Case Study 2

Graded Program
An example explained

Developed by Brad Stenner, Occupational Therapy Program 2009

What do I know?
Information obtained on referral
Client 23yo female, presents with Bilateral Carpal Tunnel Syndrome. Currently wears wrist brace on
both R and L to manage symptoms

Functional Limitations
Decreased fine motor skills, and lack of sensation in median nerve distribution, however this has not
been formally tested to date
Decreased strength bilaterally, worse in R (dominant) hand
Chronic pain

Employment Details
Returning to administration work following surgery to release carpal tunnel on R side. Duties include

telephone, data entry, word processing and accounts.

Current restrictions as per GP certificate
Avoid lifting greater than 2.5kg
Avoid repetitive grip/grasp
Avoid static postures
Must rotate between tasks during day

What do I need to find

out?
Medical Information
Employer Information
Job Information

Goal / Aim of program

For Jane (client) to return to pre-injury work as

administration assistant, completing all duties,

working 40 hours per week, following the
completion of an 8 week return to work
program.
Monitoring by OT
OT to contact client on day two of first week
OT to meet client at worksite on Friday of first

week
Weekly contact with client for next 4-5 weeks
Formal review at end of program to ensure
success

The Process
Stage

Hours

Duties

Restrictions/thin
gs to watch for

Full time
- 40 hrs per week

Full administration work

Nil

One
Two weeks
Two
Two weeks
Three
Two weeks
Four
Two weeks
Five
Ongoing

Discussion/ audio
Stage

Hours

Duties

Restrictions/thi
ngs to watch for

One
Two weeks

4 days per week

M, Tu, Th and Fri
Full hours each day

Administration duties
-Avoid typing for greater
than 15minutes without
rest
-Avoid lifting/carrying
greater than 2.5kg

To wear splint as
directed
Avoid wrist flexion
Avoid wrist extension
under load
Monitor wound/stitches
as per medical
instruction

Full time
- 40 hrs per week

Full administration work

Nil

Two
Two weeks
Three
Two weeks
Four
Two weeks
Five
Ongoing

Discussion/Audio
Stage

Hours

Duties

Restrictions/thi
ngs to watch for

One
Two weeks

4 days per week

M, Tu, Th and Fri
Full hours each day

Administration duties
-Avoid typing for greater
than 15minutes without
rest
-Avoid lifting/carrying
greater than 2.5kg

To wear splint as
directed
Avoid wrist flexion
Avoid wrist extension
under load
Monitor wound/stitches
as per medical
instruction

Two
Two weeks

5 days per week

8 hours per day

Administration duties
-Avoid typing > 30mins
without rest
-Avoid lifting/carrying >
5kg

Avoid wrist flexion and

wrist extension under
load
Massage scar/wound as
directed
Complete ROM
exercises as directed

Full time
- 40 hrs per week

Full administration work

Nil

Three
Two weeks
Four
Two weeks
Five
Ongoing

Discussion/audio
Stage

Hours

Duties

Restrictions/thi
ngs to watch for

One
Two weeks

4 days per week

M, Tu, Th and Fri
Full hours each day

Administration duties
-Avoid typing for greater
than 15minutes without
rest
-Avoid lifting/carrying
greater than 2.5kg

To wear splint as
directed
Avoid wrist flexion
Avoid wrist extension
under load
Monitor wound/stitches
as per medical
instruction

Two
Two weeks

5 days per week

8 hours per day

Administration duties
-Avoid typing > 30mins
without rest
-Avoid lifting/carrying >
5kg

Avoid wrist flexion and

wrist extension under
load
Massage scar/wound as
directed
Complete ROM
exercises as directed

Three
Two weeks

5 days x 8 hours

Administration duties
-Avoid typing > 1hr
without break
-Avoid lifting/carrying >
10kg

Commence work
without brace
Massage scar/wound as
directed
Continue with ROM and
strength exercises

Full time
- 40 hrs per week

Full administration work

Nil

Four
One week
Five
Ongoing

Discussion/Audio
Stage

Hours

Duties

Restrictions/thi
ngs to watch for

One
Two weeks

4 days per week

M, Tu, Th and Fri
Full hours each day

Administration duties
-Avoid typing for greater
than 15minutes without
rest
-Avoid lifting/carrying
greater than 2.5kg

To wear splint as
directed
Avoid wrist flexion
Avoid wrist extension
under load
Monitor wound/stitches
as per medical
instruction

Two
Two weeks

5 days per week

8 hours per day

Administration duties
-Avoid typing > 30mins
without rest
-Avoid lifting/carrying >
5kg

Avoid wrist flexion and

wrist extension under
load
Massage scar/wound as
directed
Complete ROM
exercises as directed

Three
Two weeks

5 days x 8 hours

Administration duties
-Avoid typing > 1hr
without break
-Avoid lifting/carrying >
10kg

Commence work
without brace
Massage scar/wound as
directed
Continue with ROM and
strength exercises

Four
One week

5 days x 8 hours

Administration duties
- No
restriction/limitation

Formal Review at the

end of this week if no
reported problems,
client to return to preinjury work.

Five
Ongoing

Full time
- 40 hrs per week

Full administration work

Nil

Overall notes
Client should report any of the following

symptoms to her surgeon:

1.
2.
3.

wound that is weeping, red, swollen

pins/needles return to hand/fingers
any difficulties/side effects with medication

.Client should report any of the following

symptoms to her OT:

1.
2.

Difficulties with splint, ROM or strength exercises

Difficulties with graded program

Review
This was a revision case study should you

require any further information or revision,

please see your notes and information from
EO courses throughout the program.
Grading is a key skill of Occupational Therapy
Practice to develop your skill and expertise