NEWSLETTER OF THE
Issue 114, Jan - Mar 2018
Planning your year
Janet Dindler retires FEATURES
Feature: Goodbye, Goodluck - Janet Dindler retires
Study: Attitudes, beliefs and common practices of hand therapists for base of thumb osteoarthritis in Australia (The ABC Study)
Inaugural AHTA Credentialing Council
Research Hub: A helping hand toward research success
Review: AHTA Orthotic Fabrication - Immobilisation Course 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: email@example.com www.ahta.com.au EDITOR Julia Wild E: firstname.lastname@example.org ADVERTISING SALES Kate Noller T: 02 6362 8170 E: email@example.com
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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Feature: Goodbye, Goodluck - Janet Dindler retires Review: Flare following fasciectomy: a recent literature review Study: Attitudes, beliefs and common practices of hand therapists for base of thumb osteoarthritis in Australia (The ABC Thumb Study) Research Hub: A helping hand toward research success Research Hub: Applying for an AHTA Research Scholarship Consideration of surgical and therapy treatment needs for paediatric patients with 5th metacarpal neck fractures who are prone to hypertrophic scarring Review: A literature review on the effect of hand dominance and sex on wrist kinematic proprioceptive ability Review: AHTA Orthotic Fabrication - Immobilisation Course Feature: Inaugural AHTA Credentialing Council
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National Conference Update From the Editor Clinical Pearl - DeQuervains baby handling http://bit.ly/2I37m19 Contact Us
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President Education Advocacy Membership Marketing and Promotions Communications Research and Scholarships States and Territories www.ahta.com.au l 3
The 2018 AHTA National Conference will be held at Crown Melbourne from the 19th to the 21st of October, right in the middle of the city. In order to keep your hard earned dollars away from the blackjack tables, we are in the middle of creating a dynamic program for you! The theme for the conference is “Reaching for the Future: Innovation and technology in hand therapy practice.” We are excited to confirm that Lynne Feehan, a world renowned Canadian researcher and physiotherapist will be our keynote speaker. Lynne has published many papers, and has a special interest in fracture healing, imaging and the use of new technology in hand and upper limb rehabilitation. Registrations will open in March and we will keep you updated as the program develops. In the meantime please visit the conference website www.ahtaconference.com.au and join the mailing list! Looking forward to seeing you in Melbourne! Hamish Anderson & Leanne Graham 2018 Conference Co-Conveners
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 firstname.lastname@example.org. If you are looking to share accommodation, try using the AHTA Google Group to find a buddy!
CPD points can be gained by contributions to the Newsletter in the form of... • Blog • Website review • App/YouTube review • Book review • Course or conference review • Clinical pearl • Site profile • News item • Letter to the editor • Case study • Literature review • Research article
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From the editor Planning your year! Welcome to issue 114 and the first for 2018 “Planning your year”. Hopefully everyone had a good Christmas break and are planning 2018. The AHTA courses have had a lot of work put into them from feedback and review so look at the calendar and plan. We wish Janet Dindler a fond farewell. Thank you for all your insights, wisdom and great humour. We have benefitted from your contribution to the AHTA in all your committee roles and your many presentations at the Annual Conferences and State level. We will miss your quick turn of phrase.
Anyone thinking of doing the CHT exam year? “I just want to thank you all for the immense support and encouragement that I’ve received through this great group. It gave me courage and strength to know that I was not alone on the journey!”
Join the CHT google group. Send your request to email@example.com
A fun way to remember your myotomes and dermatones Choose your song and DANCE IT!! or stick to Dr Pohl’s from the Conference 2017
This year also marks the beginning of Accredited Hand Therapist – 71 new members. Check out the list. Congratulations to these full members. If you are unsure of the new pathway have a look on the website or ask State Mentors. Congratulations to the 20 members who completed their CHT. See the list. 2017 had 31 contributions to the newsletter so get your points up and start writing. There are several ways to contribute. If you are unsure please send me an email. See who won the article of the year. A few of the executive will change this year so read the reports to see who is leaving and who is coming on. Try being on a subcommittee to see how it works and consider a position in the future. Julia Wild AHTA Communications Officer Letters to the editor are welcome and may be emailed to firstname.lastname@example.org. Letters shtould not be more than 300 words and must be accompanied by the therapist’s name (published) and contact information.
https://www.youtube.com/watch?v=qhxnYft9KKw https://www.youtube.com/watch?v=WFVaT-CNml0 https://www.youtube.com/watch?v=4III9i0-P2A https://www.youtube.com/watch?v=ZXLhwF2ptl0
Bone density app “BoneGauge” There is a new free app by Dr Jeffrey Yao from Stanford University USA looking at the possibility of measuring bone density using a measurement ratio of the 2nd MC shaft width and length. They are looking for more data. If you take a photo of a hand X-Ray and use the app to measure the 2nd metacarpal shaft then add in age, gender and bone density scan measurement (if available). Our over 50 wrist fractures are likely to have the measurement as Australian GP’s are routinely ordering this. But they are interested in the entire population numbers and all nationalities to make any recommendations applicable worldwide.” https://www.ncbi.nim.nih.gov/pubmed/2824224
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Goodbye, Goodluck How Hand Therapy Became a Passion For Me (TO THE BEST OF MY RECOLLECTION!) From Janet Dindler In 1973, 5 years after graduating as a Physiotherapist, I came home after 3 1/2 years living in Europe. Qantas had a scheme with good airfares for young Australians but you had to use your return fare before the age of 26, and my time was up. I had spent two summers in London, a winter in Rome and two years in Denmark. My return fare ($400) earned 4% interest with Qantas and that was greater than the increase in airfares……then the oil crisis struck and prices went through the roof. My most recent job in Denmark had been treating brain injured children, so my first port of call was the Adelaide Children’s Hospital. They wanted me to be their senior neurological therapist and I wanted them to send me on a Bobath course in order to do that job by the current best practice, but that did not eventuate so I took the other senior job in town…. Adult neurology and the Hand Clinic at the Royal Adelaide Hospital (RAH). I worked alone in the basement of the physio department, treating individual stroke patients of which there were many then. And managing about 30 hand clinic patients per 3 afternoons a week in a class format with brief individual assessments and electrotherapy. I attended a weekly outpatient Hand Clinic run by Plastic Surgeons. Sandy Williamson had been my predecessor in that job and had left to start a private practice with her husband 6 l AHTA NEWSLETTER l JAN - MAR 2018
Tony. No OT’s were trained in SA at that time so physios did everything. “Everything” consisted mainly of active exercises and passive stretches. Much of which we now know is not the way to go! Flexor tendons were managed in a flexed POP backslab with a stitch through the nail to attach a rubber band by safety pin to the bandage, holding the finger in flexion for three weeks when it was all taken off The battle began to get rid of the inevitable PIP flexion deformity without rupturing the 2-strand tendon repair. Microsurgery (microscopes and instruments which allowed the repair of blood vessels, anatomical alignment of nerves, and repair of tendon sheaths) was developed in the 1960’s with great improvement in surgical outcomes for hand trauma. But the understanding of healing time frames, management of swelling, scar tissue and pain for the best functional result was still a way off. My only splinting training had been making plasters for children as an undergraduate, and even when thermoplastics arrived on the scene, I only made static splints. Those were by trial and error. Then one of the plastics registrars, fresh from training in the USA, turned up at clinic wearing dark grey slacks and navy jackets instead of the ubiquitous grey suits. The local doctors (they called him Fred Astaire). He was carrying photos (slides) of extraordinary high profile dynamic splints for managing things like MCP joint replacements in
Rheumatoid hands. (Swanson 1960’s) and a better way to manage tendon repairs. These he expected me to be able to do with no training, no heat gun and for straps, only white cotton tape, buckles and grey contact adhesive, which did not stick anything to anything. Then came Velcro and then self-adhesive Velcro to help us. The development of specialist Hand Surgeons in Europe and the USA and the skills developed by the therapists who rehabilitated their patients. Together with the arrival of polyester thermoplastics that could be moulded to the patient and completed in one sitting, and adjusted as things changed, were all fundamental to the development of splinting as a Hand Therapist. Professional development in Hand Therapy happened as surgeons shared their expanding knowledge and challenged therapists to find ways to solve problems related to swelling, scar tissue joint stiffness, tendon adhesions etc. In the mid 1970’s in South Australia there was still a lot of industrial hand trauma and Industrial Injury Clinics were built so that injured workers with nonlife threatening injures such as hands were assessed there and had their surgery done by private practitioner surgeons. But there was no one (apart from Sandy) to rehabilitate them. So when Ken Robson, plastic surgeon, started his private practice in North Terrace House, Hackney, I shared rooms with him and worked half time in private
FEATURE practice there and continued at the RAH doing inpatient medical chests and rheumatology. That was 1976. After one year he moved out to more space and I stayed for 28 more years. I remember the first patient for whom I had to make a flexor tendon splint with Kleinert traction, (hospital visit day 2!) was a fisherman who could teach me how to tie fishing line so it didn’t slip. The line was attached to the finger by a suture through the nail and was threaded through a pully (bent paperclip on thermoplastic bar in the palm) , and a rubber band was used to provide enough tension to flex the finger when the patient relaxed after extending the finger to the limit of the splint (Kleinert 1973) . The splint was made in 45 degrees of wrist flexion and 20 degrees of MCP flexion, IPs extended. How things have changed.! Hugely helpful publications such as the Journal of Hand Therapy and the formation of the Australian Hand Therapy Association did not happen until the early 1980’s so there was still quite a long period of primitive hand therapy being done by me! My children were born in 1981, 1984 and in 1985. Carol Walsh joined my practice as a partner, starting 20 years of collaboration and professional growth for both of us. Carol had a combined PT and OT qualification from Canada, and had also worked in the RAH Hand Clinic. So hand therapy standards at the practice improved a lot! My first AHTA conference and AGM was in Ballarat in 1984, and I have enjoyed my involvement ever since. We were only 20 members in 1984, and we became good friends. I’m 70 now and it is time to retire. I am really delighted that Charlotte Nash has bought my practice and moved to Adelaide. I wish her the same joy that I have had in Hand Therapy. Thank you all for your fellowship and friendship.
Janet Dindler - a tribute I’ve been asked to write a few words in recognition of Janet’s contribution to the AHTA and to the development of hand therapy as a recognised area of expertise in both South Australia and in Australia. I would also like to pay tribute to her wonderful sense of humour, generous nature, expansive knowledge and mentorship to many of us who have worked with her over our whole careers. Janet has written in her piece about where she started and her journey into hand therapy which was amazing and quite ground breaking in South Australia. I first met and got to know Janet when I joined the AHTA and began working with Sandy Williamson in 1987. Our AHTA committee meetings around the dining room table at Janet’s work partner Carol Walsh’s home, were a frequent feature of our lives then. I then visited Janet’s home on a number of occasions when teleconferences became a feature of the management committee and we would sit around her phone (saving AHTA costs by having less phone lines!!). Janet was always so supportive and encouraging of any young therapist and as a physiotherapist myself I saw her as a wonderful role model and mentor. She worked and collaborated with many surgeons and really helped put Hand Therapy on the map in the physiotherapy world, particularly in South Australia. Although I never actually worked in the same workplace as Janet, she was always generous with her ideas and tips on treating and splinting and I knew If I ever needed advice she
was there. She has frequently presented at our local annual Hand Surgeon and Therapist meetings and is never afraid to stand up for therapists and put across her points very eloquently, in true Janet style! Her contributions to the AHTA are many and have spanned much of her working life: •
Joined up in the second year of the AHTA in 1983
Served on the SA management committee many times over through the 1980’s in various roles
AHTA president 1998-2000
AHTA Vice President 2000-2002
SA Divisional rep 2002-2004 and again 2009-2012
AHTA & NZAHT Conference Committee 2003
Researched and compiled the AHTA History – Librarian Historian 2004-2006
Annual Conference Committees for Adelaide AHTA meetings
AHTA Advocacy committee 2015-2016
Awarded Life membership AHTA in 2004
She has attended too many local, interstate and overseas conferences to name them all. So, in summary – we have all benefitted in so many ways from having someone like Janet in our profession. We will miss her presence, knowledge and great humour at our local and national meetings. I wish all the best for her retirement – hopefully spending time doing some of her favourite things - fishing, reading and now – not working!
Helen Burfield www.ahta.com.au l 7
Flare following fasciectomy: a recent literature review Jo Marsh
This is a summary of a literature search I conducted last year and presented at the local South Australian Hand Surgery Society Annual meeting 2017. Following a very challenging case, I was interested to learn about incidence of flare post fasciectomy for Dupuytren’s contracture. In particularly pertaining to;
• whether we can predict a client who may experience a ‘flare’ reaction following fasciectomy for Dupuytren’s.
• whether flare reaction is more common in cooler climates.
• whether hand therapy can contribute to or help manage this complication. Flare reaction is described as identified by clinical inflammation and worsening stiffness, usually after 2-3weeks of unremarkable postoperative recovery (Zemel, 1987). I conducted this literature review of articles available to AHTA members via the AHTA website, from 2004- present;
• Hand Surgery (Am), • Hand Clinics • Journal of Hand Therapy. using the search terms: ‘dupuytren’s’, ‘fasciectomy’, ‘flare’ and ‘CRPS.’ I followed this up with a google search for cited articles; articles relating to anaesthetic techniques were 8 l AHTA NEWSLETTER l JAN - MAR 2018
excluded. The terms ‘flare’, ‘CRPS’ and ‘RSD’ were used interchangeably within and between articles, but rarely defined. I have used the term as given by each author in their article. FINDINGS Incidence The incidence of flare following fasciectomy was found to be 0-13% in a systematic review of seven articles published between 1960-2010 (Chen et al, 2011).Flare rate increases in correlation to number of digits undergoing fasciectomy. For one site was 2.5%, two sites 3.6% and three sites 4.5% (Rivlin 2010, retrospective review; 228 procedures, 191 patients). Regarding gender, one retrospective review of 66 females found flare rate of female: males was 2:1 (Zemel et al 1987). Yet at later retrospective review of 109 females and 548 males found flare rates between men and women were the same, yet CRPS rates were <1% in the females and 2% in the males (Anwar et al 2007). The incidence of concurrent CTR & fasciectomy was found to be 10.4% compared to 4.1% fasciectomy only in a literature review of four studies published last year (Buller et al 2017). A review of 20 clients undergoing concurrent operations similarly found 10% had RSD (Gonzales & Watson, 1991). Whereas ASSH member surgeons by questionnaire (response
n=698) concluded that 50% of those surgeons that conduct the concurrent operations; report a CRPS rate of 3% (Lily & Stern, 2010). Splinting Tension applied (volar or dorsal stretching scar) versus tensionfree (MCPJ -40 to -50° IPJ’s neutral) splinting was found to have increased rates of flare as reported by Evans et al 2002 following retrospective review (n268); Flare mild tension-free 13% tension 42% Flare severe tension-free 2% tension 10% Rivlin et al 2010, by a retrospective review of 191 hands reported a flare rate of 3.5% with tension-free splinting. Treatment I found nothing in the literature relating to treatment of flare or CRPS following fasciectomy for Dupuytren’s Disease. Impact on function The impact on function was touched on in a few articles. Zemel reported 76% of people who suffered flare following fasciectomy experience loss of ROM (Zemel et al 1987). A British Society of Surgery of the Hand questionnaire found; “The severity of
the contracture correlated with final hand function measured using the PEM score” (Dias & Braybrook 2006). And a prospective cohort study of 90 patients hand function before and after fasciectomy stated;;that “fear of hurting the hand and worry about not trusting hand function were of greater concern than other safety or social issues” (Engstrand et al 2014).
SUMMARY My questions of whether we could predict flare following fasciectomy, or whether cold contributed were not answered in my literature search.
You can easily become a newsletter member of IFSHT and find out international However, whether hand therapy has a conferences. They have a quarterly newsletter part to play, I found it interesting that and a link into ezine publication (Hand tension applied to splinting and splint Surgeons and Hand Therapists). position has been found to increase Future dates: https://www.ifsht.org/page/ incidence. And it is recommended to nationalinternational-education-events splint fasciectomy post operatively with the MCPJ’s flexed to about 40-50°, 3 March 2018 (all day) keeping the IPJ’s in neutral. International Hand Symposium Click here to view references Kathmandu Nepal
17-21 June 2019 IFSSH and IFSHT 14th Conference Berlin
National Conferences 28 Feb - 3 Mar 2018 Australian Hand Surgery Society Annual Scientific Meeting Perth WA http://www.tayloredimages.com.au/ahss2018/
6-7 April 2018 World Symposium of Congenital Malformations of Hand and Upper Limb 2018, Hong Kong www.wchs2018.org
19 - 21 October 2018 Australian Hand Therapy Association National Conference ‘Reaching for the future, innovation and technology in hand therapy practice’ Melbourne VIC www.ahtaconference.com.au
27 April 2018 (all day) 11th Annual Canadian Society of Hand Therapists Convention Ottawa Canada
29 Nov - 2 Dec 2018 NSW Hand Surgery Association 2018 Conference, Wagga Wagga, NSW
1 June 2018 (from 10am) Nerves Bussum Netherlands 13-15 September 2018 73rd Annual Meeting of American Society for Surgery of the Hand (ASSH), Boston, MA, USA www.assh.org/annualmeeting 30 November 2018 Check IFSHT Website for further details Netherlands 20 December 2018 (all day) Congress of French Society of Hand Surgeons and Therapists www.ahta.com.au l 9
Attitudes, beliefs and common practices of hand therapists for base of thumb osteoarthritis in Australia (The ABC Thumb Study) Vicki Duong Full text available at http://journals.sagepub.com/doi/abs/10.1177/1758998317731437 Background
health setting (65%).
Osteoarthritis (OA) is a chronic disorder with a major impact on quality of life and a high economic burden1. Amongst the different subtypes of hand OA, the prevalence of radiographic base of thumb OA is reported as high as 33% in postmenopausal women2.
The majority of respondents would refer the patient in the case study for radiographs of the first carpometacarpal joint at the initial visit (n=85, 74%). The common clinical assessment tools chosen by respondents are presented in Table 1.
Methods A customised web-based survey was sent to Australian Hand Therapy Association members between November 2015 and February 2016. The survey included a clinical case scenario of a patient with base of thumb osteoarthritis with questions about assessment and non-pharmacological and nonsurgical treatment interventions for this case. A series of 20 attitude and belief statements were provided and participants were asked to rate the statements on a 6-point Likert scale. Results A total of 124 therapists accessed the survey, of which 77 (62%) returned complete responses and 47 (38%) were returned partially complete. The majority of respondents were occupational therapists (n=92, 74%) and the remaining were physiotherapists. The majority of respondents were female (90%) and worked exclusively in a non-public 10 l AHTA NEWSLETTER l JAN - MAR 2018
The most common treatment approaches for the clinical case scenario were orthoses prescription
(n=96, 92%), pain education (n=81, 78%), heat (n=78, 75%), exercise therapy (n=77, 74%) and massage with a topical non-steroidal antiinflammatory drugs (NSAIDs) (n=55, 53%). All respondents chose a combination of treatments rather than a single therapy. Specific details for orthoses prescription, pain education and exercise therapy are described in Table 2.
Table 1. Common clinical assessment tools for thumb OA.
Table 2. Most common treatment approaches
Conclusion The findings highlight commonly used assessment tools and treatments for a typical patient with base of thumb OA. Despite the low response rate, there is consistency amongst general treatment for base of thumb OA.
Variation exists within the specifics of exercise and orthosis prescription. The results of the survey reflect the lack of standardised recommendations for the management of base of thumb OA. Further high-quality randomised
are needed to establish the scientific evidence for base of thumb OA.
Click here to view references
controlled trials and meta-analysis www.ahta.com.au l 11
A helping hand toward research success Lauren Miller, PhD Unit Head Hand Therapy (on maternity leave), Sydney/Sydney Eye Hospital If your New Year’s resolution is to begin some hand therapy research in 2018, then it might be worth taking some time to think about how you’ll go about it. What are you hoping to achieve? How will you know you’ve succeeded? Is your aim to undertake research that could be awarded funding via a grant or scholarship, published in a peer reviewed journal, or perhaps presented at a conference? If so, then it’s probably worthwhile considering the logistics of not only how you are going to begin your research, but how you are going to make sure that you complete it. Crucially, how can you ensure it will be fit for dissemination to the wider hand therapy community? A brief review of the AHTA scholarships awarded since 2012 demonstrated that those undertaking a project in affiliation with a university, or who had mentorship from someone with research experience, were more likely to receive a scholarship. Further, of those who received a scholarship, the researchers who were undertaking their project in affiliation with a university or with mentorship were more likely to stay on track with their project (progress reviews demonstrated milestones being met), and less likely to cancel or withdraw the project. Having support from university supervisors or research mentors 12 l AHTA NEWSLETTER l JAN - MAR 2018
provides a strong foundation from which you can launch. Academic supervisors have expertise in undertaking research that can attract funding, and ultimately get published. Experienced researchers can tease out your best ideas, steer you away from time consuming dead-ends and help direct your energy toward fruitful projects. This means you will have assistance with establishing your research question and designing a sound methodology to address it with minimal risk of bias. Having a well-designed project can in turn help you gain ethics approval more easily (and if you are in private practise, affiliation with a university may be the main way to locate an ethics committee through which to apply). A well-designed project will make it easy to complete grant or scholarship applications, and can also make your eventual paper/s both easier to write and more acceptable to peerreviewed journal editors. Further to mentorship and expertise from academic supervisors, affiliation with a university also provides statistical support and use of library resources, including online journal access. You also have the opportunity to earn a higher degree (like a Masters or Doctor of Philosophy) along the way, which can be a good motivator when it’s all feeling a bit hard! How to find a university supervisor?
Typing “higher degree by research health science” into a search engine located seven different universities across Australia offering higher degrees by research, with links to information on how to apply and who to contact to discuss further. In their feature article “Research Higher Degrees – Why, when and how?” (Fingerprint Issue 112) Professor Andrea Bialocerkowski and Assoc. Professor Leanne Bisset from Griffith University provided in depth information on what is involved with these degrees, and is an excellent overview of the commitment required. If you’d prefer to work with a research mentor rather than undertake a formal degree, then it would be worth establishing at the outset how the relationship will work, what each of you will contribute, and what time they are able to dedicate to helping you with your project. Good luck with all your New Year’s resolutions, and in particular your research activities for 2018. Get planning, and may you have great success!
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Applying for an AHTA Research Scholarship Lauren Miller, PhD Research and Scholarship Committee, AHTA
The difficulties associated with procuring research funding have again been highlighted in the media, this time by biomolecular scientist Professor Alan Mackay-Sim, our newest Australian of the year. In post-award interviews, he drew attention to the importance of both supporting fledgling researchers over the duration of their projects (rather than over a financial year), and fostering a culture of curiosity. Fortunately for us, the AHTA has provision to allocate $10,000 per annum to seed member research projects. But how can you get that funding? As a volunteer member of the Research and Scholarship subcommittee, I thought it might be timely to spotlight the scholarship, the processes involved in applying for it, and some observations about what makes some applications more successful than others.
Download and complete the “Research Scholarship Application Form” and submit it electronically to the AHTA Executive Support Manager by the 31st July each year. Applications are then distributed to the members of the Research and Scholarship subcommittee for evaluation.
The nitty gritty- where is all the information about this scholarship? Detailed information is provided on the AHTA website. From the home page, simply hover over the “Research and Philanthropy” tab, then the “Research tab”, then click on “Resources and Scholarships”. About halfway down the page, under “Scholarship funding” you can access both the “Research Scholarship Guidelines” and the “Research Scholarship Application Form”.
Strings attached? Well yes, if you are a successful applicant, you can’t simply ride off into the sunset on your favourite horse (tempting as that may be), never to be heard from again. The whole point of the scholarship is to seed research projects (and support researchers), with the ultimate goal being publication and dissemination of your findings, so we can provide better care to our patients. Hence, there is a list of “obligations of grant recipients” in the Research Scholarship Guidelines on the AHTA website. This
How do I apply? 14 l AHTA NEWSLETTER l JAN - MAR 2018
Vital stats? The past three years have seen an average of four applications per year, although we have reviewed as many as six applications in preceding years. The funding is often split between two or more applications. This is because many projects do not require the full $10,000 grant, or parts of different projects may receive funding for items in their budgets, but not the whole budget. So don’t be put off if you don’t need the full grant.
list includes: provision of an interim project report; details on how to access the second of two installments of the scholarship funding once half-way; dissemination of knowledge gained to other members of the AHTA via either peer-reviewed journal publication, AHTA newsletter article or presentation at an AHTA conference; acknowledgement of the AHTA in all publications and presentations carried out with the assistance of the AHTA research grant; and submission of a final project report. It’s all too much! Can I talk to someone? Yes! One of the great aspects of this Scholarship is that mentorship is available – there IS someone to help. In fact, there is a list of mentors directly under the “Scholarship funding” section on the website. Even if you haven’t accessed any of these mentors prior to submitting your application, on the application form itself there is the tick box option “Would you like an AHTA research mentor to email/call, who can guide you on a monthly basis?”. So support is on hand! How can I increase my chances of success? As outlined in the Guidelines, applications are evaluated according to the following selection criteria; 1. The significance of the project to the development of hand therapy evidence.
2. Clear rationale and identified need
for the project based on a sound understanding and thorough review of previous research. Suitability of study design, project methods, outcome measures and proposed analysis, to answer the research question. Feasibility of project and likelihood of meeting stated objectives within stated timeline. AHTA Membership consideration Length of AHTA membership and contribution to the field of Hand Therapy and activities of the AHTA will be taken into consideration.
Successful applicants provide a clear, organised, succinct application that addresses each section on the form with the above selection criteria in mind. Basically, for your project, you need to demonstrate: that it is important for Hand Therapy; where it fits in with what we already know and why it is needed; suitable design/methodology; AND that it is feasible. That is, it isn’t sufficient to send through cut and pasted parts of an ethics application, but neglect the crucial element of a feasible, well thoughtout timeline. Providing some evidence from your setting that you will be able to recruit enough participants in the timeframe you specify (i.e. by including some data about numbers treated in the preceding year or two) is one good way of assisting the subcommittee to estimate feasibility. Crucially, this is an application for funding. Once you’ve convinced the subcommittee that yours is a significant, needed, well-designed and feasible project, it is important to provide a clear breakdown of how any funds provided will be allocated in the budget. An itemised budget with firm quotes or evidence, rather than rough estimates of cost, is invaluable. We look forward to many great applications this year, and in years to come!
The AFHT also has grants available Apply Now: AHTF Grants The deadline for the following grants is February 28, 2018: • Founders Grant for Research in Hand Therapy - up to $30,00 • Learn more https://goo.gl/h2wTJK • Evelyn Mackin Grant for Education by a Traveling Hand Therapy - up to $5,000 • Burkhalter New Investigator Grant for Clinical Research in Hand and Upper Limb Rehabilitation - up to $10,000 • Judy Bell Krotoski "Grab the Evidence" Grant for Fundamental Research and Evidence-based Studies up to $10,000 Learn more https://goo.gl/1sKWFY www.ahta.com.au l 15
AHTA ADVANCED OPEN TRAUMA COURSE
Consideration of surgical and therapy treatment needs for paediatric patients with 5th metacarpal neck fractures who are prone to hypertrophic scarring Emma Justins The current literature points to different surgical technique options with many choices in fixation or stabilization modalities (some with more improved immediate and longterm outcomes than others). However, for therapy post-surgery, there are very few descriptions, and none of these attempted to outline the early, middle and late phases of treatment. The case study details are outlined as well as a surgery description, based on common surgical interventions for these injuries, conducted at a tertiary paediatric hospital. The phases of treatment have been described based on a gathering of knowledge, clinical experience from professional development courses, various clinical protocols and workplace guidelines, along with many years of Occupational Therapy work within three tertiary hospital hand therapy departments. Finally, a conclusion highlights the key points to consider when working with paediatric patients with 5th metacarpal neck fractures. Literature review Fractures of the fifth metacarpal make up 20% of fractures occurring in the hand. They are particularly common among young men and boys and are mostly to the dominant hand (Shen et al., 2017). 16 l AHTA NEWSLETTER l JAN - MAR 2018
The aim of surgical and therapy interventions is to enable best alignment with functional joint movement in a short time frame (Gulabi et al., 2013). The typical pattern of a metacarpal fracture is of a volar angulation deformity with a dorsal apex and they are inherently unstable because of the deforming muscle force, specifically the interossei, and because of volar comminution (Fujitani et al., 2012; Wong et al., 2015). For some, conservative management with closed reduction is possible, however for those demonstrating a shortening of >3mm, and angulation of the metacarpal neck by >30 degrees, surgery is commonly indicated (Cepni et al., 2016; Wong et al., 2015). Examples of the many surgical techniques include: Kirshner wire, intraosseous wiring, external fixation, low-profile plate, intramedullary devices or a combination of these (Fujitani et al., 2012). In the paediatric setting, Kirshner wires are the most common fixation seen (Nellans, Chung, 2013). Many studies have been done on the different methods of surgical fixation, though most are adult studies. For example, tension band wiring was compared to dorsal plating
of 5th MC neck fractures and it was found that the dorsal plate achieved greater improvement in fracture angulation and metacarpal height and ROM (Wong et al., 2015). Lowprofile plates were compared with intramedullary nails and it was found that postoperative ROM was better in patients with intramedullary nails, and grip-strength was superior in patients with the low-profile plates (Fujitani et al., 2012). Surgical techniques have also been reviewed including a study in 2015 by Kim and Kim, investigating antegrade intramedullary pinning compared with retrograde intramedullary pinning. They found that at 3 months there was an increased return to range of motion, less pain and increased grip strength in the antegrade group, whereas there was no significant difference at 6 months. Shen et al. (2017) did however consider the paediatric patient and have described antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced 5th metacarpal neck fractures in children. Their post-op program did not include therapy but a short arm plaster cast for 2 weeks, where the plaster was removed and patients were instructed by their doctor to commence functional exercises of the MCPJ.
Fracture healing was re-evaluated at 5 and 8 weeks and the TEN removed at 3 months if healing was satisfactory. There was no description of early, middle and late treatment plans. Overall, it was difficult to find information in the journal databases about the details of the phases of therapy for 5th metacarpal neck fractures. Information was mostly limited to brief descriptions about what cast or splint was used after surgery. Cephni et al. (2016) utilized a U-shaped ulnar gutter splint to the fourth and fifth MCP and including the IPJ’s in “semi flexion”. They removed the splint at week 4, but again did not describe their treatment plans for ROM or any complicating factors that they had to manage. When comparing hand based thermoplastic splints to a standard forearm based plaster ulnar gutter cast, it was found that paediatric patients with the hand-based splint had significantly improved total ROM of the injured finger at 3 weeks compared with those in the plaster, however there was no significant difference at 6 and 12 weeks between the two groups (Davison et al., 2016). It has also been described that “early active and passive ROM exercises are keys to ensuring a good functional outcome”, but again there was no detail regarding therapy treatments (Wong et al., 2015). On investigation of the treatment of hypertrophic scars, it was identified in a Cochrane review that hypertrophic scars can cause both functional and psychological problems for patients and the options of prevention and treatment of these scars utilising silicone gel sheeting was considered. The authors were able to identify that as a preventative measure, using silicone gel sheeting resulted in a reduced incidence of hypertrophic scarring in patients who were prone
to it. Additionally, as a treatment modality, there were improvements in scar thickness and colour. However, it was indicated that the 20 trials reviewed were susceptible to bias and therefore the evidence while present, was of uncertain quality (O’Brien, Jones, 2013). Case study details Pte S sustained a displaced fracture to his Right 5th MC neck from a sporting injury. The specialist opted for ORIF. Pte S is prone to hypertrophic scarring. He wishes to return to sport. The Salter-Harris classifications and management of growth plates are directly relevant to the paediatric population but his fracture was at the neck. Why mention Salter Harris here if it is not relevant to the case study # Surgery details The displaced fracture to R) 5th MC neck had significant volar displacement and was unable to be reduced with closed technique therefore a general anaesthetic with local anaesthetic to radial, median and ulnar nerves at the wrist was required for manipulation under anaesthesia to obtain reduction and fixation. A longitudinal incision was made to allow for a k-wire to be inserted and advanced in antegrade through the distal fragment and then retrograde through the proximal fragment. The position was checked with Intraoperative Imaging and K-wires trimmed with ends 1mm proud of the skin. Early treatment phase With surgical fixation, therapy should commence as soon as possible within the first few days. This early treatment phase can last between 2-4 weeks depending on healing time of bone and soft tissues. A factor to consider for the paediatric population is the location of the fracture in relation to the growth plate, typically classified using the Salter-Harris Physeal Injury Classification (Papadonikolakis et al.
2006). But this # pattern is not a Salter Harris. The initial appointment involves removal of the surgical cast and/or bandages, and utilisation of minimal dressings for the wound. Minimal dressings enable maximal oedema management practices as well as best fit of the splinting orthosis. Patient and parent/carer education is provided regarding the nature of the injury, typical healing time, importance of non-use of the injured finger and what they can expect for therapy and a home program for the next 6-12 weeks. Oedema management is commenced where indicated including elevation, massage, Kinesio taping, and/or compression. The benefits of early oedema management include minimizing the resistance to tendon gliding and ROM, and the reduced risk of hardening oedematous tissues around 9-14 days which lead to adhesions (Wu, Tang, 2013). A thermoplastic splint with MCP positioned into 70 degrees of flexion and IP’s in extension is fabricated. MCP flexion in the splint in combination with buddy taping of little and ring fingers together works to prevent the dorsal interossei from being activated and this therefore decreases the deforming forces to the fracture. For some children, a volar, hand based RF/LF splint is satisfactory, however for others who require additional protection, a volar/dorsal ulnar gutter style splint is indicated. Typically, medical recommendations are for commencement of AROM with a stable post-surgical fixation, with PROM often not recommended until 6 weeks (though this timeframe is also due to Medical reviews being standardly scheduled for 6 weeks post-surgery). This would include tendon gliding movements to enable FDS and FDP glide as well as isolated glide of EDC and the intrinsics.
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Treatment sessions in a tertiary paediatric hospital are typically weekly to fortnightly, depending on the wound healing, oedema reduction, presence of shortening, rotation or angulation, and initial range of movement assessed at the first appointment. If there are concerns with any of these factors, appointments are scheduled weekly with phone contact available at other times if needed. Complications to consider are wound non-healing or infection, severe oedema, soft tissue tethering, rotation resulting in scissoring (radially, toward the scaphoid), shortening resulting in extensor lag and therefore decreased strength, hypersensitivity or chronic regional pain syndrome, tendon rupture, or implant failure, to name a few. Timely liaison with the medical team would be indicated for anyone demonstrating rotation or shortening. For each subsequent early phase appointment scheduled, splint fit, comfort and compliance is assessed and adjustments made and ongoing education provided where needed. Wound review, oedema and ROM assessments are completed as well as a review of the home exercise program. For younger children, less likely to complete “exercises”, age appropriate play activities that facilitate the desired movements are discussed with the child and their parent/carer based on assessment of the child’s interests and usual activities, this may include action songs such as “open-shut them”, “Row your boat”, page turning or paper tearing for MCP flexion or other play based activities with minimal grip force for the little finger. Early application of moisturiser or initial scar management by taping would commence during this time frame. Middle treatment phase The middle treatment phase in paediatrics commences between weeks 2-4 and lasts until weeks 6-8 depending on wound, oedema, fracture healing etc. A typical presentation would have wound healing around 10 days to 2 weeks, reducing or reduced oedema, 18 l AHTA NEWSLETTER l JAN - MAR 2018
improving AROM with less or no pain with ROM and good alignment. These patient’s may be reviewed fortnightly or at the same time as their medical appointments to reduce the frequency of patients and families having to attend the hospital. For a child that is prone to hypertrophic scarring; who has persistent oedema; is not compliant with home exercise or play based activities; is demonstrating any rotation; and/or is experiencing ongoing pain, continued weekly appointments may be indicated. Each appointment would involve ongoing monitoring of splint fit, position and condition; oedema assessment and management with compression bandaging, scar massage, movement and education to families on how to complete bandaging at home; review of wound (if delayed healing) or scar management would commence. Scar management typically involves commencing daily massage, moisturizer application, and with full wound closure, the use of silicone scar products such as kelo-cote in the day and cica-care overnight. This scar management would be of particular importance to Pte S, as it is already identified that he is prone to hypertrophic scarring. Depending on the size of the scar, tubigrip, or if indicated, a hand based garment could be utilized (to add pressure) to further reduce the development of hypertrophic scarring. Active range of motion would be a significant focus during this time, as well as prevention or management of adhesions from scar, oedema etc. This is managed with an ongoing focus on tendon gliding exercises as well as the introduction of passive range of motion once medically cleared. Splint review, adjustment and weaning can commence during this phase as well as returning to light functional activities. Mobilising splinting may also be commenced in the latter end of this phase. An example of this could be using a relative motion MCP Flexion splint to the little finger so that increased flexion of LF is facilitated when flexion to the other digits is initiated. It is likely
that Pte S would benefit from ongoing education regarding not returning to sports activities until medically cleared sometime between 8-12 weeks. Late treatment phase The late treatment phase during weeks 6-12 sees the addition of commencing strengthening activities. The frequency of these appointments would be determined by the ongoing deficits in ROM or other complicating factors such as scar, signs of CRPS, non-union etc. For many patients, with good ROM and functional return to previous play, school and leisure activities (excluding contact sports), patients can be educated regarding the indicators to return to hand therapy and reviewed on request of the family or the treating team. For others with complicating factors, they may be reviewed past the 12 weeks. For those with ongoing ROM deficits such as at the MCP joint, ongoing passive range of motion and composite and individual flexion and extension mobilizing techniques can be utilized. For example, the relative motion flexion splinting and/ or flexion wrapping, and heat modalities can be utilised to aim to increase MCP flexion. Conversely, night extension or flexion splints can be utilized for ongoing ROM deficits. Ongoing daily scar massage would be indicated for any scar that is raised, with reduced pliability and decreased differential glide. Non-slip matting (such as Dyceem) with pressure applied in the opposite direction to the movement of tendons during active movements may further assist with improving scar and ROM outcomes. Conclusion Metacarpal fractures are common in both adults and children and can be treated conservatively as well as surgically. Surgical indicators include shortening of >3mm and angulation of >30 degree and can be done with many fixation techniques, however k-wire pinning is currently the most common (Nellans & Chung, 2013). There are limited descriptions of therapeutic interventions, apart from www.ahta.com.au l 18
some simple splinting treatments and follow-up points. The complications that can be experienced from metacarpal fractures such as shortening, malrotation, infection, delayed union or non-union, weakness etc. were not addressed in the articles reviewed. Therapy, based on clinical protocols, workplace guidelines, and clinical experience, involves positioning in hand based splints with MCP in flexion and RF and LF buddy taped together to minimize deforming forces; early AROM, oedema management and wound and scar management, as well as regular reviews to monitor for progression and improvement or presence of complicating factors as mentioned. Most treatment programs will finish between 6-12 weeks though can continue longer if complications are experienced, as well as with patients prone to hypertrophic scarring who require longer follow-up for scar management. Return to sport is guided by the medical team and can occur at any point from 8 weeks-12 weeks depending on speed of union, nil pain on testing and ROM. What is clear is the relationship between surgical intervention of metacarpal fractures and the need for early and timely ongoing hand therapy to ensure the best functional outcomes for our patients. Additionally, therapists working within paediatrics need to know action songs. Click here to view references
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A literature review on the effect of hand dominance and sex on wrist kinematic proprioceptive ability Jonathan Clerke & Dr Anita Clerke
Introduction The importance of studying wrist proprioception in the upper limb can be appreciated by noting that it can be negatively impacted by a large variety of disorders, including: carpal tunnel syndrome; brachial plexus birth palsy; Parkinson’s disease; loss of large myelinated fibres below the neck and developmental coordination disorder. A significant proportion of people with acquired proprioceptive impairment have had cerebral lesions, such as those caused by a cerebro-vascular accident. In a study involving twenty-eight people who experienced impairments from strokes for at least one year, FuglMeyer Assessment scores revealed that 75% of them had decreased proprioception of the contralesional wrist, and over 15% had similar impairments on the ipsilesional side. These significant numbers, coupled with the fact that the prevalence of people experiencing the effects of a stroke in some countries is over 1.1%, indicate a prominent need for hand therapy. Loss of proprioception can also arise as an iatrogenic effect, for example subsequent to elbow total arthroplasty. Temporary impairment of upper limb proprioception can 20 l AHTA NEWSLETTER l JAN - MAR 2018
occur due to fatigue of the muscles responsible for cervical extension. In order to discover effective means of treatment for people with wrist proprioceptive abnormalities, it is necessary to establish quantitative methodologies and baseline data. This includes elucidating any potential effects of sexual dimorphism and handedness on proprioceptive accuracy and precision. Both sex characteristics and dominance have been shown to influence proprioception in upper limb joints, such as the shoulder. The extent of the influence of these factors on wrist proprioception does not appear to have been reviewed. Aspects of proprioception Upper limb proprioceptive abilities have been assessed by quantitatively measuring the accuracy of a hand pointing at a target or mimicking a position with visual, and sometime auditory, cues being absent. Other studies have examined the perception of passive movement detection thresholds of the entire upper limb, especially those movements at the shoulder and elbow. The perceptions of limb movement (kinesthesia) and position (joint position sense)
have been collectively termed ‘conscious proprioception’. Passive movement detection threshold testing is considered by some as being the preferred method for purely assessing afferent sensation. Whereas joint position sense, which involves muscle contractions, memory and transfer of information between the hemispheres, demands more extensive involvement of the sensorimotor system. In contrast to these kinematic studies, kinetic proprioceptive studies have examined muscle force control, such as the ability to maintain a position or adopt a posture in the presence of externally applied forces. Some papers refer to kinetic and kinematic aspects using the terms ‘proprioception’ and ‘force control’ respectively, whereas others have considered both as constituting proprioception. The combined perceptions of force and movement velocity have been considered as the proprioceptive system that generates the discernment of viscosity. This literature review focuses on kinematic proprioception at the wrist. A number of parameters have been enlisted to study proprioception, including:
• Matching error (also known as absolute error), which is the number of degrees or millimetres by which a subject misses the target;
• Constant error: As for matching error but it also incorporates the direction of the error, and thus refers to overshoot and undershoot;
• Likelihood to miss the target by more than 18º;
• Movement amplitude: The size of the movement variations occurring during the task that were not directly in line with moving towards the target;
• Movement smoothness: A measure of the number of jerks involved in moving towards the target. Aims of the Literature Review The aim of this review is to ascertain to what extent, if any, proprioception at the wrist in normal subjects is influenced by sex characteristics and handedness. A secondary aim was to discuss explanations for any such impacts. Methods Searching of the Medical Literature Analysis and Retrieval System Online (MEDLINE®), the Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete), and relevant reviews and other articles was conducted. A search for literature reviews relating to wrist proprioception was also carried out. Inclusion criteria for relevant articles included: English, all types of study design, published before the 15 November 2017. Articles were excluded if the focus of an article’s research was based on small sample sizes and any of the following: perception of force generation, illusory movements, reflex responses, and animal studies.
Results Literature reviews: The search found three literature reviews which were considered to possibly have comments or citations relating to the influences of sex and handedness. Examination of them failed to find such comments or citations. Sex: Only one study was found to have relevant information (Taylor et al., 2015). It discovered a significant difference between the two sexes when assessing proprioception using circumduction. The males were superior in terms of the likelihood to miss the target by more than 18º. However, the means and standard deviations of the matching errors of the sexes were not significantly different. Handedness: The search resulted in finding four relevant studies. Taylor et al. (2015) found a significant difference between the two hands when assessing proprioception during circumduction of 80 subjects. The dominant hand was superior due to having less likelihood of missing the target by more than 18º. However, the means and standard deviations of the matching errors of dominant and nondominant hands were not significantly different. Wright Adamo & Brown (2011) found no significant difference in sagittal plane passive movement detection thresholds between the dominant and non-dominant hands when examining two different age groups (n = 10 in each group, and all dextralists). Adamo & Martin (2009) studied sagittal plane joint position matching using three different experimental conditions, namely ipsilateral remembered, contralateral concurrent, and contralateral remembered. The ipsilateral remembered testing condition was similar to the active wrist joint position sense test of other studies. The assessment of 12 young dextralist subjects found no significant difference between the hands in
relation to matching error, movement time, nor movement smoothness. The non-dominant hand was significantly slower than the dominant hand as detected by its decreased movement amplitude while at the same time having a similar movement time. A significant difference was also found between the hands using constant error for the contralateral concurrent and contralateral remembered conditions in that when the right (i.e. dominant hand) matched the left there was a large overshoot, and when the left (i.e. non-dominant hand) matched the right there was a large undershoot. The absolute magnitude of the over/undershoots were similar between the hands for both conditions. There was no significant difference in the ipsilateral remembered condition. Carey et al (1996) found no significant difference between the hands when testing matching error in the sagittal plane with their 50 healthy volunteers, most of whom were dextralists. Sex & handedness interaction: No studies were found that examined the possible interaction of sex and handedness on wrist proprioception. Discussion This review found only one parameter showing a sex effect on proprioception of the wrist, namely the likelihood of missing the target by more than 18º. Only three parameters were found that revealed a significant effect of handedness, namely: the likelihood of missing the target by more than 18º, movement speed, and constant error. In general there is a paucity of studies on the possible effects of sex and handedness on wrist proprioception. Therefore it is not possible to say that handedness and sex have only minimal impacts on proprioception at the wrist. The potential differences in proprioceptive abilities between sinistralists & dextralists does not www.ahta.com.au l 21
FEATURE appear to have been studied in relation to the effects of handedness and sex. However, these categories are known to have effects on aspects of hand function, such as the grip strength differences between the hands and proprioception of bimanual active finger pinch movement discrimination. The study of Taylor et al (2015) appears to have been the only previous study that assessed proprioception using a multi-planar technique that tested movements essential for circumduction. The conicoid movement of circumduction involves both sagittal and frontal planes, and most closely resembles functional movements of the wrist. As the degree of proprioception at the wrist within an individual varies according to the plane of movement, then it is important that circumduction be included in future
studies. An important issue relating to the studies on proprioception and dominance is that of the determination of how hand dominance is determined. Handedness can be determined based on questionnaires such as the Edinburgh Handedness Inventory, or objectively assessing which hand performs the best at various tasks, or observing the hand a person preferentially uses to reach out. Future research Ideally new approaches to the analysis of proprioceptive abilities should be employed to explore inter- and intra- individual differences. This includes cononical correlation analysis which is able to quantify movement trajectories involving more than one degree of freedom. Cononical correlation analysis is able to detect
differences in movement duration and amplitude despite the movement endpoint remaining unaffected. More studies need to research proprioception during circumduction. Conclusion There is a lack of data concerning the potential influences of sex and handedness on wrist proprioception during circumduction and other planes of wrist movement. This hampers clinicians’ abilities to determine reasonable rehabilitation aims and to assess percentage impairments in the upper limb. Studies involving larger numbers of subjects and different forms of proprioceptive assessment are needed.
Click here to view references
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AHTA Orthotic Fabrication Immobilisation Course Jodie Williamson
I attended the AHTA Orthotic Fabrication - Immobilisation Course on the 29th to 30th July 2017 at Prince of Wales hospital in Randwick with a colleague new to Hand Therapy. I am very grateful that my attendance at the course was supported by the receipt of an AHTA Regional and Remote Professional Development Grant. My aim in attending the course was to find out any new tips, tricks and pearls of wisdom that help other therapists to be successful with splinting and also methods for educating therapists new to splinting. The course was facilitated by Dave Parsons and Tracey Clark bringing a wealth of knowledge and experience to share with the group. The course successfully catered to all participants with various levels of experience. The supportive atmosphere that developed during the course was fantastic and enabled those with a little more skill to assist those who were trying splinting out for the first time. The pre-reading and study notes assisted greatly in directing appropriate preparation to enhance understanding and synthesizing the theoretical knowledge presented. The course content included Classification of orthoses, clinical reasoning, 24 l AHTA NEWSLETTER l JAN - MAR 2018
anatomical and biomechanical principles associated with orthotic prescription, and practical sessions for making Orthosis. The practical sessions were great for developing orthosis construction skills for DIP joint Immobilisation, PIP joint restriction, wrist immobilisation, hand based thumb MCP and CMC joint immobilisation and hand based finger immobilisation.
At completion of the course the exam offered a challenge to test how well the knowledge had integrated into my memory and my ability to recall and explain this information to others. This gave me an insight into my ability to take this knowledge back to my workplace and to educate my colleagues. Additionally the casestudy due 6 weeks following course completion further enhanced this
FEATURE learning by applying the clinical reasoning for prescription of an orthotic, construction and practical skills, and critiquing the properties of the splint. Upon passing all these course components 50 CPD hours were awarded. I am very appreciative of the pearls of wisdom that I learnt during the
course. I learnt alternative designs of orthoses for mallet finger injuries, swan neck deformities, wrist and thumb immobilisation. I learnt the importance of contouring for all the hand arches and concepts such as dual obliquity. I now understand in greater working detail how to achieve and benefit from mechanical advantage in the construction of my
orthoses. I would recommend this course to all therapists new to Hand Therapy and to those wishing to improve the quality of their orthotic prescriptions. I would also like to encourage any rural therapists to apply for the AHTA Regional and Remote Grant to enhance access to professional development.
School of Occupational Therapy, Social Work and Speech Pathology Prize Giving Ceremony The AHTA is proud to support Curtin University, School of Occupational Therapy, Social Work and Speech Pathology Prize Giving Ceremony, this years winner for Highest Mark in Orthoses and Upper Limb Rehabilitation is Megan Swindell Rabjones (top) and for HIghest Mark in Orthoses Rehabilitation, Catherin Whitten (bottom)
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Inaugural AHTA Credentialing Council We would like to introduce Australian Hand Therapy Association members to the make-up of the Credentialing Council for 20182021. The inaugural Credentialing Council of the AHTA will be made up of nine members. This is a departure from the original 7 proposed members as it was felt by the Accreditation Steering Committee that for this first Council there needed to be a smooth transition between the Steering Committee who have had stewardship of the process and thus an intimate understanding of every aspect of Accreditation of Hand Therapists, to the new model of Accreditation, of which the Credentialing Council is an integral part. As such, two members of the Steering Committee will be part of the Credentialing Council for the first three-year cycle. The process of deciding on the makeup of the Council was very rigorous, and involved advertising through an expression of interest (EOI) amongst our Hand Therapy colleagues via email, the website and the AHTA newsletter. Universities were also approached to take part in the EOI process, and for the independent members of Council we advertised in the Associations Forum, the Institute of Community Directors Australia, and Board Direction. From this we were lucky to have a number of suitable applicants take part in an interview process, and in some cases a second interview, to arrive at our current Council Members.
Meet the Council Members: Tracey Clark - Chair (AHT Member, Physiotherapist) AHT Member, Tracey has chaired the Accreditation Steering Committee from 2015-2018. She is a past Vice President and President of the AHTA, and has chaired or been part of the AHTA Governance Committee, the Advocacy Committee, and the Research and Scholarship Committee of the AHTA. Tracey works both in the private and public sectors in Sydney as a Physiotherapist and Hand Therapist. She has a Master of Science (Hand and Upper Limb Rehabilitation) from Curtin University, Perth, and is a Certified Hand Therapist (USA). Tracey is also a member of the Scientific Committee for the IFSHT 2019 Berlin Conference.
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Katie Whittle - Credentialing Portfolio Officer AHTA Management Committee (Formally Membership Secretary) (AHT Member, Occupational Therapist) Katie graduated from University of Queensland in Occupational Therapy. She established her first private hand therapy practice in 1994, and now practices on the Sunshine Coast in Queensland. She completed a Post Graduate Diploma in Hand and Upper Limb Therapy through Curtin University in 1992, and has been a full member of AHTA since that time. Katie became a Certified Hand Therapist (USA) in 2007. She joined the AHTA MC in 2015 as AHTA Secretary/ Chair of Governance and mentor for Queensland, and more recently moved into the position of Membership Secretary.
Elizabeth Ward (AHT Member, Physiotherapist) Elizabeth was a member of the Accreditation Steering Committee from 2015-2018. She is a past Vice President of the AHTA, and chaired the Governance Committee and the Research and Scholarship Committee of the AHTA. She was honoured with Life Membership of the AHTA in 2014. Elizabeth has worked in the private arena as a Hand Therapist since 1995 on the Central Coast NSW, and before that spent 10 years in the public hospital sector. Elizabeth has a Master of Public Health, and a Master of Health Science (Physiotherapy) from the University of Sydney. She is also a Graduate Member of the Australian Institute of Company Directors, is on the NSW Physiotherapy Council, and is a Board Member of the HNECC Primary Health Network.
Melanie McCulloch (AHT Member, Occupational Therapist) Melanie is the Director and Senior Hand Therapist at Re-wired Hand Therapy & Nerve Recovery in Melbourne, Victoria. She has extensive experience in the treatment of brachial plexus injury, and has presented at numerous AHTA conferences including a workshop on Nerve Transfer Rehabilitation in 2017. She has previously worked in the public sector and the UK as a hand therapist in a variety of settings since 1997. Melanie graduated from La Trobe University in Occupational Therapy, and has a Graduate Certificate in Hand Therapy from Derby in the UK.
Celeste Glasgow (AHT Member, Occupational Therapist) Celeste is a past President of the AHTA. She has chaired the Research and Scholarship Committee and been involved in member Advocacy. She has held many other executive roles over the years including Vice President, membership secretary and QLD divisional representative. Celeste has a PhD from the School of Health and Rehabilitation Sciences of the University of Queensland, and a Master of Science (Hand and Upper Limb Rehabilitation) from Curtin University, Perth. Celeste is an Occupational Therapist who currently works as an Advanced Practitioner at the Royal Brisbane and Womenâ€™s Hospital. She continues to be actively involved in research and has won multiple
Andrea Bialocerkowski (Academic Member of Council, Physiotherapist) Andrea is a registered physiotherapist and the Head of the School of Allied Health Sciences, at Griffith University. Her PhD, which she completed in 2002 focused on the measurement of outcome following wrist injury. Since that time, she has completed 2 post doctoral fellowships - one funded through by NHMRC on brachial plexus injuries in children. Andrea is an active researcher who has an interest in upper limb outcomes / rehabilitation and the education of allied health professionals. She has published over 90 works, and also has a Master of Applied Science (Physio) and Graduate Diploma of Public Health. Andrea was the first academic member of the AHTA and has been an active member of the research and scholarship subcommittee for almost 10 years. www.ahta.com.au l 27
Lisa Oâ€™Brien (Academic Member of Council, Occupational Therapist) Lisa is a registered occupational therapist and the Director of Research for the School of Primary and Allied Health Care at Monash University. She is based in the department of Occupational Therapy and teaches in the Graduate Entry and Undergraduate courses. Her PhD (completed in 2011) incorporated quantitative (RCT, cohort, and audit) and qualitative methods to explore the issue of treatment adherence in people with acute hand injuries. Lisa has previously served on the AHTA research and scholarship committee, and was co-convenor for Vic SIG meetings 2015-16. She has published over 75 works, and also has a Master of Clinical Science (Hand & Upper Limb Rehab) and Grad Cert in Clinical Research Methods.
Geoff Barbaro (Independent Member of Council) Geoff is a Graduate Member of the Australian Institute of Company Directors, a Chartered Manager and Fellow of the Institute of Managers and Leaders, and a member of the International Association of Business Communicators. He has degrees in eLearning, Communication Management and Law. Geoff brings a wealth of experience in governance, constitutional review, education, professional certification, accreditation and quality management. As General Manager at the Australasian College of Physical Scientists and Engineers in Medicine, he oversaw and contributed to the development and introduction of the first clinical training and certification programs for radiopharmaceutical scientists and contributed to assessment and credentialing systems.
Leigh Clarke (Independent Member of Council) Leigh is the Executive Officer of the Australian Orthotic Prosthetic Association, and is responsible for all operations of the Association including oversight of member services and regulation, certification and accreditation processes. She was also a consultant for the National Alliance of Self Regulating Health Professions (NASRHP), and undertook completion of an environmental scan of allied health standards for all Australian regulated and self-regulating health professions. She contributed to the development of draft standards for the NASRHP, including, but not limited to qualifications, recency of practice, code of conduct, course accreditation, and competency standards. Leigh has a Master of Public Health from James Cook University and is a Director on the Board of Allied Health Professions Australia (AHPA) and a Director on the Board of NASRHP. Duties of the Credentialing Council will include:
1. Review of applications from AHTA members applying to become an Australian Hand Therapy Association Accredited Hand Therapist and review applications for recertification.
2. To provide strategic advice to the AHTA MC on the development of standards, codes and guidelines for the AHT program 3. To provide high level advice to the AHTA MC about the development of the credentials within the AHT program, ie. Associate 4. 5. 6. 7. 8.
member, AHT, and eventually Advanced AHT and Fellow AHT To ensure that the AHT program meets the needs of the AHTA, AHPRA, members and other key stakeholders including consumers, with respect to safety and quality To liaise closely with the AHPRA regarding issues underpinning competency standards, credentialing, regulation, education, accreditation and recognition activities To ensure that the policies and process of the credentialing and auditing of AHTâ€™s are consistent with the health professions under the Australian Health Practitioner Regulation Agency To coordinate a program of total quality management and evaluation for credentialing and self-regulation Review of the assessment portion of the AHTA courses to ensure integrity.
We look forward to keeping you updated following the first meeting of the Credentialing Council at the end of February in Brisbane.
28 l AHTA NEWSLETTER l JAN - MAR 2018
www.ahta.com.au l 29
The Best Article for 2017 AHTA Newsletter Congratulations go to... Sophie Marden for her article Pisotriquetral OA in issue 112. This is a very thorough review of a problem not encountered frequently. She has outlined therapy options and surgical considerations when there is little written about this. Surgeons can see excision as an easy fix but the recovery is usually longer. She has won her membership cost for 2018. We all love and use Clinical Pearls. I have to mention the well written review of vitamin E’s role in scar management by Jacqueline Chevis in issue 114. This challenges some long standing beliefs and we all await Klotz and colleagues on their systemic review protocols hopefully to be published in the near future. The old mallet-finger-with-PIP-Hyperextension splinting issue by Carmel Bain is a great simple splint for a not so simple mallet finger. See the great solution in issue 113. The Scapholunate laser: a new approach to teaching the dart throwers motion by Lachlan Shaddock outlines a simple progressive Dart throwers exercise programme in issue 114. Check out the pictures. Unusual swelling from a tourniquet by Lisa Kennan in issue 114 does highlight a process of elimination to get to the source of an unusual problem that is rather extreme. Thorough papers outlining issues such as ulnar impaction syndrome, radial tunnel syndrome, dynamic splinting for DIP and PIP issues helps remind us to consider other options and the reference lists gives us a base for further reading. The early active vector adjustable Skin Traction for Phalangeal fractures by Jason Fairclough in issue 111 shows how hand therapy involvement maybe reducing surgery numbers on fractures. I’m sure Jason has had many requests for the full paper. Thank you to all the membership who contribute and give us pause to consider our practice, food for thought and a launching pad for new ideas. Don’t forget that past editions of FINGER PRINT are on the AHTA website. Julia Wild Editor FINGER PRINT email@example.com
30 l AHTA NEWSLETTER l JAN - MAR 2018
President Happy New Year! Welcome to the first newsletter for 2018. Congratulations to all Members of the AHTA who are now recognized as Accredited Hand Therapists (as awarded by the Australian Hand Therapy Association). We are working on a marketing plan to promote the new credential and already we have had an article published in the Australian Hand Surgeons newsletter. Please ensure you follow the guidelines set out by the committee regarding the correct use of the logo and the correct wording on your material. To those Associates who did not fulfil the criteria within the given timeframe, we encourage you to join the AHTA credentialing program. You are valued members of the AHTA and we hope to see you become our first â€œgraduatesâ€?. Association Management System: Our entire association will soon be hosted on a platform which will enable the staff to get off the excel spreadsheets and join the modern world of professional associations. We are currently in the final phase which is building the website and shortly testing will begin prior to launch.
Karen Fitt President 2017
As a member you will benefit by a professional website, or interface with the public which will drive people to seek out hand therapy practitioners. You will find it easier to sign up for courses, renew membership, and find the information you want. IFSHT news: Our international body is currently accepting nominations for executive committee positions for the next three year term commencing 2019. These positions are: PresidentElect, Secretary General, Treasurer and Information Officer. Therapists with a passion for, and experience in leadership positions are ideal candidates. There are also a host of standing committee positions available. Job descriptions: https:// www.ifsht.org/page/ifsht-jobdescriptions Deadline is December 2018 for nominations. International teaching grant: US$1500 is available for an experienced therapist to provide hand therapy training in a developing country. Application is strongly encouraged.
shortly. Education: Our first Introduction of Hand Therapy Course was very well attended and received. Unused philanthropic funds from past years have been used to provide Interplast volunteer Sharon Goldby the opportunity to attend and now present the Introduction to Hand Therapy Course in Laos. In addition to philanthropic funds for overseas advancement of hand therapy, we also have a very generous series of grants for rural and regional therapists in Australia to improve access and hand therapy expertise outside of the main cities. Thank you for your support as I have muddled my way through a year of presidency. Best of luck to Nicola and Lara as I now move into the past president role. Best Regards, Karen Fitt firstname.lastname@example.org
Staffing: Sarah and Kate continue in their roles and we will commence the recruitment process for an event coordinator to replace Veronica
Nicola Cook President 2018 www.ahta.com.au l 31
Education We still have a couple of Rural and Remote grants ($750) left for this year, so don’t be shy you still have time to apply. Thanks to the additional sponsorship from Performance Health for these grants. Remember the scope of the funding will also be applicable to the AHTA conference and one off courses in addition to the core courses.
• Melanie McCullock
• Kathy Minchin
The main focus of AHTA education’s strategic plan is to:-
I would like to make a special mention and thank our course presenters and developers for 2017; their commitment and dedication is exceptional!
1. Invest in the review and update
• Joy Hanna
We are looking forward to 2018 with a great education programme mapped out for the year. With the roll out of the AHTA accreditation, our courses have been audited to ensure they meet all of the core competencies in hand therapy. We are currently developing an Elbow and Arthritis course, these are pitched to expand the scope and depth of elective choices available through the AHTA.
our core courses bi-annually to ensure they address current surgical trends and research developments.
2. Develop a broad range of elective course options.
3. Develop online accredited education modules.
4. Ensure that the AHTA provides equal opportunities to rural and remote therapist.
• Susie Stinton In addition to the team above, this years course presenters also include
• Hamish Anderson • Tracey Clark • Barbara Hall • Melissa James • Dave Parsons With Karen Fitt and Amy Geach booked to run one off courses.
• Chris Harwood • Helen Fitzgerald • Vicki Strelan I am also excited to announce that we have several highly skilled experienced therapist join our bank of course presenters and would like to welcome :-
• Shannon Edwick
Carla Bingham email@example.com
Summary of the Management Committee Meeting held 17th Feb 2018 •
The Management Committee met in Sydney for our first face to face meeting of the year
AHT has been rolled out and the first meeting of the Credentialing Council is set to take place in February 2018
Education is looking for more presenters, keep an eye out for calls for applications.
Conference preparations for 2019 are underway, we look forward to seeing everyone in Melbourne
The 2018 Media Kit will be ready for
32 l AHTA NEWSLETTER l JAN - MAR 2018
distribution to potential advertisers in the coming weeks •
Excellent uptake on Regional and Remote Professional Development Grants and with continued partnership with Performance Health, we look forward to continuing with this excellent initiative Development of the new website and Association Management System (AMS) is a little behind schedule. We are currently working on content for the website while the system is in the build phase.
We are looking forward to working even harder for our members in 2018
Kate Noller Executive Support Manager (Strategy)
Advocacy My last duty as I hand over the
chair of the Advocacy committee and finalise my last tasks as immediate Past President is to summarise the achievements and developments in the area of Advocacy in 2017.
We have continued to communicate with both the APA and OTA with regular telephone meetings and are working towards common goals in advancing Hand Therapy as an area to be recognised in both professions. We are hoping that reciprocal membership and attendances at each other’s courses may still come to fruition with a little more communication and fine tuning.
In becoming a “friend” of the Allied Health Professions Australia in 2016 has meant that through this association in 2017 many areas of national interest to our association have been highlighted and brought to the attention of the membership as they developed. Some of these initiatives were being involved in the launch of the “Close the Gap” initiative in February 2017, providing information regarding the ongoing roll out of the NDIS and the e-health
We have been working with SIRA and NSW workers compensation scheme to recognise hand therapists and have input into communication and setting of fees for treating hand trauma. The roll out of the Accreditation
Helen Burfield Past President 2017
process has been integral and will continue to be vital to further consultation with the Private Health funds and gaining recognition for further and wider ranging rebates for splints and orthoses. Continuing this work into 2018 will be vital. With the strength and number of members still growing steadily I see Advocacy as a vital component of the AHTA and I am proud of what we have achieved. Thank you to the Advocacy committee, the management committee and the Accreditation Steering Committee for hours and hours of tireless work! Helen Burfield firstname.lastname@example.org
Karen Fitt Past President 2018
www.ahta.com.au l 33
Membership At the close of 2017, the
Brodwen McBain VIC
Membership subcommittee worked tirelessly on reviewing and processing new Membership applications. The state mentors worked closely with potential new Members in collating their experience and CPD documents as per guidelines. The review process involved 3 separate reviews and successful applicants had to pass all 3.
Colleen Moloney VIC
Jane Hermolin ACT
Archena Fuller QLD
As of 1 Jan 2018, applications for Membership will be under the new credentialing pathway. Those who have not applied or fell short of hours in the previous membership cycle will only find the new process better structured, better mentored and more rewarding than before. Membership numbers now exceed 793 (life members, honorary, members, associates, affiliates and subscribers) Congratulations to all our new Accredited Hand Therapists (As awarded by the AHTA):
Colette Zemljic QLD
Kristy Pritchard QLD
Rosemarie Koh VIC
Lisa Bachmayer NSW
Helena Wieleman David Jacobs
Jayne Donovan NT Jeffrey Sanderson
Jodie Williamson NSW
Samantha Mears WA
Welcome to all our new Associate members:
Kerrie Sanderson QLD
Rebecca Darby NSW
Sheralyn Blanch QLD
Yvonne Fellner VIC
Paula Oâ€™Connor WA
Crystal Goodwin VIC
Catherine Boag VIC
Sophie Marden NSW
Michael Janetzki SA
Tyrone Williams QLD
34 l AHTA NEWSLETTER l JAN - MAR 2018
Cameron Small NSW Niamh Masterson Katie Shipp
Nichola Martyr QLD Zoe Battershill
Judith Feldman WA Taryn Collins
Kiandra McDonell WA
In addition, we would like to congratulate all the following Members who passed CHT: Catherine S. Boag Jessica Y. Chan Jeannette P. Davis Nicole M. Ekman Danielle E. Heinemann Jane E. Hermolin Michael J. Janetzki Nadia S. Jenkins
Brodwen McBain Colleen M. Moloney Montague O. Moss Taryn K. Post Jeffrey Sanderson Kerry L. White Helena J. Wieleman
The Credentialing Committee has its inaugural meeting (face to face) in late Feb 2018
Regards Katie Whittle email@example.com
George J. Kikilas Rosemarie W. Koh Felicia F. Lim Sophie D. Marden Lani H. McAuliffe
Marketing & Promotions Hello all! The marketing portfolio was quiet over the Christmas break. Belinda DeGaris, our wonderful social media coordinator, has been doing a wonderful job updating all of the social media accounts over the last two months. We have seen since this a great increase in our social media followers. Thank you Belinda. This year we are expanding our marketing reach to students. We did not get enough takers for the host a â€œMeet a Therapistâ€? event we were planning for last year where students can meet a hand therapy member and learn about our industry. We will try again for this in 2018 towards the end of the year. We have a graphic designer who has been assisting to update the branding
for photos, brochures and who has been working with us to create the new Accredited Hand Therapist logo. A large thank you to all the members who put their hands up to contribute content for the new information flyers that we are planning to have as downloads on our website. This was a wonderful effort from all involved. We are in the process of proof reading these, collating them and getting the content to the graphic designer. So far we have just over 10 information flyers on different hand therapy conditions that we can help with as therapists to promote to the public. Our next project for marketing is promotion of the Accredited Hand Therapist award throughout the year, and starting to get ready for
the annual Hand Therapy Week. We are also working closely with the Education portfolio on getting some photos organised for upcoming courses that we can also use in marketing going forward.
Many thanks Amy Geach firstname.lastname@example.org
www.ahta.com.au l 35
Communications 2018 is looking to be a busy year with lots of people already getting organised by the number of new members to the AHTA Google group already. If you have not encountered this then you should. There are questions and answers on the site for clinical to administration topics. The last 3 months has included discussions on swan neck deformity, Madelung’s deformity in Gymnasts, paediatric wrist ganglions, exercise regime on a osteoporotic wrist just to name a few. The CHT AHTA google group helped motivate so many people. Congratulations to the list of 20 people who passed. I already have someone signed up for the CHT this year. Let me know if you wish to be part of the group. We do not
announce those who are going for the CHT but they can contribute on the group when they are ready or find a study buddy close to home. Enews will be published monthly except for the months that the newsletter is released. Our membership views this 52.5% (industry standard is 15.6%!!). The newsletter will continue to be released quarterly. We had a great level of contributions last year so we are looking forward to the same level this year. I wish to thank all the contributors to the newsletter. This is the memberships newsletter so please let your colleagues know that their in-service /talk is of a great level and they shouldn’t let it go to waste. Get them to consider sharing it with the
membership by putting it into the newsletter. If we have too many we can put them in the next issue. If you have ideas you would like included in the newsletter please send me an email. Please read through the newsletter for your years planning of courses, conferences etc
Julia Wild email@example.com
Library & Resources It has nearly been a year since the online library was updated to provide the latest information for the following titles from the Exploring Hand Therapy series: • Brachial Plexus: Secrets of Treating TOS • Elbow: An Evidenced Based Approach to Effective Rehabilitation • Intrinsics: Unravel the Mystery • X-Ray Vision for the Therapist: I’ve Got You Under my Skin • All About the Thumb CMCJ Osteoarthritis • Burns: Stop, Drop and Rehab • Hand Therapy Boot Camp • Mirror Mirror on the Wall: Motor Imagery • Wound Care for the Hand 36 l AHTA NEWSLETTER l JAN - MAR 2018
Specialist: Heal em up Quickly
• Ergonomics: Tips, Tricks & Trivia To access these presentations, log in to the members section of the AHTA website, click on the video tab and it will provide you with the relevant login details. These resources include video presentation as well as Manual - PDF of slides from presentation. Please note if you complete any exams, the results and certificates will go to the firstname.lastname@example.org address. The account is for the AHTA and not individuals. To receive the 2 CPD points, you do not have to complete the exam, rather a written review Guide to completing this review: To assist in the editing process for the newsletter please:
Use Century Gothic 11 as the font; Answer using paragraphs without bullet points or tables. A thorough review should be 6001000 words long. Please include the following areas in your review: • What is the title of the DVD? • What level of practitioner would you recommend this DVD to? • Provide a general summary of this DVD? What are the key points covered? • How specifically will you be able to use the information gained in your practice? Please send reviews to resources@ ahta.com.au All other library items can be
borrowed on request by emailing the AHTA Knowledge and Resources / Librarian at email@example.com. Library loans are for 1 week only for those which are not available online.
There is no hire fee. Members are responsible for return postage (Registered Post) to Adrian Jollow, Suite 3, 1 Erskineville Rd Newtown NSW, 2042.
resources that you would be interested for the AHTA to include in the library, or as a bulk order and I will endeavour to increase the resources available. Adrian Jollow firstname.lastname@example.org
Please let me know if there are
Research & Scholarships / President Elect It has been a very active year in our committee. We have busily found ourselves reviewing and supporting the last 4 years of grants, and assessing the latest applications. We are pleased to announce that Luke Robinson was the successful recipient for 2017/8. We found his research proposal to be of very high quality and look forward to supporting him if/ as needed on the way and reading the outcomes of his project: ‘Epidemiology And Costs Of Sports Related Acute Hand Injuries: A Retrospective Analysis Of Two Emergency Departments In Australia’. The R&S committee has updated a number of items in the grant guidelines based on applicant feedback; we hope this will make the process clearer for anyone who
applies in the future. Lauren Miller has written a piece for this newsletter on how to get started with research. I would like to reiterate that some guidance or mentorship from an experienced researcher in the early stages of any project, will help you bring it to fruition in the most effective and satisfying way. There is nothing worse than running with an idea and finding out half way through your project that the question asked, or initial methods chosen weren’t robust enough to lead you to a project that can be completed and answer the question you wanted to answer. Please make use of the mentors listed on the website if you need any help ‘budding’ a research idea, and if you would like to apply for a grant then please write to the president elect email, and the committee can answer
Nicola Cook President Elect 2017
any queries you have regarding the grant process itself. I would like to take this opportunity to thank the R&S committee – Andrea Bialocerkowski, Lauren Miller, Nicola Massy-Westropp and Susan Peters, for their dedication and hard work. I feel very lucky to have worked with them for this past year; I have enjoyed our time together and learnt a lot. Thank you. Thank you also to all of the members of the management committee. I feel very grateful to work within a group of forward thinking, hardworking professionals, who all volunteer their time for the AHTA so generously. I have enjoyed this last year immensely. Thank you. Nicola Cook email@example.com
Lara Griffiths President Elect 2018 www.ahta.com.au l 37
States & Territories Welcome to 2018!! The year is already fast underway and our Divisional Coordinators have been busy planning and preparing a wonderful selection of topics for the upcoming Interest Group meetings. Make sure to read eNews and check your emails for the details of these fast approaching meetings or check out the AHTA website under the Education and Work tab to access the 2018 Divisional Meetings Calendar. You can also contact your Divisional Coordinators directly on the emails below with any queries, topic suggestions or presentation offers! It is also a good idea to contact them if you have recently moved interstate and want to know what is going on in your area. ACT: firstname.lastname@example.org NSW: email@example.com NT: firstname.lastname@example.org QLD: email@example.com SA: firstname.lastname@example.org
NSW IWe hope everyone had a Merry Christmas and welcomed the New Year in style. There was a fantastic turnout to our last special group interest meeting/Christmas party which was held at Sydney Hospital. Mitchell’s talk on vibration induced illusions and Kay’s talk of wound
VIC This year is set to be exciting for Victoria with the annual AHTA Conference - Reaching for the Future, to be held Melbourne this year. Our first SIG meeting was held on the 5th of February with two great presentations. Emily Donovan presented on Conservative Management of Proximal Phalanx Fractures and Fiona Moate presented on the management on Extensor Tendons in Zone 38 l AHTA NEWSLETTER l JAN - MAR 2018
TAS: email@example.com VIC: firstname.lastname@example.org WA: email@example.com There are a few changes happening among the Divisional Coordinators and I would like to take this opportunity to say a huge thank you to Lin Wegener who has been the ACT Divisional Coordinator for the past two years and a welcome on board to Victoria Gorringe who will be taking her place. We also have Charlotte Nash (previously one of our QLD Divisional Coordinators) moving to assist SA. Big congratulations need to go the members of Tasmania and Lara Griffiths as the Divisional Coordinator who organised and held their first face to face meeting at the end of last year where a case presentation on wrist pain was discussed. Hopefully this is the first of many face to face meetings for Tassie. I along with the Divisional product selection were informative and well received. George and Jason have an exciting year planned for the NSW state interest group meetings. The first meeting of the year will be presented by Dr Matthew Yalizis a shoulder, elbow and trauma surgeon who will be talking about Elbow Trauma. This meeting will be held at Southern Hand Therapy on the 28th
Coordinators are excited to keep moving ahead with a variety of interesting educational topics for the interest group meetings, providing you with feedback regarding attendance rates and Zoom access and streamlining the provision of the interest group professional education opportunities across the country in 2018. We look forward to working with our members to make 2018 a great year!
Warm wishes Elizabeth Giuffre firstname.lastname@example.org February 2018 at 7pm. If you have any news that you would like to be included into the newsletter or you have any suggestions for topics you would like to learn more about please don’t hesitate to email us at email@example.com We are looking forward to seeing you all there. Michele, Victoria, George and Jason
II. We had 28 attendees on the night and 33 attending via zoom, which was a great way to start off the year.
We would also like to congratulate the 15 members who have upgraded to full member status.
We would also like to recognise the contributions made by many hand therapists at the annual Victorian Hand Surgeons Society Meeting in November 2017. We would like to send big congratulations to Kelly Briody, Sharon Goldby, Emmeline Fooks, Jane Skeen and Jeff Sanderson for their great presentations on the day.
In Victoria we are still seeking volunteers for the upcoming SIG meetings. If you would to contribute to ensure these meeting can continue to run please contact ahtavic.sig@ gmail.com. Our next SIG meeting will be held on the 11th of April 2018. Hana, Helena and Marissa
SA We would love to take the opportunity to welcome everyone in SA to 2018, and we are hoping to provide an exciting schedule for the Special Interest Group meetings. We are aiming to provide bi-monthly meetings and will be investigating remote access to allow any remote Vic/WA therapists to join our program . We would also like to welcome a new hand therapist to the region – Charlotte Nash will be working with Janet Dindler as she transitions towards retirement. They will be working together under a new practice name ‘Full Circle Hand Therapy’. So expect to see a new face at the SIG’s as Charlotte will also be assisting in organising our regular CPD events. We are hoping to continue the meetings at St Andrews Hospital, but may trial holding the meetings on different evenings so that a broad cross section of people are able to attend. To increase the diversity of topics, we will be seeking assistance from all the major centres across Adelaide to secure a variety of speakers. Please email us on ahtasa. firstname.lastname@example.org if you have any ideas, educational needs, or would like to present (it’s a great opportunity to practice your presentation for any upcoming conferences!).
Please fee free to contact us for any further information on
2017 was a great year for AHTA WA. We had some informative and entertaining meetings and we are excited about what 2018 has in store for us in the West!
Vicky Allbrook, Jess De Jong, Sarah Fairthorne and Stuart Wilson.
We kicked the year off with a bang with the AHTA open trauma course being held in Perth. Those who attended loved the content and presenters!!! Our sub committee team is unchanged for 2018. Jess De Jong, Sarah Fairthorne, Vicky Allbrook and Stuart Wilson. We hope to continue to bring some excellent meetings to the great state of WA. Our aim for this year is to try to engage more rural and remote therapists with an interest in hands to attend the meetings via the telehealth link or our new Zoom system. We also welcome those in states that don’t have their own meeting to attend. The AHTA is continuing to offer the first meeting for non-members free. So please feel free to disseminate this though your networks. Our first meeting is being help on the 24th of March and is being facilitated by Specialised Hand Therapy Services. Many thanks to the team for hosting and we look forward to some excellent presentations from them.
We also have Dave Parsons attending our first meeting. Thank you Dave! Dave will We hope everyone has had a great start be discussing the new Accredited Hand to the year, and we hope to see you all at Therapist accreditation and will give us an update on the process and is there to the various events coming up. answer any question you may have. Kaveeta and Charlotte
NT With 2018 now well underway, our therapists have been busy as always. Our general interest group meetings will be starting up again in March, with dates
TAS 2017 was a great year in Tassie. We saw a significant increase in membership as members new and old cross The Bass
and topic to come. We will continue to have the opportunity to access AHTA interest groups from other states, thanks Sarah for circulating these emails. Our membership remains steady at nine, with myself and Karyn Hayes both achieving full membership at the end of from the mainland to join us here in the ‘apple isle.’ An interest group meeting was held in the north of the state towards the end of 2017 and I hope that we can extend the invitation to our friends in the south and north west and
QLD ‘Happy New Year to all our Queensland members! Sadly, we have farewelled Charlotte Nash from the QLD Divisional Liaison role. Charlotte has been outstanding in this role for over 5 years. She will be greatly missed and we wish her all the best in her exciting new endeavour in South Australia. To fill the void, we would like to warmly welcome Sally Colwell to join the QLD Divisional Liaison team. We’re certain she’ll make a valuable addition to our team. Currently, in Queensland, we have 217 total members. In the last quarter, we are proud to reveal that twenty members have recently upgraded from associate to full membership, and we also welcome 12 new associates. We are seeking volounters to present at our Special Interest Group meetings, and very much welcome anyone who might be interested in presenting. It is a wonderful way to earn CPD points. Please contact your Div Reps at email@example.com if you are interested. Otherwise, please keep an eye out for the SIG meeting calendar, which will be completed soon. We will endeavour to hold our first meeting in March. Amanda, Frances, Margo and Sally.’ last year. I’m very pleased to say that the NT now has five AHT’s, making up 55% of all members, which is an outstanding achievement. Well done to everyone for your hard work and ongoing commitment! Jayne Donovan join together later in 2018! I look forward to seeing where 2018 takes the growth of hand therapy in Tasmania. Lara Griffiths www.ahta.com.au l 39
SAVE THE DATE! For more information visit the website: www.apfssh2020.org
40 l AHTA NEWSLETTER l JAN - MAR 2018
www.ahta.com.au l 41
Contact Us Australian Hand Therapy Association Corporate Office
PO Box 5111 WEST BUSSELTON WA 6280
08 9755 0416
08 9755 0416 / firstname.lastname@example.org
Executive Support Manager (Operations)
Executive Support Manager (Strategy) 02 6362 8170 / email@example.com
MANAGEMENT COMMITTEE Position
0405 219 959
03 9458 5166
03 6348 216
08 9266 3970
07 5447 0967
02 9553 8597
07 5500 5617
Marketing & Promotions
02 6925 0157
07 5443 5474
State & Territories Affairs
02 6244 2154
DIVISIONAL COORDINATORS State
Victoria Gorringe (Main Contact)
02 6282 2728
02 6244 2154
Victoria Tricardos (Main Contact)
02 9616 8713
Michelle Chim (Yuen)
02 9460 7788
02 4737 3477
02 9553 8597
08 8951 7789
Frances Thomsen (Main Contact)
07 3636 7100
1300 420 556
07 3846 0700
0430 177 222
08 8204 5498
0434 887 646
Lara Griffiths (Main Contact)
03 6348 7216
03 6348 7216
Marissa Kwijas (Main Contact)
03 9554 8488
1300 996 690
03 5973 6911
Stuart Wilson (Main Contact)
1300 887 798
08 9324 2881
Jessica de Jong
08 9467 2470
08 9334 0776
SA TAS VIC
firstname.lastname@example.org email@example.com firstname.lastname@example.org
42 l AHTA NEWSLETTER l JAN - MAR 2018
Reference List Page 8-9 Flare following fasciectomy: a recent literature review Anwar, M. U et al (2007). Results of surgical treatment of Dupuytren’s Disease in women: a review of 109 consecutive patients. The Journal of Hand Surgery. 32A:9:1423-1428 Buller, et al (2017). The incidence of complex regional pain syndrome in simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren’s contracture. Hand. July1. Chen, N. C. et al (2011). A systematic review of outcomes of fasciotomy, aponeurotomy, and collagenase treatments for Dupuytren’s contracture. Hand. Sept;6(3):250-255. Dias, J. J. & Braybrook, J. (2006). Dupuytren’s contracture: an audit of the outcomes of surgery. The Journal of Hand Surgery. 31B;5:514-521. Enstrand, C. et al (2014). Hand function and quality of life before and after fasciectomy for Dupuytren’s contracture. The Journal of Hand Surgery Am. 39;7:1333-1343. Evans, R. B. et al (2002). A clinical report of the effect of mechanical stress on functional results after fasciectomy for Dupuytren’s contracture. Journal of Hand Therapy.16;2:175-178.
Zemel, N.P. et al (1987). Dupuytren’s disease in women: evaluation of long term results after operation. The Journal of Hand Surgery,12:6:1012-1016.
Page 10-11 Attitudes, beliefs and common practices of hand therapists for base of thumb osteoarthritis in Australia (The ABC Study) 1. Xie F, Kovic B, Jin X, et al. Economic and humanistic burden of osteoarthritis: a systematic review of large sample studies. PharmacoEconomics 2016; 34: 1–14. 2. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014:73: 1323–1330. 3. Merritt MM, Roddey TS, Costello C, et al. Diagnostic value of clinical grind test for carpometacarpal osteoarthritis of the thumb. J Hand Ther 2010; 23: 261–268. 4. Elliott B. Finkelstein’s test: a descriptive error that can produce a false positive. J Hand Surg Br 1992; 17: 481–482.
Gonzalez, F. & Watson, H. K. (1991). Simultaneous carpal tunnel release and Dupuytren’s fasciectomy. Journal of Hand Surgery (British). 16;2:175-178.
Consideration of surgical and therapy treatment needs for paediatric patients with 5th metacarpal neck fractures who are prone to hypertrophic scarring
Lily, S. I. & Stern. (2010). Simultaneous carpal tunnel release and Dupuytren’s fasciectomy. The Journal of Hand Surgery, 35A:754-759.
Cepni, S. K., Aykut, S., Bekmezci, T., and Kilic, A. 2016). A minimally invasive fixation technique for selected patients with fifth metacarpal neck fracture. Injury, Int. J. Care Injured, 47: 1270 – 1275.
Rivlin, M. et al (2014). The incidence of post-operative flare reaction and tissue complications in Dupuytren’s disease using tension-free immobilisation. Hand, 9:459-465.
Davison, P. G., Boudreau, N., Burrows, R., Wilson, K. L., and Bezuhly, M. (2016). Forearm-based ulnar gutter versus hand-
based thermoplastic splint for paediatric metacarpal neck fractures: a blinded, randomized trial. American Society of Plastic Surgeons, 137 (3): 908 – 916. Fujitani, R., Omokawa, S., Shigematsu, K., Tanaka, Y. (2012). Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. Journal Orthopaedic Science. 17:450456. Gulabi, D., Avci, C., Cecen, G., Bekler, H., Saglam, F. (2014). A comparison of the functional and radiological results of Paris plaster cast and ulnar gutter splint in the conservative treatment of fractures of the fifth metaracpal. European journal orthopaedic surgery Traumatology. 24:1167-1173 Kim, J., Kim, D. 2015. Antegrade Intramedullary Pinning Versus Retrograde Intramedullary Pinning for Displaced Fifth Metacarpal Neck Fractures. Clinical Orthopaedics and Related Research. 473:1747-1754 Nellans, K.W., Chung, K.C. (2013). Paediatric Hand Fractures. Hand Clinics. 29:569-578. O’Brien, L., Jones, D.J. (2013). Silicone gel sheeting for preventing and treating hypertrophic and keloid scare (Review). Cochrane Database of Systematic Reviews. Issue 9. Papadonikolakis, A. Li, Z., Smith, B.P., Koman, A. (2006). Fractures of the Phalanges and Interphalangeal joints in children. Hand Clinics. 22:11-18. Shen, K., Xu, Y., Cao, D., Wang, Z., and Cai, H. (2017). Outcome of antegrade intramedullary fixation for juvenile fifth metacarpal neck fracture with titanium elastic nail. Experimental and Therapeutic Medicine, 13: 2997 – 3002 Wong, P., Hay, R., Tay, S. (2015). Surgical outcomes of fifth metacarpal neck fractures – a comparative analysis of dorsal plating versus tension band www.ahta.com.au l 43
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Page 18-20 A literature review on the effect of hand dominance and sex on wrist kinematic proprioceptive ability Adamo, D., & Martin, B. (2008). Position sense asymmetry. Experimental Brain Research, 192(1), 87-95. http://dx.doi. org/10.1007/s00221-008-1560-0 Carey, L., Oke, L., & Matyas, T. (1996). Impaired limb position sense after stroke: A quantitative test for clinical use. Archives Of Physical Medicine And Rehabilitation, 77(12), 1271-1278. http://dx.doi.org/10.1016/s00039993(96)90192-6 Clerke, A. (2006). Factors influencing grip strength testing in teenagers (Ph.D). University of Sydney. http://hdl. handle.net/2123/3553 Elangovan, N., Herrmann, A., & Konczak, J. (2013). Assessing Proprioceptive Function: Evaluating Joint Position Matching Methods Against Psychophysical Thresholds. Physical Therapy, 94(4), 553561. http://dx.doi.org/10.2522/ ptj.20130103 Hagert, E. (2010). Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist. Journal Of Hand Therapy, 23(1), 2-17. http:// dx.doi.org/10.1016/j.jht.2009.09.008 Hagert, E., Lluch, A., & Rein, S. (2015). The role of proprioception and neuromuscular stability in carpal instabilities. Journal Of Hand Surgery (European Volume), 41(1), 94-101. http://dx.doi. org/10.1177/1753193415590390 Han, J., Anson, J., Waddington, G., & Adams, R. (2013). Proprioceptive performance of bilateral upper and lower limb joints: side-general and site-specific effects. Experimental 44 l AHTA NEWSLETTER l JAN - MAR 2018
Brain Research, 226(3), 313-323. http:// dx.doi.org/10.1007/s00221-013-34370 Han, J., Waddington, G., Adams, R., & Anson, J. (2013). Bimanual proprioceptive performance differs for right- and left-handed individuals. Neuroscience Letters, 542, 3741. http://dx.doi.org/10.1016/j. neulet.2013.03.020 Herter, T., Scott, S., & Dukelow, S. (2014). Systematic changes in position sense accompany normal aging across adulthood. Journal Of Neuroengineering And Rehabilitation, 11(1), 43. http://dx.doi. org/10.1186/1743-0003-11-43 Jones, L., & Hunter, I. (1993). A perceptual analysis of viscosity. Experimental Brain Research, 94(2). http://dx.doi.org/10.1007/bf00230304 Karagiannopoulos, C., & Michlovitz, S. (2016). Rehabilitation strategies for wrist sensorimotor control impairment: From theory to practice. Journal Of Hand Therapy, 29(2), 154-165. http://dx.doi.org/10.1016/j. jht.2015.12.003 Krueger, H., Koot, J., Hall, R., O’Callaghan, C., Bayley, M., & Corbett, D. (2015). Prevalence of Individuals Experiencing the Effects of Stroke in Canada. Stroke, 46(8), 22262231. http://dx.doi.org/10.1161/ strokeaha.115.009616 Krüger, M., Straube, A., & Eggert, T. (2017). The Propagation of Movement Variability in Time: A Methodological Approach for Discrete Movements with Multiple Degrees of Freedom. Frontiers In Computational Neuroscience, 11. http://dx.doi. org/10.3389/fncom.2017.00093 Lima, N., Menegatti, K., Yu, É., Sacomoto, N., Oberg, T., & Honorato, D. (2015). Motor and sensory effects of ipsilesional upper extremity hypothermia and contralesional sensory training for chronic stroke patients. Topics In Stroke Rehabilitation, 22(1), 44-55. http:// dx.doi.org/10.1179/107493571 4z.0000000023
Marchini, A., Lauermann, S., Minetto, M., Massazza, G., & Maffiuletti, N. (2014). Differences in proprioception, muscle force control and comfort between conventional and newgeneration knee and ankle orthoses. Journal Of Electromyography And Kinesiology, 24(3), 437444. http://dx.doi.org/10.1016/j. jelekin.2014.03.009 Marini, F., Squeri, V., Morasso, P., Campus, C., Konczak, J., & Masia, L. (2017). Robot-aided developmental assessment of wrist proprioception in children. Journal Of Neuroengineering And Rehabilitation, 14(1). http:// dx.doi.org/10.1186/s12984-016-02159 Mrotek, L., Bengtson, M., Stoeckmann, T., Botzer, L., Ghez, C., McGuire, J., & Scheidt, R. (2017). The Arm Movement Detection (AMD) test: a fast robotic test of proprioceptive acuity in the arm. Journal Of Neuroengineering And Rehabilitation, 14(1). http:// dx.doi.org/10.1186/s12984-017-02693 Taylor, K., Meyer, V., Smith, L., & Lustik, M. (2015). Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint. Journal Of Hand Therapy, 28(4), 369-374. http://dx.doi. org/10.1016/j.jht.2015.03.003 Tripp, B. L., Yochem, E. M., & Uhl, T. L. (2007). Recovery of Upper Extremity Sensorimotor System Acuity in Baseball Athletes After a ThrowingFatigue Protocol. Journal of Athletic Training, 42(4), 452–457 Vafadar, A., Côté, J., & Archambault, P. (2015). Sex differences in the shoulder joint position sense acuity: a crosssectional study. BMC Musculoskeletal Disorders, 16(1). http://dx.doi. org/10.1186/s12891-015-0731-y Valdes, K., Naughton, N., & Algar, L. (2014). Sensorimotor interventions and assessments for the hand and wrist: A scoping review. Journal Of Hand Therapy, 27(4), 272-286. http:// dx.doi.org/10.1016/j.jht.2014.07.002 Wright, M., Adamo, D., & Brown, S.
(2011). Age-related declines in the detection of passive wrist movement. Neuroscience Letters, 500(2), 108112. http://dx.doi.org/10.1016/j. neulet.2011.06.015
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Answers to ‘Test Yourself’ Quiz
Q7. Flexion of the finger MCPJs and extension of IPJs
Q8. Bicep Brachialis & Coracobrachialis
Q9. Froment’s sign is flexion of the thumb IPJ when gripping between IF and
Q3. Flexor Pollicis Longus
thumb. It results from weakness of the Abductor Pollicis muscle and is usually
Q4. 6-8 weeks full time then weaning out of the splint over another 4 weeks.
seen when testing for Ulna nerve injury or recovery
Q5. Middle finger
Q10. 4 muscles of the Rotator Cuff are: Supraspinatus, Infraspinatus, Teres
Q6. Abductor Pollicis Longus/Extensor Pollicis Brevis
minor & Subscapularis www.ahta.com.au l 45