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Carolle Isaacs
Michelle Bagley
Intern Mentor G/T
26 October 2015
Annotated Bibliography
Bastian, A., (2012). Cerebellar control of movement. Retrieved October 20, 2015, from Kennedy
Krieger Institute website:
They investigated novel strategies for helping people with cerebellar damage
learn to improve movement coordination. Initial results suggested that people with
cerebellar damage can show motor learning, but only when errors are due to predictable
changes in the environment that are small and gradual. This form of learning is based on
cerebral mechanisms and is therefore distinct from cerebellum-dependent motor
adaptation. Cerebral motor learning can be modulated with non-invasive brain
stimulation. Cerebellar damage dramatically impairs error-driven motor adaptation, or the
ability to elicit trial-by-trial changes in a movement in response to errors. Normally, this
type of motor learning results in storage of a new motor pattern that has to be actively
unlearned. Storage of a new motor pattern is impaired or absent in people with cerebellar
This researchs long-term goal was to determine if there are motor learning mechanisms
that remain available to people with cerebellar damage, and if it can be leveraged to
improve therapeutic approaches. Actions ranging from walking to reaching become
inaccurate and difficult to control, which has harmful effects on most functional
movements. Therapeutic approaches for cerebellar motor disorders rely heavily on
rehabilitation since there are no medications that systematically improve movement
coordination. Rehabilitation is limited by the fact that cerebellar damage also disrupts
motor learning, or the ability to learn movements through practice. Further research can
be done to see the long term benefits exist for patients with cerebral damage who are
undergoing therapy.
Boyer, K.M., Enrile, B.G., Yeates, K.O. (2006). Working memory and information processing
speed in children with myelom-eningocele and shunted hydrocephalus: analysis of the
childrens paced auditory serial addition test. Pub Med, 12(3), 305-13.
Working memory and information processing speed were examined in children
with myelomeningocele and shunted hydrocephalus using the Children's Paced Auditory
Serial Addition Test (CHIPASAT). The CHIPASAT was administered to 31 children with
myelomeningocele and shunted hydrocephalus and 27 healthy siblings, all between 8 and
15 years of age. They also completed other standardized measures of working memory
and processing speed. Children with myelomeningocele made fewer correct responses
than siblings, although the magnitude of group differences declined as the rate of
stimulus presentation increased. Children with myelomeningocele also made fewer

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consecutive correct responses and were more likely to provide correct but nonconsecutive
responses, suggesting that they responded in a way that circumvents the working memory
demands of the task.
Standardized measures of processing speed and working memory accounted for
significant variance in CHIPASAT performance after controlling for age, group
membership, math skill, and general intellectual functioning. The results indicate that
children with myelomeningocele and shunted hydrocephalus display deficits in working
memory and information processing speed, and suggest that the CHIPASAT may provide
a valid measure of these skills. These results give therapist an understanding of why a
child with hydrocephalus has a harder time completing a given task that has been
repeatedly shown to them. When I help with Occupational Therapy, I have noticed that
children who display shunted hydrocephalus take a longer time to understand directions
and following them. Finding a way to increasing their processing speed and working
memory, whether by surgery or medicine, can help those patients increasing their faster.
Brown, L.E., Dickerson, A.E. (2007). Pediatric constraint-induced movement therapy in a young
child with minimal active arm movement. American Journal of Occupational Therapy,
61(5), 563-573.
Traditional intervention methods for upper-extremity hemiparesis often produce
gains that are short lived or have little progress. Many patients compensate for the
affected arm rather than trying to use it, leading to learned nonuse and halting further
progress with the functioning of that arm. This study describes a single-subject design
that demonstrated the possible effective use of constraint-induced movement therapy
(CIMT) in producing gains in movement and function for a 24-month-old child with
chronic hemiparesis. The noninvolved upper extremity was placed in a removable splint
for 21 consecutive days. The child was involved in intensive occupational therapy in the
home environment. Daily measurements were completed on the use and quality of
motion of the involved upper extremity for eight specific fine and gross motor activities.
Change in performance and quality of movement were measured. The results of the study
contribute to the body of evidence finding CIMT to be effective for increasing movement
and function in children with hemiparesis.
Constraint-induced movement therapy (CIMT) is also used at PACT. It is a
ground-breaking approach to treating hemiparesis that facilitates use of the hemiparetic
arm through constraint of the unaffected arm. It has been shown to be an effective
treatment for hemiparesis in adults. Traditional treatment of upper-extremity hemiparesis
consists of increasing awareness of the involved side; teaching the person to integrate or
incorporate the weaker side into activities along with the stronger side; preparing the
person for function by improving trunk control, weight shift, and proximal stability; and
using neurodevelopmental treatment techniques. The improvement of this 2-year-old
child with right hemparesis corresponded with the use of CIMT treatment. He gained
both movement and function in the right upper extremity that had been relatively
nonfunctional. Thus, the study supports the efficacy of CIMT as shown in other studies of
children and suggests that children with minimal active movement of the impaired upper
extremity can benefit from CIMT and should be included in future controlled studies of

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Cahill, S.M. (2015) Perspectives on the use of standardized parents to teach collaboration to
graduate occupational therapy students. American Journal of Occupational Therapy, 69.
This study proved that a standardized parent experience may help occupational
therapy students develop the habits of mind associated with collaboration. Pediatric
occupational therapy practioners interviewed parents on a daily basis to gain important
patient information and developed collaborative intervention goals. A standardized parent
experience was developed to help masters level occupational therapy students gain the
skills needed to interview parents after their childs traumatic injury.
This article describes the approach used to develop the standardized parent
experience and reports the students general perspectives related to this assignment. This
new finding may lead to my masters level education using standardized parents to teach
Campbell, P.H., Colyvas, J.L., Sawyer, L.B. (2010) Identifying strategies early intervention
occupational therapists use to teach caregivers. American Journal of Occupational Therapy,
64(5), 776-85.
A primary purpose of early intervention services is to provide support to families
so that they may optimize the growth and development of their children. Increasing
caregiver ability by teaching caregivers to use strategies with their children is critical.
Both the extent to which occupational therapists taught caregivers and the strategies used
for teaching were examined in this study for occupational therapists within the categories
of traditional and participation-based service. It examined the routine, provider role, and
strategies OTs used to teach caregivers during early intervention home visits. Regardless
of the model of service, explicit teaching strategies were rarely used during home visits.
According to these results Occupational therapists were not likely to clearly teach
caregivers or facilitate their teaching interactions with their children. High amounts of
incidental learning strategies were used by them. Traditional occupational therapists were
more likely to model strategies by directly working with children while caregivers were
passively engaged through observation, whereas participation-based therapists more often
used joint interaction with child, a strategy in which the caregiver was actively involved.
This study investigated early intervention occupational therapists use of strategies
to teach caregivers. Using these results, a possible project for me this year could be to
find an effective way to educate parents about their childs disease or developmental
disorder, and show them what they can do at home to help their child maximize their
rehabilitation. This research provides a snapshot of the teaching strategies occupational
therapists use with caregivers in early intervention. The results of this study suggest that
occupational therapists do not explicitly teach caregivers; rather, therapists in this study
relied on modeling or joint interaction with the child as indirect opportunities for
caregivers to learn. Using explicit teaching strategies to educate caregivers can empower
caregivers to be active. The family is viewed as the most proximal influence on child
development. In early intervention, caregivers have significant opportunities to influence
their childrens development and growth

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Cerebral palsy. (n.d.). Retrieved October 21, 2015, from National Organization for Rare Diorders
Cerebral Palsy is a neurological movement disorder characterized by the lack of
muscle control and impairment in the coordination of movements. This disorder is
usually a result of injury to the brain during early development in the uterus, at birth, or
in the first two years of life. Cerebral Palsy is not progressive. Infants with Cerebral Palsy
have muscle weakness, a lack of muscle tone and, later, muscle spasticity and lack of
coordination. They may experience developmental delays during the first or second year
of life. Cerebral Palsy can affect people mildly, moderately, or severely. As a child with
Cerebral Palsy grows, other symptoms may include drooling, speech impairment, and
difficulty maintaining bladder and/or bowel control, convulsive seizures, hand tremors,
and the inability to identify objects by touch. Children with this disorder may experience
an impairment in vision more often than other children. Mild or severe intellectual
impairment are only present in some patients. Most may have average or above average
intelligence. Cerebral Palsy is classified according to the limbs that are affected and the
characteristics of the movement disturbance. If both legs are affected, the condition is
called Diplegia. If the Cerebral Palsy affects both the arms and the legs, then the
condition is termed Quadriplegia.
Therapy is designed for each patient to increase the function of those parts of the
nervous system that are not affected by the Cerebral Palsy. An important part of
rehabilitation for people with Cerebral Palsy is physical therapy that consists of a
supervised program of exercises and activities. Occupational therapy can help children
with Cerebral Palsy learn how to dress, comb their hair, clean their teeth, and to hold a
cup or a pencil. For adults with severe Cerebral Palsy, therapy may involve vocational
training or learning how to shop, cook, or keep house.
Children & youth. (n.d.). Retreived October 20, 2015, from The American Occupational Therapy
Association website:
AOTA has identified Children and Youth as a key practice area for the 21st
century. Pediatric occupational therapy practitioners support societal needs by providing
services to infants, toddlers, children, and youth and their families in a variety of settings
including schools, clinics, and homes. With the new IDEA regulations, occupational
therapy practitioners are also participating in broad new initiatives such as early
intervening services and Response to Intervention.
I can use this resource to help find journal entries. This website has a lot to offer in
promoting the development of young children through early intervention services. They
use play based therapy and have tons have information on sensory integration (everything
I see used at PACT).

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Couch, K.J., Deitz, J.C., Kanny E.M. (2012). The role of play in pediatric occupational therapy.
The American Journal of Occupational Therapy, 52, 111-7.
This study was designed to examine the roles of play within current occupational
therapy practice with preschoolers 3 to 5 years of age, where they addressed the
following questions: How do occupational therapists working with preschool-age
children incorporate play into their practices? Do occupational therapists working with
preschool-age children assess play behaviors, and, if so, what methods do they use? Are
there differences between school-based and non-school-based settings that influence the
roles that play occupies within pediatric occupational therapy? Therapists reported using
play considerably more often as a modality to reinforce than as a means of developing
role behaviors. This finding appears to be congruent with responses that sensory
integration and developmental frames of reference were used most frequently in both
school-based and non-school-based practice. Play is used as a modality in both
approaches. In sensory integration, play is used as a treatment medium and motivator to
promote organization of sensory information
The results of this study provide information on the current use of play within
pediatric occupational therapy and some important considerations regarding educational
opportunities, assessment tool development, and research. If occupational therapy is to
continue to address the roles of self-care, work, and play, then we need to find ways to
more effectively address the role behaviors of play within our practice and communicate
the importance of play. Play is one of three primary occupational roles addressed in the
theoretical foundation of occupational therapy. Therapists use play in practice for both
assessment and intervention.
Dawson, G., Faja, S., Greenson, J., Jones, E.J.H., Kamara, D., Lowy, R., Merkle, K., Murias, M.,
Rogers, S.J., Smith, M., Venema, K.,Webb S.J., Winter, J. (2012). Early behavioral
intervention is associated with normalized brain activity in young children with autism.
Journal off the American Academy of Child & Adolescent Psychiatry, 51, 1150-9.
Forty-eight 18- to 30-month-old children with autism spectrum disorder were
randomized to receive the Early Start Denver Model or referral to community
intervention for 2 years. After the intervention, the childrens EEG activity was measured
during the presentation of faces versus objects. Greater cortical activation while viewing
faces was associated with improved social behavior. Age-matched typical children were
also assessed. The ESDM group showed increased cortical activation when viewing
faces, whereas the community intervention group showed greater cortical activation when
viewing objects. This new study was the first trial to demonstrate that early behavioral
intervention is associated with normalized patterns of brain activity, which is associated
with improvements in social behavior, in young children with autism spectrum disorder.
The results concluded that the ESDM group exhibited greater improvements in autism

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symptoms, IQ, language, and adaptive and social behaviors than the community
intervention group.
I can research to see how effective the autism program in PACT is. Since there is
only one occupational therapist, it seems to me that the children are not always only
getting independent intervention. Most of the times they get a combination of one-oncare and in-group section therapy. It would be helpful to find out if a combination of both
types of therapy may be better or worse for a child with autism.
Hall, P., Herz, N.B., Jackson, P., Mehta, S.H., Morgan J.C., Sethi, K.D. (2013)
Nintendo Wii rehabilitation (Wii-hab) provides benefits in Parkinson's
disease. Parkinsonism & Related Disorders, 19, 1039-42.
In the research, it was hypothesized that the Wii is a useful tool in improving
motor and non-motor aspects in patients with Parkinson's disease. Twenty subjects with
early to mid-stage PD were enrolled in a study design where each subject was evaluated
at baseline and then re-evaluated after playing the Wii three times per week for four
weeks. Subjects were then re-evaluated one month later after not playing the Wii for a
month to see if effects carried over. Subjects demonstrated significant improvements in
the primary outcome measure, quality of life, and motor function, and a trend toward
improved mood after four weeks of Wii therapy. Follow-up assessments one month later
showed continued improvement for quality of life. The results demonstrate that Wii
therapy provides short-term motor, non-motor, and quality of life benefits in PD.
For my project, I could use Wii Balance Boards and line them up between
handrails to create a cost-effective addition to physical therapy for patients at PACT. The
Wii can be used by physical therapist and occupational therapist to aid children with
cerebral palsy, spina bifida, autism, or amputations advance balancing and cognition
skills. It serves as therapeutic tool, used to add to therapy not replace it. The wii hab can
be a possible project idea that I can use at PACT for the older children who need
motivation to exercise. I can fundraise the money for it and promote it in the day care
Hardy, K., Hermann, V., Levine, P., Stephen, J., Suever, A. (2010) Combined bracing, electrical
stimulation, and functional practice for chronic, upper-extremity spasticity. American
Journal of Occupational Therapy, 64(5), 720-726.
The most promising UE spasticity treatments are invasive and tend to rely on
pharmacologic inhibition of the spastic reflex. This study examined a noninvasive
approach that combined management of the patients current UE spasticity (bracing) with
techniques thought to reduce spasticity (electrical stimulation) and increase cortical input
(task-specific functional training). This research examined the application of a combined
technique on spasticity, disability, impairment, and function in 2 chronic stroke patients.
The study was important given the noninvasive nature of the intervention and the
possibility of functional changes as a result of study participation. When accompanied by
functional training, UE bracing and electrical stimulation have each shown independent

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promise in reducing UE spasticity. Work has also suggested that the combination of these
promising modalities decreases UE spasticity and increases function in spastic cerebral
palsy. These results showed that each participant displayed different but clinically
significant changes that were not curative. Indeed, at times, assistance from the
unaffected arm was required during functional activities. However, participation in the
intervention enabled better performance of isolated movements at certain joints and
improved functional performance.
At PACT, I had the chance to work with this technique. Ms. Temrah showed me how to
use an electrical stimulator with bracing to to reduce spasticity (electrical stimulation)
and increase cortical input. I learnt that stroke is the leading cause of disability in the
United States. It causes upper-extremity (UE) impairments in over 80% of survivors. UE
spasticity may be one of the most devastating, because it can be painful, frequently
compromises performance of activities of daily living, and diminishes independence.
Treatment that decrease spasticity and increase functional ability are very useful in both
physical therapy and occupational therapy.
Helping individuals with developmental disorders and injuries unlock their potential (n.d.).
Retrieved from Kennedy Krieger Institute website:
Kennedy Krieger Institute is an internationally recognized institution dedicated to
improving the lives of individuals with disorders of the brain, spinal cord, and
musculoskeletal system through patient care, research, and professional training, special
education, and community. Their areas of special include autism spectrum disorders,
communication disorders, muscular dystrophy, behavioral disorders, developmental
disorders, muscular dystrophy, behavioral disorders, developmental disorders,
rehabilitation, and more. They believe that early identification, intervention, and
treatment of disabilities are key to maximizing potential and preventing major problems
throughout a child's life. They have all the areas (science, medicine, therapy, and
education) necessary to bear on the problems and injuries that affect a child's
development. They show a thorough understanding of developmental disabilities that
allows them to care for our patients throughout their lives, which ensures success at home
and in their community.
In the future, I would like to be one of their 200 physicians specializing in one of
their 50 different specialists. They care for more than 16,000 patients each year who
come from throughout the region, nation, and world and they provide them with a unique
access to the latest in research and treatment models in the areas of autism,
neurorehabilitation, behavioral disorders, learning disorders and other developmental
Introduction. (n.d.). Retrieved October 20, 2015, from Evidence Based
Occupational Therapy website:
Evidence-based practice (EBP) encourages the integration of high quality quantitative and
qualitative research, with clinicians clinical expertise and the clients background, preferences
and values. It involves the client in making informed decisions and should build on, not replace,
clinical judgement and experience.

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Learning through play. (n.d.). Retrieved October 24, 2015, from The American Occupational
Therapy Association websiter:
The act of playing is an important tool that influences a childs life. Occupational
therapists have expertise in evaluating childrens neurological, muscular, and emotional
development; and determining the effects of infant and childhood illness on growth and
development. Occupational Therapy practitioner can help adapt toys or modify
the environment to provide optimal sensory input without overwhelming the child. They
can recommend toys and play activities that provide the "just right" challenge for the
child, so he or she learns while having fun. They can also recommend ways to build on
the child's strengths and abilities by offering play opportunities that encourage turn taking
and problem solving. OTs consider family routines and priorities when recommending
play strategies. They observe, identify, and develop play strategies that promote a healthy
lifestyle and relationships. They recommend ways for family members to be more
involved in the child's play and suggest toys and play activities for children of all abilities
and ages.
I can create a toy library for PACT, incorporating blocks, stacking rings,
pegboards, shape sorters, push and pull toys, balls, books, large beads, movement games,
toy cars and trucks, train sets, rattles, mobiles, playmates, mirrors, teething toys, and
squeeze toys for toddlers with learning disabilities. Each toy can be specially designed to
enhance playtime PACT. I can determine what toys will be safe, developmentally
appropriate, and fun for a particular child, based on their goals they are working on. I can
evaluate the childs and their family's needs and goals. Since it is a childs "job" or
"occupation" to play to develop physical coordination, emotional maturity, social skills to
interact with other children, and self-confidence to try new experiences and explore new
environments. The primary goals of childhood are to grow, learn, and play. It is often
through play that children learn to make sense of the world around them. Therefore I can
suggest or provide toys that will help the child develop particular skills, while having fun.
McMahon, M., Pruitt, D., & Vargus-Adams, J. (2009). Chapter 8: Cerebral Palsy. In, Pediatric
Rehabilitation: Principles & Practice (pp. 165-197). Demos Medical Publishing, LLC.
Cerebral palsy is the most common motor disability of childhood, affecting
approximately 3.6 per 1,000 school-age children with at least 8,000 new cases each year
in the United States. The population of children with CP may be increasing due to
premature infants who are surviving in greater numbers, higher incidence in normalweight term infants, and longer survival overall. The proportion of CP that is most severe
is also increasing, with as much as a third of all children with CP having both severe
motor impairments and mental retardation. The anatomic distribution of motor problems
in CP is the primary means of classification. The three categories of hemiparesis,
diparesis, and quadriparesis occur with fairly equal frequency. Hemiparetic CP affects
only one side of the body and typically demonstrates greater impairments in the upper
extremity. Diparetic CP affects the lower extremities more than the upper extremities.
Spastic quadriparetic CP affects the entire body, including the axial as well as
appendicular skeleton. Sensory deficits are important to recognize because they can
significantly affect functional use of the extremity. It is believed to be most common in

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children with hemiparesis. Visual and hearing impairments are relatively less common in
CP. Children with CP are at increased risk for respiratory illnesses. Spasticity and muscle
imbalances can often lead to joint deformities in the upper extremity.
Stretching and strengthening appears to be a promising intervention for children
with CP. Although research to find an ideal duration and frequency for it needs to done.
Physical therapists and occupational therapists working with children with CP choose
from a variety of therapy methods since there is no clear scientific evidence to support
the effectiveness of any one particular approach. Often therapists will use a combination
of therapeutic methods in association with an emphasis on functionally based therapies.
Minorities Are Disproportionately Underrepresented in Special Education: Longitudinal
Evidence Across Five Disability Conditions, 2015.
The research presented suggests that the odds of black children being identified as
have learning disabilities are 58 percent lower than white children displaying the same
levels of academic achievement, behavior, and family economic resources. Black
children are 57 percent less likely to be identified as having intellectual impairments and
77 percent less likely to be identified as having health impairments compared to white
children. The odds that black children are identified as having emotional disturbances are
also 64 percent lower than otherwise similar white children. Surprisingly this research
goes against frequent reports that minority children are overrepresented in special
education classrooms.
The authors purpose is to make educational professionals more attentive to
cultural and language barriers that may keep minority children with disabilities from
being appropriately identified and treated. All children with disabilities, regardless of
their race, ethnicity, or language use, need to receive the help they need. I can research to
see if minority kids here in Howard County are facing the same problem.
Mojtabai R., Rosenheck R. A, Susser, E. S., & Wyatt R. J. (2003). Use of VA aftercare following
military discharge among patients with serious mental disorders. Psychiatric Services,
54(3), 383388.
With nearly 1.5 million Americans currently serving in the armed forces and 22.7
million veterans, the issue of veteran care will continue to grow. Providing care will
include treating traumatic brain injury among soldiers and helping the growing number of
veterans with poly-trauma the military is failing to diagnose, treat, and document brain
injuries in veterans, and that Tricare. The insurance-style program for nearly 4 million
active-duty military and retirees will not cover cognitive rehabilitation therapy. As a
result of the U.S. engagement in two combat fronts, the high number of wounded
warriors with traumatic brain injuries who are attempting to reintegrate into the
community has highlighted and reinforced an even greater need to address the long-term
functional status of individuals with this condition. Those who have served in the military
may exhibit posttraumatic stress disorder and other vestiges of their survival training for
warfare that are not conducive to performing daily activities in a regular home or work

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environment. For example, wounded warriors may need to relearn how to drive in a
noncombative way (contrary to their safety-oriented training on the battlefield) or address
anger management issues with their families and others. Ultimately, regardless of where
or how the individual sustained a TBI, there is a need to transfer skills learned in a
rehabilitation setting to natural environments such as the home, workplace, and
recreational settings so he or she can resume participation and function as close to prior
levels as possible.
I would be interested in working as a civilian OT at a military treatment facility. I
feel it would be an amazing opportunity and there are so many different capacities that I
can work in as an OT for the army. Opportunities for the reserve OT are absolutely
incredible. Occupational therapy practitioners are key rehabilitation professionals in
assisting individuals with brain injury to reintegrate back into the community. Their
education and training make them experts at evaluation and analysis of an individuals
performance abilities relative to the demands of the activity. This perspective
encompasses all aspects of an individuals life, including activities of daily living (selfcare) and instrumental activities of daily living (home management, rest and sleep habits,
work demands, play, leisure, social participation). They can then help clients relearn how
to do these activities (remediate) or determine new ways of accomplishing them
(compensatory strategies). Occupational therapy practitioners may work with individuals
in real life settings such as the grocery store, bank, mall, bus/train, workplace, home, or
any other environment in which they need to regain competence in occupational
performance. They may work as part of a team, which may include a physical therapist,
speech-language pathologist, neuropsychologist, social worker, and other professionals as
appropriate, such as teachers or vocational rehabilitation counselors.
Mulrooney L.L., Schaaf, R.C. (2012) Occupational therapy in early intervention: A familycentered approach. Department of Occupational Therapy.
Five preschoolers who were enrolled in the early intervention program in New
Castle County, Delaware, participated in the study. Subject 1 (age 34 months) was
diagnosed with failure to thrive syndrome. Subject 2 (age 37 months) had hydrocephalus
and was visually and hearing impaired. Subject 3 (age 36 months) was developmentally
delayed. Subject 4 (age 32 months) had myotonic dystrophy and was developmentally
delayed. Subject 5 (age 35 months) had congenital anomalies and was visually and
hearing impaired. All of the subjects were scheduled to receive occupational therapy on
the basis of previous evaluations. Intervention consisted of direct and consultative
occupational therapy in the home and early intervention environments. The intervention
strategies were directed toward the parents, the classroom staff, and the 5 subjects. These
strategies consisted of one hour weekly home visits, in which environmental adaptations
were made to facilitate play; a weekly parent discussion group to discuss the importance
and relevance of play; and the use of a toy library. The results of this study suggested that
positive changes in play behavior can occur with use of the family-centered framework
for early intervention. The results also imply that occupational therapy may be effective
in enhancing the child's capability in interacting with his or her environment.

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. In this research, play was used both as an evaluative tool and as an early
intervention modality that addressed the will, adjustment, and performance of the child
and family as well as the strengths and weaknesses of the environment. Play was also
used as a primary measure of ability and change. This framework may be useful in
defining occupational therapy roles for the early intervention population. This research
also used a toy library. A toy library is a resource that can enrich the home play
environment. The therapist can use information gathered from assessment data to guide
the borrowing of toys, thereby enriching the child's environment and encouraging skills
through environmental adaptation. The toy library was quite useful in this case because
the family had a limited income and limited availability to developmentally appropriate
NBCOT. (n.d.). Retrieved October 21, 2015, from National Board of Certificate in Occupational
Therapy website:
Occupational therapy is a healthcare profession that focuses on helping people participate
in the meaningful activities they need and want to do. Occupational therapy is unique in that it
uses a holistic approach to look not only at the reasons a clients participation in activities has
been impacted, but also at the clients roles and environment and includes wellness promotion,
rehabilitation, and habilitation. The occupational therapy professional assists the client to regain
function or adapt to changes by assessing and addressing the physical, cognitive, psychosocial,
sensory, and environmental aspects of recovery.
After finishing my masters, I will have to pass the board exam explained on the
NBCOTs page. NBCOT provides a world-class standard for certification of occupational
therapy practitioners. It develops, administers, and continually reviews its certification process
based on current and valid standards that provide reliable indicators of competence of the
practice for occupational therapy. It is a not-for-profit credentialing agency that provides
certification for the occupational therapy profession and works with state regulatory authorities
and employers to providing information on credentials, professional conduct, and regulatory and
certification renewal issues.
Okonski, T.M. (2015, October 22). [Personal interview].
Ms. Temrah Okonski attended a five year program at Simmons University and
received her masters degree in physical therapy. She then joined a fellowships at George
Town University in Pediatrics and worked in Herman Hospital acute trauma. In her 27
years of experience being a physical therapist, she has also worked in outpatient,
orthopedic, rehab, school, and home therapy.
Penny, N. (2015, October 17). [Personal interview].
Dr. Penny received his post-baccalaureate certificate of Occupational
Therapy from the University of Pennsylvania. He worked for fifteen years in a
variety of psychiatric and behavioral health settings. In addition to clinical
positions, he held the positions of Director of Occupational Therapy at Philadelphia
State Hospital and Director of Therapeutic Activities at Eastern Pennsylvania
Psychiatric Institute. He has provided consultation for occupational therapy services

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to hospitals and community agencies, and has been actively involved in the clinical
education of students. Dr. Pennys areas of clinical specialty include: the use of
occupation to help people with severe and persistent mental illness, the use of group
treatment modalities. He has additional research interests in the area of attitudes
towards people with mental illness, health care ethics, moral reasoning, and moral
Dr. Penny joined Alvernia in 1999. From 1999 to 2003, he was the
Occupational Therapy Program Director during which time he led the transition
from the BSOT to the combined BSHS and MSOT degree program. It was an honor
to meet him at my visit to Alvernia University and I hope that I am accepted into the
OT program offered here.
Pico, E. L., Wilson, P. E., & Haas, R. (2009). Chapter 9: Spina Bifida. In, Pediatric
Rehabilitation: Principles & Practice (pp. 199-230). Demos Medical Publishing, LLC.
More than 70,000 individuals in the United States live with spina bifida.
Spina bifida is a complex disorder that has physical, psychological, and social
implications that affect approximately 3,000 pregnancies yearly in the United
States. The spinal cord defect associated with spina bifida is often associated with
other malformations. This results in a multisystem process that leads to a variety
of health problems and potentially life-threatening complications. Motor and
sensory deficits vary according to the level and extent of spinal cord involvement.
Spinal cord involvement may result in asymmetric motor and sensory deficits.
Sensory deficits usually follow a dermatomal pattern and may not affect all
sensory modalities equally. Neurogenic bladder and bowel dysfunction may be
present in all patient. This is true even if there is no apparent motor involvement
deficit in the legs. Musculoskeletal deformities related to muscle imbalance may
present serious clinical concerns. These deformities present at birth or may
develop over the years.
Daily range of motion programs to avoid joint contractures, daily bowel
and bladder programs to maintain bowel and bladder health and continence, and
independent mobility with the help of an occupational and physical therapist will
promote the cognitive and physical development of these patients. These patients
will need rehabilitation to focus on their different sensory problems. Individuals
with spina bifida are inclined to skin injuries because of decreased ability to
perceive pressure, pain, trauma, or heat. They will also be in need of a vision
therapist since there is a high rate of visual problems in individuals with spina
bifida. Only less than one-third of patients have completely normal visual
function. The lack of movement combined with the effect of gravity will lead to
increased lower extremity deformities. Therefore, a physical therapist can help.
Children will typical need the use of bracing and assistive devices. Long-term
ambulation through adulthood is less likely as priorities change and there are
further increases in the already high-energy demands of walking. The extent of
bracing necessary to achieve ambulation is usually related to the amount of active
knee extension.

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Providing specialized care or family support. (n.d.). Retrieved from PACT: Helping Children
with Special Needs website:
PACTs mission is to promote the development of young children with special
needs and their families through specialized child care, early intervention services, family
support services, parent education, counseling, and professional training. It offers these
young children and their families hope when they have nowhere else to turn. Ensuring
that all children get the proper start in life is the goal that has been driving PACT since
The first five years of a childs life are the most critical in terms of development.
It is during this time that 90 percent of a childs brain growth occurs, accompanied by the
cognitive development that often determines the course of the childs future. PACT is the
only medical child care center in Central Maryland where nurses and child care staff
work together to care for young children with complex medical needs. It is the only child
care center and Early Head Start program in Baltimore City for homeless infants and
toddlers, and it is the only parent training program in the state of Maryland for parents
who have intellectual disabilities and have a child under age three.
Radomski, M.V. Occupational therapy for service member and veteran recovery, resilience, and
reintegration: opportunities for societal contribution and professional
transformation. American Journal of Occupational Therapy 2014;68(4):379-380.
Approximately 2.6 million members of the all-volunteer Armed Forces have
served in the wars in Afghanistan and Iraq since 2001, and almost half have been
deployed more than once. Many return home with traumatic brain injury, stress disorders,
amputations, burns, and musculoskeletal injuries and attendant occupational dysfunction.
Although many service members easily adjust to life after deployment, others with and
without injuries struggle to resume family life, work, and community engagement
occupations of daily life. The coexisting disruption and strain are multiplied manifold
when one considers the implications for spouses and children, including health effects,
family violence, and economic burden. Two parallel strategies have the transformative
potential of post World War I reconstruction aides in terms of improving client outcomes
and shaping the profession itself: the use of traditional and novel methods of therapeutic
occupation to address occupational dysfunction among service members and veterans,
and the rigorous study of its impact on recovery, resilience, and reintegration.
Much work remains to be done in establishing the impact of occupational therapy
on recovery, resilience, and reintegration related to war injuries and the transition to
civilian life. In general, even though many service members and veterans. These facts
present fundamental questions: What Occupational therapist do to honor the service and
sacrifice of fellow citizens? What are the societal responsibilities of the profession?

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Systematic Review of Occupational Therapy Interventions to Improve Cognitive Development in

Children Ages Birth5 Years, 67. (2013)
This research shows evidence for interventions used by occupational therapists to
improve cognitive development in children from birth to age 5. Developmental
interventions occurred in neonatal intensive care units, homes, child care centers, and
preschools. Educating parents of preterm infants to be more sensitive to their childs
needs and more responsive in interactions increased cognitive outcomes and joint
Occupational therapists intervene using joint attention to increase play, language,
and social interactions in preschoolers with autism. Intervention strategies used to
enhance cognitive functioning can promote pre literacy skills such as joint attention,
imitation, memory, problem solving, and decision making.
Therapy: Improving Function While Controlling Costs. (n.d.). Retrieved October 24, 2015, from
The American Occupational Therapy Association websiter:
Occupational therapists help people of all ages participate in the things they want
and need to do through the therapeutic use of everyday activities (occupations). Unlike
other professions, occupational therapy helps people function in all of their environments
(e.g., home, work, school, community) and addresses the physical, psychological, and
cognitive aspects of their well-being through engagement in occupation. Common
occupational therapy interventions include helping children with disabilities to participate
fully in school and develop social skills, helping people recovering from injury to regain
function through retraining and/or adaptations, and providing supports for older adults
experiencing physical and cognitive changes. Their services include individualized
evaluation, during which the client, family, and occupational therapist determine the
persons goals, customized intervention to improve the persons ability to perform daily
activities and reach the goals, and an outcomes evaluation to ensure that the goals are
being met and/or to modify the intervention plan based on the patients needs and skills.
After interning at PACT, I have realized that this is the best career for me. I enjoy
working with patients, rehabilitating them and giving their life a quality lift. I am great at
helping children with disabilities and I love helping people recovering from injuries to
regain function through retraining and/or adaptations.
We are transforming lives for people with cerebral palsy today. (n.d.). Retrieved October 24,
2015, from The Cerebral Palsy International Research Foundation website:
Cerebral palsy (CP) is a term used to describe inherited neurological disorders
that affect tone and posture and impairs movement. It results from genetic or acquired
disorders which disrupt developing neurons in the brain and white matter that control
movement. Impairment in motor function and limitations in mobility and hand use, is the
primary manifestation of CP. Cerebral Palsy is classified into groups based on tone and

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limb involvement. Some of these include bilateral spasticity, unilateral spasticity,

extrapyramidal, hypotonic/ataxic and etc.
Researchers have identified specific white matter pathways that carry messages
from one part of the brain to another. DTI, a form of magnetic resonance imaging, shows
white matter pathways in three dimensions, with color codes that identify individual
bundles. Injury to these pathways is an important cause for the motor disabilities seen in
children with cerebral palsy. Previous imaging techniques have not been able to visualize
white matter in such detail. The research found injury to white matter pathways in
unexpected areas of the brain in two children born prematurely. Although they anticipated
injury in pathways that carry messages to the arms and legs from motor control areas in
the front of the brain, these children had abnormal pathways in the back of the brain
where sensory information is processed. This suggests that sensory processing may be
very important for controlling tone and movement in children. Classifying in this way
helps in guiding treatment. Research projects are designed to improve treatment for
children with cerebral palsy and are formulated on the basis of needs of affected children
and their families. In the future, DTI may be used to select appropriate therapy for
children with cerebral palsy. For example, if sensory pathways in the brain are abnormal,
therapies that activate them, such as gait training or therapeutic horseback riding
(hippotherapy), might be beneficial.
What is down syndrome? (n.d.). Retrieved October 23, 2015, from National Down syndrome
Society website:
Down syndrome is usually caused by an error in cell division called
"nondisjunction." Nondisjunction results in an embryo with three copies of chromosome
21 instead of the usual two. Prior to or at conception, a pair of 21st chromosomes in
either the sperm or the egg fails to separate. As the embryo develops, the extra
chromosome is replicated in every cell of the body. This additional genetic material alters
the course of development and causes the characteristics associated with Down
syndrome. A few of the common physical traits of Down syndrome are low muscle
tone, small stature, an upward slant to the eyes, and a single deep crease across the
center of the palm - although each person with Down syndrome is a unique individual
and may possess these characteristics to different degrees, or not at all. One in every 691
babies in the United States is born with Down syndrome, making Down syndrome the
most common genetic condition. Approximately 400,000 Americans have Down
syndrome and about 6,000 babies with Down syndrome are born in the United
States each year.
There are a couple of children diagnosed with Down syndrome, who I have had
the chance to work with at PACT. Down syndrome is usually identified at birth by the
presence of certain physical traits. There are over 50 clinical signs of Down syndrome,
but it is rare to find all, or even most, of them in one person. Some common
characteristics include poor muscle tone, slanting eyes with folds of skin at the inner
corners (called epicanthal folds), hyper flexibility (excessive ability to extend the joints),
short broad hands with a single crease across the palm on one or both hands, broad feet
with short toes, flat bridge of the nose, short, low-set ears, short neck, small head, and
small oral cavity. Individuals with Down syndrome are usually smaller than their non-

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disabled peers. Their physical and intellectual development is slower. Besides having a
distinct physical appearance, children with Down syndrome frequently have specific
health-related problems. Since there are no definitive scientific research that indicates
that Down syndrome is caused by environmental factors or the parents' activities before
or during pregnancy, further research should be done here.
World OT day. (n.d.). Retreived October 20, 2015, from World Federation of Occupational
Therapist website:
The World Federation of Occupational Therapists (WFOT) began with formal
discussions at a meeting of occupational therapists held in England in June 1951, at
which there were 28 representatives from various countries. There was a continued
discussion in September of the same year at the Congress of the International Society of
the Rehabilitation of the Disabled held in Stockholm, Sweden. The World Federation of
Occupational Therapists (WFOT) is the international voice of the occupational therapy
profession which globally comprises of 80 national occupational therapy professional
Tuesday, October 27th is World OT day. I can promote this day at PACT by making
children the children create thank you cards for their Occupational Therapist. It was first
launched on 27th October 2010. Since then, it has become an important date in the
occupational therapy calendar to promote and celebrate the profession internationally.