For those of you wondering the difference between occupational therapy and physical therapy, that answer is long on historical events and dependent upon the care setting. But the simplified version is that physical therapists promote joint, soft tissue, behavioral and postural changes that enable people to move their bodies around where they want to go. Occupational therapists use those techniques to help them do the things they want to do, (things that "occupy their time") once they get there. Hand therapy is a fine partnership between occupational and physical therapy.


The practice of hand therapy started during WWII when certain orthopedic and plastic surgeons were trained to treat arm and hand injuries. The surgeons worked with occupational and physical therapists in military hospitals where they started developing specific treatment protocols. By the 1970s there were a number of OTs and PTs who only treated patients with upper quarter injuries. Most of them worked one on one with physicians and were eager to develop their knowledge about surgical techniques in order to promote superior functional outcomes.

In 1975 a group of young and innovative OTs and PTs met at the American Society for Surgery of the Hand, having been invited by the surgeons they worked with. At the time, there was no formal hand therapy practice, but some surgeons recognized the importance of a specially trained therapist to work with their patients following delicate hand surgeries. The 4 occupational therapists and 2 physical therapists collaborated to form what is known today as the American Society of Hand Therapists.


Membership grew, and in the 1980s, government policies changed. What resulted was the need to identify competence in the practice of hand therapy. Ultimately, the Scope of Practice (guidelines) was determined, and ASHT members established there was need for a certification committee. The Hand Therapy Certification Committee (HTCC) establishes strict regulations and administers a rigorous board exam only if a therapist becomes eligible: An OT or PT had to have at least *5 years work experience as a licensed occupational therapist or physical therapist and have logged 4000 hours working specifically with patients with hand and upper extremity conditions.

*In recent years, probably due to improved access to online learning and evidence based practice research, the policy changed. Applicants are now required to have 3 or more years working as a licensed OT or PT to become eligible to sit for the board exam.


Passing the HTCC board examination is no easy task. First administered in 1991, the 4 hour, 200-question test still holds high regard today as the indicator that a clinician has gone above and beyond, intimately learning the complexities of the upper limb, being familiar with the complicated surgical procedures surgeons perform to keep it in working order, and the and ever-evolving therapeutic protocols we use to rehabilitate them to their utmost functional capabilities. Passing the HTCC board exam is what allows a small percentage of us in the rehab profession (approximately 7,000 world-wide as I’m writing this), to proudly use the credential, CHT: CERTIFIED HAND THERAPIST.