Just recently I have started my own company which offers training and consultancy related to hand therapy. The following article will appear in the British Journal of Hand therapy early 2008.
My first job was at a Private practise and to my surprise it was only after a few months that I started wondering if this really was the job I had been studying for all those years. People complain so much and there was so little I could do. Than I felt challenged to think about working in developing countries and phoned The Leprosy Mission International (TLMi) representative. At that time my wife Hilde and I just had our son who was only a few months old. The person I spoke to said that this is the right time to go out: when the kids are small.
Within one year we left our house and country joined TLMi and went to London Bible College, Summer Institute of Linguistics, three months of leprosy training in India and six months language school in Bangkok - Thailand , before moving to Chiangmai, the second largest city in Thailand to work at the McKean Rehabilitation Center.
During this preparation time in India it was the first time I got excited about wonderfully complex biomechanics of the hand was at a conference in Madras and met Prof Landsmeer (the one from the ligament) from Leiden University and Wim Brandsma, both famous people involved in anatomy and hand therapy. At that conference in Madras they showed a drawing of the extensor mechanism of the finger from KJ van Zwieten's thesis and I thought this is important to understand and copied it and hung it above my desk. It took me many months to understand what I was looking at.
While in England I had the opportunity to experience the enthusiasm of Paul Brand, a surgeon who worked his whole life in leprosy and research related to hand surgery. While he was talking about the wonders of his back pain!
Often I think that we are fortunate people as therapist, not only is it expected to touch and hold patients hands but we have time to sit down and talk and listen to their stories. Some of the stories of the patients with leprosy were difficult to imagine. I remember the man who was sitting at the PT room and laughed to see the blood stains on the floor; bingo, somebody had stepped I a nail again, followed the blood drops which ended at his own shoes. Paul Brand, together with Philip Yancey, wrote an interesting book called: Pain, the gift nobody wants.
In Thailand , I took the opportunity given to me, to teach at the Chiangmai University tp OT and PT students about hand mechanics and splinting. Those splints were made of plaster and it was fun to mess around with the plaster. I also felt it was a valuable experience for therapist to practise at the McKean rehabilitations Center and treat leprosy patients.
In 1990 somebody send me the thesis of Prof Steven Hovius, Plastic Surgeon of the Erasmus University Rotterdam, about hands. One of the statements in the thesis was that hand surgery can't go well without proper hand therapy. I thought: that's the place I want to work when back in Holland .
From 1994 onwards I worked at the department of rehabilitation medicine of the Erasmus MC - University Medical Center Rotterdam, the Netherlands as a hand therapist. With a research fund from the University Hospital a research project was started in 1999 about the measurements of the strength of the intrinsic muscles of the hand. This cumulated in a new device, the RIHM and a PhD in 2004.
I do think I am a lucky person who has lots of opportunities to study anatomy and biomechanics of our hands. Teaching is one of the things I like to do; talk about the beauty of the mechanics and understand why eg you can not flex your DIP without the PIP.
Currently I am Chairman of the European Federation of societies hand therapy permanent scientific committee and together with the members of the PSC busy with the abstracts of the Lausanne congress June 2008. A Delphi procedure was started recently on the treatment of Mallet fingers, which will be presented at the EFSHT conference. Outcome measurements is an area which is underdeveloped and which needs further developing to discover more evidence of what works and what not in hand therapy within the Netherlands but preferably within the EFSHT.
The areas of research I am involved in are the effect of mirror therapy in patients with chronic pain and nerve lesions and tendon transfers. The nerve study is done in cooperation with people form Malmö and Manchester; another great opportunity to sit over a wonderful lunch next to Prof McGrouther and talk about lumbrical function and how we move our hands.
van de dag
“ It was at first a very pleasing divertissement, to view the vivid and intense colours produced thereby; but after a while applying my self to consider them more circumspectly, I became surprised to see them in an oblong form; which, according to the received laws of Refraction, I expected should have been circular”
New Theory about Light and Colours. Philosophical Transactions of the Royal Society No.80, 1671