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![Page 1: Katie Yancosek, OTR/L, CHT. Raise awareness of hand dominance and discuss treatment options for re-training/transfer. Ultimate Goal: IMPROVE FUNCTIONAL.](https://reader035.fdocuments.us/reader035/viewer/2022070305/5513b52b497959a12f8b45e4/html5/thumbnails/1.jpg)
Katie Yancosek, OTR/L, CHT
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Raise awareness of hand dominance and discuss treatment options for re-training/transfer.
Ultimate Goal: IMPROVE FUNCTIONAL OUTCOMES via RELEVANT CLINICAL CARE PATHWAYS
Objective
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WHAT What is hand dominance?
Hand dominance is the preferential use of one hand over the other for single limb or bi-manual tasks
In bi-manual tasks one hand is the main executor and one is the supporter.
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Hand Dominance
• The dominant hand is affected (acute or chronic) more often than the non-dominant hand
• Traditional medical disability ratings consider hand dominance as a main factor
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Hand Dominance
• Limb dominance is evident in most primates and in some lower animals (ex: frogs, rabbits)
• Why do we exhibit hand dominance? unknown and still debated
• Hand dominance may be a continuous variable rather than a dichotomous variable (left-ambidextrous-right vs. left or right)– Edinburgh Handedness Inventory=Laterality
Quotient
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• 9/10 people are right handed• Greater than 60% of the 10% of lefties are
male– One theory relates to in-utero exposure to
testosterone
• “Dexterity” comes from the root word dexterous which means right-sided
Hand Dominance
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HAND DOMINANCE
Is the peripheral manifestation of cerebral dominance
Strongly LINKED TO LANGUAGE: gesturing, speech, and writing
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Hand dominance primarily defined by the writing hand
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WHO
Who should receive hand dominance
re-training?
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Brachial plexopathies, Hemiparesis following stroke, Chronic Regional Pain Syndrome, Mutilating hand
Injuries: burns, crush injuries, multi-tissue injury, Amputation
Brachial plexopathies, Hemiparesis following stroke, Chronic Regional Pain Syndrome, Mutilating hand
Injuries: burns, crush injuries, multi-tissue injury, Amputation
WHO
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WHY
Why address hand dominance
re-training?
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Loss of dexterity in dominant hand means many things…..
WHY…
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• A functional state of single-handedness• Limited dexterity, strength, endurance, speed
(awkward and slow movement) • Loss of occupational/social roles– Hand shaking, embracing, self-expression: jewelry
(bracelets, watches, wedding rings), nail painting– Work– Sports/leisure– ADL
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Why retrain hand dominance?
Current Functional Status: Impaired
Current Functional Status: Impaired
Goal: Functional Independence and
participation
Goal: Functional Independence and
participation
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WHY
Because hand dominance is the pervasive use of one hand over the other, and we need to be purposeful, not passive, in our approach!
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WHY
Offer your clients POWER and CONTROL
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HOW
HOW do we facilitate a hand dominance transfer?
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YES• Hand dominance
changes across time• Lateralized practice • Environmental
influences• Neuroplasticity:
dynamic systems capable of CHANGE
NO• CNS stability:• Innate left-handers• Obstetrical Erbs
Palsy
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One-handed ADLSee Backpack list under Resources Tab
• Adaptive equipment• You-tube videos: hair-tying, shoe-
tying, neck-tie tying, jewelry application
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Two studies
• Efficacy trial (with non-impaired participants) made statistically significant improvements in dependent variables of legibility, letters-per-minute, velocity (x and y axes)
• Clinical effectiveness trial (with impaired military members) show similar results
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Description of Intervention
• 42 day massed-practice, task-oriented approach with focus on handwriting activities that progress from simple to complex.
• Four main sections: 1. daily exercises/writing activities, 2. homework, 3. therapist’s tips, and 4. web site companion
www.handwritingforheroes.com
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1st Study: Participants wrote 32 minutes per day Clinical effectiveness study: COPM: writing in college (taking notes, taking tests), paying bills, filling out forms in the hospital, journaling, writing to-do lists, writing letters, signing one’s name
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REHAB
RE-HABIT
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Language-based activities
• *Writing• Drawing/Painting• Texting/Typing
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Power-based
• Hammering•Washing mirrors•Weight training
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Integrate Prosthesis
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• Co-morbidities and concomitant injuries• Prior level of function (PLOF) and current
occupational demands (B) and (I)ADL• Patient’s goals• Time since loss of dominant hand function• (in non-amputee population) PROGNOSIS of
recovery of function• Laterality
WHEN do you start? Consider:
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40
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