[Occupational therapeutic measures before and after surgical correction of hands with congenital malformations]

The task of the occupational therapist following surgical procedures on deformed hands is discussed. In the child with congenital malformations, we must not only be concerned with treatment of the deformity but we must be concerned about the psychic problems which can develop following prolonged hospitalization or overprotection. One must be keenly observant to detect these problems early. Preoperative testing utilizing a standardized gripping test is carried out by the occupational therapist. The necessity for this is demonstrated by the example of the radial clubhand. In this way complications such as correction of clubhand in the face of a stiff elbow or pollicisation in the presence of inadequate clubhand correction can thus be avoided. After operation training in the new functions is begun as early as possible; preferably with individual supervision. Daily repetative and progressive exercises should result in maximum utilization of gripping ability provided by the operative procedure. The treatment program also includes the adaptation of clothing, the production of appliances and splints, in co-operation with the orthopedic technician, as well as specially designed functional exercises. All these factors are as important as the operative procedure itself in contributing to maximum benifit. All essential findings and their variations must be written down. Also the photographic documentation of the functions is the job of the occupational therapist. Sufficient time should be allowed prior to discharge to inform the parents about the newly acquired functions and the use of the applicances. The maintenance and further development of the newly acquired functions is insured through the continued ambulatory supervision by the doctor and the occupational therapist. The occupational therapist thus has a significant job as a member of the team in a special unit for children with congenital malformations.