{
  "resourceType": "ActivityDefinition",
  "id": "finger-adduction-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/finger-adduction-exercise",
  "version": "1",
  "name": "FingerAdductionExercise",
  "title": "Finger Adduction Exercise (Palmar Interossei)",
  "status": "draft",
  "experimental": true,
  "description": "Strengthening palmar interossei for finger adduction. Rubber band resistance significantly increases ulnar nerve-innervated intrinsic muscle activation while minimizing extrinsic activation. Finger adduction strength is highly affected in ulnar nerve injuries (75-76% reduction).",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "finger-adduction-exercise",
          "display": "Finger Adduction Exercise (Palmar Interossei)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hand",
          "display": "Hand"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "56103003",
          "display": "Structure of collateral ligaments of metacarpophalangeal joints"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×15 reps, 2-3x daily. Brief isometric contractions preferred for partially denervated muscle [Herbison 1983]"
    }
  ],
  "usage": "Evidence: limited. Rubber band resistance: significantly increases intrinsic activation, minimizes extrinsic [Boudreau 2022]. Ulnar nerve injury: 75-76% pinch-to-zoom reduction [Bertelli 2020]",
  "note": [
    {
      "text": "Straight fingers — palmar interossei pinch toward the middle finger",
      "authorString": "focus:internal"
    },
    {
      "text": "Squeeze a folded paper between two adjacent fingers",
      "authorString": "focus:external"
    },
    {
      "text": "Hold five seconds before letting the paper drop",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand tugs the paper to test the squeeze",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Palmar Interossei"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "85212008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Profundus"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "423541009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Dorsal Interossei (Hand)"
        },
        {
          "url": "role",
          "valueCode": "lengthening"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60618007"
          }
        }
      ]
    }
  ]
}