Fall 2022 Newsletter
By Emily Wish, OTD, OTR/L, PCBIS, Lorrie George Paschal, PhD, OTR, ATP, and Duston Morris, PhD, MS, CHES, ACE-HWC
Department of Occupational Therapy
University of Central Arkansas
According to the Arkansas State Plan for Traumatic Brain Injuries (UAMS, 2020), there were approximately 2,300 individuals living with a brain injury in Arkansas between 2013-2019. In the River Valley and Central Arkansas areas (including Conway, Cleburn, Johnson, Logan, Perry, Pope, Pulaski, Van Buren, White, and Yell counties) there are 685 individuals registered with the TBI registry (UAMS, 2020). As of March 2022, it is estimated that there are approximately 611 individuals hospitalized due to a TBI in the US (CDC, 2022). Stroke, which is an acquired non-traumatic brain injury, is one of the leading causes of disability in the US (Virani et al., 2020). With the risk factors for stroke increasing since 1995, it is no surprise that the prevalence of this disease has also increased in the US (Virani et al., 2020). Arkansas is one of the top 14 states in the US in rates of stroke hospitalization (CDC, 2021). According to the Brain Injury Association of America, 95% of individuals living with a brain injury do not receive the long-term treatment and support they need to be successful in their occupations (Ashley et al., 2019). Acquired brain injuries impact individuals for a lifetime, but there is a lack of local resources that address occupational and healthcare needs for this population following discharge from rehabilitation.
To address this need, recent occupational therapy doctoral students Dr. Emily Wish and Dr. Mckenzie Svebek created the Conway Brain Injury Community (CBIC) in the University of Central Arkansas’ Department of Occupational Therapy in the College of Health and Behavioral Sciences (CHBS). This community allows members, post-acquired brain injury, to come together to work on increasing their occupational performance and overall health and well-being.
The vision of the CBIC program combines Dr. Wish’s desire to facilitate occupational performance of members and Dr. Svebek’s aim to establish a supportive interprofessional approach. Together, a community-based network of community dwelling individuals post-acquired brain injury and faculty supervised occupational therapy students was established to holistically address the needs of this community. Partnership with faculty and students from a variety of CHBS disciplines enhances the program by providing a unique approach of involving professors, students, and clinicians to meet the needs of CBIC members. At this time, primary team members include occupational therapy and health coaching. Other disciplines participate based on members’ interests. For example, this semester, dietetics students provided a presentation on heart healthy food choices.
This interprofessional program was an outcome of capstone projects but has become sustainable through partnership and supervision of occupational therapy faculty member, Dr. Lorrie George-Paschal, and health sciences faculty member Dr. Duston Morris. Through an interprofessional collaborative approach, the CBIC team leads theory-based and client-centered sessions tailored to address goals the members have set for themselves.
Operating within the UCA semester schedule, the group meets weekly, with the exception of school breaks. The program is based on the theory of Occupational Adaptation which strives to improve occupational functioning by creating a change in the internal adaptation process of members through engagement in desired occupations. At the beginning of the 14-week semester-long program, participants complete Occupational-Adaptation based Instruments, developed by Dr. George-Paschal with Dr. Krusen (2019). These instruments provide structure for the program. Because the program is research-based, participants first review and sign informed consent approved by Research Compliance at UCA. If they give consent, participants complete the Occupational Adaptation Practice Guide to set meaningful goals. When goals have been set, participants evaluate their current sense of mastery on their established goal(s) using the six-item Relative Mastery Scale (George-Paschal, Krusen, & Fan, 2021). This valid and reliable instrument is used to measure individual and group outcomes. The RMS is completed again in the middle and at the end of the semester.
Example goals of current CBIC members include improvement in upper extremity tone management and range of motion, cooking with one hand, sewing with one hand, improved handwriting with the non-dominant hand, improving awareness of the left visual field, and improving community mobility. CBIC members are partnered with one to two occupational therapy students and a health coaching student to work on their goals. Occupational therapy sessions are held for two hours each week with activities focused on each member’s specific goal(s). Activities are scaffolded to increase success. For the CBIC member who wants to sew, students and faculty created opportunities that have progressed from operating functions on the sewing machine with one-hand, to sewing straight seams, to making a drawstring bag, and most recently making their own pillow case. The next step is to meet at a local fabric store to choose Christmas fabric for the member to make a quilt top. Signs of adaptation for this member have been noted through signs of initiation and generalization as the member shared that they have visited a local sewing center to try out and consider the purchase of a sewing machine for home.
Weekly health coaching sessions are held on a separate day and last one hour. Students from occupational therapy and health coaching work together and often attend the sessions led by the other discipline. Participants feel an accountability to their health coaching goals as evidenced by one member pushing to finish a project during an occupational therapy session because they had set a goal to complete it with their health coaching student.
In addition to the individual activities, the program includes informational and support group activities. This semester, activities have included a presentation on nutrition for heart health (provided by UCA nutrition students) and various activities to promote self-worth and group connection. This supportive community provides a safe space for CBIC members to identify, establish and achieve personal and/or health-related goals throughout their rehabilitation journey. While this is not therapy, it does provide CBIC members an opportunity to reflect on their strengths through recovery and to maintain and improve their long-term occupational performance.
Starting with four members in June 2022, the program has expanded to seven members this fall and will continue to reach more individuals in the Central Arkansas area.
The goal is to provide a sustainable interprofessional program that can serve the needs of the members post-acquired brain injury while simultaneously providing opportunities for CHBS students to learn and engage in meaningful healthcare community services. UCA OT Doctoral Capstone student Kassidy Sawyer will provide program management and direction in 2023. For more information about the CBIC, please contact Dr. Emily Wish, CBIC program director at firstname.lastname@example.org.
George-Paschal, L. & Krusen, N. (2019). Occupational Adaptation Practice Guide. Copyrighted
George-Paschal, L. & Krusen, N. (2019). Relative Mastery Scale. Copyrighted 2019.
George-Paschal., L, Krusen, N.E., Fan, C.W. (2021). Psychometric evaluation of the Relative
Mastery Scale: An Occupational Adaptation instrument. OTJR: Occupation, Participation and Health. [online first 12.31.2021 Sage Journals. https://doi.org/10.1177%2F15394492211060877