After graduating from Temple University with a degree in occupational therapy, Joanne Kassimir set off to help people who had been injured or suffered ailments that limited their mobility and ability to live independently. During her first three years on the job at Nassau County Medical Center in New York, Kassimir found herself at the cutting edge of a new field—hand therapy.

It was 1979, and advances in microsurgery were enabling orthopedic and plastic surgeons to perform miracles in repairing injured hands, Kassimir says, but a different, more delicate form of occupational therapy was needed to maximize the function of these newly mended extremities. This was new territory in the world of occupational therapy, and Kassimir was leading the way in developing this specialty.

“Everything was trial and error,” Kassimir says. “There were no textbooks of diagnosis and treatment for hand therapy, which are available today. The doctors would suggest things and I would suggest things, and then we’d try them to see if they worked. We kept trying and we kept learning. Gradually, therapists and surgeons from across the country were getting together to share information. It was quite exciting to be there at the beginning.”

Kassimir was a charter member of the American Society of Hand Therapists and was among the first to become a certified hand therapist (CHT). She left her work at the hospital to offer hand therapy practices in a number of doctors’ offices, and eventually she opened her own hand rehabilitation practice in 1986. “I tell people I’m the grandmother of hand therapy on Long Island,” she says.

Patients came to her, because surgeons recognized the value of a therapist who specializes in the hand. “Any therapist out there can take on a hand patient as a case, but it doesn’t mean they are doing hand therapy,” Kassimir says. “The more involved cases really need to see a hand specialist. They need someone with that special knowledge about how the upper extremity works, and the gentle touch that doesn’t damage the small structures of the hand.”

While establishing her practice, Kassimir also spent a great deal of time lobbying for appropriate coverage of hand therapy and the broader field of occupational therapy, which was then not covered by insurance. She and colleagues from around New York went to Albany and to Washington, D.C., to educate insurance companies and Medicare about their specialty. They ultimately succeeded in earning recognition and appropriate coverage for their work. “We were running our businesses on a daily basis and not thinking about it too much. Then the HMO world hit in the mid-’90s, and we had no power again,” she recalls.

Once again inspired to get active in the legislative arena, Kassimir joined other private practitioners to form an organization called CHOT (Certified Hand Occupational Therapists). Incorporated as a group, they met with insurance companies and negotiated fees.

“We were faced with situations in which we used to be paid $100, and now we were receiving only $20. The HMOs didn’t know who we were or what we did. They didn’t see how much time we were spending with patients, what we were doing and how we were being compensated,” Kassimir says. “It’s a fight we’re still fighting. Some HMOs have lowered the reimbursement so severely that we can’t afford to treat those patients.”

Frustrated by the HMO approach, Kassimir sold her practice to a big corporation in the mid-’90s, working for that company for three years before starting up her own practice again. “They were scheduling me to treat six patients an hour. I didn’t even know my own name by the end of the day, let alone the patients I was treating,” she says.

At Kassimir Hand Therapy in Huntington Station, N.Y., Kassimir is back to her proven approach, giving patients the one-on-one care they need. She says she continues to see patients who ultimately required more surgery because their insurance didn’t allow them to get the therapy they needed or receive it in a timely fashion. Although she gets paid for only half of a visit, she insists that patients spend an hour in her office. They warm up the hand for 15 minutes, then get a half-hour of one-on-one therapy and then do hand exercises for the remaining time.

People visit Kassimir after tendon and nerve laceration repair, burn injuries, broken bones, tennis elbow, carpal tunnel syndrome, amputations and work injuries. Many cases are the result of a traumatic accident, while others result from arthritis or repetitive strain. Most patients are “everyday people like you and me,” she says, while others are musicians, concert pianists and professional athletes. Winter brings those who have fallen on ice or tangled with their snow blowers, while summer brings lawn mower and fire cracker injuries. And then, she says, there are the people who use a knife to separate frozen bagels or hamburgers and cut into their palms.

“Things happen,” Kassimir says. “They go into surgery and then to us. I’m grateful that I have patients who have followed me from office to office. They could go to someone a block away, but they drive a good distance to see me. They realize what I do and how it is different. I want to feel good about what I’m doing. I want a good result for my patient. This way everybody wins.”