The following exercises can be performed on the PowerWristor®
Radial Deviation Strengthening
Ulnar Deviation Stretching
Ulnar Deviation Strengthening
General Features (Refer to the Set-Up page for component description of the PowerWristor)
SET-UP FOR (a) EXTENSION STRETCH AND FOR (b) FLEXION STRENGTENING
For both (a) and (b):
1 Arrange seat height to allow upper arm (brachium) to be nearly vertical when the forearm rests on the Wristor SYSTEM
2 Rest the forearm on the base so the wrist joint is over the mobile tray axis.
3 Slide the elbow stop toward the elbow until it touches the elbow. Once the stop is tightened, it will prevent the elbow from sliding back and altering the wrist joint alignment over the mobile tray axis.
4 Loosen hand grip (by turning it counterclockwise) in middle slide and position the grip for patient to grasp. Tighten post by turning it clockwise. Once tightened, this will prevent the forearm from sliding forward and insure proper alignment of the wrist.
5 Bring slide support for proximal and distal forearm to bear on forearm surface, to keep forearm from shifting from side to side as the elastic force is applied.
6 Hook elastic band over the tray anchor pin or cord through the tray anchor pin, of mobile tray, and then follow directions for either (a) Extension Stretch or (b) Flexion Strengthening.
(a) EXTENSION STRETCHING
7 Depending on the diagnosis and problems, you may wish to begin with a thin tension band or cord initially, and then gradually increase the band’s or cord’ thickness as the patient tolerates it. Carefully and slowly stretch the resistance band or cord until the patient begins to feel a stretch sensation.
8 Insert the peg at this point because this is where you will want to hook the tension band. Use extra pegs to insert in nearby holes. If you are using a resistance cord then adjust the cord tension through the cam cleat to achieve the same result.
9 As the patient becomes accustomed to the initial level of stretch, the tension band or cord may be stretched to more distant peg or through the cam cleat to re-start the slow sustained stretch process again.
10 Another option that allows more discrete adjustments is to stretch the tension band around the body of a peg and hook the end of the band over a second peg that is at least two holes away. The angled elastic should be at a 90-120 degree angle to work effectively as pictured in diagram and on cover of color brochure. The first peg, around which the elastic bends, can be turned to either slowly increase or decrease the elastic force of the stretch. (The friction of the peg on the elastic causes the elastic to shorten or lengthen and thus apply a changed force to the patient). This is an ideal way to encourage patient participation. Patients can adjust way to encourage patient participation. Patients can adjust their own elastic force in either of the two manners noted. Often patients will be able to tolerate a more effective stretch if they are adjusting their own force. The patient may be more apprehensive when the therapist changes the force since the therapist cannot feel the level of discomfort.
(b) FLEXION STRENGTHENING
7 After hooking the elastic band over the tray anchor pin of the mobile tray, stretch the band in the direction that will cause the wrist to extend. Stretch band slowly to desired resistance level. If you are using a resistance cord then adjust the cord tension through the cam cleat to achieve the same result. The patient should start to feel a pulling sensation.
8 Insert peg at this point and several more nearby to provide various tension level options. If using the resistance cord then it is just a matter of securing the cord in the cam cleat at the desired point of stretch.
9 Have patient contract against band or cord resistance. If the patient does not have an effective grasp, strengthening can still proceed. The hand grip located in the palm can be pushed while the fingers are extended. Any patients, effective grasp or not, can thus promote the normal synergy of wrist flexion with finger extension.
10 Stretch band or cord tension further or add more (or thicker) bands or cords, if more resistance is desired.
11 Use the usual parameters of comfort, achieving desired or full excursion through ROM, and fatigue, to decide if resistance should be increased or decreased.
12 Use common methods of repetitions and sets, or timed durations of continuous exercise (depending on what your goals are for that particular patient), to measure and record work level.
13 This device is also designed to provide a means for HEAVY sensitive strengthening. AGGRESSIVE strengthening can be provided by the Red resistance Cord. This device IS meant to promote and provide early mobilization and early strengthening when a hand/wrist needs it, with or without an effective grasp capability.
SET-UP FOR (c) EXTENSION STRENGTHING OR (d) FLEXION STRETCH
For both (c) and (d) :
1 Arrange the seat height to allow upper arm (brachium) to be nearly vertical to the table.
2 Align the wrist joint over mobile tray axis
3 Position elbow stop to keep wrist joint properly aligned.
4 Bring side supports for proximal and distal forearm to bear on forearm surface to prevent forearm from shifting side to side as resistance force is applied.
5 Step 5 has two options:
Option 1: To promote synergistic finger flexion with wrist extension, the patient may grasp the post as part of the wrist extensor strengthening. (Refer to the picture inside Wrsitor color brochure). In this case, loosen the hand grip in the middle slide and position the grip for the patient to grasp. Tighten post and proceed with exercise.
Option 2: If the patient has inadequate grasp strength, or relaxing of the finger flexors is desired, position the adjustable hand grip to apply pressure on the dorsum of the hand, just proximal to the metacarpal-phalangeal joints. Again, loosen the hand grip in the middle slide and position the grip proximal to the MC-P joints then re-tighten the hand grip to prepare for use.
6 Hook tension band over the tray anchor pin of the mobile tray and follow directions for either (c) Extension Strengthening or (d) Flexion Stretching.
(c) EXTENSION STRENGTHENING
7 After hooking resistance band over the tray anchor pin of the mobile tray or thread the cord through the pin opening, and stretch the band or cord in the direction that will cause the wrist to flex.
8 Follow the directions numbered 8-10 previously listed under EXTENSION STRETCHING exercise.
SETUP FOR RADIAL DEVIATION AND ULNAR DEVIATION STRENGTHING OR STRETCHING
As previously noted, positioning for these activities may be better when the brachium is angled with respect to the wristor platform, and not in the vertical position used for flexion and extension functions. The ball knob may be utilized at this point as pictured in the lower pictured with the palm rest facing down on the grip on the mobile tray. The original hand grip may be unscrewed and replaced with the ball knob at the therapist’s choice.
In some cases, the original hang grip may provide optimal positioning. It may be used as follows: Once the forearm is positioned and stabilized and the wrist is volar side down over the mobile tray axis, position the hand grip in the thumb web space at or proximal to the second MCP. This point serves as the contact if the choices are stretching into ulnar deviation or strengthening for radial deviation. Alternately, position the hand grip against the hypothenar eminence, close to the fifth MCP. This point serves as the contract if the choices are stretching into radial deviation or strengthening for ulnar deviation.
Strengthening or stretching functions can proceed as indicated using the same basic procedures as outlined in detail for the flexion and extension functions.
RATIONALE FOR USE OF THE THREE DIFFERENT “SLIDES” FOR THE HAND GRIP LOCATED ON THE MOBILE TRAY
When the hand grip is located in the central slide, a patient may improve sufficiently so the mobile tray butts up against the range pin, allowing no more excursion for the wrist. If more excursion of the wrist is desired in the direction that is now blocked, the hand grip may be unscrewed from the central slide and inserted into whichever slide provides increased excursion. While the hand grip is loose in the new slide, position the grip for the patient to grasp, or at the dorsum of the MCP’s depending on which surface pressure will be applied. Tighten the post. Proceed with the stretching or strengthening technique of choice.
LIMITING RANGE OF MOTION
If limiting the excursion of the wrist is indicated, a peg can be inserted into a hole in the row that runs underneath the mobile tray (labeled motion blocking holes on the diagram). This peg would prohibit excessive stretch on the recovering anatomical structures. A peg can be placed on both sides of the mobile tray thus preventing excessive motion in both directions.
USING PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION TECHNIQUES
The HOLD-RELAX technique can be employed by placement of a peg to prevent movement of the mobile tray in one direction, while allowing free movement in the opposite directions. For example; a peg placement could prevent wrist flexion. The patient would actively contract against the peg, thus firing the flexors. Upon relaxation, a resistance band or cord that pulls the wrist into extension would then work while the flexors go into a phase of reflex inhibition following contraction. This technique is an option if the condition allows its use. As the extension ROM is increased, the blocking peg can be moved to a different hole to allow continued effective use of this technique. (Use the same principles for other directions of movement).
SIMULTANEOUS USE OF HEAT OR COLD
Heat or cold can be applied before or after a patient actually uses the Wristor SYSTEM but the option exists for simultaneous use during stretch. This beneficial treatment combination of heat during a stretch position and cold concluding a stretch, promotes the plastic-elastic concept to gain ROM. Actual application is directly over the arm with appropriate levels of insulation. If one of the side supports is not necessary to stabilize the forearm, it may be slid away from the arm so cold or heat application is more directly applied to the tissue.
Release from the stretch position should always be performed slowly. Abrupt release of the tension can be painful and thus counterproductive.