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Hand Therapy

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Becky Haller

on 25 June 2014

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Transcript of Hand Therapy

Eileen Choi
Becky Haller
Corinne Sharp

Focus of OT Services
The art and science of rehabilitation of the upper quarter of the human body.
The biomechanical issues underlying orthopedic-based upper-extremity conditions
: To optimize the functional use of the hand and arm and emphasize the performance of desired activities in an occupation-based and client-centered approach
The Scope of Services
: wound and scar management, edema control, (swelling) pain control, range of motion exercises, strengthening, dexterity training and static and dynamic splint fabrication

Typical Clients
Physiological impairments, activity difficulties, and limitations in roles or occupations due to their conditions of hands
Lacerations and amputations, fractures of the hand and arms, burns, and surgical repairs of tendons and nerves. ㅉㄹ쟈소
Arthritis, carpal tunnel syndrome, tendonitis, Repetitive Motion Disorders, Finger Amputation

Location of Services
Acute Medical Unit (after surgical wound closes)- splinting, bedside ADL training, wound care, monitor PTSD signs
Outpatient Rehabilitation - splinting, ADL/IADL training, sensory and pain management, control for edema, activity modifications, training to return to work
Private Practice

Treatment Environment
Medical station - a cabinet, a cart, or a separate room
A large table for regular OT and an individual table for more individualized and intimate treatment
Desk and chairs
Measuring tools
Splint Area (all the splinting supplies and the water used to heat up the splinting materials)

Service Delivery
Individual direct treatment - direct assessment of clients’ relevant goals and progress
Family training - helpful when client needs assistance from loved ones outside therapy

Types of Occupations
Occupation-based vs. biomedical treatment
Sometimes difficult to incorporate occupation-based practice
Work functions
AOTA Practice Guidelines and Official Documents
AOTA Fact Sheet: The Unique Role of Occupational Therapy in Rehabilitation of the Hand
Federal Laws and Regulations
Same laws and regulations as OT's in other settings
Adhere to same Code of Ethics
Specific Competencies
All OT's can treat clients with hand and arm conditions, but many OT's in this field choose to become Certified Hand Therapists
Becoming a Certified Hand Therapist is an extremely rigorous process
5+ years as a licensed and practicing OT
4,000+ hours of patient contact in hand therapy interventions
Pass 200 question certification examination
Must renew certification every 5 years
Can be a OT or a PT - same certification
Other Team Members
Physical Therapists
Hand/orthopedic surgeon
Other OTs
Appeals and Challenges
It takes many years to become a Certified Hand Therapist
Hard on your hands
Balancing the expenses of treatment with the integrity of the treatment
Hand therapy supplies are very expensive
Insurance coverage
Ability to specialize in one field of knowledge
Less physically demanding on your body then some other fields in OT
Can be one of the higher paying professions depending on your length of time practicing and if you have developed a good reputation for yourself
Length of Service
Depends on numerous factors
Diagnosis/Severity of impairment
Acute vs. Chronic
Surgery factors
Varies ~ 1 visit, months of treatment
Typical Day
Amini, D. (2011). The unique role of occupational therapy in rehabilitation of the hand.
The American Occupational Therapy Association, Inc. Retrieved June 16, 2014, from http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Hand%20Therapy%20fact%20sheet.pdf
Case-Smith, J. (2003). Outcomes in hand rehabilitation using occupational therapy
services. American Journal of Occupational Therapy, 57, 499-506.
Hand Therapy Certification Commission. (n.d.). Who is a certified hand therapist?
Retrieved June 16, 2014, from
Hand Therapy Certification Commission. (2002). Definition of hand therapy and scope
of practice of certified hand therapists. Retrieved June 16, 2014, from http://www.htcc.org/docs/downloads/definition-and-scope-of-practice.pdf?sfvrsn=0
Powell, R. K., & von der Heyde, R. L. (2014). The inclusion of activities of daily living in
flexor tendon rehabilitation: A survey. Journal of Hand Therapy, 27, 23-29. doi:10.1016/j.jht.2013.09.007
Schell, B.A., Scaffa, M., Gillen, G., & Cohn, E.S. (Eds.). (2014). Willard & Spackman's
Occupational Therapy (12th ed.). Philadelphia, PA: Lippincott.
Treatment Strategies
Hand Therapy
Varies depending on setting but generally:
Review patient workload for the day
Extensive chart review on each patient
Important to understand the diagnosis and whether or not they have had surgery
If they have had surgery - how far along are they post-op?
Need to know doctor's orders - is this a treatment session or an appointment for a splint?
Treatment: typically treat a new patient every 30 minutes
At the end of the day: clean up, write notes, and prepare for the next day
Typical Day
This daily structure is fairly typical of all environments where hand therapists work
Acute care and outpatient differences:
Travel to patients room in acute care (usually with a cart of supplies) instead of them coming to you
Acute care requires a more extensive knowledge base of other injuries/illnesses
What are the patients limitations such as lifting their head, sitting up, standing up, etc?
Preparatory methods
Purposeful activities
Performance of desired occupations
Aid in psychological and social well-being
Provide equipment
Image References
Main Image:
Amos, E. (2012). The front and back of a human right hand. Wikipedia.com. Retrieved June 17, 2014, from http://en.wikipedia.org/wiki/Hand#mediaviewer/File:Human-Hands-Front-Back.jpg
Slide 4:
Ridgefield Physical Therapy (2010). Services: Hand Therapy. Retrieved from http://www.ridgefieldphysicaltherapy.com/service.php?Hand-Therapy-2
Slide 6:
St. Joseph Hospital (2014). Occupational Therapy/Hand Therapy. Retrieved from http://www.sjo.org/Our-Services/Rehabilitation-Services/Occupational-Therapy-Hand-Therapy.aspx
Slide 7:
Stanely, S. (2013, June 9). Hand it to the therapists: After surgery, therapy essential to restoring function, strength. The Durango Herald. Retrieved from: http://durangoherald.com/article/20130609/LIFESTYLE04/130609507/Hand-it-to-the-therapists
Slide 9
: The American College of Emergency Physicians (2014). About emergencies. Retrieved from http://www.emergencycareforyou.org/YourHealth/AboutEmergencies/Default.aspx?id=26020
Slide 10
: Riveros, A. D. (2012). Repetitive stress conditions: Hand and upper extremity. The Orthopaedic Institution. Retrieved from http://www.toi-health.com/repetitive-stress-conditions-hand-and-upper-extremity.aspx
Slide 11
: Ranney, R. (2013, December 16). Mid-century modern chair restoration. Retrieved from https://owl.english.purdue.edu/owl/resource/560/10/
(Amini, 2011)

(Case-Smith, 2003)

(Case-Smith, 2003)

(Amini, 2011)
(Schell, Gillen, & Scaffa, 2014)
(G. Tune, personal communication, June 17, 2014; Schell, Gillen, & Scaffa, 2014)

(Schell, Gillen, & Scaffa, 2014)

(Hand Therapy Certification Commission, n.d.)
(G. Tune, personal communication, June 17, 2014)
Insurance and Billing is an important aspect of Hand Therapist's knowledge base because these policies constantly change
Many aspects of hand therapy treatments are not covered by insurance
(Hand Therapy Certification Commission, n.d.)
(G. Tune, personal communication, June 17, 2014)
(G. Tune, personal communication, June 17, 2014)
(G. Tune, personal communication, June 17, 2014)
Definition of Hand Therapy and Scope of Practice of Certified Hand Therapists - Official Document of the Hand Therapy Certification Commission
(Amini, 2011)
(Hand Therapy Certification Commission, 2002)
(G. Tune, personal communication, June 17, 2014; Schell, Gillen, & Scaffa, 2014)
(G. Tune, personal communication, June 17, 2014; Schell, Gillen, & Scaffa, 2014)
(Amini, 2011; G. Tune, personal communication, June 17, 2014)
(G. Tune, personal communication, June 17, 2014; Schell, Gillen, & Scaffa, 2014)
Full transcript