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Important Dates
2017 Exams
May 1 - 6
November 6 - 11
Scope of Practice and Domains of Hand Therapy

The Scope of Practice of Hand Therapy includes 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 includes knowledge areas that serve as a foundation for the other domains in practice.

Hand Therapy practice domains and their associated tasks are listed below:

Practice Domains

1.0 Evaluate Upper Limb and Relevant Patient Characteristics

  • Obtain and review medical, surgical, psychosocial, functional development, 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 skeletal, muscular, nervous, vascular, lymphatic, skin and connective tissue status
  • Assess and document psychosocial, functional, developmental, vocational, avocational and ergonomic factors
  • Interpret evaluation findings based on basic science, fundamental knowledge and knowledge of conditions of the hand and upper limb
  • Screen for cervical conditions
  • Identify complications associated with medical conditions relative to the hand and upper limb
  • Identify impairments in body functions and body structure, activity limitations and participation restrictions based on the results of the evaluation
  • Identify factors that could management of specific populations (e.g. workers, athletes performing artists, age groups)
  • Reassess and document patient status at appropriate intervals

2.0 Determine Prognosis and Plan of Care

  • 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 to 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 and/or caregiver  and referral source
  • Make recommendations to produce optimal outcomes within the constraints of the patient’s specific situation (e.g. 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 interventions
  • Identify resources to which patients can be directed (i.e. 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 the readiness to return to life/work activities
  • Determine readiness for discharge and formulate and document discharge plan

3.0 Implement Therapeutic Interventions

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

4.0 Basic Science and Fundamental Knowledge

The foundation of the practice of hand therapy is comprehensive understanding of:

  • Surface anatomy of the upper limb
  • Anatomy and physiology of the connective system
  • Anatomy and physiology of the integumentary 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 limb function
  • Principles of tissue/wound healing
  • Kinesiology and biomechanics relative to the upper limb
  • Pathomechanics and pathology relative to the upper limb
  • Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper limb
  • Physiology of bone tissue repair
  • Physiology and psychology of pain
  • Properties of  heat, water, light, electricity, and sound as they apply to physical agent modalities and electrodiagnostics
  • Mechanical properties of materials and components as related to the practice of hand therapy
  • 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 (e.g., 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
  • Documents applicable to hand therapy produced by international health organizations
  • Communication techniques and principles
  • Posture and its effects on the upper limb
  • Surgical, non-surgical, and medical treatment of conditions of the hand or upper limb 
  • Post-surgical, non-surgical, medical and therapeutic treatment guidelines and protocols
  • Assessment tools, tests, measures and their psychometric properties
  • Pharmacology as it relates to the scope of hand therapy practice
  • Basic laboratory values as they relate to the scope of hand therapy practice
  • Diagnostic imaging od the upper limb
  • Electrodiagnostics of the upper limb
  • Anticipated outcomes of  medical and/or therapeutic intervention
  • Anticipated physiological and psychological effects of therapeutic interventions
  • Rationale, indications, precautions and contraindications of interventions
  • Treatment interventions (methods, techniques, and tools)
  • Concepts and principles of orthotic devices
  • Concepts and principles of prosthetic devices
  • Concepts and principles of ergonomics

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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

(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

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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:

  •  Assessment techniques
  • Adaptive, assistive and ADL devices
  • Biofeedback techniques
  • Compression therapy
  • Continuous Passive Motion (CPM)
  • Desensitization
  • Design and/or selection of adaptive/assistive devices
  • Edema Management
  • Ergonomic and/or activity modification
  • Therapeutic Exercise
  • Functional activity
  • Graded motor imagery
  • Hand writing techniques
  • Joint protection
  • Lymphedema management
  • Manual therapy techniques
  • Modalities
  • Neuromuscular re-education
  • Orthotic design, selection, fitting, fabrication and training:
  • Patient family and/or caregiver education
  • Posture awareness, modification an adjustment
  • Prosthetics
  • Scar Management
  • Sensory re-education
  • Taping techniques
  • Work conditioning/hardening
  • Wound care (debridement, suture and staple removal, topical and dressing management, modalities)

Adopted by HTCC Board of Directors10/15/2015