to collaborate with Dr. Carter, Jack Engsberg, PhD, and Lisa Tabor Connor, PhD in developing a new tool for occupational therapists to use in clinical practice. “Through the interface we have developed, we are able convert the movements of the client into the control of the virtual environment. In this case, pointing to a red or black dot on the screen,” Foreman says. “It is useful as an assessment tool because as we shift the virtual arm, we can determine and study how the client adapts to

Issue Highlights: Understanding Stroke Recovery Page 1, 3

Virtual Technology Page 1, 3

Equine Assisted OT Page 4

Serving Those Who Serve Page 5

Student News Page 6

Understanding the factors that contribute to successful community reintegration of people with aphasia is the goal of the Stroke and Aphasia Recovery Laboratory. Lisa Tabor Connor, PhD, who heads the lab, is currently involved in several research projects to better understand barriers and facilitators to participation in people with

aphasia, which is the loss of the ability to communicate after stroke. Connor and her colleagues in occupational therapy and neurology have been studying the risk factors for non-optimal participation after stroke for the past three years. “In the participation study, we are examining how much people with aphasia resume their valued occupations in the community six months or more after stroke and what factors determine who will fully participate and who will not,” Connor says. “We are measuring factors such as stroke severity, social support, cognition, physical function, and communication.

By measuring these factors, our goal is to create a model to guide us to the most important risk factors so we can target them in future studies to optimize rehabilitation, and ultimately to enable people to participate fully in meaningful activities.” Connor is also studying cognitive load – how much effort people are experiencing when they do tasks – through the use of an EEG-based system in people with aphasia who have difficulty with auditory comprehension. Study participants listen to complex and simple auditory passages and then must answer comprehension questions while wearing the EEG device. “In the beginning phases of this study, we gave complex material to people with and without aphasia to see if we could use their brain signals to determine if they were in a high or low

Program in Occupational Therapy 4444 Forest Park Ave., CB 8505 St. Louis, MO 63108-2212 (314) 286-1600 / (800) 279-3229 (314) 286-1651 (TDD) wuotinfo@wusm.wustl.edu • ot.wustl.eduOccupational Therapy

Understanding Stroke Recovery in People with Aphasia

Developing Rehabilitation Tools Using Virtual TechnologyCONTINUED ON PAGE 3

O.T. Link

CONTINUED ON PAGE 3

Using Video Games as Therapy

Stroke and Aphasia Recovery Laboratory

Program in Occupational Therapy • Washington University School of Medicine • Spring 2014

Matt Foreman in the lab.

Lisa Tabor Connor

“While trying to decide which laboratory to choose, I found myself drawn to the use of video games as therapy that Jack Engsberg, PhD, discussed in class one day. I am a bit of a gamer myself so I knew immediately that was the lab for me,” Anne Pioppo, OTD/S ’15, says. “Through a feasibility grant, we are currently developing the programming and the technol-ogy to create computer games that can be used for rehabilitation in stroke patients with spatial neglect.” This project, led by principal investigator Alexandre Carter, MD, PhD, involves recreating the prism theory in a virtual environment using the Kinect gaming system. His grant provides a unique opportunity for Pioppo and Matt Foreman, BSME, a PhD student in Rehabilitation and Participation Science (RAPS),

From the Director

T here is always a lot happening at the Program of Occupational Therapy during the spring semester! We are gearing up for the alumni reception at AOTA’s

94th Annual Conference & Expo (April 3-6), OT Scholarship Day (April 25) and Commencement (May 16). I hope you will be able to join us for these events and learn what new and exciting things are underway at the Program. In this issue of O.T. Link, I am excited to share with you the current research projects in the Stroke and Aphasia Recovery Laboratory (page 1), led by Lisa Tabor Connor, PhD, and the work of Anne Pioppo, OTD/S ’15, and Matt Foreman, BSME, a PhD student in Rehabilitation and Participation Science (RAPS). Their virtual reality project is representative of the cutting edge science and technology being developed in the field of occupational therapy. A new offering to our clinical track this semester is Equine Assisted Occupational Therapy, led by Timothy Shurtleff, OTD, OTR/L. Dr. Shurtleff ’s work focuses on the efficacy of hippotherapy as a treatment strategy for people with neuromuscular and neurobehavioral disabilities. Read more about his innovative research and this unique clinical opportunity for our students on page 4. As always, I am proud to hear about how our alumni are putting their education into practice. I know you will enjoy reading about Matt Dodson, OTD ’06, and his focus on the occupational therapy needs of service members and veterans (page 5). Our Program was established nearly 100 years ago in response to the rehabilitation needs of World War I soldiers and to see it continue in the work of our alums is truly inspiring. I want to take this opportunity to emphasize how important it is to me and to the Program to stay in contact with you, our alumni. We are committed to providing resources for you to stay connected with the Program. New to our website is the Class Notes page, found on the Alumni tab. Please take a moment to send us your latest news or update your contact information. Also, while you are on our website, please be sure to register an account to use the Toolbox, which provides free cloud storage to our graduates (page 7). This past year, we have seen an increase in alumni gifts to the Program in Occupational Therapy Scholarship Fund.

M. Carolyn Baum

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3-2 Agreement Signing A special 3-2 agreement signing and luncheon was held on Monday, Nov. 4, in the board room of the J.C. Penney Conference Center on the campus of the University of Missouri-St. Louis. Carolyn Baum, PhD, OTR, FAOTA, represented the Program in Occupational Therapy at Washington University School of Medicine and Chancellor Thomas George and Provost Glen Cope represented the University of Missouri-St. Louis. Under the 3-2 agreement, students complete three years of undergraduate work at another school before coming to the Program in Occupational Therapy for the graduate portion of their education. In attendance were (photo, seated left to right) Dr. Glen H. Cope, Provost and Vice Chancellor, Academic Affairs; Dr. Carolyn Baum, Elias Michael Executive Director and Professor, Occupational Therapy, Neurology and Social Work; Dr. Thomas George, Chancellor; (photo, standing left to right) Dr. Susan Dean-Baar, Dean, College of Nursing; Dr. Curtis C. Coonrod, Vice Provost Student Affairs, Dean of Students; Mr. Joseph Southerland, Academic Advisor, College of Arts and Sciences; Dr. Terry Thiel, Senior Associate Dean, College of Arts and Sciences; Dr. Kathy Kniepmann, Instructor in Occupational Therapy and Neurology; Ms. Elizabeth Eckelkamp, Associate Dean, College of Arts and Sciences; Dr. Steve Taff, Associate Director of Professional Programs and Instructor in Occupational Therapy and Medicine; Dr. Alison Whelan, Senior Associate Dean for Education, Professor of Medicine; and Dr. Ronald Yasbin, Dean, College of Arts and Sciences.

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M. Carolyn Baum, PhD, OTR, FAOTA

Professor of Occupational Therapy, Neurology and Social WorkElias Michael Executive Director,

Program in Occupational Therapy

By making a gift to this fund, of which 100% is applied to scholarship support for our wonderful students, you are investing in their futures and the future of the profession. If you would like to participate in this program, please contact Rebecca Clendenen in Alumni and Development Programs at (314) 935-9680. You can also make a gift to the Program through our alumni page at ot.wustl.edu/alumni. I am thankful for these, and all the gifts, you provide to our Program as you advance our recognition every day through your professional endeavors.

load state. The answer was yes, we could,” Connor says. The next phase is to apply this information in rehabilitation. “Once we have determined their load under experimental conditions, we will then be able to use that information going forward to pinpoint which state they are in during rehabilitation tasks. If they are in a high load state, therapy intensity can then be adjusted to a lower level and increased more gradually.”

Connor’s newest project is in collabora-tion with Alexandre Carter, MD, PhD, assistant professor of neurology and occupational therapy at Washington University School of Medicine, and Jack Engsberg, PhD, professor in the Program in Occupational Therapy, utilizing virtual technology to examine spatial neglect after a right hemisphere stroke. “Patients can see on the left side of space, but neglect the information there,” Connor says. “Traditionally, prism glasses have been used to expand the visual field through a procedure that has patients practice pointing at dots in front of them while wearing them. We know it works, but it can be very repetitive and dull. We want to

take this concept into the virtual world.” Through a feasibility grant with Carter as principal investigator, Connor is involved in a one year trial using the Kinect gaming system and a “virtual” hand. Participants are not able to see their actual arm; just an extension of their virtual hand on the screen that can be deviated into or away from the neglected space. “The virtual hand translates the prism theory. We are establishing that when we deviate the virtual hand by ten degrees, we are getting the same effect we get with the glasses. In this first year, we are working on the programing and technological aspects of the project. Initial testing of the system has been promising,” Connor says. “Next steps are to take this into a gaming environment where the client will play a game using the deviated virtual hand for rehabilitation purposes.” While research still is the primary focus of Connor’s work, improving the quality of everyday life in people with aphasia has become the driving force behind it. “Since becoming part of the occupational therapy community, I think it is more important to look at things that really matter to people living with stroke and aphasia, like remembering to take medication, being able to drive again, and furthering their rehabilitation at home. The goal of all my research is to maximize participation in activities that matter to people with stroke and aphasia so they can live a full and meaningful life,” Connor says.

UNDERSTANDING STROKE RECOVERY CONTINUED FROM COVER

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VIRTUAL TECHNOLOGY CONTINUED FROM COVER

Matt Foreman (left) and Anne Pioppo (far right) testing the virtual arm.

Alexandre Carter

Jack Engsberg

the shift. Now that we know the basic concept works, we are able to move it into an interactive, gaming environment.” While Pioppo understands the technological aspects of the project, she also understands what the client needs are for rehabilitation purposes and is working with Foreman to make the games both functional and engaging before running trials. “The trials will start by testing healthy control participants before testing a select population of stroke patients,” Pioppo says. “Once we have measured the outcomes of this feasibility study, hopefully the data will power a larger study that will one day put this technology in the hands of clinicians so clients can do rehabilitation at home.” “As the technology gets better and prices come down, the development of virtual reality rehabilitation tools will only increase exponentially. It will be one more tool occupational therapists can use in their clinical toolbox,” Foreman says. “It won’t be cost prohibitive because all clinicians would need is a laptop, a TV and a Kinect system. It’s very affordable.” Both Pioppo and Foreman see this type of rehabilitation appealing to all populations and ages because it can be easily customized to fit an individual’s rehabilitation needs and interests. “For example, if clients have mobility issues or concerns, clinicians can have them play the game in a chair so they are able to do the exercises. If they don’t like a particular game, clinicians can find one they do like to help keep them motivated,” Pioppo says. “They will be able to monitor the clients’ therapy, analyze the results and make adjustments as needed. It will allow clinicians to be more intuitive and responsive to clients’ rehabili-tation needs. This technology has the potential to revolutionize outpatient services.” Foreman, whose background is mechanical engineering, encourages other engineers to explore the opportunities rehabilitation science can offer. “My PhD dissertation involves patients post-stroke, but the technology I am developing in the Human Performance Laboratory in the Program of Occupational Therapy is being used on other projects involving people with cerebral palsy, children with autism, and wheelchair propulsion. Engineers have a unique opportunity to customize a niche in rehabilitation science and I encourage them to explore all the possibilities occupational therapy can offer.”

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funded because these children were receiving therapy so I changed my focus to research.” In the Program’s Human Performance Laboratory, Shurtleff ’s research focuses on the efficacy of hippotherapy as a treatment strategy for people with neuromuscular and neurobehavioral disabilities. Recently, Shurtleff worked with Program Director Carolyn Baum, PhD, OTR, FAOTA, to develop and offer a clinical practice opportunity to Program students at the EEMV facility, which eventually will lead to a new initiative for the Program’s Community Practice. “They (EEMV) currently have therapeutic riding instructors to provide adaptive riding lessons, but it’s not therapy. We proposed using their facility, but having our licensed therapists oversee the sessions and treatments,” Shurtleff says. “The long-range goal is for them to become independent and have a licensed therapist, possibly a Program alum, on staff one day.” The students currently in the clinical track are benefitting not only from Shurtleff ’s instruction and experience, but also from the lessons the horses themselves are teaching.“The horses must move rhythmically and symmetrically so the movement is imparted to the child that way,” Shurtleff says. “The benefit of hippotherapy is the children are willing to do all kinds of therapeutic activities that they normally

wouldn’t do in a typical clinical setting. We work with children who have physical and psycho-social needs, and children with neurobehavioral disabilities, such as ADHD or autism, all which respond to this type of treatment.”

Equine Assisted Occupational TherapyHippotherapy as a Treatment Strategy

Hippotherapy is defined as the use of the movement of a horse as a treatment strategy in the context of occupational, physical or speech/language therapy.

Timothy Shurtleff, OTD, OTR/L, an instructor in occupational therapy and neurosurgery in the Program of Occupational Therapy, became involved in equine assisted occupational therapy nearly 20 years ago through his wife, Charla.

“Charla sold her horse when we were first married and in school. We ended up buying him back eight years later and we’ve had horses ever since. She developed an interest in therapeutic riding, became a certified instructor, started volunteering and decided we needed a center in our county,” Shurtleff says.

Charla formed Exceptional Equestrians of the Meramec Valley, Inc. (EEMV) in March 1991 in response to a local need she saw for affordable equine therapy and recreation for people of all ages. In 1993, EEMV became a satellite program of Therapeutic Horsemanship in St. Charles, Mo., before moving to a leased location in Washington, Mo., in 1995. It became an independent 501(c)3 not-for-profit organization in 1995. It changed its name to Exceptional Equestrians of the Missouri Valley, Inc. in 2006 in order to more easily communicate with riders from a large service area. Three years ago, EEMV bought a 30-acre site in Washington, Mo., where it now operates. “During that time, I ran a consulting business and never planned to be an instructor, let alone an occupational therapist, but I got hooked,” Shurtleff says. “In 1996, I became a certified therapeutic riding instructor and started volunteering one day a week. I met Sandy Rafferty, MA, OTR/L, co-founder of Therapeutic Horsemanship, and participated in her hippotherapy program. The therapists would ask me to make equipment modifications for the clients, which I enjoyed doing. They told me I should become an occupational therapist because I thought like one. Ultimately, I decided that was a good idea.” While pursuing his doctoral degree, Shurtleff took a neuroscience class that changed the way he looked at his past experiences with clients. “I realized there was a theory behind what I had observed in the children I’d been working with that explained why their movement was changing the way it was. Unfortunately, there wasn’t enough evidence to support it from an insurance funding standpoint. I felt it should be

Marra Robert, OTD/S 16, meets Big Mac, a 14-year-old Clydesdale.

Tim Shurtleff prepares first-year students for hands-on activities at EEMV.

First-year students learn some of the exercises that are used in therapeutic riding.

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The Program in Occupational Therapy was

established in 1918 in response to a need for the rehabilitation of World War I soldiers physically or mentally disabled by the rigors of the battlefield. Matt Dodson, OTD ’06, continues the work on which the Program was founded by focusing his practice on the occupational therapy needs of service members and veterans today. Dodson has held four jobs since graduating in 2006. He was a staff therapist at a residential severe brain injury center in Texas before spending two years in the Program in Occupational Therapy’s community practice at the Occupational Performance Center and doing in-home evaluations of veterans. In 2009, he accepted a position at Walter Reed National Military Medical Center to start outpatient Traumatic Brain Injury (TBI) programming for the occupational therapy department there. “In the four years I was in that position, I ended up starting mild TBI and Post Traumatic Stress Disorder (PTSD) programs at three different military treatment facilities in the Washington, D.C. area as part of my job,” Dodson says. “Recently, I accepted a position as a clinical policy and Knowledge Translation consultant with a D.C. firm, advising the Department of Defense as a Subject Matter Expert on brain injury and PTSD care in the military.” In his current position, Dodson enjoys figuring out ways to utilize his clinical and program development experience in tackling the “big picture” issues facing the care of active duty and veteran service members. “I now have the opportunity to bring my ‘real world’ experience to the people who make the decisions. It’s a chance for me to make a positive difference on a larger scale, and contribute to the decision-making process in a way that has the best chance of filtering down through various contextual factors to real clinicians working with real clients,” Dodson says. Looking ahead, Dodson foresees a huge growth opportunity for the field of occupational therapy in regards to

the military, especially in addressing the needs of veterans. He credits the advancement of his career to the education, gifted mentorship and networking opportunities he received while attending the Program. “There’s a good chance I wouldn’t even be an occupational therapist without the education I received at Washington University School of Medicine and the preparation of the OTD program, because I wouldn’t have had the support to discover my unique niche of practice,” Dodson reflects. “If you’re committed to being

an ‘agent of change’ or carving out a new area of occupational therapy practice, the value of an OTD degree is one of those things that becomes more clear as you gain distance, perspective, and professional experience.” Working primarily with service members and veterans has left a lasting impact on Dodson and the way he approaches his practice. “I was moved to tears on a near-weekly basis by the fortitude displayed by my patients, the trauma that permeated their day-to-day lives, and the trust they placed

in me to help move them forward in their path to recovery. Likewise, I was consistently inspired by my colleagues and staff, both military and civilian, to ‘bring it’ every single day. I am – and always will be – honored to be an occupational therapist who has had the privilege to serve those who serve.”

Alumni NewsServing Those Who Serve

Matt Dodson at Walter Reed National Military Medical Center.

Examples of TBI outpatient Lego projects at Walter Reed National Military Medical Center.

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Please Donate to the Program in Occupational Therapy

Scholarship FundPlease help support future occupational therapists

with a donation to the Program in Occupational Therapy Scholarship Fund. A gift to the Program fills an immediate need by lessening the debt burden on our students, allowing them to focus on their education

and training. Donations also may be made in honor or in memory of an individual. Checks should be payable

to Washington University and mailed to:

Washington University School of Medicine The Program in Occupational Therapy

4444 Forest Park Ave., CB 8505St. Louis, MO 63108-2212

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“For example, there was a strong advocacy component for occupational therapy due to recent changes of the Affordable Care Act (ACA).” A number of Washington University School of Medicine faculty and staff presented this year and four Program students in attendance were awarded MOTA scholarships: Rachael Baum, OTD/S ’14, Krista Fox, MSOT/S ’14, Kristen Moosmann, MSOT/S ’14, and Savannah Sisk, OTD/S ’16. Schueler encourages students and prospective students to be involved on the local level as part of their professional development.

“The MOTA Conference has definitely helped to prepare me for the upcoming AOTA Conference in April,” Schueler says. “Having experienced this on a state level gives me an increased confidence as I attend a national conference for the first time. It is something I am really looking forward to.”

Health Professional Student Leadership Council The Health Professional Student Leadership Council (HPSLC), which brings together students from Washington University School of Medicine, St. Louis College of Pharmacy, and Goldfarb School of Nursing, held a variety of activities over the fall semester. Events included the second annual HPSLC Community Service Day, an HPSLC Meet and Greet, and a multi-disciplinary pediatric case study competition. Ryan Sims, OTD/S ’14, currently serves as the HPSLC secretary and enjoys interacting with and learning from students in other disciplines such as medicine, pharmacy, physical therapy, nursing, and audiology and communication science. “Working with the other students brings different perspectives on a health issue together and creates a stronger and deeper resource from which to help clients,” Sims says. “The case study required not only recalling and synthesizing information that we may or may not be currently studying, but also sharing our conclusion effectively with others in a short amount of time. It was important to listen to the information others had to contribute while also advocating for and being confident in our own thoughts and ideas. This was a good exercise in what it can potentially be like in many real-life settings that we may work in and coming to a conclusion together as a team of health care professionals.”

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Student NewsGearing Up for Guatemala

The 3ELove apparel fundraiser supported the trip to Guatemala and the 3ELove organization, which positively supports disability awareness.

Students enjoyed attending the variousactivities at the MOTA Conference.

In March, WUSOTA students will be traveling to Guatemala for the fifth annual service learning trip. While many preparations are needed for the trip, the 16 students traveling this year have been hard at work fundraising both on and off campus. Popular fundraisers have included Pizza Mondays and Bagel Thursdays, but the students really enjoyed the 3ELove apparel sale. The fundraiser supported both the trip to Guatemala and the 3ELove organization, which positively promotes disability awareness. This is the second trip to Guatemala for Hayley Chrzastowski, OTD/S ’15. “This year, I am serving as co-leader, which has significantly changed my perspective of service learning and this trip in general. Service learning is not about immersing ourselves in a different country with the intent to implement change. Instead, the trip is focused on learning and gaining experience/exposure to another culture with health care resources that may be different than our own,” Chrzastowski says. “We will be focusing on the benefits of the available resources, including occupational therapy, to the different populations we will be serving. We will also learn how society may impact their desire to progress through rehabilitative services. By collaborating with local health care professionals, we will have a unique opportunity to learn from each other by sharing occupational therapy knowledge and experience.”

MOTA Conference The Missouri Occupational Therapy Association (MOTA) Conference was held November 15-16 at Saint Louis University in St. Louis, Mo. WUSOTA’s MOTA representatives, Jeanne Horvath, MSOT/S ’14, and Claire Schueler, MSOT/S ’14, were actively involved in the planning of student activities and the event itself. “I felt we were able to hone our leadership skills through this experience in addition to learning about emerging trends and research through the conference presentations,” Horvath says.

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For the Integrated Curriculum Experience (ICE), second-year students worked with “standard patient” actors to recreate occupational therapy interviews, assessments and interventions with a client on December 12.

“Team Calm” won the annual Gingerbread House Contest on December 5 with their accessible home.

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Social CircleWe Love This Tweet:

“I am a career scientist. I think I bring a different perspective to the [AOTA] Board.” @WUSTLOT’s Tim Wolf

http://ow.ly/qf0qP - @AOTAInc

www.twitter.com/WUSTLOT

Submit Your Class NotesStudent Happenings

Second-year students presented in the Sensorimotor Interventions Evidence-Review Poster Session on November 13.

Students learned how to make splints in the Advanced Splinting Lab on November 20.

First-year students participated in a series of ethnically diverse cooking labs this fall.

Program Website Provides Resources for Alumni

Are you a Program alum with news to share? Or do you want to learn what your fellow alumni are up to these days? We are now posting Class Notes on the Program’s

website. Click on the Alumni tab found on the top navigation bar, then click on the Class Notes tab on the left side naviga-tion. If you would like to submit your own Class Notes, or update your contact information, click the arrow button to use the online form. Class Notes can include career advancements, relocations, awards and honors, marriage or birth announce-ments and more. We want to stay connected to you, so please submit your Class Notes today! If you haven’t already, be sure to register an account to use the Toolbox feature, which provides cloud storage in which our graduates can store files such as practice models, interven-tions, resources and assessments at no cost. Click the Toolbox button found in the top navigation bar. Current students or recent graduates can access the Toolbox with their WUSTLKey login information. To learn more about the Toolbox, please visit http://bit.ly/172eKjf. If you have general questions about the Toolbox, please email wuotinfo@wusm.wustl.edu.

To read submissions, click on the Class Notes (circled above on left) in the left side navigation. To submit Class Notes, click on the top green arrow (circled above on right).

Washington University School of MedicineProgram in Occupational Therapy CB 85054444 Forest Park Ave. St. Louis, MO 63108-2212

Occupational T herapy

The Program in Occupational Therapy is accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association (AOTA), located at 4720 Montgomery Lane, Suite 200, Bethesda, MD 20814-3449. ACOTE’s telephone number,

c/o AOTA, is (301) 652-AOTA and its web address is www.acoteonline.org.

Upcoming EventsApril 3-6, 2014AOTA 94th Annual Conference & ExpoBaltimore, MD Hilton Baltimore - Booth #939www.aota.org/conference.aspx

You are invited to the Program in Occupational Therapy Alumni Reception on April 5 at the Hilton Baltimore. More information to follow. April 25, 2014OT Scholarship Day Eric P. Newman Educational Center (EPNEC) 320 S. Euclid Ave., St. Louis, MO 63110Registration information to come at: ot.wustl.edu

May 16, 2014Commencement

Please visit us at ot.wustl.edu and on Facebook, LinkedIn and Twitter for more Program news!

Program in Occupational Therapy Commencement 2013.