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A-1219 Rehabilitation
Jürgen Mack
Thursday, June 14, 2018 · 11:40 a.m. · 14m 26s
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so thank you for giving for a possibility to talk about
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rehabilitation factors in this the second is a volume you
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so first i wanna talk about shot him information saw faxes
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it's a main breaks itself is of a hand to a p. we're working with a terror piece
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and having needle duly five thousand five hundred to a treatment so you
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only four hands and basically includes all injuries of the hand
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so the day i wanna talk about assessment we do a letter e. bay and techniques to
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you within the praxis for home exercise program crop lands and making the short conclusion
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so far as important therapy to get the patient and start mister p. as soon as possible
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so we have to look what the factors like we could looking for information for
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treatment and then make in exactly assessment for us this has to include
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sex and how it happened so left or right ten for i tend
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to isn't it so left handers insidious always that's a problem
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that the left and will not be used so much of fractures
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like what's operation was like it's true so call copper wires
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it's it's all in this whole names will never get a a range of motion or you will be happy with it
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you're looking for sensitive anal about she designs and we have to measuring the movement did
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we do this active and passive to got a feeling what the includes like
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so ah x. ray pictures also of avoids fishing in the docking target no exceptions if i have to work
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uh also we're measuring the pain with uh no trouble may toward and uh we want to
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wait no what's it like so we can make a difference between central and peripheral pain
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after six wind weeks we starting with a dine on a major formatting the
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false and a wind sprints usually have to control has if it
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so important also on treatment plan of a search and if that's something special
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and we need a folk of our shoe hobbies and look of the pace and so that we can
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take up up sick objects and we have a lot of patients uh with uh accident after work
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so um shot a thing i want to talk about exercise it's uh basically
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international mandela type extension to appease caring treatment miro therapy and splints
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first at all the patients coming fast sitting for us the um and he's
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not he doesn't want to movies and for the first time and not
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yeah it's a it's a video and
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the okay you know
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okay i gone and uh he city for us in the movement doesn't take place
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in the hand it's found it starts everyday up but not in the hand
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and we want to get that is only moving it's and so we need to really relax position
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uh for the patient and uh we only want to i want to have the movement
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in the in the hand and that somewhere else in the shoulder in the fall on you
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sorry for that you know
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so perhaps it works so i go on for curve for uh being a bit
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in time and now we know was and now we go one back
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i want to to bet yeah so you see a four in that case what we nine tardy
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adapted to and there's a lot of movement and that's just wait there's a lot of movement
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here in the for um but not enough movement in the hand so we have to control in say slim
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uh no movement in the fall on he's only for the hand and his to
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get the feeling so that you can uh you can improve for therapy
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not the next one you see it we want to fit uh for the fingers
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we want the fingers from a a moving from the start the proxy my
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you want to have a full range of motion and therefore the patient has to be instructed
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and for coordination in getting up at the feeling we can go uh worked with this ball and you
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can also be instructed at home going on for we can uh work with the computer now
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doesn't work also with the computer animation in this case for flex on index since you want
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for the wrist and the other case for the finger doesn't start also sorry i
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yeah the other one one two yeah no i just i'm to wait until probably now after okay
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after six weeks of five six week if uh everything's okay so we start was advanced training
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for this we you can use weights caravans finger trainers and hand train
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that's very important at all to give the patient a repetition
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yes to do and how often has to do with that day and has to this has to be controlled all the time
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for the component r. p. we do the lymph panache we start all
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all so from this time to proxy no and then go
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from phone to the for on and to the onto the shoulder right to the soldier which showed that we do this with um
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so close interaction for on and very important to do with this a little pressure and we
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have two two three four times a week and it it's about twenty to thirty minutes
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so to support is terribly views can is your tape we have good
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experience with this week added in stripes i'm setting up basic
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setting a basic and then um s. and the stripes and does understand the attraction
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and the stretching and then we do it on the screen and you can leave it several days on the skin
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and she uh like i told that we have a good effect for getting the hands holding down
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and for a that people would take this figure caps for having a permanent a pressure and getting a good result
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though the basic uh therapy talking about the range of most and motion for us it's a mental therapy
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we have to look for good basic on here we have to fix the four
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around and are we going traction and for the backs him proximal role
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we go sliding to toss on and the others uh and others that side to attend a two more now
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and for the seal we have to fix the middle cop are there
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in removing the ankle a sliding football side and what all
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in this case it's a value really beginning we have to do very often this thing
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we have to make a very good fixation for this area and then we can work with the tape
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and with a bit and here you are we look for the metal cup on every make a
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fixation fall amid a cop harder for five and a remove with a couple of all
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so if you want to get more um for one to if we want to do more for the capsule
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we uh take this instrument it's called match anything though and with with this uh permitted
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bowman and or intimated and the patient also can be instructed to do it
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by himself and at home and we have to control the result
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so if movement doesn't get better or if you have all the fractures if we have it passions
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and uh if you have sold things for a long time we news it's plotting pants
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rabbit is a special technique and another pressure we that that uh we move the angle several
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times and after boats uh sorry that's one too much can go back to this one
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okay yeah okay so you know there's so uh we had like the
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c. and the patient have to given um although uh exercises
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to get to keep the result at first uh wrapping moving day ankles and then the patient has to do his exercises
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okay uh keeping the results in the other case for the british also over is also good pacing basic e. rat
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being moved and the patient uh getting his small um his uh exercises he has to do so that you can keep the result
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so scattering when it's the main task to prevent attentions and that's movement restrictions
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if we can start before pulling the strings will have to and you'd be neat experience uh
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and we can do with careful circles we go to this care and careful transmitter stretching
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afterwards when the uh when the and strings are pulled off we can doing the
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stronger massage and we using this materials engines it's called fast sending it
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also the patient can't would buy and sell of all we can do it uh in therapy and with the
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capping uh to get the tissue lifted off if something i once the test how this uh feels like
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this year i have some people out with me so you can try what it's about the patient has to feel when he's
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interrupted and have to do it by himself so you can try comes with me i can give it to you
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so following k. uh problems we have to to hypersensitive scares and bonded scales for example
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this patient wouldn't be um moved if i'm touched the first time and uh
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so we um uh and began was this in to the station
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now therefore we took a in this case that sixteen material we oh uh first we
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go through the glass and and we can but then we moved to the unpleasant
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and he has to working at home and also in terror p. and after rooms escaped i think i'd i'd think it to two weeks
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we could uh work would look in this area you could also uh use other materials
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so if we have have included scare it takes to kinda really deep massage and
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uh it's no fun for the patient and also no fun for the therapist
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look at the this um situation here than getting a good movement
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so in that case we have to we take splint i prefer the in the middle
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of a doubles planes because we can adapted to the situation of the patient
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if in this case the extension glass better it's getting better we can um
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of on the material can phone with no uh and the new
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and this come in with this come in and explained we have the prop and when it's to nearly uh when it's on the ankle
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um there's some pressure and we have a lot of um the patient doesn't accept it doesn't want to
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wear it and you tell tell says search and i buried in slang to home in the corner
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and therefore we have to look uh where where it is and have to get a
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good instruction and have to tell him appease right only if the for five
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minutes and then you can really with the time going on and then he will bear it and we have well we all will have a good effect
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so if the patients that sometimes it happens um when the patient comes to i think it's no imagine for his a therapy
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so we start uh with we doing the rotor okay i don't want to talk how it works is enough
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and evidence but we use it in three steps and the first step uh the injured hand is lying behind tomorrow
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and uh and not into tennis laying in front of the mirror on and and patients looking
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in the rio why moving and instructed uh from the therapist in the second part
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we uh to the uh we use the injured hand and then the
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third part you which you you wasn't sorry full um different materials
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and also we we look all always uh that's going through all of
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the right and through we always looked at the patient uh is
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uh get to enough at home so yes it would and we control it and interrupting that's why it's very important
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so that's uh the program we will class if there's nothing uh and and uh
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nothing anything from the search and so turkey after was just in case it
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we uh starting exercises as soon as possible of uh for an hour praxis uh we looked at the patients
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and after three days you get a date in all black says we all we have is organised
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and moving and and and nobody station of all signs i'll be looking for mandela tele
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t. v. dwindling finance scat treatment into and i'm i'm always intensive home exercise program
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so uh after six week that usually starting was drinking exercise and using double materials
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so conservative her for six weeks only training for the injured not into china
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the golden pinochet home in the program also you have to do and after six week
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of a movement and uh try and and starting with soft and will target p.
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so a shot and you to home exercises but that all the source and the amen finger movement the
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patient gets a plan how to has a how to lay his on and his fingers at home
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so that uh we get the figaro us opponent on the new comes back to therapy also
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he becomes and pictures week uh he can to and is
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instructed to hold off to repeat involvement with today
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uh these movements another thing you can do is a totally documentation you gets a totally planned with anything
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and you can control of all itself can bring the paper with us and we control what he has done
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so problems off the fax us we see in this case the splint was wrecked
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when or when the patient uh developed a sale pass and we needed more
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and a half a year to get him in function and function and getting the hands holding down uh i as a
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in this case i only write it off and i sent it back to the doctor i didn't start looking uh that's uh was very happy
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yeah the case a good compliance of a patient pay and take out for fracture
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and metal was inside uh we had hit a good work and we but we
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didn't didn't get the hands falling down and we didn't reach a full extension
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however and then the other case and will for no full flexion off the finger fraction you're the ankle
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this happens and it's i'm not no good result for the patient
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so for me taking home as for you take a whole message for us very
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important and um to to get the possibility to begin as soon as possible
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that's for the result in for the cherokee and fall uh uh important
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and uh we can decide what's to do and and and and the next thing is the frequency of the cherokee
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sometimes if we have good a book with of a patient it meets once a time in the other case you have to see the patients
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three for the time all um and we have patients coming from forty
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fifty kilometres to therapy so you have to decide thought so too
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an no success at all only a really good home exercise program and this
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has to be a control all the time and adapted to the patient
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and a very very important no patient can go out of the pictures with the home exercise program
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and we always have to do a re on the evaluation to see our uh to see if we're on the right
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