Milliken Research in Journal of Hand Surgery

Milliken Hand Rehabilitation Center Hand Therapists, Macy Stonner, OTD, OTR/L, CHT & Logan Berlet, OTD, OTR/L were recently published in The Journal of Hand Surgery for their paper, “The Impact of Social Deprivation and Hand Therapy Attendance on Range of Motion After Flexor Tendon Repair.” The purpose of the paper was to examine the influence of social deprivation and hand therapy attendance on active range of motion (AROM) outcomes following flexor tendon repair.

Below is information about the Milliken research that was included in the paper. It discusses how the study was performed and the overall team conclusions.

Method

We performed a retrospective analysis of patients who underwent primary zone I–III flexor tendon repair between November 2016 and November 2020. Area deprivation index (ADI) was used to quantify social deprivation. Medical record review determined each patient’s demographic characteristics, injury details, total hand therapy visits, and final AROM outcome. Active range of motion was converted to Strickland’s percentage for analysis. Spearman correlation and simple and multivariable linear regression models were used to assess relationships between explanatory variables and outcomes.

Results

There were a total of 109 patients, with a mean ADI of 53 and mean therapy attendance of 13 visits. Higher ADI and lower therapy attendance were correlated, and each was associated with significantly decreased Strickland’s percentage. In the multivariable model, therapy attendance, ADI, zone 2 injury, and age maintained significant associations with Strickland’s percentage.

Conclusions

Socially deprived patients attend fewer therapy sessions and obtain poorer AROM after flexor tendon repair. Social deprivation is likely to contribute to poor outcomes both by its association with decreased therapy attendance and by other potential pathways that make it difficult for deprived patients to achieve good surgical outcomes.

Access The Publication and Paper

 

Summer Hand Injuries

We all love summer as it brings warm weather and outdoor fun. Summer hand injuries can put a damper on the good times we look forward to. With proper caution and planning, you can save yourself a trip to the emergency room and a medically created setback!

  • Wrist fractures: Sports-related activities increase fall risk. Biking, rollerblading, skateboarding, and scootering tend often lead to wrist fractures or sprains. Be aware of uneven sidewalks and other pedestrians, and wear wrist guards for protection.
  • Burns: Bonfires, barbeques, and fireworks pose danger around open flames. Keep your distance from the fire, and use long-handled tongs when grilling to protect your hands. Keep your children safe by keeping them aware of the fire.
  • Tendonitis: Golf, tennis, and baseball become more popular in warmer weather, which is often accompanied by elbow tendonitis and pain. Prior to play, consider stretching your wrists to prevent tendon tearing and inflammation. Check your racket/club/bat to ensure proper fit and that it’s not causing unnecessary strain.
  • Lawnmower accidents: 25% of yearly lawnmower summer hand injuries lead to finger or toe amputation. Always use the proper safety guards/precautions when cleaning out lawnmower blades. Keep children away from the lawnmower.
  • ATV accidents. Every year, ATVs cause 135,000 injuries and 700 deaths. 30% of deaths are among children below age 16. If you choose to ride an ATV, please consider the following precautions:
    • Wear a helmet and protective eyewear
    • Limit the number of riders
    • Only ride during daylight hours
    • Never operate an ATV under the influence of alcohol or drugs

Have fun this summer, but keep yourself and others away from summer injuries. If you sustain an upper-extremity injury, don’t hesitate to call the Milliken Hand Rehabilitation Center!

Celebrating Hand Therapy Week 2022

June 6 – 10th, our Milliken Hand Rehabilitation Team participated in activities and challenges celebrating the annual Hand Therapy Week led by the American Society of Hand Therapists. Some of the unique ways that we were able to highlight our talented team was by showcasing “blinged-out” orthotic creations, getting the thoughts of a hand therapist who is pursuing the “CHT” certification, and sharing some throwback photos of the early days at Milliken, just to mention a few.

Here were all of the daily challenges for Hand Therapy Week 2022:

MONDAY (6/6): “Bling It” Orthosis

TUESDAY (6/7): CHT in the Making

WEDNESDAY (6/8): “Nailed It” Challenge — Like Netflix’s “Nailed It!,” we’re looking for “amateur orthosis makers”

THURSDAY (6/9): #ThrowbackThursday

FRIDAY (6/10): Grassroots Effort Day — Share photos, videos, links, etc. to all the ways you’ve spread awareness and advocated for hand and upper extremity therapy

 

Fireworks & Hand Safety

As we approach the 4th of July, it is important to keep in mind that the use of even the smallest fireworks can result in devastating injuries. Sparklers reach temperatures over 1000 degrees and can easily burn skin or ignite clothing. Larger fireworks can fracture fingers or amputate portions of the hand.  While these injuries may seem extreme, they are injuries that the Hand Therapists at the Milliken Hand Rehabilitation Center commonly see in their clinics every July.  According to the U.S. Consumer Product Safety Commission 2020 Fireworks Annual Report, hands and fingers were the most frequently injured body parts, accounting for 30% of the injuries sustained by fireworks.

The safest way to enjoy fireworks is at a public display conducted by professionals. But, if you choose to use fireworks, the Consumer Product Safety Commission has the following tips:

  • Never allow young children to hold or ignite fireworks.
  • Never place any part of your body directly over a firework device. Back up to a safe distance immediately after lighting the fuse, and only light one at a time.
  • Never try to re-light or pick up fireworks that have not ignited fully.
  • Never point or throw fireworks at another person.
  • Keep a bucket of water or a garden hose handy.
  • Never carry fireworks in a pocket or shoot them off in metal or glass containers.
  • After fireworks complete their burning, wait 20 minutes, and then douse them with plenty of water before discarding in a trash can.

Our team at the Milliken Hand Rehabilitation Center wishes everyone a Safe and Happy 4th of July Holiday! If you do experience a hand or upper extremity injury, we are here to help!

Firework & Hand Safety Tip Sheet pdf (Download)

 

 

 

 

 

 

 

 

 

 

OT Month Celebration

Washington University Occupational Therapy works with many healthcare providers, physician groups, living facilities, and community organizations to provide the best care, When & Where our patients need it most. During the month of April, we will be celebrating OT Month and promoting all that our providers and colleagues in the field do for our adult and pediatric patients. To our Community Practice Therapists and Therapists at the Milliken Hand Rehabilitation Center, thank you for all that you do for our patients our clinic wouldn’t exist without you and the expertise that you bring to the field of OT.  Please take a moment and see what the field of OT has been able to contribute to the daily well-being of patients. Learn more about Occupational Therapy from AOTA.

Chronic Condition Spring Safety Tips

Spring is a time of awakening.  As we wake up from our winter slumber, we are eager to be more active.  This could mean getting back to recreational activities such as hiking, biking, or participating in an outdoor sport.  Or it could mean doing housekeeping activities such as spring cleaning or gardening.  Returning at full force may lead to an injury or a flare-up of a chronic condition.  Here are some tips to consider should you reengage a chronic condition: 

  • It is always a good idea to warm up before and cool down after an activity. 
  • Gentle stretching prior to an activity can prevent a muscle strain while gentle stretching after can decrease soreness. 
  • While it may be tough to slow down, breaking down the activities into short intervals can prevent fatigue. 
  • Eating a healthy diet of lean proteins and vegetables can improve your endurance. 
  • Even when the weather is mild, be sure to drink plenty of fluids to prevent dehydration. 
  • To boost your confidence and enjoyment, set realistic goals. 
  • To improve your performance, seek professional tips from a tennis or golf coach.  
  • Maintaining your equipment and tools in proper condition can decrease stress on your joints. 
  • Building up the handles on your tools will lessen hand pain. 
  • Wearing sunscreen will not only protect your skin from harmful UV rays; it will preserve its youthfulness.  

Following these tips will help you to enjoy the cool spring weather but if you do encounter a chronic condition in your hands or upper extremity our team at The Milliken Hand Rehabilitation Center is here to help!

Expanding To Washington

Ryan Risley, MPM, meets with contractors just weeks before OT Services’ new clinic in Washington, Mo., is set to open. The 2,500-square-foot space is located approximately 50 miles west of downtown St. Louis in Franklin County. It is the culmination of four years of research, strategizing and planning for Risley, the manager of practice development for the Program in Occupational Therapy’s clinical operations. OT Services therapists will provide general and specialty patient care in the clinic and in home, school, workplace and community settings in Washington and the surrounding area. Risley has not only a professional, but also a personal, stake in the clinic’s future success: Washington is his hometown, and he is fully invested in the health and well-being of his community.

Expansion planning

Risley recalls discussing expanding OT Services’ footprint in his first interview with Pat Nellis, OTD, OTR/L, the director of the Division of Clinical Operations, more than four years ago. “Right off the bat, we discussed what the one-, three- and five-year plan should be for clinical services. One of the five-year goals was to be experiencing growth at a level where we could branch out to another satellite clinic,” Risley says. “Pat is a big proponent of rural communities having access to health-care services, so I conducted competitive market analyses of surrounding counties north, west and south of metro St. Louis.”

Risley dove into key data points such as population growth, demographic data, chronic disease prevalence, insurance provider options, and payment mechanisms. There also had to be future marketing opportunities and economic development in the area. “We wanted to offer that access to health care, but it had to be a solid investment as well. I put together market scorecards for each area to present to Program leadership and discuss which location made the most sense for us. Washington checked all the boxes, even though it is in a competitor’s area. However, they don’t offer the same services that we do,” Risley says. “That being said, we knew we could leverage our existing brand and bring our personalized, one-on-one approach to the area and beyond.”

“Washington University has such a reputation for excellence, and our occupational therapy services are vastly different than what anyone else offers,” adds Nellis. “We’re committed to making sure those living outside our urban reach have access to what we have to offer. Rural Missouri deserves the best, too.”

A hometown perspective

Risley was 4 years old when his family moved to Washington after his father was relocated there for his job and has lived there ever since. He has seen the area go through a period of tremendous growth in recent years.

“In high school, I remember the downtown area being somewhat stagnant. Downtown Washington, Inc., a coalition formed in 1989, had a vision for the town to serve as a center of commerce in Franklin County. Farmland at the main intersection of highways 100 and 44 were sold, and businesses started moving in. Fast-forward to today, and the real estate market is much different . Downtown is booming with commerce, so finding clinic space that fit our needs was a challenge,” Risley recalls.

After traveling extensively over the county, Risley eventually found a space for lease in a former sporting goods store situated in a complex adjacent to a Walmart Superstore and next door to a Department of Veterans Affairs Clinic Office with a flat parking lot and spots right by the entrance. In November 2020, he and Nellis presented the pro-forma report to Program leadership and to the Faculty Practice Plan (FPP).

“The original space was 5,000 square feet, but we only needed half of that. We set up meetings with FPP and worked with the Dean’s office to negotiate the lease. Then we started working with the architects and a design group to build out the space. We wanted an open floor plan and treatment space in addition to private rooms for one-on-one and telehealth services. Accessibility was a priority; we want to accommodate all clients, including those with mobility issues. They can park right in front of our clinic and enter without any obstacles,” he says.

Forging partnerships

While finding the right clinic space was certainly a priority, so was forging partnerships with local community providers and organizations to promote the clinic and its services.

“I met with the Franklin County Health Department, the Franklin County Community Resource Board, assisted living facilities, and area physicians to name a few,” Risley says. “Another health-care system has been firmly planted in the area for decades, but my approach has always been to offer our services as another option for providers and patients. Therapy, especially at the beginning, can require two or three appointments a week. We may be able to see the patient sooner, or the clinic might be easier to access. We’re here to serve the community in whatever way we can.”

Risley anticipates that the expertise of Milliken Hand Rehabilitation Center therapists will serve the needs of people who have experienced a work injury or the effects of aging. “Washington and the surrounding area are home to many manufacturing and agricultural industries. I’ve met with several workers’ comp physicians who see patients with hand, shoulder and upper extremity injuries or who experience ‘wear and tear’ on hands or joints from repetitive tasks. Hand function also decreases with age due to rheumatoid arthritis, osteoporosis and even Parkinson’s disease. Our therapists provide services to address and support all of these conditions.”

The move to Washington is also an opportunity to expand existing community partnerships. Pediatric therapist Karen Balk, MOT, OTR/L, will provide services to families with school-aged children, and Katie Bogan, OTD, OTR/L, will be able to use the clinic as a base for early intervention services through the state’s First Steps program for children from birth to 3 years of age who have disabilities or developmental delays. Aging Ahead, which supports older adults and their caregivers, provides programming in senior centers throughout the area. “We are already connected with Aging Ahead in the St. Louis region, and they are interested in working with us in Franklin County,” says Risley, who attends the agency’s monthly meetings. “The Four Rivers YMCA will be hosting their annual adult literacy event; we plan to be a part of it.”

Open for business

The Washington clinic officially opens its doors on April 11. Several existing patients who drove to other locations for care are now able to schedule their visits closer to home. Therapists Stacy Baker, MS, OTR/L, CHT, and Jill Jonas, MSOT, OTR/L, who also live in the area, are looking forward to seeing familiar faces and meeting new patients.

“Patients I’m currently treating at our Milliken Hand Rehabilitation Center Chesterfield location are eager to come see me at our new Washington clinic because it is closer to their homes, and they appreciate that,” Baker says.

Risley is already planning to bring the latest service line to the Washington clinic. “We now have therapists providing support, recovery, and rehab services for COVID ‘long haulers’ that address lasting effects such as fatigue, brain fog, and task management. Jamie Archer, MOT, OTR/L, and Debbie Turley, OTR/L, are already seeing clients in St. Louis; I imagine those services will be needed in Washington as well,” Risley says. “I’ve long referred to occupational therapists as ‘the engineers of the healthcare field.’ They provide solutions so people can manage their health and get back to the activities they want and need to do. I’m proud to bring our therapists to the Washington community.”

Photos of new clinic in Washington, MO

Safety Tips for Holiday Gathering

The holidays are shaping up to look different again this year from traditional gatherings of the past with recommendations of continued social distancing, masks, and possible outdoor meals. During these times, our annual celebrations with family and friends are so important for our mental health, but it is equally important to stay safe. As indoor dinner parties and social get-togethers are still risky this holiday season due to the COVID-19 pandemic, many people will likely be cooking and gathering outside. It is important to keep safety in mind when using a grill or turkey fryer (especially if it is for the first time) while cooking in the kitchen, and while gathering.  Below are some tips to help you and your family and friends enjoy Thanksgiving safely!

Social Holiday Safety Tips:

  • Cook and eat outdoors. Consider cooking a turkey on the grill or in an outdoor turkey fryer and having dinner outside to avoid being inside with other individuals for long periods of time.
  • Wear a mask. Remember that even outside it is important to maintain physical distance and wear face coverings when gathering.
  • Serve safer. Use single-use cutlery to decrease the transmission across surfaces and choose one person to do the serving to avoid everyone touching the serving utensils.
  • Wash your hands often.

*Refer to the CDC’s guideline to Holiday Celebrations and Small Gatherings for more information.*

Outdoor cooking safety tips:

  • Be prepared. Follow the manufacturer’s instructions and familiarize yourself with the operations, especially if you are a first-time user of a deep-fryer.
  • Use only on a safe surface. Use the deep-fryer on a stable, non-combustible surface outside.
  • Never leave a deep-fryer unattended.
  • Ensure turkey is dry. Dry turkey before placing in a deep fryer to avoid water/oil interaction that could lead to a grease fire.
  • Have a fire extinguisher nearby in case of emergency.

Kitchen Holiday Safety Tips:

  • Wear a mask while preparing food.
  • Minimize distractions. Pay attention while using a knife, removing hot items from the oven, and carrying a heavy object, to prevent injury as these are often prime times to have an accident.
  • Cut away from yourself. Always keep both hands and your body out of the path of your sharp knife to avoid injury.
  • Use a sharp knife when carving. Dull tools require more force to cut through the turkey and you are more likely to cut yourself.
  • Dry workspace. Keep the workspace in the kitchen, tools, cutting boards, and your hands clean and dry to help prevent any injuries that may occur from slipping.
  • DO NOT put water on a grease fire. Instead, smother it by placing a lid on top of the pan.

An additional safety measure has been created by the

From the Milliken team, we hope you have a safe and Happy Thanksgiving! If you do find yourself needing assistance for an injury related to your hands, wrist, or upper extremity, The Milliken Hand Rehabilitation Center is here to help!

Why See A Certified Hand Therapist (CHT)

You may ask yourself why is my physician referring me to see a hand and upper extremity specialist for my arm injury or problem?
To answer that question, a Certified Hand Therapist is a specialist in the field of either Occupational or Physical Therapy that has undergone additional training and testing to earn the designation of CHT or title Certified Hand Therapist. They are a trained specialist related directly to the upper extremity, which encompasses the shoulder to the fingers. The process to become a CHT requires the following:
  • Practice for at least 3 years
  • Complete 4000 hours of direct patient care related to hand and upper extremity
  • Sit for and pass the rigorous exam, which tests on the entire upper extremity

Working in this focused area of the body, CHT’s are more in tune with assisting your rehabilitation. They have a thorough understanding of the anatomy of the body, the mechanics of how each structure works, and how injuries complicate the healing process. Hand and upper extremity rehabilitation can become very intricate and complicated during the rehab process but a Certified Hand Therapist can direct you through this difficult time and get you back to everyday life.

Hand and Upper Extremity Therapists can treat a large variety of diagnoses: fractures, arthritis (osteoarthritis, psoriatic and rheumatoid), multi-trauma, compression syndromes, activity analysis of body postures and mechanics, tendon and nerve laceration, tendonitis, and an extensive list of other diagnoses. Learn more about The Milliken Hand Rehabilitation Center.

Help us in celebrating our Hand and Upper Extremity Therapist June 7-13, 2021 with Hand Therapy Week.