The Growth of Hand Therapy
During World War II, Orthopedic and Plastic Surgeons were specially trained to treat soldiers who had upper quarter injuries. These surgeons worked with therapists in military hospitals, and together they began to develop specialized treatment protocols. By the mid-1970’s, there were a number of occupational therapists and physical therapists in clinics in the United States and Canada who treated only patients with upper quarter injuries. Most of them worked one-on-one with physicians, and they were anxious to increase their knowledge about Hand Surgery techniques so they could refine their skills. The first Rehabilitation of the Hand conference, sponsored by Thomas Jefferson University and the Philadelphia Hand Center, was held in 1975. The format of dual presentations by physicians and therapists on the same topic has continued for nearly 30 years. Some therapists also began to attend meetings of the American Society for Surgery of the Hand (ASSH) at that time.

Birth of ASHT in 1975
In 1975, at the ASSH Annual Meeting in San Francisco, Bonnie Olivett, an occupational therapist from Denver, posted a note on a bulletin board inviting therapists who were at the meeting to get together one afternoon. Six OT's and PT's who worked closely with hand surgeons responded to the invitation and the American Society of Hand Therapists (ASHT) was born.

The six founding members of ASHT are pictured in the photo below.
Front Row: (L-R) Margaret S. Carter OTR, CHT, Bonnie Olivett OTR, CHT, Evelyn Mackin PT. Back Row: (L-R) Karen Lauckhardt MA, PT, CHT, Mary Kasch OTR/L, CHT, and Judy Bell-Krotoski, OTR, FAOTA, CHT

In 1977, all the organizational tasks were accomplished and membership applications were distributed setting the stage for the first official meeting of ASHT, held in Dallas in 1978, where Bonnie Olivett was elected the first president.

Membership Restrictions
Membership in ASHT was restricted to therapists practicing in the United States or Canada, and membership in ASHT became a de facto form of certification because of the stringent application process that required therapists to submit a patient log, case studies, and an extensive application in addition to meeting a clinical hour requirement. Members of ASHT were recognized in the field as being experts.

Governmental Influences in the 1970s
In the late-1970s, the federal government was encouraging the formation of voluntary certification programs that would not be federally regulated. By the mid-1980’s, antitrust laws against organizations with strict membership qualifications were being enforced. It was felt that restricting membership was a form of discrimination and that membership in an organization should be open to a broad range of individuals in a professional field. These two trends led ASHT to establish a certification committee in 1984 to study other organizations and present options to the members. This resulted in the discovery of guidelines established by the National Organization for Competency Assurance (NOCA) in Washington, D.C. for organizations that offer professional certification, and these guidelines were used to form the framework for Hand Therapy Certification.

First Practice Analysis in 1985
The first step in the process was a Role Delineation Study (now commonly known as a Practice Analysis) of hand therapy. A survey was written with consultation from a professional testing company and was sent to ASHT members and non-members who practiced hand rehabilitation. The results of the survey formed the basis of the Scope of Practice and were used to write the original test blueprint (the document that determines the percentage of content included on the test). The Role Delineation results also were published in the Journal of Hand Therapy in 1987. Based on the report of the certification committee, the members of ASHT voted to proceed with Hand Therapy Certification at the 1987 ASHT Annual Meeting.

Exam Construction Begins in 1988; First Exam is in 1991
Early in 1988, the testing company trained the first group of 17 item writers. They wrote approximately 600 test questions, which were then field tested at the Hand Therapy Review Course offered throughout the United States in 1989 and 1990. The final questions were selected for the first exam based on the test blueprint and the performance of each question, and the inaugural Hand Therapy Certification Examination was administered in May 1991. It marked the designation of the first group of Certified Hand Therapists (CHTs).

HTCC Becomes Incorporated in 1989
One of the NOCA guidelines for certification programs is administrative independence. That means that an organization should not certify its own members; therefore in 1989, HTCC incorporated and separated from ASHT. Today, two separate Boards of Directors govern the two organizations and neither influences the decisions of the other. Communications are relayed through an appointed liaison. HTCC sponsors a reception at the ASHT Annual Conference, but for all other activities of the two organizations are administratively separate.

Second Practice Analysis in 1994
New practice analyses are performed about every five years to ensure the integrity and viability of the Hand Therapy Examination in the future and maintain current practice standards. In 1994, a new Practice Analysis Study was performed. Based on the results of the survey, the test blueprint was revised and new domains were established.

Third Practice Analysis in 2001
A new Practice Analysis Study was conducted in 2001. This time, HTCC wanted to learn more about the clinical reasoning and judgment used by a hand therapist. The study was designed to reflect the differences between CHTs and occupational therapists and physical therapists who are not hand specialists. This study also had a much broader scope than the previous studies done in 1985 and 1994.

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