Helping Hands

A history of hand therapy and how you can become the next CHT in your community

While hand therapist sounds like a particularly narrow area of expertise, over time the definition has been broadened to the point that perhaps ‘upper-extremity therapist’ would be more appropriate.

Of course, that doesn’t roll off the tongue quite so easily. So ‘hand therapist’ it is. But in reality, these professionals are equipped, educated, and prepared to evaluate and treat any and all conditions relating to the shoulder, arm, wrist, forearm, hand, and fingers, utilizing a number of modalities and therapeutic interventions.

Hand therapy as a whole evolved from the need for a specialized rehab professional with the knowledge and experience to treat the unique complications arising from complex hand and upper extremity injuries.


According to New Grad Physical Therapy, the need for specialized hand therapists began to grow following World War II (a rough time frame, not necessarily a direct product of the war.) Hand therapy expanded into its own area of practice in the 1970s, with physical and occupational therapists joining forces to create the American Society of Hand Therapists (ASHT) by 1975.

But it wasn’t until 1991 that the specialty experienced its biggest breakthrough—the creation of a specialized exam in which specialists could prove their proficiency in treating injuries of the upper extremity, receiving in turn a distinction in the form of a specialized credential.

Certified Hand Therapists

By definition, a hand therapist is “an occupational or physical therapist who, through advanced continuing education, clinical experience and integration of knowledge in anatomy, physiology and kinesiology, has become proficient in treatment of pathological upper extremity conditions resulting from trauma, disease, congenital or acquired deformity.”

Quite the mouthful. Therefore, the rehab world has narrowed the modern-day definition to three simple letters: CHT.

A certified hand therapist (CHT) is the advanced certification available to professionals who wish to pursue the in-depth, specialized education and experience discussed above in order to treat upper extremity issues.

The initial qualifications for becoming a CHT included:

  • The therapist must practice for a period of at least five years (more on this one later)
  • In that period of time, the individual must accumulate at least 4,000 hours of treatment of hand or upper extremity injuries
  • Lastly, the candidate must pass a rigorous certification exam in order to demonstrate their proficiency

Here are some relevant statistics regarding CHTs (numbers as of May 2017):

  • Approximately 6,300 CHTs worldwide (all but a select few are located in the United States)
  • Of these CHTs, about 15 percent come from the physical therapy profession
  • About 70 percent of CHTs are female
  • On average, a CHT in the United States can expect to earn about $40 per hour
  • Growth in the profession of physical therapy has been measured at 34 percent between the years 2014–2024. It stands to reason that we will observe a similar uptick in CHTs.

Requirements to sit for a CHT Exam

The Hand Therapy Certification Commission is the central, preeminent organization for application to take the exam to become a CHT. The link in the above sentence will take you to the group’s website, where you will find all relevant information for completing the process that will allow you to take the test in the near future. The website provides mentoring opportunities, as well as a list of testing centers nearest your location.

Exams are administered on a biannual (twice a year) basis—once in May and once in November. The application deadline for an exam is the 15th day of the preceding month (April for the spring exam; October for fall.) November 5–10 is the final CHT testing period in 2018.

The HTCC also developed a self-assessment tool to help individuals preparing for the exam to determine their level of readiness. The “exam blueprint” is also available on the website.

Change in Qualification Guidelines
As of May 2017, the number of years in active practice required to become a CHT was reduced from five to three. The 4,000 hours of time spent in specialized treatment of upper extremity injuries remained unchanged, however.

This change occurred for a number of reasons, summarized in a portion of this statement from the HTCC:

In 2014, HTCC in consultation with Professional Examination Service (ProExam), performed a practice analysis study of hand therapy, the fifth in a series of similar studies performed by HTCC over a30-year period. In 2016, HTCC published the results of this analysis in the Journal of Hand Therapy. Through the practice analysis process and feedback received since it was completed, it was identified that new therapists appear to be acquiring hand therapy knowledge at a more accelerated rate than their predecessors due to immediate access of information through technology and advanced academic requirements.

The practice analysis showed that much of the knowledge gained by therapists was obtained in the first two years of specialization. In addition, both occupational therapists and physical therapists now enter practice with a graduate degree instead of a bachelor degree.

If you pass your CHT exam, congratulations! Established CHTs may recertify for the first time by following these guidelines, which include 2,000 hours of work experience—at least 1,000 of which must take place in hand therapy clinical practice. The remaining hours can be accrued through teaching, research, or direct supervision of a clinical program.

After your first recertification, the guidelines change. The particulars are explained here.

If you are planning on obtaining your CHT in 2018, remember, the application deadline is October 15. Best of luck!

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