weight traction therapy-a new approach to the hand mobilization

 ABSTRACT

For the mobilization of the stiff hands, mainly MP joints, the weight traction device was developed with help of low temperature thermoplastic, cotton thread & set of weights. The ninety-degree angle of traction approach should be followed so that the entire force acting on the device can be useful for mobilization. The advantages of devices are that easily carried by the patient, easily applied with patients own involvement in therapy, objective monitoring can be done in terms of ROM, weight, duration & frequency of traction. Also can be combined with other modes of therapy as splinting and other forms of mobilization.

 INTRODUCTION

Stiffness of the hand is common consequence of hand injury. Therapeutic management of stiff hand by and large involves active or passive mobilization by therapist, purposeful activities, work therapy, splinting. All these involve application of the force to mobilize the stiff joint.  Use of physical agent modalities is also required as an effective adjunct.

            For so many years all the aforesaid methods are effective & will continue to do so. But we as a therapist are unaware of the amount of force, duration of therapy, frequency of the intervention that is effective for mobilization of stiff joints. We hardly have the objective data on our record book except Range of Motion (ROM) as the monitoring tool. But .we doesnt know the dosage of our therapy. To know what the effective dosage of therapy is, which will be helpful for statistical analysis the traction device, was developed.

Traction is defined as an act of drawing or pulling, as by an elastic or spring force or weight. In this device the weight is performing the act of pulling. In order to mobilize (to improve range of motion) the stiff joints of fingers (index, middle, ring & little) mainly metacarpophalangeal joints (MP JOINTS), the traction device was developed.

METHOD TO PREPARE THE WEIGHT TRACTION DEVICE

Materials used: Low temperature thermoplastic material to make the finger cuff, cotton threads & set of weights (10grams, 20grams, 50grams, 100grams etc.) with hole drilled in the middle.

Measurements of the finger cuff are taken with the help of measure tape. The girth of the cuff equals the half of the girth of the proximal phalanx & length of the cuff equals 2/3^rd of the length of the proximal phalanx of the finger for which the cuff has to be made.

Cut the Low temperature thermoplastic material piece of the aforesaid dimensions. Then mold it on the dorsum of the proximal phalanx so that it takes the shape of the finger. Allow the material to set on the finger. Then drill four small holes on the cuff so that the thread can be inserted. The length of the thread should be such that the after tying the weights, they should hang below the wrist joint.

PRINCIPLE FOR WEIGHT TRACTION THERAPY

The ninety-degree angle of traction approach should be followed so that the entire force acting on the traction device can be useful for joint mobilization.

MONITORING WEIGHT TRACTION THERAPY

Finger goniometer for the measurement of Range of Motion, Stopwatch for monitoring duration, Pain Analog Scale to assess pain (PAS), Score sheet to record all the details of ROM, weight, duration & frequency.

ADMINISTRATING WEIGHT TRACTION THERAPY

Patient education is one of the most important aspects of the weight traction therapy. Explanation of the above mentioned principle to the client is obligatory for the effective administration of therapy. Instructions can be given with the help of drawing, photograph or demonstration by the therapist.

The finger cuff made is applied on the dorsum of the proximal phalanx so the weight pulls the joint in flexion & palmar direction. The proximal joints are positioned & stabilized accordingly so that the ninety-degree angle of traction approach is followed & gravity assists in therapy. In the early phase of the therapy the weight added depends upon the diagnosis of the clients & the tolerance of the client. The weight traction therapy can be graded on following parameters.

PARAMETER	GRADING
Duration	10 minutes per session &days of therapy
Frequency	Twice a day or 4 times a day
Weight	30 grams, 100 grams
Range of motion	In degrees, Total Active/Passive Motion
Pain	Severity of pain on PAS

OBSERVATIONS OF WEIGHT TRACTION THERAPY

As the duration passes the subject starts feeling the stretch on the joint. Allow the client to continue till his or her tolerance level permits. Also look for the symptoms like pain, swelling & excessive discomfort.

CONTRAINDICATIONS FOR WEIGHT TRACTION THERAPY

A non-healed fracture, Pediatric population, surgical repairs such as of extensor tendons or the others where the traction may damage the reconstructed structures.

FEATURES OF WEIGHT TRACTION THERAPY

The device can be made to fit each patient according to the size of the finger. Also the weight, duration & frequency of the therapy vary from client to client. So it is individualized approach to the therapy. Also you get the objective data for each stage of therapy.

ADVANTAGES OF WEIGHT TRACTION THERAPY

Þ   Objective monitoring of progress in therapy in terms of

1.     Weight added as the therapy progresses

2.     Range Of Motion (passive & active)

3.     Duration for which the traction is applied (min/hrs) & days of therapy

4.     Frequency of the therapy during the day

Þ   Also weight traction therapy can be combined with other form of therapy as splinting, passive mobilization, purposeful activities or work therapy. Elevation for edema control can be incorporated with weight traction therapy.

Þ   The patient can carry the device in his/her pocket or purse.

Þ   Better compliance as the weight traction device is handy, less cumbersome & not non-aesthetic

Þ   Regularity in the weight traction therapy can be maintained even if patient is not able to come for the therapy, as after education of the patient he/she can take this therapy at home, work place or any of the outdoor places such as garden, theater etc.

Þ   Weight traction therapy can be easily administered therapy with patients own involvement in therapy after the client education.

Þ   Cost effectiveness as the device is low in cost