Hand Exercises and Virtual Occupational Therapy with Hannah Pugh

In this episode of "Thriving with Arthritis," host Dr. Diana Girnita welcomes Hannah Pugh, an experienced occupational therapist from Reactiv, to discuss innovative approaches to managing rheumatoid arthritis and other joint conditions.

Episode Highlights:
1. Learn five essential hand exercises for arthritis patients, demonstrated step-by-step.

2. Telehealth Revolution: Discover the benefits of virtual occupational therapy for chronic conditions like arthritis.

3. Digital Tools for Recovery: Explore gamified exercise apps for arthritis management.

4. Debunking Exercise Myths: Understand why movement is crucial, even with inflamed joints.

5. The advantages of telehealth for busy lifestyles and limited mobility.

Hannah Pugh shares her expertise on integrating technology with occupational therapy, offering invaluable insights for anyone managing arthritis. From simple daily exercises to innovative digital solutions, this episode provides practical strategies for improving joint health and overall quality of life.

Hannah Pugh website:  https://reactivrehab.com/

Transcript

Welcome to Thriving with Arthritis, the podcast that empowers you to live a better life despite all the challenges of arthritis and autoimmune diseases. Whether you're newly diagnosed or have been living with arthritis for many years, this podcast is here to support you every step of the way.

Let's begin. 

 Welcome back to another episode of Thriving with Arthritis. Today I have the pleasure to talk to Hannah Pugh. Hannah is an occupational therapist and she has been working with a company that I was introduced about a few years ago. Hannah works with Reactive for the past seven years. three years. She is very passionate about educating patients on the benefits off movement and exercise as well as using technology to use patients with arthritis and Hannah with her work or in her work to reactive, she has helped build a clinical product and a virtual clinic to help treating patients with arthritis. 

Hannah, welcome to this show. Yeah, thank you so much for having me, Dr. Girnita. It's really a pleasure to be here, and I'm excited that we're getting to chat about these things today. You know that I'm passionate about rheumatoid arthritis, and I do a lot of education for patients with rheumatoid arthritis.

And along the things that I talk about, diet and other lifestyle modifications, I also talk to patients about the role of diet. exercise. So I'm going to ask you from your point of view, what is the role of exercise in patients with rheumatoid arthritis and other types of arthritis? Yeah. Yeah. No, I think that's a really great question.

And one that a lot of people don't understand necessarily. So I think first it's important to recognize the difference between exercise and physical activity. And there actually is a difference. And I think sometimes people confuse. both of those and they lump them in one as the same and so physical activity is the things that we're doing, all the time throughout the day to grab the groceries, to walk around the house, to any sort of movement that we're doing just that's integrated in into our daily life and we can obviously  improve that, but in a lot of different ways.

And there's a lot of health benefits with being physically active. But on the other side, exercise and the definition of exercise is doing physical activity for a specific goal. and or for a specific purpose. And so you could walk for physical activity, but you could also walk to improve cardiovascular health or lung capacity or leg strength or something like that.

And that's when it would be exercise. So for people with rheumatoid arthritis, other types of arthritis, both physical activity and exercise is important, but specifically exercise. plays a really important role because you can target the exercises for whatever you're working on and so maybe that's, you have some strength deficits or some weakness and those joints so you can do specific targeted exercise to strengthen those joints.

You can work on specific exercises to help with the flexibility or the range of motion, which is something that's also really important. And for arthritis and. Just in general, the exercise can help maintain that muscle strength, help, it can help maintain that joint flexibility and can just help you maintain your ability to do things.

So your ability to continue to be able to open a water bottle or, brush your hair and all of those things. It plays a really important role in your joint function and also. In your mental health in the overall your wellness and how you're feeling and all of that, which can can have a toll taken on it if you have a chronic condition like rheumatoid arthritis or even any other type of arthritis. 

I will share something with you. My patients, when they have their inflamed joints, they are afraid to do exercise because they think it might be detrimental to the joints.  Will exercise cause more damage if you have inflamed joints? No. So that's obviously, that's Honestly, a really common misconception.

We hear that all the time. And that's why it's really important to work with someone when you're trying to figure out what exercises or what, physical activity is going to be beneficial for you. Because maybe if you are in more an inflamed state or you're having a flare up, then maybe exercise during that day, during that week, during that period of time looks different than maybe it does when you're not in that inflamed state.

And so working with someone can help you figure out exactly, how to modify which exercise you're doing, modify the intensity and maybe modifying the way that you're doing it. So it's not going to be causing any pain. But in terms of the joint inflammation and exercise it's not going to make that worse and it's not going to make that inflammation worse.

It's actually on the other hand, it's going to improve it and physical activity helps to reduce inflammation amongst other things, the medication, nutrition, all of that stuff, but exercise and. Movement in general can help to decrease that inflammation in the joints. And so I think that's something that's we really want to emphasize is it's not going to make it worse.

The only way you're going to make it worse and the only way that you could maybe  damage those joints would be doing an exercise. incorrectly or doing an exercise, that is maybe way too intense for what you're doing. In an extreme situation where you're going from not moving at all to trying to run a marathon or something like that's obviously not going to work for anyone, but let alone someone with some sort of  arthritis condition.

I know that you have an Instagram account and I often watch your your posts. And I do encourage my patients to watch your Instagram account because you are one of the few occupational therapists that is sharing exercises for hands for my patients. So I know you have a lot of videos there that people can watch.

And I, With I would invite you to tell people about your Instagram account, but I would also like to ask you the favor to show us five exercises, or how many you want, to show us that somebody with rheumatoid arthritis can do them every day in the comfort of their home. Yeah. Yeah, so our Instagram account is for Reactive, which is a company where I am the head of clinical experience and an occupational therapist, and we treat patients virtually.

And so on our Instagram or other social media accounts, we post a lot of educational content, exercises to help  improve some of those. education and understanding about the relationship between exercise and how it can be beneficial for people, not only with arthritis, but other conditions, other upper extremity conditions, other ways that occupational therapists can be beneficial for people.

And. other tips of like how to protect your joints, how to reduce the stress on your joints long term. And so that's what we focus a lot on our Instagram page. And so some of the exercises that you could do specifically we'll focus on the hand today. We do showcase other things and we do work with people with other joint conditions, but we'll.

For this conversation, we'll keep it to the hands. And so one of the first ones that I show people that just incorporates some gentle movement into the hand is bringing the palm. So your palm is facing away from you. And what you're doing is you're just gently closing the hand  and then opening the hand.

Yeah.  I'm gonna follow you to see how easy it is. Closing the hand, opening the hand, closing the hand,  opening the hand. And so for this one, you really want to focus on going as far as you can without increasing any of the pain. And that goes with all of these hand exercises. You don't want to do them if they're causing any sharp or shooting or increase of numbness or anything like that.

And so my, I have very flexible hands. So sometimes when I'm demonstrating and people are like, Oh, I can't do that. And that's okay. Your hand is only going to hear that's still super beneficial. Then just not doing anything with it. This one is also beneficial. because you're keeping your hand above the level of your heart.

And so if you're noticing some swelling, it can help to reduce that swelling as well. So it's a two for getting your joints moving, but then also can be beneficial to help reduce some of that swelling in your hands. The next one that I would showcase is similar position. You have your hand up, your hands are spread apart.

And what you're doing is you're spreading those fingers apart, and then you're pulling them. back together. And then you're spreading those fingers apart,  pulling them back together. You could also do this one like with your hand on a table or a surface, but I'll keep it up just for demonstration purposes.

And you're spreading those fingers apart and pulling those fingers together. So that's activating  these tiny muscles that we have in our palm, which help to spread those fingers. They're like little the palm side and then some on the backside of the hand as well. And so that's activating those tiny, what are called intrinsic muscles.

So those muscles that are within the hand, which often can get really weak, especially if you're not using your hand, but they're really important for that finger function and that hand function. So that's exercise number two exercises. Number three, exercise number four, is working a bit more on the dexterity of the hand.

And so that's like the fine motor, your control, the smaller movements of the finger. And so what you're going to do for that one, and you're going to take the thumb,  And you're going to reach it over to the tip of your pinky finger, you'll open back up, and then you'll go to the thumb, to the tip of your index, or sorry, your ring finger, open back up, to the tip of your middle finger, open back up, and the tip of your index finger, open back up.

And then cycle  through that. 

And so you're going one finger at a time. You can work on it for more of a challenge. You can work on it more as a speed. You're trying to go super fast and that's working again on more of that control. If you go slow, it can help work on the range of motion and the motion of that thumb reaching over to the finger.

If you want a little bit more challenge with that. thumb. You can reach instead of at the fingertips, you can reach down to that middle joint of the finger or that joint that's closest to the palm that works a little bit more on the range of motion. And you can do that for all those fingers as well.

So working on that motion, but usually starting at the fingertips. It's going to be the easiest, but then as you work down, it's a little bit more challenging. It's also a little bit more of a brain activity as well. You could rotate from, the fingers and then down to the the close, the part closest to the palm.

So those are some exercises. The next one I would recommend is for the wrist. And so getting that wrist moving a lot of times with people with rheumatoid arthritis or other types of arthritis have some sort of wrist involvement. And so what we're going to do is we're just going to move that wrist. 

to the back as far as you can and then to the front as far as you can. To the back as far as you can,  to the front as far as you can. And so this one is getting that wrist moving in those directions  and it's helping increasing that joint lubrication at that wrist joint.  This one, again, you may not have that same range of motion that I do.

You may not be able to go, all the way back like this or all the way forward like this, but that's okay. Again, trying to work through your range of motion without causing any increased pain. Again, just be mindful of how you're feeling when you're doing these because we don't want it to increase that pain and everyone's a little bit different.

Yeah, I would just encourage you when you're starting it to just check in with yourself, see how you're feeling. The last one that I'm going to show you today is more for strengthening. And so this one's a little bit more advanced. So if any of the other ones were bothering you, I would hold off on this one, but you don't need any equipment.

A lot of times when people think about strengthening, they think about. Okay, I need to lift heavy weights or I need to, um, it's going to be something that's like really challenging for me. But the truth is you can do strengthening, especially at the hand without any weights and with things that are with a type of exercise that's called isometric exercise.

And so isometric means that muscle isn't lengthening or shortening, and it's maintaining that same length, but we're applying pressure for it to maintain that strength. And so one that I'll show you today is you can have your hand on a table or on a surface. I have mine on this tabletop here so you can see it.

And so my forearm is resting on the table. If you're listening on the podcast, I'll explain it. You're Forearm is either on a table a surface could be like on an armrest or something over here Whatever is comfortable with this if the position with it right on front is uncomfortable on the shoulder Then I would opt for it to be on the side like on a chair But you're gonna bring that wrist up as high as you can Again, you may not be able to bring it back as far as I can and then you're gonna take your other hand and you're gonna press on that back side of your hand.

And so this hand, the hand that's pressing on the back side of the hand is pressing  while my hand is trying to stay in this position. And so I'm pressing  and I'm staying. And so otherwise my wrist would fall down if I wasn't activating this hand. And so I'm pressing here, And I'm staying here like this and I'm activating.

So this one, although it is, your wrist is moving, you'll actually feel it all the way up into the forearm, up into this part of your forearm because that's where those muscles are at. And so from the front, it looks like here. and then up. So I'll zoom out just a little bit so you can see a little bit more.

So here, and if I'm doing it this way, my hand is staying still  and I'm just pressing and resisting that. And so this way, if I was coming this way, just to show you pressing and resisting. So you want to hold that for about 10 to 15 seconds  and then you'll relax and then repeat. Again,  and then relax, you repeat again.

And so again, this one's more for strengthening. It's a little bit more challenging, but that's just one way that you can work on strength, especially if you're feeling like your wrist is a little bit weaker. A lot of times people, will go straight into squeezing those balls, but sometimes those can be pretty intense, especially if you're not used to, or if you have like a lot of weakness in the hand.

Sometimes those can be.  Because a lot of times when people do it, they just tend to do it. Over and over again, which then causes a lot of soreness in the hand or in the forearm. And I like that one, that isometric exercise, because you can grade it or challenge yourself as much as you want.

And you don't need a lot of pressure and you don't need any equipment. You don't need anything. You just need Your two hands. Those are the ones that I would recommend to start with. But again, everyone's a little bit different. So just pay attention to your body and your, like, how you're feeling as you're doing them.

If they cause any increase to pain you may notice some soreness, which will be okay, but you don't want your pain to, to to jump up or to feel any like sharp or shooting type of pain. Thank you very much for sharing those exercises. They are very easy to be done. At least to my understanding. And I think there will be very beneficial for patients when they wake up and they have a lot of stiffness.

Because as I heard from your world from people from your world, a saying called motion is lotion. So I think that's important for patients to understand that if they start with, this kind of exercises, especially for the hands, then they can progress through the day. For how long do they have to do these exercises when they start?

Is it like a series of, five minutes or  how do you recommend it to your patients? Yeah, so it's a little bit different For every patient depends again you go back to the goal of if you're trying to improve range of motion or that flexibility if you're trying to Improve the strength, but typically if you're not doing any exercise at all, typically I recommend Just started like just trying to do it. 

Even if you can't do it every day. Let's do it Let's try to do it three times a week if you know you take your kids to school Every day try to do it as soon as you get home and or maybe right before you leave or so just like Getting it built into a habit  But otherwise, if you're working more on the strengthening of it, then I recommend being a bit more rigid with it, trying to do like 3 sets of 10 to start, but then progressing to 3 sets of 12, or maybe 3 sets of 15, just so that you're continuing to challenge those muscles, so that you can build some of that strength, but I think originally, or initially, when you're trying to When you're just getting started, just get started and just start trying to move.

There's one thing that I also tell people to do is, if it's too much to do them or you feel like it's too stiff in the morning I'll sometimes have patients put their hands in warm water. And do these same exercises in the warm water. And sometimes that can be a really helpful way to to just get started and to get used to those movements.

Sometimes that warm water can bring an extra layer of comfort, you can do it like if you take baths, you could do them in the water. Sometimes I'll have patients do it, after they do the dishes at night to leave the water in the sink and do those exercises separately. Okay. Other people like to do dedicated time, not tied to any sort of activity, but that's just another recommendation that I sometimes get to people. 

In our days we all use technology and we love the fact that we have a phone where we can access not only, we don't use it only to call other people, but we use it for entertainment or we use it to even to buy things or to get to the doctor.  Do you know about any digital tools that patients can use to do those exercises?

Yes. Actually Reactive, like I mentioned before, the company that I am a part of, we do offer these exercises in the form of videos and in the form of exercising games. And so the exercises that I just went over today, we have a game, an exercising game, for example, like the one that you just open and close your hand.

We have one that's linked to an exercising game and that game is like a, it's a bubble shooter game. And so you're using your hand in the front facing camera. Of your phone and it's tracking your hand movement and as you open and close the hand or do whatever movement that's tied to that game, but in the bubble shooter game, it's opening and closing the hand as you open and close the hand, you're releasing the hand.

a bubble that's hitting the targets. And so it's just more of a fun, interactive way to do some of these exercises. And sometimes it can be a good even mental distraction that you're doing them, but you're also playing a game, having a little bit of fun. And also it's a good accountability thing that you have them there.

But if you're not into exercises, or sorry, into exercising games, we also have them in the form of exercising videos within our within the reactive app that you have, you can have access to and just follow along the videos so that you can see them. You can see them doing them in the video, but then you can also do them yourself.

And yeah, I think that's a really great tool for people with arthritis, with rheumatoid arthritis that are looking for exercises, looking for a more structured plan and then they can have access to that. So when they play those games, in the app, do they get rewards or how do you incentivize people to continue to play?

Yeah, it's a bit like a  If you've ever done any sort of video game or, I know, I don't want to say everyone, but I'll say almost everyone has played some sort of game in their life. And whether that was like, like Tetris or Candy Crush or Pac Man or, any type of game, there's always these little bit of rewards.

And so our games are based off of a lot of games. We have one that's similar to Keone Crush that's a wrist game. And so they have those kind of same gaming principles designed within them to, hit levels and hit targets and to progress through it. And so that makes it a little bit more fun, a little bit more exciting.

more challenging but also rewarding that you're doing it. And we also have different like streaks that you can get. So that can also encourage you as well to to play often. I think that's a wonderful digital tool for patients to start, because not only it's gonna bring them a good quality time, but it's also gonna serve the purpose of doing the exercise. 

Now, I know that you practice telehealth and you teach patients how to do exercises through telehealth. What is the role of telemedicine or telehealth when it comes to physical therapy, occupational therapy? Yeah, I think that, I know that  they're your patients. They know the benefit of telemedicine through through you and your practice.

And I think there is  so much benefit for them. patients to see an occupational or physical therapist virtually through a telehealth through a telehealth session, especially people with a chronic condition and one that you have to manage not only for, four weeks or six weeks that you normally would go to an outpatient facility for, but for life.

And I think occupational therapists are uniquely. place to help people with virtually through telehealth. And for a multitude of reasons, occupational therapists are a little bit different than physical therapists. Occupational therapists, which is what I am and what Reactive has and hires. And we focus a lot on patient's function within their environment.

And so not only are we teaching you exercises, but we're teaching you exercises to help you be able to do the things that you want to and need to do. And so that can, look very different from person to person. It could be for one person, the, they need to I don't know, make coffee in the morning, and that's something that they can't do because they can't open their Keurig or something.

And so we're teaching you exercises to strengthen your hand, but then also we can look at that in That situation in your environment and talk about strategies of how can you maybe change the placement of where you're going to grab that mug from so that you're not putting so much pressure on your thumb joint or how could we, maybe adapt that button so that it's not as challenging to press when you have to like, press the coffee maker.

And that's just One example and one very like very descriptive sample, but there's so many different ways that occupational therapists can help. And I also think it's a benefit for people who are busy, maybe you work a nine to five, maybe you have, Kids, maybe you are a caregiver for someone and you don't have time to go into the clinic.

I think that telehealth can be a really beneficial tool to fit into your day, to fit into your night routine or just be able to have access. And so I think access is a huge thing for people and it just, Takes away that burden of having to travel having to drive and to get there.

And then I think the last thing  or the last thing I'll talk about, I could talk about this all day. But I think another really huge benefit for patients. to see a virtual occupational therapist is the one to one quality time that you get with the therapist. And I know you, Dr. Canino, probably can, really relate to that.

And that's something that we really value at Reactive. Myself, as a clinician, I really value is, I've worked in an outpatient clinic, I've worked in a hospital, I've worked in a lot of, settings before in my career and I feel like that the quality time I get with patients is  night and day Versus working with someone in person and I think that's that's a multitude of reasons Why but I think a lot of it is there's a lot of other demands when you're in a clinic There's a lot of other people that are helping, you have the front desk staff.

You have maybe some aides or other people that are working. You don't always see the same therapist You're like bouncing around and all of that stuff and then you're doing the session But you're also as a therapist. You're also trying to treat many patients and jump around.

But when you're on a virtual session and you're in a telehealth call,  you only have the therapist attention and they're really only doing it like the session with you. 

I find that we get to a much better place within the first session than I sometimes would ever get with patients. And we build that relationship, which helps build the trust.

And I think it also helps patients.  feel like they're getting better or they are getting better because, they have that established connection with someone who they can talk to, really have someone that understands their condition and what's going on and can take that time, that dedicated time to talk to them and to understand their unique person or their unique personality, their unique situation, their unique condition.

Yeah. And tailor the exercises to them, tailor their plan to them and really make it about that individual patient and the uniqueness of that  individual patient. So I'll just sum it up there, but I really think the value is efficiency, time, and the like tailored, customized plan, but also that tailored, customized, dedicated time with each of those patients.

I think the way that you express is, this is the true personalized patient centered type of care as as you mentioned before. I know from my experience that I practiced telemedicine for four years, that when you are one on one with the patient, you give that attention only to the patient. And what you did explain that you are there. 

With the patient in their environment positions you to such a high level of of beneficial effect because there is no way that you can anticipate in a clinic what it is at home, what it is for that patient at home, they cannot tell you and you cannot imagine how you could help them more than just general principles, just giving them general principles.

So I think the way that you practice today, it's unique, it's truly personalized care and the efficiency, it's going to be tremendous. so much better because you are addressing their needs to the right place. And that's really important for these patients because they don't have, like you said, they don't have the time to travel.

They are in pain to travel. And then they're going to quit. coming to these appointments because they don't see the value because it doesn't apply to them. So I love the fact that you do that. And I know there might be patients that will look for unoccupational therapies. How can patients access your services? 

So we do accept insurance. That's one way you can find us is through your insurance. And it's called reactive, but it's spelled R E A C T I V. There's no E on the end of it rehab, and that's our website. And you can go in there and fill out, there's a little form. I think it's a sign up. And then you just enter your basic information, like your name the state you're in and the, you're from.

Insurance that you have and then we'll reach out to you and let you know if you're eligible if you are available But you can also download our app and do it Yourself. So the app is also called reactive, R E A C T I V, no E in the app store and on the Google play store. So you can do that.

And so you, even if we're not in network or we're not available to see you for these one on one sessions, you can still have access to the app and to the exercises and to the the exercising games. And so you can still have access to those, like I said, but you may just may not be able to see the therapist.

And that's a little bit dependent on the state that you live in, the state that we are credentialed and licensed in, and then which insurances that we accept. And the best way to do it is to either look on our website and fill out that form or to download the app directly and we can reach out to you.

I will put the link to your app and patients will know where they can Find the app and also the videos that you just mentioned. Hannah, thank you so much for giving your knowledge, your time. I really appreciate the work that you have done and that you continue to do. And I hope to see you again in a future episode to tell us more about other exercises that patients with arthritis can use and also to share about what other.

Things you're going to bring to the market of arthritis, because what you do is truly unique and it's really powerful and it helps patients. I had patients that I have recommended the app and they they did the games and they did they did watch the videos and they love it. And that's why I brought you to the show today, because I know you are doing something that is really impactful for patients with arthritis. 

Thank you. Thank you so much for having me.