Preferred by hand surgeons and appreciated by their patients, hand therapists are in demand for their unique expertise and experience in assessing and treating hands, arms and the entire upper-body quarter. These therapy specialists frequently develop close relationships with the hand surgeons who perform very delicate surgery, often with microscopic techniques, and they also nurture patients through the crucial postoperative recovery period.

Hand in Hand

"Hand surgeons seem to have a special relationship with the therapist that sees most of their patients, because many realize that the outcome of their patient's care is in many cases largely dependent on the rehabilitation," says Christine Muhleman, OTR/L and president of the American Society of Hand Therapists (ASHT). As a certified hand therapist (CHT) with University Physicians Healthcare, Muhleman evaluates a patient's level of function, and then develops and implements a treatment plan in coordination with the physician, patient and sometimes the patient's family.

Sisters Stephanie and Sheila Yakobina, both CHTs with the Capital Medical Center, relish the close relationships that often develop from treating patients two to three times weekly for an extended period. "We also enjoy the variety of injuries and conditions as well as [the] diverse patient population we treat -- from babies to 98-year-olds, from investment bankers to lumberjacks to homemakers," says Stephanie Yakobina.

The Yakobinas see a wide variety of conditions, including traumatic injuries, fractures and dislocations, sports injuries, tendon and nerve injuries, repetitive motion syndromes, amputations, burns and arthritis.

Fellowship Fast-Forward

Most hand therapists begin as general occupational therapists (OTs), or, less often, as physical therapists (PTs). Building on exposure to hand therapy in school and general practice, therapists can bone up on hand therapy in many ways.

As a traveling OT, Stephanie Yakobina embarked on a crash course in hand therapy when she was assigned to an outpatient clinic with 23 hand therapy patients. "I began reading the hand therapy bible, Rehabilitation of the Hand and Upper Extremity, and started attending courses that dealt with evaluation and treatment of the upper extremity," she says. She also started attending the ASHT's annual conference.

Seeking a more intense learning experience, she and Sheila completed a 14-week hand therapy fellowship at Texas Woman's University.

Certified hand therapist Tammy LeSage, OTR/L, also did a postgraduate hand therapy fellowship, which she calls "one of the best experiences" of her life. LeSage is now an assistant professor of OT at the University of St. Augustine for Health Sciences. Besides teaching OT and PT students, LeSage practices as a hand therapist eight to 10 hours a week at a private-practice hand therapy clinic she established with two fellow CHTs. "I have the best of both worlds," she says. "I teach full-time and share my knowledge with students, and I have the privilege of making a difference in the ability of my patients."

Respect and Rewards

Voluntary certification through the Hand Therapy Certification Commission, which awards the CHT credential, is rigorous. Applicants must practice as a hand therapist for five years, pass the certification exam and recertify every five years thereafter. Is it worth it? "CHTs have become well-recognized by physicians, third-party payers and patients as well," Muhleman says. "Patients want the provider with the best expertise. Employers recognize that patients can return to work quicker with more expert rehab providers. Hand surgeons in many cases demand that they work with experienced hand therapy providers."

What's more, ASHT's 2007 salary survey showed that 52 percent of CHTs outearn their noncertified peers.