This article summarizes an industrial rehabilitation company called Rehab At Work that offers both physical and occupational therapy services. It discusses the company's history starting in 1990 focusing only on occupational therapy, and expanding to add physical therapy in 1994. Currently they have 9 clinics across Maryland and Virginia treating a diverse population of injured workers. The CEO discusses the rewards and challenges of working in this specialty area of returning injured workers to their jobs.

1. 1ADVANCE for Occupational Therapy Practitioners

2. [ cover story ]
Maryland-based industrial
rehab company offers PT and
OT services under one roof
By Brian W. Ferrie
Maryland-based industrial
rehab company offers PT and
OT services under one roof
By Brian W. Ferrie
8 ADVANCE for Occupational Therapy Practitioners

3. W
hen therapists in other specialties think of indus-
trial rehab, a couple preconceived notions might
come to mind. First is a patient population com-
prised of burly blue-collar workers who have sus-
tained injury due to heavy lifting. Second is a perception those
patients could lack motivation to get back on the job because they’d
rather enjoy worker’s compensation benefits.
Julie Milanick Howar, OTR/L, CWA, CWT, CES, strongly dis-
putes both notions. And with more than 25 years of industrial
rehab experience, she has plenty of credibility on the matter. Howar
became an OT in 1981, started specializing in industrial rehab in
1985, then cofounded an OT practice focused on industrial rehab in
1990 in Germantown, MD.
“When my original partner and I founded that practice, it had no
outpatient physical therapy component,” she told ADVANCE. “Our
role in the continuum of care was confined to when a patient had
already received acute physical therapy and increased his strength
and flexibility, but it still wasn’t known whether he could go back
to work. We were the next piece of the puzzle for a person to return
to work full-time.”
Howar and her partner would evaluate patients at that point,
using the extensive space and distinctive equipment available in
their clinic to help make a determination.
“On-site we had cinder blocks, wheelbarrows, hand trucks, dry-
wall and all kinds of machinery to help rehabilitate a person back
to work, which most physical therapy offices didn’t have. So we
made a marketing decision in 1990 for that to be our niche because
there were already so many physician-owned physical therapy ser-
vices in the area. If we went to a physician to market that we could
take care of his patients, of course he’d just want to keep them in
his practice for acute rehab.”
Branching Out
By 1992, Howar and her partner moved to another space in near-
by Rockville, MD, outside Washington, DC. Then in 1994, a couple
pivotal developments occurred. The first was Howar’s partner de-
ciding she wanted to leave the business and become a full-
time mom. Second, Howar chose to add physical therapy to her
clinic’s services due to a changing economic climate. Thus, Rehab
At Work was born.
“In the four years since we started that practice, the number of
physician-owned PT clinics in the county had greatly decreased,”
Howar remembered. “Because of that, it made sense to offer PT so
we could take care of an injured worker through the whole con-
tinuum. From right after injury with physical therapy that would
look at function, then on to a functional capacity evaluation and
work hardening or work conditioning if needed.”
Explosive growth quickly followed. By 1995, Howar added a sec-
ond Rehab At Work location. Within another five years, the Rehab
At Work brand had grown to include nine total clinics, including
seven in Maryland and two in Virginia.
“The theory at that time was grow or go, because there were
large national competitors coming into the area,” Howar explained.
“And if you’re going to market to an insurance company or case
manager that you can take care of their injured worker, it makes
sense to say you can also take care of other injured workers who
live or work in other counties.”
The years since have been dedicated to growing those nine clin-
ics, each with its own distinctive patient population.
“We get different kinds of occupations at different centers,”
Howar explained. “For example, when you think of Washington,
DC, which Rockville is suburban to, you don’t think of factory
workers. You think of attorneys, lobbyists and more sedentary jobs.
On the other hand, our office in Alexandria, VA, gets a lot of air-
line workers because it’s very close to Ronald Reagan Washington
National Airport. Our Frederick, MD, office tends to see many cli-
ents from a nearby hospital, such as injured nurses or nurse assis-
tants. The Rockville clinic also has a good working relationship
with the police and firemen in Montgomery County. Baltimore
is more of an industrial city so our Baltimore clinic tends to see
many of those types of injuries. There really is quite a mix based
on where the center is and that local economy.”
PT Perspective
Nathan Paraska, MPT, director of physical therapy services for
Rehab At Work, echoed Howar’s sentiments about patient diversity.
“I can honestly say there isn’t one type of injury or worker that
we see all the time,” he told ADVANCE. “We see it all. And when
I come into work tomorrow, I’ll probably see something I’ve never
seen before.”
Paraska has been with Rehab At Work since becoming a PT in
2001.
“I was actually looking for an outpatient orthopedic position
when I first came out of PT school,” he related. “But I graduated in
2001 and at that time, I think anybody in the field would remember
there weren’t a huge number of jobs available. So I found a posi-
tion with this company. I was intrigued by the specialty but hadn’t
learned much about it in school. Since then, I’ve really enjoyed it.
Either it fits you or it doesn’t, but the people who really like this
type of work tend to stick around and make a profession out of
it. You really do have to be an expert to work with this popula-
tion on a regular basis. But once you become an expert, it can be
very satisfying.”
Paraska has certainly proven himself worthy, rising in short
order from staff PT to a management role overseeing one clinic and
then a regional management role supervising two clinics. His pro-
motion to director of PT services for the entire company occurred
about a year ago. 8
Rehab At Work CEO Julie Milanick Howar, OTR/L, CWA, CWT, CES,
and Kristina Kline, OT, work with patient Marion Sterrett. With nine
clinics in Maryland and Virginia, Rockville, MD-based Rehab at Work
specializes in treating injured workers throughout the continuum of
care and returning them to work.
KyleKielinski
9ADVANCE for Occupational Therapy Practitioners

4. [ Cover Story ]
“That’s my new fancy title,” he laughed. “Basically I have a qual-
ity assurance role with respect to our clinical services. So my job
is to maintain appropriate company standards and our license
requirements for all nine clinics. To make sure we’re doing the
best we can on a clinical level.”
Overall, Rehab At Work employs about 50 people, Howar said.
That includes 13 physical therapists, three occupational thera-
pists, eight PTAs and three exercise physiologists, as well as office,
human resources and financial staff. Howar estimated that 70 per-
cent of the business comes from worker’s compensation/injured
worker cases and the other 30 percent from outpatient orthopedic
physical therapy.
Specialty Appeal
So what attracted Howar to this specialty in the first place?
“At one point in my life, I sustained a head injury and had diffi-
culty working,” she related. “That made me realize how important
work is to a person. Second, industrial rehab really pulls together
both parts of occupational therapy—the psychosocial/behavioral
aspect as well as the physical disability. Third, I think it offers a
little more variety in terms of interaction. For example, an OT in
a hospital or school system might work with an on-site team that
only includes a PT and speech therapist, with an occasional call to
a physician.”
Whereas in the industrial rehab setting, Howar communicates
on a daily basis with case managers, vocational rehabilitation
counselors, insurance adjusters, primary-care physicians, specialty
physicians such as orthopedists, insurance-company attorneys, as
well as the employers or supervisors of injured workers.
“So we’re able to work with many distinctive layers of team
members who are external,” she explained. “That requires us to
be very experienced and well-versed in communication, includ-
ing written documentation that has to be timely because it
affects the worker’s compensation case, as well as verbally relay-
ing our findings and the person’s progress to all the people
involved in this injured worker’s life. It can be very complex but I
like those layers.”
Challenges and Rewards
What’s the greatest challenge of working in this setting?
“The belief among some people that everybody is faking it,”
Howar responded. “In fact, research says only about 15-20 per-
cent of patients involved in worker’s compensation cases are
truly presenting to get a secondary gain. So that’s number one,
in terms of the external perception. Internally, the greatest chal-
lenge is when injured workers come in very much not trusting the
process. Many times, patients have lost a lot physically and fi-
nancially, don’t have much familiarity with the system, so our
challenge is to help them increase their performance to the highest
level, work with the employer and insurance company, address
continued on page 22
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11ADVANCE for Occupational Therapy Practitioners

5. [ Cover Story ]
the patients’ fears and mistrust, while
also providing strategies to manage
their symptoms.”
And the most rewarding aspect of indus-
trial rehab?
“To me, it’s the client who visits us
months later and says, ‘Thank you so much
for getting me back to my job,’” related
Paraska. “‘I was in a desperate place, didn’t
think I’d be able to return to the profession
I love and you helped me do it.’ I’ll never
get tired of hearing that. I think it’s really
why everybody goes into the therapy busi-
ness. Even with the clients who have a dif-
ficult disposition at first, when you help
them out and show you’re on their side,
then they’re able to overcome some of their
issues and get back to more meaningful
lives, it’s very rewarding.”
Howar echoed the sentiment: “I find
it an honor to work with this popula-
tion. We’re assisting people during one of
the most challenging times of their life.
They’ve lost their occupation and physi-
cal ability, and in many cases are dealing
with an extremely altered financial situ-
ation. They’re in a very vulnerable place
and often don’t know what’s going on or
why. But we get to see them for as many
as eight hours a day and have an oppor-
tunity to help improve performance in all
aspects of their lives, really treating the
whole person.” n
Brian W. Ferrie is an ADVANCE contributing
editor.
continued from page 11
by providing alternates such as support-
ing the child: seated on caregiver’s lap, lay-
ing on caregiver’s chest, over caregiver’s
shoulder, in a football hold, lying
on caregiver’s lap with baby’s feet
in the air, laying on his/her side
while playing with toys, prone
with support from a towel roll
or boppy under baby’s chest, and
laying on his/her stomach with care-
giver on the floor at eye-to-eye level; and
5. ways to start early placement of the
infant in prone. Specifically, start with 5
minutes and gradually increase by 5-min-
ute intervals up to 30 minutes, twice a day,
to help the infant develop head, neck, arm
and upper-body strength.
These recommendations are espe-
cially important during the infant’s first
6 months of life; that is the period when
head molding, early bonding, social skills,
language, upper-body strength and eye-
hand coordination develop rapidly. n
References available at www.advanceweb
.com/OT or upon request.
Patricia Angermeier, OTR/L, has worked
with children with special needs for over 25
years and is co-creator of the FACES (Fun
Activities to Connect, Engage and Socially
Succeed) program for social-skills devel-
opment. She would like to thank
Tere Bowen-Irish, OTR/L, for
sharing her concerns and working
together to inform and educate fel-
low professionals as well as encour-
age AOTA to support an initiative on
infant positioning and development. Visit
www.advanceweb.com/OTFromPrint for a
complementary article by Ms. Bowen-Irish on
educating teachers to provide accommodations
in the classroom.
[ Children anD Youth ]
continued from page 13
More on the Web:
We’ve got much more pediatric content
online, including:
• A handout for caregivers on tummy time
• An exclusive article on educating teachers
to provide accommodations in the
classroom
• Pediatric OTs’ favorite therapy tools
Find it all at www.advanceweb.com/
OTFromPrint
GO TO: www.advanceweb.com/OT
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24 ADVANCE for Occupational Therapy Practitioners ❘ January 7, 2013 ❘ www.advanceweb.com/OT
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22 ADVANCE for Occupational Therapy Practitioners