Could Your Patient Benefit From Hand Therapy?
By: Alex Strauss
Kendra Harms, MOTR/L, CHT, knew that she wanted to be a hand therapist, a highly-specialized and highly-competitive subspecialty area of occupational therapy, from her first encounter with a patient whose hands had been disabled by a stroke.
“This patient had been a seamstress for the opera and had had some high end jobs,” recalls Harms. “I remember sitting with her as she brought out a book of pictures of some of the beautiful gowns that she had made and she began to cry, realize that she may never be able to perform that part of her life again.”
To achieve certification, a hand therapist must work in the field for at least five years before sitting for an exam that historically has just a 40 percent pass rate. Harms, an OT by background, is one of just 5,300 certified hand therapists worldwide and one of six in Sioux Falls. As part of the Hand Clinic at Orthopedic Institute, Harms work with another hand therapist, an occupational therapist, and OI surgeons to restore functional use to hands impacted by conditions such as
- Rheumatoid arthritis
- Congenital deformities
- Traumatic amputations or injuries
- Wounds and infections
- Joint replacement
- Carpal tunnel syndrome
- Stroke-related contractures
- Postoperative rehabilitation
“Our training is from the cervical spine all the way down, although we typically leave difficult shoulders to our physical therapists,” says Harms. “Any condition that affects the upper extremities should be seen by a certified hand therapist. We have an extensive evaluation process to determine if hand therapy could help them.”
Her patients range from infants to the elderly and are typically referred by rheumatologists, pediatricians, chiropractors and other specialists across a five-state area. Sometimes, Harms says patients end up at the Hand Clinic after being seen by several other doctors who were uncertain about how to handle their case.
“It is surprising how many patients we have that have had multiple surgeries or multiple therapies,” says Harms. “Some just want to be able to play golf again. Others are serious athletes who want to get back to gymnastics or football. My job is never boring because every patient is so different.”
Unlike other body parts with fewer bones and less complex vasculature, Harms says injured hands often require several surgeries, going through stages of repair and therapy. In these cases, a hand therapist may work closely with the surgeon and the rest of the clinical team to create a customized therapy plan. If that plan includes a splint, Harms and her colleagues offer custom splint fabrication. These moldable plastic splints are removable to allow for postoperative wound care.
“You have to apply the appropriate postoperative protocol, protecting certain things while moving others,” says Harms. “These custom splints allow us to help do that. No other practice does that but certified hand therapy.”
While Harms says she loves the challenge of complex medical cases, the best thing about her job is the satisfaction of seeing function restored.
“It is great to see someone go from disability back into life,” she says. “People come to us in a really vulnerable place and we are able to help them, literally hand-in-hand, walk through the process of regaining function.”
“You get to know people, sitting two feet away from them for months. When someone comes back and says, ‘I finally went fishing again and caught my first walleye!’, it feels so rewarding.”