1. ROM Wrist and Finger Movements, Passive and Active (13)

Position: Seated
Targets: Mobility of the wrist and finger joints
Instruction: All movements should occur with affect elbow flexed 90 degrees. Passive wrist flexion/extension: With affected palm up, patient grasps around affected hand as shown to passively move the wrist gently into extension, then flexion. Active wrist flexion/extension: With affected thumb up and towel under hypothenar side of hand, patient flexes and
extends the wrist as towel slides along table. Passive radial/ulnar deviation: With affected palm up, patient grasps around affected hand to passively move the wrist gently into radial and ulnar deviation. Active wrist radial/ulnar deviation: With affected palm on towel, patient brings thumb in toward body (radial deviation)
and then away from body (ulnar deviation) as towel slides along table. Passive thumb: Hooking the affected fingers under a table, patient uses other hand to move the thumb in and out (flexion and extension) and up and down (adduction and abduction). Patient then moves to MCP and IP joints, moving into flexion and extension. Active thumb: With thumb up, patient lifts thumb toward head (extension) and then down toward table crossing over palm (flexion/opposition). With palm up, patient lifts the thumb straight up toward ceiling like a "sock puppet" (abduction) and back down (adduction). For thumb MCP and IP flexion, patient places opposite hand palm to palm and flexes the MCP and IP of the thumb over the second digit of the other hand.
Passive Fingers: Patient grasps around each finger, moving MCP, PIP, and DIP joints into flexion and extension. Patient moves each joint separately, then combines flexion and extension of the entire finger. Active fingers: For finger active movements, patient may block proximal joints to isolate each movement and actively flex and extend each MCP, PIP, and DIP separately, and then combines all movements together. Active finger lifts: Finger extension can be done with palm down, lifting one finger at a time off the table. Active opposition: Active thumb abduction and finger flexion combination movements are done by having patient touch tip of thumb to tip of each finger. Have patient open hand between each touch for great ROM of thumb. Passive MCP abduction/adduction: With palm down, use unaffected fingers to spread digits apart one at a time, separating from the digit next to it. Active MCP abduction/adduction: With palm down, open fingers to spread digits apart and back together. Active fist-to-finger spread: Close fingers into palm, making a fist, then open fingers and palm to spread digits apart.
Parameters: 10 times holding a 3 to 5 seconds at end range, 1 set, 1 to 3 times per day

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