1. Hand and Upper Extremity Focus Group 2009 Skip Brown, OTR,CHT Peggy Haase, OTR,CHT Joanna Hearington, RN Dana Moulton, OT CHT Lisa Perrone,OTR,CHT Pam Harrell, OTR,CHT Facilitator

2. Practice Tools Update Consistency between practices at VOI and VOCS Information provided to patients referred outside VUMC Patient education handouts Basic ROM exercise handouts Protocols last updated in 2005

3. Project Process – Patient Education Tools Reviewed all patient education and exercise handouts Developed a list of materials needed Created exercise handouts with original photographs and written instructions Developed patient education handouts for home programs and discharge instructions

4. Patient Education Handouts Developed Splint instructions Desensitization home program Cryotherapy Contrast bath home program Discharge home instructions

5. Home Exercise Programs Created Elbow and wrist A/PROM Digital A/PROM Tendon gliding exercises Thumb A/PROM Hold middle joint of your affected hand to prevent bending. Slowly bend end joint. Perform ____ sets per session. Peform ____ sessions a day. Use unaffected hand to bend finger at all three joints. Hold _____ seconds. Perform ____ sets per session. Peform ____ sessions a day.

6. Project Process – Updating of Protocols Reviewed protocols developed in 2005 Utilized Rehabilitation of the Hand, Fourth Edition and Diagnosis and Treatment Manual for Physicians and Therapists, The Hand Rehabilitation Center of Indiana All protocols were updated with input from VOI/VOCS hand therapists, hand practice RN Approved by Drs. Weikert, Watson and Lee

7. Hand Therapy Protocols Elbow – distal biceps repair, triceps repair, dislocation, lateral epicondylar debridement, radial head arthroplasty, ulnar verve transposition, olecranon ORIF, elbow release and total elbow arthroplasty Wrist – carpal tunnel, deQuervain’s release, ganglion cyst excision, distal radius ORIF Hand – crush injuries, fingertip injuries, tenolysis, trigger finger, MP/PIP arthroplasty Thumb – CMC arthroplasty Miscellaneous protocols – nerve repair, pain management, wound care

8. Accessing Handouts and Protocols Shared drive VSMC folder VOI therapy folder Hand therapy folder

9. Next Steps Project for 2010 identified Extensor tendon management Continue to develop patient education tools

10. Thank You!!! Questions???