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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
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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)
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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
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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
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