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NOVEMBER 12, 2012



for Seating and Positioning

A Model for Acute Rehab Settings

OT on Display at Museums OT Leadership Philosophy Fieldwork Issues News, Capital Briefing, & 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 20 • NOVEMBER 12, 2012

Three Tiers for Seating and Positioning
A Model for Acute Rehabilitation Settings

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: Interim Chairperson, Administration & Management Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Linda M. Olson: Chairperson, Mental Health Special Interest Section Regula Robnett: Chairperson, Gerontology Special Interest Section Tracy Van Oss: Chairperson, Home & Community Health Special Interest Section
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

Nettie Capasso and Elizabeth Kloczko describe a three-tiered model for providing seating and positioning during the acute phase of the rehabilitation process.

Occupational Therapy on Display at Museums


News Capital Briefing
QAPI Is Coming to Nursing Homes: Occupational Therapy’s Role

3 7 18 19 21 26 33

Fieldwork Issues

Benefits for Fieldwork Educators in Working With Students


Andrew Waite reports on how occupational therapy practitioners are using their skills to facilitate more meaningful interactions in children’s exhibits in museums around the country.

Defining Reality: The Importance of Articulating a Leadership Philosophy


Continuing Education Opportunities

Employment Opportunities Research Update

Trauma Patients’ Outcomes, ConstraintInduced Therapy With Trunk Restraint, and Handwriting Program’s Effectiveness

• 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.




Association updates...profession and industry news
and state occupational therapy associations have been working together to advocate for the profession. The calls are a follow up to the State Health Care Reform Symposium that was held during AOTA’s Annual Conference & Expo in Indianapolis. To listen to the chats, visit www.talkshoe. com/tc/28233.


AOTA’s EvidenceBased Practice Guidelines Win Award
he American Occupational Therapy Association (AOTA) has received a 2012 Power of A Silver Award from the American Society of Association Executives (ASAE) for its evidence-based practice guidelines, which were developed as a way to ensure that occupational therapy practitioners and external audiences have access to the best available evidence and recommendations from clinical experts. ASAE’s Power of A Awards honor associations that engage in activities and initiatives that benefit America and the world. For more, visit news/centennial/asae-award.


Don’t Miss AOTA’s Stroke Specialty Conference

AOTA Drafting Bylaws Amendments
OTA is in the process of drafting amendments to our Bylaws to ensure compliance with the DC incorporation law affecting nonprofit organizations. Watch the presentation ( for more information about AOTA governance changes that will occur as a result of the law.


f you work with older adults, be sure to attend the AOTA Adults With Stroke Specialty Conference, to be held from November 30 to December 1 in Baltimore, Maryland. An estimated 5.4 million people in America live with the disabling effects of stroke, and that number is predicted to increase as the population ages. Occupational therapy helps those recovering from a stroke resume valued activities through a holistic approach to intervention. Join speakers Carolyn Baum, PhD, OTR/L, FAOTA; Glen Gillen, EdD, OTR, FAOTA; Jan Davis, MS, OTR/L, and other experts offering comprehensive sessions, while earning up to 13 contact hours (1.3 CEUs/13 NBCOT PDUs). Register now at

State Affairs Talks Health Care Implementation
OTA State Affairs Group staff recently held two conference calls for state occupational therapy association leaders to discuss health care reform implementation at the state level. More than 35 people from more than 25 states participated in discussions about state implementation of health care reform, with a focus on essential health benefits (EHBs). EHBs are important to occupational therapy because they will define the benefits covered by health insurance policies offered in the small group and individual insurance markets, including on the health insurance exchanges. AOTA


Call for Spring RA Motions
ecome an active participant in your “Congress,” the Representative Assembly (RA). Give thought to the professional issues you encounter and draft motions that you would like to be considered by the RA at its spring meeting in San Diego, California. Specific instructions on how to write motions are found at www.aota. org/governance/ra. 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. The deadline for submitting motions to be considered at the RA Spring Meeting is January 1, 2013.


Accreditation Visits Scheduled for Winter/Spring/ Summer 2013
s required by the U.S. Department of Education, this serves as notice to the public of upcoming accreditation visits and the opportunity for written third-party comment. Written comment concerning accreditation qualifications for the following institutions or programs listed (i.e., determining whether a program appears to be in compliance with Accreditation Council for Occupational Therapy Education [ACOTE®] accreditation standards or ACOTE accreditation policy) may be submitted no later than 20 days prior to the program’s


scheduled on-site evaluation to Sue Graves, assistant director of Accreditation, AOTA, 4720 Montgomery Lane, Suite 200, Bethesda, MD 20814-3449. Receipt of the third-party comment will be acknowledged and processed according to ACOTE’s Policy on Third-Party Comment, which includes sending a copy of the comment letter to the director of the occupational therapy or occupational therapy assistant program named in the letter. The following programs are scheduled for on-site evaluations in winter, spring, or summer 2013. Unless otherwise noted, programs will be evaluated under the current 2006 ACOTE Accreditation Standards. Programs noted with an asterisk (*) have opted to be evaluated under the new 2011 ACOTE Accreditation Standards. January 14 to 16, 2013: Adventist University of Health Sciences (formerly Florida Hospital College of Health Sciences) (OTM), Orlando,

A O TA B u l l e T I N B O A r d

Linking Research, Education, & Practice

Continuing Education

Occupational Therapy in Acute Care


H. S. Gabai his text provides a detailed look at what occupational therapy practitioners need to know about how diseases and trauma affect the human body. Chapters review the evaluation process, including chart review, measures, and interpretations and recommendations for intervention to ensure the ultimate level of independence for each client. $109 for members, $154 for nonmembers. Order #1258. http://

Understanding the Assistive Technology Process to Promote School-Based Occupation Outcomes
(ONLINE COURSE) B. Goodrich, L. Gitlow, & J. Schoonover Earn 1 AOTA CEU (12.5 NBCOT PDUs/10 contact hours). his six-lesson course provides case examples for experiential learning activities, enables matching of technology to desired schoolbased outcomes, distinguishes occupational therapy skills on a school-based assistive technology (AT) team, and explores the rising role of AT in successful interventions with children. $225 for members, $320 for nonmembers. Order #OL31. http://


Autism: A Comprehensive Occupational Therapy Approach, 3rd Edition


H. M. Kuhaneck & R. Watling sing the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition as a guide, this book discusses the client-centered, occupation-based interventions occupational therapy practitioners can provide to individuals with an autism spectrum disorder (ASD). Highlights include an introduction to ASD; common strengths and challenges for individuals with an ASD; occupational therapy evaluation and intervention; and occupational therapy practice, contexts, and use of evidence. $69 for members, $98 for nonmembers. Order #1213B. ?SKU=1213B Ready to order? Call 877-404-AOTA or go to Enter Promo Code BB

Seating and Positioning for Productive Aging: An Occupation-Based Approach
(CEonCD™) F. Chew & V. Pierman Earn .4 AOTA CEU (5 NBCOT PDUs/4 contact hours). nhance the lives of your clients through this important course. The content reviews seating and positioning from evaluation to outcome, with a concentration on interventions, and primarily addresses manual wheelchair mobility. $97 for members, $138 for nonmembers. Order #4831. http://
Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.


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

Florida—initial on-site evaluation Inter American University of Puerto Rico-Ponce Campus (OTA), Mercedita, Puerto Rico—initial on-site evaluation January 28 to 30, 2013: Chattahoochee Technical College (OTA), Austell, Georgia— initial on-site evaluation Newman University (OTA), Wichita, Kansas* Weatherford College (OTA), Mineral Wells, Texas—initial on-site evaluation February 4 to 6, 2013: Lewis & Clark Community College (OTA), Godfrey, Illinois February 11 to 13, 2013: California State University, Dominguez Hills (OTM), Carson, California* Spokane Falls Community College (OTA), Spokane, Washington—initial on-site evaluation February 25 to 27, 2013: James Madison University (OTM), Harrisonburg, Virginia* Kaplan Career Institute–Pittsburgh (OTA), Pittsburgh, Pennsylvania* March 4 to 6, 2013: Louisiana State University Health Sciences Center, New Orleans Campus (OTM), New Orleans, Louisiana March 11 to 13, 2013: Columbia University (OTM), New York, New York* St. Catherine University (OTM), St. Paul, Minnesota St. Catherine University–Minneapolis (OTA), Minneapolis, Minnesota March 18 to 20, 2013: Jefferson College of Health Sciences (OTA), Roanoke, Virginia* University of the Sciences (OTD), Philadelphia, Pennsylvania— initial on-site evaluation March 25 to 27, 2013: Cuyahoga Community College (OTA), Cleveland, Ohio*

April 1 to 3, 2013: Arkansas Tech University–Ozark Campus (OTA), Ozark, Arkansas—initial on-site evaluation April 2 to 4, 2013: Western Technical College (OTA), LaCrosse, Wisconsin April 8 to 10, 2013: Keiser University, Fort Myers (OTA), Fort Myers, Florida— initial on-site evaluation Lake Area Technical Institute (OTA), Watertown, South Dakota* Loma Linda University (OTM), Loma Linda, California Touro College (OTM), Bay Shore, New York, and Touro College, Manhattan (OTM), New York, New York (an additional location of Touro College, Bay Shore, NY) May 6 to 8, 2013: East Arkansas Community College (OTA), Forrest City, Arkansas—initial on-site evaluation* McHenry County College (OTA), Crystal Lake, Illinois—initial on-site evaluation Panola College (OTA), Carthage, Texas Stony Brook University (OTM), Stony Brook, New York* May 13 to 15, 2013: Jefferson College-Hillsboro (OTA), Hillsboro, Missouri— initial on-site evaluation* Medical University of South Carolina (OTM), Charleston, South Carolina* June 3 to 5, 2013: University of Tennessee Health Science Center (OTM), Memphis, Tennessee* June 10 to 12, 2013: Eastwick College (OTA), Ramsey, New Jersey—initial on-site evaluation* Tidewater Community College, Virginia Beach Campus (OTA), Virginia Beach, Virginia* June 17 to 19, 2013: Brown Mackie College–Birmingham (OTA), Birmingham, Alabama—initial on-site evaluation


June 24 to 26, 2013: Laredo Community College (OTA), Laredo, Texas* Southwest Virginia Community College (OTA), Richlands, Virginia, and Southwest Virginia Community College at Virginia Highlands Community College (OTA), Abingdon, Virginia (an additional location of Southwest Virginia Community College, Richlands, Virginia)*


RtI Available
new AOTA Practice Advisory on Response to Intervention (RtI) is now available on the AOTA Web site at Practitioners-Section/Childrenand-Youth/Browse/School/RtI/ Practice-Advisory.aspx?FT=.pdf.


Upcoming Chat
OTA will host a pediatric virtual chat on Common Core Standards: Role for Occupational Therapy on December 10, 2012, at 11:00 a.m., EST. To participate and view chat archives, visit www.

n Anne E. Dickerson, PhD, OTR/L, FAOTA, professor in the Department of Occupational Therapy at East Carolina University in Greenville, North Carolina; Elizabeth Green, OTR/L, CDRS, executive director of The Association for Driver Rehabilitation Specialists; and Elin Schold Davis, OTR/L, CDRS, project coordinator of AOTA’s Older Driver Initiative, recently participated on a team of experts assembled by the MIT AgeLab that conducted research to better understand which technologies can improve safety and comfort for older drivers. Joseph Coughlin, the keynote speaker at AOTA’s 2012 Annual Conference & Expo in Indianapolis, is the director of MIT AgeLab. n Deborah Yarett Slater, MS, OT/L, FAOTA, AOTA’s staff liaison to the Ethics Commission & the Bylaws, Policies, and Procedures Committee; Judy Thomas, AOTA’s Senior Policy manager; Tim Nanof, AOTA’s director of Federal Affairs; Mary Foto, OT, CCM, FAOTA, AOTA’s advisor on the RUC HCPAC Review Board; Mary Jo McGuire, MS, OTR/L, OTPP, FAOTA; Doris Shriver, OTR, FAOTA, QRC, CLCP; and Leslie Davidson, PhD, OTR/L, FAOTA, recently attended the Common Procedure Terminology (CPT)/Relative Value Update Committee meeting in Memphis, Tennessee, to share the AOTA proposal about revisions to the CPT codes.


AOTA Hosts Largest Hill Day
ith 514 registered attendees, AOTA’s 2012 Capitol Hill Day was the largest Hill Day in AOTA history, besting last year’s record of 400-plus attendees. In addition, AOTA members participating in Virtual Hill Day sent more than 2,000 messages to Congress in support of their colleagues on the Hill. For more on the effort, visit hill-day-2012.



Practitioners in the News
n Peggy Boineau, OTR, CHT, a senior occupational therapist at Methodist Sugar Land Hospital in Sugar Land, Texas, was recently elected treasurer of the International Federation of Societies for Hand Therapy. n Ellen S. Cohn, ScD, OTR/L, FAOTA, has been appointed as program director for the Master of Science in Occupational Therapy Program at Boston University, Sargent College of Health and Rehabilitation Sciences. Cohn also recently presented Autism: A Unique Museum and Theater Experience at the Leadership Exchange in Arts and Disability Conference in Boston. n Mary Foto, OT, CCM, FAOTA, has been selected to serve on the California Division of Workers’ Compensation’s Medical Evidence Evaluation Advisory Committee, which develops guidelines for workers’ compen-

Call for Papers Issued for AOTA’s Education Summit
OTA has issued a call for papers for its upcoming Education Summit, to be held October 4 to 5, 2013, in Atlanta. Submissions are due January 15, 2013. For additional information, e-mail


sation policies. Foto’s presence on the board will help ensure that the group has a more complete understanding of occupational therapy services. “To be able to talk about what occupational therapy can do in the face of instances like back or neck problems that are preventing people from working is very valuable,” Foto says. “I am able to contribute to their subject matter how occupational therapy has the skills to return injured people to their jobs.” n Stacey Lehrer, MEd, OTR/L, ATP, was named Big Sister of the Year for 2012 by Big Brothers Big Sisters of the Ocean State (Rhode Island). She has been matched for 3 1/2 years with a girl with significant emotional and behavioral needs, providing one-on-one mentoring. n Kathleen Matuska, PhD, OTR/L, has been awarded the 2012 Bonnie Jean Kelly and Joan Kelly Faculty Excellence


ASD Publishes First Newsletter


OTA’s Assembly of Student Delegates has published its first-ever student newsletter. To read it, go to www.scribd. com/doc/106420887/AOTA-Student-Newsletter-Issue-1.

Older Driver Safety Awareness Week Just Ahead
OTA’s upcoming Older Driver Safety Awareness Week (ODSAW), from December 3 to 7, promotes the importance of safe mobility and transportation for ensuring that older adults remain active in the community—shopping, working, or volunteering—with the confidence that transportation will not be a barrier to independence. Throughout the week, AOTA will bring attention to a different aspect of older driver safety. Go to for more. On November 8, AOTA hosted a virtual chat on Building Awareness During ODSAW: An Opportunity for Easing Fears and Empowering Drivers and Thier Families. To listen to the recorded chat, go to
Award, the highest faculty honor at St. Catherine University in Minneapolis, Minnesota. n Claire Morress, MEd, OTR/L, ATP, a clinical faculty member of the Department of Occupational Therapy at Xavier University in Cincinnati, Ohio, co-presented an instructional course at the 2012 conference of the American Academy of Cerebral Palsy and Developmental Medicine in Toronto, Canada. The 2-hour course, Clinical Practice Points for Therapists: Infants and Toddlers with Motor Disabilities, included key concepts, evidence, and therapeutic interventions that support critical outcomes for infants and toddlers with cerebral palsy. n Marnie Renda, MEd, OTR/L, CAPS, ECHM, won the National Association of Home Builders’ Homes for Life award for a project remodeling a 30-yearold bathroom. The Homes for


n Laura Vogtle, PhD, OTR/L, FAOTA, has been elected as director at large of the American Academy for Cerebral Palsy and Developmental Medicine. Her 3-year term began September 15. n Mary Warren, PhD, OTR/L, SCLV, FAOTA, associate professor in the Department of Occupational Therapy and director of Low Vision Rehabilitation Graduate Certificate at the University of Alabama at Birmingham, has been selected by a panel of her peers to receive Envision’s “Excellence in Education” Award for 2012. n Debra Young, MEd, OTR/L, SCEM, ATP, CAPS, presented on Technology for Aging in Place at the 2012 Remodeling Show in Baltimore. Young also participated in a panel presentation, Complete Communities and Aging in Place, at the Maryland/Delaware Chapter of the American Planning Association Conference in Columbia, Maryland.

of perceptual motor and, later, sensory integration theory within the curriculum. Among other accomplishments, del Pilar Christian Mariani was instrumental in the development of the Puerto Rico Occupational Therapy Association and served as its president twice, and she was the first occupational therapist in Puerto Rico to be appointed to AOTA’s Roster of Fellows. —Dyhalma Irizarry, PhD, OTR/L, FAOTA

In the September 10, 2012, issue of OT Practice, the article “Preparing Students for Ethical Practice” mistakenly refers to a citation as “Neil and You” instead of “Penny and You.” The correct citation should be “Penny, N. H., & You, D. (2011). Preparing occupational therapy students to make moral decisions. Occupational Therapy in Health Care, 25(2–3), 150–163.” Also in that issue, a Practitioners in the News item on an occupation-based mentorship program called PAR FORE mistakenly identified Alex Lopez, JD, OT/L, the creator of PAR FORE, as an associate professor in the Department of Occupational Therapy at Kean University. Lopez is currently an assistant professor in Touro College’s Department of Occupational Therapy. Jennifer Gardner, OTD, OTR, is an assistant professor in the Department of Occupational Therapy at Kean University who oversees the New Jersey local chapter of PAR FORE. The story that appeared on local television covered news about the PAR FORE NJ summer camp. We apologize for the errors.
Andrew Waite is the associate editor of OT Practice. He can be reached at

Life awards recognize Certified Aging in Place Specialists designees for excellence in aging-in-place design and accessible home modifications in remodeled homes. n Theresa Marie Smith, PhD, OTR/L, CLVT, recently became a co-principal investigator on an R01 grant from the National Eye Institute of the National Institutes of Health, investigating low vision rehabilitation outcome measures. n Leonard G. Trujillo, PhD, OTR/L, FAOTA, associate professor and chair of the Department of Occupational Therapy at East Carolina University (ECU) in Greenville, North Carolina, exhibited his collection of relief carvings (Artistry in Wood: Reflections of Past and Present, Preserved Forever) at the Laupus Health Sciences Library located on the ECU west campus.

In Memoriam
María del Pilar Christian Mariani, MA, OTR/L, FAOTA, professor emeritus of the School of Health Professions, Medical Sciences Campus, University of Puerto Rico, passed away on August 28, 2012, in San Juan Puerto Rico. Del Pilar Christian Mariani was a key person in the 1976 development of a new academic unit within the Medical Sciences campus, the College of Health Related Professions, for which she served as chairperson of the Department of Physical and Occupational Therapy until 1990, 1 year before retirement. In addition, Del Pilar Christian Mariani helped develop and implement grants for establishing clinical services and community outreach projects. As a professor in occupational therapy, she was a pioneer in the inclusion

c A p I TA l B r I e f I N g

QAPI Is Coming to Nursing Homes


Occupational Therapy’s Role
Jennifer Bogenrief
and Minnesota; a Web site containing resources and materials to help providers prepare for QAPI; a new regulation being drafted to require nursing homes to submit their QAPI plans to CMS 1 year after the regulation is promulgated; and a questionnaire that was sent to a sample of nursing homes to identify baseline information related to quality systems and processes in nursing homes. areas. They also discussed the role of Quality Improvement Organizations.

he Centers for Medicare & Medicaid Services (CMS), in collaboration with the University of Minnesota and Stratis Health, is developing tools, resources, and technical assistance for implementing Quality Assurance and Performance Improvement (QAPI) in nursing homes. Section 6102(c) of the Affordable Care Act (ACA) requires CMS to establish QAPI standards and provide technical assistance to nursing homes on developing best practices. This provision greatly expands the level and scope of required QAPI activities by requiring facilities to identify and correct quality deficiencies while continuing to improve performance.

The presenters emphasized that everyone in a nursing home makes a difference—staff, residents, and residents’ families. The QAPI Contractor specifically mentioned occupational therapists as part of the interdisciplinary team that can help successfully implement QAPI in their facilities. CMS expects that every nursing home will develop their QAPI specific to their unique facility and resident population. Occupational therapy practitioners are well positioned to help identify ways to change their facility’s culture and improve quality. Occupational therapy practitioners should seek out opportunities to be part of their facility’s QAPI—specifically, by getting involved in PIPs. This is your chance to work on a possible issue before a surveyor forces you to address it. In the coming months, before the final rule comes out, learn more about QAPI and provide feedback to CMS about how occupational therapy practitioners can contribute. CMS indicated that the new regulation will be proposed soon but did not provide a specific date or timeline, except to say that the regulation is currently being drafted. AOTA will continue to monitor developments related to QAPI in nursing homes; the latest information will be available on our Web site at under the Advocacy Highlights section. Questions or comments about Nursing Home QAPI may be submitted directly to CMS via e-mail to n
Jennifer Bogenrief is the manager of AOTA’s Reimbursement and Regulatory Policy Department. She can be reached at

AOTA was invited to attend a stakeholder meeting for QAPI at CMS headquarters on September 14, 2012. AOTA reached out to members who are experts in skilled nursing facility issues and have expressed an interest in advocacy with AOTA in order to provide perspective from an occupational therapy practitioner who has expertise in the nursing home setting. AOTA staff and AOTA member Elaine Adams, OTR, attended the meeting, along with representatives from more than 30 other stakeholder organizations. (For Adams’ perspective, see the Questions and Answers column in the next issue of OT Practice, on November 26.) During the meeting, 15 CMS staff representing five different CMS offices and the CMS QAPI contractors provided an update on QAPI. They discussed the demonstration project, steps that demo nursing homes are taking, successes and challenges that some nursing homes in the demo are experiencing, and tools that nursing homes have identified as being the most useful for QAPI, which will be available on the QAPI Web site at They discussed Performance Improvement Projects (PIPs) as a way to address specific identified deficiencies and focus

In 2011, CMS announced plans for a nursing home demonstration project to test a QAPI prototype. CMS also announced that it would promulgate a new QAPI regulation in addition to the existing Quality Assessment and Assurance (QAA) regulation found at 42 CFR, Part 483.75(o). The QAA regulation sets forth the QAA committee composition and frequency of meetings in nursing facilities and requires facilities to develop and implement plans of action to correct identified quality deficiencies. The new regulation will provide more details about how this must be accomplished. The new regulation will require all nursing homes to submit a plan to meet QAPI standards and implement QAPI best practices. On June 29, 2012, CMS issued a memorandum providing a brief overview of the initiatives to implement the ACA QAPI requirements, including QAPI tools and resources; a demonstration project in 17 nursing homes in California, Florida, Massachusetts,





for Seating and Positioning

he average length of stay in acute rehabilitation facilities has been steadily decreasing in recent years due to rapidly shifting changes in public and private payer policies and regulations. In the past, clients had significantly more time during the acute phase of the rehabilitation process to make desired functional and clinical improvements before discharge. Perhaps more importantly, occupational therapists had more time to determine the most appropriate future equipment needs. Seating and positioning is a critical foundation for addressing the basic needs of clients with complex clinical needs. Some clients are so physically and/or perceptually involved that they are unable to sit at all unless they are provided with a seating system that provides the maximal amount of specialized support. At times, they may literally slide right out of their wheelchairs unless appropriate accommodations are made. Therefore, it is critical that interventions are implemented immediately upon admission. The Occupational Therapy Department at the Rusk Institute for Rehabilitation Medicine, NYU Langone Medical Center, was challenged several years ago with an extremely diverse and involved client population that required highly specialized dynamic seating and positioning interventions. Unfortunately, the staff at that time had little knowledge or experience in providing these clients with effective seating

A three-tiered model for providing seating and positioning during the acute phase of the rehabilitation process.

interventions. Additionally, there were a number of financial constraints that limited procurement of the necessary equipment that clients needed during their inpatient rehabilitation stay. We realized that we not only needed to improve our clinical competence, but that we also needed to develop an efficient and structured way of categorizing (essentially, “triaging”) our clients’ needs and the urgency of their particular situations. We also needed to do this with a limited equipment budget. This article describes our journey to meet this challenge.

On the inpatient unit, occupational therapists are responsible for evaluating and providing in-house seating and positioning equipment. Currently, there are 11 occupational therapists with a wide range of clinical experiences. A seating and positioning clinical specialist oversees staff clinical training and mentoring and manages complex client needs. This organizational ladder was put into place to provide numerous onsite educational opportunities and to empower therapists at all levels of experience to become active participants in their clinical growth. It also

provides a structured and effective approach for addressing client needs. Our first significant task in this process was to better understand and determine a way of categorizing our clients’ dynamic and complex seating needs. Clients admitted to our facility present with a variety of conditions. These include orthopedic injuries (e.g., joint replacements, multiple upper- and lower-extremity fractures), spinal cord injuries, and neurological conditions (e.g., stroke, traumatic and nontraumatic brain injury, multiple sclerosis, Parkinson’s disease). As expected, adult clients also arrive at Rusk with various body shapes and sizes. These may range from the 4' 8" grandmother with osteoporosis who sustained a hip fracture, to the 550-pound middle-aged office worker who underwent an elective total knee replacement, to the 6' 4" basketball player recovering from a stroke. Our clients also present at various levels of mobility and clinical involvement, from the client who is ambulating independently but cannot express his or her basic needs due to aphasia, to the client who requires three therapists to transition from supine to a seated position at the edge of the bed.

Left: Client unable to contact back support without reclining her body all the way back. Thus it makes it difficult for her to complete her daily tasks.

Right. Specialty back allows her to sit more upright for better participation in daily tasks

Figure 1.
One of our first and most important responsibilities as occupational therapists is to evaluate our clients and provide necessary and timely seating and positioning equipment. Our clients need to be able to get out of bed, perform their functional activities as independently and safely as possible, and fully participate in the required 3 hours of daily therapy. Additionally, they need to be able to do all these things the day after they are admitted, regardless of their body size or physical, cognitive, perceptual, or visual impairments. absence of pressure ulcers or significant postural asymmetries. Each new staff member takes part in a module that provides an overview of the seating program and levels of competency. At a Tier 1 level of competence, therapists have basic seating knowledge and are able to recognize that only simple changes are needed. They are expected to take basic measurements—hip width, femur length, lower leg length, and shoulder height— to determine corresponding wheelchair modifications. These include but are not limited to wheelchair width, seat depth, seat-to-floor height, wheelchair style, arm rests, leg rests, and necessary additional features such as residual limb supports or half lap trays. Therapists who have achieved basic seating and positioning competence make these seating system modifications independently and in a timely manner following occupational therapy evaluation. As an example of Tier 1 care, Sam was a 70-year-old male admitted after undergoing an elective right total hip replacement. During the initial occupational therapy evaluation, it was determined that Sam would need a different wheelchair to accommodate his size. The therapist measured Sam’s hip width and found it to be 20" (hip width is defined as the widest point between the hips when the client is in a seated position). Sam was currently sitting in an 18" wheelchair, so his therapist was concerned that this was 2" too narrow. Sitting in an 18" wheelchair could

Mat Evaluation Areas of Assessment
1. Trunk (Sitting position) • Kyphosis • Lordosis • Rotation • Convexity 2. Pelvis (Sitting and Supine Position) • Anterior or posterior tilt • Rotation • Obliquity 3. Hip • Range of motion limitations • Flexion • Abduction • Adduction • Internal rotation • External rotation 4. Knee Range of motion limitations with extension 5. Foot • Neutral • Plantarflexion • Inverted • Everted 6. Skin • Area of pressure ulcer • Size of pressure ulcer • Stage of pressure ulcer • Indication for pressure mapping 7. Measurements • Hip width • Sacrum to popliteal fossa • Popliteal fossa to heel • Chest width • Length of trunk (Height to top of the shoulder) 8. Summary and Recommendations for Wheelchair

We decided to divide our clients’ seating and positioning needs into three categories (defined as “tiers”). Specific responsibilities correspond with the tiers to empower all levels of therapists, from the new graduate to the seasoned clinical specialist, to adequately and efficiently provide seating equipment for any client. Tier 1 addresses basic seating interventions such as a change in wheelchair dimensions (e.g., seat width, seat depth, seat-to-floor height), leg and arm rest style (e.g., elevating, desk length, full length), residual limb supports for those who have had amputations, and upper-extremity supports for clients with hemiparesis or hemiplegia. Seating and positioning needs categorized in Tier 1 are minimal and include relative physical mobility (i.e., clients who require no more than supervision or minimal assistance to transition from sit to stand), and an


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Occupational therapy practitioners are using their skills to facilitate more meaningful interactions in museums around the country.
interactions between the exhibits and the day’s special guests. Sheldon helps put on the inclusion event at AHA and purposefully invited occupational therapy practitioners because he recognized their skill at increasing participation. Brenda George, MS, OTR/L, took control and coordinated between museum administrators and Zane State College’s OTA program to give occupational therapy a presence at the event. In addition to staffing the exhibits, occupational therapy assistant students and George modified some of the exhibits to make them more accessible to children with physical and cognitive disabilities. They worked with museum administrators to gain early entrance into the building and apply some of their recommendations. “For example, there were some high reaching surfaces or door handles that might not be accessible, so I gave the suggestion of either using pull sticks or reachers, or bringing surfaces down,”
Ingrid M. Kanics, OTR/L, above, has consulted with more than 40 children’s museums on how to make the museum experience more meaningful to kids with disabilities.


t first, Jacob didn’t realize that his favorite food was right in front of him. Jacob, a 5-year-old boy with autism, was at A Hands-on Adventure (AHA) museum staring at an exhibit designed to let visitors make their own pizza from cardboard cutouts of pepperoni and various vegetables. But Jacob didn’t get it right away, his father, Gary Sheldon, recalls. “He looked at it and didn’t see the pizza. He just saw the pieces,” Sheldon says. “But then someone said ‘pizza’ and it clicked.” After a while, Jacob was pretending to bake his pizza in the oven before pantomiming eating his lunch. But it wasn’t just anyone who yelled “pizza.” It was an occupational therapy assistant student from Zane State College in Zanesville, Ohio. The occupational therapy assistant students were at the museum in Lancaster, Ohio, to facilitate greater

George says. “Small things can make big changes in how kids can interact.” The result was a great day of inclusion and discovery at AHA. Jacob is a regular visitor at AHA, but he typically only engages with a few of the exhibits. “Having OT there, he ended up visiting all the stations when he otherwise might have only stopped at a half dozen,” Sheldon says. “If he doesn’t get it at first, he will usually move on, but with the students giving that extra bit of encouragement and information, it allowed him to take the time to see what it was all about. “Jacob is verbal but he’s not all that talkative, but after the museum I asked him, ‘How did you like it?’ and he said, ‘Good, very good,’” Sheldon says. “So I

for occupational therapy practitioners because it means that the profession’s services are not just valued on a personal level; they are also seen as helping facilities’ bottom lines.

Ingrid M. Kanics, OTR/L, is at the forefront of this opportunity for occupational therapy. She has consulted with more than 40 children’s museums nationwide and has been a regular speaker at the Association of Children’s Museums’ annual conference. One of Kanics’ earliest consulting jobs in this field was with the Chicago Children’s Museum, which was looking into incorporating more universal design principles through a Play For All initiative in 2004. Kanics’ work in Chicago began with an initial evaluation that focused on taking the Americans With Disabilities Act requirements1 a step further. She advised staff trainings and encouraged museum leaders to re-examine some of their programming elements. “If they are doing a program that involves finger painting, I wanted them to understand that different children like to finger paint in different ways,” Kanics explains. “It’s about being creative for the kids who don’t like to get too messy, and giving the museum some strategies like putting plastic over the paint so the child can mix it but never has to touch it, or allowing the child to use a tool like a piece of foam so they are comfortable with how dirty their fingers get. For the kids who really want to get messy, add things like the rice and the beans and all those other textures that those kids like.” Many of Kanics’ recommendations in Chicago were relatively simple, such as installing stools of varying heights and sizes to accommodate people of different shapes, and offering crayons and scissors of different weights, lengths, and sharpness. “Then there were other areas where we did some concrete design work,” Kanics explains. Chicago Children’s Museum has an exhibit called “Dino Dig,” which is a pit with a buried skeleton that allows visitors to simulate an archeological dig. “Getting into it from a wheelchair was really complex. The ramps actually

Ohio World of Wonder (OH WOW!) museum in Youngstown has seen 25% more yearly visitors since re-opening in 2011 with universal desgn principles incorporated.

knew from his response that he had a good time.” As universal design principles are embraced and inclusion becomes a priority, occupational therapy practitioners have the chance to regularly provide important services to enhance the experience for all museum goers, whether or not they have a physical or cognitive challenge. Several occupational therapy practitioners are already demonstrating that members of the profession can effectively facilitate greater participation in children’s museums. The Association of Children’s Museums is so focused on making these facilities more accessible that it offers a Universal Design for Learning Award ( awards.htm#universal). Its staff recognize that occupational science principles can lead to more inclusive facilities. “A lot of our children’s museums are in the process of developing capital

campaigns for expansion, and they are looking more at universal design within buildings now and not just the programs and exhibits,” says Korie Twiggs, program officer of Education with the Association of Children’s Museums. “Accessibility in terms of what it means in children’s museums has stepped up. It’s not only the programming and the exhibits; it really is that full-on experience that children receive once they come into the building.” In addition, museum staff are learning that it makes financial sense to focus on inclusive design principles. “Are we going to limit our customer base, or does it make sense to expand into being accessible to the greatest number of people? It’s obvious what our answer is,” says Suzanne Barbati, president of the Ohio World of Wonder (OH WOW!) museum in Youngstown. Barbati says her museum has seen 25% more yearly visitors since re-opening in 2011 with universal design principles incorporated. That’s good news


Students from the University of Pittsburgh devised ways to make a Carnegie Museum of Natural History Exhibit on Human Ancestry more engaging. Left: The original exhibit. Center: the redesigned exhibit. Right: A visitor making use of the interactive features of the revised exhibit.

put the person in the wheelchair much higher and not level with the pit. So the person in the wheelchair would have to lower herself below the floor to get into the pit,” says Kanics, who uses a wheelchair herself. Kanics advised installing a transfer station along one of the exhibit’s walls. The station worked perfectly, and it will soon open with a new design incorporating Kanics’ suggestions. Kanics knows it works because she tested the exhibit herself. “It was simply a matter of leveling off part of the exhibit so I could hop up out of my chair, onto the wall, and then just drop into the pit. For parents who have to help children, that’s also an easier transfer.” The Chicago Children’s Museum leadership has embraced Kanics’ expertise and is now considered a trendsetter in the realm of inclusive museums. The museum won the Association of Children’s Museums’ Universal Design for Learning Award in 2009. “[Kanics] opened our eyes to the fact that there is so much out there that we can be doing. She really introduced us to the whole idea of universal design,” says Lynn Walsh, manager of Guest Access and Inclusion at the Chicago Children’s Museum. One of the most affirming experiences Walsh has had since working with Kanics was observing a group of children playing in the Move exhibit. The exhibit features play equipment


like plastic tunnels and climbing equipment meant to encourage fine and gross motor activity; body movement and spatial awareness; dramatic play; language development; problem solving, critical thinking, decision making, and planning; and teamwork and collaboration. “I knew that morning we had a group of kids with disabilities in, and I walked into the exhibit and the first thing I saw was a row of empty wheelchairs. I turned and looked into the exhibit and couldn’t identify who was who. All the kids were able to get out of their chairs and experience the exhibit. It was truly amazing,” Walsh recalls. Ingrid also provided beneficial staff trainings in Chicago to familiarize employees with engaging guests of all abilities. Some of the sessions include universal design, universal design for learning and sensory integration, and the importance of sensory play. “I know it’s working because every time after we have a training, the first time new employees have any interaction with someone with a disability, they will come running to me and share what they were able to do to assist. So that’s been how we measure the success,” Walsh says. The museum also measures success based on how visitors respond. Easter Seals Metropolitan Chicago has been taking groups of kids on the autism spectrum to Saturday Play For

All events at the museum since 2008. There’s a reason they keep going back. Roberto is one of them. The 9 year old with autism usually struggles with rules. He has to be reminded not to run in the hallway and often has difficulty transitioning between activities and adjusting to changes in his schedule. He also has trouble engaging with fellow classmates. But at the Chicago Children’s Museum, Roberto is different, says Michelle Fieldman, MEd. “At the museum, he seems just to be a lot more confident in himself. He tends to take on a leadership role,” Fieldman says. “He takes on the role of helping to guide others. For children who have had a hard time leaving the museum, we will use Roberto to help them get back on the bus. He’ll walk with them and talk with them, and ask, ‘Oh, what did you do at the museum?’ He seems to stay engaged longer after his visits.” Fieldman believes the design of the museum has a lot to do with Roberto’s positive attitude, self-advocacy, and socialization. “He is able to explore his environment in a comfortable setting so he can be in charge for that little bit of time. He can say, ‘I’m done playing by the water. I want to do something else,’ and he can. He has control and can decide what he wants to do,” she says. “The exhibits are so hands on and so interactive that there’s a lot of opportunity for sensory input. There’s

a lot of opportunity for playing within your own interests. It’s built to accommodate whatever it is you want to play with in whatever way the child wants to imagine it.” Kanics had a similar impact at OH WOW! There, she made many recommendations, including a way to improve access to a popular airplane exhibit. “It’s one of their key exhibits and it’s elevated above the play area to give visitors the sense that they are in the air. Initially, the design called for a set of stairs leading to it. But I led several different presentations and discussions and we turned the stairs into a ramp, which is actually very aesthetically pleasing. The way the plane is framed on the circular platform and the way the ramp wraps around it, you wouldn’t think it was done for accessibility. You look at it and think it’s some nice architectural detail,” Kanics says. It seems Kanics really gave wings to inclusion principles at OH WOW! “She worked with us through the planning process and with the architectural team as well as with the exhibit designer. She was involved at every juncture to help us understand how we could best embrace universal design principles, both in the facility itself and in the exhibits,” says museum president Barbati. “For example, our admissions desk has an area that allows people to roll up if they are in a wheelchair. It’s

An exhibit at the Chicago Children’s Museum before (left) and after (right) accessibility recommendations were implemented.

has focused his attention on better preparing families and children before going to a museum. His work began as a student project focused on increasing accessibility for children on the autism spectrum at the Adventure Aquarium in Camden, New Jersey. “We started with traditional strategies that we use with kids with autism, like picture schedules or picture cards, social stories, and other sensory and motor experiences, to help these children understand the experience of the aquarium. We wanted them to have a sense of what they were going to see, what it would feel like, and try to feed them as much information as possible so they could process it before we took them to the actual aquarium,” Ideishi says.

of varying heights so everybody has an area that they would gravitate to based on their individual abilities.”

But occupational therapy practitioners can also positively influence children’s museum visits without actually altering any of the exhibits. Roger Ideishi, JD, OT/L, FAOTA, an associate professor of occupational therapy at the University of the Sciences’ Samson College of Health Sciences Department of Occupational Therapy in Philadelphia,

He encouraged families to take virtual tours of the building, and he collected attendance data to help families plan visits at the least busy times. That project garnered attention. Other museums and theaters in the region became interested in Ideishi’s work and wanted his advice on how to increase accessibility within their facilities. “The work that I have done is not to go in and change the museum or change the exhibits or change the theater experience, but really to support

Of course, accessibility doesn’t just apply to people with physical and cognitive disabilities. Occupational therapy practitioners are also in a position to simply help museums make their exhibits more interesting. That’s what Nancy Baker, ScD, MPH, OTR/L, an associate professor in the Department of Occupational Therapy at the University of Pittsburgh, and her students did at the Carnegie Museum of Natural History in Pittsburgh.


“The work that I have done is... to support the family, support the institutional staff, support the child, support the teachers, so that we can help the child build skills to foster experiences going out in the community.” —Roger Ideishi, JD, OT/L, FAOTA

the family, support the institutional staff, support the child, support the teachers, so that we can help the child build skills to foster experiences going out in the community,” Ideishi says. “Then, hopefully, as the children grow older, they will be able to do this more and more.” Ideishi’s work at the local level led to an appointment on the advisory board of the Smithsonian Institution and Kennedy Center for the Performing Arts as an advisor on autism accessibility. He is currently drafting a guidebook with Ellen Cohn, ScD, OTR/L, FAOTA, and Gael Orsmond, PhD, at Boston University, to help cultural arts administrators implement accessibility programming for people with sensory, social, and cognitive challenges. “Museum staff don’t always know about autism, and they don’t always know the strategies that we employ. So as they start to develop programming and exhibits, I am there to say, ‘Oh, kids with autism often respond in these various ways, so we need to take X into consideration,’” he says.

Museum leaders were worried that some of their exhibits in the “Discovery Room” were not as engaging as possible. The room is aimed at younger children and includes a lot of hands-on exhibits. So Baker did an initial evaluation. “The main thing that I talked about was the idea of accessibility and making museums as open and as available to as many patrons as possible, with the idea that the museum is a community place and that we are talking about a wide range of people,” Baker says. She brought her students back to the museum for a more detailed evaluation of the Discovery Room, specifically to focus on the Human Ancestry exhibit, which consisted of six skulls representing different human ancestors. “We sat in the corner of the room and observed every person that came in and interacted with the exhibit. We noted the length of their interaction, the quality of their interaction— whether they just viewed it or whether they took the time to read any information,” says Kate Schramm, MOT, OTR/L, who is currently a staff occupational therapist at UPMC Centers for Rehab Services and was one of the University of Pittsburgh occupational therapy students who participated in this project. “What we found was that they weren’t really doing that. A lot of times it was just purely a motor action. They were looking at the skull and turning it. They were not delving into the information available.” Schramm says the exhibit was confusing and difficult to engage with properly. “The information was on these books that were posted on a bottom shelf, which made the exhibit difficult to access and text heavy,” Schramm says. So Baker and her students devised ways to make the display more appealing. “We wanted to create something that was more visually attractive to get people interested in the exhibit. The whole thing was a neutral tone. Nothing stood out,” Schramm says. “So we increased the color. We also decided to direct the play to a specific age group. We developed information cards geared

Fact Sheet: Occupational Therapy and Universal Design for Learning Autism: A Comprehensive Occupational Therapy Approach, 3rd Edition By H. M. Kuhaneck, 2010. Bethesda, MD: AOTA Press. ($69 for members, $98 for nonmembers. To order, call toll free 877-404-AOTA or shop online at Order #1213B. Promo code MI) Occupational Therapy Practice Guidelines for Children and Adolescents With Autism By S. D. Tomchek & J. Case-Smith, 2009. Bethesda, MD: AOTA Press. ($69 for members, $98 for nonmembers. To order, call toll free 877-404-AOTA or shop online at ?SKU=2212. Order #2212. Promo code MI) Activity Analysis, Creativity, and Playfulness in Pediatric Occupational Therapy: Making Play Just Right By H. M. Kuhaneck, S. L. Spitzer, & E. Miller, 2010. Boston: Jones & Bartlett. ($76.95 for members, $109.50 for nonmembers. To order, call toll free 877404-AOTA or shop online at view/?SKU=1444. Order #1444. Promo code MI) Sensational Kids: Hope and Help for Children With Sensory Processing Disorder By L. Miller, 2006. New York: Perigree. ($16 for members, $23 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store. Order #1403A. Promo code MI)

specifically at age groups, which was important because it matched the person to the environment and activity.” Additionally, the group developed masks that showed the faces of the human ancestor represented by the skulls. These masks humanized the skulls: Patrons put them on to see how they would look as a human species from long ago. After the University of Pittsburgh group incorporated their changes, they observed the exhibit again. “I think one of the most important observations was what people weren’t doing,” Baker says. “Initially, the skulls were in drawers that slid in and out. The first time we observed the exhibit, the interaction consisted of somebody pulling one of the drawers out, spinning the skull around, and pushing it back in again. When we went back and observed with all the changes, we maybe saw one person do that, but it wasn’t the [typical] mode of interaction anymore. The interaction was much more playful, much more fun. People would see the mask and say, ‘Come over here and see this!’ We engaged people in a way that they had not been engaging with that exhibit before.” The Carnegie Museum continues to partner with Baker because leaders saw value in occupational therapy’s services in increasing visitor participation in the Discovery Room. “While their staff is incredibly skilled at developing interesting, fact-filled exhibits, they have not been trained in human development and matching the

task to people. We as OTs might not know the facts and history in depth, but we know what needs to be done there to make it engaging. We understand task, environment, and people, so our skills really fit in nicely,” Baker says. Now, Baker is helping museum leaders develop an interactive forest environment geared toward young children. The idea is to build a complete sensory experience and also facilitate more meaningful interactions between parents and children in the exhibit. But, much like occupational therapy practitioners consulting with museums, the exhibit is an evolving process. So perhaps it’s fitting that the new exhibit will involve trees and plant life. “It grew,” Baker says of the profession’s influence at the Carnegie Museum. “When we came in it was a very small thing that we did for them. Now it’s becoming much larger.” n Reference
1. Americans with Disabilities Act of 1990. Pub. L. 101-336, 42 U.S.C. § 12101. Andrew Waite is the associate editor of OT Practice. He can be reached at

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


Defining Reality


The Importance of Articulating a Leadership Philosophy
Jim Burns

s with workplace leaders in any profession, managers of occupational therapy practitioners able to articulate their leadership philosophy better help employees understand how they are expected to work together effectively and collegially to achieve their organizations’ common goals. Organizational leaders should have a vision supported by a strategic plan with measurable objectives. When leaders take the time to write down their values and share how those values can be integrated into the work setting, employees learn more about their leaders and how to relate to them. They also learn how their leaders can best help them achieve both their individual and organizational goals. Conversely, when occupational therapy leaders neglect to write a leadership philosophy, their employees may make inappropriate use of organizational resources or jump to the wrong conclusions about the direction their leaders want to go. A philosophy gives leaders an opportunity to learn more about what they truly stand for, how their values support their beliefs, and what actions need to be taken to turn those beliefs into reality. For occupational therapy managers who have not yet articulated a leadership philosophy, the leadership development philosophy of the U.S. Army, for which I serve as an occupational therapist, might be helpful as a model for development. The army stresses seven basic values: loyalty, duty, respect, selfless service, integrity, honor, and personal courage. Along with these values, my leadership philosophy is based on discipline, motivation, and altruism. As an example of what other occupa-

SGT Willie Linson, MAJ Larissa Coon, MAJ Jim Burns, SSG Matthew Greniger, and SPC Della Hokett in front of the Army values sign at Fort Carson, Colorado.

tional therapy managers can craft, the following is an abridged version of my own leadership philosophy.



Discipline is a virtue that one can cultivate in order to grow as a clinician, worker, or soldier. Each of us should have the common goal of learning how to improve job performance in order to maximize the effectiveness of our service. Discipline can be practiced in everyday living with a set of behavioral patterns that promote a strong work ethic and military bearing. For example, every day I ask myself, “What do I hope to accomplish?” and “Am I practicing behaviors that are focused on mission-oriented tasks?”

Altruism is a virtue that guides the self toward working to improve the welfare of others. I work on trying to enhance my own altruistic frame of mind by taking a client/colleague-first perspective when approaching my daily tasks. Altruism is contagious; it will permeate through the unit if every soldier actively practices with the welfare of others in mind. Physical fitness is an important part of my daily living routine. Maintaining a high level of physical fitness helps me to cope with daily life stressors, manage my weight responsibly, and meet the basic army requirements to carry out physically challenging duties in garrison or abroad. I encourage everyone on my staff to familiarize themselves with the Army Physical Fitness Standards to coordinate exercise routines that will support a good performance at the next Army Physical Fitness Test. continued



Motivation is an internal force that one can use to perform to the best of his or her ability. I continually set short- and long-range goals that can clarify the objectives that lead to a productive lifestyle. In setting goals, I actively seek out the advice of those with whom I work.



Throughout my career, I have continued to take professional training courses to maintain my professional skills. I am committed to providing Level II fieldwork opportunities for occupational therapy and certified occupational therapy assistant students to teach the future generation of our profession. I learned to think critically or think outside of the box as a graduate student to solve problems logically and take a pragmatic and efficient approach to meeting the demands of client care. Creativity with new treatment interventions is key to maintaining a thought-provoking and mentally stimulating clinical environment.



I treat others as I would like to be treated. I promise to give each and every one of you the dignity and respect fellow soldiers deserve in order to thrive in a cohesive working environment. Become familiar with the phrases, “How can I help you?” or “What can I do for you?” Make clients feel welcome and at ease within the clinic to promote a healing environment.

For all occupational therapy managers, whether in the military or not, the following are some suggestions for articulating a leadership philosophy. n Decide on and write down the top three work-related values that motivate you to achieve the outcomes necessary for organizational success (e.g., selfless service, promptness, effective communication). n Write attainable, short- and long-range organizational goals. n Share your priorities as a worker and as a leader so your staff can understand what you intend to focus on in your daily business. n Make it clear what you expect of others and what others can expect of you so people know you better and how you plan to contribute to your organization. n Allow a mentor to review your leadership philosophy so you can receive honest feedback to make any adjustments before you share it with your staff. Anyone can write a leadership philosophy regardless of the stage of his or her career. In fact, the crafting of a leadership

philosophy should be a continual process, as one’s potential to lead will change over time as one accumulates new knowledge and experiences. Occupational therapy practitioners must look at themselves and articulate how they will provide the leadership and direction necessary to sustain the profession. A leadership philosophy should be a working document, inviting open feedback for improvement. But I think some aspects of leadership remain constant, regardless of time, place, or individual. A quote by business executive Max DePree illustrates what I believe is a key aspect of leadership—selfless service: “The first responsibility of a leader is to define reality; the last is to say ‘Thank you.’ In between the two, the leader must become a servant” (p. 9).1 n

1. DePree, M. (1989). Leadership is an art. New York: Doubleday.

Jim Burns, MOT, OTR/L, CHT, a major in the U.S. Army, is chief of occupational therapy at Evans Army Community Hospital in Fort Carson, Colorado. He can be reached at

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distance learning course is designed for those working with individuals who present with limitations in daily function due to visual/cognitive/ perceptual impairment. Specific topics related to evaluation and interventions include poor awareness, visuospatial deficits, apraxia, neglect, memory loss, attention deficits, executive dysfunction, agnosia, etc. See for more information. Instructor: Glen Gillen,

Improving Function for Those Living With Cognitive & Perceptual Impairments. This self-paced

of today’s health care environment and results in increased moral distress for occupational therapy practitioners. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4840, AOTA Members: $45, Nonmembers: $65. view/?SKU=4840


Let’s Think Big About Wellness, by Winnie Dunn.

Official documents and materials that support OT concept of wellness, interdisciplinary literature, and models from other disciplines. Earn .25 CEU (3.13 NBCOT PDUs/2.5 contact hours). Order #4879, AOTA Members: $68, Nonmembers: $97. http://store


This course is designed to train OTs in objectively assessing the impact of cognitive perceptual impairments (e.g., neglect, agnosias, spatial dysfunction, apraxia, body scheme disorders) on ADLs and mobility, highlighting our unique contribution to this practice area. Limited enrollment. AOTA CEUs. Contact: Glen Gillen at 212-305-1648 or GG50@

Self-Paced Clinical Course


The Philadelphia Meeting

Surgery and Rehabilitation of the Hand: With Emphasis on the Wrist. Sponsored by Hand Reha-

Apr. 6–9, 2013

community mobility issues are complex and changes in independence are life-altering. This comprehensive SPCC gathers researchers and clinicians in a team effort to offer expert guidance in this developing practice area. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3031, AOTA Members: $259, Nonmembers: $359. http://store.

NEW! Driving and Community Mobility: Occupational Therapy Strategies Across the Lifespan, edited by Mary Jo McGuire, MS, OTR/L, FAOTA, and Elin Schold Davis, OTR/L, CDRS. Driving and

Framework supports practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4829, AOTA Members: $73, Nonmembers: $103.50. http://

Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition, by Susanne Smith Roley and Janet V. DeLany. Ways in which

Online Course


bilitation Foundation and Jefferson Health System. Hands-on workshops, panel discussions, surgery demos and anatomy labs compliment didactic sessions. Pre-conference 3-day tutorial; new 1-day pediatric pre-course available. Honored Professors: Pat McKee, M.Sc., OT Reg.(Ont.), OT(C); William W. Walsh, MBA, MHA, OTR/L, CHT; Gregory I. Bain, FRACS, PhD; Elisabet Hagert, MD, PhD; John D Lubahn, MD; Alexander Y. Shin, MD; Scott W. Wolfe,

OT Manager Topics, by Denise Chisholm, Penelope Moyers Cleveland, Steven Eyler, Jim Hinojosa, Kristie Kapusta, Shawn Phipps, and Pat Precin. Supplementary content from chapters

tional therapy and the occupational therapy process as described in the 2008 second edition of Framework. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #OL32, AOTA Members: $180, Nonmembers: $255. =OL32

Occupational Therapy in Action: Using the Lens of the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition, by Susanne Smith Roley and Janet DeLany. Occupa-

in The Occupational Therapy Manager, 5th Edition with additional applications relevant to selected issues on management. Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota. org/view/?SKU=4880


Self-Paced Clinical Course

Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation, edited by Margaret Christenson and Carla Chase. 21

Education on home modification for OT professionals and an overview of evaluation and intervention and detailed descriptions of assessment tools. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3029, AOTA Members: $259, Nonmembers: $359. =3029


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

final recommendations about the capacity for older adults with dementia to drive or not. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4842, AOTA Members: $68, Nonmembers: $97.


The Short Child Occupational Profile (SCOPE), by Patricia Bowyer, Hany Ngo, and Jessica Kramer.

Introduction of SCOPE assessment tool and description of documenting child motivation for occupations, habits and roles, skills, and environmental supports and barriers. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #4847, AOTA Members: $210, Nonmembers: $299. http://store.


Strategic Evidence-Based Interviewing in Occupational Therapy, presented by Renée R. Taylor.

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.


Self-Paced Clinical Course

public awareness strategies on expertise in transitioning early childhood development into occupational engagement in natural environments. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3026, AOTA Members: $259, Nonmembers: $359.

Early Childhood: Occupational Therapy Services for Children Birth to Five, edited by Barbara E. Chandler. Federal legislation in OT practice and

Self-Paced Clinical Course

Structured, semi-structured, and general clinical interviewing and set of norms and communication strategies that can maximize accurate, relevant, and detailed information. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4844, AOTA Members: $68, Nonmembers: $97. http://store.aota. org/view/?SKU=4844


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

Collaborating for Student Success: A Guide for School-Based Occupational Therapy, edited by Barbara Hanft and Jayne Shepherd. OT collab-


Model of Human Occupation Screening Tool (MOHOST): Theory, Content, and Purpose, by Gary Kielhofner, Lisa Castle, Supriya Sen, and Sarah Skinner. Information from observation, interview,

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

orative practice with education teams using professional knowledge and interpersonal skills to blend hands-on services for students and system supports for families and educators. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3023, AOTA Members: $259, Nonmembers: $359. http://


chart review, and proxy reports to complete the MOHOST occupation-focused assessment tool. Earn .4 AOTA CEU (5 NBCOT PDUs/4 contact hours). Order # 4838, AOTA Members: $125, Nonmembers: $180.

ADED Approved CEonCD™

Autism Topics Part I: Relationship Building, Evaluation Strategies, and Sensory Integration and Praxis, edited by Renee Watling. Content

quired professional reasoning and ethics for making

Determining Capacity to Drive for Drivers with Dementia Using Research, Ethics, and Professional Reasoning: The Responsibility of All Occupational Therapists, by Linda A. Hunt. Re-

from Autism, 3rd Edition to expand OT practice with children through building the intentional relationship, using evaluation strategies, addressing sensory integration challenges, and planning intervention for praxis. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4848, AOTA Mem-

Continuing Education
Hand Rehabilitation Foundation
Presents _____________________________________

Continuing Education Los Angeles, CA Starting January 25, 2013 Sensory Integration Certification Program Sponsored by USC/WPS Course 1: Jan. 25–27, & Feb. 2, 3 Course 2: Mar. 1–3, & 16, 17 Course 3: May 3–5, & 11, 12 Course 4: Aug. 23–25, & Sept. 7, 8 For additional sites and dates, or to register, visit or call 800-648-8857

Continuing Education

The Philadelphia Meeting 2013

Surgery and Rehabilitation of the Hand with Emphasis on the Wrist April 6–9, 2013 Pat McKee, M.Sc., OT Reg.(Ont.), OT(c) William W. Walsh, MBA, MHA, OTR/L, CHT Gregory I, Bain, FRACS, PhD Elisabet Hagert, MD, PhD John D. Lubahn, MD Alexander Y. Shin, MD Scott W. Wolfe, MD 1-Day Pediatric Pre-course available 4/5/13 Sponsored by the Hand Rehabilitation Foundation Supported by the Jefferson Health System For information, please contact us: 610.768.5958 D-6188

Honored Professors

Continuing Education

Physical Agent Modalities
Occupation based certification course


Assessment & Intervention Training 2008 Conference Schedule
San Francisco, CA Feb 29-Mar 1 Two Days of Hands-On Learning (1.6 CEU)
Upcoming Locations & Dates: Houston, TX Mar 28-29 Fayetteville, AR TX Apr.11–12, 2013 McAllen, January 4-5 Stafford, TX January 18–19, 2013 Chicago, IL Apr 11-12 Mobile, AL February 22–23, 2013 San Antonio, TX Apr 19-20 Charleston, SC Apr 25-26 Atlanta, GA March 1–2, 2013 Tampa, FL May 8–9, Lexington, KY March2-3 2013 Manhattan, March 17-18 Morganton, NC NY Jul21–22, 2013 Virginia Beach, VA Sep 20-21 Peck, MI NC 11–12, 2013 Morganton, April Sep 25-26 San Antonio, TX Oct 10-11 2013 Chicago, IL May 23–24, Houston, TX August 16–17, 2013 Columbia, SC Oct 16-17 Sacramento, October 24–25, San Antonio, TX CA Oct 24-25 2013 Orlando, November 1–2, Columbia, TN FL Nov 14-15 2013
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Faculty Faculty

Search For
(occupational Therapy Fulltime Tenure Track Faculty) (assistant or associate Professor) DeParTMeNT oF occUPaTIoNaL TheraPY SchooL oF heaLTh ScIeNceS
Winston-Salem State University, one of the 17 constituent institutions of the University of North Carolina system, occupies a picturesque 110-acre campus overlooking the woodlands of Salem Lake in the heart of WinstonSalem. This Master’s Level I university enrolls approximately 6,000 diverse students and offers more than 40 bachelor’s programs, ten master’s programs through the university’s School of Graduate Studies and Research, and one certificate program in computer science. The School of Health Sciences at Winston-Salem State University produces clinically and culturally competent undergraduate and graduate health care students, with a framework of altruistic values, who are dedicated to serving the best health interest of society. The school’s focus is to also produce pragmatic field-relevant research that advances both health care practice and knowledge, in improving the availability, accessibility, acceptability, and quality of health services, particularly for the medically underserved experiencing health care disparities.

Department of Occupational Therapy

The Department of Occupational Therapy at Tufts University is seeking applicants for a tenure-track position at the rank of assistant professor, to begin September 2013. Required concentration is research focused on promoting activity and participation in the homes and communities of people living with or at risk of disability. This position holds a primary appointment in the Department of Occupational Therapy, a graduate department in the School of Arts and Sciences (http://ase.tufts. edu/bsot/faculty.htm). There is a secondary appointment in the undergraduate Community Health Program ( commhealth). Responsibilities include 50% teaching in occupational therapy and 50% in community health. The Community Health Program focuses on the social determinants of health and well-being, including the policy environment. Faculty have the opportunity to develop collaborations with researchers in other programs in the arts and sciences, health and medical sciences, and engineering. Tufts University overlooks the city of Boston in an intellectually and culturally vibrant and diverse environment, with endless prospects for research in the community and in clinical sites around the Boston area. The candidate must hold a research doctoral degree by May 2013 (PhD or equivalent) in occupational therapy, public health, public policy, or other relevant discipline. The applicant should discuss his or her research agenda, the target population (e.g., type of disability, chronicity, age, race, ethnicity, sexual orientation, socioeconomic status), and the personal, social, and environmental factors that impact activity and participation. The focus of research can be anywhere along the lifespan. Cross-cultural and interdisciplinary expertise and graduate-level teaching experience strengthen the application. The position requires a blend of scholarship, teaching, advising, and service activities. Send an electronic copy of CV; statement of research interests and teaching experience; and a list of the names, e-mail addresses, and phone numbers of three references to Occupational Therapy Department Administrator, Michelle Molle, at Review of applications will begin November 15, 2012, and continue until the position is filled. Tufts University is an Affirmative Action/Equal Opportunity employer. We are committed to increasing the diversity of our faculty. Members of underrepresented groups are encouraged to apply.

General responsibilities: • assist in occupational therapy program/curriculum development and evaluations at graduate level • teach 18 semester hours annually • maintain office hours consistent with faculty guidelines • advise students and guide student research • supervise students in Level I Fieldwork • develop research agenda and maintain research skills and interest consistent with OT department and university policies • assist in departmental administrative tasks • serve on university, School of Health Sciences, and departmental committees • serve in community or civic organizations or activities as specified by university guidelines • maintain active membership in state and national associations education: Ph.D. or Ed.D, from a regionally accredited college or university and eligibility for North Carolina licensure as a practicing occupational therapist required. Preference given to candidates who possess experience in occupational therapy education, including mental health, physical rehabilitation, and/or research. experience: Two years or more fulltime or part-time teaching experience in a college or university. Five years or more clinical experience. Two years supervising students. Scholarly Production: Should have record of scholarship at state, national, or international level. Salary: Commensurate with education and experience. Position open until filled. For immediate consideration, please visit applicants will be asked to attach a letter of interest, curriculum vita, names of three references, and unofficial transcripts. official transcripts will be required for the successful candidate. No applications will be accepted by mail. Serious applicants must complete their application by January 15, 2013. For Inquiry about program contact: Dr. Dorothy P. Bethea Chair & Professor Occupational Therapy Department 432 F.L. Atkins Building Winston-Salem, NC 27110 Phone: 336-750-3170



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