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Important Dates
2017 Exams
May 1 - 6
November 6 - 11

Test Blueprint, Hand & Upper Limb Patients, Treatment Tools

The test blueprint is a document that has been derived from 2014 Practice Analysis of hand therapists about the nature of their practice and determines the percentage of content included on the test. For example, 26% of the questions on the exam will have content related to evaluation.

The following is a a description of the domains of hand therapy including the relevant tasks  and knowledge areas that have been identified as essential to the practice of hand therapy.

Practice Domains

1. Evaluate Upper Limb and Relevant Patient Characteristics 26%

Tasks Performed

  • Obtain and review medical, surgical, psychosocial, functional, developmental vocational and avocational history
  • Conduct patient, family and/or caregiver interview
  • Perform screening examination and systems review to identify symptoms of co-morbidities that may or may not have been previously identified
  • Identify factors that may require further consultations/referrals
  • Monitor factors that may affect rehabilitation potential and participation
  • Plan for and select reliable and valid assessment tools, tests, and outcome measures
  • Assess and document physical status of skeletal, muscular, nervous, vascular, lymphatic, skin and connective tissue
  • Interpret evaluation findings based on basic science, fundamental knowledge, and knowledge of conditions of the hand and upper limb
  • Screen for cervical conditions
  • Assess and document psychosocial, functional, developmental, vocational, avocational and ergonomic factors
  • Identify impairments in body function and body structure, activity limitations and participation restrictions based on the results of evaluation
  • Identify factors that could affect management of at-risk populations (e.g. workers, athletes, performing artists, age groups)
  • Reassess and document patient status at appropriate intervals

Knowledge Required

  • Communication techniques and principles
  • Principles of tissue/wound healing
  • Posture and its effects on the upper limb
  • Differential diagnosis
  • Surgical, non-surgical, and medical management of conditions of the hand or upper limb
  • Post-surgical, non-surgical and therapeutic intervention guidelines and protocols
  • Assessment tools, tests, and measures and their psychometric properties
  • Pharmacology as it relates to the scope of hand therapy practice
  • Basic laboratory values as they relate to hand therapy practice
  • Diagnostic imaging of the upper limb
  • Electrodiagnostics of the upper limb

2. Determine Prognosis and Plan of Care 20%

Tasks Performed

  • Establish an individualized plan of care by integrating basic science, fundamental knowledge, best clinical evidence, and clinical experience with evaluation results and patient goals Determine rehabilitation potential and expected outcomes and communicate these with the patient, family and/or caregiver
  • Establish functional and measurable goals of intervention that are specific to the evaluation findings including an anticipated time frame for attainment
  • Establish frequency and duration of interventions in collaboration with patient, family, caregiver  and referral source
  • Make recommendations to produce optimal outcomes within the constraints of the patient's specific situation (for example, financial considerations, transportation, time/schedule restrictions, readiness to learn)
  • Select interventions and treatment techniques
  • Document the plan of care using defined parameters of frequency, duration, focus and treatment and interventions
  • Identify resources to which patients can be directed (for example, social services, patient education materials, community services)
  • Consult with and facilitate referrals to other health care professionals
  • Reassess the plan of care and make modifications as needed
  • Determine readiness to return to life/work activities
  • Determine readiness for discharge and formulate and document discharge plan

Knowledge Required

  • Surgical, non-surgical, and medical management of conditions of the hand or upper limb
  • Post-surgical, non-surgical, and therapeutic intervention guidelines and protocols
  • Anticipated outcomes of medical and/or therapeutic treatment
  • Anticipated physiological and psychological effects of therapeutic interventions
  • Rational, indications, precautions, and contraindications for interventions
  • Treatment interventions (methods, techniques and tools)
  • Concepts and principles of orthotic devices
  • Concepts and principles of prosthetic devices
  • Concepts and principles of  ergonomics

3. Implement Therapeutic Interventions 32%

Tasks Performed

  • Implement therapeutic interventions by integrating basic science, fundamental knowledge, best clinical evidence, clinical experience and patient preferences with plan of care to safely meet established goals
  • Select or create educational materials and home programs for the patient and/or caregiver
  • Implement education plans and verify patient understanding
  • Modify therapeutic interventions based on patient response and progress toward goals

 Knowledge Required

  • Anticipated outcomes of medical and/or therapeutic interventions
  • Anticipated physiological and psychological effects of therapeutic interventions
  • Rational, indications, precautions, and contraindications for interventions
  • Treatment interventions (methods, techniques and tools)
  • Concepts and principles of orthotic devices Concepts and principles of prosthetic devices
  • Concepts and principles of ergonomics

4. Fundamental Knowledge and Basic Science 22%

Knowledge Required

  • Surface anatomy of the upper limb
  • Anatomy and physiology of connective tissue
  • Anatomy and physiology of the integumentary system
  • Anatomy and physiology of skeletal system
  • Anatomy and physiology of muscular system
  • Anatomy and physiology of nervous system
  • Anatomy and physiology of vascular and lymphatic system
  • Development of age-specific hand function
  • Kinesiology and biomechanics relative to the upper limb
  • Pathomechanics and pathophysiology of medical conditions that may manifest with signs or symptoms in the hand or upper  limb
  • Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper limb
  • Physiology of bone and soft tissue repair
  • Physiology and psychology of pain
  • Physical properties of heat, water, light, electricity and sound as they apply to physical agent modalities and electrodiagnostics
  • Mechanical properties of materials and components of orthotic and prosthetic devices
  • Behavioral science (including cultural diversity and biopsychosocial factors) and psychological reactions to impairment
  • Research design and statistics
  • Principles of evidence-based practice
  • Teaching and learning styles
  • Safe use and maintenance of equipment and devices
  • Safety techniques and procedures (for example, infection control, emergency procedures, practitioner safety, environmental safety)
  • Technology related to the practice of hand therapy
  • Hand Therapy Certification Commission's policies and regulatory guidelines
  • Physical therapy and occupational therapy practice standards and codes of ethics

In addition, the 2014 Hand Therapy Practice Analysis found that Certified Hand Therapists typically treat the following conditions and use appropriate techniques and tools as listed below:

Hand and Upper Limb Patients

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

  • Adhesions or tightness (e.g., musculotendinous, 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:

Techniques to Assess

ADL, IADL

Edema

Vascular status

Pain

ROM

Tightness (intrinsic, capsular, extrinsic)

Strength (for example, dynamometry)

Muscle function (for example, MMT, tone, imbalance)

Sensibility

Sympathetic function

Handedness and dexterity

Functional capacity and work site

Wounds

Tests and Measures

Outcome Measures

Signs and Tests

Standardized Tests

Electro-diagnostic Tests

Differential Diagnosis

Therapeutic Exercise

Mobility (e.g., active, passive ROM)

Strengthening

Nerve gliding

Tendon gliding

Dexterity and coordination

Endurance

Modalities

Contrast baths

Cryotherapy

Fluidotherapy

Thermal/hot

Iontophoresis

Electrical stimulation

Paraffin

Ultrasound/phonophoresis

Whirlpool

Orthotic design and/or selection

Orthotic fitting, fabrication and training

Static

Dynamic

Static progressive

Serial casting

Casting to mobilize or immobilize

Soft materials (for example, neoprene, buddy taping, etc.)

Prosthetic design and/or selection

Prosthetic fitting, fabrication and training

Adaptive, assistive and ADL devices

Ergonomic and/or activity modification

Joint Protection

Posture awareness, modification, and adjustment

Edema management

Lymphedema management

Functional activity

Sensory re-education

Desensitization

CPM

Manual therapy techniques

Joint mobilization

Soft tissue techniques

Instrument assisted soft tissue mobilization

Taping

Patient/family/caregiver education

Work conditioning/hardening

Biofeedback

Neuromuscular reeducation

Graded motor imagery (e.g. laterality training, imagery, mirror therapy

Wound Care Techniques and Tools

Debridement

Mechanical (other than sharp debridement)

Sharp (scissors/forceps or scalpel)

Suture removal

Non-selective

Chemical / enzymatic

Suture and staple removal

Cleansing

Application of topical medications

Selection / application of dressings

Scar management

Physical Agent Modalities for Wound Care

Whirlpool

Electrical Stimulation

Ultrasound