The Role of Occupational Therapy in Hand Therapy

Let’s spend some time talking about the role Occupational Therapy (OT) plays in Hand Therapy and the large contribution the profession makes to this specialized area of Occupational Therapy (OT).

The contribution that OT has been making with regards to research, education and treatment can be dated back to World War II (Melvin, 1985). That means that the OT profession has been part of developing and delivering upper limb rehabilitation for 79 years (if we calculate it from the year 1939 in which World War II started).

Occupational therapists have one ultimate goal – to improve or maintain functionality. This means that intervention provided by Occupational Therapists focuses on assisting you in maintaining or regaining your ability to participate in activities of your daily life after suffering an injury/impairment. (Therapists, 2014)

Have a look at upper limb conditions/injuries/impairments that are treated by OTs (remember we said that the upper limb includes the whole arm, hand + fingers):
• Wounds and scars
• Thermal and Electrical Injuries
• Arthritis and rheumatic diseases
• Arthritis and rheumatic diseases
• Ligament injury and instability
• Muscle strains, tears and avulsions
• Dislocations and subluxations
• Cumulative trauma
• Neuromuscular pathologies
• Tendon injuries and conditions (lacerations, tendonitis, ruptures)
• Nerve injuries and conditions (neuropathies, palsies, nerve repair)
• Pain (complex regional pain syndrome, fibromyalgia)
• Fractures
• Amputations
• Replantation and revascularization
• Congenital anomalies

Occupational Therapy intervention for treating the above mentioned conditions may include the following:
• Wound and scar management
• Pain management
• Joint protection
• Sensory re-education
• Post-injury/post-surgical safety education
• Therapeutic exercise
• Therapeutic activities
• Work hardening and conditioning
• Orthosis design, fabrication, fitting and education
• Environmental modification/adaptation (home & work)
• Adaptation of the way activities of daily living are performed
• Education and training in the use of adaptive/assistive devices

(The American Occupational Association, 2014)

Having a hand injury or impairment will inevitably have debilitating consequences on your functionality – on your ability to do what you need to do in your everyday life. Therefore OTs use therapeutic exercise and purposeful therapeutic activities to reach the identified rehabilitation goals (e.g increasing range of motion and improving muscle strength).

Please entertain me by playing along for a second…
– Hold your dominant hand (the hand that your write with) up in front of you
– Point with your index finger (finger next to your thumb)
– While holding the ‘point position’ bend your finger “in half”
– This is now the ‘new’ functional part of your finger
– Open your hand by straightening the rest of your fingers
– You are NOT allowed to straighten your finger under any circumstance (keep your finger in this bent position)

– Pick up your phone (if you are not reading this totally amazing blog from your phone and have it in your hand already 😉 )
– Rotate your phone 360ᵒ (keeping the screen facing upwards) and remember to keep your index finger bent at all times
– Easy?

– Now grab a pen if you can – keep that finger bent! 😉
– Can you hold it?
– Try to write something.
– Difficult?

– Try to imagine the impact on your ability to take part and/or complete your daily activities and tasks, if you had to keep your finger in the ‘bent position’ the whole day.

Imagine any other injury/impairment of your arm wrist or hand:
– The impact it will have on your ‘getting ready’ routine in the morning
– Getting dressed with buttons, zips, buckles and shoelaces
– Making food.
– Driving/using public transport
– Having to do your work
– Bathing/showering, shaving, brushing teeth, doing your hair
– Bathing and dressing your children
– Doing your favourite hobby

Persons with hand dysfunction often struggle to perform the above mentioned activities and the ability to perform these activities independently is taken for granted.

Occupational Therapists understand the impact an upper limb injury/impairment can have on your daily activities (The American Occupational Association, 2014). That is why the roles and context of the total person is taken into consideration in treatment. The needs of the person are identified and activities that are meaningful to the client are used to guide treatment goals. This is called following a client-centered approach in using occupation-based treatment, and this = Occupational Therapy 🙂

The outcome of occupation-based hand therapy is to ensure that the rehabilitation process will facilitate healing/improvement while you are performing activities that have purpose and are meaningful to you (The American Occupational Therapy Association, 2016).

To provide optimal treatment therapists that give hand therapy need understanding of the anatomy as well as the physiology of the arm and hand. Hand Therapists are professionally qualified to help you progress safely from the critical first period after injury or surgery through the course of treatment until discontinuation of your treatment plan. While OTs frequently work closely together with your doctor and/or surgeon to ensure the best possible recovery it is found that occupation-based therapy increased the client’s motivation, satisfaction and compliance. This in return promoted a faster functional recovery due to the relevance of the activities to the client’s individual interests and daily life. (Collaianni MS, 2010)

Pinkie to Point:

The emphasis of Occupational Therapy on function, work, purposeful activity and adaptation is critical to the success and livelihood of a person trying to overcome the limitations of a hand injury or impairment and to help them resume a meaningful and productive role in society. (Melvin, 1985)

Chanel Vlok McCabe
Occupational Therapist
Author of Hand Matters Blog

Works Cited:
1. Collaianni MS, P. I., 2010. The Benefits of and Challenges to the Use of Occupation in Hand Therapy. Occupational Therapy in Health Care, 24(2), pp. 130 – 146.
2. Melvin, J. L., 1985. Roles and Functions of Occupational Therapy in Hand Rehabilitation. The American Journal of Occupational Therapy, 39(12), pp. 795 – 798.
3.The American Occupational Association Inc., 2014. The role of Occupational Therapy for Rehabilitation of the Upper Extremity. [Online] Available at: http://www.aota.org [Accessed February 2018].
4.The American Occupational Therapy Assosiation Inc., 2016. The Unique Role of Occupational Therapy in Rehabilitation of The Hand. [Online] Available at: http://www.aota.org [Accessed February 2018].
5. Therapists, C. o. O., 2014. The Importance of Occupational Therapy in Hand Therapy. [Online] Available at: http://www.COT.org.uk [Accessed February 2018].