I have been very excited for this interview to be released since I first started emailing with Diana. When I originally sent out a request to my followers on Instagram about finding OTs with specialties or certifications to be featured on my blog, I had a follower reach out and tell me about OrthoGeorgia, an outpatient clinic in Georgia, where I could find Certified Hand Therapists. I reached out through their Instagram page, here, to see if one of their CHTs would be interested in completing an interview that highlights this specialty area.
From there I was connected with Diana Williams, OTR/L, CHT, who has been practicing for over 45 years now! While Diana does not have an Instagram account for you to follow, through this interview, she gives wonderful insight into the field of hand therapy and shares her experiences with humility and respect for this profession and those she serves. (The first time I read through it I teared up and felt so so inspired!)
I encourage you to follow the OrthoGeorgia_OT Instagram page, they post great resources, intervention ideas, and share interesting cases that they see in their clinic!
Now, what is hand therapy, and how can OTs specialize in this field?
Hand therapy is a specialty practice area that focuses on the treatment of the upper-extremity, and is usually orthopedic-based. As a student, I’ve often heard that hand therapy is one of the hardest certifications to acquire! I was very lucky to have a few professors who are CHTs as they have an amazing understanding of upper extremity biomechanics and the healing process.
Estimated Time to Acquire Certification: 4,000 hours + 3 years as a licensed OT
Estimated Total Cost: $500 + exam study materials
You can read about OTs role in hand therapy here from AOTA.
You can find all of the requirements for applying for a certification in hand therapy here.
You can learn about the American Society of Hand Therapists here.
There is even a Journal of Hand Therapy!
Now onto this wonderful interview!
Where did you go to OT school and when did you graduate? How long have you been practicing as an OT?
As an Occupational Therapist, I have been privileged to practice in the specialty of Hand Therapy for forty-five years. I graduated from the Medical College of Virginia school of Occupational Therapy in 1975 and began working at MCV Hospital in their inpatient acute care services.
I was fortunate during this time to work with two passionate and dedicated individuals who introduced me to hand therapy. These two were Dr. Wyndell H. Merritt who developed the first masters program in hand therapy in the United States and Chris Blake, OTR/CHT, who is an outstanding therapist and was the 2003 president of the American Society of Hand Therapy (ASHT).
Why did you choose OT?
After completing my tour of duty in the Army Medical Corp, my heart’s desire was to be actively involved in the care of patients suffering disabilities sustained from injuries and/or disease processes. I saw the dedication of OTs and PTs throughout my military experience and decided that Occupational Therapy was the best choice for me.
What setting(s) do you work in/have you worked in? Do you have a favorite? Why?
I started my career in OT as an acute care therapist working at the MCV/VCU Medical Hospital. I worked primarily on the trauma care and burn units. This is where I met and worked under the direction of Dr. Merritt and Chris. I would have continued under their guidance but my family was transferred to Chapel Hill, North Carolina.
I was fortunate to obtain a position at the UNC Hand Center. My time at the Hand Center provided me with an excellent foundation in hand therapy and connected me with therapists who became lifetime friends and professional colleagues. I was fortunate to work side-by-side with outstanding hand surgeons and therapists that increased my knowledge and skills in hand therapy. I gained a deep appreciation for these professionals who dedicated themselves to promoting an in-depth understanding of hand rehabilitation and to the development of standards of care in hand and upper extremity trauma and disability. Following my time at UNC, I went on to work at other facilities as a team member with hand surgeons and therapists to restore functional independence of people with hand and upper extremity injuries.
My favorite setting to work in is a free standing practice where surgeons, nurses, and therapists work collaboratively to rehabilitate upper extremity patients. Being able to have direct communication with onsite surgeons provides the best opportunity for progressing patients through the rehab process.
What has your involvement been like with the progression of the field of hand therapy?
The field of hand therapy has a history that is rich and evolutionary to say the least. As many who remain in ASHT can confirm, hand therapy has been on the cutting edge in its growth and development. ASHT began in 1975 when six OTs and PTs met at the ASSH Annual Meeting in San Francisco. The full history of this organization can be found on the Hand Therapy Certification Commission website. It is well worth the read for anyone who is interested in pursuing the specialty of hand therapy.
I was one of many therapists during this early stage that had the opportunity to develop a hospital-based hand therapy clinic. I contribute this to the work and dedication of therapists and surgeons who believed in the value of hand therapy teams.
How has the field of hand therapy changed over the years?
While the fundamental principles and basic science in wound healing have remained constant, the rehabilitation approaches have continued to evolve from long term immobilization to early controlled active motion. Surgical strides in repair techniques and materials along with research in early mobilization have contributed to improved treatment approaches. Where patients were once held in plaster casts for weeks at a time, internal fixation now gives us the freedom to work on early protected movements that reduces residual scarring and facilitates better outcomes for functional recovery.
As we face an ever-changing healthcare system that is insurance driven, our surgical and clinical approaches to expedite care in a cost effective manner have been challenged. None-the-less, clinicians are steadfast in keeping pace to work within shrinking clinic visits while maximizing positive patient-center outcomes. As caregivers, hand therapists have never wavered in their commitment to staying patient-focused. We have chosen to remain dedicated and ethically focused in restoring the functional outcomes of our patients. While we all have different approaches in achieving these outcomes, the basic drive and focus of patient care remains the same.
What does a typical day in the clinic look like for you?
Overall, my days are relational– with clients, their families, and my colleagues. Every day brings its own set of challenges and demands. No two days are identical- that’s the beauty of what I do as a hand therapist. It is a continuous learning curve that has allowed me to grow in my knowledge and understanding of the human body as well as the privilege to go through a season of hardship with individuals who always seem to rise to a level of independence no matter the circumstances. Each day brings new lessons and experiences that have forever changed me.
How do you stay client-centered and occupation-based in your practice?
I concentrate on the goals of the patient to assist them in setting realistic expectations for their recovery. As OTs we are taught to focus on restoring functional independence. It is a creative process that is imperative for helping patients succeed and achieve satisfaction with their outcome. Part of the bedrock of hand therapy involves knowledge. I spend a great deal of time educating patients regarding their injury, surgery, and recovery process. I tell clients that this is about them and not about me. Empowerment is central to their recovery. Patients need to feel they are actively involved in their recovery process. This, I believe, is key to their success.
What are the steps to acquiring the credentials for a hand therapist?
Therapist can sit for the hand therapy certification after three years. Hand therapists re-certify every five years and must provide proof of having completed a specified number of clinic treatment hours as well as providing verification that they have completed a minimum of eighty hours of CEUs. These hours include live workshops/education along with other areas such as clinic instruction, presentations, etc. Full details for acquiring certification can be found on the Hand Therapy Certification Commission (HTCC) website (linked above).
Could you have worked in your setting in the capacity you do without being a CHT? Do you believe having the credentials is worth it?
While therapists can and do work in hand therapy clinics without being a CHT, it is strongly recommended that they work to achieve this credential. Because of the time and intense study required to achieve this certification, many clinics have mentor programs to develop the skill sets of therapists during the hiring process. Hand injuries in and of themselves are highly complex. While the hand may not be viewed as an organ, it remains none-the-less one of the most complex systems of the body. Upper extremity injuries of the wrist, forearm, elbow, and shoulder that OTs treat makes the need for in-depth knowledge critical. Having a certification in hand therapy is well worth the time and effort as it provides a solid foundation in the care and management of these patients.
Do you have any other certifications or interests?
Over the years, I have worked extensively with post op wounds. This experience and understanding has proven invaluable during mission trips to third world countries. I have been honored to see the world through the lens of medical professionals who have dedicated their lives to serving those less fortunate in countries that have limited medical resources. My years of learning and growing in the field of OT/HT have served me well in meeting the challenges of working in these settings. Yet, while I have gone to serve those in need, the blessings and personal rewards I have received have been far greater than what I have given.
Do you have any words of advice for someone wanting to pursue a hand therapy certification?
My advice to someone wanting to pursue hand therapy would be to follow your heart and pursue your passion. Gain as much knowledge as you can initially by working with CHTs who can mentor you. The field of hand therapy will continuously challenge and change you as a clinician and more-so as a person. There is no greater opportunity than to extend a healing hand. Being a therapist is about being relational. And, being a hand therapist gives you a unique opportunity to come along side those whose lives have been turned upside down and inside out physically, emotionally, financially, and spiritually. We are the privileged few who can be a part of the season of restoration in a person’s life that can be forever changed because of our healing touch.
OT Caroline 