Jay Tucker's quick reflex was to use his hand and fend off the boat that was about to bump into his, but he just wasn't quick enough and his thumb got crushed between the two. It was probably an instant ouch! And four months later during a hand therapy session, while he smiles and jokes, it's clear that the exercises Morrisa Francis gives him, physically hurt.

In January, Ms Francis became the first full-time hand therapist in the Occupational Therapy Department at King Edward VII Memorial Hospital. Working as a summer student in the department from 1997 to 2003, Ms Francis was clear that occupational therapy was the field for her.

She said during that practical experience she most enjoyed splinting. That is, constructing physical supports for patients' hands and/or fingers. In the department, therapists custom-make splints for patients in the same way that casts are custom-fitted for patients in the Fracture Clinic.

"When I started the professional OT (occupational therapy) programme and learned that hand therapy was a speciality I became interested," she said. "I was excited to know that I could take my favourite part of occupational therapy and make it my full-time job.

But this realisation meant she had to spend two more years training as a specialist in hand therapy. Upon graduation she didn't come straight back home. She spent two years working in the field at a hospital in Dallas, Texas, and another two years at an outpatient clinic in Northern Virginia. Armed with this experience she returned to KEMH in January and suggested she be retained full-time in her speciality. The hospital agreed and she's had a full slate of patients from the start.

"I see between six and eight patients every day," she said. Treatment time varies from individual to individual but on average, Ms Francis said she spends 45 minutes to an hour with each patient. It depends on what the injury is and the rate of healing. Everyone's body is unique.

The bulk of patients are accident victims – construction workers injured on the job and traffic accidents.

"Hand therapy relates to anything to do with the upper extremities, from the fingers up the arm to the shoulder," said Ms Francis. But at KEMH the OT department only sees patients with injuries from the elbow down to the fingers.

"Physical therapists handle anything higher than the elbow," she said. In fact it's only since she's started that patients have this type of therapy in the department at all. It used to be that an occupational therapist would make a splint for a patient but the actual therapy on an upper extremity was carried out by a physical therapist.

Ms Francis explained how her service differs from what was offered by physical therapists. "Hand therapy is a speciality area that both occupational therapists and physical therapists can specialise in," she said. "I am the only person that specialises in hand therapy on the Island. "The difference between having treatment from a physiotherapist and a hand specialist is continuity of care – the splint and the treatment are done by the same person. A speciality allows you to become more of an expert on a few things as opposed to a generalist who knows a bit of everything."

She added: "An example is comparing a GP to a cardiologist. Both are doctors however the cardiologist has more experience with heart-related issues because that is all he does. Occupational therapy being my background I do focus on the overall functional progress."

To this end, she sets real life goals for each patient. They might not be earth-shattering things but rather practical tasks that help them to function normally like being able to wash their hair or turn a doorknob. She puts a time frame on simple feats like this so that a patient may have a goal of being able to wash their hair in two weeks time. In the case of Mr. Tucker, he broke his right thumb in that boat accident on December 20 last year. The thumb was put in a cast for six weeks and after that he was sent to Ms Francis to begin therapy. She made a splint for the thumb to help support it and then began massaging the muscles in the area twice a week. "I am working on the tissue around the broken bone and the stiff joint, to help soften the tissue," she said. Softening the tissue will help Mr. Tucker to be able to move his thumb without pain.

"I don't know what would have happened without the therapy," he said. "I can tell you that I believe it has helped. I am right handed so it was a real challenge for me to be able to do things. You don't realise how much you depend on something until you lose it. I still have difficulty writing," he said.

Along with direct massage to the area, Ms Francis also forces Mr. Tucker to exercise his right thumb by having him try to mould theraputty. Theraputty is much like Playdough or plasticine and comes in different hardness levels to enable patients to build up their strength.

During the interview, Mr. Tucker had to play with green theraputty which has a medium resistance. Ordered to squeeze and mould it, he contorted his face as he complied. The task was clearly at least a bit painful for him.

Following his hard work she had him touch the palm of his hand with his thumb, and then measured the angle. She does this at each visit and said it enables her to see the progress the patient is making. It also gives patients tangible evidence of the progress they are making.

Similarly she measures the circumference of the finger, so that both she and the patient see the swelling reducing.

"The work involves a lot of hand stretching and the patients have to do more on their own," she said. "As a hand therapist I may use heat, ice, and even a hand held massager to help me break up tissue where a tendon has been injured," she said.

But sometimes progress just doesn't come. "At times patients who do all the exercises come to all therapy appointments, do not see the results that they would like," she said. "Not being able to change the outcomes or do anything more to make it better can be difficult for me."

But overall she's still passionate about the field and what she enjoys most is the people she meets. "Each patient is unique and I have found that I learn so much from each one as it relates to his or her occupation, life history and experiences," she said. "At the end of the day each patient is grateful for the help they received."