Institution: CENTRO RIABILITATIVO DALLA MANO ALLA SCHIENA – CRIMAStocco

Years of experience in HT: 13 YEARS

Main areas in HT you’ve been working in: TRAUMATOLOGY, DEGENERATIVE DS, SPLINTING

Main subjects that you’ve presented in a meeting: SPLINTING, TENDON INJURIES, WRIST PATHOLOGY

Please, tell us more about you…

What was your first encounter with hand therapy?

I first came in contact with the magnificent world of HT during the first week of my first year at McGill University in Montreal, Canada where I undertook my undergraduate program in Occupational therapy (OT). The first week was useful for students to familiarize themselves with different areas of OT. When my future mentor, Barbara Shankland came to speak to us about the benefits of OT in hand rehabilitation, I knew then and there that I would become a hand therapist!!

 

What is the most important training you’ve had and where was it? Could you tell us some anecdotes about that?

In the course of my career, I had grateful encounters with several speakers and teachers. However, the single most important moment that changed my method of working and treating several finger injuries occurred in 2004 during a weekend course in New England (USA). The speaker at the time gave several talks on tendon injuries over a 2 day period. Class finished early on the second day and most participants took advantage to visit the area. Some of us stayed for clinical pearls and were introduced to a new material called Quickcast Finishing tape®!!! This material has revolutionized the way I now treat effectively many finger injuries such as the mallet finger, Boutonniere and Swan-Neck deformities and even some phalangeal fractures. Because this product was not marketed in Europe at the time, I took it upon my self to introduce It, with the help of the UK distributor Patterson-Medical, on this side of the Atlantic ocean. This became a reality only in 2012. Ever since, Orfit Industries introduced a similar product: Orficast®. Both products are now available to treat in timely and cost-effective manner many hand conditions that require more time to treat with regular thermoplastic. If during that moment in New England I had decided to go sightseeing with the rest of the group instead of staying for the extra learning, I would have missed this important learning experience forever.

 

In your opinion which is the book you think a hand therapist needs to have near her bed?

Well, there are many books that can make you fall asleep quickly if read in bed! LOL!! Seriously, if a hand therapist could by a single textbook, I believe the “Rehabilitation of the Hand and Upper Extremity” which came out with a 6th edition a few years ago, is the one to own. Another “book” that could serve a purpose to novel therapists which wonder, like I did years ago, what protocol to use or what to do at any given time for most hand pathologies, should keep a copy of the Indiana Hand Center “Diagnosis and Treatment Manual for Physicians and Therapists” close to their treating table, which desperately needs a newer version by the way, since the last publication was done in 2001. Many other books may be handy for hand therapists but the choice should be personal and based on individual needs.

 

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?

I cannot decide on a single article but I do remember reading an entire issue (2002, Vol. 15, Issue 2) on splinting in the Journal of Hand Therapy (Am.) just as I began my career in HT. This was up-to-date information on splinting, all gathered in a single issue by the most renowned experts around the World! Lots of time saved there!! Exactly a year later, another very important issue came out on fracture management (2003, Vol. 16, Issue 2). I recall these 2 issues very well and continue to splint and manage fractures according to the general principles read in those articles.

 

Has your professional practice changed over the years? How did it use to be and how is it now?

I keep in mind that regardless of how much experience I can gather throughout the years, I still need to learn more. The amount of knowledge increases rapidly year after year and thus the science of hand rehabilitation evolves quickly. I have surely changed several aspects of my clinical practice throughout the years. For example, I was recently shown how to buddy tape fingers in a way that will last several months without having to replace Velcro straps, or continuously change phyisiotape. I became aware of the benefits of sensory re-training through graded-imagery and mirror therapy, and I have introduced these in my practice. I have improved my knowledge and skills about NMES, which I have used since 2004 but just recently improved in locating motor-plates of all muscles of the hand and wrist! I developed a technique to treat PIPj flexion contractures in a timely fashion (publication pending), , and many more things will change in the course of my career. However, one thing will never change I hope… the will to learn and improve my practice.

 

In which projects are you involved in this moment?

I have been teaching basic and advanced splinting in workshops for several years but I have just recently began teaching a series of annual practice modules in splinting. Several research projects are underway: one on the professional practice in Italy, another on the role of hand dominance on the speed of recovery following distal radial fractures, and finally an old project should be completed early next year on splinting management of PIPj flexion contractures. I dedicate a considerable amount of time to improve hand therapy in Italy, acting as a member of the Board of Executive in Italy and as the European Delegate. If days were longer, I would have many more projects. But being a full-time clinician, a new project normally walks in the clinic each day: patients!

 

In your opinion which are the next highlights for HT in the coming years?

This is a difficult question to answer since HT is different in each country of Europe and the World. In Italy, I hope in the next 5 years, the numbers of competent hand therapists will double to reach 200 since many areas of our beautiful country are without hand therapists. Internationally, I would like to see a flexor tendon management approach that could definitely resolve the problems regularly seen in Zone II! Lots of research as been done to find the best surgical approaches or mobilization techniques but still, zone II remains a No Man’s Land. I hope to read in future textbooks the term “formerly-known as No Man’s Land”, with revolutionary methods of treatment. This single area of HT mandates the tight relationship that has come to create its self between hand surgeons and therapists ever since the 1970’s, when a handful of American therapists got together to address this problem! I think the hundred thousands of hand therapists worlwide will eventually find strategies to consistently and adequately treat flexor tendon injuries alongside hand surgeons.

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