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April 29, 2014 > Washington Outpatient Rehabilitation Center:

Washington Outpatient Rehabilitation Center:

April is National Occupational Therapy Month

The human hand is an amazing, complex structure. Just think of all the things you do with your hands: touching, holding, feeling, grasping, pinching, and so much more. It's hard to imagine getting through the day without using your hands in countless ways - from precise movements such as threading a needle or tying a shoelace to performing heavy labor such as pounding a hammer or lifting a bulky crate.

For many people, though, using their hands each day can be a struggle due to a traumatic injury such as a fracture or a tendon laceration, a repetitive stress injury such as carpal tunnel syndrome, or a progressive disease such as arthritis. For those people, hand therapy can help restore the function of their hands and enable them to perform everyday activities again.

"Our number one goal for patients with conditions that limit the use of their hands is to help them get back to whatever activities they used to be able to perform," says Mark Neves, OTL, MS, a licensed occupational therapist at Washington Outpatient Rehabilitation Center. Neves also provides shoulder and elbow therapy, as well as hand therapy. His colleague at the center, Melissa De Unamuno, MOTL, HTC, is also a licensed occupational therapist. She has additional certification in hand therapy from the state of California.

"In many cases, there are conditions that start from the shoulder on down that can cause problems with using the hands," Neves says. "For example, a hand problem may be related to injury of the shoulder's rotator cuff or impingement of the shoulder. Tendinitis of the elbow, such as 'tennis elbow' or golfer's elbow' also might be a factor. So the first step is to evaluate all the factors contributing to limited use of the hands. The initial evaluation takes about an hour."

Neves notes that therapists at Washington Outpatient Rehabilitation Center see hand therapy patients from across a wide range of ages.

"We treat children who injure themselves on the playground, middle-aged workers who are hurt on the job, and elderly patients who have fractured bones during a fall," he explains.

"Approximately half of our hand therapy patients have work-related injuries," says De Unamuno." The most common problems involve tendinitis and carpal tunnel syndrome. Part of our job is encouraging our patients and letting them know that following their hand therapy program diligently can help them regain function.

"We try to focus on the things patients can do, and build on that in small incremental steps, rather than overwhelm them with long-term goals," she adds. "It may take several months of therapy for some patients to regain more normal function - it doesn't happen overnight. It's important for us to let patients know that therapy is a process and to educate them about the precautions they should take to avoid re-injury or disruption of the healing process after a surgery."

Some of the treatments offered for hand therapy at the Washington Outpatient Rehabilitation Center can include:

* Heat to loosen joints and tendons, or ice packs to reduce swelling and inflammation. Heat and ice treatments also may relieve pain. In addition, heat can increase blood circulation to the affected areas and reduce stiffness, including stiffness associated with arthritis.

* Manual manipulation treatments to improve the range of motion in affected joints.

* Soft-tissue mobilization to increase the flexibility of muscles and improve blood flow to the muscles.

* Stretching to lengthen the muscles and improve flexibility.

* Strengthening exercises that include movement against resistance and the use of gripping tools to improve the hand's functional grasp.

* Custom-made splints to support and protect injured bones or soft tissues.

"We also work on patients' fine-motor skills to improve their dexterity and help them use their fingers more effectively," Neves says. "Our facility has a broad range of equipment to help with hand therapy, such as strengthening exercise equipment, electrical stimulation to help reduce pain and stiffness, and ultrasound equipment that provides deep-tissue heat, which is a way to increase blood flow to the tissues under the skin."

In general, each hand-therapy session lasts 30 to 45 minutes and involves a variety of treatment modalities. The duration of participation in therapy depends on the severity of the patient's problems, with most patients requiring between 6 to 12 visits. Patients with severe injuries, such as tendon repairs, may require additional sessions.

In most cases, hand therapy is covered by insurance, including Medicare, Medicaid, Worker's Comp and private insurance. Participation in hand therapy at Washington Outpatient Rehabilitation Center requires a physician referral from a primary care physician or a specialist such as an orthopedic surgeon or a neurologist. Cash payments are accepted in cases where insurance does not cover services. Discounts and payment plans are available for patients who need payment assistance.

The results of hand therapy can be quite remarkable, according to Neves.

"One of the most extreme cases I've seen was a man who had been in a car accident with his arm out the window," he recalls. "The car rolled over on top of his arm, and he had very traumatic injuries - broken bones, torn tendons and ligaments, and muscle lacerations. The patient didn't regain 100 percent of his previous abilities, but he was able to regain a lot of function and perform everyday activities. It was rewarding to see him improve so dramatically."

De Unamuno, who has worked at Washington Outpatient Rehabilitation Center for 11 years, concurs, "I always wanted to work in the health field, and when I was in school I was drawn to occupational therapy and hand therapy. It's a very gratifying career to be able to work with patients and see them really improve and return to their previous level of function.

"I'm also grateful that Washington Hospital supports our efforts and contributes to our continuing education," she adds. "That helps us keep up with the latest therapies and techniques to continue providing the best possible care for our patients."

Washington Outpatient Rehabilitation Center is located at 39141 Civic Center Drive in Fremont. For more information about the services available, including hand therapy, visit or call (510) 794-9672.

Washington Outpatient Rehabilitation Center is now on the same electronic medical record system as Washington Hospital, which helps facilitate coordination of care with patients' doctors. The system also provides a service for patients, called MyChart, to allow patients to access portions of their medical records such as test results, prescriptions and immunizations. In addition, MyChart lets patients send an email message to their participating physicians' offices, schedule appointments and request referrals to other participating health care providers. For more information about MyChart, or to enroll in the service, visit

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