Advancement in Hand Therapy & Upper Extremity Diagnoses Kenzie Maddy | Doctor of occupational therapy Program | Huntington University Fort Wayne, Indiana

Project Description

There are currently 6,774 certified hand therapists (CHTs) in the United States, and 86% are occupational therapists (OTs) (Hand Therapy Certification Commission, 2021). Subsequently, there were approximately 2.8 million upper extremity injuries and infections that practitioners treated in the United States in 2010 (Wenzinger et al., 2019). There is an excessive amount of upper extremity injuries each year. It is crucial to improve clinical practice skills and utilize evidence-based best practices to improve quality of life and patient outcomes. Groth (2011) shows implications for increasing research use in clinical practice among hand therapists and CHTs by considering attitudes and subjective norms. Sultana et al. (2013) explained how clinicians should consider using early mobilization protocols as a possible alternative treatment for tendon transfer rehabilitation. This is just one example of emerging protocols and exercises that may need to be updated when providing resources and education to patients. With increasing concern about occupational therapists not utilizing occupation-based procedures in the field of hand therapy, this project must advocate for improved hand therapy practices and encourage current and future practitioners within occupational therapy to utilize the foundational aspects of occupational therapy (Malikayil & Jameson, 2018).

This project gave the opportunity for the student to advance their skills and understanding in hand therapy and upper extremity for better preparedness for future occupational therapy practice in the hand therapy setting as a new graduate. This was accomplished through 180 hours of onsite immersion with hand therapists (who were also CHTs), and the creation of two case studies which discuss the plan of care, interventions, and goals for two patients—one with DeQuervains Tenosynovitis and one with Dupuytren’s Contracture. The student completed a continuing education course through the American Society of Hand Therapists (ASHT). The title of the course is “Top Five Upper Extremity Procedures Therapists Should Know.” This project produced an interactive PowerPoint presentation that was presented to the Huntington University Hand Therapy Specialty Club. The student observed six different surgeries on the hand and upper extremity and creating an experiential newsletter for future capstone students. The six surgeries consisted of Thumb Ulnar Collateral Ligament (UCL) Repair, Carpal Tunnel Syndrome (CTS) & Cubital Tunnel Syndrome (CuTS) Release, DeQuervain’s Tenosynovitis Release, Dupuytren’s Contracture Release / Nodule Removal, Volar Forearm Mass Removal, and Volar Finger Mass Removal. The experiential newsletter was created as a resource to explain the purpose of understanding surgical methods for hand injuries translation to OT services. Additionally, the student created a total of 161 home exercise videos, which the student uploaded to the MedBridge HEP Program. The updated and specific home exercise videos served the purpose of increasing patient understanding of their home program. The goals of this project were completed at OrthoCincy Orthopedics in Cincinnati, OH in collaboration with the entire hand therapy team.

Future Directions

Upon completing the DCE, I aim to begin my career working as a hand therapist following graduation and boards certification. I hope to also become a fellow in a hand therapy fellowship program. This will help me work towards my goal of attaining my CHT certification in the future.

If you ever need to reach me in the future, my contact information is as follows:

(p) 513-448-7575 | (e) kenzie.p.maddy@gmail.com

Acknowledgements

Thank you to my faculty mentor Dr. Nathan Short and my expert mentor Whitney Quiambao for all their support and guidance throughout the DCE process.

References

Groth, G. (2011). Predicting intentions to use research evidence for carpal tunnel syndrome treatment decisions among certified hand therapists. Journal of Occupational Rehabilitation, 21(4), 559–572. https://doi.org/10.1007/s10926-011-9305-5

Hand Therapy Certification Commission. (2021). Who is a certified hand therapist (CHT)? Hand Therapy Certification Commission. https://www.htcc.org/consumer-information/the-cht-credential/who-is-a-cht

Malikayil, R., & Jameson, J. (2018). The use of occupation-based interventions in hand therapy. OCCUPATION: A Medium of Inquiry for Students, Faculty & Other Practitioners Advocating for Health through Occupational Studies, 3(1), 78-86.

Sultana, S. S., MacDermid, J. C., Grewal, R., & Rath, S. (2013). The effectiveness of early mobilization after tendon transfers in the hand: A systematic review. Journal of Hand Therapy, 26(1), 1–22. https://doi.org/10.1016/j.jht.2012.06.006

Wenzinger, E., Rivera-Barrios, A., Gonzalez, G., & Herrera, F. (2019). Trends in upper extremity injuries Presenting to US emergency departments. HAND, 14(3), 408–412. https://doi.org/10.1177/1558944717735943