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Upper Body Activities - Buffalo Occupational Therapy
  2. Upper Body Treatment for Occupational Therapy
  3. Page 2

General:

Upper Body treatments for occupational therapy practitioners are extremely important because of the stereotype that plagues the profession. It’s unfortunate, but true that people put occupational therapy practitioners into the “upper body” box. Well, if we are going to have that stereotype than our treatments for the upper body better be ON POINT. Am I right? As The Portal evolves, more information will be added to the upper body treatments and documentation section of The Portal. We want to ensure you are equipped with the information, tools, articles, and resources you need to make your occupational therapy treatments the best they can be. 

What are some general ideas about treating the upper body that you should consider?

You do not need to be specialized in hand therapy or any other aspect of the shoulder to the fingertip in order to treat every diagnosis!!

While it is absolutely required to establish competency through continuing education and optional certifications before treating your client to ‘do no harm’, every occupational therapy practitioner is a generalist which means you have the freedom to treat the diagnoses, conditions, or barriers affecting the upper extremity.  

You can NOT just treat 'the hand'.

Because of our holistic training on the human body that includes both medical science and social science, every occupational therapy practitioner must remember that the hand is the distal attachment of the entire upper extremity and the upper extremity is connected to the trunk by way of the shoulder complex. The muscles encasing the skeletal anatomy are connected through kinematic chains and therefore if the trunk or shoulder are experiencing dysfunction, this may manifest in the functional performance of ‘the hand’. Work proximal to distal! The shoulder complex drives the functional performance of the hand. 

BEWARE of compensatory strategies!

As we know from Applied Kinesiology, the body wants to move and will find a way to do this REGARDLESS of whether or not it is a ‘safe and efficient movement pattern’. This desire for your body to engage in occupational performance will result in compensatory movements in the neck, shoulders or trunk to complete a task. We canNOT carry on with a treatment if our patient can not use their upper extremity in an activity without shoulder hiking, lateral trunk flexion, trunk rotation and flexion, neck lateral flexion or a combination of any of the above. Additionally, if you can see the client can not reach their arm above 90 -110˚, assess their scapular mobility and stability!  Are they winging? Do you see little movement within the shoulder girdle (Boney ring)? If this observed, this is a hands-on treatment and you will be providing stability for upper body exercises until you have helped your patient regain strength in those structures through therapeutic exercise and neuromuscular re-education. You can not achieve maximum occupational engagement by repeating the occupation over and over again. You must break it down and address the deconditioned body structures! 

Showcase: Fine Motor Activities

Showcase: Upper Extremity Activities

BOT OT Treatment Portal Assessments and reference - Buffalo Occupational Therapy

Assessments to use in Evaluation and Progress Notes:

  • AROM 
  • MMT
  • 9 Hole Peg Test
  • Dynomometer 
  • Pinch Guage
  • Quick DASH
  • Brief Pain Inventory
  • Screen for Dysdiadochokinesia

Helpful Printables in the Occupational Therapy Store

Clinical Interview for Arthritis 1 - Buffalo Occupational Therapy
Trigger Finger thumbnail - Buffalo Occupational Therapy
Fine Motor Documentation Series Buffalo Occupational Therapy - Buffalo Occupational Therapy
Resources for Approaching a Cognitive Examination - Buffalo Occupational Therapy
BOT OT Treatment Portal OT approach to treatment - Buffalo Occupational Therapy

How should you approach upper body treatments in Occupational Therapy? 

I can’t stress this enough – IT IS NOT ABOUT THE ACTIVITY YOU USE FOR THERAPY THAT MAKES YOU AN OCCUPATIONAL THERAPIST! For all the years you have been taught that you need to “make it functional”…..I am giving you permission to DUMP. THAT. THOUGHT. (…..or….ummmm….at least modify it a little bit.) 

Remember that you do not and should not repeat an activity like feeding, washing a window, folding laundry, making the bed, opening and shutting lids, etc. until your client magically gets better. This is not the therapeutic process. Your job is to remediate the underlying condition by restoring or maximizing musculoskeletal and neuromuscular function. An occupational therapy practitioner remains top-down throughout the plan of care, but we use activity analysis to repair and maximize function bottom-up. You must use your knowledge as top-down functional specialist, your knowledge of social science, and your skills in physical medicine to restore function and help your client use his/her upper extremities with the least amount of resistance or external modifications. Let the repair begin!

Shoulder Complex

Check out week 5 of Applied Kinesiology about the shoulder complex!

  • Perform quick ROM and MMT screen
  • Work proximal to distal
  • Identify joint mobility and stability concerns as well as barriers to maximizing functional potential
  • Don’t be afraid to JUST use AROM without any weights, cones, tools, or anything
  • Start with Isometric contractions (especially if there is arthritis present)
  • Support humeral-scapular rhythm if necessary using your hands! Don’t be afraid to get in their and use your body for a therapist-supported active assist (AAROM) 

Elbow

Consider the middle joint of the upper extremity and what movements occur here!

*Pronation and Supination* (Rotation of the radius)

*Flexion and Extension*.     (Class 3 Lever)

  • Pronation, supination, flexion, extension + internal and external rotation sometimes occur within one functional movement pattern. Each part must be functioning at its best so that our clients can put them all together when picking up and pouring a gallon of milk or feeding their baby after making a bottle.  

–> Activity analysis is essential to define the performance skills necessary for the maximum, least-restrictive, participation of occupation.

Wrist & Hand

The wrist and hand are loaded with intricacies. Remember that general edema, tendon inflammation, and scar tissues will be a huge concern in this region due to its small compartments. Ensure you have some education and action steps to offer your client! 

Protocols! Many times after wrist and hand procedures, each surgeoun may have a different protocol! Make sure you know your research as well as the protocol for treatment (if any).  

What are some key words to use in upper body treatment documentation in occupational therapy?

    • Gross BUE AROM
    • Gross BUE coordination 
    • Gross BUE strengthening
    • Neuromuscular communication
    • Reaction time 
    • Gross BUE mm endurance
    • Bilateral Training 
    • Crossing Midline 
    • Simultaneous vs Alternating BUE engagement in activity
    • Shoulder complex stability 
    • Movement integration
    • Chronic Pain Management
    • Fine motor skills 
    • Neuromuscular re-education 
    • Grasp and prehension 
    • eye-hand coordination
BOT OT Treatment Portal OT treatment videos and documentation - Buffalo Occupational Therapy

Occupational Therapy Treatment and Documentation Examples

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Activity Analysis

Occupational therapists specialize in activity analysis. Activity analysis is breaking down a task into its basic parts and you master each part of the whole activity in order to enable maximum independence.

Neuromuscular Re-education

NMRE is used by neurocentric occupational therapists to improve communication between your muscular system and nervous system. By promoting this stream of communication, you close the circle of recovery. Without NMRE, you can have the biggest muscles in the world and still experience mobility deficits due to poor reaction time, coordination, and mixed signals. 

Fine Motor Skills

Fine motor skills are a fancy way of saying functional wrist, hand, and finger movement. Many people require fine motor training after a stroke, traumatic brain injury, hand injury, neuropathy, or throughout the progression of a progressive diagnosis. 

Fine motor skills include open thumb web space, bilateral coordination, thumb IP joint flexion, finger isolation, upper body stabilization, strength, and mobility, dexterity, prehension, intrinsic muscle strength, precision, motoric separation of the two sides of the hand, motor control, pincer grasp, pinch strength, grip strength, and the ability to grasp and release. 

Cross Crawl Techniques

A cross-crawl technique is used in movement and mobility training of both upper body and lower body. By recruiting both sides of your brain using opposite movement patterns we strengthen the communication across the two sides of your brain known as your corpus collosum.