Southwest Therapy Specialists, P.C.
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Certified Hand Therapy


When seeking therapy consider The Hand Therapy Certification Commission (HTCC) .www.htcc.org/consumer-information/the-cht-credential/who-is-a-cht endorses the Hand Therapy at Southwest Therapy Specialists, PC. Look at the credentials of the therapist when selecting a practice for shoulder, elbow, wrist, and/or hand injuries. Only a Certified Hand Therapist can utilize the term "CHT" as this national credentialing ensures the public of demonstrated successful passing of "...a comprehensive test of advanced clinical skills and theory in upper quarter rehabilitation...and continued professional development and competency by recertifying every five years...www.htcc.org/consumer-information/the-cht-credential/who-is-a-cht Let the physician know a generalist will not do and ask for a referral specifying CHT.



    Certified Hand Therapist

    According to the Hand Therapy Certification Commission, "The skill and understanding of upper extremity surgery requires specialized therapists with high skill and expertise.  Functional restoration of injured and diseased shoulders, elbows, wrists and hands, takes place more effectively following surgery when performed by a therapist with focused training and experience."


    Hands. Critical to every aspect of life.

         To hold a child or pet without fear of dropping. To feel heat or the touch of a loved one's skin. To squeeze out a washcloth or a tube of toothpaste. To open the package or twist off a jar lid. To twist a key in the door or to start a car engine. To handwrite a name or type or text a message. To push a cart or handle change. To lift, carry, pull, push, reach, grip, pinch or work the essential duties of a job. To earn a living. To care for your family, yourself.

         From open wound to fully healed skin. From swollen, stuffed thick joints that do not move to supple, flexible motion. From scar that is stuck and raised (keloid) and "ugly" to flat, free-moving scar. From weak, puny grip to normal grasp and release. From numb, pins and needles, hyper-sensitive or burning to fully sensitive and "normal". From excruciating, debilitating pain to no pain.

         This is why a Certified Hand Therapist.

         "People value the use of their hands and any loss of function through injury or accident may have a devastating effect on their lives. Anyone with an injury wants the very best of treatment to assure maximal recovery. The Certified Hand Therapist credential offers assurance to the public that the therapist has achieved the highest level of competency in the profession and stays up to date with practice within the field.

         The intricate anatomy of the arm and hand frequently requires very delicate surgery, often with microscopic techniques. The technical complexity of these kinds of surgeries necessitates a high level of competence by therapists with advanced skills in upper quarter rehabilitation during postoperative recovery. Therapists must be knowledgeable about these advanced surgical techniques and postoperative therapy programs to become CHTs. They must also remain current with changes in hand therapy practice.


    Certification of a Certified Hand Therapist (CHT)    

    Certification is voluntary and difficult to attain. It involves meeting rigorous standards, developing a long-range career path, and acquiring the advanced study and training required to pass the certification examination. CHTs are therapists who demonstrated a personal dedication to the profession of hand therapy and a desire for advanced competency; they bring to their work a commitment and dedication to reach and maintain the highest standards in their profession. The CHT credential is recognized by many professional organizations as a benchmark for excellence in advanced specialty credentialing in health care."
    source  https://www.htcc.org/consumer-information


    At Southwest Therapy Specialists, PC, the person with an injury to the upper quadrant will usually be seen by our CHT, initially certified as a CHT in 1990.

    In order to sit for their first exam, the therapist must have five years or more years of clinical experience, including 4,000 hours or more in direct treatment practice in hand therapy. Only a Certified Hand Therapist (CHT) has successfully passed a comprehensive test of advanced clinical skills and theory in upper quarter rehabilitation. In addition, once certified, every CHT is required to demonstrate continued professional development and competency by recertifying every five years. www.htcc.org


    Certified Hand Therapy treatment provided at Southwest Therapy Specialists, includes but is not limited to:

     


    • Wound and scar management, dressing changes;

    • Edema control, lymphedema control, compression therapy;
    • Manual therapy, soft tissue mobilization, trigger point therapy, positional release technique, PRRT
    • Range of motion exercises;
    • Continuous Passive Motion (CPM);

    • Custom static and dynamic orthotic design, selection, fitting, fabrication, issuing of prefabricated braces or splints;

    • Pain management, stress management;
    • Taping techniques;

    • Home program instruction, patient education, wellness education;

    • Sensory re-education, desensitization;

    • Dexterity training; fine motor training, gross motor training, coordination, hand writing techniques;

    • Prosthetic and orthotic training;

    • Activities of daily living education, design and/or selection of adaptive/assistive devices;

    • Joint protection instruction, arthritis management, energy conservation instruction;
    • Health ergonomic and activity modification for work, home, school, leisure or play;

    • Modalities: electrical stimulation, FES (Functional Electrical Stimulation), TENS (transcutaneous electrical nerve stimulation), iontophoresis, heat, cold, Fluidotherapy;

    • Therapeutic exercises, functional activities;
    • Strengthening; and

    • Work conditioning.

     

    Certified Hand Therapists utilize TENS,electrical stim.,heat,cold,Fluidotherapy and other modalities
    Certified Hand Therapists (CHT) focus on function through tools such as:TheraBar,HandHelper,PowerWeb
    Successful hand surgery=50% the Hand Surgeon & 50% the Certified Hand Therapist - source: HTCC.org
    Visual Feedback Therapy utilizes a Mirror Box treatment to help the Hand Therapist teach kinesthesia
    Certified Hand Therapy restores the brain's homunculus cortical activation ensures accurate tool use
    Certified Hand Therapists help the cortical activation of the homunculus of the opposite hemisphere.
    Certified Hand Therapists improve hand use, proprioception, kinesthesia, & return to work & leisure.
    Hand intrinsic & extrinsic tendon glides, pain control, strengthening, dexterity & sensory re-ed.
    Manual Mobilization Pitting Edema Lymphatic Drainage Soft Tissue Edema Swellling of elbow fracture
    Pitting Edema Swelling Fracture Humerus Manual Soft Tissue Mobilization
    Pitting Edema Swelling Fracture treatment myofascial mobilization

    Certified Hand Therapy

    The Certified Hand Therapist (CHT) at Southwest Therapy Specialists has a comprehensive knowledge of chronic pain, acute pain, and all aspects of the Upper Quadrant: scapula, shoulder, elbow, wrist and hand. Areas of education include, but are not limited to:


     

    • Surface anatomy of the shoulder, elbow, forearm, wrist and hand;
    • Anatomy and physiology of the skin/connective system, muscular system, skeletal system, nervous system, and vascular and lymphatic systems;
    • Development of age-specific hand function;
    • Use of modalities and related physical properties (examples include: heat, water, light, electricity, and sound);
    • Principles of tissue, wound, scar healing;
    • Proprioception, kinesiology, and biomechanics relative to the shoulder, elbow, forearm, wrist and hand;
    • Posture, core stability and its effects on the scapula, shoulder, elbow, wrist and hand;
    • Pathomechanics relative to the upper extremity;
    • Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper extremity;
    • Surgical, non-surgical, and medical treatment of conditions of the hand or upper extremity;
    • Post-surgical, non-surgical, and medical treatment guidelines;
    • Standardized and non-standardized evaluation tools; quality assurance measures;
    • Expected functional outcomes of treatment;
    • Expected physiological and psychological effects of treatment procedures;
    • Treatment rationale, indications, precautions and contraindications;
    • Treatment methods, techniques, and tools;
    • Concepts and principles of orthotics (including mechanical properties of materials and components);
    • Principles of ergonomics at home, work, school or leisure;
    • Behavioral science (including cultural diversity) and psychological reactions to impairment;
    • Research design and statistics including evidence-based practice;
    • Pharmacology and its effects;
    • Basic lab values;Diagnostic imaging; Electrodiagnostics (e.g., electromyography, nerve conduction studies);
    • Teaching and learning styles;
    • Regulatory and legal guidelines;
    • Professional codes of ethics;
    • Safe and appropriate use and maintenance of equipment and assistive devices;
    • Safety techniques and procedures (e.g., infection control, emergency procedures, practitioner safety, environmental safety); and
    • Uniform Terminology (Practice Framework).

    "What happens when a Hand Therapist sees me?"

    EVALUATION

    There will be paperwork!

    As part of the Affordable Health Care Reform Act and overall requirements, your first visit will require registration, quality assurance forms, and information about the reason the patient is needing skilled therapy. We work to minimize the paperwork and if the person with the injured hand needs help with handwriting or filling out the forms, our team is very willing to help.

    The Certified Hand Therapist will assess the patient's condition based on history, objective measurements, and functional limitations to be considered in establishing the goals and treatment plan.  Southwest Therapy Specialists' Occupational Therapist, registered nationally and licensed in Arizona (OTR/L), Certified Hand Therapist (CHT) uses clinical reasoning from the information gained in evaluation and reevaluations to improve the quality and efficacy of treatment.   Comparisons may be made with normative data, with the opposite side, and/or with statistical analysis as required to best develop the treatment care plan or assist the referring source with further information for management of the case.


    "I have had therapy before at another practice. That therapist never did as thorough an eval as you have done. I learned more today in this first session than the entire time I had treatment before." - first time Hand Therapy Patient

    Southwest Therapy Specialists CHT's may evaluate any or all of the following areas:


    Range of Motion - Goniometric measurements of the joint active and/or passive movement through the range available.


    Wound/Scar - Assessment of the wound type & classification to determine overall wound care and dressings needed; scar classification and overall scar management needed to minimize adhesions is also assessed.


    Splinting/Orthotic Needs - Assessment of the need for immobilization and/or mobilization and/or restriction through splinting over joints or non-articulating tissues; considerations for splint/orthotic design include the stages of healing, anatomical location and purpose, material characteristics and comfort, and wearing schedules based on tissue response, stage of disease, and/or need for motion.  May include orthotic needs of custom fabricated (designed directly on the client) and/or pre-made devices/braces from vendors.


    Muscle Strength - Manual test of the strength of muscles during functional demands.


    Dexterity/Coordination - Speed and accuracy tests with standardized evaluations.


    Sensibility - Assessment of light touch discrimination, two point threshold, vibratory response, including with or without vision following sensory changes (e.g. nerve compression) using standardized sensibility tests.


    Pain - Standardized and functional pain questionnaires for self-reported intensity, location, and description of pain.


    Time Method Testing - Tests which incorporate time motion studies of repetition of task, speed, accuracy, and fatigue during functional activity.


    Edema Assessment - Using either volumetric (water displacement) and/or circumferential measurements, and clinical reasoning, swelling is evaluated.


    Job Descriptions - Following the ADA (Americans With Disabilities Act of 1990), job tasks described with essential (primary) duties and nonessential (secondary) duties in percent of time and physical demands (e.g. sitting, standing, lifting, carrying, pushing, pulling, handling, fingering) may be detailed.







    MODALITIES

    Following the evaluation's Plan Of Care, the Certified hand Therapist may initiate treatment. Modalities may be utilized and are treatments which may not require continuous attendance by a therapist. Examples include:


    Hot Packs - Gel filled fabric packs soaked in hot water to create moist heat. These are used for muscle relaxation and for pain relief by heating superficial tissues prior to functional activity.


    Cold Packs - Ice filled or gel filled packs used for reduction of inflammation, control of reoccurring inflammation, and pain relief.


    Functional Activities - Tasks and movements related to activities of daily living at work and home to increase range of motion, strength, endurance, comfort, and functional abilities.


    Paraffin - A hot wax treatment to heat tissues, alleviate pain and stiffness, and promote hand joint flexibility.


    Electrical Stimulation - Safe electrical impulse to stimulate muscle contractions,reduce swelling,, reduce areas of muscle tightness, and relieve pain.


    TENS (Transcutaneous Musculoskeletal Nerve Stimulation) - Pain management through safe electrical impulses to temporarily "block" the pain intensity experienced.


    Whirlpool - Warm or cool water with air jets to stimulate circulation, heat superficial tissues, and debreed necrotic tissue of burns or post-surgical incisions.


    PROCEDURES

    Treatments which require personal attendance of the therapist and education of the consumer.


    Splinting - Fabrication and fitting of various custom made splints for positioning to rest, restrict motion, immobilize or mobilize to prevent further deformity of hand, wrist, elbow, and shoulder joints, or to promote movement and increased joint range of motion.  Fitting of pre-made splints from various vendors.


    Wound Management - Techniques to promote the optimum healing of wounds and speed of recovery.


    Scar Management - Methods to minimize the adhesions inherent in scar formation, to promote the best possible scar esthetics and overall function. Scar Extractor. Silicone Gel, compression sleeves or digital compression sleeves.


    Desensitization - Decreasing the sensitivity (e.g. pain, hypersensitivity, burning, tingling) through standardized techniques following trauma.


    Pain Management - Methods to help decrease the intensity of acute pain and/or improving the ability to cope with chronic pain (lasting greater than six months).

    Functional Activities - Tasks and movements related to activities of daily living at work and home to increase range of motion, strength, endurance, comfort, and functional abilities.


    Therapeutic Exercise - Exercises to increase range of motion, flexibility, strength and endurance, and to decrease stiffness. Update home exercises on a regular basis.


    Neuromuscular Re-education - Improve function by using principles from nerve and muscle physiology. Improve muscle coordination with specific types of exercises and functional movements.


    Manual Edema Mobilization - Manual treatment techniques for acute or chronic edema (swelling) through elevation, compression, and/or mobilization to influence soft tissue drainage, to improve circulation, and to relieve pain.


    Myofascial Release - Manual treatment techniques combined with positional release techniques for acute or chronic tender points, trigger points, and stressed tissues to relieve pain, increase circulation, improve flexibility, and overall movement.


    Soft Tissue/Joint Mobilization - Very specific stretching and movement techniques at various soft tissues and joints to facilitate elongation and joint range of motion. PRRT (Primal Reflex Release Technique). Trigger Point Release. Positional Release Technique. Deep pressure utilizing Fibroblaster.


    Ultrasound - High frequency sound waves at various intensities for heating deep tissues, to increase circulation and relieve pain as prescribed by a doctor.


    Phonophoresis - Combination of ultrasound and anti-inflammatory medication through the skin as prescribed by a doctor.


    Iontophoresis - Electrical impulses to introduce anti-inflammatory medication through the skin into an inflamed area as prescribed by a doctor.


    Conditioning - Custom designed strengthening and endurance exercise programs to improve the ability to sustain activities.


    Work Conditioning - Intensive four to six week daily program to improve the ability to perform work related job requirements prior to return to work if the employer requires returning with full duty status.

    99% rating of Excellent in all areas of Certified Hand Therapy, since 1984- Patient Satisfaction Surveys


    EDUCATION

    We are here to teach.

    Southwest Therapy Specialists, PC's Certified Hand Therapists strive to help the patient understand the diagnosis, anatomy, physiology and prognosis of condition.  We instruct in self-care and symptom management for home and work. Our team aims to minimize reoccurrence based on individual lifestyle. Our expertise with over 30 years of hands-on job site analysis and Functional Capacity Evaluations aide in our instruction in ergonomic workstation design. We teach and develop a customized maintenance program that maximizes independence, and aims to have the graduate hand therapy patient return to life, to work, to school, to play and to leisure.