Building independence

For 100 years, the occupational therapy program has helped people engage mind and body

By Candace O’Connor

Credit: BERNARD BECKER MEDICAL LIBRARYHandwork was viewed as a means to speed healing in the early days of occupational therapy.

In 1995, Washington University’s new chancellor, Mark S. Wrighton, paid his first visit to the Program in Occupational Therapy, which is part of the School of Medicine.

Carolyn Baum, PhD, the program director, gave Wrighton a tour and asked her lean but energetic 12-member faculty to take turns describing their clinical and teaching activities. He wasn’t as impressed as she’d hoped.

“I’ll never forget it,” Baum said. “Afterward, he took me out to the hall and said, ‘Carolyn, you’re doing good things, but I really don’t support a program that just trains occupational therapists.’ And I replied, ‘We’re building an academic department. It’s going to take time — but wait and see.’”

Twenty-three years later, Baum, the Elias Michael Director and professor of occupational therapy, of neurology and of social work, and her colleagues have created a rigorous, graduate-level program aimed at advancing human health through evidence-based practice and innovative research. “If you teach students not only what they need to know and how to apply it, but also how to take the knowledge we’ve gained through research and grow with that knowledge, that makes you a discipline,” Baum said.

Credit: Washington universityCarolyn Baum, PhD, the Elias Michael Director of the Program in Occupational Therapy, interacts with students. Baum is considered one of the 100 most influential people in the field.

Today, Wrighton holds the program in high regard. “I am very proud of our occupational therapy program and the leadership of Carolyn Baum,” he said. “The program has met and exceeded our expectations and risen to become a true leader in its profession and a model for other programs nationwide.”

This year, the occupational therapy (OT) program is celebrating its 100th anniversary. A Centennial Gala Weekend is planned for Oct. 5 and 6, and the program has commissioned a history book, “The Rise of a Program and a Profession, Occupational Therapy at Washington University: The First 100 Years,” by St. Louis writer Cynthia Georges.

Spearheaded by St. Louis civic leader Rachel Stix Michael, the program opened in 1918 to train “reconstruction aides” — civilian women who could help injured World War I soldiers. These aides led soldiers in handwork such as basketry, weaving and wood-carving, as it was believed that such diversions would speed healing by keeping the mind and body engaged. Program admission was open to women at least 23 years old, “native or allied born,” with a college education and a “suitable personality.”

Credit: BERNARD BECKER MEDICAL LIBRARYCirca 1922, a man in a wheelchair uses a small loom at an occupational therapy patient workshop. Today, the Program in Occupational Therapy leads the profession with its research-driven approach.

U.S. News & World Report now ranks the program No. 1 in the country. Baum credits this achievement, in part, to the program’s affiliation with the School of Medicine. It is one of only three OT programs nationwide with a medical school base. The relationship allows faculty to build collaborations with top researchers in neurology, pediatrics, medicine, orthopedics, plastic surgery, cancer and psychiatry. These research ties also extend to the Danforth Campus — in social work, psychology and engineering — and into the community, with some 100 agencies, such as Paraquad and the St. Louis Area Agency on Aging.

As direct experience is an important educational requirement, the program maintains fieldwork contracts with more than 500 locations throughout the U.S. and some abroad. In these many settings, the program’s students serve people across the lifespan.

Credit: tim parkerSusy Stark, PhD, conducts research to promote successful aging in place. One way she does this is by observing patients in their homes and suggesting modifications to reduce risks and improve daily performance.

“This is the richest environment in the world for an OT program — to have access to resources, ask important questions, and give our students these incredible opportunities,” she said.

Baum acknowledges that some people don’t understand exactly what OT professionals do or what kind of research they undertake. The field strives to enhance “occupational performance,” she said, which translates to “engagement with life”: that is, giving clients with disabilities, developmental challenges or chronic health conditions the environmental supports they need to do everyday things that are important to them. “If you look at the three major rehabilitation fields — speech, physical therapy and OT — each one is based on a different concept,” Baum said. “Speech is communication, physical therapy is movement and OT is performance.”

Science behind service

Each year, about 90 new students — seeking an array of master’s and doctoral degrees including the clinical doctorate, launched in 2001 — arrive with eager idealism, hoping to break down barriers so that people can lead better lives.

“A lot come to us because, in their families, there has been a personal experience — like their grandmother had a stroke or their brother has autism,” said Baum, who has directed the program since 1988. “Our students have made wonderful contributions to society already. They have done lots of volunteer work, assisting the elderly or helping kids with disabilities. So, they are attracted to putting science behind how they can serve.”

Unlike studies in the hard sciences, OT research does not involve microscopes, pipettes or mouse models. “Our laboratories are the ordinary lives of people,” Baum said. “We look at the cognitive, psychological, physiological, sensory, motor and environmental issues that are limiting their daily life performance. How do we build better approaches to parent education in supporting children with cancer? Or create a safe environment for older adults who want to live independently at home and need to learn self-management skills?”

Leveraging biomedical data

OT professionals use a wide array of tools and assessments to help patients self-report their levels of participation and mastery in major life activities. A number of assessments developed by the program’s faculty are internationally recognized and are available to practitioners free of charge.

Two PhD students‚ Nathan Baune and Pin-Wei Benny Chen, both with backgrounds in cognitive neuroscience and rehabilitation science, are developing an activity recognition system called Proprio that uses ambient and wearable sensors to unobtrusively monitor the quality of a patient’s post-hospitalization life at home: their success in cooking, eating and caring for themselves.

“Occupational therapy makes it possible for individuals to do what they need and want to do every day.”
— Carolyn Baum, PhD

To make the project a reality, the students are partnering with PlatformSTL, a St. Louis-based software development company focused on university technologies, and BioSTL — the nonprofit arm of BioGenerator. Working with Assistant Professor Alex Wong, PhD, DPhil, the students and PlatformSTL also just received a Small Business Innovation Research Program grant from the National Institute on Disability, Independent Living and Rehabilitation Research.

“I believe strongly that we are the bridge between biomedical data and population health. It’s a kind of precision medicine, if you think about it,” Baum said. “You are a different person than I am; even though we may have the same health condition, we do different things. Occupational therapy makes it possible for individuals to do what they need and want to
do every day.”

Making it possible for people to do what they need to do every day requires entry into many environments, whether they be someone’s home, a school playground, a homeless shelter, a construction site or a coal mine.

Credit: Matt MillerScott Brandon, who sustained a spinal cord injury 16 years ago, said he is grateful to the Program in Occupational Therapy for helping him build physical and mental strength. He participates in research to calibrate cameras that track his motion (above left and below) and finetune wheelchair propulsion. Teaching correct wheelchair propulsion skills can help reduce upper limb pain and injury.

Tackling societal challenges

Among their productive, 22-member faculty are eight members on the investigator track, who collectively are participating in 39 funded research projects:

  •  Allison King, MD, PhD, focuses on children with chronic illness, such as sickle cell anemia and cancer. 
  • Erin Foster, PhD, OTD, develops rehabilitation programs for people with Parkinson’s disease. 
  • Susy Stark, PhD, does translational research to support aging in place. 
  • Kerri Morgan, PhD, an American Paralympian wheelchair racer, improves mobility in patients with spinal cord injury, multiple sclerosis and cerebral palsy. 
  • Benjamin Philip, PhD, studies the brain’s control of movement and uses that knowledge in rehabilitation. 
  • Alex Wong, PhD, DPhil, develops assessments and interventions for patients with neurological conditions, especially stroke. 
  • Bobbi Pineda, PhD, works with premature infants, bridging the gap between the Neonatal Intensive Care Unit and home. 
  • Carolyn Baum, PhD, designs and studies interventions that support the cognitive needs of older adults and improve quality of life.

Other faculty members are on the clinical track, working with children who are hearing-impaired or who have Tourette’s syndrome, adolescents with substance abuse issues and patients of all ages who are cancer survivors.

Monica Perlmutter, OTD, specializes in assisting older adults with vision loss. In 2017, Perlmutter began helping a new client, Sharon Anders, who experienced significant vision loss due to myopic macular degeneration. Anders had difficulty reading, using a computer, operating appliances and watching TV, had given up driving, and was in the process of planning for early retirement from her job as an assistant accountant. Now she needed to learn how to navigate her house and community and live with her disability.

When Perlmutter first visited Anders’ house in Affton, she noted how dark it was — “like a cave.” Anders had assumed the dimness was due to her failing sight. Perlmutter began by using a lighting assessment tool she had developed and then made key improvements. She also outfitted Anders’ appliances with easier-to-read labels. She helped Anders maximize her remaining vision by training her to look obliquely at objects instead of straight on and in the use of a video magnifier. Perlmutter also gave her contact information for agencies such as St. Louis Society for the Blind and St. Louis County Corp and made homework assignments to ensure that Anders called.

As a result of Perlmutter’s visits, Anders gained confidence and independence. “If it wasn’t for her, I wouldn’t have known all these things,” Anders said. “Her help was off the charts!”

Perlmutter said that clients like Anders change her life, too. “I am inspired by their resilience, patience, determination and generosity. When you go into people’s homes, you have a window into their world.”

Seeding the field

The program also takes care of its own students, strives to make sure they are exposed to the most rigorous instruction and involves them in the shaping of these endeavors. Steve Taff, PhD, OTR/L, leads five faculty and 30 students who are studying innovations in teaching methods, developing experiential learning clinics, exploring theoretical problems in education and designing supports for graduate student health and wellbeing.

The end result reaches far and wide: Today, OT faculty and alumni are improving the everyday lives of people across the globe. In the past 100 years, more than 2,700 alumni have graduated from the program. Many seed hospital-based programs or OT school faculties nationwide. Alumna Kristin Will, OT ’14, is founding an OT clinic in eastern Uganda.

The spark for all this success has come from Baum, who joined the faculty in 1976 as director of occupational therapy clinical services at the Irene Walter Johnson Institute of Rehabilitation (IWJ). Under her guidance, IWJ eventually merged with other occupational therapy services at the medical school to create the formal program in 1987.

When she assumed leadership, the program had only three faculty and 18 students. Baum believed strongly in evidence-based research and hired faculty who would move the field forward. In 2017, the American Occupational Therapy Association named Baum as one of 100 influential people who have shaped the field.

Locally and nationally, the field has come a long way in 100 years and continues to gain momentum. Baum is excited about the projects yet to be undertaken and the patients yet to be served. “At our 100th anniversary, the future of occupational therapy has never looked brighter. Really, it’s the best.”

Faculty, students and alumni of the Program in Occupational Therapy are having an everyday impact in a wide variety of settings.

Published in the Autumn 2018 issue