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Ann Marie's Story

Ann Marie is a 36 year old working mother of 2 daughters. She is also an accomplished guitarist and loved to play guitar every Sunday at her church.

Ann with her Ultraflex Supronation Brace On February 16, 1997, while ice skating with her daughters, Ann’s life was about to have a minor setback. She had fallen backwards while exiting the ice rink and suffered a left distal radius and ulnar fracture. She had ORIF surgery requiring 3 pins and had her arm in a full cast to immobilize the fracture.

On March 25th, 1997 (approximately 5 weeks later) the cast was removed and Ann began occupational therapy with a static splint 3 times a week, working on ROM at wrist and elbow extension/flexion, supination and pronation. The surgical pins were removed in April and more aggressive occupational therapy began. Elbow AROM was restored to almost 170° extension, but supination was still lacking ROM, which meant she couldn’t play her beloved guitar! In June, 1997, Ann was referred to Frank Caruso by a Philadelphia area Novacare outpatient Rehab. The occupational therapist wanted to increase Ann’s supination and requested an evaluation for an Ultraflex® system, which he had seen demonstrated at an inservice at his facility. He was concerned that Ann’s functional goals had not been met and that her therapy time was ending, due to insurance constraints.

Frank Caruso’s evaluation took place in June, and between that, the doctor’s X-rays (that determined no bony block) and the OT’s input, it was determined that Ann’s loss of ROM was due to adverse soft tissue healing caused from surgery and immobilization, which also lead to secondary muscle weakness. Ann was then casted for a custom molded Ultraflex EWHO to increase supination ROM, using Ultraflex’s supination traction/resistance therapy.

Initial evaluation showed Ann’s PROM at 28° and AROM at 20° of supination/pronation. The orthosis was fitted on July 2, 1997 and measurements showed that PROM was 28° and AROM was 18°.

Ann Enjoying her Guitar Ann was discharged from occupational therapy and was put on a self-therapy protocol using the Ultraflex® EWHO. She was started on a 10 ratchet resistance setting towards supination and placed on the following schedule to establish compliance:
First 3 days...1-2 hours
Second 3 days...3-4 hours
Third 3 days 5-6 hours
Fourth 3 days....7-1O hours

Ann was then re-evaluated in 2 weeks to check on wearing tolerance, motion increase/decrease, and any problems with the fit of the orthosis. She was tolerating the orthosis well, with no fitting or skin pressure problems. She was not wearing the orthosis at night. However, she was wearing it during the day at work. Because she was right-handed, Ann was able to file, write, answer phones and perform various other office duties, while her left hand received continuous Ultraflex therapy. Her boss was very supportive and Ann felt she could be more productive and at the same time do her therapy! She was re-evaluated on July 16, 1997 and her supination PROM was 35°, an increase of 7° and AROM was 35°, an increase of 17°.

Frank decided to keep wearing time the same, but increase tension to a 15 ratchet setting. Ann was very encouraged and was happy with her initial gain.

She was next seen on July 30, 1997. Ann was delighted! PROM and AROM showed 90° full motion symmetry! She was able to play the guitar again, since supination is a necessary function for playing. Even though the OT helped bring back most ot her everyday function, it was important for Ann to gain back the necessary supination/pronation to be able to do the things most important to her life goals!

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