Therapy of the Hand

By Therapist Rosário Simões

The growing importance of rehabilitation to encourage improvement in the functionality, and prevention of dysfunction in the conditions and pathologies of the upper limb led to the appearance of a new speciality – Hand Therapy or the re-education of the hand.

According to the Hand Therapy Certification Commission (HTCC), it is the art and science of rehabilitation of the upper limb, hand, wrist, elbow and shoulder.

The Hand Therapist is an occupational therapist or physiotherapist who, through specialised advanced academic and clinical experience, has acquired skills and knowledge specific to the treatment of upper limb disorders resulting from trauma, congenital deformities or acquired diseases.

The Hand Therapist develops, through evaluation techniques, rehabilitation programmes tailored to each patient according to the individual’s clinical condition.

The Hand Therapist works in quite diverse areas, both in the manufacture of orthoses (splints), treatment or prevention, but their intervention is more frequent in the following clinical situations:

• Fractures/dislocations/joint instabilities: fracture fixation/bone graft.

• Inflammatory and degenerative arthritis: rheumatoid arthritis arthroplasty, arthrodesis, joint synovectomy .

• Tendon injury and disorders: tendon grafts and repairs, tendon transfers .

• Treatment and scar revisions

• Amputation

• Congenital abnormalities/anomalies

• Oedema

• Trauma disorders/repetitive stress injuries

• Peripheral nerve compressions and disease: nerve decompression

• Dupuytren’s contracture

• Peripheral nerve injury: nerve grafts/nerve repairs, neurolysis

• Soft tissue injury

Innovation and constant refresher courses of personnel is a guarantee that this service provides quality patient-centred treatment, valuing early, intensive intervention, regular and multidisciplinary work with different medical specialties, all of which are key work factors of the Hand Therapist.

Assessment, treatment and the manufacture of orthoses (splints) of the upper limb during pre- and post-surgical orthopaedics/traumatology, plastic surgery and rheumatology are generally the responsibility of the Hand Therapist, where internationally defined treatment protocols are followed.

The department of Hand Therapy at the Hospital Particular do Algarve – Gambelas has materials and equipment available which enable aninnovative approach in the following areas:

• Splinting/orthotics

• Therapeutic activities

• Aid techniques

• Standardised and non-standardised assessment tools

• Training in activities of daily living (ADLs)

• Functional training

• Compressive therapy

• Reeducation sensitivity and desensitisation

• Electrical modalities

• Exercise

• Manual therapy

• Oedema control

• Patient and family education, economy articular and rheumatoid arthritis

• Scar management

• Prosthetics

From what has been said it is important to reinforce the idea that for attaining optimal patient results, the Hand Therapist will have to have present the following set of competencies: scientific knowledge, technical skills, professionalism and interpersonal communication skills.

It is important that treatment goals are understood by the patient and the engagement of the entire team. The level of success of the therapy will always depend on the joint action of the triad – patient, physician and therapist.

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Rosário Simões, Occupational Therapist, Specialist in Hand Therapy, working at Hospital Particular do Algarve, Gambelas – Faro