A gallery of measuring meaning in hand therapy

Vicki Strelan, Principal Occupational Therapist and Hand Therapist at Arm to Palm Upper Limb Clinic

“Occupational therapists don’t ask what’s the matter with you, they ask what matters to you.” These words were inscribed on mugs gifted in thanks from a young woman at the end of her hand rehabilitation.

OT Week 2021 provided an opportunity to reflect on the role of occupational therapy in meaning-making. How do we measure outcomes in occupational therapy intervention? Technology, albeit inherently useful, is a superficial measurement. One of the founders of the occupational therapy profession was Eleanor Clark Slagle, and if her beliefs stand the test of time, the true measurement of therapy outcome is in the narrative of occupation and meaningful activity (Reed, 2019).

Shortbread biscuits – baked by a labourer who had 200kg of metal fall from a two-metre height onto both his thumbs – are periodically handmade and hand-delivered to our clinic via a 200km round trip. At the beginning we saw fear, anger and despair. While he was waiting for a suitable duties program to start, he decided to teach himself something new, and took up baking. At the end of hand therapy, he was fully employed in his original job, engaging in long distance cycling, home renovating, and hobby farming cows. He offers us a calf when they birth, however to date we have only accepted biscuits.

“Handybear” was handmade and gifted by a woman with a tissue erosion form of scleroderma. She was one of the first clients to our private practice 21 years ago, and has cycled back to us after subsequent surgeries. Today we see meaning and function as she is planning new ways to explore handcrafts. The hand therapy strap storage debacle well known to anyone working in splinting has had two skilled tradesmen volunteer solutions. One female tradie recovering from a circular saw injury to her non-dominant hand installed an inbuilt splint strap holding system inside a cupboard at our former workplace. A second quietly spoken worker with a tendon and wrist injury spent months fabricating a stunning portable splint strap storage system which has hands at each end, with carved fingernails!

To measure outcomes in hand therapy we have technology in the form of goniometers and dynamometers, gauges and tape measures.

Is this a true measure of outcome?

Leatherwork brings meaning and function to a correctional services officer whose hand required surgery after a violent work event. She created a quote from her heart to match the energy she found in coming to our clinic “FACT: Do not judge me by my material possessions but by the friends I choose to keep”.

The crooked smile of the young cowboy testifies to facial injuries from his bull-riding days. He acted quickly when he saw his employer was about to be crushed by a vehicle and in averting disaster received a crushed and lacerated hand that required microsurgery. When the black dog of depression was nipping at his heels a few months into rehabilitation, a positive turning point occurred when we replaced putty exercises with leatherwork, and a keyring was the first project. In 2019 a beautiful painting was made for the Australian Hand Therapy Association (AHTA) national conference with the theme “To Extremity and Beyond”. The artist is one of Queensland’s eminent hand therapists running a public occupational therapy department. This artwork is proudly displayed in our clinic as a reminder of the artist’s passion for hand therapy and passion for her art, meaningful activities both.

The young woman who gave us the mugs that were mentioned at the beginning of this article had her fingers guillotined by a posthole digger on a remote property, later replanted after a Royal Flying Doctor flight. When we first met her, hand therapy involved tears, screams, sobbing and trembling. At the end of hand therapy, we saw smiles, a return to horse riding and employment in a new area. We saw meaning and function. We sensed that her end with us was a new beginning. She appreciated that we asked what mattered to her, not what was the matter with her.

Hand therapy crosses the barrier of touch and may require numerous hours of face-to-face contact. It is natural for the stories to emerge. To measure outcomes, goosebump moments arise considering the teddy bear, the horse riding, the biscuits, the cycling, the leatherwork, the employment. This is how we measure hand therapy. This is how occupational therapy enables meaning-making.

Work occupies a huge slice of our lived time. The artwork on the clinic wall reminds me how grateful I am to have passion for my work as an occupational therapist in hand therapy, a career that makes meaning for me.

References can be viewed by scanning the QR code About the author Vicki Strelan has worked as an occupational therapist, hand therapist and educator for more than 30 years. Based in Townsville, North Queensland, Vicki runs her private practice Arm to Palm Upper Limb Clinic and is actively involved in creating pathways for occupational and physiotherapists to become accredited hand therapists with the Australian Hand Therapy Association.