April 15, 2002

The Honorable Liz Figueroa, Chairwoman
Senate Business and Professional Committee
State Capital Building, Room 2053
Sacramento, CA 94814

Re: Support for Senate Bill 1402 (Murray)

Dear Chairwoman Figueroa:

As President of the American Society of Hand Therapists, a 2,700 member association comprised of physical and occupational therapists specializing in the treatment of the hand and upper quarter, I would like to speak to Senate Bill 1402, currently under legislative review in California. It is felt that the original bill fails to fairly represent hand therapy practice and offer the following as justification in support of amendment, as proposed in Senate Bill 1402.

In section 1 (l), the original bill defines "hand therapy" as the treatment of the hand, wrist and forearm. The term hand therapy can be somewhat misleading. Hand therapists treat the entire upper quarter, and have an educational background which encompasses the treatment of disorders of the cervical spine, shoulder and elbow, in addition to the treatment scope defined above. For example, in the last five years, 52% of pre conference and instructional courses offered at the Society’s Annual Meetings, deal with the treatment of the upper extremity above the forearm. Moreover, Hunter, Mackin & Callahan’s Rehabilitation of the Hand and Upper Extremity (2002), currently in its 5th edition and considered fundamental to hand rehabilitation, includes chapters on the anatomy of the neck and axilla, anatomy and kinesology of the elbow and shoulder, upper quarter screening, management of breast cancer edema and sections dedicated to common elbow and shoulder injuries. Additionally, The American Society of Hand Therapists’ Comprehensive Survey of Hand Therapy, considered a basic level course for hand therapists, includes chapters on Peripheral Nerve Injuries and Anatomy of the entire upper quarter, as well as chapters on Joint Mobilization, Soft Tissue Relationships, Strengthening and Exercise, Arthritis, and several others inclusive of the elbow, shoulder and cervical spine.

ASHT also disagrees with the existing bill’s identification of only two additional treatment techniques that hand therapists may utilize (physical agent modalities and massage). We feel that this clause gives the impression that these two additional skills alone differentiate hand therapists. Hand therapists are trained and tested during the Hand Therapy Certification Examination on the techniques of wound management (including debridement), joint mobilization and therapeutic exercises to the entire upper quarter, as well as many other techniques. Hindering the application of these essential treatment skills by therapists would compromise their ability to effectively treat these disorders. Restricting a population of therapists from performing techniques that they have demonstrated competency in during their certification exam is unfounded.

Finally, I would like to note incongruities in the logic of mandating supervision of occupational therapists treating hands by certified hand therapists (CHTs). There are currently 437 CHTs in the state of California, of which 87% (381) are occupational therapists. To be eligible to sit for the Hand Therapy Certification Examination a therapist must document 2,000 hours of treatment of the upper quarter. California occupational therapists will find it near impossible to amass this experience when forced to find supervision by so few CHTs. This will eventually lead to fewer therapists who are qualified to sit for the examination, consequently resulting in fewer CHTs available in your state for supervision. Given this causal relationship, the unfortunate outcome for California could be the exodus of therapists seeking experience in the treatment of the upper quarter and the eventual loss of highly qualified specialists to treat upper extremity injuries of California residents.

I appreciate your consideration of the aforementioned arguments relative to Senate Bill 1402. I hope I have effectively demonstrated to you the importance of preserving and promoting occupational therapy and the specialty of hand therapy to ensure quality patient care for California residents. If I can supply your office with any additional information on hand therapy, and its relationship to occupational and physical therapy, please feel free to contact me.

Sincerely,

Ginger H. Clark, OTR, CHT                                                                                                              
2002 President, ASHT

References:                                                                                                                                    
Mackin, Evelyn J., et al, (2002). Hunter, Mackin & Callahan’s Rehabilitation of the Hand and Upper Extremity (5th ed). Philadelphia: Mosby.