University of Southern California
Department of Occupational Science and Occupational Therapy
Instructor: Lisa Deshaies, OTR/L, CHT
OT 573
Spring, 2015
Principles of Hand Rehabilitation
Class Time and Location:
Wednesday, 5:30-8:50 pm, CHP 111
Instructor Contact:
Work E-mail ldeshaies@dhs.lacounty.gov
Home E-mail lddeshaies@aol.com
Please e-mail to both addresses for the most immediate response.
Course Purpose:
This introductory course is an elective and can be applied toward the 12-unit elective requirement for the
Master of Arts in Occupational Therapy. This course will explore occupation-based evaluation and
treatment for individuals with common hand disorders. Through lecture, lab, small group work, and
class discussions, this course will emphasize functional anatomy of the hand and will promote sound
clinical reasoning skills based on consideration of key anatomical principles and patients’ occupation
goals.
This course will begin with reflective exercises and discussion related to the beauty and complexity of
hand function and the symbolic nature of hands. A strong foundation of forearm, wrist, and hand
anatomy, kinesiology, and physiology will be built over several weeks utilizing lecture, videos, cadaver
specimens, and lab activities. This will be followed by diagnostic-specific sessions where anatomy will
be integrated along with evaluation and treatment techniques. Throughout this course, occupation-based,
patient-centered, and evidence-based approaches will be emphasized. The student will appreciate that,
although quite specialized, hand therapy is not a discipline unto itself. It is through a balance of science
(tissue-specific treatment) and art (core occupational therapy premises) that Occupational Therapists
provide the most effective hand rehabilitation.
Course Objectives:
1. Understand anatomy, kinesiology, and physiology of the forearm, wrist, and hand.
2. Recognize a variety of evaluation and treatment modalities commonly used in hand
rehabilitation.
3. Demonstrate clinical reasoning skills based on key anatomical principles and patient
factors when planning evaluation and treatment for commonly seen hand conditions.
4. Understand the value of a patient-centered and occupation-based approach and identify
means to apply it in hand rehabilitation.
5. Identify resources for future reference and further study.
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Statement for Students with Disabilities:
Any student requesting academic accommodations based on a disability is required to register with
Disability Services and Programs (DSP) each semester. A letter of verification for approved
accommodations can be obtained from DSP. Please be sure the letter is delivered to me (or to TA) as
early in the semester as possible. DSP is located in STU 301 and is open 8:30 a.m.–5:00 p.m., Monday
through Friday. The phone number for DSP is (213) 740-0776.
Statement on Academic Conduct:
Plagiarism – presenting someone else’s ideas as your own, either verbatim or recast in your own words –
is a serious academic offense with serious consequences. Please familiarize yourself with the discussion
of plagiarism in SCampus in Section 11, Behavior Violating University Standards
https://scampus.usc.edu/1100-behavior-violating-university-standards-and-appropriate-sanctions/. Other
forms of academic dishonesty are equally unacceptable. See additional information in SCampus and
university policies on scientific misconduct, http://policy.usc.edu/scientific-misconduct/.
Discrimination, sexual assault, and harassment are not tolerated by the university. You are encouraged
to report any incidents to the Office of Equity and Diversity http://equity.usc.edu/ or to the Department
of Public Safety http://capsnet.usc.edu/department/department-public-safety/online-forms/contact-us.
This is important for the safety whole USC community. Another member of the university community –
such as a friend, classmate, advisor, or faculty member – can help initiate the report, or can initiate the
report on behalf of another person. The Center for Women and Men http://www.usc.edu/studentaffairs/cwm/ provides 24/7 confidential support, and the sexual assault resource center webpage
sarc@usc.edu describes reporting options and other resources.
Support Systems:
A number of USC’s schools provide support for students who need help with scholarly writing. Check
with your advisor or program staff to find out more. Students whose primary language is not English
should check with the American Language Institute http://dornsife.usc.edu/ali, which sponsors courses
and workshops specifically for international graduate students. The Office of Disability Services and
Programs http://sait.usc.edu/academicsupport/centerprograms/dsp/home_index.html provides
certification for students with disabilities and helps arrange the relevant accommodations. If an officially
declared emergency makes travel to campus infeasible, USC Emergency Information
http://emergency.usc.edu/ will provide safety and other updates, including ways in which instruction
will be continued by means of blackboard, teleconferencing, and other technology.
Required Readings:
Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses
of the Upper Extremity (2nd ed.), by C. Cooper, 2014, Elsevier, ISBN: 978-0-323-09104-6, available
from USC Bookstore, Health Science Campus. Additional reading to be provided.
Expectations for Readings:
The syllabus clearly identifies required readings. Readings are due prior to class and are viewed as a
support for in-class material. In many cases, the student will NOT be able to participate in class without
completing the required readings.
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Assignments:
The syllabus clearly identifies assignments. Assignments are due the following class unless otherwise
instructed.
Expectations for Participation:
It is expected that all students will actively participate in and attend each class unless there is an excused
absence or illness.
Instructor’s Role:
The role of the instructor is to present course material, lead discussions, be available to answer
questions, and provide a supportive environment to facilitate student learning.
Class Schedule:
Week 1
January 14
 Course Overview
 Introduction to Hand Rehabilitation
 Introduction to Occupation-Based and Patient-Centered Care in Hand Rehabilitation
Required Reading: None
Assignment: None
Week 2
January 21
 Clinical and Occupation-Based Evaluation of the Hand
Required Reading:
 Fundamentals of Hand Therapy, Chapter 13, “Fundamentals of Client-Therapist Rapport”
 Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper Extremity”
 Rehabilitation of the Hand and Upper Extremity, Chapter 6, “Clinical Examination of the Hand”
Assignment: None
Week 3
January 28
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Rehabilitation of the Hand and Upper Extremity, Chapter 1, “Anatomy and Kinesiology of the
Hand”
 Fundamentals of Hand Therapy, Chapter 2, “Functional Anatomy”
Assignment: None
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Week 4
February 4
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Rancho Los Amigos Functional Anatomy of the Wrist and Hand
Assignment: “Functional Anatomy Study Questions I”, 1-5
Week 5
February 11
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Fundamentals of Hand Therapy, Chapter 1, “Fundamentals: Hand Therapy Concepts and
Treatment Techniques”
 Fundamentals of Hand Therapy, Chapter 38, “Preventing and Treating Stiffness”
Assignment: “Functional Anatomy Study Questions I”, 6-10
Week 6
February 18
 Peripheral Nerve Problems
Required Reading:
 Fundamentals of Hand Therapy, Chapter 24, “Peripheral Nerve Problems”
 Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper Extremity”
Assignment: “Fight On Study Questions”
Week 7
February 25
 Arthritis
Required Reading:
 Fundamentals of Hand Therapy, Chapter 33, “Arthritis”
Assignment: “Arthritis Case Studies”
No class March 4, March 11, March 18
Week 8
March 25
 Wound Healing
 Scar Management
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Required Reading:
 Fundamentals of Hand Therapy, Chapter 21, “Wound Care”
 Fundamentals of Hand Therapy, Chapter 19, “Burns”
Assignment: “Functional Anatomy Study Questions II”, 1-5
Week 9
April 1
 Edema Management
 Physical Agent Modalities
Required Reading:
 Fundamentals of Hand Therapy, Chapter 3, “Edema Reduction Techniques: A Biologic
Rationale for Selection”
 Rehabilitation of the Hand and Upper Extremity, Chapter 117, “The Use of Physical Agents in
Hand Rehabilitation”
 American Journal of Occupational Therapy, “Physical Agent Modalities: Developing a Framework
for Clinical Application in Occupational Therapy Practice”
Assignment: None
Week 10
April 8
 Tendon Injuries
Required Reading:
 Fundamentals of Hand Therapy, Chapter 30, “Flexor Tendon Injury”
 Fundamentals of Hand Therapy, Chapter 31, “Extensor Tendon Injury”
Assignment: “Functional Anatomy Study Questions II”, 6-10
Week 11
April 15
 Digital Splinting/Casting
Required Reading:
 Fundamentals of Hand Therapy, Chapter 7, “Orthoses: Essential Concepts”
 Introduction to Splinting, Chapter 12, “Splinting for the Fingers”
 Rehabilitation of the Hand and Upper Extremity, Chapter 125, “Tissue Remodeling and
Contracture Correction Using Serial Plaster Casting and Orthotic Positioning”
Assignment: Complete fabrication of thermoplastic “gutter splint” and plaster “digital cast”
Assignment: Complete “Hand Observation Log”
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Week 12
April 22
 Occupation-Based Practice in Hand Therapy
Required Reading:
 Fundamentals of Hand Therapy, Chapter 16, “Narratives in Hand Therapy”
 Occupational Science for Occupational Therapy, Chapter 27, “The Use of Occupation in Hand
Therapy”
 OT Practice, “Hand Rehabilitation: Matching Patient Priorities and Performance with Pathology
and Tissue Healing”
 OT Practice, “Occupation-Based Treatment in Physical Disabilities”
 OT Practice, “Symbolic Aspects of Hand Therapy”
 OT Practice, “Clinical Reasoning and Occupation-Based Practice: Changing Habits”
 OT Practice, “Renaissance Occupational Therapy and Occupation-Based Hand Therapy”
 OT Practice, “Occupation-Based Hand Therapy and the Occupational Therapy Practice
Framework”
 American Journal of Occupational Therapy, “Embracing Our Ethos, Reclaiming Our Heart”
 American Journal of Occupational Therapy, “Documenting Progress: Hand Therapy Treatment
Shift from Biomechanical to Occupational Adaptation”
Assignment: Internet exploration of one to two “Professional Resources”
Week 13
April 29
 Evidence-Based Practice/Outcomes in Hand Therapy
 Professional Resources
 Hand Therapy Certification
 California Licensure Regulations for Advanced Practice Approval
Required Reading:
 Fundamentals of Hand Therapy, Chapter 8, “Assessment of Functional Outcomes”
 Journal of Hand Therapy, “An Introduction to Evidence-Based Practice for Hand Therapists”
 OT Practice, “Evidence-Based Practice: What Can It Mean for Me?”
 OT Practice, “Measuring Occupational Performance”
 American Journal of Occupational Therapy, “Outcomes in Hand Rehabilitation Using
Occupational Therapy Services”
 American Journal of Occupational Therapy, “Adaptation to Hand Injury: An Evolving
Experience”
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Assignment Descriptions:
“Functional Anatomy Study Questions I”: Each student will answer all ten questions in as much detail as
possible, including references to justify your answers. This assignment is worth 20% of the overall
grade.
“Fight On Study Questions”: Each student will answer all questions in as much detail as possible,
including references to justify your answers. This assignment is worth 10% of the overall grade.
“Arthritis Case Studies”: Each student will complete with as much detail as possible, including rationale
and references to justify your answers. This assignment is worth 10% of the overall grade.
“Functional Anatomy Study Questions II”: Each student will answer all ten questions in as much detail
as possible, including references to justify your answers. This assignment is worth 20% of the overall
grade.
“Gutter Splint” and “Digital Cast”: Each student will complete fabrication, be able to describe how the
splint and the cast work, and be prepared to state two clinical indications for using this splint and cast. This
assignment is worth 20% of the overall grade.
“Hand Observation Log”: Each student will observe ten persons of varying age performing an
occupation. Impressions related to hand function will be recorded and a verbal summary may be shared
with the class. This assignment is worth 10% of the overall grade.
“Professional Resources”: Each student will explore one to two web sites, videos, or apps relevant to
hand rehabilitation, will print the home page, and will prepare a two- minute summary of what each has
to offer. This assignment is worth 10% of the overall grade.
All assignment materials will be distributed in class by course instructor.
Assignment Grading:
Each assignment will be graded. Students must earn a grade of 80% or better to get credit for the course.
A grade of below 80% will earn a “No Credit” grade. Missing assignments will not be awarded points.
Late assignments will be marked down 5 points for each day late.
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References:
Abrahams, P.H., Hutchings, R.T., & Marks, S.L. (2003). McMinn’s Color Atlas of Human Anatomy
(5th ed.). St. Louis, MO: Mosby.
Acland, R.D. (1996). The Video Atlas of Human Anatomy, Tape 1: The Upper Extremity. Baltimore, MD:
Williams & Wilkins.
Bracciano, A.G. (2008). Physical Agent Modalities: Theory and Application for the Occupational
Therapist (2nd ed.). Thorofare, NJ: Slack.
Brand, P.W., & Hollister, A.M. (1999). Clinical Mechanics of the Hand (3rd ed.). St. Louis, MO: Mosby.
Burke, S.L., Higgins, J., McClinton, M.A., Saunders, R., & Valdata, L. (2006). Hand and Upper Extremity
Rehabilitation (3rd ed.). New York, NY: Churchill Livingstone.
Cannon, N.M. (Ed.). (2001). Diagnosis and Treatment Manual for Physicians and Therapists (4th ed.).
Indianapolis, IN: Hand Rehabilitation Center of Indiana.
Casanova, J.S. (Ed.). (1992). Clinical Assessment Recommendations (2nd ed.). Chicago, IL: American
Society of Hand Therapists, Inc.
Colditz, J.C. (2001). The Hand: An Interactive Study for Therapists. Bethesda, MD: American Occupational
Therapy Association.
Cooper, C. (Ed.). (2014). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for
Common Diagnoses of the Upper Extremity (2nd ed.). St. Louis, MO: Elsevier.
Coppard, B.M., & Lohman, H. (2008). Introduction to Splinting: A Clinical Reasoning and ProblemSolving Approach (3rd ed.). St. Louis, MO: Mosby.
Fess, E.E, Gettle, K.S., Philips, C.A., & Janson, J.R. (Eds.). (2005). Hand and Upper Extremity Splinting:
Principles and Methods (3rd ed.). St. Louis, MO: Mosby.
Hentz, V.R., & Chase, R.A. (2001). Hand Surgery: A Clinical Atlas. Philadelphia, PA: W.B. Saunders.
Jacobs, M.A., & Austin, N.M. (Eds.). (2013). Orthotic Intervention for the Hand and Upper Extremity:
Splinting Principles and Process (2nd ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Malick, M.H., & Kasch, M.C. (Eds.). (1984). Manual on Management of Specific Hand Problems.
Pittsburgh, PA: AREN Publications.
McKee, P., & Morgan, L. (2010). Orthotics in Rehabilitation: Splinting the Hand and Body (2nd ed.).
Philadelphia, PA: F.A. Davis.
Michlovitz, S.L., Bellew, J.W., & Nolan, T. (Eds.). (2012). Modalities for Therapeutic Intervention
(5th ed.). Philadelphia, PA: F.A. Davis.
Pierce, D.E. (Ed.). (2014). Occupational Science for Occupational Therapy. Thorofare, NJ: Slack.
Prosser, R., & Conolly, W.B. (Eds.). (2003). Rehabilitation of the Hand and Upper Limb. Edinburgh:
Butterworth-Heinemann.
Skirven, T.M., Osterman, A.L., Fedorczyk, J.M., & Amadio, P.C. (2011). Rehabilitation of the Hand and
Upper Extremity (6th ed.). Philadelphia, PA: Mosby Elsevier.
Tubiana, R., Thomine, J., & Mackin, E. (1996). Examination of the Hand and Wrist. St. Louis, MO: Mosby.
Weiss, S., & Falkenstein, N. (2013). Hand and Upper Extremity Rehabilitation: A Quick Reference Guide
and Review (3rd ed.). St. Louis, MO: Elsevier.
Wolfe, S.W., Hotchkiss, R.N., Pederson, W.C., & Kozin, S.H. (Eds.). (2010). Green’s Operative Hand
Surgery (6th ed.). Philadelphia, PA: Churchill Livingstone.
Advance for Occupational Therapy Practitioners. King of Prussia, PA: Merion.
American Journal of Occupational Therapy. Bethesda, MD: American Occupational Therapy
Association.
Journal of Hand Therapy. Philadelphia, PA: Hanley and Belfus.
OT Practice. Bethesda, MD: American Occupational Therapy Association.
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