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 Eye & Vision Safety

As we enjoy the summertime outdoors engaging in activities such as hiking, gardening, swimming, and home maintenance projects it’s important to consider the effects of the sun and protecting your eye & vision health! July is healthy vision month and while spending time outdoors and getting exercise are vital, so are your eyes. The American Academy of Ophthalmology and National Eye Institute offer the following recommendations that can be followed to protect your eyes from sun exposure and other hazards.

  • Wear sunglasses with 100% UV or UV400 protection or sunglasses that block UV-A and UV-B rays on sunny AND cloudy days. Keep in mind that the sun’s damaging rays can penetrate clouds, fog, and haze.
  • Wear a hat in addition to sunglasses; a broad-brimmed hat is the best option.
  • Remember that the sun’s rays are strongest in the afternoon and at higher altitudes.
  • Avoid getting an “eye sunburn”. This is called photokeratitis and can occur when the sun’s UV rays reflect off water or other surfaces and burn the eye. Symptoms include pain, redness, blurry vision, and possibly temporary vision loss.
  • Do not look directly at the sun at any time (including during an eclipse). This can cause significant damage to the retina.
  • Avoid tanning beds because they expose you to the same risks as outdoor sunlight and UV rays.
  • Other tips:
    • Prevent swimmer’s eye by wearing good swim goggles and splashing your closed eyes with fresh water after swimming.
    • If you have a condition called “dry eye”, wear wrap-around glasses to protect yourself from wind and sun exposure and use artificial tears recommended by your doctor to keep your eyes refreshed.
    • Wear protective eyewear when mowing the lawn, gardening, completing home maintenance tasks, and playing sports to avoid a serious eye injury.

Following these recommendations, this summer and year-round will allow you and yours to enjoy all outdoor activities fully and safely. If you are having issues with your vision consider taking a look at our low vision services.

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)

 

 

 

 

 

 

 

 

 

 

Summer Activities For The Kids

The start of summer is such a fun and exciting time for kids!  But, for many the lazy, hazy days of summer can start to drag if the kids are bored or spend too much time in front of the screen.  However, with a little bit of planning, it’s easy to keep kids engaged in a variety of activities.  Summer is a great time to try out some new, exciting learning opportunities.  Engaging, hands-on activities over the summer help to ensure kids are ready for the grade ahead and don’t regress.

  1. Explore local attractions. Within the St. Louis metropolitan area, there are so many great local attractions to check out.  Even if you have been to these places before, there are always new things to explore and new ways to keep your child learning throughout the experience.  If you go to the zoo have your children plan out on the map how they are going to get around to see their favorite animals.  Of, if you go to the botanical gardens have them practice their reading skills by reading out loud the posted signage.   Even a small trip to a local park or trail can be a great time to search out different species of wildflowers, trees, or birds.  Regardless of where you go, there are so many opportunities to keep children learning while at our local attractions.
  2. Attend a local summer camp. While all camps are great for keeping kids engaged, if you want to keep your kids learning over the summer look for camps that focus on science, art, and other educational skills.  Washington University Program in Occupational Therapy actually offers its own summer camp for children ages 9-16 with executive function difficulties (difficulty with planning, organization, goal-setting, task monitoring, etc.).  If interested in learning more about this camp, see link below.

https://otservices.wustl.edu/items/trainyourbrain/

  1. While swimming is often a go to over the summer, especially in the St. Louis heat, swimming can have great benefits for kids who struggle to manage sensory input.  Swimming provides vestibular input by moving in all directions, proprioceptive input by the resistive muscle activity with the water, and tactile input as swimmers are constantly feeling pressure from the water.   Regardless if kids have sensory needs or not, swimming is also a great form of exercise to help keep active over the summer and improve coordination skills.
  1. STEM Projects. STEM (science, technology, engineering, and math) projects are great for kids of all ages.  On a rainy summer day, stay inside and create a marshmallow catapult, make slime, make ice cream in a bag, experiment with various versions of the same chocolate chip cookie recipe to learn how each ingredient affects the overall cookie, or figure out what household materials you could use to build a bridge.  These activities are great to help build problem-solving skills, teamwork, direction following, etc.  In addition, they all result in a final outcome your kid will be proud to show others.
  1. Fuel their passions. While there are certainly many ways to try and keep kids engaged and learning over the summer, the best way to do that is to incorporate their passions and favorite things into learning experiences.  Whether they are into sports, Minecraft, gymnastics, space, or history find age-appropriate ways to feed their interests through books, movies, games, and other hands-on experiences.  The more they are interested in what they are learning the more they will get out of it.

No matter how you choose to keep your kids engaged, the value of any learning over the summer cannot be overstated.  Parents can feel good about keeping their kids engaged in tasks that don’t involve spending hours in front of a screen and kids can look forward to trying new things that keep their minds and bodies active.

 

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!

Parkinson’s Disease Awareness Month

April is Parkinson’s Disease Awareness Month. Parkinson’s Disease (PD) is a chronic, progressive neurologic condition that affects dopamine production in the brain. Approximately one million people in the U.S. are living with PD. Parkinson’s is a movement disorder and is characterized by motor symptoms that include slow movement, stiff joints, impaired coordination, and tremor; as well as non-motor symptoms like impaired cognition, fatigue or lack of energy, apathy, and depression.  All of these symptoms can lead to difficulties in accomplishing everyday tasks. Whether you are newly diagnosed or have been living with PD for some time, OT can offer strategies to help navigate the difficulties of everyday life. Washington University Occupational Therapy offers in-home and clinic-based services that are personalized to help individuals analyze and solve problems related to performing everyday activities that can be complicated by PD. The goal of our program is to ensure that you are able to live independently and safely at home and to maintain your quality of life. PD, like many chronic conditions, can change over time. Occupational therapists help to teach self-management skills and address barriers across all stages of this disease by adapting tasks and the environment to support performance. Listed below are areas that we commonly address:

  • Medication management
  • Activity and exercise programs
  • Home safety and fall prevention
  • Driving assessments
  • Care partner education and training

WUOT also offers LSVT BIG®, a program targeted specifically for people living with PD. Read more about LSVT® here https://www.lsvtglobal.com/.

Local resources for PD can be found by visiting the American Parkinson Disease Association St. Louis Chapter https://www.apdaparkinson.org/community/st-louis/.

Learn more about Washington University Occupational Therapy Services for Parkinson’s Disease.

Credits:

LSVT® is a trademark of LSVT Global, Inc., registered in the U.S. and other countries.

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

The Importance of Lymphedema Therapy

Following breast cancer, your risk of developing lymphedema may increase based on risk factors such as radiation or lymph node removal. Being able to receive lymphedema therapy is key to your long-term health outcome.

Signs and symptoms of lymphedema include heaviness, tightness, or fullness of the affected area. You may notice that clothes or jewelry begin to feel tighter. Lymphedema tends to happen gradually over time and progresses slowly. Most often, lymphedema onset is within 3 years of initial breast cancer treatment.  If you experience any of these things, it is important to speak with your doctor and get referred to a certified lymphedema therapist.

At The Milliken Hand Rehabilitation Center, we not only offer therapy following lymphedema diagnosis but have a specialized program for early detection and prevention. Early detection improves therapeutic outcomes and often results in more successful treatment. Utilizing bioimpedance spectroscopy technology, we can detect early changes in fluid before standard circumferential measures notice the change. This allows for early intervention to prevent the progression of lymphedema.

With therapy, you can expect manual treatment as well as compression therapy to reduce swelling. Therapy focuses on reducing the swelling as much as possible before fitting patients with maintenance garments. For those at risk, we provide routine screenings to address swelling changes as early as possible.

For further information about lymphedema or the therapy programs offered, please visit The Milliken Hand Rehabilitation Center or Washington University Division of Plastic & Reconstructive Surgery. 

5 Ways To A Healthier You In 2022 – Stroke Prevention!

While our title, “5 Ways To A Healthier You In 2022 – Stroke Prevention!” is focused on this year, we must make note that In December 2021, the beloved American icon, Betty White passed away of a stroke at 99 years old. We feel the time to increase awareness of strokes and ways to prevent them is now! In recent years, younger adults are also experiencing strokes. Because up to 80% of strokes are preventable, you can practice the actions below to help reduce your risk.

  1. Nourish your body with vegetables, fruits, whole grains, low-fat dairy products, fish, legumes, and nuts. Limit salt, sweets, and red meat.
  2. Increase physical activity. Engage in moderately-intense aerobic activity for 10 minutes 4 times per week, or vigorous aerobic activity for 20 minutes twice per week. Find a partner to exercise with you – you and your partner will both benefit.
  3. Begin a smoking cessation program if you smoke, and limit alcohol consumption. Tobacco and alcohol use significantly increases the risk of stroke.
  4. Take prescribed medications as directed to manage health conditions that may contribute to stroke risks, such as diabetes, hypertension, and high cholesterol.
  5. Keep an open line of communication with your healthcare provider, and collaborate on managing health by asking questions, exploring options, and sharing decision-making about other conditions that may increase stroke risks, such as sleep apnea or birth control use.

An occupational therapist can help you develop skills to better manage your health and to implement lifestyle changes. If you would like guidance and support to incorporate these actions into your daily routine, take a look at our services or give us a call at (314) 286-1669 #1.

American Stroke Association (stroke.org)

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!

“Turn the lights on” this holiday season with iCST

The holidays are fast approaching and many people are preparing to gather with close family and friends. For many, this is a time to reminisce and think of fond memories from past holidays. It is also an opportunity to see a family member with dementia. Here are some tips and ideas for planning meaningful activities for your loved ones:
Ideas for holiday activities:
  • Smell different holiday scents such as pumpkin, cinnamon, and pine. Ask your loved one how it makes them feel when they smell each scent.
  • Watch holiday movies or listen to holiday music. 
  • Look through old family photos from previous holidays. Talk about how these photos make them feel.
  • Do a simple holiday art project.
  • Drive or walk around a neighborhood and look at holiday lights. Talk about which types of holiday decorations are your favorite.
  • Bake cookies and decorate cookies together. Provide your loved one with simple instructions as they assist with the baking. You can always buy premade cookies to decorate to simplify the activity.
  • Take a walk outside, talk about different things that you see while walking.
Tips for communicating with your loved ones:
  1. Speak clearly. Use short and simple sentences.
  2. Ask your loved one how they are feeling instead of asking them direct of factual questions.
  3. Provide your loved one with choices when they need to make decisions.
  4. When talking to your loved ones, stand directly in front of them so they can clearly see you.
  5. If you are unsure what your loved one is talking about, be sure to clarify with them gently. They may be saying one thing and meaning something else.
  6. Use gestures or visual aids to support communication.
Washington University Occupational Therapy offers services for patients with mild to moderate dementia to help stimulate cognition through individual cognitive stimulation therapy. iCST is a research-based program (and standard of care for dementia patients in the UK http://www.cstdementia.com/ ) that promotes prompting memories and thoughts to stimulate working memory for assimilation and manipulation of thought. In the program, an OT guides individuals with dementia and their loved ones through activities to help improve the individuals’ cognition and quality of life. Learn more about our program and how to make an appointment.

Hand Safety When Pumpkin Carving

With Halloween being this weekend, we know pumpkins are being carved in preparation for display.  While usually not thought of as a dangerous activity, injuries from knives or other tools used for carving can require surgical repair and sometimes take multiple months to rehabilitate. Here are a few safety tips to help keep you away from our clinic!
  • Be sure that the tools you plan to use, as well as your hands, are dry before you begin carving. This will help prevent any injuries that may occur from slipping.
  • Purchase a pumpkin carving kit that includes a small serrated knife. This is safer than using a large sharp knife.
  • Cut away from yourself and use small, controlled strokes.
  • Be sure that the hand you are using to stabilize the pumpkin is not in a location that the knife could contact if it slips or pierces through both sides of the pumpkin.
  • Find appropriate ways for children to help. They can scoop the seeds and draw the pattern on the pumpkin, but in most cases should not be handling the carving knife.   You can also consider painting or applying stickers to your pumpkins instead of carving them.
  • If you plan to put a lit candle inside your pumpkin, consider cutting a hole in the bottom of the pumpkin. This way you can place your pumpkin on top of the candle, rather than reaching into the pumpkin to light the candle (which may result in a burn).
  • If you cut your hand or finger, apply direct pressure to the wound with a clean cloth. If the bleeding doesn’t stop or slow after 15 minutes of continuous pressure, head to the emergency room.

If you do sustain a hand injury this Halloween season our team at the Milliken Hand Rehabilitation Center is here to help!

Self-Advocacy Leads to Better Health & Well-Being

Self-advocacy is often a phrase that may be misunderstood and certainly underappreciated when it comes to managing your own health and well-being.  It is a practice that can be learned by anyone.  An added benefit is that there is evidence showing when you learn how to self-advocate and practice it, you can improve your quality of life and pursue those things most important to you.

Self-advocacy refers to the process of effectively communicating, conveying, or negotiating your needs or interests in order for you to gain new knowledge, learn new skills, or gain access to resources that will help you achieve your goals.  Developing self-advocacy skills will help you build resiliency, or the ability to manage stressors in your life, and will boost your confidence or belief that you are in charge.

In our current health care system, a critical mandate for all health care providers is to deliver “client-centered care”.  While this may sound simple and obvious to many, it remains a challenge since health care has historically been focused on knowing what is best for clients or patients; after all, many people seek out health services to “fix” a problem they are experiencing.  Today though, many individuals seek out services to learn how to live with health conditions, some of which are chronic with no real permanent “fix”.  In order to meet the requirements for client-centered care, providers need to know your struggles/challenges/needs so they can provide you with options for your care and include you in making decisions about things that affect your life.

The time is right to build your own self-advocacy skills and here are a few simple things you can do to prepare for that next visit:

  • Be aware of what is going on with your health, your body, your routines, and habits.
  • Do your homework to understand how your health condition affects you doing the things you want or need to do.
  • Identify what is important to you, both in long and short-term timelines.
  • Engage in some problem-solving – if you are having specific issues, jot down what they are, when they happen, or other information. Your healthcare provider can use this to help with options.
  • Write down your specific needs, concerns, and goals to discuss with your provider when you visit, and make sure you take it with you.
  • Stay positive and focused; remember, it is your life, your health, your well-being and you are the one affected by the decisions you make.
  • Take a “partnership” approach with your healthcare provider and know that you too, will have some responsibility to make sure you meet your own needs and goals.
  • Continue to track/communicate with your provider about results over time. They value your efforts and doing this closes the loop and helps both parties be successful.

Learn more about Washington University Occupational Therapy patient services…

Fieldwork Students Help Community Members Map Path to Independence

Master’s-level Washington University Occupational Therapy students, Jacqueline Crues and Logan Reeves, engaged in a unique dual-setting fieldwork rotation during the 2021 summer term. This multifold experience entailed delegating a portion of their fieldwork hours interning in a traditional clinical setting within the Washington University Occupational Therapy outpatient clinic, while the remaining time was allotted for the provision of services to community members diagnosed with various mental illnesses in alliance with the Independence Center of St. Louis, through a program called Map Your Path. While the center, located at 4245 Forest Park Avenue, provides a great deal of assistance and resources to its members, WUOT Director of Clinical Operations, Dr. Patricia Nellis, recognized the opportunity to illustrate the benefits of supplementing their approach with that of the occupational therapy lens.

While the grant-funded endeavor included more general OT services, under Dr. Nellis’ tutelage, Jackie and Logan most notably piloted the Washington University Occupational Therapy-developed Map Your Path to Well-Being program to Independence Center (IC) members onsite once weekly for seven weeks. The students were first tasked with modifying and updating the program, previously developed to address a senior population, to the more diverse demographics of IC members. They planned, developed, and co-led each session, each addressing components of habits and habit change and/or one of 6 key dimensions of well-being: meaningful activities, spirituality, positive emotions, relationships, physical health, and knowing yourself. Sessions included education, both in-session, and take-home exercises, and group discussions.

Overall, 8-12 diverse participants, ranging in age from ~25-85 years of age, attended the weekly sessions. Participants were encouraged to share their perspectives and experiences, with the goal of increasing the collective understanding of well-being and for providing tangible strategies for self-management and habit modification. An indirect but equally important goal was to foster social engagement and promote connectivity among participants.

Both Jackie and Logan reflect positively on their Independence Center groups experience:

“I believe the most innovative and appealing aspect of the Map Your Path program is its step-wise approach to habit change and its initial emphasis on identifying and attaining a layman’s understanding of the underlying mechanisms responsible for creating and perpetuating habits. It challenges participants’ development of insight into the ultimate outcomes of their habits—positive, negative, and neutral. That integral step of self-recognition not only produces the opportunity for accountability and action but also affords participants the basis for utilizing a strengths-based approach, capitalizing on their existent good habits to address the less productive ones. Not only are the techniques intuitive once learned, but they can also be used to address the full spectrum of well-being components. It provides a somewhat universal recipe for intentional habit change.

The group format was an especial joy to be a part of, as the diversity of perspectives flourished and fostered an atmosphere of collaboration, social support, and social learning—experiences often lacking for members of the Independence Center population. As facilitators, one might expect us to have been the experts, but the learning was consistently bi-directional. I am, without question, taking away every bit as much as I put in.”

Jacqueline Crues, MSOT/S

“Overall, I felt the program empowered participants to better manage their well-being through strategies we talked about in sessions. People often get stuck in the idea of well-being consisting of exercise, healthy diets, and ‘feeling happy’ which can make improving well-being a daunting task for people with chronic health conditions. We had a lot of ‘a-ha’ moments when talking about factors that participants didn’t realize had such a substantial effect on their well-being such as sleep, social participation, and spirituality. I think most people struggle to improve their well-being because the concept has been largely generalized when it’s almost completely subjective. Some participants found walks spiritual while others attended church. Some found listening to music meaningful while others enjoyed spending time with family. Map Your Path to Well-Being helped participants look at well-being from that perspective and gave them the tools and strategies to make an effectual change.”

Logan Reeves, MSOT/S

Learn more about the Independence Center…

USAWR Brings Home Silver Medal!

Washington University Occupational Therapist & Instructor, Sue Tucker, OTD, OTR/L, ATP is an Assistant Coach for USA Wheelchair Rugby (USAWR), and this past week Sue was helping guide the team as they played on the big stage in the Paralympic Games Tokyo 2020!

The USAWR Team had an outstanding showing at the Paralympic Games Tokyo 2020, with the team going undefeated in the pool play portion of the tournament and continuing on to reach the Gold Medal Final against Great Britain.  A tough match against Great Britain saw Team USA bring home the Silver Medal during these Paralympic Games!

We want to highlight and congratulate Assistant Coach Sue Tucker, OTD, OTR/L, ATP who is a Therapist & Instructor for Washington University Occupational Therapy. Sue has been coaching with the USA Wheelchair Rugby team since 2013 and has more than 17 years of experience in coaching adaptive sports. When not coaching or teaching, Sue is a practicing therapist and works with adults and adolescents with neurological and orthopedic conditions affecting their mobility to provide comprehensive assessments to assist patients in obtaining the mobility device, seating systems, and/or assistive technology that best meets their needs for their preferred daily activities through our Wheelchair, Seating, Mobility & Assistive Technology program.

Once again we want to congratulate all Paralympic athletes, the USA Wheelchair Rugby team, and especially our Washington University OT, Sue Tucker.

New Nerve and Tendon Transfer Chapter

The third edition of ‘Orthotic Intervention for the Hand and Upper Extremity’ was published this year and is recently in print. New to this edition is a chapter devoted to nerve and tendon transfers. The editors reached out to therapists at Milliken Hand Rehabilitation Center at Washington University to write this chapter given the national recognition this center has for treating patients who have had these procedures. In addition, Miliken’s therapists have spoken on the subject both nationally and globally and published peer-reviewed papers about nerve and tendon transfer rehabilitation.

The Surgeons at Washington University are known globally for their work in advancing peripheral nerve care. Patients come from across the country to be treated here and the surgeons rely on the hand therapists at the Milliken Hand Rehabilitation Center to develop post-operative nerve and tendon transfer rehabilitation treatment plans for the patients to take with them to their local therapists.

Lorna Kahn, PT, CHT, Macy Stonner, OTD, CHT and Anna Miller, MScOT, CHT co-authored this work. They collaborated over many months on both the written and visual content that enables any hand therapist to understand and replicate post-operative treatment programs in their own clinic. The text is a comprehensive, valuable resource for both the therapist and surgeon.

Learn more about our services at the Milliken Hand Rehabilitation Center.

Occupational Performance Center (OPC)

The Occupational Performance Center (OPC) is a work assessment rehabilitation program that is unlike others in the St. Louis area. Our teams’ expertise in neurological conditions and the impact they can have on thinking skills and physical performance makes us stand apart from the rest.  Occupational Therapists in the Occupational Performance Center work with individuals from adolescence to adulthood to assess their “readiness” to return to work, school, or community life following an injury or diagnosis. By gaining a deeper understanding of the person’s mental and physical abilities our team help patients’ set goals, make positive changes, and successfully engage in life roles again.

Our Occupational Therapists partner with clients in an outpatient setting to address individual vocational needs.  Services may include:

  • Analyzing mental and physical essential job functions along with the patients’ actual job performance to determine needed modifications or accommodations which can promote greater success.
  • Helping patients find ways to successfully manage chronic or progressive health conditions in the home, community, and workplace.
  • Meeting with employers to help with advocacy and facilitating productive discussions regarding work performance expectations and accommodations.
  • Providing guidance to college students regarding school readiness, goals, accommodations, and study habits.
  • Exploring alternative options for community engagement for those in need of a new role.
  • Creatively evaluating assistive technology options and how to acquire them. Skilled instruction on how to apply to school/work for increased ease and performance.
  • Helping patients transition to disability status or productive retirement role.

Learn more and see if the Occupational Performance Center can be a valuable resource for you!

Let’s Give Them A Hand

June 7th – 13th we will recognize our Hand Therapists during the American Society of Hand Therapists (ASHT) Hand Therapy Week. This highly specialized group of therapists provide patient care at the Milliken Hand Rehabilitation Center.

The Milliken Hand Rehabilitation Center was one of the first three hand rehabilitation facilities established in the U.S. With over 60 years of experience treating complex and common injuries, Milliken’s occupational, physical and certified hand therapists assist Washington University plastic surgeons, orthopedic surgeons, and community physicians in providing treatment for patients with hand and upper extremity injuries. Some specific conditions that are treated:

  • Arthritis of the hand and wrist
  • Brachial plexus injuries: affecting nerves in the shoulder, elbow, forearm, wrist, and fingers
  • Congenital Hand and Upper Extremity differences
  • Dupuytren’s Contracture
  • Fractures/crush injuries
  • Nerve Compression Syndromes/Peripheral nerve injuries
  • Pre & Post-Operative care for Breast Cancer
    Pre-Operative evaluation and education includes:
     Baseline measurements of upper extremity function, A home program to complete pre-surgery to improve the recovery process post-operatively, Activity of daily living demands and anticipated needs
    Post-Operative care includes: Wound and scar management, Ensure full motion of arms is achieved, Home program personalized to your situation, Activities of daily living deficits, Work demands addressed, Pain management techniques
  • Sports-related injuries of the elbow, hand or wrist
  • Tendon lacerations
  • Tendonitis
  • Work-related injuries and conditions

Pre and Post Operation Services

Milliken therapists are able to work with injuries that both require an operation and provide hand therapy for those that don’t. We provide therapy techniques and services to help optimize your function.

Continue reading about who we are…

Physical Activity As An Occupation

Did you know physical activity is a main occupation for all human beings?  It just happens to fall under a larger umbrella “occupation” known as Health Management.  On a daily basis, we engage in many activities aimed at developing, managing, and maintaining health and well-being routines in order to support being able to participate in other, more widely recognized occupations such as work, childcare, volunteer work, or going to school.  In reality, many of us routinely spend time paying attention to our diet/nutrition because we need to eat and want to feel well.  We may take medications for a medical condition because our life depends on it, or we want to restore our health to a more normal state.  We connect with family members or other people to make sure we maintain or social and emotional health.  All of these examples are things we do to manage our health.  All of them are pretty “easy” to integrate into our daily routines.  We have regular meals, medications are prescribed to take at specific times, and social interactions happen by way of our other “main” occupations.  The same cannot be said for physical activity.  Integrating physical activity into our daily routine seems to come with many barriers, despite it being a major occupation that comes with multiple health benefits.  To be successful, physical activity needs to become a habit.  In order for that to happen, we need to value our efforts to improve cardiovascular status, strength, and balance knowing that doing so will help us maintain health and allow us to enjoy other parts of life.  Increasing physical activity does not need to be difficult – we just need to believe it is an important occupation and it’s helpful to actually like what you choose to do.  After all, humans were meant to move!

For some interesting information on becoming more active, check out the resources below.

https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

https://www.10tipsforhealth.com/10-helpful-tips-how-to-get-and-stay-physically-active/

https://www.cdc.gov/ncbddd/disabilityandhealth/pa.html

Occupational Therapy, Technology, Healthcare Access and Telehealth

As we close out a month of celebrating Occupational Therapy 2020 during the COVID 19 crisis, we want to take time to reflect on some of the positive changes this unprecedented event has ushered in.  For the past 6-8 weeks, life has been something very different for all of us.  We have been told to “stay at home”, meaning more time with families, including meals, schooling, and leisure.  We have assumed new roles we really had not considered, such as substitute teachers and adapted to established roles with “new” ways of doing things, such as virtual meetings at work or social happy hours.  We gained new knowledge such as the difference between bacteria and a virus and how viruses need a host to survive.  We learned new skills, how to don/doff PPE, and even how to make homemade masks.  Some of us developed our volunteer roles to make those masks and some unlocked their creative spirit through other forms of art or doing.

Health care delivery also shifted in a much-needed way with a focus on expanding access to services while keeping patients or clients safe in their own environment through the use of modern technology.  Telehealth has been around for many years, making a slow appearance, but now has come to be a common offering many by many practitioners. COVID 19 ushered in the mass use of telehealth services across the country, ranging from telephone touch base visits to virtual visits with telephone and video capability.  Regulatory bodies and insurance companies relaxed their standards and opened up ways to make sure the process was still confidential and could also be billed by more providers.  Patients could stay at home, log in to an appointment, and continue to receive the great healthcare they expect and received through an in-person visit, in a more intimate and less distracting setting.

Washington University Occupational Therapy has been a part of the movement.  We have used telehealth to help patients develop cognitive, motor, and performance skills; use assistive technology, adapt techniques to complete daily needed tasks; modify work, home, or school environments; and create health-promoting habits and routines. We’re able to reach those who live distances or those who live nearby but have transportation challenges.  By removing access barriers and reducing our turn-around time to receive OT services, we are able to able to help our patients make improvements in the areas of occupational performance, adaptation, health and wellness, chronic disease management, health promotion, and quality of life.  While not every intervention we offer lends itself to telehealth or virtual visits, many do, and often a combination of in-person and virtual is very effective and convenient for our patients.  In this way, we are achieving our goals of improving access, delivering great care, and reducing overall costs via the streamlined use of telehealth.

We are very excited to be able to continue these services moving forward.  We know we offer services that others do not and are thrilled to be able to expand to reach more people who we know will benefit from what we have to offer. Take a look at our adult and pediatric services.