UNIVERSITY OF SOUTHERN CALIFORNIA
Department of Occupational Science and Occupational Therapy
Instructor: Lisa Deshaies, OTR/L, CHT
OT 573
Fall, 2008
Hand Rehabilitation
Class Time and Location:
6:00-8:50pm, VKC 102
Instructor Contact:
Work Email ldeshaies@ladhs.org ; Work Phone (562) 401-7425
Home Email lddeshaies@aol.com
Please email 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’ occupational goals.
The 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 the
course of several weeks utilizing lecture, videos, cadaver specimens, labs, and study
cards. This will be followed by diagnostic-specific sessions where anatomy will be
integrated along with evaluation and treatment techniques. Throughout the 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 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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Accommodations for Disability:
Any student requiring academic accommodation 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 8:30am-5:00pm, Monday through Friday. The phone number for
DSP is (213) 740-0776.
Required Readings:
Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for
Common Diagnoses of the Upper Extremity, by C. Cooper, 2007, Elsevier, ISBN:
0323033865, available from USC Bookstore, main campus. Additional handouts to be
distributed in class.
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.
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
August 25
 Course Overview
 Introduction to Hand Rehabilitation
 Introduction to Occupation-Based and Patient-Centered Care in Hand
Rehabilitation
Required Reading: None
Assignment: None
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Week 2
September 1- HOLIDAY- No Class
Week 3
September 8
 Clinical Examination of the Hand
Required Reading:
 Advance for Occupational Therapy Practitioners, “The Art of the First Impression”
 Fundamentals of Hand Therapy, Chapter 8, “Fundamentals of Client-Therapist Rapport”
 Rehabilitation of the Hand and Upper Extremity, Chapter 8, “Clinical
Examination of the Hand”
 Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper
Extremity”
Assignment: None
Week 4
September 15
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Rehabilitation of the Hand and Upper Extremity, Chapter 3, “Anatomy and
Kinesiology of the Hand”
 Fundamentals of Hand Therapy, Chapter 2, “Upper Extremity Anatomy”
Assignment: None
Week 5
September 22
 Functional Anatomy of the Wrist and Hand
Required Reading:
 “Rancho Los Amigos Functional Anatomy of the Wrist and Hand” sheets
Assignment: “Functional Anatomy Study Questions I”, 1-5
Week 6
September 29
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Fundamentals of Hand Therapy, Chapter 1, “Fundamentals of Clinical Reasoning:
Hand Therapy Concepts and Treatment Techniques”
Assignment: “Functional Anatomy Study Questions I”, 6-10
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Week 7
October 6
 Functional Anatomy of the Wrist and Hand
Required Reading:
 Fundamentals of Hand Therapy, Chapter 23, “Preventing and Treating Stiffness”
Assignment: None
Week 8
October 13
 Peripheral Nerve Injuries
 Sensation/Sensibility
Required Reading:
 Fundamentals of Hand Therapy, Chapter 12, “Common Peripheral Nerve Problems”
 Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper
Extremity”
Assignment: “Fight On Study Questions”
Week 9
October 20
 Arthritis
 Physical Agent Modalities
Required Reading:
 Fundamentals of Hand Therapy, Chapter 17, “Arthritis”
 Rehabilitation of the Hand and Upper Extremity, Chapter 107, “Ultrasound and
Selected Physical Agent Modalities in Upper Extremity Rehabilitation”
 Thermal Agents in Rehabilitation, Chapter 13, “Heat and Cold in Hand
Rehabilitation”
Assignment: “Arthritis Case Studies”
Week 10
October 27
 Tendon Injuries
Required Reading:
 Fundamentals of Hand Therapy, Chapter 16, “Tendon Injury”
Assignment: None
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Week 11
November 3
 Wound Healing
 Scar Management
 Edema Management
Required Reading:
 Rehabilitation of the Hand and Upper Extremity, Chapter 20, “Care of the Hand Wound”
 Clinical Assessment Recommendations, Chapter 3, “Wound/Scar Assessment”
 Fundamentals of Hand Therapy, Chapter 3, “Edema Reduction Techniques”
 Fundamentals of Hand Therapy, Chapter 19, “Burns”
Assignment: “Functional Anatomy Study Questions II”, 1-5
Week 12
November 10
 Hand Splinting
Required Reading:
 Splinting the Hand and Upper Extremity: Principles and Process, Chapter 6,
“Process of Splinting”
Assignment: Complete fabrication of thermoplastic “lumbrical bar splint”
Assignment: “Functional Anatomy Study Questions II”, 6-10
Week 13
November 17
 Digital Splinting/Casting
Required Reading:
 Rehabilitation of the Hand and Upper Extremity, Chapter 114, “Plaster Cylinder
Casting for Contractures of the Interphalangeal Joints”
 Introduction to Splinting, Chapter 12, “Splinting for the Fingers”
Assignment: Complete fabrication of thermoplastic “gutter splint” and plaster “digital cast”
Assignment: Complete “Hand Observation Log”
Week 14
November 24
 Occupation-Based Practice in Hand Therapy
Required Reading:
 AOTA Fact Sheet, “Occupation-Based Hand Therapy
 Advance for Occupational Therapy Practitioners, “It’s Time to Choose Which
Path You Take”
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Advance for Occupational Therapy Practitioners, “The Integration of
Occupation-Based Treatment Into Hand Therapy”
Advance for Occupational Therapy Practitioners, “Where We Are and Where
We’re Going”
Advance for Occupational Therapy Practitioners, “Peers Will Spread
Occupational Approach”
Advance for Occupational Therapy Practitioners, “Occupation Starts on Day One”
Advance for Occupational Therapy Practitioners, “Practicing OT to its Fullest”
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”
Assignment: Internet exploration of one to two “professional resource” web sites
Week 15
December 1
 Evidence-Based Practice/Outcomes in Hand Therapy
 Professional Resources
 Hand Therapy Certification
 California Licensure Regulations for Advanced Practice Certification
Required Reading:
 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”
 Advance for Occupational Therapy Practitioners, “Research and the Hand
Therapist”
 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”
 Fundamentals of Hand Therapy, Chapter 6, “Assessment of Functional
Outcomes”
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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 10% of the overall grade.
“Fight On Study Questions”: Each student will answer both 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 10% of the overall grade.
“Lumbrical Bar Splint”: Each student will complete fabrication, be able to describe how
the splint works, and be prepared to state two clinical indications for using this splint.
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 Resource”: Each student will be assigned one to two web sites to explore
and will prepare a three to five minute summary of each site and what it has to offer
related to hand rehabilitation. 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:
Acland, R.D. (1996). The Video Atlas of Human Anatomy, Tape 1: The Upper Extremity.
Baltimore, MD: Williams & Wilkins.
Brand, P.W., & Hollister, A.M. (1999). Clinical Mechanics of the Hand (3rd ed.). St. Louis,
MO: Mosby.
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.
Clark, G.L., Wilgis, E.F., Aiello, B., Eckhaus, D., & Eddington, L.V. (Eds.). (1998). Hand
Rehabilitation: A Practical Guide (2nd ed.). New York, NY: Churchill Livingstone.
Colditz, J.C. (2001). The Hand: An Interactive Study for Therapists. Bethesda, MD:
American Occupational Therapy Association.
Cooper, C. (Ed.). (2007). Fundamentals of Hand Therapy: Clinical Reasoning and
Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis,
MO: Elsevier.
Coppard, B.M., & Lohman, H. (2008). Introduction to Splinting: A Clinical Reasoning and
Problem-Solving 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.
Green, D.P., Hotchkiss, R.N., & Pederson, W.C. (Eds.). (1999). Green’s Operative Hand
Surgery (4th ed.). Philadelphia, PA: Churchill Livingstone.
Hentz, V.R., & Chase, R.A. (2001). Hand Surgery: A Clinical Atlas. Philadelphia, PA:
W.B. Saunders.
Jacobs, M.A., & Austin, N.M. (Eds.). (2003). Splinting the Hand and Upper Extremity:
Principles and Process. Baltimore, MD: Lippincott Williams & Wilkins.
Mackin, E.J., Callahan, A.D., Skirven, T.M., Schneider, L.H., & Osterman, A.L. (Eds.). (2002).
Rehabilitation of the Hand and Upper Extremity (5th ed.). St. Louis, MO: Mosby.
Malick, M.H., & Kasch, M.C. (Eds.). (1984). Manual on Management of Specific Hand
Problems. Pittsburgh, PA: AREN Publications.
McKee, P., & Morgan, L. (1998). Orthotics in Rehabilitation: Splinting the Hand and Body.
Philadelphia, PA: F.A. Davis.
McMinn, R.M.H., Hutchings, R.T., Pegington, J., & Abrahams, P.H. (1993). Color
Atlas of Human Anatomy, (3rd ed.). St. Louis, MO: Mosby.
Michlovitz, S.L. (Ed.). (1996). Thermal Agents in Rehabilitation (3rd ed.). Philadelphia,
PA: F.A. Davis.
Prosser, R., & Conolly, W.B. (Eds.). (2003). Rehabilitation of the Hand and Upper Limb.
Edinburgh: Butterworth-Heinemann.
Tubiana, R., Thomine, J., & Mackin, E. (1996). Examination of the Hand and Wrist.
St. Louis, MO: Mosby.
Weiss, S., & Falkenstein, N. (2005). Hand Rehabilitation: A Quick Reference Guide and
Review (2nd ed.). St. Louis, MO: Elsevier.
Wilton, J.C. (1997). Hand Splinting: Principles of Design and Fabrication. Philadelphia,
PA: W.B. Saunders.
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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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