Examination Blueprint

Hand Therapy Certification Examination Blueprint

The HTCE Blueprint is an outline of the scope of practice of hand therapy. It guides the development of test items and the overall construction of the examination. This ensures that the HTCE is comprehensive and weighted in a manner that reflects the critical tasks, knowledge, and skills required in the professional practice of hand therapy. The blueprint is organized into four domains of hand therapy and the tasks and knowledge associated with each domain; hand therapy treatment techniques and tools; body parts treated by hand therapists, hand therapy patient diagnoses and conditions, and medical and surgical procedures seen in hand therapy practice.

This blueprint has been derived from the most recent Practice Analysis of Hand Therapy performed in 2019 by HTCC. This practice analysis validates the previous scope of practice and determines the frequency of performance and criticality of various aspects of hand therapy practice. The domains of hand therapy practice and their respective percentages on the examination have not changed from the previous blueprint. This blueprint will be implemented starting with the May 2021 Hand Therapy Certification Examination.

HAND THERAPY CERTIFICATION EXAMINATION BLUEPRINT

©Hand Therapy Certification Commission

  • Assess Upper Limb and Relevant Patient Characteristics (26%)
  • Determine Prognosis and Individualized Plan of Care (20%)
  • Implement Plan of Care and Therapeutic Interventions (32%)
  • Fundamental Knowledge and Basic Science (22%)
Domain 1. Assess Upper Limb and Relevant Patient Characteristics (26%)

Tasks Performed

  • Review History:
    • Medical
    • Surgical
    • Pharmacologic
    • Imaging
    • Neurodiagnostics
    • Co-morbidities
  • Conduct patient, family, and/or caregiver interviews pertaining to hand therapy needs
  • Perform an upper limb screen and systems review
  • Select, perform and interpret assessment of:
    • Accessory motions
    • ADL/IADL function
    • Dexterity and coordination
    • Edema and swelling
    • Functional capacity and work site
    • Muscle function (MMT, tone, imbalance, atrophy)
    • Pain
    • Patient-reported outcomes
    • Posture
    • ROM
    • Sensibility
    • Special signs and tests of the upper extremity
    • Strength (dynamometry)
    • Sympathetic status
    • Tightness (intrinsic, extrinsic, capsular) Vascular status
    • Wounds
  • Interpret examination findings based on basic science, fundamental knowledge, and knowledge of conditions of the upper limb to diagnose, validate the diagnosis, and/or consider differential diagnosis
  • Assess the need for orthotic and/or prosthetic intervention
  • Identify complications associated with medical condition(s)
Domain 2. Determine Prognosis and Individualized Plan of Care (20%)

Tasks Performed

  • Determine prognosis, rehabilitation potential, and expected functional outcomes and timeframe based on condition, medical, and/or surgical management and planned interventions
  • Establish goals specific to the assessment
  • Interpret data considering complications and contraindications to select interventions for the patient:
    • Adaptive and assistive devices
    • Edema management
    • Ergonomics
    • Joint protection and energy conservation
    • Manual therapy
    • Modalities
    • Neuromuscular reeducation
    • Orthotics
    • Pain management
    • Posture and positioning
    • Prosthetics
    • Scar management
    • Self-care and home management
    • Sensory re-education and desensitization
    • Therapeutic activity
    • Therapeutic exercise
    • Work conditioning and return-to-work programs
    • Wound care and management
  • Establish an individualized plan of care based on hand and upper extremity treatment guidelines and medical/surgical management by integrating basic science, fundamental knowledge, best clinical evidence, clinical experience, and patient goals
  • Recognize the need to consult with and/or refer to other health care professionals
  • Modify the plan of care based on reassessment, outcomes, and patient characteristics
  • Formulate a recommendation about readiness to return to life and/or work activities and for discharge
Domain 3. Implement Plan of Care and Therapeutic Interventions (32%)

Tasks Performed

  • Implement and modify interventions:
    • Adaptive and assistive devices
    • Edema management
    • Ergonomics
    • Joint protection and energy conservation
    • Manual therapy
    • Modalities
    • Neuromuscular reeducation
    • Orthotics
    • Pain management
    • Posture and positioning
    • Prosthetics
    • Scar management
    • Self-care and home management
    • Sensory re-education and desensitization
    • Therapeutic activity
    • Therapeutic exercise
    • Work conditioning and return-to-work programs
    • Wound care and management
Domain 4. Fundamental Knowledge and Basic Science 22%

Knowledge Required

  • Surface anatomy of the upper limb
  • Anatomy and physiology of connective tissue and integumentary system
  • 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
  • Age-specific upper limb function
  • Kinesiology and biomechanics relative to the upper limb
  • Pathomechanics and pathophysiology relative to the upper limb
  • Etiology and pathology of medical conditions that may manifest with signs or symptoms in the hand or upper limb
  • Histology of bone and soft tissue healing and repair
  • Physiology and psychology of pain
  • Properties of heat, water, light, electricity and sound as they apply to physical agent modalities and electrodiagnostic tools
  • Psychological reactions to impairment
  • Research design and statistics
  • Principles of evidence-based practice
  • Physical properties of orthotic and prosthetic materials

Knowledge Areas Related to the Assess, Plan and Implement Domains

  • Communication techniques and principles
  • Posture and its effects on the upper limb
  • Differential diagnosis
  • Surgical, non-surgical, and medical management of conditions of the hand or upper limb including expected outcomes and complications
  • Post-surgical, non-surgical, medical and therapeutic intervention guidelines and protocols
  • Assessment tools, tests, and measures and their psychometric properties
  • Pharmacology as it relates to the scope of hand therapy practice
  • Diagnostic imaging of the upper limb
  • Electrodiagnostics of the upper limb
  • Anticipated outcomes of medical and/or therapeutic intervention
  • Anticipated physiological and psychological effects of therapeutic interventions
  • Rationale, indications, precautions, and contraindications for interventions
  • Therapeutic interventions (methods, techniques and tools)
  • Concepts and principles of orthotic devices
  • Concepts and principles of prosthetic devices
  • Concepts and principles of ergonomics

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:

  • Adaptive and assistive devices
  • Desensitization
  • Edema management
  • Ergonomic modification
  • Joint protection
  • Lymphedema management
  • Manual therapy techniques
    • Joint mobilization
    • Soft tissue techniques
    • Instrument assisted soft tissue mobilization
    • Mobilization with movement
  • Modalities
    • Cryotherapy
    • Fluidotherapy
    • Thermal/hot
    • Iontophoresis
    • Electrical stimulation
    • Paraffin
    • Ultrasound/phonophoresis
  • Biofeedback
  • Neuromuscular re-education
  • Orthotics
    • Custom-fabricate basic static orthoses (e.g., finger, thumb spica, wrist support)
    • Custom-fabricate complex static orthoses (e.g., Muenster, airplane, long arm elbow/wrist)
    • Custom-fabricate dynamic orthoses (e.g., MP extension, elbow flexion)
    • Custom-fabricate static progressive orthoses
    • Custom-fabricate casts for rigid immobilization (e.g., fiberglass or plaster)
    • Custom-fabricate casts for mobilization (e.g., elbow/hand contractures)
    • Custom-fabricate playing casts (semi-rigid, removable) (e.g., sports, restrict motion)
    • Custom-fabricate soft orthoses/supports (e.g., neoprene)
    • Custom-fabricate orthosis as an exercise device (e.g. MP block, relative motion)
    • Custom-fabricate orthosis as a functional assist device
    • Custom-fabricate orthosis as a temporary prosthesis
    • Adjust/modify an existing custom-fabricated orthosis
    • Provide patient education for a custom orthosis (e.g., don/doff, wearing schedule, precautions)
    • Custom fit pre-fabricated static orthoses (e.g., Stax, Oval-8, wrist)
    • Custom fit pre-fabricated dynamic orthoses (e.g. LMB, hinged elbow)
    • Custom fit pre-fabricated static progressive orthosis
    • Custom fit pre-fabricated soft supports (e.g. Neoprene thumb, buddy strap, digi sleeve)
    • Adjust/modify an existing pre-fabricated orthosis
    • Provide patient education for the pre-fabricated orthosis (e.g. don/doff, wearing schedule, precautions)
  • Patient, family, and caregiver education
  • Pain management
    • Graded motor imagery (e.g., laterality training, imagery, mirror therapy)
    • Stress loading
    • Relaxation techniques
  • Posture awareness, modification, and adjustment
  • Sensory re-education
  • Telehealth (e.g., video conference consultation)
  • Taping
  • Therapeutic activity
    • Activity modification
    • Functional simulation
  • Therapeutic exercise
    • Mobility (e.g., active, passive ROM)
    • Strengthening
    • Neural mobilization
    • Proprioceptive training
    • Tendon gliding
    • Dexterity and coordination
    • Endurance
    • Stabilization
  • Work conditioning and return-to-work programs
  • Wound care
    • Debridement
    • Suture or staple removal
    • Cleansing
    • Application of topical medications
    • Selection and application of dressings
    • Scar management

Theoretical knowledge and technical skills are applied, using good clinical judgment, in assessment and treatment of individuals with diagnoses related to the upper limb extremity(hand, wrist, elbow, shoulder girdle, cervical area or multiple joints). These may include but are not limited to:

Diagnoses and Conditions

  • Adhesions or Tightness (e.g., musculotendinous, 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)
  • Neuromuscular Diseases – ALS, MS, MD
  • Pain (e.g. Complex Regional Pain Syndrome, Fibromyalgia)
  • Replantation and Revascularization
  • Spinal Cord & Central Nervous System Injuries
  • Tendon Injuries and Conditions (e.g., lacerations, transfers, tendonitis, ruptures)
  • Thermal and Electrical Injuries
  • Vascular Disorders
  • Wounds and Scars

Medical and Surgical Procedures

  • Amputation
  • Arthrodesis
  • Arthroplasty/joint replacement
  • Fasciectomy/fasciotomy
  • Fracture fixation/bone graft
  • Ganglionectomy
  • Injections
  • Ligament repair/reconstruction
  • Nailbed repair
  • Nerve blocks/sympathectomies
  • Nerve decompressions
  • Nerve repair/grafts/transfer
  • Replantation/re-vascularization
  • Scar release/revisions
  • Skin grafts/flaps
  • Synovectomy/tenosynovectomy/tenovaginotomy
  • Tendon repair/graft
  • Tendon transfer
  • Tenolysis
  • Use of pharmaceutical agents