In October, AnyHand was tested in the practice of hand therapist Beate Jung and her team in Munich. In our interview she talks about the importance of patient education and the possible applications of AnyHand.

"The patient must become an expert for his hand"
AnyHand in use

Let's start with your choice of profession: Why are you a hand therapist?

When I took my exams as an occupational therapist in 1992, hand therapy had just been established in Germany. In the USA, hand therapy had been a separate discipline within occupational and physiotherapy since 1977, so I took their work as an example. I have always found hands exciting because they are highly specialized and incredibly versatile. We all need our hands in order to master our everyday life. The range of patients is enormous, all age groups are represented with a wide variety of diagnoses; illnesses as well as injuries. The professions range from construction worker to pianist to surgeon, but sports injuries and child hand dysfunction also play a major role. To further specialize, I passed the exam as a certified hand therapist according to the guidelines of the German Association for Hand Therapy (DAHTH) in 2012.

How is the cooperation with patients like?

I focus on the intensive and individual cooperation with patients. The better the education, the more I involve the person and explain to him*her which structures are affected and which measures we can take, the more I motivate people. They notice that they can actively contribute to the improvement themselves. I think it is very important that patients know what their hand's exact diagnosis and problem is. My opinion is: "The patient must become an expert on his hand". The more the affected persons know about their disorder and which hand therapeutic techniques can be used to improve it, the better they can cooperate. That's why I think it's crucial not to convey: "My hand will bet treated for half an hour and that's it".

How did the contact with LIME come about?

Pascal got in contact with me at the therapy congress of DAHTH. Later he visited me in my practice so we discussed which requirements a hand therapy robot has to meet in terms of functionality and handling. We realized: the usability must be simple and intuitive and take as little time as possible. By involving experienced hand therapists at an early stage, Pascal and his dedicated team constantly developed the device further according to the therapy needs.

What was your impression during the AnyHand product trial?

AnyHand fulfilled almost all requirements in the practical test: A hand stencil helps to measure the hand size and to adjust the device correctly. The lateral guidance of each individual finger is anatomically favorable, the pivot point is close to the joint and therefore treats the joint very gently. In case of rotational malposition of a finger or after amputation, individual fingers can be left out during adjustment. AnyHand has been tested by patients with different diagnoses and from different age groups. The unanimous feedback was that it was easy to handle and that they would also use it as a home device. In conversation with one of the patients, Pascal and I also found out that the thumb's range of motion could be extended by the external rotation.

"The patient must become an expert for his hand"

In which context do you see AnyHand's greatest advantage?

I can very well imagine AnyHand as an extension of therapy. It is important for the hand therapist to carry out a precise analysis of the status quo, for example temporary arthrodesis [1] or healing phases of the affected structures, e.g. after osteosynthesis [2] or tendon suture. I do not only see the prevention of finger joint stiffness as a field of application of AnyHand, but also the joint mobilization as preparation for an operation, for example before a tenolysis [3].

In my practice, I often experience that at the beginning of the therapy
some patients are uncertain how far they are allowed to exercise their affected fingers. Therefore it is very important for the therapist to adjust AnyHand exactly and to give it a try together with the patient. This makes it easier for the patients to relax their hand, because they know that the device's movement ends exactly where the radius of movement was previously set.

Could the AnyHand also be used to warm up before and cool down after manual therapy?

Before therapy, I always perform a visual examination first: Especially in the morning the hand is a bit stiff and less mobile than it was the day before. Therefore, I would use AnyHand if a higher degree of mobility has already been achieved with manual therapy and this new degree of movement needs further training.

Would you recommend AnyHand for home use to maintain the range of motion?

Yes, but only in combination with the therapy in the practice. AnyHand is a good tool to maintain the results after therapy is completed. But at least once or twice a week therapy must take place in the practice. The hand therapist can always vary the individual treatment and adapt the range of motion to the respective condition. AnyHand's settings can then be adapted accordingly. One thing is certain: Those patients who train at home uphold the treatment's success even between therapy sessions and thus prevent relapses.

What role does the documentation of therapy progress play for you?

We use standardized measuring instruments, for example the dynamometer for hand force or the goniometer for measuring the angle of the joints. In this way, we not only document treatment progress, but we also set measurable therapy goals. This is very motivating for the patients: they can see the success and can illustrate the way to recovery. It also shows which steps still lie ahead. The documentation of the measured data from AnyHand would be an ideal supplement here.

About Beate Jung

"The patient must become an expert for his hand"
© ergo jung

Beate Jung completed her training as a certified occupational therapist at the state vocational school in Munich in 1992. She is a founding member of the German Working Group for Hand Therapy (DAHTH), of which she was chairperson for two years. In 1999 she started a "Hand Therapy Fellowship" in Houston, Texas, and subsequently completed internships in Sacramento and San Francisco.

During her time as an international delegate of the DAHTH, she expanded the contacts she made there, and was able to win renowned speakers for the international congress of the IFSHT/DAHTH 2019 in Berlin, among others. Beate Jung is a specialist book author and speaker at national and international congresses. Eight years ago she founded her own practice in Munich, which specializes in hand therapy. As a lecturer for the DAHTH, it is her concern to promote education and training in hand therapy.

[1] Temporary surgical fixation of a joint, e.g. with Kirchner wire
[2] Surgical joining of a fractured bone, e.g. using screws or plates
[3] Operative loosening of tendon adhesions to restore tendon gliding