Desensitization Techniques for the Hand and Upper Extremity – Occupational Therapy

After surgery or a condition, hypersensitivity may occur with or without pain in areas such as the upper limbs. Recovery is often slow and may be resistant to treatment. This guide describes conditions, assessment, precautions, treatment techniques, and research for desensitization (tactile).

Definition: Hyperesthesia is both a lower threshold to sensory stimuli and a higher responseto stimuli.

Conditions

• Amputation
• Injuries
• Surgical repairs

Barriers

• Self-perceived pain
• Discomfort

Assessments

• Occupational Profile
• Visual analog scale (0-100)
• Downey Hand Center Sensitivity Test
• Semmes-Weinstein monofilment

Occupation Limitations

• Self-care
• IADLs
• Return to work
• Health management
• etc. etc.

Desensitization Techniques

Barber’s Approach

1. Patients rank how different textures feel on sensitive skin areas according to comfortability level. Textures vary from Velcro brand hook to soft cotton.
2. The arm is placed in a comfortable position and supported by the body or table.
3. Patients massage in the same direction and speed and pressure until numbness occurs for 2-5 minutes.
4. Textures that patients cannot tolerate are provided to bring home for a similar desensitization technique 3x/day.
5. Patients may progress to a tougher texture after 1-3 weeks.
6. Patients meet with occupational therapists to update their treatment plan.^[1]Göransson, I., & Cederlund, R. (2011). A study of the effect of desensitization on hyperaesthesia in the hand and upper extremity after injury or surgery. Hand Therapy, 16(1), 12-18.

Hardy’s Program

1. Paraffin
2. Massage
3. Vibration
4. Constant touch-pressure
5. Texture and object identification
6. Activity engagement^[2]Hardy MA, Moran CA, Merritt WH. Desensitization of the traumatized hand. Va Med 1982; 109:134–138.

Variations

• Tapping
• Using a large or mini electric massager electric vibrators
• Buckets or bins with different textures, e.g., rice, corn, bean, macaroni^[3]Chu, M. M., Chan, R. K., Leung, Y. C., & Fung, Y. K. (2001). Desensitization of finger tip injury. Techniques in hand & upper extremity surgery, 5(1), 63-70.

Complementary Interventions

• Remedial activities (can be repetitive)
• ROM
• Strengthening
• Theraputty
• Return to work simulation
• Functional use with tools, e.g., screws and bolts, clothespins^[4]Chu, M. M., Chan, R. K., Leung, Y. C., & Fung, Y. K. (2001). Desensitization of finger tip injury. Techniques in hand & upper extremity surgery, 5(1), 63-70.

Precautions

• Pain that appears initially can get worse upon further massage and should be terminated.
• Some patients ay benefit from a protective barrier over the sensitive areas such as a film or gel sheet for more severe cases.
• Consider splinting in such cases.
• Use mild pressure initially.^[5]Göransson, I., & Cederlund, R. (2011). A study of the effect of desensitization on hyperaesthesia in the hand and upper extremity after injury or surgery. Hand Therapy, 16(1), 12-18.

Research

A study of long-term TENS showed improvement in tactile sensitivity in MS patients. The duration was 3 weeks for 1 hour per day. Long-term effects were observed 3 weeks post-intervention. TENS may also have multiple therapeutic benefits as well such as pain and improved underlying function. Careful selection must be considered for stimulation parameters such as frequency, intensity, and duration of stimulus as each condition and patient is different. Observe the reaction and therapeutic result to see if TENS can advantageous. Con: may take several weeks to notice an improvement in insensitivity and requires strict adherence to a protocol that can take up a significant portion of the patient’s day (1 hour) being tethered to a TENS unit.^[6]Cuypers, K., Levin, O., Thijs, H., Swinnen, S. P., & Meesen, R. L. (2010). Long-term TENS treatment improves tactile sensitivity in MS patients. Neurorehabilitation and neural repair, 24(5), … Reference List