Independent Assignment Martha Washington

Independent Assignment
Martha Washington is a 78-year-old female, art teacher, with a history of osteoarthritis of
the spine, knees and hips, diagnosed with carpometacarpal (CMC) osteoarthritis. She has been
experiencing pain and stiffness in her thumbs over a year. The pain is notably invoked and

greater on the left than on the right hand. Her right hand is dominant. Martha experiences pain
while performing all functional tasks requiring movement of the thumb. It is important to note
that there is obvious muscle atrophy around the region of the thumb known as the thenar emi-
nence. Movements into thumb opposition and tasks that require sustained tight gripping or pinch-
ing are painful and restricted. The CMC osteoarthritis has greatly affected her day-to-day activi-
ties such as caring for her handicapped dogs and painting. Currently, all her activities of daily
living (ADL’s) instrumental activities of daily living (IADL’s) are limited by the CMC os-
teoarthritis. Her medical history is significant for osteoporosis.
In Martha’s case, intervention is necessary to address her difficulty in pinching and
grasping. Furthermore, limitation in strength and endurance in performing her ADLs and IADLs
should be addressed. Considering the length of time Martha spends catering for her handicapped
dogs, it is important to use modalities that will enable her to continue with her daily activities,
while promoting rehabilitation and healing.
To address Martha’s concerns in thumb grasping and pinching, I have chosen evidence
based management modalities that will allow Martha to continue with her work of feeding dogs
as well as engaging in her hobbies in painting and dog training. The occupational therapies se-
lected are easy to teach and applicable in a home set up based on Martha’s age and living condi-
tions. The interventions identified include activity use of physical agent modalities (PAM) and
biomechanical devices such as a custom-made neoprene thumb carpal metacarpal orthosis with
thermoplastic stabilization and activity modification practices.
In preparation for definitive occupational therapy, Martha will utilize physical agent
modalities (PAM) to reduce pain and promote healing before and after engaging in her daily ac-

tivities. A ‘hot pack therapy’ is advocated for as an effective method to relieve pain, enhance lo-
cal circulation, facilitate tissue healing, and decrease joint stiffness (Bellew et al., 2016).
Additionally, a ‘hot pack’ will be used as an adjunct to the biomechanical therapy applied. The
warmth from the ‘hot pack’ is reported to cause a change in temperature on the surface of the
skin that promotes blood flow, thus, oxygenation of the area, fostering tissue healing (Bellew et
al., 2016). Martha‘s response to thermal changes must be ascertained prior to the implementation
of ‘hot pack’. The heat pack will be applied around the carpalmetacarpal joint of the left and the
right thumb and the area of reduced muscle tone. The ‘heat pack’ is efficient and reducing in-
flammation in the CMC joint, hence lowering pain during function.
As an adaptation to the environment, Martha’s occupational therapy would involve
biomechanical devices. In this case I would opt for a device that is custom to Martha’s social
life. Considering that she stays alone, the occupational therapy modality should aim to restore
body functions that were impaired by the disease or injury. The biomechanical approach will fo-
cus on reestablishing functional skills while limiting pain (Aebischer et al., 2016). Since Martha
needs to feed her dogs and draw, it is important to institute therapy that will allow her to perform
her roles independently and as effectively as possible. Therefore, for Martha, I will suggest a
custom-made neoprene thumb carpal metacarpal orthosis with thermal plastic stabilization.
Splinting using an orthosis for thumb CMC osteoarthritis is an effective occupational
therapy. The treatment modality aims to stabilize the CMC joint and prevent contracture while
hand function is maintained. Orthoses lower pain experience and enhance thumb function.
Ahmadi et al. (2014) recommends provision of orthoses to be based on individual need and pa-
tient factors. With this knowledge, Martha is a good patient to recommend a custom-made neo-