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.


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.


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.


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.

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.

  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.


Mental Health Awareness Month

Occupational Therapy is a profession that assists people throughout their lifetime and believes that participation in daily activities (aka occupations) is vital to mental health and well-being.

Your Washington University Occupational Therapist may help you utilize familiar activities as coping mechanisms, such as listening to music, playing cards, writing, doodling, cooking, or cleaning to help provide calming or grounding strategies.

OTs are also well versed in sensory strategies. A person’s sensory system helps process information from the environment. For individuals with mental health conditions, their ability to process this information may be compromised, which can cause the patient to feel upset and not safe.

One important qualification that sets occupational therapists apart from other qualified mental health professionals is their background in physical rehabilitation. Mental health issues are often accompanied by issues of physical health. In a mental health setting, you may find an OT addressing general strengthening, adjusting wheelchairs, recommending adaptive equipment, or any other task that is within the scope of practice in the field of occupational therapy.

Ultimately, your Washington University OT will work to assist you in participating in daily activities. If your condition is keeping you from being able to participate in daily activities, speak to your occupational therapist about your concerns. If they do not have the tools to assure that your needs are being met, they can serve as a resource in getting you the necessary help. Learn more about our self-management services.

Milliken PT publishes paper in Springer Nature’s publication

Nerve transfers are a surgical technique used to restore function in people with a nerve injury. The Milliken Hand Rehabilitation Center is well known in the hand therapy world for its work with these patients due to their close relationship with the Washington University Physicians who are world-renowned for developing this type of reconstructive surgery. In the past 15 years, this surgery has been applied to individuals with cervical spinal cord injuries to help them regain some volitional movement in their hands. Following surgery, it is important for the patients to have adequate therapy to optimize outcomes. Lorna Kahn, PT, CHT has worked closely with Dr. Ida Fox for the past 15 years to develop such a program.  After 4 years of writing, submitting, editing, and reediting their paper was finally published this month in Springer Nature’s Spinal Cord Cases and Series. Read the paper here. 

The paper is a retrospective case series that reviews 9 individuals who had surgery and hand therapy at Washington University. A chart review was performed and data points that highlight the timing of recovery and the specific functional changes noted by the patients were gathered. Additional objective measures were included. The paper is designed to give therapists a general guideline for treating individuals who have had this surgery. The timeline for recovery is protracted and often both the individual and therapist discontinue treatment before the recovery is completed. We hope this paper will provide a framework for motor re-education after nerve transfers and improve outcomes for the patients.

Cancer Survivorship Services

Cognitive changes are a common side-effect of cancer treatments for many adult cancer survivors. Increased fatigue, stress, and anxiety are also among the most common symptoms experienced. The combination of these symptoms and side effects can profoundly impact participation in daily activities and reduce quality of life. The interventions used in our Cancer Survivorship Program target functional cognitive performance and help participants become more aware of what situations and factors may present a greater challenge.

During the first couple of sessions, the OT completes a comprehensive evaluation tailored to the individual’s cognitive concerns and other physical or psychosocial factors that could further impact their performance. Such factors may include coordination, visual perception, hearing, balance, fatigue, sleep quality, anxiety, stress, depression, and/or social considerations.

An evidence-based metacognitive strategy training intervention called “The MultiContext (MC) Approach” ( provides the foundation from which executive function deficits are addressed. In the MC approach, the therapist uses specialized mediation methods to coach and guide individuals in a way that facilitates their own thinking. This helps the person become more aware of factors and situations that pose greater challenges. Ultimately, this therapeutic approach empowers the person to generate and use cognitive strategies to manage cognitive errors across a variety of everyday activities (Toglia & Foster, 2021).

Fatigue, anxiety, and stress management are also core components of the program. Participants are offered education and opportunities to practice a variety of adaptive strategies to manage these symptoms as they relate to activities they want and need to do.

Potential outcomes for participants of this include increased independence, maintaining or returning to home and community roles, improved confidence with social relationships, reduced stress and anxiety, lowered fatigue, and improved use of strategies to successfully complete cognitive tasks.

If you or someone you know could benefit from our Cancer Survivorship services, please call 314-286-1669 to inquire about scheduling an appointment.



Toglia, J., & Foster, E. R. (2021). The multicontext approach to cognitive rehabilitation: A metacognitive strategy intervention to optimize functional cognition. Gatekeeper Press.

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

Local resources for PD can be found by visiting the American Parkinson Disease Association St. Louis Chapter

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


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. 

Common Sense of Learned Skills?

Parents – does this sound like you?

  • I don’t understand how you’ can get 100% on your math test but you forget to turn in your homework every day!
  • You’re so great a building complex Lego kids, but why can’t you organize and clean your room better?
  • The refrigerator is RIGHT THERE! Please just open it and put the milk back in next time rather than leaving it on the counter.

If so, then you are most definitely NOT alone!

Some of these skills may seem like common sense. Skills in one area, like math or tinkering and building, are strengths for our children. But these skills don’t necessarily translate to other important areas of functioning, like remembering to turn in homework or organizing a messy room (which have nothing to do with intelligence).

When looked at through a lens of discreet skills that are actively developing in our children, then we see a more comprehensive picture than just “smart” or “logical.” We start to see our children’s skills of organization, time management, working memory, and planning. Then, we can start to provide direct and specific strategies to support the development of these skills.

Called executive functions (EFs), these can set your child up for not only school success but for life success, as well. These higher-level thinking skills, like working memory, planning, and attention, are so important that the Center for the Developing Child at Harvard University reports that “individuals and society experience lifelong benefits” when opportunities to learn and practice EF skills are presented. And research backs up that EF skills can be explicitly taught (Takas, Z. K. & Kassai, R, 2019).

WashU’s Program in Occupational Therapy offers just such an opportunity for your 9-16 year old each summer. The Train Your Brain summer camp is a week-long, half-day program for your child (with or without a diagnosis that affects EF skills) that explicitly teaches time management, planning, goal setting, and organization through engaging STEM projects. Different than other science or STEM summer camps, Train Your Brain uses STEM projects as a means to an end of learning EF strategies that campers can take with them to use at home and school.

So if you see yourself in the statements at the beginning of this article, take a look at the Train Your Brain summer camp and consider giving your child an opportunity to learn and practice important life skills.


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 (

5 Tips for a Healthy Thanksgiving

Thanksgiving only comes around once a year, so why not go ahead and splurge? Year after year, we can all attest that during the holidays thinking about healthy eating may not be our primary consideration.
But Thanksgiving does not have to sabotage your diets. With a little self-control, we can satisfy our desire for traditional favorites and still enjoy a guilt-free and healthy Thanksgiving feast.

1. Get Active

Create a calorie deficit by exercising to burn off extra calories before you ever indulge in your favorite foods. Eat less and exercise more is the winning formula to prevent weight gain during the holidays. Increase your steps or lengthen your fitness routine the weeks ahead and especially the day of the feast.

Make fitness a family adventure. Many communities have created “Turkey Day” 10K, 5K, and 1 – mile fun runs and walks to help you start off Thanksgiving with exercise so that you are burning those exercise calories in preparation for your afternoon and evening meals.  It is a wonderful way for families to get physical activity and enjoy the holiday together.

2. Eat Breakfast

While you might think it makes sense to save up calories for the big meal, experts say eating a small meal in the morning can give you more control over your appetite. Start your day with a small but satisfying breakfast — such as an egg with a slice of whole-wheat toast, or a bowl of whole-grain cereal with low-fat milk — so you won’t be starving when you arrive at the gathering.

Eating a nutritious meal before you arrive takes the edge off your appetite and allows you to be more discriminating in your food and beverage choices.

3. Police Your Portions

Thanksgiving tables are bountiful and beautiful displays of traditional family favorites. Before you fill your plate, survey the buffet of options and decide what you’re going to choose. Then select reasonable-sized portions of foods you cannot live without.

Don’t waste your calories on foods that you can have all year long. Fill your plate with small portions of holiday favorites that only come around once a year so you can enjoy desirable, traditional foods.

4. Be Realistic

The holiday season is a time for celebration. With busy schedules and so many extra temptations, this is a good time to strive for weight maintenance instead of weight loss if you have decided to work on a diet ahead of the new year.

9. Focus on Family and Friends

Thanksgiving is not just about the delicious bounty of food. It’s a time to celebrate relationships with family and friends. The main event should be family and friends socializing, spending quality time together, not just what is on the buffet. Your mental health and wellbeing are equally as important as your overall body health.

Most importantly our team at Washington University Occupational Therapy wishes each and everyone a Happy & Healthy Thanksgiving and Holiday season.  We’re thankful for all of our colleagues in the healthcare field, community organizations & partners, and the patients that give us the opportunity to help them focus on the daily tasks they need and want to do.

“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 ) 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…

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.

Functional Neurological Disorder

Washington University Occupational Therapy has developed a program to treat patients experiencing functional neurological disorders. A Functional Neurological Disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body send and/or receive signals.

The FND program at Washington University Occupational Therapy is provided to adolescence through adults who present with functional neurological disorder (FND) symptoms.

Functional neurological symptoms can include:

  • functional weakness
  • disassociative attacks
  • pseudo seizures
  • functional cognition
  • functional tremors
  • functional dystonia
  • functional tics
  • functional gait disorder
  • functional speech

FND program includes:

  • Education on diagnosis
  • Awareness training of triggers of FND symptoms
  • Training in FND management

The program is designed to assist patients in managing symptoms and taking control of their daily activities to resume life as they know it without an inpatient stay. Traditional FND programs require a multi-week inpatient stay.  Our program has adapted the inpatient program model but allows our patients to stay at home; while still engaged in their daily activities. Patients meet with our clinician within our outpatient clinic or via telehealth services.

Please call (314) 286 – 1669 or email to schedule an appointment.

COVID-19 Recovery Resources

Occupational therapy’s goal is to help patients utilize their strengths, maximize their potential, and counteract their limitations to help them meet their goals. As we continue to see rising numbers of COVID-19 cases, our team is here to work with patients recovering from the physical and emotional challenges patients may be facing from the virus. Please read through this article and see below for some COVID-19 related resources that you can share or contact us regarding OT Services for COVID-19 Recovery & Rehab.


COVID Recovery Website Resource

Mindfulness Resources:

Mindfulness is being present and aware of what you’re sensing and feeling, without interpretation or judgment. Mindfulness has been shown to improve mental health, cognition, and sleep quality. Mindfulness helps you pay attention to what is happening, which may enhance your memory, as well. Paying attention to your surroundings and yourself can lead to insights about current stress levels and help you respond with a sense of calm. There are many ways to practice mindfulness. Listed here are some resources to get started.


Stress Management Resources

Self-Compassion Affirmations
Caring for yourself not only makes you feel better, but research shows that self-compassion makes you more likely to care for others, as well. Repeat these affirmations to yourself.
  • I accept myself as I am.
  •  I am enough.
  • I am worthy of compassion.
  •  I allow myself to make mistakes and learn from those mistakes.
  •  I let go of the old and make room for the new.
  • I am resilient.
  • I nurture myself with all the kindness I would shower on someone I cherish.

Progressive Muscle Relaxation
Tighten each body part for 5 seconds. Release for 10 seconds. Repeat for all body parts listed.

  • ï‚· Forehead (raise eyebrows)
  • Mouth (smile wide)
  • Eyes (squint)
  • Head (tilt up)
  • Hands (clench fists)
  • Arms (flex biceps)
  • Shoulders (raise arms)
  • Upper back (shoulder blades together)
  • Chest (deep breath)
  • Stomach (deep breath)
  • Low back (arch)
  • Buttocks (clench)
  • Thighs (press knees together)
  • Feet (point toes toward the sky, then ground)

Grounding Techniques to Reduce Anxiety in the Moment
These techniques may help distract you from anxiety and refocus on what’s happening in the present moment.

  •  Pay attention to what you are touching, smelling, hearing, tasting, and seeing.
  • Focus on your breathing.
  • Take a short walk.
  • Move around.
  • Do math problems or count backward from 100.
  • Recite something you know by heart.
  • Describe what’s around you.
  • Picture the face of someone you love.
  • Sit with a pet.
  • Visualize your favorite place.
  • Listen to music.
  • Put your hands in water or hold a piece of ice.

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!

Research on Parkinson’s Disease

Our Clinic Manager, Jamie Archer, MOT, OTR/L was recently published for her work on
Occupational Therapy Interventions for Instrumental Activities of Daily Living for Adults With Parkinson’s Disease: A Systematic Review. Congratulations to Jamie and her colleagues for their work and recent publication in the American Journal of Occupational Therapy (AJOT).


Click here or the journal image below to read the article:


AJOT Image

Keep Kids Active During Summer Break

While the school year might be over and “traditional” learning is on pause for a few months, the summer is a great time to help kids continue to learn and gain skills.  Keeping kids active and learning over the summer helps make sure they are ready for the grade ahead and don’t regress in any areas.  The summer is the best time to try out new and exciting learning opportunities that are hands-on and engaging.

  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, or if you go to the botanical gardens have them practice their reading skills by reading out loud the postage signage.   Regardless of where you go there are so many opportunities to keep children learning while at our local attractions.
  1. Attend a local summer camp. While all camps are great for keeping kids active, 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 Occupational Therapy offers its’ own summer camp for children ages 9-12 and new this summer 13-16 yr olds with executive function difficulties (difficulty with planning, organization, goal-setting, task monitoring, etc.).  If interested in learning more about this camp, see the link below.


  1. Explore the outdoors. Thankfully this summer has more opportunities to experience indoor attractions due to more things being open and available, but it is still important to spend time outdoors.  Whether this is going for a hike and learning about the leaves and trees around you, camping for the weekend and problem solving on how to pitch a tent, or trying out fishing for the first time and researching the different species of fish, each of these opportunities provides a fun experiential learning experience for kids and parents alike.
  1. Cook together. Cooking is a great home-learning opportunity that combines math, science, and reading skills.  From picking out a recipe, getting and measuring the ingredients, as well as learning the science behind how foods are cooked, this fun activity will keep children constantly learning.  If you want to change things up, even more, have themed cooking nights where you cook foods from different cultures and eat the meal the way individuals would in those countries.
  2. Fuel their passions. While there are certainly many ways to try and keep your 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.  While this summer certainly holds more opportunities for traveling and being with others, also use this time as a great way to explore new learning opportunities while gearing up for the school year ahead.

Strategies To Reduce Mental Fatigue

Here are some tips and strategies to help with mental fatigue:

  • Set aside time to plan and prioritize the tasks you need to accomplish for the day. Make a list and keep the expectations realistic. Be sure to allow a little time cushion for unexpected interruptions. Carving out this time to make decisions in advance will provide a reference to keep you on track and avoid undue stress and pressure to make decisions quickly.
  • Reduce distractions and focus on one thing at a time. For example:
    • Emails: If you are frequently interrupted by email notifications, simply log out of your email account. Incorporate time throughout the day to chunk the time you spend on emails. By intentionally checking and responding to email on your terms individual emails won’t veer your attention away from a task you are trying to check off your to-do list.
    • Conversations with co-workers: Using a good set of noise-canceling headphones or ear protection is another way to keep your attention focused. They also provide a visual cue to others so they will think twice before interrupting you.
  • Give yourself a break. When you notice your concentration waning and find yourself reading the same sentence over and over, you’re overdue for a break. Taking short breaks throughout the day can actually improve productivity and your mental fatigue. When you start working on a task, set a timer (20-25 minutes is a good place to start). When the timer goes off, take a short active rest break; stretch, step outside to observe the weather and sounds or do a short meditation in addition to the usual bathroom or snack breaks.  Set the timer again and continue what you were working on or move to the next task, etc. Adjust the length of time to your personal needs to optimize your productivity and focus.
  • Looking for additional information?  Learn more from Medical News Today

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.

Our Aging Thumbs

Take a moment to assess your posture.  Did you immediately correct the position of your neck, back, and shoulders?  Although keeping those parts of our body in good alignment is important, there’s another body part that is just as important.  They are something small, but undeniably useful.   They are the two short appendages on your hands; your thumbs.

Our thumbs do quite a bit of work; they are responsible for at least 40% of our hand function.

Take another moment to see how useful they are to you right now.  Imagine how you would function in your daily life without your thumbs.  They are so important that if you were to lose one of them in a terrible event, another finger would be sacrificed to create a “thumb” in a procedure called pollicization.

Our thumb joint, like any joint in our body can wear down prematurely.  It may be due to genetics, wear, and tear, or trauma.   We can’t change our DNA or undo past injuries, but we can minimize wear and tear.  And if you are like me, you like to have control over your body.

Thumb posture has the same philosophy as back posture.  Good back posture means maintaining the natural curves of our spine.  Good thumb posture means keeping the thumb bones in a “C” curvature during use.

Reducing forces, and thus injury, to our back means practicing the no BLT rule.  Not Bacon, Lettuce, and Tomato, but Bending, Lifting, and Twisting.  That means the use of good back mechanics during lifting tasks.  Joint protection techniques for our thumbs have a similar philosophy of decreasing forces or stress to the thumb joint.  Joint protection techniques in its simplest form is just asking “how I can decrease wear and tear?”.  It is changing how you do things, but not stopping what you are doing.

Whether it is from an injury, recent surgery, chronic poor posture, or aging, recovery from a bad back requires adherence to a back exercise program.  Like our back, our thumbs have its own exercises to keep them in good shape.

It is inevitable that our thumbs will “mature” like the rest of our bodies and develop osteoarthritis.  However, early practice of thumb posture, joint protection techniques, and thumb stabilization exercises, will allow you to maintain your lifestyle as your thumbs mature.

The team at the Milliken Hand Rehabilitation Center is here to help your aging thumbs!

Your Kid Needs a Brain Break

After the school year that our kids just went through, their brains are fried. Isn’t yours? Especially for our children with learning needs, this year’s virtual learning environment presented huge challenges. We are multisensory beings in a vibrant environment, and we learn through all of our senses. Online school only gives our children visual and auditory information, which can dull our senses, lead to boredom, and create difficulty fully exploring new concepts and ideas. Our attention, task monitoring, problem-solving, and planning are all dulled by this monotonous routine. Let’s go have fun at summer camp!

Thankfully, Washington University Occupational Therapy is offering an in-person option for learning fun. Train Your Brain (TYB) summer camp is back to support children’s executive functioning skills through hands-on games and motivating projects. Following COVID-19 safe protocols with fully vaccinated staff, TYB will offer hands-on activities that stimulate your child’s mind in multisensory ways.

This year, camp will feature egg drop activities in which campers must build contraptions to protect a raw egg from falling 10+ feet. They will set goals, plan, problem-solve, manage time, and edit their work to make a successful egg protector. Children and teens ages 9-16 are eligible to join in the fun. So if your child’s executive functions are dulled from online learning, consider Train Your Brain to sharpen their cognitive skills this summer. Learn more about our camp and register here!


Celebrate OT Month During April!

Washington University Occupational Therapy works with many healthcare providers, physician groups, living facilities, and community organizations to provide the best OT care, When & Where our patients need it most. During the month of April, we will be celebrating our OT providers and colleagues and all that they do for our adult and pediatric patients.  Please take a moment and see what the field of OT has been able to contribute to the daily wellbeing of patients.

What Is Coronasomnia?

One year has passed since the world shut down in response to the pandemic. During that time, life has been full of unexpected twists and turns. Who has not laid awake in the bed during the pandemic, restless and wondering what is going to happen next or asking how will everything get done? Those periods of uncertainty and grief have been associated with increased reports of stress and anxiety. When we are stressed, especially as we try to sleep, the body’s “fight or flight” hormones can trigger insomnia. The pandemic has led to such a spike in stress-related insomnia that a new phrase has been coined – coronasomnia.

Coronasomnia can affect the ability to cope with social relationships and life changes that come with the pandemic. It can also wear down your immune system, increasing the risk for new health conditions and making it difficult to care for existing conditions.  A few tips that may help to combat coronasomnia include:

  • Reserve your bed for sleep.
  • If you cannot rest, try getting up from the bed to do a brief, quiet activity and return for rest.
  • Be careful with napping so that you get a 7-9 hour stretch of sleep, if possible.
  • Add more structure to your daytime schedule to intentionally separate work activities/space from home and hobbies.
  • Take advantage of natural light.
  • Increase physical activity, during the day/evening.
  • Create a personal bedtime routine (“me-time”) that tells your body it is time to sleep. (OTs can help with this process if you are experiencing difficulty).

Try these lifestyle changes to see if they help you to embrace sleep. If you find yourself unable to self-manage, consult with a physician or other professional such as occupational therapists, regarding additional options. Here’s to quality sleep!

The importance of sleep is underappreciated. Many people wear lack of sleep as a badge of honor, believing that they can “catch up” when they miss it or that sleep is a waste of productive time. On the contrary—quality sleep helps to heal the body! While the amount of sleep needed varies for different people, an average of 7 to 9 hours provides the energy to meet daily activity demands.

Many symptoms can arise due to poor quality sleep, including fatigue, falls, problems with thinking; irritability, pain, and weight gain.  These symptoms can impact work and lifestyle and even worsen health conditions such as heart disease and diabetes. Yet, most people do not think of sleep as the culprit.

There are many things that can be done to improve the quality of sleep, such as taking a warm shower before bed, making sure the mattress and pillows are comfortable, raising the head of the bed around 4 to 6 inches to make breathing easier, and dimming the lights. Getting physical activity during the day and avoiding caffeine before bed also helps. However, there are times when you check with your physician and you still cannot seem to get to sleep, stay asleep, or feel rested. This is a good opportunity to ask for a sleep study to make sure you do not have an undiagnosed sleep disorder or to seek help from other professionals, like occupational therapists.

Remember to shoot for quality sleep so that you have a positive effect on your heart, mind, body, and spirit!

American Heart Month “Self-Care” Routine Tips

Washington University Occupational Therapy works with our patients on self-management and self-care all-year-round. With February being American Heart Month we want to promote self-care heart-healthy tips for your daily routine. Below are some actions that you can include in your routine;

  • Get a daily dose of physical activity, such as a brisk, 30-minute walk.
  • Cook meals that are low in sodium and unhealthy fats.
  • Take your medications as prescribed and keep your medical appointments.
  • Sleep 7-8 hours a night.
  • Manage stress through yoga, mindfulness, and wellbeing, or quiet time with a book.
  • Try to reach or stay at a healthy weight by moving more and having snacks like fruits and veggies on hand when hunger kicks in.

Infant Toddler Autism Program (ITAP)

The Infant Toddler Autism Program (ITAP) has recently made its home in the Washington University Occupational Therapy Pediatric Services portfolio of clinical offerings.  In addition to providing community education and student learning opportunities, ITAP offers a high-quality, parent-mediated, early intensive behavioral intervention service for infants and toddlers through the MC²: Motivation, Connection, Communication intervention.  MC² was developed under the direction of Dr. Michael Gaffrey at the Washington University William Greenleaf Eliot Division of Child and Adolescent Psychiatry.  Dr. Gaffrey is currently on faculty at Duke University.

ITAP’s MC² intervention is designed to increase the social engagement and functional communication skills of infants and toddlers (age 6-33 months) who exhibit early signs of autism, which may include any the following:  frequently not responding to their name, not sharing interest by showing or pointing, delayed communication skills, limited eye contact, and appearing to pay more attention to objects than people.  Social engagement is a critical component of communication and learning, and while caregivers often recognize their child is not meeting milestones as expected, they often report not knowing how to best support their child’s development.

For that reason, ITAP’s MC² is a parent-coaching program.  A therapist works with the caregiver over the course of 24 sessions to teach the intervention and coach the parent on using the strategies fluidly with their child.  The strategies are designed to be easily implemented within daily activities and routines, allowing the parent to realistically use them given time constraints while also giving the child access to higher levels of therapeutic dosage within their natural setting and schedules.

Sessions are typically scheduled for two 60-minute sessions/week for 12 weeks and occur in-person in the family’s home.  During the Covid pandemic, accommodations were made to the intervention to allow for virtual sessions when needed.  ITAP has partnered with Missouri First Steps and offers the program through the early intervention system when authorized by a family’s therapy team.  Additionally, moving into the OT program has allowed ITAP to now offer a self-pay option for families who are not enrolled in First Steps.

To learn more about ITAP and the MC² intervention, or to make a referral, please visit

2020 Clinical Publications Work

In 2020 our Therapists provided their expertise to the following Clinical Publications & Journals:

  • Annals of Surgery
  • Hand Therapy
  • Plastic and Reconstructive Surgery
  • The Journal of Hand Therapy


Berlet, L., & Kaskutas, V. (2020). Developing occupation kits in a Hand Therapy Student Experiential Learning Clinic. Hand Therapy25(2), 73-82.

Cochrane, S. K., Calfee, R. P., Stonner, M. M., & Dale, A. M. (2020). The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditionsJournal of Hand Therapy. 

McQueen, K. S., Powell, R. K., Keener, T., Whalley, R., & Calfee, R. P. (2020). Role of strengthening during nonoperative treatment of lateral epicondyle tendinopathyJournal of Hand Therapy.

Power, H. A., Kahn, L. C., Patterson, M. M., Yee, A., Moore, A. M., & Mackinnon, S. E. (2020). Refining indications for the supercharge end-to-side anterior interosseous to ulnar motor nerve transfer in cubital tunnel syndromePlastic and reconstructive surgery145(1), 106e-116e.

Stonner, M. M., Mackinnon, S. E., & Kaskutas, V. (2020). Predictors of functional outcome after peripheral nerve injury and compressionJournal of Hand Therapy.

Yee, A., Padovano, W. M., Fox, I. K., Hill, E. J., Rowe, A. G., Brunt, L. M., Kahn, L. C., & Mackinnon, S. E. (2020). Video-based learning in surgery: establishing surgeon engagement and utilization of variable-duration videosAnnals of Surgery272(6), 1012-1019.

Stay tuned for a new Clinical Publications section on our website to keep up with the work our Therapists are doing to advance healthcare.

Stay Focused On Your 2021 Goals

The beginning of the year is the most common time to set self-improvement goals. However, after just a few weeks into the New Year, many people find themselves discouraged, not focused, and ready to abandon their goals.  If this sounds familiar, it is quite possible your goal statement and plans to get there are the source of this derailment. Don’t give up though; stay focused, get back on track instead and view this experience as an opportunity to apply S.M.A.R.T. principles to your goals and couple them with a comprehensive Action Plan.

S.M.A.R.T. goals are Specific, Measureable, Achievable, Realistic, and Timebound. For example, “Get in shape and lose weight” is a broad and general long-term goal statement and lacks substance. The same goal, adding S.M.A.R.T. principles becomes, “Run a 5k before October” or “Lose 20 pounds by July 1st.”

Once you make your goals S.M.A.R.T., the next step is to create a short-term ACTION PLAN to accompany those goals. This is a crucial step where the goal is broken down into smaller activities that can be completed in 1-2 weeks. For example, if the goal is to lose weight, some examples of activities to include in a 1-week action plan are:

  • Walk 20 minutes 3 days a week before showering for work
  • Add blueberries, carrots, and celery to the shopping list
  • Prepare fresh fruit and vegetable snacks on workdays
  • Select and prepare 2 new healthy recipes
  • Drink water at lunch instead of soda

Your action plan should also consider when and where you will complete the activity and if anyone else needs to be involved in the plan (ie: for childcare, accountability, or other support). Potential distractions and barriers to carrying out the plan must also be taken into consideration to help avoid pitfalls.

Once you complete your plan, rate your confidence to follow through with it. If your confidence is less than 7 out of 10, then your plan may not be realistic and needs to be adjusted. Once you are confident with your plan, pick a date to review it. When the time comes, think about what worked well, what didn’t work so well, and why that may be. From there, you can update and adjust your action plan accordingly.

Applying S.M.A.R.T. principles to your goals and developing focused action plans may take a little more time, but will ultimately keep you rolling on track towards achieving your goals more quickly. Try it and see where your goals will take you in 2021?

Learn more about our self-management services…

Managing Stress During The Holidays

November and December are times that families cherish; as it brings warm memories of cherished traditions. Many emotions surround this timeframe including stress, excitement, and love. 2020 has brought with it many changes to how we do things within our own families and our communities. Which will affect how we will celebrate this holiday season. Washington University Occupational Therapy would like to provide you with some tips on how to maintain self-regulation during a challenging holiday season.

Tip #1: Simplify the expectations of your holiday events. Identify the top 3 to 4 things that are important to your family and set goals to do those things.

Tip #2: Pre-plan, identify barriers that will affect your holiday activities, and identify solutions 1-3 weeks prior. Preplanning decreases stress and promote self-regulation to enjoy the event.

Tip #3: Use self-affirmation messages to help remind you of the goals set for the holiday season. Self-affirmation messages help self-regulate your brain by providing a plan and a solution. It also helps manage negative thoughts. An example of a self-affirmation message is, “Making this apple pie by myself with keep me and my mom safe. It will feel good to give her the pie as it will help her remember our past holiday traditions”.

Tip # 4: Use self-regulation strategies when feeling stressed to calm your emotions.

Self-regulation strategies include:

-Taking a walk to clear your mind

-Listening to calm music to slow your breath and heart rate

-Journaling your thoughts to help manage when you feel overwhelmed

-Snuggling up in a comfortable outfit or with a comfortable blanket; it is like giving yourself a hug

-Eat crunchy food or food that makes your mouth work to promote self-regulation through sucking and swallowing or chewing.

Washington University Occupational Therapy pediatric and adult services are available to help people through this challenging holiday season by assisting with identifying strategies to plan, organize, and self-regulate their life.

Learn more about our adult and pediatric OT Services...

Halloween Safety for You and Your Kids – It’s not just WHAT you do, it’s HOW you prepare

What is in store for you and your family this holiday season? How much thought have you given it? One of the hardest things we are faced with this year is that there aren’t always clear right and wrong decisions when it comes to what, where, with whom, and how to engage in our meaningful activities. Instead, we are faced with low, medium, and high-risk activities, people, and places. I know not to accept homemade treats from strangers at Halloween, but what about my in-laws’ homemade pie at Thanksgiving? I know I’ll wear a mask when hanging out, but what do I do during the meal? 

With the holidays fast approaching, our annual celebrations of the season, family, and fun are incredibly meaningful and important for our mental health and sense of belonging even more so than they usually are. So how do we move through this festive season celebrating safely? Let’s start by thinking about Halloween and Día de los Muertos, but remember that these principals can be applied throughout the holidays. It’s imperative to think ahead and make a plan. This list won’t tell you what to do, rather it will help guide you through how to make smart decisions that are right for you. Be sure to refer to the CDC’s guide to Holiday Celebrations for more information and always plan to wear a mask when you plan to be in close proximity to others.

  1. Make a list of your usual traditions and new ones that you’re considering this year.
  2. Analyze the task. Think like an OT and break down the activity; what does it require that I do? For instance, traditional neighborhood trick-or-treating requires (1) dressing up, (2) walking outside, (3) walking in or past groups of people, (4) knocking on doors, (5) speaking with someone up close, (6) and accepting or grabbing candy. If you’re in a really fun neighborhood, it might also include going through a front yard or garage haunted house.
  3. Assign risk level. Compare your list to the CDC’s list and really know how much risk each activity poses.
  4. Decide your comfort level with the level of risk posed by each activity. This is where things differ greatly from person to person, and that’s OK.
  5. Make your choice.
  6. Share your choice with your family and friends with whom you plan to spend time. Children, especially, will be comforted to know what the plan is ahead of time. This can also reduce whining and complaining when reminded in the middle of their fun that going through the neighbor’s garage haunted house is, in fact, not part of the plan.
  7. Be kind – Kindness towards yourself and others will go a long way during these unusual times.

OT Programs For Spinal Cord Injury/Disease

Are you working with or know patients that are experiencing Spinal Cord Injury/Disease? Washington University Occupational Therapy has programming and information for you to share with them!

Persons with Spinal Cord Injury/Disease may benefit from knowing about opportunities below.

First, the Enabling Mobility in the Community Lab is seeking research participants to complete a phone or on-line survey about their experiences and needs during the Covid-19 pandemic. Participants volunteer their time but will receive community resources catered to their needs. Resources range from assistance with grocery delivery and internet services to personal care assistance services.  For more information, contact Kim Walker at (314) 273-7010 or

If you are a wheelchair user, it is particularly important to periodically wipe down the most commonly used surfaces of your wheelchair during the Covid-19 pandemic which include: handrims, push handles, arm supports, wheel locks, removable footrests, and tires.  Also, washing your hands is incredibly important. Any virus that might be on your hands is transferred to your handrims as you push your wheelchair.  Also, if you push on your tires instead of your handrims, you are basically touching every surface over which you roll, so you may want to wear gloves if unable to use handrims. To clean your handrims, you can use washcloths or paper towels and apply antibacterial soap and push around the house, sliding the washcloths on the handrims as you go. Or, wheelchair users can have someone push them slowly in the home, while they wipe down the handrims.  Be sure to maintain social distancing of at least 6 feet as wheelchair users tend to sit lower and are more vulnerable to infected saliva droplets and aerosols from persons standing.   Wearing a face mask in this instance would be beneficial.

For more information on Covid-19 for persons with Spinal Cord Injury and Disease, see the Christopher and Dana Reeve Foundation site:

For more information on the remote and in-person group and one-on-one programming available for persons with spinal cord injury and disease for the fall, contact Carla Walker at or (314) 273-7011. If a new wheelchair or environmental evaluation is needed please remember we provide those OT services for adult and pediatric patients.

Handwriting and Motor Control Study

Handwriting Study

Stroke Clinic For The Community

Washington University Occupational Therapy operates a student-run stroke clinic with the guidance and oversight of licensed Occupational Therapists. The clinic offers free services for under-resourced patients to help increase safety and independence for people following a stroke. We work to empower our patients and families by providing them with the knowledge and tools they need to best manage their health, while also providing an opportunity to enrich our student’s education through this real-world clinical experience. During our interactions with patients and families, we commit to:

  • Listening to our patients and their families.
  • Providing experiences that are unique to each person’s health and functional needs.
  • Exploring the home environment and personal support available for each patient to help them be safe, healthy, and functional.
  • Partnering together with physicians, families, communities, and other professionals to deliver the best care possible.
We are now accepting referrals and new patients for the Fall Semester! Please contact The Student Stroke Clinic at (314) 286 – 1615 or email for more information.

Learn More About Our Student stroke Clinic and all of our Student Experiential Learning Clinics.

Map Your Path To Well-Being Program

Are you working with patients or community members that are wanting to make goals for themselves or focused on improving their sense of wellbeing and their overall ability to manage life’s transitions? Washington University Occupational Therapy is collaborating with Aging Ahead on an 8 – week Map Your Path To Well-Being Program. Topic areas discussed in the program will include:

  • Habits and Behavior Change
  • Personal Strengths and Values
  • Positive Emotions and Mindfulness
  • Physical Activity, Nutrition
  • Sleep
  • Engagement and Doing
  • Relationships
  • Serving Others, Joy, Spirituality

Map Your Path To Well-Being participants must be 60 years of age or older and able to join the program via their home computer, additional details can be found below:

  • The 8-week program meets weekly September 15th – Monday, November 2nd.
  • Group meets weekly on Tuesdays at 10 am for 90 minutes via Zoom.
  • The course will be limited to 20 participants.
  • Participants are expected to attend all sessions.
  • Program is led and facilitated by Washington University Occupational

This program is very unique, “There are few, if any, comprehensive tools that evaluate areas such as meaningful occupation, social connectedness, mindfulness, and joy through helping others, says Pat Nellis, Director of Clinical Operations for Washington University Occupational Therapy. “We want to help people develop an action plan to improve their quality of life and a sense of wellbeing and then share those proven tools with community groups, physicians, and others as well as incorporate them into our occupational therapy clinical practice curriculum”.

To register please contact Jean Sotomayor at (636) 207- 4227 or email

Learn more about our patient services!

UV Safety Month

This summer likely finds many people spending even more time outdoors engaging in activities that allow for social distancing such as hiking, gardening, and home maintenance projects. Think about UV safety while you are spending time outside. 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.