FingerPrint (Issue 112)

NEWSLETTER OF THE

Issue 112, Jul - Sep 2017

Come see the dendrites mobilising in Glenelg on September 22 - 24

FEATURES The Old ‘Mallet-Finger-with-PIP-Hyperextension’ Splinting Issues Scars: A Therapist’s Perception and Review of Current Concepts Pisotriquetral Joint Osteoarthritis Splinting to Improve Forearm Supination - A Research Review

UPDATES Research Higher Degrees – why, when and how?

Library Resources Review – Burns Portfolio Reports 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 Kate Noller T: 02 6362 8170 E: executiveadmin@ahta.com.au

FEATURES

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Case Study: The Old ‘Mallet-Finger-with-PIPHyperextension’ Splinting Issues Review: Scars: A Therapist’s Perception and Review of Current Concepts Report: Pisotriquetral Joint Osteoarthritis Review: Splinting to Improve Forearm Supination - A Research Review Research Higher Degrees – Why, when and how?

REGULARS

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National Conference Update From the Editor Product Profiles - Evaluation Products Mentor List Contact Us

REPORTS 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.

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

www.ahta.com.au l 3

Australian Hand Therapy Association National Conference 22 - 24 Sept 2017 • Stamford Grand, Glenelg SA It is not long to go before the national conference in Adelaide.

We are looking forward to hosting everyone at The Stamford Grand in Glenelg, a seaside suburb of Adelaide. The hotel is about 4 km from the airport and situated right next to the beach with lots of cafes and boutique shops behind the hotel.

Our conference dinner is to be held at The Glenelg Surf Life Saving Club which is a two minute walk from the hotel. More information is to follow regarding the dinner but, as it will be finals time for the winter sports, the theme will be based around this. It should be a fun night but bring along some competitive spirit!!

Dr Christine Novak, our keynote speaker from Canada has an

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

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.

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immense experience in the management of nerve transfers and nerve compression. We look forward to her presentations and workshops. There will be a significant pain management component including workshops and plenary talks from NOI and Body in Mind. We are extremely excited to have, for the first time, a fresh live upper limb dissection session, performed by one of our experienced hand surgeons. There will be a session for all therapists followed by a Members only session where Members will have the opportunity to request particular procedures or look at specific structures.

Most of the breakout sessions still have vacancies. There is a wide range of topics, but with an

emphasis on nerve function and repair. These include Christine Novak’s session on carpal tunnel syndrome, an inspiring session on anatomy and neurology of the forearm by Dr Tony Pohl, constructing a brachial plexus, the therapist’s management of nerve transfers and ‘a trip from the peripheral neurone to the majesty of the brain’ by Tim Cocks.

We look forward to catching up with colleagues and making new friends and contacts. Hope to see you there!!

Warm regards

Kathy Minchin Conference Convener

From the editor Welcome to the 3rd edition of Fingerprint this year.

We have several contributions this edition which will give you lots of clinical tips. If you are considering research, read Andrea & Leanne’s article with food for thought.

We are pleased to have some course DVD reviews for feedback to the membership so read to see if they spark your interest.

We are looking forward to meeting many of the membership face to face at our exciting Annual Conference, Connecting Pathways at Glenelg SA on September 22-24th. Read Kathy Minchin’s update on page 4 for the list of interesting topics and great speakers.

Hand Therapy Around the World In 2015, eight year old, Zion Harvey become the first child in the world to receive two new hands in a revolutionary transplant procedure. Two years on, the sports-mad boy from Baltimore, Maryland, is enjoying the freedom and independence his new hands have given him For the full article visit: https://www.theguardian.com/ society/2017/jul/18/first-double-hand-transplant-zionharvey-child-declared-success

Full Member Advertising Benefits Full member benefits include 1 free E-News advertisement per year.

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.

This could be: • Job vacancy • Position wanted • Course

• Workshop • Equipment for sale • Equipment wanted

For more details see www.ahta.com.au/site/membershipbenefits-table

AHTA 1-day course

Managing the Lymphatic System in Hand Therapy Saturday 14 October 2017, Canberra

This course will provide participants with the theoretical and practical knowledge required to competently assess the lymphatic function in the upper limb and apply strategies to managing lymphatic flow for clients.

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

FEATURE

CASE STUDY

The Old ‘Mallet-Fingerwith-PIP-Hyperextension’ Splinting Issues Carmel Bain Specialists on Hand

This was intended to be a case study about a 49 year old male with a mallet finger injury who damaged his right index finger while playing football. Two years previously he had done the same injury on the same finger and the last recorded DIP AROM was 10/63. On presentation this year he had some hyperextension at the PIP. Initially, I made the distal portion of the mallet style splint with a proximal hood over the PIP and P1 but was not satisfied with the finish after a few tweaks to get good angles at the PIP & DIP. Don and doffing is always tricky with these ones because of the need to maintain DIP hyperextension. The other problem I had was that I tried to dry the inside of the splint myself and couldn’t navigate a bit of tissue into the splint. It was going to be a maceration disaster.

A splint shouldn’t be hard to put on so I drew on the principles of the volar/dorsal wrist cock-up splint for hypertonicity where the wrist is levered into extension by the 6 l AHTA NEWSLETTER l JUL - SEP 2017

volar component when the dorsal component is placed onto the forearm.

The positioning was far easier with this design than the mallet finger

splint with P1 dorsal hood. The patient must have been so happy with his splint that he didn’t return for follow-up. Hence it isn’t a case study about him anymore.

FEATURE

Then there was patient #2. He had a hypertonic-into-flexion middle finger following a brain aneurysm/ surgery. He wanted a resting splint to passively extend the finger so I trialled the design again using 2mm Orfit Classic but in retrospect I should have used a more rigid material. It needs more extension at the next appointment.

Wanting to play around with the design a bit more I enlisted the most convenient, hypotonic, non-compliant people I knew and practised on the kids. My takehome points from that are:

• Tape the PIP into flexion on the volar surface prior to splinting.

• Aim for at least 60 degrees flexion at the PIP or use an adhesive foam to minimise the potiential for slipping.

• Unlike an Anti-Swan Neck Deformity splint where you punch the holes small and stretch them over the patients finger for a low profile fit, this splint I punched the hole slightly smaller than the circumference of the finger so there is limited thinning of the material.

• My preference would be for a 2mm Aquaplast or Orfit Colour but it may be worth trying a thermoplastic casting tape.

AHTA 2-day course

Hand & Upper Limb Orthotic Fabrication - Mobilisation Sat & Sun 21 & 22 October 2017, Perth

This course covers the principles and practice of mobilising orthoses for the hand and upper limb.

This two-day program is designed to be an active learning experience with both lectures on the important theoretical foundations of orthotic fabrication and hands-on practical sessions.

Visit the Online Store at www.ahta.com.au to book your place today www.ahta.com.au l 7

FEATURE

REVIEW

Scars:A Therapist’s Perception and Review of Current Concepts Kara Cepo Occupational Therapist, Hand Works Occupational Therapy

A large scar may be a talking point or souvenir of overcoming a trauma for some. However a poorly formed scar can be a real issue for patient and therapist alike.

Having both physical and psychological ramifications, a scar can have significant effect on a patient’s everyday life. Decreased AROM, pain, hypersensitivity and that feeling of ‘tightness’ are just some of the physical consequences of a scar (Barasch, 2006). Mixed with the overall ‘look,’ a problematic scar can be very distressing for patients and can affect their willingness to go ahead with future surgical procedures. Small linear scars may not be a cause for concern, however hypertrophic/keloid scars or scars in a highly mobile area such as a digit can cause significant issues (Monstrey et al., 2014). A better outcome will be obtained if the scar is considered early on.

The saying prevention is better than a cure really rings true with scars. A prolonged inflammatory wound phase, infection or excessive 8 l AHTA NEWSLETTER l JUL - SEP 2017

tension on a wound can negatively impact the final product (Monstrey et al., 2014). An increase in active fibroblasts seen in these scenarios, can lead to excessive formation of collagen resulting in more scar tissue (Commander, Chamata, Cox, Dickey, & Lee, 2016). In turn, producing a scar that may limit movement and be unaesthetically pleasing. Consideration of dressing choices, infection control procedures, patient education and patient factors will all indirectly affect the formation of a scar from the wound phase (Von Der Heyde & Evans, 2011).

As therapists our role is to educate the patient on the process of scar healing and what they can do to influence the scar for a more positive outcome. Consideration of the underlying anatomy and physiology provides a basis to guide patients to achieve their goals; whether functional or cosmetic. While a majority of scars will not need specific intervention, it is important to recognise when a scar may become problematic.

These are often scars that have

had an extended inflammatory period due to infection/wound complications, scars around a joint or scars in a highly visible area such as the face. Darker pigment skin types are also known for producing excessive scarring (keloid or hypertrophic) and may require extra consideration for scar prevention and treatment (Atiyeh, 2007). Cosmesis may also bear more importance to some patients and cultural groups. It is easy to focus on the functional impact of a scar, forgetting the connotations that may come with each scar. Certain religious practices may also dictate whether anything can be worn on a wound of scar. It is important to consider all patient factors, not just the physical.

We have the ability to make the biggest impact in the first three months post injury while the scar is still in the fibroblastic phase and collagen production is high. After this phase collagen production begins to be balanced with collagen lysis as the scar moves into the maturation phase (Parry, Sen, Palmieri & Greenhalgh, 2013).

FEATURE

As therapists, it is important to be aware of non-invasive and invasive methods available to our patients. Being up to date with current literature and practices will assist in delivering best practice.

A multimodal approach has been shown to be most effective when looking at scars. There is no one gold standard treatment, however best practice is to combine relevant techniques, whether conservative or more invasive (Widgerow, Chait, Stals & Candy, 2009).

which can lead to an adverse reaction on new fragile skin. The goal of these skin formulas is to maintain moisture and hydration as well as assist scar massage.

Research has shown that in the year following wound healing, water evaporates more rapidly from scar tissue than the surrounding normal tissue (Suetake, Sasai, Zhen, Ohi & Tagami, 1996). Simple formulas such as Vaseline or sorbolene may be enough if other non-invasive measures cannot be administered.

Non-Invasive Treatments

Pressure Therapy (Tapes, compression)

Massage Scar massage is commonly recommended by therapists and surgeons as part of a scar management program. However regimes and techniques often vary as there is little literature is available supporting its use and administration. Anecdotally, therapists value scar massage acting as a mechanical force to break up scar tissue and maintain suppleness of the scar. Techniques often involve a combination of pinching, rolling, firm circles, friction and vibration (Shin & Bordeaux, 2012). It has been suggested that 20-25 minutes of daily massage can increase ROM if the scar is over a joint (Morien, Garrison & Keeney Smith, 2008). Less apparent benefits of scar massage include increased acceptance of the scar and desensitisation of hypersensitive skin. Massage can be started once the wound is closed and sutures have been removed, adjusting pressure in line with healing (Barasch, 2006).

Special Skin Care Formulas There are many specialised scar creams and gels on the market however they often contain fragrance, colouring or alcohol,

Paper tapes can be used to decrease tension on the scar by providing an external support.

Reducing the tension prevents unnecessary aggravation and inflammation of the new tissue, which can prevent excessive scar formation (Von Der Heyde & Evans, 2011). Compression on the other hand may be reserved for larger scars such as those from skin grafts or burns, to help control collagen synthesis and encourage reorganisation of the extracellular matrix. Like silicone, the exact mechanism of action is unknown, theories attribute these changes to hypoxia, cellular influences and biomechanical changes in the scar (Mokos et al., 2017) (Li, Li-Tsang, Huang, Chen, & Zheng, 2013).

Silicone Silicone therapy is considered a non-invasive first line prophylactic treatment for most types of scars.

There are little risks or side-effects involved with using silicone products, making it a good option for majority of scars. The way silicone works on scars is yet to be fully determined; it is thought that it is likely a combination of occlusion

and hydration of the scars stratum corneum that produces beneficial results (Mustoe, 2008). The stratum corneum is the outermost layer of the skin, it’s function is to prevent unwanted materials entering the body, as well as prevent excessive water loss from the underlying tissues (Menon, Cleary & Lane, 2012). Many authors have agreed that silicone products work on the stratum corneum by reducing evaporation and restoring homeostasis. It is proposed that in turn this reduces mast cell activity, oedema, vasodilatation as well as preventing excessive extracellular matrix formation.

Other suggested explanations include pressure effect, hydration and changes in temperature at the skins surface (Chan, Lau, Adeeb, Somasundaram & Nasir-Zahari, 2005). Silicone has been found to be an effective preventive treatment for hypertrophic scarring. It has been reported that scars treated with silicone gel were much smaller, less painful, more pliable and had decreased itchiness, vascularity and pigmentation (Chan, Lau, Adeeb, Somasundaram & Nasir-Zahari, 2005).

Other Treatments Conservative measures are best administered before the scar reaches the maturation phase.

More invasive measures such as laser, cryotherapy, corticosteroid injections or surgical revision can be considered with the help of a plastic surgeon, if a scar has not responded to prophylactic conservative measures. Again, a multimodal approach combining invasive and non-invasive measures is still advisable to avoid the scar from becoming problematic post the above procedures (Barasch, 2006).

www.ahta.com.au l 9

FEATURE

Despite adequate prevention and advancing techniques, scars will always be apart of any surgical procedure. Scar management is about getting the best outcome post injury or surgery to ensure a successful procedure and a happy patient.

Take Home points:

• Scar management is best considered from day one

• Conservative management has the greatest impact in the first three months post injury/ surgery

• There is a lack of high level evidence for non-invasive scar treatments, however due to the low risk, it is advisable to continue in practice

• A multimodal approach combining multiple techniques is seen as best practice

• Education, prevention and early intervention are the key domains to minimise the impact of a scar, whether physical or psychological.

REFERENCES Atiyeh, B. (2007). Non-surgical management of hypertrophic scars: Evidence-based therapies, standard practices, and emerging methods.

Aesthetic Plastic Surgery 31 468-492 Barasch, T. (2006). Chapter 4: Scar management. In Burke, S., Higgins, J., McClinton, M., Saunders, R. & Valdata, L. (Eds.) Hand and Upper Extremity Rehabilitation: A Practical Guide (3rd ed.).

Chan, K.Y., Lau, C.H., Adeeb, S.M., Somasundaram, S. & NasirZahari, M. (2005). A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plastic and Reconstructive Surgery, Sept 15, 1013-1020 Commander, S. J., Chamata, E., Cox, J., Dickey, R. M., & Lee, E. I. (2016). Update on Postsurgical Scar Management. Seminars in Plastic Surgery, 30(3), 122–128. https://doi. org/10.1055/s-0036-1584824 Li, J. Q., Li-Tsang, C. W. P., Huang, Y. P., Chen, Y., & Zheng, Y. P. (2013).

Detection of changes of scar thickness under mechanical loading using ultrasonic measurement.

Burns, 39(1), 89–97. https://doi. org/10.1016/j.burns.2012.05.009 Menon, G.K., Cleary, G.W. & Lane, M.E. (2012). The structure and function of the stratum corneum. International Journal of Pharmaceutics. 435 (1): 3-9 Mokos, Z. B., Jović, A., Grgurević, L., Dumić-Čule, I., Kostović, K., Čeović, R., & Marinović, B. (2017).

Current Therapeutic Approach to Hypertrophic Scars. Frontiers in Medicine, 4(June), 1–11. https://doi. org/10.3389/fmed.2017.00083

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Monstrey, S., Middelkoop, E., Vranckx, J. J., Bassetto, F., Ziegler, U. E., Meaume, S., & Téot, L. (2014). Updated Scar Management Practical Guidelines: Non-invasive and invasive measures. Journal of Plastic, Reconstructive and Aesthetic Surgery, 67(8), 1017– 1025. https://doi.org/10.1016/j. bjps.2014.04.011 Morien, A., Garrison, D., & Keeney Smith, N. (2008). Range of motion improves after massage in children with burns: A pilot study. Journal of Bodywork and Movement Therapies 12, 67-71 Mustoe, T.A. (2008). Evolution of silicone therapy and mechanism of action in scar management.

Aesthetic Plastic Surgery. 32, 82-92 Shin, T. M., & Bordeaux, J. S. (2012). The role of massage in scar management: A literature review.

Dermatologic Surgery, 38(3), 414– 423. https://doi.org/10.1111/j.15244725.2011.02201.x Suetake, T., Sasai, S., Zhen, Y.X., Ohi, T. & Tagami, H. (1996).

Functional analyses of the stratum corneum in scars. Sequential studies after injury and comparison among keloids, hypertrophic scars, and atrophic scars. Arch Dermatol 132 1453-1458 Von Der Heyde & Evans, (2011).

Chapter 18: Wound classification and management. In Skirven, T., Osterman, A., Fedorczyk, J. & Amadio, P. (Eds.), Rehabilitation of the hand and upper extremity (6th ed.) (pp 219-232). Philadelphia, PA: Elsevier Mosby

FEATURE

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WWW.ROCKTAPE.COM.AU www.ahta.com.au l 11

FEATURE

REPORT

Pisotriquetral Joint Osteoarthritis Sophie Marden Southern Hand Therapy It is well acknowledged that Osteoarthritis (OA) can be termed a chronic non-inflammatory joint disease characterised by breakdown in the articular cartilage, and often resulting in development of bony spurs and cysts. In the wrist, it is typically secondary to a pathological condition and can result in major functional impairments due to pain. Although OA of the wrist is commonly encountered, its prevalence is poorly documented. Pevney, T et. al examined 25 cadaveric wrists and identified mild to moderate

degenerative changes in all specimens. Yamaguchi S, V et. al performed a cadaveric study of 80 wrists, of which 74% had OA in the Pisotriquetral joint (PTJ), indicating a higher incidence rate than initially thought. Furthermore, the occurrence of ulnar nerve neuropathy associated with Pisotriquetral joint dysfunction has been reported to be 33% (Pevney, T et. al). This submission aims to provide some insight on the rather underrated Pisiform; OA at the PTJ; and management techniques.

The Pisiform The Pisiform itself is often described as a sesamoid bone “embedded” within the Flexor Carpi Ulnaris (FCU) tendon. However, Pevney, T et al identified that the FCU was attached purely to the anterior aspect of the pisiform, rather than “embedding” the bone.

Regardless, it is designed to act as a lever of the tendon. It is pea shaped, anatomically included in the proximal carpal row, and is the only carpal bone with a single articulation and any tendinous insertion. The Pisiform ossifies at a mean age of eight years and nine months, and is fully developed at 12 years of age.

The ulnar nerve and artery are closely related to the pisiform with the nerve lying more medially and closer to the bone. Surprisingly, anatomical studies have indicated there are 12 soft tissue attachments to the pisiform: FCU; abductor digiti minimi; extensor retinaculum (having a complex insertion); transverse carpal ligament; volar carpal ligament; TFCC; pisohamate ligament; pisometacarpal ligament; radial pisotriquetral ligament; ulnar pisotriquetral ligament; pisohamate arcade; and the ulnar collateral ligament. Primary stabilisers of the pisiform include the pisohamate ligament, pisometacarpal ligament

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FEATURE and ulnar pisotriquetral ligament.

Whilst secondary stabilisation is provided via the transverse carpal ligament and the radial pisotriquetral ligament. FCU is the most substantial proximal stabiliser, with normal forces tending to pull the pisiform proximally and medially. Mechanical testing has shown that the soft tissue structures around the PTJ are strongest proximally and distally; and weakest medially Pevney, T et. al.

Beckers and Köbke identify two main functions of the pisiform: 1. To act as a fulcrum to control the triquetrum; and 2. To act as a space holder for Guyon’s canal by stretching the volar carpal ligament over the ulnar nerve and artery.

Kinematics As the pisiform is assumed to be insignificant in respect to wrist kinematics, its indirect contributions are frequently underestimated.

Knowledge of the normal motion of the pisiform and its relationship to surrounding structures is necessary to identify any abnormal excursion or instability patterns.

A study completed by Jameson, B. H. et. al evaluated 45 “normal” wrists to assess pisiform motion.

Analysis of the findings showed that the pisiform migrates distally during wrist extension and proximally during flexion (in relation to the Triquetrum); and that the amount of proximal migration was greater than distal migration. Beckers and Köbke similarly discuss that the pisiform is a crucial factor in stabilizing the wrist during extension; and how wrist extensors and deviators act indirectly by generating forces that result in displacement.

considerable motion between the pisiform and triquetrum in different planes”. Spatial motion of the pisiform is recorded to occur in four planes: proximal distal (vertical gliding) with average movement of 4.0mm; anterior posterior (gapping) with average movement of 1.5mm; ulnar radial (horizontal gliding) with average movement of 3.2mm; and uniaxial rotation (angulation).

contraction of the FCU, especially with the wrist in ulnar deviation.

Crepitus may be identified with ballottement. Other causes of ulnar sided wrist pain need to be excluded as differential diagnosis.

These may include ulnar styloid non-union; DRUJ subluxation; TFCC injury; lunotriquetral pathology; ulnar collateral ligament injury; and FCU tendinosis.

With consideration of the multiple dynamic forces that act on the pisiform it is clear how it can easily be a source of ulnar sided wrist pain; and how damage to the surrounding structures can lead to dysfunction of the joint.

Radiographic imaging can be a useful tool in diagnosis, however again requires knowledge to enable recognition of abnormalities. A lateral view with 20 to 30 degrees of supination is supported in the literature. Using this view, a normal width of the PTJ is between 1-4mm; with a widened space during wrist flexion and a narrowing during extension. The following views are reported to give greater insight into PTJ motion and can be beneficial in assessing instability:

Diagnosis OA of the PTJ commonly results from trauma or instability, can impair movement and irritate the ulnar nerve, resulting in decreased function and a symptomatic wrist.

Ulnar sided wrist pain following Carpal Tunnel Release is also not uncommon as the normal medial and lateral excursion of the pisiform may be increased leading to arthrosis at the PTJ. PTJ OA produces a relatively common clinical presentation of mechanical pain at the anterior and ulnar aspect of the heel of the hand; active range of motion limitations; decreased strength; and occasionally swelling and redness.

Pain is typically the outstanding symptom and aggravated by

- Full wrist extension and 30 degrees supination; - Neutral wrist and 30 degrees supination; - Both active and passive full wrist flexion; and - 45 degrees supination with full thumb abduction (to prevent the first metacarpal from obscuring the PTJ).

The following table taken from Jameson, B. H. et. al can be used as a guideline for comparison when pathology is suspected.

Jameson, B. H. et. al remark how “…multiple dynamic forces in the normal wrist are responsible for www.ahta.com.au l 13

FEATURE Treatment As therapists our aim in treatment of PTJ OA is to manage pain, preserve joint mobility and enhance function. Whilst we all aim to preserve joint mobility, studies indicate that nearly all everyday activities can be performed regardless of active range limitations and pain management is the priority.

Treatment can include a resting splint with 0 to 30 degrees of wrist flexion to reduce tension on the FCU tendon as supported in the literature. Education not only regarding injury; but also, the close relationship between structures in the ulnar side of the wrist should be utilised to support activity modification principles.

A patient needs to be aware that FCU contraction can aggravate symptoms, especially with the wrist in ulnar deviation. Furthermore, the relationship between ADM and FCU contraction could be considered.

Patients should be encouraged to avoid activities that require gripping or pressure along the volar ulnar aspect of the palm. Gel lining, or as we use at Southern Hand Therapy, a “pisiform doughnut” may be used inside an orthosis to protect the area. The neoprene doughnut can be sewn on pre-fabricated splints that have been adjusted to the correct wrist position. NSAID may also prove helpful.

If symptoms remain, an intra-

14 l AHTA NEWSLETTER l JUL - SEP 2017

articular CSI is indicated with immobilisation in an orthosis. If a confirmatory response to injection is found but not maintained then surgical intervention is recommended.

Surgical intervention Sub-periosteal excision of the pisiform is the treatment primarily chosen by surgeons. Arthrodesis may be considered and denervation is reported to provide pain relief in three quarters of patients.

During excision, care is taken to preserve surrounding fibrous tissue to maintain FCU function and strength. The ulnar nerve is at considerable risk because of its close relationship to the pisiform.

Post operatively, the literature recommends protective splinting for four to six weeks to allow wound healing and fibrotic tissue to fill the void left by the excised pisiform.

Again, the wrist should be splinted in 0 to 30 degrees of flexion; and gentle active range of motion is suggested to commence at week two. There is concern that excision leads to loss of protection to the contents of Guyon’s canal; and that the patient must be aware of this to enable close monitoring of the nerve and artery.

Clinically we see patients have a bulky postoperative crepe bandage for the first 10 days. As long as the pain and nerve symptoms are relieved the Hand Surgeons do

not expect more than a six week follow up. Yet what we see is the rehabilitation process is determined by the scar formation between two to four weeks. The external scar tissue is slightly red but usually flat.

The internal scar bulk can be very thick. If this leans on the ulnar nerve then a wrist splint in slight flexion for heavy activities may be required.

Silicone gel sheet at least at night is helpful (often also needed during the day) and scar massage. Rarely are the finger flexors adhered. As soon as the internal scar bulk is reduced then grip strength and wrist function return. Of course, activity modification to prevent leaning on the pisiform would have been dealt with pre-operatively.

Eijzeren, JV et. al investigated the effect of pisiform excision on wrist function with age and sex matched control subjects. They found no significant difference in grip and pinch strength between patient and control groups in both operated and non-operated wrists. Wrist extension was however significantly reduced in operated wrists compared with non-surgical and control wrists. It was speculated that the formation of scar tissue would reduce tensile strength of the skin locally and account for this limitation. After excision, a significantly greater FCU force (up to 29% greater than an intact wrist) was required to move the wrist. Carroll and Coyle reviewed

FEATURE results of 67 Pisiform excisions over a 30 year period. 65 patients were reported to have complete pain relief without loss of wrist ROM. O’Keefe KD et. al specifically investigated the effect on FCU forces following pisiform excision and deduced that excision caused the FCU tendon to significantly move more proximally during all wrist motions as compared with an intact wrist or after arthrodesis. From their findings, they speculate that arthrodesis may be the treatment of choice for high demand patients as the mechanical advantage of the FCU is not affected; and no difference in movement was documented between the intact wrist and arthrodesis.

Several studies have been performed to investigate the anatomical relationship on the ulnar side of the wrists. They all describe a close relationship between the Pisiform and the surrounding tissues including the ulnar nerve and ligaments. Conclusively, studies acknowledge complete pain relief and no long term adverse effects on strength and function post excision if the surrounding structures are preserved. Loss of integrity to the surrounding structures however may lead to dysfunction.

REFERENCES 1. Beckers A, Köbke J. Mechanical strain at the pisotriquetral joint.

Clinical Anatomy. 1998; 11(5): 320-326.

2. Campion H, Goad A, Rayan GM, Porembski M. Pisiform excision for Pisotriquetral instability and arthritis. J Hand Surg. 2014; 39(7): 1251-1257.

3. Eijzeren J, Karthaus R. The effect of pisiform excision on wrist function. J Hand Surg. 2014; 39(7): 1258-1263.

4. Jameson BH, Rayan GM, Acker RE. Radiographic analysis of Pisotriquetral joint and pisiform motion. J Hand Surg. 2002; 27A: 863-869.

5. Laulan J, Marteau E, Bacle G. Wrist osteoarthritis.

Orthopaedics and Traumatology: research. 2015; 101: S1-S9.

6. O’Keefe KD, Werner FW, Boyette M, Palmer AK, Garcia-Elias M, Harley BJ. Effect of pisiform excision or pisotriquetral arthrodesis as a treatment for pisotriquetral arthritis: a biomechanical study.

J Hand Surg. 2013; 38A: 19131918.

7. Paley D. Pathologic conditions of the pisiform and pisotriquetral joint. J Hand Surg. 1987; 12(1): 110-119.

8. Penvy T, Rayan GM, Egle D. Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study. J Hand Surg. 1995; 20A: 299-304.

9. Rayan GM, Jameson BH, Chung KW. The Pisotriquetral joint: anatomic, biomechanical, and radiographic analysis. J Hand Surg. 2005; 30(3):596-602.

10. Yamaguchi S, Viegas SF, Patterson RM. Anatomic study of the Pisotriquetral joint: ligament anatomy and cartilaginous change. J Hand Surg. 1998; 23(4): 600-606.

Coming Events 31 Aug - 1 Sep 2017 Complex Regional Pain Syndrome Cork, Ireland www.crpscork2017.com

8 - 10 September 2017 New Zealand Association of Hand Therapists - Annual Conference ‘Fit To Play, The Injured Athlete’.

SKYCITY, Auckland NZ conference@nzaht.org.nz

22 - 24 September 2017 Australian Hand Therapy Association National Conference ‘Connecting Pathways... Firing Up Our Nerve Potential’ Stamford Grand GLENELG SA www.ahtaconference.com.au

6th -8th October 2017 3rd Annual Congress - Asia Pacific Wrist Association Adelaide SA www.apwa.asia/3rd-apwacongress/

15 - 18 October 2017 MUSoc 2017 - The 27th Annual Meeting of the Musculoskeletal Ultrasound Society Tel Aviv ISRAEL www.musoc2017.org

www.ahta.com.au l 15

FEATURE

REVIEW

Splinting to Improve Forearm Supination A Research Review Achini Soysa Supination of the forearm is necessary for various activities of daily living such as turning keys and doorknobs, eating, dressing and personal hygiene. Supination is also essential in many sports including catching and swinging a racquet.

Normal forearm supination range tends to average between 80 -85 degrees1. While most activities of daily living can be performed with 50 degrees of supination2. Deficits in supination of the forearm present a greater functional limitation than deficits in pronation. This is because the shoulder abduction and internal rotation will compensate for a lack of pronation. However there is no other movement that can substitute for supination, making a supination loss very debilitating for patients.

Forearm supination is made possible by the proximal and distal radioulnar joints and the interosseous membrane, in between the joints3. The proximal radioulnar joint consists of the disc like radial head, which glides in the corresponding concave shaped radial notch of the ulnar. The distal radioulnar joint consist of the ulnar notch of the radius, which slides around the head of the ulna during forearm rotation. Injuries to any of 16 l AHTA NEWSLETTER l JUL - SEP 2017

these structures can potentially lead to loss of supination.

Common conditions associated with a loss of supination include distal radius fractures, radial head fractures, Galeazzi fractures, Monteggia fractures and EssexLopresti injury4. Stiffness can also occur without any bony injury. It can occur from inflammation and immobility following an injury, leading to scarring and contracture of soft tissues3 and joints5, despite a well aligned radius and ulna.

Supination loss due to DRUJ adhesions and soft tissue injury can be corrected, to some extent by splinting and exercise. However bony constraints to supination such as with DRUJ malunions3, osteophytes, and heterotrophic bone are usually not amenable to conservative intervention.

Splinting Principles to consider when fabricating a forearm supination splint.

• Mobilisation splinting is based on the concept that an adequate level of stress, applied over long periods of time, will stimulate

connective tissue growth and reorganization needed to achieve permanent lengthening of tissues (Glasgow 2003)7.

This permanent lengthening of tissues is known as plastic deformation. However too much stress will result in pain and the tissues will tear. Tissue failure is concerning as it will re stimulate the inflammatory process, leading to an increased risk of scar tissue production and increased joint contracture. Therefore patients should be advised to tension the supination splint so the joint is held at end range without causing pain.

• The increase in PROM in a stiff joint is directly proportional to the total amount of time the joint is held at its end of range (TERT)5.In other words, the longer the stiff joint is held at its end range , the greater the gain in PROM.

• Tissue ischemia can occur if too much stress is applied to the skin. This is especially important to consider in the forearm, which has a lot more mobile skin and soft tissue

FEATURE than in the hand and fingers.

Therefore great care needs to be taken when using elastic straps, such as neoprene, to provide a supination force. This is because the stress on the skin would be considerably more than the stress on the joints beneath the skin. Therefore where possible inelastic straps and circumferential strapping needs to be considered, to reduce the shear stress on skin and increase the surface area of force application.

Evidence supporting the use of Forearm rotation splinting A search on PubMed and EBSCO reveal there are no randomised controlled trials or systematic reviews, investigating the efficacy of forearm rotation splinting. However a number of authors have published retrospective studies investing both static progressive and dynamic forearm rotation splinting.

A prospective study by Shah and colleagues8 investigated the use of dynamic forearm rotation splint in patients following distal radius fractures with a forearm rotation contracture who had all failed conventional therapy.

The 15 patients involved in the study had either supination contracture, pronation contracture or both supination and pronation contracture. All patients wore their dynamic forearm supination splint, for an average of 3 months. The study found that dynamic forearm

rotation splinting improved forearm rotation by 52% over an 11 week period. It is worthwhile noting that one patient in this study developed heterotopic ossification. At the completion of her treatment, she regained 35 degrees of pronation but lost 5 degrees of supination.

The dynamic splint design used in the study consisted of a 2 piece design, including a proximal elbow splint with an outrigger and an ulnar gutter wrist splint, with outrigger.

The splint used rubber tubing (approx. 3mm) to connect the 2 outriggers, to create a rotational torque. The splint was worn for 6 hours per day for supination or pronation only contracture and 12 hours per day if the patient had both supination and pronation contractures. Nocturnal use was up to the patient’s discretion, but almost all patients reported that night use was difficult due to positioning problems. One of the benefits of this design is that the force application is concentrated perpendicular to the joint axis.

However it is likely that the bulky appearance of the splint, especially the large outrigger may reduce splint compliance during the day.

Furthermore using a single elastic rubber tube to apply a single rotational force, concentrates force application to a single area, this may lead to pressure issues.

Furthermore as the outriggers are bonded to the wrist and elbow splint, it is likely that the components can become loose and detach with ongoing use.

A retrospective study by Lucado and colleagues3 demonstrated that patients following a distal radius fracture, regained supination following a period of static progressive splinting. The study retrospectively reviewed data collected from 6 patients who were treated with static progressive forearm rotation splint. The patients were instructed to adjust the

tension of their splint as close to end range as their comfort allowed.

The patient were also instructed to wear the splint for 30 min daily during the first week, increasing to two 30min sessions per day during the second week and three 30min sessions during the third week. The splints were initiated on average 94 days postoperatively and worn for an average duration of 75 days. The splint used in the study was a prefabricated forearm based static progressive splint from the company Joint Active System Inc. The splint costs approximately $130 USD. The results of the study reveal that supination increased by an average of 14.5 degrees and all patients had a better functional outcome, as measured by grip strength and DASH score.

Lee, LaStayo & von Kersburg in 2003 retrospectively reviewed data from 11 patients who were treated with a dynamic supination splint. The patients involved in the study had various types of elbow and/or wrist fractures, who had made inadequate gains in supination, as determined by the therapist or physician. It is unknown how many months post injury, supination splinting was initiated.

Also the patients continued usual therapy whilst receiving dynamic supinating splinting. Therefore it is possible that patient in this study commenced therapy earlier than in the other 2 studies and improved due to other intervention received (i.e. usual therapy) .The patients were treated for an average of 10 weeks and the splint was worn for www.ahta.com.au l 17

FEATURE 4-8 hours per day. The authors state that all the patients made significant gains in range of motion from initial visit to discharge, with the average supination ROM increasing by 50 degrees. However there are some concerns regarding the reliability of the data. Nonetheless the splint design is unique and worthy of consideration.

The dynamic splint used in the study consists of a long wrist splint that wraps around the forearm and ends below the elbow. Thermoplastic hooks are attached around the ulnar styloid and lateral epicondyle using a heat gun. Then an outrigger, made using a rectangular wire bonded with thermoplastic wrist splint is attached mid-way between the hooks. The supination force is applied by resistive elastic tubing.

Some of the issues with this design include that a large outrigger is required to direct the rotational force perpendicular to the axis of forearm rotation. Unlike the smaller joints of the hand, the forearm joints are considerably larger and require larger rotational forces to position the forearm in supination.

Therefore large forces are required of the rubber tube and the bonded thermoplastic hooks and outrigger are subject to large rotational forces. Over time these significant forces may cause the rubber tube 18 l AHTA NEWSLETTER l JUL - SEP 2017

to deform and the hooks and outriggers to become loose.

Other Potential forearm rotation splinting options Colello-Abraham developed a forearm rotation splint, published in the book, ‘Hunter’s Rehabilitation of the Hand’ (3rd edition).This splint consists of a humeral cuff with 2 lateral bars acting as outriggers that run parallel to the forearm, with multiple ring attachment sites for rubber bands. The rubber bands are also attached to a wrist splint, so that the rubber bands pull perpendicular to the rotational axis of the forearm, creating a supination torque. One of the advantages of the Colello-Abraham splint is that the use of multiple force arms increases the area of force application and thus, decreases pressure and improves comfort.

However personal experience suggests that the less inhibiting the splint is, the more often the patient will wear the splint.

The Rolyan forearm rotation splint is a commercially available splint that employs a twisted rubber tube to generate the rotational force.

One of the advantages of this splint is that it may be more time efficient, as the construction of an outrigger is not required. However the twisted rubber tube applies not only supination torque, but also produces deforming forces in other directions, often producing pressure around the mid forearm8. Shah and colleagues8 reported suboptimal results using this splint and that most of their patients complained about an unpleasant sensation

caused by the pressure of the tube around the forearm. The splint is also relatively expensive, with the components alone costing $75.

Judith Wilton, in her book ‘Hand Splinting- Principles of Design and Fabrication’11 describes a static progressive splint which is simple in design and relatively easier to make. It consists of a semi-circumferential wrist splint (in neutral) and an anterior elbow splint. The rotational torque is created by inelastic Velcro strap that attaches to both splints, applying force perpendicular to the axis of motion. The area of force application can be maximised by using wider straps but it is also dependant on the size of the wrist splint. Clinically it is apparent, that the less bulky the splint is, the more likely the patient will wear the splint for prolonged periods of time, especially at night. The key benefits of this splint include the simplicity of its design and that the tension can be easily adjusted by the patients as the soft tissues lengthens.

FEATURE I have been using this design to improve forearm supination for the past 5 years. The basic premise of this splint is a corkscrew about the axis of forearm rotation that positions the forearm in supination.

The splint consists of a volar wrist component (in neutral) and a short anterior elbow splint, with the 2 parts overlapping slightly.

The supination torque is applied using an inelastic Velcro strap (durable strap), starting from the distal palmar crease through to the first web space , then wrapping circumferentially around the wrist, then up the forearm, finally attaching onto the elbow splint. The key features of this splint include the circumferential strapping maximises the area of force application and the secure attachment of the Velcro onto the elbow splint , minimises the movement of the splint on the limb, thereby decreasing shear stress on the skin. Other benefits include the simplicity of this design and that the tension can also be easily adjusted by the patient.

Why Neoprene supination wraps should not be used on contractures?

Neoprene supination wraps are a useful way to prevent pronation contractures. They are commonly used in stroke patients and children with neurological conditions, like Erb’s palsy, to position the forearm in supination, to prevent pronation contractures from developing.

However they should not be used to improved supination in patients with contractures. The main reason being that neoprene is a flexible elastic material, there is a potential that the neoprene may over compress the soft tissue causing ischemia. This is of particular significance in the forearm, as to position the proximal and distal radio-ulnar joints in end range supination, the more mobile soft tissues of the forearm would be subject even greater forces more than the joints below, which may cause tissue damage .So for patients with forearm contractures, static progressive or dynamic splints should be used instead.

expensive components need to be purchased. Further study is needed to compare the efficacy of the 2 splints.

BIBLIOGRAPHY 1 Norkin CC,White DJ.Measurement of Joint Motion :A Guide to Goniometry. 2nd ed. Philadephia, 1995 2 Morrey BF,Askew LJ,An KN ,Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am .1981; 63:872-7 3 Skirven TM, Osterman AL, Fedorczyk, J. Amadio PC. Rehabilitation of the Hand and Upper Extremity. 6th ed.2011; Chapters 69 - 78: 1229-1370 4 Morrey BF. The Elbow and its Disorders. 3rd ed. 2000 5 Ward LD, Ambrose CG, Masson MV, Levaro F. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg 2000; 25A:341–351.

Conclusion A review of literature and textbooks suggest there are many different splints that can improve forearm supination. The bigger nature of the forearm joints mean that static progressive splints are better suited than dynamic splints as significant resistance is needed to produce enough rotational force to position the forearm in supination. Judith Wilton’s static progressive splint and the author’s preference static progressive splint both have a sound physiological basis for use and are the most simple in design.

Both splints are relatively easy to make and the tension can be easily adjusted by the patients, as their tissues lengthen. Furthermore the lack of dynamic components and bonded plastic hooks means the components will less likely break off with use. Also both designs are relatively inexpensive as all material can be commonly found in most hand therapy rooms and no

6. Flowers KR, LaStayo P. Effect of total end range time on improving passive range of motion. J Hand Therapy. 1994; 7:150-7 7 Glasgow C, Wilton J, Tooth L. Optimal daily total end range time for contracture: resolution in hand splinting. J Hand Ther.2003; 16:20718.

8 Shah M, Galveston T, Lopez J, Escalante A, Green D, Antonio S. Dynamic splinting of forearm rotational contracture after distal radius fracture. J of Hand Surgery.

2002; 457-463.

9 Lucado AN, Li Z, Russel GB, Papadonikolakis A, Ruch DS. Changes in impairments and function after static progressive splinting for stiffness after distal radius fracture. J Hand Therapy .2008; 319 -325 10 Colello-Abraham, K. Dynamic pronation-supination splint. in: J Hunter et al, (Ed.) Rehabilitation of the Hand. 3rd Edition. Mosby, St. Louis; 1990.

11 Wilton, J & Dival, T. Hand SplintingPrinciples of Design and Fabrication.

London, W.B. Saunders; 1997. www.ahta.com.au l 19

FEATURE

UPDATE

Research Higher Degrees – Why, when and how?

Andrea Bialocerkowski & Leanne Bisset Griffith University

Have you got a burning clinical question that you seek answers to?

Are you considering that it might be time to take on a new challenge in your career? If so, then you might also be considering enrolling in a research higher degree. This article will provide information about the benefits of conducting research while being enrolled in a research higher degree, as well as some of the logistical matters that require consideration before and during your candidature.

The most frequent types of research degrees are 1) a Master of Philosophy; and 2) a Doctor of Philosophy.

The Master degree (often termed an MPhil) consists of 18 months of full time study or 3 years of part time study. This is in comparison with the Doctor of Philosophy, otherwise known as a PhD, which is 3 years of full time study, or 6 years of part time study. As these degrees differ in their duration, the scope of the work undertaken within each of the degrees differs.

The number and scope of studies will differ between universities and between degrees, but all research higher degrees involve writing and submitting a thesis for 20 l AHTA NEWSLETTER l JUL - SEP 2017

examination. In most institutions, there are options to upgrade from an MPhil to a PhD; and likewise options to move from a PhD into an MPhil. Entry requirements often differ between an MPhil and a PhD. Equally so, entry requirements differ between universities. So check this out carefully to gain an understanding of your eligibility.

When you study an MPhil or a PhD, you undertake work continuously throughout a whole calendar year. Often there is a provision of 4 weeks recreation leave per year. As you can imagine, this is intensive study over a sustained period of time. Many students likened this to having a full time (or part time) job. This is a large commitment, particularly when your study must be juggled with other commitments, such as paid employment and family. If you are studying part time, it is important to quarantine at least 2 days per week for your studies. Likewise, with full time study, this is a 4-5 days per week (i.e., 40 hours/ week) commitment. However it is important to note that there will be periods of time when more time will need to be spent on study activities due to immovable deadlines. So the key to a successful research

program is to consider the timing of your study, and be organised by knowing what your study commitments are before you submit your application.

So, how do you define your research topic and how do you choose the right supervisors for your research degree? We recommend that you speak to a wide cross section of people before you make a commitment to study, so that you have multiple perspectives, which will aid in your decision making.

It is important to speak to current MPhil/PhD students and those who have recently graduated, to gain an understanding of what a research higher degree really is like, as well as the support systems which are provided at each university. Speak to potential supervisors to gain an understanding of their expectations, their expertise in the topic area as well as with research student supervision. Ascertain whether your potential supervisor actually has time to supervise you. Discuss your research ideas with your potential supervisors. However, it is important to remember that you may not be able to solve all of your burning unanswered clinical questions within the time frame of either an MPhil or a PhD. By enrolling in a

FEATURE

research higher degree, you are embarking on a research training apprenticeship. These degrees will provide you with the knowledge and some practical experience to undertake more research into the future.

The last piece of advice is do not rush into submitting your application or rush into starting a study. Planning is key – it is imperative that you plan, plan and plan, by incorporating multiple perspectives into your thinking and decision-making. To be successful in research, you need to pay attention to detail. This means you need to be meticulous when conducting your studies, and when writing your thesis. The aim is to produce high quality work, for you to become an “expert” in a particular area.

So think carefully about whether a research higher degree is right for you and do your homework before you make any commitments.

But also think of how you might feel when you have completed your MPhil or PhD. As one of our students said, upon completing her PhD, “I think WOW…. I‘ve just completed a PhD and I’m sure I have a silly grin on my face!! People must think I’m bonkers! Its all a bit weird and quite remarkable.”

Andrea Bialocerkowski Head of School School of Allied Health Sciences Griffith University a.bialocerkowski@griffith.edu.au

Leanne Bisset Research Higher Degree Coordinator School of Allied Health Sciences Griffith University l.bisset@griffith.edu.au

AHTA Handwriting Course Review The AHTA writing course was held over the weekend of the 24 -25th of June and although interested in the topic, I admit to feeling less than enthusiastic early on Saturday morning to be giving up my weekend. Fortunately my lack of enthusiasm was short lived, as the course proved to be very informative and interesting.

The presenters Amy Geach and Abbey Philpott are competent presenters and generous with their knowledge. They are particularly skilled at facilitating participant input and this greatly enhanced the amount of information shared. The atmosphere was relaxed and participants had varying levels of experience in this field of expertise. Clinical pearls were shared between the participants and the presenters.

The course progressed through the topics of: Components of Hand Writing; Common Conditions Affecting Hand Writing; Assessment of Hand Writing and Intervention ideas. The course content was presented via slides and discussion and each participant was provided with a comprehensive folder. The folder contained course notes (slides), appendices containing some standardised assessments and intervention ideas, a glossary and a resource list. Amy and Abbey were happy to provide additional information raised in questions. The conference started and finished on time and the number and duration of breaks enabled networking and further discussion.

Several of the therapists expressed ethical concerns regarding requests for special consideration for exams and there was much lively discussion around this topic and the teaching of handwriting in the schools.

The venue was difficult to access via public transport not being in the Melbourne CBD; however a less central location may have been a better option for those ‘out of towners’ seeking more economical accommodation nearby. The room was small and initially had no desks however the ever resourceful Amy and Abbey managed to source tables and water which added to our comfort. On a positive note the small size of the room encouraged more informal discussion, and a relaxed atmosphere.

In conclusion I enjoyed the conference and I came away with a renewed appreciation of the complexity of handwriting and I feel more confident to approach the growing number of handwriting referrals.

Cath Reid www.ahta.com.au l 21

REPORTS

President What’s on your mind??

In the past, the return rate on the AHTA annual member survey has been around 12%. In order to improve on this, we have decided to distribute the survey during the conference, as a live event. We will be simultaneously emailing the survey monkey link out to members and associates who are not attending the conference and this link will remain open for 24 hours.

We have looked at the member survey very closely this year, and re-written the different sections to find out what really matters to

you. The annual survey represents the clearest opportunity for you to influence the direction of the AHTA, so we urge you to give the survey your attention and tell us what’s on your mind.

The management committee looks forward to the survey results and uses your responses when they are formulating the strategic goals for the upcoming year.

The mission of the AHTA is to advance the profession of hand therapy. Do you have any big ideas or any simple suggestions to help us to continue to achieve our mission?

Hope to see you in Adelaide!

Best Regards,

Karen Fitt president@ahta.com.au

ADVANCE YOUR SKILLS & KNOWLEDGE IN HAND THERAPY BY ATTENDING THESE AHTA TRAINING COURSES      

Quality post-graduate education programs Developed and accredited by the 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) hours

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

2018 COURSE DATES INTRODUCTION TO HAND THERAPY

ORTHOTIC FABRICATION – MOBILISATION

16 March 2018 14 July 2018

13 – 14 April 2018 15 – 16 September 2018 23 – 24 November 2018

Melbourne Perth

FUNDAMENTALS OF HAND THERAPY 17 – 18 January 2018 11 – 13 May 2018 6 – 8 September 2018 6 – 8 December 2018

Canberra Melbourne Sydney Brisbane

ORTHOTIC FABRICATION – IMMOBILISATION 16 – 17 February 2018 15 – 16 June 2018

Adelaide Gold Coast

22 l AHTA NEWSLETTER l JUL - SEP 2017

Sydney Perth Melbourne

ADVANCED TRAUMA: OPEN 1 – 3 February 2018 6 – 8 August 2018

Perth Townsville

ADVANCED TRAUMA: CLOSED 22 – 24 October 2018

Melbourne

REPORTS

www.ahta.com.au l 23

REPORTS

Education The Education subcommittee has been very busy in the past 3 months organising next year’s courses venues and dates. These will be released in

• Carmel Bohan – Sports Injuries

the next month. We have reviewed and developed all of the core courses and are rolling out new and improved course content. Helen Fitzgerald with the assistance of Hamish Anderson have reviewed and updated both the Mobilisation and Immobilisation Orthotics courses. Vicki Strelan has reviewed our current fundamentals course and developed the Open Trauma.

Vicki also has in the pipeline the development of a Closed Trauma course.

We have Amy Geach’s – Managing the Lymphatic System in Hand Therapy running later in the year with additional specific courses being sourced i.e. An Elbow course and Dry Needling to add to our depth of practice.

We have bridged the gap in becoming involved in hand therapy with an introductory course, Hand therapy 101 which Chris Harwood has expertly taken on.

Diverse ‘one-off’ courses have been offered throughout the year with high attendance and positive feedback received, these have included:

of the Elbow, Wrist and Hand

• Karen Fitt – Assessment and Treatment of the Wrist

• Amy Geach – Managing Handwriting in Hand Therapy

We have a shortage of Course presenters nationally and have just released an expression of interest to recruit suitable skilled applicants to be trained in the delivery of our core courses. The advertisement for this role has already been sent out, with the criteria for applicants.

Geographically our country can present us with challenges to ensure that equal opportunities are provided to all members. The webinar programme which has been operational for some years now continues to deliver a broad range of educational opportunities to all of our members. To further compliment the use of digital media

to reach our members we proposed that an educational grant would enable better equity to those that are disadvantaged by their remote location. This year we offered six grants ($500 each) to suitable members that meet the ‘rural and remote’ criteria to use towards attending our core courses. What a great incentive to further promote a hand therapy skill base across the nation.

The education subcommittee has grown to five members which has been essential to meet the growing needs of our members. I have been fortunate to work with an exceptionally enthusiastic team and am looking forward to striving to meet the ongoing requirements of our new accreditation process.

Carla Bingham education@ahta.com.au

AHTA 1-day course

Introduction to Hand Therapy Saturday 2 December 2017, Brisbane

This course bridges the gap between university and work, prepping therapists for their impending rotation into hands or providing the skills required to apply for an entry level position in private practice.

Visit the Online Store at www.ahta.com.au to book your place today 24 l AHTA NEWSLETTER l JUL - SEP 2017

REPORTS

Advocacy The Advocacy committee has met again recently and actions taken on many fronts to support our members. Along with the Accreditation Steering Committee we are working hard towards the roll out of the AHTA Accredited Hand Therapist credential in February 2018.

On other fronts

• There has been continued

•

communication with OTA with bimonthly teleconferences between myself and Anita Volkert (National Manager – Professional Standards and Representation for OTA).

We are continuing to keep communication open and are working toward some collaboration.

OTA has agreed to look into the ability of OT members in Victoria to sign TAC forms and

• •

•

•

the ongoing desire for QLD OTs to order x-rays.

Communication to the members re My Health record was undertaken via E news.

Keeping in touch with AHPA has been useful and I have disseminated information relevant to the membership via emails and E News.

An updated letter has been written to the Health Funds to inform them of terminology for custom made splints so that they are all on the same page.

This should assist in raising the profile of the AHTA in their space.

In the new year, we will look at presenting our Accredited Hand Therapy status and look for further cooperation from the health funds with rebating for splints

• The NDIS and the language used by therapists so that they can claim and provide effective services for their clients is also being looked at.

I look forward to seeing everyone in Adelaide in September. It looks like a wonderful program and I know the local committee has worked extremely hard to get the programme together.

Helen Burfield pastpresident@ahta.com.au

Summary of the Management Committee Meeting held 7th Aug 2017 •

AHTA National Conference – Adelaide September 2017. Numbers are steadily increasing for the conference and there are still some spaces available for most of the workshops still. To register click here.

•

Management Committee are currently progressing a Memorandum of Understanding with the APA around attendance of courses and also currently exploring an opportunity for the Association to become the leading provider for Orthoses courses. These are exciting avenues for the Associations and all discussions /feedback are carefully considered by the Executive before any agreements are entered into.

•

The Research and Scholarship Committee have extended the deadline for submissions for applications this year with a revised date of the 31 August. Email sent to all members. Link to application process can be found here.

•

We are currently actively recruiting for Course presenters. Criteria has been reviewed and we encourage any of our Members who would like to pursue this avenue with the Association to apply. Emails will be sent out shortly or you can contact Kate at executiveadmin@ahta.com.au

•

Final stages of the Education program for 2018 are being confirmed as we speak and will be published when available. Check out the website, your inboxes and social media platforms for updates

•

Management Committee members are busy writing their annual reports at present and prep is underway for the AGM. We also have some positions available for nomination and we encourage you to get in touch for further information info@ahta.com.au o President Elect o Education o Marketing o States & Territories

Sarah Dixon Executive Support Manager (Ops)

•

A motion was passed for the Credentialing Committee to commence the process of gaining approval from AHPRA to use the title “Accredited Hand Therapist”.

We will inform of any updates / outcomes as we receive them.

•

Further discussions and investigations are currently underway in regards to the following and appropriate updates will follow: o Professional Indemnity Insurance Proposal – Still working on this one! o Corporate partnership with Performance Health o Developing countries being able to access the AHTA Google Group – your feedback will be sort shortly to identify any objections o Combining our Conference in the future – Policy required o Advertising external events policy is being developed to ensure consistency

www.ahta.com.au l 25

REPORTS

Membership The Membership Committee continues to be a busy with applications. Many associates are working closely with their mentors to finalise application for Membership prior to the deadline of the 31 December 2017. January 2018 will see the roll-out of Accredited Hand Therapist and a change in the Member application process.

Thank you to all the hardworking members of the Membership Committee. Membership numbers now exceed 765 (life members, honorary, members, associates, affiliates and subscribers) Congratulations to all our new AHTA Members:

• • • • • • • • • • • • • • • • • • • •

Elaine Leahy NSW Natalia Alfaro NSW Rachel Tattersall WA Amanda Robertson VIC Susan Williams QLD Jamie Harradine ACT Terra Bredy QLD Taya Klisowski WA Stacey Jackson QLD Sally Bewley QLD Daniel Vukovic NSW Sarah Walsh NSW Sheree Colquhoun NSW Emmeline Fooks VIC Leanne Graham VIC Lauren Storey NSW Thuy Tran WA Anna-Lisa Baker WA Germaine Sim QLD Shawn McDowell QLD

Welcome to all our new Associate Members:

• Anna Matthew QLD • Terry Johnson QLD • Wendy Maher QLD 26 l AHTA NEWSLETTER l JUL - SEP 2017

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Anne Dillon VIC Mark Polley QLD Grace Delaney VIC Jamie Exton NSW Wai Sze (Zoe) Ko VIC Anna McGlynn NSW Nicole Perera WA Clare Beintema WA Kimberly Williams QLD Melissa Clifford VIC Georgia Gillett SA Regina Rousson NSW Georgia Cooper VIC Rachel McKay Cameron WA Ashild Krige QLD Simone Paget WA Victoria Deacon NSW Nikki Hiscock NSW Abbey Philpott NSW Graham Pemberton VIC Pei Yuan Lum WA Ashleigh Robbins VIC Amelia Clarke VIC Mitchell Lawson QLD Hannah Meecham QLD Hannah Kurnadi QLD Rachel McGough WA Kathryn McDougall VIC Kassandra Jarvis WA Hayley Calata VIC Melinda Overland VIC Carly Williams WA Nichola Quinn VIC Katelyn Morrissey VIC Fiona Beverley NSW Hayley McLellan NSW Gail Kingston QLD Christine Redmond SA Danielle Chambers NT Julie Brayshaw WA Aleasha Ward NSW Regina Gordon QLD Katie Street NSW Jenny Martin QLD Tamika Fasoli VIC Nicola Thomas QLD Ross Bruce VIC Rodney Wenceslao QLD

The introduction of the new AMS has necessitated the review of CPD points accrual for new Members and maintaining membership. In addition, evidence forms have been updated for contributions to the profession, informal education, proof of hand therapy caseloads (for those in non-full time hand therapy positions and conferred applicants). These forms will be used for Member applications for coming 6 months and maintenance of membership. These forms have been made readily available for copying on the website and have been distributed to the membership via email.

I look forward to receiving all new Member applications and those preparing their CPD documentation for maintaining Membership at the end of the year.

Katie Whittle membership@ahta.com.au

REPORTS

Communications We are looking forward to meeting everyone at the Annual Conference in SA. I will be there so if anyone is thinking of contributing to the newsletter but not sure please grab me for an informal discussion.

The Google group continues to have lots of varied topics and great advice. I wish to thank everyone for being aware of all the rules so there are no copyright issues. We have 429 members. There has been activity of sharing in the CHT AHTA group so if you are going for the CHT exam in November contact me to put you in touch with others who

are studying hard communications@ ahta.com.au.

There was an issue with google groups where some people stopped receiving posts. Once we were alerted then we removed them from the google group and added them again as a new member. This fixed the posts. This anomaly has apparently been happening to all google groups.

Don’t forget full members get 1 free Enews advertisement per year. See the list on the website under full member benefits.

We wish to welcome Performance Health as a major sponsor. You will see them more in newsletter, Enews and conference.

Julia Wild communications@ahta.com.au

Marketing & Promotions Hi everyone,

Conference exhibition

Handouts

In late August we held an exhibitor stand at the National Allied Health Conference in Sydney to promote our association, the hand therapy industry and encourage signups to our memberships and also our workshops. I am currently also working on a new design for our marketing posters and pull up banners.

This month I have been meeting with a graphic design team to work on the final stages of developing some diagnosis handouts that will be available on our website for the public. These will showcase some of the common hand and wrist conditions that we treat. The handouts are being designed so you can also add you own logo on to the handouts to be co-branded with the AHTA. More information about this will be available over the next two months. Anyone interested in writing a handout would be warmly welcomed!

Please let me know if you have a great handout on a particular topic already that you would be happy to share.

Student marketing This year we have collated a list of universities that run undergraduate courses in physiotherapy or occupational therapy. Our graphic design team are currently updating our student brochure and as mentioned in past reports, this year we are aiming to host a ‘meet a therapist’ week for undergraduate students. I am seeking our members who are interested in being part of this. It would involve

donating your time for one night to be available to meet students. We are needing members from all over Australia to be part of this great event. You will receive a ‘pack’ outlining exactly what you need to do on the night. It will be informal and not designed to be scary!

I am looking forward to the conference. Be sure to come over to the AHTA conference booth and say hi to myself, Sarah or Kate.

Warm regards

Amy Geach marketing@ahta.com.au www.ahta.com.au l 27

REPORTS

Research & Scholarships Many thanks to our dedicated subcommittee Andrea Bialocerkowski, Nicola Massy-Westropp, Lauren Miller and Susan Peters, and to our research mentors Dr Bronwen Ackerman, Professor Andrea Bialocerkowski, Dr Leanne Bisset, Dr Celeste Glasgow, Dr Nicola Massey-Westropp, Dr Susan Peters and Professor Kathryn Refshauge. They support the advancement of hand therapy through research with their work as volunteers in the AHTA and their personal research and teaching.

Remember that if you have any research queries the R&S mentors details are on the Research and Scholarship page on the AHTA website for you to make direct contact. If you are working in

a public institution – hospital/ university etc. – the mentors can also work with you to identify whether there is any funding available via your employment.

Please note that there is also funding available internationally.

The following excerpt is taken from the IFSHT Hand Therapy Connections Newsletter July 2017: “The American Hand Therapy Foundation’s (AHTF) mission is to fund research in hand therapy that would benefit the world of hand therapy. AHTF grants support research efforts. Grant applications are not limited to researchers in the USA but are welcomed from other countries. More specific details regarding grant requirements can be found at www.ahtf.org.”

If you are a volunteer and wish to access philanthropic grant funds, please go to the Philanthropy tab under the Research and Philanthropy heading on the AHTA website for details and application forms, funds are available every year, with no deadline for applications to be received by.

Nicola Cook presidentelect@ahta.com.au

Snapshots from the AHTA Orthotics Fabrication - IMMOBILISATION Course 29 & 30 July 2017, Prince of Wales Hospital (Sydney) Presented by Dave Parsons and Tracey Clark

28 l AHTA NEWSLETTER l JUL - SEP 2017

REPORTS

Library & Resources Access to online video courses continues through the Video tab of the Members section of the website, where there are instructions regarding username and password, and a link to the courses. Under the agreement, the following courses are available:

• Brachial Plexus: Secrets of Treating TOS

• Elbow: An Evidenced Based Approach to Effective Rehabilitation

• Intrinsics: Unravel the Mystery

• Ergonomics: Tips, Tricks & Trivia

• X-Ray Vision for the Therapist:

These online courses will be periodically updated, so members will have access to the most up to date information on these topics. This will obviously benefit members when they access online. Depending on demand for additional courses in this format, we will look into further expanding this avenue of online learning.

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

Adrian Jollow & Nicola Cook resources@ahta.com.au

Library Resources Review DVD – Burns – Stop, Drop and Rehab The DVD runs for 2 hours. The presentation of theory is by a key note speaker with reference to power point slides and video clips. I would recommend this to a beginner burns therapist.

The DVD provided a basic overview of burns management. It covered:

• • • • • • • •

Skin anatomy Zones of burn injury Burns classifications Wound care goals and management Guidelines for ROM post graft Splinting and positioning Common contractures Scar classification + management specific to burns

There were some key points that the speaker highlighted which I found to be of importance. These included:

• Therapists need to understand and respect the skin and healing process in order to best manage burns

• Patient education starts day 1 • Scar contracture when prevented should be • •

minimal Splinting and positioning is essential for effective burn care and scar management Healing is internal and external for the burns patient

My hand therapy experience has been in hospitals where we do not manage burns. I chose to watch

this DVD to begin to understand the basics of burn management. I learnt a lot through watching this DVD. There were some practical points that the DVD highlighted which has changed the way I have thought about burns management. These include a greater respect for wound dressings as they are key to maintaining function and limiting scar formation.

It is also important to open dressings up to visualise wounds before commencing aggressive ROM. I learnt more about contractures and in particular noted that it is much easier to prevent PIPJ contractures than to treat them and to pay close attention to the little finger as it is very common to contract. The DVD also highlighted that we can continue to change scars 3 – 24 months post injury.

As I currently do not have exposure to managing burns I will not be able to put into practice the methods discussed in this DVD directly to burns. I will be able to transfer some of this knowledge gained however to hand therapy that I do treat: in particular wound management; preventing scar contracture and maintaining ROM. Unfortunately, there is minimal evidence provided in this DVD. The word “literature” is referred to however with minimal details provided. There is no reference list at the end of presentation.

Anna Begbie Logan Hospital, Brisbane www.ahta.com.au l 29

REPORTS

States & Territories Did you know that if you bring along a colleague or friend that is interested in Hand Therapy to a Special Interest Group Meeting they can access their first meeting for Free? So if you know someone in your workplace that would benefit from a friendly education environment why not bring them along to the next SIG near you!

Liz Giuffre stateaffaris@ahta.com.au

VIC

We recently held our bimonthly meeting which was a great success.

Our presenters, Bernadette Kelly and Tony Berger shed great light on DRUJ instabilities and the TFCC. Our next meeting is to be held on the 2nd of October. We have 2 presenters: Samantha Mears will be talking to us about Infection of the Upper Extremity. Melbourne Hand Rehab will be discussing Tendinopathy in the Upper Limb. We look forward to seeing you there.

We are also very excited that the Combined Asia Pacific Hand Surgeon Conference in combination with the Asia Pacific Federation for Societies of Hand Therapy on coming to Melbourne. It is to be held from the 11th to the 14th of March 2020 at the Melbourne Convention Centre.

Thanks Hana 30 l AHTA NEWSLETTER l JUL - SEP 2017

SA

As 2017 is flying by us all the AHTA conference committee are finalising details for September’ conference. SA member’s; Jo Marsh, Kathy Minchin, Erica Elliot, Belinda DeGaris and Jordan Lefmann have been meeting regularly to help put this together and we are so excited for you all to come to SA to enjoy yet another amazing AHTA conference.

The latest IG meeting saw Tanja Klotz present her Master’s systematic review findings on the effectiveness of different moisturisers on scars. There were some glitches with communication of this meeting so unfortunately numbers were small. Those who attended got an opportunity to have a valuable practical discussion on scar management products and ideas.

There are so many inspirational members amongst our Association, here are some examples of some great work that SA members have been involved with in the last few months. Jo Marsh has been an active promoter for Hand Therapy. In June, she was interviewed by national ABC and local radio for Hand Therapy Awareness week and has featured in August’s ‘Yours Magazine’ discussing OA thumb. In addition to this Jo was the recently announced winner for 2016’s AHTA newsletter’s best research paper. Kathy Minchin travelled to Sri Lanka in July to share her skills and knowledge in hand therapy.

Suzanne Caragianis has returned to Bhutan where she has continued her work.

The next interest group meeting will be held in October, details will be released in early September. We will hopefully be trialling zoom for this meeting so please look out for the email about this closer to the date.

Kaveeta Deut

NSW

In NSW our most recent SIG meeting was on Wednesday 18th August, it was on the National Disability Insurance Scheme for Hand Therapy Providers. The talk was an interesting update on the NDIS rollout and what this means for therapy providers. Our next meeting will be Christmas party meeting on Wednesday 13th of December so please keep the date free! It will be at Sydney Hospital with the topic and further details to be shared with members and associates closer to the day.

Michele, Victoria, George & Jason

TAS Tasmania has a flourishing posse of therapists. We now have 9 members in total, including 5 Members, 2 Associates and 2 Life Members.

We are looking at holding our first face to face Special Interest Group Meeting later this year.

Lara Griffiths

REPORTS

QLD

There is so much going on in Queensland hand therapy in the last few months. There has been a number of positions advertised in both the public and private world.

Congratulations to all the successful applicants.

Many thanks to Michelle Rehbein who is continuing to work tirelessly to update the resources for the Queensland hand therapy networkwe really appreciate all the effort you have put in.

Congratulations to Sue Driessens, John McPherson and Brendon Gray for the success of their two day hand therapy course for QMOPN held in Brisbane recently.

We hope to reschedule our elbow meeting in the coming months.

Until then, we look forward to catching up at the conference.

ACT

Full membership has now grown with 5 full members (3 CHT’s) in the ACT in 2017. Special interest group meetings are continuing to be held on a bi-monthly basis with a range of local Hand and Upper Limb Surgeons offering their time to present at these education sessions. ACT therapists have also been invited to NSW Special Interest Group meetings via zoom which has provided additional education opportunities that have benefited our members. During Hand Therapy Awareness Week in June 2017, local therapists at Sportscare Physiotherapy held a ‘Think Hands’ event which was a great success for education and networking opportunities. The next Special Interest Group meeting will be held on Tuesday 29th August 2017.

Liz Wegener

Margo, Fran, Amanda and Charlotte

WA

AHTA WA’s third interest group meeting will be held on the 2nd of September and will be facilitated by Redimed.

We are expecting some really interesting presentations, which are still in the final stages of preparation. These include:

• Pollicisation: a case study • Hook plate ORIF • Therapy protocol post hemi•

hamate arthroplasty We are also hoping to have one of our surgical colleagues come along to present on the surgical aspects of these topics.

As usual we would like to welcome all those interested in hand therapy

NT We currently have eight members in the NT, two full members and six associates. Welcome to Danielle Chambers who recently joined us as a new associate member.

Due to our small numbers AHTA SIG’s are not held. We are now invited to attend both WA and QLD SIG meetings, which has not been widely used as yet; however, as remote access technology continues to be improved this may be another avenue of PD for our members to access.

There is also a general hand therapy interest group that is held every three months in Darwin, which has been running successfully for some time. This group is well utilised by our members who regularly attend.

Most therapists are making the trip to Adelaide to attend the national conference and are looking forward to some great sessions, sand and catch up’s!

Jayne Donovan

to attend. Rural therapists and those from states that don’t have their own state meetings are most welcome to join in the learning through the tele-health link.

July brought the Western Australia Society for Surgery of the Hand annual scientific meeting. This was an interesting meeting and was attended by many ATHA members.

This was a great opportunity to learn from and catch up with our surgeon colleagues and we were lucky enough to have some great interstate speakers including Professor Brain Morrison, Professor Randy Bindra and Mr Anthony Berger. ATHA member Brent Byrne from Sir Charles Gardner hospital presented a wonderful presentation on proximal phalanx fractures and the successful pathway and protocol

they have developed.

We would like to congratulate the following members who have recently worked hard to upgrade to full membership status: Sath Segra, Anna-Lisa Baker, and Thuy Tran. We would like to also welcome our new associate members Julie Brayshaw, Carly Williams, and Kassandra Jarvis.

We hope you have all had a great winter – I know we have had our fair share of football and hockey injuries - and are looking forward to some warmer weather.

Please fee free to contact us for any further information on ahtasig.wa@ gmail.com.

Vicky Allbrook, Jess De Jong, Sarah Fairthrone and Stuart Wilson www.ahta.com.au l 31

Product Profiles Evaluation Products Product Name

HALO Digital Goniometer

Supplier

RehaCare Pty Ltd

Description

Improves patient care and enhances practice management Some key advantages and specifications include: • Higher accuracy +/–1 degree - precision assessment for patient confidence.

• One handed use - you can now support your patient’s limb with your free hand.

• Faster measurements, clear, large LCD display - delivers reading for you, with no guesswork.

• Collimated laser beams - project the full length of any limb to intersect with anatomical landmarks for repeatable measurements

Designed for/ application

HALO was designed by our Australian Physiotherapy team for you. We need to present and practice with the best tools available to separate from competing professions. The manual or standard goniometer is over 40 years old and when used between two therapists has an error of up to 35 degrees. Good enough for your profession? No. Absolutely not. If your clinic, hospital, practice has more than one therapist then you have an inter-rater issue: Error between your therapists when measuring joints. This is the very problem we have solved with HALO. Patients report feeling a greater sense of trust with you when having HALO used on them, because they can see it is the latest technology. In their minds you are using the best tools which translates to patients feeling you offer a superior level of care. Besides superior benefits of HALO, such as the 1 degree of accuracy and the ability to capture any joint range in less than 5 seconds. Trust is key in keeping the patient, private client, returning to your practice. HALO is designed to evolve the practice of joint ranging, with its accuracy, reliability and speed. Lead the way, use HALO.

More info phone

1300 653 522

Website

www.rehacare.com.au

Product Name

Touch Test Two Point Discriminator

Supplier

OPC Health

Description

Consists of two rotating, plastic disks that are joined together. Rounded tips are spaced at standard testing intervals from 1 to 15mm, at 20mm and 25mm apart. One disk setting tests from 1 to 8mm, and the other setting tests from 9 to 15mm.

Designed for/ application

Tests static and moving two-point discrimination.

More info phone

03 9681 9666

Website

www.opchealth.com.au

32 l AHTA NEWSLETTER l JUL - SEP 2017

Product Name

Jamar Smart Digital Hand Dynamometer (PAT-081669928)

Supplier

Performance Health

Description

Electronic Hand Dynamometer that works wirelessly with a tablet app.

The free app (Jamar Smart App) includes the standard hand grip test and features- ability to set number of reps from 1-5, calculates average, standard deviation and coefficient of variation, compares results to norms based on patients gender and age. For a nominal fee, you can also download the fully featured app which includes the following additional tests; Rapid Exchange, 5 Position Grip and Sustained Grip. Results for 5 position and Sustained Grip also display as a real time graph for easier interpretation of results. With the fully featured App you can also export the results as a PDF (please refer to website for further details and features of the Jamar Smart Dynamometer)

Designed for/ application

Grip Strength Testing

More info phone

Customer Service- 1300 473 422

Website

www.performhealth.com.au (under Jamar Smart can download Jamar Smart flyer, manual and tutorial video)

Product Name

Recognise™ App

Supplier

Noigroup

Description

A large body of literature now demonstrates that Left/Right Discrimination (the ability to quickly and accurately recognise an image of a body area as either left or right) is impaired in a range of difficult pain states including neuropathic pain, phantom limb pain, Complex Regional Pain Syndrome, carpal tunnel syndrome and osteoarthritis. The Recognise™ App allows clincians and patients to both assess Left/Right Discrimination, and develop customised pain treatment programs as part of a Graded Motor Imagery approach. Recently updated, the Recognise™ App features new ways to train Left/Right Discrimination including Memory and Speed Match games, as well as powerful in-app tracking and graphing options.

Designed for/ application

Using Recognise™ has been shown to reduce pain, improve performance and assist with rehabilitation in a range of complex pain, and injury states, when used as part of a Graded Motor Imagery programme.

More info phone

08 8211 6388

Website

http://www.gradedmotorimagery.com/left-right-discriminiation.html www.ahta.com.au l 33

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

Susie Ellis

susiecue22@hotmail.com

0407 981 368

Helen Fitzgerald

hfitzgerald@inhand.net.au

0412 288 593

Emma Staples

emmatstaples@gmail.com

08 9272 1424

WA

AHTA 2.5-day course

Fundamentals of Hand Therapy Fri 3 - Sun 5 November 2017, Gold Coast

This course will provide you with a comprehensive basis for understanding hand injuries and conditions. It uses a dynamic format including lectures, case studies, demonstration and hands on practical activities. It teaches, anatomy, biomechanics, human structure & function, assessment and tissue injury & repair advancing our understanding of the hand and upper limb.

Visit the Online Store at www.ahta.com.au to book your place today 34 l AHTA NEWSLETTER l JUL - SEP 2017

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

08 9755 0416 / info@ahta.com.au

Email:

info@ahta.com.au

Web:

Executive Support Manager (Operations)

Kate Noller Executive Support Manager (Strategy)

www.ahta.com.au

02 6362 8170 / executiveadmin@ahta.com.au

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

VIC

ahtavic.sig@gmail.com

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

WA

ahtawa.sig@gmail.com

36 l AHTA NEWSLETTER l JUL - SEP 2017