Hand therapy as a specialty area is typically considered an orthopedic practice setting where therapists work with individuals who have conditions or trauma affecting the shoulder, elbow, wrist and hand, noted Debbie Amini, EdD, OTR/L, CHT, assistant professor of occupational therapy at East Carolina University in Greenville, NC.
"The goal is to improve the ability of the client to engage in all activities that are meaningful and relevant to them within the context of their lives," she explained.
Since the certified hand therapist (CHT) was first designated as a credential in 1991, the Hand Therapy Certification Commission has strongly advocated for and marketed this credential to physicians and various practices that care for clients with hand and upper extremity concerns. For this reason, the CHT designation has become a way for a clinician interested in working in these areas to market themselves.
"According to the originators of this credential, individuals who have passed the certification examination have a demonstrated level of expertise with this client population," said Amini.
A 'Highly-Desirable' Credential
The Certified Hand Therapist credential is both voluntary and difficult to attain. To receive a CHT, an OT or PT who has been a licensed clinician for five years and has documented 4,000 hours treating hand therapy clients can then sit for a four-hour certification examination which costs approximately $500.
"Only about 50% of people pass," said Steven Kremer, OT, CHT, occupational therapist at Contact Physical Therapy.
Why then would an OT choose to acquire the advanced study and training that is required to pass the certification examination? Recognition of your proficiency, responded Kremer. "It is much easier to get jobs in hand therapy with the credentials," he added.
The credential signifies you have achieved a higher level of proficiency/knowledge in the treatment of significant hand and arm injuries. Many CHTs have even treated patients from out of state simply because someone searched out a CHT, said Kremer.
"In the medical community, it is recognized as highly desirable. Depending on where you work, you might be in line for a promotion or raise," he commented.
If a clinician has the time, ambition and money to go forward with this process, there are no downfalls, said Amini.
Benefits & Barriers
Because OTs must maintain 80+ hours of continuing education focused on upper extremity treatment every five years, Katherine Russo, OTR/L, CHT, senior occupational therapist at Massachusetts General Hospital in Boston, noted that opting to pursue the credential inherently leads to advanced clinical knowledge in a specialized field, further understanding of anatomy in regards to tissue/bone healing, how to apply protocols, and how to modify protocols based on the clinical presentation.
Other benefits include a larger referral base from physicians (credentialed OTs are listed in a national database) and a higher probability of getting hired to work in a hand/upper extremity practice.
Conversely, Russo says OTs may choose not to pursue certification for various reasons, including, lack of time and/or money to keep up with studying for the exam, and maintaining continuing education hours.
"They might not want to pursue certification if hand therapy is not going to be their primary practice area," she said.
Kremer concurred that time and resources are barriers for some OTs.
"You have to put in significant time to study. You need regular access to hand therapy patients to get the number of hours you need. There is a cost to take the exam. There is no guarantee you will pass," he explained.
Those who opt to put in the time, however, will be rewarded, Kremer believes.
"The work it takes to study and get ready helps to improve your skills," he said.
A Personal & Professional Accomplishment
OTs specializing in hand therapy treat many conditions affecting the upper extremity. The list can be quite long, noted Kremer, and includes ligament sprains, muscle strains, fractures, nerve compression, nerve lacerations, tendon rupture/tear/laceration, osteoarthritis, rheumatoid arthritis, joint arthroplasty, tendonitis, synovitis, neuromuscular diseases, joint instability, amputations, soft tissue crush injuries, animal or human bites, infections, burns, upper extremity issues caused by auto-immune disorders, congenital anomalies, Dupuytren's disease, and other rare genetic issues such as epidermolysis bulosa.
"Some but not all also work with shoulder injuries, such as rotator cuff injuries, labrum injuries (SLAP tears, Bankhart lesions), adhesive capsulitis and partial or full joint replacement," he said.
And the need for therapists specializing in treatment of the hand and upper extremity looks like it will continue to grow. Use of the computer seems to have caused an increase in overuse injuries, believes Kremer. "There is a possibility in the future that the significant increase in use of thumbs with handheld devices and computer games will cause an increase in hand pain in the general population," he said.
Kremer considers becoming a CHT a gratifying accomplishment, both personally and professionally.
"I have been asked to talk at doctor's offices and conferences for a variety of hand and arm issues. Professionally, it just opens doors," he concluded.
Beth Puliti is a frequent contributor to ADVANCE.