Inpatient Settings: OT in Acute Inpatient Rehab Overview
Can someone say to functional independence and beyooooonddd???????
In regard to occupational therapy servicing the rehabilitative patient within the acute inpatient rehab unit (ARU) setting -also known as an inpatient rehab facility (IRF)-, the occupational therapy practitioner can play an integral role in contributing to positive and functional outcomes.
Envision a person who…
- a) just “graduated” from ICU***/acute care*** but is just not functional or safe enough to return home (which home in this sense can be returning to living alone, living with family support, or living in assisted living apartments, etc.) or
- b) has had a functional decline which may include an increase in falls or needing extensive assistance to complete his/her living routines (due to a variety of reasons such as due to having a progressive disease such as Parkinson’s Disease, new onset of Traumatic Brain Injury as a result of several little falls…)àthese are both relative examples of types of patients that may be involved in a post-acute care setting.
Here is the kicker: While in a skilled nursing facility (SNF) a patient would typically receive less intensive therapy in a shorter duration (such as 1-2 hours), in order to qualify for admission to an acute inpatient rehab unit (ARU), a patient must typically be able to tolerate 3 hours of therapy 5 days per week. Patients admitted to an ARU have traditionally much shorter length of stays in comparison to patients admitted to SNFs (duly noted- SNFs are very important too- we will be discussing OT’s role in SNF in a future post)!
Occupational therapy services in the acute inpatient rehab unit setting may consist of continued early functional mobility to promote increased activity tolerance for out of bed activity, implementation of motivational interviewing in effort to better facilitate the person’s understanding that you are there to help them help themselves (#promoteselfefficacy,) functional transfer / mobility training to enable improved safety and efficiency in moving around and getting to desired destinations (ex: safe maneuvering around in the kitchen with an unfamiliar walker), neuro reeducation such as biofeedback, bilateral integration, training on self-range of motion, mirror therapy…, self-advocacy training to empower the patient and family, Activities of daily living training based on patient’s unique needs (ex: CVA –hemi dressing task oriented approach in supine using; Hip replacement – teachback of hip precautions followed by incorporated adaptive equipment training during lower body dressing), occupation-based interventions (endless possibilities here), Instrumental Activities of daily living training(unilateral meal prep training, transporting clothing into the dryer with good body mechanics after an amputation…), patient/ family education to promote understanding of the disease progress, life after diagnosis, ways to be resilient…and so much more.
Occupational therapy in the acute inpatient rehab setting requires a lot of patience, empathy, thinking on your feet, time management, the ability to grade tasks and activities to fit many different needs, communication skills, as well as a deep understanding of how a disease or diagnosis may impact one’s occupational performance.
Additionally, I would be doing a disservice if I did not make it clear that this setting is physically VERY EXHAUSTING! In this setting, it is paramount that the occupational therapy practitioner is prepared to have some Low lows______, but also some wonderfully high HIGHS^^^^.
The role of occupational therapy within the acute inpatient rehab unit setting is astronomical. Out of 17 FIMs (which is the typical assessment tool which stands for Functional Independence Measure used at this point in time in this type of setting), 8 are ADL based which is traditionally where OT comes into play. Not to mention occupational therapy will likely be held accountable in increasing cognitive FIMs if that patient is not a speech therapy candidate. …more of FIMs later…
In brief, per the Rehabilitation and Participation Distinct Value Statement:
Occupational therapy’s distinct value is to improve health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life. Occupational therapy is client-centered, achieves positive outcomes, and is cost-effective. “
What does Acute Inpatient Rehab look like?
ARU in an abbreviation for acute rehab unit.
The acute rehab patient will likely portray various presentations that my vary from being medically complex and low level (such as a patient who moved from the ICU to the acute rehab unit only a few days after onset of a major stroke…could be a spinal cord injury patient with uncontrolled blood pressure… the young man who had a motor vehicle accident which resulted in a lower limb amputation (due to crush injury) and a traumatic brain injury…the little girl who has spastic diplegic cerebral palsy…the little boy who dived into the pool which resulted in a spinal cord injury…someone who requires significant even up to 2 person assistance / mechanical lift…) to medically needing attention but fairly functional (such as the feisty little old lady who is deconditioned and debilitated partially due to her gastro issues in addition to being a severe diabetic….the middle aged man who is having an exacerbation of his COPD…someone needing some assist of one person…).
ARUs generally (but there are exceptions) achieve discharge to home after completion of the patient’s length of stay.
ARUs are typically specialized units within a hospital and have medical directors that are physiatrists (aka the type of physician who really understands the rehab life and won’t mistake you as the physical therapist)…
ARU belief: The fact of the matter is after a major medical complication, many individuals need more than a brief acute care stay before they can safely return home.
Before we dive in further let's think about Acute Inpatient Rehab as part of the many INPATIENT settings occupational therapy serves an invaluable role in: Inpatient therapy services typically occur within the context of a hospital or medical facility in which the person receives services during their stay at that hospital or medical facility. Some specific settings within the inpatient category that will be explained in this and future blog posts includes the following: Intensive Care Unit Acute Care Acute Inpatient Rehab (Adults) Acute Inpatient Rehab (Pediatrics) Sub Acute /Inpatient Rehab (short term stay) Skilled Nursing Facility (long term stay) DISCLAIMER: The above-mentioned list is not all inclusive. This article should not be used as medical advice and paints a subjective picture portrayed through different perspectives from occupational therapy practitioners. Each setting may look entirely different than what will be shared through the following interview portions based on region, economics, and more.
Questions and Answers:
OT in Acute Inpatient Rehab by OT practitioners
The following section of this blog article stems from information collected via online interviewing. Answers reviewed and edited with permission from the interviewees by me (Shannen). ***This post is a little different than the others, however, because I answered a few questions myself since this is the setting I currently work at*** In addition, these answers demonstrate insight from both adult and pediatric acute rehab sites!! To respect the privacy of the contributors, I have provided underneath each interview answer their desired form of identification
Q: What initially made you interested in the field of occupational therapy?
A: I think that COTAs/OTRs are a special breed and I’m so thankful I chose this as my career.
I was in a near fatal car accident at age 19. I fractured my neck, collarbone, arm, hand, wrist, and thumb, punctured my lung, and suffered a brain injury and a stroke. I think that everything in life happens for a reason and I think my life has come full circle.”
During my recovery my therapists helped to change my life and I love being able to help change other’s lives now. –Sara
Q: Describe your setting (Is it rural? Urban? Accessible to lots of resources? Do you work with other healthcare practitioners or with other OT/OTAs? Are there other places/settings like yours nearby or is your setting one of its kind?…)
A: I work in a 233 bed hospital in Nashville, TN. The hospital is about 8 miles from the center of downtown. We have 7 floors in the hospital, 6 floors of acute care and one floor dedicated to acute inpatient rehab (adults). I work with other healthcare professionals, OTs, OTAs, PTs, PTAs, speech therapists, nurses, doctors, social worker, dieticians, etc. There are other hospitals in the area, however Skyline rehab specializes in stroke and trauma and is fairly well known for its stroke rehab. –Sara
A: I currently work at a not for profit pediatric hospital that is located on the outskirts of a city. I work in both acute inpatient rehabilitation and a specialized outpatient setting. The acute inpatient team is comprised of occupational therapists, physical therapists, speech therapists, social workers, case management, child life specialists, psychologists, neuropsychologists, nurses, and doctors. Our unit has access to a multitude of resources that allow us to provide skilled intervention. Examples include: splinting and casting material, samples of typically recommended durable medical equipment, access to the assistive technology (AT) lab to identify appropriate AT or devices (such as switches, blue-tooth interfaces, eye gaze technology, etc) to facilitate independence in access to technology or the environment, wheelchair seating and mobility, in-house orthotics/prosthetics for any devices or braces to promote quality of life and function ( ie compression vests, shoulder supports, etc). We also provide resources to those who may need specific treatments/therapies after discharge (i.e, hand therapist, day rehabilitation, driver rehabilitation, robotics and technology, early intervention, etc). There are no other pediatric acute inpatient rehabilitations in the metropolitan area however there are other facilities located in the state. –Marissa
A: I work in a <20 bed acute inpatient rehab unit within a small hospital in a rural city. I work closely with several different medical healthcare professionals including a Physiatrist (a medical doctor that specializes in physical and rehabilitation medicine and will have the credentials MD or DO), Physical Therapists, Physical Therapist Assistants, fellow Occupational Therapists, Certified Occupational Therapy Assistants, Speech Language Pathologists, Rehab Nurses, Social Work, Clinical Liaisons, Nursing assistants, Care techs, and more. I usually work with patients that are moderately-severely impaired functionally and medically as well as not yet at the stage to transition back to their home or at least to a lesser restrictive environment than a hospital. -Shannen (author)
Q: Who benefits from OT services in your setting? (Specific to a certain population? Describe a “typical patient” in your setting? What are the typical patient diagnoses? How does or how can a person get referred to your setting? Who qualifies?)
A:In pediatric acute inpatient rehabilitation, we treat children ages 0-21 with a multitude of diagnoses including, but not limited to: non-accidental trauma, brain injury, spinal cord injury, stroke, cerebral palsy, cancer, cardiac conditions/complications, orthopedic injuries, burns, and amputations. Our inpatient team also consists of liaisons at local hospitals at well as major hospitals throughout the state that treat pediatrics patients. The liaisons identify any child who may be appropriate and will benefit from acute inpatient rehabilitation. We also have an in-house nurse dedicated to conversing with hospitals in other states to facilitate care and transition from the hospital to our inpatient rehabilitation program. Both the liaisons and in-house nurse will coordination insurance verification and approval. If the family is unable to pay, there are options for financial assistance and this is typically discussed with the social worker. –Marissa
Q: What value does occupational therapy bring to the table in the Acute Inpatient rehab setting?
A: Apart from our obvious awesomeness, occupational therapy practitioners are exceedingly valuable to this setting as we play an instrumental role in fulfilling the needs of completing the Admission and Discharge assessment with the utilization of the Functional Independence Measure (FIM). The Admission assessment will be collected within the first 72 hours from the start of care; likewise, the Discharge assessment will be gathered within the last 72 hours of care. The FIM is a comprehensive assessment comprised of a Motor Scale and a Cognition Scale that basically assesses 18 items such as Eating, Grooming, Bathing, Upper Body Dressing, Lower Body Dressing, Toileting, Transfers, Social Interaction… among others and scores the person on a 7 point ordinal scale. The scale rates the level of caregiver burden with a score of FIM 1 or Total Assistance to a score of FIM 7 or Independent.
This leads to why I really like this setting vs other settings which do not suffice the amount of time needed to complete full routines within the more natural context…There is NO SIMULATION in this setting (which I love because simulation does not equate to true ability). If the patient did not complete the actual task in its entirety then it did not count (jkjk that would be highly impractical-what I mean is that in order to score “FIM” the patient in for example “shower transfer” the patient must physically complete this task while in the bluff and wet—funny to say but the truth comes out in regards to a patient’s true safety/ reasoning/ insight ability when they are in the most vulnerable and I’d be inclined to say -more dangerous / increased fall risk due to higher chance of slipping- arenas. Thus, simulations of occupations does not suffice the demands of this setting.
Performing the occupation (necessary or meaningful activity) to its full capacity allows the therapist to collaborate with the patient to develop an intervention plan that addresses the specific factors such as decreased ROM and activity tolerance, poor problem solving, or impaired sequencing that are limiting independence while working on the more comprehensive feats.”
A: OT brings so much to the table in our setting. When the patients are in the hospital our job is to maximize their time and prepare them to go back out into the community at their most independent level possible. I incorporate occupation-based interventions by getting to know my patients and asking them what they find value in, and then incorporating that into interventions. –Sara
A: In pediatric acute inpatient rehabilitation, occupational therapy plays a major role in the child’s recovery. Our ultimate goal is to help the child engage in age appropriate and meaningful activities. This can mean so many things depending on the child’s age. For the younger clients, this may mean engaging in play and basic activities of daily living (such as feeding or participating in dressing). For older clients, we typically focus on activities of daily living. We assess areas such as vision, cognition, range of motion, strength, sensation, and fine motor skills so that we can identify deficits that impact the child’s ability to safely engage in activities. When appropriate, we will schedule a client for AM care session (focus on dressing, bathing, and grooming). We also use activities of interest for younger children to facilitate development positions, range of motion, visual scanning, etc.
Therapists save the last 10-15 minutes of a session to assess/complete a more functional task that was indirectly addressed during session (i.e., for a client with paraplegia, playing basketball/ball toss while in ring sit on the mat to promote balance in preparation for lower body dressing task such as donning/doffing socks) –Marissa
Q: What type What does occupational therapy look like in your setting? (What is the duration, frequency, etc of treatment? What is a patient’s typical length of stay and where do they go after discharge -do they transition to another follow up setting….? What theories or frames of reference do you incorporate into treatment planning? What type of outcome measures /assessments do you use? How do you describe occupational therapy to a new patient in your setting who asks “what is OT for me?”)
A: In the inpatient rehab setting- each patient gets 3 hours of therapy per day. So typically each person receives one hour of OT, one hour of PT, and one hour of Speech. If the paient doesn’t qualify for speech therapy, then they will get 90 minutes of each PT/OT. Typically in this setting patients will stay anywhere from 10-28 days depending on their needs/insurance/etc. From inpatient rehab, most patients go home (that is our goal), if they are not ready to go back home then they will go to the next level of care such as skilled nursing facility for further therapy services. I would say MOHO is the theory that I use day to day. When a patient asks me why they need OT, I always ask them what they do in their day-to-day life and then I explain to them that I am trying to help them to become stronger and independent to be able to fully function in each of their roles in their life. –Sara
A: In pediatric inpatient rehabilitation, sessions are typically 30 to 60 minutes. Each patient receives 3 hours of therapy 5 days a week and 45 minutes each day of the weekend. Length of stay is dependent on diagnoses, age, medical complexity/complications, and discharge disposition. There are clinical pathways for common diagnoses seen (i.e. Paraplegia = 4-6 weeks). Most clients do return home with family/guardians. We use a variety of frames of reference, as it will depend on the diagnosis. Some examples include biomechanical, compensatory, rehabilitative, neurodevelopmental, cognitive-behavioral, MOHO, and developmental.
We use FIM (as well as WeeFIM in acute inpatient rehabilitation for 0-3) for functional outcome measures. Assessments typically used, when appropriate, include range of motion, manual muscle testing, informal vision, nine-hole peg test, dynamometer, pinch gauge, and Peabody Developmental Motor Scales. We have access to more assessments however these are the primary ones used. I typically describe the goal of OT “is to help the child engage in age appropriate and meaningful activities” I will further delve into this depending on the child’s age. The occupation of play is the primary focus on younger children with some integration of ADLs including feeding and participation in dressing (like removing socks). With older children, I will discuss activities of daily living, instrumental activities of daily living (such as simple meal preparation and cleanup), academics/school, and leisure.-Marissa
Q: What are examples of challenges in this setting?
A: In comparison to my experience during Level 1 (5 total: acute care, skilled nursing facility, outpatient pediatrics/feeding, schools based, orthopedics/hands) and Level 2 fieldwork settings (2 total: outpatient pediatrics, skilled nursing/rehab) –like I said earlier this is my first and current OT job setting–, I NEVER witnessed so much documentation in my short, immature OT life than I have in the setting of acute inpatient rehab. I am likely (highly likely) in the minority of therapists who kind of like documenting (I just love to write…in fact I write too much…gee wonder why I started this blog – to write write write #sidenote), because I view documentation as the opportunity to show the skill behind the occupation-based task which to someone with a non-OT lens may view the same series of tasks as simple or routine. There is just a LOT of detailed documenting with an emphasis on function. From evaluations, daily treatment notes, FIM score notations, discharges, individual plan of care notations, and Team Conference weekly goals, it is a documentation nation in an acute inpatient rehab unit. Also, the demand to be “more productive” is always on the back of my mind, but what the patient needs will always come first over being more efficient. -Shannen (author)
Q:Why do you like this setting? Describe a moment in which you felt like you facilitated a positive change in your patient’s life or trajectory of functional recovery?
A: I like this setting because I like the variety of patients that I see and I love to see them progress. Also, the patient usually isn’t there more than about 28 days, so you get enough time with them but not too much, it’s never a dull day and I love that. Since I just graduated in Spring of 2017 I am still learning and I love having the support of other therapists around me all the time. I think the hospital setting is a great setting for a new graduate to start because of that support system.
A moment that sticks out to me that I feel like I really helped a patient who had a stroke. Upon admission to the hospital he did not have much function and was very emotional, I reassured him to keep trying and focus on the improvement each day. By the time he left he had gained so much back and was very thankful for the perspective I gave him to look at the improvement each day instead of what he was still missing.
Many positive changes in my life have happened since I’ve been working in rehab, I have become more organized (because of the fast paced schedule), I have more compassion for all types of people, and I never take being able to be independent for granted.
A: I love that every day is different and I am constantly learning new information, techniques, and treatment ideas. There are multiple settings in which OT is offered in this hospital system (acute care, inpatient rehabilitation, day rehabilitation, wheelchair clinic, outpatient rehabilitation, hand therapy, robotics and technology) providing much room for growth. Managerial staff fosters staff’s personal and professional goals and provides appropriate opportunities for growth when they become available. –Marissa
Q: What specific “special skills” (like things you aren’t prepared from entry level OTA/OT skills) do you need to be successful in your setting?
A: I don’t exactly know if time management is a special skill, but you definitely need it in this setting, it is scheduled out by the minute so you need to be able to manage time effectively. Also, patience is a big one and compassion, these patients have been through a lot and those are two qualities that you must have to be successful in this setting. -Sara
A: Most of my experiences with pediatrics in school included school based, early intervention, or sensory processing disorders. Physical dysfunction and medically complex children can present with lines and tubes (IVs, trach/ventilator, NG/peg tubes, pulse ox, oxygen, etc). I experienced this and felt competent working with medically complex adults; however positioning and handling is much different when working with younger children. It is important to know all of the lines as well as how the equipment works and what signals are important to know (i.e., the ventilator is alarming for low pressure). It is also important to be aware of what your client currently has and manage all the lines/tubes when transferring or repositioning. –Marissa
Q: How do you deal with grief and loss in your setting to prevent yourself from burnout?
A: Our inpatient rehabilitation team is absolutely amazing and filled with resources that address this area exactly. All children see a child life specialist who helps them cope with stress associated with their illness/injury or any treatment they will undergo (i.e., going under sedation, receiving an IV, bronchoscopy, etc). They use developmentally appropriate interventions to reduce fear and anxiety (i.e., may use a doll or pictures to help them understand what procedure is about to happen). Psychology typically evaluates all clients. All therapy staff works closely with psychology and complete co-treatments, when appropriate, in order to address any behavioral or psychosocial barriers that may be impacting a client’s ability to participate in therapy sessions.
Clients and their caregivers also have access to chaplains to provide support and guidance for spiritual needs. For family members, there are weekly caregiver support groups as well as outings/ transport to local stores to allow the parents to take care of their needs outside of the hospital. Families also have access to mentor programs where clients and their family who are experiencing a new, challenging medical experiences are matched with trained, veteran parents. These mentors provide information, coping skills, strategies for the transition home, and managing their child’s care. For staff, we have chaplains specifically dedicated to employees. They are available at any point, whether it is work related or personal, to converse about your feelings. For example, one day I experienced a medical emergency (code blue) with one client (thankfully, all turned out well!). The family designated chaplain spoke with the client’s guardian after the event and the staff designated chaplain contacted me to discuss the events and to make sure I was mentally, emotionally, and psychologically OK. For staff there is also an employee assistance program, which is professional and confidential counseling to help staff and their family resolve any personal concerns. –Marissa
A: This one is tough for me because I feel like I have a passion for people that is very deep. At first it was hard for me to “leave it at work” and I would come home being burnt out, sad, and emotional about my day. What I’ve learned is that we are all human and we can only do our part the best way we know how in helping our patients, and after that we don’t have control over the outcome. So give it your best and put your heart into it and then you have to leave it at the door. It may sound harsh, but that is what has worked for me. –Sara
A: I will be genuinely honest and say that I am a feeler. I feel things intensely which is both a positive and negative trait. I feel pain that my patients have (obviously I am not saying I truly feel how much pain they are in because only the patient -person- knows how he/she feels inside) just as much as I feel joy when they achieve the smallest of successes. I attended my first funeral for a patient 6 months into my career.
I will never forget the stillness I felt in that moment as I sat in the church pews a week before my wedding, listening intently to his family’s words during his service. Even as a novice practitioner (< 2 years experience) I FEEL and I grasp onto those feelings so that I can maintain my humanism and never veer away from being compassionate. -Shannen (author)
The human spirit
is stronger than anything
than can happen to it”
Q: How did you “get your foot in the door” to work in this setting?
A:I feel that having a strong knowledge and background in spinal cord injury aided in my hiring; however, my best advice is to apply to places that have a mentorship programs to help you transition to a new setting! My facility has knowledgeable staff that provides excellent mentorship. I found this particularly helpful in the transition from adult rehabilitation to pediatric. Having a solid foundation in physical dysfunction and rehabilitation is important, as this is the basis for you to apply and modify tasks to ensure they are developmentally and age appropriate. -Marissa
A: I sing actual praises to my 2nd Fieldwork Level 2 Clinical Instructor who actually completed the application process, but then suggested that I apply and interview to my first and current job. To be honest, I was confused on the difference of inpatient rehab short term stay in a skilled nursing facility which was where my fieldwork site was vs. acute inpatient rehab. I am still grateful for her encouragement to pursue this setting that I can attest is definitely different and faster-paced that inpatient rehab within a skilled nursing facility. -Shannen (author)
Q: Where do you see yourself in 5 years? 10 years? How does working in this setting help you reach your personal professional goals?
A: I have answered then deleted my own answer to this question at least 5 times because my aspirations are fluid. I know that I greatly enjoy working with adults, prefer neuro over ortho, want to remain in a hospital, but I do not know where my path is pointing. I am interested in palliative care and aspire to increase my exposure to OT within the hospice setting. I love writing -clearly- so perhaps I will dabble in more freelance writing; I have a long (long long) term goal of writing a book of narratives based on anecdotal memories. In some form or fashion I aspire to be in academia part time as well as stay up to date in the field.
My family comes before my career; when the time comes for my husband and I to start a family I hope to have the best of both worlds by reducing my hours “on the career job” when they are little and increase my hours “on the Mom job” (seriously I am amazed by all the mom and dads who balance career life with family life like it’s nothing!). -Shannen (author)
A: My first love is, and will always be, spinal cord injury. I have fully enjoyed the transition from adult to pediatric and not quite sure where I will be in 5 or 10 years. I enjoy both the inpatient and outpatient settings but feel a stronger pull towards inpatient. -Marissa
In summary: Occupational therapy services in acute inpatient rehab play a dynamic role in facilitating functional independence and quality of life into the lives that we serve on their journey back to reinstalled purpose, wellness, health, and occupational engagement.
It is up to us to continue to advocate for and highlight what we bring to the table in regards to providing necessary, useful skilled services to all populations.
About the contributors:
Shannen Coley, MS, OTR/L (IG: @shannenmarie_ot) (AUTHOR)
Shannen graduated with her Master of Science in Occupational Therapy from the University of South Alabama in December 2016. Since January 2017, Shannen has been working full time as an occupational therapist at an acute inpatient rehabilitation unit in a small hospital in Alabama. Shannen is an avid writer and has written for American Occupational Therapy Association (CLICK HERE to view “With Love: Thoughts on Being an Empathetic OT Practitioner”) New Grad Occupational Therapy (CLICK HERE for links to published works on NGOT) and this personal blog (ShannenMarieOT.com) as well as enjoys advocating and networking with others on her Instagram. She is active in mentoring future practitioners of the field and enjoys providing PreOT presentations to local colleges. She is looking forward to new adventures and new opportunities upon relocating in summer of 2019 for her husband James’s medical residency. Location –> #tobedetermined
Sara Howe, COTA/L (IG: @sarathowe)
Sara is a new grad occupational therapy assistant. She graduated from COTA school in the spring of 2017 from Nashville State Community College. She currently works in the inpatient rehab settings at Skyline Medical Center which is known as being a “stroke” hospital. Sara is a strong advocate for her patients and finds joy in helping others gain back their independence. She primarily works with patients who have had strokes, but also works with patients with diagnoses related to trauma, ortho, burns, debility, cardiopulmonary conditions among others.
Marissa Malady, OTR/L (IG: @marissalynn86)
Marissa has been practicing occupational therapy since 2011 in a variety of settings including adult and pediatric acute inpatient rehabilitation, home health care, acute care, and outpatient pediatric occupational therapy. She is a 2010 graduate of Temple University. She has presented at multiple national and international conferences for spinal cord injury. Her areas of interest include spinal cord injury, wheelchair seating and mobility, and use of assistive technology. She is currently working per diem at three different facilities in multiple settings.
Thanks for reading!! Love to hear from our readers, comment below where you work!! Next up INPATIENT SETTINGS: OCCUPATIONAL THERAPY IN SUB ACUTE REHAB / INP REHAB SHORT TERM STAY!
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain & process (3rd ed.). American Journal of Occupational Therapy, 68, S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006