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Functional Home Exercises
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In this episode, Miranda and Josh discuss functional exercises that can be prescribed for home use to improve range of motion, strength, and overall hand function. They share practical, easy-to-follow exercises that you can recommend to your patients.
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Transcript
Introduction to Hand Therapy Academy
00:00:09
joshmacd
I'm Josh McDonald.
00:00:11
mmateri
And I'm Miranda Materia, and we are Hand Therapy Academy.
Engaging Wrist Exercises
00:00:15
joshmacd
We're gonna chat a little bit about some functional home wrist exercises. So often we we give our patients exercises to do at home, but those exercises start to get outside of what we bring to the rehab table as the functional activity, and we end up just giving them that the plain old boring exercises that lack some like function to them. So let's talk about some functional wrist exercises that fit for home program stuff for both dynamic stability and range of motion stuff.
00:00:43
mmateri
yeah and so I think one of my go to favorites is washing or scrubbing that motion, and I think you can grade up and grade down you know, like maybe you say hey I want you to wash your bathroom mirror first. and then gray down to where you're putting more weight on it, like a countertop, um and then using different items to scrub, right? If you're using a heavier towel, that's gonna be much harder than using, you know, a cut up washcloth. So those are, I think, simple ones that are functional um and that actually produce a good outcome, right? You see the cleanness and you're like, oh, that has a positive um association with it.
00:01:19
joshmacd
Yeah, yeah, for sure.
Functional Tasks for Wrist and Shoulder
00:01:21
joshmacd
And I think a lot of like, as we talked about this beforehand, I was saying that I like to tell patients, here's the level at which you can use your arm or hand now. Here's what you're like, we're releasing you to maybe it's weight restrictions or whatever. So I like to start with wherever they're at and say like, you know what, just folding clothes. because it may seem it may not seem like a wrist exercise, and patients want like the three-way wrist concept at home, but if you're folding clothes, pulling them out of the dryer one at a time, maybe someone helps carry the basket, but you're folding them, you're putting them on hangers, you're reaching up, that's good, like even like a PNF movement, and so just that functional movement of something very light like folding clothes, I'll say like maybe we're not gonna fold a fitted sheet together, like like that's a whole different thing, or heavy you heavy um beach towels, but the lighter stuff,
00:02:07
joshmacd
Absolutely. That's a good way to just get lots of even not end range movement, but functional mid-range control. And that helps you get gain end range later anyway.
00:02:17
mmateri
Yeah, and I think that's great for managing edema. You get the shoulder, you know, a lot of times when we have wrist injuries, we have shoulder pain as well. So I really like your example of hanging clothes.
00:02:27
joshmacd
Yeah. I like that one for shoulder things. I like that one for wrist. I mean, we're kind of focusing on wrist right now, but yeah, it's, it's good for like just how high can you reach overhead? And some patients may not even realize they can't reach overhead because they don't really need to for a lot of things, even like putting cups in the cupboard or clothes. Like you don't have to go past 90 shoulder if you're an otherwise sedentary person. So really trying to exaggerate that movement when they're, you know, hanging up clothes that it's
Sensory Experience Through Daily Routines
00:02:51
joshmacd
a good one.
00:02:51
mmateri
yeah that's a good one I like to when like telling them to um brush their teeth with that hand or just at least do the first like couple of minutes with that hand or brushing their hair or even running their fingers through their hair I think is helpful for um not only like the movement pattern but also for sensor the sensory experience.
00:02:58
joshmacd
Okay. Yeah, and and I tell patients the same thing. Brush your hair, brush your teeth with your injured hand and they'll say, well, but it's my non-dominant hand. Like, well, right? We got to do some things that are a little bit different, but it's such a functional task that like, yes, you're going to stab yourself in the gums a couple of times. Like you're going to, you know, it be all over the place, but making yourself to even like eating the first 10 bites of a meal with that affected side dominant or otherwise. Yeah, it's awkward, but that's how you get out of these things. But it's then paired with a task that is immediately meaningful.
00:03:41
mmateri
Yeah, that's so important. I think especially for the brain body connection.
00:03:47
joshmacd
Yeah, yeah. And getting them out of that like dissociative dissociative problem.
00:03:54
mmateri
Yeah, sometimes I'll have them eat with that hand too, like especially finger foods where they can like pick up grapes, put it in their mouth. um It's a very functional movement. And then they have to oppose, you know, their thumb to their um fingers. And I have them opposed to different digits. And I feel like that's a little bit more pleasurable too than our traditional, you know, just touching each finger to the, your thumb to each finger, at least they're going through and like picking up something and um it doesn't feel so futile.
00:04:21
joshmacd
Yeah. Yeah. And so then I start to like step things up a little bit and, you know, feeding with grapes is great
Mind-Body Connection in Rehabilitation
00:04:28
joshmacd
at that level. But then when they progress, what's the next step? And so I'll say, make a sandwich. And that hand is responsible for picking up the containers out of the refrigerator and trying to open containers as long as they're clear for that kind of resistance and spreading things. That's force grading and proprioceptive awareness and bilateral integration and all these different things that they have to judge. and reestablish that mind-body connection, but it's an immediately functional task, and sometimes it helps them feel like they're getting back into maybe a caregiving role, maybe independence again. Like, I can do my own food. I don't have to have someone do that for me.
00:05:03
mmateri
Yeah. And so many times people forget to even use that hand, right? Like they'll carry it around like this and, and then they'll be like, Oh, I didn't even realize it works. You know, I can turn on the sync with it or the light switch, you know, sometimes I'll be like, just turn on your light switches with that hand and then tell your family or your friends that are around you to remind you to use your hand.
00:05:14
joshmacd
Yeah.
00:05:21
mmateri
Cause people, a lot of people have that learned this use.
00:05:25
joshmacd
Yeah. I love telling the caregivers that come in with patients, like you're the police, your job is to nag them and remind them, Hey, you can use that hand. Like I'll hand them their home program when they walk out and say, put it in that affected side. And so now that risk, that hand is doing the functional task of even just carrying something. So establishing that, establishing that awareness again.
Benefits of Functional Movements
00:05:45
mmateri
Yeah, and I think there's been um lots of studies and publications done on functional movement patterns over our traditional reflection extension, only already d like those programs that we prescribe and give to them. And the studies show that the functional movement patterns are you know, they provide better outcomes than the more traditional exercises. So I think you need a little bit of both. I don't think we're going to get rid of those traditional exercises, but I think by incorporating more function, I think it makes a big difference in helping the patient recover faster. And also it makes a big difference in their psychosocial health as well.
Social Engagement in Rehabilitation
00:06:23
joshmacd
Yeah, yeah, getting them back to that independence to say like, oh, like they just needed permission to go try those daily things around their house. That's just, like you said, the psychosocial aspect is giving them back involved in social activities and ADLs and IADLs.
00:06:38
mmateri
In making them believe that it's going to work again, like how many times do you hear patients say, do you think my hands ever going to work again?
00:06:45
joshmacd
Yeah, yeah.
00:06:46
mmateri
You know, you're like, yeah yes, I do. Yes, I do.
00:06:48
joshmacd
Yep, yep, it works right now.
00:06:49
mmateri
fact i'm pretty cool I'm pretty confident.
00:06:51
joshmacd
Yeah.
00:06:51
mmateri
it will But to them, you know, they don't see it every day.
00:06:53
joshmacd
Yeah, yeah.
00:06:55
mmateri
We see these things every day. They, they, you know, they just feel how bad it feels and how difficult it is to move. So.
00:07:02
joshmacd
Yeah, and and it's important for us to make sure that we're including other people in those roles too, so when we're doing those functional activities, it's good to incorporate and say, you know, if you're gonna make a sandwich, make a sandwich with your spouse in the room, or make do something with your kids, or engage those other, because it then gets them distracted off of how hard it is to use that hand. And there's this whole other dynamic of social happening that says, okay, I'm using that hand. And when they're done, they used it even more because they weren't so laser focused on the the injury area.
00:07:34
mmateri
Right. Yeah, definitely.
Practicing Wrist Movements
00:07:35
mmateri
Another one that I really like is, um, having them cup up, pick up a cup and drink, you know, so they're doing that like dart throwers type motion, especially if they've had like escape a lunate injury or something like that. I feel like that's a really functional, a movement pattern. And it's hard sometimes for patients to grasp what the dart throwers motion is. Right?
00:07:54
joshmacd
Yeah.
00:07:54
mmateri
Like, I don't know. It's so awkward when you try to explain it to some patients, they just don't really get it. And I feel like that's a really good functional one. And you can start, you know, with like a paper cup to start with just a little bit of fluid or water in it, and then advance all the way up to like a ceramic cup with coffee in it or whatever, you know, tea, whatever you drink.
00:08:14
joshmacd
Yeah, yeah. And for those patients who are at a very, very introductory level, we think we have to give them just the basic exercises like a tendon glider, dart throwers. But sometimes it's just a matter of putting a functional object in their hand and doing the same thing that gives it that functional connection. So dart throwers with a cup or a magic or a sharpie or something in their hands to get that idea or if it's you know you can't sweep you can't do the full resisted but just hold the broom and and let that weight set in and doing some distraction stress loading carrying or give them functional objects and that is at least a step towards that functional activity.
00:08:52
mmateri
Yeah, definitely. It definitely helps to build their confidence.
00:08:55
joshmacd
Yeah.
Community Interaction and Feedback
00:08:56
joshmacd
So let us know in the comments below, what are some of your favorite functional activities to give for home program, maybe specifically for wrist? We all have kind of ah an area we like to focus on, but today we're talking about risks. So what are some of your favorite functional activities for home wrist programming? um Leave them in the comments below, or you can also reach out to us with any questions in our email info at hand therapy academy or on our social media platforms at hand therapy academy.