OT Practice September 10 Issue

AOTA T H E
A MERIC A N
OC C UPAT IONAL
T HE RAPY
ASSOCIAT ION
SEPTEMBER 10, 2012
Home Modification
n n
Lighting for Clients With Low Vision Bathroom Safety & Aging in Place Working With Rebuilding Together
PLUS
Preparing Students for Ethical Practice Call for Nominations for 2013 AOTA General Election News, Capital Briefing, & More
aota SPecialty coNFereNce
adults With Stroke

November 30December 1, 2012 baltimore, marylaND earn Up to 13 contact Hours (1.3 aota ceUs/13 Nbcot PDUs)
register now at www.aota.org/confandevents/stroke A stroke can take meaning out of life, but occupational therapy can restore it.
An estimated 5.4 million people in America live with the disabling effects of stroke and that number is bound to increase in the years to come. Occupational therapy must take the lead in stroke rehabilitation for survivors, families and caregivers, so join us this fall at Adults With Stroke and take advantage of top-level continuing education!
PR-213
Chief Operating Officer: Christopher Bluhm Director of Communications: Laura Collins Director of Marketing: Beth Ledford Editor: Ted McKenna Associate Editor: Andrew Waite CE Articles Editor: Maria Elena E. Louch Art Director: Carol Strauch Production Manager: Sarah Ely Director of Sales & Corporate Relations: Jeffrey A. Casper Sales Manager: Tracy Hammond Advertising Assistant: Clark Collins
AOTA THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

VOLUME 17 ISSUE 16 SEPTEMBER 10, 2012
Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org

OT Practice External Advisory Board
p. 8
p. 14
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Donna Costa: Chairperson, Education Special Interest Section Michael J. Gerg: Chairperson, Work & Industry Special Interest Section Dottie Handley-More: Chairperson, Early Intervention & School Special Interest Section Kim Hartmann: Chairperson, Special Interest Sections Council Gavin Jenkins: Chairperson, Technology Special Interest Section Tracy Lynn Jirikowic: Chairperson, Developmental Disabilities Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Linda M. Olson: Chairperson, Mental Health Special Interest Section Regula Robnett: Chairperson, Gerontology Special Interest Section Tracy Van Oss: Chairperson, Home & Community Health Special Interest Section Jane Richardson Yousey: Chairperson, Administration & Management Special Interest Section
AOTA President: Florence Clark Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge Chief Professional Affairs Officer: Maureen Peterson
2012 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, Suite #200, Bethesda, MD 20814-3449; 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, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449. 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 the Copyright Clearance Center to reproduce or photocopy material appearing in this magazine. Direct all requests and inquiries regarding reprinting or photocopying material from OT Practice to www.copyright.com.
COVER ILLUSTRATION DON BISHOP / JUPITER IMAGES
FEATURES
Light the Way
Providing Effective Home Modifications for Clients With Low Vision
Bathroom Safety
Environmental Modifications to Enhance Bathing and Aging in Place in the Elderly
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Debra Young discusses how each client, as well as each home environment, has its own set of unique needs that requires a holistic and personalized approach.
Tracy Van Oss, Michael Rivers, Brianna Heighton, Cherie Macri, and Bernadette Reid describe a project that provided modifications in the bathroom, where falls often occur.
DEPARTMENTS
News Capital Briefing
Medicare Proposes Collecting Functional Data on Outpatient Therapy Claims for 2013
2 6
Calendar
Continuing Education Opportunities
22 28 32
Employment Opportunities Questions and Answers

Felipe Zamarron
Fieldwork Issues In the Clinic
Preparing Students for Ethical Practice
Occupational Therapy and Rebuilding Together: Working to Advance the Centennial Vision
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SPECIAL
Call for Nominations for 20 the 2013 AOTA General Election
Discuss OT Practice articles at www.OTConnections.org in the OT Practice Magazine Public Forum. Send e-mail regarding editorial content to otpractice@aota.org. Go to www.aota.org/otpractice 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 Practices 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 Practices 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, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to members@aota.org, or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTAs Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.
OT PRACTICE SEPTEMBER 10, 2012
News
Association updates...profession and industry news
AOTA News
to come. Occupational therapy provides irreplaceable skills to restore meaning in the lives of those who survive stroke through rehabilitation. As our aging population increases rapidly, your best practice skills become more urgent than ever. If you work with older adults, be sure to attend the AOTA Adults With Stroke Specialty Conference, November 30 to December 1 in Baltimore, Maryland. Take advantage of this special continuing education opportunity in comprehensive sessions from keynote speaker Carolyn Baum and other renowned speakers. Register now at www.AOTA.org/ ConfandEvents/Stroke. capwiz.com/aota, for additional information.
Chatham University (OTM), Pittsburgh, PennsylvaniaAccreditation Cincinnati State Technical and Community College (OTA), Cincinnati, OhioAccreditation Concordia University Wisconsin (OTM), Mequon, WisconsinAccreditation Gannon University (OTM), Erie, PennsylvaniaAccreditation Long Island University, Brooklyn Campus (OTM), Brooklyn, New YorkAccreditation Midwestern University (OTM), Downers Grove, Illinois, and Glendale, ArizonaAccreditation Milwaukee Area Technical College (OTA), Milwaukee, WisconsinAccreditation Oklahoma City Community College (OTA), Oklahoma City, OklahomaAccreditation Tennessee State University (OTM), Nashville, TennesseeProbationary Accreditation University of South Alabama (OTM), Mobile, AlabamaAccreditation Zane State College (OTA), Zanesville, OhioAccreditation Final ACOTE decisions subsequent to a review of a Progress Report: Lincoln College of New England (OTA), Southington, ConnecticutAccreditation (changed from Probationary Accreditation) Trident Technical College (OTA), Charleston, South Carolina Accreditation (changed from Probationary Accreditation) Final ACOTE decision subsequent to a request from the program to voluntarily withdraw from the accreditation process: Keuka College at Niagara County Community College (OTM), Sanborn, New York (Developing additional location of Keuka College, Keuka Park, New York) Developing Status Voluntarily Withdrawn Final ACOTE decision subsequent to a request from the program to be placed on inactive status: Sanford-Brown College (OTA), Hazelwood, Missouri AccreditationInactive Inactive Status: The status inactive does not replace any other current accreditation status. The designation follows the regular accreditation status (e.g., AccreditationInactive or
SEPTEMBER 10, 2012 WWW.AOTA.ORG
Last Call for SIS Nominations (Chairperson Positions)

eptember 15 is the final day to nominate the next chairperson of four Special Interest Sections (SISs): Education, Gerontology, Physical Disabilities, and Technology. The term of office is 3 years, beginning July 1, 2013. The chairperson coordinates the projects and activities of the Standing Committee, including the sections program(s) at AOTAs Annual Conference & Expo, SIS Internet activities, and the topics for the SIS Quarterly publication. The chairperson represents the SIS with all bodies of AOTA and is a member of the SIS Council. Each nominee will submit the information outlined in the SIS Chairperson Nomination Form (Attachment E of the SIS SOPs) to the Nominating Chairperson via e-mail. This form is available on the AOTA Web site in the Nominations and Election areas of the SIS section. Nominees may also request this form by contacting the SIS administrative assistant, Barbara Mendoza, at bmendoza@aota.org or 800-SAY-AOTA, ext. 2042. Selfnominations are welcome.
Register for the 2012 Student Conclave

ccupational therapy students and soon-to-be new practitioners can get a head start on a successful career by attending the 2012 AOTA/ NBCOT National Student Conclave, to be held from November 9 to 10 in Columbus, Ohio. The Conclave will provide attendees with evidence-based knowledge about current issues and emerging practice areas, exclusive opportunities to speak with leaders and experts, opportunities to meet with job recruiters and have rsums critiqued, and much more. Registration is now open. For more information, go to www.aota.org/confandevents/ conclave.
Hill Day Almost Here

heres still time to be part of the contingent of occupational therapy practitioners converging on Washington, DC, as part of AOTA Capitol Hill Day 2012 on September 24. If youre passionate about our profession, dont miss this chance to meet with elected officials to discuss key legislative issues affecting occupational therapy practice. By participating, you can help make a difference in the lives of your clients and for the profession. For more, visit www.aota. org/practitioners/advocacy/ hill-day-12. Even if you cant be there in person, you can help your colleagues coming to DC make the voice of occupational therapy heard on Capitol Hill. In concert with our in-person Hill Day activities, AOTA will be hosting a Virtual Hill Day to support our efforts on Capitol Hill on September 24. Visit AOTAs legislative action center, at http://
ACOTE August 2012 Accreditation Actions
he AOTA Accreditation Council for Occupational Therapy Education (ACOTE) met from August 2 to 5 and took the following accreditation actions:
Final ACOTE decisions subsequent to an initial on-site evaluation: Brown Mackie CollegeQuad Cities (OTA), Bettendorf, Iowa (additional location of Brown Mackie College Northern Kentucky)Accreditation Concorde Career InstituteMiramar (OTA), Miramar, Florida Accreditation Hawkeye Community College (OTA), Waterloo, IowaAccreditation Final ACOTE decisions subsequent to a re-accreditation on-site visit: Baker College of Muskegon (OTA), Muskegon, MichiganAccreditation Casper College (OTA), Casper, WyomingAccreditation
Adults With Stroke Specialty Conference
Earn up to 13 contact hours (1.3 CEUs/13 NBCOT PDUs)

n estimated 5.4 million people in America live with the disabling effects of stroke, and that number is bound to increase in the years
2
Probationary AccreditationInactive). Students graduating from a program with AccreditationInactive or Probationary AccreditationInactive status are considered graduates of an accredited program. A program may remain on inactive status for a maximum of 3 years depending on the accreditation term remaining. Final ACOTE decision subsequent to a review of a Significant Program Change: Mount Mary College (OTM), Milwaukee, WisconsinApproval of Curriculum Changes Stanbridge College (OTA), Irvine, CaliforniaApproval of a Part-Time Program Format University of Medicine and Dentistry of New Jersey (OTA), Scotch Plains, New JerseyApproval to add the following partner colleges in New Jersey to the consortium: Camden County College, Blackwood; Cumberland County College, Vineland; Hudson Community College, Jersey City; Ocean County College, Manahawkin; Raritan Valley Community College, Branchburg; and Thomas Edison State College, Trenton. Final ACOTE decision subsequent to a review of an initial Report of Self-Study (step 2 of the Initial Accreditation Process): Adventist University of Health Sciences (formerly Florida Hospital College of Health Sciences) (OTM), Orlando, FloridaLetter of Review Granted Arkansas Tech UniversityOzark Campus (OTA), Ozark, Arkansas Letter of Review Granted Chattahoochee Technical College (OTA), Austell, GeorgiaLetter of Review Granted Spokane Falls Community College (OTA), Spokane, Washington Letter of Review Deferred University of the Sciences (OTD), Philadelphia, PennsylvaniaLetter of Review Granted Weatherford College (OTA), Mineral Wells, TexasLetter of Review Deferred Letter of Review Granted: The proposed program would appear to meet the Standards if fully implemented in accordance with the plans of the sponsoring institution. An initial on-site evaluation will be conducted before an accreditation decision is made. Letter of Review Deferred: Information received from the program is incomplete and/or insufficient for evaluation. Supplementary information is requested for consideration at a subsequent ACOTE meeting. Developing Program Status Granted (Step 1 of the Initial Accreditation Process):
Brown Mackie CollegeBirmingham (OTA), Birmingham, AlabamaDeveloping Program Status Brown Mackie CollegeOklahoma City (OTA), Oklahoma City, OklahomaDeveloping Program Status Kaplan CollegeJacksonville (OTA), Jacksonville, FloridaDeveloping Program Status MGH Institute of Health Professions (OTD), Boston, Massachusetts Developing Program Status National American University Independence Campus (OTA), Independence, MissouriDeveloping Program Status Northern Virginia Community College (OTA), Springfield, Virginia Developing Program Status Remington College (OTA), Heathrow, FloridaDeveloping Program Status Developing Program Status Granted: The proposed program may now admit its first class of students according to the approved timeline and proceed to step 2 of the initial accreditation process (the initial review), which will be followed by step 3 (the initial on-site evaluation). Developing Program Status indicates that the program meets the requirements for Developing Program Status and the plans and resource allocations for the proposed program, if fully implemented, appear to demonstrate the ability to comply with the 2006 ACOTE Accreditation Standards. As of August 10, 2012, the number of programs in the accreditation process totaled 379. OT OT Doctoral Masters OTA TOTAL Accredited Programs 4 145 159 Programs With Developing Program Status 5 3 30 Applicant Programs 4 9 TOTAL 13 157 20 209 308
A O TA B u l l e T i N B O A r d
OUTSTANDING RESOURCES FROM
Occupational Therapy Home Modification: Promoting Safety and Supporting Participation

(SPCC) M. Christenson & C. Chase Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). his SPCC, which consists of text, exam packet, and a CDROM of hundreds of photographic and video resources, was created for occupational therapy professionals new to home modification. Those who have been practicing in this area will learn about the latest assessment tools and new assistive technology. Therapists who work with adults and those who work with children will find helpful guidelines and suggestions. $259 for members, $359 for nonmembers. Order #3029. http://store.aota.org/ view/?SKU=3029
Occupational Therapy Practice Guidelines for Home Modifications
C. Siebert he book provides a succinct overview of the occupational therapy process in home modification interventions. It defines processes within the boundaries of acceptable practice and describes occupational therapy contributions through evaluation, consultation, and training with clients. $59 for members, $84 for nonmembers. Order #1197C. http://store.aota.org/ view/?SKU=1197C
Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults
Low Vision: Occupational Therapy Evaluation and Intervention With Older Adults, Revised Edition
(ADEDAPPROVED SPCC) M. Warren Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). his revised edition provides occupational therapists and occupational therapy assistants with a continuing education resource that supports the AOTA SCLV certification process. It includes revisions, updates, new information on evaluation, and lessons related to psychosocial issues and low vision. $259 for members, $359 for nonmembers. Order #3025. http://store.aota.org/ view/?SKU=3025
Ready to order? Call 877-404-AOTA or go to http://store.aota.org Enter Promo Code BB
38 33 379
Additional information regarding occupational therapy accreditation may be obtained from the ACOTE Accreditation section of the AOTA Web page (www. acoteonline.org) or from AOTA accreditation staff at 301-652-6611, ext. 2914, or accred@aota.org.
N. Leland, S. J. Elliott, & K. Johnson o support productive aging and participation, preventive care models and strategies are needed to assist older adults in managing their chronic conditions and preventing illness and injury. These new guidelines help occupational therapists and occupational therapy assistants, as well as the individuals who manage, reimburse, or set policy regarding occupational therapy services, understand the contributions of occupational therapy in treating community-living older adults. $69 for members, $98 for nonmembers. Order #2220. http://store. aota.org/view/?SKU=2220
Take Advantage of AOTF Scholarship Opportunities

he American Occupational Therapy Foundation (AOTF) will offer more than 40 scholarships in the
Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.
Questions? Call 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555
c A p i TA l B r i e f i N g
T
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Medicare Proposes Collecting Functional Data on Outpatient Therapy Claims for 2013
Jennifer Hitchon
Table 1. Proposed Nonpayable G-Codes for Reporting Functional Limitations1
Functional limitation for primary functional limitation
GXXX1 GXXX2 GXXX3 GXXX4 GXXX5 GXXX6 GXXX7 Primary functional limitation Primary functional limitation Primary functional limitation Current status at initial treatment/episode outset and at reporting intervals Projected goal status Status at therapy discharge or end of reporting
he Middle Class Tax Relief and Job Creation Act of 2012 (H.R. 3630), passed by Congress and signed by President Obama on February 22, 2012, makes a number of changes to the Medicare Part B outpatient therapy landscape for the 2012 and 2013 calendar years. Among other things, the law mandated the collection of functional data on outpatient therapy claims beginning in 2013. Consequently, contained in the Centers for Medicare & Medicaid Services (CMS) CY 2013 Medicare Physician Fee Schedule Proposed Rule is a plan to collect additional data on therapy claims related to patient function during the course of therapy.1 Under the proposal, practitioners furnishing outpatient therapy services would be required to include new, nonpayable G-codes and modifiers on claim forms for therapy services. The G-codes would be used to identify what is being reported (current status, goal status, or discharge status; see Table 1), and a scale of 12 modifiers would indicate the percentage of functional change (see Table 2). CMS proposes a reporting frequency for G-codes and associated modifiers of once every 10 treatment days or at least once during every 30 calendar days, whichever time period is shorter (this is consistent with the Medicare Benefit Policy Manual guidelines). Reporting will begin on January 1, 2013, in accordance with the authorizing statute. The first 6 months would be a testing period under the proposed rule, which grants providers time to make the transition in their reporting systems. After July 1, 2013, CMS would not process any claims without the required G-codes and modifiers. The professionals required to report these data on the claim form include occu-
Functional limitation for a secondary functional limitation if one exists

Secondary functional limitation Current status at initial treatment/outset of therapy and at reporting intervals Secondary functional limitation Projected goal status Secondary functional limitation Status at therapy discharge or end of reporting Provider confirms functional reporting not required
Provider attestation that functional reporting not required
pational therapists; physical therapists; speech-language pathologists; physicians; and certain nonphysician professionals, such as physician assistants, nurse practitioners, and clinical nurse specialists. CMS plans to use the information collected to measure patient functional improvement and ultimately fundamentally reform the payment system for outpatient therapy. AOTA has serious concerns about this proposal. Although the plan could present opportunities to showcase the results of occupational therapy, we question the ability of such a system to gather the necessary information and are concerned about the provider outreach and education necessary to responsibly and accurately collect these data in the 2 months between the release of the final rule and the slated implementation date. In the weeks and months ahead, AOTA will continue to meet with both Medicare and our coalition partners to ensure that data collection requirements are reasonable and reflect the value of occupational therapy. Our comments were submitted September 4,
Table 2. Proposed Modifiers1

Modifier
XA XB XC XD XE XF XG XH XI XJ XK XL
Impairment Limitation Restriction Difficulty

0% Between 1%9% Between 10%19% Between 20%29% Between 30%39% Between 40%49% Between 50%59% Between 60%69% Between 79%79% Between 80%89% Between 90%99% 100%
2012, and CMS will release its final rule on or about November 1, 2012. We will share detailed information on our Web site as it becomes available. n
Jennifer Hitchon, JD, MHA, is AOTAs regulatory counsel. She can be reached at jhitchon@aota.org.
Reference
1. Centers for Medicare & Medicaid Services. 42 CFR Parts 410, 414, 415 et al. Federal Register, 77(142). Retrieved from http://www.gpo.gov/ fdsys/pkg/FR-2012-07-30/html/2012-16814.htm
Fieldwork issues
A
photograph Daniel leflor / istockphoto

Debra Hanson
reciprocity among participants. A total of 160 students completed the Defining Issues Test (DIT), (a measurement of the interconnected processes that comprise moral behavior, including moral sensitivity, moral judgment, moral motivation, and moral character)3 as freshman and sophomores in a liberal arts program and again as juniors, seniors, and graduates in a professional occupational therapy program. All of the students were enrolled in a professional program in which the topic of ethics was dispersed throughout the curriculum rather than taught in one identifiable course. Although there was an increase in the use of Post Conventional schema from the freshmen to the graduate level, the highest mean schema score at each educational level was in the Maintaining Norms category, suggesting that this was the preferred type of moral reasoning used to resolve ethical dilemmas. A two-way analysis of variance revealed no significant differences in Post Conventional mean scores for students enrolled in professional occupational therapy education. The findings suggested that without explicit attention given to education in ethics, occupational therapy education may prepare practitioners for moral reasoning using established rules or social norms, but fail to influence future practitioners to use universal principles to make moral decisions. In contrast, Geddes, Salvatori, and Eva found that directed attention to ethics in education can make a positive difference!4 They followed 10 groups of 155 occupational and 135 physical therapy students over continued on page 12
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re students prepared for the kinds of ethical dilemmas that they may encounter during fieldwork? What can be done to assist them in this process? Kinsella, Ji-Sun Park, Appiagyei, Chang, and Chow examined the nature of ethical tensions witnessed or experienced by occupational therapy students during fieldwork.1 Following a phenomenological approach, in-depth interviews were conducted with 25 occupational therapy students who had completed at least four fieldwork placements in diverse practice areas, such as physical health, psychiatry, neurology, hand therapy, physical/mental health, learning disability, and medicine/surgery/ orthopedics. Four themes emerged from the data: the prevalence of systemic constraints interfering with ethical practice, conflicting values, witnessing questionable behavior, and failure to speak up in regard to ethical events. Students were surprised at the prevalence of systemic constraints such as inadequate time for client intervention, insufficient staff, large caseloads, and lack of resources these realities ran counter to the vision of therapeutic practice they learned in school. Conflicting values between practitioners and clients, practitioners from different disciplines, and students and the supervising therapist was another theme; differences of opinion were particularly evident in discussions regarding client discharge planning. Students reported witnessing questionable behavior by other health care practitioners, including disrespectful attitudes toward clients, inappropriate language in reference to clients,
failure to communicate with clients, and breaches of confidentiality. Many students reported hesitating to speak up in regard to ethical tensions, particularly in the areas of protecting client rights, facilitating independence, and ensuring safety of clients. This occurred both in the context of their relationship with their supervisor and with members of the treatment team. The authors advocated for ethics education that considers both clinical practice and public health care policy. They recommended that future practitioners have the opportunity to identify and reflect on ethical tensions in order to gain competence for situations requiring advocacy, interprofessional dialogue, and moral courage. Can education make a difference? Penny and You investigated the types of moral reasoning used by occupational therapy students at various points in the educational process.2 They considered three schema for moral reasoning: (1) Personal Interest schema, in which rules are followed to gain prestige or avoid negative consequences; (2) Maintaining Norms schema, in which rules are used to justify actions and maintain social order; and (3) Post Conventional schema, in which moral reasoning makes use of universal ideals and involves full
Light the Way

Providing Effective Home Modifications for Clients With Low Vision
Each client, as well as each home environment, has its own set of unique needs that requires a holistic and personalized approach.
DEBRA YOUNG
s the population continues to age, eye diseases like macular degeneration, glaucoma, and diabetic retinopathy, among many others, continue to affect older adults performance of activities of daily living. A recent study completed by Northwestern Universitys Department of Medicine reported that although data taken from 1984 to 2010 show visual impairment in those 65 and older is on the decline, 9.7% of older adults continue to report a visual problem that affects everyday life.1 Age-related macular degeneration is the leading cause of blindness and visual impairment among people aged 65 and older. Macular degeneration affects more than 1.75 million individuals in the United States, and this number is expected to increase to almost 3 million by 2020 due to the rapid aging of the U.S. population.2 The rate of visual impairment increases with age, with 15% of individuals aged 45 to 64 years, 17% of those 65 to 74 years, and 26% of those over the age of 75 reporting some form of visual impairment.35 Home modifications cover a large spectrum, meeting the needs of those with illness, injury, and/or disability as well as those who are healthy and
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desire to age in place safely. Each client, as well as each home environment, has its own set of unique needs that requires a holistic and personalized approach. Home/environmental modifications for low vision are no exception.
CONSIDER THE LIGHT

The first consideration in a home modifications assessment for a person with low vision is lighting. Most of what we know of our world comes to us through our eyes, and we have learned that the way we see things depends on how they are lighted.67 There are three main categories of light to consider in a space: task lighting, which illuminates specific areas where work is being performed; accent lighting, which is light added to provide extra attention to a selected area within the space; and ambient or space lighting, which is the overall lighting that defines the whole area. But how do you know there is enough light in the room for safely performing functional tasks? Appropriate light levels depend on the type of activity and the environment for which the activity is to be completed. According to the Illuminating Engineering Society of North America (IESNA) Lighting Handbook, ambient light levels should be at least
30 footcandles (fc; or 300 lux) and task lighting levels should be at least 100fc (or 1,000 lux).8 Along with these two general guidelines, there are specific light level guidelines for different spaces within the home as well. Consider using a light meter when you are completing any home assessment, and definitely use one when completing a home assessment for a person with any vision concerns. Light meters can be purchased at hardware and home supply stores. Although lighting guidelines are important, always consider your clients specific needs. Using a light meter combined with the IESNA standards is a good starting point, but lighting needs are unique to each individual and for each space. Providing 100fc of light for one client with low vision may be just right; for another client, it may be too much light and/or cause too much glare. Either insufficient or intense lighting may be problematic depending on the clients specific type of vision loss. Also important to consider is the change of the natural lighting throughout the day and how this affects the clients movement within the home from one room to the next. Whether the building or house faces north, south, east, or west, and how much sun
ILLUSTRATION DON BISHOP / JUPITER IMAGES
The author uses a light meter during an assessment.
exposure the home receives throughout the day, may change the light levels within the space. Consideration must be given for controlling the changing light levels throughout the home to help the eyes adjust to these transitions by filtering and/or shielding light coming into rooms and into the users eyes. These light transitions include changing from dark to very bright and/or for when previously light areas become much darker throughout the day. This can be accomplished using blinds or shades that the client would manually open or close as desired, although this scenario requires that the client actively transition into the space with either low or intense light to adjust the blind or shade accordingly. A high-tech option is a lighting control system that automates the opening and closing of shades and/or turning on and off lights set to a certain light level via a timer or schedule to adjust natural daylight, manage glare, and maintain even light transitions throughout the home. DimOT PRACTICE SEPTEMBER 10, 2012
mer switches can also help control the amount of light in each space.
TYPES OF LIGHT
Along with determining the amount of light, find out what type of light best meets your clients needs. This ideal level may not be what the client is currently using within the home. Determining clients preferences for incandescent, fluorescent, halogen, LED, etc. is imperative to increasing comfort and safe navigation throughout the home, as well as providing appropriate light to complete functional tasks. In addition, understand the differentiating characteristics of each type of lampbulb. This knowledge includes the correlated color temperature (a description of the color appearance of a light source, measured on the Kelvin scale) as well as the color-rendering index (a method for describing the effect of a light source on the color appearance of objects being illuminated) for each type of lamp and how these characteristics affect how
your clients see in their home environment.9 Determining the type of light that best meets your clients needs is a trial-and-error process and, if feasible, should be done for both ambient as well as task lighting during the completion of a functional activity. Your clients will determine which light source provides the best illumination, most contrast, minimal glare, and overall comfort for their eyes. The color-rendering index is especially important because many clients with low vision have difficulty distinguishing certain colors. We know that as we age we need more light; it has been estimated that the typical 60 year old needs three times as much light as a 20 year old to properly distinguish color and contrast in a given target.4 The typical aging process diminishes the pupil size, allowing less light into the eye. There is also a thickening of the lens, which decreases the amount of light that reaches the retina. These age-related changes, combined with a low vision diagnosis (especially macular degeneration, as this affects the cone cells of the eyethe ones that detect detail, color, and contrast) are sure to affect how clients perceive color and contrast and can compromise safety.
BALANCE LIGHT LEVELS

After you have determined the amount and type of light, evaluating the uniformity of light is of equal importance. Ensure that the light levels are balanced throughout rooms and the home. As we age, our visual systems cannot completely adapt to dim conditions. Light levels in transitional spaces such as hallways and entrance foyers should be balanced with those of the adjacent spaces. Create intermediate light levels in transitional spaces that lead from bright to dim areas.7 This will enable your clients with low vision to adapt more completely as they move through the different spaces. Uniformity of light on stairways increases safety and decreases falls
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PHOTOGRAPH COURTESY Of THE AUTHOR
risk. Light levels on the stairs should be at least as high as in adjacent areas in the home. The lighting should make the tread nosings (the horizontally projecting edge of a stair tread) visible and not cause any glare or shadows. Light switches at each point of stairway access are also recommended.10 Many great new products on the market can help illuminate the not-sotypical spaces within the home. These products include under-cabinet lights, backlit cabinets, LED rope and string pathway lighting, lighted closet rods, lighted toilet seats, and even lighted glass countertops and shelving. Part of the evaluation process is taking the time to analyze available products and then matching their features to clients current and potential future needs. There are many variables to consider when recommending a product, including usability, safety, ease of maintenance, aesthetics, and price. Always consider the products flexibility of use to ensure that it can be used by clients with their current vision and potential future vision changes.
occurs even when the client has had an appropriate amount of time to adapt to the ambient lighting. Using blinds, shades, and/or sheers to help filter light as it comes into the room, as well as rearranging the furniture or sitting with your back to the sun, are always good options to minimize glare coming into a space from outside. Also, for task lighting, positioning the lamp over your shoulder on the side with the better eye, so that the light falls only on what you are doing, helps to reduce glare. However, the goal is to minimize the glare but not decrease the light level in the space. Take care to maintain an appropriate amount of light that meets the needs of your clients. Having more than one lamp in a room to create evenly distributed light throughout the space, versus one source of light in one area of a room, will help decrease glare and provide a more uniform, balanced light level.
CONTRAST AND GLARE FILTERS

Top: Unbalanced light in a hallway. Above: Various colors of glare filters.
UNDERSTANDING GLARE
The IESNA defines glare as one of two conditions: too much light and/or excessive contrast, meaning the range of luminance in the field of view is too great. Glare sensitivity is associated with the aging eye as well as with many eye diseases that cause low vision. But what exactly is glare? Glare is a visual sensation caused by excessive and uncontrolled brightness.11 Glare is caused by stray or scattered light that raises the visual brightness (or luminance) of both the visual target and the background to the same levels. It can cause visual discomfort and/or be disabling. When the eye is exposed to glare, the pupils constrict and limit the amount of light transmitted to the retina, limiting the image that the eye perceives. This forms a veil of luminance, which reduces the contrast and visibility of the target. It is important to know the different types of glare in order to determine how they can be managed within the home as well as just outside the home environment. According to Ludt, there are three types of glare to consider with regard to clients with low vision.12
10
Discomfort glare occurs when light reaches a level of intensity at which the eye is unable to adapt naturally, resulting in true eye discomfort and reduced ability to see. Discomfort glare is caused by everyday bright light. This can even occur on a cloudy day, causing squinting and eye fatigue, as the ultraviolet light still penetrates through the clouds on the cloudiest of winter days. Veiling glare (or disabling glare) is caused by excessive intense light that blocks visionthe eyes ability to adapt is exceeded, and the ability to discern detail is significantly compromised. Eye discomfort becomes significant, and vision can be impaired. An example of veiling glare is the shining of headlights or a flashlight in your eyes, or even the bright reflection of the sun off of water or the hood of a car on a sunny day, reflecting into your eyes and temporarily blocking your vision. Dazzling glare is the abnormal visual sensitivity to the intensity of ambient light, typically caused by the dysfunction of the iris and retinal disease. This type of glare
If clients continue to have concerns with glare even after minimizing it from outside and inside, contrast and glare filters may help. These filters are available in virtually all colors. Each client will have a specific individual preference for which color filter best minimizes glare and enhances contrast. Therefore, try a range of color tints to assist the client in determining which filter works best for both indoor and outdoor glare conditions. Traditional sunglasses may not provide the correct filtering and will only provide protection from light directly in front of the eye. The filters should wrap around the face, providing glare protection laterally as well as overhead. When outside, a visor or a hat with a wide brim also provides protection from overhead glare. To further minimize glare within the home, forego using materials that create a glossy surface. Opt for matte style paints, carpet, and/or unpolished tiles. Pay attention to the placement of picture frames and mirrors in the home, especially within the bathroom, so lighting does not reflect off of them and create added glare. According to the American Foundation for the Blind, contrast sensitivity refers to the ability to detect differSEPTEMBER 10, 2012 WWW.AOTA.ORG
PHOTOGRAPHS COURTESY Of THE AUTHOR
ences between light and dark areas.13 Therefore, by increasing the contrast between an object and its background, the object will be more visible. Using contrast is key to maximizing independence within the home for persons with low vision, although it is important to consider what colors create the most amount of contrast for clients, as it may not always be as clear as black and white. Some ideas for creating contrast within the home include painting door frames in colors that contrast with the colors of the doors, and creating contrast between the floor and the walls and between the furniture and the flooring. This will increase visibility for navigation within the home and decrease falls risk. Providing a con-
F
n n n n
Falls Prevention Awareness Day 2012

alls Prevention Awareness Day is September 22 (the first day of fall). The following are some ways that occupational therapy practitioners can let others know about their role in this area: Write a brief article for your local paper describing some of the ways in which practitioners help prevent falls, providing tips for readers on what to be aware of and how to make their own environments safer. Pitch a story to local TV news organizations offering to demonstrate an in-home assessment to prevent falls. Provide a free workshop to members of your community. Many libraries, places of worship, senior centers, and community centers provide free space for educational programs. Work with other staff members (e.g., physical therapists, nurses) to develop or bring a fall prevention program to your facility as a community service or part of patient services. Offer to do a show-and- tell presentation of products and equipment to prevent falls at your local hardware or home store using products that can be bought there. Post information on your Facebook page, Twitter feed, Pinterest page, or other social media venues. Describe how occupational therapy can help and link to resources. Visit www.ncoa.org/improve-health/center-for-healthy-aging/falls-prevention/fallsprevention-awareness.html for more information on organizing and participating in local events for Falls Prevention Awareness Day.
n n n
PHOTOGRAPH fANCY IMAGES / fOTOSEARCH
trasting edge on countertops and tables will decrease the chance of clients dropping items on the floor during meal prep and dining as well as accidentally bumping into corners and edges. Also consider using color switches and outlets that contrast with their covers as well as with the adjacent walls to maximize visibility. With stairways, consider marking landings and/or nosings of stair treads with highly contrasting colors, preferably with paint or stain, because tape can pull up and become, a falls risk. Lighting can also be used to enhance contrast.
TExTURE CHANGES
Contrast is not always in color; it can be in texture changes as well. This can be done by having a change of floor texture when navigating from one room to another. This change should not be so severe as to create a falls risk. As
with all recommendations, texture changes should be individual specific; changing floor textures may be contraindicated for some clients if there is a chance it can create a falls risk. Another texture contrast option is placing a tactile cue at the edge of a handrail to alert clients that they have reached the top and bottom steps. Both visual and tactile texture cues can be used to distinguish surfaces on hand rails and any placed grab bars. Another consideration is what kind of glasses your clients wear. Are they bifocals (including progressives), trifocals, or single vision lenses (near or distance vision only)? Research shows increased falls when wearing bifocals and walking down a stairway, due to looking through the bottom portion (near view) of the lens versus maintaining line of sight through the top (distance) portion.14 This risk will also occur when clients are looking at their feet while walking down a stairway. One option is to have two pairs of glasses, one for near vision and one for distance, to eliminate this concern on a stairway. However, this recommenda-
tion is very client specific. Changing from one set of glasses to two brings a host of potential new issues, including forgetting where the other pair is, having to change glasses throughout the day to manage different tasks (e.g., taking a break from reading to stand up and walk to the bathroom), and paying for two sets of spectacles. Creating a dialogue with clients to increase their awareness of these concerns and determine their preferences is the foundation of client-based practice.
CONSIDER CLIENT ROUTINES

Most of us have a very specific traffic pattern within our homes. A place for everything, and everything in its place, as the saying goes, and our clients with low vision are no exception; they rely heavily on the familiar. Reflect on the changes you are recommending to clients homes and consider how they may affect navigation and safety. One option, as appropriate, is to place handrails along the hallways and/or frequently used pathways to act as a guide and maximize safety. To maintain clear pathways, remove clutter, unsecured throw rugs, and any other dcor or furniture that may interfere with functional mobility. Obstacles include hanging dcor, the undersides of open stairways, and other
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FOR MORE INFORMATION

AOTA/CDC Falls Prevention Project www.aota.org/falls AOTA Online Course Low Vision in Older Adults: Foundations for Rehabilitation By R. Cole, G. Rovins, & A. Schonfeld, 2005. Bethesda, MD: American Occupational Therapy Association. (Earn .8 AOTA CEU [8 NBCOT PDUs/8 contact hours]. $158 for members, $225 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=OL28. Order #OL28. Promo code MI) AOTA Self-Paced Clinical Course Low Vision: Occupational Therapy Evaluation and Intervention With Older Adults, Revised Edition By M. Warren, 2008. Bethesda, MD: American Occupational Therapy Association. (Earn 2 AOTA CEUs [25 NBCOT PDUs/20 contact hours]. $259 for members, $359 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store. aota.org/view/?SKU=3025. Order #3025. Promo code MI) AOTA Self-Paced Clinical Course Occupational Therapy and Home Modifications: Promoting Safety and Supporting Participation Edited by M. Christenson & C. Chase, 2011. Bethesda, MD: American Occupational Therapy Association. (Earn 2 AOTA CEUs [25 NBCOT PDUs, 20 contact hours]. $259 for members, $359 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=3029. Order #3029. Promo code MI) Occupational Therapy Interventions for Adults With Low Vision By M. Warren & E. A. Barstow, 2011. Bethesda, MD: AOTA Press. ($89 for members, $126 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=1252. Order #1252. Promo code MI) Occupational Therapy Practice Guidelines for Home Modifications By C. Siebert, 2005. Bethesda, MD: AOTA Press ($59 for members, $84 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1197C. Order #1197C. Promo code MI) Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults By N. Leland, S. J. Elliott, & K. Johnson, 2012. Bethesda, MD: AOTA Press. ($69 for members, $98 for nonmembers. To order, call toll free 877404-AOTA or shop online at http://store.aota.org/ view/?SKU=2220. Order #2220. Promo code MI)
FIELDWORK ISSUES
continued from page 7 6 years of attending McMaster University in Ontario, Canada. The program of study was based on the pedagogical framework of problem-based learning, incorporating small group and case-based study with substantial development of the ethics content in the coursework. Students completed the DIT within 1 month of entry into the professional occupational therapy or physical therapy program and during the final academic term. In this study, the moral reasoning of students in both the occupational therapy and physical therapy programs significantly improved over time spent in the professional program (P<0.001). No differences were found in scores across gender, program of study, year of entry, or previous education, suggesting that differences were due to the quality of the educational program provided. The findings suggested that directed attention to contextual learning in ethics education, which can be accomplished in both the academic and fieldwork components of the curriculum, can help prepare new practitioners for the ethical dilemmas they may encounter as health care professionals. n
CONNECTIONS
Discuss this and other articles on the OT Practice Magazine public forum at http://www.OTConnections.org.
tripping hazards such as pet beds or shoes left near doorways. Client involvement throughout the process is key to successful home modification. n References
1. Tanna, A. P., & Kaye, H. S. (in press). Trends in self-reported visual impairment in the United States: 1984 to 2010. Ophthalmology. doi:10.1016/j.ophtha.2012.04.018 2. Centers for Disease Control and Prevention. (2009) Common eye disorders. Retrieved from http://www.cdc.gov/visionhealth/basic_informa tion/eye_disorders.htm#3 3. American Occupational Therapy Association. (2010). Low vision FAQ. Retrieved from http:// www.aota.org/Practitioners-Section/ProductiveAging/FAQ/LV-FAQs.aspx 4. Leonard, R. (2002). Statistics on vision impairment: A resource manual (5th ed.). New York: Lighthouse International. 5. Prevent Blindness America. (2008). Vision problems in the U.S: Prevalence of adult vision impairment and age-related eye disease in America. Retrieved from http://www.preventblindness.net/site/DocServer/VPUS_2008_ update.pdf 6. Illuminating Engineering Society of North America. (2003). Light in design: An application guide. Retrieved from http://www.iesna.org/ PDF/Education/LightInDesign.pdf 7. Figueiro, M. G. (2001). Lighting the way: A key to independence. Retrieved from http://www.lrc. rpi.edu/programs/lightHealth/AARP/index.asp 8. Illumination Engineering Society of North America. (1998). IESNA guide for choosing light
9.
10.
11.
12.
13.
14.
sources for general lighting. Report DG-10-98. New York: Author. Lighting Research Center. (2004). Light sources and color. Retrieved from http://www.lrc.rpi. edu/programs/nlpip/lightinganswers/lightsources/ abstract.asp Pauls, J. (2011). Checklist for home stairways. Retrieved from http://www.stairusabilityandsafety. com/downloads/downloads_for_webpage/Check list-HomeStairways.pdf Lighting Research Center. (2007). What is glare? Retrieved from http://www.lrc.rpi.edu/programs/ NLPIP/lightingAnswers/lightPollution/glare.asp Ludt, R. (1997). Three types of glare: Low vision O&M assessment and remediation. RE:view, 29, 101113. American Foundation for the Blind. (2012). Contrast and color. Retrieved http://www.vision aware.org/section.aspx?FolderID=8&SectionID= 121&DocumentID=3240 Haran, M. J., Cameron, I. D., Ivers, R. Q., Simpson, J. M., Lee, B. B., Tanzer, M.,Lord, S. R. (2010). Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. British Medical Journal, 340, c2265. doi:10.1136/bmj.c2265
References
1. Kinsella, E., Ji-Sun Park, A., Appiagyei, J., Chang, E., & Chow, D. (2008). Through the eyes of students: Ethical tensions in occupational therapy practice. Canadian Journal of Occupational Therapy, 75(3), 176182. 2. Penny, N.H., & You, D. (2011). Preparing occupational therapy students to make moral decisions. Occupational Therapy in Health Care, 25(23), 150163. 3. Rest, J. (1979). Development in judging moral issues. Minneapolis, MN: University of Minnesota Press. 4. Geddes, E., Salvatori, P., & Eva, K. (2008). Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training? Learning in Health and Social Care, 8(2), 92102. Debra Hanson, PhD, OTR/L, is the academic fieldwork coordinator at the University of North Dakota, which has campuses in Grand Forks, North Dakota; and Casper, Wyoming. Hanson has more than 20 years of experience working with fieldwork educators and students. She is the academic fieldwork coordinator representative for AOTAs Commission on Education.
Debra Young, MEd, OTR/L, SCEM, ATP, CAPS, is the founder of EmpowerAbility, in Newark, Delaware, which provides accessibility services to builders, remodelers, architects, and designers, as well as other professionals and consumers. She has 17 years of clinical experience, working in hospital, educational, and community settings as an occupational therapy and assistive technology consultant.
12
TRACY VAN OSS
MICHAEL RIVERS CHERIE MACRI
BRIANNA HEIGHTON BERNADETTE REID
Bathroom Safety
Environmental Modifications to Enhance Bathing and Aging in Place in the Elderly
he Centers for Disease Control and Prevention (CDC) estimated that by 2020, the medical costs for falls for adults 65 years of age and older will be greater than $54.9 billion each year.1 The chance of falling among older adults increases to 40% after the age of 80.2 Two thirds of adults over the age of 65 who fall will then have another incident within 6 months of their first fall.3 Six out of 10 falls will occur in the home environment, most of which involve environmental hazards.4 Falls occur most commonly in the bathroom, often due to unsuitable toilet height or the absence of grab bars and mats on the floor of the bathtub or shower.56 Occupational therapy practitioners can play a pivotal role in helping older adults age in place, including through recommendations and training in the use of environmental modifications. The authors define environmental modification to include anything that has been added to an environment to assist people with participating in activities and occupations. Environmental modifications can enhance safety for aging persons with or without chronic health conditions to maintain or improve function and increase overall independence. Ahluwalia et al. indicated the need for more clientcentered interventions because of the varied attitudes older adults may have toward bathing and the need for individualized bathing interventions specific to preferences of each patient.7 This client-centered focus in turn
14
Helping older adults age in place includes recommendations for environmental modifications in the bathroom, where falls most commonly occur.
can lessen occupational performance disruption by enhancing the performance capabilities through personalized assessment and intervention. Occupational therapy practitioners are uniquely educated to emphasize the appropriate individualized fit between clients abilities and the environment in which they live to safely engage in chosen occupations.
REDUCING PHYSICAL BARRIERS IN THE HOME

As our population ages, it is important to investigate new strategies to reduce physical barriers in the home environment. Aging in place and preventing relocation from their homes are important goals for most older persons.8 Goals of aging in place include enhancing the quality of life for older adults in their home environment by making the necessary modifications for them to participate in valued activities.9 According to the AARP/Roper Public Affairs and Media Group, in 2005, 91% of adults between the ages of 65 and 74, and 95% of adults over the age of 75, reported that they would prefer to age in place for as long as possible.10 In addition to aging in place, older adults have expressed that they would like to be as safe, independent, productive,
and integrated into the community as possible.10 However, as people age, limitations in physical and cognitive abilities increase their need for social, medical, and environmental supports. The physical environment directly impacts older adults functional abilities, safety, and productivity. Environmental modifications, particularly in the bathroom, are needed to provide physical support to maintain independence in the home.
PROJECT PURPOSE
Naik and Gill showed that bathroom modifications were being underutilized and in some cases were absent in older adults homes.5 The purpose of the authors graduate capstone project at Quinnipiac University in Hamden, Connecticut, was to evaluate the bathroom environments of four older adults residing in an independent living community, provide free adaptations and modifications to enhance performance and safety, and follow up to determine which modifications were most effective. Students were supervised by an occupational therapist during the home visits, which included training in use of new equipment or modifications. Between January and March 2012, four older adults volunteered to particiSEPTEMBER 10, 2012 WWW.AOTA.ORG
PHOTOGRAPH JAZZIRT / ISTOCkPHOTO
pate in a client-centered study to identify potential home modifications that may decrease risk of injury in the home bathroom environment. All participants were 65 years of age or older, able to follow multi-step commands, and able to bathe without assistance. Exclusion criteria included persons already receiving occupational therapy services for the purpose of environmental modification or those who already used more than four pieces of adaptive equipment in the bathroom. One occupational therapy student researcher was paired with one study participant throughout the entire 2-month process in the clients home. Data were collected through the use of informal interview; Functional Reach Test12; a modified version of the I-Hope to include sections related to the bathroom13; the TVO bathroom assessment, developed by lead author Tracy Van Oss; the Mini Mental Status Examination (MMSE)14; and followup participant surveys. Occupational therapy student researchers developed a 13-item information questionnaire to gather relevant demographic data, daily bathroom routines/occupations, and past medical history. The Functional Reach was used to assess balance, safety, and possible influences on bathroom performance. A modified version of the I-Hope was used to determine areas in the bathroom routine that may have been causing the participant difficulty as well as satisfaction and performance within these noted areas. The TVO bathroom assessment was conducted to determine physical contexts
of the bathroom, including accessibility, environmental barriers, and general safety of the space. The MMSE was used to determine cognitive functioning of the participants, including orientation, attention, memory, comprehension, and perception. Follow-up surveys using a 5-point Likert scale were administered to gather information about usefulness, satisfaction, and frequency of use of equipment provided to Occupational therapy and nursing students and a participant the participants immediin the project. Equipment was ordered and installed at no cost to participants using a grant from Quinnipiac Universitys ately and 1 month after Center for Interprofessional Healthcare Education. the modifications were put in place, and traincontinued along in their traditional ing on appropriate and safe usage was clinical experience. The other four provided by the occupational therapy nursing students accompanied the student, to determine whether the occupational therapy students on their modifications created a lasting effect. initial home visits with older adults to The occupational therapy students acquire an understanding of the role were teamed with eight senior nursof occupational therapy in this context ing students from the same institution. as well as to provide input for compreThis was structured as a secondary hensive care. Results from the pre- and purpose to promote understanding of posttest surveys of all eight students occupational therapy among nursing showed that the four nursing students students. Pre-planning was required for who interacted with the occupational scheduling to provide an interprofestherapy students on a weekly basis sional collaboration. A nine-question increased their overall perception survey was administered as a preof the occupational therapy practice and posttest to evaluate the nursing domain. A $2,000 grant ($500 for each students knowledge of occupational study participant) from Quinnipiac therapy services. Four of the students Universitys Center for Interprofeswere randomly selected to participate sional Healthcare Education funded the in the control group and did not experiproject for recommended environmenence working with an occupational tal modifications. therapy student on the project, but
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PHOTOGRAPHS : TOP LEfT, SCIMAT SCIMAT/GETTY; TOP RIGHT, LISA f. YOUNG/ISTOCkPHOTO; BOTTOM, COURTESY Of THE AUTHORS
iN The cliNic
Occupational Therapy and Rebuilding Together
w
PHOTOGRAPH COURTESY PAM HEwITT
Working to Advance the Centennial Vision

Claudia E. Oakes Cathy Leslie
and unskilled workers, a tremendous amount of effort goes into ensuring a successfulNational Rebuilding Day. RTs Safe at Home Initiative strives to improve the safety and accessibility of homes, making the organization a natural fit for involvement by occupational therapy practitioners. Currently, there are occupational therapy practitioners working with approximately 50 affiliates.
hen most Americans envision where they will live out their senior years, they usually picture their current home. However, as people age, their homes may no longer support participation in occupations and, in fact, may become barriers that inhibit participation. Making the necessary home repairs and modifications can be expensive and time-consuming. For low-income homeowners, this burden can be overwhelming. Fortunately, nonprofit organizations such as Rebuilding Together work to help low-income, disabled, and intergenerational families age in place by providing free repairs and home modifications. Occupational
therapy practitioners and students can contribute knowledge and insight because of their appreciation of the relationship between a person, the environment, and the occupations in which the person engages. By volunteering, practitioners and students directly help people in their communities while also promoting the role of occupational therapy to the public. This presents a unique opportunity to enact the Centennial Vision by linking education, research, and practice and making the role of occupational therapy visible to the public.1
HOW CAN PRACTITIONERS CONTRIBUTE TO RT?

Occupational therapy practitioners can be involved with RT in a variety of ways. First, practitioners can complete home assessments and make recommendations for modifications that will enhance the safety and function of homeowners. Additionally, they can assist with the house selection process. House selection refers to the steps involved in determining which applicants will be chosen for National Rebuilding Day or other projects throughout the year. Members of RTs House Selection committee take into consideration a prioritized list of recommendations that practitioners believe will support homeowners safety and function. After houses have been selected, practitioners can work with the house captains (the project managers assigned to each home) to clarify the occupational therapy recommendations. At some affiliates, practitioners participate in training groups of house captains to ensure that they adequately understand the role of occupational therapy and the recommendations that are provided.
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WHAT IS REBUILDING TOGETHER?

Rebuilding Together (RT) is a nonprofit organization that provides free home repairs and home modifications to low-income homeowners. There are nearly 200 affiliates of RT across the country. Although many affiliates do year-round projects, the cornerstone of the organization has been National Rebuilding Day, a 1-day event, typically held on the last Saturday in April, in which volunteers come together to perform home modifications and repairs on multiple houses. Although National Rebuilding Day receives the most media attention, the behindthe-scenes work occurs all year. From selecting the houses to evaluating the needs of each homeowner, ordering supplies, and coordinating skilled
In other affiliates, practitioners work one on one with house captains to address the needs of specific homeowners. Practitioners may be instrumental in negotiating reduced rates on adaptive equipment that is provided for projects. On the actual National Rebuilding Day, practitioners fulfill a variety of roles, from assisting with clutter management to troubleshooting when issues arise regarding grab bar installation or other recommendations. Practitioners can also play an important role in collecting data related to the outcome of interventions.
WHY ASSESS OUTCOMES?

Outcomes are important to measure not just to ensure that homeowners are getting the best possible interventions, but also to ensure that RT is spending resources on interventions that are most beneficial to the homeowners. Nonprofit organizations have limited resources and must ensure that they are providing the most cost-effective and valuable services possible. Additionally, nonprofit organizations such as RT depend on funding from foundations and charitable-giving organizations. Many grant funders demand evidence that interventions are effective, and outcome studies are a requirement for grant reporting. Additionally, having established outcome processes can open the door for new funding opportunities. Assessing outcomes is also necessary for the profession of occupational therapy.2 Although there is emerging research related to the effectiveness of home modifications, there is still much to learn.3 Outcomes research provides the evidence so that the best practices related to home modifications can be operationalized and disseminated.
and after intervention could prove useful. The Modified Falls Efficacy Scale is a 14-item tool that asks clients to rate their fear of falling while completing everyday activities on a 1 to 10 Likert scale.5 Additionally, there are logistical issues to consider when completing outcomes research. These include: n Who should measure the outcome? Should it be an occupational therapist or a volunteer or staff member of RT? The expectation of what can reasonably be assessed differs considerably depending on who is collecting the data. n How long after modifications are installed should the outcomes be assessed? What is a reasonable amount of time for homeowners to get a sense of how the modifications are having an impact on their performance? n Will the data be collected during a face-to-face interview with the homeowner or through a mail-in survey or phone interview? n Does the assessment need to include observation of occupational performance or can it rely on self-report?
CASE ExAMPLE
f O r M O r e i N f O r M AT i O N
To locate a Rebuilding Together affiliate in your area, search the RT Web site at www.rebuildingtogether.org or call the Rebuilding Together National Office at 800-473-4229.Additional information, including detailed information about setting up a Level I Fieldwork experience for students, is available in the Rebuilding Together section of the AOTA Web site at www.aota.org/practitioners/awareness.
MEASUREMENT ISSUES
A critical issue regarding home modifications for older adults is what to measure in order to show the effectiveness of the modifications. There is no single answer to this question and many factors must be taken into consideration. One potential starting place is to learn about the frequency with which the homeowners use the modifications, and their satisfaction with them. Additionally, an assessment of homeowners perceptions of safety, independence, or function may be useful.
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Because most of the homeowners are functioning relatively independently at home, a standardized assessment of activities of daily living (ADL) may lack the sensitivity to detect change. Assessments of higher-demand instrumental ADL (IADL) function may more accurately reflect improvements. Because many RT efforts are geared at fall prevention, falls are a potential area of exploration. Collecting data about actual incidence of falls is notoriously difficult.4 Data about fear of falling before
Cathy Leslie, MOTR/L, completed a research study while she was a graduate student in the occupational therapy program at Bay Path College in Longmeadow, Massachusetts. She worked with the Hartford affiliate of RT to complete her research, under the supervision of Claudia Oakes, PhD, OTR/L, and Karen Sladyk, PhD, OTR/L. Her study attempted to answer the following questions: Does the provision of home modifications in the bathrooms of older adults improve their occupational performance during the ADLs of toileting and bathing? In what ways did the provisions of home modifications improve homeowners occupational performance during toileting and bathing? To answer these questions, Leslie completed face-to-face interviews in the homes of nine of the 11 homeowners who received grab bars in April 2009. (Two of the recipients were unavailable by mail or phone.) Interviews were conducted between 8 and 9 months after the installation. Of the eight participants who received grab bars in or around the shower area, 75% said they used the grab bars all of
PHOTOGRAPHS COURTESY Of CLAUDIA OAkES
CALL FOR
Nominations
FOR THE 2013 AOTA GENERAL ELECTION
October 22, 2012, by 5:00 PM EST: Deadline for Receipt of Nominations
T
n n n n n
he American Occupational Therapy Association (AOTA) Nominating Committee invites AOTA members to consider and submit nominations of Association members for the following Association leadership positions to be elected in 2013: Secretary 2 Directors (at least one must be an occupational therapy assistant) Commission on Practice ChairpersonElect Commission on Continuing Competence and Professional Development Chairperson-Elect Special Interest Section Council Chairperson-Elect
SPECIFIC ELIGIBILITY CRITERIA BY POSITION SECRETARY

n
To determine whether you or your colleagues are qualified to enter the nominations process for these positions, please review the specific criteria below and those detailed in the Standard Operating Procedure (SOP) or Job Description (JD) for each office, which are posted on AOTAs Web site at www.aota.org under Get Involved/ Governance.
Minimum of 10 years as an occupational therapist (OT) or occupational therapy assistant (OTA). Minimum of 8 years of multiple roles with progressive occupational therapy leadership responsibilities in state, national, or international organizations, or established occupational therapy networks. Evidence of strong listening and recording skills, ability to use a computer, and document management skills. Knowledge of parliamentary procedures. Strong organizational skills. Ability to effectively deliver both oral and written reports. Evidence of willingness to devote considerable time to travel, communication, and leadership. Ability to participate in duties as a member of the Bylaws, Policies, and Procedures Committee; Representative Assembly; and Board of Directors.
broad-based knowledge of the profession and the environments in which the profession operates. Demonstration of strong character and professionalism; able to uphold ethical standards, have a track record of successful job completion, be motivated by opportunities, and have the analytical skills to support objective decision making. Evidence of strong communication skills, good judgment, and knowledge of parliamentary procedure; ability to build relationships with key people and alliance partners. Evidence of willingness to devote time to travel, communication, and Association building. Awareness and understanding of the time commitment.
COMMISION ON PRACTICE CHAIRPERSON-ELECT

n
DIRECTOR (2 POSITIONS);
Note: At least one director must be an OTA n OT or OTA with minimum of 5 years of experience. Engaged in contemporary practice, education, policy, or research. n Minimum of 5 years of demonstrated leadership across multiple roles in state and national associations or established occupational therapy networks requiring a substantial commitment of time and effort to understand and support the issues that confront the profession, including advocacy at local, state, and national levels. Evidence of established contacts with the Associations many constituencies. n Evidence of strong business sense, ability to foster collaboration, and
GENERAL ELIGIBILITY CRITERIA

n
Member in good standing of the Association and election area affiliate at the time of nomination and throughout the term of office. Knowledge of the official documents of the Association (bylaws, policies, appropriate SOP/JD, AOTA Occupational Therapy Code of Ethics and Ethics Standards (2010), Administrative SOP, and Strategic Plan). Consistent access to a computer with a high-speed Internet connection and comfortable working in an e-mail environment. This includes opening, saving, editing, and sending attachments in e-mail as needed.
Minimum of 5 years of experience as an occupational therapist or occupational therapy assistant. Minimum of a masters degree. Minimum of 3 years combined experience as a member of an AOTA committee, commission, ad hoc committee, or body; have held a leadership position in an established network; or have been an invited contributor to an AOTA official document or a major AOTA initiative resulting in a publication. Leadership management experience at the state or national level, such as an elected position, or chairperson of a committee or task force. Commitment to practice issues as evidenced by sustained professional activity, publications, continuing education, presentations, and/or advocacy with other professional organizations or consumer groups.
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The Nominating Committee truly appreciates your interest in serving the Association and the profession.
COMMISSION ON CONTINUING COMPETENCE AND PROFESSIONAL DEVELOPMENT CHAIRPERSON-ELECT
n n
Go For Your Career Touchdown!
OT with a minimum of 5 years of experience in occupational therapy. Minimum of 3 years of experience on an AOTA committee or commission, or on AOTA ad hoc committees and bodies, or leadership positions in established networks. At least 2 years of demonstrated leadership experience as a committee/commission/board chairperson at the local, state, or national level. Commitment to continuing competence issues as evidenced by professional activity related to continuing competence that includes publication, continuing education, and presentations, and/or advocacy with other professional organizations or consumer groups.
Involved in sufficient breadth of Association activities as to provide advice to the Association. Documented record of attendance at the AOTA Annual Conference & Expo within the past 5 years.
All of these positions are critical to the Association, so please consider yourself or a colleague and submit nominations by completing the form posted on AOTAs Web site at www.aota.org under Get Involved/Governance. Elections will
be conducted in January 2013, with assumption of office July 1, 2013.
SPECIAL INTEREST SECTION COUNCIL CHAIRPERSON-ELECT

n
For more information about these positions or the nomination process, contact the Nominating Committee by e-mail (include your name, address, and telephone number). A member of the committee will be assigned to assist you throughout your submission process. Interested members with questions may contact staff or any member of the committee at the addresses below.
The deadline for receipt of nominations by the Nominating Committee is Thursday, October 22, 2012, by 5:00 pm EST.
2012 AOTA/NBCOT National Student Conclave

November 910, 2012 Columbus, Ohio
As an occupational therapy student and soon-to-be new practitioner, you have already started setting up the field goals for your career. The 2012 AOTA/NBCOT National Student Conclave is a terrific opportunity for you to know how to score those points and be an OT pro! Heres why you should attend Evidence-based knowledge about current issues and emerging practice areas Exclusive opportunities to speak with leaders and experts Perfect chances to meet with job recruiters and have your rsum critiqued Important information on the NBCOT certification exam Super networking with peers from your school and across the country
n n n
Minimum of 5 years of experience in occupational therapy as an OT or OTA. Minimum of 3 years of experience as a member of a SIS Standing Committee or as an SIS Standing Committee Chairperson. Minimum of 3 years of leadership or management experience, including a minimum of 1 year of paid leadership or management experience. Experience in developing occupational therapy programs and services. Experience in project management and/or strategic planning. Experience in planning and/or managing a budget. Written and verbal communication skills as demonstrated by professional publications and/or presentations at professional conferences. Experience with developing and implementing policies and procedures.
The Nominating Committee truly appreciates your interest in serving the Association and the profession. n AOTA Nominations: nomcom@aota. org (Note: All nomination materials should be sent to this e-mail address.) n Chairperson Karen Sames, MBA, OTR/L: kmsames@stkate.edu n Alexa Trolley-Hanson, MS, OTR/L: alexa.trolley@gmail.com n Kathyrn M. Eberhardt, MAEd, COTA/L, ROH: keberhardt@ssc.edu n Camille Skubik-Peplaski, MS, OTR/L, BCP, FAOTA: camsku@insightbb.com n Penny Rogers, MAT, OTR/L: progers2@umc.edu n Margaret Frye, MA, OTR: fryem@dyc.edu n Tanya Bay, OTD, OTR: tjb2@pvhs.org
Register today at www.aota.org/ conclave!
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CALENDAR
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per insertion and may be up to 15 lines long. 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. September
occupational therapists working with children with fine motor deficits and sensory motor delays. Participants will review traditional approaches and learn new protocols for effecting positive change and functional skill refinement. Case studies and video presentations will be incorporated as well as opportunities for discussion and sharing of challenges that block progress. for additional courses, information, and registration, visit our web site at www. chs-ce.uwm.edu or call 414-227-3123. persons who are visually impaired and/or use bioptic lens. Our instructors are master clinicians with this specialty group, knowledgeable in state licensing requirements, and skilled in focused interventions in this sub-specialty practice area. Teaching strategies include classroom instruction, working in the car with the instructors, and observing real clients in the car. Instructors: Mary Ellen keith, COTA, CDRS; and Carmen Palanca, OTR, CDRS. To register, call 407-4268020 or click on educational workshops for therapists at www.adaptivemobility.com.
2012 ICDL Annual Conference
Syracuse, NY
Eval & Intervention for Visual Processing Impairment in Adult Acquired Brain Injury Part I. This
Sept. 2930
The Power of Affect: Developing Human Potential Through DIRFloortime, Self-Determination and Mindsight. At Montclair State University,
Nov. 1618
Montclair, NJ. Register at registration@icdl.com or www.floortime.org. AOTA CEUs Available!
intensive updated course has the latest evidence based research. Participants learn to identify visual processing deficits, interpret evaluations, develop interventions and document. Topics include: visual inattention and neglect, eye movement disorders, hemianopsia and reduced acuity. faculty: Mary warren PhD, OTR/L, SCLV, fAOTA. Also New Orleans, LA, March 9 to 10, 2013. Contact: www.visabilities. com or (888) 752-4364, fax (205) 823-6657.
Ongoing
Clinicians View Offers Unlimited CEUs
San Diego, CA
October
Milwaukee, WI
Manually Managing Pain. This workshop will intro-
Oct. 5
duce the therapist to an understanding of persistent pain in light of the newest discoveries of neuroscience. Peer-reviewed literature will be used to make these insights clinically relevant and immediately applicable to common clinical problems. Simple Contact, a method of manual care, will be demonstrated and practiced by participants. Ideomotion for the relief of mechanical deformation leading to pain will be discussed and studies describing its use as a movement therapy in conjunction to traditional manual care will be provided. for additional courses, information, and registration, visit our web site at www.chs-ce.uwm.edu or call 414-227-3123.
tion of Part I course, this intense practicum provides hands-on experience in administering, interpreting, and using evaluation results to develop intervention for visual processing decits including eye movement disorders, hemianopsia, reduced visual acuity, and visual neglect. Offered only once a year. faculty: Mary warren PhD, OTR/L, SCLV, fAOTA. Also Boston, MA, November 810, 2013. Contact visABILITIES Rehab Services: www.visabilities.com or (888) 752-4364, fax: (205) 823-6657.
Eval & Intervention for Visual Processing Decits in Adult Acquired Brain Injury Part II. Continua-
Oct. 1214
Two great options: $177 for 7 months or $199 for 1-Full Year of unlimited access to over 640 contact hours and over 90 courses. Take as many
courses as you want. Approved for AOTA and BOC CEUs and NBCOT for PDUs. www.clinicians-view. com 575-526-0012.
Internet & 2-Day On-Site Training
November
Chattanooga, TN
Greenville SC
designed for individuals new to the field of driver rehabilitation. Topics include program development, driver training, adaptive driving equipment, and program documentation. Course will also emphasize collaboration with mobility dealers and consumers and families. Contact ADED at 866-672-9466 or visit our web site at www.aded.net.
Introduction to Driver Rehabilitation. Course
Oct. 5-6
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 Dallas, TX, November 313. 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.
Lymphedema Management. Certification courses
Nov. 313
Shoshana Shamberg, OTR/L, MS, fAOTA. Over 22 years specializing in design/build services, technologies, injury prevention, and ADA/504 consulting for homes/jobsites. Start a private practice or add to existing services. Extensive manual. AOTA APP+NBCOT CE Registry. Contact: Abilities OT Services, Inc. 410-358-7269 or info@aotss.com. Group, COMBO, personal mentoring, and 2 for 1 discounts. Calendar/info at www.AOTSS.com. Seminar sponsorships available nationally.
Become an Accessibility, Home Modifications & Ergonomic Jobsite Consultant. Instructor:
Self-Paced Clinical Course
community mobility issues are complex and changes in independence are life-altering. This comprehensive SPCC gathers researchers and clinicians in a team effort to offer expert guidance in this developing practice area. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3031, AOTA Members: $259, Nonmembers: $359. http://store. aota.org/view/?SkU=3031
NEW! Driving and Community Mobility: Occupational Therapy Strategies Across the Lifespan, edited by Mary Jo McGuire, MS, OTR/L, FAOTA, and Elin Schold Davis, OTR/L, CDRS. Driving and
Online Home Mods Courses
right from the comfort of your computer. By completing all five courses, you can obtain an Executive Certificate in Home Modification from the National Resource Center on Supportive Housing and Home Modification at USC. The next Series starts October 9, 2012 with Course 1, Home Modification: The Basics and Beyond. 12 CEU hours are offered for each course. The courses connect professionals from around the country who learn from each other as well as experts in the field. Get access to the latest home modification research, products, funding, assessments, and community planning. for more information, please visit www.homemods.org and click Online Courses or email overtonusc@aol.com
Executive Certificate in Home Modification Courses offered by University of Southern California, an AOTA Approved Provider. Take interactive courses
Starting Oct. 9
Orlando, FL
Take the Wheel: A Driver Education Workshop for the Therapist. A live, unique workshop for the thera-
Nov. 58
CEonCD
pist who desires to transition into the in-vehicle work for a driver evaluation program. All skills that are important for in-vehicle work are taught and practiced safely in a training vehicle with our master clinicians. Topics include setting up the evaluation car; structuring the in-car time; planning driving routes; and practicing the physical, visual and cognitive skills needed by a therapist in an evaluation car to control the route, the car, and the client. Instructors: Susan Pierce, OTR/L, SCDCM, CDRS; Carol Blackburn, OTR/L, CDRS; and Miriam Monahan, MS, OTR, CDRS, CDI. Only 12 spaces available! Contact Adaptive Mobility Services, Inc. at 407-426-8020 or visit us at www.adaptivemobility.com.
The Occupational Therapy Manager, 5th Edition with additional applications relevant to selected issues on management. Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota. org/view/?SkU=4880
OT Manager Topics, by Denise Chisholm, Penelope Moyers Cleveland, Steven Eyler, Jim Hinojosa, Kristie Kapusta, Shawn Phipps, and Pat Precin. Supplementary content from chapters in
CEonCD
Milwaukee, WI
Impact on Fine Motor and Sensory Integration Development of Current OT Intervention in Children. This course will provide in-depth coverage of
treatment options for pediatric and school-based
Oct. 12
Carmel, IN
Driver Rehabilitation for Drivers Using Bioptics by Occupational Therapy Process and Intervention.
A focused workshop sponsored by Adaptive Mobility Services, Inc. for the OT practitioner who is interested in evaluation and in-vehicle interventions with
Nov. 811
basic ethics information that gives context and assistance with application to daily practice and rationale for changes in the Occupational Therapy Code of Ethics and Ethics Standards 2010. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4846, AOTA Members: $105, Nonmembers: $150. http://store.aota.org/view/?SkU=4846
Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition, by AOTA Ethics Commission and presented by Deborah Yarett Slater. foundation in
22
cAleNdAr
AOTA CEU (3.75 MBCOT PDUs/3 contact hours). Order #4843, AOTA Members: $108, Nonmembers: $154. http://store.aota.org/view/?SkU=4843
REhABIlITATION, DISABIlITY, & PARTICIPATION
AOTA Self-pAced clinicAl cOurSe
CEonCD
Seating and Positioning for Productive Aging: An Occupation-Based Approach, by Felicia Chew and Vickie Pierman. Manual wheelchair mobil-
Dysphagia Care and Related Feeding Concerns for Adults, 2nd Edition, edited by Wendy Avery.
ity through review of seating and positioning from evaluation to outcome with a concentration on interventions applicable to a variety of settings. Earn .4 AOTA CEU (5 NBCOT PDUs/4 contact hours). Order #4831, AOTA Members: $97, Nonmembers: $138. http://store.aota.org/view/?SkU=4831
Up-to-date resource in dysphagia care written from an occupational therapy perspective for OTs at entry and intermediate skill levels. Earn 1.5 AOTA CEUs (18.75 NBCOT PDUs/15 contact hours. Order #3028. AOTA Members: $199, Nonmembers: $299. http://store.aota.org/view/?SkU=3028
Online Course
prevention to support OTs in providing evidencebased fall prevention services to older adults at risk for falling or that seek preventive services with sections on prevalence, consequences, and evaluation of fall risk. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #OL34, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/ view/?SkU=OL34
Falls Module IFalls Among Community-Dwelling Older Adults: Overview, Evaluation, and Assessments, by Elizabeth W. Peterson and Roberta Newton. first module in 3-part series on fall
The Hand: An Interactive Study for Therapists, by Judy C. Colditz. written coursework with interac-
tive, computer-based learning to present the anatomical basis and clinical presentation of problems in the hand and forearm and preparation for Hand Therapy Certification Exam. Earn 1.6 CEUs (20 NBCOT PDUs/16 contact hours). Order #3017, AOTA Members: $182, Nonmembers: $252. http://store. aota.org/view/?SkU=3017
CEonCD
Occupation-Focused Intervention Strategies for Clients With Fibromyalgia and Fatiguing Conditions, by Rnee R. Taylor. Evidence-based strate-
Online Course
module in 3-part series on fall prevention with overview of falls that occur in the hospital setting and identification of older adults at risk, factors that contribute to fall risks, and assessment strategies. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #OL35, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SkU=OL35
Falls Module IIFalls Among Older Adults in the Hospital Setting: Overview, Assessment, and Strategies to Reduce Fall Risk, by Roberta Newton and Elizabeth W. Peterson. Second
gies for managing fibromyalgia and other fatiguing conditions, such as chronic fatigue syndrome, with interdisciplinary treatment approaches and collaboration with other professionals. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4839, AOTA Members: $68, Nonmembers: $97. http:// store.aota.org/view/?SkU=4839
Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation
Edited by Margaret Christenson, MPH, OTR/L , FAOTA, and Carla Chase, EdD, OTR/L, CAPS
CEonCD
Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations, by Rene R. Taylor. Examines strategies
Online Course
Falls Module III: Preventing Falls Among Community-Dwelling Older AdultsIntervention Strategies for Occupational Therapy Practitioners, by Elizabeth W. Peterson and Elena Wong Espiritu.
for managing client pain, fear, and avoidance in OT practice with six distinct modes of interacting based on the authors conceptual practice model. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4836, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SkU=4836
Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours) This course consists of in-depth text, an exam packet, and a CDROM with hundreds of photographic and video resources, all of which provide education on home modification for both occupational therapy professionals new to the practice area and to practitioners experienced in environmental modification. Professionals who work with either adults or children will find an overview of evaluation and intervention, detailed descriptions of assessment tools, and guidelines for clientcentered practice and occupationbased outcomes. Order #3029 AOTA Members: $259 Nonmembers: $359
CE-252
Third module in 3-part series on fall prevention with evidence-based intervention strategies to reduce falls among community-dwelling older adults that include both older adults who are well and those who are living with chronic diseases. Earn .45 AOTA CEU (5.63 NBCOT PDUs/4.5 contact hours). Order #OL36, AOTA Members: $158, Nonmembers: $225. http://store.aota.org/view/?SkU=OL36
CEonCD
Hand Rehabilitation: A Client-Centered and Occupation-Based Approach, by Debbie Amini.
Online Course
tent and updated links on research, tools, and resources to help advance knowledge about instrumental activity of daily living (IADL) of driving and community mobility. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #OL33, AOTA Members: $180, Nonmembers: $255. http://store.aota. org/view/?SkU=OL33
Driving and Community Mobility for Older Adults: Occupational Therapy Roles, Revised, by Susan L. Pierce and Elin Schold Davis. Expanded con-
Occupation-based intervention to enhance hand rehabilitation protocols without sacrificing productivity or detracting from the concurrent client factor focus. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4832, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/ view/?SkU=4832
ASHT Test Preparation. Comprehensive overview of all topics related to upper extremity rehabilitation with 25 PowerPoint chapters and more than 2,000 slides and sample multiple-choice test questions. Earn 30 AOTA approved contact hours (3 AOTA CEUs/30 NBCOT PDUs). Order #4850, AOTA Members: $300, Nonmembers: $450. http://store.aota. org/view/?SkU=4850
Available From AOTA
Find AOTA on Facebook

www.aota.org/facebook
Follow AOTA on www.aota.org/twitter
To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/ ?SKU=3029

27
eMplOYMeNT OppOrTuNiTies
Faculty Faculty
henandoah Universitys Division of Occupational Therapy (SUDOT) invites applications for Program Director. This position provides opportunities to lead our cutting edge of curricular hybrid design for entry level occupational therapy and develop multiple programming initiatives including our entry level program in Jerusalem (launch date expected August, 2013) and an OTD. We are seeking dynamic and innovative leaders who will continue to build on a strong program foundation involving use of technology in practice and education, integration of research and practice, community-based experiential learning opportunities, and studentfaculty mentored research. Duties include but are not limited to program development and curricular design, engagement in interdepartmental and university-wide collaboration, engagement in teaching responsibilities in the applicants area of expertise, development and enhancement of current relationships with area agencies and community partners, and participation in scholarly activity in collaboration with students. Additional requirements include providing general oversight of all division activities including human resources, budget, curriculum, facilities, admissions, and accreditation. Pre-employment background check is required. Qualifications: Candidates must have an earned doctorate, 6 years of clinical experience, a minimum of 4 years of teaching experience, a background in management/administration, and evidence of scholarly work. Experience with Web-based learning platforms (i.e., Blackboard) is strongly recommended. Application Procedure: Send a letter of interest including a statement of your philosophy of education and teaching, current C.V., and contact information for three professional references to Shenandoah University-OT, Office of Human Resources, 1460 University Drive, Winchester, VA 22601 or e-mail all of the above to HR4U@su.edu and indicate Program Director OT in the subject line.
We encourage and support diversity in the workplace. EOE. Faculty
f-6128
Program Director, Division of Occupational Therapy
Fall 2013 CHP-N-2601 The Department of Occupational Therapy and Occupational Science at Towson University, established in 1975, is currently recruiting a tenuretrack faculty member with experience in teaching research and with graduate programs. Current programs include a combined BS/MS degree, professional and post-professional masters degree programs, and a doctoral degree program in occupational science. Position Responsibilities: Teaching and advising Conducting scholarship in a research line consistent with the mission of the department, college, and university Developing and obtaining external grant funding to support research line Contributing to service mission of the department, college, and university Qualifications: Applicant must be licensed or eligible for licensure as an occupational therapist in the state of Maryland, have a minimum of 3 years of occupational therapy practice experience, have an earned doctoral degree with a research component (i.e., PhD, ScD, EdD), and a commitment to excellence in teaching, scholarship, and service. Prior academic teaching experience is required. Ongoing involvement in professional activities and evidence of scholarship outcomes with external funding are preferred. Candidates for the rank of associate professor must have 6 years at the rank of assistant professor and a well-established line of research. Application Process: Applications will be reviewed beginning on October 29, 2012, and should include a letter of application; curriculum vitae; transcript(s) from degree granting institutions; evidence of initial certification as an OTR; and names, addresses, and telephone numbers of four references to: Sonia Lawson, PhD, OTR/L, Search Committee Chair, Department of Occupational Therapy & Occupational Science, Towson University, 8000 York Road, Towson, MD 21252-0001 slawson@towson.edu Upon submitting your curriculum vitae to indicate that you are an applicant for this position, please be sure to visit http://www.towson. edu/odeo/applicantdata.asp to complete a voluntary online applicant date form. The information you provide will inform the universitys affirmative action plan and is for statistical purposes only and shall not be used to illegally discriminate for or against anyone. f-6114
Assistant/Associate Professor Occupational Therapy and Occupational Science College of Health Professions, Towson University
DEPARTMENT OF OCCUPATIONAL THERAPY

Assistant/Associate Professor, Tenure-Track Beginning September 1, 2013
New York University, founded in 1831, is located in the Greenwich Village area of New York City, a world class city famous not only for its size, but also for its cultural health and financial leadership. Ranked 10th in the nation, the Department of Occupational Therapy is one of the oldest, largest occupational therapy departments in the United States. The combined resources of the city, the university and the department incorporate an incomparable learning environment for professional and personal growth. Responsibilities: An active agenda of research and publication; graduate teaching and the ability to advise doctoral dissertation research. Participation in faculty meetings, committees and other service appropriate to a university faculty member is expected. Qualifications: An earned research doctorate and a record of high level competency in scholarship and teaching experience for occupational therapy. Applicant must be eligible for the New York State license in Occupational Therapy upon hire. NYUs dynamic Global Network University includes NYU Abu Dhabi and international programs and academic centers around the world. NYU Steinhardt faculty may be afforded the opportunity for variable term work at these global study and research sites. NYU is committed to building a culturally diverse educational environment and strongly encourages applications from historically underrepresented groups. To Apply: Please apply online with a two-page letter of interest highlighting qualifications, curriculum vitae, three letters of reference, and at least two samples of peer reviewed publications. The three letters of reference should be submitted online directly to the committee by the referees. www.nyuopsearch.com/applicants/Central?quickFind=51043 Further information about the position can be obtained from: Kristie P. Koenig, Ph.D., OTR, FAOTA, Chair of the Search Committee, New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, 35 West 4th Street, Room 1103 New York, NY 10012-1172, email: occupational.therapy@nyu.edu. Ph: 212-998-5825
New York University is an Equal Opportunity/Affirmative Action Employer. 28
f-6129
EMPLOYMENT OPPORTUNITIES
Faculty Northeast South
University of South Alabama Department of Occupational Therapy FacultyAssistant or Associate Professor Positions
Welcome to the exception
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he University of South Alabama invites nominations and applications for assistant or associate professor faculty positions in the Department of Occupational Therapy. The University of South Alabama (USA) is a doctoral/research-intensive institution offering a variety of undergraduate and graduate programs. USA is located in the historic southern city of Mobile, Alabama, on beautiful Mobile Bay close to the Gulf Coast beaches and a short drive to New Orleans. This innovative occupational therapy (OT) program is organized around occupational performance areas and has an outstanding reputation. Qualifications: Requirements for the positions include a minimum of a masters degree, with credentials appropriate for rank of assistant or associate professor. A doctorate in OT or related field is preferred (required for associate professor). Successful candidates must be eligible for OT licensure in Alabama. Teaching and research experience is preferred (required for Associate Professor). Qualified applicants should be team oriented and have interest in emerging practice areas. Successful candidates will teach courses in areas of expertise and in general OT topics, advise students, and direct graduate research projects. Candidates should possess excellent interpersonal, organizational, and problem-solving skills. Salary is competitive and dependent on qualifications and experience. These 12-month positions are available immediately. Review of applications is ongoing and will continue until the positions are filled. Please send CV and names of three individuals who may be contacted for letters of reference to: Dr. Marjorie Scaffa, Chair, Search Committee, University of South Alabama, HAHN Bldg. Room 2027, 5721 USA Dr. North, Mobile, AL 36688, or e-mail mscaffa@southalabama.edu or phone 251-445-9222. The University of South Alabama is an Equal opportunity/Equal Access Employer f-6143 West
Join the exception .
al
Shepherd Center
The Art of restoring Hope, rebuilding Lives
Shepherd Center, located in Atlanta, GA, specializes in the treatment and rehabilitation of people with acquired brain and spinal cord injuries. We are seeking an experienced:
Exceptional is the best way to describe SunDances commitment to our patients care and your career. Our national network of extensive resources and consistent practices allows you to be your patients strongest advocate.
Full-Time Occupational Therapist to cover East Brunswick, Manalapan and Englishtown, NJ

Contact Danielle Pignetti Phone: 866-441-9109 Danielle.Pignetti@sunh.com
advocacy :: competency innovation :: versatility :: partnership
Occupational Therapist
OUTPATIENT POST-ACUTE BRAIN INJURY
Staff Therapist, Full-Time For information please call 404.350.7340 or apply online at shepherd.org
www.SunDanceRehab.com
We are an equal opportunity employer that believes difference is what makes us exceptional. Drug-free workplace.
N-6130
S-6145
EOE
This book is designed specifically for therapists working in a hospital setting to acquire better knowledge of the various body systems, common conditions, diseases, and procedures. Students and educators will find this new publication to be the x 5.937 OT Member Become aPractice/AOTA PUBLICATION SIZE 2.25most useful text available on the topic. lpifeatures SCREEN 100 It color illustrations of the B&W human bodys systems and functions, as well as WO # 143189 IO # 609568 tables delineating the signs and symptoms for various diseases. NOTES *STARS* StudentTherapy.com w-6037
Phoenix, Tucson, & Burbs 602-478-5850/480-221-2573 Schools, 16 wks off, 100% Paid: Health, Dental, Lic, Dues, CEU-$1,000,401K, Hawaii/Spanish I trips Jobs@StudentTherapy.com
ARIZONA OTs$65,000
Occupational Therapy in Acute Care

Edited by Helene Smith-Gabai, OTD, OTR/L, BCPR
OT Practice 2.25 x 5.937
CONNECTIONS
AOTAs Online Community
Order #1258. AOTA Members: $109, Nonmembers: $154
www.otconnections.org
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To order, call 877-404-AOTA, or visit http://store.aota.org/view/?SKU=1258

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Q &A
uestions and Answers

Many occupational therapy practitioners might consider government agencies such as the National Institutes of Health or the U.S. Department of Health and Human Services to be an outside influence on their everyday work. In fact, many occupational therapy practitioners work at these agencies, doing everything from shaping policy that affects practitioners to actually providing occupational therapy services.
Felipe Zamarron, OTR/L, CLT, LCDR, USPHS, is one such

occupational therapist. Zamarron works in the Rehabilitation Services Department of the Hastings Indian Medical Center in Tahlequah, Oklahoma. Hes spent his career as a U.S. government employee and recently spoke with OT Practice associate editor Andrew Waite about providing occupational therapy services to the underserved.
Waite: How did you get started in the U.S. Public Health Service? Zamarron: I was in the army for 12 years (4 years as an occupational therapist) and a friend recruited me to join. I didnt know what the Public Health Service was, to be quite honest. But once he informed me about it, I really liked the idea. One thing that really appealed to me is that part of our duty in the Public Health Service is that we are deployed in cases of national emergency such as Hurricane Katrina. Waite: What was the post-Katrina work like? Zamarron: I was with the mental health team there. As OTs, we are primarily assigned to mental health teams, but we can be part of different teams or leadership positions. Of course, once you get deployed, if there is any kind of need that falls outside of the primary mission, you fill in any way you can. When I was deployed to Louisiana for Katrina, there was a special needs shelter that people had been taken to in Monroe. [A number of] these people had recently had total hip replacements and total knee replacements, so we had to do rehabilitation that was not part of the mental health mission. Thats all part of the excitement and our ability to help. Waite: Can you explain a little bit about your employment structure? Zamarron: I work for the U.S. Public Health Service, and we fall under the U.S. Department of Health and Human Services. Our main boss is the surgeon general. We are assigned to different areas where there are underserved populations. Initially, I started in the Federal Bureau of Prisons, providing the prison population with basic occupational therapy rehabilitation services. [Later], as the primary occupational therapist at [the] Rochester, Minnesota, Federal Medical Center, I provided a lot of wound care as well as rehabilitation for spinal cord patients and stroke patients. I also rehabilitated patients with hand and upper-extremity issues. So mainly I was providing all interventions that we as occupational therapists provide to a population that doesnt regularly have access to our services. Waite: Where are you working now? Zamarron: I am assigned here to the Cherokee Nation in Oklahoma, and now I work in an outpatient setting approximately 70% of the time and an inpatient approximately 30% of the time. I am introducing occupational therapy to the Cherokee Nation. I am the very first occupational therapist in the state of Oklahoma working for the Indian Health Service. Waite: What specific services do you provide? Zamarron: When I first came in, 4 years ago, I developed a hand clinic and introduced splinting services for people with hand injuries. I also began working with a diabetes management educator nurse, and I now teach a stress-management class and how stress affects diabetes. I also provide upper-extremity rehabilitation [and have worked with] a few cognitive rehabilitation patients as well. I recently became a certified lymphedema therapist, and will start doing that work soon. Right now there are no lymphedema therapists in the area. I also do wound care and was a key player in creating a wound care center for inpatient clients in the Cherokee Nation. Waite: How does public health compare to working in a private setting? Zamarron: This kind of setting is a little more liberating because we are able to provide services for as long as patients need them, regardless of whether they have insurance or not. The other thing is that we can provide them with some of the basic adaptive equipment that they need that would not otherwise be covered because it would have to be paid out of pocket. That is a good thing as well because a lot of these people have low incomes. n
32
PHOTOGRAPHS COURTESY Of fELIPE ZAMARRON
NEW FROM AOTA PRESS!

Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation (w/CD-ROM)
Edited by Margaret Christenson, MPH, OTR/L, FAOTA, and Carla Chase, EdD, OTR/L, CAPS Participation in meaningful activities in the home and community contributes to health, wellness, and good quality of life. One way in which occupational therapy supports that participation is by advocating for increased accessibility through universal design and ISBN: 978-1-56900-327-5 environmental modification. Occupational therapy professionals fill a unique role in environmental modificationthrough evaluation, intervention, and outcomes measurementby facilitating the creation of safe, accessible homes that allow people to do what is important and relevant to them. This publication, which also contains a CDROM of hundreds of photographic and video resources, is divided into three sections: Evaluating the Client and Environment, Developing and Implementing the Plan, and Moving the Profession Forward. Chapters, written by occupational therapy professionals as well as policymakers, researchers, designers, and builders, articulate the meaning of home to clients, define universal design, offer assessments and outcomes measurements, delineate collaborative roles, discuss funding options, and provides networking and marketing guidance. This text was created for occupational therapy students and professionals new to home modification but also will benefit those who have been practicing in this area through discussions of the latest assessment tools and new assistive technology. Therapists who work with adults and those who work with children will find helpful guidelines and suggestions.
ORDER #1259. AOTA Members: $55, Nonmembers: $79

BK-287
To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/?SKU=1259

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AOTA T H E

SEPTEMBER 10, 2012

aota SPecialty coNFereNce

adults With Stroke

AOTA THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

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Environmental Modifications to Enhance Bathing and Aging in Place in the Elderly

Continuing Education Opportunities

Employment Opportunities Questions and Answers

Fieldwork Issues In the Clinic

Preparing Students for Ethical Practice

Call for Nominations for 20 the 2013 AOTA General Election

OT PRACTICE SEPTEMBER 10, 2012

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Register for the 2012 Student Conclave

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Occupational Therapy Home Modification: Promoting Safety and Supporting Participation

Occupational Therapy Practice Guidelines for Home Modifications

Take Advantage of AOTF Scholarship Opportunities

Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.

Functional limitation for a secondary functional limitation if one exists

Provider attestation that functional reporting not required

Table 2. Proposed Modifiers1

Impairment Limitation Restriction Difficulty

Preparing Students for Ethical Practice

OT PRACTICE SEPTEMBER 10, 2012

Light the Way

CONSIDER THE LIGHT

ILLUSTRATION DON BISHOP / JUPITER IMAGES

The author uses a light meter during an assessment.

BALANCE LIGHT LEVELS

PHOTOGRAPH COURTESY Of THE AUTHOR

CONTRAST AND GLARE FILTERS

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MICHAEL RIVERS CHERIE MACRI

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REDUCING PHYSICAL BARRIERS IN THE HOME

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Occupational Therapy and Rebuilding Together

Working to Advance the Centennial Vision

HOW CAN PRACTITIONERS CONTRIBUTE TO RT?

WHAT IS REBUILDING TOGETHER?

WHY ASSESS OUTCOMES?

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