“Working with patients in rehabilitation requires understanding the details of how a condition has affected an individual’s ability to function in their daily lives. It also requires being able to apply rehabilitation techniques and technology to help the patient achieve their highest level of function so they can get back to the activities that they value.” Terri M. Skirven, OTR/L, CHT
When I was considering careers when I was in high school, I was interested in a career that would allow me to work with people in a health care environment. What I really enjoy and what I think I’m good at is problem solving and organization of details and communication. Working with patients in rehabilitation requires all three of those skills. It requires understanding the details of how a condition has affected an individual’s ability to function in their daily lives. It also requires being able to apply rehabilitation techniques and technology to help the patient achieve their highest level of function so they can get back to the activities that they value. So that is what really interested me in occupational therapy. The other thing about occupational therapy is that there’s a wide range of fields that you can go into, ranging from mental health issues, patients with physical disabilities, geriatric patients who have different types of problems dealing with their activities of daily living, and of course in the hand and upper extremity arena which is a very specialized area.
I’m involved in a research project that involves the use of an injection for a condition called Dupuytren’s contracture, which causes fibrous thickening of the tissue in the palm and can cause the fingers to draw into bent positions. There are surgeries that are done for that condition, but more recently the FDA has approved a drug that is used as an injection which weakens the tissue and allows the fingers to be straightened out without surgery. I’m involved with a controlled study investigating rehabilitation approaches for this, which is very exciting. Another interesting topic is the approach to pain management. Patients with hand and upper extremity conditions may sometimes have persistent and chronic pain, which can be very difficult to treat so that patients can return to their functional activities and to their work. There are some interesting neuro-physiological approaches using what’s called “graded motor imagery” which is a way of helping to retrain the brain to experience performing the activity without pain.
One of the most exciting things for the sixth edition is the electronic media that we were able to include. The entire book is available online and we have over 80 videos that are of surgical procedures as well as of clinical practice techniques and examinations that are relevant to hand and upper extremity rehabilitation.
The beginning chapters of the book are the basics—basic anatomy, basic examination, and evaluation procedures. Later chapters address a higher level of practice. In this edition, we’ve brought in new authors who are doing research and advancing new techniques and added many more chapters, so for the experienced clinician there’s advanced information that we’ve been able to incorporate. In this edition, we have separate sections on the shoulder, the elbow, the wrist, and the hand. Some other additions include a section on yoga and its therapeutic value, and the treatment of the injured musician, which is a very unique process. We have also really worked hard to make this an evidence-based book by including supporting literature where available. We’ve really tried to emphasize that.
Terri M. Skirven, OTR/L, CHT, is the Director of Therapy at the Philadelphia Hand Center. She also serves as director or the Hand Rehabilitation Foundation. The Hand Rehabilitation Foundation, established in 1975, was formed to promote medical research and education and disseminate information to physicians and therapists who work with children and adults with hand disorders caused by injury, disease, or present at birth. Dr. Skirvin is an editor of Rehabilitation of the Hand and Upper Extremity.
