Hand Therapy with LaQuestis

What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?

Hand therapy. Hand therapy is for anyone who has an injury or condition of the upper extremity (shoulder, elbow, wrist, hand). Most hand therapists are OTs but there are some that are PTs. The setting can seem very much like it is all PT but it is our job as OTs to try and stand out in ways that help distinguish us from PT

What is OT’s role in this setting?

As mentioned before, OTs make up most of the certified hand therapists in the world, but there still aren’t enough! OTs in the hand therapy setting are responsible for evaluating patients with upper extremity injuries or conditions and creating a plan of care that will help them regain the function to engage in everyday tasks. If this becomes difficult, OTs can help establish adaptive strategies that would help the patient be as independent as possible..

Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?

I felt okay. We did have anatomy in the beginning of the program, and we had other classes that emphasized upper extremity conditions. So I didn’t feel too bad. As far as preparation, my CI emailed me resources and a list of common diagnoses to review, which was really helpful.

What resources were the most helpful during your time there?

Hand and Upper Extremity Rehab, borrowed from my CI; any anatomy resource; handcare.org

What did you bring with you during work to help you stay organized? // How did you stay organized and manage your time?

I brought a clipboard with blank paper in case I needed it for evals, OT pocket guide, and I always carried a planner. I didn’t really need much to stay organized, but I did make sure I knew who my patients were for the following day to be prepared and more efficient. I also tried doing notes during sessions if my patients were becoming more independent with their exercises and I wasn’t doing anything hands on.

What was your schedule like?

My FW placement had several locations and I worked at 2 of them. MWF I worked in one location from 7-4 and TTh I worked at the second location, Tue 7-4, Thus 9-6.

What assessments did you use most?

QuickDash, Orebro Musculoskeletal Screening Questionnaire (OMSQ-12), 9-hole peg, Semmes Weinstein, goni, MMT

What conditions/diagnoses did you see most often?

The most common were Distal radius fractures, and carpal tunnel syndrome. We also saw patients with arthritis, lateral epicondylitis, DeQuervains, crush injuries to digits, shoulder pain. My CI was not only a CHT, but also a CLT, so I had the opportunity to observe and help treat lymphedema patients.

What did a typical session look like?

Depending on the condition and how the patient felt that day, I started with a warm up, whether it was stretches, the upper body ergonometer, or soft tissue mobilization. The remainder of the session included activities or exercises, including strengthening, proprioception, occasional ADL simulation, education, etc. It really depended on the patient.

How did you stay client-centered and occupation-based?

Being considerate of how the patient felt at start of session was important in the hand therapy setting- to avoid causing more discomfort and to adjust session as needed… It’s a little more difficult in an ortho setting to stay occupation-based, but I used the clients goals and activities that they wanted to return to to guide their plan of care. Some of that included simulations of movements that they used at home/work with therabands (wheelchair pushing or lawn mowing), therabars (jar or bottle opening, operate motorcycle throttle), putty (pinching small items such as keys, zippers, coins), and even towels (wringing out wash cloth or dish rag).

Did you have to do a project or in-service? Could you share what topic you chose? (if you can)

I had to complete a presentation for a CHT zoom meeting for the company. I presented on TFCC injuries, causes, treatment options, therapy session ideas, etc.

What was your favorite part of this fieldwork experience?

The very best part of this experience was meeting new people and helping them improve their occupational performances. Hearing an older patient with a distal radial fracture say that they were able to comb their hair before the session was one of my favorite moments, and things like that were bonus parts of my fieldwork experience.

What was your least favorite part of this fieldwork experience?

My least favorite part was of course the difficulty to be more occupation-based, especially if there were protocols to adhere to.

What is something you learned that you will take with you for the rest of your career?

Though this is not hand therapy related, my CI always stressed the importance of self-care and leaving work at work. Stepping away from the treatment area during lunch to get some fresh air or completing all documentation before going home are things my CI reiterated. As OTs, we spend our days dedicating our hearts and minds to patients and it’s vital for us to be able to decompress and have time for ourselves.

What advice do you have for a student about to start in this setting?

The upper extremity is very meticulous but don’t be intimidated by it. Be sure to review the anatomy of the shoulder, elbow, wrist, and hand. Your CI will likely provide you with some guidance on what to expect and review for your placement. Don’t expect to know everything, you will learn as you go, and don’t be afraid to ask questions. Soak in as much as you can. As stated in a previous question, practice self care and leaving work at work. Most importantly, give yourself grace.