Page 18 - A Guide to Physical and Occupational Therapy for CMT

Occupational

Therapy

Goals of Occupational Therapy
The initial evaluation will provide your OT with insight into your specific
challenges with activities of daily living (ADL). Interventions and education to
help maximize your independence and engagement in meaningful activities can
be tailored to meet your individual needs. The plan of care will outline exercises
and activities, adaptations or assistive devices, modification to the environment,
splinting options and guidance/education designed to achieve these goals.
Your plan of care may include programs for stretching and exercising,
recommendations for adaptive equipment and potential home modifications,
ergonomic solutions, upper extremity splinting, tremor reducing techniques,
pain relieving modalities and energy conservation techniques. OTs use both
remedial methods – the process of restoring or maintaining function – and
compensatory methods – strategies or equipment that compensate for a deficit
– of intervention.

Hand Function
CMT can result in sensorimotor impairments – involving both sensory and
motor functions – in the upper extremities that present as early as the first
decade of life. Typically, the distribution of impairment follows a distal (hands)
to proximal (shoulders) pattern, with the hands being most impaired and the
proximal muscles relatively spared, although more severe cases or those
further along in their disease process may present with proximal weakness
as well. Sensory disturbances in CMT can result in burning, tingling pain,
numbness and loss of sensibility, which is the ability to detect size, shape,
texture and temperature in the hands. Additionally, decreased proprioception,
which is the ability to perceive the position of the hand/fingers in space along
with movement, speed and excursion, can affect hand use during tasks.

Motor impairment in CMT can limit active movement of the hand, thumb
and fingers, cause fatigue, result in decreased muscle strength and lead to
progressive muscle wasting or loss of muscle bulk and hand contracture/
deformity. The intrinsic muscles of the hand, which are small muscles within the
hand itself that help with refined finger movement, tend to be affected the most.
This can result in decreased dexterity and the inability to complete manipulative
tasks. Extrinsic muscle weakness, which involves the larger, forearm-based
muscles responsible for opening and closing of the fingers and movement of
the wrist, can limit forceful grasp and movement of the wrist. Muscle cramping
of the hands/forearms, cold intolerance resulting in stiff fingers and tremor
of the hands can also be present in people with CMT and contribute to
ADL limitations.