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Becoming a Certified Hand Therapist: A Virtual Journey to Achieve My Goal.

Written by: Vanessa Truxal, MS, OTR/L

Virtual Hand to Shoulder Therapy Fellow '20


For almost 10 years I was a pediatric occupational therapist. This was a large part of my identity. It was how I saw myself. I worked with children in a variety of settings from medical-based preschool, servicing children with complex special needs; to hospital-based outpatient and inpatient pediatric rehabilitation; to pediatric acute care with specialization in neonatal and cardiac intensive care. I had always felt drawn to working with children, but I equally felt a drive to continue learning and to challenge myself in new areas.

After giving birth to my second child I took some time way from my professional life to focus on my family. When I was ready to return to my career, I again felt the urge to challenge myself, but in a new direction. With two young children I knew I needed to find a way to balance my time between my career aspirations and the precious short time that I have with my children. Fortunately, with the support of my husband and family, I have been able to invest the time to making a significant career move and develop expertise in the area of hand and upper extremity rehabilitation. I’d like to tell you how.

“A hand therapist is an occupational therapist or physical therapist who, through advanced study and experience, specializes in treating individuals with conditions affecting the hands and upper extremity. A qualified hand therapist can evaluate and treat any problem related to the upper extremity. The hand therapist can effectively treat and rehabilitate the patient through post-operative rehabilitation, preventative, non-operative or conservative treatment or industry consultation. The therapist works closely with the physician and patient to provide a continuum of care. This often starts within days of the injury or surgery right through the patient’s return to work and/or a productive lifestyle. A hand specialist may also have advanced certification as a Certified Hand Therapist (CHT)” (ASHT). This advanced certification requires 4000 hours of experience in upper extremity rehabilitation and passing a rigorous exam.

Once I decided this highly skilled specialization was my goal, I knew this undertaking would require extensive commitment in drive, dedication and time to achieve. I began studying independently. It did not take me long to realize the vast amount of specialized knowledge was overwhelming. I searched for fellowship programs in hand therapy. However, I was limited by time constraints. With young children at home I could not commit to commuting four or more hours per day to the closest fellowships in Philadelphia and New York City. I worried that my goal was not achievable at this point in my life. I was intrigued when I found a posting for the Virtual Hand to Shoulder Institute on the website for the Hand Therapy Certification Commission. I learned this was a 12-month program of weekly, synchronous, online learning with a CHT mentor that is an expert in the field of hand therapy. The program offered remote learning with comprehensive didactic lectures on all topics related to hand and upper extremity rehabilitation and a live, on-site, weekend session for hands-on training. Other features included interdisciplinary guest speakers, weekly journal article reviews and group study sessions, monthly blogging, opportunities for grant writing and research, an option to become involved with tele-rehabilitation, coaching for resume building, interview skills, and job search, and network opportunities. While this was still a significant time commitment, it would allow me to be with my family when I needed to be and find that balance between work and family life that I sought.

My mentor is Mirella Deisher, OTD, MS, OTR/L, CHT. She has 21 years of experience in the field of a hand and upper extremity therapy at excellent institutions, where she managed hand therapy departments, developed and directed hand therapy fellowships, and worked closely with exceptional surgeons. From our first zoom meeting, Mirella has been a warm, open, and professional mentor. As a teacher, she is organized, efficient, and comprehensive. She actively seeks feedback, constantly striving to improve and evolve the program. She listens intently and always responds to questions. She has been available and responsive throughout the week via text and email, and provides 1:1 zoom meetings for individualized attention and coaching. I have a tendency toward precision and I am detail oriented, especially when learning new topics. Mirella is never impatient and responds to all of my incessant questions.

When I started my fellowship with the Virtual Hand to Shoulder Institute I had very little experience with online teleconferencing, but I have found the venue to be extremely user friendly and surprisingly intimate. There are 4 fellows in my cohort, initially located across the globe in New Jersey, Alaska, South Korea and Australia with different backgrounds and experiences. This small group allows for conversation and personal attention each week. When we started our program in January 2020 we had no idea of the tsunami that was about to surge across the world with the coronavirus pandemic. Telecommuting and telehealth have been around for a while, but the vast majority of work and therapy have occurred in-person, onsite in offices, hospitals, clinics and schools. Following lockdown orders in the United States and many other countries, our children, friends and loved ones were abruptly thrust into the world of remote working, remote learning, and teletherapy. We were already comfortably up and running in this virtual world. I am currently getting set up and hope to soon begin practicing teletherapy through the Virtual Hand to Shoulder Institute under the supervision of my CHT mentor. I feel fortunate to have this opportunity to practice in this new and rapidly expanding field of telehealth. This is a highly marketable skill that I will be able to bring with me into my job search in the future.

Eventually we will prevail over the coronavirus. We will not be locked down forever, but I do believe the world will be forever changed in many ways. One of those changes I believe will be in the delivery of education, health, and rehabilitative services. Telehealth and distance learning will never replace in-person, onsite delivery of services. It was never intended to and it is not the best fit for every person or every patient. However, now that the world has had the opportunity to experience the benefits of remote services and braved the learning curve of technology, I believe the virtual world will be more widely recognized as a beneficial option to provide access to many who might otherwise have not had the opportunity to participate in educational pursuits or receive therapeutic services they needed due to a variety of barriers.

Making a career change is a big decision and a serious commitment. I am new to the specialization of hand and upper extremity rehabilitation, but I am confident that my experiences with the Virtual Hand to Shoulder Institute will prepare me with strong foundational knowledge and skills to rise to the occasion in this dynamic and challenging field.


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