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Giving patients a hand

Posted by on Tuesday, May 31, 2011 in Features, June 2011.

photograph by Anne Rayner

The human hand has five digits, 27 bones, and a complicated system of nearly 80 tendons and muscles, and Peggy Haase and Skip Brown have spent the last 20 years caring for each and every one of them.

Haase and Brown were the first occupational therapists at Vanderbilt University Medical Center to become certified hand therapists, taking the credentialing exam in its inaugural year in 1991.

“I wanted to be more knowledgeable and have a credential that reflected that I knew more about how to treat a hand than the average O.T. There wasn’t anybody pushing us to do it,” Brown said.

“We were already the hand experts,” Haase added. “This was an opportunity we seized to learn more and be recognized for our expertise.”

“I have worked with Peggy for the last six years and I am still in awe of her abilities as a therapist. She has literally worked miracles for our patients and she is a true asset to our institution,” said Wesley Thayer M.D., Ph.D., assistant professor of Plastic Surgery. “Skip has great technique and he develops strong, trusting relationships with his patients. The patients that see him love his work, and I know that they are receiving excellent care.”

Haase first heard about occupational therapy at a high school career fair, and then trained at the University of Florida. On her first job out of college in Knoxville, she started working with a hand surgeon, decided to specialize in hand therapy, and became a founding member of the American Society of Hand Therapists. When the job for an occupational therapy hand therapist opened at Vanderbilt in 1983, she came to Nashville.

To restore and return

“The goal of an occupational therapist is to restore and return people to all their daily activities and occupations. Most hand therapists are intrigued with the anatomy and the science of the hand and upper extremity and also love the art of what we do with splinting and motivating patients,” Haase said.

Brown started with a career in counseling, but a fracture in his ring finger required occupational therapy and the burned-out counselor decided it was time for a new field. He trained at Texas Women’s University, a branch of Texas A&M that admitted males to health sciences programs, and then started at Vanderbilt in 1984. His interest in hand therapy was piqued on the burn unit because so many burn patients have hand injuries from trying to protect themselves.

The floor above the burn unit housed the outpatient hand clinic at that time, and Brown would help out when they got busy, receiving impromptu lessons on splinting and protocols for different injuries. He eventually moved to the clinic full-time.

“Unless you understand the mechanics of the hand, it’s hard to explain how important it is,” he said. “It’s very intricate with all the muscles and all the synergy that is involved in the hand doing all that it does. Your hand is how you experience your environment.”

When they learned that the first credentialing examination for hand therapy would be offered, Haase and Brown studied hard, nearly every day for eight months in advance and traveled for review courses.

“I felt like I knew everything until I took the practice test. I was arrogant and cocky but was humbled big time. I didn’t realize how much stuff I didn’t know,” Brown said.

But they both passed, becoming the first certified hand therapists at VUMC.

Today’s certified hand therapist exam is administered by the Hand Therapy Certification Commission and entails five years of practice as a physical or occupational therapist plus 4,000 hours of direct practice experience in hand therapy. Recertification is required every five years.

In search of “maximum functional use”

Much has changed in hand therapy over the past 20 years, as surgeons’ techniques improve and new research leads to better protocols.

“When Skip and I first started working in hand therapy, the hand injury patients would be kept in the hospital for two or three weeks easily at a time. They’d bring them to us one or two times during the day. Now everything is done primarily outpatient,” Haase said.

Hand injuries have also changed over the years. They originally saw many machinery injuries – hands mangled in a punch press machine, for example – but government workplace safety regulations have prevented many of those accidents. Now there is more automobile trauma.

Haase and Brown both agree that the socializing is the best part of the job, whether with surgeons, other therapists, or their patients.

“I feel like a bartender,” Brown said. “People pull up a chair and sit down in front of you and tell you stuff you never want to hear. Their encounter with the doctor is pretty short; we’re the ones they spend all their time with, and they’ll talk with us about just about anything.”

“We’re often like life coaches,” Haase added. “One of the things that intrigues me is that everybody is different. I love to see that individual response to an injury or trauma. It’s also fun to work with patients to get the maximum functional use.”

Haase and Brown also relish the three months they spend teaching occupational therapy students rotating through the hospital.

“They keep us sharp because they ask why we do something. We just think of it as something we’ve always done and do it by rote, but they make us think about why,” Brown said. “There are three former students of mine who now work here at Vanderbilt, so it is fun to see them around the hospital. We feel like we’ve passed it along a little bit.”