{
  "resourceType": "ActivityDefinition",
  "id": "thumb-ip-mcp-strengthening",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thumb-ip-mcp-strengthening",
  "version": "1",
  "name": "ThumbIpMcpStrengthening",
  "title": "Thumb IP and MCP Strengthening",
  "status": "draft",
  "experimental": true,
  "description": "Isolated thumb joint exercises targeting FPL (IP flexion), EPL (IP extension), FPB (MCP flexion), and EPB (MCP extension). FPL and EPL are the only two extrinsic thumb muscles capable of sustaining individual activations without significant coactivation.",
  "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": "thumb-ip-mcp-strengthening",
          "display": "Thumb IP and MCP Strengthening"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hand",
          "display": "Hand"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "115955008",
          "display": "Structure of interphalangeal joint of thumb"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "56310002",
          "display": "Structure of metacarpophalangeal joint structure of thumb"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps each direction (IP flex/ext, MCP flex/ext), 3x/week. Modified Borg Scale moderate-to-somewhat-hard [Lamb 2015]"
    }
  ],
  "usage": "Evidence: moderate. FPL: linear EMG-force relationship [Cooney 1985]. EPL: independent activation at 20-50% MVC [Birdwell 2013]",
  "note": [
    {
      "text": "Quiet wrist, isolated thumb — each joint moves independently",
      "authorString": "focus:internal"
    },
    {
      "text": "Bend just the thumb tip down to touch the index pad",
      "authorString": "focus:external"
    },
    {
      "text": "Straighten the thumb tip against light band resistance",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand stabilizes the proximal joint as the distal one moves",
      "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": "Flexor Pollicis Longus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "82465007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Pollicis Longus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "81440007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "20588008"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Abductor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "32573001"
          }
        }
      ]
    }
  ]
}