Posted on: August 25, 2015
Getting a Handle on Hand Therapy
By Michele Comen
When you lose the full function of your hand, wrist, elbow or shoulder, whether through injury, surgery, arthritis, or a progressive disorder like Dupuytren’s contracture, your doctor may recommend that you see a hand therapist. Here I explain what hand therapy is, whom it’s for and why it is so important.
What is hand therapy?
Hand therapy requires complete understanding of the upper limb: The hand, wrist, elbow and shoulder. It is used to both prevent dysfunction and restore function. In my practice, types of therapy at NWHmay include wound care, splinting, pain management, and focus on range of motion, strengthening, motor learning, restoration of functional abilities, and activities of daily Living (ADLs).
What happens in hand therapy sessions?
Every hand therapy session is customized to the patient. The goals are to eliminate pain and help the patient regain as much function as possible as quickly as possible. While this is done in many different ways, some of the most common methods we use are:
- Fluidotherapy® – a dry, heated, closed whirlpool that swirls tiny particles around the hand and arm to promote healing and alleviate pain
- Ultrasound – which uses high-frequency sound waves to break down scar tissue and decrease sensitivity
- Paraffin (hot wax)
- Therapeutic activities that mimic what you do every day
For example we have pegboards, grippers, therapeutic putty, and even a board with a lock, a spigot, dials, pushbuttons and switches, to duplicate what people encounter at home and at work. For manual laborers we simulate strenuous work activities like lifting, pushing and pulling heavy objects.
What was one of your most challenging cases?
I remember treating a young man, an underwater construction worker who had suffered the loss of one and a half fingers in a work accident. He was passionate about his job, and also loved to SCUBA dive recreationally, and he was worried that he wouldn’t be able to dive again. For his hand therapy program we developed a re-conditioning program using resistive tools that simulated his underwater job responsibilities. With therapy, he was able to get back to his job and what he loved.
What are some of the common misperceptions about hand therapy?
Some patients think it is something they can do on their own. And, it’s true that some of the activities do seem basic and can even be fun, though we make them challenging. But it’s important to learn these activities in a therapeutic setting in order to maximize recovery and avoid further injury.
Another misperception is that it’s going to be painful. Hands are extremely sensitive. If a patient is experiencing pain while doing a therapeutic activity, we stop and look for other options.
When should I start, and how long does hand therapy take?
Once your doctor recommends therapy, you should begin as soon as possible. The sooner you start after surgery or a diagnosis, the better the outcome. Every patient is different, so the duration of hand therapy required will vary.
What should I look for when choosing a hand therapist?
You should look for a Certified Hand Therapist – a CHT. Because the hand is so complicated, it’s a rigorous process to become a hand therapist. Certified hand therapists need 4,000 hours of direct patient care, a certification in occupational or physical therapy, and must pass a certification board exam. While there are many options for where you get hand therapy, it’s important to consider the expertise of the therapist, the location, and if the provider or facility accepts your health insurance. Another important consideration is personal attention. At some facilities, patients are treated in a group setting. However, at Northern Westchester, patients receive one-to-one therapy.
Editor’s Note: NWH hand therapist, Michele Comen, MA OTR/CHTat Northern Westchester Hospital, has over 20 years of experience in treating hand and upper extremity injuries. She has expertise in splinting, myofascial release, alternative/Eastern therapy, and kinesiotaping for pain management and upper extremity strengthening. Michele has been published in the Journal of Hand Therapy and regularly conducts ergonomic evaluations for the prevention of repetitive strains.