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The Treatment of the Pediatric Hand Patient: Part II "Congenital Conditions"

The Treatment of the Pediatric Hand Patient: Part II "Congenital Conditions"
Valeri Calhoun, MS, OTR/L, CHT
February 2, 2016

Congenital Conditions


How do we classify and define congenital conditions? There is a new classification that was modified in 2013 called the Oberg, Manske, and Tonkin (OMT) classification. It is good to be familiar with the OMT classification because it is being used most often by surgeons and by individuals who are performing research. The earlier classification systems were based on description or functional limitation, but the OMT classification focuses on the embryological developmental classification. The OMT breaks the embryological developmental classification down into malformations, and then divides it by axis of development, such as the whole limb vs. the hand plate, deformations and dysplasias. 

Who is the Congenital Population?

The congenital population refers to a child who is born with a congenital hand developmental difference. Please do not reference these conditions as a "deformity" or by some of the more common names, such as a "claw-hand". It is important to try to use positive terminology not negative terminology. These children are not missing something because they never had a hand, digits, or the separation of digits.


Figure 1. Example of hand development difference.

When studying embryology, the upper limb is fully developed at 8 weeks of gestation. Typically, the upper limb is developed prior to most women even knowing they are pregnant. Many mothers may question, "What did I do wrong?", "How did I cause this?", "Why is this here?", or "How am I going to deal with it?" Most parents have a large amount of guilt when they are dealing with birth anomalies.

Treat the Family 

One of the first jobs for both the OT and the surgical team is to reassure the family that the majority of congenital hand differences have no known cause or reason. This will educate the family so that they can start to deal with their guilt that they might have. This is a unique population because these patients are seen by OT at a very young age, typically newborns to six months. The baby and the family will come in to see the OT or the doctor, and they usually have multitudes of questions, "Why did this happen?" "What did I do?" "What kind of limitations are they going to have?"

I have had parents of babies that are a couple of months old come in and ask me, "How are they going to get their wedding ring on their hand?" or "How are they going to be able to put their hair up?" The parents are already thinking ahead about their children. I think one of the biggest jobs for OT is education. You are definitely treating the families when you are dealing with children with congenital hand differences. You are reassuring them that there is nothing that they have done or that they can do to change this at this time. Possibly there are some surgical interventions that may help them as they grow.

Reassuring the patient and the family is important. Educate them that no matter what their hands look like they will be able to do everything they want to do. They might just need to make some adaptations. These children are amazing. They teach me every day how to do different functional activities in ways that I had not thought about.

valeri calhoun

Valeri Calhoun, MS, OTR/L, CHT

Valeri is an occupational therapist with over 30 years of experience in a variety of settings, with the last 8 being in an exclusive pediatric hand therapy setting. She received a BS in OT from Indiana University, and an MS in Community Health from The University of Kansas. Valeri has been a Certified hand Therapist since 1994. In addition to working in clinical settings, Valeri’s experience includes over 15 years teaching at the graduate level for occupational therapy programs in the Midwest. She has provided professional presentations and lectures both nationally and internationally for therapists on a variety of therapy topics. For the past six years, she was on the faculty of the CHT test prep course for ASHT. Valeri is an active member in a pediatric hand surgeon and therapist special interest group.  She is involved in research projects regarding pediatric orthopedic care, and has published results.  She was co-author of a pediatric hand therapy protocol book.  She was implemental in the development and execution of Hand Camp, a camp for children with upper limb differences. Her special interest areas of practice include splinting for orthopedic populations, children with arthrogryposis and congenital hand differences.

Related Courses

Series: The Pediatric Hand
Presented by Valeri Calhoun, MS, OTR/L, CHT
Recorded Webinar
Course: #3371Level: Intermediate2 Hours
Part I: This course will outline the evaluation and treatment principles for the pediatric orthopedic hand patient, including the traumatic hand injured patient, and how it differs from the adult hand population. This course will provide specific evaluation techniques along with treatment ideas. Part II: This presentation will build on the foundational information provided in Part I. It provides the learner with specific information on the evaluation and treatment of the congenital hand patient and the unique challenges this brings to clinicians. Explore functional issues unique to this population and interventions that may assist in improving their abilities.

Please note: This course series is comprised of the following individual recordings: #2533 and #2599.

This course is part of the “Hand and Upper Extremity Review Series.”

Put Down the Drugs: Evidence-Based Interventions to Reduce Unwanted Behaviors with Dementia
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, OTR/L
Recorded Webinar
Course: #3072Level: Intermediate1 Hour
PTs can apply evidence-based interventions to improve dementia care. This session reviews the etiology of common behaviors. Cognitive-emotion, multi-sensory, animal-assisted, and exercise interventions to reduce agitation are discussed as well as specific strategies for improving task-related engagement. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Supporting the LGBTQ Senior in Healthcare
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP, OTR/L
Recorded Webinar
Course: #4096Level: Intermediate2 Hours
This training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Clinical Use of the Reformer for the Lower Body
Presented by Rhondi Miller, PT, MS, SCS, ATC
Recorded Webinar
Course: #3329Level: Intermediate2 Hours
The reformer is an effective tool for rehabilitating the lower body. This course will provide exercises appropriate for progressing lower extremity rehab from ankle injury, to post-op knees, to hip pain. Exercises focus on the concepts of motor control, stability/mobility system balance, movement competency and training functional movement patterning. This course is part three of our four part series on Pilates. This course is directly related to the practice of physical therapy and athletic training and therefore appropriate for the PT/PTA and AT.

Wheelchair Seating: Considerations for the Hands-Free Sitter
Presented by Michelle Lange, OTR, ABDA, ATP/SMS
Recorded Webinar
Course: #3585Level: Advanced1 Hour
Wheelchair seating is designed to provide postural support and alignment, stability for function and mitigate pressure issues. This course will address assessment and intervention when working with a client who can sit without the support of their hands, referred to as the ‘hands-free’ sitter.