Jonathan Jones demonstrates his ability to use the pincer motion of fingers to thumb. Two operations and occupational therapy have allowed Jones to increase his hand and arm function since a diving accident left him paralyzed.

Doing whatever's needed." That's how Teresa Foy, OTR/L, therapy manager of the spinal cord injury program at the Shepherd Center in Atlanta sums up the role of the occupational therapist.

"OT is about teaching people skills for living and it's about adaptation," she said. "A patient wants to be able to do something and an occupational therapist will figure out a way to get him there."

Shepherd Center is a catastrophic care hospital specializing in medical treatment and the rehabilitation of patients with spinal cord injuries, paralyzing neurological diseases, acquired brain injury and multiple sclerosis.

About 30 occupational therapists work at Shepherd. Their specialties vary as much as their patients, but a quote hanging in the office near the rehab gym defines their mission. "People who say it cannot be done should not interrupt those who are doing it."

Outside the hospital, Michele Luther-Krug, COTA/L, AP, CDRS, CDI, and Pat Daviou, OTR/L, ATP, CDRS, are about to get into a car with patient Jody Leonard, a street bike stunt rider with the team, Illconduct. Injured in a motorcyle accident, Leonard was paralyzed from the waist down, but is regaining some movement. He wants to relearn to ride a motorcycle, but today's challenge is driving a car.

Driving is a complex skill and other therapists have been working on the building blocks to get Leonard behind the wheel.

Natalie Barnhard, left, applies makeup with the help of occupational therapist Patti Pasch at the Shepherd Center in Atlanta. Barnhard suffered a spinal cord injury when a weight rack fell on her.

"For many patients, this is a last step to independence," Daviou said. "It can mean going back to work and taking back some control over their lives, but some days, I think I'm nuts for doing this."

Both Luther-Krug and Daviou are certified driving-rehabilitation specialists.

"There isn't a diagnosis that we haven't seen. This is one area of practice where I put all my previous skills to work - from physical assessment to psychology," Luther- Krug said.

In vehicles adapted for special needs, the OT must teach the driver how to use the technology, while staying alert to the cues that would signal fatigue, a loss of attention, a flashback or other unsafe condition, and intervene if necessary.

"Every patient has a unique set of circumstances - so the job is never boring," Luther-Krug said.

"Of course, the big payoff is when someone passes and can safely drive again," Daviou added.

Michele Luther-Krug, a certified driving-rehabilitation specialist, helps Jody Leonard get oriented behind the wheel of a car. Leonard, who was paralyzed from the waist down in a motorcycle accident, is being recertified to drive.

Determination
When Jonathan Jones paints a picture, he's not practicing his artistic skills, so much as his ability to use the pincer motion of fingers to thumb. It's a new ability for him.

Confined to a wheelchair since a diving accident in 2003, Jones underwent two tendon transfer operations last year that have increased his hand and arm function.

"There are three muscles used to bend the elbow," said Amy Bohm, OTR/L. "If all are strong, then surgery can attach one from the bicep to the wrist. The patient has to relearn how to bend his elbow and use his hands, since the muscles are attached differently.

"After months of therapy, Jonathan can perform everyday tasks like eating, dressing, grooming and manipulating his wheelchair without adaptive equipment. It's pretty amazing."

Bohm knew she wanted to be an occupational therapist after watching OTs help her mother recover from Guillain-Barré syndrome.

"Specialists told us she'd be paralyzed for life, but she learned to walk again," said Bohm, who later went on to specialize in spinal cord injuries and coach quad-rugby. "I love seeing people get back to a level of function and a quality of life where they can even play sports."

Jones plans to return to Georgia State University in the fall to pursue a degree in psychology and become a rehab counselor. He's nervous about going back to college, but not because of his disability - thanks to Leah Barid, OTR/L, who recently took some patients to tour Georgia State.

"We visited the disability service offices, ate in the cafeteria, checked out ramps and elevators and practiced riding MARTA," Barid said. "Planning takes some of the anxiety out of going back to school or work."

Innovation
In the assistive technology department, Ruth Fierman, OTR/L, is helping 11th-grader Ashley Gambino learn how to use a voice-activated computer. Gambino is in a wheelchair and uses a ventilator for breathing support. But like most teens, she's in a hurry to get to the Internet.

She's learning to speak slowly and to wait for the machine to respond. Last week, she ordered a pair of pink tennis shoes online. Sending e-mail to friends and researching school projects is where she's headed.

In her 23 years at Shepherd Center, Fierman has seen the technology change constantly, but one tool has remained consistent.

"I think OTs use themselves as a therapy tool to engage and encourage a patient to move to the next level," Fierman said. "Some patients are afraid of the technology, but when they learn they can read a newspaper online, do their own banking or order a pair of shoes - that's motivation."

She also teaches the use of environmental control units that turn on a light, fan or radio, allowing a patient to control their surroundings and regain some independence.

Therese Mastangelo works with Alishia Eaken as she makes a sandwich. Eaken, who suffered multiple physical injuries and brain trauma in a car accident, is relearning activities of daily living.

Creativity
"Patti Pasch doesn't know the word 'no,' " Foy said. "You've heard the story about giving a man a fish and feeding him for a day, or teaching him to fish so that he can feed himself for life. Patti's taught us all how to fish."

Natalie Barnhard, a physical therapy assistant and massage therapist, suffered a spinal cord injury when a weight rack fell on her. To help her apply makeup, Pasch uses plastic splinting material and Velcro to make a stand for the makeup, puts easy-tograsp Velcro around brushes, and some shelf liner underneath everything to prevent skidding.

"You have to be a creative problem solver in this job," said Patti Pasch, OTR/L. "There's often nothing commercially available to help your patient do what they want to do, so you make it."

A Pasch-designed pronged tool made from a coated paperclip and plastic tube allows Barnhard to operate a portable CD player.

Pasch uses a dog provided by Cosby's Therapy Animals Inc. to make therapy more enjoyable. By brushing the dog for two minutes and working up to five minutes, Barnhard uses extended hand and arm movements and grows stronger.

"I've seen OT in a different way since I've been here," Barnhard said. "I've seen how much it helps."

She proudly lists her accomplishments in the last two months: learning to sit balanced, feeding herself, brushing her teeth, putting on makeup, using a cell phone, turning a page and signing her name.

"My goal is to be as independent as possible. My therapists push me, but that's what you need. I've seen how much it really helps," Barnhard said.

Success
A car accident left Alishia Eaken with multiple physical injuries and brain trauma, but thanks to therapy, a foundation grant and the Shepherd Pathway's community-based rehab program, she's living in an apartment with her father and son and is taking back her life.

"Patients with brain injuries participate in various kinds of rehab therapy for three hours a day to regain physical and cognitive skills," said Genia Herbst, OTR/L, who works in the acquired brain injury unit and Shepherd Pathways program. "They have to relearn the basic activities of daily living - how to shower, remembering to rinse after shampooing and the sequence of things - [like] socks before shoes. Safety is the biggest part of everything we do."

Patients graduate to working on instrumental activities of daily living, the skills that will help them manage their home and community life.

"My therapists are awesome," Eaken said. "When they started working with me, I couldn't talk or move my left leg. Now I'm talking, walking and practicing habits that will help me live better."

Wanting to take care of her 4-yearold son, Cody, has been Eaken's most powerful motivator. She's learned hemiphagia (one-handed) dressing techniques and how to cook by working with Therese Mastangelo, OTR/L.

"These people have made tons of stuff possible that I didn't believe was possible," Eakens said. "And I can't tell you how many times I've heard words of encouragement, like 'good job' or 'you're doing so much better.' "

"Seeing all the progress along the way and their final discharge is the greatest satisfaction of this job," Mastangelo said.

Behind all the function therapy is the goal of a person take responsibility for their lives again.

"To see them regain their roles in society, to be a wife or mother, go back to school or to work - that's the biggest reward," Herbst said.