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A OTA is working in home health with a patient who has bulbar onset of Amyotrophic Lateral Sclerosis. The patient is progressively declining in motor function. He presents with bilateral wrist drop and tightness in the long flexors. He wants to continue working on his computer and perform grooming with less hand and wrist pain. The OT has the OTA fit the patient with custom wrist-hand-finger orthoses (WHFO) in neutral during activities as well as volar pan splints in a semi-rigid thermoplastic at rest. What would be the primary biomechanical purpose for the orthotics?
a. To allow slack for inflamed tendons in the dorsal compartment and immobilize the CMC joint in radial abduction
b. To maintain the reflex-inhibiting pattern to inhibit abnormal spasticity of the fingers and palm
c. To support the DIP joints in extension while permitting unrestricted movement of the PIP joints
d. To allow muscle balance in the long flexors, sensibility, and maximum pain-free passive extension of the digits

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Posted by (Questions: 108, Answers: 97)
Asked on February 7, 2019 11:35 am
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Answer: d) Addresses both the wrist and fingers. The wrist orthoses prevent compression of the median nerve when set in a neutral position. The pan supporting fingers in passive extension reduces pain and prevents further contractures. The WHFO allow the patient to feel his face during grooming. A) The purpose of a long forearm-based radial gutter splint for tenosynovitis. B) The purpose of a cone splint. C) The purpose of a finger gutter splint to treat fractures or avulsion injuries.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235924/
Ivy, C. C., Smith, S. M., & Materi, M. M. (2014). Upper extremity orthoses use in amyotrophic lateral sclerosis/motor neuron disease: three case reports. Hand (New York, N.Y.), 9(4), 543-50.
(For above question)

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Posted by (Questions: 108, Answers: 97)
Answered on February 7, 2019 11:36 am
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