Real recovery, real outcomes

Initial challenges

Following road traffic trauma, the client developed CRPS, with significant pain and hypersensitivity in the wrist and hand. At the start of OT, active wrist extension was 0°, and radial and ulnar deviation were severely limited.

They had very limited use of the hand, and the condition had a marked effect on their confidence and wellbeing. Daily activities were restricted, and work and leisure had been disrupted.

Assessment and intervention

• Assessment of active and passive wrist and hand range of movement, pain, sensitivity, function and the demands of daily life and work
• Carefully graded heat therapy, where tolerated, to manage symptoms and prepare the hand for activity
• Passive range-of-movement exercises and graded mobilisation, then active and active-assisted wrist and hand exercises, including extension and radial and ulnar deviation
• Sensory desensitisation, pacing, graded exposure and confidence-building
• Functional hand and upper-limb work: gripping, handling objects, lifting, carrying, dexterity and two-handed daily tasks
• Progressive strengthening, including resistance work, grip exercises and graded weight-bearing through the arm, such as modified push-ups and planks
• Advocating to the case manager for a specialist pain service and consultant review, given the significant effect of CRPS on wellbeing
• Graded return to valued activities and work, with MDT liaison

Functional outcomes

By the end of the programme, the client had regained full active and passive wrist range, including extension and radial and ulnar deviation. Grip strength and tolerance for loading the arm improved.

Most importantly, they returned to the things that mattered: driving, work, socialising, walking the dog and going on holiday. These everyday activities show recovery that goes well beyond movement in the wrist alone.

Range of movement was assessed clinically. Participation outcomes were reported at discharge. Details have been changed to protect confidentiality, and outcomes vary from person to person.

Initial challenges

An adult with family responsibilities and a screen-based working role was referred after an injury. They were experiencing significant fatigue and visual difficulties, which grew worse with screen work, along with a heavy load on attention and information processing.

Household tasks, travelling in the community and work had all been disrupted, and they were unsure whether they would be able to drive or work again.

Assessment and intervention

• Assessment of work, home management, community travel, fatigue, vision and cognition in everyday tasks
• Recommending a neuropsychology review, which helped focus rehabilitation on fatigue, vision and adjustment
• At work: visual scanning techniques, and trialling different screen equipment, settings, positioning and ergonomic adaptations to reduce visual fatigue
• Graded exposure to screen-based tasks, with planned breaks
• Compensatory strategies linked to daily life: task sequencing, checklists, written prompts, alternating demands and planning around fatigue
• A graded return-to-work programme with monitored hours and duties, an adapted environment and liaison with the workplace
• Strategies for everyday routines, including planning family meals, community and transport planning, and dog walking

Functional outcomes

Following graded rehabilitation, the client returned to full-time work. They made independent bus journeys to work, resumed driving, returned to cooking meals for the family and to walking the dog, and used their fatigue and visual strategies with growing confidence.

Outcomes were reported at discharge. Details have been changed to protect confidentiality, and outcomes vary from person to person.