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Journey to CHT
EHT would like to congratulate all the therapists who recently passed the hand certification exam and earned the credentials of CHT. We encourage our colleagues who did not pass to continue to strive for their goal. For those thinking about taking the exam, this issue is dedicated to you. Learn how EHT readers prepared for the big day.EHT’s new website is designed with you in mind (Susan was the master designer. Thank you Susan for your attention to detail). The website is interactive with quizzes, case studies, podcasts, movie clips and more. Check it out at www.handtherapy.com EHT is looking for instructors for
neurological disorders (CVA), geriatrics, pediatrics and more. If you are interested in teaching please contact EHT for more information: [email protected]
Thank you to our sponsors for making this magazine possible. Please click on their ads (if viewing online) to learn more.EHT’s magazine is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Content is the opinion of the contributors and not necessarily of EHT.
ENJOY!
From The Editors Desk
Nancy Falkenstein OTR, CHT, CEES
Susan Weiss OTR, CHT
The Road to Becoming A CHT
My name is Brian Boyd. I am an Occupational Therapist and a Certified Hand Therapist. I recently had the great honor of earning the credential of CHT. I have been practicing OT for
almost 11 years. My first eight years I worked in various settings including inpatient and outpatient with an emphasis in upper extremity dysfunction. Three years ago I began my my journey to CHT. My career lead me to treating upper extremity pathologies in a private practice outpatient setting. I enjoy working with all upper extremity injuries and pathologies with a special interest in the shoulder. I enjoy the complexity of the shoulder and its pathologies, such as shoulder instability (MDI and TUBS), scapular dysfunction, RTC pathologies, various surgical procedures, adhesive capsulitis, etc. Shortly after
achieving my certification in hand therapy, I was contacted by Exploring Hand Therapy to share my “journey” with the hand therapy community. I said “sure” since I could not have done it without some of the excellent educational products that Exploring Hand Therapy offers. So here goes my journey.
One of the foremost pieces of advice I can offer to anyone preparing to take the test is to make 100% sure you are committed to obtaining the CHT credential.
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www.handtherapy.com
In This IssueJourney To CHT .......................................1
Splinting Tips ...........................................3
CHT STATS ............................................6
Political Corner ......................................10
Newly released courses ........................12
What’s Hot .............................................14
EHT updated SITE ................................20
Higher Education for OTs ......................22
Ergo Corner ...........................................23
World Traveler .......................................23
Modalities ..............................................28
Volume 7, Issue 1 Apri l - June 2007
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NCM Vanillai has moderate characteristics that allow the splinter to controlthe material with ease throughout the molding process, offering ample timeto form the splint, remove it and make final positioningadjustments. NCM Vanillai is a versatile thermoplastic thatsuits all experience levels and is ideal for almost any typeof splint. Call for a free sample, 800-821-9319.
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CREATIVE SPLINTING:A Case Study by Chad Royer, OT, CHT
Bob is a 62 year-old left-handed male who underwent a left rotator cuff debridement, decompres-sion, bursectomy, and Mumford clavicle resection on 01/17/07. He has a past medical history of heart issues (for this reason we decided to stay away from electri-cal modalities). He is active and enjoys hunting, fishing, canoeing, and photography.
Pertinent measurements taken at initial evaluation on 01/30/07 were:
shoulder ext=35•
shoulder flexion = 50 (75)shoulder abduction = 50 (75)internal rotation at 65 degrees = 60 (65)external rotation at 65 degrees = 10 (10)
Pt. had a history of conservative treatment for rotator cuff impinge-ment with limited success. The physical therapists involved in his initial treatment reported decreas-ing ROM as time passed. During the time between Bob’s surgery and his initial therapy evalua-tion, he was performing resistive exercises because he thought he should do what he was do-ing during his previous therapy visits! He presented at the OT initial evaluation with significant
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pain and significantly decreased ROM.
Treatment initially focused mostly on PROM for adhesive capsulitis but I also tried to stay in touch with the protocol regarding his RTC decompression. The big-gest hindrance to Bob’s progress was (and remains) his tendency to guard during PROM. He had significant tightness in the pec. and the upper trap. muscles. Re-laxation techniques, ultrasound to the capsule, prolonged stretch, taping, and a heavy emphasis on compliance with home exercise program were all showing limited-
Splinting Tips and Tricks By Chad Royer OT/L, CHT
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My experience was life altering in so many ways. I have to say it has changed not only my skill level & status in the profession; but, it has changed me as a person. However, if you are not committed you will likely have greater risk of disappointment and find it difficult to keep your focus. Now, if you’re married, which I am with two daughters, probably the best piece of advice is that you MUST HAVE A SUPPORTIVE SPOUSE! I could not have reached my current status without the loving support of my wife; and to some extent my daughters. There is nothing like having your 5 year old quizzing you on flaps and grafts late at night or while you’re on vacation. Seriously, outside of these two key pieces of advice
I would like to share my plan which I think you will find similar to most anyone that has passed the test.
I decided to take the test after attending a continuing education course on April 23-24 of 2006. I realized time was short as I had talked to several people who told me they studied for a year or more. Thus, I felt it was imperative to make a plan for my studying. I would recommend to anyone thinking of taking the test to plan on what you will study, when you will study and commit to it. I planned to study a minimum of 1-2 hours daily. The next question I faced was “Where do I begin?” I addressed this question with a quick list of what I felt were my “weak
areas”. This is a vital step. I strongly encourage this step as it is prudent to identify your “weak” areas to maximize your preparation. Next, I made it my mission to obtain what I felt where the best resources to prepare myself for the CHT exam. I looked at the “list” of recommended readings at the HTCC website and felt overwhelmed. I took a deep breath and talked to a couple of people regarding recommended reading material. The resources on my short list were as follows: Rehabilitation of the Hand and Upper Extremity by Mackin, Callahan, and Hunter; 5th edition; Hand Rehabilitation, A Quick Reference Guide
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and Review (known as the “Purple Book”), by Weiss and Falkenstein, 2nd edition; and Basics and Beyond, A Comprehensive Study of the Hand and UE Rehabilitation, CD-ROM. I read a couple of other hand books; but, the aforementioned 3 titles were my main study guides. Typically, I had one of the above with me at all times. I MEAN AT ALL TIMES no matter where I was! When you are committed to the journey you will find the ability to study almost anywhere at anytime. Also, I utilized the 3 mock up tests that Exploring Hand Therapy offers. Since I had only 5 months to prepare for the test I made a time line out to accomplish my reading list which is something I strongly encourage. For
example, I started with Rehab of the Hand and read a minimum of one chapter or more a day until I had read both volumes one and two in exactly 90 days. Next up was my other two main sources mentioned above. I tried to study at least one chapter in each respective resources each day. Finally, by the beginning of September I had read all 3 and began to study the “Purple Book” and Basics and Beyond CD again. I continued to study each for the next two months until test time. I took two days off prior to the exam to play with the mock up tests, review a few areas and simply relax for the “big day.” Although I did not have anyone to study with since I live in a rural area, my plan was successful as I passed the CHT exam on my
first try. I knew going in that I was as prepared as I could possibly be. In fact, after I took the test I felt a huge relief and comfort in knowing the test was not as bad as I expected. All in all, I have to say a big “Thank You” to my wife and family for their support and to the hand enthusiasts in the world such as Susan Weiss and Nancy Falkenstein who produce excellent education tools. To this day, I still read in the “Purple Book” (5 times and counting) as I always find some new little gem. I hope my story helps someone out there prepare for what is certainly one of the greatest professional accomplishments one can achieve as a therapist. Just remember it is possible;
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MEMBERSHIP INCLUDES all this and MORE...
Free DVD or CD-ROM course with Membership Club member discounts Interactive Discussion Board Case studies presented for open discussion Q & A on the discussion boards EHT magazine mailed to your home quarterlyNetwork with other therapists Prepare for the hand exam by networking and MORE
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The FIRST and ONLY CLUB dedicated to the
Hand Therapy Community
YOUR EXCLUSIVE MEMBERSHIP IS JAM PACKED WITH BENEFITS!
JOIN TODAYwww.handtherapy.com
success. At 2 weeks, Bob’s mea-surements were as follows:
shoulder ext=45 (60)shoulder flexion = 100 (100)shoulder abduction = 85 (85)internal rotation at 65 degrees = 60 (65)external rotation at 65 degrees = 25 (35) 6-8/10 pain reported by patient
While these represent improve-ment, Bob was still significantly behind for 4 weeks post-op RTC decompression and he continued to guard limiting progress.
I spoke with the surgeon about surgical mobilization and the patient spoke with the surgeon about muscle relaxors but sur-geon declined both options. I
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also spoke to two companies about dynamic and static pro-gressive shoulder splints but his insurance would not cover the splint. Bob would be required to pay 100% out of pocket which was over $700/month. At this point, mother necessity insisted I design my own version of the shoulder splint! I based my de-sign on the commerically avail-able designs. We (the patient was a big help giving me feed-back and suggestions during the fabrication of the splint) fabricat-ed the splint on 02/15/07 in a little over an hour. Modifications were made at the next visit to improve the strapping, base stability, and padding was added. I had the patient use the static progres-sive splinting (JAS) protocol of
3/day x 30 mins per session with reassessing the tension to allow increase tension every five min-utes. Initially, the patient was only able to wear the splint 2-3 mins at a time with significant pain and then only for 1-2 times daily. By the end of the first week, Bob was wearing the splint 17 mins at a time 2-3 times daily. He is now able to wear the splint 25 mins per session 3 times daily. I think he is stopping 5 mins short of the recommended time just to be contrary . . . if you knew the patient, you would understand! By 03/06/07 (almost 3 weeks of splint wear) the patient mea-sured:
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A Certified Hand Therapist (CHT) is an OT or PT who has a minimum of five years of clinical experience, 4,000 hours or more in direct practice in hand therapy and who has passed the hand therapy exam.
How Many CHTs Are There?
There are 4834 Certified Hand Therapists worldwide:
United States 96%Canada 3%Australia & New Zealand 1%Other countries <1%
They are broken down by profession as follows:
OT 85%PT 15%CHTs (both OT & PT) <1%
Visit www.htcc.org to learn more about taking this exam.
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Splinting CASE STUDY continued
CHT STATS
but, only if you are committed to making it happen.
Brian Boyd works at Top Rehab in Tullahoma TN. He is active in his community.
My name is Beth Peterson and I was asked to provide CHT candidates with tips on preparing for the exam. I feel well qualified
for this task as I have taken the test more than once. I graduated from Quinnipiac College
in 1998. I have been an OT for eight years, with the past four years devoted to hand and upper extremity rehabilitation. I received a Post Professional Certificate in Hand and Upper Quarter Rehabilitation from Drexel University in 2004.
The biggest recommendation I can make is to have a good support system because family and friends will help you keep your sanity. Be sure to ignore things like, “You are already studying for a November exam?” and, “Are you sure you don’t get a huge pay raise for passing?”
I devoted ten months to studying for the exam the first time around. I lived and breathed Rehab of the Hand by Hunter and Macklin, making flash cards for every chapter. Almost every weekend was spent studying
for hours and hours. I do not recommend this technique. I do, however, recommend having a study group. We kept each other on track while challenging our critical thinking skills. We used the “purple book” to quiz each other and we also made up our own quizzes for each section of Rehab of the Hand.
I correlate studying for the CHT exam like training for a marathon. It is best to do a little bit of studying every other day, than to be weekend warrior. There is greater potential for success to absorb information in smaller intervals. You are less likely to get injured from running if you follow a training schedule and try different techniques to build endurance and strength.
I missed the 2005 exam by two points. Was it because I changed an answer? Did I not study the shoulder enough? Or did “pregnancy brain” really exist? I will never know the answer. I do know that I am a much better therapist for all the time I put into studying.
I chose to take the exam again in 2006 not only because missing it by two points killed me, but it was also my personal and professional goal. My approach was slightly different because I had an infant. I needed a concise organized method that would best utilize my time. I purchased the Basics and Beyond: A Comprehensive Review of the Hand and Upper Extremity put out by Exploring Hand Therapy to use as my
study guide. I went through the CD topic by topic and read additional information as needed from Hunter and Macklin to solidify the concept. I then supplemented these methods with taking practice exams online and in the purple book. If you have the opportunity you want to “pick the brain” of a hand surgeon, or better yet, observe a few surgeries that will be helpful.
The long and short of it is this: choose a study method that best suits your learning style. Make sure you set aside time a few hours a week for studying but also for play. It is a comprehensive exam that, although scary, can be conquered. I am proof!
CHT Journey by Fran Fleishman MS, OTR/L, CHT
When I decided to take the CHT exam, I was immediately overwhelmed with wanting to master every fact and nuance that I heard or read, because it may be on THE TEST.
I acquired numerous texts including the famous purple book, hoarded journals, attended conferences, and Google searched. Even while reading one thing, I felt nervous that I wasn’t reading another: the task of organizing the material was too big, and lists of recommended
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texts were daunting. I enrolled in a year long distance learning program from Drexel University (Philadelphia), in order to have the information presented to me in a systematic way. It was very good, and laid an excellent groundwork.
I allowed a whole year for studying, beginning by reviewing lectures and notes. I intended to reread and notate the reading assignments with each unit (Ha!), as this was always a really successful study method for me, but quickly realized this was totally impractical with such a huge and dense body of information.
Speaking of dense, as I read and read and wrote and wrote I had no way of knowing if I really knew anything! I found that the BEST way to learn was by having to answer questions, and the purple book (if they ever change the cover color, no one will know what I’m talking about) became my main study tool. It’s a very good idea to get accustomed to answering multiple choice questions, because that’s the format of the CHT test, and it’s amazing how blank your mind can go when confronted by a question. After a while, you will notice that you tend to answer questions on certain topics incorrectly. These are your weak areas, and these are the ones requiring detailed reading.
Practice tests are available online from Exploring Hand Therapy, and are invaluable. They are a notch more challenging because
instead of a series of questions on the same topic, as in a study guide chapter, the topics are mixed up and you have to mentally jump from one thing to another. The answer is not immediately available and so you get the emotional experience of selecting an answer and trusting yourself. Upon completion you do get instant feedback- a grade and the correct answers.
Another source for question-answering practice (as well as good subject matter review) is the ASHT Hand Therapy Certification Study Module. Here the answers are not provided, instead you have to read through the accompanying CD, and even think (!) and cross reference a little, to find “the best answer” for @ 20 questions for each of 20 chapters of subject matter. And “the best answer” is often what you need to give on the real test- uncomfortable but true.
Many questions on the CHT exam call on your ability to understand concepts and to apply them clinically, but there are many hard facts requiring memorization. I practiced drawing and labeling the brachial plexus, and wrote out “flashcards” to test myself on details of the brachial plexus, sequences of innervation and reinnervation, anatomy, specific fractures, tendon transfers, and so on.
You’ll need to intensify your studying for the last few months. An hour or two a day becomes hours and hours; but try not to
panic and cram as it gets days-close. Keep up the practice questions especially on your weaker topics, and look things up if you need clarification, but all your heavy studying is best done before you get too close to THE DAY. The night before your test, try to get a good night’s sleep, knowing that you have done your best, and that most people taking the exam are in your same position.
Best of luck to you,Fran
Fran Fleishman MS, OTR/L, CHTGraduated from Columbia University and has been practicing since 1993. She currently works in a private practice owned by four orthopedic surgeons, and just passed the CHT exam in November 2006.
Betty Smith’s journey to being certified.
Studying for any examination is a personal thing, that’s for sure, and what works for one person won’t work for another. The first time
I prepared for the hand exam, I started studying about 6 months before. I read Rehab of the
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Political Corner
Action Alert
Oppose Legislation Permitting “Incident-to” Billing for Thera-py Services by Non-Qualified Therapists:
Protect Occupational Therapy’s Scope of Practice
History
The Access to Physical Medicine and Rehabilitation Services Improvement Act of 2007 (H.R. 1846) was recently introduced in the House of Representatives by Representative Edolphuous Towns (D-NY). The legislation would allow non-qualified therapists to bill the Medicare program for therapy services “incident-to” the physician’s professional services, thereby eroding the May 2005 Centers for Medicare and Medicaid Services (CMS) regulations that restrict the billing of therapy services under Medicare to those qualified to deliver physical therapy, occupational therapy, and speech language pathology services. This legislation would allow the billing of services provided by athletic trainers and lymphedema services at 80% of the physician fee schedule and would apply the therapy cap limitations to these services. Legislators in the Senate are currently debating introducing the legislation for the 110th Congress in the Senate.
In the 2005 Medicare Physician Fee Scheduled rule, CMS determined that occupational therapy services provided in a physician’s office
incident to a physician’s professional services be furnished by personnel who meet certain standards. This rule meets the intent of Section 4541(b) as passed by Congress in the Balanced Budget Act of 1997. The rule established qualifications and clinical preparation standards for those providing “incident to” occupational therapy services, implementing the requirements adopted by Congress in 1997 which were designed to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of occupational therapy services by qualified occupational therapists.
In the past, a number of provider groups (i.e., athletic trainers, massage therapists, low-vision specialists, and others) have been paid “incident to” occupational therapy services. Since CMS published this rule, these provider groups have formed a coalition to support reversing the changes outlined in the “incident to” rule legislatively.
AOTA’s PositionAOTA strongly supports Medicare’s qualifications standards. Services reimbursed as occupational therapy should be provided by an occupa-tional therapists or an occupational therapy assistant under the supervi-sion of an occupational therapist.
AOTA is monitoring the issue closely and will continue to work with all members of Congress to uphold the intent of Section 4541(b) in the Balanced Budget Act of 1997. This legislation, and the corresponding rule by CMS, eliminates the abuse of nonqualified
individuals providing services that were billed to the Medicare program, and ultimately will help protect the scope of occupational therapy and ensure beneficiaries that the services they receive are of the highest possible quality.
Action Needed:
Contact your Representatives (one member of the House of Representatives and 2 Senators) to urge their opposition to this legislation. If you are contacting your member of Congress in the House of Representatives, ask he/she to oppose the Access to Physical Medicine and Rehabilitation Services Improvement Act of 2007 (H.R. 1846). If you are contacting your Senator, ask for their opposition to any legislation similar to the House bill. Please contact the AOTA Federal Affairs Department at [email protected] or 1-800-SAY-AOTA if you have any questions or comments.
If viewing online click the link below. You will be directed to AOTA action alert page. Then scroll to the bottom of page to the send your views to your local representatives. If reading please go to: http://capwiz.com/aota/issues/alert/?alertid=9424141
AOTA has a user friendly form for you to complete and your concerns will automatically be sent to your representatives. Don’t hesitate respond now.
Used with permission from AOTA. Your action NOW will benefit the future of OT. Please respond. THANK YOU
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Hand, underlined the points I thought were important, and took notes. I included anything I felt was important including anatomy pictures. I took the test, spent the whole 4 hours there, and within 10 minutes of taking that exam, I thought, “Man, I cannot believe this, I am sitting here failing this test.” I walked out of there thinking I made a 30% at best. Come to find out, I missed it by just a couple of questions, but boy, did I feel stupid!!
Well, that was about 8 years ago. I decided when I retire from the Air Force (this year), I wanted to work with the hand and upper extremity in an orthopedic clinic. I contacted of of our area CHT’s in November of 2005 and he said that if I wanted to work in hands, I needed to be certified. I thought, here we go again. I started studying in December/January. I began by reviewing Rehab of the Hand....again. I used my study notes from 8 years earlier and enhanced them in certain areas. I copied all the anatomy pictures that I came across from every source I could find. I attended the Philadelphia Hand Therapy Conference and bought the “purple book” to help prepare me for the test. I kept studying and decided I needed the sample tests from Exploring Hand Therapy to ease my test anxiety, so I ordered the package. I even went as far as to tape the hand muscle & nerves on my mirror!! The purple book was a great study tool as it kept me focused. It helped put the key areas in neat, compact chapters. As the study months went on, the
purple book helped me find my areas of weakness, so I could address them. I kept a log of my study hours and I put in over 550 hours. I know, you beloved OT”s, I am a hard-headed PT and sometimes it takes us longer to get it!! HA! Then, came the dreaded day for the exam. I didn’t study the night before, I visited my best friend, of over 40 years, and felt pretty good about the test. I went in the exam center and lo and behold, I was finished in 1 ½ hours. I found out in January, I passed it. Like I said before, what works for one, doesn’t work for another, but I felt that I needed to study sooner than the first time. I really feel if I had the purple book the first time (did it exist?) I would have passed the exam. The purple book focuses you on certain areas, but I would recommend that you expand on those areas and attack those where you are weakest.
Good luck to you, my fellow therapists. Figure out your plan of attack for your study sessions and go for it. Betty Smith was born at Luke AFB, Phoenix, Arizona and raised on the west side of Phoenix. She joined the Air Force in January 1972 to serve her country and to see different parts of the world. While in the AF she become interested in physical therapy. After her 4 year enlistement was completed she pursued her physical therapy degree through Northern Arizona
University, Early in her PT career she was introduced to hand therapy and pursued yet another interest. She worked three years as a civilian PT then joined the AF National Guard in 1985. The AF National Guard did not have PT so she worked in other areas until she became active duty in 1992 in physical therapy. Since then, Betty has introduced and developed hand therapy at three different AF bases, saving the Air Force over $35,000 in disengagement costs. She had been a Flight Chief over two sections and clinic chief at 4 bases. Betty will be retiring from the Air Force in December 2007 After retirement she want to practice soley in hand and upper extremity.
How to pass the CHT exam, insight from Melissa Jurgen
Dear prospective CHT exam takers, having passed the CHT exam, I was asked to share my methods for passing this huge, very comprehensive exam!
First, experience is the foremost reason I passed. I have worked in hands since graduating college six years ago. I have worked with many experienced therapists and most importantly I have
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Newly Released and Popular CEU Courses
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Yoga: Mind & Body - Therapeutic TechniquesThis 4.0 contact hour (.4 AOTA CEUs) movie course Integrates Yoga in the Clinic. It will provide participants with the knowledge and expertise needed to implement comprehensive and individualized treatment strategies for multiple diagnoses. The course will enhance conventional therapeutic approaches and provide alternative methods to treatment. Course content includes breathing techniques, muscle strengthening and re-education techniques for the entire body, as well as pain and anxiety management techniques. These techniques are geared for clinical application, rehab clients, wellness programs, and home programs for many others.
Yoga: Child’s PlayThis 4.0 contact hour (.4 AOTA CEUs) movie course will provide participants with the knowledge and expertise needed to complement and individualize treatment strategies for multiple pediatric diagnoses. Such diagnoses include Down Syndrome, Cerebral Palsy, Autism, ADHD and learning disabilities. The course will enhance conventional therapeutic approaches and provide alternative methods of treatment. The course content includes balanced yoga poses to increase body awareness, position in space, strength and flexibility. Also, specialized breathing exercises and relaxation techniques to improve concentration and reduce hyperactivity. All of the
these directly relate to therapy provided in a pediatric settings. The course also will provide participants with the knowledge and expertise needed to offer the same benefits of increased body awareness, position in space, strength, flexibility, improved concentration and relaxation to healthy children.
Hand Therapy Certification Package Discount PROMOThis package includes:
Basics & Beyond: A Comprehensive Study of the Hand & UE (CD)Three Practice Exams (200 questions each)Two movie courses Membership in EHT’s popular Hand Club for one year
Total Savings: $600.00
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(and continue to) work closely with hand surgeons. My first advice is to ask lots of questions – no matter what the question. That saying “no question is a stupid question…” is very real - you have to ask anything and everything in order to learn anything and everything.
Above and beyond, all prospective CHT’s need to own - the one and only “purple book”, Hand Rehabilitation A Quick Reference Guide and Review. Its content and layout is FABULOUS! I first became aware of this text as a student in my hands clinical. I was amazed when I flipped through the first few pages, I had the ability to quiz myself AND research treatment techniques
for certain diagnoses. I have continuously used this amazing text as a student and a professional. I used this book’s test question format as a tool to determine in what subject areas I had weaknesses. This made studying much more efficient. Take note- this texts’ Socratic Method makes it possible to learn the wording of possible test questions.I also purchased the CD “Basics and Beyond: A Comprehensive Study to Hand and Upper Extremity Rehabilitation.”, provided by Exploring Hand Therapy. This course was fantastic! I reviewed it over a period of six months and two weeks prior to the CHT exam I took the test for CEU credit, just to see if I could really pass the
CHT exam. It was a great overall review – I passed it and used that confidence going into the actual CHT exam.
In addition, I have always referenced Hunter, Mackin & Callahan’s “Rehabilitation of the Hand and Upper Extremity.” It sits on top of my desk at work and I always refer to it in times of need. I have read every chapter thoroughly over six years (not at once!). This text is a great way to read everything about hand therapy. I also referred to this text to “brush up” on the subject content I found that I had weaknesses in.
Lastly, I have attended every
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Philadelphia Hand Conference: “Surgery and Rehabilitation of the Hand” for the past five years. I rarely see this conference mentioned as a study tool (surprisingly) – this continuing education course is excellent. This conference has lecture format moves quickly and holds your attention. There are smaller sessions at the end of the day which you choose to attend based on subject content. These sessions vary widely from anatomy basics to splinting. In addition, you have the chance to visit with vendors of hand therapy products which assists in learning about the newest products on the market. As an aside, you can also meet the authors/founders of the wonderful “purple book” and EHT – Susan and Nancy!
In summary, my total time spent studying for the exam has been over a course of six years of practice in hand therapy. However, the year prior to the exam I set aside time to study three to five hours per week. I reviewed previous continuing education manuals and from the resources I listed above. However, I can tell you the week before my exam I was studying and quizzing myself from the “purple book” it was the ONLY book that came to the hotel room with me the night before – just in case…you know last minute jitters!
I hope this helps all prospective CHT exam takers, GOOD LUCK! It was a long road, but remember - your “hand” comes to the exam!
Melissa Jurgen OTR/L, CHTConnecticut Orthopaedic Specialists / Star Sports Therapy and Rehabilitation2408 Whitney AvenueHamden, CT 06518
Star Sports Therapy and Rehabilitation is an outpatient facility that creates personalized treatment and exercise programs for each patient. The staff of hand picked therapists works closely in conjunct with the physicians on staff to coordinate therapeutic regiments and evolve the best outcome for each patient. Melissa currently practices fulltime specializing in the hand and upper extremity. She received her degree in Occupational Therapy from Quinnipiac University.
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When treating patients & you want to increase the challenge, have the ability to grade progress objectively, and see the benefits you should try finger weights. FingerWeights LLC -www.fingerweights.com has a unique device to incorporate into your clinical practice. I have been using finger weights for years. I like the ability to adjust the weight and record the progress. I use finger weights with many pathologies from tendonitis, to fracture rehabilitation to general weakness. Finger weights are great tools to increase demand on the
targeted structures without increasing pain. I have found them beneficial with musicians, athletes, office workers and retired patients. Give them a try. See ad on page 22.
What’s Hot? Nancy Falkenstein
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My name is Jessica Chin. Formerly known as Jessica Lam, Lamb without
a “b”. I have a 21/2 year old toddler who is ever so energetic and curious, and a supportive husband who loves to hear my stories while the TV is running, on the side. Needless to say, it was a challenge to prepare for my CHT, as I, like so many others, have multiple “roles” to fulfill. I not only have a supportive family, I have a great mentor, who is an experienced CHT. She and other CHT colleagues have shared their
perspectives on the exam preparation. Their experience and perspectives have helped me a great deal. I would like to share what has been invaluable advice as well as my own 2 cents. 1. Know your own study habit. (Don’t study with a friend if you are friendly and chatty. Don’t kid yourself) 2. Plan ahead. I recommend deciding on all the materials that you plan to study one year prior to the exam and set goals. The primary resource, I used, was Hunter’s 2 volume book. I used Exploring Hand therapy’s “purple book” (Weiss/Falkenstein), Basics and Beyond (CD), & the practice exams as reviews.
Planning a year ahead might seem long, but is always nice to have more time and not need it, than having acid reflux if you don’t have enough time. My warnings to procrastinators, you might be able to pull it through, but watch out for those crows feet after the exam. 3. Set aside time. I don’t care if you can sing and chew gum at the same time, you cannot study in the park with one eye watching your child. In other words, no “multi-tasking”. 4. Bribe your family members to be supportive. Trust me, it takes a village for you to study if you are married with children. The
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difficulty of the exam increases as the number of your household increases. 5. Balance yourself in your ADL’s. All study and no play makes Jack a dull boy. The best is to let yourself relax while you relax and study hard while you study. If this is hard, refer back to suggestion #2. 6. Choose the right brain food. Remember you cannot go IV on caffeine, it can only take you so far. Besides withdrawal after the exam is horrible, a personal testimony. Exercise and bring oxygen to your brain is better than overdosing on caffeine. Omega 3 fish pills claims to help memory, (if you remember to take it.) 7. The day of the exam. If you can stay in a hotel the night before. This will decrease any anxiety about over sleeping or getting lost on the way to the exam. Assessing the exam room before the test not only can help you eliminate stress, but can help you to get better prepared. (ie. Is the room cold or hot?) 8. Attending a study group or a exam prep course may be helpful (I personally get distracted easily, so I decided to use the software Basics & Beyond CD prep course because I can rewind it as much as I wanted). God bless you!
Hello CHT!POOJA OAK’s Journey
Can I really do this? I haven’t taken an exam in years! These words kept ringing in my head in early 2005. I wanted to make a career change into Hand Therapy but the last time I had sat down and studied was in 1993 when I became an OTR. Late nights surrounded by books and tea seemed such a thing of the past. How was I going to accomplish this?
‘Hands’ have always been my passion. I had attended different courses for splinting, hand rehab, modalities, etc. The days and years passed by and one fine day in early 2005, I decided to take on the project of to earn the credential of ‘CHT’.
Initially, I didn’t even know where to start but I decided ‘The Hand’, a self-paced course offered by AOTA, would be my first step. Fantastic experience! I got my initial confidence. I realized that I still remembered the subject. Then I went on the internet and printed out a list of CHTs in town, and literally called every one for guidance. Two senior hand therapists agreed to be my men-tors.
I bought the ‘Bible’ of Hand Therapy…big yellow books by
Hunter, et al, and also a purple book by Weiss/Falkenstein. Enthusiastic enough, I started reading the yellow books and guess what? …just handling these heavy ‘hand’ books, started bothering my hands more than my brain. Reading and recollection was another hurdle. Again I went on the internet and I found this Ali Baba’s den….EHT! I am not computer savvy and so I preferred to call Susan and Nancy. Promptly they returned my calls. I was whining ‘Susan- I need HELP!’ She guided me and I bought the ‘Basic and Beyond’ and practice exams in December 2005.
I started on ‘Basic and Beyond’ but did not have courage to even take the exams. They remained in original packing for a few months, but ‘Basic and Beyond’ was the best thing that happened to me. I think it should be re-named as ‘Basic and Beyond..the Best’!
My seniors were guiding me on what chapters from the Yellow Book to focus on. Now I was ready to send my paperwork to HTCC. I literally waited till end of June 2006, but once done, I planned my studies. Considering there were about 30 topics, at 3 days per topic, it would take me 3 months. But I had to get there. I gathered a lot of reference material and simultaneously read B& B, purple book, and also referred to the Yellow Book. Through this journey, I came across some
continued on page 19
Splinting Tips and Tricks
shoulder ext=50 (55)shoulder flexion = 105 (115)shoulder abduction = 100 (115)internal rotation at 65 degrees = not measuredexternal rotation at 75 degrees = 50 (55) 3-4/10 pain reported by patient
Patient’s last visit before pub-lication of this case study was on 03/16/07. During this visit, I only measured external rotation because we had to modify splint again to make allowances for increased ROM and we are now working more on strengthening than before. Current measure-ment is:
external rotation at 105 degrees = 70 (80)
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Materials needed for the fabrica-tion of my prototype static pro-gressive shoulder external rota-tion splint:
splint material 12” x 14” or 14” x 14” as pa-tient’s size demandsshoulder stabilizing/tuner base wrist/hand piecetuner mounting piecewood supports for edges ap-proximately ¾ to 1” thick 10-12” wood screws (not too long . . . shouldn’t stick out from wood)7” curved outrigger with foot (Sammons part # 769301)thumb screws (Sammons part # 7643)line guide (Sammons part # 7697)medium and large speedy rivets1/8” foam for comfort
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tuning device fishing line (25# test)Velcro and strapping material, hole punch, scissors, and all the other usual suspects for splinting!
Figure 1: I changed the short wooden piece to extend to the corner (final version)
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continued on page 18
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Figure 2 Slots and D Rings
Create slots in base to work as D-rings for your strapping. This allows the patient to don the splint independently. Leave plenty of space between the slots because if these fail, the straps fail.
Figure 3 Shoulder Stabilizer Strap
Shoulder stabilizer strap is an-chored with rivets.
Figure 4 Anchoring
Anchor humerus strap to base with riveted loop
Figure 5 Straps
Each strap goes through a D ring allowing
easy patient adjustmentStraps then go through the D-ring slots so patient can adjust them snuggly and independently.
Figure 6 Velcro hook stuck to back of splint
Velcro hook stuck back to back will allow you secure strap ends to the rest of the strapping.
Figure 7 Hand Wrist splint
Hand/wrist com-ponent includes base of palm only to help patient know where to fit it and to help decrease migration of the component. Pull actually comes from the wrist level. If you pull from the palm, the wrist will extend and cause problems.
Figure 8 Fishing Line
Tie a 25# test fishing line in a loop
through the dorsal part of splint. I use a blood knot but you can use
a regular crossover knot if you prefer.
Figure 9 Outrigger
Outrigger with 2 thumb screwsAttach outrigger with 2 thumb screws before the wooden supports are screwed in place. Notice line guide position is adjustable.
Figure 10 Support
Secure corner to wooden supportBe sure to secure corner to wooden support or it will rise as you tighten the splint.
Figure 11 thermoplastic and soft shoulder stabalizer
Thermoplastic and soft shoulder stabalizerAttach shoulder stabilizer by overlapping the edge of base and then riveting to reinforce. Shape this to the patient and pad it for
continued on page 22
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Basics and Beyond:I’ve Got You Under My Skin
X-RaysBasics and Beyond:
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tormentors like Roselyn Evans, Judy Colditz, and others. But I always found ‘one fi ne day’ to study their work thoroughly, and then they became my virtual mentors. I started making a daily reading fi le’ for the last month of studies. Believe me, the fi le started becoming very large. So I came up with another idea. The brachial plexus went on my fridge. Numbers…temperature for modalities, Weber’s, SWT went on my study wall, different tests on my work place wall, BUT nothing in my family room, as it is my relaxation area.
In the meanwhile, I came to know that ASHT arranges a review course. I could not attend the course, but bought the course material. Another great resource!
And now I was ready to take the practice exams. My confi dence started building up but at the same time I was getting anxious because, I could not recollect many things. So one suggestion… do not be a hyper like me! Take the practice exam before you start studying, and baseline your knowledge level. It defi nitely would give a good perspective. Practice Exams were helping me to plan the timing for the D Day! Two hundred questions, and 240 minutes. So one minute per question, more or less, after adjusting for warm up time, blank spots or blackouts (Oh yes, it does happen, and it is quite normal), and don’t forget the restroom time. Don’t worry about the line at the restroom as only one person is allowed at a time.
On the day prior to the CHT exam, I drove by the exam center and headed to Staples… New pencils and New erasers! Wow!! I remembered the back to school shopping.
After all that prep, one fi ne day, November 4th arrived. Before I knew it, I was packing up my stationery and heading out of the Exam room. Remember one thing you do not get extra marks for walking out early. Four hours of your life… so why hurry? Take enough time for each question. Coming out of the hall, I felt a glimpse of confi dence that I might not fail! That was good enough for me.
“Excellent review as well as great new information presented. This course is presented in an easy to understand
teaching style. Don’t miss it!”
continued on page 20
20
NEW EHT WEBSITE www.handtherapy.com
I could not muster enough cour-age to check the result online. On December 14 my husband called me at work (normally he doesn’t)! Scary enough I picked up the phone and I heard ‘Hello CHT’! I just fl ipped and hugged the nurse standing near me. It was all congrats and well done thereafter.
In all sincerity, preparing for the CHT was a time consuming and diffi cult process. I was trying to accomplish my goals while handling my job and my day to day responsibilities. But I did it! And so can you! Just set your goals and work towards them day by day. Believe me, you will get there and one fi ne day, you too will get a call...........
‘Hello CHT’!
Pooja is an experienced Occupa-tional Therapist who has worked in a variety of settings. She was a clinical associate of Boston Uni-versity (1995-1997) and taught ‘Pediatric Occupational Therapy’ at Lasell College, Newton, MA (1999-2000). She obtained her certifi cation in Hand Therapy in 2006, and currently works as a OTR/CHT at Brigham and Women’s Hospital in Boston, MA. Her other interests include Yoga, Gardening, and Bridge.
Thank you all for sharing your Journey to CHT.
We want to congratulate all the newly designated CHTs.
Thank you all for sharing your Journey to CHT.
We want to congratulate all the newly designated CHTs.
EHT is very excited about our new website and we want to thank you for being our valued viewers. We created this site based on feedback from you! We have podcasts, movie tips, case studies, quiz corner and more. Email us at:
[email protected] and tell us what you like best.
• We are looking for contributors. Share ideas, case studies, photos or anything you like with your colleagues. To submit ideas email Exploring Hand Therapy at:
• Post your job listings for FREE. Yes FREE on our site. Hand Therapists check out the job opportunities. CLICK here to view. If reading a printed copy go to www.handtherapy.com under FREE Content & you can click on classifi ed to post a job or to browse the job openings.
•
Congratulations!
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Hand Rehabilitation FoundationThe Philadelphia Hand Center, P.C. College of Health Professions at Thomas Jefferson University provides a funded fellowship position in the Hand Therapy Department of the Philadelphia Hand Center, P.C. This position starts in July 2007 and is a six month fellowship. For more information please visit www.handrehabfoundation.org or contact Terri Skirven, OTR/L, CHT at [email protected]
Rocky Mountain University of Health ProfessionsThe transitional doctorate programs at Rocky Mountain University of Health Professions
are designed to bridge the gap between entry-level Bachelor’s and Master’s degrees with the newly emerging entry-level clinical doctorates (DNP, DPT, and OTD). Contact Susan Michlovitz PT, PhD, CHT www.rmuohp.edu [email protected]
Boston UniversityBU’s post-professional Master of Science degree for OT program is now offered exclusively in an online format. This innovative program allows students to earn their degree without disrupting their careers or relocating their families. www.otdegree.com/handtherapy_en/Drexel University
The Certificate Program in Advanced Practice in Hand and Upper Quarter Rehabilitation is designed for practicing clinicians in OT and PT who wish to gain advanced understanding of the upper quarter, including the cervical spine, shoulder, elbow, wrist, and hand. Contact information: website: www.drexel.edu Jane Fedorczyk PT, CHT, ATC at:[email protected]
Higher Education for OTs & PTs
22
comfort. Apply the tuner and line it up with the line guide on the outrigger. It doesn’t have to be exact, but line it up so that the line won’t jump out of the track when it is tightened.
Figure 12 is the com-pleted splint without patient.
Figure 13 Completed Splint with patient
Completed splint on my lovely assistant (fi gure 13)
Figure 14: Splint Prototype with patient secured in the splint.
Figure 15 Finished splint with Bob smiling on 3/16/2007. This is the original prototype splint on my favorite patient! Notice how we have had to bend the outrigger to allow for increased ROM. I enjoyed fabricating this splint and my patient is benefi ting.
Thank you Chad. We are impressed with your engineering OT skills. Way to go!
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ERGONOMIC Corner
Ergonomics for Kids --Home and School / Basic Precautions
Are children at risk?
Computer technology is an integral part of life in this country, especially for children. Yet serious efforts to prevent computer-related injuries have largely been limited to the workplace.
Musculoskeletal disorders (MSDs) are the scourge of the computerized workplace. Workers can develop chronic pain if their workstations are set up without proper attention to ergonomics. A small change, such as re-positioning the screen or keyboard, or using an adjustable chair, can often eliminate the problem.
MSDs are a family of painful disorders affecting tendons, muscles, nerves and joints in the neck, upper and lower back, chest, shoulders, arms and hands. They include repetitive strain injuries (RSIs) which may take years to develop. Recovery can be difficult and may even require surgery in extreme cases.
Caused by work that is repetitive or requires awkward postures, these disorders account for a very high proportion of Workers’ Compensation claims. Disability costs have motivated employers to minimize the risks. As a minimum, workstations are designed to meet ergonomic standards and frequent breaks are recommended.
It is not rare for children to play computer games or surf the Net for hours at a time with hardly a break. Young children crane their necks to view monitors perched on old-style computers. “One size fits all” placement of equipment forces children’s elbows and wrists into awkward angles. Such practices would not be tolerated in a workplace setting.
Is the ergonomics issue a ticking time bomb for the health of the computer generation?
Injuries to the spine and soft tissue are harder to track than traumatic injuries such as broken bones. This may explain in part why statistics on RSIs in children
continued on page 26
Annual Conference Fun!
The American Society of Hand Therapists, 29th Annual Meeting was in Atlanta, Georgia. EHT had great booth assistants
allowing both Nancy and Susan to fulfill their busy teaching schedule. Susan’s X-rays 60 Pearls in 60 minutes was a huge hit. She is authoring a X-ray journal article in the JHT soon. Due to the popularity of her X-ray course at the annual meeting
she developed a superb DVD/CD course. To view the description and order go to www.liveconferences.com.
Nancy’s Laser Course was also a success and she was complimented by many who attended. To view EHT’s LASER course description and details go to www.liveconferences.com
Busy in PhiladelphiaWe enjoyed another successful year at the Philadelphia Hand Meeting. EHT loved meeting all the attendees. The Military is well represented at this meeting and we always enjoy chatting with the men and women of our Armed Services. Nancy and Susan had the privilege to teach a Myofascial lab. We had a sold out crowd and lots of interaction
& fun as we helped wind down the meeting on Monday afternoon. We could not have done it without our supurb booth assistants. EHT thanks you all for your hard work, dedication, and your good sense of humor.
Thank You Everyone! We made some great BFFs(best friends forever)
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EHT has over 60 AOTA approved courses. We are also California and BOC approved continuing education providers.
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continued on page 25
Report from a World-wide Traveling Hand Therapist
Debby Schwartz, OTR/L, CHT
Have you ever thought about hand therapy practice in different countries? How about on different continents? Not only was I fortunate enough to visit our southern neighbors in Venezuela, South America in October of 2006, but six months later I found myself “down under” with friends and colleagues in Sydney, Australia as well. Traveling abroad in the hand therapy world has led to very interesting adventures which I want to share with you.
I was invited in October by the Sociedad Venezolano de Terapeutas de Mano(Venezuelan Hand Therapy Society) to be a guest speaker at their Tenth Anniversary Congress of Hand Therapy. I had the distinct honor of presenting on hand therapy topics
with Shrikant Chinchalkar, OTR/L, CHT from Canada. All of our talks were presented in English, but were simultaneously translated into Spanish. Everyone was wearing headphones! When we were introduced in Spanish, we listened to the English translation in our headphones as well. Our conference topics were wide and varying. Shrikant and I presented on anatomy, arthritis, X-rays and fracture stabilization, tendon transfer protocols, splinting, sports injuries, and overuse tendinopathies.
Jose Manuel Pineda of Caracas, the vice president of the Sociedad Venezolana de Mano, was our extremely friendly and charming host. He took care to prepare all of our travel arrangements with great detail, including hotel stay, and rides around Caracas. We ate out at a local Venezuelan restaurant and learned to eat arepas, a traditional cornmeal muffi n. Rosa Marina Perez, the president of the Sociedad
Venezolana de Mano, also took great care of us and attended to all of our requests. Many other members of the Venezuelan Hand Therapy Society accompanied us on all of our outings and made sure we felt right at home. I have never met so many affectionate and friendly people who hug you, kiss you on both cheeks smile at you, and thank you warmly for sharing information with them. Our efforts were so appreciated!
Venezuelan hand therapists have little experience or education with regard to hand splinting. Orfi t Industries generously provided each participating therapist with a sample kit of splinting materials, and an excellent splinting book by Paul Van Lede, OT, MS. Participants at the congress also enjoyed watching a DVD presentation on Orfi t Industries products and splinting, and loved my hands on splinting demonstration. Everyone
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EHT has over 60 AOTA approved courses. We are also California and BOC approved continuing education providers.
Clinically relevant movie courses created to fi t your busy schedule. Watch rewind and replay your CEU course while in the comfort of your home.
wanted to be the volunteer and have a splint molded on their hand! Afterwards, all the therapists were eager to go home and practice splint making on family members.
Along with the intense teaching and learning experiences, I also enjoyed noshing on coffee and pastries, and chatting with the Venezuelan therapists. My Spanish is limited but I made myself understood! We discussed families, patients, work schedules, and educational opportunities. Although the government in Venezuela has been given a lot of bad press in our newspapers, the people are extremely warm and caring. We share many similarities with regard to therapist motivation and eagerness to learn, sensitivity to our hand therapy patients, and concern for our profession in diffi cult fi nancial situations.
The International Federation of Societies of Hand Therapy meets every three years in a different country. The American Society of Hand Therapists is a member society of IFSHT; therefore all members of ASHT are also members of IFSHT! I was fortunate to attend the pre-conference delegates’ meeting where one representative from each country and the executive board of IFSHT meet to discuss bylaws, accept new member countries, and decide where future conferences will be held. I am happy to report that both India and Slovenia are now offi cial members of IFSHT! And future IFSHT meetings will be held in Orlando, Florida in 2010, and in New Delhi, India in 2013. So make your plans now to attend!
Darling Harbour Convention Center, Sydney Australia!This March, over 500 hand therapists from all over the world converged on Sydney, Australia to attend the 7th Triennial Congress of IFSHT. After months of intense preparation involving travel plans, scheduling, bookings, etc, I found myself on a ferry in Sydney’s Darling Harbour,
right in front of the Convention Center! Sydney is an awesome city with beautiful skyscrapers, a delightful harbor of ferry boats speeding off in all directions, and the world famous Royal Opera House and Harbour Bridge as landmarks on the water.
The hand therapy conference, entitled Hand in Hand, shared the conference center with the International Federation of Societies for Surgery of the Hand, which had over 1500 doctor and surgeon participants. So over 2000 hand interested attendees roamed around between the lecture rooms and exhibition hall! The wide range of topics covered in the lectures included pain, stiffness, tendon repair, trauma, nerve injury and more, with excellent symposiums on research, the PIP joint and the brain’s ability to adapt. Many speakers from the thirty representative countries gave talks and presentations. I also presented two research papers in the free paper sections! (My talks of six minutes each were about the use of Contrast Baths and the use of Continuous Passive Motion after tenolysis.)
Between sessions, there were many opportunities to meet and greet hand therapists from all over the globe. I spent time with therapists from the United States, Australia, Korea, New Zealand, Ireland, and England to name but a few far off places. We shared stories of patients, work experiences and travel plans. We discussed interesting cases and shared remedies for diffi cult ones. We were ferried by boat to a Gala dinner one evening and to the local amusement park for dinner and a Ferris wheel ride overlooking the city the next. Hand therapy conferences are more than just lectures and presentations!
And that brings me to my fi nal note and what I have found to be true in all of my travels abroad. (You can read about my travels to Israel at www.asht.org and about my trip to Norway in the Journal of Hand Therapy (2006; 2006; 19:358-364.) The world is actually
quite small and we are all more alike than we think! It is truly unique to travel abroad and explore the world through the eyes of hand therapy. Therapists in every country share a desire for knowledge and motivation to learn. We all express concern for our patients and demonstrate an intense desire to help others. I enjoy the friendliness and openness of all my colleagues everywhere I go.
I strongly encourage you travel to other countries to learn more about how hand therapy is practiced abroad for it will surely enrich your own practice here. Here are fi ve suggestions to begin your involvement in international hand therapy:
Check out the international center at www.asht.org to see what countries ASHT members have visited and what they have accomplished in their travels.Visit www.ifsht.org. Here is a wealth of information about the organization, its purpose and structure, as well as information on conferences in other parts of the world.On the web site above is a list of member countries and host centers where you would be welcomed as a visitor. Add a day for hand therapy clinic visits into your next foreign travel itinerary.Contribute to the forum or international discussion on the above web site.Join the international committee of ASHT and fi nd out more about upcoming hand therapy missions to other countries, projects to collect and distribute donated splinting and rehabilitation materials, and how to promote international relations.
Become a world traveler and see the world through the eyes of hand therapy!
Thanks Deb for sharing your exciting travels!
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ERGONOMIC Corner (continued)
are generally lacking. Nor is there much research on injuries and conditions specifically caused by improper computer use. (Certain sports, or even playing a musical instrument, may also lead to RSIs.) Nonetheless, evidence is emerging that children are not immune to the physical problems that can result from improper use of computer equipment.
Anecdotally, doctors and physiotherapists are seeing more school age children with pain symptomatic of prolonged computer use at workstations that do not fit. The seriousness of computer-related injuries in adults raises serious questions about their effects on children.
As adults, will they suffer chronic pain? MSDs can take years to develop; latent problems could show up later in life. In addition, back, neck and shoulder pain at a young age may be a predictor of similar pain in adulthood.
Will their eyesight be damaged? Looking at the screen for hours is very stressful for the child’s vision system and can lead to myopia at a young age. Eye problems must be addressed early to prevent damage.
Is there an impact on bone development? Children’s bones grow and calcify. In the late teens, bone density reaches its peak. The effects of sustained poor body position (and in some cases, computer use replacing physical exercise) are not known.
Home and SchoolProper set-up and work habits are •
equally important at home and at school. Not only teachers but also parents must put a high priority on preventing computer-related inju-ries.The push to have computers in schools has by and large ignored the physical needs of growing chil-dren. Often, the equipment is placed on ordinary desks with standard plastic chairs, for use by children of all sizes. Funding for the equipment is not matched with funding for suit-able workstations.Moreover, the time spent on com-puters in school pales in comparison with that outside the classroom. In many homes, workstations are poorly suited to children’s needs. Ubiquitous handheld electronic devices further complicate the issue. Young people play games, send and receive messages, and surf the Net for long periods at a time non-stop, oblivious to posture or physical discomfort.In 2000, the International Ergonom-ics Association established a Tech-nical Committee on Ergonomics for Children in Educational Environ-ments. The committee’s Web site offers practical guidelines as well as an online library of research.
The BasicsMore study is needed on how children physically interact with computers and the effects of that interaction. Hardware and software are evolving, along with the ways people use them. For now, the Can-ada Safety Council recommends applying what is known about adult ergonomics to children.For a conventional workstation, start with proper placement of the equip-ment, and furniture that promotes good posture and proper hand posi-tion:The keyboard and mouse should be directly under the fingers when el-bows are bent to about 90 degrees
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with upper arms relaxed. Make sure the child’s wrists stay straight when keying or mousing, and do not bend up, down or to the side; this helps prevent carpal tunnel syndrome. The mouse should be right next to the keyboard so it’s easy to reach. For small hands, invest in a kid-sized mouse and keyboard. Children should not need to bend their neck back to look at the screen. Align the top of the monitor screen with the child’s forehead so it is below eye level, directly in front, not off to the side. To minimize strain on the eyes make sure children sit about an arm’s length from the screen. Make sure the screen is free from glare, and adjust the bright-ness and text size for comfort. If the workstation serves users of different sizes, an adjustable key-board tray and pneumatic chair can help assure comfort for all. If, on the other hand, workstation furniture is not adjustable, choose a chair that places the child at the proper height in relation to the equipment. If that means a higher chair, provide a footrest to support the feet and a pillow to support the back.Active breaks and frequent changes of position increase circulation and let the eyes relax. Parents must insist that children who use the computer for an hour or more at a time should move around often and get up every half-hour or so. They should also arrange for regular eye examinations, and encourage recre-ational exercise to counterbalance all the sitting.
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Used with permission from Canada Safety Council http://www.safety-council.org/info/child/ergo.html#Anchor-Th-27203
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