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Occupational Therapy


What is occupational therapy?
What do occupational therapists do?
How can occupational therapy help my child with a hand anomaly?
When should my child start receiving occupational therapy services?
How do I find an occupational therapist?
Will insurance cover occupational therapy services?
Are there other types of therapy services that my child may need?
My child’s pediatrician says that she is doing just fine. Does that mean that s/he doesn’t need occupational therapy?


What is occupational therapy?

Occupational therapy (OT) helps people to be as functional as possible, despite physical or mental limitations. There are two primary ways that OT can improve people’s lives. The occupational therapist (OT) can adapt the person’s environment, such as replacing round door knobs with lever door handles, or teach the person strategies to simplify or make a task easier to perform, such using more efficient movements when handwriting. Or, the OT can teach a person new skills that enable him to be more independent or reach a developmental milestone, such as helping a child to learn how to use a pincer grasp to pick up finger foods. Sometimes the OT instructs the client how to strengthen a part of the body so that the person is better able to accomplish a task without adaptations. For example, the OT may create an exercise program for someone with weak arm muscles, so that the person can be more active.

An additional way that OT helps people is through pain management strategies. This can include teaching a child better ways to use his body, or creating splints to hold his fingers in a resting position.

To find out more about OT, visit the website of the American Occupational Therapy Association (AOTA) and click on Consumers (at the top).


What do occupational therapists do?

Based upon their training in human anatomy and physiology, knowledge of various disabilities and diseases human development, psychology, adaptive technology, and standardized and non-standardized assessments of functioning, OTs evaluate their clients’ functional abilities and limitations in a number of different settings and roles. For example, the OT may look at how the person functions in school, home, or work settings as a student, caregiver, or employee. As part of the evaluation, the OT interviews the client in order to get a good sense of the client’s priorities. The OT then incorporates all of this material into a treatment plan that outlines specific goals and breaks down those goals into manageable steps.

OT treatment usually consists of weekly or regular sessions in which the OT helps the client to practice the skills that will enable the person to be more functional. This may include being able to accomplish everyday tasks (also known as activities of daily living) such as brushing teeth, preparing a snack, or making a grocery list.


How can occupational therapy help my child with a hand anomaly?

Children, like athletes, need instruction and opportunity to practice how to maneuver their bodies gracefully and safely to participate fully in the game (of life) while avoiding injury. How much more so for children with bodies that have fewer bones, tendons, or joints on one or both arms. No matter what your child’s age, you want to be sure that she is using her anomalous hand safely, not hiding it from view out of embarrassment or self-consciousness. Children who use their anomalous hand feel better about themselves. However, due to the anatomy of anomalous hands, learning efficient, graceful, and strain-free use is a process that is not always intuitive. Finding this balance between use and conservation can be difficult.

An occupational therapist who is trained in the use of the hand can be of enormous help in providing strategies and suggestions as well as actual practice doing real life tasks. This is the first step in a long series in which your child ultimately will learn for himself how to use his hand in a healthy way. An occupational therapist will evaluate your child to determine his functional abilities and areas of need. The occupational therapist will gather this information through conversations with you and your child, direct observation of your child performing tasks, and some type of formal assessment tool that measures hand strength or functional ability. The occupational therapist will then create a treatment plan that may addresses any of the following areas:


Management of the Hand after Surgery or Pain:
  • Providing post-surgical care, including scar massage and de-sensitization, stretching contractures, and strengthening exercises
  • Fabrication of protective and functional splints to minimize pain and maximize function in either hand

Family Education and Counseling:
  • Introducing gadgets and adaptive aids that allow your child increased independence in functional tasks (e.g. elastic shoelaces or shoes with velcro straps to make shoe tying unnecessary)
  • Adapting a particular activity to allow the child to participate more fully in school, extra-curricular, or family life (e.g. substituting a xylophone or other instrument for the recorder in 4th grade music class)
  • Providing support and suggestions to the child’s parents, teachers, or activity leaders (e.g. giving suggestions to the child’s Brownie or Boy Scouts troop leader to enable her/him to incorporate the child without drawing focus to the hand anomaly)
  • Providing information and resources for you and your child on support groups, pen-pal programs, and organizations that pair children with similar anomalies to provide a social/emotional outlet
  • Providing referrals to social workers or other providers for counseling and to genetic counseling for future family planning
Preventing Overuse and Promoting a Balanced Body:
  • Teaching strengthening exercises to improve symmetry and balance in the muscles of the right and left arms
  • Promoting posture and body awareness
  • Problem-solving strategies for involving the anomalous hand more in daily activities (e.g. demonstrating how to hold a bowl steady with the anomalous hand while the "doer" hand mixes the contents)

As you can see, occupational therapy looks at the whole child, focusing on helping her to participate as fully as possible in her life. Occupational therapy treatment also addresses people in the child's environment, offering support and information for those who interact with the child. These include of course the child's parents and caregivers, as well as her siblings, extended family, friends, teachers, and extra-curricular leaders. Depending on the chosen treatment goals, the occupational therapist may create a home program of activities that the parents and child can practice in-between visits, in order to maximize the child's success in therapy.


When should my child start receiving occupational therapy services?

Deciding when to seek occupational therapy services is a personal decision for you, your spouse, and your child, as every family will have different needs and time-constraints. Some families are introduced to medical intervention and therapy services when the child is still quite young, while others only begin treatment when a problem arises for the child, such as pain in either hand or difficulty participating in an activity or sport. If there is a problem, you will want to obtain a referral from your child’s physician immediately so that your child can begin occupational therapy services to remedy the problem.

Since children begin using their hands to pick up items during their first year of life and body habits begin to form at that young age, it is never too early for a child to start receiving occupational therapy services. No matter how old your child is, it is a good idea to familiarize yourself with the typical developmental progression of hand skills if you haven’t already done so.


How do I find an occupational therapist?

Your child’s pediatrician may recommend a particular OT or OT clinic at a local hospital. Alternatively, you could call the OT or rehabilitation departments at your local children’s hospital. Some children’s hospitals even have hand anomaly clinics.

When you call to schedule an appointment with an occupational therapist, you frequently will be given the OT's name. Take the opportunity to ask whether the occupational therapist has had experience treating children with hand anomalies.

You will want to find an OT who specializes in treating conditions of the hands. OTs with the distinction CHT, Certified Hand Therapist, have undergone extensive training including a minimum of 2,000 hours of direct practice experience in hand therapy and have successfully complete the Hand Therapy Certification Examination. The CHT certification is awarded by the Hand Therapy Certification Commission (HTCC), the only organization granting hand therapy certification in the United States and Canada. You can search for a Certified Hand Therapist on the HTCC website. The CHT is recognized by the American Society of Hand Therapists (ASHT). The ASHT website also has a Patient Referral Directory, which allows consumers to search for a Certified Hand Therapist (CHT) in their area.

CHTs have the most experience in treating hand trauma, that is, injuries and accidents that have impaired the hand. CHTs frequently work with patients after they have had hand surgery. If your child has a congenital hand anomaly, she may not be experiencing hand trauma. Nevertheless, CHTs are trained to evaluate functional limitations and can help to problem-solve areas of need.

Finally, if none of these options exist, you may be find an occupational therapist through the American Occupational Therapy Association (AOTA).


Will insurance cover occupational therapy services?

Most insurance plans include coverage of OT services for a limited number of sessions with particular in-network providers with a physician’s referral. You should call your insurance company to determine eligibility for benefits for your child. You will want to ask about the number of allowed visits, rate of reimbursement, allowed services (for example, do they cover splints and adaptive equipment?), and allowed providers. You also want to check whether your plan includes a deductible and whether you need a referral for OT services from your child’s physician.


Are there other types of therapy services that my child may need?

CHTs (Certified Hand Therapists) can be OTs or physical therapists, so it could turn out that you find a hand PT for your child rather than an OT.

Depending on the type of hand anomaly that your child has, you may wish to consult a prosthetist as well, who can assess whether a prosthetic device is appropriate for your child (see page on prosthetics for more information) To find a prosthetics clinic in your area of the country, go to The Association of Children's Prosthetic-Orthotic Clinics (ACPOC) website and click on the Clinics link.


My child’s pediatrician says that she is doing just fine. Does that mean that s/he doesn’t need occupational therapy?

Don’t expect your child’s physician to volunteer that OT or any other service would be helpful for your child. Not because the physician doesn’t care about your child, but rather because your child’s pediatrician most likely is very busy with a large caseload; has never treated a child with a hand anomaly before; and is trained to look for actual problems, rather than anticipate preventable problems. Children with hand anomalies often fall in the cracks of the health care field because they look normal, especially compared with children with special needs, and they usually are quite eager to solve their own problems rather than seek lots of professional help.

Remember, however, that OT is not just about solving immediate problems. It also can help your child develop strategies to avoid future problems. It is much better to prevent your child from developing an overuse syndrome than to try to remedy one after it has developed.



© 2004. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy.
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