Understanding of People Vital to
Success of Hand Therapist

o be a good hand therapist, you need to figure out patients quickly, according to Becky Nelson, OTR, a specialist in hand therapy at the Baptist Medical Center Rehabilitation Pavilion.

"We make good use of all the psychology courses we are required to take in college," she said. "I must consider a variety of factors, such as, How aggressive can I be with this person? How much soothing will he or she need? How can I build up confidence and assure him or her that everything will be all right? How much education does this patient need?"

"People are naturally very protective of their hands, and often what I have to do is convince them it's not only okay, it's good for them to go ahead and use that finger or hand, even if they've just had surgery," Nelson said.

She encounters the occasional malingerer, but treats such a patient no different than others. "You can't make someone progress who has no interest. They have to work with you."

Self-employed people pose yet another challenge because they usually want to do as much as possible in the least amount of time. "In their rush to get better," she said, "they can be too aggressive. The challenge is to keep them within the guidelines."

Nelson is the first medical specialist many patients see following surgery. "After trauma, whether it comes from surgery or an injury, the brain perceives movement as pain. It's my job to help them work through the pain and to start moving their hand or wrist, in spite of pain. Often I have to convince patients that this won't harm injured tissue. They naturally want to be very protective of that hand or wrist," she said.

Nelson loves the challenge of hand therapy. "Every injury is different," she said. "You constantly problem solve. For me, the greatest reward is this challenge. I don't think other areas of therapy have as much variety."

At any given time, her caseload may include tendon lacerations; hand, finger, forearm, wrist, and elbow fractures; tendinitis; crush injuries; nerve compression; and arthritis. During the winter she sees a few ski injuries.

Typically, she works about a month with a patient. "That's ideal," she said. "It takes that long to get everything calmed down. If we don't see improvement by then, I refer them back to their physician. If they have not had some kind of surgery, it's a t that point their physician my decide it's time to try it."

Depending on the injury, she works with patients on such issues as controlling pain, reduction of swelling, range of motion, strengthening, and scar management. At the same time, Nelson evaluates what caused the problem: Is it job related? Leisure related? If it was caused by a particular activity, she begins seeking ways to teach patients to modify the responsible activities so they do not constantly re-irritate an injury.

Nelson sees some patients within a day or two of surgery and doesn't see others for several weeks. Sometimes that span of time is for the very same type of injury of surgery. "When I get involved depends on their physician," she said.

"If the patient is seeing a hand surgeon, for example, I usually begin working with them sooner than if they see a general surgeon. Hand surgeons are usually more aggressive in their techniques and want their patents to start therapy as soon as possible."

Just recently Nelson treated two men with the same type of flexor tendon injury. One was operated on by a hand surgeon, the other by a general surgeon. She began therapy with the hand surgeon's patient two days after his surgery. The other man was in a cast for four weeks before starting therapy.

"You're going to get better results the sooner you get that hand moving," Nelson said. "It's frustrating when you feel the patient could be doing better, and you can't do anything about it."

Another frustration is trying to teat patients within the guidelines established by insurance companies. "When I have a new patient with pain and swelling, for optimal treatment I should see him or her three times a week, but often it's only twice because that's all the insurance allows. I must often justify to case managers why a patient needs more therapy than they're allowed, These days, we have more paperwork than ever to complete. These business tasks are the downside of this job," she said.

"But the people more than make up for it. The really great patients, and there are plenty of them, make it all worthwhile."

For selected articles from previous issues of "On Track" and other publications, visit the Orthopaedic Health Library.

Return to "On Track" Spring 2000