Question
What are some important areas to keep in mind with hand transplants?
Answer
There are many important areas in the rehab process with hand transplants. Once the client has been selected as an optimal candidate and the surgery has been performed, there is a progression of activities that take place.
During the initial healing phase, it is important to be looking for early signs of rejection. Things to look for would be: increased edema, a rash or red spots that do not blanch or skin breakdown. If any of these signs are noted, they need to be reported to the medical team as early treatment can sometimes reverse the effects of this. During this phase, our role is to provide protective forearm splints and bed/chair positioning for optimal healing.
In the early phases of splint use, it is imperative to support the arm until the underlying bones, muscles and blood supply have had time to stabilize. In proximal transplants (upper arm), the distal joints will need to be supported until muscular control returns. Sometimes a sling can be used in these cases. In more distal transplants, once the forearm bones have had time to heal, a hand based splint can be used to position the hand in an anti-deformity position.
In general, the healing time is about 6 weeks. After 6 weeks, gentle PROM and AAROM can begin. This time is an important time as this is integral to their acceptance of their new limb. In the early stages of rehabilitation, you can adapt their splints to allow them to complete functional activities such as pushing buttons on a phone, eating or light ADLs. Adaptations such as projections added on to the splint, univeral cuffs or ace wrapping items to their hand can help them to achieve these functional tasks.
As they get stronger and the transplant heals, you can progress functional tasks. Once a valued activity is selected, it is modified so that it is possible for the client to complete it given their current sensory and motor function. A good rule of thumb is to move from large/light items to smaller/heavier items as they progress.
