Ankle Rehabilitation
Lloyd's Dupuytren's Contracture Treatment
Transcript:
Andy: Hello. This is Andy Smith. I'm the neurological consultant for Dynasplint Systems in Lexington, Kentucky. I'm here with Mr. Lloyd Trimble, and Lloyd was referred to us by Harrodsburg Healthcare, and Sheena Barton, who is an occupational therapist we'll introduce you to in just a minute. But Lloyd is a gentleman that was diagnosed with ALS, Lou Gehrig's Disease, about five years ago. Secondary to that, he has also developed some Dupuytren's contractures in both hands. Lloyd is aphasic; he's not able to communicate verbally. He uses a dry erase board for all his communicating. Well secondary to his diagnosis, both hands bilaterally were contracted, and he was unable to write, or at least write as well as he did in the past.So Sheena contacted us, we used a combination of our MCP extension Dynasplints bilaterally. We also used a few of our PIP extension Dynasplints. At nighttime Mr. Trimble wore our resting-hand wrist orthosis, and he has done a remarkable job; he's worked very hard.
I'm going to introduce you now to Sheena, and she can talk a little bit about his results.
Sheena: Hi, I'm Sheena Burton, and I'm an occupational therapist here at Harrodsburg Healthcare. In 2008, Lloyd was referred to us for the Dupuytren's contractures. And he was having difficulty not only with the legibility of his handwriting, but with the speed and the ease of the writing.
When I first looked into standard treatment techniques for this type of diagnosis, I found that not only were they invasive, but they were expensive and very time-consuming and not always effective. Some of those treatments include steroid injections, radiation treatment like what's used for cancer, partial fasciectomies, where they go into the hand and remove some of the tissue and replace it with skin grafts. And in some severe cases, fingers may be amputated because of skin breakdown, infection, gangrene and that sort of thing.
So upon looking into some of the treatment options, I found that therapy was not one of the common things used to treat this type of contracture. So after speaking with Mr. Trimble's doctor, we decided to give therapy a try and just see what would happen. When I contacted Andy about Mr. Trimble and explained the situation, he suggested that we start out with these dynamic finger splints. So we applied these to Mr. Trimble's fingers, his middle, ring and pinkie on both hands, and we also used moist heat to kind of help the blood flow and comfort and that sort of thing. We would do real aggressive range of motion, and we gradually increased the tension as well as the wear time on these. And he went from about 45 degrees of flexion at the IP joint of the middle and ring fingers and about 15 degrees of flexion at both of his pinkies to full, complete extension at all of those joints.
So once we got the IPs looking better, we started working on the MCP joints. And these were especially tough because that's where the thick band of tissue from the Dupuytren's was causing most of the problem. So we started out again with the moist heat application, very aggressive stretching and applied the MCP splint, and over a period of time we made some remarkable gains with his range of motion. He went from about 90 degrees of flexion at the middle finger MCP, 60 at the ring finger, and about 30 at the pinkie, to almost complete full extension. He's at about 20 degrees MCP at the middle, 40 at the pinkie, and he does have complete full extension at the MCP of both pinkies.
So the way the this translates into function is that not only has the legibility of his handwriting improved greatly, which allows people to be able to read what he's trying to communicate much easier, he can do it much, much faster, and it doesn't require as much concentration and effort because he's not having to, you know, really look at what he's doing because his hands wouldn't do what he wanted them to do. And other tasks that require motor coordination and range of motion in the fingers, such as nail care, cleaning out his nails, trimming his nails, filing them, he can do all that kind of stuff now.
So it's just been a remarkable treatment program. The splints have done wonderfully for him, and I would highly recommend that any therapist or patient that's looking at treating this type of contracture speak with the doctor and suggest that this be incorporated in as part of the treatment. It's a lot less expensive than surgery or injections, and there's no risk of complications like infections and things like that. So we're very pleased with how things worked out, and I'd like to say a special thank you to Andy and Dynasplint for all their help and in recommending the right product for us. Thank you.
Andy: Lloyd, can you give us an example of your handwriting? The sheet on the left was his handwriting prior to the implementation of the splints, and then he just wrote on his dry erase board today. You can probably see it's much more legible, it's much easier for him to do that, and he's going to give us an example and sign his name for us. All right. Thank you, Lloyd, and thank you to Sheena.
Sheena: Very welcome.
These are just two examples of how Dynasplint® can help with ankle rehab. Our colleagues work with physical therapists, ocupational therapists, doctors and other medical professionals to ensure that our patients ankle rehabilitation goes as smoothly as possible.
