F A C H A R T I K E L
The right dose to the right target:
notes on hand treatment of stiffness
using mechanotherapy (MAPS Method)
Vicenç Punsola-Izard, Gemma Romera-Orfila, Aroa Casado Rodríguez
Context and Rationale:
Stiffness is one of the most common
conditions treated in Hand Therapy.
Traditionally, splinting and other mo-
bilization techniques of low-intensity
and long-duration have been used to
modify the length and volume of tis-
sue restricting movement. However,
in the absence of bone deformity,
these classic techniques often reach
their limits of effectiveness.
Methods:
This article proposes an innovative
method, called the MAPS (Mechano-
therapy-Assisted Progressive
Sequential) approach, which offers
new tools in addition to traditional
splinting combined with a clinical rea-
soning procedure. This approach is
based on a mechanical assessment
that allows the therapist to determine
the ideal treatment dosage (intensi-
ty). Progressive and sequential analy-
tical mobilization techniques are
introduced, applying low-intensity
and long-duration doses using me-
chanotherapy devices.
Results:
Implementation of this new method
has demonstrated more precise and
effective mobilization. Through a
32 Zeitschrift für Handtherapie 1/2024
case study example, this approach
significantly improves patient outco-
mes, and enables therapists to con-
duct more effective and efficient ses-
sions.
Conclusion:
The integration of progressive mobili-
zation techniques and the use of
mechanotherapy devices represents a
significant advancement in the treat-
ment of hand stiffness, especially in
cases without bone deformity. This
method not only improves the effica-
cy of the treatment, but also optimi-
and zes the efficiency of the therapeutic
session
Keywords:
• Stiffness
• Contracture
• Arthrofibrosis
• Pain
Introduction:
Hand stiffness is one of the main
complications encountered following
hand trauma and surgery (Akeson et
al 1987). The management of this
condition remains a significant chal-
lenge due to the various factors that
can influence its progression. In Hand
Therapy, the primary approach to
address stiffness involves preventive
measures, including protocols for
early mobilization and edema control
protocols that help to prevent the
onset of stiffness (Feehan/Basset
2004). While this strategy can mini-
mize the development of stiffness, it
is not always successful in preventing
its establishment. Once stiffness is
established, it is critical to identify the
most effective treatment strategy.
The first challenge in treating stiffness
is to clearly understand how it deve-
lops and behaves. We know that the
initial observed loss of mobility is
associated with edema and inflam-
mation. However, once this is resol-
ved, scar-related stiffness becomes
more apparent between the prolifera-
tive and maturation phases of the
healing process (Rodrigues et al
2019). This stiffness is sometimes
temporary and self-limiting, and can
resolve spontaneously as seen in con-
ditions such as frozen shoulder. In
other cases, scar tissue can shorten
and thicken structures, narrow joint
spaces, and affect planes of gliding
(Curtis 1954). In these cases, stiffness
sets in decisively without showing
signs of resolving (Wong et al 2017),
making therapy essential.
When stiffness manifests as a clear

sign of movement limitation, it is
often accompanied by a variety of
symptoms that need to be identified
and effectively neutralized. Among
these, pain is the most prominent
symptom and can pose a direct con-
traindication to therapeutic treatment
if not properly managed. Typically,
pain associated with stiffness is rela-
ted to tissue damage and the healing
process. For this reason, such pain
exhibits distinctly nociceptive charac-
teristics, which can be associated
with inflammatory symptoms when
the tissue is highly irritated, or even
ischemic symptoms when the tissue is
particularly stiff (Smart et al. 2010).
In addition, pain may be linked to
various complications, including neu-
ropathic or dysfunctional disorders. In
cases of neuropathic pain, it is crucial
to ensure that the irritative mecha-
nism affecting the nerve is not active.
If this mechanism has been neutrali-
zed, it is necessary to focus on redu-
cing the patient's symptoms before
proceeding with other techniques
aimed at addressing stiffness. Someti-
mes, this pain may be related to a
process of central sensitization, ma-
king it essential to recognize psycho-
logical factors such as fear, catastro-
phizing, and kinesiophobia, which
can significantly influence pain per-
ception and treatment response
(Smart et al. 2010).
In situations where pain-related com-
plications occur, an extremely cau-
tious treatment approach is required,
although the treatment of stiffness is
not explicitly contraindicated.
It is essential that the patients have a
clear and complete understanding of
their medical condition, and it is
equally important to provide them
with the necessary tools and strate-
gies to effectively manage their situa-
tion. A key aspect in advancing the
F A C H A R T I K E L
treatment of stiffness in the presence
of pain is the identification of ische-
mic pain. This type of pain only indi-
cates the limit of the patient's ability
to move and generally carries no
additional risks for the patient or the
existing injury (Butler 2000). This
understanding is crucial to ensure
that the treatment is not only safe,
but also effective in improving the
patient´s mobility and the quality of
life.
Furthermore, it is appropriate to
apply mobilization techniques specifi-
cally to the structure causing the
restriction, with the explicit therapeu-
tic goal of improving its kinematics
(Michlovitz et al 2004). Sometimes,
the stiffness may originate directly
from the scarring of the injured struc-
ture. In such cases, it is crucial to pro-
ceed with caution during mobiliza-
tion to avoid any excessive stress that
could further damage the affected
structure. If the stiffness is due to
excessive scarring also involving adja-
cent uninjured structures, or if the
stiffness is in the injury but past the
high-risk period, mobilization techni-
ques can be safely applied. However,
it is essential that these techniques be
performed with carefully controlled
and progressive intensities, always
respecting the limits imposed by the
patient's pain level. These precau-
tions ensure that the treatment is not
only effective but also respects the
structural and functional integrity of
the affected area.
There is a broad consensus among
specialists that traditional mobiliza-
tion techniques, which involve inten-
sive mobilizations using maximum
force and long levers, are not only
ineffective in altering stiffness, but
may also induce prolonged inflamma-
tory responses that worsen the clini-
cal situation (Light et al 1984). In the
field of Hand Therapy, the techniques
that have proven to be most effective
are those employing low-intensity
and long-duration mobilizations (LLPS)
(Light et al 1984). For this reason,
most therapists focus on improving
mobility by using splints.
Research has shown that time is a
crucial factor in the effectiveness of
techniques aimed at improving stiff-
ness. This principle is known as Total
End Range Time (TERT), which refers
to the total number of daily hours
during which a constant force is app-
lied via a splint to modify stiffness;
the longer the time, the greater the
daily accumulated TERT and the grea-
ter the improvement (Flowers/LaStayo
1994; Glasgow et al 2003; Prosser
1996; Punsola-Izard et al 2023a). Alt-
hough relatively few studies focus on
the intensity of the force applied,
recommendations based on expert
experience suggest that modulation
of intensity is crucial (Bell-Krotoski/
Figarola 1995).
Using splints that apply continuous
forces can be counterproductive if
the applied pressure is excessive, as
this may reduce the patient's toleran-
ce for using the splint (Glasgow et al
2012). Therefore, splint application
time should be adjusted inversely
proportional to the pressure it exerts
on the skin, maintaining a careful
balance to maximize both patient
comfort and treatment effectiveness
(Punsola-Izard et al 2023b). When an
optimal balance between pressure
and time is achieved, patients tend to
tolerate the splints better, and it is
possible to increase the TERT, leading
to a faster and more efficient impro-
vement in mobility (Punsola-Izard et
al 2023c). However, it is important to
recognize that this type of treatment
is not universally effective in all cases.
In clinical practice, there are occa-
Zeitschrift für Handtherapie 1/2024 33
 F A C H A R T I K E L

involves extending the duration

Table 1. Treatment strategies based on patient response of the treatment over time to
to mobilization therapy (Author's property) consolidate and maintain impro-
Tolerance Issue Patient Type Strategy vements in mobility, reducing the
likelihood of relapses.
No tolerance Reactive Patient Reduce symptom

Does not yield Resistant Patient Increase intensity dose The application of Total End Range
Time Treatment (TERT) (Table 2) is
Recurs Recurrent Patient Increase dose by accumulated TERT
most straightforward when stiffness
is limited to a single joint and in one
direction (Bell-Krotoski/Figarola 1995).
However, when stiffness affects a
Table 2. Distribution of Total End Range Time (TERT)
based on joint complexity (Author's property) joint in multiple directions or multiple
joints simultaneously, a more integra-
Difficulty Level in TERT
Description ted approach combining the use of
Distribution
splints and therapeutic exercises is
One joint, one direction Maximum daily TERT towards main direction
required (Midgley 2016). In these
One joint, two directions Sub-maximum daily TERT distributed cases, it is inevitable to assume the
risk of reducing daily TERT. The situa-
More than one joint Reduced TERT in multiple directions
tion becomes even more complex
when the stiffness is extensive and
involves multiple joints and tendons,
sions when, despite the use of recog- hest intensity they can tolerate, requiring a more sophisticated thera-
nized effective mobilization techni- but stiffness is not completely peutic approach (Kaplan 2010). In
ques, the expected results are not modified or only partially modi- response to these challenges, it is
achieved for a variety of specific rea- fied. These patients, known as crucial to implement therapeutic stra-
sons (Table 1): "resistant patients", require a tre- tegies that allow for an increased tre-
atment adjustment, which typi- atment dose through more analytical
1. Reactive patients: In some cases, cally involves increasing the inten- techniques. These techniques should
even at low intensities, some sity of the mobilization applica- be able to precisely target the struc-
patients do not tolerate the treat- tions. Since the TERT dose is al- tures causing stiffness to increase the
ment due to significant pain and ready maximized and cannot be effectiveness of the treatment. This
discomfort. In these situations, a increased further, the necessary approach includes managing an
further reduction in intensity and adjustment focuses on the inten- increase in treatment intensity to
duration of treatment is required. sity of the treatment to attempt directly address the affected areas
However, this change may result to overcome the stiffness resis- (Flowers 2002) and precisely reaching
in inadequate stiffness modifica- tance. the structures responsible for stiffness
tion. In these patients, identified to optimize outcomes (Cyriax 1996).
as "reactive patients", the thera- 3. Recurrent patients: There is also Achieving these objectives presents
peutic approach must focus on a group of patients who, alt- certain technical limitations. For
neutralizing the painful symptoms hough they initially respond well example, when managing numerous
to improve their ability to tolerate to treatment and show significant movement restrictions in the same
the treatment and thus allow for improvement in movement, do patient, conventional therapy ses-
more effective intervention. not maintain these results in the sions may be insufficiently short. The
long term and tend to relapse. use of techniques based on therapeu-
2. Resistant patients: Other pa- These "recurrent patients" requi- tic exercise that allow the patient to
tients may receive the maximum re a therapeutic approach that work with greater autonomy under
allowed dose of TERT at the hig- increases accumulated TERT. This the supervision of the therapist can

34 Zeitschrift für Handtherapie 1/2024


help overcome this limitation, making
the treatment not only more mana-
geable but also more efficient. This
increased autonomy facilitates a
more extensive and effective applica-
tion of the treatment in the context
of the patient's daily life, which can
significantly contribute to improving
long-term outcomes.
Methodology
The MAPS method (Progressive and
Sequential Analytical Mobilization) is
an advanced approach to the treat-
ment of hand immobility, using speci-
fic techniques applied through
mechanotherapy devices. This me-
thod is particularly effective because
it complements and extends the tra-
ditional tools used in Hand Therapy.
To effectively carry out these techni-
ques, it is essential to follow a struc-
tured clinical reasoning process in
three fundamental phases. That sets
the stage for the effective application
of mobilization techniques to optimi-
ze the improvement of the patient's
movement. The first step in this pro-
cess is the diagnosis. During this initi-
al phase, the therapist assesses and
diagnoses the specific nature of the
patient's immobility. This involves a
detailed analysis of the patient's cur-
rent condition, identifying specific
movement deficits and possible
underlying causes. The second step is
to determine the appropriate treat-
ment doses to be applied. This step
requires careful consideration of the
intensity, duration, and frequency of
the mobilization sessions, tailored
specifically to the patient´s individual
needs. Determining these doses is
crucial to ensuring that the treatment
is not only effective but also safe for
the patient. The third and final step is
to determine which specific structu-
res will be treated and in what order.
F A C H A R T I K E L
This order is critical to ensure that the
treatment is administered in a logical
and systematic manner, addressing
the most critical areas first and pro-
gressing in a manner that maximizes
the effectiveness of the treatment.
This step ensures that each therapy
session is meticulously planned and
executed with precision. Once these
three steps are completed, the thera-
pist is prepared to proceed with the
mobilization treatment in an appro-
priate and effective manner. This
structured approach not only allows
for a more targeted and personalized
treatment, but also maximizes the
patient´s chances of functional reco-
very, allowing for faster and more
lasting improvements in mobility.
Step One: Diagnosis
In the first step, we will conduct a
diagnosis of the movement dysfunc-
tions of the hand. Based on the
patient's explanation, we will identify
the pathology and determine when it
first occurred. From this point, we will
carry out a functional assessment to
understand which functional activi-
ties are most altered. Finally, we will
perform an analytical diagnosis to
identify all the anatomical structures
that contribute to the movement dys-
function.
There are many different structures
that can restrict movement (Kaplan
2010). From superficial to deep,
these include the skin, cutaneous ner-
ves, fascia, muscle, tendon, and cap-
suloligamentous elements. Each of
these elements can cause movement
restrictions with distinct characte-
ristics. The implementation of selecti-
ve tension tests will allow us to preci-
sely detect the various structures con-
tributing to stiffness (Cyriax 1996).
Skin and fascia will affect movement
globally in the direction of their ten-
sion, affecting one or more joints.
Muscles and tendons will produce
polyarticular deficits affecting move-
ment in the plane they manage and
will influence both passive movement
in the direction of stretching and acti-
ve movement in the direction of con-
traction (Kilgore et al 1975). Joint-
level dysfunctions will affect a single
joint level and can have two clearly
differentiated aspects. On the one
hand, there will be retraction-like
alterations where movement restric-
tions in one direction are found (Mac-
Conaill/Basmajian 1969), and on the
other hand, there will be conditions
such as arthrofibrosis that create multi-
directional restrictions (Usher et al
2019).
Step Two: Identify the therapeutic
moment for intervention
The goal of the second step is to
determine the appropriate treatment
dose to establish a therapeutic pro-
gression to be applied. This progres-
sion is primarily related to two fac-
tors: the biological state of the tissues
and the accompanying symptoms.
As therapists, we are familiar with
the different phases of the healing
process and have an approximate
understanding of the duration of
each phase and subphase. By kno-
wing the patient’s history and symp-
tom characteristics, it is easy to deter-
mine at what point in the healing
process the therapeutic intervention
is taking place.
Based on the symptoms and signs the
patient is presenting, we can determi-
ne wether these symptoms or signs
correspond to the actual therapeutic
moment or if they are outside of the
temporal graph. If the signs or symp-
toms do not match to the phase we
are in, we can hypothesize what is
happening and why.
Zeitschrift für Handtherapie 1/2024 35

Nociceptive pain would be one of the
main symptoms we might encounter.
If these symptoms do not change
over time, we can intervene to modi-
fy them, but if they persist or worsen,
we can suspect that some kind of
painful complication is developing.
Painful complications will be associa-
ted with neuropathic pain or dysfunc-
tional pain. The presence of these
symptoms is not an impediment to
performing treatment per se, but
there are circumstances that require
adaptability on the part of the thera-
pist. With this information, we can
determine the doses necessary to
treat immobility, adapting our techni-
ques to the state of the tissue.
Step Three: Treatment sequence
In the third step, we must determine
the therapeutic sequence to be used
for our patient. Both the injured
structures and the affected structures
will be considered in this sequence.
The injured structures should be pro-
tected to facilitate their healing, al-
though we can apply the maximum
dose of mobilization that will not jeo-
pardize the integrity of the structure.
The affected structures can be mobili-
zed with higher doses, taking care to
respect the symptoms so as not to
cause painful complications.
Once we have identified all the
restrictions to be addressed, we can
prioritize treatment based on the
patient's functional needs and the
safety of the hand. In this step, we
establish the treatment sequence for
all structures contributing to immobi-
lity and define the types of techni-
ques that will be required. We must
accurately assess the progression of
the treatment and adapt it to chan-
ges in symptoms and new therapeu-
tic goals as they emerge.
36 Zeitschrift für Handtherapie 1/2024
F A C H A R T I K E L
Therapeutic Intervention
Once the clinical reasoning process is
complete, we can begin the thera-
peutic intervention. This intervention
is carried out through therapeutic
exercises performed on specially desi-
gned mechanotherapy devices. These
devices allow us to stabilize the seg-
ments of the hand that we do not
want to move and release the seg-
ments that we want to mobilize.
Mobilization techniques can be app-
lied passively to structures that need
to improve their movement by wor-
king on their flexibility and extensibili-
ty through oscillatory mobilization
techniques such as Maitland-like
exercises (Maitland 1991) or through
maintained Kaltenborn-like exercises
(Kaltenborn 1989) performed on the
mechanotherapy devices. Active mo-
bilization techniques are used to
address muscle contraction and pro-
ximal tendon gliding. All these tech-
niques can be adapted in terms of
range, intensity, and time to the state
of the tissues at any given therapeu-
tic moment. These techniques are
performed under the supervision of
the therapist, but are self-controlled
by the patient. This application will
allow for a reduction of in the time
the therapist intervenes, will increase
the dose of TERT, will allow effective
pain management, and will reduce its
perceived risk during the session
(Caneiro et al 2022).
Results:
A patient suffered a metacarpal frac-
ture in November 2023 and under-
went surgical stabilization with plate
and screw osteosynthesis three weeks
post-injury (Fig. 1, Fig. 2 and Fig. 3).
Despite daily rehabilitation, no im-
provement was observed at the six-
month follow-up. The healing pro-
cess was advanced and stable, ente-
ring the maturation phase. The pa-
tient presented a with non-painful
stiffness in the metacarpophalangeal
joint (MCP) extension and in the pro-
ximal interphalangeal joint (PIP) fle-
xion. The mobility restriction was cha-
racterized by joint-specific features,
including collateral ligament retrac-
tion at the MCP and palmar plate at
the PIP. The limitation being unidirec-
tional toward flexion at the MCP and
extension at the PIP. The tendons
appeared free within this range, as
neither proximal nor distal gliding of
the flexor and extensor tendons were
symptomatic. Given the duration and
lack of improvement, the patient was
considered a “resistant patient”. We
decided to initiate low-load prolon-
ged stretch techniques to modify
stiffness and stabilize the result with
serial splinting, The first treatment
goal was to achieve a maximum daily
Total End Range Time (TERT) on the
MCP, addressing one direction at a
time.
At the beginning of the first session,
the patient showed 30 degrees of
MCPJ flexion. We used three techni-
ques: an elastic tension technique
towards flexion, a second-level IV
oscillatory technique in flexion, and a
third technique involving anterior
translation of the first phalanx. This
resulted in an increase of 35º, rea-
ching 65° degrees of flexion at the
end of the session after 45 min,
which we then stabilized with a
splint.
In the second session, the increase of
mobility was maintained. We reapp-
lied the oscillatory translation techni-
que of the first phalanx anteriorly at
level IV, reaching 80° degrees. We
observed difficulty in the gliding of
the extensor tendons distally and
added another technique for distal
gliding of the extensors in zones 5-6.
 F A C H A R T I K E L

Fig. 1. Initial examination session Day 0: Patient with a pre-treatment Fig, 4. Beginning of the second
contracture on the MCP joint and PIP joint. treatment session a week after the
first session Day 8: Patient maintains
the results of the previous sessions
and shows a clear gain in the MCP
joint mobility.

By the end of the session, full fist clo-

sure was achieved. We stabilized the
MCP with a splint.
In the third session, we noticed a
slight loss of MCP extension of about
Fig, 2. First treatment session: Patient working during a therapy session 15 degrees, The first day we got full
using the MAPS method to correct the fifth finger limitation. From left to extension at the MCPJ. We addressed
right, we can observe the progressive placement of the MAPS pegs to achieve
this and within 10 minutes achieved
the progressive MCP joint flexion. From left to right is an elastic tension
technique, an active assisted exercise and self-range exercise. The therapist full extension without losing any fle-
can control the intensity to increase the TERT dose. xion; the extension stiffness did not
recur. We started treating the PIP
towards extension to test elasticity.
We improved from -35 degrees to
-25 degrees in 10 minutes. We fabri-
cated a PIP extension splint to be
used for four hours a day but conti-
nued to use the MCP splint without
alteration to stabilize the result and
confirm the non-recurrence of the
MCP problems.

Since the flexion of the MCPJ was

preserved by the fourth session we
Fig. 3. First treatment session: Patient after 40 min. completing the
began to work on the PIPJ. Achieving
MAPS session. The figure on the left shows the gained mobility degrees.
To maintain this improvement, a serial casting is made to keep the desired a nice intrinsic plus and intrinsic
posture in the patient. minus position.

Zeitschrift für Handtherapie 1/2024 37

 F A C H A R T I K E L

Discussion:
Traditional Hand Therapy techniques,
such as early mobilization and the
use of splinting, play a crucial role in
managing many of the challenges
encountered during treatment.
However, these techniques are often
limited when faced with complex
cases. It is essential to have a clinical
Fig. 5. Second treatment session: From left to right, we can observe the progressive
reasoning process that evaluates the placement of the MAPS pegs to achieve the progressive MCP joint flexion. From left
tissues and assesses their mechanical to right is two exercises of self-range exercises for flexion of the MCP joint and
capabilities. This process enables the- then two exercises for distal gliding of the extensor tendons in zone 5-6.

rapists to be more confident in selec-

ting the most appropriate technique
for each specific case.

The incorporation of mechanothera-

py-assisted mobilization techniques
significantly expands the therapeutic
arsenal available to Hand Therapists,
offering new technical possibilities
Fig. 6. End of the second session: Fig. 7. Third treatment session two
that integrate seamlessly with exis-
Patient after completing the MAPS weeks after starting the treatment
ting methods. This synergy allows for session shows a full fist. To maintain Day 15: patient evaluation before star-
more effective therapy outcomes to this improvement, a splint is made to ting the session. The patient maintains
be achieved in less time and facilita- keep the desired posture in the the results of the previous sessions and
patient. shows a clear gain in mobility.
tes the establishment of a safer, and
more personalized exercise protocol
tailored to each patient's unique
needs.

This methodology not only makes the

treatments more effective and effi-
cient but also maximizes the produc-
tivity of each session. Continuous re-
evaluation throughout the course of Fig. 8. Third treatment session two weeks after starting the treatment:
Starting the PIPJ treatment to improve extension. From left to right passive
treatment enables therapists to provi- extension exercise, self-range exercise, passive extension obtained and elastic
de patients with a clearer prognosis tension digital neoprene orthosis to improve extension.
regarding the duration of treatment
and a more accurate prediction of
potential outcomes.
By adapting the therapy in response
to ongoing assessments, therapists
can adjust treatment strategies to
better match the patient´s evolving
condition, thereby increasing the ove-
rall effectiveness of the therapy.
Fig. 9. At three weeks full fist and full extension is obtained but treatment is not
ended more time is needed to stabilize the result.

38 Zeitschrift für Handtherapie 1/2024


Conclusions:
Hand Therapy is a broad discipline
that encompasses a variety of patho-
logical scenarios and diverse thera-
peutic needs. While the current array
of techniques available to therapists
is extensive, they often encounter
challenging limitations, whether due
to time constraints, resource availabi-
lity, or the inherent capabilities of tra-
ditional methods. In today's healthca-
re landscape, where insurance com-
panies are tightening budgets and
reducing allotted time for therapy
sessions, it is imperative to explore
and adopt new tools that comple-
ment existing techniques and ad-
equately meet patient needs.
Mechanotherapy mobilization techni-
ques offer a wealth of benefits that
address these challenges: They offer
high precision in application, increase
the TERT available to patients, allow
for controlled adjustment of intensity
levels, and enable patient-managed
therapy under professional supervi-
sion without the need for additional
therapist time. All of this is integrated
into a carefully structured clinical rea-
soning process.
These innovations make it possible to
provide more contemporary Hand
Therapy services that meet today´s
needs. By incorporating such advan-
ced techniques, therapists can deliver
more personalized and effective treat-
ments that are better suited to the
evolving dynamics of healthcare deli-
very and patient expectations. These
options not only increase the efficacy
of the treatments, but also improve
the efficiency of therapy sessions,
making it possible to achieve signifi-
cant therapeutic outcomes within
the constraints imposed by today's
healthcare systems.
F A C H A R T I K E L
Mit der richtigen Intensität ans Ziel:
Anmerkungen zur Handbehandlung
von Bewegungseinschränkungen und
Gewebesteifigkeit mit Hilfe der
Mechanotherapie (MAPS-Methode)
Kontext und Begründung: Rigidität ist eine der am häufigsten
behandelten Symptome in der Handtherapie. Traditionell werden
Schienen und andere Mobilisierungstechniken mit geringer Intensität
und langer Dauer eingesetzt, um die Länge und das Volumen des
bewegungseinschränkenden Gewebes zu verändern. Manchmal
stoßen Therapeuten mit diesen klassischen Techniken jedoch an
Grenzen.
Methoden: In diesem Artikel wird der MAPS-Ansatz (Mechano-
therapy-Assisted Progressive and Sequential) vorgestellt. Eine innova-
tive Methode, die die traditionelle Schienenbehandlung durch einen
neuen, klinisch erprobten Ansatz ergänzt. Dieser basiert auf einer
differenzierten Untersuchung, die es dem Therapeuten ermöglicht,
die ideale Behandlungsintensität zu bestimmen. Es werden progressi-
ve, sequentielle Mobilisierungstechniken eingesetzt, bei denen Be-
handlungen mit geringer Intensität und langer Dauer mit Hilfe von
Mechanotherapiegeräten durchgeführt werden.
Ergebnisse: Diese neue Methode ermöglicht eine präzise und wirk-
same Mobilisierung. Ein Fallbeispiel zeigt, dass dieser Ansatz die
Ergebnisse für die Patienten deutlich verbessert und es den Thera-
peuten ermöglicht, effektivere und effizientere Sitzungen durchzu-
führen.
Schlussfolgerung: Die Integration von progressiven Mobilisations-
techniken und der Einsatz von Mechanotherapiegeräten stellt einen
bedeutenden Fortschritt in der Behandlung von Bewegungsein-
schränkungen durch Gewebesteifigkeiten an der Hand und an den
Fingern dar, insbesondere in Fällen ohne knöcherne Deformität.
Diese Methode verbessert nicht nur die Wirksamkeit der Behand-
lung, sondern optimiert auch die Effizienz der Therapiesitzungen.
Schlüsselwörter:
• Steifheit
• Kontraktur
• Arthrofibrose
• Schmerz
Zeitschrift für Handtherapie 1/2024 39
 F A C H A R T I K E L
Authors
Hand Therapy Barcelona
Physical Therapy and
Clinical Investigation
Center
Corresponding Author:
v.punsola@handtherapy.com
Vicenç Punsola-
Izard, PhD
Director
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