Gale-Force Rehab!

Kgale

On the 1st August 2014 Kevin Gale was rushed to RPH via helicopter and had a mid-forearm subtotal replant to his right arm in a 9 hour surgery following an incident involving a ‘superaxe’ machinery at his self-employed workplace in Kojanup. The   involved structures in his injury include: ORIF to the distal radius and ulna, ulna and radial artery repair with vein grafts, repair of the ulnar and median nerves, all flexor and extensor tendons, with a massive skin graft from the left to the right arm.

We first met Kevin at 4 weeks post-surgery date. Previous to this, he had been treated at RPH. Kevin’s treatment has certainly been a team effort. In the early days of rehab, Kevin and his 86 year old mother, Marion (who was also chauffeur) were     travelling up and down from Kojonup twice weekly. Caring for the split skin graft, managing oedema and fighting against     adhesions was initially our primary focus as well as maintaining sensory mapping and reinforcing neural connections. Kevin’s psychological wellness remains an ongoing consideration throughout treatment given that he has a history of depression.

We are now at the stage of minimizing scarring with Otoform, InterX and compression garments from Second Skin along with massage and vibration to minimize adhesions. Kevin’s compression garments are also addressing oedema that we originally tackled with coban and lycra gloves, Manual Oedema massage techniques and contrast bathing. Active and passive movement was commenced as soon as we met Kevin with the aim of minimizing stiffness and adhesions. As he was already 4 weeks post op, this process was already well and truly on its way. With all muscle groups affected, the emphasis was on as much active and passive movement as possible. Thanks to the persistence of his mother Marion (the home therapist extraordinaire!), and   Kevin’s self discipline with the extensive home therapy regime combine with our clinic sessions ,we have managed (to date) maintain full passive digit ROM. Active ROM is a greater challenge as would expected due to the severity of nerve damage but nevertheless there is approximately 20 degrees movement (stronger in flexion) in most digits and thumb joints except for the index finger IP’s.

Despite complete severance of both ulnar and median nerves, Kevin is reporting return of sensation particularly in the ulnar nerve distribution. We have been using a lot of motor imagery, mirror box and sensory glove stimulation to maintain the cortical maps. Kevin has been very enthusiastic about reading up on neuroplasticity and putting techniques into play. Hand Works OT referred Kevin to Driving OT services as he wished to return back to driving, he is now able to drive independently using a steering wheel knob with one hand.

Three months post-surgery date, we have commenced the Rosenscore, which is a standardized, validated instrument for measuring ulnar and median nerve recovery. It will be interesting to track Kevin’s functional recovery. Stay posted for progress updates!