50 years of helping hands

Milliken Hand Rehabilitation Center celebrates its 50th anniversary

by Michele Berhorst  • November 15, 2021

Patricia Phelps, BSOT, OTR, with a patient in 1976.

The year was 1971. Three years before the creation of the American Society of Hand Therapists, a major development was taking place in St. Louis that would showcase the value and power of collaborative clinical practice and research among physicians, occupational therapists and physical therapists dedicated to hand surgery and rehabilitation. Paul Weeks, MD, the new chief of Washington University’s Division of Plastic Surgery, was determined to create a comprehensive hand rehabilitation center that would enhance treatments, surgery and therapeutic procedures. Weeks, a prominent hand surgeon, recruited two hand rehabilitation specialists, Patricia Phelps, BSOT, OTR, and Virginia Moyers, BSPT, PT, and opened the doors to what was then called the John T. Milliken Hand Center.

It was the first center of its kind in the Midwest, and only the third comprehensive hand center established in the United States. When it got under way in the Irene Walter Johnson (IWJ) Rehabilitation Institute, it was a time when innovative minds realized the value of multidisciplinary approaches to enhance patient outcomes. It also was a time when the University promoted patient care as well as education and research in rehabilitation services. By 1980, hand rehabilitation was noted as part of the School of Medicine’s coursework at the IWJ Institute and in the Department of Rehabilitation Medicine at Jewish Hospital.

In 1972, Paul Manske, MD, an orthopedic surgeon, joined the faculty at Washington University. He rose through the ranks, becoming chairman of the Division of Orthopaedic Surgery in 1983. He took note of the Milliken Center in the Division of Plastic Surgery.

“He was a well-known hand surgeon, and he wanted his own therapists,” recalled Pat Barton Slama, BSOT, OTR. “Marlene Coe, OTR, and then Debbie Beaulieu Goldblum, OTR, started with him, and I joined the group when Marlene moved to Germany. At that time, we were working with patients at IWJ, or in basically what I’d call a closet in the orthopedic office.”

“That small room was our charting area and treatment space,” recalls Cheryl Caldwell, DPT, PT, the first physical therapist in what became known as the Orthopedic Center for Upper Extremity Rehabilitation (OCUER). “OCUER was ahead of its time related to the inclusion and importance of the whole upper extremity. Dr. Manske did a great job of encouraging interactions in various ways between the orthopedic residents and the occupational therapy (OT)/physical therapy (PT) hand team. We participated in article reviews and in-service meetings with the orthopedic residents, and we worked directly with them and Dr. Manske to develop the guidelines and protocols used for the management of upper extremity orthopedic conditions.”

There were multiple challenges to the start-up of the two hand rehabilitation centers. Slama remembers the hard work to define everyone’s individual role within the center as well as efforts to develop protocols, find appropriate space in which to provide quality care, and understand both insurance and workers’ compensation regulations. Still, she says, the early days were exhilarating. “We had FUN,” she notes with a laugh. “We worked hard to better ourselves and really, really enjoyed the job, even when we worked way past 5 p.m.!”

Its therapists were among the first to become certified when the American Society of Hand Therapists offered the first certification exams in 1991. “There was a great atmosphere of learning and many opportunities, along with support, to do whatever you wanted to do to advance the profession,” says Caldwell, who served as Coordinator of OCUER from 1987 to 1992.

Then came the advent of mergers and acquisitions in health care. In St. Louis, Barnes Hospital and The Jewish Hospital of St. Louis merged to form Barnes- Jewish Hospital in the early 1990s. The combined hospital then joined with nearby Christian Health Services to form BJC Health System (now BJC HealthCare), the nation’s first health-care system that integrated academic and community-based hospitals together. Within the complexities of combining services and programs, the two distinct hand rehabilitation centers in plastic surgery and orthopedic surgery came together to form the Milliken Hand Rehabilitation Center.

“Our team was busy as, in addition to our clinics, we handled occasional coverage for inpatients needing post-op orthoses,” recalls Lorna Kahn, BSPT, PT, CHT, who started at OCUER in 1987 and remains on the Milliken staff today. “We also covered the resident clinic, and we had a ‘splint cart’ that we would wheel over to the Wohl clinic to treat patients. I remember when orthopedic surgery renovated their space in the mid-1990s and our treatment space was eliminated for a while. We set up clinic in an old wheelchair closet behind the therapist desks in the inpatient neurology department at Barnes.”

Kahn says that the affiliation with Washington University as well as the caliber of therapists who joined the Center have contributed to a long-standing national reputation. She says, “Early on, therapists such as Gail Groth were publishing important work and speaking on a national level.”

Tim Pemberton, MSOT, OTR/L, agrees. As one of the more recent occupational therapists at Milliken, Pemberton recognizes the strong emphasis that leaders placed on advancing care practices. “We are a highly research-minded team with a foundation grounded in strong evidence-based clinical practices,” he says. “I think this makes us a leader in providing high-quality care proven to maximize patient outcomes and satisfaction.”

Milliken leaves, then returns to Washington University

As BJC HealthCare consolidated and moved services, it established a partnership with HealthSouth, a leader in rehabilitation services. The Milliken Center then became part of BJC/HealthSouth outpatient services available at The Rehabilitation Institute of St. Louis for several years. In 2016, however, recognizing the strengths of Milliken’s therapeutic programs as well as its contributions to advancing research and in educating the next generation of hand therapists, the Washington University Program in Occupational Therapy took over operations and staffing of Milliken as part of the Program’s Community Practice.

At the time, Pat Nellis, OTD, OTR/L, director of the Division of Clinical Operations, noted, “Milliken Hand Rehabilitation Center has been a core of excellence since it began. Having the clinic back in Washington University space allows us not only to continue to pursue excellent care, but also to engage in research related to hands/upper extremity rehabilitation that helps our physicians improve their overall care and for our therapists to really focus in on efficiencies for the best possible functional outcomes. Together, these efforts work to decrease the cost of care. Since Milliken is well-represented in the world of rehabilitation on a national and international level, they’ve consistently shared their knowledge with others to help improve health care on a broader scale.”

Today, the Milliken Hand Rehabilitation Center has locations in West St. Louis County and on the main campus of Barnes-Jewish Hospital. Many of its current therapists trained at Washington University. “My first experience here was as a student 13 years ago. After my first rotation, I knew I needed to either work here or find a place that would support my thirst for knowledge,” says Stacy Baker, MOT, OTR/L, CHT. “They opened my eyes to what makes a job a passion. Here, we are a team, and our voice is extremely valued by our physicians.”

Luu Wong, OTR/L, CHT, joined the team at Milliken two years ago. “I remember the impression made upon me when Stacy Baker told me a story about her dad and his visit to a physician regarding his hands. He informed his physician that his daughter worked at Milliken and shared her thoughts about his hands. The physician replied that he should listen to his daughter, ‘especially when she works at Milliken.’ This story, to me, reflects the skill set and knowledge that our staff has and the respect that has been earned through the years.”

Looking ahead to the next 50 years, the Milliken Hand Rehabilitation Center continues to lead — in advancements in patient care, research and the development of evidence-based therapies, and education.

“Milliken remains on the cutting edge of hand therapy services because their therapists are committed to providing innovative care to their patients. In the past five years, their practice has expanded to include breast cancer and lymphedema services to optimize function and recovery for pre- and post-operative patients,” says Lisa Tabor Connor, PhD, MSOT, OTR/L, associate dean and director of occupational therapy. “As one of our fieldwork sites, Milliken therapists train our students on the latest evidence-based therapies and provide skilled mentorship in emerging areas of occupational therapy practice.”

Adds Caldwell, “I think we all have a drive to learn and be the best we can be. Here, the structures and culture support those goals.”

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