Hand Therapy Center

What is a Hand Therapist?

A hand therapist can be either an occupational or physical therapist who, through advanced study, specializes in rehabilitating patients with problems affecting the hands and arms.

To become a hand therapist requires a high degree of specialization, continuing education, and most often, advanced certification. This advanced knowledge enables the hand therapist to work with patients to hasten their recovery and thus their return to a productive lifestyle.

Who Benefits from Treatment by a Specialized Hand Therapist?

A hand therapist treats patients with a problem in the upper extremity, which includes the hand, wrist, elbow or shoulder. This can include someone who may have been involved in an accident leaving them with wounds, scars, burns, injured tendons and/or nerves, fractures, or even amputation of the fingers, hands or arms. Patients who suffer from the effects of repetitive type disorders, such as tennis elbow, carpal tunnel syndrome, or a rotator cuff tear, also benefit from specialized treatment by a hand therapist. Arthritic conditions and neurological conditions affecting the arms or hands are also best treated by the hand therapist.

Why is Treatment by a Hand Therapist Important?

The specialized and advanced knowledge the hand therapist has of the anatomy of the upper extremity and the treatment of conditions affecting it often allows the hand therapist to provide therapy starting within days of the surgery or injury up to the point of recovery, allowing for a better continuum of care.

The result of a thorough and accurate assessment and treatment by a specialized hand therapist results in a more comprehensive, yet shorter, treatment time. The hand therapist's specialized training and clinical expertise provides quick identification of complex problems of the upper extremity and the best mode of treatment or treatments of these problems.

Specialized Treatments Provided by Hand Therapists

The following is just a brief list of the unique problems of the upper extremity which the hand therapist has specialized knowledge to address:

• management of hypertropic (thick and/or limiting) or hypersensitive scars
• management of open or sutured wounds to aid healing
• management of swelling
• management of acute or chronic pain
• desensitization and sensory re-education following a nerve injury
• fabrication of splints to prevent or correct injury or deformities
• training and/or adaptation to allow the patient to independently perform activities of daily living
• management and implementation of exercise programs to address decreased dexterity, strength, and/or coordination problems
• work conditioning prior to returning to work
• utilization of computerized equipment to evaluate and treat strength deficits
• utilization of several specialized modalities in the treatment of injuries of the upper extremity

Specialized Computer Aided Evaluation and Treatment

Knox Orthopaedics was one of the first, and remains one of the few, facilities utilizing computerized Hand/Upper Extremity therapy equipment. This equipment provides objective evaluation of the movements, strength, and sensation of the upper extremity. This computerized system also provides treatment in any strength deficits of the upper extremity, with individualized treatment protocols established for each individual patient's deficits and needs.

Special Modality Treatments Available

Fluidotherapy

Fluidotherapy is a special heat/massage modality utilized to gain range of motion, decrease pain, and desensitize the hypersensitive hand or arm. The best part of this modality is that it allows the patient to be mobile and perform their exercises while in the heat, rather than the patient being immobilized when using a heating pad.

Ultrasound

Ultrasound is a deep heat treatment which has the following benefits:

• Promotion of circulation
• Muscle relaxation
• Cell membrane permeability
• Increased tissue regeneration
• Pain relief
• Edema reduction

Iontophoresis

Iontophoresis is a form of transdermal (through the skin) drug delivery system used to control pain and swelling on a smaller scale, such as in a tendon or ligament of the finger. It can also be used to introduce medicines to soften scar tissue or desensitize a neuroma.

Phonophoresis

Phonophoresis is another transdermal drug delivery system used to control pain and swelling in a major muscle group.

Lido Workset Simulates Work Tasks

Equipment in the Knox Orthopaedics occupational therapy department can help injured workers regain the ability to do specific work tasks. It can simulate driving a truck, turning valves, painting a surface overhead, and many others. So, the worker can practice the specific motions needed on the job and probably return to work quicker, according to occupational therapist Missy Smyth.

The equipment, called the Lido Workset, made by Loredan, allows Smyth and her staff to help patients much more precisely than ever before. The machine, using isokinetic and isotonic principles, responds to the level of strength the patient can apply and adjusts throughout the entire range. If the patient has little mobility in an injured limb, the machine will move the arm in continuous passive motion to increase stretching capability, stopping when it detects resistance from the patient.

Viewing an attached monitor, patients see the results of their efforts, a technique known as biofeedback. For example, the monitor can display the number of repetitions that have been done and graph other indicators, such as resistance, for the patient.

Mrs. Smyth can also work with the patient to do more upper extremity strengthening. The Lido Workset provides objective testing of muscle strength and can provide resistance measured from ounces up to 1200 pounds. The new Lido Workset will serve a majority of the Knox Orthopaedics occupational therapy patients, according to Dr. Knox, surgeon. "It will be useful with up to 75 percent of our occupational therapy patients," he said.

Knox Orthopaedics will use the machine in its therapy with athletes, also, because the Lido Workset is able to simulate the motions of throwing a baseball or football and other arm motions often repeated in popular sports. It will also do a specific exercise for a specific motion, measure the patient's performance, and give the patient feedback.

Staff

Knox Orthopaedics Hand Therapy Center staff includes a licensed and registered therapist, Melissa Smyth, OTR/L, who graduated from Northeast Louisiana University with a B.S. in Occupational Therapy in 1989. She has had extensive experience in the field of industrial medicine/rehabilitation and has since specialized in the field of hand therapy. She has been in the hand therapy field since 1990 with a practice emphasis in trauma care (such as amputations and replantations) and with multiple trauma cases.