Ever since Cate Weaver injured her right wrist 10 years ago during a karate maneuver, she’s had nothing but trouble with her hands. The graphic designer in Art As Applied to Medicine needed surgery to reset the wrist. Not long afterwards, she re-injured it when her car came to a sudden stop; a surgical repair followed.
If that weren’t enough, while walking her dog recently, Weaver felt a yank on the leash. The sudden jerking ripped a pulley ligament in a finger—this time in her left hand—requiring yet another surgery. In each case, Weaver’s surgeon had the same advice: Go see Amy Schimberg as soon as possible following surgery.
Schimberg, a certified hand therapist, assessed Weaver’s range of motion, strength and sensation. Then she crafted a therapy plan that included massage, heat treatments, exercises and splinting.
Now Weaver is back, complaining of pain in her wrist, exacerbated by rigorous athletic activities. During the hour-long visit, Weaver will receive ultrasound, a deep heat modality using sound waves, to reduce pain, swelling and scar formation. She’ll also get a new splint to better support the wrist. The two women have developed a close relationship over the years. “Amy calls me her repeat offender,” says Weaver. Teasing aside, “she stays on top of every problem.”
Hand therapy only became a subspecialty of occupational therapy in 1991. Instrumental in establishing the specialty clinic in Physical Medicine and Rehabilitation 15 years ago, Schimberg is the only certified hand therapist at Hopkins. Certified hand therapists have a comprehensive knowledge of upper-quarter anatomy—from the hands to the shoulder—as well as a thorough understanding of healing principles. The CHT credential is the highest level of competency in the field, requiring rigorous testing, clinical skills and at least five years’ experience.
A Baltimore native, Schimberg received degrees from Towson State University and worked for several years with hand trauma inpatients at Union Memorial Hospital, the regional hand trauma center, before coming to Hopkins.
In addition to Schimberg, the hand OT staff includes Susy Stanley, the other JHOC 8 hand therapist, one inpatient hand therapist, a pediatric hand therapist and a hand therapist at Green Spring Station’s occupational therapy clinic.
More hand therapists will likely be needed as demand rises—thanks to our aging population and more sophisticated joint replacements, tendon repairs and reconstructive hand surgeries—says Occupational Therapy Director Kathryn Kaufman. “The greater the potential for a good outcome, the more someone will benefit from using hand rehab.”
Kaufman is convinced that technology-related repetitive hand-use injuries will also bring more people to the clinics. “We’re already seeing a spike in carpal tunnel syndrome and what we call cumulative trauma,” she says, “though we haven’t quantified it yet.” The challenge, she admits, will be meeting the demand for services, given the national shortages of physical and occupational therapists. In 2006, area hospitals, including Hopkins, posted a 15 percent vacancy rate, in part because of increasing demand and stricter educational requirements.
Meanwhile, despite a packed schedule, Schimberg, who also mentors students and staff, appears to be keeping pace. Of the six to eight patients she sees every day, 50 percent to 75 percent will have had some type of hand trauma. Kitchen mishaps—like lacerating tendons while slicing vegetables—rival wrist fractures, but there are endless ways to inflict damage. Other hand problems Schimberg treats include compression syndromes, like carpal tunnel, as well as arthritis and degenerative neuromuscular disorders, like lupus.
On-the-spot splinting accounts for 50 percent of Schimberg’s job. Tracing the hand on paper, she transfers the image onto a piece of thermoplastic material. With a potter’s precision, she molds it to a custom fit, sometimes adding a hinge or other hardware to allow more movement.
On this day, a full 100 percent of Schimberg’s patients are employees. Echoing Kaufman’s observations, a nurse comes in complaining of pain in her fingers from years of tubing and drawing patients’ blood; a surgeon asks Schimberg for help relieving stiffness after long, delicate operations. And an administrative assistant with carpal tunnel syndrome is back after surgery.
The full hour Schimberg spends with clients, she notes, is twice that of most other outpatient rehab programs. “It gives me ample time,” she observes, “to not only relieve pain and practice exercises, but to also work on purposeful activities, like opening containers—the essence of OT.”Keeping up with insurance limitations remains a challenge, but, says Kaufman, “no matter how much changes, Amy stays on top of it all. She’s been the foundation of this service.”
For Schimberg, helping patients regain even partial hand function is so fulfilling that she’s remained focused on patient care. One reason is the grateful feedback—like this last stanza of a poem from a pianist and former patient with a serious hand injury:
When way up there upon my cloud,
I will sing your praises loud
And play for all on baby grand,
“Well Done, Amy,” with my left hand.