Hand therapy, a specialty practice area of occupational therapy, istypically concerned with treating orthopedic-based upper-extremityconditions to optimize the functional use of the hand and arm.Conditions seen by the occupational therapy practitioner specializingin this area include fractures of the hand or arm, lacerations andamputations, burns, and surgical repairs of tendons and nerves.Acquired conditions such as tendonitis, rheumatoid arthritis andosteoarthritis, and carpal tunnel syndrome also are treated by handspecialists. Occupational therapy practitioners who treat clients withconditions of the hand or arm can do so without additional formaleducation in most states. However, many practitioners choose to gainseveral years of experience before treating hand clients, and therapistsmay choose to become specially certied through the Hand TherapyCertication Commission.
Occupation-Based Hand Therapy
Hand therapy typically addresses the biomechanical issues underlyingupper-extremity conditions. However, occupational therapypractitioners bring an added dimension to this specialty area. Theyuse an occupation-based and client-centered approach that identiesthe participation needs of the client—what he or she wants to be ableto do in daily life that is fullling and meaningful—and emphasizesthe performance of desired activities as the primary goal of therapy.
What Does an Occupation-Based Approach to Hand Therapy Look Like?
The client–therapist relationship is key to an occupation-basedapproach. Occupational therapists begin intervention with aclient-centered assessment tool, such as the
Canadian Occupational Performance Measure
This tool will give an occupational prole of the client that highlights functional decits and desired occupationalgoals rather than focusing solely on the physical components of function.• Laying strong groundwork through the initial evaluationfocuses intervention in two ways. First, the therapist willknow immediately what things the client values and enjoys,and what he or she needs to “get back to.” This groundworkenables the therapist and client to collaboratively set goalsthat reect what the client needs and wants to do. Second,the client will understand that therapy is addressing his or herwhole body, mind, and lifestyle—including any psychologicaland social issues—and not just an isolated injury.
The Unique Role of Occupational TherapyIn Rehabilitation of the Hand
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The Benets of Occupation-BasedHand Therapy
Evidence indicates that clients view themselves inrelation to their occupational abilities and roles.
Injuries and conditions that interfere with life roles,habits, time use, activity patterns, occupationalexperiences, and full participation will create asense of dysfunction and yearning for normalcy.
Incorporating “usual and customary” occupationalactivities into treatment and focusing goals onenabling performance of those activities providesbenets to clients, including
preserving roles and habits, as well as relatedpsychological well-being, through attention todetails of day-to-day functioning early in therehabilitation process;
increasing motivation for therapy and more cost-effective rehabilitation because clients can see adirect relationship between their occupationaltherapy intervention and being able to resumenormal participation in their activities; and
making the client a partner in his or her rehabilitation. Not all intervention can or shouldbe completed within the clinic. Consultingwith the client about what he or she can andshould not do outside the clinic as well asgiving “homework” assignments can addressoccupational goals that go beyond clinical staff time and budget constraints.