Clinical Practice Posters

New this year! Clinical practice posters are non-research posters that can highlight a clinical innovation, a complex case, a knowledge translation or clinical implementation story. Clinical practice posters can be viewed on site on the kiosks in the Exhibit Hall or through the ASHT on-demand platform. Additionally, several clinical practice posters will be spotlighted at two spotlight sessions on Friday at 5:15-6:15 PM and on Sunday at 8:00-9:00 AM.

Assessment and Intervention for a Patient with Concurrent Traumatic Ulnar and Median Nerve Injury: A Case Example

Major traumatic and industrial upper limb nerve injury is a devastating condition to the patient and also a challenge to the therapist. Comprehensive examination, communication to patient and expectation management are all necessary to ensure a smooth journey in rehabilitation. This poster will highlight how to formulate a prognostic picture in a patient with nerve injury and how to design rehabilitation, including identifying tricks in performing sensory and motor assessment, managing expectations, and considering psycho-social care. The clinical reasoning is elaborated with a real case scenario to help the reader understand the overall flow of assessment and treatment planning.

Learning Objectives:

Identify the factors necessary to formulate the prognosis for a patient with traumatic upper limb nerve injury
Describe tricks and common mistakes for sensory and motor assessment in a patient with traumatic upper limb nerve injury
Discuss the importance of psycho-social communication and expectation management with a patient with traumatic upper limb nerve injury

Level: Intermediate

Author: Ho Wing Kelvin Fung, CHT

Exploring the Lived Experience of a Jazz Musician with Charcot-Marie-Tooth (CMT) Disease

This presentation provides valuable insight into the lived experience of a jazz musician, J., who successfully navigates his rewarding musical career despite the impacts of Charcot-Marie-Tooth (CMT) disease. CMT disease is characterized by the degeneration of peripheral nerves leading to muscle weakness and atrophy. This condition can significantly impact any individual's ability to perform independent ADL’s. For a jazz musician, whose art relies heavily on manual dexterity, coordination, and agility, the progression of CMT could be perceived as a major threat to their career. J. is a highly talented and influential jazz musician: performing, composing, recording, and teaching. His unique artistic journey, self-administered adaptation strategies and persistence helped him achieve recognition in the musical world. At age 78 and facing continued battles with CMT, J. persists with playing his beloved trumpet and piano. J. describes the personalized adjustments, strategies and modifications he makes to negate the impact of CMT on his life and the modified orthoses which enable him to position his fingers appropriately. J.’s story contributes to a deeper understanding of the challenges faced by individuals with neurological disorders in general and describes strategies and potential avenues for overcoming these limitations.

Learning Objectives:

1. Examine the general effects of Charcot-Marie-Tooth disease on individuals and explore its specific impact on a jazz musician
Examine and differentiate the diverse finger and thumb orthotic interventions employed to support a jazz musician in pursuing their musical interests
Outline three to five strategies that empower a musician to actively pursue a career in music while managing the challenges of Charcot-Marie-Tooth disease

Level: Intermediate

Author: Deborah Schwartz, OTD, OTR/L, CHT

Treatment of Zone III Extensor Tendon Injuries Using a Single Relative Motion with Dorsal Hood Orthosis and a Modified Short Arc Motion Protocol

Zone III extensor tendon injuries are typically treated with early mobilization or by a period of immobilization followed by gradual motion. In both scenarios, the use of multiple orthoses is required. It is becoming more common to use a relative motion flexion orthosis to correct or improve extensor lag due to boutonniere deformity or stiffness after finger fractures. This poster presents educational information on the fabrication and treatment protocol to use a new orthosis called the relative motion dorsal hood orthosis. This orthosis can be used to treat a variety of zone III injuries including those both acute and chronic in nature. Anatomic education will be presented at an an entry level, and treatment techniques and orthosis fabrication will be at an intermediate level.

Learning Objectives:

Describe the anatomical structures that constitute the zone III of the extensor tendon
Describe the steps to fabricate a relative motion with dorsal hood orthosis
Identify 2-3 appropriate orthoses to treat a zone III extensor tendon injury or repair

Level: Intermediate

Authors: Kathrine Manolopoulos, OTR/L, CHT | Clyde Johnson, PT, CHT | Megan Swanson, MOT, OTR/L, CHT

Characteristics of Successful Orthopedic Fellowship Training Programs

The presentation will systematically review current mentorship/fellowship training to prepare entry-level occupational therapists to work in hand therapy. Critical appraisals of evidence relating to characteristics of successful fellowship training will be presented and summarized into four critical themes for future development in fellowship and mentoring of occupational and physical therapists specializing in hand therapy intervention.

Learning Objectives:

Identify a critical research question related to the topic of orthopedic fellowship program evidence
Recall four themes related to orthopedic fellowship training characteristics
Discuss one of the recommendations for practice associated with fellowship training

Level: Entry

Author: Rebekah Pogwizd, CHT, OTR/L, MSOT

Management of Musculoskeletal Pathology Related to Long Covid

Various upper extremity musculoskeletal conditions, such as tendonitis, arthritis, nerve compression, and contractures, may be secondary to Long Covid. Are we managing these patients efficiently and effectively or are there other concerns that we are overlooking?

Learning Objectives:

Describe causes and symptoms of long COVID as well as current medical management of long COVID
Describe unique considerations for therapeutic rehabilitation for patients with long COVID and musculoskeletal pathology
Describe barriers related to social health that compromise successful treatment

Level: Intermediate

Authors: Carol Beistle, OTR | Ann Maguire, MD | April Lowther, Social Worker

A Hand Therapist's Guide to Breast Cancer Related Lymphedema

Breast cancer related lymphedema (BCRL) is a form of secondary upper extremity lymphedema reported as a complication following breast cancer intervention and lymph node dissection. Occurring in as many as 1 in 5 breast cancer survivors, BCRL drastically impacts the quality of life for patients, limiting their performance in daily activities, reducing mobility, and impacting psychosocial wellbeing. As hand therapists, it is important to recognize the early signs/symptoms of upper extremity lymphedema and how our interventions may need to be altered to best serve these patients. Further, we must also know how to tailor our treatments to best meet the needs of patients with a current diagnosis of BCRL. The goal of this poster is to highlight the significant impact BCRL poses, both directly and indirectly to patients and their families, and provide best practice treatment techniques. Starting with a baseline understanding of the main components of the lymphatic system, this poster builds on these fundamentals to teach hand therapists methods of identifying clinical signs and risk factors of lymphedema, and it describes the use of manual lymphatic drainage as a treatment technique.

Learning Objectives:

Identify the main components and functions of the lymphatic system as they relate to the upper extremity
Identify clinical signs and risk factors for early identification and intervention for lymphedema
Describe the technique for manual lymphatic drainage to the upper extremity

Level: Entry

Authors: Sarah Fench, MOT, OTR/L, CHT

Effectiveness of Dry Needling to Treat Lateral Epicondylosis: A Case Report

This case report presents the use of dry needling as a safe and effective intervention for an adult diagnosed with lateral epicondylosis.

Learning Objectives:

Describe the use of dry needling as a supportive intervention to address lateral epicondylosis as part of a broader plan of care with a focus on restoration of function
Discuss the theorized physiological effects of dry needling and their impact on the cycle of pain and tissue degeneration
Evaluate the evidence for the use of dry needling to address lateral epicondylosis and similar chronic tendinopathies

Level: Advanced

Authors: Nate Short, PhD, OTD, CHT

Preparing the Next Generation of Hand Therapists: Innovating Clinical Education Through a Community-Based Pro Bono Clinic

Many CHTs face productivity demands, limited resources, and limited experience supervising fieldwork students, resulting in a shortage of fieldwork opportunities. Literature cites concerns for student preparedness and perceptions that CHTs are not translating current evidence of occupation-based interventions into practice. There is a need for innovative change to prepare the next generations of CHTs. Student participation in a pro bono clinic may increase the volume of clinical education opportunities in hand therapy. Using the Diffusion of Innovation Theory and Kolb’s theory of experiential learning, the Helping Hand Center was created to increase OT students' confidence and ability to participate in fieldwork and entry-level work while also strengthening the organizational culture between university educators and surrounding OT community clinicians who practice in the specialty of hand therapy and contributing to equity in healthcare access. A business plan for the Helping Hand Center was sent to OT CHTs working in academia. Recipients completed an acceptability survey to inform its improvement for a realistic solution. Formative evaluation revealed barriers and facilitators to be considered with implementation. Results will inform tailoring of the business plan to specific academic programs with application of implementation strategies to address barriers.

Learning Objectives:

Identify opportunities for professional growth by volunteering as clinical educators in hand therapy pro bono clinics
Collaborate with academic programs regarding inclusion of hand therapy content within their program that will foster improved knowledge translation and clinical care
Translate knowledge of alternative pathways that promote advancement of the specialty of hand therapy towards the quintuple aim of health care

Level: Entry

Authors: Nicole Bickhart, OT, CHT | Jessica Asiello, OTD, OTR/L

New Pattern of a Thumb Spica Orthosis

The thumb spica is a very common orthosis for positioning the thumb in functional position. A researcher designed a new pattern of a thumb spica orthosis to reduce thermoplastic waste and improve thumb positioning. This poster will provide instructions for how to fabricate an orthosis using the new pattern.

Learning Objectives:

Describe the new pattern for a thumb spica orthosis that is cost-effective and easy to fabricate
Discuss an advantage and limitation of the new thumb spica pattern

Level: Entry

Authors: Kedsrin Ktavutvatm, OT

Promoting Diversity in Upper Extremity Rehabilitation: Strategies for Enhancing Underrepresented Minorities Representation for Excellence in Client Outcomes

The indispensable and essential role of underrepresented minorities in upper extremity rehabilitation influences client outcomes. Understanding the diversity that is present in the client population and ensuring it is reflected in the therapists providing services is essential to progressing the specialty. This poster delves into the strategies aimed at enhancing underrepresented minorities in the upper extremity rehabilitation workforce. The challenges that are present in the current landscape of the profession will be explored. Valuable insights will be provided on creating a rehabilitative environment that fosters inclusivity and optimizes positive client outcomes, thereby contributing to a more comprehensive and culturally competent approach in the field.

Learning Objectives:

Understand the crucial role of underrepresented minorities in upper extremity rehabilitation and its impact on fostering culturally competent practices and improved client outcomes
Integrate practical strategies to enhance inclusion of underrepresented minorities in upper extremity rehabilitation settings

Level: Intermediate

Authors: Sharniece PierceOTD, OTR/L, CLT-UE, CEAS, CSC

Utilization of the External Rotation Abduction Thermoplastic Shoulder Orthosis for Adolescents with Birth-Related Brachial Plexus Injuries Following Shoulder Reanimation Surgery

A review of postoperative therapeutic management following brachial plexus birth injuries found severe shortcomings and limitations in the literature. Of the limited published recommendations, Buchanan and colleagues eloquently described the fabrication of an external rotation abduction thermoplastic shoulder orthosis (ERATSO) for infants with brachial plexus birth injuries following primary nerve surgery and secondary shoulder surgeries. The orthosis aids in maintaining the postoperative position to preserve the range of motion achieved in surgery, following joint contracture and soft tissue releases, as recommended by other authors. However, when attempting to implement the ERATSO for older children following external rotation tendon transfers, we encountered many difficulties. This led our multidisciplinary team, consisting of occupational therapists specializing in hand therapy, an orthopaedic surgeon, and a neurosurgeon specializing in correcting brachial plexus injuries, to partake in creating the ERATSO for children of any age. In this clinical poster presentation we provide a comprehensive, step-by-step outline on how to construct a two-piece orthosis suitable for use in the adolescent and young adult population following tendon transfer surgery for correction of brachial plexus birth injuries.

Learning Objectives:

Implement a step-by-step process for creating a shoulder orthosis following tendon transfers for children and young adults of any age
Develop skills to adjust orthotic design and fabrication to accommodate for specific needs of a complex patient population
Adapt established postoperative therapeutic rehabilitation practices for unique patient populations

Level: Intermediate

Authors: Ann Marie Feretti, EdD, OTR/L, CHT | Victoria Ferrante, OTR/L, CHT | Manisha Joshi,OTR/L, CHT | Nathan Khabyeh-Hasbani | Steven Koehler, MD, FAAOS

Regaining Strength: A Patient’s Journey Back to Elbow Flexion After Brachial Plexus Injury

Imagine losing the ability to bend your elbow. This life altering outcome affects individuals with traumatic brachial plexus injuries (TBPI). One technique, the free gracilis flap muscle transfer, offers a potential path for restoration of elbow flexion. For most TBPI patients, it takes 6 months to regain basic elbow function and 18 months to regain functional strength. This poster will highlight a remarkable international patient regaining 3+/5 elbow flexion muscle strength in 4 months. It will delve into the specific rehab program used based on the available evidence and how the hand therapist tackled the challenge of limited distal control and mobility. This poster isn’t just about one patient’s success. It aims to bridge the information gap about the rehabilitation of TBPI patients with muscle transfers, offering hope and practical guidance for reclaiming lost function.

Learning Objectives:

List and differentiate key components of a rehabilitation program for restoring elbow flexion in patients with traumatic brachial plexus injury
Analyze appropriate modifications to a rehab program that addresses limitations in distal control and mobility of the hand/wrist when progressing strength in patients with reanimation of elbow flexion

Level: Entry

Authors: Valerie Aziegbe, OTR/L, CHT

From Classroom to Clinic: Aligning the Level II Fieldwork Experience with Hand Therapy Education

This clinical practice poster describes the process of aligning didactic education in an Occupational Therapy program with the Level II Fieldwork experience with a regional provider of hand therapy services. Fieldwork educators in hand therapy report feeling that their students lack foundational knowledge (Short et al., 2018), which impacts factors such as clinical reasoning, intervention, and assessment. Short et al. (2020) described inconsistent didactic hand therapy-related content presented in Occupational Therapy education. When a Level II student is not prepared for placement in an advanced practice setting, fieldwork educators become frustrated (Valdes et al., 2022). Fieldwork educators may then opt not to take future students (Varland et al., 2017). Identifying key components to a successful Fieldwork II experience and aligning classroom content with the basic and advanced didactic and clinical skills required for Level II Fieldwork in hand therapy can help students be better prepared for the rigor of this setting.

Learning Objectives:

Articulate the benefits of incorporating an upper extremity advanced practice course into Occupational Therapy programs
Appraise and modify their own site-specific learning objectives for alignment with basic and advanced hand therapy education

Level: Entry

Authors: Sarah Donley, MSOT, CHT, COMT-UL | Brenda Bodine, MS, OT, CHT, COMT-UE

Building Confidence, Identifying Needs, and Translating Knowledge About Chronic Pain: The Empowering Dynamics of Collaboration

Hand therapy is one of the specialties within the rehabilitation continuum at a large health system, and, therefore, may lack interaction with other disciplines. There are various work groups surrounding these specialties, often homogeneous in nature, that focus on performance improvement. However, the Chronic Pain Work Group consists of a diverse group of caregivers with various backgrounds and was created to share knowledge, develop treatment protocols, and improve patient experience and quality of care. Chronic pain is a specific problem that requires additional knowledge and skills specific to its management and is one of the most challenging things to treat in outpatient therapy. The hand therapist's participation in the Chronic Pain Work Group over the last two years fostered confidence in concepts largely discussed in the context of low back pain and identified a need to extend these concepts to the hand therapy population in which at least 25% have chronic pain presentations. This collaboration in a multidisciplinary working group has inspired new treatment approaches and continuing education to improve quality of care within outpatient hand therapy. Continued collaboration is essential in the transition to value-based care.

Learning Objectives:

Explain 3 ways in which a clinical hand therapist's involvement in an interdisciplinary work group was a mutually beneficial collaboration.
Describe how exposure to new perspectives through collaboration identified a need to consider chronic pain presentations within a hand therapy population
Identify how collaboration inspired knowledge translation and performance improvement within hand therapy via continuing education, ASHT contributions, and case studies and why this process is relevant in the transition to value based care

Level: Intermediate

Authors: Karen Mainzer, OTR/L, CHT

Use of Bilateral Stimulation within a Multi-Modal Treatment Approach for Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a neuropathic pain disorder that often includes pain out of proportion with the injury as well as sudomotor, vasomotor and trophic changes. This condition can be seen following injury to the upper extremity and can present many challenges for the treating therapist. Research from Adriaan Louw has introduced the concept of “The Brain’s Pain Meeting,” which helps clinicians to understand the different areas of the brain involved in the processing of pain messages. One of these areas is in the amygdala which is responsible for autonomic functions of the brain and may be overactive in CRPS. It is thought that bilateral stimulation may help lessen overactivation of the amygdala; therefore, we have trialed use of the ‘Bi-Tapp’ device in the clinical treatment of CRPS. 'Bi-Tapp’ is a modality developed by a mental health therapist to provide bilateral stimulation, which is used in Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of trauma. EMDR was initially developed in 1987 and is included in the APA Clinical Practice Guideline for the treatment of post-traumatic stress disorder. Use of the ‘Bi-Tapp’ device was paired with Pain Neuroscience Education, and the patients were able to engage in therapy to address their functional deficits. As part of a multi-modal treatment approach, the 'Bi-Tapp' may have been a helpful tool contributing to improved patient reported outcomes per the Quick DASH.

Learning Objectives:

Identify the use of bilateral stimulation as an effective modality to use in the treatment of anxiety, post-traumatic stress disorder, etc.
Identify the role of the amygdala and the sympathetic nervous system as part of the Brain’s Pain Meeting in patients with CPRS
Integrate the concept of using bilateral stimulation (via the Bi-Tapp device) and pain neuroscience education within a multi-modal treatment approach to help manage increased sympathetic nervous system responses through the amygdala with patients with CPRS

Level: Intermediate

Authors: Rhonda Marsh, OTR/L, CHT

Unique Considerations when Treating Upper Extremity Trauma in the Pediatric Population

This poster will highlight two complex pediatric cases, both under the age of six years old, involving upper extremity trauma. One was due to farm machinery, and the other was the result of a lawn mower accident. Combined injuries sustained in both cases include fractures, partial digit amputation, nerve trauma requiring surgical intervention, extensive skin grafting, and psychological trauma associated with the incident. Highlighted treatment interventions using a "pediatric friendly" approach will include edema/scar management, desensitization, splinting, range of motion, and integration of the affected upper extremity. The poster will include how treatment was prioritized using guidance from the literature and adapted as clinically appropriate to meet the individual needs of each patient using a pediatric lens. Innovative therapeutic interventions and pediatric considerations will be provided to show how they were used to maximize patient engagement, provide client-centered care, and address the unique needs of the pediatric population.

Learning Objectives:

Identify at least 3 innovative strategies to implement standard treatment interventions and formal assessment (i.e. wound care, scar massage, ROM, splinting, etc.) to achieve goals while meeting the unique needs of the pediatric patient
Identify at least 3 pediatric considerations when treating upper extremity trauma
Identify at least 2 challenges and potential solutions with implementing formal assessment and standard protocols of care designed primarily for adolescents/adults in the pediatric population

Level: Intermediate

Authors: Michelle Hagenbaugh, MS, OTR/L, CHT

Interprofessional Collaboration for the Conservative Management of an Individual with an Upper Extremity Neuropathy

Physical and occupational therapy utilized together can be advantageous to address movement impairments. Interprofessional teamwork emphasizes the importance of a person-centered holistic lens when managing care for patients. Individuals presenting with cervical radiculopathy can have higher functional limitations and overall disability, and a multimodal model can be effective for treatment. This case study describes an interprofessional approach for an individual with cervical radiculopathy, which can improve safety, effectiveness, efficiency, person-centeredness, and equity of care. The combination of manual therapy and exercise can help to reduce pain and functional limitations. Further research is warranted to investigate collaborative leadership, as it can improve the quality of care as well as promote a positive workplace environment.

Learning Objectives:

Recognize the need for collaborative efforts for particular clinical presentations
Analyze a case study to help guide the clinical decision making process
Develop a clinical framework that encompasses an interprofessional approach to manage individuals presenting with upper extremity radiculopathies

Level: Intermediate

Authors: Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT | Sabashnee Govender, OTR/L, CHT, CLT-LANA

Collaborating with Purpose: A Hand Therapist’s Approach to Changing Lives with Gender Affirming Care

The purpose of this poster is to increase the hand therapist’s knowledge of post-op rehabilitation after radial forearm free flap phalloplasty. Gender affirmation surgeries are available to those in the transgender community and vary based on gender reassignments. Phalloplasty is a procedure commonly performed to create a neophallus for those transitioning from female to male gender or for cisgender males who have had a history of trauma, malignancy, or congenital abnormalities to their phallus. The radial forearm free flap has become the preferred approach for many surgeons (Schecter et al, 2018). Hand therapy for patients undergoing this procedure is multifaceted and addresses many crucial topics including activity modification, wound care, scar management, edema management, desensitization, range of motion deficits, and weakness. Additionally, clinicians help encourage patients to engage in their usual occupations to promote recovery and improve overall mental health after such significant surgeries. Alongside an interdisciplinary team of physicians, nurses, OTs, and PTs, we have established an early mobilization protocol for patients status-post phalloplasty, which focuses on patient independence with activities of daily living. Through patient education and focus on occupation, hand therapists have the unique ability to empower this patient population on their rehabilitation journey.

Learning Objectives:

Explain the use of the radial forearm free flap during gender affirming phalloplasty procedures.
Describe the common issues and deficits at the forearm donor site which are addressed during hand therapy
Recognize standard care protocol and special considerations when working with the transgender community

Level: Entry

Authors: Jamie Nguyen, OTR/L, CHT | Eugene Gersh, MOT, OTR/L

Effect of Aesthetic Appeal and Comfort on Patient Adherence for Orthotic Devices

Patients with chronic joint pain conditions (e.g. carpal tunnel syndrome, osteoarthritis, autoimmune arthritis) can find relief from pain and improved function from wearing over the counter orthotic devices. Orthotic devices (e.g. compression wear, braces and splints) are recommended by the American College of Rheumatology. There are many affordable and medically effective devices available to patients via their medical provider and / or over the counter. However, patient compliance for wearing these devices can be surprisingly low. Qualitative feedback gathered from patient lived experience interviews suggests a link between adherence rates, aesthetics and comfort. This poster will describe the role of perceived aesthetic appeal and comfort in patient adherence to an orthosis-wearing protocol and consider if these aspects of over-the-counter orthotic devices can be improved through a more collaborative human-centered design process between product designer and patient.

Learning Objectives:

Describe the effect of comfort and aesthetics on patient adherence for orthotic devices

Level: Entry

Authors: Trevor Petrie, OTR/L, MOT, CHT

Treatment Recommendations for Diabetes and the Upper Extremity

Tens of millions of people in the U.S. are living with diabetes and millions more are prediabetic or at risk for developing type 2 diabetes. Individuals with diabetes face an increased risk of conditions of the upper extremity, with a lifetime prevalence of up to 85%. When patients with diabetes undergo surgical interventions to address their upper extremity conditions, they are at greater risk for complications than their non-diabetic peers. Hand therapists routinely encounter patients with co-occurring diabetes and hand/arm conditions, yet there is very little guidance on how to best manage the unique needs of diabetic patients in the hand therapy setting. This presentation includes evidence-based treatment recommendations, developed by the presenter, designed to support and enhance the clinical practice of hand therapists. The recommendations emphasize the occupational and psychosocial needs of patients with both diabetes and upper extremity conditions.

Learning Objectives:

Describe the relationship between upper extremity conditions and diabetes.
Identify as least one specific evaluation and intervention approach that can improve the outcomes of patients with diabetes

Level: Intermediate

Authors: Hilary Marshall, OTR/L | Susan Magasi, PhD, FACRM, MS, BScOT, BSc | Heidi Fischer, OTD, MSOT | Megan McCray, OTR/L, CHT

Nutrition and Other Lifestyle Resources to Support Thoracic Outlet Syndrome Self-Management

Neurogenic Thoracic Outlet Syndrome (TOS) can be functionally devastating with lifelong need for self-management. There is an increase in prevalence with our increase in computer-based jobs and sedentary lifestyle with implications for habit and routine modification. Occupation-focused care with a multidisciplinary mindset in addition to traditional therapy approaches offers additional tools for individuals with TOS developing self-management skills to support long-term independence and occupational performance. To address key areas of occupation, our clinic has implemented such tools including yoga mat routine for sleep hygiene, desk Pilates reset, nutritional recommendations, and breathing exercises for stress reduction. Sleep and work are commonly disrupted with positioning suggestions highlighted. This poster will include evidence-based resources utilized in our clinical implementation of TOS self-management program with goal of knowledge translation for improving clinical care in building long-term TOS self management skills.

Learning Objectives:

Describe a lifestyle-based resource with appreciation for how it can support individuals’ occupational participation while managing thoracic outlet syndrome
Understand the value of a multidisciplinary approach to thoracic outlet syndrome self-management.

Level: Intermediate

Authors: Melanie Hubbuck, MS, OTD, OTR/L

Treatment of Partial Hand Absence: From Injury to Functional Prosthetic Use

Historically there were few prosthetic options for partial hand amputees to improve their function. While digital and partial hand amputation is commonly seen in hand therapy clinics, referral for prosthetic restoration and subsequent prosthetic training is not always considered. This session will educate the audience on current prosthetic options for various levels of partial hand absence/loss as well as appropriate referral. Participants will gain knowledge in evaluation, preprosthetic training, and prosthetic training techniques for partial hand loss/absence. Individuals living with partial hand loss/absence will demonstrate their functional improvement with prosthetic restoration.

Learning Objectives:

Demonstrate understanding of the epidemiology of partial hand amputations
Identify the reasons to refer an individual with partial hand loss/absence for prosthetic fitting
Describe the principles of evaluation, preprosthetic, and prosthetic training for the partial hand amputee

Level: Intermediate

Authors: Julie Klarich, OT, CHT

The King System: Exploring New Populations; The Role of a Hand Therapist in Breast Cancer Rehabilitation

The Milliken Hand Rehabilitation Center has created an innovative program for treating individuals who undergo surgical intervention for breast cancer treatment. As Hand Therapists, we believe that we are in a unique position to assist this niche population. This poster will discuss our developed program for pre- and post-op patient care. In our program, we address ROM limitations, pain, ADL modifications, functional performance, myofascial techniques, and scar management. We believe that this patient population deserves more support, intervention and advocacy and it is our hope to inspire other hand therapists to feel confident providing care for this population.

Learning Objectives:

Understand the anatomy and structures involved with common breast reconstructive surgeries
Understand the typical treatment course and timeline including the treatment approaches for both pre and post-operative care and common restrictions/limitations patients experience during the post op recovery phase
Identify common pre-operative education aspects to address ADL/IADL modifications to remain independent within post-operative restrictions

Level: Entry

Authors: Sarah Fench, MOT, OTR/L, CHT | Ellen King, OTR, CHT | Kelly Santel, MOTR/L, CHT | Terence Myckatyn, MD

On a Mission: Helping Pediatric Hands Across Borders

This presentation will review two approaches to providing treatment and educating on pediatric hand therapy internationally in countries with limited resources. We will discuss preparation for the trips internationally, typical clinical and surgical days, patient populations served, treatment and documentation methods, education for families, as well as providing in depth education to local therapists on pediatric hand population. The first approach will outline providing hand therapy services in tandem with United States based hand surgeons with limited local therapy follow up available. Therapists' roles included pre-screening/evaluations for surgical candidates, providing orthoses pre surgery for post surgery use, extensive education of family members on post surgery care and rehabilitation as local therapists were not available. The second approach will outline spending the majority of the time educating local therapists on the pediatric hand population and implementing learned material with local patients. To conclude, we will describe strategies to overcome cultural barriers that we have encountered. In the end, you will have a better understanding of ways that a hand therapist can share their knowledge and help patients with upper extremity problems in underdeveloped countries.

Learning Objectives:

Identify ways to prepare for a successful trip abroad
Effectively communicate and educate novice health care workers in an underserved country on hand therapy principles and skills while addressing and acknowledging cultural differences
Identify important qualities or attributes of a therapist wishing to pursue humanitarian work in an underserved country

Level: Entry

Authors: Lauren Mione, MSOT, OTR/L, CHT | Katie McQueen, OTD, OTR/L, CHT | Michelle Burke, OTR/L

Proximal Stability as it Relates to Distal Dysfunction: Exploring the Forgotten Chain

This presentation will focus on the interplay between the thoracic spine, ribs and shoulder girdle and how its function affects the distal portion of the upper extremity. It looks to describe the mechanics of the upper quadrant and their effects down the chain that contribute to pain and dysfunction as well as look at muscular referral patterns proximally and their presentation distally. Its goal is to teach how to interpret and synthesize the above information to create an effective treatment program of manual therapy and neuro-muscular re-education to restore function and eliminate pain.

Learning Objectives:

Describe the arthrokinematics, osteokinematics, joint play, glide and stability and the function of the musculature that affect the upper quadrant and how they relate to distal extremity function
Interpret objective and subjective exam findings and successfully identify proximal compensatory dysfunction, its effect distally and its contribution to the presentation of pain and dysfunction
Synthesize the interpretation of proximal dysfunction and prescribe appropriate manual therapy and neuro-muscular techniques to resolve compensatory strategies and return to pain-free ADL function and resume higher level activities

Level: Intermediate

Authors: Lauren Carleton, PT, DPT, CHT

A Hands-On Approach to Teaching Future Hand Therapists

A career in hand therapy requires an individual to have an in-depth knowledge of upper extremity anatomy, related diagnoses, and orthotic fabrication. Current entry level occupational and physical therapy programs primarily train students to be generalists; however, students interested in pursuing a career in this specialization may not be getting the education and mentorship needed to apply for these positions post-graduation. To meet this need, an interdisciplinary team of educators developed an elective course for students to learn this content. To increase student engagement with the course material, only active learning activities were used, and the course did not include lecture style teaching. The course included unembalmed cadaver dissection, orthotic fabrication, treatment of actual and simulated pediatric patients, building and labeling models, drawing diagnoses, role playing, completing case scenarios, and discussing ethical dilemmas. Students enrolled in this course further developed critical thinking and hands on skills. The successful implementation of this course could be translated to other programs and healthcare professions.

Learning Objectives:

Identify the benefits of using active learning methods for teaching students about hand therapy
Describe examples of active learning activities for teaching students about hand therapy

Level: Intermediate

Authors: Jennifer Radziak, OTD, OTR/L, CHT | Kelsey Picha, PhD, ATC | Katie Jones, MA, OTR/L, CLT-LANA

Implementation of In-Hand Manipulation Tests from Prehabilitation to Rehabilitation

Can you write measurable and meaningful goals using standardized Dexterity Tests? Gain a better understanding of In-Hand Manipulation (IHM) skills and have a renewed perspective of standardized Dexterity Tests for Monday morning take-away. IHM plays an essential and consequential role in ADLs. Clinical therapists are responsible for writing measurable and functionally relevant goals related to this crucial upper extremity skill in required plans of care. Updated research suggests standardized tools with more complex visual-motor and proprioceptive demands should be utilized to evaluate In-Hand Manipulation. This Clinical Practice e-poster presents a comparison of trustworthy, evidence-based dexterity tests.

Participants, from all levels of experience, will have the opportunity to critically review standardized dexterity tests and address the value of Performance Based Outcome Measurement of Dexterity(PBOMD). An algorithm of a biopsychosocial approach to CMC arthroplasty pre-habilitation and rehabilitation will be provided. A preoperative CMC arthroplasty therapy visit allows the hand therapist to obtain objective data, ensure patient understanding of surgery and recovery, and identify biopsychosocial factors that may influence outcomes. This presentation will change the way you “choose wisely” for meaningful results.

Learning Objectives:

Define 3 of the 10 classic components of in-hand manipulation skills.
Analyze and compare standardized In-Hand Manipulation assessment tools to gather meaningful outcomes.
Implement an approach for pre-habilitation and rehabilitation specifically for the CMC arthroplasty population thereby enhancing patient experience.

Level: Intermediate

Authors: Julie Corbett, MS, OTR, CHT | Rose Bankers, OTR/L, CHT, CLT

Serial Casting for Pediatric Upper Extremity Spasticity: A Case Study

This presentation will include 1-2 case studies of serial casting in pediatric patients with spasticity in the upper extremity prior to surgery. Range of motion measures before and after treatment will be presented.

Learning Objectives:

Discuss the benefits of serial casting in pediatric patients with spasticity to improve flexion contracture of the wrist
Describe when it may be appropriate to recommend or trial upper extremity serial casting in the pediatric population

Level: Entry

Authors: Carrie Shotwell, OTR/L, MEd, DHS

Use of Neuromuscular Electrical Stimulation in Newborns with Brachial Plexus Birth Injuries

Neuromuscular electrical stimulation was previously controversial for use in infants with brachial plexus birth injuries. This presentation will provide guidelines and evidence to support its use in this population

Learning Objectives:

Identify proper parameters for neuromuscular electrical stimulation in the newborn population with brachial plexus birth injuries
Identify research on safety and effectiveness of neuromuscular electrical stimulation for newborns with brachial plexus birth injuries

Level: Intermediate

Authors: Jordan Wilson, OTR/L

Hand in Hand Support Group: Building a Community

This presentation will explore the development of a support group for caregivers and children with congenital hand and upper limb differences. The session will provide information on the process of creating a support group, including conducting a needs assessment with primary and secondary sources, the value of interprofessional collaboration, developing program goals, and obtaining funding. The presentation will demonstrate to learners an opportunity to expand their practice by moving into community-based programs. The presentation will also provide information on the benefits of creating a community for caregivers and children with congenital hand and upper limb differences in order to provide holistic care beyond the clinic.

Learning Objectives:

Identify a non-traditional practice area within their field and recall the steps involved in creating a community-based program
Recognize how the needs of caregivers and children with congenital hand and upper limb differences can be addressed through a support group
Explain the importance of interprofessional collaboration in non-traditional program development

Level: Entry

Authors: Amy Sitabkhan, OTR, MOT

Treatment for Infants with Brachial Plexus Injury (BPI): A Guide for Rehabilitation Therapists

Brachial plexus birth injury in infants is a complex condition that requires specific treatment intervention strategies to maximize functional outcomes. Clinicians who do not specialize in this population can benefit from access to a simple tool like a clinical practice guideline that offers evidence-based intervention strategies. This session will introduce a clinical practice guideline for infants with brachial plexus injury and will offer evidence-based methods for use of the guideline in practice.

Learning Objectives:

Discuss five treatment recommendations for infants with brachial plexus birth injury based on their strength of evidence
Describe two or more ways a clinical practice guide on treatment recommendations for infants with brachial plexus birth injury can be integrated into clinical practice

Level: Intermediate

Authors: Krystal L. Vermillion, MOT, OTR/L |Pamela E. Toto, PhD, OTR/L, BCG, FAOTA, FGSA

Current Trends and Strategies to Support Therapist Recommendations for Early Management of Brachial Plexus Birth Injury

Brachial plexus birth injury (BPBI) occurs in up to 1/1000 live births resulting in lifelong upper extremity weakness and joint contracture in up to 30% of cases. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. This presentation will report on findings of a survey of the practices used by therapists who work in brachial plexus clinics in the United States. Based on the findings we recommend that PROM at the shoulder should be initiated as soon as possible after birth until research provides evidence for efficacy of a different frequency and duration. We also recommend strategies to support efficacy of caregiver education, based on a scoping literature review that identified factors that facilitate and are barriers to caregiver adherence.

Learning Objectives:

Describe the importance of early referral for all infants with known or suspected brachial plexus birth injury
Discuss factors that facilitate or are barriers to supporting families in adhering to home therapy recommendations for infants with brachial plexus birth injury

Level: Intermediate

Authors: Jennifer Wingrat, ScD, OT/L

DAFRA for Pediatrics: Play Activities for Exercise

The Donor Activation Focused Rehabilitation Approach (DAFRA) for rehabilitation after nerve transfer surgery is well known and commonly used. In the population of brachial plexus birth injuries (BPBIs), nerve transfer surgery is advancing and proving to be highly successful for many deficits and extremely popular with surgeons. As nerve transfer techniques become more targeted and specific, creating a need for an organized, methodical approach to post-operative therapy. Applying the original DAFRA model, complete with specific exercises and home programs, proves impractical for infants who are optimal candidates for early nerve transfers in BPBIs.We were challenged to adapt protocols for nerve transfer rehabilitation to be more targeted for this population. The presentation will focus on practical tips to engage young children with activities to elicit the desired active movements from children who have undergone nerve transfer surgery. The presentation will discuss nerve transfers employed in birth brachial plexus reconstructions, expected outcomes, and postoperative rehabilitation protocols needed to achieve those outcomes. As with all therapy aimed at infants and toddlers, the education focusis directed towards the caregivers and parents. Beyond providing ideas for in-therapy activities, we will explore best practices for effective communication with parents and caregivers to ensure their sustained engagement and focus.

Learning Objectives:

Identify common nerve transfer procedures for brachial plexus birth injuries
Discuss application of the Donor Activation Focused Rehabilitation Approach protocol in the treatment of children
Explore examples of activities appropriate for infants and toddlers to elicit the desired movements after nerve transfer surgery

Level: Intermediate

Authors: Ann Marie Feretti, EdD, Adv, MS, OT, BsC, OT | Victoria Ferrante, MS OT | Megan Horowitz, MS, OT | Nathan Hasbani | Steven Koehler, MD, FAAOS

Use of a Novel 3D Printed Dynamic Orthosis to Improve Upper Extremity Function in Children with Cerebral Palsy

Upper extremity therapies for children with cerebral palsy (CP) have been validated for improving function in higher functioning patients. Those who function at the lowest end of the Manual Ability Classification System scale, (MACS) III-V, comprise 34-54% of the population, but as of yet have no evidence-based interventions specific to their needs. A collaborative interdisciplinary team was established with involvement of a pediatric orthopedic surgeon, occupational therapists, and engineers. It has been demonstrated that lower functioning children often retain some voluntary control of the elbow in spite of limited finger motion. This innovative 3D-printed dynamic orthosis for children with CP utilizes patient initiated elbow extension to drive finger extension and release while retaining flexor tone for grasp, creating a portable therapeutic tool. The dynamic orthosis can be used as part of comprehensive occupational therapy treatment sessions. The use of this dynamic functional orthosis will be a benefit to the child in occupational therapy sessions for functional use and improved skills to carry over to home after the therapy sessions. Standardized evaluation tools and motion analysis testing/software were utilized to compare and contrast improvements.

Learning Objectives:

Identify which children may benefit from this dynamic orthosis based on clinical presentation
Describe the mechanics of the 3D printed orthosis and how it biomechanically benefits the child/adolescent with cerebral plasy and can be used for motor learning

Level: Intermediate

Authors: Alice Chu, MD | Caitlin Finnegan, MOTR/L | Katelyn Prais, MOTR/L | Janelle Lenzo-Werner, MS, OTR/L

From Rookies to Rockstars: Designing Competency Frameworks for a Hand Therapy Fellowship Program

This project aimed to establish a set of core competencies expected of a hand therapy fellow to achieve by graduation from the program. The domains of competence selected were chosen from the learning objectives established through the American Occupational Therapy Association, the Competencies in Hand Therapy published in 2003, and the most recent 2019 Hand Therapy Certification Commission practice analysis. The framework enables evaluating the fellow's performance and sets a benchmark for their development. Additionally, a pilot evaluation tool was created to assess the fellow’s competency at the program's start, midterm, and final graduation. The milestones, or expectations for each competency, are defined in specific terms to measure the fellow's capabilities as they progress through the program.

Learning Objectives:

Identify the essential competencies established to create a framework for a hand therapy fellowship program.
Identify an assessment tool to evaluate the effectiveness of the fellowship program and guide skill development for hand fellows.

Level: Intermediate

Authors: Wendy Moore OTR/L, CHT | Brian Kemp OTR, CHT

Hand Therapy Screening Tool

Hand therapy screenings are designated for identifying persons in need of hand therapy services. Screenings allow clinicians to extend our services beyond the clinic and into the communities in which we reside. We have the unique capability to provide screening services to assist with closing the gap with inaccessible healthcare and facilitating a referral to the appropriate provider. The primary purpose of this poster presentation is to explore a hand therapy screening tool that can be a valuable resource used to identify a prospective client's needs for formal hand therapy services which can be utilized in pro bono clinics or health fairs or with economically disadvantaged populations.

Learning Objectives:

Identify health disparity areas that would benefit from using a hand therapy screening tool.
Describe a hand therapy screening tool that can be used in the clinic, at health fairs, or during volunteer activities.

Level: Entry

Author: Miremonde Joseph, OTD, OTR/L, CHT, CLT

The Process of Creating a Knowledge Share in a Hand Therapy Practice

At Mayo Clinic there is an effort to increase evidence-based practice in all areas of therapy, especially in hand therapy. In Arizona, we have 8 certified hand therapists working across 3 campuses. An initiative to bridge the gap between practice and research will help to improve patient outcomes. This may be a huge undertaking, but with the right approach and open minds, certified hand therapists will be better equipped to share knowledge and information on how to better meet the needs of our patients. This poster presentation will outline the specific process of how this group proposes to start, maintain, and grow a knowledge share.

Learning Objectives:

Describe two elements of a knowledge share within a clinical setting.
Explain two components of evidence-based practice that add value to hand therapy.

Level: Entry

Author: Sabby Wade, OTD, OTR/L, CHT

Creating Peer Connections Between Clinician Managers to Advance Leadership Skills

Clinician Managers in hand therapy today face increasing pressure to focus on tasks related to clinical operations, human resources, and corporate compliance along with their role of providing quality patient care. The health care climate today has made tracking metrics and quality indicators paramount. These competing priorities can leave clinician managers overwhelmed. There is little time left to focus on improving management and leadership skills. Many clinician managers have never had formal management training which only adds to their burden. These factors support the need for additional resources to better equip this unique group of hand therapy leaders. This project explores the concept of “connectedness” in social leadership theory and how growing social connections between peer clinician managers/leaders can positively impact performance.

Learning Objectives:

Describe the value of fostering social connectedness between peer clinician managers.
Envision a program structure for peer leader involvement that can positively impact overall performance and wellbeing in the workplace.

Level: Entry

Author: Lisa Dominick MS, OTR, CHT

Hand Therapy Resources for the International Therapist: Collaboration to Expand Hand Therapy in Latin America

Hand therapy services have been gradually expanding throughout the world for decades. While the CHT credential is well-established in the United States for several decades, other countries have also expressed interest in affirming their status as advanced practitioners via certification and other continuing education resources. Because of the specialty nature of our services, it is vital to collaborate with other upper extremity therapists to address the needs of patients worldwide. A guide was created to assist those in Latin America who are new to treating the upper extremity. It also includes a section devoted to those individuals who have dedicated their time to this specialty and require additional resources. The purpose of this guide is to provide resources to upper extremity therapists and provide opportunities for collaboration between therapists in the United States and Latin America

Learning Objectives:

Identify relevant resources for the international therapist treating the upper extremity.
Discuss the importance of seminal articles and online resources for the international therapist treating the upper extremity.

Level: Entry

Authors: Carlos Alvarado OT/L, CHT | Brooke Ochoa, OTR/L, CHT

Bridging Theory and Practice: Empowering OT Students Through a Pro Bono Hand Therapy Clinic

This poster presentation explores the impact of a pro bono clinic integrated into an elective hand therapy course on occupational therapy (OT) students' competency and the health and wellness of a campus community. By participating in this clinic, students engaged in experiential and problem-based learning, allowing them to develop essential clinical reasoning skills, self-efficacy, and hands-on competency in hand therapy. Through direct patient interactions and real-world problem-solving, students enhanced their practical skills and theoretical understanding of hand therapy. The clinic provided a unique environment for students to apply classroom knowledge to real cases, fostering a deeper comprehension and confidence in their abilities. As students navigated diverse clinical scenarios, they honed their decision-making and critical thinking skills, crucial for fieldwork experiences and future professional practice. Moreover, the pro bono clinic served the dual purpose of benefiting the campus community by offering much-needed hand therapy services, thereby improving community health and wellness. The poster will highlight key outcomes, student and participant testimonials, and case studies, demonstrating how this innovative approach effectively bridges the gap between theoretical learning and practical application in occupational therapy education.

Learning Objectives:

Analyze how a pro bono clinic integrated into an elective hand therapy course can enhance OT students' clinical reasoning skills and hands-on competency.
Evaluate the impact of experiential and problem-based learning in a pro bono clinic on the self-efficacy and professional development of OT students.

Level: Intermediate

Author: Lisa Owen, OTD, OTR/L, CLT, CHT

Embedding a Culture of Professional Engagement in a Fellowship Program

Early career therapists often find themselves in a mentee role which frequently consists of receiving guidance in the clinic setting, improving their clinical reasoning skills and expanding their hand therapy knowledge. Often what is lacking, is direction on how to widen their professional engagement in the early career stage. This poster outlines the first stage of adding a professional engagement component into a fellowship curriculum and how this will support the fellow’s professional identity development.

Learning Objectives:

Explain three reasons why professional engagement is important in hand therapy.
Describe three ways to support an early career therapist to increase their professional engagement and develop their professional identity.
Identify 1-3 examples of actionable items a therapist can participate in to increase their professional engagement.

Level: Intermediate

Author: Sarah Schmeda OTD, OTR/L, CHT

Inclusion of Professional Career Development in an OT Level II Fieldwork Experience

Many facilities offer structured educational programs for their Level II Fieldwork students or interns. However, much of the content is focused on increasing knowledge of specific pathologies they may treat and developing clinical treatment skills and documentation competencies. In contrast, there may be a lack of resources for these students related to professional career development. This poster aims to discuss a plan to include professional career development in an occupational therapy level II fieldwork program in a hand therapy setting along with developing clinical skills.

Learning Objectives:

Discuss why incorporating career development into an OT Level II fieldwork program makes new grads better prepared for beginning their careers.
Describe potential components of a professional career development program for OT Level II fieldwork students.

Level: Entry

Author: Tyler Henson, OT, CHT

Exploring the Strengths of Introverted Occupational Therapists to Serve as Impactful Hand Therapy Leaders

Traditionally, leaders are viewed as extroverted individuals who manage large groups of people. In reality, individuals who are introverted by nature have qualities that uniquely allow them to serve as impactful leaders. This presentation will define what it means to be a leader, examine characteristics of introverts, and then connect how characteristics of introverts can lead to strong leadership potential. The presenter is an OT, CHT who participated in the ASHT leadership development program this year and who thereby gained knowledge into how her own introverted nature can complement leadership. Knowledge gained in the ASHT leadership program and the connection with introverted leadership potential are explained in this presentation. This includes exploring serving as a leader of patient care, as a leader through fieldwork supervision, and as a leader on a community level.

Learning Objectives:

Differentiate between the strengths and weaknesses in extroverted and introverted characteristics in hand therapy leadership.
Outline how a structured leadership development program can foster leadership potential in an introverted hand therapist.
Describe the importance of amplifying introverted individuals to pursue leadership roles in the current healthcare climate to support the future of hand therapy.

Level: Entry

Author: Emily Gottier, OTR/L, CHT

Preparing the Next Generation: Identifying Barriers to Service in Leadership Roles for Early-Career Therapists

This poster presentation encapsulates the findings of a comprehensive survey targeting early-career therapists, defined as professionals with five or fewer years of experience. The survey delved into the multifaceted barriers these therapists encounter when aspiring to leadership roles within their field. The presentation not only sheds light on these systemic challenges but also underscores the importance of addressing them to foster a more inclusive and supportive environment that encourages professional growth and leadership aspirations among emerging therapists.

Learning Objectives:

Identify the predominant barriers that early-career therapists encounter when aspiring to service-oriented leadership roles in a therapeutic context.
Identify methods of encouraging early career therapists to aspire to service-oriented leadership roles.

Level: Entry

Author: Amanda West, OTR/L, CHT

Exploring the Lived Experiences of BIPOC Hand Therapists

It is undeniable that the therapy professions lack diversity, but when exploring the diversity in hand therapy or lack thereof, the number of BIPOC hand and upper extremity therapists is overall significantly low. Per Keller et al. (2019), “overall the specialty shows less diversity than the general population. The great majority of therapists were Non-Hispanic Caucasian (87.1%) and Asian or Asian American (6.9%). Each of the other groups represented less than 2% of the respondents. Reviews of the practice analysis studies for occupational therapy and physical therapy show the parent professions may be slightly more diverse than the hand therapy specialty." The purpose of this project is to highlight various BIPOC clinician (new graduate to seasoned clinician) lifework stories. By means of a qualitative approach, insight will be gained on the BIPOC hand therapists' lived experiences throughout their hand therapy journey and career in an effort to provide examples of how these clinicians overcame barriers, seized opportunities and became leaders in hand therapy. This project will increase visibility of BIPOC hand therapy leaders and provide advice and direction for future diverse leaders.

Learning Objectives:

Describe at least two common themes among the lived experiences of BIPOC hand therapists.
Discuss the clinical implications and impact of the lack of diversity in hand therapy

Level: Entry

Author: Laura L Carlos, MOT, OTR/L, CHT