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DECEMBER 17, 2012

Buyer’s Guide
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OccupatiOnal therapy

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n Neuromuscular Electrical Stimulation n Guidelines for Documentation n Writing a Critically Appraised Paper n Developing Inexpensive Toilet Aids n Bringing the Profession to India n Origami: Artful OT Interventions

And More!

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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

VOLUME 17 • ISSUE 22 • DECEMBER 17, 2012

Ad inquiries: 800-877-1383, ext. 2715, or e-mail
ot Practice External Advisory Board

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 Sharon Kurfuerst: Chairperson, Administration & Management Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Muñoz: 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
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

Buyer’s Guide
News Capital Briefing Practice Perks
The End Game: A Call to Action Guidelines for Documentation

therapy 2013 OccupatiOnal

Category Locator Listings Company Directory

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Neuromuscular Electrical Stimulation and Task-Specific Training After Stroke: Putting Evidence Into Practice

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Jessica J. Bolduc, Kristin Brewster, and Sheila Reid report on the effects of neuromuscular electrical stimulation on remediating lost muscle control for a client poststroke.

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In the Classroom

Origami: Artful Interventions for a Variety of Settings and Conditions

Social Media Spotlight Research Update Calendar

Updates From Twitter, Facebook, Pintrest, and OT Connections Highlights From the ACRM–ASNR Annual Conference Continuing Education Opportunities

Evidence Perks In the Clinic Careers

Evidence Exchange: Writing a Critically Appraised Paper Developing Inexpensive Self-Wipe Toilet Aids Breaking New Ground: Reflections on Bringing the Profession to India
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Employment Opportunities

• Discuss OT Practice articles at in the OT Practice Magazine Public Forum. • Send e-mail regarding editorial content to • Go to to read OT Practice online. • Visit our Web site at for contributor guidelines, and additional news and information.
OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practice’s editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to, or make the change at our Web site at Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.




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With appreciation for your continued support of the American Occupational Therapy Association

and OT Practice magazine, we extend our warmest wishes for a happy and prosperous New Year!


Association updates...profession and industry news
Editorial Panel, which oversees code development, agreed to establish an internal workgroup to discuss possible changes to the PM&R Codes. For more, visit reimb/coding/cpt-codingchanges.aspx. for January 15 to 19, 2013, at the University of North Carolina in Chapel Hill. For more on TIGRR, visit news/announcements. reviewing issues such as essential health benefits, the Medicaid eligibility expansion, and the creation of health insurance exchanges. AOTA will continue to work with state occupational therapy associations to advocate for the profession as health care reform implementation moves forward. The call was recorded and is available at


2013 Conference Registration Now Open
ow is the time to register for AOTA’s 93rd Annual Conference & Expo, which promises to be the most dynamic gathering for occupational therapy professionals in 2013. San Diego, a vibrant city known for its perfect climate, beautiful coastline, fabulous attractions, and charmingly diverse neighborhoods, is the site of the 2013 AOTA Annual Conference & Expo. What better reason to attend Conference and tie it in with a great vacation. Combine days of inspiration, education, and professional renewal with days of adventure and relaxation. Learn more online at www.aota. org/conference.


AOTA Elections Begin Soon
lections for General, Special Interest Section (SIS), and Assembly of Student Delegates (ASD) positions begin January 15 and will end on February 26. Descriptions of each position and candidate information and position statements are available on the AOTA 2013 Election site at In addition, visit AOTA’s election blog at http://otconnections. election/default.aspx for coverage of the elections.


Submit Motions for the Spring RA Meeting


AOTA Moves Forward on CPT Coding Changes

AOTA Helps Build Research Capacity
OTA has pledged support to the T-15 proposal: Intensive Rehabilitation Research Grant Writing workshop (TIGRR), which provides approximately 300 attendees the expertise and support to be successful in obtaining research grants at the national level. The target audience for the workshop includes junior and mid-level faculty in all rehabilitation research disciplines who are on the cusp of success in National Institutes of Health–funded or similar research but could benefit from expert, one-on-one mentorship in grantsmanship. AOTA has agreed to help sponsor the national workshop, scheduled

ow occupational therapy is paid for, described, and understood is bound up in the use of Common Procedural Terminology (CPT) codes. In October, AOTA provided the CPT Health Care Professionals Advisory Committee (HCPAC), part of the American Medical Association’s coding process structure, with a draft coding proposal to elicit feedback from member physician and nonphysician advisors. Following the presentation by AOTA’s advisors to the HCPAC, and that committee’s recommendation that a Physical Medicine and Rehabilitation (PM&R) Workgroup be formed, the CPT


he deadline for submitting motions to be considered at the Representative Assembly (RA) Spring Meeting is January 1, 2013, so there’s still time to draft motions. Specific instructions on how to write motions may be found at www. Contact any of the RA officials or your representative(s) for advice on whether your idea should be a motion and to discuss appropriate topics and issues for policy changes. For the names(s) of the officials or your representative(s), go to the Members section of AOTA’s Web site and click on Get Involved/Governance, then Representative Assembly for the RA Roster. Alternatively, you can call AOTA at 800-SAY-AOTA (729-2682), ext. 2103, or contact Laurel Radley at for assistance.

Call for Papers Continues for AOTA’s Education Summit
OTA invites educators, scholars, postprofessional graduate students, and clinicians who share the common vision of enhanced understanding of teaching and learning in occupational therapy and occupational therapy assistant degree programs to submit a proposal for presentation at the upcoming Education Summit, to be held in Atlanta from October 4 to 5, 2013. Submissions are due January 15, 2013. For additional information, e-mail or visit education-summit.


AOTA Helping States Implement Health Care Reform
OTA State Affairs staff recently held a conference call with representatives of various state occupational therapy associations. Approximately 30 representatives from about 20 states participated in the discussion about health care reform implementation at the state level. Time was spent



OT Practice Index and SIS Quarterly Newsletters Archive
he 2012 OT Practice index and Special Interest Section Quarterly newsletters archive are now available online. Go to Annual-Indexes.aspx for the OT Practice indexes from 2000 to 2012, and pubs/sisqs for the SIS Quarterly archives from 1998 to 2012.

a O ta B u l l e t i n B O a r D

Using the Occupational Therapy Practice Guidelines for Adults With Stroke to Enhance Your Practice
(CEonCD™) J. Sabari Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). ourse participants will learn key considerations for occupational therapy intervention, depending on whether the client is in the acute phase after stroke, the rehabilitation phase, or the phase of continuing adjustment. Findings from published research that guide best practice in occupational therapy intervention with the stroke population are presented. $68 for members, $97 for nonmembers. Order #4845. http://



Cognition, Occupation, and Participation Across the Life Span: Neuroscience, Neurorehabilitation, and Models of Intervention in Occupational Therapy, 3rd Edition N. Katz his comprehensive new edition represents a significant enhancement in the knowledge translation of cognition and its theoretical and practical application to occupational therapy practice with children and adults. Chapters, written by leaders in an international field, focus on cognition, which is essential to everyday life. $89 for members, $126 for nonmembers. Order #1173B. http://


OT Practice Thanks Reviewers
he staff members of OT Practice thank the following persons for sharing their expertise by providing content reviews of manuscripts and articles from October 8 through December 17: Lauren Bonacci, Donna Costa, Deborah Lieberman, Susan Lin, Maria Elena Louch, Helen Magers, Lauro Muñoz, Maureen Peterson, Jody Nieman, Sandy Schefkind, Deb Slater, and Karen Smith.



Tips on Toys

anta isn’t the only one who should have a list and check it twice this holiday season. Encourage your clients to take a look at AOTA’s selecting toys tip sheet when considering buying toys to help facilitate development during play. To see AOTA’s complete list of tip sheets, visit You’ll find “How to Pick a Toy: Checklist for Toy Shopping” in the Children and Youth section.

Industry News


WFOT Congress Call for Papers
he 2014 World Federation of Occupational Therapists (WFOT) 16th International Congress will be held in Yokohama, Japan, and the call for papers is open until March 2013. For more, visit www. There, you can also find information about how to be a reviewer. In addition, don’t miss your chance to download WFOT’s 60th anniversary poster at www.wfot. org/aboutus/history.aspx.


Attention Early Intervention Providers

Occupation-Focused Intervention Strategies for Clients With Fibromyalgia and Fatiguing Conditions
(CEonCD™) R. R. Taylor Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). his course presents several evidence-based strategies for managing fibromyalgia and other fatiguing conditions, such as chronic fatigue syndrome. Biomechanical intervention strategies, common assistive devices, and occupationfocused interventions that can address the multifaceted symptoms and needs of these populations are presented. $68 for members, $97 for nonmembers. Order #4839. http://

Occupational Therapy in Acute Care



H. S. Gabai his text lays the foundation for occupationbased practice and addresses the contextual issues of working within the acute care setting. Research covers key aspects of how diseases affect the human body, including the cardiovascular, nervous, and endocrine systems. It features color illustrations of the human body’s systems and functions, as well as tables delineating the signs and symptoms of various diseases. Highlights also include orthopedics and musculoskeletal disorders. $109 for members, $154 for nonmembers. Order #1258. http://
Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.

he first module of the Part C training curriculum has been launched. The Basics of Early Intervention leads off the curriculum on the 2011 Part C regulations of the Individuals with Disabilities Education Act. It gives users a training resource on the eight basic steps of early intervention, important acronyms to know, key definitions, and more. The module is available at http:// partc/module1.


AOTF Announces Scholarships
he American Occupational Therapy Foundation (AOTF) has announced the creation of the Fred Sammons and Barbara Rider Endowed Scholarship of the Michigan Occupational Therapy Association, the Fred Sammons Endowed Scholarship of the Virginia Occupational Therapy Association, and the Robert and Sharon Ryan Endowed Scholarship. For more visit AOTF’s Web site at http://www. aspx.


Go4Life E-Cards

oes your friend (or client) need encouragement to keep exercising? Go4Life, created by the National Institute on Aging, has an e-card for that, so get ready to hit the send button. For more, visit stay-in-touch/send-e-card.

n Jennifer Bogenrief, AOTA’s manager of Reimbursement and Regulatory Policy, recently attended the National Association of Rehabilitation Providers and Agencies Fall 2012 Conference in Las Vegas, Nevada.

Ready to order? Call 877-404-AOTA or go to Enter Promo Code BB

Questions? Call 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555


She participated in the skilled nursing facility work group. n Susan Lin, ScD, OTR/L, AOTA’s director of Research, attended a colloquium at the National Institutes of Health campus in Bethesda, Maryland, commemorating the National Institute of Child Health and Human Development’s 50th anniversary. n Amy Lamb, OTD, OTR/L, FAOTA, AOTA’s vice president, spoke about the Affordable Care Act at a seminar at St. Joseph Mercy Hospital in Ypsilanti, Michigan. n Sandra Schefkind, MS, OTR/L, AOTA’s pediatric coordinator, recently attended the OCALICON Conference in Columbus, Ohio, and spoke about AOTA’s efforts in helping children with autism get the therapy they need. Schefkind also attended the Association of University Centers on Disabilities conference in Washington, DC, where she spoke about early signs of autism and AOTA’s efforts in the “Learn the signs. Act Early” campaign.

Practitioners in the News
Monica Heltemes, OTR/L, was recently a featured guest on Alzheimer’s Speaks Radio. She discussed how occupational therapy helps people with dementia. To listen to the show, visit alzheimersspeaks/2012/11/01/ staying-active-with-dementiafamily-caregivers-unite. n Nathan “Ben” Herz, OTD, MBA, OTR/L, AOTA Board of Directors treasurer, has been named founding director of the Doctor of Occupational Therapy Program in the Murphy Deming College of Health Sciences at Mary Baldwin College, in Staunton, Virginia. n Michelle Michaud, OTR/L, was named practitioner of the year by the Maine Occupational Therapy Association.

n Terry Olivas-De La O, COTA/L, ROH, Susan Burwash, MSC, OT, Anita Hamilton, Karen Jacobs, EdD, OTR/L, CRE, FAOTA, Helen Rushton, MBA, MCOTSS, and Marilyn Pattison, OT, MBA, recently participated in a podcast organized by Family Success by Design, Inc., in recognition of occupational therapy around the world. To listen to the archived show, visit latino-role-models-success/. n Occupational therapy students at Quinnipiac University in Hamden, Connecticut, recently visited the United Nations to learn about human rights. For more, visit news-events/ot-students-learnabout-human-rights-at-the-un. n Elizabeth Skidmore, PhD, OTR/L, associate professor in the Department of Occupational Therapy at the University of Pittsburgh, was awarded the School of Health and Rehabilitation Sciences 2011–2012 Dean’s Distinguished Teaching Award as an exemplary educator, who masterfully integrates professional knowledge (neuroscience and neurorehabilitation), interpersonal knowledge (human interactions), and intrapersonal knowledge (reflective capacity and ethics) in her teaching. n Jennifer Stenga, a first-year occupational therapy student at a joint program between Creighton University and the University of Alaska–Anchorage, has won a $7,500 Dr. Pepper Tuition Giveaway scholarship. Applicants created a 1-minute video explaining how they will make an impact in their community or even in the world for a chance to win either $2,500 or $100,000 in tuition. n Debra Young, MEd., OTR/L, SCEM, ATP, CAPS, has been appointed to the Home Builders Association of Delaware 2013 Board of Directors. Andrew Waite is the associate editor of OT Practice. He can be reached at


AOTA CEonCDTM OT Manager Topics
By Denise Chisholm, PhD, OTR/L, FAOTA; Penelope Moyers Cleveland, EdD, OTR/L, BCMH, FAOTA; Steven Eyler, MS, OTR/L; Jim Hinojosa, PhD, OT, BCP, FAOTA; Kristie Kapusta, MS, OT/L; Shawn Phipps, PhD, OTR/L, FAOTA; and Pat Precin, MS, OTR/L, LP

Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). This new CE course presents supplementary content from chapters in The Occupational Therapy Manager, 5th Edition (Order # 1390C), and provides additional applications that are relevant to selected issues on management. The course focuses on 6 specific topics with individual learning objectives, and it is strongly recommended that participants read the selected chapters prior to studying the topics. Order #4880. AOTA Members: $194, Nonmembers: $277


To order, call 877-404-AOTA, or visit

c a p i ta l B r i e f i n g b


The End Game: A Call to Action
Tim Nanof
Members of Congress will act only if they feel grassroots pressure from you, your colleagues, and your clients. To take action, go to AOTA’s Legislative Action Center, at
it is critically important that this initial action includes extending the therapy cap exceptions process so that we are well placed for more long-term action next year. Changes to the exceptions process that were implemented in October 2012 included setting the manual medical review threshold at $3,700, and Congress will want to see the effects of those policies before making additional changes to the therapy benefit. This helps buy time before additional proposals that dramatically change the way Medicare pays for therapy will be necessary. AOTA has already begun the process of exploring a new per-session coding system that is being discussed over the next few months at the American Medical Association’s Current Procedural Terminology Committee, but those potential changes remain a few years away at the earliest. To ensure continued access to care for Medicare beneficiaries, we must keep the issue of the cap front and center with members of Congress. To take action, go to AOTA’s Legislative Action Center, at aota/home/. Because of AOTA’s work with Congress, we have a well-crafted proposal to extend the exceptions process, but members of Congress will act only if they feel grassroots pressure from you, your colleagues, and your clients. AOTA’s Legislative Action Center is open to the public, and we have crafted messages from clients as well as practitioners, so please urge your Medicare clients to use AOTA’s resources to be advocates for their own care as well. Together, we can ensure that Congress acts to protect access to occupational therapy and help your clients live life to its fullest. n
Tim Nanof, MSW, is AOTA’s director of Federal Affairs.

t presstime, Congress had yet to take substantive action to address any of the significant challenges it faces before the end of the year. Previous Capital Briefings have discussed the “fiscal cliff” so often covered in the news, including expiring tax provisions, mandatory cuts to discretionary spending through sequestration, and a series of expiring Medicare provisions that would result in a cut of more than 26.5% to all Medicare providers paid on the fee schedule, including occupational therapists and occupational therapy assistants. All told, the Congressional Budget Office expects the policy changes facing Congress to have an economic impact of nearly $750 billion in 2013 alone. Among the many financial issues Congress must address that are of immediate importance to occupational therapy practitioners are the Medicare fee schedule and the outpatient therapy caps, which account for a comparatively paltry $26 billion for next year. Because of the vast challenges Congress faces, and the many stakeholder groups competing for members’ attention, it is critical for practitioners to continually draw the attention of Congress to the devastating effect the scheduled 26.5% cut would have on seniors’ access to care, and how the therapy cap would deny medically necessary care to more than 700,000 Medicare beneficiaries who need therapy beyond the cap. In this political and budgetary environment, the problem of the cap looms larger than ever. Extending the exceptions process is expected to cost just under $1 billion for 2013 in a year when any additional spending is looked upon with skepticism and the cap seems insignificant compared with

the projected impact of sequestration. Thus the need for continued and passionate grassroots advocacy. Rehabilitation advocates from the provider and consumer communities must work together to spread the word about the cap and draw the attention of Congress to this issue. Just last week, AOTA partnered with the American Physical Therapy Association; the American Speech-Language-Hearing Association; the Consortium for Citizens with Disabilities; and a host of consumer advocacy organizations, including the Parkinson’s Action Network and the National Multiple Sclerosis Society, to conduct a Virtual Hill Day that reached every Congressional office in Washington. The message was simple: Extend the exceptions process and ensure access to rehabilitation services for Medicare beneficiaries. AOTA’s Federal Affairs staff continue to meet with key Congressional staff in both the House and Senate to pave the way for the policy necessary to extend the exceptions process, but the pressure must be maintained on Congress to act before the end of the year. Because the size and scope of the year-end package under consideration is expected to be enormous, there is a good chance that the only major action achieved in 2012 will be to push larger decisions down the road into 2013. But


in the clinic


Developing Inexpensive Self-Wipe Toilet Aids
Bonnette Macklin My hypothesis: If therapists can easily make an inexpensive
long-handled object that allows clients to extend their reach and to attach and release a wipe, then therapists will be more effective and consistent in giving their clients the tools to be independent in the essential activity of wiping themselves.
My hypothesis: If therapists can easily make an inexpensive long-handled object that allows clients to extend their reach and to attach and release a wipe, then therapists will be more effective and consistent in giving their clients the tools to be independent in the essential activity of wiping themselves. With the first intervention I conducted, the client’s baseline performance was that she required total assistance in wiping and washing herself. Carmen was a 76-year-old female who lived alone and was functionally limited by severe obesity, left wrist fracture in a cast due to a fall, limited right shoulder AROM due to an old injury, and severe back pain due to compression fractures. For Carmen to continue living alone with a supportive family living close by, her primary goal was to be independent in toilet hygiene. A slow walk through at the local dollar store allowed me to identify a wire whisk as something that could possibly assist Carmen in safely securing and releasing toilet paper or wipes. For Carmen’s device, I used splinting material reinforced with a wire as the long handle, which was attached to the wire whisk. But this proved to be too wobbly and did not allow Carmen to firmly grasp and control the whisk. Unfortunately, my work with Carmen ended before I could modify her toilet aid, as she was subsequently admitted to the hospital as the result of complications from her existing conditions, and she was discharged from home health services. I got another opportunity, though, to advance my project thanks to Renee, a short, 55-year-old female with moderate obesity who also lived alone. Renee was independent in toilet transfers with the use of a walker, but she was unable to wipe herself. Renee was highly motivated to achieve independent toilet hygiene. Thanks to the opportunity to work with Carmen, I applied the basic principles of failure and success that I learned from her to redesign a toilet aid specific to

he everyday and very essential task of toilet hygiene can also be very embarrassing for clients when they need someone to assist them with it. Because I have found that clients frequently report that commercial toilet aids are too expensive for them and often are not even effective because of their particular functional limitations, I was inspired by an article in the July 25, 2011, issue of OT Practice on “Performing Single Subject Research Designs in Practice”1 to apply the systematic method of a single subject research design to fabricate and test an inexpensive self-wipe toilet aid with two clients. My project eventually proved successful, as it allowed me to apply lessons learned from one client to the next. My research question was, “What are the functional limitations preventing the client from being independent in toilet hygiene?” The factors I identified as limiting effective toilet hygiene included inadequate shoulder, elbow, and hand active range of motion (AROM) because of acute injury and/ or chronic disease, including obesity.

Table 1. Client Satisfaction With the Toilet Aid

n Carmen

n Renee


Neuromuscular Electrical Stimulation and Task-Specific Training After Stroke
Putting Evidence Into Practice


epending on the extent of damage from stroke, the neural mechanisms within a client’s brain can potentially be reorganized, allowing motor skills to be relearned.1 One potential aid to recovery is neuromuscular electrical stimulation (NMES), a physical agent modality that helps stimulate paralyzed or paretic muscles affected by stroke. The stimulation has been shown to aid in remediating lost muscle control.2 There are varying applications for NMES, such as a neuroprosthesis (e.g., Bioness), and various triggered NMES units (e.g., biofeedback with electrodes).2 Typically, electrodes are placed over the desired muscles to be activated and the unit is programmed to deliver an electrical current to facilitate muscle contractions. How NMES

Occupational therapists report on the effects of neuromuscular electrical stimulation on remediating lost muscle control for a client poststroke.
is applied depends on the desired outcome; for the case example discussed in this article, the goal was to have a flexible application to accommodate high repetitions of various functional tasks while incorporating a task-specific training (TST) approach. When considering motor learning, it appears that unless people work actively to achieve a task, NMES is unlikely to affect upper-extremity function at the activity or participation level.2 For this reason, NMES was combined with TST for a client who had sustained strokes. Combining NMES with TST uses real-life task training with the goal of reacquiring a skill, using high repetition of functional tasks.3 Principles of TST state that tasks should be challenging and progressively advanced or adapted with common basic objects, involve active participation and problem solving, target the area of deficit, be practiced randomly, and be meaningful and novel.3 Task shaping involves advancing the challenge of the task by altering one of the following object characteristics: shape, size or weight, texture, surface, or rigidity. Clinicians can use various strategies to help facilitate client learning, including providing verbal


With neuromuscular electrical stimulation, electrodes typically are placed over the desired muscles to be activated, and the unit is programmed to deliver an electrical current to facilitate muscle contractions.



feedback, coaching, modeling the task for the client, and encouraging the client to continue with the task.4 Based on evidence and expert opinion, criteria for using NMES and TST with a client were a score of at least 10/60 on the Modified Fugl Myer Assessment of Motor Recovery for the Upper Extremity (mFMA-UE)5; at least 10° of active wrist motion, no contraindications for NMES5–6; and the ability to follow two-bstep commands, participate in problem solving, and give consent to the intervention after reviewing risks and benefits.

Table 1. Outcome Measures
Pre-Neuromuscular Electrical Stimulation (NMES) Measures Rehab Day 21 (unless otherwise noted) 63/108 (15/60 UE) Assessed on rehab day 5 Right—not tested Left—unable

Assessment Modified Upper Extremity (UE) Fugl Meyer*11–12 Box and Block test*

Post-NMES Measures, Rehab Day 41 87/108 (39/60 UE) MCID** is 10% of total score change13 Right—48 blocks/minute Left—2 blocks/minute (modified) (norm: R: 66 blocks/minute, L: 64 blocks/minute) MCID**: 7 blocks12

Mr. H was a 74-year-old right-handed white male who lived with his wife in rural New York. He was retired, on disability and, prior to this recent stroke, independent with basic activities of daily living (ADLs), and he and his wife together completed instrumental activities of daily living. He was showing signs of mild dementia—for example, difficulty managing money (e.g., balancing a check book, paying bills on time). His medical history included two previous mild strokes (no residual effects), coronary artery disease, hypertension, obstructive sleep apnea, hyperthyroidism, glucose intolerance, and a history of smoking. Mr. H’s occupational profile reflected a new diagnosis of acute right thalamic hemorrhagic stroke, resulting in left hemiparesis, decreased activity tolerance, decreased standing balance, dysphagia, and dysarthria. Without use of his left hand, Mr. H struggled with basic ADL tasks that required bilateral arm use. He felt that if he could gain function of his left hand, he could regain some independence and feel less of a burden on his family.



16/49 MCID**: 6.3 points14

Grip strength

Right—not tested Left—unable

Right—77# Left—average 5.5# (norm: R: 75.3# ± 21.5# L: 55# ± 17#) MCID**: L hand 13.64#12

Motor control

Right—within normal limits Left—Brunnstrom level 4=Spasticity decreases, synergistic movements predominate15 10° of active wrist extension motion, and trace finger and thumb movement

Right—within normal limits Left—Brunnstrom level 6=Coordination and movement patterns near normal, but trouble with more rapid complex movements15 Wrist extension to neutral, full wrist flexion, and thumb and finger opposition Setup assistance with grooming; minimal assistance with upperbody bathing and dressing, with the client using both hands; moderate assistance of one person for lower-body bathing and dressing using both hands; minimal to moderate assistance with toileting needs using both hands


Maximal assistance with grooming, bathing, and dressing, with the client unable to use his left hand for assist

*Psychometrically strong, standardized outcome measures **MCID = minimal clinically important difference

Mr. H was admitted to our inpatient rehabilitation hospital 10 days after a cerebral vascular accident. Evaluation revealed intact left upper-extremity light touch and muscle contraction at the shoulder, but no functional movement in the entire left upper extremity (see other baseline information in Table 1). Mr. H was able to follow twostep instructions and was an active and engaged client. Mr. H wanted to regain

full use of his left hand to be able to complete self-care tasks with both hands. His occupational therapy plan of care included standard interventions using sensorimotor, rehabilitation, and biomechanical frames of reference for ADL retraining, activity modification, neuromuscular reeducation, and client and family education.7 By rehabilitation day 20, Mr. H had 10° of wrist extension, which fit our evidence-based criteria for potential enhanced functional recovery through NMES and TST. Occupational therapist and first author Jessica Bolduc, MS, OTR/L, obtained

Mr. H’s consent and medical approval, and selected tasks with him for TST during NMES intervention.

NMES was started on rehabilitation day 22. Initial sessions focused on extending the wrist and fingers, selecting tasks, targeting electrode placement, and determining the most effective NMES settings. Muscles selected for NMES included the extensor carpi radialis longis and brevis, and extensor digitorum communis. The functional tasks chosen included pushing a water


Breaking New Ground
Reflections on Bringing the Profession to India
Siraj Sharma, MS, OTR, MBAOT, has worked at the Veterans
Administration Medical Center, the Philadelphia State Hospital, and the Philadelphia Psychiatric Center, among other facilities. Sharma has been recognized for her work in the profession by the World Federation of Occupational Therapists, the World Health Organization, and prominent political leaders. But it was her time in India that will always mean the most. Sharma shared this story with OT Practice associate editor Andrew Waite.
place to another without hindrance. So I invented a type of chair with the wheels from skates and showed her how to use it so she could move herself. She was delighted that she could get from one place to another. I had to be inquisitive to find the right solution. But there was such a need for facilitating a person with so much limitation. Then one day we were visited by a representative from the United Nations who was very excited by the work we were doing. Mrs. Nimbkar assigned me to work with the UN as a rehabilitation expert, so I helped start a UN Rehabilitation Center that brought in experts from the United States and Europe to India. It was the first comprehensive rehabilitation program in India covering all aspects of services from within a hospital to in-home as well as on-the-job situations. The center was a major milestone in the field of rehabilitation in India, and I am so proud to have been a part of it. In 1957, my father became ill and I moved to Hyderabad to be with him. But I did not lose focus on occupational therapy. In Hyderabad I started two occupational therapy departments––one at the general hospital and another at the women’s hospital. That led to a role with the national health department in India in which I surveyed various hospitals in Hyderabad and provided education on establishing occupational therapy programs. I also participated in the inaugural medical conference in Hyderabad and spoke about occupational therapy’s role in rehabilitation. It was then I realized that Mrs. Nimbkar had really brought occupational therapy to India. She was the earliest pioneer, but I had become one of the people to carry out its legacy and determine which direction it should go. And, to think, there was a time when I had no idea about occupational therapy. n

had not yet heard of occupational therapy in 1950, when Kamala Nimbkar wrote my father. I was a 17-year-old girl interested in studying mental health, and Mrs. Nimbkar was an American who had moved to India to marry one of my father’s friends. She was trying to start the first occupational therapy school in India, and she wanted to know if I would be interested in moving to Bombay to enroll. She sent the syllabus for the program and explained that it would be a new subject that very few people in India would have heard of. My father was familiar with Bombay, so he felt comfortable sending me there, and I was soon to be 18, so it was a good time for me to leave the house. So, in 1950, I left my home in Hyderabad to join the occupational therapy training program in Bombay. There were six of us in the class––three girls, three boys. Our training program covered basic medical subjects––anatomy, physiology, psychology, psychiatry, general medicine, surgery, and pathology. The clinical areas were general medicine, psychiatry, pediatrics, tuberculosis, and the infirmary. As part of our clinical training we worked at various city hospitals under Mrs. Nimbkar’s supervision to start occupational therapy services. The occupational therapy school was affiliated with the


King Edward Memorial Hospital, so all of the medical training was conducted by the senior medical staff at the hospital. We also received lectures on setting up occupational therapy departments and administration strategies. Then, in 1952, I got a scholarship for the London School of Occupational Therapy. In London, occupational therapy was already established and was recognized as a complementary aspect of health care service. Occupational therapy services were provided soon after the acute stage of the illness as an integral part of the treatment process! As a result, London offered me opportunities to work in inpatient and outpatient units and demanded a good grasp of theoretical knowledge and adaptability of therapeutic technologies. The focus was on activity analysis, self-care, activities of daily living, and household tasks linked to a person’s independence and job skills. After such comprehensive training for 3 years in London, I returned to India to become Mrs. Nimbkar’s assistant at her occupational therapy training school. My favorite thing became crafting devices so people could be more independent. There was one woman who had hemiplegia, so, naturally, she could not walk. So it was then a question of how to give her mobility so that she can go from one

i lDw cla s in the CLAssr If N e T H E O r K Si Ss Rs Ou Oe M

Rebecca Lipnick
a square from a rectangle and encouraged to make their own paper squares from magazines, wrapping paper, newspapers, or wax paper. Origami is an appropriate intervention, not only in pediatric settings, but in virtually any setting. It can serve as a means of improving hand and finger strength, fine motor dexterity, visual spatial skills, and directionality, as well as of facilitating use of higher-level thinking functions such as memory, sequencing, and following directions. Origami engages multiple senses and can be adapted to a variety of disabilities and settings. Origami activities can be easily graded without increasing the complexity of the model, by simply decreasing the size of the paper squares used. Smaller paper requires increased dexterity and precision, and closer visual attention to detail. Heavier weight paper will increase resistance, but it tends not to fold as easily and may be frustrating. Manipulating the paper to execute folds provides practice in fine motor dexterity and requires using graded finger movements to make fine adjustments to correctly align edges of the paper. Bilateral use of hands, crossing midline, and strength are also addressed through the folding process. Descriptions of folds involve directionality and spatial relations. Higher level executive functions are tapped by this activity. The client can plan and then recall steps, sequence, and extrapolate (“What will it look like if we unfold it?”). Following directions is a critical element of origami. Yet one of the wonderful characteristics of paper folding is that errors can often be corrected on the original piece of paper.


Artful Interventions for a Variety of Settings and Conditions

rigami (a combination of the Japanese words for fold and paper) has been used in educational settings in Japan and Europe for many years.1 In the first half of the 19th century, Friedrich Froebel, the founder of the kindergarten system, discussed the use of paper folding as an active means of engaging in learning—part of a classification of activities that he called “occupations.”2 Origami has been used in school settings as a means of encouraging exploration and the creative process while facilitating eye-hand coordination and dexterity. More recently, there has been a revival of the art form, especially for promoting and understanding mathematical processes.3–4

Origami lends itself well to both inclusion settings and Response to Intervention (RtI).6 In inclusion, a special education student is seen in the classroom for a functional activity that the entire class is engaged in. RtI involves seeing students who have not been placed in special education, but who may be at risk for difficulties. The goal of RtI is to provide interventions that will effectively correct the students’ difficulties without a referral to special education. RtI is usually done in groups. A benefit of both RtI and inclusion is that interventions are available to students with weaknesses

Among the relevant applications to occupational therapy, the Miller Function and Participation Scales (M-FUN), for example, uses an origami item to assess fine motor accuracy, motor planning, and sequencing in children 3 to 8 years of age.5 The items can be quickly scored, and the child can take the object home. I have used origami as an intervention with children in various settings and with a wide variety of conditions for more than 30 years. It has consistently been one of the best received and most frequently requested activities. An unexpected benefit of this intervention has been parent and caregiver involvement. Parents almost always ask for a piece of paper so they can perform the activity with their child. They often report trying it at home. In the school setting, students frequently ask for extra paper to take home. Students can be taught to make



A mural completed by special education students at one of the author’s schools.

that may have gone undetected. These settings provide increased opportunities for interaction and socialization with peers without disabilities. Origami adapts well to many other settings, including rehabilitation,7 mental health, home heath, acute care, and elder care. When origami is provided in a large group, it is essential that the model being taught is well known to the instructor. Large-size paper that has been prefolded makes it easier to demonstrate the model and for students to see the steps. It is possible to begin a session with body folding—“folding” arms to left and right sides, or folding diagonally, by reaching with the right or left hand to the opposite foot. This activity uses gross motor movement, works on directionality, and may allow the clients to increase their level of alertness prior to performing the actual paper folds.8

Inclusion. Origami was used in an
inclusion setting in a fifth grade classroom. Only one student in the classroom received occupational therapy, although five other students were in special education. When origami was introduced, the class could not complete a model involving five steps. In the course of one semester, with origami presented seven times, the students could name and execute basic folds (including inventing the names “hotdog fold” for a book fold and “taco fold” for a diagonal fold) and complete a six- to seven-step model, including multistep folds. The classroom teacher indicated that the students were doing better with visual tracking activities and logical thinking. Three years later, all the special education students from that class were seen in a large group setting in which origami was one possible activity.

Every student from the inclusion setting chose the origami activity and executed several models, using smaller and smaller paper and recalling the steps after one demonstration. Oppositional defiant disorder. Brendon was a 13-year-old eighth grader with oppositional defiant disorder and attention deficit hyperactive disorder. Brendon’s treatment goals involved completing assignments, increasing self-control, and accepting directions from adults. During one session, he was asked to sort the directions for origami models from two origami-a-day calendars. He did not want any assistance and quickly sorted the pages, establishing categories on his own and asking only for clarification. He sorted out duplicates and asked if he could have them. He returned to the occupational therapist the next week, having done many of the models and asked for help with the “bases” he couldn’t do without specific directions. When complimented on his work, he actually gave the occupational therapist a grudging smile! Mental retardation. Michael was a 10 year old with a qualifying disability of mental retardation. He had poor social skills, difficulty with short- and long-term memory, and low self-esteem. In a group occupational therapy session, an origami model was presented. The model involved 8 steps to create the base form and 11 additional steps to complete the model. Michael was interested and engaged


throughout the session. Three weeks later, the same group of three boys asked to do the same model. The treating occupational therapist indicated that while there was origami paper available, she did not have the instructions and could not recall them. Michael insisted that he knew how to do it. Michael not only recalled each step, but he was able to explain and demonstrate the process to the other boys in the group. He was extremely proud when he left and would often remind the occupational therapist that he had done it.

f O r M O r e i n f O r M at i O n
British Origami Society Origami: The Art of Paper Folding The Ultimate Origami Book Morin, J. (1998). The ultimate origami book. Philadelphia, PA: Courage Books, Running Press.
3. 4.




A challenge facing many occupational therapy practitioners is finding the means of engaging clients through activities with an occupational relevance and making such activities interesting. Origami can be a powerful element of an occupational therapy toolbox. It is a fun and engaging activity that addresses numerous occupational skills and can be applied to numerous disabilities and a wide variety of settings. It appeals to a wide range of ages and is conducive to group and family participation. Origami’s very simplicity is one of its strengths, as it can be done almost anywhere and at any time with minimal preparation. Even specialty paper is not required. It should be considered by occupational therapy practitioners searching for motivating activities for clients of all ages. n

University of Surrey Roehampton. Retrieved from pdf Pearl, B. (2008). Math in motion—Origami in the classroom. Yardley, PA: Math in Motion. Pope, S. (2002). The use of origami in the teaching of geometry. Proceedings of the British Society for Research into Learning Mathematics, 22(3), 67–73. Miller, L. J. (2006). The Miller Function and Participation Scales (M-FUN). San Antonio, TX: Harcourt Assessment. Hanft, B., & Shepherd, J. (2008). Collaborating for student success: A guide for school-based occupational therapy. Bethesda, MD: American Occupational Therapy Association. Wilson, L. M., Roden, P. W., Taylor, Y., & Marston, L. (2008). The effectiveness of origami on overall hand function after injury: A pilot controlled trial. British Journal of Hand Therapy, 13(1), 12–20. Williams, M. S., & Shellenberger, S. (1994). “How does your engine run?” A leader’s guide to the alert program for self-regulation. Albuquerque, NM: TherapyWorks.

Rebecca Lipnick, OTR/L, has 30 years of experience as a pediatric occupational therapist in acute and critical care, outpatient, and school settings. She currently works as a school-based occupational therapist on the Navajo Reservation in New Mexico and is enrolled in the Master’s Degree in Occupational Therapy Program at Quinnipiac University in Hamden, Connecticut.

1. Kasahara, K. (2004). The art and wonder of origami. Hove, East Sussex, United Kingdom: Apple Press Sheridan House. 2. Weston, P. (2000). Friedrich Froebel: His life, times & significance. London, United Kingdom:

Continued from page 14

1. Birkenmeier, R. L., Prager, E. M., & Lang, C. E. (2010). Translating animal doses of TST to people with chronic stroke in 1-hour therapy sessions: A proof-of-concept study. Neurorehabilitation and Neural Repair, 24, 620–635. 2. Hayward, K. S., Barker, R. N., & Brauer, S. G. (2010). Advances in neuromuscular electrical stimulation for the upper limb post-stroke. Physical Therapy Reviews, 15, 309–319. 3. Davis, J. Z. (2006). Task selection and enriched environments: A functional upper extremity training program for stroke survivors. Topics in Stroke Rehabilitation, 13, 1–11 4. Taub, E., Uswatte, G., King, D. K., Morris, D., Crago, J. E., & Chatterjee, A. (2006). A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke, 37, 1045–1049. 5. Gladstone, D. J., Danelles, C. J., & Black, S. E. (2002). The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabilitation and Neural Repair, 16, 232–240.

6. Houghton, P. E., Nussbaum, E. L., & Hoens, A. M. (2010). Electrophysical agents contraindications and precautions: An evidence based approach to clinical decision making in physical therapy. Physiotherapy Canada, 62, 26–38. 7. Pendleton, H. M., & Schultz-Krohn, W. (2006). Pedretti’s occupational therapy practice skills for physical dysfunction (6th ed.). St. Louis, MO: Mosby. 8. Gowland, C., Stratford, P., Ward, M., Moreland, J., Torresin, W., Van Hullenaar, S.,…Plews, N. (1993). Measuring physical impairment and disability with the Chedoke McMaster Stroke Assessment. Stroke, 24, 58–63. 9. Hsu, S. S., Hu, M. H., Wang, Y. H., Yip, P. K., Chiu, J-W., & Hsieh, C. L. (2010). Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke, 41, 821–824. 10. van Halteren-van Tilborg, I. A. D. A., Scherder, E. J. A., & Hulstijn, W. (2007). Motor-skill learning in Alzheimer’s disease: A review with an eye to the clinical practice. Neuropsychology Review, 17, 203–212. 11. Sandford, J., Moreland, J., Swanson, L. R., Stratford, P. W., & Gowland, C. (1993). Reliability of the Fugl Meyer Assessment for test motor performance in patients following stroke. Physical Therapy, 73, 447–454. 12. Woodbury, M. L., Velozo, C. A., Richard, L. G., Duncan, P. W., Studenski, S., & Lai, S. M. (2007). Dimensionality and construct validity of the Fugl Meyer Assessment of the upper extremity. Archives of Physical Medicine and Rehabilitation, 88, 715–723.

13. Lang, C. E., Edwards, D. F., Birkenmeier, R. L., & Dromerick, A. W. (2008). Estimating minimal clinically important differences of upper-extremity measures early after stroke. Archives of Physical Medicine Rehabilitation, 89, 1693–1700. 14. Gowland, C., Stratford, P., Ward, M., Moreland, J., Torresin, W., Van Hullenaar, S.,…Plews, N. (1993). Measuring physical impairment and disability with the Chedoke McMaster Stroke Assessment. Stroke, 24, 58–63. 15. Teasall, R., McClure, A., & Murie-Fernandez, M. (2012). Motor recovery post stroke educational supplement. Retrieved from http://www.ebrsr. com/~ebrsr/modules.php

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sOcial MeDia spOtlight

Electric Wheelchair Foot Plates

Holly Brydl-Andrews Posted: Wed, Nov 7 2012 4:40 PM
I have a question to pose to those creative OT minds. I’ve run into this dilemma several times in the past few months now and cannot find a great solution: Many of my clients who are elderly in power wheelchairs are unable to bend down and are unable to use their feet to raise the foot plate of their electric wheelchair prior to doing transfers. This puts them at a big risk for falling, as some of them will just stand on the foot plate, and others will attempt to bend all the way forward in their chairs to try to reach to the floor to lift it. I have tried teaching the clients to use a cane to push the foot plate up, but not all of my clients have canes and sometimes they are not strong enough to do this either. Any other ideas/suggestions/creative methods to try?

@4stephy Attended my first #AOTA meeting. So proud to love my profession and join others in supporting its growth! @AOTAInc #OccupationalTherapy @AOTAInc 14 Nov Friend’s war injury inspires NJ Occupational Therapist Kristin Perelli to create home for wounded vets. Video: @OT_Advocacy Quality sleep means quality peace. #OccupationalTherapy @Zainy07 13 Nov As an #occupationaltherapist I jus gotta’s not about being occupied but about doing things that make ur heart go boombaroomboom! @Anna Haertling 13 Nov One of my tweets was pinned on @AOTAInc’s Pinterest on a “Top #Conclave12 Tweets” list! #flattered @AOTA News & PR 6 Nov Fast-growing jobs that don’t require a 4-year degree. Occupational therapy assistant on the list, via @HuffPost

meganadair replied on Wed, Nov 7 2012
I have only run into this once or twice, and I was able to teach the client to reach down or use their feet, but what about attaching a string or rope that they can pull up on? Or have you tried a dressing stick or reacher instead of a cane? It might be easier for them to grip if they are weak. Just some thoughts, hope they help!

Jody Niemann, MS, OTR/L replied on Fri, Nov 9 2012
I have had some success with using a reacher for moving the footplate. It does take a certain amount of UE strength and trunk control to do this though. Even if the reacher can bring the plate up a portion of the way, sometimes then they can reach more safely with hands or use feet at that point. One resident used a folding reacher for this as it is not realistic sometimes to carry a standard sized reacher along with them in their chair but the folding one was handy and this resident could fold and unfold on their own.

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Self-Paced Clinical Course


Neurorehabilitation Self-Paced Clinical Course Series, by Gordon Muir Giles, Kathleen Golisz, Margaret Newsham Beckley, and Mary A. Corcoran. Includes 4 components—the Core SPCC, and

Autism Topics Part II: Occupational Therapy Service Provision in an Educational Context, edited by Renee Watling. Second in 3-part CE series with

3 Diagnosis-Specific SPCCs. Core SPCC: Core Concepts in Neurorehabilitation: Earn .7 AOTA CEU (8.75 NBCOT PDUs/ 7 contact hours). Order #3019, AOTA Members: $91, Nonmembers: $128.80. http:// Diagnosis-Specific SPCCs: Neurorehabilitation for Dementia-Related Diseases (Order #3022 view/?SKU=3022), Neurorehabilitation for Stroke (Order #3021, and Neurorehabilitation for Traumatic Brain Injury (Order #3020 Each: 1 AOTA CEU (12.5 NBCOT PDUs/10 contact hours), AOTA Members: $129.50, Nonmembers: $184.10.

content from Autism, 3rd Edition addressing OT practice within public school systems and early intervention through elementary years and transition process. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4881, AOTA Members: $210, Nonmembers: $299. 4881


Assessment and Intervention Assessment & Intervention Training 2-day hands-on workshop (1.6 CEU)
Two Days of Hands-On Learning (1.6 CEU) 2008 Conference Schedule

NEW! Autism Topics Part III: Addressing Play and Playfulness When Intervening With Children With an Autism Spectrum Disorder, edited by Renee Watling. Third of 3-part series with content


Using the Occupational Therapy Practice Guidelines for Adults with Alzheimer’s Disease and Related Disorders (ADRD) To Enhance Your Practice, by Patricia Schaber. Evidence-based

perspective in defining the process and nature, frequency, and duration of interventions and case studies of adults at different stages of Alzheimer’s disease. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4883, AOTA Members: $68, Nonmembers: $97. ?SKU=4883

from Autism, 3rd Edition. Provides topics—Core Concepts, Formal and Informal Assessments, Intervention Planning, and Tying It All Together—to incorporate the occupation of play into both evaluations and interventions with children with autism spectrum disorders. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4884, AOTA Members: $210, Nonmembers: $299. http://store.aota. org/view/?SKU=4884


ADED Approved CEonCD™

Determining Capacity to Drive for Drivers with Dementia Using Research, Ethics, and ProfesOT PRACTICE • DECEMBER 17, 2012

issues of autism in adulthood and knowledge and tools to advocate health and community participation of young adults and adults on the autism spectrum. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4878, AOTA Members: $105, Nonmembers: $150. =4878

Young Adults on the Autism Spectrum: Life After IDEA, by Lisa Crabtree and Janet DeLany. Critical

For complete training schedule & information visit Host a Beckman Oral Motor Conference in 2009! For Hosting info call (407) 590-4852, or email Host a Beckman Oral Motor Seminar! Host info (407) 590-4852, or D-6253

San Francisco, CA Feb & Dates: Upcoming Locations 29-Mar 1 Burlington, January 14-15 Fayetteville, AR NC Mar. 11–12, 2013 Houston, January 28-29 Stafford, TX TX Mar18–19, 2013 McAllen, TX Apr. 4-5 Mobile, AL February 22–23, 2013 Chicago, March 11-12 Atlanta, GA IL Apr 1–2, 2013 San Antonio, March 19-20 Lexington, KY TX Apr8–9, 2013 Charleston, SC Apr 25-26 Morganton, NC March 21–22, 2013 Tampa, FL May 2-3 Montery, CA NY Jul 17-18 Manhattan, April 4–5, 2013 Peck, Beach, VA Sep 2013 Virginia MI April 11–12, 20-21 San Antonio, TX May 23–24, 2013 Morganton, NC Sep 25-26 Chicago, August 16–17, Houston, TX IL Oct 10-11 2013 Columbia, SC Oct 16-17 Hartford, CT September 7–8, 2013 Sacramento, CA Oct 24-25 Seattle, WA October 5–6, 2013 Orlando, October 24–25, San Antonio, TXFL Nov 14-15 2013 For additional info and to register, 2013 Columbia, TN November 1–2,visit


eMplOyMent OppOrtunities

Assistant/Associate Professor of Occupational Therapy
The School of Occupational Therapy at Belmont University is seeking applications for two tenure-track faculty positions at the rank of Assistant/Associate Professor beginning August 1, 2013. One position requires expertise in the content areas of research, assistive technology, and/or general rehabilitation; the other position requires expertise in the content areas of research, neuroscience, and/or rehabilitation (neurorehabilitation), although those with other areas of expertise will be considered. A minimum of five years clinical experience in occupational therapy is required. Two years of full-time graduate teaching experience or its equivalent is preferred. An earned doctorate (PhD, EdD, DrPH, post-professional OTD) is required. Occupational therapy candidates must have certification by NBCOT and must be eligible for licensure in TN. The university seeks persons of Christian faith and commitment to the mission of the university. For additional information about the position and to complete the online application, candidates are directed to During the application process, applicants will be asked to respond to Belmont’s mission, vision, and values statements, articulating how the candidate’s knowledge, experience, and beliefs have prepared him/her to contribute to a Christian community of learning and service and give a brief statement of teaching philosophy. An electronic version of a Cover Letter, Curriculum Vitae, and List of References with contact information must be attached in order to complete the online application. Belmont University seeks to attract an active, culturally and academically diverse faculty of the highest caliber skilled in the scholarship of teaching, discovery, application, and integration of faith. Belmont is a student-centered Christian university focusing on academic excellence and is among the fastest growing universities in the nation. Belmont University is an equal opportunity employer committed to fostering a diverse learning community of committed Christians from all racial and ethnic backgrounds. Women and minorities are encouraged to apply. Review of applications will begin immediately and continue until the positions are filled. The selected candidate for this position will be required to complete a background check satisfactory to the University. If you have questions about the position, please contact Faculty Search Chair: Debra Gibbs, EdD, OTR/L, FAOTA at (615)460-6702.



Department of Occupational Science & Technology

Clinical Assistant/Associate Professor
The University of Wisconsin-Milwaukee Occupational Therapy Program within the Department of Occupational Science & Technology is seeking a talented individual to fill a teaching academic staff position for fall 2013. About the position: Appointees of this 9-month, academic year position will be responsible for teaching core courses and participating in curriculum development in the Occupational Therapy Program, establishing and maintaining university-to-community links to enhance fieldwork education, sharing expertise between and among faculty and clinicians, and participating in service activities related to the university and profession. Candidates must have: • nitial Certification by NBCOT as an OTR and be eligible for a license in Wisconsin I (to be obtained upon position acceptance) • Earned master’s degree or clinical doctorate • 5 years clinical experience in physical/neurological rehabilitation • Experience in occupational therapy clinical education • Teaching experience in an area relevant to OT practice • xcellent communication, interpersonal, and organizational skills E Evidence of the following preferred qualification will be considered a plus: • Experience with assistive technology • Experience with diverse groups • Experience and success in teaching college level courses • Experience using distance education About Our Campus The University of Wisconsin-Milwaukee (UWM) is a public doctoral research institution located in Milwaukee, Wisconsin, close to the shores of Lake Michigan on a 90-acre campus and has a total enrollment of more than 30,500 students. For more information about the university, visit For more information about the College of Health Sciences and the Department of Occupational Science & Technology, and the Occupational Therapy Program, please visit

About Our Department UWM’s Department of Occupational Science and Technology (OS&T) is comprised of internationally recognized faculty and staff with expertise in both traditional and emerging areas of practice relevant to occupational therapy. With 12 full-time faculty positions and 4.25 full-time academic staff positions, the department offers entry-level OT degrees, an interdisciplinary PhD in Health Sciences and certificates in therapeutic recreation, ergonomics, and assistive technology and accessible design. The OT graduate program is rated in the top 25% in the United States. The Rehabilitation, Research, Design, and Disability (R2D2) Center and the Center for Ergonomics have been developed to provide in-depth interdisciplinary research opportunities. Application Procedure: Applicants must apply online at and submit electronically a) a cover letter with a statement of the candidate’s teaching interests and experiences, b) a curriculum vitae detailing educational background, work experience, and courses taught, and c) a list of three professional references with contact information to include telephone number, mailing address, and e-mail address. Review of applications will begin February 1, 2013. The names of those applicants who have not requested in writing that their identities be withheld and the names of all finalists will be released upon request. The state of Wisconsin will require a criminal background check. The University of Wisconsin-Milwaukee is an affirmative action, equal employment opportunity employer. Web sites for the university and this position are found at and For the UWM Campus Security Report, go to or call the Office of Student Life, 118 Mellencamp Hall at (414) 229-4632 for a paper copy.




Jockey Club Sarah Roe School
Principal: Mr. Alan Howells Web site: Jockey Club Sarah Roe School is an international special school for children and young people who have additional support needs aged between 5 and 19.

Occupational Therapist (Paediatric)
Fixed-term gratuitable contract with benefits
A qualified and experienced paediatric OT is required to join a dynamic team of teachers and therapists, who work together to meet the individual needs of the students, filling a vacancy in the secondary department of the school. The package for this position includes: • ratuity payment of 20% of salary on completion of G each 2 year contract • Cash allowance toward accommodation • Education allowance for up to three children • Paid professional development opportunities • edical/dental schemes (worldwide cover provided M by BUPA) • Annual leave 30 days per year —

The successful candidates must: • ave a bachelor’s or master’s degree in occupational H therapy from a recognized institution. • e registered with the Supplementary Medical B Professions Council of Hong Kong (Part 1 of Register) Note—Application for registration can be made through the Occupational Therapists’ Board of Hong Kong (Web site: Closing Date: Sunday, January 6, 2013 Please go to for more details and submit application online. For further enquiries, please contact the vice principal, Mr. Robert Szorenyi, at I-6249


School-based OT’s-IL
Special ed agency seeks licensed full/parttime OT’s for job in Aurora. Competitive salary, excellent benefits, pension, mentoring. New grads welcome. Contact Mary Kolinski, Northwestern Illinois Association, 630-402-2002. Fax resumes to 630-513-1980 or email mkolinski Web site: EOE South

Occupational Therapists
Multidisciplinary pediatric practice seeking occupational therapists on a full-time and part-time basis in Los Angeles and San Fernando Valley. Competitive pay based on experience. Generous benefit package for full time employees. Independent contracting available. Job Description: Provide OT services to clients in clinic, home and schools. Participate as a member of the interdisciplinary team of speech pathologists, occupational therapists, BCBA’s, behaviorists, educational therapists, early interventionists and child development specialists. Graduates from an accredited Occupational Therapy program, current certification by AOTA/National Board for Certification of Occupational Therapy. California State Licensure. Must have 2+ years’ experience. Strong assessment, treatment planning, communication/organizational skills, knowledge of and interest in working with children and adults. Speech, Language & Educational Associates 16500 Ventura Boulevard, Suite 414 Encino, CA 91436 818-788-1003 FX 818-788-1135

Occupational Therapists Physical Therapists
School-Based Opportunities in the Washington, DC area • Friendly, diverse working environment • Students with disabilities, ages 3 to 21 years • Excellent mentoring, support, and training • Recent graduates welcomed Apply online at
Named twice by the US Department of Education as a Blue Ribbon School of Excellence, The Ivymount School and Programs is a non-profit school and outreach center providing quality educational programs and therapeutic services to students with special needs from 4 to 21 years of age. Since its founding in 1961, Ivymount has helped more than 8,000 young people, from throughout the Washington metropolitan area to lead independent and fulfilling lives as productive members of their communities. Ivymount has been chosen by respected researchers and practitioners as a training and research site, and currently has over a dozen collaborative partnerships with leading organizations in the Washington DC area—including: Children’s National Medical Center, Georgetown University Hospital Pediatrics and The Smithsonian Institution.N-6258 29



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…

ARIZONA OTs—$65,000

*STARS* W-6037



AOTA’s 2013 OT Practice Buyer’s Guide...
is the single comprehensive and accurate database of currently marketed products and services, colleges/universities, recruitment/staffing opportunities, and rehabilitation facilities for occupational therapy professionals.

Can’t find what you’re looking for?
The OT Practice Buyer’s Guide will be available online through 2013. An addendum will be added to the back of the online version to provide access to new listings throughout the year. Be sure to check it out at


Buyer’s Guide


OccupatiOnal therapy

93rd Annual Conference & Expo
April 24–28, 2013 ~ SAn DiEgO, CAlifOrniA
an Diego provides the ideal setting for discovering the heartfelt leadership and compassionate care that defines occupational therapy. Our profession is

The American Occupational Therapy Association’s


Register at

experiencing great opportunity as we expand in evidencebased research and practice. But we also face serious challenges in health care legislation and public awareness. As we take our place as leaders in the profession and as skilled providers of excellent practice, research, and education, the more opportunities will arise and the more challenges will be met. The AOTA Annual Conference & Expo is the most dynamic gathering for occupational therapy professionals each year. Stimulating Presidential and keynote addresses, hundreds of focused educational sessions, exceptional speakers, valuable connections, and an Expo brimming with state of the art products and opportunities are all under one roof in San Diego. This is your chance to



from heartfelt leadership to compassionate care

Cognition, Occupation, and Participation Across the Life Span: Neuroscience, Neurorehabilitation, and Models of Intervention in Occupational Therapy, 3rd Edition
Edited by Noomi Katz, PhD, OTR
Foreword by Beatriz Colon Abreu, PhD, OTR/L, FAOTA The translation of cognitive neuroscience into occupational therapy practice is a required competence that helps practitioners understand human performance and provides best practice in the profession. This comprehensive new edition represents a significant advancement in the knowledge translation of cognition and its theoretical and practical application to occupational therapy practice with children and adults. Chapters, written by leaders in an international field, focus on cognition that is essential to everyday life. GENERAL TOPICS • Cognitive Intervention and Cognitive Functional Evaluation • Higher-Level Cognitive Functions Enabling Participation • Impact of Mild Cognitive Impairments on Participation • Transition to Community Integration for Persons With Acquired Brain Injury • Family Caregivers’ Participation in Recovery • Cognitive Information Processing • Cognitive Aging • Virtual Reality for Cognitive Rehabilitation MODELS FOR INTERvENTION • Dynamic Interactional Model of Cognition in Cognitive Rehabilitation • Dynamic Interactional Model in Schizophrenia • Metacognitive Model for Children With Atypical Brain Development • Cognitive Rehabilitation of Children and Adults With Attention Deficit Hyperactivity Disorder • Retraining Model for Clients With Neurological Disabilities • Cognitive Orientation to Daily Occupational Performance (CO-OP) • Dynamic Cognitive Intervention: Application in Occupational Therapy • A Neurofunctional Approach to Rehabilitation After Brain Injury • The Cognitive Disabilities Model in 2011 • The Cognitive Disabilities Reconsidered Model: Rehabilitation of Adults With Dementia

A must-read book for occupational therapy professionals and students to consider cognitive intervention strategies as critical to promote occupation-based, client-centered care and everyday participation in a fuller life!

Each model includes (1) a theoretical base; (2) intervention, including evaluation procedures, assessments, and treatment methods; (3) individual and group treatment case studies that illustrate the intervention process; and (4) research supporting the evidence base of the model or parts of it. Chapters feature learning objectives and review questions.
ISBN: 978-1-56900-322-0

Order #1173B. AOTA Members: $89, Nonmembers: $126


Shop online at, or call 877-404-AOTA!

• Professional Liability Insurance*—Protect yourself from the costs of malpractice lawsuits and claims. • Disability Income Insurance Plan**—Help safeguard your standard of living should you become Totally Disabled. • Group Term Life Insurance Plan**—Help guard your family’s future with life insurance coverage at a price you can afford. • Long-Term Care—Prepare for the long-term care you or a loved one may need.

...with AOTA-Sponsored Group Insurance Plans.
As an AOTA member, you are eligible to take advantage of a variety of important benefits and insurance plans. AOTA sponsors these group insurance plans designed especially for your needs.
• Customized Major Medical—Develop an affordable medical package to meet your specific needs. • Group Enhanced Dental Insurance***—Provides coverage for diagnostic, preventive and specialty dental treatments. • Pet Insurance****—Provide affordable health coverage to help you pay the treatment costs of your pet’s accidents, illnesses and routine medical care.

Learn about AOTA-Sponsored Group Insurance Plans for a secure future.

for a free information kit including costs, exclusions, limitations and terms of coverage or visit us at
NOTE: Plans may vary and may not be available in all states.

Call 1-800-503-9230

* Underwritten by Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance. 55 Water Street, New York, New York 10041. May not be available in all states. Pending underwriter approval. ** Underwritten by Hartford Life and Accident Insurance Company and Hartford Life Insurance Company, Simsbury, CT 06089. *** Underwritten by The United States Life Insurance Company in the City of New York. **** Underwritten by Veterinary Pet Insurance Co. (CA), Brea, CA; National Casualty Co. (Nat’l), Madison, WI. Administered by Marsh U.S. Consumer, a service of Seabury & Smith, Inc.

Pending underwriting approval. May not be available in all states.

CA Ins. Lic. #0633005, AR Ins. Lic. #245544 d/b/a in CA Seabury & Smith Insurance Program Management

AG 9561 55464, 55827, 55991, 55992, 55828 (10/12) ©Seabury & Smith, Inc. 2012