With Ali Hunter, Musgrave Park Hospital
We caught up with Occupational Therapist and Hand Therapy Specialist, Ali Hunter, to see how they use objective assessment and rehabilitation in the NHS. Their department treats patients who have musculo-skeletal hand and upper limb conditions –patients who have undergone surgery, which would be orthopaedic elective or in some cases following traumatic injury and also patients who require conservative management.
What clinical challenges do you face?
The clinical challenges we face are related to obtaining measurable data to show how patients are progressing in therapy and also how to demonstrate objectively the analysis of specific areas of weakness and the impact on function. More specifically we faced challenges when assessing and treating patients where a high level of strength or endurance is required. For example preparing for return to work or sporting activities and that is because we were unable to offer graded work hardening or vocational rehabilitation.
What solution did you use prior to the BTE Primus?
Previously we attempted to simulate work and functional tasks through existing equipment in our department. However I knew there was a shortfall particularly to cover the diversity of activities and also address strength and endurance. We also did not have anything with continuous passive movement which now gives us the opportunity to introduce passive stretches and also leads onto low load resistance work.
Why did you pick the BTE Primus?
We chose the BTE Primus as I felt it would be a fantastic addition to our dept due to its work hardening properties and ability to replicate a vast range of activities used in the home, work, sport and leisure. We knew it would enable us to grade and customise rehabilitation programmes to facilitate patient goals such as mobilisation, strength, endurance. The fact that it generates objective assessments and reports, and compares against standardised norms we felt would be useful for demonstrating effectiveness of treatment and audit. The results from the evaluation and treatment modes can then help us review and redirect treatment goals.It also gives excellent feedback to the patient on their progress.
On what patients/conditions do you use the system?
We use the Primus with a wide range of conditions such as wrist fractures, wrist arthroscopies, proximal row carpectomy, distal biceps repair, CRPS and trapeziectomies. We have set up programmes using the evaluation mode to assess and get baselines of hand grip strength – isometric, power and endurance and also assess lifting capacity. Within the treatment mode the CPM and isotonic modalities have been regularly used and we are able to customise these to simulate activities which are relevant to each individual. The way the Primus stores results makes it very easy to monitor improvement and upgrade programmes.
What outcomes have you seen?
We have only had the BTE Primus for around 2 years so we are still exploring and learning about the different ways it can be used. I have seen measurable improvement in mobility of: for example range of movement in wrist injuries and various surgeries on the wrist, hand and elbow. We have used a broad range of attachments which has been very beneficial in working on specific joints but also in upper limb conditioning. The ability to replicate countless functional activities has a definite carry over to real-life tasks e.g. day to day tasks at home, driving or use of DIY tools. The objective improvement in strength and endurance has given patients confidence and has motivated them to resume day to day activities and also enable return to work.