Occupational therapy Airmen go above and beyondApril 11, 2016
JOINT BASE ELMENDORF-RICHARDSON – “My finger went ba-doink,” the noncommissioned officer said as he demonstrated an unnatural bend for any digit.
Air Force Master Sgt. Robert Wagner, 773d Civil Engineer Squadron primary security manager, and a musician and athlete, lost most of his right middle finger’s mobility in an injury Oct. 23 during an intramural soccer game as a goalie with the CE team.
“It’s a big part of my job to have movement in my hands,” he said. “Who knows how I would be able to recover. Maybe I would never have had full function of my hand again - that was always a possibility.”
There was hope.
The two primary occupational therapists who helped him were Air Force Lt. Col. Diana Medina, 673d Medical Operations Squadron Physical Occupational Therapy Flight commander, and Air Force Staff Sgt. Devin Rudd, 673d MDOS physical medicine technician.
“Everybody needs a balance of work, leisure and taking care of oneself,” Medina said. “For [Wagner], his stress reliever is [sports], and if you don’t have your stress reliever things can pile up. From my perspective, if I can get him back to doing this type of stuff, this will restore his quality of life.”
The first two months of Wagner’s therapy was focused on straightening his finger using numerous therapeutic practices.
“I worked with different people within the OT [clinic] ... they did a wide range of techniques like heating it up for 10 minutes then stretching it out,” Wagner said. “With their techniques, like dunking it in wax, using an ultrasound, hot towels and stuff like that, I was able to gain a little mobility.”
Throughout January and February, the technicians worked on his range of motion.
“We kept working on getting his finger straight [and, when] we got it nice and straight, then he couldn’t get full function back,” Medina said. “Flexion is usually easier to get back, so we worry about getting it straight, but he just wasn’t progressing.”
Wagner’s recovery hit a stagnant period, when he could not firmly grip anything, and could only flex his finger about halfway.
If the occupational therapists couldn’t fix his finger, the next step would be surgery. It would take even more time, and recovery would be much longer, so Medina and Rudd decided to make a dynamic splint.
A dynamic splint can reduce recovery time and improve the overall range of motion for a joint injury using controlled, prolonged stretching.
“If we can’t get it with non-dynamic means, then we will go into a dynamic splint,” Medina said. “They are more cumbersome to make, they are harder to wear - because they have big components.”
The only option the occupational therapists had was to make the splint, which had its own difficulties.
“This is where it [got] interesting; our biggest issue with him was getting the [splint] on,” Medina said. “When we finally had it on and we pulled his finger down, we realized that the [tuning] component was too far up.”
The splint wrapped around the palm of the hand and a string holding onto the middle finger would be pulled by a guitar tuner to force the tendons to stretch.
“We had a good angle, but we had to move [the tuner] further down to get full flexion,” Rudd said. “We had to redo the entire thing.”
On the second try, they ran into even more problems.
“Other things went wrong like the splint material wasn’t sticking, so we were like ‘OK, that’s not working - oh yeah! Rivets!’ So we just kept at it,” Medina said. “Making this splint took a little more than an hour because of the additional modifications.”
Wagner said when he was amazed by their ingenuity.
“In CE, we build stuff that people are in awe of, but when you think about occupational therapy it’s usually stuff like balls, rollers, stretching out and stuff, not intuitive contraptions using fulcrums and pulleys to put your body against itself - to heal itself,” Wagner said. “You just tighten that tuner [and] it just wrenches [my finger] down, stretching all the tendons.
“This is not just a piece of bubblegum and some duct tape,” Wagner said. “There had to be a lot of engineering going through [their] head to build that thing. This is the innovative engineering that takes therapy into a new dimension.”
The OT clinic doesn’t see hand injuries every day, let alone ones that need dynamic splints, but they are trained to adapt and overcome.
“We don’t make very many dynamic splints, but for hand-therapy protocol, they are common,” Medina said. “Since I’ve been here, that is the first dynamic splint I’ve had to make.”
After two weeks of ‘fine tuning’ 15 to 20 minutes a day, Wagner was able to extend his finger straight and close his hand into a fist.
”I think [occupational therapists] are very needed in the Air Force, because otherwise we would have a bunch of broke bodies without any proper technique to heal them and put them back in the work force,” Wagner said. “In a job that is customer-service based, it is very easy to become stagnant and just do your job, but the positive outlook that they want to help their people is refreshing.”