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Craig Hospital Occupational Therapists Study the "Enigma" of the Shoulder

Updated: Sep 19, 2018

Ellen Severe is the Director of Occupational Therapy at one of the top rehabilitation hospitals in the country.

She oversees a team of 80, including occupational therapists, certified OT assistants, and rehab engineers.

Working with patients who have had catastrophic spinal and brain injuries, Severe and her team create function in the human body where that function has been destroyed or damaged.

Severe has a bachelor’s degree in Occupational Therapy. She has done her fair share of anatomy exploration, including considerable work on cadavers. For Severe, staying current with ongoing science and understanding how to treat patients at the scene of the trauma is critical. Research has shown that early intervention to reduce swelling and reduce shock, for instance, play a big role in long-term recovery.

In most cases, unless something like a gunshot has completely severed the spine, injuries are what Severe calls “incomplete.” And that means there is room for Occupational Therapists to work, to restore “what makes you you,” she says. The OTs adapt what the patients do in order to restore quality of life.

To that end, it’s critical that her team stay current, particularly with understanding the muscles of the rotator cuff and hand. The Craig Hospital training is highly specialized. It’s different than what the OTs are taught in school. Craig Hospital, says Severe, “thrives” on education.

So in April, for the first time, Severe brought 15 members of Occupational Therapists to the Anatomy in Clay® Centers, a non-profit teaching facility in Denver. It was the first time Severe built with the clay system. Led by Anatomy in Clay® founder Jon Zahourek, the therapists spent the day building the muscles of the rotator cuff including supraspinatus, infraspinatus, teres minor, and subscapularis and they looked at the related nerve systems, too.

The shoulder complex, says Severe, is complex. “It’s an enigma. Even though we say the shoulder hasn’t change since we stood upright, you just need to know the structures and how they function. You can look at a normal shoulder, hundreds of shoulders, but until you see one that doesn’t function normally, it’s a whole different ball of wax. It’s something we always want to learn about.”

The day of classes was made possible by a grant from Dr. Charles Hamlin, a world-renowned hand surgeon who helped pioneer tendon transfer surgeries to help quadriplegics decrease their reliance on others for some basic functions. Dr. Hamlin also started a hand clinic at Craig.

Craig Hospital’s Occupational Therapists, says Severe, gained insight from the day-long class on the rotator cuff because the Anatomy in Clay® Learning System approach requires building from the inside-out. “It’s a great way to learn,” she says. “Now that we have had experience with real bodies that have had impairments, to go back in and say, ‘let’s build this from the inside out and help me determine what’s happening to my patient’ … it makes a lot more sense.”

Adds Severe, “What we do at Craig is not book learning. You can pull out some of the aspects of what you learned in school about nerves and muscles and structure and function, but in real life it’s impacted by so many different things—a pre-morbid issues, fractures, spasticity, agitation, whatever. So you really have to be on your game about knowing the body and the structures, along with literature out there that is constantly growing and changing about how to improve function.”

Take, for instance, serratus. The serratus has a broad range of nerve roots, but what if it’s badly damaged due to injury? Understanding how the pieces fit together, she says, is critical.

“If somebody doesn’t have an active serratus, their scapula doesn’t move, right?” says Severe. “It doesn’t sit on the thoracic wall to be able to support the structure of the arm to be able to lift and move. So we have to figure out how to compensate for that and help facilitate strength.”

Severe is bringing another group of OTs back to Anatomy in Clay® Centers in the fall. There is always something more to learn. After all, she’s a dedicated therapist. Learning never stops.

Severe has a tattoo on her back. It’s the Old Mayan / Aztec image of the healing hand including a spiral that represents community and togetherness. And a third tattoo, in case there’s any question about her level of commit, is a Kanji symbol.

It happens to be the one for obsession.



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