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Why Apex Hand Therapy?

October 31, 2013 at 12:12 AM

At Apex Hand Therapy only a Certified Hand Therapist (CHT) will treat you. We believe in early motion, patient education, patient privacy (separate treatment rooms of each patient), keeping exercises simple and direct one on one therapy sessions. I (Bharat Vallurupalli) worked in Vienna, VA with Dr. Thomas Shepler, M.D. (Hand Surgeon) for over 9 years and we shared a common hand therapy philosophy. Our philosophy in Dr. Shepler's words:

I have been very adamant about saving patients as well as insuring organizations money.  I basically try to teach patients things (hand therapy things) that they can do in any environment. I find that following several principles create good results.  We try to teach patients to self manipulate (passive motion) as well as actively manipulate their hand frequently (every hour that they are awake) in any environment feeling that frequency is a key component for recovery of a mobile extremity. We concentrate on motion first and strength second, feeling that loss of motion is a cause of pain and pain related to that loss can be reduced by regaining motion.  We feel that simplicity is a critical component of good hand therapy. I personally feel that most “modalities” (heat, cold, vibration, hot corn, hot wax, compression wraps, etc.) are expensive and a waste of time and hence we do not use them.  I honestly feel that some of the modalities became more popular as a way of augmenting income when the remuneration of hand therapist direct services was reduced.  Hand Therapy also becomes prohibitive financially when some poor sole has no insurance to bear these costs.

If modalities or special machines at the hand therapist facility are taught, promoted and/or used, patients tend to wait until they find “hot” or “cold” or some “vibration” before therapy and end up not doing the basic hourly passive and active range of motion exercises that one could do in any environment. We also try to never have the patient rely on another person to accomplish their therapy, which adds to delay since that other person may not be around the patient constantly throughout the rehabilitative time. Additionally, I rarely use any splint (dynamic, static progressive or static)Though in theory they are meant to augment and not substitute for conscious effort, inevitably the patient tends to rely on them too much and not do the basic range of motion exercises frequently.

I ran an orthopaedic residency training program and was shocked when I first came to the program to see how diminished many of the hand surgery results were. I thought at first the physician teaching staff was not close enough to the residents and the patients to influence their postoperative hand therapy and mobilization results. I then realized that the occupational therapist had dominated the hand therapy at my institution and that everyone seemed to be placed in a transition splint. We had a fantastically accomplished splint shop. When I stopped the transition and frequent use of splinting the results returned to the heights I was formally used to. It was quite a lesson for me. I also showed an occupational therapist from the Ray Curtis Hand institute in Baltimore our results w/o splinting and she was shocked at how good they were to the point that she wanted to write a book about her experience at the MANUS Center.

There are some uses of splinting but they are far from frequent in our practice. We also believe in very early motion and hence the theme is exactly that.  We also have close collaboration between doctor and therapist. To promote that conversation all therapy and return and new visits are done in one location not multiple ones scattered throughout geographic areas. I believe in doctor involvement in the postoperative period of hand rehabilitation because I believe that we (the doctors) can be very influential in outcomes. It also ratchets up the pressure on the patient to perform since they must face not only the hand therapist but also the doctor.  I also personally take range of motion on almost very visit for then this becomes a powerful motivational tool. What patient can argue with motion that show decline or progress when taken by the same person on every visit. So this allows me to have more authority with the patient since I have now clinical facts as to their progress.

Therefore, we have had in my opinion outstanding results that any patient, therapist and doctor can be proud of.  In my former center you would feel that the hand therapist is an integral part of rehabilitation to regaining maximal function. I feel that the “shake and bake” routines are very expensive.  I also feel that an hour spent doing various tasks on various gizmos is a waste. I find that the patients are kept busy, but do not get much attention from the therapist when a therapist is simultaneously seeing 4 patients. In effect they spent an hour in therapy but only get 15 minutes worth of therapist time. The costs become prohibitive and do not serve the rehabilitative field well. This is unfortunately a common practice. This did not occur at my former MANUS Center. The whole idea is to teach and coach the patient to do his/her own therapy and to then check on their efforts. So 15 minutes intensively spent is very accepted. I suspect no one can beat our results.

The result of this philosophy is excellent results that are cost effective and an excellent ethical reputation with patients and insuring organizations. This approach without modalities obviously diminishes our income. If you were to visit my former facility you would find the hand therapy area though pleasant and spacious, it is simple and not filled with all kinds of machines that patients can only use when they are on the premises. Our results are obvious since they are motion related and documentable. We time after time get many thanks from our patients.  I hope this philosophy is helpful to you as well. It worked for me for 36 years of clinical practice.