Ocupation: Occupational Therapist
Institution: Fisiomano Bergamo www.fisiomano.com, Papa Giovanni VIII hospital, part-time instructor at University of Milan-Occupational Therapy
Years of Experience in HT: 14
Main areas in HT you’ve been working in:
After completing my occupational therapy studies at Columbia University in New York, I worked in Pediatrics. I then attended a hand therapy fellowship at Texas Woman’s University USA. After the fellowship, I worked for a hand therapy contracting agency that provided hand therapy services to various hospitals in Chicago, Illinois USA where I evaluated and treated flexor and extensor tendon Injuries, work related injuries, and PIP joint injuries. Shortly after, I moved to Italy where I have been living and working for the past 13 years in an acute care setting at a public hospital and at a private hand therapy clinic. I am also the international Italian hand therapy delegate for IFSHT, a board member of the Italian Hand Therapy Association AIRM www.riabilitazionemano.org and member of the education committee of EFSHT for the European Certified Hand Therapist (ECHT) in which I have been given the task to promote ECHT. Therefore, I take this wonderful opportunity to strongly encourage all hand therapists in Europe who are already certified in their respective countries to apply for ECHT certificate.
Main subjects that you have presented in a meeting?
Recently at the 2015 XX FESSH Congress & European Federation of Hand Therapists (EFSHT) meeting held in Milan, Italy, I presented a workshop on “Flexor Tendons: when and how to apply an early controlled active motion protocol. Other presentations include: “Rehabilitation of acute open extensor tendon injuries”; “Use of splinting in treating hand stiffness”; and Therapy following metacarpofalangeal joint arthroplasty.
What was your first encounter with hand therapy?
While doing an internship at Lenox Hill hospital in New York in the hand therapy department.
What is the most important training you’ve had and where was it? Could you tell us some anecdotes about that?
The most important training I had was the hand therapy fellowship I attended at Texas Woman’s University in Houston, TX USA with Dorit H. Aaron, OTR, CHT, FAOTA former president of the American Society of Hand Therapists (ASHT) and Barbara Winthrop Rose, OTR, CVE, CWA, CHT, FAOTA current president-elect of ASHT. A typical day at the fellowship consisted of lectures, clinical observation and hands-on learning (evaluation, splinting and treatment) in various clinics, surgery room, attending rounds and visiting patients with surgeons, cadaver labs and case study presentations on a weekly basis and intense studying day and night of the book: Rehabilitation of the Hand and Upper Extremity! I read both volumes cover to cover and we also had weekly exams on each chapter of the book! I also met and learned a great deal from some wonderful therapists who completed the fellowship with me Saba Kamal, CA USA, Linda West, CA USA, and Nicola Fellowes from Johannesburg, South Africa.
In your opinion which is the book you think a hand therapist needs to have near her bed?
Well if the hand therapist like me is interested in the learning more about flexor tendons I recommend: Tendon Surgery of the Hand by Jin Bo Tang et al. 2012.
Which article do you think is the most essential for a hand therapist to read? What did you find in this article that you want to share?
Well if the hand therapist like me is interested in learning about flexor tendons, I recommend the April/June 2005 issue of Journal of hand therapy especially the article: “The Evolution of Early Mobilization of Repaired Flexor Tendon” by Karen M. Pettengill. In addition the 39th chapter of Hand Surgery 1st edition “Early Active Motion after Flexor Tendon Repair” by Rosyln B. Evans; the article “Rehabilitation of flexor and extensor tendon injuries in the hand: current updates” Injury 2013 by Howell & Peck and most recent important article I highly recommend is: “Tendon healing, Edema, and Resistance to Flexor Tendon Gliding: Clinical Implications” by Wu & Tang 2013 Hand Clinics 29. These articles and chapters provide vital information for the therapist who designs treatment programs for flexor tendons. The perfect protocol for all repaired flexor tendons would be the one in which the tendon can be mobilized actively early 1st 3 weeks in order to have true proximal glide of the repair site and prevent adhesions. Even though passive mobilization is important in order to overcome joint stiffness and in ↓resistance to flexion prior to applying active motion, it may only result in pushing the tendon proximally and may cause it to buckle or fold. However, implementation of an active motion protocol is dependent on a thorough evaluation of several variables, such as, the extent of the injury, surgical repair, status of the tendon following surgery, and patient compliance. In my own clinical experience, in all the cases in which I have applied a controlled active motion protocol, I have found that even a small amount of active flexion starting at the DIP joints in the 1st 3 weeks following repair results in good to excellent excursion of the tendon.
Has your professional practice changed over the years? How did it use to be and how is it now?
I was a new therapist I often referred and implemented treatment based on therapy protocols, now through acquired experience and techniques I have learned attending conferences and reading articles I modify and change protocols accordingly.
In which projects are you involved at this moment?
Promoting EFSHT-ECHT certification and hand therapy certification in Italy.
In your opinion which are the next highlights for the HT in the coming years?
Creating a global hand therapy community through social networking and the internet. Facilitating interaction between therapists and doctors on an international and national level through international meetings such as the upcoming IFSHT meeting in Argentina www.ifssh-ifsht2016.com.