Hand therapy - An OT’s paradise something
for everyone
Helen McKenna, Hand Occupational Therapist
Pulvertaft Hand Centre
Derby Hospitals NHS Foundation Trust
#theotshow #theotshowselfie
Hand Therapy An OTs
Paradise- Something for
everyone
Who am I ?
Hands are
amazing!
Precision &Power
Self expression
sport
Communication
Comfort
Care
Art & Culture
Hobby
Endurance
Co-ordination
Socializing
Dexterity
Creativity
Leisure
Caring for others
Self expression
Its not just us who think hands are
amazing……..
Our Unit
1972-One Hand Physiotherapist
1985-First Hand Occupational Therapist appointed
1987-First Hand Therapy Course
1992-Rolls Royce sponsors another Hand Occupational Therapist
2006 Dual Competencies initiated
2010 Hand unit moved to new hospital
2015 currently -26 Therapists 3 assistants
What do we see?
 Acquired conditions
 Trauma
 In and outpatients
 Peripheral clinics
Service delivery
 Assessment
 Treatment






1:1
Workshops
Clinics
Education groups
Craft/Baking
Wards
We Look carefully at each
individual their characteristics,
needs and lifestyle
 THERAPEUTIC
 Prevent dysfunction
 Restore function
 Enhance ability to carry out
tasks
 Participate fully in life
situations
 Provision of emotional and
psychological support
Teach
Researchers

Dual Competency
 Generic working.
 The OT and PT sharing certain skills.
 Enabled simple / routine hand injuries or conditions to be seen by one
therapists rather than both an OT and a PT
 Improving efficiency within the hand therapy team by reducing waiting lists
and waiting times in clinic.
 Better for the patient as reduces numbers of appointments and repetition.
Hand therapists-Generic working
OT
PT
It wasn’t easy…………..
•
•
•
•
•
Trust
Respect
Time
Tried various approaches
Shared notes
Recognition that some people
develop more slowly i.e. part timers
Attitudes –positive negative
It took a long time many were on the fence
So Are we better therapists
or worse because of generic working?
Dual or Duel ?
CORE
CORE
Dual
(Generic)
We haven't forgotten our roots
Collaboration
Enablement balance in their activities
Using activity as a therapeutic tool
Group work
Problem solving
Analysing and adapting environments
to increase function and social participation
We recognise individuality
We all use our hands in different
ways
We turn these into ……………….
Ta dah!
We embrace new
ideas
9 days of taping
Pre taping
Camouflage
Current Developments
 Exercise app
 Formalising Psychological service
 Business case psychology session
 CBT
 More training for therapists
 Outcome measures. Departmental initiative on IPad




GAD
Quick dash
Disease specific
?PEM
Pt Friendly
Embracing
technology
If you squeamish
Please look away now!
What do we do? – We turn this – into this…
And this into this…
Into this
And this…..
Psychology
Psychological Care and Hand
Therapy
 “Adjustment after a hand injury
improves when we acknowledge the
complex interplay between physical,
psychological, and social elements
and incorporate them into our hand
therapy assessment and treatment
interventions”, Hannah, 2011
Why hands??
Function of the Hand
• social
• communication
• dexterity and skill
• strength and power
• adornment
• tenderness and intimacy /
sexual
• gesticulation and expression.
• always present.
Problems post injury
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




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


Changed appearance
Pain
Loss of function
Changed sensation
Loss of expertise
Embarrassment
Stigma
Low self esteem
Reduced confidence
Lost of different roles
Difficult to hide (clothing often
covers other bits of body)
Expect the
unexpected!!!
There is no relation
between the extent of
the injury and the
psychological impact
on the individual
How might a person
present?
ANGER
FIXATED
ANXIETY
Patient
FRUSTRATION
DEPRESSION
GUILT
BEHAVIOURAL
CHANGES
Psychological support
 Historically OTs provided mainstay
 CBP project
 Training for therapists to manage
The wonders of being dual trained!
Factitious Disorders
“-deceive for gain”
Self mutilation
• tourniquets
•
•
•
•

Secretans- peritendinous fibrosis
Cutting
Body Integrity Identity disorder
SHAFT syndrome
Sad, hostile, anxious, frustrating
& tenacious
 Psycho flexed hand
Case study
 65 year old man who had his
dominant thumb blown off by a
musket in a historical reenactment activity – Replant not
an option
 Lived alone no close family
 Retired
Thumb Function
“on the length, strength, free lateral
motion and ... mobility of the thumb,
depends the power of the human
hand.”
Charles Bell
Opposable thumbs differentiate
us from apes!
The thumb is the most important
finger on the hand, accounting for
at least 40% of function by some
estimates. Loss of function with
thumb amputation can be
devastating,
Prehensile Functions
of the thumb
Thumb often not required during activities requiring hook grip
e.g. carrying case
But it is required for.......
Prehensile function
 Cylinder grip
 Power grip
 Precision handling
 key pinch
 Lateral pinch
Non prehension functions of the
thumb
 Support
 balance
 Push
 stabilise
 Hold
Treatment
Pain management
Wound care
 Psychological Ax/support
 One handed living advice
 ROM
 Oedema mx
 Scar mx
 Desensitisation
Pts Functional Goals
 Return to sailing
 Cycling
 DIY
 Pad’ls
Adamant did not want any further surgery!
Individual character traits
Positive
Determined
Simple thinker
Independent
Clear functional goals from day 1
Treatments
 Strengthening
 Task simulation
 Dexterity (knotting stool seating etc)
 Problem solving
 Opponens splint
prosthetic thumb
Once healed
Dexterity
 Preferred to avoid
use of gadgets
Functional ability with
prosthesis
Sailing
Adl
And finally..........
...... Sailing was
my life and I
thought I would
never do it again
...... Thank you!
Occupational Therapist as an ESP
in “Hands”
Why Not an OT?
 We are client centred
 Good understanding of learning styles and able to effectively
educate pts on conditions and appropriate injuries
 High level of knowledge of impact of trauma on
acquired condition on Occupational performance
 Good knowledge and understanding of therapy interventions
and guidelines – Able to provide specific advice to therapy
team
Underpinning principles
 To free up highly trained
medical staff for more
complex procedures
 Reduce waiting times
 Increase efficiency
 Core competencies
 Autonomous practice
(Judgements, accountability)
 Critical thinking
 Value based care (care
negotiated with service users
as equal partners)
 Improving practice (EBP, role
model that enables change)
Learning skills outside scope of practice
My ESP Role in Hands
 Initially a new role
 0.5 PT
 0.5 OT
 Business case and funded by hand unit
 Trauma & elective clinics
 Peripheral clinics
 Diagnose trauma & acquired
conditions
 Plan & direct management
 Conservative
 Surgical
 Order investigations
 Xrays (Interpret)
 NCS
 Ultrasound
 Refer
 Therapy
 Casts
 Follow ups
Conditions
Mallet
Tendon
#
Metacarpals
Tuft #
Closed
extensors
OA
Dislocations
DIP
PIP
Nerve
Compressions
 Trauma, post op, acquired
 Inject
Large#
Post op
• Tendons
• Dig nerve
UCL
Ligaments
Triggers
MCP
PIP
DIP
Injection therapy
Current
 Unable to do Independent prescribers module
 ( can do supplementary)
 Continue to expand repertoire
 Enriched my OT role
 Helps the team
 Career progression
Come and join me !!