Early Therapy Modalities in Singapore
History of Hand Therapy in Singapore
Ho Meng Jang
Hand Therapy was never a specialisation of Occupational Therapy until the Hand Surgery was established as a specialist clinical practice. But it did not mean that Occupational Therapists were not providing hand rehabilitation. They did. In 1961, the Occupational Therapy department was situated in Norris Block of Singapore General Hospital. The main objective of hand rehabilitation was to maintain or improve joint mobility. Towards that end, we have modalities such as rug and tabby looms and basketry. Loom was useful for mobility of elbow and wrist joints and bilateral hand movement because the shuttle holding the cotton thread had to pass from left hand to right hand and vice versa. Basket weaving aided mobilization of fingers. Other patients sewed, cross-stitched, and made soft toys.
To holistically rehabiliate injured hands, it was necessary to include vocational assessment, training and placement. SGH Occupational Therapy Department convinced Fraser and Neave to provide some contract work for patients. In those days bottles of aerated drink were portered in wooden crates. Often, these crates were in need of minor repair, and some were taken to O.T. Department in SGH for repair. Patients requiring vocational assessment and training undertook some aspect of the works under the supervision of a medical attendant and therapists. Eventually this was phased out as plastic crates replaced wooden ones.
Hand Therapy Specialization
Prior to 1985, when SGH Hand Surgery department was founded, there was no formal Hand Therapy unit. Most hand injuries were treated in various Orthopaedic departments and patients received varying levels of care. With the establishment of the Hand Surgery department in 1985, a Hand Therapy unit was established to complement its services and this is a key step to the specialization of Hand Therapy from Occupational Thearpy. The early crew consisted Lim Chen Ming, Nathan Vaithalingam, Lau Cheng Mun and Josephine Chow. Hand Therapy continued its expansion when the university Hand Surgery (then known as Orthopaedic C) was reestablished in 1990 at National University Hospital as the department of Hand and Reconstructive Microsurgery (HRM), where Josephine Yip relocated to set up the Hand Therapy unit.
The era of Professor Robert Pho
Prof Pho had very clear ideas of rehabilitation. Rehabilitation must be specific to post surgery requirement. The long flexor cut required certain method of splinting and mobilisation. Mobilisation based on arts and crafts would not do. Prof Pho needed protocols. He needed therapists to work with him to protocolize hand therapy. Progressively, handicraft was replaced with more advanced and objective modalities. Activities were devised with specific goals in mind, emphasizing on activities of daily living, transfer and other forms of acute therapy.
One of the pet emphasis of Pho was control of oedema. Tissue swelling or oedema was also one of the causes of joint stiffness. If oedema could be reduced, finger stiffness would likewise diminish. We used coban and crepe bandages and hand elevation to reduce swelling and subsequently therapists also learnt to use Lycra pressure garment to manage swelling. Anna Liu, a senior physiotherapist of SGH, returned from United States with a Lycra glove. She thought it might be of interests to Occupational Therapists to use pressure garment to manage scars and soft tissue contractures of burns cases. The problem was where to get hold of the fabric Lycra. With the support of SGH Material Management, we managed to trace Lycra to a small Chinese trading company that supplied local brassiere cottage industry. When Lycra was available, we began experimenting sewing pressure garment for burns patients, addressing some of Prof Pho’s concerns on oedema. Early versions of splints for tendon protocol were fabricated by plaster technicians and later modified by therapists with hooks, outriggers, and other devices as required. Often the specified angles were not achieved. Having experimented with various novel materials appeared on the market in the ensuing years, therapists generally settled for thermoplastic for its curing and tensile properties. An ingenious suggestion from Dr Joshe from India, who was visiting Prof Balachandran, suggested filleting discarded garden hose to form volar trough splint and C-bar. While this was not widely used here, it provided us with invaluable advice when we visited our colleagues in China, then far from a powerhouse.
The era of Professor Teoh Lam Chuan
The hallmark of Professor Teohís era was the close collaboration between surgeons and therapists. Often he quipped to his doctors and visitors that his surgery was only as good as his therapistsí rehabilitation. To foster understanding between therapists and surgeons, joint in-service education sessions were held weekly. During these sessions, surgeons spent time with therapists explaining what they had done for patients, what they required of therapists, and where the pitfalls were. Dr Yong Fok Chuan explained tendon rupture and adhesions, and introduced terminal hold to the flexor protocol, that remained a cornerstone of the practice to this day.
To broaden the horizon beyond Singapore, therapists were sent abroad to learn from other hospitals. Josephine Yip visited various centres in America, including Louisville and Indiana, which were the leading institutions. Karen Leong visited Dr Songchaoren in Thailand and Professor Doi in Japan to support rehabilitation of brachial plexus reconstruction, in its nascent stages.
One of the memorable moments for therapists happened at the end of Prof Teohís presentation of his work at an international symposium. A member of the audience, Dr Ueli Buchler, complimented the outcome, but not before drawing attention to the importance of close collaboration with therapists. Many a therapist swelled with pride that day.
Nanyang Polytechnic
In 1992, Nanyang Polytechnic began an Occupational Therapy course to meet local demand. Hand Surgery needed graduates from NYP to possess a strong foundation in Hand Rehabilitation. Recognizing this demand, hand rehabilitation was incorporated into the core curriculum for therapist in training, with the appointment of Dr Teoh and Dr Yong as honorary lecturers.
International Exposure
The local fraternity was enriched by the opportunity to exchange ideas and experience with visiting experts from abroad. Therapist participated in lectures and clinical sessions during each of these visits. To broaden exposure, therapists presented papers and travelled to report the experience that was gained from various collaborations.
Today, there are three major Hand Therapy departments that provide comprehensive therapy services alongside the Hand Surgery departments in Singapore General Hospital, National University Hospital, and Tan Tock Seng Hospital. This would not have been possible with the relentless contribution and selfless sacrifice by the pioneering therapists and surgeons. As disease pattern continue to evolve, we will grow to meet the needs of our patients.
Ho Meng Jang
Hand Therapy was never a specialisation of Occupational Therapy until the Hand Surgery was established as a specialist clinical practice. But it did not mean that Occupational Therapists were not providing hand rehabilitation. They did. In 1961, the Occupational Therapy department was situated in Norris Block of Singapore General Hospital. The main objective of hand rehabilitation was to maintain or improve joint mobility. Towards that end, we have modalities such as rug and tabby looms and basketry. Loom was useful for mobility of elbow and wrist joints and bilateral hand movement because the shuttle holding the cotton thread had to pass from left hand to right hand and vice versa. Basket weaving aided mobilization of fingers. Other patients sewed, cross-stitched, and made soft toys.
To holistically rehabiliate injured hands, it was necessary to include vocational assessment, training and placement. SGH Occupational Therapy Department convinced Fraser and Neave to provide some contract work for patients. In those days bottles of aerated drink were portered in wooden crates. Often, these crates were in need of minor repair, and some were taken to O.T. Department in SGH for repair. Patients requiring vocational assessment and training undertook some aspect of the works under the supervision of a medical attendant and therapists. Eventually this was phased out as plastic crates replaced wooden ones.
Hand Therapy Specialization
Prior to 1985, when SGH Hand Surgery department was founded, there was no formal Hand Therapy unit. Most hand injuries were treated in various Orthopaedic departments and patients received varying levels of care. With the establishment of the Hand Surgery department in 1985, a Hand Therapy unit was established to complement its services and this is a key step to the specialization of Hand Therapy from Occupational Thearpy. The early crew consisted Lim Chen Ming, Nathan Vaithalingam, Lau Cheng Mun and Josephine Chow. Hand Therapy continued its expansion when the university Hand Surgery (then known as Orthopaedic C) was reestablished in 1990 at National University Hospital as the department of Hand and Reconstructive Microsurgery (HRM), where Josephine Yip relocated to set up the Hand Therapy unit.
The era of Professor Robert Pho
Prof Pho had very clear ideas of rehabilitation. Rehabilitation must be specific to post surgery requirement. The long flexor cut required certain method of splinting and mobilisation. Mobilisation based on arts and crafts would not do. Prof Pho needed protocols. He needed therapists to work with him to protocolize hand therapy. Progressively, handicraft was replaced with more advanced and objective modalities. Activities were devised with specific goals in mind, emphasizing on activities of daily living, transfer and other forms of acute therapy.
One of the pet emphasis of Pho was control of oedema. Tissue swelling or oedema was also one of the causes of joint stiffness. If oedema could be reduced, finger stiffness would likewise diminish. We used coban and crepe bandages and hand elevation to reduce swelling and subsequently therapists also learnt to use Lycra pressure garment to manage swelling. Anna Liu, a senior physiotherapist of SGH, returned from United States with a Lycra glove. She thought it might be of interests to Occupational Therapists to use pressure garment to manage scars and soft tissue contractures of burns cases. The problem was where to get hold of the fabric Lycra. With the support of SGH Material Management, we managed to trace Lycra to a small Chinese trading company that supplied local brassiere cottage industry. When Lycra was available, we began experimenting sewing pressure garment for burns patients, addressing some of Prof Pho’s concerns on oedema. Early versions of splints for tendon protocol were fabricated by plaster technicians and later modified by therapists with hooks, outriggers, and other devices as required. Often the specified angles were not achieved. Having experimented with various novel materials appeared on the market in the ensuing years, therapists generally settled for thermoplastic for its curing and tensile properties. An ingenious suggestion from Dr Joshe from India, who was visiting Prof Balachandran, suggested filleting discarded garden hose to form volar trough splint and C-bar. While this was not widely used here, it provided us with invaluable advice when we visited our colleagues in China, then far from a powerhouse.
The era of Professor Teoh Lam Chuan
The hallmark of Professor Teohís era was the close collaboration between surgeons and therapists. Often he quipped to his doctors and visitors that his surgery was only as good as his therapistsí rehabilitation. To foster understanding between therapists and surgeons, joint in-service education sessions were held weekly. During these sessions, surgeons spent time with therapists explaining what they had done for patients, what they required of therapists, and where the pitfalls were. Dr Yong Fok Chuan explained tendon rupture and adhesions, and introduced terminal hold to the flexor protocol, that remained a cornerstone of the practice to this day.
To broaden the horizon beyond Singapore, therapists were sent abroad to learn from other hospitals. Josephine Yip visited various centres in America, including Louisville and Indiana, which were the leading institutions. Karen Leong visited Dr Songchaoren in Thailand and Professor Doi in Japan to support rehabilitation of brachial plexus reconstruction, in its nascent stages.
One of the memorable moments for therapists happened at the end of Prof Teohís presentation of his work at an international symposium. A member of the audience, Dr Ueli Buchler, complimented the outcome, but not before drawing attention to the importance of close collaboration with therapists. Many a therapist swelled with pride that day.
Nanyang Polytechnic
In 1992, Nanyang Polytechnic began an Occupational Therapy course to meet local demand. Hand Surgery needed graduates from NYP to possess a strong foundation in Hand Rehabilitation. Recognizing this demand, hand rehabilitation was incorporated into the core curriculum for therapist in training, with the appointment of Dr Teoh and Dr Yong as honorary lecturers.
International Exposure
The local fraternity was enriched by the opportunity to exchange ideas and experience with visiting experts from abroad. Therapist participated in lectures and clinical sessions during each of these visits. To broaden exposure, therapists presented papers and travelled to report the experience that was gained from various collaborations.
Today, there are three major Hand Therapy departments that provide comprehensive therapy services alongside the Hand Surgery departments in Singapore General Hospital, National University Hospital, and Tan Tock Seng Hospital. This would not have been possible with the relentless contribution and selfless sacrifice by the pioneering therapists and surgeons. As disease pattern continue to evolve, we will grow to meet the needs of our patients.