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Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston, Becki Cohill, Susan Macdermott Dec 2019

Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).

Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …


Perspectives Of Occupational Therapists On Telehealth, Taylor Corey, Becki Cohill, Susan Macdermott Dec 2019

Perspectives Of Occupational Therapists On Telehealth, Taylor Corey, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

The purpose of this project is to gain a better understanding of the provider’s perspectives about the strengths and barriers of OT services provided via telehealth. Based on the evidence that will be collected through surveys and interviews, it can help determine specific factors on whether or not therapist choose to provide services through telehealth. Centered around those perspectives of telehealth, the results can help explore more in depth on the issues and concerns therapists have when it comes to telehealth as a service delivery model.


The Role Of Occupational Therapy For Survivors Of Human Trafficking, Margaux Mariano, Becki Cohill, Susan Macdermott Dec 2019

The Role Of Occupational Therapy For Survivors Of Human Trafficking, Margaux Mariano, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Human trafficking involves sex trafficking, labor trafficking, and trafficking of children. The needs of survivors of human trafficking are widespread due to the traumatic experiences they face. Concerns that may arise include decreased participation in meaningful activities in an individual's life, possibly due to anxiety, depression, suicidal ideation, memory loss, posttraumatic stress disorder, and social isolation. Individuals who have been subjected to human trafficking often experience occupational deprivation and occupational therapy has yet to establish its role in the recovery process for survivors. This poster presents a capstone project consisting of the process towards the development of an occupation-based, trauma-informed, …


Occupational Therapy's Role In Maternal Mental Health Within Transition From Nicu To Home, Victoria Briltz, Becki Cohill, Susan Macdermott Dec 2019

Occupational Therapy's Role In Maternal Mental Health Within Transition From Nicu To Home, Victoria Briltz, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

The purpose of this capstone project is to identify OT’s role in maternal mental health following the transition home from a NICU setting. This capstone project focused on mothers’ roles, routines, and environment during the transition from the NICU to home. Mothers may feel unprepared for the discharge home when their babies are ready to leave the NICU (Boykova, 2016). Occupational therapists address occupational performance through skilled interventions for women during the perinatal period; however, there is a lack of evidence guiding occupational therapy for providing services for maternal wellness (Slootjes, 2016). This capstone project will help share information, ideas, …


Developing Financial Literacy Skills For A Secondary Transition Program For Students With Learning Differences, Rose Marie Borillo, Becki Cohill, Susan Macdermott Dec 2019

Developing Financial Literacy Skills For A Secondary Transition Program For Students With Learning Differences, Rose Marie Borillo, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Under the Individuals with Disabilities Education Act (IDEA), schools are required to provide transition planning for students with disabilities and mental illness by age 16 (Eismann et al, 2017). Occupational therapists have been underutilized in secondary transition planning, despite their expertise in targeting functional abilities, comprehension, and health using activity analysis to promote skill attainment and achieve independence (Mankey 2012; Eismann et al, 2017).

At the Winston School, there was no formal transition program aside from the individual college counseling provided by a staff member. A coordinated transition program was indicated to prepare students for life after high school to …


Weight-Bearing Interventions To Decrease Spasticity And Improve Gait In Stroke Patients: A Case Report, Melin Nguyen, Shelby Peterson, Jessika Sun, Irene Taing, Faris Alshammari Dec 2019

Weight-Bearing Interventions To Decrease Spasticity And Improve Gait In Stroke Patients: A Case Report, Melin Nguyen, Shelby Peterson, Jessika Sun, Irene Taing, Faris Alshammari

San Marcos, Fall 2019

The purpose of this case report was to determine the success of weight-bearing interventions on spasticity reduction and improved gait patterns in a 61 year-old-male patient recovering from a chronic left hemorrhagic CVA. The patient’s primary impairments included right upper and lower extremity spasticity, circumduction gait, weakness and decreased range of motion of right extremities.

The interventions included in this patient’s treatment program included standing calf stretches, toe raises, ankle range of motion and gait training for 1 hour once a week for 4 weeks. This case report supports the application of weight-bearing through the paretic limb, which has been …


Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott Dec 2019

Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott

San Marcos, Fall 2019

Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular …


Application Of Occupation-Based Models To Edward Of Edward Scissorhands: Oa And Ehp Models, Amy Griswold, Kelsey Harris, Whitney Marwick, Whitney Wilbanks, Courtney Wild Dec 2019

Application Of Occupation-Based Models To Edward Of Edward Scissorhands: Oa And Ehp Models, Amy Griswold, Kelsey Harris, Whitney Marwick, Whitney Wilbanks, Courtney Wild

San Marcos, Fall 2019

This presentation examines the character Edward Scissorhands, a young adult with hand deformities and poor social skills, through the lens of the Ecological Human Performance (EHP) Model. We propose occupational therapy interventions based off of the EHP model. Through the use of establishing social skills training, as well as adapting and modifying Edward’s hands with tips and attachments, Edward’s life could be immensely improved


Case Study: Efficacy Of Physical Therapy On A Patient With Cva In Normalizing Gait And Shoulder Mechanics, Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, Faris Alshammari Dec 2019

Case Study: Efficacy Of Physical Therapy On A Patient With Cva In Normalizing Gait And Shoulder Mechanics, Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, Faris Alshammari

San Marcos, Fall 2019

Background & Purpose: Cerebrovascular Accident (CVA) is known as Stroke. It is a damage to the brain due to an interruption of blood supply. Two main types of stroke are ischemic stroke and hemorrhagic stroke. Ischemic stroke, the most common type of stroke, is due to a blocked artery and a hemorrhagic stroke is due to a leak or burst of a blood vessel. Signs and symptoms of stroke are presented contralaterally. The purpose of this case report is to demonstrate the use of PT interventions to improve shoulder function and gait mechanics in a post CVA patient.

Case …


Fragile X Syndrome And Family Occupations: Sertraline Treatment Via Case Studies, Decerie Mendoza, Tracy P. Ye, Martina C. Dualan, Elena A. Javier Dec 2019

Fragile X Syndrome And Family Occupations: Sertraline Treatment Via Case Studies, Decerie Mendoza, Tracy P. Ye, Martina C. Dualan, Elena A. Javier

Student Research Posters

Current research on children with Fragile X Syndrome (FXS) lacks inclusion of qualitative outcomes on the child’s daily occupational performance. Standardized measurements are frequently utilized and provide useful information, however, can be less sensitive to change (Berry Kravis et al., 2013) and miss capturing family perspectives and improvements within meaningful occupations. This research incorporates family perspectives via semi-structured interviews to promote an in-depth understanding about FXS and its impact on child and family occupations in addition to standardized assessment scores through in-depth case study analysis. This study used a mixed method research design examining four male participants who were given …


Parenting With Down Syndrome: The Role Occupational Therapy Plays, Kalhie M. Mayer, Bs, Otas, Aubrey Rubin, Otas, Jessica Schatzan, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Parenting With Down Syndrome: The Role Occupational Therapy Plays, Kalhie M. Mayer, Bs, Otas, Aubrey Rubin, Otas, Jessica Schatzan, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

  • OTPs can help individuals with Down Syndrome complete their activities of daily living so they can be independent and start a family
  • Sex education is an very important area for OTPs to work on with individuals who have Down Syndrome or other intellectual disabilities
  • OTPs play a huge role in helping people with Down Syndrome parent efficiently and effectively through various strategies such as recommending adaptations to support the occupations of a parent
  • OTPs can be instrumental in advocating for individuals with Down Syndrome who have children through linking them with agencies, completing performance assessments, and testifying in legal proceedings …


Inclusive Community: Exploring The Benefits Of Sensory Friendly Environments, Corinne Hanna, Otas, Shoshana Weisberg, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Inclusive Community: Exploring The Benefits Of Sensory Friendly Environments, Corinne Hanna, Otas, Shoshana Weisberg, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

Sensory friendly environments support inclusivity for children with autism and their families. Environmental barriers often cause an unpleasant experience for children who experience sensory processing disorders. Occupational therapy practitioners have a role in collaborating with teachers for modifications in the classroom and advocating for sensory friendly events within the community to promote engagement in childhood occupations.


Occupational Therapy’S Role In Oncology: Returning To Work During And After Treatment, Annamarie Scheidell, Otas, Stephanie Sloane, Bs, Ms, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Occupational Therapy’S Role In Oncology: Returning To Work During And After Treatment, Annamarie Scheidell, Otas, Stephanie Sloane, Bs, Ms, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

Medical advances have improved the five-year survival rate for patients diagnosed with cancer and some late-stage cancers that once were terminal have now become manageable, chronic conditions. Because of this, more individuals with cancer as well as survivors of cancer are re-entering the workforce. Resuming the role of worker is considered an important step in recovery for many. Occupational therapy (OT) can play an important role in facilitating a successful transition back to work for both cancer patients and survivors.


Going Beyond Accessibility By Advocating For Inclusive Playgrounds, Alexander Herrera, Otas, Amanda Shoffner, Otas, Kiondrah Wilson, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Going Beyond Accessibility By Advocating For Inclusive Playgrounds, Alexander Herrera, Otas, Amanda Shoffner, Otas, Kiondrah Wilson, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

Play is the primary occupation of all children and is vital for the development of physical, cognitive, and social-emotional skills. Children of all abilities benefit from play and should all have equal opportunity to use and explore playground equipment. Many community playgrounds are limiting and create barriers which do not allow all children to use them. It is important that occupational therapy practitioners (OTPs) step up and utilize their skills and knowledge to bring about a change.

Occupational therapy practitioners, with their knowledge of environmental barriers, understanding of disability and specific knowledge of activities, are in an ideal position to …


Fighting A Battle Against The Opioid Epidemic With Occupational Therapy, Emily Best, Otas, Douglas Milke, Otas, Teresa Vega, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Fighting A Battle Against The Opioid Epidemic With Occupational Therapy, Emily Best, Otas, Douglas Milke, Otas, Teresa Vega, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

  • The opioid epidemic is an opportunity for occupational therapy practitioners to help promote health and wellness within communities, populations, and individuals.
  • Occupational therapy practitioners are trained to understand unique learning styles by looking at a person’s habits, roles, routines, environments, performance skills, client factors, etc.
  • Occupational therapy’s client-centered and holistic values provide an advantage in adapting intervention strategies to what works best for a particular client or population


Impact Of Spinal Cord Injuries On Occupational Performance And Successful Role Acquisition During Motherhood, Caitlin Defrehn, Bs, Otas, Marie Quainoo, Ba, Otas, Sara Loesche, Ms, Otr/L, Cht Oct 2019

Impact Of Spinal Cord Injuries On Occupational Performance And Successful Role Acquisition During Motherhood, Caitlin Defrehn, Bs, Otas, Marie Quainoo, Ba, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

OT services can be utilized to optimize a mother’s function, mobility and engagement during and after pregnancy

OTPs can help women with SCIs fulfill the role of mother by providing

  • “training, adaptations, and resources” (para. 14)
  • “evaluating and recommending wheelchair seating and positioning” (para. 6)
  • Evaluating [mental], physical and environmental barriers in the home and community and recommending modifications (para. 8) (AOTA, 2015)

Current literature indicates that there are limited resources for mothers living with SCIs, especially regarding care of infants

Additional research is necessary to “examine the most effective strategies and adaptations” (p.2)


Effects Of Sleep Hygiene In The Hospital, Tina Bhakta, Paxton Arsenault, Maya Ahluwalia, Rachel Coats Apr 2019

Effects Of Sleep Hygiene In The Hospital, Tina Bhakta, Paxton Arsenault, Maya Ahluwalia, Rachel Coats

Occupational Therapy Student Research Posters

Research poster by UNE Occupational Therapy and Physical Therapy students investigating the definition of and recommendations for good sleep hygiene, the limitations of the hospital setting on attainment of sleep hygiene, and the benefits of sleep hygiene for hospital patients.


Evolution Of Occupational Therapy Practice: Life History Of Dr. Barbara L. Kornblau, Jd, Otr/L, Faota, Daspe, Ccm, Cdms, Cpe, Abby Wavra, Kelsey Sherry Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Dr. Barbara L. Kornblau, Jd, Otr/L, Faota, Daspe, Ccm, Cdms, Cpe, Abby Wavra, Kelsey Sherry

Oral History Posters

This paper is a summary of an interview completed with Dr. Barbara L. Kornblau. Barbara is a licensed occupational therapist and lawyer who was interviewed by two occupational therapy students at the University of North Dakota as a part of a larger life history qualitative study that included 30 total participants. This study was done to gather an understanding of her experience in occupational therapy (OT). The interview was semi-structured and lasted approximately 90 minutes, followed by a transcription and data analysis used to organize the information into twelve codes and six emerging themes. This single interview is a part …


Physiological Responses Of Adults With Sensory Over-Responsiveness, Catherine Anne Datu, Nicholas Wing Or, Megan Melody Valentine, Megan Jeanne Velcich Jan 2019

Physiological Responses Of Adults With Sensory Over-Responsiveness, Catherine Anne Datu, Nicholas Wing Or, Megan Melody Valentine, Megan Jeanne Velcich

Student Research Posters

The purpose of this research study is to identify if there are physiological response patterns associated with self-reported sensory over-responsiveness (SOR) in typical adults. SOR is the most common sensory modulation disorder and negatively affects the daily experiences of those that report SOR. The first phase of the study consisted of phone interviews where participants were screened for any potential characteristics that could affect physiological function. Then, the SRQ and AASP were used in conjunction to identify low and high SOR, typical adults. The last phase utilized the Sensory Challenge Protocol, which is both standardized and randomized, to expose participants …


Evolution Of Occupational Therapy Practice: Life History Of Anne Macrae, Phd, Otr/L, Bcmh, Faota, Danielle Cox, Brock Wahlert Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Anne Macrae, Phd, Otr/L, Bcmh, Faota, Danielle Cox, Brock Wahlert

Oral History Posters

This life history is one of 30 life history interviews which are part of a larger project, Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) at the National Level and Beyond. The purpose of study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will be a powerful way to …


Life History Of Provost Beth Cada, Ed.D., Otr/L, Faota, Janice Finley, Emily Utech Jan 2019

Life History Of Provost Beth Cada, Ed.D., Otr/L, Faota, Janice Finley, Emily Utech

Oral History Posters

The life history of Provost Beth Cada was one of 9 life history interview which are a part of a larger project of Life Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) in North Dakota and Wyoming. The purpose of the project is to obtain information about the history and evolution of OT practice in North Dakota and Wyoming. This study intends to provide current and future generations of occupational therapists a view of the history and how OT practice has evolved. The life history of Beth Cada is a case study that examined her life …


Evolution Of Occupational Therapy Practice: Life History Of Kathlyn L. Reed, Ph.D., Otr, Faota, Mlis, Tristen Smith, Audrya Tarango Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Kathlyn L. Reed, Ph.D., Otr, Faota, Mlis, Tristen Smith, Audrya Tarango

Oral History Posters

This life history is one of 30 life history interviews which are part of a larger project, Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) at the National Level and Beyond. The purpose of the study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will be a powerful way …


Evolution Of Occupational Therapy Practice: Life History Of Yvonne Randall, Edd, Mha, Otr/L, Faota., Alycia Peacock, Brianna Peterman Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Yvonne Randall, Edd, Mha, Otr/L, Faota., Alycia Peacock, Brianna Peterman

Oral History Posters

Objective: This qualitative life history study was completed through a semi-structured interview with Dr. Yvonne Randall. This paper reflects a piece of a larger study gathering information and insights about occupational therapy throughout history and how it has evolved. The purpose of the study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will …


Life History Of Margo B. Holm, Phd, Otr/L, Faota, Abda, Emma Chafin, Jessica Lambert Jan 2019

Life History Of Margo B. Holm, Phd, Otr/L, Faota, Abda, Emma Chafin, Jessica Lambert

Oral History Posters

This life history is one of 30 life history interviews which are part of a larger project, Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) at the National Level and Beyond. The purpose of study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will be a powerful way to …


Life History Of Elizabeth Crepeau, Phd, Otr/L, Faota, Nathina Crabtree, Sara Gregoire Jan 2019

Life History Of Elizabeth Crepeau, Phd, Otr/L, Faota, Nathina Crabtree, Sara Gregoire

Oral History Posters

The purpose of the study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will be a powerful way to gather this information. This life history is part of the larger study consisting of 30 occupational therapists. The larger project is Histories of Individuals Who Have Been Influential in Developing Occupational Therapy (OT) at …


The Evolution Of Occupational Therapy: Life History Of Shirley A. Wells, Drph, Otr, Faota, Hope Schuster, Hailey Johnson Jan 2019

The Evolution Of Occupational Therapy: Life History Of Shirley A. Wells, Drph, Otr, Faota, Hope Schuster, Hailey Johnson

Oral History Posters

Objective: The purpose of the life history of Dr. Shirley Wells is to gain an insight about her life experiences and leadership throughout her years of work in the profession of occupational therapy.

Method: An in-depth, semi-structured, hour and a half interview was conducted via the telecommunication app, Zoom. The interview was later transcribed verbatim and coded for the emergent categories and corresponding themes.

Results: The predominant categories representing the major elements of her life history were overcoming challenges, providing a seat at the table, and developing practice. The findings indicate that she made a significant impact for …


Evolution Of Occupational Therapy Practice: Life History Of Jaime Munoz, Ph.D., Otr/L, Faota, Kaitlyn Berglund Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Jaime Munoz, Ph.D., Otr/L, Faota, Kaitlyn Berglund

Oral History Posters

The purpose of this study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. This particular study reflects the life history of Dr. Jaime Munoz, a leader in occupational therapy education and advocate for marginalized populations. The study design used for this project was qualitative research using a life history approach, which allowed the focus to be on the participant’s involvement in …


Evolution Of Occupational Therapy Practice: Life History Of Elizabeth Skidmore, Phd, Otr/L, Faota, Facrm, Emily Annen, Seira Goddard Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Elizabeth Skidmore, Phd, Otr/L, Faota, Facrm, Emily Annen, Seira Goddard

Oral History Posters

Objective: The purpose of the study is to provide current and future generations of occupational therapists a view of the history and how occupational therapy practice has evolved from its inception to current practice through the life history stories of occupational therapists who have held leadership roles at the national level and beyond. It is anticipated that the life history process will be a powerful way to gather this information.

Method: A detailed, semi-structured interview was conducted at the University of North Dakota School of Medicine and Health Sciences. The interview took approximately 120 minutes to complete, followed …


Evolution Of Occupational Therapy: A Life History Of Dr. Michael Iwama, Phd, Msc, Bscot, Bschp, Sarah Lovelace, Annabelle Tarnowski Jan 2019

Evolution Of Occupational Therapy: A Life History Of Dr. Michael Iwama, Phd, Msc, Bscot, Bschp, Sarah Lovelace, Annabelle Tarnowski

Oral History Posters

A life history interview with a qualitative approach was conducted with Michael Iwama, PhD, MSc, BScOT, BScHP by two student researchers and an advisor from the University of North Dakota Department of Occupational Therapy. The purpose of this study is to provide occupational therapists with a view of history and how occupational therapy practice has evolved from inception to current practice through the life history of Michael Iwama. The research was guided by the Kawa model to shape the interview schedule, and the view of the individual and their context (Iwama, Thomson, & Macdonald, 2009). The two-hour interview was recorded, …


Evolution Of Occupational Therapy Practice: Life History Of Sandy Hanebrink, Otr/L, Clp, Faota, Amira Ragab Jan 2019

Evolution Of Occupational Therapy Practice: Life History Of Sandy Hanebrink, Otr/L, Clp, Faota, Amira Ragab

Oral History Posters

The purpose of the life history project is to examine Sandy Hanebrink’s occupational therapy practice and how the profession has evolved at the national level. By completing a literature review, gathering information on the participant, and completing a semi-structured video interview, the researcher was able to analyze the data. The findings from the data emerged into three categories: systematic evolution of the OT profession, personal journey, and influences over the years. The categories were then formed into two overall assertions: Over the years, the systematic evolution of occupational therapy, countless influences, and her personal journey to become an occupational therapist …