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Living for the OT Moment

10/18/2016

As a child, Todd Levy, MSOT ’02, OTR/L, CBIST, wanted to be a veterinarian.

“It’s rarely a straightforward path to occupational therapy,” he laughs. “My mother taught kindergarten for 30 years and from time to time, I would help her in the classroom. That had a lot to do with shifting my interest in healing and rehabilitation from animals to humans to eventually pediatrics.”

“At the time, I was interested in child psychology, neuroscience and physical therapy. I was able to do an independent study with Dr. Amli, and working in his lab gave me an opportunity to explore all my interests,” Levy remembers. “When I finished my bachelor’s degree in psychology a year early, I wanted to stay on campus. It was ‘the decade of the brain’ and exciting things were happening at WashU.”

Levy continued on in Amli’s lab as a research assistant for the next two years, working on animal models of neonatal hypoxia ischemia. He studied the injury’s effect on learning, memory and behavior, and explored neuroprotective agents to mitigate those effects. There, Levy met the OT faculty and students and learned about the profession in addition to behavioral neuroscience.

“Because I had such a variety of interests, I realized becoming a clinical practitioner would allow me to apply my skills to help people directly and still keep a foot in neuroscience research,” says Levy, who eventually applied to the master’s degree program. “As an OT student, my research shifted to studying environmental enrichment using an animal model. Dr. Amli served as my mentor, and taught me to approach problems objectively and creatively. He helped me evaluate work critically, including my own. It’s difficult to imagine my life and career without his influence. To this day, we still keep in touch on both a professional and personal level.”

Upon graduation, Levy accepted a position at The Children’s Hospital of Philadelphia (CHOP) as a pediatric OT. For more than a decade, Levy has focused his practice on brain injury, neurological rehabilitation and hand therapy. Like many clinicians, Levy lives for the “OT moment.”

“Something simple, like showing a family how to apply a functional split that allows a child to open a hand to grasp a ball, can create that moment. Seeing their faces light up because they didn’t know it was possible makes it so rewarding for me,” shares Levy, who truly enjoys working with children. “I’m constantly amazed and inspired how kids see the world when they’re sick or going through some kind of extraordinary difficult life event. They see the magic and wonder in little things and it makes even the most challenging day lighter and enjoyable. I get to act silly and revel in these moments of levity on a daily basis.”

A definite highlight of Levy’s career is the case of eight-year-old Zion Harvey, who became the world’s first pediatric double hand recipient in 2015. Following a case of sepsis as a toddler, Harvey’s hands and legs were amputated. Two years later, he received a kidney transplant from his mother. Like other children and adults who have lost extremities, Harvey tried prosthetics. While he did great with lower extremity prosthetics, Harvey wasn’t satisfied with the upper extremity prosthetics and abandoned them. His family took him to Shriner’s Hospitals for Children in Philadelphia where Chief of Staff Scott Kozin, MD, was struck by Harvey’s personality. “There were many factors that made Zion the ideal candidate. Besides his personality, he was already taking immunosuppressive agents for the kidney transplant, and such medications are necessary to prevent rejection of new limbs,” explains Levy. “He also had the incredible support of his mother, Pattie.”

Harvey’s surgical team included a variety of professionals from CHOP, the University of Pennsylvania and Shriner’s Hospital. L. Scott Levin, MD, chairman of the Department of Orthopedic Surgery and professor of surgery (Division of Plastic Surgery) at Penn Medicine, and director of the Hand Transplantation Program at CHOP, led the 40-member multidisciplinary team through the 10-hour operation. Just six days following surgery, Levy and his OT colleagues were there to remove Harvey’s dressings and begin the therapy process.

“I must admit I was pretty nervous,” Levy remembers. “As we removed the bandages, Zion looked up at us and said, ‘So… you guys want to play a game or something?’ I smiled, breathed a sigh of relief and replied, ‘Yes, yes we do!’ That is very typical of Zion – when the clinical situation is intense and challenging, he knows how to bring a smile to your face.”

The rehab team consisted of four primary occupational therapists – Levy, Deborah Humpl, OTR/L, Michelle Hsia, MS, OTR/L, and Kelly Ferry, MOTR/L – who spent countless hours with Harvey during the two months he was hospitalized.

“There were constant assessments of skin, edema, range of motion and Zion’s adjustment to his hands. We evaluated his progress and changed our treatment plan and rehab strategies as he progressed. The goal was for Zion to use the donor hands as if they were his own. We used both biomechanical and neurological approaches, but it was important to use some occupational strategies as well. This allowed Zion to engage in activities and so he felt some success as he was going through the more remedial rehab process,” says Levy.

In addition to providing therapy, the OT team was the eyes and ears of the larger surgical and medical team. Every day, the OTs met with them early in the morning and late in the evening to update the surgeons and the transplant doctors on Harvey’s progress. They also shared pictures and videos documenting his achievements. Benjamin Chang, MD, co-director of the Hand Transplant Program and attending surgeon in CHOP’s Division of Plastic and Reconstructive Surgery, was one of the minds behind the surgery. He worked closely with the OT team throughout the process of rehabilitation.

Following hospitalization, Harvey transitioned to a day program closer to home at The Kennedy Krieger Institute and continued to make excellent progress with his therapists. Eventually, Harvey transitioned to outpatient care so he could return to school. The CHOP surgical and rehab teams continue to follow up with him on a regular basis to track his progress. “We are working with the neurologists at CHOP to correlate his functional recovery with cortical reorganization and to use neural imaging to help guide therapy. We continue to see improvement in the way he uses his hands. Just the other day, he swung a metal baseball bat to hit a line drive across our gym. Zion can also catch and throw a ball, which was one of his goals. He’s less dependent on others for self-care and he’s writing with one hand.”

Looking to the future, Levy is hopeful that research and technology to improve the sense of touch and sense of position of injured limbs, artificial limbs and transplanted limbs will revolutionize rehabilitation for children like Harvey, and for children with hemiparesis. “I work with many patients who can’t sense the position of an extremity. Without sensation, the brain doesn’t develop a full body schema. Such an altered body schema seems to limit a child’s intrinsic motivation to use the affected hand.”

Levy’s advice for those considering the OT profession is rooted in his own path toward it. “Our field is so diverse, it’s important to pursue your own unique interests and experiences to shape your career and practice. Neuroscience, engineering, fitness, whatever interests you – use that as an occupational therapy tool. Surround yourself with mentors from within the field and outside the field. Study cognition, work with neuropsychologists, physical therapists, speech-language pathologists and other health-care professionals because you are going to learn a lot from them,” says Levy. “Being a part of a multidisciplinary health-care team is becoming commonplace for OTs, so understanding what the other professions bring to the table only enables everyone to give the best care possible to the client and their family.”

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