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Evangelical Christian ​yeah I guess so i must be my locker well thank you Dave thank you very much for inviting me and thank all of you for coming and you know there's sunny Tuesday I'm impressed I really the seats have been taken yeah thanks thanks for inviting me my name is Mark and as David said I'm an occupational therapist I'm a certified therapist and I offered to David that I could talk about kind of what hand therapy is more specifically as well as to generalize it to it was kind of point out some of the common things that were out there that might kind of dusky suited by it to be seen by a therapist in case you're not sure where this person might be able to go or what type of thing that might be best suited for that type of person whether it's a an injury that happens at an overworked or older maybe somebody know where yourselves all about some of the things that we could kind of do and some of the unique things that we can provide so I can get a little background of myself I graduated a long time ago so that's quite a long time I first got interested in doing had when I was in school as a specialty and it was in 1994 when I joined up with a hand surgeon actually in Phoenix and I got to work within his practice which was a really unique situation that I really love so he was really a mentor to me as well as the other therapists were great mentors to me and that's where I really decided at that I really wanted to focus my career designating what I do to hand injuries and trauma and that's that's my passion is seeing you know traumatic hand injuries and helping people progress through that whether it's the just the physical side of it but also that emotional kind of social connection to being hurt and traumatized as well those things come into place so much and that's where I really learned to appreciate all the components I worked in Phoenix for the Han circuit for about three years and after that I moved up to abbotsford to start a private practice with a partner of mine and we did that for we had that practice for about 15 years I've since moved on and away from that practice I've been living in Bellingham since about 2003 but I was commuting up there for many years and since April actually I no longer am an owner of that practice and i joined the capstone group so now i'm here in Bellingham trying to offer have therapy services within the capstone physical therapy group so today we'll kind of outline the generalities of the profession of hand therapy as a kind of a specialty profession a lot lines and commonly treated conditions review some evaluation techniques and brought some tools in here as well and then I'll just kind of outline and point out some of the treatment techniques that we use I also brought some different varieties of custom splints that we may splints formerly known as ortho seas or orthotics but I thought I'd bring some common things out that you can kind of you know handle and touch and kind of slide it on your hands and see what they feel like I'm sure you're probably very familiar with everything they've had some of your home it had family will over some of your patients that have had a need for them so I thought I'd just bring some samples as well for you to just kind of fool around with so hand therapy is a profession the hemp therapy certification Commission is kind of our credentialing body that's within the US and every certified hand therapist that launched it call themselves a certified Han Thetis has to go through the credentialing of of the hem therapy certification Commission and what they define hand therapy as is the quote that you see there the art and science of rehab of the upper border of the human body so they kind of outline it's an emerging and this is where it's kind of unique is a merging of occupational therapy and physical therapy theory and practice that combines you know the comprehensive knowledge of the upper body function and activity so it's really utilizing both sets of skills that traditionally can either come from a PT background but also it can come from an occupational therapy bracket background because there's such a merger between the physical components of the rehab but also what the occupational side of therapy brings to have therapy which is a lot of the custom orthotics so we do a lot of combining the ideas of how to gain range of motion for instance there's the typical techniques of active and passive range of motion joint mobilization now the physical therapy world is very very familiar with but we also then incorporate a lot of the splinting not just as protection but we use splinting to actually gain motion in many cases and we also use it to prevent motion in many cases to limit motion during this certain phases of rehab so so both of those worlds kind of County other and that's where occupational therapist and physical therapist can then focus on becoming specialized as a certified hand therapy so it's really a blending of those two worlds philosophically and and II realize as I talked about Oh teasin and fiscal therapists can become certified hand therapist and what it requires

upon you know the initial you graduate of any PT royalty you have a minimum of five years of experience as a graduated professional where you can even then apply to become a certified hand therapist through the hand therapy certification Commission during that five years and you have to accumulate at least 4,000 direct hours of providing hand therapy which is then a tricky thing to do what are a lot of people are a lot of places are looking for a hand therapist but aren't sometimes willing to take people on who are not experience so it becomes a delicate balance and I was lucky because the surgeon I work for was happy to take new people like me and that we're trying to start in the profession so I got to mentor from the hand surgeon as well as some of the senior therapist so sometimes those environments are critical for our development once those two criteria are met there's that there's a national exam that's regulated by the hand therapy certification Commission that's now written twice a year and it's it's written now and offer in multiple countries throughout the world but it's the it's they have their be certification Commission and still credentials anybody worldwide who wants to call themselves a certified hand therapist so hand therapist you know what we like to tell people is that we have a comprehensive knowledge of anatomy physiology of all the systems whether it's the skin from the surface muscular skeletal nervous system the vascular system and how it functions we deal a lot with the early trauma and we like to see things early so we like to deal with people who are not early phase of an injury even if they not even agreement but addressing the the swelling addressing the circulation addressing the potential pain patterns that the nervous system is reacting to already and that sometimes is much earlier where we would like to see people then is traditionally kind of done then for you know for people we're a lot of times the assumption is well you're not ready for therapy you're not ready for lifting weights yet so I'll hold you back from therapy but what we would prefer to see as people right at the very beginning right after surgery while the wounds are still healing thinking we can help with that edema management that desensitizing the nervous system help with the pain control help kind of educate patients on what it is that they are to expect during this initial phase and then recovering into the other phases so so those are some of the the parameter some of them i guess the content what we like to focus on is well and very literally I'm so we educate patients on on the pathology of their conditions you know we'd like to you know be aware oh you know what is the cause of your condition what led you to this the mechanism of the injury can tell us a lot of things a lot of times to that sometimes just receiving that diagnosis doesn't necessarily tell us for instance we can you know see something with a wrist fracture so we're dealing with a distal radius fracture that's in a cast or just coming out of calves but if I talk to somebody about the the nature and the cause of the injury you know that they've had a high impact injury than I can also you know assess them to a ruler or whether I'm suspecting the additional ligament trauma to that region that often gets overlooked as they recover so all of those components we try to piece together right from the beginning and then again the earlier the better so again we deal with a lot of the surgical and medical treatment you know we you know we kind of pride ourselves on being experts of not only the anatomy but how the anatomy functions that can eval joint and the tissue and how it moves and how response to movement and pain and the psychological response to that which is very important to you know again like I said we deal with a lot of the wounded tissue healing and again earlier the better for us we can we can also identify you know even in the early phases you know what people need to do what their function acquires whether they're a mom at home that just had a surgery because she fractured her wrist how can we can make her life easier for instance in dealing with her newborn whether she's wearing a brace or her suggestions on how to function a little bit easier or whether it's that an injured worker for instance that had a trauma and whether it's even an amputation of a finger or something that we can engage in you know assessing their environment even to just in an interview with them to prepare them for what's about to come and prepare them to discuss some of the fears of what's about to come to so again we take in account of all of these items it kind of treated this holistic person not just this injury that's come in localized to this body part so the idea then that we're also trying to promote us you know why why a hand therapist why not just the general neighborhood physical therapist and again the two things can be very much the same in most cases but what we try to promote again is this idea that we threw our education for a background through our training is we like to consider ourselves kind of experts in the fine tuning the finer things of that injury so not just dealing like I said with the wrist fracture for instance but the finer components that may be an additional sequelae of that whether it's a potential early start up of a complex regional pain syndrome whether whether something is also showing us that there's that leads of a number secondary injury with that wrist fracture so we so we we look at all those little details again in and fine-tune them along the way we also really focus on this idea of fun comes we have all these tools that we measure motion you measure strength but again relating it to people's function whether it's at home whether it's you know whether it's it for them at school whether it's for them to work generating a functional goal and you know combining that with a patient school to really create a successful outcome not necessarily dependent on whether we've achieved normal range of motion or normal strength that we always hear of but whether they can engage themselves

back into activity and that's really how we help people define whether they're successful about in a recovery so what are some of the common treated conditions and I'm sure that all of you have seen and know many of them just out of curiosity just a show of hands how many of you have had to actually see a physician or surgeon for your own hand injury has anybody had to actually get medical attention so there's maybe about a third of you here how many of you have actually had to have surgery on your dad so again there's there's a few people here obviously dave is one of them I'm still chaplain out of curiosity to is how many of you have either friends or relatives or immediate family that have had actual surgery to their hands so you can see it's a very common thing you know it's it's one of those tools that we all use no matter what kind of work we do no matter what kind of play we do I always you know kind of say these are the tools that we use we use our we use our hands we use our backs we use our legs you know a lot of us don't use our brains a lot if you're like me and some people I know but Beijing's tools a lot so they could commonly get her some of the injuries that that we routinely see tendon and nerve injuries whether they're due to crush injuries or amputations whether they're immediately from the emergency room or whether they've been repaired subsequently by the surgeon or multiple surgical repairs down over time those are some of the more intricate things that we would then see and again a lot of those we would seem very early especially intended repairs and a lot of these wound healing ideas because you can just see with a wound especially with crushing injuries there's a lot of swelling there's a lot of trauma that's going on there's a lot of pain associated with it so helping someone through those really early phases is critical you know these examples where there is a lot of swelling they can have these secondary effects that are very detrimental long-term joint stiffness those are some of the most common problems that we deal with when things are not attended too early and it's really difficult to work backwards then from everything healed and once you know once the swelling is controlled then dealing with the joint stiffness later is always more difficult than dealing with along the way can have a more immediate effect wounds infections I'm young to see what you know as they're being treated you know we do a lot of wound care to abandon changes in that kind of thing so we are definitely we're trained in that as well so the people who are seeing their attending physicians who eat band changes or if they may be getting nursing care they may be getting home care for certain things I mean you can also provide that service as well right from the very basic only fair phases fractures dislocations frames some of the men climbing things that you may have all experienced to know finger dislocations are very easy to occur you know I've had them happen in people who are just riding a bike I've had them having commonly people walking their dogs you know the dog pulls and they slip and all of a sudden they're on the ground and you're dislocating a finger with what seems like a very minimal impact injury so it can very easily happen so that you know the general tendency is well I need to go the doctor go to the emergency and get my finger put back in place within lot and I find that the follow-up after that is somewhat variable people are maybe pull to put it in a splint so they leave it in there but to what extent and what position is it in ideally we want to certainly position certain joints in ideal positions after a traumatic injuries especially a dislocation or a fracture and again those left unchecked or in a non ideal position situation can create problems later on with abnormal movement patterns or loss of person that can be permanent so those are the kinds of things that we like to see early even if the early intervention has already been provided with the initial splinting a cast or whatever it may be just to think preventatively along the way amputations burns frost by amputations you know at my practice in abbotsford were very calm there's such a heavy meal industry in wood wood industry out there that amputated fingers of the varying degrees on a very number is on any given person was a very common problem and oftentimes it seems like a simple thing once it's healed it should be fine but again it can create a lot of joint stiffness it can affect the adjacent fingers of that injured joint or then injured finger there's a lot of issues with hypersensitivity a nerve related pain that can happen at that amputated site so we can look very early emotion again a TV management desensitizing pain control and a lot of these people are dealing with a psychological people in that trauma as well because that's not going to grow back they're not going to be essentially like they were before with the appearance of it and that component takes a lot of discussing and oftentimes you know with our clinic when we have it where we have an open environment it's actually very third paid for people to see other people in the same situation and I'm sure that you've all seen probably know people with varying degrees of finger amputations it's much more common than we think and having people exposed to that in our clinic is sometimes psychologically therapeutic as well as the physical part of the therapy that we're giving as well some of the other conditions that aren't necessarily related to trauma rheumatoid arthritis osteoarthritis where there's essentially a lot of joint deformity and associated pain that can come with it you know with joint deformity and with pain with positioning that's where we get into a lot of Education with patience to teach them joint protection and just energy conservation activity modification types of suggestions that are very basic that people just aren't aware of how to think about that sometimes of how to take the stress and strain off of your joints to prolong the idea of the rather than being more debilitated because you're actually affecting more and more

stress on the joints so a lot of times education is what we can do for a lot of those patients guide them on how to manage their pain because their pain is going to fluctuate too depending on seasonal changes depending on their activity levels and depending on time as they continue to you know to age these changes in become more and more prevalent as well you know with joint deformities with rheumatoid arthritis for instance there's their varying types of positioning splinting that maybe we did it help people either during function or just to give them support for comfortable position for sleeping for instance and again they're just tools to use to give them comfort and to also prevent further deterioration to be not going to stop the process but we're going to maybe slow down the process a little bit to to give them a little more time without having time ago maybe a surgical procedure or just to help them manage their paying with that prevention as far as positioning things like do kitchens contracture where there is these you know these nodules this tight fashion that bands in the hand that's that's a that's a genetic type of a condition that can develop over time there's not a lot we can do with that conservatively unfortunately as therapists but we can at least guide people and what to do identify what it is and then what to do about it and where to seek help referring to surgeons for instance them is certainly helping them after the surgical care to again restore motion help with the wound care help with pain management Law Center, Central Islip.