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Motivated patients key factor in OT success by Heather Woolwine Public Relations The apparatus on Mary Dawson’s left hand looks like something from Arnold Schwarzenegger’s Terminator movies, with metal pieces and wires encasing her fingers and wrist. Like a tiny crane operation, Dawson opens her hand to clasp a soft rubber ball, and bites her lower lip as she concentrates on getting the ball into a tall cylinder. Mary Dawson, left, concentrates as she grasps a soft rubber ball with the help of a new orthotic called the FTM. Victoria Whalen stands ready to offer support. “This really has been her best day by far,” said Victoria Whalen, MUSC occupational therapist. “Patients like her do the best in terms of recovery because she is committed to carrying home the therapy she learns here. She’s highly motivated to regain use of her hand and that’s what makes the therapy work.” Dawson began her occupational therapy in 1996 after suffering a stroke and has been an off-and-on patient ever since. She joins scores of others helped weekly, or even daily, by MUSC’s Occupational Therapy Clinic; patients suffering from a variety of debilitating conditions like stroke, brain tumors, head traumas, or spinal cord injuries that render them unable or make it difficult to perform the day-to-day functioning life requires. As the most comprehensive occupational therapy program in the state, MUSC treats inpatients, outpatients, adults, and children with a high volume of neurologically-impaired patients, specialized hand therapy, and specialized pediatric treatment. “There are several things that make our program unique,” Whalen said. “One of the most important is that each patient receives individualized attention, meaning there’s always that one-to-one ratio. Some clinics in the area see as many as five patients with each therapist. We also offer a new orthotic that most other facilities cannot offer, as it requires certification.” Whalen is one of a handful of therapists in the state who possess that certification, and thus MUSC patients like Dawson are reaping benefits related to its use. Called the Functional Tone Management (FTM) Arm Training Program and designed to retrain grasping and releasing in the upper extremities, the new orthotic strengthens patients’ elbows and shoulders as well. After regaining more strength, Whalen encourages them to begin releasing and grasping things normally taken for granted, like purse straps and twisting off bottle caps. Whalen said the FTM orthotic is making great strides in therapy because it strengthens other parts of the arm as well, and “this makes the patient use the shoulders and elbows. It’s hard to retrain grasp and release when a patient can't open their fingers in the first place.” And while some of the challenges Whalen faces when working with patients may seem obvious, like low self-esteem or reactions to pain, others are not. “Since the recent changes in public transportation, and the nature of the population we see, transportation is now one of my greatest challenges,” she said. “Many of our patients rely on others to get here. If they don’t have a ride, they don’t get therapy.” Whalen said the rewards of her job far outweigh any challenges she must face. “Every day I have about four or five Kodak moments,” she said. “I see patients progress from low function or self-esteem to regain not just a physical part of themselves, but also their sense of self-worth. One of the greatest things is being a part of their lives and sharing in that experience with them. The patients teach me as much as I try to teach them.” Working with Pediatric Patients Owen Wieters, 3, sits on a stool blowing bubbles. He blows, dips the blow stick back in the container, and blows again. Seems perfectly normal, and he executes the activity without pause.  As his mom, Mottie Wieters, observes, she notes just how far Owen has come since his first OT session when he was nine months old. “He has epilepsy, which has affected his motor and developmental skills tre-mendously,” she said. “We’re constantly switching his medications around. We’ve just passed the milestone of letting Owen feed himself, which is a good thing, even if it means my kitchen is always covered with food.” Owen Wieters, 3, stretches a Matchbox car toward a cardboard slope, unaware that this play time with Patty Coker, MUSC pediatric occupational therapist, is really meant to strengthen his developmental and motor skills. Owen worked on balance, hand-eye coordination, and getting himself dressed during his weekly appointment with Coker April 8. Pediatric OT Patty Coker has been the second set of eyes on Owen’s development for years now, and attributes Owen’s success thus far to figuring out an overall plan that works best for him and his family, as she does with all her patients. “My overall job is amazingly rewarding,” Coker said. “Obviously, the children can be very ill or recovering from a serious injury, and getting out of bed for therapy may not be first on their list of things to do in a given day. We try to make therapy fun and playful so it doesn’t seem like work for them.” And while Owen must participate in therapy “games” that strengthen feeding skills, motor skills, and other developmental aspects, he obviously saw these activities as fun. Owen loved playing with toy cars and, with Coker’s help, seemed to enjoy the workout he gave his abdominal and arm muscles while rolling the cars down a cardboard hill. “There is nothing better than seeing the smile on a child’s or parent’s face when the child reaches a new goal, something he or she couldn’t do before an OT started working with them,” Coker said. “This is especially true for kids recovering from accidents or major illnesses that require prolonged hospitalization.” Like the adult OT program, the pediatric program is individualized for inpatients and outpatients and responsible for children from birth to adolescence. The pediatric therapists at MUSC receive advanced training in child and infant feeding disorders, neuro-developmental treatment approaches, sensory integration treatment, orthopedics, and splinting. They also participate in activities like the high-risk infant clinic and developmental training workshops for hospital personnel. “The important thing to remember for all OT’s, especially new ones, is to be creative during therapy, respect and understand your patient’s needs, and always make sure the family and child are actively participating in their therapy plan,” Coker said. More than arts and crafts Occupational therapy faces the problem of stereotyping, like many health care disciplines, and is often confused with physical therapy. “I like to tell people that physical therapy gets people up and moving,” said Ann Benton, MUSC occupational therapy program director. “And then we apply those movements to functioning in everyday life.” Occupational therapy gives people the skills to handle the job everyone shares, life. Typically, OTs work with people of all ages with physical, developmental, or emotional conditions that disable them or interfere with their everyday lives. OTs are found in many health care settings including hospitals, rehab centers, nursing homes, school systems, mental health clinics, and private practices.  With 16 full-time OTs, MUSC’s program is one of the largest in the state, Benton said.  And MUSC is active in training OTs for the future through the College of Health Professions Occupational Therapy Master's Program. New students begin in August each year and must complete the three-year, full-time, year-round program to receive a degree. Semester coursework consisting of classroom, laboratory, and clinical work and structured learning experiences allows students to apply theoretical knowledge and develop clinical skills. For more information about MUSC’s occupational therapy educational program, go to http://www.musc.edu/chp/ot/index.shtml.     Friday, April 23, 2004 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.