OT clinic helps people regain mobility
September 29, 2011
FORT SILL, Okla. -- People fill their days with a variety of activities, both physical and mental, and when something disrupts their ability to enjoy those pursuits chances are good occupational therapy can help.
The Reynolds Army Community Hospital occupational therapy clinic staff meets those needs on Fort Sill providing therapy to eligible patients of all ages.
Maj. Art Yeager, chief therapist, said occupation applies not just to work but any activity or thought process a person engages in to fill his or her time. With that in mind, it doesn't matter what a person does before coming to the clinic, but what they can do once they leave.
"The clinic staff is all about functional performance," he said. "We strive to help people through activity modification or create custom-made adaptive devices and treatment plans to help them regain the freedom of movement they previously enjoyed."
Although occupational therapy comes in many different forms, the Reynolds clinic focuses on orthopedic therapy. Patients mostly come for treatment of broken fingers and wrists or repetitive use injuries to tendons or nerves, such as tennis elbow or carpal tunnel syndrome.
Yeager is a 23-year veteran who first served as an enlisted mechanic on helicopters. This led to seeking a commission so he could fly what he fixed. Then his career took another turn and he retrained into occupational therapy because of its near endless options he could work in. Autonomy is one benefit to working OT in the Army. Yeager called this "physicians' extenders" because of what therapists can do for patients, independently.
"Therapists go to a course where we learn to diagnose and treat, separate from a doctor. We can order MRIs and X-rays, and come up with treatment plans. Then, based on the response patients have to treatment, we can adjust the plan to best suit their needs," he said.
Armed with this information, patients are closely evaluated, first, to determine what activities they like to do, and, second, what their expectations are once treatment ends. Along the way, treatment is tailored to each individual, again, with the aim to increase their range of motion and reduce inflammation in the affected area. With progress, the therapist can recommend ongoing treatment in the clinic or at home with later visits to re-evaluate the patient's status.
Bill Schneider is a retired Army chaplain and comes to the clinic to get treatment on the tendons in each of his forearms. He joked that his therapist told him until treatment was done he'd have to give up doing the sign of the cross. He said he appreciates how the staff considers his needs, and though treatment has been intense, he believes it was specifically created for his benefit.
The major said tennis elbow, a common problem, is often tough to treat, because a lot of patients want something to fix them. The injury is caused by repetitive use to the elbow in a way that puts stress on the tendon. Changing the way people perform a task is but one aspect to prevent further injury. Unlike flexible muscles that depend on blood flow to function, tendons are tough, fibrous tissues that often attach muscle to bone. Because no blood flows through this tissue, it takes longer to heal once damaged. He compared tendons to the wire in a coat hangar. The wire is rigid, and under normal use give years of service. However, if someone were to bend that wire back and forth in the same spot, it becomes supple as it heats up. If this bending is continued without pause, eventually the wire breaks.
Yeager said stretching and taking breaks are the most important things people can do to prevent injury to nerves or tendons. People can also change their body position at work and adjust furniture to ensure the neck, shoulders, arms and wrists stay in relaxed, neutral positions.
Fortunately, treatment offers a variety of options, Yeager said there's probably at least 20 ways to aid tennis elbow. These include wearing a splint on the wrist or an elbow strap that minimizes the pull in the tendon area. Other options are ultrasound, laser light, heat or massage. Everything doesn't work for all people, but usually therapists can find a treatment that helps relieve the symptoms and promotes healing.
"I'm going to do anything and everything I can, even if it's only 10 percent good. Whatever the gain, I'll take it because it may make the difference for that particular patient," he said.
Carpal tunnel syndrome is another issue, because there aren't a lot of treatments available. Normally, the best option is to splint the wrist to minimize movement and allow the affected area to rest and rejuvenate.
He said there's misconceptions about this malady, because most people associate any wrist pain with this syndrome. Actually the affected nerve rides atop blood vessels and a bundle of tendons and their protective sheaves that all enter the hand through a gap in the bone in the wrist. Over this area, bands of muscle protect these tendons and the nerve. When tissues get irritated, the body directs fluid to alleviate friction. However, this fluid build up causes swelling that diminishes space around the nerve resulting in the tendons or muscle tissue pressing on the nerve. When that happens, people feel a tingling, numbness or pain in their fingers, the beginnings of carpal tunnel.
Better than treating the condition, Yeager said avoidance is the best option.
"Carpal tunnel is much cheaper and easier to prevent, and educating people is the key," he said.
Just like tendon care, people need to stretch and take breaks to allow the wrist area to rest. Also, WebMD recommends the following ideas people can employ to ward off the effects of CTS:
- Keep arm, hand and finger muscles strong and flexible;
- Stop any activity that may be causing finger, hand, or wrist numbness or pain;
- Use hand and wrist movements that spread the pressure and motion evenly throughout the hand and wrist; and
- Switch hands and change positions often when doing repeated motions.