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December 22, 2011 Volume 2, Issue 46
Please share the Recovery to Practice (RTP) Weekly Highlights with your
colleagues, clients, friends, and family!

To access RTP's Weekly Highlights, quarterly e-newsletters, Webinar recordings,
and PowerPoint presentations,
please visit http://www.dsgonline.com/rtp/resources.html.
The 2011 "Recovery-Oriented Care Continuum" Webinar series featured four steps:

Step 1: Outreach & Engagement
Step 2: Person-Centered Care Planning
Step 3: Promoting Recovery Through Psychological and Social Means
Step 4: Graduation

Click on the links above to download the PowerPoint presentations and recordings.

The Role of Occupational Therapy in Adult Cognitive Disorders
by Patricia Cheney, MBA, OTR/L, BCG, and Lisa Rivera, MS, OTR/L
Cognition includes processes such as orientation, attention, perception, problem solving, memory, judgment, language, reasoning, and planning. It is essential for taking in information, synthesizing it, and using it to control behavior. Therefore, a cognitive deficit will have at least some impact on function. Cognitive disorders may be caused by traumatic brain injury (TBI), infection, tumors, stroke, dementias such as Alzheimer's disease, or existing congenital conditions.

Cognitive disorders are a growing problem in the U.S. As people live longer and demographics shift toward an aging population, the incidence of these disorders is accelerating among older adults. In 2010, an estimated 5.3 million people in the U.S. had Alzheimer's disease, and an additional 3.7 to 5.3 million people had other types of dementia,1 most of whom were over 65 years of age.

Among younger adults, cognitive impairment is often caused by injury. Although it is difficult to find statistics for the total number of adults with cognitive impairment, TBI alone accounted for almost 750,000 annual injuries of people between the ages of 15 and 64 from 2002 to 2006.2

Occupational Therapy's Role in Cognitive Rehabilitation
Occupational therapists are experts on determining how cognitive deficits can impact everyday activities, social interactions, and routines. Their knowledge about neurology and neuroanatomy helps them understand the impact of the brain disorder on deficits, administer appropriate tests and measures to identify the extent of cognitive function loss, and determine the extent to which deficits are likely to be remediated or circumvented. Occupational therapists have the skills necessary to assess cognitive aspects of functional activities and design an intervention plan, from acute care to community reintegration.

There is significant evidence that the brain has considerable neuroplasticity, or capacity to redirect pathways and relearn skills, even many years after damage has occurred.3 Occupational therapy practitioners facilitate this process through the use and modification of motivating daily activities and adaptation of the client's environments.

Where Do Occupational Therapy Practitioners Provide Cognitive Rehabilitation?
Occupational therapy services for cognitive impairment are provided in a number of settings:

Acute Care
Typically for individuals with sudden onset, such as cases with stroke or TBI
  • Evaluation of performance ability for safety and independence in self-care activities
  • Preparatory activities to facilitate balance and stability
  • Family and caregiver education
  • Home program may be developed, with client/caregiver training as needed
Rehabilitation Center or Skilled Nursing Facility
Follow-up to acute care intervention when incident is severe
  • Intensive, daily therapy to improve all aspects of functioning
  • Intervention to address attention, problem solving, and perceptual deficits, and to manage impulsive behavior
  • Initial intervention to address basic daily activities, such as eating, bathing, dressing, grooming, and sequencing tasks. If basic skills are achieved, progression to more difficult tasks may include
    • Preparing meals
    • Managing medication
    • Balancing a checkbook/paying bills
    • Organizing daily routines
    • Doing laundry and light housekeeping
    • Responding to an emergency situation, using the telephone, and engaging in socially appropriate behavior
    • Preparing for community re-entry, driving, and workplace assessment as appropriate for the client's level of progress
Outpatient/Home Health Services or Community Reintegration Day Programs
  • Adapt remediation/compensatory strategies as required to support performance in the person's home, workplace, etc.
  • Carryover of cognitive strategies in different environments (workplace, place of worship, grocery store, etc.) and contexts.
When the cognitive disorder has a gradual onset and degenerative course, as is the case with most dementias, the client will usually be seen at home or in a supervised setting such as adult day care, an assisted living facility, an outpatient clinic, or a nursing home. Intervention often involves educating caregivers, adapting the environment, setting up compensatory strategies, and reorganizing and simplifying tasks. These approaches allow the individual to engage in familiar activities to maintain his or her quality of life. Progressive cognitive disorders worsen over time, but with appropriate treatment, clients can remain independent, continuing self-care and other activities well into the disease process.

Occupational therapy practitioners fulfill a vital role for adults with cognitive impairment, helping to facilitate new brain pathways and improve functional skills by adapting activities and retraining. Enabling people to more fully participate in self-care, work, leisure, and community activities enhances their quality of life while reducing the burden on caregivers and societal resources.

Patricia Cheney is the Director of Dementia Services for Fox Rehabilitation in Cherry Hill, N.J. Lisa Rivera is the Supervisor of Occupational Therapy at New York–Presbyterian Hospital. Both are practicing occupational therapists and consultants for the American Occupational Therapy Association.

  1. Centers for Disease Control and Prevention. Injury prevention and control: Traumatic brain injury. Retrieved December 2010 from http://www.cdc.gov/traumaticbraininjury/statistics.html.
  2. Faul, M.; L. Xu; M. M. Wald; and V. G. Coronado. (2010). Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths, 2002–2006. Atlanta, Ga.: Centers for Disease Control and Prevention.
  3. McCombe Waller, S., and J. Whitall. (2004). Fine motor control in adults with chronic hemiparesis: Baseline comparison to non-disabled adults and effects of bilateral arm training. Archives of Rehabilitation and Physical Medicine, 85, 10761083.

Save the Date for an RTP Webinar
"Assessing for and Addressing Trauma in Recovery-Oriented Practice"
This session will help practitioners determine when and how extensively traumatic experiences have affected people with behavioral health conditions and how to incorporate that knowledge into their care-planning approach. In a comprehensive discussion on trauma-informed care, presenters will describe a range of supports, implementation tools, and interventions to address the role of trauma in recovery.

January 25, 2012

3–4:30 p.m. EST

Three multidisciplinary practitioners will share their perspectives on the differences between trauma-informed systems and other systems of care, including how trauma-informed assessment incorporates approaches to ensure safety, meet the consumer's needs, and avoid interventions that could recreate aspects of previous traumatic experiences. Presenters include practitioner Kevin Huckshorn, RN, MSN, who will talk about assessing trauma in an outpatient setting; Paula Panzer, MD, a recovery-oriented practitioner who will address trauma-informed care planning; and Eric Arauz, MLER, a member of the American Psychiatric Nurses Association RTP Steering and Curriculum Committees, who will discuss interventions and supports that have helped facilitate his recovery from personally traumatic experiences.

To register, click here.

NEW RTP Resource
In the October 2011 issue of Professional Psychology: Research and Practice, four authors describe an ongoing transformation of mental health services—a transition that presents opportunities for seasoned and aspiring psychologists. "Emerging Opportunities for Psychologists: Joining Consumers in the Recovery-Oriented Care Movement" reflects the experiences of a Department of Veterans Affairs (VA) staff psychologist, a psychology postdoctoral fellow, a clinical training director, and a psychologist who leads the Psychosocial Rehabilitation and Recovery Section of the VA Office of Mental Health Services.

The paper illustrates how psychologists are uniquely positioned to direct emerging practices in mental health treatment and lead specialized recovery-oriented systems of care.

For more information, go to http://www.apa.org/pubs/journals/pro/index.aspx.

Forensic Psychiatric Nurses Council
Interactive Panel
By establishing an interface between psychiatric nursing and the criminal justice system, mental health nurses can meet many challenges created by violence and crime. This interactive panel will focus on crucial issues related to forensic interviewing, evaluation, and documentation; court and expert witness testimonies; and forensic consultation. The free, hour-long session is the first podcast from the American Psychiatric Nurses Association's annual conference and provides one continuing education contact hour.

Session Objectives
  1. Identify best practices for forensic interviewing, evaluation, and medico-legal documentation.
  2. Explore strategies for court and expert witness testimonies.
  3. Discuss opportunities for forensic consultation.
To register, click here.

The New York Times 'Lives Restored Series'
Having struggled in the past with mood disorder and serious addiction, Antonio Lambert has finally reached a good place. He now works for the National Association of Peer Specialists (NAPS) teaching others who have hit rock bottom to open up, cope, and heal.

Antonio suffered through some particularly dark times before finding his way again. A friend introduced him to peer support and training, and he met Steve Harrington, chief executive and founder of NAPS. Together the two formed Recover Resources, a company that provides peer support manuals, DVDs, and other educational materials.

Antonio is living proof that peer support is one of the most effective components of the recovery process. Read his powerful story in the last of a poignant series on people who spoke out about their struggles with severe mental illness.

This Year's Gift for the Holidays
Stories Filled with Hope
The holiday season is a joyful time of giving and sharing. Over the next 2 weeks, the Douglas Institute will post videos of people who have shared a very personal gift—the stories of their recovery journeys. Researcher Myra Piat, PhD, initiated the "Recovery Stories" series, having been inspired for many years by recovery-related initiatives in the mental health field. "As researchers, we strive to discover what promotes or impedes recovery; an excellent way to gather data is to let people tell their own stories," she said. Recovery Stories features participants of all ages and backgrounds speaking openly about mental illness and the steps they took to achieve healthier, more meaningful lives.

Project coordinator and program participant Janina Komaroff, who has struggled with schizophrenia and alcohol dependence, said discovering the common bond she had with so many others helped her pull through. "The key factors for me were building a strong social network and listening to people who experienced the same problems I did, and who got through them."

Recovery is not a clinical cure; it's a process that encourages people to create a life for themselves despite disease, just as those who suffer from a chronic illness like diabetes or asthma do. "It is a way of living a satisfying and useful life that leaves room for hope, despite the limitations imposed by the illness," explained Dr. Piat.

A new testimonial will be posted every day from December 12 to 22 on the Douglas Institute Web site.

The RTP Resource Center Wants to Hear From
Recovery-Oriented Practitioners!
We invite practitioners to submit personal stories that describe how they became involved in recovery-
oriented work and how it has changed the way they practice.
The RTP Resource Center Wants to Hear From You, Too!
We invite you to submit personal stories that describe recovery experiences. To submit stories or other recovery resources, please contact Cheryl Tutt, MSW, at 877.584.8535,
or email recoverytopractice@dsgonline.com.

We welcome your views, comments, suggestions, and inquiries.
For more information on this topic or any other recovery topics,
please contact the RTP Resource Center at
877.584.8535, or email recoverytopractice@dsgonline.com.

The views, opinions, and content of this Weekly Highlight are those of the authors, and do not necessarily reflect
the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.