http://c.ymcdn.com/sites/www.motafunctionfirst.org/resource/resmgr/Docs/MOTA_2015_Early_Activities_i.pdf

This is a link to a presentation from Mayo Clinic on OT in an ICU setting and why intervention early on in an ICU experience is important. Although there is not a right or clear cut answer to how much or what you can do with a client in ICU, there are several examples of why this is important and ideas of how to begin regaining ADL function in the ICU. Some other highlights from this presentation include the importance of teamwork to facilitate patient progress and the use of the PEO model in this setting.

https://newgradoccupationaltherapy.com/acute-care-occupational-therapy-sandwich-method/

This resource covers OT in acute care using an interesting sandwich analogy that actually makes a ton of sense. The top piece of bread is gathering info through chart review, ensuring that you are as prepared as possible for your evaluation. The meat and cheese are referred to as "the good stuff" which is really whatever service you may be providing. This may be treatment or evaluation in this setting. Assessing the clients current level of function, comparing it to prior level of function, finding out whether they have things like durable medical equipment or family/home health support to help if needed. Finally, the bottom piece of bread is documentation and interprofessional communication. Documentation may play a key role in making sure your client gets the adaptive equipment they need to increase their independence and safety while completing ADLs when they return home. Interprofessional communication is important to update nursing and other staff on client's medical and functional status pre and post intervention.

https://otpotential.com/blog/acute-care-occupational-therapy

This is a good resource for any of us that may be considering taking an acute care OT position. A group of interviews of acute care OTs with varying levels of experience which gives insight on what to expect from working in the setting as well as some pros and cons.

https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/AcuteCare.aspx

This is the AOTA fact sheet for OT in an acute care setting. The sheet includes information on the multiple populations/settings that may fall under the acute care description including med-surg, neurology, ortho, psych/behavioral, critical care and pediatrics. Along with these descriptions are lists of expected roles filled by OTs in the settings. In the fact sheet AOTA states, "improving functional status comes second only to medical stabilization in this setting." I have experienced this played out in my acute care rotation. We often get orders immediately following a patient becoming stabilized to get them up, moving and working on the things they need to do to remain independent and to begin their discharge planning process.

Gage, M., Cook, J. V., & Fryday-Field, K. (1997). Understanding the Transition to Community Living After Discharge From an Acute Care Hospital An Exploratory Study. American Journal Of Occupational Therapy, 51(2), 96-103.

This study looks at challenges and demonstrates the importance of the transition back home from hospital treatment for OT clients. Clients need to be aware of discharge plans and limitations that may be present when returning to their home environment. This article boils down to the importance of communication and relationship between client and therapist. It is better error on the side of over communication, making sure the client is informed of limitations and strengths as well as potential barriers to independence in the community that they are discharging too.

Nicks, R., DeGruyter, M., Walkenhorst-Maccanti, H., & Bernhardt, J. (2007). Changing practice for acute hemiplegic shoulder care: a best practice model. International Journal Of Therapy & Rehabilitation, 14(6), 266-273.

This best practice study found that the Management Tool for Acute Hemiplegic Shoulder (MTAHS) was the most appropriate tool for identifying risks for patients suffering from UE hemiparesis following a CVA in an acute care setting where time is limited. Some other challenges we face as OTs working with these clients in this setting include proper handling and positioning of the affected limb. Best practice for these challenges is also addressed in this article.

Blaga, L., & Robertson, L. (2008). The nature of occupational therapy practice in acute physical care settings. New Zealand Journal Of Occupational Therapy, 55(2), 11-18.

This study used a questionnaire planning, holistic approaches, occupation based treatments and occupation as an end and OTs unique contribution to the acute care setting. Overall, OTs concluded that their ultimate goal in this setting was discharge planning to the safest, least restrictive environment. Therapists also ultimately agreed that their training and skills allowed them to provide services to prepare patients for this environment and to care for them in unique, client centered ways.

Hobbs, J., Boysen, J., McGarry, K., Thompson, J., & Nordrum, J. (2010). Development of a unique triage system for acute care physical therapy and occupational therapy services: an administrative case report. Physical Therapy, 90(10), 1519-1529. doi:10.2522/ptj.20090166

This article looks at the development of a system to ensure that evaluations being performed in an acute care were on patients who were appropriate for therapy. Amount of clients seen per day ultimately decreased from around 18 to around 12. I think this is useful to look at it in the acute care setting based on my experience. My FE and I have reported to multiple rooms only to find patients who were in no where appropriate for an OT evaluation. Decreasing the number of referrals for inappropriate patients would ultimately increase the quality of care for patients who are appropriate and cut the cost of healthcare.

Atwal, A., McIntyre, A., & Wiggett, C. (2012). Risks with older adults in acute care settings: UK occupational therapists' and physiotherapists' perceptions of risks associated with discharge and professional practice. Scandinavian Journal Of Caring Sciences, 26(2), 381-393. doi:10.1111/j.1471-6712.2011.00946.x

This article highlights what I believe to be one of my most important roles as an OT in the acute care setting, discharge planning. There are inherent risks with discharging a patient to the wrong setting, inhibiting their ability to be independent and maintain quality of life. All too often we see re-admissions in the acute care setting and one of our main goals should be limiting these occurrences through proper discharge placements for our clients. The article mentions that an interdisciplinary approach is key and I would agree.

Robertson, L., & Blaga, L. (2013). Occupational therapy assessments used in acute physical care settings. Scandinavian Journal Of Occupational Therapy, 20(2), 127-135. doi:10.3109/11038128.2012.737369

This study used a survey which produced a response rate of 47% totaling 72 clinicians working in the acute care setting. The study found that most OT assessments used in the acute care setting are not standardized. Unfortunately, this aligns with what I have experienced on my current level 2 rotation in a similar setting. Many therapists reported some of the same struggles associated with using standardized assessments that my fieldwork educator would identify as well. The largest of these being time, which is something largely required by most standardized assessments. I've found that we use little chunks of different assessments in more of a rapid screening process to complete the evaluations in a timely fashion.

Wilson, L., Atwal, A., Richards, C., McIntyre, A., Johnston, K., & Lilja, M. (2012). Do occupational therapy pre-discharge home visits affect the longer term outcomes of the discharge process?...including commentaries by Johnston K and Lilja M. International Journal Of Therapy & Rehabilitation, 19(6), 335-343.

This study looks at the helpfulness of pre-discharge home visits by OTs when working with older adults in the acute care setting. I've heard of this being done a lot with inpatient rehab settings, especially SNFs. However, as the article mentions it is not as common in acute care settings. The article ultimately states that though it seems it would be helpful with older adults in this setting, more research needs to be done to determine the effectiveness of these visits.

Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M., Miller Kuhaneck, H., Pfeiffer, B., & ... Bodison, S. C. (2017). Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration. American Journal Of Occupational Therapy, 71(2), 1-10. doi:10.5014/ajot.2017.019281

http://eds.b.ebscohost.com.proxy01.shawnee.edu/eds/pdfviewer/pdfviewer?vid=3&sid=32ec3e6c-8651-4ac8-9d0d-d9dd7ff92f35%40sessionmgr102

This article looks at the challenges of sensory integration based OT to treat in a multifaceted fashion. The three types of treatments are used in SI therapy are environmental supports/adaptations, care-giver/parent focused interventions and child focused. Child focused are used most frequently among pediatric SI therapists. The article suggest the importance of using all three and looking through and SI lens but also treating things like skills and muscle strength when necessary. I have seen this in my fieldwork setting, We have several kids who have functional deficits that are a result of underlying sensory issues. Therefore, we treat the sensory issues often at the same time we are developing their functional skills. Regulating a child's sensory system often allows us to work on those functional skills more effectively.

Kugel, J., Hemberger, C., Krpalek, D., & Javaherian-Dysinger, H. (2016). Occupational Therapy Wellness Program: Youth and Parent Perspectives. American Journal Of Occupational Therapy, 70(5), 1-8. doi:10.5014/ajot.2016.021642

http://eds.a.ebscohost.com.proxy01.shawnee.edu/eds/pdfviewer/pdfviewer?vid=1&sid=fffef25b-ba78-4537-9f46-ab050df3634e%40sessionmgr4010

This study reviewed the impact of a family based wellness program on activity levels of parents and children. The study was created to address increasing obesity rates in both adults and children. During the structured interviews after the program, both parents and children noted positive results from the program. One specific parent noted that she had experienced a significant positive change in her daughter's routine. Her daughter reinforced that during her interview by stating that she could not remember her bedtime before the program and often woke up in the night when she was suppose to be sleeping. After the program she stated that she went to bed at the same time every night and slept all through the night. This article shows that OTs can certainly meet the psychosocial needs of their clients with a family based approach to community programs.

Rainville, E. B., Cermak, S. A., & Murray, E. A. (1996). Supervision and Consultation Services for Pediatric Occupational Therapists. American Journal Of Occupational Therapy, 50(9), 725-731.

http://eds.b.ebscohost.com.proxy01.shawnee.edu/eds/detail/detail?vid=0&sid=bf5f606d-d769-4d4d-9785-0fd5555ebf3a%40sessionmgr102&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=107944026&db=rzh

This article is a little older, but it is very applicable to my current setting. The study used a survey to ask OTs and special education administrators about current supervision and consultation within their work place. The results of the survey showed that both professions believed OTs benefit from supervision from others with advanced experience or expertise in a given area. This is really applicable to the SI setting I'm in right now. If the clinic were to hire another OT that does not have extensive experience in SI therapy, I believe supervision from my fieldwork education would be an absolute necessity.

Mu, K., & Royeen, C. (2004). Interprofessional vs. interdisciplinary services in school-based occupational therapy practice. Occupational Therapy International, 11(4), 244-247.

http://eds.a.ebscohost.com.proxy01.shawnee.edu/eds/pdfviewer/pdfviewer?vid=1&sid=12586553-fcdb-4a7d-acdf-493758c727b7%40sessionmgr4006

This article delineates the terms profession and discipline as they are commonly misused when talking about interactions between therapists and others in the school setting. The article states a profession requires specific knowledge and an individualized standard of practice whereas a discipline is a field of study. Therefore, OT can have several different disciplines, but it is a single profession. The article goes on to state that interprofessional is more appropriate than interdisciplinary, especially in the school setting. This is because we are working with other professions rather than working with other disciplines of a similar profession. The authors believe that although many individuals use profession and discipline interchangeably, understanding and better using our language will increase our overall professionalism.

Delany, C., & Galvin, J. (2014). Ethics and shared decision-making in pediatric occupational therapy practice. Developmental Neurorehabilitation, 17(5), 347-354. doi:10.3109/17518423.2013.784816

http://eds.a.ebscohost.com.proxy01.shawnee.edu/eds/pdfviewer/pdfviewer?vid=2&sid=a24164da-e4cd-4bce-b467-d5130a9bb9ef%40sessionmgr4010

This is an excellent article about the ethics surrounding communicating information regarding client care to the parents' of children in the clinic. This is something I see day-to-day. The clinic I'm in focuses on family centered care, so parents are invited back for most treatments and are updated consistently on POC. This article highlights the importance of sharing information tastefully and in an ethical fashion.

Kadkol, M. S., Parkar, S. R., & Chadha, N. (2014). Sensory Processing and Visuo Motor Integration in Preschoolers: Understanding the Link. Indian Journal Of Physiotherapy & Occupational Therapy, 8(2), 1-4. doi:10.5958/j.0973-5674.8.2.048

At my current level two rotation we use Sensory Integration all the time. This article does an awesome job showing the link between the two, which is something that I have experienced in the clinic as well. Clinical reasoning in the outpatient, sensory integration setting often equates to observing a child's strengths and limitations and seeing how that correlates to their sensory profile. Often their sensory profiles reveals deficits in processing that correlate to their deficits in visuo-motor skills and/or praxis. My clinical reasoning has grown exponentially by looking at a child's strengths and limitations through a lens that seeks to treat their underlying sensory deficits before working on their visuo-motor skills.