{
  "resourceType": "ActivityDefinition",
  "id": "grip-strengthening",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/grip-strengthening",
  "version": "1",
  "name": "GripStrengthening",
  "title": "Grip Strengthening (Squeeze Ball)",
  "status": "draft",
  "experimental": true,
  "description": "Squeeze a therapy ball or putty, then release. Trains finger flexion and grip strength used in all hand activities of daily living.",
  "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": "grip-strengthening",
          "display": "Grip Strengthening (Squeeze Ball)"
        }
      ]
    }
  ],
  "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"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "725412007",
          "display": "Structure of distal interphalangeal joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "371232006",
          "display": "Structure of proximal interphalangeal joint of finger"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps with 3-5 second holds, 3x/week"
    }
  ],
  "usage": "Evidence: moderate. Hand exercises reduce short-term pain (VAS -5.0) and improve grip strength (21 lbs) in hand OA [Thakker 2025]",
  "note": [
    {
      "text": "Long wrist, full finger flexion — flexor digitorum drives the squeeze",
      "authorString": "focus:internal"
    },
    {
      "text": "Crush the ball into a smaller shape",
      "authorString": "focus:external"
    },
    {
      "text": "Spread the fingers wide between each squeeze",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand around the wrist — wrist stays neutral",
      "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"
      }
    },
    {
      "type": "citation",
      "label": "deveza-thumb-oa-conservative-2021",
      "citation": "Deveza LA, Robbins SR, Duong V, et al.. (2021). Efficacy of Conservative Therapies for Thumb Base OA",
      "document": {
        "url": "https://doi.org/10.1016/j.joca.2021.07.010"
      }
    },
    {
      "type": "citation",
      "label": "thakker-thumb-cmc-nma-2025",
      "citation": "Thakker A, Ramchandani JP, Divall P, et al.. (2025). Most Clinically Effective Nonoperative Interventions for Thumb CMC OA: Network Meta-Analysis",
      "document": {
        "url": "https://doi.org/10.1097/CORR.0000000000003300"
      }
    },
    {
      "type": "citation",
      "label": "akbas-grip-strength-meta-2025",
      "citation": "Akbaş A. (2025). Hand-Focused Strength and Proprioceptive Training for Improving Grip Strength and Manual Dexterity: A Systematic Review and Meta-Analysis",
      "document": {
        "url": "https://doi.org/10.3390/jcm14196882"
      }
    },
    {
      "type": "citation",
      "label": "dodds-grip-normative-2014",
      "citation": "Dodds RM, Syddall HE, Cooper R, et al.. (2014). Grip Strength Across the Life Course: Normative Data From Twelve British Studies",
      "document": {
        "url": "https://doi.org/10.1371/journal.pone.0113637"
      }
    },
    {
      "type": "citation",
      "label": "mcgrath-grip-mortality-2018",
      "citation": "McGrath RP, Vincent BM, Lee IM, Kraemer WJ, Peterson MD. (2018). Handgrip Strength, Function, and Mortality in Older Adults",
      "document": {
        "url": "https://doi.org/10.1249/MSS.0000000000001683"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Superficialis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "89895007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Profundus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "423541009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Digitorum"
        },
        {
          "url": "role",
          "valueCode": "stabilizer"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "50176000"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Opponens Pollicis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "79727005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Lumbricals (Hand)"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "88229007"
          }
        }
      ]
    }
  ]
}