2017_DCOTA_Presentation_-_Hand_Therapy_in_2017.pdf

Transcript

1. State of Hand Therapy 2017
2. Outline • The Hand Therapy Profession • History of Hand Therapy • Commonly treated conditions and treatment techniques • Current and future challenges • How do I get started on this journey?
3. THE HAND THERAPY PROFESSION
4. Hand Therapy “The art and science of rehabilitation of the upper quarter“ “Hand therapy is a merging of occupational therapy and physical therapy theory and practice that combines comprehensive knowledge of the upper quarter, body function, and activity. Using specialized skills in assessment and treatment, hand therapists promote the goals of prevention of dysfunction, restoration of function, and/or reversal of the progression of pathology in order to enhance participation in life situations for individuals with upper quarter disease or injury.” Source: Hand Therapy Certification Commission (www.htcc.org)
5. A Hand Therapist is… • An Occupational or Physical Therapist who specializes in the care of upper extremity conditions and injuries including the hand, wrist, elbow, and shoulder • Many of these specialists have chosen to pursue the Certified Hand Therapist (CHT) credential
6. A Certified Hand Therapist (CHT)….  Minimum of 3 years of experience (NEW for 2018!)  4,000 hours of time practicing and being mentored in the intricacies of the upper extremity  Has passed a rigorous examination of advanced clinical skills and theory in upper extremity rehabilitation  Maintains certification through high quality continuing education courses  Source: Hand Therapy Certification Commission (www.htcc.org)
7. A Certified Hand Therapist (CHT)….  6284 CHT’s worldwide  85% of CHT’s are OT’s  14% of CHT’s are PT’s  1% of CHT’s hold both OT/PT credentials  Source: Hand Therapy Certification Commission (www.htcc.org)
8. Hand Therapists Have Comprehensive Knowledge of:  Anatomy and physiology  Etiology and pathology of medical conditions  Surgical and medical treatment of upper  extremity conditions  Kinesiology, biomechanics, and pathomechanics  Wound and tissue healing
9. Hand Therapists Have a Comprehensive Knowledge of:  Ergonomics and body mechanics  Expected functional outcomes of treatment  Expected physiological and psychological  effects of treatment
10. A historic year for OT!
11. History of Hand Therapy WWII - Regional Hand Centers As thousands of injured soldiers returned home from the battlefield, Dr. Sterling Bunnell, MD realized hand injuries needed comprehensive orthopedic, plastic, and neurosurgery. The US Army Surgeon General tasked him to develop 9 regional hand centers on US Army Base Hospitals
12. History of Hand Therapy Hand Therapy Centers  Dr. Paul Brand, working with Leprosy patients in India saw that a comprehensive approach to returning these patient’s to functional lives was needed.  Revolutionized reconstructive surgeries and tendon transfers for upper extremity surgery.
13. History of Hand Therapy 1960-1980 Many US Hand Rehabilitation Centers sprang to life  Hand House - Chapel Hill, NC Janice Maynard, OTR  Curtis National Hand Center - Baltimore, MD Janice Maynard, OTR Raymond Curtis, MD  Philiadelphia Hand Center - Philadephia, PA Evelyn Mackin, PT/CHT James Hunter, MD  Indiana Hand Center - Indianapolis, IN Nancy Cannon, OTR/CHT James Strickland, MD
14. History of Hand Therapy
15. History of Hand Therapy
16. History of Hand Therapy
17. History of Hand Therapy 1975 - ASSH Meeting of the "original six" - Bonnie Olivett OTR - Karen Pendergast Lauckhardt PT - Evelyn Mackin-Henry PT - Judy Bell-Krotoski OTR - Mary Kasch OTR - Pegge Carter-Wilson OTR 1978 - First ASHT meeting in Dallas, TX
18. History of Hand Therapy 1987 - The Journal of Hand Therapy published for the first time. (Began with the support of the ASSH) 1988 - Certification test development began, to protect the field 1989 - The Hand Therapy Certification Commission founded 1991 - First Hand Therapy Certification Test given (CHT)
19. COMMONLY TREATED CONDITIONS
20. What Injuries/Conditions Benefit from Hand Therapy?  Tendon and nerve injuries  Wounds and infections  Soft tissue injuries
21. What Injuries/Conditions Benefit from Hand Therapy?  Fractures, dislocations, and sprains  Sports injuries
22. What Injuries/Conditions Benefit from Hand Therapy?  Amputations  Burns and frostbite  Congenital differences
23. What Injuries/Conditions Benefit from Hand Therapy?  Rheumatoid arthritis and osteoarthritis  Dupuytren’s contracture  Pain-related disorders
24. What Injuries/Conditions Benefit from Hand Therapy?  Tendonitis such as tennis elbow  Cumulative trauma disorders  Nerve compressions such as  carpal and/or cubital tunnel  syndrome
25. EVALUATION TECHNIQUES
26. Range of Motion
27. Strength Testing
28. Sensory Testing
29. Edema Assessment
30. Pain Assessment
31. Wound Status
32. Scar Status
33. Soft Tissue Status
34. Functional Dexterity Testing
35. Functional Assessment
36. Provocative Testing
37. TREATMENT TECHNIQUES Meeting your client’s needs
38. Fostering a Therapeutic Environment
39. Fostering a Therapeutic Relationship
40. The Interdisciplinary Approach
41. Client Education
42. Wound Care and Pin Care
43. Scar Management
44. Desensitization Techniques
45. Edema Management
46. Soft Tissue Mobilization
47. Range of Motion Exercises
48. Functional Activities
49. Joint Protection and Energy Conservation
50. Strengthening Exercises
51. Work Hardening
52. Ergonomic Modifications
53. Electrical Stimulation
54. Neuromuscular Electrical Stimulation
55. Ultrasound
56. Heat Modalities
57. Heat Modalities
58. Cold Modalities
59. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
60. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
61. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
62. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
63. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
64. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
65. Customized Splinting • Static • Static Progressive • Dynamic • Pre-fabricated
66. Challenges in 2017 CMS 6012P “Establishment of special payment provisions and requirements for qualified practitioners and qualified suppliers of prosthetics and custom fabricated orthotics” Essentially, this would require current OT’s and PT’s who fabricate custom orthoses to undertake a 18 month training program to become certified by the American board for Orthotists and Prosthetitist Certification.
67. Challenges in 2017 HR 807/S253 Medicare Access to Rehabilitation Services Act This bill, presented to congress 2/2017 would permanently repeal the arbitrarily applied “Outpatient Therapy Cap” that is based on balanced budget concerns rather than patient outcomes or clinical need. Interestingly, this “cap” was deferred 16 years in a row due to AOTA/APTA/ASHA and ASHT pressure. In 2017, the bill that would eliminate this for good fell just 2 votes short of the 60 votes required to pass.
68. Challenges in 2017 H.R.1608/S2373 Lymphedema Treatment Act (LTA) Improve current lymphedema treatment coverage. Promote and enable patient self-treatment plan adherence by improving access to needed medical supplies for home use. Reduce total healthcare costs associated with lymphedema, including reducing the incidence of complications, comorbilities and other disabilities that could result from lymphedema
69. Challenges in the FUTURE Research!  Treatment Effects  Outcomes  Natural History/Recovery  Screening/Prevention  Correlation  Causation Barriers?  Time  Knowledge of process - Should improve as OTD becomes the norm
70. Challenges in the FUTURE New Frontiers of Treatment/E-Visits - The use of telepresence to reach to underserved areas.
71. Challenges in the FUTURE Technology and it’s impact ……  Hypothesized that grip strengths are trending downward.  Suggestion is that changing demands of the workforce.  Data shows some drift from the previous levels.  Lower avg. grip in all age groups except women 30-34 yoa.  Small study, not as inclusive as Mathiowetz 1985 study.
72. Challenges in the FUTURE Technology and it’s impact on Hand Rehabilitation  Use of computerized documentation and assessment technology can facilitate accurate and efficient use of therapists time.  Use of virtual reality and computer assisted technology in hand therapy can enrich patients experiences, but is not superior to direct therapist interactions.
73. How do I become a Hand Therapist? Self Study Rehabilitation of the Hand Journal of Hand Therapy ASHT membership
74. How do I become a Hand Therapist? Continuing education  Philadelphia Symposium  Hand Care (Biannually - 2018)  Exploring Hand Therapy
75. How do I become a Hand Therapist? Residencies/Fellowships  Philadelphia - Mackin Fellowship http://handfoundation.org/fellowship  Hospital for Special Surgery – NY https://www.hss.edu/hand-therapy-fellowship.asp  Johns Hopkins - Baltimore, MD http://www.hopkinsmedicine.org/physical_medicine_reh abilitation/_downloads/hand-therapy-residency.pdf  University of Michigan http://pmr.med.umich.edu/education-training/otpt- residency/hand-residency-program
76. How do I become a Hand Therapist? Spend time with local surgeon Join a journal club/interest group Research, read and ask the “why”
77. Acknowledgements  Parts of this presentation were drawn from the marketing package provided by the American Society of Hand Therapists.  This presenter has no financial or personal ties to any organization mentioned within.