Joining hands

On November 1, 2016, the Program in Occupational Therapy acquired the Milliken Hand Rehabilitation Center from The Rehabilitation Institute of St. Louis (TRISL). Milliken's services are now part of the Program’s growing Community Practice, a move that brings the center back to WashU, where it began more than 45 years ago.

Founded in 1971 by Paul Weeks, MD, as part of the Irene Walter Johnston (IWJ) Institute of Rehabilitation at the School of Medicine, the center was initially funded by Thomas M. Moore, the president of the Milliken Publishing Co. in St. Louis, and James Lee Johnson. It was eventually named in honor of Moore’s grandfather, John T. Milliken. The center became the first of its kind in the Midwest and only the third hand center in the U.S. Weeks served as director and performed all medical treatments and surgical procedures.

The Milliken Hand Rehabilitation Center relocated to the East Pavilion at Barnes Hospital in the early 1980s. In the 1990s, Barnes Hospital and Jewish Hospital of St. Louis joined with Christian Health Services to form BJC HealthCare. When BJC HealthCare later entered into a partnership with HealthSouth, the Milliken Hand Rehabilitation Center became part of the outpatient services at TRISL. Following the acquisition last November, the Program welcomed the center’s five physical therapists and 11 occupational therapists into its clinical practice.

“It really is a sort of homecoming for us,” says Patricia Nellis, MBA, OTR/L, director of clinical operations for the Program in Occupational Therapy. “Several therapists on staff are alumni of our Program, and Milliken has been one of our fieldwork sites since 1995. We are pleased to partner with Milliken on research initiatives, educational opportunities for our students and extending our reach into the community moving forward.”

A strong, evidence-based practice

More than 1,000 patients visit Milliken each month. The therapists on staff work with plastic, orthopedic and neuro surgeons, and other physicians, from Washington University School of Medicine and the community. The collaborative relationship between physician and therapist not only sets Milliken from other facilities, it provides a greater level of personalized care for patients.

“Following surgery, occupational and physical therapy can help ensure patients recover fine-motor skills, restore function and movement and improve their ability to perform daily tasks as quickly as possible. Hand injuries can significantly impact a person’s ability to function as desired, and this unique partnership opportunity between patient, physician and therapist allows us to deliver exceptional care and empower patients in a way other providers cannot,” says Nellis.

The patient, physician and therapist relationship extends to research. Physical therapist Lorna Kahn, BSPT, CHT, has co-authored several papers with Susan Mackinnon, MD, chief of the Division of Plastic and Reconstructive Surgery, who is renowned for her work in peripheral nerve injuries and nerve transfer techniques. Kahn’s area of research examines functional outcomes in spinal cord injury patients following nerve transfers in the upper extremities.

Occupational therapist Anna VanVoorhis, MS, OTR/L, has been working with W. Zachary Ray, MD, assistant professor of neurosurgery, on a study funded by the Department of Defense to investigate hand function after nerve transfer in spinal cord injury. For her portion of the study, VanVoorhis is examining rehabilitation outcomes and how hand function improves with therapy after nerve transfer.

“Working on the study has been a great learning opportunity for me, as well as a wonderful opportunity to meet amazing patients and families from around the country. It has been amazing to see recovery of hand and upper extremity function in patients and the way that patients and families work together to achieve their functional goals,” says VanVoorhis.

Looking ahead

In addition to expanding the reach of Washington University’s Community Practice, acquiring Milliken Hand Rehabilitation Center creates rich educational opportunities for master’s and doctoral students in the Program.

Program alumna Macyn Stonner, OTD ’16, OTR/L, joined the clinical staff at Milliken in February 2017. She became interested in hand injuries when she shadowed a therapist as an undergraduate. Stonner further explored her interests with her Program mentor, Vicki Kaskutas, OTD, OTR/L, FAOTA.

“I began exploring the intricacies and complexities of the structures involved in the upper extremities in Dr. Kaskutas’ anatomy class. I then became involved in the American Society of Hand Therapists (ASHT) Hand Therapy Review Course that is held in St. Louis each year by assisting in the cadaver lab with the guided anatomy review,” says Stonner.

Stonner later completed her Fieldwork Level I at Milliken. “There is a lot of literature on the biomechanical factors people with upper-extremity peripheral nerve injuries face. I wanted to delve deeper into the more holistic issues individuals may experience such as emotional, quality of life, effect on work performance, sleep quality and the ability to perform household tasks,” explains Stonner. “My doctoral model focused on upper-extremity care by identifying occupational needs and exploring environmental factors.”Stonner returned to Milliken to complete the 16-week doctoral experiential component.

The advanced clinical practice and research environment present at Milliken gives students the opportunity to learn from and work with some of the best hand therapists in the nation. Nellis hopes to expand the experiential learning opportunities at Milliken even further.

“We are currently exploring the idea of starting a student-run hand therapy clinic to offer free services for under-resourced clients. Personalized care will be provided by a graduate occupational therapy student, who will assess and treat clients with oversight from a licensed, practicing occupational therapist. We have been successful using that model for our student-run stroke clinic, and it could provide needed therapy to people who wouldn’t otherwise have access to services,”
says Nellis.