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Table 9 Expert panel suggestions

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