July 2018 No. 51
Please Steal the Cherries!
Karol Young OTD, OTR/L, CHT
With insurance companies increasing co-pay amounts and limiting treatment visits, research comparing outcomes for therapy attendance to independent home exercise programs is a hot topic. A recent article in the Journal of Hand Therapy compared outcomes of a supervised therapy program to that of an independent home exercise program following metacarpal fractures (1). The study demonstrated that at six weeks, both home exercise programs and traditional physical therapy treatments are effective in the postoperative management of metacarpal fractures.
Adherence to a home exercise program positively impacts patient outcomes, but what is the proper number of exercises to give a patient? If we instruct the patient in too many different exercises will they become overwhelmed and not remember the exercises or have the time to perform them all? One exercise in the above referenced study called “steal and hide the cherries,” which combines several simultaneous upper extremity joint movements, is easy to remember.
The starting position for “stealing cherries” requires shoulder flexion and elbow, wrist, and finger extension (Figure 1). The patient then makes a fist and moves the arm downward close to the body (Figure 2 & 3). Next the patient continues to bring the arm downward alongside the body while flexing the wrist (thus hiding the cherries). See Figure 4.
Why is performing this exercise beneficial? “Stealing and hiding the cherries” allows the therapist to observe the patient’s posture and, if needed, also instruct the patient in proper postural control. When combined with deep breathing this exercise can also be beneficial in assisting lymphatic flow in the upper extremity. Active composite wrist and finger extension and flexion promotes tendon gliding in the hand. The pattern of movement facilitates motor re-learning and encourages a synchronized movement pattern. This exercise also simulates functional movement which may encourage the apprehensive patient to use the injured extremity to engage in daily tasks such as putting dishes away or fastening a seat belt.
Can you think of any other benefits to this exercise? I am going to start instructing my patients to “steal the cherries.” Will you?
|Figure 1. Shoulder flexion and elbow, wrist, and finger extension||Figure 2. Making a fist||Figure 3. Bringing the arm downward close to the body||Figure 4. Bring arm along-side body while flexing wrist|
1. Gulke J, Leopold B, Grozinger D, Drews B, Paschke S, Wachter N. Postoperative treatment of metacarpal fractures-Classical physical therapy program compared with a home exercise program. JHandTher, 2018;31:20-28.
© HandLab; 2018 all rights reserved
Disclaimer: HandLab Clinical Pearls are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.