a brief role of occupational therapist in RA

1. OCCUPATIONAL
THERAPY IN
RHEUMATOID
ARTHRITIS
PRESENTED BY: SHIKHA MAMGAIN
MOT (MUSCULOSKELETAL)

2. INTRODUCTION
• Chronic systemic autoimmune disorder
• Can affect lungs, cardiovascular system, and eyes in some
patients
• Occurs most frequently between 20-40 years of age and more
in women than men
• May range from mild to severe and can result in joint
deformity and joint destruction of varying degrees

3. PATHOLOGY
• An external trigger (eg, cigarette smoking, infection, or
trauma) that sets off an autoimmune reaction, leading to
synovial hypertrophy and chronic joint inflammation along
with the potential for extra-articular manifestations, is
theorized to occur in genetically susceptible individuals.
• Synovial cell hyperplasia and endothelial cell activation are
early events in the pathologic process that progresses to
uncontrolled inflammation and consequent cartilage and bone
destruction. Genetic factors and immune system
abnormalities contribute to disease propagation.
(-Howard R Smith et al, 2016)

5. DIAGNOSIS
The American Rheumatism Association 1987 for the
Classification of Rheumatoid Arthritis
• Morning stiffness
• Arthritis of 3 or more joint areas
• Arthritis of hand joints
• Symmetric arthritis
• Rheumatoid nodules
• Serum rheumatoid factor
• Radiographic changes

7. SIGNS & SYMPTOMS
• Persistent symmetric polyarthritis (synovitis) of hands and feet
(hallmark feature)
• Progressive articular deterioration
• Extra-articular involvement
• Difficulty performing activities of daily living (ADLs)
• Constitutional symptoms

8. OCCUPATIONAL THERAPY
ASSESSMENT
• ID data
• Chief complaints
• History
• Observation – appearance of joints for heat, redness, edema,
deformity, skin, joint enlargement, rheumatoid nodules
• ROM and end feels
• Strength- manual muscle test
• Hand functions- Jebsen test of hand functions
Arthritis Hand Function test
Sollerman hand function test
• Sensation- if there is nerve compression caused by swelling

9. • ADL- Arthritis Impact Measurement Scale
Rheumatoid and Arthritis Outcome Measure

10. STANDARDIZED SCALES
• JEBSEN HAND FUNCTION TEST
7 subtest, performed on both non-dominant and dominant
hand
Writing a letter,
Card turning
Picking up small common objects and placing them in a
container
Stacking checkers
Stimulated feeding
Moving light objects
Moving heavy objects

11. • ARTHRITIS HAND FUNCTION TEST
-Catherine Backman et al
11 item performance based test designed to measure hand
strength and dexterity
4 subscales: strength, applied strength, dexterity, applied
dexterity
Items are administered in order on the scoring worksheet in
the manual. Right and left hands are tested seperately for the
strength and dexterity items. The applied strength and applied
dexterity are performed using both hands.
Time to administer: 20 mins

12. • SOLLERMAN HAND FUNCTION TEST
 20 item objective measure designed to assess hand function with 7 different
hand grips of persons with hand dysfunction
 Subject is given 60 seconds to complete each item
 Test is administered in seated position with eqipment box placed in front of
subject
 Sollerman box includes:
 Door handle with lock
 Coins and coin purse
 Zipper
 Wooden cubes
 Iron
 Screwdriver
 Nuts
 Jars and lids
 Buttons
 Play dough with knife and fork
 Pen, paper

13. SPECIFIC JOINT PROBLEMS
AND DEFORMITIES
• Swan –neck deformity- PIP hyperextension and DIP flexion
• Boutonniere deformity- PIP flexion and DIP hyperextension
• Trigger finger- thickening of flexor tendon of finger or thumb
• Ulnar drift
• Deformities of thumb-
1. Flexion of MP joint with hyperextension of IP joint (type 1
deformity)
2. Flexion of MP joint with IP hyperextension and CMC
involvement ( type 2 deformity)
3. MP lateral instability and CMC adduction (type 3 deformity)
4. MP hyperextension and IP flexion (type 4 deformity)

15. OT TREATMENT PROTOCOL
1 SPLINTING-
• A recent study of RA patients wearing prefabricated wrist
splints reported a 32% reduction in VAS pain scores.
• Splinting RA patients’ hands and wrist can provide pain relief,
support, joint protection, stability and reduce inflammation.
• It should be considered early as a part of comprehensive
treatment program, and can be instrumental in enhancing
function for those living with RA.
- (Dianne Freeman 2009)

17. 2. PRINCIPLES OF JOINT PROTECTION-
• Respect pain
• Distribute the load over stronger joints/ or over large surface
areas
• Avoid maintaining the same joint position over prolonged time
• Reduce excess body weight
• Use good posture and body mechanics
• Use the minimum amount of force necessary to complete a
job
• Simplify the work using efficiency principles: plan, organize,
balance work with rest
• Maintain strength and range of motion

18. • Intervention strategies may include:
• Physical agent modalities (e.g., heat, cold) to assist with pain
management, enhancing the client’s ability to perform daily
tasks
• Techniques to manage or control edema and inflammation,
including limb elevation, compression garments, exercise, and
splinting
• Therapeutic activities and exercises to promote gross and fine
motor control, range of motion, endurance, and strength,
thereby improving functional abilities with daily tasks such as
self-care, home management, and work and leisure activities
• Provision of custom or prefabricated orthotic devices to assist
with controlling pain, maintaining functional positions of the
hand, and enhancing function

19. • Training in the use of joint protection and energy conservation
techniques, including the use of adaptive and assistive devices
and modified daily routines to ensure adequate rest and to
avoid overuse
• Ergonomic assessment and activity modifications in home,
work, and school settings
(AOTA fact sheet 2010)

21. THANK YOU