- Hand Therapy Team
1 - 4 Weeks Before Surgery
The hand transplant candidate will meet with the hand therapists for an initial evaluation and education session prior to the transplant surgery. The therapists will perform an evaluation of the functional status of the patient and will perform baseline subjective and objective testing that will be followed throughout the course of the transplant. They will instruct the patient on exercises to be performed while they prepare for the transplant. Hand therapists will make an assessment of the level of commitment the patient has to the post-operative therapy protocol. Additional sessions may be scheduled before surgery at the discretion of the therapists.
2 - 10 Days After Surgery
At this point the patient will still be in the hospital. They will wear a bulky post-operative splint for 2-3 days and then the hand therapists will make a custom splint that will be worn at all times. The shoulder and elbow will be exercised several times a day, and the arms will be positioned in bed to help manage swelling. Therapy sessions will be 1-2 hours twice a day.
10 Days After Surgery
Around this time, patients may be discharged from the hospital depending on progress. They will stay locally for extensive therapy during this time. Patients will continue to wear a splint at all times although it may be removed during therapy. Using adaptive techniques, patients will be allowed to start using the hand with daily living tasks. Therapy sessions will last from 2-6 hours, 5 days per week.
3 Weeks After Surgery
Patients will continue to wear a splint at all times although it may be removed during therapy. Therapy during this phase focuses on adapting functional tasks so that the patient can start to be as independent as possible. Therapy sessions will last from 2-6 hours, 5 days per week.
6 Weeks After Surgery
Patients continue to wear the splint when not exercising. A smaller splint will be made to wear while exercising. At this point, the patient will be able to start moving the hand and wrist more. Therapy sessions will involve exercising the hand, practicing functional tasks (combing hair, using a cellphone), and reintegrating the hand into daily life. An iPad will be provided to patients with a number of helpful apps to assist in rehabilitation. Therapy sessions will continue to last from 2-6 hours, 5 days per week.
3 Months After Surgery
Patients will continue to wear the smaller splint for daily living tasks and when not exercising. In therapy, patients begin stretching and strengthening the hand. They will be able to complete a variety of functional tasks by this time. A number of functional tests will be performed regularly at this point to track progress. Therapy sessions will continue to last from 2-6 hours, 5 days per week.
6 Months After Surgery
At this point, the muscles and ligaments of the hand may start causing tightness of the hand which will be addressed with a new splint that stretches out the hand. By this point, therapy sessions focus on strengthening and improving motor skills. There may be some loss of range of motion as muscle tone increases. At this point it may be appropriate to transition to a hand therapist in the patient’s home town if they live a ways away from the transplant center. This decision will be based on the patient’s progress and comfort level as well as input from the hand therapists and transplant surgeons. The frequency of therapy sessions will depend largely on individual patient progress, but will often last 1-4 hours a day, 3-5 times a week.
1 Year After Surgery and Beyond
Depending on the level of transplantation and the patient’s progress, they will likely be more independent at this point. A small “anti-claw” splint may still need to be worn depending on the amount of intrinsic hand muscle function. Patients will continue with therapy that focuses on day-to-day tasks and on regaining fine motor skills. The frequency of therapy sessions will depend largely on individual patient progress, but will likely be 1-3 times per week. Patients will come to the transplant center every 6 months to 1 year for formal testing and assessment of progress thereafter.
Norma M. Arras, MA, OTR/L, CHT
Mary C. Burns OTR/L, CHT
Donna C. Canavan, OTR/L, CHT
Wendy E. Gerger, OTR/L, CHT