Project Description
My doctoral capstone focused primarily on clinical practice specific to OT in the Army. I spent time growing my clinical skills through practice and observation in the top three clinical settings in which Army OTs primarily work – upper extremity/hands, human performance optimization, and behavioral health. Because Army OTs are expected to work in multiple settings and specialties, a clinical capstone fit this project best. A component of growing my clinical skills included creating an evidence-based resource for my capstone site. The secondary focus of my capstone was education. I quickly learned by talking with my peers, and later confirmed with a needs assessment, that not many OTD students were aware of the opportunities for OTs in the Army. I educated a cohort of OTD students on the role of OT in the Army, the opportunities available to OTs in the Army, and the requirements of OTs in the Army.
Literature Review
- Thomas Kidner, a founder of occupational therapy, specialized in vocational training for Canadian WWI veterans, hand therapy originated during the Vietnam War due to war-related injuries, and military occupational therapists have contributed heavily to improving techniques and research on upper extremity injuries (Yakobina et al., 2008).
- U.S. Army occupational therapists have the opportunity to receive training to become a Neuromusculoskeletal Evaluator (NMSE), allowing them to work as physician extenders in outpatient and deployed environments (Amaker, 2008). This increases opportunities and expands roles occupational therapists can fill; however, it also increases the complexity of upper extremity evaluations.
- Holistic Health and Fitness is a relatively new initiative in the U.S. Army focusing on readiness training of soldiers through five domains: physical, nutritional, mental, spiritual, and sleep. Readiness in these domains is intended to support occupational performance, such as nutrient optimization for specific tasks (Borgeson, 2021).
- A study conducted with active-duty U.S. Army servicemembers investigating the effectiveness of an occupational therapy-based psychoeducational sleep program as an intervention for poor sleep behavior and quality found significant improvement in sleep hygiene (Woods& Tennekoon, 2018).
Needs Assessment
Despite the intertwined origins of occupational therapy and the military, few OTD students are aware of the roles and opportunities available for OTs in the military today. The needs assessment for this project surveyed a cohort of second-year OTD students with the following significant findings relating to their knowledge on OT in the Army.
- 0% of students reported hand or upper extremity clinics as a setting in which U.S. Army occupational therapists work (6.7% of students reported ortho)
- 73% of students reported they do not know what settings Army occupational therapists work or reported an incorrect setting
- 20% of students reported loan forgiveness as an opportunity available to U.S. Army occupational therapists
- 0% of students reported that U.S. Army occupational therapists have the opportunity to obtain a PhD for free, specialty pay for board certifications, retention bonuses, a housing and food allowance, or military benefits
Mission Statement: To develop competency in addressing upper extremity deficits amongst the US Army population.
Upper Extremity
- The majority of my clinical time was spent observing and practicing in an upper extremity setting
- The complexity of this setting varies from civilian outpatient hands in that patients often arrive without a diagnosis
- In this setting I performed evaluations, provocative testing, and splinted patients when necessary
- I had the opportunity to shadow an orthopedic hand surgeon who frequently referred patients to OT
Holistic Health and Fitness
- Holistic Health and fitness (H2F) is a human performance optimization setting
- The H2F interdisciplinary team consists of: occupational therapists, physical therapists, dietitians, and sports psychologists
- OTs typically focus on mental and sleep readiness
- I spent about a week of my capstone with H2F OTs across the base and shadowed their classes, evaluations, treatments, and meetings
Behavioral Health
- Army OTs can evaluate and treat in outpatient and inpatient behavioral health settings
- Common conditions resulting in the need for inpatient behavioral health services at this site include depression, anxiety, and stress
- I had the opportunity to spend a few days during my capstone observing inpatient behavioral health OT services and taught two group classes
Project Outcomes
Development of an orthosis manual: An evidence-based step-by-step guide to creating 21 upper extremity orthoses with pictures and links to videos. The manual is primarily a digital tool to allow for sharing
5 CEUs relating to upper extremity diagnoses
Development of two clinical case studies
Formal Presentation to OTD students on OT in the Army with an analytics report for effectiveness
Creation of a lesson plan with accompanying activities
What's Next:
My capstone solidified my desire to pursue a career in Army OT and helped me grow the necessary clinical skills to be successful in this role.
Project Support
Project Leader: Spencer Blankenship, OTDS
Expert Mentor: Jon Farmer, OTR/L
Faculty Mentor: Dr. Jill Linder, DHSc, OTR, CBIS, CSRS
Student may be contacted at blankenships@huntington.edu
References
- About Us. Blanchfield Army Community Hospital. https://blanchfield.tricare.mil/About-Us
- Amaker RJ, Brower KA, & Admire DW. (2008). The role of the upper extremity neuromusculoskeletal evaluator at peace and at war. Journal of Hand Therapy, 21(2), 124–129.
- Borgeson, N. (2021, February 23). Holistic health and fitness: physical and nutritional readiness. U.S. Army. https://www.army.mil/article/243611/holistic_health_and_fitness_achieving_physical_and_nutritional_readiness
- Shore, S. (2016, June 28). Army Times. https://www.armytimes.com/news/your-army/2021/12/17/fort-campbell-soldier-killed-another-injured-while-training/
- Yakobina SC, Yakobina SR, & Harrison-Weaver S. (2008). War, what is it good for? Historical contribution of the military and war to occupational therapy and hand therapy. Journal of Hand Therapy, 21(2), 106–114.
- Woods, Y., & Tennekoon, R. (2018). Evaluating the experience and effectiveness of an occupational therapy–based Sleep Hygiene Program for U.S. Army Service members: A mixed methods study. The American Journal of Occupational Therapy, 72(4_Supplement_1). https://doi.org/10.5014/ajot.2018.72s1-po5047