THE HISTORY OF HAND THERAPY AND HAND rehabilitation began during World War II when the Surgeon General, Major General Norman T. Kirk, determined that severe hand injuries and surgeries were worthy of specialized treatment. This led to the development of nine “hand centers” in select military hospitals across the country where officers trained in plastic, orthopedic, and neurologic surgery were designated to repair wounded hands. These surgeons realized that postoperative therapy was as critical to recovery and socioeconomic well-being as the surgery itself and worked closely with therapists to develop specialized protocols and technical manuals to manage this patient population.
By the mid-1970s, there were occupational and physical therapists in the United States and Canada who were only treating patients with upper-quarter injuries. About that time, a group of six occupational and physical therapists joined together and created the American Society of Hand Therapists (ASHT). In 1984, ASHT established a certification committee to develop a framework for hand therapy certification. This committee discovered guidelines established by the National Organization for Competency Assurance (NOCA) for organizations who offer professional certifications. This led to the first practice analysis, which formed the basis of the scope of practice. The results of the practice analysis were subsequently used to develop the original blueprint for the certification examination (which determined the percentage of content included in the examination). In 1987, ASHT voted to move forward with a hand therapy certification, and the first exam was administered in 1991, which marked the first cohort of Certified Hand Therapists (CHTs).
One of the NOCA guidelines for certification programs is administrative independence, meaning that an organization should not certify its own members. This led to the incorporation of the Hand Therapy Certification Commission (HTCC), which functions administratively as a separate entity from ASHT. In 2008, HTCC conducted a detailed practice analysis of CHTs in the United States and Canada, and from this analysis the current definition and scope of practice for hand therapy was established.
“Hand therapy is the art and science of rehabilitation of the upper limb, which includes the hand, wrist, elbow and shoulder girdle. It is a merging of occupational and physical therapy theory and practice that combines comprehensive knowledge of the structure of the upper limb with function and activity. Using specialized skills in assessment, planning and treatment, hand therapists provide therapeutic interventions to prevent dysfunction, restore function and/or reverse the progression of pathology of the upper limb in order to enhance an individual's ability to execute tasks and to participate fully in life situations.”1,2
To become a CHT, a licensed physical or occupational therapist must have a minimum of 3 years of clinical experience, including 4,000 hours or more of direct practice in hand and upper extremity therapy. In addition, the CHT candidate must successfully pass a comprehensive examination of advanced clinical skills and theory in upper-quarter rehabilitation. Because of changes in ...