From: Hand surgery and hand therapy clinical practice guideline for epidermolysis bullosa
Exercises: post op Type | Indications | Contraindications/comments | Duration and repetitions |
---|---|---|---|
Active ROM | Start when individual tolerates, as soon as possible Week 1–4 post op Start while dressings are still in use Work on finger extension/flexion, abduction/adduction, thumb motion all planes Wrist and forearm motion all planes | Fixation such as K wires or banjo type orthosis Skin grafts need to be able to tolerate motion | Three to four times a day 10–30 repetitions each exercise |
Active assisted ROM | May need to use initially Hand over hand finger and thumb flexion and extension, with gentle guidance Help overcome fear of moving | Individual intolerance | Three to four times a day 10 slow repetitions each exercise |
Active ROM via activities | Engage in individuals preferred activities: art, technology use, grooming, eating | none | Daily |
Passive ROM | For well healed/tough skin Generally, only with adults Web space and digit extension stretching Wrist stretching | Individual intolerance May not be indicated until several months post op. Not indicated for all | Two times a day 3–5 repetitions holding for count of 30–60 seconds Orthosis use to address contractures may be considered instead |
Strengthening | For well healed/tough skin Focus on lumbrical grip and lateral pinch. Use soft objects such as a light foam block | Be cautious of skin shear | Every other day 15–20 repetitions each exercise |