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Assistive Devices

Life of a Rural OT

Two overflowing bags that look like something Santa Claus might carry, sit just inside the door of her home. They hold inflatable splints, bolsters, balloons and bubbles. Toys to her clients, these are the carefully chosen tools of her trade. As a rural pediatric therapist, Nancy is a modern day circuit rider.

During Susan's fieldwork, she and Nancy would pick up the bags and head out the door at 7:30 a.m. First they drove to a rural school where Nancy gave six children therapy.

Two hours later, they drove to a home 90 miles away to treat a 6 month-old infant with spina bifida. The floor is littered with bits of peanuts, pretzels and crackers. Nancy spreads a blanket on the floor and hands Susan a toy to use in checking the infant's visual tracking skills. Nancy picks up tiny Theresa and begins to gently roll and relax her over a ball. Meanwhile three brothers, all under the age of seven, enjoy going through Nancy's toy bag. She massages the baby's feet to increase circulation while keeping an easy dialog going with the baby's mother.

Mom expresses her frustration with the two-hour drives to the doctor appointments in St. Louis. Nancy offers to leave the therapy ball and printed instructions so that mom can work with her baby between visits. The father declines stating that the ball might be ruined. Nancy leaves the family a bag of clean baby clothes she had purchased at a garage sale and sets the next appointment for a month from now. Lack of transportation and low or unstable incomes are a reality for some of Nancy's rural clients.

Back on the road, Nancy questions Susan about the case, not to test her for right answers, but to generate ideas. She stresses that problem solving is an important strength for therapists. Rarely will a child mirror the situations found in textbooks.

Back at the farm that evening, Nancy explains how she does her billing. She is reimbursed by the Department of Mental Health, a not-for-profit Home Health Care Agency, local school districts, the Bureau of Special Health Care Needs, and Medicaid. Each has their own policies and paperwork.

Nancy uses a photocopier, a computer with fax and CD-ROM in her home to keep up. The computer allows her to take advantage of a Managed Care Course offered on line from her professional organization. Susan sees first hand how a rural therapist stays up-to-date through journals, conferences, and technology with the wider professional community.