Scope of Practice and Domains of Hand Therapy

The Scope of Practice of Hand Therapy may include one or more of the domains described below. Domains describe major areas of responsibility in hand therapy. The first three domains include assessment and treatment of hand therapy patients. In compliance with state and federal law, treatment is based on the results of assessment and may be provided on a one-to-one basis, in a group, or by consultation. The fourth domain describes activities associated with professional practice.

Hand Therapy practice domains and their associated tasks are listed below:
Practice Domains >> Scientific Knowledge Basis of Hand Therapy
Hand and Upper Quarter Patients >> Treatment Techniques and Tools

Practice Domains

1.0 Evaluate Upper Extremity and Relevant Patient Characteristics

Obtain and review medical, psychosocial, vocational and avocational history
Interview patient and/or caregiver
Identify factors that may affect rehab potential (e.g. co-morbidities)
Plan for and select assessment tools
Assess and document skeletal, muscular, nervous, vascular, lymphatic, skin and connective tissue status
Assess and document psychosocial, functional, and ergonomic factors and status
Identify impairments, functional limitations and disabilities based on the results of assessment
Reassess and document patient status at appropriate intervals
Identify factors that could affect at-risk populations (e.g. industrial, athletes, performing artists)

2.0 Determine Prognosis and Plan of Care

Integrate basic science and fundamental knowledge with results from evaluation and patient goals into an individualized plan of care
Determine rehab potential and expected outcomes
Determine needs of an at-risk population (e.g., industrial, athletic, and performing artistic groups, etc.) and develop wellness and prevention programs
Establish functional and measurable goals of intervention with an anticipated time frame for attainment
Establish frequency and duration of interventions in collaboration with patient and referring physician within the guidelines of third party payers
Select appropriate interventions and treatment techniques
Document the plan of care including rehab potential, goals and interventions
Identify appropriate sources to which patients can be referred
Consult with and refer to other health care professionals
Reassess goals and outcomes and change plan of care as needed
Assess readiness to return to former daily activities
Assess readiness for discharge and formulate and document discharge plan

3.0 Implement Therapeutic Interventions

Implement/apply and modify the therapeutic interventions
Develop patient education plans and home programs
Provide patient education and validate patient learning

4.0 Promote Professional Practice

Utilize evidence-based practice (integrate best available research evidence with clinical expertise and patient preferences)
Interpret and apply clinical research and outcomes studies
Assess patient satisfaction
Maintain ethical standards
Comply with regulations that ensure environmental safety
Comply with regulations governing practice based on regulatory agencies
Comply with organizational policies and procedures
Document services provided
Bill for services provided
Advocate for patients
Manage fiscal resources (i.e. recognition and consideration of fiscal restraints in patient management)
Manage clinic administration (order supplies, review charges, perform chart audits)
Supervise clinical support staff in the delivery of patient care
Manage human resources (e.g., staffing, performance appraisal)
Participate in case management
Advocate for the profession of hand therapy with employers, third-party payors, consumers, and other healthcare professionals, etc.
Participate in ongoing professional development; Participate in activities and associations that advance professional practice and public welfare
Develop and implement educational programs for professionals
Participate in clinical research
Participate in professional development of students and/or other therapists

Scientific Knowledge Basis Of Hand Therapy

The foundation of hand therapy is comprehensive understanding of:

Surface anatomy of the shoulder, elbow, forearm, wrist and hand
Anatomy and physiology of the skin/connective system
Anatomy and physiology of the muscular system
Anatomy and physiology of the skeletal system
Anatomy and physiology of the nervous system
Anatomy and physiology of the vascular and lymphatic systems
Development of age-specific hand function
Physical properties (e.g., heat, water, light, electricity, and sound)
Principles of tissue/wound healing
Kinesiology and biomechanics relative to the shoulder, elbow, forearm, wrist and hand
Posture and its effects on the upper extremities
Pathomechanics relative to the shoulder, elbow, forearm, wrist and hand
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 assessment tools
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)
Concepts and principles of prosthetics
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)
Billing and coding principles
Uniform Terminology (Practice Framework)

Hand And Upper Quarter Patients

Theoretical knowledge and technical skills are applied, using good clinical judgment, in assessment and treatment of individuals with diagnoses related to the upper quarter (hand, wrist, elbow, shoulder girdle, cervical area or multiple joints). These may include but are not limited to:

Adhesions or tightness (e.g., musculotendinis, capsular)
Amputations
Arthritis and rheumatic diseases
Congenital anomalies/differences
Crush injuries/mutilating trauma
Cumulative trauma disorders
Cysts and tumors
Developmental disabilities
Dislocations and subluxations
Dupuytren's disease
Edema
Factitious disorders
Fractures
Infections
Ligamentous injury and instability
Lymphedema
Muscular strains, tears, and avulsions
Nerve injuries and conditions (e.g., neuropathies, palsies, nerve repairs)
Neuromuscular diseases – ALS, MS, MD
Pain (e.g. complex regional pain syndrome, fibromyalgia)
Replantation and revascularization
Spinal cord and central nervous system injuries
Tendon injuries and conditions (e.g., lacerations, transfers, tendonitis, ruptures)
Thermal and electrical injuries
Vascular disorders
Wounds and scars

Treatment Techniques And Tools

A variety of techniques and tools may be used in therapeutic intervention with hand and upper quarter patients, including but not limited to:

Biofeedback techniques
Compression therapy
Continuous Passive Motion (CPM)
Desensitization
Design and/or selection of adaptive/assistive devices
Ergonomic and activity modification in home, work, school or leisure
Exercise
Functional activity
Hand writing techniques
Joint protection instruction/energy conservation instruction
Manual therapy
Modalities
Nutrition instruction
Orthotic design, selection, fitting, fabrication and training:
Patient education
Prosthetics
Scar Management
Sensory re-education
Taping techniques
Training in ADL/adaptive/assistive devices
Wellness education
Work conditioning
Work hardening
Wound care

Adopted by HTCC Board of Directors 9/30/2008