Occupational Therapy Pre-Authorization Note

PRE-AUTHORIZATION REQUEST FORM Please indicate your request type with an X: [ ] First rehabilitation report [ ] Extension of treatment period required [ ] Clinical vocational rehabilitation intervention [ ] Amendment to treatment codes required [X] Additional treatment sessions are required INJURY / SYMPTOM DETAILS Diagnosis: Right wrist distal radius fracture, post-operative ICD 10 Codes: S52.501A Date of injury: 15 August 2024 Date of surgery: 22 August 2024 Weeks post: 10 weeks post-surgery F/U Dr: "Dr. Thomas Kelly" RTW: Modified duties, light lifting only, 4 hours/day CURRENT PRESENTATION Impairment Description Objective report: Patient reports persistent moderate pain (4/10 at rest, 6/10 with activity) in the right wrist, particularly during gripping and fine motor tasks. She struggles with everyday activities such as dressing, cooking, and opening jars. Her ability to type and use a computer mouse for extended periods is limited, impacting her modified work duties. She expresses frustration with the slow progress and a strong desire to regain full function for independent living and return to full-time work. Outcome Measures Range of movement (Active): - Wrist Flexion: R 30° / L WNL - Wrist Extension: R 35° / L WNL - Ulnar Deviation: R 10° / L WNL - Radial Deviation: R 5° / L WNL - Forearm Supination: R 60° / L WNL - Forearm Pronation: R 70° / L WNL - Digits: Full AROM bilateral except for limited thumb opposition and flexion of D2-D5 on the right hand. Grip strength: - R: 12 kg (average) / L: 35 kg (average) Pinch strength: - R: Tip pinch 1.5 kg, Lateral pinch 2.0 kg, Palmar pinch 2.5 kg (average) Swelling: Mild oedema noted dorsally over the right wrist, circumference 19cm (Left 17.5cm). Sensation: Intact to light touch and sharp/dull discrimination in all dermatomes of the right hand. Scar: Well-healed surgical incision on the volar aspect of the right wrist, slightly raised and hyperpigmented but non-tender. Wound: Closed and dry. Pain: Rates pain as 6/10 with functional use, sharp and aching in nature, exacerbated by gripping and sustained wrist movements. Treatment Provided - Manual therapy techniques for scar mobilisation and joint mobilisation of the wrist. - Therapeutic exercises focusing on gentle active range of motion for wrist and digits, light grip strengthening with putty, and pain-free wrist extension exercises. - Education on pain management strategies, activity modification for ADLs, and ergonomic principles for computer use. - Home exercise programme instructed to include tendon gliding, wrist mobilisations, and progressive light resistance exercises. Plan The patient requires an additional 6 weeks of occupational therapy to address persistent functional limitations, improve strength, and facilitate a full return to work. The plan includes advanced strengthening, fine motor coordination training, and simulated work tasks. A. TREATMENT PLAN Rehabilitation Goals [X] Improve AROM of the affected hand for successful participation in activities. [X] Improve strength of the affected hand for successful participation in activities. [X] Promote oedema management so that AROM is not impaired for activity participation. [X] Promote scar management to prevent excess scar tissue formation or adhesions which may limit AROM for activity participation. [X] Facilitate desensitisation to manage pain during activity participation. [ ] Provide splinting to rest the hand and facilitate healing of the hand. [X] To comment on the client's functional abilities (injury specific) compared to their related job demands. [ ] Facilitate improvement in physical endurance and strength by means of work hardening to enable the patient to cope with the demand required of an 8-hour work day. [X] Facilitate independent and pain-free successful participation in ADL and RTW. [ ] Other: Anticipated Duration and Frequency of Treatment Overall expected number of treatment sessions: 12 Frequency of treatment intervention: 2 sessions per week for 6 weeks Complicating Factors: The patient's job as an administrative assistant requires extensive computer use and fine motor dexterity, which currently exceeds her functional capacity. She also lives alone, which makes managing household tasks challenging without full bilateral hand function.