About Hand Therapy Practices at Surrey Sports & Rehabilitation

Hand measurement

About Hand Therapy

Hand therapy combines the theory and practice of both occupational therapy and physical therapy for comprehensive knowledge of the upper quarter, body function and activity. Hand therapists use specialized skills to assess and treat diseases or injuries of the upper quarter (hand, wrist, elbow, shoulder girdle, cervical area or multiple joints). In addition, hand therapists work with clients to prevent dysfunction, restore function and/or reverse pathological progression to improve quality of life.

Hand grip gauge

Who Are Hand Therapists?

Hand therapists are licensed or registered physical therapists or occupational therapists who have become skilled in the assessment and treatment of pathological upper quarter conditions by means of advanced continuing education, clinical experience and independent study. A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist who has met the standards established by the Hand Therapy Certification Commission, Inc.

Treatment Techniques and Tools

Various techniques and tools may be utilized in therapeutic interventions with hand and upper quarter patients, including but not limited to:

  • Activity

  • Adaptive/Assistive Devices

  • Training in Activities of Daily Living (ADLs)

  • Behaviour Management

  • Compressive Therapy

  • Desensitization

  • Electrical Modalities

  • Ergonomic Modification

  • Exercise

  • Manual Therapy

  • Patient and Family Education

  • Prosthetics

  • Sensory Re-education

  • Splinting

  • Standardized and Non-Standardized Assessment Tools

  • Strengthening

  • Thermal Modalities

  • Work Hardening/Retraining

  • Wound Care/Dressings/Topical Agents

Scope of Practice

The scope of hand therapy practice may involve one or more of the domains listed below. Domains outline the key areas of responsibility in hand therapy practice. The first three domains listed below involve assessment and treatment of hand clients. As per provincial and federal law, hand therapy treatment is based on the assessment results and may be given on a one-to-one basis, in a group setting or by consultation. The fourth domain lists the services for specific patient population. The final two domains outline responsibilities related to professional practice. The domains and their associated tasks are listed below:

Evaluate Upper Quarter and Relevant Patient Characteristics

  • The therapist obtains and reviews the patient's medical, psychosocial and vocational history.

  • The therapist interviews the patient.

  • We plan for and select assessment tools.

  • We assess and document skeletal, muscular, nervous, vascular, skin and connective tissue status, functional and/or ergonomic status and psychosocial factors.

  • We reassess and document patient status at appropriate intervals.

Develop Treatment and Discharge Plans

  • We integrate theoretical knowledge bases and patient goals into treatment.

  • We establish short-term and long-term goals of treatment.

  • We establish frequency of treatment in collaboration with patient and referring physician and determine rehabilitation potential.

  • We select appropriate treatment techniques.

  • We identify appropriate resources to which patients can be referred.

  • We consult with and refer to other health care professionals.

  • We document the treatment plan.

  • We assess readiness and determine discharge needs including return to work.

  • We formulate and document a discharge plan.

Implement Treatment Plans

We implement and modify treatment/interventions to address edema/vascularity, pain, scar, range of motion/flexibility, wounds, strength, dexterity, sensation, function, endurance and posture/movement.

Provide Population-Based Services

  • We determine needs of the target population (e.g., industrial, athletic and performing artistic groups).

  • We make intervention recommendations (e.g., education programs, prevention strategies, ergonomic modifications and screening) based on available resources.

  • We assist in implementation of interventions.

  • We monitor effectiveness of interventions.

  • We serve as a resource person/consultant.

Organize and Manage Services

  • We comply with regulations that ensure environmental safety.

  • We advocate for patients.

  • We ensure compliance with organizational policies and procedures.

  • We participate in case management.

  • We assess patient satisfaction.

Promote Professional Practice

  • We maintain ethical and legal standards.

  • We make intervention recommendations (e.g., education programs, prevention strategies, ergonomic modifications and screening) based on available resources.

  • We interpret and apply clinical research and outcome studies.

Scientific Knowledge Basis of Hand Therapy

The foundation of hand therapy is a comprehensive understanding of:

  • Surface Anatomy

  • Anatomy and Physiology of the Skin/Connective, Muscular, Skeletal, Nervous and Vascular/Lymphatic Systems

  • Physical Properties (e.g., Heat, Water, Light, Electricity and Sound)

  • Wound Healing

  • Behavioural Science, and Psychological Reactions to Impairment

  • Research Design and Statistics

  • Kinesiology and Biomechanics

  • Posture and Pathomechanics

  • Etiology and Pathology of Medical Conditions

  • Surgical and Medical Treatment of Conditions

  • Standardized and Non-Standardized Assessment Tools

  • Treatment Rationale, Indications and Contraindications

  • Treatment Methods, Techniques and Tools

  • Expected Functional Outcomes of Treatment

  • Expected Physiological and Psychological Effects of Treatment Procedures

  • Regulatory and Legal Guidelines

  • Resource Management

  • Professional Codes of Ethics

  • Safe and Appropriate Use and Maintenance of Equipment and Assistive Devices

  • Safety Techniques and Procedures (e.g., Infection Control, Emergency Procedures, Practitioner Safety, Environment)

Hand and Upper Quarter Patients

Theoretical knowledge and technical skills are used, along with good clinical judgment, in the assessment and treatment of individuals diagnosed with hand and upper quarter conditions. These may include but are not limited to:

  • Amputations

  • Central Nervous System Disorders As They Relate to the Upper Quarter

  • Congenital Differences/Anomalies

  • Cumulative Trauma Disorders/Repetitive Stress Injuries

  • Dupuytren’s Contracture

  • Flexor/Extensor Tendon Injuries

  • Fractures/Dislocations/Joint Instabilities

  • Infections

  • Inflammatory and Degenerative Arthritis

  • Multiple System Trauma

  • Nail Bed Injuries

  • Pain-Related Symptoms

  • Peripheral Nerve Compression and Disease

  • Peripheral Nerve Injuries

  • Post-Mastectomy/Post-Radiation Lymphedema

  • Psychogenic Disorders Involving the Upper Quarter

  • Soft Tissue Injuries

  • Thermal Injuries

  • Tumours and Cysts

  • Vascular Disorders

Such patients may be referred to a hand therapist following a variety of medical or surgical interventions including:

  • Amputation Revision

  • Fracture Fixation/Bone Graft

  • Joint Synovectomy

  • Nerve Decompression

  • Scar Revisions

  • Tendon Transfer

  • Tissue Transfers

  • Arthroplasty

  • Ganglionectomy

  • Ligament Repair

  • Nerve Grafts/Nerve Repairs

  • Skin Grafts/Flaps

  • Nail Bed Repair

  • Neurolysis

  • Soft Tissue Releases

  • Tenosynovectomy

  • Fasciectomy/Fasciotomy

  • Joint Reconstruction

  • Joint Releases

  • Nerve Block/Sympathectomies

  • Replantation/Re-Vascularization

  • Tendon Grafts/Tendon Repairs

  • Use of Pharmaceutical Agents

  • Injections

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