From patient to practitioner: impacting lives through occupational therapy

While she received high-quality care, it was not geared toward kids or their families.  

“My therapy looked very much like a younger version of adult therapy,” said Cardin, associate professor of occupational therapy at Missouri State University. “I loved my therapists, but my therapy wasn’t fun.” 

Her parents also lacked the information and guidance to help her at home. This caused them to see her as fragile, afraid of what she could and could not do.  

“They didn’t have that person or coach who came alongside them and said, ‘It’s OK she does cartwheels or push-ups or goes across the monkey bars. Her movements are going to look a little bit different. Here’s how we protect her body. Here’s how we adapt,’” Cardin said.  

Their collective experiences — both positive and negative — led her to pursue a career in health care, as a pediatric occupational therapist (OT).   

From hospital to university

For over two decades, Cardin has worked in the Neonatal Intensive Care Unit (NICU) at Mercy Hospital in Springfield. She is a board-certified pediatric OT by the American Occupational Therapy Association and a certified neonatal therapist by the Neonatal Therapy National Certification Board. 

“I knew I wanted to be in a position where I could help parents be less anxious.” 

“And in the NICU, parents are so fearful. It’s an alien world,” Cardin said.

In 2013, while working at Mercy and pursuing her Doctor of Occupational Therapy at St. Catherine University, she got a call that would lead her to academia. A friend told her MSU was starting an occupational therapy program and asked if she had interest in a faculty position.  

Cardin notes it was nowhere on her radar. But she applied, and the rest is history. She has been a faculty member since 2014, helping get the program off the ground and growing it.  

Understanding occupations

In her role as professor, Cardin’s research focuses on exploring how people’s daily occupations influence their health and well-being. These occupations are the meaningful daily activities people need to do, want to do or must do that occupy their time. When they cannot engage in these activities, it affects their health and quality of life. 

“I study those extraordinarily ordinary moments people may not think about on a day-to-day basis until they can’t do them or they’re kept from doing them due to a barrier.”

Barriers may be caused by things like traumatic accidents, diseases and developmental delays.  

Cardin dives deeper into two areas that affect different populations: 

• Occupational deprivation – refers to people being restricted from participating in necessary or meaningful activities for reasons beyond their control.   

• Occupational injustice – occurs when people are denied the right to engage in activities that are important to their health and well-being.  

Cardin has published papers in several peer-reviewed health-related journals.  

Immersed in the hi-tech NICU

The main populations she works with are babies in the NICU and their families. This is a complex environment, where “parenting is so disrupted and parents share responsibilities with strangers,” Cardin notes. 

Two of her most recent studies focused on feeding — the primary occupation of NICU babies and parents.  

“Feeding is huge,” Cardin said. “A baby’s ability to eat what he or she needs and grow in an appropriate way is the ticket to get out of the NICU.” 

She adds that feeding in the NICU is a type of co-occupation. It is the mutually beneficial dance between the baby and parent. Both enjoy the experience and end up leaving the feeding situation feeling empowered. 

Cardin and her team, which included her occupational therapy students, conducted the research over five years. Both studies were published in the Journal of Neonatal Nursing in 2023.  

The first was a quantitative study involving 150 infants. It examined how several factors affect length of stay (LOS) and time to full oral feeding (TTFF). 

Results showed: 

• LOS and TTFF were directly correlated. 

• Factors that influenced LOS and TTFF included: gestational age, birthweight, type of respiratory support, number of breastfeeding episodes, number of feedings offered by either professionals or family and number of distinct caregivers. 

To ensure shorter LOS and TTFF, the study suggests professionals should understand how other medical conditions affect infant feeding progression. They should also help families stay engaged and keep consistent caregivers and feeding routines. 

The second qualitative study focused on feeding complexity and culture in the NICU. Researchers asked 13 professionals who fed babies in the NICU for their views. 

It involved four focus groups. Paige Conner, one of Cardin’s graduate students, helped to conduct some of them.  

“We dove deeper into their perspectives of roles, NICU culture, infant feeding enablers and barriers, and successful infant feeding,” Conner said. 

From the interviews, three activity-focused feeding themes emerged: doing, doing with others, and doing for others. 

Factors that promoted feeding success were: 

• Familiarity with the infant and family. 

• Self-efficacy (competence and confidence). 

• Specialized and continuing education. 

• Effective and collaborative communication. 

• Sustained relationship-based interactions. 

According to Cardin, this effort filled a gap in existing research. Before this, there was not much that identified the perspectives of NICU professionals who helped with feeding. 

Conner believes Cardin’s NICU-related endeavors are life changing.  

“Her findings and ideas have strengthened NICU infant care, including the collaboration between health professionals and families,” Conner said.  

Serving the private Amish community

About 18 years ago, Cardin’s work in the NICU connected her with families of the local Old Order Amish community.  

“The NICU’s a very difficult place to be for any non-Amish family, but for the Amish, that chasm is huge,” she said. “They live like it’s the 1850s and the NICU operates like it’s 2050. How do you find the middle ground between 200 years of differences? My heart broke for them, and I wanted to be a voice if they needed that.” 

Over the years, Cardin has built trust with the Amish community in Seymour, Missouri. She provides pro bono therapy services in families’ homes in the Amish Community.  

She and her students have also worked on different research projects that revolve around the Amish.  

“We want to ensure these Amish children are meeting their developmental milestones,” Cardin said.

“We also want to give their families the knowledge they need to maximize their children’s development.” 

One such effort is a partnership with a researcher at Rutgers University to create a functional reading, writing and mathematics assessment for school-aged Amish children.  

Additionally, an occupation-based health care adult assessment called the PLAIN Assessment is in the works. It stands for Promoting Life-Balance After Identification of Needs. Plain is also a term the Amish use to refer to themselves and others who live simple lives.  

The PLAIN Assessment would be useful in the primary care setting. Amish patients would use it and answer a questionnaire about their health, including issues that may affect their daily occupations.  

Cardin and her team have piloted the assessment twice. They will conduct validity testing in 2024.  

“There are several medical clinics in our area that treat Amish patients,” Cardin said. “The goal is to give them a culturally sensitive tool to capture their needs differently than the ones traditionally used in non-Amish clinics.”

In working with Amish and NICU families who face occupational deprivation or injustice, Cardin’s goal is simple. She wants to serve them and help them advocate for their children. 

“As an OT, I can better contribute to my client’s healing and wellness if I can set families up to be their own agents of change,” Cardin said. “When medical professionals partner with families versus prescribing or dictating to them a plan of care, the impact is immeasurable.”