Monday March 4, 2013
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Here we take a look at five standouts in the occupational therapy field, each of whom has employed his or her own unique strengths to showcase the value of occupational therapy within the healthcare continuum. The creativity and drive found in each of these professionals has helped recast the popular perception of what an occupational therapist can contribute to the well-being of society at large.
Outpatient rehabilitative therapist, Princeton Community Hospital
The scene has played out frequently, with variations, in Brooks’s career as an OT. The disbelieving patient — this one recovering from a hip replacement — grumbled, “You can’t get me up and out of this bed. I need to be the one taking care of you.”
Brooks, who was born without arms, was undaunted. With confidence and skill, she encouraged the patient while maneuvering a wheelchair and steadying a walker with her leg. She cautiously positioned her foot under the patient’s fragile and motionless foot to slide it forward, and guided her reticent charge into the wheelchair. Then she tied the patient’s shoes — with her toes.
Brooks is, as her voicemail message confirms, “the totally talented toes lady,” who is “left-footed.”
“I’ve been putting on my own shoes and socks since I was 5. What I do every day is adapt my situations, modify whatever I’m working with so I can handle it myself,” said Brooks. “There’s nothing to overcome — it’s just how I normally do things. I do have to be good with balance and coordination, though.”
Since starting practice in 1995, Brooks has worked in outpatient, inpatient and home health settings, with a focus on geriatrics. And her creativity knows no bounds. Brooks learned to use air splints in an effort to protect her joints and lessen her own fatigue. “It’s easier to control the patient’s arm because the elbow isn’t going to bend and the wrist won’t flop,” she said. “I can sit down in a chair beside the patient, use my feet to hold and control the air splint and do some ranges. Patients get more from the actual modality itself — and I can do a better job, longer.”
Who better to work with patients who face physiological and psychological challenges than someone who’s “been there, done that”? Brooks remembers being in Shriners Hospital for Children in Lexington, Ky., for treatment of her scoliosis. “I thought I wanted a prosthesis then because I wanted to be a teacher — thought it would help me carry a briefcase. The prosthesis was custom-made, went from my shoulder on down, and after six to eight hours, felt like a tree limb hanging from my side. I hated it,” she said.
Her aversion to prosthetics did not prove a deterrent in her pursuit of an occupational therapy career — the lure of helping others won over. At Shriners, her care team sent her to occupational therapy to ensure she could dress herself — victories over buttons and zippers on her skinny jeans as a teenager were small but mighty. While in her therapist’s office, she watched with fascination as the OT worked with other children with many different diagnoses.
“OT just made sense to me,” Brooks said. She went on to complete a bachelor’s degree in health sciences from Bluefield (Va.) College, followed by her OT degree from Temple University, Philadelphia.
“I’m best when a person is stuck in a negative place and doesn’t think they’ll get better. I talk to them, and sometimes I say, ‘I won’t let you forget me,’” she said. “I also say, ‘I’m not going to give you a book answer but a life answer.’ I’ve dealt with people who are angry when bad things happen — I won’t let them give up on themselves.”
Brooks helps people keep their minds open. “My biggest goal is to get people to see that even though I might look different or do things differently than the majority of people, those things aren’t negatives — they’re ways I live my life. I want people not to focus on the word ‘disability,’ but to stay focused on what disabled people are able to do.”
Outside of work, Brooks drives a car with a front license plate that reads: “Unarmed and Dangerous.” And she adores her 26-toed cat “Thumbelina” and figures they have things in common, even though the cat has a lot more digits. “I’m a little quirky, so the cat is a good complement.”
Founding director, doctor of occupational therapy program, Mary Baldwin College
Occupational therapy called when Herz was in the Army and he quickly answered. “What’s drawn me to the profession has been the different people I treat, helping them be independent in life, and then witnessing the outcomes. It takes a unique personality to do what we do,” he said.
Once back in the civilian world, Herz earned his bachelor’s degree in occupational therapy, then his MBA and, soon, academia felt like the right place to be. Herz joined Jefferson College of Health Sciences in Roanoke, Va., in 2000. “I just got a card from a former student about what makes a person a hero,” he said. “I don’t see myself that way at all. I’m here to help prepare them for the future. My teaching is my first priority, and making sure students get what they need is what’s made me successful for 31 years.”
Later, at Georgia Regents University, Augusta, Herz began to carve his niche in movement disorders and degenerative diseases, treating clients in the movement disorder clinic. He earned his doctorate in occupational therapy from Creighton University in Omaha, Neb., in 2004.
Herz has conducted four studies with the Nintendo Wii, funded by the National Parkinson Foundation, and one with Wii Fit. Participants engaged in simulated tennis, bowling and boxing. In one study, they made notable improvements in rigidity, movement, fine motor skills and energy levels, and their levels of depression decreased to zero, he said. One participant was able to walk down the aisle in his daughter’s wedding, while another stopped using a cane.
“People said they were moving better, feeling better, that their quality of life improved,” he said. “From a clinician’s standpoint, it was remarkable. I think games systems will play a major role in rehab. With OT and PT and allied health sciences, we’re not here to find cures, but to slow the disease process down.”
Appointed founding director of the doctor of occupational therapy program and professor at Mary Baldwin last November, his arrival came shortly after groundbreaking for the Murphy Deming College of Health Sciences in Fishersville, Va. The campus is scheduled to open in June 2014, and Herz’s program is in the accreditation process.
Starting a new job, with a new title, a new doctoral program and a new facility motivates Herz to do even more. “My hope is for a really innovative curriculum and an interactive, integrated type of approach.”
And about that new degree program: “Ask me two years ago, I might have said we don’t need a doctoral degree. Now there are six doctoral programs in the country. Having it will give us an advantage in legislation, at places at the table we might not have had — like in mental health. ‘Doctor’ has a specific connotation,” said Herz.
The professor, clinician and researcher thanks academia for allowing him to mold the future of the occupational therapy field through his students. “It keeps me sharp with lifelong learning. Seeing results drives my clinical side, and keeping my professional skills current makes sure I can talk the talk and walk the walk.”
As for the future, he’s ready to take on the world, from Virginia. “Not me, but I’d like for us to have one of the top programs in the country. That’s my vision — and it’s going to take lots of people to do that.”
Director of occupational therapy, Shenandoah University
Soon after college, Davidson rode a chairlift up a ski mountain in Aspen, Colo., on which she struck up an enlightening conversation with her fellow rider — an OT. “I was doing some volunteer work for blind skiers there, and I found out I could get paid for everything I volunteered for. I never looked back,” she said of her decision to go into occupational therapy.
“Things that people do in their everyday lives — making coffee, building a house — reflect who they are internally and are a window to their essence. Nothing is more devastating than having something happen that takes that away,” Davidson said. “Helping them figure out what they do that’s ‘theirs’ is so important, versus having someone do it for them.”
Davidson’s resume includes OT positions at Walter Reed Army Medical Center and Georgetown University Medical Center. With 21 years of experience in traumatic brain injury rehabilitation across the continuum of care, she serves as a fellow in the Rehabilitation and Reintegration Division of the Army Surgeon General’s office, where she helps design programs for soldiers with TBI. Her research focuses on transitions for these service members and their families.
Last July, Davidson became the first OT to be appointed to the American Medical Association’s Current Procedural Terminology Editorial Panel. She’s one of two nonphysicians on the esteemed 17-member committee. Davidson said she believes one of her greatest gifts is facilitation, “working with people with different frames of reference.” Her understanding of “the processes” and use of team- and systems-oriented thinking may have played a part in her being named to the panel, she said.
“I hope in the future to encourage OTs to understand coding and billing processes better, to maximize reimbursement and do more entrepreneurial work,” she said. Healthcare reform will change the field’s landscape, she said. “I think we’ll see OT become more a part of medical home communities and accountable care organizations.”
Teaching is a source of joy in her position at Shenandoah in Winchester, Va. “The community has embraced us, and our students have really fostered my growth as a professional.”
Davidson’s next move may be into global health. “I’d love to run some type of organization or institute that focuses on education, evaluation [and] intervention post-concussion. This career has taken me on journeys I didn’t expect — and I imagine it will continue to do that.”
Professor, Virginia Commonwealth University
Projections that more than 8 billion hand-held or personal mobile-ready devices will be in use globally by 2016 (by Cisco Systems) aren’t lost on Gentry, who sees the future as right now. With a 15-page CV rich in academic appointments; memberships in scientific, honorary and professional societies; along with lengthy lists of published works, he is an acknowledged leader. His calling card leverages emerging hand-held technologies as cognitive aids for people with brain injuries, multiple sclerosis, autism and other neurological conditions.
Gentry is an associate professor in the department of occupational therapy in Virginia Commonwealth’s School of Allied Health Professions in Richmond, Va., and an assistant professor in the department of physical medicine and rehabilitation in the university’s school of medicine, plus he heads VCU’s Assistive Technology for Cognition Laboratory. “Assistive technology is a key element of the OT tool kit,” he said.
The tireless innovator is also proud of having co-founded a community-based day rehabilitation program for adults with brain injury, now called Virginia NeuroCare, and creating an online training program for brain injury clinicians.
Understandably, some remain unconvinced that people with cognitive challenges can learn to use handheld devices, but Gentry knows otherwise. He first researched the use of PalmPilots as cognitive aids for people with brain injuries and autism in 2001. “I found them to be great reminder tools that helped people with memory and organizational impairments achieve their daily goals and function more independently,” he said. “Opportunities to leverage apps, video cameras and video-chat have also grown. Now, of course, we all use our smartphones as life coaches, so it would seem odd for people with disabilities not to use them.”
Gentry is wrapping up a five-year study of Apple iPod Touches as vocational aids for autism, using off-the-shelf apps that anyone can buy. His research is funded by a grant from the National Institute for Disability and Rehabilitation Research and conducted in partnership with VCU’s Rehabilitation Research and Training Center. He’s especially excited about how technology can help those with autism obtain jobs and excel in them. “I can say that all participants were able to learn to use the iPod Touch as a vocational aid, and all performed more independently on the job, needing less supervision,” he said.
“The trick is leveraging the right suite of apps and training strategies for each worker and her/his job,” he said. “The apps help people with autism with task reminders, to-do lists, videos of complex tasks — steps easily forgotten — behavioral cues and social stories, plus FaceTime face-to-face video chats with supervisors.”
The device and apps can’t do all the work, Gentry reminds OTs. “You can’t just throw these devices at someone and walk away. OTs are trained to understand client conditions, task analysis, strategies for training people with cognitive-behavioral challenges, so I feel that our expertise is key to success.”
That autism is such a wide-ranging disability category remains a challenge, Gentry said. “Some workers with high-functioning autism are quite computer-literate and immediately get it, whereas others are nonreaders, have sensory issues, or are more cognitively impaired, so you have to adapt your approach. For instance, there are picture-based reminder apps for nonreaders.”
Continually ahead of the technological curve, Gentry also is collaborating with a team of bioengineers, researching the use of body-worn monitors linked to iPhones to help military veterans with post-traumatic stress disorder manage anxiety, sleep and exercise. “I think this approach offers potential for people with other disabilities as well, providing real-time health coaching. So that’s where we’re headed next,” he said.
Energized about “amazing technologies available to consumers,” Gentry lamented that “they’re not adapted in ways that people with disabilities can use them. It doesn’t take much to bridge that gap. Maybe I’m an early pioneer — I can see people’s lives changing for the better.”
Assistant professor, Kean University; PAR FORE program director
Gardner said she can’t imagine doing anything else. An OT for seven years, Gardner said she is “blessed.” She teaches courses in clinical conditions, activity group processes, occupations across the lifespan and service learning. “It’s not like this is a job, because I feel so at ease. But it also comes with lots of responsibility,” she said.
Although she’s not a golfer herself, Gardner also serves as program director for the Newark, N.J., arm of PAR FORE — Perseverance, Accountability, Resiliency, Fellowship, Opportunity, Respect and Empowerment — an integrated, occupation-based mentor program for at-risk youth. Newark is home to 23 street gangs. The program uses golf to teach kids skills to successfully fulfill their roles as students, friends, family members and community members. They play on a local county golf course, where last year, Kean’s occupational therapy department launched a six-week summer camp, supplemented with activities at other locations, as part of the program. “They’ve gone to a zoo, gone roller-skating — we’re keeping them ‘occupied,’” Gardner said.
Thirteen boys and girls, ages 11 and 12, came from local schools for summer camp and now once-weekly meetings, and they’ll stay active until age 17.
The year-round program’s executive director, Alexander Lopez, OTR/L, JD, is a Kean graduate who grew up in Newark. Chaz Moses of the nonprofit The First Tee of Metropolitan New York — a similar program across the river — collaborates as the Newark program’s golf professional.
While earning her bachelor’s degree in psychology from The College of New Jersey, Ewing Township, Gardner read an article about an OT helping a schizophrenia patient with activities of daily living, and that changed the course of her career. While fulfilling her occupational therapy master’s degree requirements at Kean in Union, N.J., she was able to work with clients of all ages, including children. “I realized what I was meant to do,” she said. Next, Gardner pursued her clinical doctorate at Chatham University, Pittsburgh.
After working full time as a mental health specialist, in 2007, Kean invited Gardner to join the adjunct faculty, and in 2010, Gardner applied for her current full-time teaching position. The university website recognizes her as having “evaluated and developed intervention programs to address the needs of children and adolescents,” and as developing “age-appropriate coping and developmental skills via engagement in purposeful activity and occupations.”
Last summer, three full-time OTs completing their fieldwork joined Gardner at camp, and three students doing fieldwork now support her in PAR FORE’s after-school curriculum. “We’re able to help keep costs lower by using OT students — and they really help me,” she said. “It’s great for them to be able to do structured fieldwork with kids and have fun.”
For other OTs and OTAs who envision their own community-based programming, Gardner said, “Don’t limit yourself to the game of golf — any sport can build coping and resiliency. Seek the support of local universities or OT programs — especially related to cost and funding — and collaborate with the community for donations.”
Gardner has performed assessments of last summer’s camp, with annual reassessments planned. To establish baseline data, her team uses Canadian Occupational Performance Measure; Culture Free Self-Esteem Inventory; Resiliency Scales for Children & Adolescents; and the Beck Youth Inventories for Children and Adolescents.
Scientific data aside, the “real people” factor inspires Gardner to strive for success. “One parent told me at the end of camp. ‘I see such a tremendous change in my son.’ Nothing could make me happier than to see them win at the game of life.” •
Stephanie Stephens is a freelance writer.
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Monday March 4, 2013