Test Blueprint

The test blueprint is a document that has been derived from surveying hand therapists about the nature of their practice and determines the percentage of content included on the test. For example, 26% of the questions on the exam will have content related to evaluation.

A description of relevant tasks performed and knowledge required that fall under each domain and knowledge areas that have been identified as essential to the practice of hand therapy are provided here.

Practice Domains
1.0	Evaluate Upper Extremity and Relevant Patient Characteristics	26%
	Tasks Performed Obtain and review medical, psychosocial, vocational and avocational history Interview patient or family Identify factors that may affect rehab potential (e.g. co-morbidities) Plan for and select assessment tools Assess and document skeletal, muscular, nervous, vascular, lymphatic, skin and connective tissue status Assess and document psychosocial, functional, and ergonomic factors and status Identify impairments, functional limitations and disabilities based on the results of assessment Reassess and document patient status at appropriate intervals Identify factors that could affect at-risk populations (e.g. industrial, athletes, performing artists) Knowledge Required Principles of tissue/wound healing Posture and its effects on the upper extremity Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper extremity Differential diagnosis Pathomechanics relative to the hand or upper extremity Surgical, non-surgical, and medical treatment of conditions of the hand or upper extremity Post surgical, non-surgical and medical treatment guidelines Standardized and non-standardized assessment tools Pharmacology and its effects Basic lab values Diagnostic imaging Electrodiagnostics The effect of trauma, surgery or medical interventions on the upper extremity.
2.0	Determine Prognosis and Plan of Care	18%
	Tasks Performed Integrate basic science and fundamental knowledge with results from evaluation and patient goals into an individualized plan of care Determine rehab potential and expected outcomes Establish functional and measurable goals of intervention with an anticipated time frame for attainment Establish frequency and duration of interventions in collaboration with patient and referring physician within the guidelines of third party payers Select appropriate interventions and treatment techniques Document the plan of care including rehab potential, goals and interventions Identify appropriate sources to which patients can be referred Consult with and refer to other health care professionals Reassess goals and outcomes and change plan of care as needed Assess readiness to return to former daily activities Assess readiness for discharge and formulate and document discharge plan Knowledge Required Principles of tissue/wound healing Posture and its effect on the upper extremity Surgical, non-surgical, and medical treatment of conditions of the hand or upper extremity Post surgical, non-surgical, and therapeutic treatment guidelines and protocols Expected outcomes of medical and/or therapeutic treatment Expected physiological and psychological effects of treatments and interventions Treatment rational, indications, precautions, and contraindications Treatment interventions (methods, techniques and tools) Concepts and principles of orthotics including mechanical properties of materials and components Concepts and principles of prosthetics Ergonomic principles Behavioral science (including cultural diversity) and psychological reactions to impairment Pharmacology and its effects
3.0	Implement Therapeutic Interventions	30%
	Tasks Performed Integrate basic science and fundamental knowledge with plan of care to implement/apply and modify therapeutic interventions Develop patient education plans and home programs Provide patient education and validate patient learning Knowledge Required Principles of tissue/wound healing Posture and its effect on the upper extremity Expected outcomes of treatment Expected physiological and psychological effects of treatments and interventions Treatment rational, indications, precautions, and contraindications Treatment interventions (methods, techniques and tools) Concepts and principles of orthotics including mechanical properties of materials and components Concepts and principles of prosthetics Ergonomic principles Behavioral science (including cultural diversity) and psychological reactions to impairment Pharmacology and its effects
4.0	Promote Professional Practice	6%
	Tasks Performed Utilize evidence-based practice Interpret and apply clinical research and outcomes studies Assess patient satisfaction Maintain ethical standards Comply with regulations that ensure environmental safety Comply with regulations governing practice based on regulatory agencies Comply with organizational policies and procedures Document services provided Bill for services provided Advocate for patients Manage fiscal resources (i.e. recognition and consideration of fiscal restraints in patient management) Manage clinic administration Supervise clinical support staff in the delivery of patient care Manage human resources Participate in case management Advocate for the profession of hand therapy with employers, third-party payers, consumers, other healthcare professionals, etc. Participate in ongoing professional development Participate in activities and associations that advance professional practice and public welfare Develop and implement educational programs for professionals Participate in clinical research Participate in professional development of students and/or other therapists Knowledge Required Research design and statistics including evidence-based practice Teaching and learning styles Regulatory and legal guidelines Professional code of ethics Safe and appropriate use and maintenance of equipment and devices Safety techniques and procedures (e.g. infection control, emergency procedures, practitioner safety, environmental safety, etc.) Billing and coding principles Uniform terminology (Practice Framework)
5.0	Fundamental Knowledge and Basic Science	20%
	Knowledge Required Surface anatomy of the upper extremity Anatomy and physiology of connective tissue Anatomy and physiology of skeletal system Anatomy and physiology of muscular system Anatomy and physiology of nervous system Anatomy and physiology of vascular and lymphatic system Development of age-specific hand function Physical properties of heat, water, light, electricity and sound, etc. Kinesiology and biomechanics relative to the upper extremity Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper extremity Pathomechanics relative to the hand or upper extremity
	In addition, the 2008 Hand Therapy Practice Analysis found that Certified Hand Therapists typically treat the following conditions and use appropriate techniques and tools as listed below:
	Hand and Upper Quarter Patients
	Theoretical knowledge and technical skills are applied, using good clinical judgment, in assessment and treatment of individuals with diagnoses related to the upper quarter (hand, wrist, elbow, shoulder girdle, cervical area or multiple joints). These may include but are not limited to:
	Adhesions or tightness (e.g., musculotendinis, capsular) Amputations Arthritis and rheumatic diseases Congenital anomalies/differences Crush injuries/mutilating trauma Cumulative trauma disorders Cysts and tumors Developmental disabilities Dislocations and subluxations Dupuytren's disease Edema Factitious disorders Fractures Infections Ligamentous injury and instability Lymphedema Muscular strains, tears, and avulsions Nerve injuries and conditions (e.g., neuropathies, palsies, nerve repairs) Pain (e.g. complex regional pain syndrome, fibromyalgia) Replantation and revascularization Spinal cord and central nervous system injuries Tendon injuries and conditions (e.g., lacerations, transfers, tendonitis, ruptures) Thermal and electrical injuries Vascular disorders Wounds and scars
	Treatment Techniques and Tools
	A variety of techniques and tools may be used in therapeutic intervention with hand and upper quarter patients, including but not limited to:
	Biofeedback techniques Compression therapy Continuous Passive Motion (CPM) Desensitization Design and/or selection of adaptive/assistive devices Ergonomic and activity modification in home, work, school or leisure Exercise Functional activity Hand writing techniques Joint protection instruction/energy conservation instruction Manual therapy Modalities Nutrition instruction Orthotic design, selection, fitting, fabrication and training: Patient education Prosthetics Scar Management Sensory re-education Taping techniques Training in ADL/adaptive/assistive devices Wellness education Work conditioning Work hardening Wound care