{
  "resourceType": "ActivityDefinition",
  "id": "thumb-opposition-sequence",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thumb-opposition-sequence",
  "version": "1",
  "name": "ThumbOppositionSequence",
  "title": "Thumb Opposition Sequence",
  "status": "draft",
  "experimental": true,
  "description": "Touch thumb tip sequentially to each fingertip, emphasizing rotation of the thumb pad to face the finger pad (true opposition, not just flexion).",
  "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-sequence",
          "display": "Thumb Opposition Sequence"
        }
      ]
    }
  ],
  "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"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "10 reps × 3×/week (hand-OA protocols); daily for post-nerve injury."
    }
  ],
  "usage": "Evidence: moderate. Included in multiple hand-OA and CMC-arthritis RCTs [Østerås 2017; Deveza 2021 JAMA IM; Thakker 2025 network meta-analysis].",
  "note": [
    {
      "text": "Rotated thumb pad — pad meets pad with each finger",
      "authorString": "focus:internal"
    },
    {
      "text": "Form a clean O with each finger in turn",
      "authorString": "focus:external"
    },
    {
      "text": "Move from index to pinky, then reverse the sequence",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on thenar eminence to confirm activation",
      "authorString": "focus:tactile"
    }
  ],
  "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": "Abductor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "32573001"
          }
        }
      ]
    },
    {
      "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": "Flexor Pollicis Longus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "82465007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Adductor Pollicis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60114005"
          }
        }
      ]
    }
  ]
}