Department of Occupational Science and Occupational Therapyspring, 2017

University of Southern California OT 573 Department of Occupational Science and Occupational Therapy Spring, 2017 Instructor: Lisa Deshaies, OTR/L, CHT

Principles of Hand Rehabilitation

Class Time and Location: Wednesday, 5:30-8:50 pm, CHP 111

Instructor Contact: Work E-mail [email protected] Home E-mail [email protected] Please e-mail to both addresses for the most immediate response.

Course Purpose: This introductory course is an elective and can be applied toward the 12-unit elective requirement for the Master of Arts in Occupational Therapy. This course will explore occupation-based evaluation and treatment for individuals with common hand disorders. Through lecture, lab, small group work, and class discussions, this course will emphasize functional anatomy of the hand and will promote sound clinical reasoning skills based on consideration of key anatomical principles and patients’ occupation goals.

This course will begin with reflective exercises and discussion related to the beauty and complexity of hand function and the symbolic nature of hands. A strong foundation of forearm, wrist, and hand anatomy, kinesiology, and physiology will be built over several weeks utilizing lecture, videos, and lab activities. This will be followed by diagnostic-specific sessions where anatomy will be integrated along with evaluation and treatment techniques. Throughout this course, occupation-based, patient-centered, and evidence-based approaches will be emphasized. The student will appreciate that, although quite specialized, hand therapy is not a discipline unto itself. It is through a balance of science (tissue-specific treatment) and art (core occupational therapy premises) that Occupational Therapists provide the most effective hand rehabilitation.

Course Objectives: 1. Understand anatomy, kinesiology, and physiology of the forearm, wrist, and hand. 2. Recognize a variety of evaluation and treatment modalities commonly used in hand rehabilitation. 3. Demonstrate clinical reasoning skills based on key anatomical principles and patient factors when planning evaluation and treatment for commonly seen hand conditions. 4. Understand the value of a patient-centered and occupation-based approach and identify means to apply it in hand rehabilitation. 5. Identify resources for future reference and further study. Statement for Students with Disabilities: Any student requesting academic accommodations based on a disability is required to register with Disability Services and Programs (DSP) each semester. A letter of verification for approved accommodations can be obtained from DSP. Please be sure the letter is delivered to me (or to TA) as early in the semester as possible. DSP is located in STU 301 and is open 8:30 a.m.–5:00 p.m., Monday through Friday. The phone number for DSP is (213) 740-0776.

Statement on Academic Conduct: Plagiarism – presenting someone else’s ideas as your own, either verbatim or recast in your own words – is a serious academic offense with serious consequences. Please familiarize yourself with the discussion of plagiarism in SCampus in Section 11, Behavior Violating University Standards https://scampus.usc.edu/1100-behavior-violating-university-standards-and-appropriate-sanctions/. Other forms of academic dishonesty are equally unacceptable. See additional information in SCampus and university policies on scientific misconduct, http://policy.usc.edu/scientific-misconduct/.

Discrimination, sexual assault, and harassment are not tolerated by the university. You are encouraged to report any incidents to the Office of Equity and Diversity http://equity.usc.edu/ or to the Department of Public Safety http://capsnet.usc.edu/department/department-public-safety/online-forms/contact-us. This is important for the safety whole USC community. Another member of the university community – such as a friend, classmate, advisor, or faculty member – can help initiate the report, or can initiate the report on behalf of another person. The Center for Women and Men http://www.usc.edu/student- affairs/cwm/ provides 24/7 confidential support, and the sexual assault resource center webpage [email protected] describes reporting options and other resources.

Support Systems: A number of USC’s schools provide support for students who need help with scholarly writing. Check with your advisor or program staff to find out more. Students whose primary language is not English should check with the American Language Institute http://dornsife.usc.edu/ali, which sponsors courses and workshops specifically for international graduate students. The Office of Disability Services and Programs http://sait.usc.edu/academicsupport/centerprograms/dsp/home_index.html provides certification for students with disabilities and helps arrange the relevant accommodations. If an officially declared emergency makes travel to campus infeasible, USC Emergency Information http://emergency.usc.edu/ will provide safety and other updates, including ways in which instruction will be continued by means of blackboard, teleconferencing, and other technology.

Required Readings: Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity (2 nd ed.), by C. Cooper, 2014, Elsevier, ISBN: 978-0-323-09104-6, available from USC Bookstore, Health Science Campus. Additional reading to be provided.

Expectations for Readings: The syllabus clearly identifies required readings. Readings are due prior to class and are viewed as a support for in-class material. In many cases, the student will NOT be able to participate in class without completing the required readings. Assignments: The syllabus clearly identifies assignments. Assignments are due the following class unless otherwise instructed.

Expectations for Participation: It is expected that all students will actively participate in and attend each class unless there is an excused absence or illness.

Instructor’s Role: The role of the instructor is to present course material, lead discussions, be available to answer questions, and provide a supportive environment to facilitate student learning.

Class Schedule:

Week 1 January 11  Course Overview  Introduction to Hand Rehabilitation  Introduction to Occupation-Based and Patient-Centered Care in Hand Rehabilitation

Required Reading: None

Assignment: None

Week 2 January 18  Clinical and Occupation-Based Evaluation of the Hand

Required Reading:  Fundamentals of Hand Therapy, Chapter 13, “Fundamentals of Client-Therapist Rapport”  Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper Extremity”  Rehabilitation of the Hand and Upper Extremity, Chapter 6, “Clinical Examination of the Hand”

Assignment: None

Week 3 January 25  Functional Anatomy of the Wrist and Hand

Required Reading:  Rehabilitation of the Hand and Upper Extremity, Chapter 1, “Anatomy and Kinesiology of the Hand”  Fundamentals of Hand Therapy, Chapter 2, “Functional Anatomy”

Assignment: None Week 4 February 1  Functional Anatomy of the Wrist and Hand

Required Reading:  Rancho Los Amigos Functional Anatomy of the Wrist and Hand

Assignment: “Functional Anatomy Study Questions I”, 1-5

Week 5 February 8  Functional Anatomy of the Wrist and Hand

Required Reading:  Fundamentals of Hand Therapy, Chapter 1, “Fundamentals: Hand Therapy Concepts and Treatment Techniques”  Fundamentals of Hand Therapy, Chapter 38, “Preventing and Treating Stiffness”

Assignment: “Functional Anatomy Study Questions I”, 6-10

Week 6 February 15  Peripheral Nerve Problems

Required Reading:  Fundamentals of Hand Therapy, Chapter 24, “Peripheral Nerve Problems”  Fundamentals of Hand Therapy, Chapter 5, “Evaluation of the Hand and Upper Extremity”

Assignment: None

Week 7 February 22  Arthritis

Required Reading:  Fundamentals of Hand Therapy, Chapter 33, “Arthritis”

Assignment: “Arthritis Case Studies”

No class March 1, March 8, March 15 Week 8 March 22  Wound Healing and Scar Management

Required Reading:  Fundamentals of Hand Therapy, Chapter 21, “Wound Care”  Fundamentals of Hand Therapy, Chapter 34, “Burns”

Assignment: “Functional Anatomy Study Questions II”, 1-5

Week 9 March 29  Digital Splinting and Casting

Required Reading:  Fundamentals of Hand Therapy, Chapter 7, “Orthoses: Essential Concepts”  Introduction to Splinting, Chapter 11, “Orthotics for the Fingers”  Rehabilitation of the Hand and Upper Extremity, Chapter 125, “Tissue Remodeling and Contracture Correction Using Serial Plaster Casting and Orthotic Positioning”

Assignment: Complete fabrication of thermoplastic “gutter splint” and plaster “digital cast” Assignment: Complete “Hand Observation Log”

Week 10 April 5  Tendon Injuries

Required Reading:  Fundamentals of Hand Therapy, Chapter 30, “Flexor Tendon Injury”  Fundamentals of Hand Therapy, Chapter 31, “Extensor Tendon Injury”

Assignment: “Functional Anatomy Study Questions II”, 6-10

Week 11 April 12  Edema Management  Physical Agent Modalities

Required Reading:  Fundamentals of Hand Therapy, Chapter 3, “Edema Reduction Techniques: A Biologic Rationale for Selection”  Rehabilitation of the Hand and Upper Extremity, Chapter 117, “The Use of Physical Agents in Hand Rehabilitation”  American Journal of Occupational Therapy, “Physical Agent Modalities: Developing a Framework for Clinical Application in Occupational Therapy Practice” Assignment: None Week 12 April 19  Occupation-Based Practice in Hand Therapy

Required Reading:  Fundamentals of Hand Therapy, Chapter 16, “Narratives in Hand Therapy”  Occupational Science for Occupational Therapy, Chapter 27, “The Use of Occupation in Hand Therapy”  OT Practice, “Hand Rehabilitation: Matching Patient Priorities and Performance with Pathology and Tissue Healing”  OT Practice, “Occupation-Based Treatment in Physical Disabilities”  OT Practice, “Symbolic Aspects of Hand Therapy”  OT Practice, “Clinical Reasoning and Occupation-Based Practice: Changing Habits”  OT Practice, “Renaissance Occupational Therapy and Occupation-Based Hand Therapy”  OT Practice, “Occupation-Based Hand Therapy and the Occupational Therapy Practice Framework”  American Journal of Occupational Therapy, “Embracing Our Ethos, Reclaiming Our Heart”  American Journal of Occupational Therapy, “Documenting Progress: Hand Therapy Treatment Shift from Biomechanical to Occupational Adaptation”

Assignment: None

Week 13 April 26  Evidence-Based Practice and Outcomes in Hand Therapy  Professional Resources  Hand Therapy Certification  California Licensure Regulations for Advanced Practice Approval

Required Reading:  Fundamentals of Hand Therapy, Chapter 8, “Assessment of Functional Outcomes”  Journal of Hand Therapy, “An Introduction to Evidence-Based Practice for Hand Therapists”  OT Practice, “Evidence-Based Practice: What Can It Mean for Me?”  OT Practice, “Measuring Occupational Performance”  American Journal of Occupational Therapy, “Outcomes in Hand Rehabilitation Using Occupational Therapy Services”  American Journal of Occupational Therapy, “Adaptation to Hand Injury: An Evolving Experience”

Assignment: “Summative Experience Paper” due 5/3/17 Assignment Descriptions:

“Functional Anatomy Study Questions I”: Each student will answer all ten questions in as much detail as possible, including references to justify your answers. This assignment is worth 20% of the overall grade.

“Arthritis Case Studies”: Each student will complete with as much detail as possible, including rationale and references to justify your answers. This assignment is worth 10% of the overall grade.

“Functional Anatomy Study Questions II”: Each student will answer all ten questions in as much detail as possible, including references to justify your answers. This assignment is worth 20% of the overall grade.

“Gutter Splint” and “Digital Cast”: Each student will complete fabrication, be able to describe how the splint and the cast work, and be prepared to state two clinical indications for using this splint and cast. This assignment is worth 20% of the overall grade.

“Hand Observation Log”: Each student will observe ten persons of varying age performing an occupation. Impressions related to hand function will be recorded and a verbal summary may be shared with the class. This assignment is worth 10% of the overall grade.

“Summative Experience Paper”: Each student will submit a three-page paper reflecting on lessons learned from class and about balancing the science of tissue-specific treatment and the art of core occupational therapy premises to promote effective hand rehabilitation. This assignment is worth 20% of the overall grade.

All assignment materials will be distributed in class by course instructor.

Assignment Grading: Each assignment will be graded. Students must earn a grade of 80% or better to get credit for the course. A grade of below 80% will earn a “No Credit” grade. Missing assignments will not be awarded points. Late assignments will be marked down 5 points for each day late. References: Abrahams, P.H., Hutchings, R.T., & Marks, S.L. (2003). McMinn’s Color Atlas of Human Anatomy (5th ed.). St. Louis, MO: Mosby. Acland, R.D. (1996). The Video Atlas of Human Anatomy, Tape 1: The Upper Extremity. Baltimore, MD: Williams & Wilkins. American Society of Hand Therapists. (2015). Clinical Assessment Recommendations (3rd ed.). Chicago, IL: American Society of Hand Therapists, Inc. Bracciano, A.G. (2008). Physical Agent Modalities: Theory and Application for the Occupational Therapist (2nd ed.). Thorofare, NJ: Slack. Brand, P.W., & Hollister, A.M. (1999). Clinical Mechanics of the Hand (3rd ed.). St. Louis, MO: Mosby. Burke, S.L., Higgins, J., McClinton, M.A., Saunders, R., & Valdata, L. (2006). Hand and Upper Extremity Rehabilitation (3rd ed.). New York, NY: Churchill Livingstone. Cannon, N.M. (Ed.). (2001). Diagnosis and Treatment Manual for Physicians and Therapists (4th ed.). Indianapolis, IN: Hand Rehabilitation Center of Indiana. Colditz, J.C. (2001). The Hand: An Interactive Study for Therapists. Bethesda, MD: American Occupational Therapy Association. Cooper, C. (Ed.). (2014). Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity (2nd ed.). St. Louis, MO: Elsevier. Coppard, B.M., & Lohman, H. (2015). Introduction to Orthotics: A Clinical Reasoning and Problem- Solving Approach (4th ed.). St. Louis, MO: Mosby. Fess, E.E, Gettle, K.S., Philips, C.A., & Janson, J.R. (Eds.). (2005). Hand and Upper Extremity Splinting: Principles and Methods (3rd ed.). St. Louis, MO: Mosby. Hentz, V.R., & Chase, R.A. (2001). Hand Surgery: A Clinical Atlas. Philadelphia, PA: W.B. Saunders. Jacobs, M.A., & Austin, N.M. (Eds.). (2013). Orthotic Intervention for the Hand and Upper Extremity: Splinting Principles and Process (2nd ed.). Baltimore, MD: Lippincott Williams & Wilkins. Malick, M.H., & Kasch, M.C. (Eds.). (1984). Manual on Management of Specific Hand Problems. Pittsburgh, PA: AREN Publications. McKee, P., & Morgan, L. (2010). Orthotics in Rehabilitation: Splinting the Hand and Body (2nd ed.). Philadelphia, PA: F.A. Davis. Michlovitz, S.L., Bellew, J.W., & Nolan, T. (Eds.). (2012). Modalities for Therapeutic Intervention (5th ed.). Philadelphia, PA: F.A. Davis. Pierce, D.E. (Ed.). (2014). Occupational Science for Occupational Therapy. Thorofare, NJ: Slack. Prosser, R., & Conolly, W.B. (Eds.). (2003). Rehabilitation of the Hand and Upper Limb. Edinburgh: Butterworth-Heinemann. Skirven, T.M., Osterman, A.L., Fedorczyk, J.M., & Amadio, P.C. (2011). Rehabilitation of the Hand and Upper Extremity (6th ed.). Philadelphia, PA: Mosby Elsevier. Tubiana, R., Thomine, J., & Mackin, E. (1996). Examination of the Hand and Wrist. St. Louis, MO: Mosby. Weiss, S., & Falkenstein, N. (2013). Hand and Upper Extremity Rehabilitation: A Quick Reference Guide and Review (3rd ed.). St. Louis, MO: Elsevier. Wolfe, S.W., Hotchkiss, R.N., Pederson, W.C., & Kozin, S.H. (Eds.). (2010). Green’s Operative Hand Surgery (6th ed.). Philadelphia, PA: Churchill Livingstone. Advance for Occupational Therapy Practitioners. King of Prussia, PA: Merion. American Journal of Occupational Therapy. Bethesda, MD: American Occupational Therapy Association. Journal of Hand Therapy. Philadelphia, PA: Hanley and Belfus. OT Practice. Bethesda, MD: American Occupational Therapy Association.