worthwhile. Already looking forward to 2018.

FEATURE

UPDATE

Indigenous Allied Health Association Karen Fitt AHTA President

In March, I was invited to attend the IAHA Close the Gap event in Melbourne to witness the recommitment to a statement of intent to improve Aboriginal and Torres Strait Islander health and wellbeing.

I went along in support of our newly established status as “friends� of AHPA (Allied Health Professional Association) with a vague understanding that we would all be signing a document in support of Close the Gap initiatives. I was unsure about what, if anything, the AHTA could do to help close the gap.

In part, I went along because the promotional material highlighted the difference in lifespan between indigenous and non-indigenous Australians to be 17 years. This has been the case for a long time, and alarmingly, despite resourcing and strategizing, the gap has not reduced and only 1 of 7 targets is close to being met.

about what the AHTA can do to help close the gap.

1. We can hold cultural sensitivity training sessions. These sessions are appropriate for all Australians, not only health workers. The relevance of cultural sensitivity training is very important in health in order for health workers to better understand possible cultural factors impacting health, and adherence to health plans for example. IAHA asserts that all health professionals need to be both clinically competent and culturally responsive to positively impact the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

2. We can provide scholarships to indigenous allied health workers to attend hand therapy courses

and conferences. IAHA works to lift the indigenous allied health workforce and would be happy to administer a hand therapy award/s to improve the level of knowledge in the indigenous allied health workforce.

Both of these initiatives are being implemented by the AHTA and I look forward to welcoming more indigenous physios and OTs to the hand therapy fold. I also hope to see a healthy turn up to the cultural sensitivity session at the 2018 conference.

Want to do more?

IAHA has a mentoring program suitable for indigenous and nonindigenous health practitioners at every stage- student to experienced professional. See the website for more details www.iaha.com.au.

I’ll cut to the chase: Following several informative presentations, lunch, photo opportunities, informal chatting with other allied health representatives and some excellent live music, I left with two great ideas www.ahta.com.au l 23

REPORTS

President I’m very pleased to update the membership on the association’s accomplishments and activities over the past month.

1. Provide professional development opportunities

Our association management system (including a new website) is currently being configured. Stage one will be ready to launch around August.

4. Establish standards and encourage best practice in hand therapy

We are working on our annual survey of the membership and this will be delivered at the conference in order to improve on the engagement rate. The survey presents the membership an opportunity to influence the activities of the AHTA, so please take part, share your ideas, and let us know what you think.

5. Support research into hand therapy

Happy Hand Therapy Week everybody!

The management committee met last month for our annual strategic planning weekend and I am delighted to provide our mission and 7 pillars below. We trust this reflects the best interests of the profession and the members.

6. Foster international & professional links

Best Regards,

Mission: The Mission of the Australian Hand Therapy Association is to advance the hand therapy profession.

In order to achieve its Mission, AHTA will:

2. Promote and communicate the practice of hand therapy 3. Advocate on behalf of members and the profession

7. Govern and manage the association well We have attached a series of activities and time frames to each pillar in order to achieve all of our goals. Where necessary, budget frameworks have been attached to activities to ensure we continue with the sound financial management and good governance of the association.

Karen Fitt president@ahta.com.au

Coming Events 24 - 27 July 2017

22 - 24 September 2017

The 11th Symposium of Hand and Wrist Biomechanics

Australian Hand Therapy Association National

International, in conjunction with International Society

Conference ‘Connecting Pathways... Firing Up Our

of Biomechanics Congress XXVI

Nerve Potential’

Brisbane Convention and Exhibition Centre, QLD

Stamford Grand GLENELG SA

www.hwbi.org/2017

www.ahtaconference.com.au

31 Aug - 1 Sep 2017

15 - 18 October 2017

Complex Regional Pain Syndrome

MUSoc 2017 - The 27th Annual Meeting of the

Cork, Ireland

Musculoskeletal Ultrasound Society

www.crpscork2017.com

Tel Aviv ISRAEL

8 - 10 September 2017

www.musoc2017.org

New Zealand Association of Hand Therapists - Annual Conference ‘Fit To Play, The Injured Athlete’.

SKYCITY, Auckland NZ conference@nzaht.org.nz

24 l AHTA NEWSLETTER l APR - JUN 2017

REPORTS

Advocacy It’s hard to believe it is approaching the middle of 2017 already. The Advocacy committee met in March and we are continuing to work on several fronts to ensure the hand therapy profession is being seen and heard.

Here are just a few areas that have been discussed and acted upon.

QLD OT’s query regarding being able to order X-rays We have had a couple of Qld OT hand therapists contact us regarding their inability to order X-rays and what the rules are under AHPRA and the OT board. The legislation for this varies from state to state so to change it would require a change in the law. In Qld the legislation comes under the Radiation Safety Act and the persons listed as authorised to order a diagnostic medical imagery is as follows: -To order plain film diagnostic radiography a person who is: (a) a medical practitioner; or (b) a nurse practitioner; or (c) a registered nurse; or (d) a physiotherapist As this is legislated it would require a change in QLD state law and of course this would mean changing the legislation for all OTs to be able to order imaging not just hand therapists.

On contacting the OT board they didn’t see it as a high priority for them to lobby for this at this stage.

We will continue to look at this and how we can look to change this with support from the Qld therapists.

OTA Discussion/Collaboration I had a very fruitful and meaningful discussion with Anita Volkert – the national manager of professional standards and representation for OTA. She is very keen for the AHTA to work with OTA in representing and supporting OT hand therapists. She stated that at this stage there is no intention as far as she is aware for OTA to develop their own hand therapy groups and would really like to develop some good practice guidelines on behalf of OTA and AHTA collaboratively. She also supports our education endeavours with OTA not encroaching into this space at this stage apart from a planned upper limb training course in WA soon.

These discussions are similar to the collaborative discussions we are having with the APA and I aim to keep this dialogue open.

So I am planning to have bi monthly discussions with Anita and we are going to keep in touch regarding any OT related issues we can work on together.

Communication with IPTAAS re travel expenses eligibility in NSW A NSW country member asked Advocacy to look into the reason that her clinic was no longer eligible for patients to claim travel expenses when coming to see her for treatment when often she is the closest hand therapy clinic and they often have to travel 2-3 hours to see her.

I contacted IPTAAS - NSW (Isolated patients travel and accommodation assistance scheme) to ask why this had been altered and they gave

me a list of eligible clinics – all in and around major centres in NSW and all associated with Hospitals.

The new guidelines came out in February 2016.

However, they have provided a form for Clinics to fill out and this will be considered by the Ministry of Health in NSW. I can forward this form to any clinics that may be interested in applying to be included on this list of eligible clinics.

Advocating for the use of the Hand Therapy title With the discussion regarding the terms we can use in advertising and promotion it has become obvious that we need to lobby to AHPRA and the registration boards regarding the use of the title Hand Therapist and from next year Accredited Hand Therapist (AHT). To this end we are seeking legal advice to present our case to these bodies. This process is being undertaken and we will let members know as soon as we have some information.

Keep warm over the winter months.

I hope to see many of you at the National Conference in Adelaide!

Helen Burfield pastpresident@ahta.com.au

www.ahta.com.au l 25

REPORTS

Membership Interested in becoming a member?

Here are some hints that will help with your application:

• Ensure you fulfil the criteria as per guidelines • Complete upgrade application online and forward to the office for processing

• Organise and label evidence documents in PDF format as they are introduced in the application

• “Evidence of Professional Development” document to be sent as a word file / Docx so it may be edited

• Pay careful attention to accrual of hours in each of the categories.

• Ensure that any in-service program organised in your workplace credits CPD hours according to AHTA Guidelines. In-service evidence should include date, duration of presentations and signed by all attendees and presenters/co-presenters.

• Send complete application via dropbox organised into folders for each category to ease the review process (3 separate reviewers)

• Work closely with your state mentor to ensure appropriate activities and hours are being presented

• Current applications should only include activities since Feb 2012

Katie Whittle membership@ahta.com.au

Google Group Gems Our topics have been widely varied and interesting: drumming injuries, Guillain-Barre Syndrome, Laser hair removal in flaps, extensor tendon injuries in infants, swan neck deformities, Pain questionnaires, hinged elbow braces, splint pan cleaning practice. It is a great place to find good sites to visit for information, post questions clinical and how or where to get...

26 l AHTA NEWSLETTER l APR - JUN 2017

If people want to ask for recommendations of articles or courses then ask for a personal reply rather than reply to google group due to copyright issues.

Directing people to websites is recommended.

Please notify me if you change your email at communications@ahta.com.au.

REPORTS

Education The Education Committee has been busy in the first half of 2017.

AHTA Training Courses Places are filling up quickly for the AHTA Training Courses.

We encourage you to visit the Online Store on the AHTA website and book early to avoid disappointment:

• 24 - 25 Jun 2017 - Mastering Handwriting in Hand Therapy (Melbourne)

• 29 - 30 Jul 2017 - Orthotic Fabrication- IMMOBILISATION (Sydney)

• 4 - 6 Aug 2017 - Fundamentals of Hand Therapy (Melbourne)

• 19 Aug 2017 - Sports Injuries of the Elbow, Wrist & Hand (Perth)

• 14 Oct 2017 - Managing the Lymphatic System in Hand Therapy (Canberra)

• 21 - 22 Oct 2017 - Orthotic Fabrication – MOBILISATION (Perth)

• 3 - 5 Nov 2017 - Fundamentals of Hand Therapy (Gold Coast)

The Fundamentals of Hand Therapy and Orthotics Courses (Mobilisation and Immobilisation) have been completely reviewed and re-developed. These new courses were implemented over the past two months and feedback has been extremely positive. A big thanks to Vicki Strelan and Helen Fitzgerald for their huge commitment in this project.

Keep an eye on your inbox for details coming soon for the updated Open Trauma Course (tentatively booked in for 6 – 8 November on the Gold Coast following the Fundamentals Course) and the new Hand Therapy Introductory Course also planned for late this year.

and remote areas to access AHTA training courses. Details about how to apply will be circulated by email soon.

Webinars The following webinars (FREE FOR MEMBERS AND ASSOCIATES!!!) are planned in the coming months

• 22 June - 3D-printed upper limb prostheses: an overview and current research

• TBA - NDIS in Hand Therapy • 11 August - Non-invasive, interactive neurostimulation

• 14 October - Management of persistent pain in the upper extremity: what to know, say and consider

The vision of the Education Committee for the near future is to develop online course modules, updates on this project will be circulated as they occur.

Rural and Remote Grants for Courses The Management Committee has approved up to six grants of $500 each to assist members in rural

Carla Bingham education@ahta.com.au

AHTA 1-day course

Sports Injuries of the Elbow, Wrist and Hand Saturday 19 August 2017, Perth

This course will provide you with comprehensive guidelines for undertaking the Assessment and Management of a wide variety of Sports Injuries of the Elbow, Wrist and Hand.

Visit the Online Store at www.ahta.com.au to book your place today www.ahta.com.au l 27

REPORTS

Research & Scholarships The R&S subcommittee is currently working hard to review and support the scholarship grant candidates from the last two years.

Over the coming 2-3 months any queries regarding research and scholarships will be re-directed to Sarah Dixon in the AHTA office as I will be on Maternity Leave. They will then be filtered on to very kind

members of this subcommittee or to the management committee as appropriate – the work of the team and the support for the members will still be there!

Please remember that the grant applications close on 31st July each year. If you have an interest in applying for a grant, please feel free to contact any of the research mentors for advice, and remember that Lauren Miller wrote a very informative piece on how to apply

for a grant in the last quarterly Newsletter.

Nicola Cook presidentelect@ahta.com.au

AHTA Educational Resources Thank you for all that were involved with the survey earlier this year regarding Educational Resources. Your input was invaluable to negotiations with Exploring Hand Therapy in organising online material. The AHTA has secured licensing agreements for 10 courses with Exploring Hand Therapy. The AHTA may use the selected courses for unlimited use within the AHTA for the duration of the licensing agreement.

The following titles are available under this agreement:

• Brachial Plexus: Secrets of Treating TOS • Elbow: An Evidenced Based Approach to Effective • • •

Rehabilitation Intrinsics: Unravel the Mystery X-Ray Vision for the Therapist: I’ve Got You Under my Skin All About the Thumb CMCJ Osteoarthritis

• • • • •

Burns: Stop, Drop and Rehab Hand Therapy Boot Camp Mirror Mirror on the Wall: Motor Imagery Wound Care for the Hand Specialist: Heal em up Quickly Ergonomics: Tips, Tricks & Trivia

These resources include Video presentation as well as Manual - PDF of slides from presentation.

To access the above, log in to the Members Area, click on the videos link, and then follow the link with user id and password.

For those interested in 2 CPD points, a review, aimed for publication in the newsletter is the way to go.

Guide to completing this review: • To assist in the editing process for the newsletter please:

- Use Century Gothic 11 as the font;

- Answer using paragraphs without bullet points or tables.

• A thorough review should be 600-1000 words long.

Please include the following areas in your review: 1. What is the title of the DVD? 2. What level of practitioner would you recommend this DVD to?

3. Provide a general summary of this DVD? What are the key points covered?

4. How specifically will you be able to use the information gained in your practice?

Please send reviews to resources@ahta.com.au andif there is any resource which members would be interested in purchasing via bulk order, let me know at resources@ahta.com.au so we can see what we can do.

Happy Learning - Adrian Jollow 28 l AHTA NEWSLETTER l APR - JUN 2017

REPORTS

Communications It is great reading google groups as I learn a lot at the same time as checking it. It’s fantastic how many therapist contribute ideas and suggestions.

If you get on and read you will see the exchange of ideas from clinical and practice management that goes together in being part of a growing group. It is not always the

experienced ones commenting but our enthusiastic, helpful new members.

I will be reviewing some of our rules over the next 3 months to make it simpler and more useful to give information that people are looking for without copyright infringement.

Keep an eye out for updated rules.

Julia Wild communications@ahta.com.au

Marketing & Promotions HAND THERAPY AWARENESS WEEK JUNE 5-11 Hope everyone has got some activities organised to promote this week and help make the public and referrers aware of our great skills.

There are two new logos.

Member Logo - to download click on this link Member Logo

‘title’ that we can use as therapists working in the area of hand therapy.

The AHTA is endeavouring to continue to work on recognition of ourselves as ‘hand therapists’ in Australia and this is a current project that the Executive Committee are working on. In the meantime, we are bound by AHPRA regulations for how we advertise ourselves. I have spoken in depth to AHPRA who have advised the following for therapist working in hand therapy:

• Therapists need to list their Life Member - to download click on this link Life Member Logo

AHPRA registered qualification in their title, therefore the use of ‘hand therapist’ is not permitted.

• Practitioner of hand therapy is

There has been a review on the logo policy please click here to download the Use of Logo Policy to ensure you are up to date with your letterheads and websites etc.

The AHTA Use of Logo Policy also includes recommendations for the

not recommended. AHPRA have also advised that calling ourselves a Certified Hand Therapist is not permitted in Australia as the CHT is not a recognised award. It therefore needs to be used AFTER you list your registered qualifications. Listing Certified Hand Therapists needs to include USA afterwards. AHPRA have suggested instead, that practitioners do something like the following: Physiotherapist, B.App.Sc (Phy), Member of Australian Hand Therapy Association, Certified Hand Therapist (USA).

Many thanks,

also not permitted, as there is no recognised qualification in hand therapy. Occupational therapist, practitioner in hand therapy would be more appropriate.

• Stating the letters CHT is not permitted under the AHPRA advertising guidelines as acronyms are

Amy Geach marketing@ahta.com.au

www.ahta.com.au l 29

REPORTS

States & Territories It is hard to believe that we are almost half way through 2017!

Our State and Territory Divisional Representatives have been busy to date organising a variety of Special Interest Group Meetings.

NSW, VIC and QLD have been successfully using Zoom Conferencing for a number of their meetings which has allowed members who would have been previously unable to attend and our rural members to access these meetings. Although it was not without a few hiccups to begin with, due to poor sound quality, with the purchase of microphones these issues seem to have resolved.

Speaking on behalf and as a member of the ACT we definitely appreciate the access to the NSW

Interest Group Meetings as another platform for gaining education and networking. It is my hope over the next year to increase the number of our rural members attending special interest group meetings via Zoom conferencing.

encourage any non members that are attending about what a great Association we have so that we can continue to grow in to the future – so keep your eye out for the upcoming meetings in your States and Territories!!

I would like to encourage all members to ensure they are accessing these Special Interest Group Meetings which take time and effort to organise (a big thank you must go to our State and Divisional Representatives for undertaking this numerous times each year) as they are a wonderful opportunity to learn, meet therapists and assist in shaping your clinical practice. I would also like to remind everyone that they also provide us with an opportunity to

Many Thanks

QLD

The Qld members have had some excellent education opportunities in the first half of 2017, with Karl Bagraith presenting on Pain in the Upper Limb, the Sports injury Symposium in April and Logan Hospital presenting on Technologies in Hand Therapy. The learning won’t stop here, with the AHTA Mobilising splinting course being held on the 3-4th of June, and the Hand and Wrist Biomechanics International Symposium from the 23-25th of July.

Feedback from the attendees at the Sports Injury Symposium was overwhelmingly positive, with many discussions occurring about treatment protocols and managing the challenges of athletes and injuries. It is a course that is highly recommended for anyone yet to complete it.

Alongside all the learning - we have been celebrating!

Queensland therapists are preparing for a week of celebrating Hand Therapy Awareness Week, with many practices and departments promoting the ‘art and science of hand therapy’.

Amanda, Charlotte, Margo & Frances 30 l AHTA NEWSLETTER l APR - JUN 2017

Liz Giuffre stateaffaris@ahta.com.au

SA

As 2017 is flying by us all, the conference committee has been working hard to get the impending AHTA conference in Adelaide ready for us all to enjoy. What an amazing line-up they have for us so far!

South Australia has had two interest group meetings this year, which have continued to have healthy attendance.

April’s interest group meeting was a wet lab session facilitated by staff from UniSA. This session had an intimate group attend. The combination of the small group and 3 passionate facilitators allowed us a great opportunity to explore the upper limb’s complex anatomy. Can I express formal thanks to Nicola MassyWestropp, Arjun Burlakoti and Harsha Wechalekar for their work in putting this session together and for their enthusiasm on the topic.

Kaveeta Deut

REPORTS

NSW

The last few months we have had some informative talks in NSW. Our next talk will be on Multidisciplinary Pain Management in Upper Limb Injury on Wednesday 21st June at RNSH by Maria de Souza and Dr. Sarah Overton. Then the next will be on Wednesday 16th August on the National Disability Insurance Scheme. Please check the AHTA website for more details https:// www.ahta.com.au/site/nswdivisional-meetings-calendar---2017 In NSW, we would like to congratulate Natalia Alfaro and Elaine Leahy for upgrading to fullmembership. We would also like to welcome as new associate members Victoria Deacon, Jamie Exton, Nikki Hancock, Anna McGlynn Abbey Philpott and Regina Rousson. In addition, we wish to welcome back from QLD Sally Wajon as an associate member.

For those who might be interested, the NSW Hand Surgeons Conference will be held in the Hunter Valley in November.

We are looking forward to catching up with everyone at the next interest group meeting.

Cheers Victoria and Michele NSW AHTA Divisional Co-ordinators

VIC

The Victorian SIG recently enjoyed our second meeting of the year hosted

by Monash University. The Anatomy lab was well received and proved a valuable learning experience for all!

Our meeting calendar for the year is nearly finalised. We have an exciting presentation planned for 7th June from Raf Ratinam from Monash University providing insight into 3D printing in the world of Hand Therapy.

We would like to welcome our new associate members Terri Johnson, Grace Delaney, Anne Dillon, Zoe Ko, Georgia Cooper, Melissa Clifford, Graham Pemberton, Ashleigh Robbins, Amelia Clarke, Kathryn McDougall. and affiliate member Cathy Jordan. We are also pleased to welcome Samantha Mears, associate member transferred from WA. Samantha will be presenting on post traumatic joint stiffness at our October meeting.

Marissa, Hana and Helen

ACT With 5 full AHTA members in the ACT, we are hoping that membership will continue to grow in 2017. Special interest group meetings continue to be held on a bi-monthly basis with the next meeting scheduled for June. To celebrate Hand Therapy Awareness Week in the ACT, Sportscare and Physiotherapy Hand Clinic are holding a free event, “Thinking Hands� on Saturday 3rd June. For full details and the link to register - https://thinkinghands. eventbrite.com.au.

WA WAHTA WA had a fabulous start to our education year with our first interest group meeting held on the 25th of March.

Joining us were our fellow rural therapists from around the state using our telehealth link. Thank you to those from the South West and Broome for joining us! If you are a country therapist and are interested in joining our meetings please get in contact with the WA team and we can send you some information ahtasig.wa@gmail.com.

Dr Patrick Mickalka presented to our group on Paediatric fracture management. The Hand and Upper Limb Centre presented on the history and current practices for MCP joint replacements and on Scapholunate interosseous ligament injuries. All talks were brilliant and we thank all our presenters for volunteering.

Our next meeting will be held on the 20th of May and we very much look forward to seeing the same great turn out as last time!

We would like to welcome our new associate members: Simone Paget, Rachel Cameron, Clare Beintema and Nicole Perera. And we would like to congratulate Taya Klisowski and Rachel Tattersall on their full membership status!

Vicky Allbrook, Jess De Jong, Sarah Fairthorne and Stuart Wilson

Liz Wegener www.ahta.com.au l 31

Practice Profiles The Hand Physio Clinic Year practice/organisation began: 2017 Contact details: Susan Tran Phone: 0426 560 336 Email: info@thehandphysioclinic.com.au Locations: Marrickville: 76 Calvert St, Marrickville NSW 2204

Lidcombe: Shop 4, 46-50 John St, Lidcombe NSW 2141

Concord: Orthosports

47-49 Burwood Rd, Concord NSW 2137 The Hand Physio Clinic is newly established however we’re ready to rise up to the challenge. Operating across three locations gives our patients options to be treated where it is convenient to them.

Name

Susan Tran

Qualification

Bachelor of Applied Science (Physiotherapy) USyd Certified Hand Therapist

Likes

• •

Tendon repairs PIP joint injuries

Dislikes

• •

Fracture management Tennis elbow

One of the best things about living and working in London was the opportunity to travel to places you never imagined you would…just like Iceland (as pictured).

We also provide a free triage service for local GPs in the Concord area with regards to fracture management.

Favourite hand therapy things from our clinic/site: 1. Comfort cool splints 2. Mallet splints with orficast 3. The “purple book” when studying for the CHT exam

MGS Physiotherapy – Hand Therapy Commenced 2016 1 Whistler St, Manly NSW 2095 Ph 02 9967 2666 E vanessakirkham@mgs.physio

It’s a happy, dynamic and well balanced work environment. Everyone’s up for an ocean swim, a surf or a run each Friday lunchtime.

Favourite hand therapy things from our clinic/site: 1. Wrist widget for all the athletes who want support but also want to get back to training and competing asap.

We offer Hand Therapy services within a busy physiotherapy practice.

Referrals come from within the practice and sister practices in the area, local GP’s and Hand Surgeons.

2. WAGs wrist support gloves for all the patients attending the Pilates classes upstairs

In an iconic Sydney location, the practice is located in the centre of Manly, only a short walk to the beach.

3. Low profile splints to get injured sports enthusiasts back to training that I learnt about at a sports course run by Ben Cunningham and Hamish Anderson – thanks guys !

After owning and running my hand therapy practice in the northwest of Sydney for 16 years, I decided to sell it and have a change of scene.

Luckily, for me, at the same time, Nicola Cook, who established this service, decided to move to the NSW North Coast.

Previously I had been working in rooms with a Hand Surgeon. It’s refreshing to now be working in a large practice with lots of physios (I’m the only OT and championing our joint professions as the hand therapist). It’s fun, challenging and occasionally daunting, being the resident ‘specialist’ in hand injuries.

I’m working amongst some senior and highly experienced sports physios who have worked with professional athletes, Olympians, dancers and good old general population. It’s great being able to discuss things and bounce ideas amongst peers, something that I haven’t had for years.

I see a variety of patients from the professional beach volleyball players, surfers, mad cross fitters and all the usual types: post-surgery, sporting hand and wrist injuries, fractures and overuse injuries. We also get a lot of expats due to the location and that keeps my day interesting!

Within my typical day I have to do a lot of diagnosing myself and be confident in my clinical reasoning skills, or refer on to GP or surgeon for medical opinion and imaging. I enjoy the challenge of this.

32 l AHTA NEWSLETTER l APR - JUN 2017

Name

Vanessa Kirkham

Qualification

MSc(Hand & Upper Limb Rehab), BAppSc(OT) and Certified Hand Therapist (USA)

Likes

• • • •

Dislikes

Rainy cold days

Wrist injuries Tennis Live music Beach holidays

Practice Profiles Hand & Upper Limb Therapy (HAULT) Changes Ownership – Rebranded Hills Family Physio

as to provide ergonomics, occupational rehab and disability service provision.

In February 2017, the Hand and Upper Limb Therapy Practice (HAULT) changed ownership with Jason Fairclough taking on the reins of the established practice from Vanessa Kirkham. The practice is based in Castle Hill and Wahroonga (SAN Clinic of Sydney Adventist Hospital).

Jason will also continue his internationally recognised research work on skin traction for phalangeal fractures, and competency based learning.

Jason outlined his vision for the practice, “Hand therapy has been a passion of mine for many years and HAULT is an amazing and well-established business and operates out of rooms at the SAN Clinic which is part of the Sydney Adventist Hospital in Wahroonga; as well as Castle Hill. I will be providing physiotherapy and hand therapy services to the many sectors of the Hills community from sports people, to children and the disability sector, and aged care.”

The business has been rebranded ‘Hills Family Physio’ which allows Jason to utilise his twenty years of physio experience to return to his roots – massage, spinal, sports and musculoskeletal services. Hault will continue as a service within the practice.

Jason currently provides physio cover for the Parramatta Beavers Rugby League team, and is keen service other sporting groups as well

Jason indicated he is keen to expand and therapists who have a research interest and are interested in a job with time flexibility would be welcome to contact him.

Location and Contact numbers Castle Hill Rooms: Suite 29, 15 Terminus St Castle Hill, NSW 2145 Tel: 02 9473 8580 Wahroonga Rooms: Suite 508B, SAN Clinic, 185 Fox Valley Rd Wahroonga NSW 2076 Tel: 02 9899 2233 Email: info@hillsfamilyphysio.com.au www.hault.net.au www.hillsfamilyphysio.com.au

List of Mentors Several AHTA Members have made themselves available to act as mentors to hand therapists wishing to apply for Full Membership of the AHTA. Please contact one of the mentors in your state or territory for assistance with your application.

Contact should be established 3-6 months prior to submitting the application to ensure adequate time frames for professional dialogue between the therapist and mentor. The purpose of this is to: 1.

2.

Help you locate a mentor (or be a mentor) if you do not already have one; and Review your application to ensure it is complete and accurate before submitting State

Name

Email

Phone

NSW

Cathy Merry

cathymmerry@hotmail.com

02 4626 1333

Naomi White

naomiw@sapphirephysio.com.au

02 6492 0023

ACT

Cara Gilbert

craigandcara@gmail.com

02 6260 4777

QLD

Joanne O'Sullivan

jo@toowoombahandtherapy.com.au

07 4638 1222

Catherine Chong

catherlicity@hotmail.com

07 3646 4319

SA

Suzanne Caragianis

suzanne_caragianis@bigpond.com

08 8277 9667

VIC

Hamish Anderson

hamish@andersonhandtherapy.com.au

0413 426 474

WA

Helen Fitzgerald

hfitzgerald@inhand.net.au

0412 288 593

Emma Staples

emmatstaples@gmail.com

08 9272 1424 www.ahta.com.au l 33

Product Profiles Dressings

Product Name

ADAPTIC® DIGIT Non-Adhering Digit Dressing

Supplier

Independence Australia, BrightSky, CH2

Description

ADAPTIC® DIGIT Non-Adhering Digit Dressing is made of a unique, tacky, silicone-coated fabric covered with a tubular bandage. It is specifically designed for dressing fingers and toes.

Designed for/ application

ADAPTIC® DIGIT dressing is indicated to manage a range of mild to severe digit injuries, such as: • Lacerations and abrasions • Traumatic injuries • Nail extractions • Suture lines ADAPTIC® DIGIT can be used both as a primary and secondary dressing

More info phone

1300 524 822

Website

http://www.systagenix.com.au/our-products/ minimise-adherence/adapticandtrade-digit-470

Product Name

PolyMem Finger/Toe Dressings

Supplier

Practitioner Supplies

Description

PolyMem dressings help reduce edema, bruising, pain and inflammation when applied to open or closed injuries. Made to roll comfortably directly onto the finger, when applied to open wounds the dressings continuously cleanse, fill, absorb and moisten wounds. The dressings help relieve both persistent and procedure related pain associated with the injury throughout the healing process.

Designed for/ application

Sprains, Strains, Contusions, Abrasions, Lacerations, Burns, Ulcers, Matricectomies.

Appropriate for use as a combined primary and secondary dressing or as a secondary dressing.

More info phone

08 8397 3106

Website

www.practitionersupplies.com.au

34 l AHTA NEWSLETTER l APR - JUN 2017

SPOTLIGHT ON IFSHT MEMBER SOCIETY: FRANCE

that can offer events in two different countries on the same day!

The French Society of Hand Therapists (Société Française de Rééducation de la Main: GEMMSOR), established in 1984, currently has 210 members (191 PTs & 19 OTs.) Each year GEMMSOR organizes two congresses. The joint congress with the French Society of Hand Surgery will be held June, 2017 on “Paediatric Hand Surgery and Rehabilita-

WELCOME NEW MEMBERS: AUSTRIA & MEXICO

At the Delegate’s council meeting in Buenos Aires, Austria became a new full member, and Mexico became an Associate Member.

PAUL VAN LEDE (1944-2017)

Back (L to R): F. Degez (President), F. Apaix, G. Mesplié, F. Julien; Front (L to R): M. Boutan, H. Parmentier, J.C. Arias, P. Lamat, S. Rouzaud (Treasurer), D. Gerlac (IFSHT Delegate), J.C. Rouzaud, N. Basset, S. Célérier (Secretary), B. Fabre, C. Le Lardic, & V. Legac. tion” in Paris. More about GEMMSOR can be found at gemmsor.com. Denis Gerlac, the GEMMSOR IFSHT Delegate, invites visitors to get in touch to visit French hand therapy clinics.

AUSTRIAN HAND THERAPY MEETING

On March 3-4 of this year 210 surgeons and therapists gathered in Bad Radkersberg, Austria for the annual joint congress of the Austrian Hand Surgery and Hand Therapy Societies. The program focused on in-depth examination of upper extremity compression neuropathies with presentations by anatomists, neurologists, and radiologists as well as therapists and surgeons. All participants were asked to bring their passports to the congress, so they could cross into Slovenia for The Austrian Hand Therapy Society Anthe welcome re- nual Business Meeting was chaired by ception. It is not board members (L to R) Brigitte Stern-Grilc, every congress Brigitte Sparl (President) & Brigitta Kolmayr.

Graduating in 1967 with a BSc OT degree, Paul van Lede later pursued a post graduate diploma in Orthotics and for many years worked with acute patients before joining Orfit Industries as a product manager.

Using his knowledge of hand anatomy and biomechanics, Paul introduced innovative splinting techniques with a variety of thermoplastic materials. He travelled to more than 60 countries teaching splinting to therapists interested in hand rehabilitation.

A memorial fund to honor him by supporting therapists from developing countries to advance their skills and knowledge is available on the IFSHT website: www.ifsht.org/ page/memorial-fund.

IFSSH EZINE

The September 2016 IFSHT contribution to the IFSSH Ezine is “An Exercise Program for the Chronically Painful Wrist” by Annemieke Videler in which there is a thorough description of the treatment rationale and functional exercises. The February 2017 IFSHT contribution to the IFSSH Ezine by John Avery is “Proximal Interphalangeal Joint Dorsal Dislocation,” presenting management principles for these common and potentially complex injuries.

Both are available at: www.ifssh.info/ezine.html.

IFSHT is keen to have clinically relevant articles for the IFSSH Ezine. Contact presidentelect@IFSHT. org if you would like to contribute, or you have a topic to suggest.

For hand therapy educational events, go to “National/ International Education Events” under “Education” at www.IFSHT.org.

1 1 t h Tr i e n n i a l I F S H T Co n g re s s

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Berlin, Germany

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i f s s h - i f s h t 2 0 1 9. co m www.ahta.com.au l 35

Contact Us Australian Hand Therapy Association Corporate Office

Staff Contacts:

Address:

PO Box 5111 WEST BUSSELTON WA 6280

Sarah Dixon

Phone:

08 9755 0416

Email:

info@ahta.com.au

Kate Noller (Maternity Leave) executiveadmin@ahta.com.au Executive Support Manager (Strategy)

Web:

www.ahta.com.au

Veronica Dullens

info@ahta.com.au Executive Support Manager (Operations) 08 9755 0416

Marketing, Communications & Events

events@ahta.com.au 0400 449 100

MANAGEMENT COMMITTEE Position

Name

State

Phone

Email

President

Karen Fitt

VIC

03 9458 5166

president@ahta.com.au

Past President

Helen Burfield

SA

08 8211 8002

pastpresident@ahta.com.au

President Elect

Nicola Cook

NSW

0405 219 959

presidentelect@ahta.com.au

Treasurer

David Parsons

WA

08 9266 3970

treasurer@ahta.com.au

Secretary

Olga Alkin

QLD

07 5447 0967

secretary@ahta.com.au

Communications

Julia Wild

NSW

02 9553 8597

communications@ahta.com.au

Education

Carla Bingham

QLD

07 5500 5617

education@ahta.com.au

Marketing & Promotions

Amy Geach

NSW

02 6925 0157

marketing@ahta.com.au

Membership Secretary

Katie Whittle

QLD

07 5443 5474

membership@ahta.com.au

State & Territories Affairs

Elizabeth Giuffre

ACT

02 6244 2154

stateaffairs@ahta.com.au

DIVISIONAL COORDINATORS State

Email

Contact

Phone

ACT

ahtaact.sig@gmail.com

Lin Wegener (Main Contact)

02 6244 2222

Elizabeth Giuffre

02 6244 2154

Victoria Tricardos (Main Contact)

02 9616 8713

Michelle Chim (Yuen)

02 9460 7788

Jason Fairclough

02 4737 3477

George Kikilas

02 9553 8597

NSW

nswigmeeting@gmail.com

NT

ahtant.sig@gmail.com

Jayne Donovan

08 8951 7789

QLD

ahtaqld.sig@gmail.com

Frances Thomsen (Main Contact)

07 3636 7100

Amanda MacKillop

1300 420 556

Charlotte Nash

0434 887 646

Margo Coffey

0430 177 222

SA

ahtasa.sig@gmail.com

Kaveeta Deut

08 8204 5498

TAS

ahtatas.sig@gmail.com

Lara Griffiths (Main Contact)

03 6348 7216

Carolyn Asman

03 6348 7216

Marissa Kwijas (Main Contact)

03 9554 8488

Helen Scott

1300 996 690

Hana Peake

03 5973 6911

Stuart Wilson (Main Contact)

1300 887 798

Victoria Allbrook

08 9324 2881

Jessica de Jong

08 9467 2470

Sarah Fairthorne

08 9334 0776

VIC

WA

ahtavic.sig@gmail.com

ahtawa.sig@gmail.com

36 l AHTA NEWSLETTER l APR - JUN 2017