MEDICA@MUSC (Medical University of South Carolina)
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Developing a Scheduling Method for Animal-Assisted Therapy in Acute Rehabilitation
No full textAnimal-Assisted Therapy (AAT) provides meaningful benefits in rehabilitation, including reduced anxiety and improved motivation and physical outcomes (Burres et al, 2016, Denzer-Weiler & Hreha, 2018). However, barriers such as inconsistent scheduling and limited clinician experience hinder implementation in fast-paced healthcare settings. This project took place at a large inpatient acute care hospital where therapy staff sought to integrate AAT more effectively into rehabilitation sessions.
The purpose of this quality improvement project was to develop a sustainable scheduling method to facilitate coordination between therapy staff and volunteer animal-handler teams. Goals included improving interdisciplinary communication, enhancing patient engagement through AAT, and creating accessible tools for consistent implementation.
Over a four-week period, AAT sessions occurred on nine days, involving 12 therapists, 6 animal-handler teams, and 15 patients. A shared scheduling document was created and refined based on real-time feedback. Post-implementation surveys showed that 100% of clinicians rated the system as “very convenient,” and all volunteers found communication “very effective.” Qualitative feedback indicated AAT increased patient participation, motivation, and morale.
Deliverables included a digital scheduling tool, educational materials for staff and volunteers, and an updated therapy animal role description. This project supports AAT integration in acute rehab settings by addressing logistical barriers and promoting interdisciplinary collaboration.
References
Burres, S., Edwards, N. E., Beck, A. M., & Richards, E. (2016). Incorporating pets into acute inpatient rehabilitation: A case study. Rehabilitation Nursing, 41(6), 336-341. 10.1002/rnj.260
Denzer-Weiler, C., & Hreha, K. (2018). The use of animal-assisted therapy in combination with physical therapy in an inpatient rehabilitation facility: A case report. Complementary Therapies in Clinical Practice, 32, 139-144. 10.1016/j.ctcp.2018.06.00
What About Participation? Using Key Form Mapping to Emphasize Community Participation in Stroke Survivors
No full textThe purpose of this MUSC Occupational Therapy (OT) Doctoral Capstone project was to determine if stroke survivors demonstrate participation gains resulting from Rasch-derived, patient-spectice practice, i.e., “keyform mapping,” program by evaluation participation at 3 levels. Approximately 50% of stroke survivors have participation restrictions that may impact their engagement with fulfilling, meaningful activities. This is a secondary analysis of data collected from a stroke rehabilitation RCT parent study which tested the effect of a tailored. task-practice program using Rasch-derived keyform map of the individual’s FMA-UE item responses. Participation levels were evaluate by the Activity Card Sort Low-Demand Leisure and Social Acitivites subsections and the Stroke Impact Scale Percent Recovery subsection. The means and standard deviations for change in retained activity and change in percent recovery were calculated. Our results show a statisitcally significant increase low-demand leisure and self-reported recovery. Participation-oriented focus of therapy may enhance independence, support social integration, promote confidence, and improve quality of life
Developing Staff Training Modules to Enhance Neurodiversity-Affirming Care in an Inpatient Psychiatric Setting
Get PDFIntroduction: Individuals with autism spectrum disorder (ASD) are admitted to psychiatric hospitals at higher rates and for longer durations compared to neurotypical individuals (Kuriakose et al., 2018). Externalizing behaviors, such as aggression and self-injury, significantly increase hospitalization risk, yet standard psychiatric interventions (e.g., traditional process groups) are often ineffective for this population. A key barrier is the lack of ASD-specific training among hospital staff (Siegel & Gabriels, 2012). This capstone project aimed to address this gap by developing and implementing an educational training program to improve patient-centered, neurodiversity-affirming care across all inpatient psychiatric units. The primary aims were to: (1) develop evidence-based training modules that educate staff on neurodiversity, ASD, and individualized care strategies, and (2) improve staff competency and confidence in providing effective care to neurodivergent individuals. Methods: Interactive, self-paced training modules were created and disseminated to all patient-facing staff. Post-training feedback was collected through REDCap surveys (n = 4) and informal interviews (n = 4). Data were analyzed using descriptive statistics and thematic analysis. Results: Following training using the evidence-based modules, quantitative results showed 75% of participants felt very confident in grading tasks and using multimodal communication. Confidence in implementing routines and supporting emotional regulation was more evenly split between fairly and very confident (50% each). Lower confidence was reported for adapting the environment and accommodating sensory needs—areas also cited as needing additional training. Qualitative feedback highlighted barriers such as inconsistent staffing, short patient stays, and limited resources. Suggestions for improvement included in-person, unit-specific follow-ups, inclusion of more adult-relevant examples, and streamlined content. Conclusion: The training improved staff confidence and competency in neurodiversity-informed care. Continued access, leadership support, and targeted reinforcement strategies are recommended to sustain and expand its impact
Utilization of Digital Platforms to Enhance Usability and Knowledge for Fieldwork Educators; Increasing Access to the Intentional Fieldwork Education Model (IFWEM)
No full textFieldwork education plays a pivotal role in shaping student outcomes in occupational therapy programs. The effectiveness of fieldwork education is significantly influenced by the fieldwork educator\u27s communication style, teaching approach, learning preferences, competency, self-efficacy, and level of preparedness. The Intentional Fieldwork Education Model (IFWEM) and its associated IFWEM course provide an evidence-based framework designed to enhance fieldwork educators’ competency, self-efficacy, and preparedness prior to student fieldwork. In collaboration with the creators of the IFWEM, efforts were made throughout this capstone project to increase the usability, availability, and accessibility of the current IFWEM course. This project aimed to create a more suitable learning environment that increases the ease of navigation, adding more accessible information to each module, and catering to diverse learner backgrounds and preferences. By improving access, usability, and availability of the IFWEM course, the ultimate goal is to increase participation among fieldwork educators, thereby fostering enhanced student outcomes during fieldwork experiences. As part of this update to the IFWEM course effort, a website was developed to further disseminate the IFWEM diagram, the IFWEM course, and the IFWEM article. Through the creation of the website, the IFWEM creators will also have a platform to continue to disseminate research and provide further access to fieldwork educator resources as well as student resource. Feedback from fieldwork educators and academic fieldwork coordinators has been overwhelmingly positive with regard to the website\u27s layout, design, and organization. Both third-year capstone students and fieldwork educators have expressed that the website is informative, well-balanced, and user-friendly, providing valuable feedback to guide the future of the IFWEM
HDAC5 Enzymatic Activity Regulates SCN4B Expression to Control Relapse-Like Cocaine Seeking
Get PDFSubstance Use Disorder (SUD) is a relapsing disorder characterized by repeated seeking and use of psychoactive substances despite negative consequences to the individual. Epigenetic changes within the medium spiny neurons (MSNs) of the nucleus accumbens (NAc) are thought to underly the lasting propensity to relapse in SUD. The epigenetic enzyme histone deacetylase 5 (HDAC5) in NAc MSNs limits the formation of reward-cue associations in rodent models of drug seeking, but not sucrose seeking, leading to decreased relapse-like behavior. However, whether HDAC5 reduces drug seeking behavior through its own deacetylase activity or through the recruitment of co-repressors is unknown. Furthermore, these HDAC5-mediated behavioral changes are associated with a decrease in MSN intrinsic excitability and the downregulation of numerous genes associated with transmembrane cation transport. One of these genes, Scn4b, encodes a sodium channel auxiliary subunit that functions to increase action potential frequency in MSNs. We hypothesized that HDAC5 limits relapse-like behavior through reducing MSN intrinsic excitability via the deacetylase-dependent downregulation of Scn4b.
To test this hypothesis, we first characterized a conserved cysteine-containing structural zinc-binding motif within HDAC5’s enzymatic domain using targeted mass spectrometry, molecular dynamics modeling, and enzymatic and transcriptional activity assays. We found that HDAC5 exhibits high basal levels of an intramolecular disulfide bond at this motif. Mutation of the involved cysteine residues selectively disrupts HDAC5’s intrinsic deacetylase activity without disrupting co-factor association or altering subcellular localization, indicating a critical involvement of these cysteine residues in the intrinsic deacetylase activity of HDAC5.
We next assessed the role of HDAC5’s intrinsic deacetylase activity in relapse-like cocaine seeking behavior and NAc MSN electrophysiology. Using viral-mediated gene transfer in a rat cocaine self-administration paradigm, we found that HDAC5’s intrinsic deacetylase activity is required to limit cue-induced reinstatement of cocaine seeking. This behavioral effect was associated with a deacetylase-dependent reduction of NAc MSN intrinsic excitability, indicating that HDAC5’s enzymatic activity regulates relapse-like behavior through the modulation of NAc MSN firing rate.
Finally, we investigated the HDAC target gene, Scn4b, as a critical mediator of HDAC5’s electrophysiological and behavioral effects. Short hairpin RNA-mediated reduction of NAc Scn4b transcript levels limited MSN intrinsic excitability and reduced cue-induced reinstatement of cocaine seeking, while having no effect on sucrose seeking behavior.
Taken together, the data in this dissertation provide new insights into the molecular mechanism of HDAC5’s limiting of relapse-like behavior. It positions NAc MSN intrinsic excitability as a major factor underlying the establishment of lasting drug-cue, but not natural reward-cue, associations and reveals Scn4b to be a critical HDAC5 target gene mediating these processes
Making Room at the Table: Improving Understanding of the Role and Value of the Occupational Therapist as Part of the Child and Adolescent Mental Health Team
No full textAbstract
Objective: Child and adolescent mental health (CAMH) is of global concern, and there are not enough mental health providers to address the growing needs of this population. Although occupational therapy practitioners (OTPs) can help improve client outcomes as part of the CAMH team, they are often not included. This project aimed to increase the understanding of the role and value of occupational therapy in CAMH for OTPs, occupational therapy students, behavioral health team members, and administration.
Methods: A job description for the CAMH OTP was developed, and an educational module was created to demonstrate the OTP’s unique role and value on the CAMH team and increase awareness of occupational therapy (OT) interventions with these clients. The educational module was presented twice to a variety of professionals.
Results: The job description was reviewed by OTPs with mental health experience and deemed ready for use. There were 36 attendees of the educational module, and 29 completed both the pre-and post-test survey, providing quantitative and qualitative data. The results demonstrated improved 1) confidence in knowing the role and value of OT in CAMH, 2) confidence in knowing when to refer to CAMH OT, and 3) perception of the importance of OTPs in supporting the mental health of this population.
Conclusion: There is a knowledge gap about the role, value, and occupation-based interventions of OTPs on the CAMH team. This knowledge gap impacts whether or not OTPs are 1) considered to be crucial members of the CAMH team and 2) whether funding is provided for these necessary positions. We must advocate for OTPs to be considered valuable and complementary members of this team and develop research demonstrating our interventions\u27 effectiveness
Innovating Incarcerated Care in South Carolina: Establishing a Dedicated Hospital Wing and Expanding Telehealth for Chronic Disease, Preventive Care, and Mental Health Services
No full textSouth Carolina correctional facilities face significant obstacles in providing adequate healthcare, particularly in chronic disease management, preventive care, and mental health services, with rural areas disproportionately affected. This study explores the collaboration between the Medical University of South Carolina (MUSC) and the South Carolina Department of Corrections (SCDC), the establishment of a dedicated prison wing, and the expansion of telehealth to address these systemic issues. Using a descriptive case study design guided by Yin’s (2003) framework, this research examines the partnership within its real-world context. A mixed-methods approach combines qualitative data (interviews, hospital reports, document analysis) and quantitative data to evaluate telehealth\u27s impact on care quality and operational efficiency. Grounded in the Donabedian model, the study focuses on telehealth’s role in improving access to care, particularly for chronic disease management and mental health services, while reducing logistical barriers in rural prisons. Findings highlight how the MUSC and SCDC partnership enhances healthcare delivery, achieves cost-effectiveness, and addresses stakeholder concerns. This research offers critical insights into the operational realities of correctional healthcare reform. It provides a replicable framework for leveraging telehealth to advance patient safety and healthcare quality within correctional environments
Development of a Mobile App for Parents and Caregivers of Children with Autism
No full textBackground: Caring for children with autism who experience sensory challenges often leads to increased caregiver stress and reduced self-efficacy. Research suggests that smartphone apps can effectively mitigate stress and empower parents. A needs assessment highlighted the necessity for an app centered on sensory processing tools and strategies, considering the limited resources available for addressing children’s emotions and behaviors.
Objective: This project aimed to develop and evaluate a comprehensive app to support parents and caregivers of children with autism, focusing on reducing stress and enhancing parental efficacy. Objectives included: 1) designing the app with relevant resources, 2) assessing the app’s content, effectiveness, and quality through feedback from content experts and users, and 3) disseminating findings through scholarly presentations.
Method: The app was developed using “Adalo,” an app development platform, with input from content experts and potential users, using REDCap surveys, short-course group discussion, and semi-structured interviews. Recruitment for these activities included social media and outpatient clinic flyers. Twenty users with a subset of 7 parents/caregivers of children with autism completed the survey.
Results: There was high satisfaction reported with the effectiveness, quality, and usability of the app. Additionally, several themes emerged, including opportunities for financial sustainability, promotional strategies, potential avenues for expansion, convenience, ease of use, and accessibility.
Conclusion: Through this project, a valuable resource has been established to support caregivers in addressing the sensory needs of children with autism
The Neonatal Care Project: Empowering Parents Through Education and Support
No full textThe purpose of this capstone project was to develop and provide an informational and evidence-based resource for parents to utilize after discharge from the Shawn Jenkins Children’s Hospital (SJCH) Neonatal Intensive Care Unit (NICU). An in-depth needs assessment showed a need for increased parental support and better resources to improve parent mental health outcomes due to feelings of unpreparedness following a NICU stay. To support this goal, and in collaboration with the occupational therapy team at SJCH, two informational websites were created, one in English and the other in Spanish. The website is entitled “The Neonatal Care Project” and contains detailed information on the following 11 topics: developmental milestones, feeding, tummy time, sleep, hydrotherapy, infant massage, sensory development, BabyNet and early intervention, getting connected and other resources, other professionals, and the Proyecto Neonatal App. In addition to the information provided on the website, each page contains links to other helpful and reliable resources. Parents (n=22) verbally reported the material is valuable and they will utilize the resource once discharged from the NICU. Four themes were derived from parents feedback, (1) appreciation for the knowledge and support to continue care at home, (2) confidence in connecting with BabyNet services, (3) valuing feeding support and bottle guidance, (4) excitement around infant massage at home. Additionally, the occupational therapy team at SJCH (n=8) provided feedback via a Redcap survey and reported that they are very likely to provide their patients with this resource and feel very confident in answering any questions that families have regarding the website. Future research should focus on the effects of providing informational discharge resources and improved continuum of care on the direct mental health outcomes of parents with NICU infants
Zonal Hepatocellular Responses to Acute Ethanol: Impacts on Mitochondrial Function and Metabolism
Get PDFBackground: Ethanol (EtOH) consumption causes hepatocellular mitochondrial depolarization (mtDepo) and mitophagy. Here, the Aims were to develop techniques to characterize sublobular hepatocellular metabolism and the distribution of mtDepo and mitophagy after acute EtOH. Methods: Wildtype and GFP-LC3 transgenic mice were treated with EtOH or vehicle and administered the covalently labeling mitochondrial membrane potential (ΔΨ) reporter, MitoTracker Red (MTR), and/or the non-covalent ΔΨ reporter, rhodamine 123 (Rh123), prior to intravital imaging, liver fixation, or hepatocyte isolation. After in vivo MTR, hepatocytes were isolated and sorted. Enrichment in E-cadherin (ECAD) and cytochrome P4502E1 in periportal (PP) and pericentral (PC) hepatocytes, respectively, validated the sort. Oxygen consumption rates (OCR) were assessed by Seahorse respirometry. Results: Multiphoton microscopy showed that Rh123 and MTR fluorescence distributed zonally, decreasing from periportal (PP) to pericentral (PC) zones in a flow-dependent fashion. After vehicle, intracellular MTR fluorescence was mitochondrial in all liver zones, signifying mitochondrial polarization. OCRs (ATP-linked, proton leak-linked, and maximal) of sorted PP hepatocytes were ~4 times that of PC. After EtOH, intracellular MTR fluorescence became non-mitochondrial in the central half but not the portal half of liver lobules, signifying mtDepo. Mitophagy indicated by GFP-LC3 puncta was also only increased in the central half. After EtOH, OCRs of both PP and PC hepatocytes were ~2-times that of vehicle, but PC hepatocytes displayed greater proportional increases. In PC hepatocytes, basal OCR was inhibited by oligomycin and stimulated by uncoupler, suggesting reversal of mtDepo, which Rh123 uptake confirmed. Conclusions: After EtOH, mtDepo is restricted to the central half of liver lobules with a sharp midzonal demarcation from the portal half. In sorted hepatocytes without EtOH treatment, OCRs of PP hepatocytes are substantially greater than PC, but both PP and PC OCRs increase after EtOH. However, mtDepo in PC hepatocytes after in vivo EtOH treatment reverses during isolation. Increased mitochondrial respiratory capacity in all sublobular zones likely adaptively promotes detoxifying EtOH metabolism. These findings document sharp zonal differences in hepatic metabolic responses to EtOH exposure that may help shed light on the progression to alcoholic liver disease