{
  "resourceType": "ActivityDefinition",
  "id": "thumb-opposition-exercise",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thumb-opposition-exercise",
  "version": "1",
  "name": "ThumbOppositionExercise",
  "title": "Thumb Opposition Exercise",
  "status": "draft",
  "experimental": true,
  "description": "Touch the thumb to each fingertip in sequence, then reverse. Trains opposition coordination used in fine motor tasks.",
  "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-opposition-exercise",
          "display": "Thumb Opposition Exercise"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hand",
          "display": "Hand"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "782474003",
          "display": "Structure of ligament of first carpometacarpal joint"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "56310002",
          "display": "Structure of metacarpophalangeal joint structure of thumb"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps per finger, 3x/week; part of multimodal hand program"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Rotated thumb pad — opponens turns, then flexes",
      "authorString": "focus:internal"
    },
    {
      "text": "Touch the thumb pad firmly to each fingertip in sequence",
      "authorString": "focus:external"
    },
    {
      "text": "Form a clean O with each finger before moving to the next",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on thenar eminence to confirm activation",
      "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": "algar-thumb-cmc-delphi-2022",
      "citation": "Algar L, Naughton N, Ivy C, et al.. (2022). Assessment and Treatment of Nonsurgical Thumb CMC OA: Modified Delphi",
      "document": {
        "url": "https://doi.org/10.1016/j.jht.2023.08.008"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Opponens Pollicis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "79727005"
          }
        }
      ]
    },
    {
      "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": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "32573001"
          }
        }
      ]
    }
  ]
}