Patty Chichester, OTR/L, performing hand therapy


Sustaining an injury to the upper extremity or hand can severely affect a person’s ability to complete everyday tasks, such as getting dressed, eating, or performing a task at work.


For this reason, some patients require treatment from occupational therapists that specialize in hand therapy.


“People might be surprised by how many different reasons a client might be referred to see an occupational therapist in outpatient therapy,” said Patty Chichester,OT, who holds a certificate in Upper Quarter Specialization from Hahnemann University Hospital. “ In a typical day, I may work with a client who is a stroke survivor working on regaining upper extremity use, a 5th grader working on developmental skills like writing, cutting with scissors, fine motor tasks, tying shoes, eye and hand skills, or a client with arthritis referred for custom splinting and to learn about adaptive equipment or techniques to help do their daily activities more independently or with less pain.”

Patty Chichester demonstrates a strengthening exercise.


In addition to hand therapists, some OTs continue their education and training to become certified hand therapists. These therapists specialize in treating hand, wrist, elbow, and shoulder injuries.


Amanda Duboys, who works at Bacharach’s Linwood satellite, began her career as an occupational therapist in 2003 and became a certified hand therapist in 2009.

Amanda Duboys, OTR/L, CHT

“I like the intricacies of the hand,” said Duboys. “People don’t realize how an injury to any particular finger can really affect their daily function. To assist patients to regain use of their hand and fine motor skills is so great to be a part of.”


Similar to Duboys, LauraLee Smith OTR/L,CHT, who works in the Galloway therapy center, became interested in hand therapy because of the science involved with the specialty.


Laura Lee Smith with several patients.


“I enjoyed learning about the science of hand therapy. The study of nerves, tendons, and muscles – starting in the neck down,” she said. “I enjoy working closely with the surgeons, seeing complex injuries of the arm and hand and the reconstruction of nerves.”


Smith said one of the most interesting cases she has worked on involved a child who was born without a thumb and had her index finger repositioned.


“I worked with her post-surgey,” she recalled. “ After three months, she was able to feed herself and hold toys  and crayons.”


What makes hand therapy different from other specialties is that therapists often get the opportunity to follow their patients all the way through their journey, from surgical intervention through the recovery and rehabilitation process. Because hand therapists and certified hand therapists work so closely with their patients, they are able to customize their rehab plans and techniques based on the patient’s individual needs and goals.


“I often meet clients at the beginning of their rehab process and I get to learn about them, not just why they were referred but how the injury or condition may be altering their ability to do things independently,” explained Chicester, adding that she finds it rewarding to celebrate with her patients once they improve their level of function. “Often they have been through a traumatic event and it is a scary, sometimes vulnerable and physically painful time for them. As the days go by, I see how hard they work, physically and mentally, to recover and adapt.”


Duboys also enjoys helping patients, especially those with distal radius fractures (also known as a wrist fracture, recover.


“They come in with limited range of motion, very stiff, swollen, with scar adhesions, and weak overall,” she said. “These patients usually progress gradually week to week and, most of the time, can make a full recovery returning to their previous activities.”


Smith, who has practiced occupational therapy for 31 years and hand therapy for 18, said the techniques used have changed a lot over the years, enabling patients to recover in a faster period of time.


“There are better surgical techniques now,” said Smith. “Splinting is not as extravagant and casting is not as stiff, so we are able to move patients along faster. We experience better outcomes due to early intervention.”


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