Occupational Therapy Association of Hawaii

Upcoming Events
Updated:07/01/2010

Teepa Snow, MS, OTR/L, FAOTA

Teepa is an occupational therapist currently working as a dementia care and dementia education specialist. She has an independent practice. She has clinical appointments with Duke University's School of Nursing and UNC-Chapel Hill's School of Medicine. She provides educational and training sessions to organizations and providers throughout the US. She also lectures for gerontology and health professional programs at colleges and universities across the country. She provides training and education for Alzheimer's Association and Alzheimer Society conferences, state health care provider organizations, professional association meetings, and caregiver programs and organizations. She works closely with several assisted living and retirement communities, hospice and day service programs, & dementia specialty service providers throughout the US to improve and optimize programs and services to people with dementia and their families.

Teepa has over 28 years of experience in geriatrics. Previously, she served as the education director and lead trainer for the Eastern NC Chapter of the Alzheimer's Association. She has also been a program director and an instructor for community college and a clinical associate professor at UNC's School of Medicine, Program on Aging. She has a strong and varied clinical background. She was the OT director in a head injury facility, a clinical specialist in geriatrics at a Veteran's Administration Medical Center and has worked as a restorative care coordinator for long term care facilities, as well as providing direct care in community, home health, long term care, assisted living, and rehabilitation settings. She has worked collaboratively to conduct clinical research in a variety of settings and on a variety of geriatric topics.

Teepa was born in West Virginia and raised in West Virginia and Pennsylvania. She attended Duke University as an undergraduate and graduated with a major in zoology. She then received her MS degree from the University of North Carolina in Chapel Hill in Occupational Therapy. Since that time she has lived in central North Carolina.

Teepa is a Fellow of the American Occupational Therapy Association, has received local, statewide, and national recognition for her expertise in geriatrics, dementia care and programming, and staff training. She has developed two training videos, published many articles, and presents locally, regionally, and nationally on a variety of topics and to a wide variety of audiences. This past year she has presented over 350 programs. She has received awards for her clinical and teaching skills from a wide variety of organizations.

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Gordon Muir Giles, PhD OTR/L FAOTA
Samuel Merritt University, San Francisco, CA., USA school of Medicine.,

" A Neurofunctional Approach To Rehabilitation of Functional and Behavioral Disregulation Following Traumatic Brain Injury"

About The Neurofunctional Approach

This workshop outlines the principles of the Neurofunctional Approach (NFA) to rehabilitation after traumatic brain injury (TBI). The NFA is the only approach that has been demonstrated in a large multi-site randomized controlled trial (RCT) to be as effective as a major form of cognitive rehabilitation. Further the NFA has been shown to be superior to cognitive intervention in working with persons over 35 who have independent living goals. Further the NFA has been described as the only rehabilitative approach that has been demonstrated to be effective in persons who are over 10 years post TBI. Occupational therapists who want to provide evidence-based approaches after TBI may wish to be familiar with the NFA, its target population, and clinical applications.

Prior to the recent findings cognitive interventions have been preferred to functional interventions for individuals following TBI based on the theoretical relationship between cognition and function. It was believed that if the individual's cognitive deficits could be successfully addressed then the functional deficits would be reduced or eliminated (i.e., a top-down approach). Functional approaches to rehabilitation have been considered inferior because they addressed only the consequences of the hypothetically more fundamental cognitive problems. In contradistinction to this cognitive approach, the NFA focuses on "learning by doing." In the NFA this "doing" is structured to develop internalized performance models intended to automatically guide future performance. Practice of the actual task in a prescribed format reduces the executive demands of the activity. When individuals have impaired decision-making skills one approach to improving independence is to reduce the domain in which decisions are made. Practiced tasks are expected to improve, and as the individual develops competencies there may be effects on his or her goal-states and self-esteem that will further enhance performance (i.e., a bottom-up approach). A randomized controlled trial (RCT) reported by Vanderploeg and co-workers (2008) is the first to show that an occupational therapy approach modeled on the neurofunctional approach of Giles and Clark-Wilson (1993) is as effective as an established form of cognitive rehabilitation when added to standard care in assisting individuals with TBI achieve return to work/school or independent living. Additionally the RCT showed that each intervention offered significant advantages for a specific sub-population. Building on the findings of this RCT, and other recent studies supporting the NFA, the workshop will review the evidence base and describe the theoretical principles and practical application of the NFA so as to allow therapists to apply its tenets immediately to improve client outcomes.

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