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 patients in compliance with state and federal laws; 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 services designed for specific population groups. The final two domains describe activities associated with professional practice. Click to download this Scope of Practice document as a PDF.

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

Evaluate Upper Quarter and Relevant Patient Characteristics

Obtain and review medical, psychosocial, and vocational history
Interview patient
Plan for and select assessment tools
Assess and document skeletal, muscular, nervous, vascular, skin connective tissue status, functional and/or ergonomic status, and psychosocial factors
Reassess and document patient status at appropriate intervals

Develop Treatment and Discharge Plans

Integrate theoretical knowledge bases and patient goals into treatment
Establish short-term and long-term goals of treatment
Establish frequency of treatment in collaboration with patient and referring physician and within the guidelines of third party payers
Determine rehabilitation potential
Select appropriate treatment techniques
Identify appropriate resources to which patients can be referred
Consult with and refer to other health care professionals
Document the treatment plan
Assess readiness and determine discharge needs including return to work
Formulate and document discharge plan

Implement Treatment Plans

Implement and modify treatment/interventions to address edema/vascularity, pain, scar, ROM/flexibility, wounds, strength, dexterity, sensation, function, endurance, and posture/movement

Provide Population-Based Services

Determine needs of the target population (e.g., industrial, athletic, and performing artist groups)
Make intervention recommendations (e.g., education programs, prevention strategies, ergonomic modifications, and screening) based on available resources
Assist in implementation of interventions
Monitor effectiveness of interventions
Serve as a resource person/consultant

Organize and Manage Services

Comply with regulations that ensure environmental safety
Advocate for patients
Ensure compliance with organizational policies and procedures
Participate in case management
Assess patient satisfaction

Promote Professional Practice

Maintain ethical and legal standards
Participate in evidence-based practice (e.g., scientifically-based, outcome-based)
Interpret and apply clinical research and outcome studies

Scientific Knowledge Basis Of Hand Therapy

The foundation of hand therapy is comprehensive understanding of:

Surface anatomy
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/lymphatic system
Physical properties (e.g., heat, water, light, electricity, and sound)
Wound healing
Behavioral science, and psychological reactions to impairment
Research design and statistics
Kinesiology and biomechanics
Posture and pathomechanics
Etiology and pathology of medical conditions
Surgical and medical treatment of conditions
Standardized and non-standardized assessment tools
Treatment rationale, indications and contraindications
Treatment methods, techniques, and tools
Expected functional outcomes of treatment
Expected physiological and psychological effects of treatment procedures
Regulatory and legal guidelines
Resource management
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)

Hand And Upper Quarter Patients

Theoretical knowledge and technical skills are applied, using sound 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:

Amputations
Central nervous system disorders as they relate to the upper quarter
Congenital differences/anomalies
Cumulative trauma disorders/repetitive stress injuries
Dupuytren’s contracture
Flexor/extensor tendon injuries
Fractures/dislocations/joint instabilities
Infections
Inflammatory and degenerative arthritis
Multiple system trauma
Nail bed injuries
Pain-related syndromes
Peripheral nerve compression and disease
Peripheral nerve injuries
Post-mastectomy/post-radiation lymphedema
Psychogenic disorders involving the upper quarter
Soft tissue injuries
Thermal injuries
Tumors and cysts
Vascular disorders

Such patients may be referred to a hand therapist following a variety of medical or surgical interventions including:

Amputation revision
Arthroplasty
Arthrodesis
Fasciectomy/fasciotomy
Fracture fixation/bone graft
Ganglionectomy
Injections
Joint reconstruction
Joint releases
Joint synovectomy
Ligament repair
Nail bed repair
Nerve blocks/sympathectomies
Nerve decompressions
Nerve grafts/nerve repairs
Neurolysis
Replantation/revascularization
Scar revisions
Skin grafts/flaps
Soft tissue releases
Tendon grafts/tendon repairs
Tendon transfer
Tenolysis
Tenosynovectomy
Tissue transfers
Use of pharmaceutical agents

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:

Activity
Adaptive/assistive devices
Training in activities of daily living (ADLs)
Behavior management
Compressive therapy
Desensitization
Electrical modalities
Ergonomic modification
Exercise
Manual therapy
Patient and family education
Prosthetics
Sensory re-education
Splinting
Standardized and non-standardized assessment tools
Strengthening
Thermal modalities
Work hardening/retraining
Wound care/dressings/topical agents

Adopted by HTCC Board of Directors 5/16/2002