San Marcos, Fall 2019

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  Developing Financial Literacy Skills for a Secondary Transition Program for Students with Learning Differences

  Rose Marie Borillo, Becki Cohill, and Susan MacDermott

  Under the Individuals with Disabilities Education Act (IDEA), schools are required to provide transition planning for students with disabilities and mental illness by age 16 (Eismann et al, 2017). Occupational therapists have been underutilized in secondary transition planning, despite their expertise in targeting functional abilities, comprehension, and health using activity analysis to promote skill attainment and achieve independence (Mankey 2012; Eismann et al, 2017).

  At the Winston School, there was no formal transition program aside from the individual college counseling provided by a staff member. A coordinated transition program was indicated to prepare students for life after high school to include college and career readiness, and independent living skills, especially financial literacy. Financial literacy has become a priority not just for Winston, but globally as a lack of financial planning has been linked to greater rates of dropping out of college (Blue et al, 2014; Poynton et al, 2014). The purpose of this project is to develop the financial literacy component as a part of a coordinated, comprehensive transition program that addresses the specific skills and needs of diploma bound students with learning differences to transition into post-secondary education and work using an occupational therapy lens. A total of ten students participated in the pilot program. Needs were assessed using informal assessments including interviews, surveys, and reflection. As a result, a total of 20 lessons were created for financial literacy using multimodal presentations to meet individual needs. Students expressed their growth in knowledge through the meaningful activities they participated in throughout the course.

  With the use of occupation-based activity analysis, curriculum development for financial literacy resulted in meaningful, experiential learning opportunities with appropriate modifications to meet student learning needs and preferences. School-based occupational therapists can expand their role in the classroom in supporting students to develop the necessary skills to prepare them for independent living.

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  Occupational Therapy's Role in Maternal Mental Health within Transition from NICU to Home

  Victoria Briltz, Becki Cohill, and Susan MacDermott

  The purpose of this capstone project is to identify OT’s role in maternal mental health following the transition home from a NICU setting. This capstone project focused on mothers’ roles, routines, and environment during the transition from the NICU to home. Mothers may feel unprepared for the discharge home when their babies are ready to leave the NICU (Boykova, 2016). Occupational therapists address occupational performance through skilled interventions for women during the perinatal period; however, there is a lack of evidence guiding occupational therapy for providing services for maternal wellness (Slootjes, 2016). This capstone project will help share information, ideas, and resources for occupational therapists providing services in maternal wellness.

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  Anatomy of an Exhibit: The Academic Library as Place of Self-Instruction

  Matthew Chase

  This exhibition project addresses the central question: How can we creatively transform academic library spaces to support and engage students in critical information literacy? The project used physical library space to install a series of exhibitions at the San Marcos Campus Library of the University of St. Augustine for Health Sciences. Guided by the theoretical frameworks of Foucauldian perspective on knowledge and discourse, Falk and Dierking’s Contextual Model of Learning, and critical librarianship, the exhibit series engages students in a self-guided journey to discover and evaluate how knowledge is constructed, produced, and disseminated. Particular focus is directed to the Fall 2019 Theatre of the Body exhibit, in which Renaissance-era anatomical illustrations are displayed in the library accompanied with information about the socio-cultural history of human anatomy as a legitimized medical and academic practice. Students, faculty, and staff learned about the history of ethics concerning the use of cadavers, the technological advancements and educational power of anatomical illustration, the overlooked gaps in history regarding anatomists of color, and other topics of human anatomy. Preliminary qualitative data showed a positive reception to this exhibition by students, faculty, and staff as an engaging, critical discourse about human anatomy.

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  Perspectives of Occupational Therapists on Telehealth

  Taylor Corey, Becki Cohill, and Susan MacDermott

  The purpose of this project is to gain a better understanding of the provider’s perspectives about the strengths and barriers of OT services provided via telehealth. Based on the evidence that will be collected through surveys and interviews, it can help determine specific factors on whether or not therapist choose to provide services through telehealth. Centered around those perspectives of telehealth, the results can help explore more in depth on the issues and concerns therapists have when it comes to telehealth as a service delivery model.

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  Application of Occupation-Based Models to Edward of Edward Scissorhands: OA and EHP Models

  Amy Griswold, Kelsey Harris, Whitney Marwick, Whitney Wilbanks, and Courtney Wild

  This presentation examines the character Edward Scissorhands, a young adult with hand deformities and poor social skills, through the lens of the Ecological Human Performance (EHP) Model. We propose occupational therapy interventions based off of the EHP model. Through the use of establishing social skills training, as well as adapting and modifying Edward’s hands with tips and attachments, Edward’s life could be immensely improved

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  Caregiver Perspectives on Telehealth: A Service Delivery for Occupational Therapy

  Rebecca Johnston, Becki Cohill, and Susan MacDermott

  Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).

  Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive aging; health and wellness; mental health; rehabilitation, disability, and participation; work and industry (Cason, Hartmann, Jacobs, & Richmond, 2013). Occupational therapists use telehealth to “develop skills; incorporate assistive technology and adaptive techniques; modify work, home, or school environments; and create health-promoting habits and routines” (Cason et al., 2013, p. 69). Telehealth is beneficial because it increases accessibility of services, increases access to specialists and/or providers, increases client and therapist flexibility of treatment times, reduces travel time, and reduces delays in service by allowing for online consultation (Cason et al., 2013; Gardner, Bundy, & Dew, 2016; Kairy, Lehoux, Vincent, & Visintin, 2009).

  Telehealth will be investigated in this project with the population of caregivers of children receiving early intervention (EI) services. Early intervention services “promote the development of skills and enhance the quality of life in infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living” (Cason, Behl, & Ringwalt, 2012, p. 1). Using telehealth to deliver EI services helps to improve access to care in underserved areas (Cason et al., 2012). Telehealth also promotes “inter-disciplinary collaboration, coordinated care, and consultation with specialists” who are not normally available in these underserved communities (Cason et al., 2012).

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  What is Congenital Talipes Equinovarus?

  Cornelia Lieb-Lundell

  An estimated 80% of clubfoot cases occur in low to middle-income countries. Incidence of clubfoot is estimated to be 1-1.5 per 1000 births, and male to female occurrence is 3:1. (1) Left untreated, this congenital anomaly becomes a “neglected clubfoot” and can result in lifelong hardships including limited ambulation related to gait deviations, pain, foot deformities and an inability to wear shoes. Without treatment, this health condition can lead to functional limitations with limited independence in activities of daily living and participation restrictions within the family and community related to decreased mobility. (2)

  The intervention presented is the main components of the Ponseti approach which consists of a defined sequence of manipulation of the foot followed by a period of casting and, in approximately 90% of the cases, an Achilles tenotomy. Long term follow-up is bracing which continues for 3-5 years after the initial treatment period of manipulation. A comparison of Ponseti and conservative non-Ponseti methods achieved a good to excellent prognosis in an average of 91.6 % vs 76.6% of patients. (3)(4)

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  The Role of Occupational Therapy for Survivors of Human Trafficking

  Margaux Mariano, Becki Cohill, and Susan MacDermott

  Human trafficking involves sex trafficking, labor trafficking, and trafficking of children. The needs of survivors of human trafficking are widespread due to the traumatic experiences they face. Concerns that may arise include decreased participation in meaningful activities in an individual's life, possibly due to anxiety, depression, suicidal ideation, memory loss, posttraumatic stress disorder, and social isolation. Individuals who have been subjected to human trafficking often experience occupational deprivation and occupational therapy has yet to establish its role in the recovery process for survivors. This poster presents a capstone project consisting of the process towards the development of an occupation-based, trauma-informed, evidence-based, and survivor-centered program that focuses on facilitating community integration and independent living skills for survivors of human trafficking.

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  Case Study: Efficacy of Physical Therapy on a Patient with CVA in Normalizing Gait and Shoulder Mechanics

  Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, and Faris Alshammari

  Background & Purpose: Cerebrovascular Accident (CVA) is known as Stroke. It is a damage to the brain due to an interruption of blood supply. Two main types of stroke are ischemic stroke and hemorrhagic stroke. Ischemic stroke, the most common type of stroke, is due to a blocked artery and a hemorrhagic stroke is due to a leak or burst of a blood vessel. Signs and symptoms of stroke are presented contralaterally. The purpose of this case report is to demonstrate the use of PT interventions to improve shoulder function and gait mechanics in a post CVA patient.

  Case Description: Patient is a retired 75-yo male who sustained a left ischemic CVA in 2017 with an insidious onset. Comorbidities include Central and Obstructive Sleep Apnea, HTN, and Benign Prostatic Hyperplasia. He has been receiving PT, OT, and SLP intermittently for the past 2 years. The patient’s body structure and function impairments include balance and coordination deficits, R hemiparesis, impaired sensation RUE, decreased ROM of RUE, RUE partial flexor synergy, difficulty speaking, right homonymous hemianopsia, and decreased endurance. Activity limitations include difficulty walking greater than 1 mile and inability to reach overhead with the RUE. Participation restrictions include difficulty cooking independently (I) and socializing in groups due to his speech impairment. Specific interventions included balance and gait training, therapeutic exercise and neuromuscular re-education for RUE and RLE, and patient education. PT services were provided 1 time per week for 4 weeks.

  Outcomes: Patient had significant improvement in functional gait as well as awareness of ankle motion. Dynamic Gait Index (DGI) increased from 18/24 to 20/24 with improvements in alternating gait speed, ambulation with head turns, and pivoting on command compared to pre-test. Although his time for Timed Up and Go (TUG) went from 7 sec to 7.3 sec, he did not stumble as compared to the pre-test. Patient also demonstrated decreased RUE partial synergy during TUG and DGI. He was d/c from PT services with a plan to continue progressing shoulder flexion ROM, increasing endurance of R ankle dorsiflexors, and continuation of LE stretches to improve gait.

  Discussion: For a patient who has experienced a CVA, scapulohumeral rehabilitation and gait training are effective PT management options to increase functional mobility and (I). This study supports previous research for the effectiveness of scapulohumeral rhythm in increasing shoulder ROM and gait training in implementing proper gait mechanics, efficiency, and endurance. Although the patient’s stroke had occurred two years ago, the patient was able to make significant functional improvement with shoulder ROM and improved quality in gait mechanics. The outcome of this study may help guide future clinicians in decision making with stroke patients who need improvement with shoulder ROM and gait mechanics.

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  The Effect of Aquatic Interventions in Combination with Early Start Physical Therapy Services on Gross Motor Development in a Male Child with Down Syndrome

  Roxanne Mueller

  Introduction: Aquatic therapy has been used in various patient populations as a modality to facilitate motor control and manage tonicity.^1-3 Despite the variety of literature addressing individuals with Down syndrome (DS) and aquatic therapy, there has been little described about the effects of aquatic therapy on early gross motor development in children with DS.

  Purpose: The purpose of this case study is to examine whether aquatic physical therapy interventions combined with early start physical therapy influence gross motor developmental delay in a child with DS.

  Case Description: The patient is a 31-month-old boy with diagnosis of DS presenting with moderate-severe hypotonia and lengthy medical and surgical history related to complications secondary to his diagnosis. He began receiving early start physical therapy at 4-months-old at a frequency of one in-home session weekly. His Peabody Developmental Motor Scales-2 (PDMS-2) scores at 2 months (T1) and 14 months (T2) of age showed a 50% gross motor delay across all categories, and his 26 month (T3) score showed a 59% gross motor delay across all categories.⁴ At the time of T3, the patient would not tolerate quadruped positioning and used rolling as his primary method of mobility. He was able to pull himself into kneeling and standing with guarding but would not maintain either position longer than 20 seconds. In order to combat his increasing gross motor delay, warm water therapy sessions were added to the patient’s plan of care at 26-months-old at a frequency of two sessions per month. His physical therapy interventions emphasized core stability and strength, upper and lower extremity weight bearing, and dynamic balance in order to facilitate continued development of gross motor skills. A fourth evaluation, (T4), was performed 5 months following initiation of warm water therapy.

  Outcomes: The patient’s PDMS-2 raw score increased by 18 points between T2 and T3, and 16 points between T3 and T4. Minimal Clinically Important Difference (MCID) for PDMS-2 is 8.39, showing significant improvement between both T2 to T3 and T3 to T4. The percent of gross motor delay between T2 and T3 increased by 9%, but remained stable, and increased 2% between T3 and T4. Minimal detectable change (MDC) for change in developmental delay is 8.2%, showing regression between T2 to T3 and stabilization between T3 to T4.^4-5 As of T4, the patient tolerates quadruped briefly but prefers tummy crawling for long distances. He can independently pull to stand and initiate cruising steps.

  Discussion: Aquatic therapy in a child with DS was associated with improved gross motor abilities and stabilization of gross motor delay over 5 months. While gross motor delay is normal in children with DS, progression of milestones is still expected, and therefore growing gross motor delay can be cause for concern.^6-7 This case report supports prior research indicating that aquatic interventions can improve gross motor control.¹ The findings suggest that aquatic interventions can be a beneficial modality within Early start physical therapy services to promote gross motor development in this population. The information gained from this case report can be utilized to help guide decision making for practitioners working with children with DS.

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  A case study on the effects of functional exercises in improving quality of life (QOL) in a patient diagnosed with glioblastoma multiforme (GBM)

  Kathy Nguyen, Savonna Reed, Sepehr Rezaei, Vanessa Rindge-Silvas, and Brianne Bozzella

  Background and Purpose: The estimated prevalence of primary brain tumors in the US population is 14 per 100,000. GBM accounts for 50% of primary central nerve tumors in people older than 15 years old. Approximately 12,820 deaths each year are due to primary and nervous system tumors. There is limited research on the optimal interventions and effects of physical therapy on individuals diagnosed with GBM.¹ The purpose of this case report was to determine which aspects of the International Classification of Functioning, Disability, and Health model are the most important to consider during physical rehabilitation and possible interventions that can be beneficial for patients diagnosed with GBM.

  Case Description: The patient, a 50 y.o. male, was diagnosed GBM 8 mos prior. He had a history of falls that resulted in a visit to the Emergency Room which lead to the discovery of his medical diagnosis. The patient’s primary impairments include impaired balance, coordination deficits, right-sided muscle weakness, dysarthria, hyperreflexia, and decreased endurance. These impairments and activity limitations make it difficult for the patient to work and participate in community activities. Interventions were chosen to improve coordination, balance, and ambulation to reach his goals to increase independence and safety for activities of daily living (ADL).

  Outcomes: The patient demonstrated improvements in mental/physical health as measured by the HRQOL-4 and BBS. During the initial evaluation, the patient indicated on the HRQOL-4 that within the last 30 days, he felt that his physical health was not good on 30 of those days and that his mental health was not good on 5 of those days. He reduced that number to 0 days at discharge. He also reported that within the last 30 days, 0 of those days he felt very healthy and full of energy. Upon discharge, he increased that number to 25. He also improved his BBS score from 18/56 to 26/56 to demonstrate a decreased risk for falls. With the 5xSTS, he improved from 46s to 19.5s. He also achieved his goal of ambulating 25 feet with FWW on level surfaces in order to improve his independence with household ambulation. The patient was discharged with the plan to continue coordination, balance, and endurance exercises at home.

  Discussion: Functional Exercises were found to be more beneficial in managing musculoskeletal symptoms and activity/participation restrictions in people diagnosed with GBM. Those diagnosed with GBM have a high mortality rate with a life expectancy of only two years. There is a lack of research that has been conducted to establish the best rehabilitation practices. Therefore, the clinical decision making for the plan of care (POC) has to take into consideration the patient’s goal and maintaining/improving their QOL. In this case study, the patient’s goal was to increase independence, endurance, and efficiency with daily tasks. Our team utilized evidence-based research to create a POC that was “individualized, achievable, time-based, functional, and goal-oriented.”² The interventions also challenged the patient’s cognitive abilities by dual-tasking for neural overlap.³ Research studies have found that functional therapeutic activities such as STS, balance, music with movement, and gait training are more beneficial in improving postural control, precise coordination, and performance of ADLs.⁶ Within three treatment sessions, the patient was more engaged in the exercises and optimistic about his outcome, QOL, and capabilities. Thus, the case study demonstrates the importance of physical activity in improving the QOL in patients with GBM.

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  Weight-Bearing Interventions to Decrease Spasticity and Improve Gait in Stroke Patients: A Case Report

  Melin Nguyen, Shelby Peterson, Jessika Sun, Irene Taing, and Faris Alshammari

  The purpose of this case report was to determine the success of weight-bearing interventions on spasticity reduction and improved gait patterns in a 61 year-old-male patient recovering from a chronic left hemorrhagic CVA. The patient’s primary impairments included right upper and lower extremity spasticity, circumduction gait, weakness and decreased range of motion of right extremities.

  The interventions included in this patient’s treatment program included standing calf stretches, toe raises, ankle range of motion and gait training for 1 hour once a week for 4 weeks. This case report supports the application of weight-bearing through the paretic limb, which has been proven to be beneficial for reducing spasticity and increasing ROM to improve gait patterns for a patient recovering from a CVA.

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  Lifestyle Management for Individuals with Vestibular Disorders

  Michelle Pock, Becki Cohill, and Susan MacDermott

  Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular disorders.

  The purpose of this capstone project was identify common lifestyle factors that impact vestibular symptoms and can support management of symptoms, develop and propose a program that addresses and promotes lifestyle modification, assess opportunities and barriers for current occupational therapy role in vestibular settings, and advocate for occupational therapy role in prevention and management of lifestyle concerns for vestibular populations.

  Individuals with vestibular disorders and practitioners working with these individuals were interviewed at RISE Physical Therapy and an otoneurology practice. Patient appointments were observed using field notes. Individuals from an online vestibular support group were also surveyed. Responses were recorded and analyzed for themes. The findings were used to develop and propose an occupation-based lifestyle modification program for individuals with vestibular disorders.

  The findings from this capstone project support previous research on the impact vestibular disorders have on daily life and the need for an increased role for occupational therapy in providing lifestyle-based intervention for the population. Occupational therapy can provide a unique contribution to the interdisciplinary healthcare team working with individuals with vestibular disorders.