Building the Evidence

AOTA T H E

AMERICAN

OCC U PAT I O N A L

T H E R A P Y

A S S O C I AT I O N

®

MAY 10, 2010

Building the Evidence ence d i v e e r h Using t e a protocol fo es. to creat ith feeding issu w infants

PLUS

Breakfast Group in Acute Rehab Hearing Impairments Doctoral Education Fieldwork Educator Role

PLUS

Breakfast Acute Rehab Group Hearing Impairments Doctoral Education Fieldwork Educator Role

™

One of the most effective treatment approaches to restoring both visual and motor function is one that incorporates functional movement patterns with goal directed activities. Dynavision D2™ is an FDA cleared visuomotor system for neurological patients with cognitive and motor deficits, visual impairments and attention disorders. The Dynavision D2™ provides therapists with a unique approach to rehabilitation. Benefits may include: • Visual motor and cognitive assessment/training • Improved hand-eye coordination and reaction times • Improved visual tracking and peripheral awareness • Increased efficiency to absorb visual information under a variety of cognitive demands These benefits may help influence or increase memory, safe driving, response time performance and motor training.

Platinum sponsor of aota’s 90th annual Conference & Expo VIsIt BootH #915

DYNAVISION D2™ Distributed by

ContaCt us at 877.362.0390 | BIonEss.CoM Bioness® and the Bioness Logo are trademarks of Bioness Inc. | www.bioness.com Dynavision D2™ and the Dynavision D2™ Logo are trademarks of Performance Enterprises

015 P-4749

Chief Operating Officer: Christopher Bluhm Director of Marketing & Member Communications:

Beth Ledford

Editor: Laura Collins Senior Editor: Molly Strzelecki CE Articles Editor: Sarah D. Hertfelder

AOTA • THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

Art Director: Carol Strauch

V O L U M E 1 5 • I S S U E 8 • M AY 1 0 , 2 0 1 0

Production Manager: Sarah Ely Director of Sales & Corporate Relations: Jeffrey A. Casper Advertising Manager: T  racy Hammond

FEATURES

Advertising Assistant: Clark Collins

Ad inquiries: 800-877-1383, ext. 2715, or e-mail [email protected]

Asha Asher, Chairperson, Developmental Disabilities Special Interest Section Salvador Bondoc, Chairperson, Physical Disabilities Special Interest Section Tina Champagne, Chairperson, Mental Health Special Interest Section

FE

TU

A

Tara Glennon, Chairperson, Administration & Management Special Interest Section

Breakfast Group in an Acute Rehabilitation Setting

F

Elizabeth Francis-Connolly, Chairperson, Education Special Interest Section

RE

AU

TH OR SA

Kimberly Hartmann, Chairperson, Technology Special Interest Section

.C TO HO KP C ND © TO DIANE DEIDERICH /IS

M O

Leslie Jackson, Chairperson, Early Intervention & School Special Interest Section

DEPARTMENTS

Kathy Maltchev, Chairperson, Work & Industry Special Interest Section

News

3

Pamela Toto, Chairperson, Special Interest Sections Council 

Capital Briefing

States Enact Insurance Mandates To Cover OT for Autism

6

Renee Watling, Chairperson, Sensory Integration Special Interest Section Missy Zahoransky, Chairperson, Home & Community Health Special Interest Section

In the Clinic

7

AOTA President: Penelope Moyers Cleveland Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge

Meeting the Needs of Clients With Hearing Impairments

Continuing Competence

19

Fieldwork Issues

20

Calendar

22

Doctoral Education: Steps To Consider

Chief Professional Affairs Officer: Maureen Peterson © 2010 by The American Occupational Therapy Association, Inc. OT Practice (ISSN 1084-4902) is published 22 times a year, semimonthly except only once in January and December by the American Occupational Therapy Association, Inc., 4720 Montgomery Lane, Bethesda, MD 20814-3425; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offices. U.S. Postmaster: Send address changes to OT Practice, AOTA, PO Box 31220, Bethesda, MD 20824-1220. Canadian Publications Mail Agreement No. 41071009. Return Undeliverable Canadian Addresses to PO Box 503, RPO West Beaver Creek, Richmond Hill ON L4B 4R6. Mission statement: The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public. Annual membership dues are $225 for OTs, $131 for OTAs, and $75 for student members, of which $14 is allocated to the subscription to this publication. Subscriptions in the U.S. are $142.50 for individuals and $216.50 for institutions. Subscriptions in Canada are $205.25 for individuals and $262.50 for institutions. Subscriptions outside the U.S. and Canada are $310 for individuals and $365 for institutions. Allow 4 to 6 weeks for delivery of the first issue. Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from AOTA to reproduce or photocopy material appearing in OT Practice. A fee of $15 per page, or per table or illustration, including photographs, will be charged and must be paid before written permission is granted. Direct requests to Permissions, Publications Department, AOTA, or through the Publications area of our Web site. Allow 2 weeks for a response.

OT PRACTICE • MAY 10, 2010

9

Patty Coker and colleagues used evidence to create a protocol for infants with feeding issues.

YO ES

Sharon J. Elliott, Chairperson, Gerontology Special Interest Section

Emerging Research on an OT Intervention for Infants Born With Cardiac Defects

RT OU SC COVE R PHOTOGRAPH

OT Practice External Advisory Board

Building the Evidence

The Fieldwork Educator Role Continuing Education Opportunities

Employment Opportunities

26

14

A Restorative Program for Incorporating Clients’ Hemiparetic Upper Extremities for Function Nettie Capasso, Amie Gorman, and Christina Blick use the “real-world” experience of eating breakfast to encourage stroke survivors to use their affected limbs.

Living Life To Its Fullest

OT Reflections From the Heart Crafting a Therapeutic Group

33

• Discuss OT Practice articles at www.OTConnections.org in the OT Practice Magazine Public Forum. • Send e-mail regarding editorial content to [email protected]. • Go to www.otpractice.org/currentissue to read OT Practice online. • Visit our Web site at www.aota.org for contributor guidelines, and additional news and information. OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practice’s editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, PO Box 31220, Bethesda, MD 20824-1220, e-mail to [email protected], or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last. To request each issue in Word format (without graphics or other design elements), send an e-mail to [email protected].

1

Exclusive Savings. Without the firewall.

AOTA members could get an additional discount on car insurance. Get a free quote today.

Discount amount varies in some states. Discount is not available in all states or in all GEICO companies. One group discount applicable per policy. Coverage is individual. In New York a premium reduction is available. Some discounts, coverages, payment plans and features are not available in all states or companies. Government Employees Insurance Co. • GEICO General Insurance Co. • GEICO Indemnity Co. • GEICO Casualty Co. These companies are subsidiaries of Berkshire Hathaway Inc. GEICO: Washington, DC 20076. GEICO Gecko image © 1999-2010. © 2010 GEICO

P-4717

News AOTA Updates

AJOT Goes Digital View Full Content and Submit Manuscripts Online

I

n March, AOTA Press launched AJOT Online through HighWire, a scholarly research journal platform and a division of Stanford University Press. The new format allows readers to view the full content of each AJOT issue online, including all figures and tables. The full text is searchable by key word, and the cited references include hyperlinks to Medline and to the full text of many other online journals. Members and subscribers can sign up to receive e-mail alerts announcing each issue’s table of contents as well as create their own virtual library of articles. See http://AJOT.aotapress.net for all the exciting new features! At the same time, AJOT also launched an online manuscript submission and peer review system through BenchPress. Sign up today at http://AJOT. submit2aota.org. For more information, contact Chris Davis, director of AOTA Press, [email protected]; 301-652-6611, ext. 2653.

ACOTE Seeks New Accreditation Evaluators

T

he Accreditation Council for Occupational Therapy Education (ACOTE®) is seeking new members for the Roster of Accreditation Evaluators (RAE). RAE members evaluate the compliance with ACOTE Standards for more than 325 occupational therapy and occupational therapy assistant educational programs, OT PRACTICE • MAY 10, 2010

Association updates...profession and industry news

helping to ensure the competency of future occupational therapy practitioners. The on-site evaluations and paper reviews conducted by RAE members provide ACOTE with the information necessary to make its accreditation decisions. Commenting on her experience as an accreditation evaluator, ACOTE member Dahlia Castillo, MS, OTR, stated, “As a therapist, I find it fascinating to have a direct link to the education of future practitioners. As a member of the RAE, I have had the privilege of meeting exceptional OT and OTA educators, clinicians, and students all over the country. Being a volunteer on the RAE is something I recommend to clinicians as an opportunity for professional growth and personal fulfillment that is beyond compare.” For the positions to be filled in 2011, ACOTE is placing a strategic emphasis on the recruitment of a diverse pool of accreditation volunteers. OT and OTA clinicians, and OTA educators, are especially needed and are strongly encouraged to apply. To qualify as an accreditor (RAE member), the applicant must n be either an occupational therapist or occupational therapy assistant; n be a member in good standing with AOTA; n have at least 5 years of experience as an occupational therapy practitioner, including 3 years in education or fieldwork, occupational therapy administration, or another area of expertise; and n NOT hold concurrent positions on any AOTA policy-

making or decision-making body to include the Representative Assembly (Representative or Alternate), Board of Directors, Ethics Commission, or Commission on Education. In addition, RAE members may not hold a position in a credentialing capacity (e.g., National Board for Certification in Occupational Therapy [NBCOT] Executive Board member or Certification Examination Item Writer). Applications will be accepted by the AOTA Accreditation Department until June 30, 2010. Members of the ACOTE Executive Committee, in collaboration with AOTA Accreditation staff, will review all eligible applications, and the final list of applicants will be reviewed by members of ACOTE. After the selections are made, all applicants, whether selected or not, will be informed in writing of ACOTE’s decision by August 2010. All new members of the RAE will receive 2 1/2 days of training at the November 12–14 Accreditation Evaluator Workshop to learn how to review and evaluate programs using the 2006 Standards. Newly trained evaluators will begin their 3-year terms on January 1, 2011. RAE members are expected to participate in on-site accreditation evaluations as requested; complete paper reviews and peer evaluations as requested; and maintain communication with AOTA Accreditation staff and ACOTE members. All expenses for on-site visits are fully reimbursable. If you or someone you know would be well suited for this exciting and important

volunteer position, you may download the Practitioner or Educator Application for Membership from the Announcements & Newsletters section of the ACOTE Web site at www. acoteonline.org or request an application from AOTA Accreditation at accred@aota. org or 301-652-6611, ext. 2914. Applications should be completed and returned by e-mail to [email protected] or by mail to the ACOTE Accreditation Program, c/o AOTA, P.O. Box 31220, Bethesda, MD 20824-1220 no later than June 30, 2010.

Ethics Commission Public Disciplinary Actions

T

he Ethics Commission (EC) has taken the following recent disciplinary actions. According to Section 1.3 of the Enforcement Procedures for the Occupational Therapy Code of Ethics, with the exception of those cases involving only reprimand, the American Occupational Therapy Association (AOTA) “will report the conclusions and sanctions in its official publications and will also communicate to any appropriate persons or entities.” Name: Donna C. Greene, OTR/L Sanction: Suspension of Membership for 1 year: Effective March 23, 2010. Violation of Principles 1, 4F, 4G, 5A, and 7 of the Occupational Therapy Code of Ethics (2005) Name: Laura B. Cox, OT/L Sanction: Censure: Effective February 9, 2010. Violation of Principles 5A, 5B, and 6A of the Occupational 3



A O T A B u l l e tin boa r d OUTSTANDING RESOURCES FROM

Occupational Therapy Practice Guidelines for Adults With Stroke

J. Sabari etails the significant contribution of occupational therapy in treating adults dealing with difficulties related to the functional limitations that can result from a stroke. Appendixes include other valuable resources such as CPT™ codes related to occupational therapy for stroke survivors. $49 for Members, $69.50 for Nonmembers. Order #2211. http:// store.aota.org/view/?SKU=2211

D

New IDEA: An Occupational Therapy Toolkit, 2008 Edition (CD-ROM)

L. Jackson esigned as a research and training tool for occupational therapists and occupational therapy assistants to help improve early intervention (EI) and educational results for children and youth with disabilities, this toolkit contains key resources about the Individuals with Disabilities Education Improvement Act (IDEA). It also serves as a reference guide to relevant federal, national, and AOTA resources that can support effective occupational therapy practice in EI, preschool, and school settings. $49 for Members, $69 for Nonmembers. Order #4810A. http://store. aota.org/view/?SKU=4810A

D

Questions? Phone: 800-SAY-AOTA (members) 301-652-AOTA (nonmembers and local callers) TDD: 800-377-8555 Ready to order? By Phone: 877-404-AOTA Online: http://store.aota.org Enter Promo Code BB

4

Hemianopsia: Strategies Based on Research and Clinical Experience That Support Performance in Daily Occupations

(Webcast) T. Holmes Earn .15 AOTA CEU (1.5 NBCOT PDUs/1.5 contact hours) omonymous hemianopsia is the most common visual impairment resulting from stroke or traumatic brain injury. This short course provides an update on what appear to be the most effective interventions for occupational performance for people with visual field loss. It covers intervention techniques as well as research on and clinical experience with scanning techniques, vision restoration therapy, and optokinetic therapy. $45 for Members, $64 for Nonmembers. Order #CSC223. http:// store.aota.org/view/?SKU=CSC223

H

Elective Session 2: Occupational Therapy for Infants and Toddlers With Disabilities Under IDEA 2004, Part C

(Online Course) M. Muhlenhaupt Earn .1 AOTA CEU (1 NBCOT PDU/1 contact hour). his course focuses on the provision of occupational therapy services under Part C of IDEA 2004. Reviews current regulatory influences on early intervention along with recommended practices for working with families and their infants and toddlers. It also defines and emphasizes the significance of young children’s learning in natural environments. Includes additional recommendations and resources for self-study to meet the needs of therapists who are new to early intervention practice. $29.95 for Members, $41 for Nonmembers. Order #OLSB2A. http://store. aota.org/view/?SKU=OLSB2A

T

Bulletin Board is written by Jennifer Folden, AOTA Marketing Specialist.

Therapy Code of Ethics (2005) Name: Rinea Lyn Lucia, OT/L Sanction: Censure: Effective January 19, 2010. Violation of Principle 6 of the Occupational Therapy Code of Ethics (2005) and Guidelines 1 and 2 of the Guidelines to the Occupational Therapy Code of Ethics. Name: Jacquita Lovelace Sanction: Revocation of Membership: Effective March 23, 2010. Violation of Principles 5 and 6 of the Occupational Therapy Code of Ethics (2005) Please contact Deborah Slater, AOTA liaison to the EC, at [email protected] if there are questions concerning this information.

Intersections

National Coalition of Health Professional Education in Genetics

A

OTA continues to participate in discussions of the potential implications of advances in genetics for health care providers. As a member organization, AOTA regularly sends a representative to attend the annual conference of the National Coalition for Health Professional Education in Genetics (NCHPEG). The 12th annual meeting took place in September 2009. Attendees included representatives from more than 30 NCHPEG member organizations, and included a diverse range of health providers, educators, researchers, and representatives from related industries. Topics highlighted at this most recent meeting focused on the content and delivery of genetics information. The keynote address was delivered by Francis S. Collins, MD, PhD, director of the National Institutes of Health

and formerly the director of the National Human Genome Research Institute (NHGRI). At NHGRI, Collins spearheaded the effort to complete the Human Genome Project (HGP), including announcing completion of the sequencing of the human genome in 2002. His keynote address presented a review of the recent advances and opportunities in genetics. Other speakers at the NCHPEG meeting continued the discussion of issues and projects related to the dissemination of genetics information throughout the United States, Canada, and the U.K. Among the speakers was occupational therapist Penny Kyler, MA, OTR, FAOTA, of the Health Resources and Services Administration. Kyler presented the Community Genetics Education Network Project, a model developed to improve the genetic literacy of minority populations. The PowerPoint from Kyler’s presentation, as well as those of the other sessions, is available for free public viewing at http://www.nchpeg.org/content. aspx?sc=meeting&sub=6. The Web site also includes numerous genetics resources for health professionals, including the Core Competencies in Genetics for Health Care Providers. —Jenna Yeager, PhD, OTR/L, associate professor, Department of Occupational Therapy and Occupational Science, Towson University, Maryland

Practitioners in the News n Robinette (Bobbie) J. Amaker, COL, SP, PhD, OTR/L, CHT, FAOTA, provided the 10th Sharon Sanderson Lectureship at the University of Oklahoma Health Sciences Center on April 2. The title of her presentation was “Occupational Therapy in the Treatment of Injuries from Operations Enduring and Iraqi Freedom.” n Lea Brandt, OTD, MA, OTR/L, member-at-large for the AOTA Ethics Commission had MAY 10, 2010 • WWW.AOTA.ORG

the article “Investing in Social Capital” published in Ohio’s Spring 2010 issue of BIO Quarterly, a publication from the Bioethics Network of Ohio. n Matthew Dodson, OTD, OTR/L, was a speaker for the Traumatic Brain Injury Staff Lecture Series at Walter Reed Army Medical Center in Washington, DC. The lecture, “Boots on the Ground: Cognitive Rehabilitation from the Trenches,” described how occupational therapy and speech-language pathology use cognitive rehab concepts as part of the multidisciplinary team approach to treatment, and more. n Laura Gitlin, PhD, director of the Center for Applied Research on Aging and Health and a professor in the Department of Occupational Therapy at Thomas Jefferson University in Philadelphia, was nominated by AOTA to serve on the Physician Consortium for Perfor-

mance Improvement Dementia Work Group. The group had its first meeting in Chicago in April to identify and define quality measures aimed at improving outcomes for patients with dementia. n Karen O’Brien, OTR, MS/ CDS, an occupational therapist for the Plumsted Township School District in New Jersey, received a grant from the New Jersey Council on Developmental Disabilities for the primary school handwriting program. O’Brien uses a multisensory program in the preschool classes to help students develop prereadiness skills for handwriting. The grant money will be used to purchase supplies needed to continue the program. n Carolyn Sithong, OTR/L, CAPS, was recently featured with a client in Orlando Homebuyer magazine’s 2009 Home Design Challenge. Sithong and her client challenged local

architects to design a home for a young person with paraplegia who wishes to age in place, including meeting the requirements submitted by Sithong to meet her client’s occupational needs and priorities, supported by sustainable design. Sithong is the founder of the Central Florida Aging in Place chapter and owner of Home for Life, Consulting and Design. n Ann Marie Turo, OTR/L, owner of Integrated Mind & Body, LLC, was featured in an article in the South End News. The article discussed Turo’s proactive, holistic approach to breast cancer treatment.

In Memoriam Suze Dudley, MSEd, OTR/L, FAOTA, passed away in April, following a lengthy illness. Dudley was a past president of the Florida Occupational Therapy Association (FOTA) and held

many other positions in FOTA throughout her long career. She was one of the founders of the Nova Southeastern University OT Program and served as the chair from 1993 to 1996; before that, she was an OT faculty member at Florida International University from 1976 to 1993. She will be sincerely missed by her colleagues, family, and friends. Correction

AOTA apologizes for the unintentional exclusion of the St. Louis University OT program from the Gold Level list of 2009–2010 Student Membership Circle schools in the April 26 issue of OT Practice. We are grateful for their support of AOTA through the 100% student membership that has been achieved. Molly V. Strzelecki is the senior editor of OT Practice.

NEW Self-Paced Clinical Course on Feeding, Eating, and Swallowing! Dysphagia Care and Related Feeding Concerns for Adults, 2nd Edition Edited by Wendy Avery, MS, OTR/L Earn 1.5 AOTA CEUs (15 NBCOT PDUs/15 contact hours) Written from an occupational therapy perspective, this new edition of the 2003 SPCC Dysphagia for Adults provides an up-to-date resource in dysphagia care for occupational therapy practitioners at both the entry and intermediate skill levels. It will educate occupational therapists and occupational therapy assistants who are at the entry level with an academic foundation, but without experience in dysphagia intervention, to provide skilled care. It will also assist practitioners who are currently providing skilled intervention to advance their expertise by broadening their knowledge of interventions and approaches with dysphagia clients. New 2nd Edition Feature! “The Dynamic Swallow” CD provides an enhanced learning experience on the anatomy and physiology of the swallow through diagrams, animations, and videofluoroscopic images of the normal and abnormal swallow. The CD provides optional subject matter that reinforces course content. CD-ROM

Order #3028 AOTA Members: $285, Nonmembers: $385

CE-155

To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/?SKU=3028 OT PRACTICE • MAY 10, 2010

5

c a p ita l b r i e f in g

I

States Enact Insurance Mandates To Cover OT for Autism

n 2010, two states enacted autism insurance reform legislation, and 20 states are still considering legislation that includes provisions mandating that health insurance plans cover treatment for autism spectrum disorders (ASDs). Kentucky and Maine enacted legislation this spring, with both states including occupational therapy in mandated coverage provisions for ASD treatment. In addition, Utah enacted legislation that will impact Medicaid autism policy. Kentucky’s new law states that coverage for individuals in the large group and state employee market between the ages of 1 and 7 years will be subject to a maximum annual benefit of $50,000 and that coverage for individuals between the ages of 7 and 21 years will be subject to a maximum monthly benefit of $1,000. Individuals in the small group and individual market will be subject to a maximum monthly benefit of $1,000 regardless of age. Coverage for occupational therapy, along with speech and physical therapy, is incorporated into therapeutic care as a type of treatment for ASDs. Maine now requires health insurance companies to provide coverage of the diagnosis and treatment of ASDs for individuals age 5 years and younger, and coverage of treatments will be provided when prescribed, provided, or ordered for an individual diagnosed with autism by a licensed physician or a licensed psychologist who determines the care to be medically necessary. Therapy services provided by a licensed occupational therapist are listed as a type of treatment covered for ASDs. Speech therapy and physical therapy are also included. Utah has developed a range of options for a Medicaid waiver that would

6

Marcy M. Buckner authorize the Medicaid program to provide services to persons with autism. The range of options include: (1) an option based on Maryland’s waiver for children with ASD, and (2) an option using applied behavioral analysis for children ages 0 to 9 years. Each option will include the estimated cost of implementing the waiver to the state Medicaid program and to an individual Medicaid client. The Health and Human Services Interim Committee will determine whether to sponsor legislation to require the Department of Health to apply for a Medicaid waiver to provide services to persons with autism by December 1, 2010. No other treatments other than applied behavioral analysis were specified in the Utah bill. In March 2010 Iowa and Kansas enacted legislation, but at this time they are still awaiting the governor’s signature. If H.B. 2531 is signed into law, Iowa will require coverage for individuals under the age of 21 years, private health insurance companies to provide coverage for the diagnosis and treatment of ASDs, and a $36,000 annual cap on treatments for children with ASDs. As in Kentucky, coverage for occupational therapy, along with speech and physical therapy, is incorporated into therapeutic care as a type of treatment for ASDs. In Kansas, if H.B. 2160 is signed by the governor, there will be an annual cap on treatments for children with ASDs who are enrolled in the health insurance plan for state employees: $36,000 up to age 7 years and $27,000 between ages 7 and 19 years. For individuals diagnosed with autism by a licensed physician, or a licensed psychologist who determines the care to be medically necessary, coverage of treatments will be provided when prescribed, provided,

or ordered. Occupational therapy is not specifically included as a covered treatment; however, reimbursement shall be allowed only for services provided by a provider licensed, trained, and qualified to provide such services or by an autism specialist or an intensive individual service provider. These service providers are yet to be defined by the Department of Social and Rehabilitation Services Kansas Autism Waiver. Of the 20 states that are still actively pursing autism insurance reform legislation, 17 include occupational therapy as a form of treatment that should be included in coverage for ASDs. The majority of these states include coverage for occupational therapy, along with speech and physical therapy, as incorporated into therapeutic care as a type of treatment for ASDs while a handful of states list occupational therapy as a separate qualifying treatment. Last year, several states enacted autism reform legislation, with the majority these state laws including occupational therapy. In total, 17 states have enacted autism reform legislation: Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Kentucky, Louisiana, Maine, Montana, Nevada, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, and Wisconsin. Thirteen of these states include coverage for occupational therapy as a treatment for ASDs. As legislators pursue autism reform legislation, new opportunities for occupational therapy practitioners arise through an increase of consumer access to occupational therapy, creating a new demand for services through mandated coverage of occupational therapy. n Marcy M. Buckner, JD, is a state policy analyst at AOTA. She can be reached at [email protected]. MAY 10, 2010 • WWW.AOTA.ORG

I n t h e c l ini c

A

Meeting the Needs of Clients With Hearing Impairments

ccording to the National Institute on Deafness and Other Communication Disorders (NIDCD),1 hearing loss affects almost 17% of American adults (36 million people). Aging is one of the primary causes of hearing loss. According to the NIDCD, hearing loss becomes more prevalent as people age, with 18% of American adults 45 to 64 years old, 30% of adults 65 to 74 years old, and 47% of adults 75 years old or older experiencing issues related to deficits in hearing. Among younger persons, “over 40,000 children are born in the United States [every year] with significant hearing impairment, with about 4,000 of these [being] profoundly deaf.”2 Therefore, it is highly likely that most occupational therapy practitioners will work with a client with a hearing impairment at some point during their careers. Although the terms deaf, Deaf, and hard of hearing are oftentimes used interchangeably in practice, each defines a unique hearing condition. The term deaf (with a lower-case “d”) refers to someone who has a hearing deficit. The term Deaf (with an uppercase “D”) is used to describe a person who self-identifies with the American Deaf Community.3 Finally, the term hard of hearing (HOH) refers to individuals who have some hearing, are able to use it for communication purposes, and feel reasonably comfortable doing so.4 The authors’ curiosity regarding practice guidelines for working with clients who are deaf, Deaf, or HOH arose during a previous research study involving a community-based program for the well-elderly.5 Two of the participants involved in the program were Deaf. As the therapists prepared to launch the project, many questions

OT PRACTICE • MAY 10, 2010

Ellen Herlache

Arica Sheff

arose regarding how the two Deaf participants would be able to fully participate, and how their experiences would differ from the rest of the participants’.

Cultural Factors Related to Hearing Loss The presence of a hearing impairment or deafness/Deafness can be a part of a person’s culture and will influence how that person views the world. As stated by Hearnberg Johnson, “beliefs, lifestyles, attitudes, and behaviors can be influenced not only by racial, ethnic, or language differences, but also by differing physical abilities, including the ability to see or hear” (p. 35).6 Many people erroneously assume that those who are Deaf would prefer to fully integrate into the “hearing world.” In truth, persons who are Deaf view their lack of hearing as a positive, defining personal characteristic. Members of the Deaf culture share a history comprised of unique “… language, history, arts, beliefs, mores, [and] behavior patterns…” (p. 168).7 The ability to communicate and share stories about Deaf history through the use of American Sign Language (ASL), including a history of overcom-

ing discrimination and adversity, is an important part of Deaf culture. To this end, Deaf persons have created works of art (including plays and films) that use ASL to communicate their sense of pride in their unique, shared background—a background that cannot be fully understood or appreciated by persons with hearing.8 However it is also erroneous to assume that all persons who are deaf or who use ASL identify with Deaf culture. Thus, therapists working with clients with hearing impairments must learn about each client’s history and personal beliefs to ensure that intervention plans and recommendations are respectful of the client’s perspectives about his or her hearing loss and goals of therapy.8 Additional evaluation and treatment challenges may exist due to the language barrier between English and ASL. ASL is a “visual/gestural” language that bears little similarity to spoken English.9 ASL is “…an independent language in its own right, with its own grammar and syntax, idioms and metaphors, jokes and poems….with no written form” (p. 165).7 Furthermore, ASL relies on the use of abstract symbols rather than words to convey messages. Whereas spoken English follows a linear sequence based in time, ASL uses four dimensions in signed messages: location, hand shape, timing, and movement. These dimensions allow users to express multiple elements simultaneously. However, they complicate the process of communication, as messages expressed via ASL can be much more complex than those communicated via spoken English.7 Because of this complexity, understanding “basic” ASL is not enough to provide competent services for Deaf clients who use only sign.7,10,11 7

It is important that we provide information to our clients in a way that is clear and respectful of cultural factors. Practitioners also need to be careful when working with clients who are deaf or HOH who use lip reading rather than ASL. As reported by Porter, previous research has demonstrated that, “… under optimal conditions, only 26 to 40% of words actually can be read” through the use of skilled lip reading (p. 166).7 This can present a concern when working with clients in situations in which clear communication is especially important (e.g., during initial evaluations or client education sessions).

Working With Clients With Hearing Impairments in the Clinical Setting The following guidelines may be useful for occupational therapy practitioners who are working with clients who are deaf, Deaf, or HOH, to help them provide the best possible services: 1. Get your client’s attention before initiating interactions to let him or her know you are there.12 If the client is not facing you, use a gentle touch to signal your presence. 2. Face the client when speaking to allow him or her to see your facial expressions, which will complement lip reading.12 3. Inquire about preferred communication styles: These preferences can range from writing on a white board or a pad of paper, to lip reading, to using ASL with an interpreter.6 If the client communicates in ASL, it is critically important to find out what information he or she feels comfortable providing through different interpreters; people may not want to share personal or potentially embarrassing information in front of family members or friends who are acting as interpreters.7 4. Set the environment. It may be useful to be sure that all communication takes place in well-lit areas. Avoid bustling environments with excessive background noise whenever possible.12 5. Communicate clearly: Avoid using slang, do not speak too fast, and try to enunciate each word. Avoid shouting, as 8

this will not help the client hear better, and it will convey a sense of anger or frustration.12

Case Example One of the participants from the community-based well-elderly study5 previously mentioned in this article, was an 83-yearold woman who has been deaf since the age of 8. “Sally” considers herself to be fluent in lip reading and ASL. She carries a pad of paper and pen to communicate basic information with other people in the apartment complex where she lives, as only one other resident at the facility (who is also Deaf) knows sign language. During her initial evaluation for the study, Sally reported that she was fearful of going into the community for advanced instrumental activities of daily living and leisure activities because of her inability to hear what was going on around her. She was also concerned about what would happen if she were unable to communicate complex information to others through writing. As a result, she displayed limited community mobility. She went to a corner store for groceries or household items if absolutely necessary; otherwise, she relied on a family member who visited once a week to help her run errands. Sally’s involvement in the program was a learning experience for both her and the researchers. Sally had lived in the apartment complex for several years prior to participating in the program. However, before joining the program, which involved meeting twice a week with other members at the building for social, educational, and community outings, she had very little interaction with her peers. In fact Sally reported having only one close friend in the apartment complex, as her Deafness made functional communication with others living there very difficult. Sally also noted that she rarely participated in social activities at the complex or in the surrounding community. Due to scheduling issues, the ASL interpreter was available for only about half of the program sessions. The other client who was Deaf came to as many

sessions as he could; however, he was employed at the time so he was unable to attend on a regular basis. When the interpreter was present, Sally was continuously engaged in whatever activity was going on, as long as it was in the apartment complex. When an activity took place outside of the complex, however, she refused to participate. Although she enjoyed being with the group, she still harbored much anxiety about going out. Looking back, it appears that the therapists could have made changes to improve Sally’s participation and their communication with her. For example, during the first few sessions of the program the researchers assumed that Sally preferred to communicate using pen and paper. They therefore decided to use a picture/ letter board to assist in sharing information with her during program sessions. As the program progressed, however, it became clear that Sally preferred to read lips and body language, along with using pen and paper, for communication. She expressed that using a communication board made her feel “like a child.” The therapists should have established this preference in the first session. Additionally, it would have been beneficial to have a back-up interpreter available to facilitate Sally’s involvement in more sessions and activities. Despite these hurdles, the program was a success. Through her participation in group activities, Sally was able to show not only her peers but herself that just because she communicated differently, her participation in the group was not any less helpful than that of the others. Upon conclusion of the program, it appeared that the other residents had increased their understanding of Sally as an individual, rather than simply as “a person who can’t hear.” As a result of her participation in the program, Sally’s circle of friends at the complex grew. She became more comfortable socializing with others, including the other resident who was Deaf.

Conclusion Working with clients who are deaf, Deaf, or HOH can present a challenge to occupational therapy practitioners. It is important that we provide information to our clients in a way that is clear and respectful of cultural factors. continued on page 21 MAY 10, 2010 • WWW.AOTA.ORG

OT Photograph courtesy of the authors. clipboard photograph © diane deiderich / istockphoto.com

Building the Evidence Using the evidence to create a protocol for infants with feeding issues.

A

recent series of editorials in the American Journal of Occupational Therapy by editor Sharon Gutman, PhD, OTR, FAOTA, have discussed the lack of effectiveness studies published in the five most prominent occupational therapy research journals.1,2 In these editorials, Gutman clearly outlines the barriers to conducting clinical studies on the effectiveness of occupational therapy intervention and examines potential strategies to increase the generation of evidencebased research. This article discusses a research study currently being conducted by occupational therapists at the Medical University of South Carolina (MUSC) Hospital in Charleston, South Carolina, in collaboration with OT PRACTICE • MAY 10, 2010

Patty Coker Jennifer Biro Laura French Jamie Lee Marie Martin Kerry Mitchum Chau Nguyen Kathryn Williams academic faculty and graduate students enrolled in the Division of Occupational Therapy, College of Health Professions, at MUSC. This unpublished clinical study, on the effectiveness of an oral motor stimulation program for infants born with complex congenital heart defects (CCHD), closely aligns with the strategies outlined by Gutman and

Photo: An infant receiving oral motor stimulation to facilitate feeding.

provides an example of how to begin a pilot study that draws on resources from clinicians, academic educators, and occupational therapy students.

Introduction Occupational therapy practitioners’ core values are grounded in occupation. “Occupation is all about the business of living, everyday living” (p. 370).3 What happens when the normal cycle of “everyday living” is disrupted? Infants born with CCHD and their families experience a disruption in this cycle due to feeding problems that consequently affect the occupations of both the parents and the infants. As occupational therapists, it is our role 9

to determine how this dysfunction has affected both individual occupations and co-occupations between the parent and infant, and how to counteract its effects.

circulation. There is a relatively small threat to the health of the infant and, typically, the defect will not require immediate surgery after birth. Examples of the most common acyanotic

Infants born with CCHD and their families experience a disruption in [the normal cycle of “everyday living”] due to feeding problems that consequently affect the occupations of both the parents and the infants.

Feeding is the earliest and most important occupation in an infant’s life. Esdaile and Olson stated that feeding is considered to be a co-occupation between mothers and infants; the mother takes on a feeding role while the infant reciprocates by taking on an eating role.4 Successful feeding builds an emotional bond between the mother and infant that leads to feelings of pleasure and satisfaction. Successful feeding also supports a mother’s image of herself as a good parent who is effective in her main occupation: motherhood.

Background: Infants With Congenital Heart Defects Congenital heart defects (CHDs) affect approximately 9 out of every 1,000 live births.5 CHDs refer to abnormal structural conditions of the heart that are present at birth. Structures that may be affected include the walls, valves, or large vessels entering or exiting the heart. There are two main categories of congenital heart defects: cyanotic and acyanotic. A cyanotic condition reflects a lack of oxygen and atypical levels of oxyhemoglobin saturation in the blood, causing the baby to have a bluish discoloration. Some of the most common examples of cyanotic CHD are tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome (HLHS), hypoplastic right heart syndrome (HRHS), and Ebstein’s anomaly.6,7 An infant with an acyanotic heart condition has normal levels of oxyhemoglobin saturation in blood 10

CHD include ventricular septal defect, atrial septal defect, aortic stenosis, and atrioventricular canal defect.6 CHDs that require surgical intervention are referred to as CCHDs. One example of a CCHD is HLHS, in which parts of the left side of the heart (mitral valve, aortic valve, left ventricle, and aorta) are not fully developed.8 If this condition is not treated surgically, it is fatal. Palliative surgical intervention consists of the Norwood, Glenn, and Fontan procedures. Survival rate after the first stage of surgical interven-

dysfunction due to nerve damage, can require prolonged endotracheal intubations irritating the airway, and demonstrate decreased caloric intake due to rapid fatigue or hypoxemia.10,11 These infants are at great risk for malnutrition, poor growth and development, and oral aversions.9 In addition, Davis et al. found that infants with HLHS experience significantly greater feeding difficulties than infants with other CCHD, thereby illustrating the need for interventions for infants with this specific cardiac defect.11 Current studies on difficulties encountered by infants recovering from cardiac surgery have focused on identifying and describing their types of feeding problems. There is no research on the effects of specific interventions to improve feeding behaviors or on how to build successful interactions between infant and parent during feeding sessions.9 Therefore, our team focused a literature review on successful feeding interventions used with premature infants who share many of the feeding issues currently seen in infants with CCHD. Feeding performance in both groups of infants can be affected by lack of feeding experience and oral

A literature search of successful feeding interventions used with premature infants revealed the benefits of oral motor stimulation and provided the evidence used to develop a comprehensive feeding program at the MUSC for infants born with CCHD.

tion, the Norwood procedure, is greater than 75% and is ever improving.8 Over the past several decades, improvement in the diagnosis and treatment of CHD has increased the life expectancy of infants with cardiac defects.5,7,9 As a result, many current studies focus on the secondary complications following surgical correction. Unsuccessful transition to full oral feeding is one of the most critical problems that families of infants recovering from surgeries to correct CCHD encounter. Infants born with CCHD have increased metabolic requirements, may demonstrate swallowing

motor incoordination. Many premature infants and infants with CCHD must wait weeks before attempting bottle or breast feeding. Extremely premature infants do not begin orally feeding until they are at least 31 weeks gestational age and may not begin breast or bottle feeds until they are medically stable. Infants born with CCHD who require surgical interventions may not orally feed for several weeks following complicated medical procedures. Both groups also demonstrate feeding deficits related to poor endurance and fatigue after breast or bottle feedings are initiated. MAY 10, 2010 • WWW.AOTA.ORG

A literature search of successful feeding interventions used with premature infants revealed the benefits of oral motor stimulation and provided the evidence used to develop a comprehensive feeding program at the MUSC for infants born with CCHD. Studies on the effects of oral motor stimulation programs on the feeding behaviors of premature infants have revealed improvements in time to transition from tube to bottle or breast feedings, leading to earlier discharges from the hospital.12–15 Therefore, we decided to measure the outcomes of implementing the successful oral motor simulation components and strategies for premature infants with infants diagnosed with CCHD.

Developing a Feeding Program for Infants With CCHD MUSC serves as a specialty medical center for infants born with complex pediatric heart problems. Paige Merrill, OTR/L, and Courtney Jarrard, MRS, OTR/L, C/NDT, collaborated with faculty in the Division of Occupational Therapy and with graduate occupational therapy students enrolled in research practicum coursework to develop a clinical research study on the effects of an oral motor stimulation program for infants with feeding difficulties. Additionally, the occupational therapists collaborated with key medical personnel at MUSC, including nurse practitioners, nurses, pediatric cardiothoracic surgeons, and speechlanguage pathologists to coordinate efforts for the research study. A consensus was reached to initiate a pilot study to determine the effectiveness of an oral motor stimulation program for infants with CCHD; we narrowed this concept to infants born with single ventricle anatomy such as HLHS, which requires surgical intervention shortly after birth. Several steps were completed prior to initiating the clinical research study. The occupational therapists conducting the study were trained in the Beckman Oral Motor Treatment approach in the spring of 2008.16 An oral motor protocol was developed to meet the unique needs of the cardiac infants to be enrolled in the study. This protocol included specific peri-oral and intraOT PRACTICE • MAY 10, 2010

Steps To Conducting a Clinical Study n

Determine a need for the study, which includes the study population and clinical interventions to be examined.

n

Conduct a literature review to collect the current evidence on clinical interventions used with this patient population.

n

Decide on the specific clinical intervention to be studied based on the latest evidence in the literature and available resources at your facility.

n

Modify existing clinical interventions and protocols to meet the needs of your specific patient population.

n

Develop an interprofessional team, including key members (e.g., physicians, nurses, therapists), to enhance the success of the study.

n

Collaborate with faculty in an occupational therapy program who may provide support through student research teams.

n

Establish methods for the study including the design, inclusion criteria, potential outcome measures, and data collection strategies.

n

Draft a research proposal with documents necessary for submission to an Institutional Review Board (e.g., informed consent, HIPPA form).

n

Enroll study participants and collect data after receiving approval from the Institutional Review Board. —Patty Coker, PhD, OTR/L

oral exercises. A study design was developed outlining the inclusion and exclusion criteria for study participants as well as specific information on data collection, including developing charting documentation. Types of information collected for each infant participating in this study included length of hospital stay, amount of milk or formula taken at each feeding, length of time to transition to full oral feeds, and nutritional status at discharge. A decision was made to have

a comparison group of subjects using archived data from infants with single ventricle anatomy born from 2005 to 2006 who did not receive the oral motor stimulation protocol. This historical control group, while not optimal due to extraneous variables that may have occurred, allowed us to further evaluate the effectiveness of the new clinical program. The two groups were matched for CCHD diagnosis, weight, and gestational age (full-term). The infants in both the comparison group and experimental group were all born full term between 37 and 40 weeks gestational age and had birth weight between 2,400g and 3,999g. These infants were further matched for gestational age and birth weight to the majority of all infants born in Charleston County in 2006 without medical complications. Following development of the oral motor stimulation protocol, the occupational therapists presented the program and the aims of the pilot study to the hospital staff. In 2008, the occupational therapy student research group helped draft and submit the clinical research proposal to the Institutional Review Board (IRB). After the IRB approved the proposal, the student research team worked closely with the treating therapists to organize collected data and manage study files. The occupational therapists developed questionnaires for all parents who participated in the study. The survey provided information on families’ perceptions of how participation in the study and use of the oral motor protocol affected their infant. It included questions on whether the parents felt adequately trained in the protocol, whether they felt more comfortable handling or touching the infant since completing the protocol, and whether participation in the study improved their understanding of the importance of positive oral experiences for their infant. Parents were given an opportunity to make additional comments about the oral motor protocol research study at the bottom of the questionnaire.

Case Example: Joe Joe, the fourth child in his family, was born at home with assistance from a 11

Table 1. Infants Receiving Oral Stimulation Program vs. Standard Feeding Program

Experimental Group, n=10

Comparison Group, n=10

Days to initiating feeding from birth

17.8

19

Length of stay in hospital (days)

25.4

35.1

midwife. Although unknown at birth, Joe was later diagnosed with HLHS. Initially, Joe was breast feeding well, but he soon began to tire during feedings and had an episode of apnea during a feed, causing his parents to take him to the emergency room. He was admitted to the hospital 3 days after birth and underwent surgery 5 days later to correct his CCHD. Occupational therapists began administering the oral motor simulation protocol 3 days after surgery; the treatment was provided 6 days per week for 10 to 12 minutes per session. Throughout the next several treatment sessions, Joe displayed a non-nutritive suck and appropriate oral motor reflexes, such as rooting and sucking. Twenty-five days after the surgery and after extubation from mechanical ventilation, Joe took a full bottle for the first time during an occupational therapy feeding session. The following day, blood was noticed in his stool and the physician expressed concerns that Joe may have necrotizing entercolitis; thus, he was re-intubated. The occupational therapist continued administering the oral motor simulation protocol to Joe while he was unable to bottle or breast feed. Early in the therapy sessions, the occupational therapist educated Joe’s mother on the oral motor protocol, which allowed her to become an informed, active, and integral member in her son’s treatment sessions. She had expressed an interest in breast feeding, and although initially apprehensive when touching and holding her child, she soon became comfortable and interacted well during feeding sessions. Once bottle feeds were re-initiated, Joe was able to master full bottle and breast feedings. Although Joe had significant medical issues following his cardiac surgery that resulted in a prolonged hospitalization of 45 days, he did not receive a gastrostomy tube and went home feeding fully by mouth. 12

Case Example: John John was born at MUSC with a known congenital heart defect. The health care team had prior knowledge that John would be born with a single ventricle anatomy; he received surgery to correct this congenital heart defect 8 days after birth. Occupational therapy was initiated 1 day postsurgery when the oral motor stimulation protocol was introduced, and by 7 days postsurgery (15 days after his birth), John was able to begin attempting bottle feeds. Additionally, he successfully took all bottle feeds 1 day after initiating oral feedings and was discharged from the hospital 17 days after birth. The occupational therapist not only evaluated John’s needs and provided recommendations to the medical team, but also spent time talking to and educating

of the kindness [from the occupational therapist]” on the parent questionnaire form completed before John was discharged from the hospital.

Conclusion The preliminary results of this pilot clinical study indicate that infants who received the oral motor stimulation protocol achieved full oral bottle or breast feeds in a shorter amount of time than those infants born between 2005 and 2006 who did not receive the intervention (see Table 1). Additionally, infants receiving the protocol were discharged approximately 10 days earlier than those infants from the 2005–2006 group. The approximate average cost for an infant to stay in MUSC’s Pediatric Cardiothoracic Intensive Care Unit is $2,500 per day, which includes room, board, and nursing care, and excludes additional costs for procedures, blood work, or specialist consults. Discharging an infant 10 days earlier equates to a cost savings of at least $25,000. Also, a majority of the infants receiving the oral motor stimulation protocol are leaving the hospital meeting all nutritional needs through bottle or breast feeds without requiring a gastrostomy tube.

This pilot study provides an example of a

successful partnership between academic faculty, graduate occupational therapy students, and practicing clinicians in order to support and enhance occupational therapy practice.

the family. Furthermore, the therapist engaged the family in using the oral motor simulation protocol during early treatment sessions. John’s mother was apprehensive with him at first, but she became more comfortable as she developed a better understanding of the medical situation. After receiving education about the oral motor protocol and how it affects feeding, John’s mother stated, “I feel comfortable with oral motor exercises.” The occupational therapist felt that she had had a positive impact on the overall success of bottle feedings and on the relationship between John and his mother. John’s mother wrote, “I really appreciate all

More importantly, this occupational therapy intervention, which focused on both parents and their infants, led to improvements in the early co-occupation between parents and children. Parents whose infants participated in the study expressed increased confidence and comfort in feeding. This pilot study provides an example of a successful partnership between academic faculty, graduate occupational therapy students, and practicing clinicians in order to support and enhance occupational therapy practice. Development of this oral motor stimulation protocol, based on current literature, has greatly enhanced the clinical pracMAY 10, 2010 • WWW.AOTA.ORG

tice of the occupational therapists at MUSC. The process of implementing the oral motor protocol has highlighted the unique role of occupational therapists in addressing the feeding, eating, and swallowing needs of vulnerable infants. By undertaking this clinical study, the occupational therapists have established positive relationships with other disciplines on the medical team, including physicians, nurse practitioners, nurses, and speech-language pathologists, thereby increasing referrals for occupational therapy services and supporting the practice of occupational therapy. In order to improve evidence-based research and clinical practice within the occupational therapy profession, Gutman outlines the following necessary components one should consider with regards to the efficacy of research: “To best build the profession’s evidence base, research questions should focus on effectiveness, safety, patient satisfaction, and cost and time efficiency” (p. 384).2 This pilot study embodies those elements. Pilot studies at this level have not only laid the foundation for further research in academia, but have improved “best practice” in clinical settings where interventions should be based on sound evidence. n References 1. Gutman, S. (2009). Why haven’t we generated sufficient evidence? Part 1: Barriers to applied research. American Journal of Occupational Therapy, 63, 235–237. 2. Gutman, S. (2009). Why haven’t we generated sufficient evidence? Part II: Building our evidence. American Journal of Occupational Therapy, 63, 383–385. 3. Mitcham, M. D., Burik, J. K., & Wicks. A. M. (2005). An occupational therapy perspective. In B. Haight and F. Gibson, Working with the elderly: Group processes and techniques (4th ed.). Sudbury, MA: Jones and Bartlett. 4. Esdaile, S., & Olson, J. (2004). Mothering occupations: Challenge, agency, and participation. Philadelphia: F. A. Davis. 5. American Heart Association. (2009). Common heart defects. Retrieved July 7, 2009, from http:// www.americanheart.org 6. Children’s Heart Foundation. (2006). It’s my heart. Lincolnshire, IL: Author.

F O R M O RE I N F O R M A T I O N If Your Child Has a Congenital Heart Defect— Our Guide for Parents By the American Heart Association, 2009. http://www.americanheart.org/presenter. jhtml?identifier=3007586.

AOTA Fact Sheet: Occupational Therapy for Children: Birth to 3 Years of Age By the American Occupational Therapy Association, 2008. http://www.aota.org/Practitioners/Resources/ Docs/FactSheets/Children/38516.aspx

Intervention Techniques for OTs in the NICU By L. Bader, 2010. OT Practice, 15(2), 7–11. http://www.nxtbook.com/nxtbooks/aota/ otpractice_vol15issue2/index.php#/0

Specialized Knowledge and Skills in Eating and Feeding for Occupational Therapy Practice By the American Occupational Therapy Association, 2007. American Journal of Occupational Therapy, 61, 686–700.

It’s My Heart By the Children’s Heart Foundation, 2006. http:// www.childrensheartfoundation.org/publications/ its-my-heart/english Mothering Occupations: Challenge, Agency, and Participation By S. Esdaile & J. Olson, 2004. Philadelphia: F. A. Davis.

7. National Heart Lung and Blood Institute. (2007). Congenital heart defects. Retrieved July 12, 2009, from http://www.nhlbi.nih.gov/health/dci/ Diseases/chd/chd_what.html 8. Medline Plus. (2007). Hypoplastic left heart syndrome. Retrieved July 12, 2009, from http://www. nlm.nih.gov/medlineplus/ency/article/001106.htm 9. Jadcherla, S. R., Vijayapal, A. S., & Leuthner, S. (2009). Feeding abilities in neonates with congenital heart disease: A retrospective study. Journal of Perinatology, 29, 112–118. 10. Brausid, N., Curley, M., Beaupre, K., Thomas, K., Hardiman, G., Laussen, P., Gauvreau, K., & Thiagarajan, R. (2009). Pediatric Critical Care Medicine, 19(3), 1–6. 11. Davis, D., Davis, S., Cotman, K., Worley, S., Londrico, D., Kenny, D., Harrison, A.M. (2008). Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatric Cardiology, 29, 328–333. 12. Boiron, M., Da Nobrega, L., Roux, S., Henrot, A., & Saliba, E. (2007). Effects of oral stimulation and oral support on non-nutritive sucking and feeding performance in preterm infants. Developmental Medicine & Child Neurology, 49, 439–444. 13. Fucile, S., Gisel, E., & Lau, C. (2002). Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. Journal of Pediatrics, 141, 230–236. 14. Fucile, S., Gisel, E., & Lau, C. (2005). Effect of an oral stimulation program on sucking skill maturation of preterm infants. Developmental Medicine and Child Neurology, 47, 158–162. 15. Rocha, A. D., Moreira, M. E., Pimenta, H. P., Ramos, J. R., & Lucena, S. L. (2007). A randomized study of the efficacy of sensory-motor-oral stimulation and non-nutritive sucking in very low birthweight infant. Early Human Development, 83, 385–388.

FAQ: What Is the Role of Occupational Therapy in Early Intervention? By the American Occupational Therapy Association, 2009. http://www.aota.org/Practitioners/Practice Areas/Pediatrics/Browse/EI/EI-FAQ.aspx

CONNECTIONS Discuss this and other articles on the OT Practice Magazine public forum at http://www.OTConnections.org.

16. Beckman, D. (2007). Beckman Oral Motor Assessment and Intervention. Maitland, FL: Beckman & Associates.

Patty Coker, PhD, OTR/L, is an assistant professor in the Division of Occupational Therapy at the Medical University of South Carolina (MUSC) in Charleston. Her professional experience includes working on feeding, eating, and swallowing issues in preterm and high-risk infants in the neonatal intensive care unit at MUSC. Her research interests also include investigating successful rehabilitation interventions for children with cerebral palsy. She helped develop a camp-based constraint induced movement therapy (CIMT) program at MUSC in 2001 and has published outcome studies on successful CIMT interventions. Jennifer Biro, Laura French, Jamie Lee, Marie Martin, Kerry Mitchum, Chau Nguyen, and Kathryn Williams are students in the Division of Occupational Therapy, Department of Health Professions, College of Health Professions, at the Medical University of South Carolina in Charleston.

Acknowledgements: The authors would like to acknowledge Paige Merrill, OTR/L, and Courtney Jarrard, MRS, OTR/L, C/NDT, who implemented this study. Merrill has been practicing for 15 years and is currently the pediatric team leader at MUSC. Jarrard

This occupational therapy intervention, which focused on both parents and their infants, led to improvements in the early co-occupation between parents and children.

has been practicing for 6 years with a primary interest in preterm infant motor development and NDT approaches. We would also like to thank Francis Kline-Woodard, CNP, co-investigator of this study. Further we would like to acknowledge the pediatric cardiothoracic physicians and nurses at MUSC who continue to support this study.

OT PRACTICE • MAY 10, 2010

13

Breakfast Group

in an Acute Rehabilitation Setting A Restorative Program for Incorporating Clients’ Hemiparetic Upper Extremities for Function

C

lients with hemiparesis following stroke or other neurological events often face complex challenges in the recovery of motor function. Learned non-use almost invariably develops after acute injury,1 and prevents clients from attempting to use their available motor control for functional activities. Clients typically compensate with the uninvolved upper extremity (UE) and fail to spontaneously incorporate the involved side into functional tasks. This significantly limits otherwise normal and beneficial opportunities for bilateral UE practice, thus further reducing the potential for motor recovery. Cortical reorganization is influenced by this behavioral compensation, as well as by central nervous system adaptations.2 Recent evidence increasingly supports the use of repetitive task-specific training as

The Breakfast Group at the Rusk Institute for Rehabilitation Medicine in New York was initiated in 2006 to give clients with hemiparesis a daily opportunity to engage their involved UE into the functional task of eating. It was developed in part to maximize the limited time that the occupational therapists have to address activities of daily living (ADLs) each morning. Although carryover of acquired motor skills outside the occupational therapy clinic is the ultimate goal, this presents significant logistical challenges in a dynamic interdisciplinary rehabilitation setting. We decided to begin with a group where clients would have a consistent opportunity to practice their UE skills as a supplement to their individual occupational therapy sessions. The task of eating in particular seemed an ideal way for clients to engage their involved UE during a meaningful, functional, and repetitive daily task. The

The task of eating in particular seemed an ideal way for clients to engage their involved UE during a meaningful, functional, and repetitive daily task.

a way of enhancing neuroplasticity.3 Repetitive functional tasks allow clients numerous opportunities for practice with the involved upper extremity. This repetitive use is thought to help overcome “learned non-use”2 and promote changes in the brain (neuroplasticity) which can lead to motor improvements, and in turn functional gains. 14

Breakfast Group provides a contextual learning environment for valuable repetitive task-specific training. Sessions are primarily restorative and focus on improving clients’ use of their available UE motor control, such as stabilizing containers or using adaptive utensils (i.e., built-up handles).

Despite having some hand function, it is frequently observed that clients fail to spontaneously incorporate the involved UE when eating, relying almost exclusively on the less involved UE (i.e., learned non-use). At the Rusk Institute, clients’ UE function is classified according to their level of ability. Therapists focus on using the available UE movement in a repetitive and taskspecific manner. For example, a client whose involved UE is at the maximal active assist level is able to maintain a gross grasp on an object.4 In the Breakfast Group, clients at this level are encouraged to use their involved UE to grasp, stabilize, and release food and containers (i.e., cereal, juice, milk) on the table throughout the meal, while the other hand performs the necessary fine motor control. For example, a client may grasp a milk container with the involved UE while opening the spout with the other hand. The client then uses both hands (if necessary) to pick up the carton and pour the milk onto the cereal. A hierarchy of cues is used to provide clients with the least amount of assistance needed to complete tasks as independently as possible. For example, a client may initially require maximal hand-over-hand assistance to initiate a task, and then progress to a simple tactile cue or reminder. As the client becomes more independent, physical cues are gradually withdrawn, and only a verbal reminder may be indicated. The client continues to progress as less input is required from the therapist. Environmental adaptations are also made to ensure client success. In this example, a non-skid MAY 10, 2010 • WWW.AOTA.ORG

Nettie Capasso Amie Gorman Christina Blick

Photograph COURTESY OF THE AUTHORS

The “real-world” experience of a breakfast group encourages stroke survivors to use their affected limbs. placemat or a sheet of Dycem placed under the milk carton prevents it from sliding while it is being opened. An appropriate height table and a stable pelvis help to ensure that both UEs are positioned properly for successful task completion. The therapist may also give specific suggestions for how to manage small or awkwardly sized containers. In another example, a client at the maximal active assist level is encouraged to hold the base of a banana with the involved UE while peeling the skin with the other hand. The client then brings the banana to his or her mouth using both hands. The therapist gradually decreases cues as the client is able to accomplish tasks in this manner more independently. This approach gives sensory input to the involved UE (via the table and objects being touched), allows for bilateral UE incorporation, provides numerous opportunities for practice using available motor control, and increases independence in eating and container management. Ideally, skills acquired during eating are applied to other ADLs throughout the day. OT PRACTICE • MAY 10, 2010

For example a maximal active assist approach applied to a grooming activity requires the client to use the involved UE to hold the toothpaste tube while twisting off the cap with the other hand. Similarly, the involved UE can be used to grasp a bottle of lotion while the other hand removes the top, or to hold onto the waistband of a pair of pants while dressing. The longer-term goal is to help the client develop the skills necessary to progress to the next UE neurological level of function. In our experience, realistic long-term goals in the acute rehabilitation setting vary greatly, but involved neurological clients (i.e., those with severe cognitive, perceptual, or sensory deficits) may only progress one level of function during their inpatient stay.

Group Protocol The Breakfast Group is composed of a maximum of four to six clients and is led by two occupational therapists on a weekly rotational basis, Monday through Friday, from 8:00 a.m. to 9:00 a.m. in the occupational therapy clinic. Breakfast Group participation adds 1

hour to the daily 3 hours of rehabilitation provided. The first 30 minutes are devoted to breakfast and the second 30 minutes are a practice session where clients engage in specific activities based on their goals and individual level of UE function. These activities vary according to clients’ goals and level of function, and are not necessarily related to eating. The protocol is designed for those who have difficulty eating and drinking due to a combination of physical, cognitive/perceptual, or visual deficits. Most clients attend the group for 2 out of the 3 weeks of their acute inpatient rehabilitation stay. Exclusions are infrequent; the most common reason is client fatigue or a reduced ability to participate in the required rehabilitation schedule. On occasion potential candidates refuse to participate, possibly due to a reluctance to reveal deficits during a group meal setting. Attempts are made to persuade would-be participants of the anticipated benefits. Most are willing to try, and several have expressed that the group provides a supportive atmosphere, where they can share experiences with others facing similar challenges. Clients frequently encourage each other and express appreciation of the social aspect of these meals. The primary occupational therapists are responsible for determining whether a particular client on their caseload is appropriate for the group. A referral form is completed that includes information on a candidate’s diet, swallowing precautions, level of neurological UE function, and specific suggested activities (see Figure 1 on page 16). 15

reach the apples. The ratio of clients to therapists varies depending the client census, number of group-appropriate clients, and staffing. The completed referral forms are placed into a binder and serve as an ongoing daily reference for group leaders. They are updated by primary therapists and group leaders to reflect client progress, changes in status, or response to particular interventions. Using the involved UE to stabilize a cereal bowl while eating. After a minimum of 1 week of group participation, the primary therapist initiates a 6-question (4-point Likert scale) of the more medically and functionally satisfaction survey with the participant. complex clients. Because the meal Questions focus on clients’ perceptrays are delivered bedside, nursing is tions of their benefit from the group, also responsible for making sure pargoal achievement, skill acquisition, ticipants do not eat prior to the group and eating performance improvement. (signs are posted outside clients’ doors The majority of clients consistently if they will be participating). Addition“strongly agree” with a perceived ally, the group is held on a different benefit from this protocol. Qualitative floor from the client bed locations, and comments include, “keep the group the elevator escort service is not availgoing,” “it was really very good,” “being able until 8:30 a.m. Group leaders and in this group was helpful because I a rehabilitation aide are responsible for learned new strategies bringing clients and their meal trays for feeding myself as well to the clinic area in time for the group. as learning from other These obstacles have been significantly Figure 1. Breakfast Group Referral Form patients,” and “the OT reduced through ongoing collaboration Patient’s name: Mr. K specialists are very carwith nursing and through an interdisciing individuals who strive plinary appreciation of the benefits of Diagnosis: (L) middle cerebral artery CVA in taking their time to the group. on April 2, 2009 ensure that their patients Clinical challenges included occupaRoom: 112 feel ‘whole’ again. I rectional therapy staff training to ensure ommend this group to all competence with managing special Primary OT: Elizabeth who will participate.” dietary and swallowing precautions Doctor: Dr. R. for several clients simultaneously. Additionally, since the initiation of the Logistical Transfer status: Moderate assistance standing pivot group, occupational therapists have and Clinical 3Yes q No Swallow study: q dramatically improved their ability to Challenges provide repetitive task training specific Initiation of the BreakDiet: (check appropriate diet) to each client’s neurological UE level fast Group presented a 3Honey thick q Thin liquids q Nectar thick q of function during the meal as well number of logistical and 3Mechanically soft q Pureed q Regular q as during the practice session. This clinical challenges. Occu3Diabetic q was accomplished by pairing senior pational therapy relies Precautions: Coumadin, impulsive therapists with more novice therapists, heavily on the nursing and by providing mentorship from staff’s cooperation to UE level of function: Minimal active assist the neurological rehabilitation cliniensure that participants Relevant deficits (include for example sensory, cal specialist and the unit supervisor. are dressed and have perceptual, motor-control, or cognitive deficits): Senior therapists developed a reference received necessary mediLeft spatial and body neglect guide of specific treatment strategies cations prior to the 8:00 for each level of UE neurological funca.m. start time. This is 3Left (check one) q Right q tion and provided in-services for the not an easy task considoccupational therapy staff. Staff can ering that these are some

16

MAY 10, 2010 • WWW.AOTA.ORG

PhotographS COURTESY OF THE AUTHORS

For example, “set-up activities” are used when there is a higher client-totherapist ratio, because they require the client to perform tasks more independently. An example of a set-up activity at the minimal active assist level4 is a client practicing stabilizing food containers with the involved UE or engaging in targeted reaching tasks by knocking items off of a low table with the involved UE. Activities are not necessarily related to eating but should maximize clients’ available movement. The goal is for improved UE movement to ultimately carry-over into function. “Ideal activities” are used when there is a lower patient-to-therapist ratio, and the therapists have more 1:1 time with each participant. An ideal activity at the minimal active assist level may involve engaging the client in a dynamic reaching activity (i.e., grasping and releasing apples on a table). In order to accomplish this, the therapist applies a Bioness unit to the hand to facilitate grasp and release. Additional manual guidance by the therapist at the client’s shoulder and elbow helps displace the weight of the UE so the client can use the available movement to

Using a Bioness orthosis to facilitate grasp and release.

refer to this guide for treatment ideas. For example, at the non-assistive and minimal stabilizing assist levels,4 the client is encouraged to use the involved UE on the table to stabilize a plate while eating, or to stabilize a menu while filling out choices with the other hand. Approaches are further divided into set-up activities and ideal activities so therapists have a choice of interventions, depending on the therapistto-client ratio. Strategies emphasized for all levels of UE function include repetitive use of available movement during meaningful activities (i.e. eating), bilateral integration, and, where possible, active mental focus on incorporating the involved UE. Clients are encouraged to think about moving and using their involved UE, and not just performing these activities passively.

PhotographS COURTESY OF THE AUTHORS

Case Example Mr. K. is a 70-year-old male who sustained a right middle cerebral artery CVA approximately 1 month ago. He is on a mechanically soft, diabetic diet with honey-thickened liquids. Mr. K. presents with left body and spatial neglect, but he is able to use his left UE as a minimal active assist with moderate verbal cuing. He has some left shoulder movement (0° to 60° of pain-free shoulder flexion against gravity), but no hand movement. While setting up for breakfast, the therapist lowers the height of the table so Mr. K. can independently place his left UE on the surface. She removes the breakfast items from the slippery tray, and places them on the right and left sides OT PRACTICE • MAY 10, 2010

Grasping a milk carton with the involved UE while opening it with the other.

of a non-skid placemat so he will be able to incorporate his left UE as much as possible. The therapist considers whether she should modify any plates or containers to facilitate Mr. K.’s success (e.g., transferring cereal from the single-serving package to a larger scoop bowl). She decides that Mr. K. will be able to manage with the present set up. At the start of the group, Mr. K. begins eating with his left UE in his lap. With verbal cuing from the therapist, he places it on the table. He requires additional cuing to locate the coffee on the table because it is on his left side. At first he tries to open the lid with his right hand alone. With prompting from the therapist, he moves his left UE to the side of the cup so he can use it as a stabilizer while he opens the lid with his right hand. Similarly, he uses his left hand to stabilize the plate while he puts jam on his toast using a knife with his right hand. As expected, Mr. K. has the most difficulty with the small milk carton and sugar packets. The therapist provides additional stability to his left hand as it contacts the milk carton. He uses his right hand to open the spout. By the end of breakfast, the therapist notes that Mr. K. is consistently incorporating his left UE to stabilize items independently as a minimal active assist with only minimal verbal cuing. During the second half of the group, the therapist needs to give Mr. K. an activity that he will be able to do at a set-up level (she is required to work with two other clients in the group simultaneously). She decides to give him a number of various shaped empty

Suggested Activities Please be sure there are written MD orders if requesting FES, B ioness or other modalities. Set-up Activities 1. Use (L) UE as minimal active assist while opening grooming item containers 2. Mirror box—cue patient for active mental practice 3. Set up with Bioness—active mental practice finger flexion and extension 4. Reach across low height table and grasp/ release objects Ideal Activities 1. Use Bioness with proximal guidance at shoulder/elbow during breakfast. 2. Use Bioness with proximal guidance at shoulder/elbow during functional reach activities. Rusk Institute NYU Langone Medical Center, 2009

containers (i.e., lotion, toothpaste), and instructs him to practice stabilizing them with his left hand while he opens and closes lids with his right hand. During the last 15 minutes (while the other two clients are set up), she has time to apply the Bioness orthosis. She provides proximal manual guidance while Mr. K. reaches for and grasps 17

F O R M O RE I N F O R M AT I O N AOTA CEonCD™: ASHT—Management of Upper Extremity Problems—Cadaver Demonstrations and Therapeutic Management By P. Bonzani; D. Kline; K. Landrieu; M. Robichaux; & H. Strokes. (Earn .6 AOTA CEU [6 NBCOT PDUs/6 contact hours]. $120 for members, $240 for nonmembers. To order, call 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=4851. Order #4851, Promo code MI) AOTA Webcast: Hemianopsia: Strategies Based on Research and Clinical Experience That Support Performance in Daily Occupations Presented by T. Holmes, 2009. Bethesda, MD: AOTA Continuing Education. (Earn .15 AOTA CEU (1.5 NBCOT PDUs/1.5 contact hours). $45 for members, $64 for nonmembers. To order, call 877-404-AOTA or shop online at http://store.aota. org/view/?SKU=CSC223. Order #CSC223, Promo code MI) AOTA CE Article: How Occupational Therapy Influences Neuroplasticity By G. L. McCormack, B. Douglas, S. Pauley, M. Schultze, & J. Volkers, 2009. (Earn .1 AOTA CEU [1 NBCOT PDU/1 contact hour]. $29.95 for members, $41 for nonmembers. To order, call toll free 877-404-AOTO or shop online at http://store. aota.org/view/?SKU=CEA0909. Order #CEA0909, Promo code MI)

CONNECTIONS Discuss this and other articles on the OT Practice Magazine public forum at http://www.OTConnections.org.

several containers, and places them on different height surfaces.

Conclusion and Future Directions Future goals involve extending the repetitive task-specific strategies applied at breakfast to other meals, and eventually to other functional daily activities (e.g., grooming, bathing, toileting, dressing). Higher-level clients will have a structured schedule for using their available UE movement for unsupervised meals and functional tasks. In addition, caregivers of lower-level clients will be instructed on how to help these individuals carry over techniques throughout the day. We have begun giving specific written instructions to higher-level clients and those with involved caregivers to facilitate carry over of skills learned at the breakfast group to lunch and dinner. Clients and caregivers check off “assignments” the client has 18

Occupational Therapy Practice Guidelines for Adults With Stroke By J. Sabari & D. Liberman, 2008. Bethesda, MD: American Occupational Therapy Association. ($49 for members, $69.50 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=2211. Order #2211, Promo code MI) AOTA Webcast: Paradigm Shift and Innovations in Stroke Rehabilitation By L. S. Dunn, V. Hill-Hermann, & L. Finnen, 2009. (Earn .3 AOTA CEU [.3 NBCOT PDU/3 contact hours]. $79 for members, $112 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=CWS402. Order #CWS402, Promo code MI) Stroke Rehabilitation: A Function-Based Approach, 2nd Edition By G. Gillen & A. Burkhardt, 2004. ($85.95 for members, $122 for nonmembers. To order, call 877404-AOTA or shop online at http://store.aota.org/ view/?SKU=1395. Order #1395, Promo code MI) Online Course: Treating the Patient With Hemiplegic Shoulder Pain (AOTA/Dynamic Learning) By L. Anderson. (Earn 1 AOTA CEU [10 NBCOT PDUs/10 contact hours]. $258 for members, $358 for nonmembers. To order, call 877-404-AOTA or shop online at http://store.aota.org/view/ ?SKU=OL2011. Order #OL2011, Promo code MI)

References 1. Taub, E., Uswatte,G., King, D. K., & Morris, D. M. (2003). Improved motor recovery after stroke and massive cortical reorganization following constraint-induced movement therapy. Physical Medicine and Rehabilitation Clinics of North America, 14, S77–S91. 2. Taub, E., Uswatte, G., King, D. K., Morris, D. M., Crago, J. E., & Chatterjee, A. (2006). A placebo controlled trial of constraint induced movement therapy for upper extremity after stroke. Stroke, 37, 1045–1049. 3. Kwakkel, G., Waganaar, J. W., Twisk, G. J., & Lankhorst, J.C. (1999). Intensity of leg and arm training after primary middle-cerebralartery stroke: A randomized trial. Lancet, 354, 191–196. 4. Wilson D. J. (1980, March). Stroke rehabilitation: Setting realistic occupational therapy goals. Physical Disabilities Special Interest Section Newsletter, 3(3), 3–4.

Nettie Capasso, OTR/L, RD, is an occupational therapy inpatient supervisor at the Rusk Institute for Rehabilitation Medicine, NYU Langone Medical Center. Amie Gorman, OTR/L, ATP, is a senior occupational therapist at the Rusk Institute for Rehabilitation Medicine, NYU Langone Medical Center. Christina Blick, MS, OTR/L, is a clinical specialist in visual perceptual rehabilitation at the Rusk Institute

completed; for example, “I placed my right hand on the table at the start of lunch” or “I used my right hand to stabilize the plate as I ate with my left hand at dinner. Clients and caregivers are also trained in how to incorporate these techniques at home. Instructions include set up of the environment (i.e., lowering the bedside tray table to an appropriate height, or using a suitable table at home). Education with nursing and other disciplines is ongoing; however, consistent application of these strategies on the units remains a challenge and a goal for the future in this dynamic setting. Occupational therapists face numerous challenges in helping their clients achieve UE motor recovery following stroke and neurological injury. This breakfast group protocol outlines the use of the daily task of eating as a simple contextual vehicle for repetition and practice of available UE movement. Clients report benefits of increased practice, socialization, encouragement, and support from other clients, and the opportunity to work with a variety of therapists. n

for Rehabilitation Medicine, NYU Langone Medical Center. The authors would like to thank the occupational therapy department and the interdisciplinary rehabilitation team at the Rusk Institute for their support in this endeavor.

Authors Wanted!

Are you interested in writing for OT Practice? See our guidelines at

www.aota.org.

Click on Publications, then OT Practice.

MAY 10, 2010 • WWW.AOTA.ORG

Contin u in g Com p e t e n c e

Doctoral Education

O

Steps To Consider Pamela S. Roberts

ccupational therapy practitioners with doctoral degrees have an opportunity to significantly contribute to AOTA’s Centennial Vision, which asserts that by 2017, “occupational therapy [will be] a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs.”1 Leadership through research, education, and practice is critically needed to achieve this vision. Doctoral programs attract individuals with various motives, goals, and interests and when harnessed, the training can provide invaluable opportunities to advance practical skills and expertise, acquire research training, gain experience in teaching and education, and assume a leadership role in policy and advocacy. A doctoral degree can create career mobility and help you make your best contribution to the profession.

Focus on Clinical versus Research: Which One Is for Me? Consider your future plans and goals when deciding which degree to pursue. The OTD (doctorate in OT) is a common clinical path for occupational therapists, though there are other clinical paths that are relevant to occupational therapy such as the DrPH (doctorate in public health). Programs that offer clinical doctorates emphasize training to enhance your leadership in practice. Though most clinical doctoral programs offer courses in research, typically the emphasis is on using existing research to inform practice. These programs typically focus on professional advancement of clinical experts and leaders in OT PRACTICE • MAY 10, 2010

Sue Berger

Mary E. Evenson

Doctoral programs attract individuals with various motives, goals, and interests and when harnessed, the training can provide invaluable opportunities to advance practical skills and expertise, acquire research training, gain experience in teaching and education, and assume a leadership role in policy and advocacy.

an area of practice. Postprofessional OTD programs range in length of time depending on the program, the student’s educational background, and the program format (part- or full-time), though most take 1½ to 3 years to complete. Research doctoral programs include programs that grant a PhD (doctor of philosophy), an ScD (doctor of science), or an EdD (doctor of education). These programs focus on research education and teaching skills. Students enrolled in research doctoral programs must perform independent research (dissertation) that adds to the body of knowledge of the discipline studied. Programs vary in length, though 3 years beyond a master’s degree is usually the minimum time needed to complete all requirements. As occupational therapists, we have many options of programs within and outside of our discipline to pursue doctoral study. Though many occupational therapists choose a doctoral program in occupational science,

Mary Alunkal Khetani occupational therapy, or rehabilitation science, others enroll in doctoral programs in related fields such as psychology, public health, gerontology, health sciences, and education.

Academic Program Formats Degrees are available in a variety of formats. Traditional degrees are earned in an academic field through an on-campus program of study. Advances in technology and the increased use of the Internet have expanded the ways individuals can pursue education. Electronic learning is available in different formats, which include online or blended programs. Some examples include a mixture of online and face-to-face meetings; synchronous learning (e.g., videoconference, chat, etc.); asynchronous learning (e.g., e-mails, files, forums, blogs); online classes led by an instructor; self-study with a content expert; Web site–based; CD-ROM– based in which the student interacts with content stored on a CD-ROM; PocketPC/Mobile learning where the student accesses course content stored on a mobile device or through a wireless server; and integrated distance learning (e.g., integration of live, in-group instruction or interaction with a distance learning curriculum).

Funding and Time Considerations Your decision to pursue doctoral study will likely hinge on practical considerations of time and money. Full-time students are likely to rely more heavily on program funding to meet basic living expenses. It is worth getting started early by learning about funding options continued on page 21 19

Fi e l d w o r k i s s u e s

H

The Fieldwork Educator Role Debra Hanson

istorically, research articles with a focus on fieldwork education have investigated the impact of student, supervisor, and site variables on student learning. Student-centered fieldwork research typically focuses on student performance and student attributes, and might include topics such as tools for evaluating student performance, predicting success in fieldwork students, strategies for promoting student success, and the impact of fieldwork on the development of professional attributes. Supervision-centered fieldwork research addresses the role of the fieldwork educator and methods for performing supervisory and educational functions. Examples of research in these areas could include topics such as managing challenging situations, student perceptions of supervisory experiences, and various supervisory models or styles. Site-centered fieldwork research tends to examine the contextual factors impacting fieldwork, and issues that facilitate or hinder implementation of student fieldwork programs. Topics related to fieldwork in emerging practice settings, comparisons of fieldwork settings, descriptions of unique models of fieldwork, and the costs and benefits of clinical education fit into this category. In addition, research on over-arching fieldwork issues explores the issues, purposes, and processes of fieldwork, and the practice area–fieldwork relationships. From these studies, resources have been developed to assist students and fieldwork educators in their respective roles. There is a strong need for ongoing research in the area of fieldwork education to advance best practice ideals. Beginning with a focus on the fieldwork educator role, we will

20

Caryn Johnson

Patricia Stutz-Tanenbaum

Beginning with a focus on the fieldwork educator role, we will periodically showcase recent research related to fieldwork in order to provide fieldwork educators, students, and academic fieldwork coordinators with up-to-date resources to successfully navigate the ever-changing variables related to fieldwork education.

periodically showcase recent research related to fieldwork in order to provide fieldwork educators, students, and academic fieldwork coordinators with up-to-date resources to successfully navigate the ever-changing variables related to fieldwork education.

Student Perspectives of Outstanding Supervision Occupational therapy students value a fieldwork educator who creates a positive learning environment, guides student learning through graduated student assignments and effective feedback and serves as a positive role model for practice. Mulholland, Derdall, and Roy examined a total of 103 student nominations for clinical teaching awards for the Alberta Association of Registered Occupational Therapists (AAROT) in Alberta, Canada, for themes related to exceptional performance as a placement (fieldwork) educator.1 Nominees were working in both rural and urban settings, such as hospitals, rehabilitation centers, and community placements, predominantly in the provinces of Alberta and Saskatchewan. Results supported the importance of creating a positive and welcoming learning environment and facilitating learning through appropriate pacing and specific feedback. Exceptional educators served as role models for students through demonstration of positive

personal attributes and evidence of knowledge, skill, and dedication to their work. The practice placement experience offered by exceptional fieldwork educators had a significant, long-lasting impact on student development in the areas of confidence, interest in a particular clinical area, and appreciation of the profession.

Valued Supervisory Practices of Fieldwork Educators The value of supportive supervisory functions was underscored in a recent qualitative study of experienced fieldwork educators.2 Three fieldwork educators, each with an average of 6 years of experience and who had supervised 5 to 10 students in mental health and adult rehabilitation settings, were interviewed on three separate occasions regarding prior and current supervisory experiences and reflective insights. Participants indicated that prior negative experiences as students had influenced them to provide supportive learning environments for their students. Prior experiences of diminished support included “once a week status reports” and “peer supervision without direction from an experienced clinician,” whereas participants characterized a supportive environment as “ongoing exchanges where questions are welcomed and structure is adjusted to meet individual learning needs” MAY 10, 2010 • WWW.AOTA.ORG

Call for Fieldwork Research Articles! Researchers interested in submitting fieldwork research in press or published within the last 5 years for consideration for this column should contact Debra Hanson, PhD, OTR/L, at [email protected] for further information and deadlines.

Continuing Competence

IN THE CLINIC

continued from page 19

continued from page 8

and application timelines with the program director, faculty member(s) with whom you might want to work, current students enrolled in the program, and financial aid directors at each institution. It is helpful to (a) ask how students have been funded in the past 2 to 3 years to gauge the funding climate at that institution, (b) identify eligibility requirements, and (c) obtain information about the process and timeline for each application. Funding options can include (a) direct support through research or teaching assistantships, university fellowships, predoctoral training grants, or dissertation awards; and (b) indirect funds to hire research assistants or secure fellowships that provide funds for supplemental training.

The guidelines provided in this article may provide practitioners with a starting point for establishing effective therapeutic relationships with clients who are deaf, Deaf, or HOH. n

Doctoral Education

Hearing Impairments

References

with campuses in Grand Forks, North Dakota,

References

and Casper, Wyoming. She has over 20 years of

value of research to inform educational efforts.

1. American Occupational Therapy Association. (2006). AOTA’s Centennial Vision. Bethesda, MD: Author. Retrieved February 10, 2010, from http://www.aota.org/News/Centennial/ Background/36516.aspx

Caryn Johnson, MS, OTR/L, FAOTA, is the academic

Pamela S. Roberts, PhD, OTR/L, SCFES, FAOTA,

fieldwork coordinator at Thomas Jefferson Uni-

CPHQ, is a manager at Cedars-Sinai Medical Center

versity in Philadelphia. She has served as chair of

in Los Angeles and serves as a member of the AOTA

the Fieldwork Subsection of the Education Special

Commission on Continuing Competence and Profes-

Interest Section for the past 3 years, during which

sional Development.

1. National Institute on Deafness and Other Communication Disorders. (2008). Quick statistics. Washington, DC: National Institutes of Health. Retrieved February 3, 2009, from http://www. nidcd.nih.gov/health/statistics/quick.html 2. Ear and Hearing Center. (2008). Auditory genetics. Retrieved February 3, 2009, from http:// www.chdr.org/AuditoryGenetics.html 3. Saylor, P. (1992). Teaching and practice: A hearing teacher’s changing role in Deaf education. Harvard Educational Review, 62(4), 519–534. 4. National Association of the Deaf. (n.d.). Difference between deaf and hard of hearing. Silver Spring, MD: Author. Retrieved September 9, 2008, from http://www.nad.org/site/ pp.asp?c=foinkqmbf&b180410 5. Bodary, A., Burzynski, S., Malcolm, J., & Sheff, A. (2008). Improving senior quality of life through occupational therapy services. Unpublished master’s thesis, Saginaw Valley State University, University Center, MI. 6. Hearnberg Johnson, L. (2002, July). The building blocks for helping patients with sight or hearing impairments. PT Magazine, 10(7), 34-39. 7. Porter, A. (1999). Sign-language interpretation in psychotherapy with deaf patients [Electronic version]. American Journal of Psychotherapy, 53(1), 163-176. 8. ASLInfo.com. (n.d.). Deaf culture. Retrieved January 25, 2010, from http://www.aslinfo.com/ deafculture.cfm 9. Filer, R. D., & Filer, P. A. (2000). Practical considerations for counselors working with hearing children of deaf parents [Electronic version]. Journal of Counseling and Development, 78, 38–43. 10. de Bruin, E., & Brugmans, P. (2006). The psychotherapist and the sign language interpreter [Electronic version]. Journal of Deaf Studies and Deaf Education, 11(3), 360–368. 11. Vernon, M., & Leigh, I. W. (2007). Mental health services for people who are deaf. American Annals of the Deaf, 152(4), 374–381. 12. Adams-Wendling, L., Pinple, C., Adams, S., & Titler, M.G. (2008). Nursing management of hearing impairment in nursing facility residents. Journal of Gerontological Nursing, 34(11), 9–17.

AOTA Fieldwork Educator Certificate Program. She

Sue Berger, PhD, OTR/L, BCG, is a clinical assistant

Ellen Herlache, MA, OTR/L, is the research coor-

has also authored/co-authored the Occupational

professor at Boston University, College of Health

dinator for the Master of Science in Occupational

Therapy Exam Review Guide and the COTA Exam

and Rehabilitation Science, Sargent College.

Therapy program at Saginaw Valley State University

(p. 164).2 Attention to the situated context, student self-directedness, pace, and structure of the experience, as well as opportunities for regular feedback and reflection were identified as supportive for student learning. Data supported constructivist and situated learning theories of adult learning. n

Conclusion References 1. Mulholland, S., Derdall, M., & Roy, B. (2006). The student’s perspective on what makes an exceptional practice placement educator. British Journal of Occupational Therapy, 69, 567–571. 2. Richard, L. (2008). Exploring connections between theory and practice: Stories from fieldwork supervisors. Occupational Therapy in Mental Health, 24, 154–175. Debra Hanson, PhD, OTR/L, is the academic field-

As you consider ways to expand your knowledge base, enhance your professional skills, and advance the profession toward its Centennial Vision and beyond, keep the idea of earning a doctoral degree in the foreground. It is one way to work towards linking education, research, and practice. For more information go to http://www.aota.org/. n

work coordinator at the University of North Dakota

experience working with fieldwork educators and students, resulting in a deep appreciation for the

time she worked on the development of the new

in University Center, Michigan. She also works as a

Review Guide. Mary E. Evenson, OTD, MPH, OTR/L, is a clinical

field representative for Paws With A Cause, an orga-

Patricia Stutz-Tanenbaum, MS, OTR, is an academic

associate professor and the academic fieldwork

nization that trains assistance dogs for people with

fieldwork coordinator (AFWC) at Colorado State

coordinator at Boston University, College of Health

disabilities, including hearing impairments.

University. She has been the AFWC representative

and Rehabilitation Science, Sargent College.

Arica Sheff, MSOT, OTR/L, was a graduate student

with AOTA’s Commission on Education for the past

in the Master of Science in Occupational Therapy

3 years and contributed to the development of the

Mary Alunkal Khetani, MA, OTR/L, is a doctoral candi-

program at Saginaw Valley State University at the

AOTA Fieldwork Educator Certificate Program.

date in Rehabilitation Sciences at Boston University,

time this project was completed. She is currently

She also serves as a workshop trainer and faculty

College of Health and Rehabilitation Sciences,

employed at Pine River Healthcare Center in St.

member for Train-the-Trainer Institute.

Sargent College.

Louis, Michigan, through La Vie Rehabilitation.

OT PRACTICE • MAY 10, 2010

21

C A LE N D A R To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or [email protected]. Listings are $95 each for 1–10 lines, $150 for 11–15 lines, per event. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA endorsement of content, unless otherwise specified. Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course has met the APP requirements and has been awarded AOTA CEUs.

May

Ft. Lauderdale, FL

May 22–27

Upper Extremity Lymphedema Certification.

This 86-hour program is taught in only 3½ working days; the course length is 5½ days in total. The program covers the complete anatomy, physiology, and pathology of the lymphatic system, and will qualify graduates to effectively treat primary and secondary upper extremity lymphedema with the techniques known as MLD and CDT. The textbook “Lymphedema Management” (included in tuition) authored by the Academy’s director was published in 2004 by Thieme Medical and Scientific Publishers, NY. Tuition also includes: educational CD, course manual, set of bandages, CD for limb volume calculation, and a set of posters of the “Lymphatic System.” Also in Charlotte, NC, September 18–23, 2010. AOTA Approved Provider. For more information or to order a free brochure, please call 800-863-5935 or log on to www.acols. com.e

Jun. 2–5

Association of Children’s Prosthetic-Orthotic Clinics, 2010 Meeting, combining with the Orthopaedic Rehabilitation Association at the beautiful

Sheraton Sand Key Resort on the Beach. Highlights include: New Investigator Research Awards; Vernon Nickel Award; spina bifida, cerebral palsy, brachial plexus injury, & military orthopaedics symposia. Several Technical & Scientific Workshops. Contact [email protected] or www.acpoc.org.

Ft. Lauderdale, FL

Jun. 5–15

Lymphedema Management. Certification courses

in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and advanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certification for compression-garment fitting included. Certification course meets LANA requirements. Also in Chattanooga, TN, June 19–29. AOTA Approved Provider. For more information and additional class dates/locations or to order a free brochure, please call 800-863-5935 or log on to www.acols.com.

Orlando, FL

Jun. 14–18

Building Blocks for Becoming a Driver Rehabilitation Therapist. STOP-LEARN-GO! A comprehen-

sive course that provides advanced knowledge and skill to transition into the specialty of driving and community mobility. Highlighted are best practice model for driving evaluations and the OT Practice Framework for assessment and intervention strategies. Online component offers convenient, at-home learning to enhance live instruction. Free follow-up mentoring provided. Key topics include starting/ managing a driving program, risk/liability manage-

22

Orlando, FL

Sept. 20–24

Getting a Green Light for a Van Evaluation Program. STOP-LEARN-GO! A MUST workshop for

the driver rehabilitation therapist who is ready to develop a van program or performing van evaluations. Topics: wheelchair and posturing/transfer evaluation, prescription writing, in-van set-up for moving evaluation, and inspection/fitting strategies. All vehicle and equipment options for van drivers are addressed in lecture, hands-on experience, and REAL client evaluations. Instructors: Susan Pierce, OTR, CDRS, SCDCM, and Carol Blackburn, OTR, CDRS. Contact us at www.adaptivemobility.com or call 407-426-8020.

Ongoing July

Indianapolis, IN

Internet/Home Study Jul. 12–15

Bioptic Driver Rehabilitation by OT Process and Intervention. STOP-LEARN-GO! Designed for the

Ongoing

Become an Accessibility and Home Modifications Consultant. Incorporate home safety, environmental

specialist practitioner to learn and practice evaluation and intervention strategies for the visually impaired and/or bioptic driver. Emphasis on foundational knowledge of low vision, compensatory lens, pre-driving skill building, observing real client/ therapist interaction, and practice strategies/skills in-car with an expert. Follow-up mentoring support offered. Instructor: Mary Ellen Keith, COTA, CDRS. Visit our website at www.adaptivemobility.com or call Mary Ellen at 317-660-6506.

modifications, assistive technology, and ADA consulting in your present career, or begin a private practice. Extensive manual included. Instructor: Shoshana Shamberg, OTR/L, MS. Cost: 2-Day $350–$400; COMBO+Internet $625–$675; Internet-Home Study $300–$400. Also in Baltimore, MD, June 6–7, 2010 and Phoenix, AZ/Baltimore, MD, Summer/Fall 2010; see website for dates/locations. Earn CEUs OT/ OTA/PT/PTA; college credits; AOTA Approved Provider. Member NBCOT PP Registry. Contact Abilities OT Services, 410-358-7269. Brochure/free info: www. aotss.com; e-mail: [email protected].

Kansas City, MO

Video Seminars

Jul. 30–31

The Impact of Disabilities, Vision, & Aging and Their Relationship to Driving. Course designed for

June

Clearwater, FL

ment, documentation and critical thinking activity with case studies and real clients. Visit us online at www.adaptivemobility.com or call Susan Pierce at 407-426-8020.

September

those allied health professionals who wish to apply their knowledge of the different types and levels of disabilities to the driving task. 828-855-1672. Visit our Web site at www.aded.net.

Kansas City, MO

Jul. 30–31

Application of Vehicle Modifications. Course

designed for those desiring knowledge of adaptive driving equipment as well as the process for prescribing and delivering such equipment to individuals with disabilities. Contact ADED 866-6729466; fax 828-855-1672. Visit our Web site at www. aded.net.

Kansas City, MO

Jul. 30–Aug. 3

ADED Annual Conference and Exhibits. Profes-

sionals specializing in the field of Driver Rehabilitation meet annually for continuing education through workshops, seminars, and hands-on learning. Earn contact hours for CDRS renewal and advance your career in the field of Driver Rehabilitation. Contact ADED: 866-672-9466; fax 828-855-1672. Visit our Web site at www.aded.net.

August

Orlando, FL

Aug. 24–27

Take the Wheel: A Driver Education Course for the Therapist. STOP-LEARN-GO! A practical hands-

on course for learning the knowledge and skill for the in-vehicle phase of a driver evaluation. Online component provides foundational knowledge so skills can be practiced during live instruction and in-car practice with experts in the field. All critical issues of in-car evaluation covered. Free follow-up mentoring provided. Instructors: Susan Pierce, OTR, SCDCM, CDRS, and Carol Blackburn, OTR, CDRS. Visit us online at www.adaptivemobility.com or call at 407-426-8020.

Unlimited CEUs

All The Continuing Education Hours You Want for Only $177. For one low price of $177, you can have

unlimited access to over 600 hours of clinical continuing education; over 80 CEU seminars and programs. Take as many courses as you want for 1 Full Year for only $177. Save time, money, and travel expenses. Once you register you will receive a special code that will allow you complete access to all of our courses. Take them online, or if you prefer, DVDs—you pay only shipping. Approved for AOTA and IACET CEUs. Meets NBCOT Criteria for PDUs. Take advantage of this Special Offer while it lasts! www.clinicians-view.com; 575-526-0012.

AOTA CEonCD™

Ongoing

Ethics Topics—Organizational Ethics: Occupational Therapy Practice In a Complex Health Environment. Lea Cheyney Brandt, OTD, MA, OTR/L,

and Member-at-Large, AOTA Ethics Commission. Explores organizational ethics issues that may influence the ethical decision making of occupational therapy practitioners. Participants will be introduced to strategies that will assist in addressing situations in which occupational therapy practitioners may be pressured by an organization’s administration to provide services that are in conflict with their personal or professional code of ethics. Earn .1 AOTA CEU (1 NBCOT PDU/1 contact hour). Order #4841, $45 AOTA Members, $65 Nonmembers. http://store. aota.org/view/?SKU=4841

AOTA CEonCD™

Ongoing

Ethics Topics—Moral Distress: Surviving Clinical Chaos. Lea Cheyney Brandt, OTD, MA, OTR/L,

and Member-at-Large, AOTA Ethics Commission. Explores how the complex nature of today’s health care environment may result in increased moral distress for occupational therapy practitioners. Offers coping strategies for reducing negative outcomes associated with moral distress. Earn .1 AOTA CEU (1 NBCOT PDU/1 contact hour). Order #4840, $45 AOTA Members, $65 Nonmembers. http://store.aota. org/view/?SKU=4840 MAY 10, 2010 • WWW.AOTA.ORG

Learn . . .

The “Missing Link” in Occupational Therapy! John F. Barnes, PT, LMT, NCTMB

International lecturer, author, and authority on Myofascial Release.

Myofascial Rebounding (Prerequisite: MFR I)

Myofascial Release I Las Vegas, NV May 20-23 ( 1⁄2 days), 2010 Edmonton, Alberta May 28-30 2010 Lake Tahoe, NV June 3-6 ( 1⁄2 days), 2010 Green Bay, WI June 18-20, 2010 Pacific NW Columbia River Area Stevenson, WA July 15-18 ( 1⁄2 days), 2010 Lake Geneva, WI August 5-8 ( 1⁄2 days), 2010 New York City, NY August 13-15, 2010 Cape Cod, MA September 9-12 ( 1⁄2 days), 2010 Oklahoma City, OK September 17-19, 2010 Tucson, AZ September 17-19, 2010 San Luis Obispo, CA September 24-26, 2010 Omaha, NE October 15-17, 2010 Panama City, FL October 29-31, 2010 Burlington, VT November 5-7, 2010 Toronto, Ontario November 12-14, 2010

Sedona, AZ June 17-20 ( 1⁄2 days), 2010 Chicago, IL November 5-7, 2010

Myofascial Unwinding (Prerequisite: MFR I)

Pacific NW Columbia Gorge River July 19-21, 2010 New York, NY August 17-19, 2010 Cape Cod, MA September 13-15, 2010 Toronto, Ontario November 16-18, 2010 Key West, FL January 10-12, 2011

Women’s Health Seminar: The Myofascial Release Approach (Prerequisites: MFR I, Myofascial Unwinding & Fascial-Pelvis)

Sedona, AZ July 8-11 2010 West Chester, PA Suburban Philadelphia December 6-9, 2010

Fascial-Pelvis Myofascial Release II (Prerequisite: MFR I)

Pacific NW Columbia Gorge River July 22-25 ( 1⁄2 days), 2010 New York, NY August 20-22, 2010 Cape Cod, MA September 16-19 ( 1⁄2 days), 2010 Toronto, Ontario November 19-21, 2010 Key West, FL January 13-16 ( 1⁄2 days), 2011

Evanston, IL May 21-23, 2010 Toledo, OH June 4-6, 2010 San Antonio, TX September 10-12, 2010 Lansing, MI September 24-26, 2010 Sedona, AZ Oct. 14-17 ( 1⁄2 days), 2010 Colorado Springs, CO October 22-24, 2010 Milwaukee, WI November 19-21, 2010 Danvers, MA December 3-5, 2010

Myofascial Mobilization South Bend, IN June 12 & 13, 2010 Thunder Bay, Ontario September 11 & 12, 2010 Allentown, PA October 2 & 3, 2010 Branson, MO October 23 & 24, 2010 Brownsville, TX November 6 & 7, 2010 Stuart, FL November 20 & 21, 2010

Advanced Myofascial Unwinding (Prerequisite: MFR I, Unwinding, MFR II)

Sedona, AZ June 24-27 ( 1⁄2 days), 2010 Chicago, IL November 8-10, 2010

D-4783

FASCIA

American Occupational Therapy Association, Inc. Provider # 3338. All core seminars with the exception of the Fascial-Pelvis Seminar. “The assignment of AOTA CEU’s does not imply endorsement of specific course content, products, or clinical procedures by AOTA.”

Fascia Photo by Permission of Dr. J.C. Guimberteau

Myofascial Release Seminar Series Register for 3 Seminars & Receive $300 off ! SEDONA, AZ Myofascial Rebounding June 17-20 ( 1⁄2 days), 2010 Myofascial Healing June 21, 22, 23, 2010 Advance Unwinding June 24-27 ( 1⁄2 days), 2010

PACIFIC NW

COLUMBIA RIVER GORGE AREA Myofascial Release I July 15-18 ( 1⁄2 days), 2010 Myofascial Unwinding™ July 19, 20, 21, 2010 Myofascial Release II ™ July 22-25 ( 1⁄2 days), 2010

Register Today . . . Call

™

NEW YORK, NY

CAPE COD, MA

Myofascial Release I ™ August 13-15, 2010

Myofascial Release I ™ September 9-12 ( 1⁄2 days), 2010

Myofascial Unwinding™ August 17-19, 2010

Myofascial Unwinding™ September 13-15, 2010

Myofascial Release II ™ August 20-22, 2010

Myofascial Release II ™ September 16-19 ( 1⁄2 days), 2010

1-800-FASCIAL

Visit our website: MyofascialRelease.com

C A LE N D A R AOTA CEonCD™

Ongoing

Occupation-Focused Intervention Strategies for Clients With Fibromyalgia and Fatiguing Conditions. Renee R. Taylor, PhD. Presents a number of evidence-based strategies for managing fibromyalgia and other fatiguing conditions, such as chronic fatigue syndrome. Learners will become familiar with interdisciplinary treatment approaches and how to work best with other professionals treating these syndromes. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4839, $68 AOTA Members, $97 Nonmembers. http://store.aota.org/ view/?SKU=4839

AOTA CEonCD™

Ongoing

Model of Human Occupation Screening Tool (MOHOST): Theory, Content, and Purpose. Gary

Kielhofner, DrPH, OTR/L, FAOTA; Lisa Castle, MBA, OTR/L; Supriya Sen, OTR/L; and Sarah Skinner, MEd, OTR/L. Occupation-focused practice and top-down assessment make occupational therapy unique when assessing and documenting client services. Unfortunately, therapists often turn to quicker impairment-oriented or performance-based assessments. The MOHOST occupation-focused assessment tool is comprehensive and easy-toadminister with a wide range of clients at different functional levels. This new course teaches you how to use a variety of information from observation, interview, chart review, and proxy reports to complete the MOHOST tool. Earn .4 AOTA CEUs (4 NBCOT PDUs/4 contact hours). Order # 4838, $125 AOTA Members, $180 Nonmembers. http://store.aota.org/ view/?SKU=4838

AOTA CEonCD™

Ongoing

Driving Assessment and Training Techniques: Addressing the Needs of Students With Cognitive and Social Limitations Behind the Wheel. Miriam Monahan, MS, OTR, CDRS, CDI. Occupational therapy practitioners in the driver rehabilitation area are challenged by students with Asperger’s syndrome, nonverbal learning disabilities, autism, traumatic brain injury, attention deficit disorders, and lower IQ scores. This new course is highly visual and creative in addressing critical issues related to driving assessment and training. Course highlights include skills deficits related to these diagnoses, methods and tools that address driving skills (including video review), assessment techniques to determine the readiness to drive, and intervention techniques for developing specific social and executive function skills necessary for driving tasks. Earn 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #4837, $249 AOTA Members, $355 Nonmembers. http:// store.aota.org/view/?SKU=4837

AOTA CEonCDTM

Ongoing

Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations. Reneé R. Taylor, PhD. Discover strategies for

managing three of the most common and difficult emotions in occupational therapy practice—pain, fear, and avoidance. Using six distinct modes of interacting that are based on the conceptual practice model recently developed by Dr. Taylor, you will learn how to best manage these emotions and behaviors so that treatment goals can be accomplished. The model is particularly useful when therapists are having difficulty engaging clients or sustaining active participation in therapy. It is designed for practitioners and supervisors at all experience levels to identify and build upon existing interpersonal strengths and develop new skills to enhance their work. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4836, $68 AOTA Members, $97 Nonmembers. http://store.aota.org/ view/?SKU=4836

AOTA CEonCD TM

Ongoing

Sensory Processing Concepts and Applications in Practice. Winnie Dunn, PhD, OTR, FAOTA. Participants in this new program from AOTA will

24

examine the core concepts of sensory processing based on Dunn’s Model of Sensory Processing. The course explores the similarities and differences between this approach and other sensory based approaches, examines how to implement the occupational therapy process, and reviews evidence to determine how to create best practice assessment and intervention methods. With school as a major context for children, applications within school-based practice will also be discussed and several case studies will be examined to practice implementation within everyday lives of children. In addition, the course looks at the knowledge and practice issues on the horizon as occupational therapy approaches that employ sensory processing concepts are refined. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4834, $68 AOTA Members, $97 Nonmembers. http://store. aota.org/view/?SKU=4834

AOTA CEonCDTM

Ongoing

Staying Updated in School-Based Practice.

Yvonne Swinth, PhD, OTR/L, FAOTA, and Mary Muhlenhaupt, OTR/L, FAOTA. Provides participants with information and practical strategies they can use to keep current with issues, trends and new knowledge related to providing services for children and youth in the public schools. Topics include current legislation such as the Individuals with Disabilities Education Improvement Act (IDEA 2004), the No Child Left Behind Act (NCLB), and Section 504 of the Rehabilitation Act. Ideas and approaches will be presented that can be implemented by an individual occupational therapy practitioner or in collaboration with other colleagues or members of a school district team. Participants will also explore web-based resources, resource manuals, education sources, collaborative methods and more. Earn .15 AOTA CEU (1.5 NBCOT PDUs/1.5 contact hours). Order #4835, $51 AOTA Members, $73 Nonmembers. http://store.aota.org/ view/?SKU=4835

AOTA CEonCDTM

Ongoing

Creating Successful Transitions to Community Mobility Independence for Adolescents: Addressing the Needs of Students With Cognitive, Social and Behavioral Limitations. Miriam Mo-

nahan, MS OTR, CDRS, CDI, and Kimberly Patten, OTL, AMPS certified. Addresses the critical issue of community mobility skill development for youth with diagnoses that challenge cognitive and social skills, such as autism spectrum and attention deficit disorder. Community mobility is vast in that it includes mass transportation, pedestrian travel, and driving, and is essential for engaging in vocational, social, and educational opportunities. The course is appropriate for occupational therapy practitioners practicing in educational settings and in driver rehabilitation. Earn .7 AOTA CEU (7 NBCOT PDUs/7 contact hours). Order #4833, $175 AOTA Members, $250 Nonmembers. http://store. aota.org/view/?SKU=4833

AOTA CEonCDTM

Ongoing

Hand Rehabilitation: A Client-Centered and Occupation-Based Approach. Presented by Deb-

bie Amini, MEd, OTR/L, CHT. Describes how to use the occupation-based intervention to enhance hand rehabilitation protocols without sacrificing productivity or detracting from the concurrent client factor focus. CD-ROM includes MP3 audio file of the entire course. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4832, $68 AOTA Members, $97 Nonmembers. http://store.aota.org/view/ ?SKU=4832

AOTA CEonCDTM

Ongoing

Evidence-Based Review of Interventions Used in Occupational Therapy for Children With Autism Spectrum Disorder. Presented by Jane Case-

Smith, EdD, OTR/L, FAOTA, BCP. Identifies the primary issues in children with ASD that limit daily

occupations and participation in school, home, and community settings. Based on an extensive review of the research literature, evidence-based interventions for children with ASD will be identified and described. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4830, $68 AOTA Members, $97 Nonmembers. http://store.aota.org/ view/?SKU=4830

AOTA/Genesis CEonCDTM

Ongoing

Seating and Positioning for Productive Aging: An Occupation-Based Approach. Presented by Felicia

Chew, MS, OTR, and Vickie Pierman, MSHA, OTR/L. Reviews seating and positioning from evaluation to outcome, with a concentration on interventions. Information reviewed will be applicable to a variety of settings, including skilled nursing facilities, home health, rehab centers, assisted living communities, and others. Primarily addresses manual wheelchair mobility. Earn .4 AOTA CEU (4 NBCOT PDUs/4 contact hours). Order #4831, $97 AOTA Members, $138 Nonmembers. http://store.aota.org/ view/?SKU=4831

Available From AOTA

Ongoing

ASHT Test Preparation. This intermediate-level

course provides a comprehensive overview of all topics related to upper extremity rehabilitation. There are twenty-five PowerPoint chapters with over 2,000 slides and sample multiple-choice test questions accompany each chapter. Earn 30 AOTA approved contact hours (3 AOTA CEUs/30 NBCOT PDUs). Order #4850, $300 AOTA Members, $450 Nonmembers. http://store.aota.org/ view/?SKU=4850

AOTA CEonCDTM

Ongoing

Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition. Presented by

Susanne Smith Roley, MS, OTR/L, FAOTA; Janet V. DeLany, DEd, OTR/L, FAOTA. Explore ways in which the document supports occupational therapy practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3 NBCOT PDUs/3 contact hours). Order #4829, $73 AOTA Members, $103.00 Nonmembers. http://store.aota.org/ view/?SKU=4829

AOTA CEonCDTM

Ongoing

The New IDEA Regulations: What Do They Mean to Your School-Based and EI Practice? Presented by

Leslie L. Jackson, MEd, OT, and Tim Nanof, MSW. Understand what the 2004 reauthorization of IDEA and the new Part B regulations, released in August 2006, mean and what impact they have on your work as a school-based and early intervention practitioner. This CE course is an excellent opportunity to update your knowledge on IDEA. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4825, $68 AOTA Members, $97 Nonmembers. http://store. aota.org/view/?SKU=4825

AOTA CEonCDTM

Ongoing

Response to Intervention: A Role for Occupational Therapy Practitioners. Presented by Gloria

Frolek Clark, MS, OTR/L, BCP, FAOTA. Response to Intervention (RtI) is a process for educational decision-making promoted by the U.S. Department of Education. High-quality instruction and interventions are matched to the student’s needs, and progress is monitored frequently. Occupational therapy practitioners need to understand how federal statute and data-based decision-making have changed how we address the needs of students. Addresses the evolving role of occupational therapists and occupational therapy assistants who work with students in grades K–12. The information contained in this course is from the Audio-Insight™ Seminar originally presented on March 7, 2007. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4826, $68 AOTA Members, $97 Nonmembers. http://store.aota.org/view/?SKU=4826 MAY 10, 2010 • WWW.AOTA.ORG

Continuing Education

D-4759 D-4759

OT PRACTICE • MAY 10, 2010

25

C A LE N D A R

E M PL O Y M E N T

Continuing Education

Faculty

Assistant/Associate Professor

Doctorate of Science in Occupational Science Individualize your educational and research experiences. Choose between the Science of Human Occupation and Practice in Occupation tracks. Apply knowledge gained through the advanced study of occupational science and social justice to promote the health and participation of society. Courses available through a combination of online and directly supervised learning experiences. Select between part-time and full-time enrollment options. Located near Baltimore, MD, a great place to learn and live! http://grad.towson.edu/program/doctoral/osc-scd/ D-4740

Continuing Education

Continuing Education

Indianapolis, IN Starting July 15, 2010 Sensory Integration Certification Program sponsored by USC/WPS Course 1: July 15– 19 Course 2: August 19–23 Course 3: November 12–16 Course 4: January 7–11

Treatment2Go’s

For additional sites and dates, or to register, visit www.wpspublish.com or call 800-648-8857 D-4510 Continuing Education

Physical Agent Modalities Occupation based certification course

Only $549.00

Equal Opportunity/Affirmative Action Employer

for 45 contact hours

Thermal & Electrial Agents AOTA Approved course Meets most state requirements This fantastic interactive movie course retails at $599.00. Save $50.00 for a limited time. Use Promo Code: OTPAMS

Order at www.liveconferences.com Call: 727.341.1674 AOTA APP approved 4.5 CEUs Treatment2go is a registered trademark of EHT

Two Days of Conference Hands-On Learning (1.6 CEU) 2008 Schedule

Sacramento, CA Oct 24-25 Orlando, FLinformation Nov 14-15visit For additional

Forwww.beckmanoralmotor.com additional info and to register, visit www.beckmanoralmotor.com Host a Beckman OralConference Motor Seminar! Host a Beckman Oral Motor in 2009! For Hosting infoinfo call (407) or email Host (407)590-4852, 590-4852, or [email protected] [email protected] D-4434

26

D-4410

View complete job description and requirements at https://ecu.peopleadmin.com/applicants/ Central?quickFind=61956.

F-4781

Faculty

    

       

The Department of Occupational Therapy at Long Island University-Brooklyn Campus is seeking to fill two positions for its new B.S./M.S. in Occupational Therapy afternoon/weekend program set to start in the fall of 2010.

Full-Time Clinical Faculty Position: This is a non-tenure track full-time faculty position. We are seeking an educator with experience in teaching (in class or on-line) and student advisement. Qualifications: Qualified applicants will have an earned doctoral degree or would be at the final stage of completion of their doctoral degree. Clinical experience of 5 years or more and eligibility for State of New York licensure required.

Assessment and Intervention

Assessment & Intervention 2-day hands-on workshop (1.6Seminars CEU) San Francisco, Feb 29-Mar 1 2010 Upcoming CA Locations & Dates: Burlington, NC Mar. 14-15 Columbus, OH May 22–23 Houston, TX Mar 28-29 Bradenton, FL June McAllen, TX Apr. 11–12 4-5 Hastings, IL NE Apr June11-12 18–19 Chicago, SanHouston, Antonio,TXTXJune Apr25–26 19-20 Charleston, Apr 12–13 25-26 Conway AR SC August 2-3 GrandTampa, Rapids, FL MI May Manhattan, NYSeptember Jul 17-189–10 Shelby, NC September Virginia Beach, VA Sep 16–17 20-21 Manchester, Morganton,NH NCSeptember Sep 25-2624–25 Chicago, Oct 10-11 Summit, MSIL October 15–16 Columbia, Oct 16-17 Orlando, FLSCNovember 5–6

Vacancy # 975070 Occupational Therapy The Department of Occupational Therapy invites applications for a 12-month, tenure-track position in our Master of Science program. Responsibilities will include teaching in areas of expertise, engaging in curriculum development and evaluation, directing graduate projects and theses, developing a research agenda, and performing departmental, school, university, and professional service. An earned doctoral degree in occupational therapy or a related field is required, as is eligibility for licensure in North Carolina. A minimum of three years of professional experience and evidence of involvement in professional activities is also required. Teaching and research experience is preferred. Expertise and clinical backgrounds in varied areas will be considered. Rank and salary will be commensurate with qualifications. Screening will begin May 13, 2010, and continue until the position is filled. To be considered, submit an online candidate profile, curriculum vitae, letter of interest, and list of three references (noting contact information) at www.jobs.ecu.edu.

Academic Fieldwork Coordinator: This is an administrative, 12-month contracted position. Responsibilities include facilitating student placements for all fieldwork levels, counseling students regarding fieldwork choices and serving on programmatic and University committees. Some teaching is required in area(s) of expertise.

Link to your future with

Qualifications include some teaching experience (class and/ or online), master’s degree, eligibility for New York State Occupational Therapy license, strong professional values, minimum of 5 years of clinical experience, and excellent communication skills with the ability to work in a team setting. Previous experience as a fieldwork supervisor is desirable. Our Department offers high quality education to students from diverse socio-cultural backgrounds, using innovative teaching pedagogies that integrate theory, evidence-based practice and on-going clinical experience through community service and fieldwork education. Our faculty is committed to teaching, scholarship, and service to the University and the Community. As an Equal Opportunity Employer/Affirmative Action Employer, LIU seeks a diverse pool of applicants. For consideration please forward your letter of interest, Curriculum Vitae and three letters of references to: Holly Wasserman M.S., OTR/L, Chair, Search Committee, Department of Occupational Therapy, Long Island University, 1 University Plaza, Brooklyn, NY 11201, Email: [email protected] F-4792 MAY 10, 2010 • WWW.AOTA.ORG

E M PL O Y M E N T O PP O R T U N I T I ES Faculty

The UTMB Department of Occupational Therapy invites applications for a 12-month tenure-track faculty position at the rank of Assistant or Associate Professor. Track and rank will be commensurate with the individual’s record of prior experience and productivity. Duties will include teaching, research and scholarly work, and service on departmental, school, and university committees. The department has experienced recent growth, and we hope to expand our faculty with the addition of a team-minded individual committed to education and to expanding the knowledge base of occupational therapy. The individual would benefit from associations with experienced OT faculty and opportunities to network with faculty from other schools, the Division for Rehabilitation Sciences, and various centers of excellence. Founded in 1891, UTMB is a major medical research and medical humanities center located within a resilient and multi-cultural community that offers numerous venues for collaboration and practice. The successful applicant will have a minimum of 3 years of practice in occupational therapy and eligibility for occupational therapy licensure in Texas. Preferred education will be an earned PhD or OTD degree in occupational therapy, rehabilitation sciences, or other related discipline. Individuals whose degree is near completion may also apply. Please send a letter of application and curriculum vitae to: Suzanne Peloquin, PhD, OTR, FAOTA Chair of the Occupational Therapy Search Committee Department of Occupational Therapy School of Health Professions The University of Texas Medical Branch at Galveston 301 University Blvd. Galveston, TX 77555-1142 The University of Texas Medical Branch is an Affirmative Action/Equal Opportunity institution that proudly values diversity. Candidates of all backgrounds are encouraged to apply. F-4737 OT PRACTICE • MAY 10, 2010

Faculty

Academic Fieldwork Director and 2 FT Faculty Positions Auerbach School of Occupational Therapy (ASOT) JOB SUMMARY

The Auerbach School of Occupational Therapy (ASOT) at Spalding University is looking for an Academic Fieldwork Director and an additional two (2) faculty members to join our team in 12-month tenure track positions to meet our growing enrollment demand. Spalding University is a comprehensive doctoral institution located in the urban downtown center of Louisville, Kentucky. Spalding University places a strong emphasis on faculty teaching, scholarship, and service with a mission of creating a diverse community of learners dedicated to meeting the needs of the times through quality graduate liberal and professional studies grounded in spiritual values, with emphasis on service and the promotion of peace and justice. The local region supports varied community-based occupational therapy practice opportunities with a large multisystem medical complex a few blocks away. Our programs include ACOTE accredited BS/MSOT and MSOT entrylevel programs. SKILLS AND EDUCATIONAL REQUIREMENTS

• Candidates must hold a master’s degree or higher from an accredited program of occupational therapy. • Beginning work toward a doctorate degree or a completed doctorate in occupational therapy or a related area is preferred. • Requirements include demonstrated experience in OT practice and fieldwork supervision with a minimum of 5 years of clinical or related experience. • Current NBCOT certification and KY OT license (or eligibility) is required. • Academic rank, salary, tenure track status is commensurate with credentials and experience. INTERRELATIONS

• Daily contact with administration, faculty, staff, and students • Regular contact with the general public • Must be able to work with diverse populations CONTACT

A letter of application, curriculum vitae, and three letters of recommendation should be sent to: Laura Schluter Strickland, EdD, OTR/L Chairperson, Auerbach School of Occupational Therapy 851 South Fourth Street Louisville, KY 40203 (502) 585-9911 ext. 2324 or [email protected] Spalding University is an Equal Employment Opportunity/ Affirmative Action employer. The University complies with all federal, state and local equal employment opportunity laws. It is the University’s policy not to discriminate against any individual or group of individuals and to provide equal employment opportunity to all qualified persons regardless of race, color, national origin, age, disability, religion, sex, pregnancy, sexual orientation, gender identity, marital status, military status, veteran status or other protected status. All job offers are contingent upon successful completion of a criminal background check and pre-employment drug screen.

F-4762

27

E M PL O Y M E N T O PP O R T U N I T I ES Faculty

Faculty

U niversity of the S ciences S amson C ollege of H ealth S cience

Want to Work for a University Worth Discovering?

Department: Department of Occupational Therapy Position: Assistant Professor of Occupational Therapy The University of the Sciences is seeking a dynamic individual to join our Department of Occupational Therapy in a new 12-month (tenure-track) assistant professor position. University of the Sciences is a comprehensive health care university situated in the University City area of Philadelphia, offering tremendous academic and educational opportunities. Our department is known for providing a wide variety of hands-on learning experiences. We have developed strong community partnerships which provide active service learning programs for our students. We highly value student-centered learning, innovative teaching and active scholarship with student participation. Responsibilities include teaching in our BS/MOT program and in our proposed entry level Dr.OT program, scholarship and service to the University. This position offers the right candidate a unique opportunity to be involved in the inception of an entry level doctoral program, with tracks in leadership and community based practice. This will be an exciting opportunity involving working with faculty leaders, course development and a chance to influence the future of the profession. The ideal candidate for this position will hold an earned doctorate, and have at least three years of clinical experience. Strong candidates will be considered regardless of area of clinical expertise. Preference will be given to those with teaching experience and a defined research agenda. All candidates must be initially certified by NBCOT and be eligible for a Pennsylvania license. Qualified applicants are invited to submit their resume, unofficial transcripts, and a cover letter indicating their interest via e-mail submissions only as MS Word or PDF attachment to: Roger Ideishi, Search Committee Chair • E-mail: [email protected] USP is an equal opportunity / affirmative action employer

F-4768

The new COTA to MOT bridge program invites applicants for a 10 month Assistant or Associate Professor position to start in August, 2010. Enjoy the sunny climate, or stay where you are and teach with this on-line and weekend format program. Qualifications: • Master’s degree required; • Doctorate preferred Demonstrated experience in OT practice; minimum of 3 years • Experience in research, pediatrics, physical disabilities, or neuroscience teaching needed; on-line teaching background a plus • Eligibility for New Mexico OT license a must Review of applications will begin immediately and continue until the position is filled. For additional information and details on how to apply, please visit our website at: http://www.wnmu. edu and click on Human Resources. Western New Mexico University is an affirmative Action/Equal Employment Opportunity Employer. Minorities and women are especially encouraged to apply. All qualified applicants will receive consideration without regard to race, color, religion, gender, age, handicap, or national origin.

F-4785

Faculty

Faculty

OCCUPATIONAL THERAPY

   

The College of Nursing and Health Sciences at Florida International University seeks outstanding faculty candidates for the Chair position in the Department of Occupational Therapy. The desired candidate will have an earned doctoral degree in occupational therapy or related field; a minimum of 6 years of experience in the field of occupational therapy, including practice as an occupational therapist; administrative or supervisory experience; and at least 2 years of experience in a full-time academic appointment with teaching responsibilities. A successful candidate will also have initial national certification as an occupational therapist and licensure or eligibility for licensure in the state of Florida. The Chairperson is responsible for the management and administration of the department, including planning, evaluation, budgeting, teaching, selection of staff, maintenance of accreditation, and commitment to strategies for professional development. Additionally, the Chairperson represents the Department at the College, University and community levels and serves the profession by participation in committees and scholarly activities. The Occupational Therapy Department is housed in the Nursing and Health Sciences building, a new 103-square-foot building with state of the art technology including medical simulation, rehabilitation, biomechanics laboratories, and media classrooms. Florida International University is ranked by the Carnegie Foundation for the Advancement of Teaching as a Doctoral/High Research Activity University, and as such has a strong support network for research and scholarly activity. FIU has over 38,000 students enrolled in more than 200 academic programs. Located in Miami, the gateway to the Caribbean and Latin America, the University offers unequaled diversity among faculty and students. Additional information about the College and program may be obtained by visiting our website at http://www.cnhs.fiu.edu. Application review will begin May 1, 2010, and continue until position is filled. To apply online go to www. fiujobs.org and reference position number 34074. An application should include a letter describing relevant experiences and interest in the position; curriculum vitae/resume; and names, titles, addresses, business and home telephone numbers, and e-mail addresses of three references. For questions, please call Dr. Kathleen Blais at 305-348-7712. A member of the State University System of Florida An Equal Opportunity/Equal Access/Affirmative Action Employer

28

Western New Mexico University

F-4784

   

                                                                                                                                                                                 

F-4745

MAY 10, 2010 • WWW.AOTA.ORG

CLIENT: EMC JOB #: 5291 PUBLICATION: OT Practice SIZE: 2.25” X 9.187” Faculty DEADLINE: 4.23.2010

E M PL O Y M E N T O PP O R T U N I T I ES West

BRING YOUR

Junior Faculty Position For Training to Become a Rehabilitation Science Researcher The University of Florida (UF) in collaboration with the University of Texas Medical Branch at Galveston (UTMB), received NIH funding to train occupational therapists for a research career, through the Rehabilitation Research Career Development Program (RRCD). The goal of the program is to provide scholars with the skills and research experience necessary to become independent investigators and future academic and scientific leaders in occupational therapy and in physical therapy. The RRCD Program is funded by a grant through the National Center for Medical Rehabilitation Research in the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Note the RRCD will have other positions at both UTMB and UF for physical therapists and occupational therapists. This announcement applies to one currently open position for an occupational therapist who will receive training at UF. Candidates for this UF RRCD position should be licensed occupational therapists with a research doctorate and be within 3–5 years of completing a postdoctoral fellowship or equivalent experience. Applicants must have a strong commitment to the development of a scientific career. Other requirements include U.S. citizenship or permanent residency, no experience as a principal investigator on a major NIH research project, and willingness to train for two to three years at the University of Florida. More information on the program can be obtained from the web site at http://www.sahs.utmb.edu/k12, or contact Dr. William Mann at [email protected]. edu. Qualified candidates should complete the application form located on the web site and submit all materials by email to [email protected]. The University of Florida and the University of Texas Medical Branch are equal opportunity/affirmative action institutions which proudly value diversity. Candidates of all backgrounds are encouraged to apply.

F-4757

LIFE CAREER

MOVE YOUR

Are you ready for a change, open to new opportunities? Take a close look at Eisenhower Medical Center. A 2010 Gallup “Great Workplace Winner,” Eisenhower captures the spirit of Southern California: energetic, optimistic, and dynamic. The new Annenberg Pavilion increases our capacity to 500 beds, and our recent JCAHO Certification for Stroke and Joint Replacement means a growing need for high-quality Occupational Therapists like you. Our current program includes outpatient vision and driving programs, and Eisenhower is committed to additional program development.

For you, Eisenhower means:

• Outstanding benefits package and matched retirement plan • Reimbursement for professional dues and continuing education • Relocation bonus • Competitive salary • 4 day/10 hour work-week available • Inpatient acute care, outpatient hand clinic, and off-campus options • New facilities in stunning Southern California location

We are currently seeking:

Occupational Therapists

South

To apply visit Careers.EMC.org

Occupational Therapists Join the Greenville Hospital System! We are a leader in research, medical education and critical care in South Carolina. We are just a short drive away from the Blue Ridge Mountains and beautiful coastal beaches. We offer competitive pay, excellent benefits package, relocation assistance, COBRA reimbursement and we cover interview expenses. Sign On Bonus! SC license or license eligible candidates. New graduates are welcome to apply. We are seeking Full-time, SC License or SC License eligible OT candidates:

OT—Brain Injury Program, OP—Days. Job # 2010-2411 Visit our website at www.ghs.org to apply for this position and to learn about our other part-time and PRN opportunities. Revised 03 18 10 OT PRACTICE • MAY 10, 2010

S-4736

39000 Bob Hope Drive, Rancho Mirage, CA 92270

W-4787

29

E M PL O Y M E N T O PP O R T U N I T I ES National

Faculty

Occupational Therapy Assistant/Associate Professor We are currently seeking a faculty member as we expand our occupation-based team at the University of Utah. This fully accredited program has an integrated curriculum design with emphasis on occupation, evidence-based practice, research, and the development of strong professional skills. We believe in educating our future colleagues with skills to work in traditional, non-traditional, and emerging practice areas. Our program offerings include an entry-level MOT, an on-line, post-professional OTD, and a faculty practice clinic. The University of Utah is a major research university—come experience what our local and international visitors have discovered: A beautiful and natural setting; friendly, knowledgeable faculty and staff; and a diversity of people and ideas that are the University of Utah. For more information visit our website at: www.health.utah.edu/ot/faculty/jobs/index.html Position Available: Assistant or Associate Professor in the College of Health, Division of Occupational Therapy. Full-time, tenure track, 9-month position with opportunities for summer negotiable. Qualifications: Research doctorate (PhD, EdD, or ScD), eligible for Utah licensure. Responsibilities: Teaching in an innovative, occupation-based curriculum, establishing a research agenda, service opportunities, student mentoring, and program development. Interested candidates should submit a resume and contact information for three references to: Donna Costa, DHS, OTR/L, FAOTA, Chair, Search Committee, 520 Wakara Way, Salt Lake City, UT 84108, E-mail: [email protected], Phone: 801-581-4248, Fax: 801-585-1001 The University of Utah is an Equal Opportunity/Affirmative Action Employer

U-4625

F-4751

West

South

Therapists needed in our therapeutic seacoast locations. Georgetown Hospital System is the largest provider of physical rehabilitation services in our local area, the South Carolina coast between Myrtle Beach and Charleston. We offer competitive salaries & benefits, sign on bonus, and relocation assistance. Georgetown Outpatient Therapy Center, Georgetown Memorial Hospital and NextStep Pediatric Rehab Center | Georgetown, SC HealthPoint Center for Health & Fitness | Pawleys Island, SC Waccamaw Community Hospital, Waccamaw Medical Park Outpatient Rehabilitation, The Neuro Rehab Center at Waccamaw Medical Park & Waccamaw Rehabilitation Center | Murrells Inlet, SC Azalea Lakes Adult & Pediatric Outpatient Rehabilitation | Myrtle Beach, SC Andrews Medical Center Outpatient Rehabiliation | Andrews, SC

Available positions are listed on our website. Apply online at www.georgetownhospitalsystem.org

W-4791

30

Georgetown Hospital System HR, 606 Black River Road, P.O. Box 421718 Georgetown, SC 29440 EOE

S-4735

MAY 10, 2010 • WWW.AOTA.ORG

E M PL O Y M E N T O PP O R T U N I T I ES South

Faculty

Improving lives, one student at a time…

Make the decision to join the Cantex Family based on our 32 year history of excellence. Let us change your opinion of Residential Health Care. We’ll empower you to BE THE DIFFERENCE! Positions available in the following locations: Allen, Alvin, Cedar Hill, Dallas, Denison, Houston, Lancaster, Lufkin, Pearland, Seagoville, South Lake, Woodville Contact Jennifer Ronda, Executive Recruiter at [email protected] or call 888-226-8390, ext. 145 for additional info. Fax: 214-871-3057 • www.cantexsc.com

Join Concorde Career Colleges, a nationally recognized for-profit education company, as we prepare committed students for a successful career in a healthcare profession, through high caliber training, hands on experience and student support. Our faculty gives students more than just knowledge and technical skills; they instill integrity, discipline, team work, and the drive that define today’s professionals. We like to call it healthcare education with a purpose.

Occupational Therapy Assistant Program Directors Memphis, TN * San Bernardino, CA

• Registered Occupational Therapist (OTR) and current state license or certificate. • Masters degree required plus a minimum 5 years clinical experience in Occupational Therapy. • 1 year experience as an educator for an approved Accredited Council for Occupational Therapy Education (ACOTE) campus. • Previous program director with start up experience preferred. • Previous management experience required. • Must be capable of teaching both the clinical and didactic aspects of the program.

Apply Online! jobs.concorde.edu We offer a competitive benefits package to support our associates; medical/dental/vision, 401K retirement plan, paid holidays and education reimbursement! EOE. F-4780 S-4789

CCC 4-13 4.687x4.375 AOTA.indd 1

4/13/10 4:14 PM

National

i a remarkable ALLIANCE for

OT professionals.

i The national partnership between the AOTA and Genesis Rehab Services promises remarkable outcomes. Working together, our organizations will advance best practices in OT and proactively support practitioners with enhanced educational and professional-clinical opportunities. It’s a professional partnership that guarantees a rewarding career.

Find out why more than , licensed therapists have chosen Genesis Rehab Services.

8 000

Now Hiring Occupational Therapists and other rehabilitation professionals.

Apply NOw! at www.genesiscareers.jobs or call -jObS

877 403

EOE M/F/D/V 100827_GENE_7.125x4.375_AOTA.indd 1 OT PRACTICE • MAY 10, 2010

U-4722

4/14/10 4:24:23 PM

31

E M PL O Y M E N T O PP O R T U N I T I ES West

Faculty

Bangor, Maine, is searching for Occupational Therapy candidates for a position as:

Assistant/Associate Professor & Academic Director

For a job description, qualifications, and application information, please visit the Husson University Web site at www.husson.edu/careers. Husson University is an Equal Opportunity Employer. F-4743 West

OCCUPATIONAL THERAPISTS Anchorage School District • Anchorage, Alaska

Join a dynamic team of 30 OT's! W-4790

National

Competitive salary • Great benefits $3,000 signing bonus for 2009-2010 school year. $2,000 salary supplement for SI or NDT. Contact Kate Konopasek at

907-742-6121

occupational therapists

([email protected]) or apply online at www.asdk12.org

we have the opportunities you’ve been looking for In return for providing the best care for America’s Veterans, you’ll receive a competitive benefits and incentives package that includes: • • • • • • •

Competitive salary 13 to 26 days annual paid vacation 13 sick days and 10 holidays One license/50 states Stable health and retirement benefits Liability protection Exceptional education support opportunities (subject to funding availability)

Anchorage School District Educating All Students for Success in Life

W-4311

Midwest

Children’s Therapy & Rehab Specialists Specializing in all aspects of therapy. Strictly for children. Seeking licensed

Occupational Therapists For Elgin, IL Full & Part time/flexible hours Please fax resume to: 847-756-2682 [email protected] M-4744 West

Hiring Veterans and non-Veterans

Apply today at www.VAcareers.va.gov or call 1-800-949-0002 U-4598

32

D2-OT06_4.6875x4.375.indd 1

ARIZONA—OTs $65K Phoenix, Tucson, & Burbs 602-478-5850/480-221-2573 Schools; 16 wks off; 100% Paid: Health, Dental, Lic, Dues, Ed$, 401K, Hawaii/Spanish I trips… [email protected] *STARS* StudentTherapy.com

W-4671

9/14/09 2:08:59 PM

MAY 10, 2010 • WWW.AOTA.ORG

Living Life To Its Fullest OT Reflections From the Heart

A n

n

n

n

Crafting a Therapeutic Group

fine piece of furniture and a therapeutic group have several commonalities. The tools used to create both are different in form but parallel in function. n The master craftsman identifies a need and creates a design to fulfill this need. The design is conceived in his or her head, flows into the hands, and is brought to fruition through labor. A group leader has similar experiences. He or she recognizes a need, drafts a plan, and facilitates its creation and completion. The craftsman and group leader must both use the proper tools and supplies to promote success. The craftsman must create and follow a set of blueprints, much as the group leader will create a plan, set goals, and establish rules. The craftsman will use a framing square during all aspects of the labor. This tool ensures that the furniture will have a stable base on which to build. The group leader will use the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition1 in the same manner. Raw lumber must be gathered. It will have many imperfections, some noticeable and some not. This is of little consequence. The craftsman will use expertise to identify the problematic areas and enhance the wood’s natural beauty. A group leader must gather the members. The members’ imperfections are their conditions, disabilities, and individual group roles. The blueprints specify the measurements to be used. A tape

OT PRACTICE • MAY 10, 2010

Stacy L. McCleaf

A fine piece of furniture and a therapeutic group have several commonalities. The tools used to create both are different in form but parallel in function.

n

n

n

n

measure facilitates this process. An effective group leader must measure the group’s behaviors against expected norms. If a standard saw does not create the proper cut, the craftsman may need to use a miter saw to shape the wood and produce custom angles. As the craftsman creates the perfect cut or angle, so must the leader properly grade the group’s activities. The craftsman may notice that some wood surfaces are higher than others. A lathe is used to remove the extra wood, layer by layer. A group leader should expose each member’s true feelings and opinions in the same manner. This will facilitate effective processing, generalizing, and adapting. The pieces of wood are secured with nails or screws for strength and stability. It is the group leader’s job to create and promote cohesiveness to strengthen and stabilize the group. The craftsman uses a chalk line to ensure that all parts are as they should be. The final piece should match the original design. Similarly, a group leader must maintain the group’s focus and keep the members aimed toward the final goal.

n To be functional, the piece must sit flatly on a surface. The craftsman will frequently use a level to check for proper balance. A group leader must monitor the group’s balance and correct any problem areas. n Small imperfections may still be evident, even after the lathe is used. The craftsman will spot sand these areas until the wood is smooth and uniform. Observable problem areas within the group must be addressed by the leader. Complete resolution is the goal. n After construction is finished, the craftsman will apply the stain. As the stain soaks into the wood it highlights the wood’s grain and emphasizes its inherent beauty. Therapeutic use of self is the group leader’s “stain.” It should permeate the entire group plan, as well as the group members. It is generously applied and cannot be depreciated. n During the final step, the craftsman applies a coat of lacquer. This not only protects the furniture but also renders it completely functional for use in its intended environment. When the therapeutic session is complete, the members will hopefully have achieved the stated goal. Areas or contexts of member difficulty will no longer pose a threat. Success has been achieved.

Reference 1. American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.

Stacy L. McCleaf is an occupational therapy assistant student at Penn State University in Mont Alto.

33

P-4697