Mary Ferraro, PhD, OTR/L, is a long-time employee at MossRehab who has served 35 years at the Drucker Brain Injury Center in various roles. Starting as a clinical therapist, she moved into teaching after earning her PhD in educational psychology. Today, she splits her time between MossRehab and Moss Rehabilitation Research Institute (MRRI) in education and research roles focused on traumatic brain injury.
We talked to Dr. Ferraro about her background, different roles, and the development of a new protocol in treating patients with post-traumatic amnesia.
What Is Your Background?
I earned my bachelor’s degree in occupational therapy at the State University of New York (SUNY) Downstate Medical Center after some undergraduate work at Tufts University. I started working for MossRehab at the Philadelphia campus, first as a clinical occupational therapist (OT) and then as a supervisor on the inpatient brain injury unit.
When I came to MossRehab, I wanted to pursue research and teaching. So, I attended Temple University where I attained my doctorate in educational psychology. I now serve as educator coordinator across the brain injury center and contribute to hospital-wide education. I have participated in research and clinical projects with MRRI including the naturalistic action analysis, classification of hemispatial neglect subtypes, and rehabilitation treatment specification to enhance therapeutic interventions. My recent work focuses on a new protocol to improve care for patients in a state of post-traumatic amnesia (PTA).
What Roles Do You Serve at MossRehab?
I’ve worked at MossRehab for 35 years. I currently hold a dual roles as a researcher at MRRI and an educator in occupational therapy at MossRehab. I serve in a variety of leadership, research, and direct service positions. These include:
Education Coordinator for the Drucker Brain Injury Center
In this role, I support the ongoing education of occupational, physical and speech therapists, nurses, and other clinicians on the topic of brain injury. We aim to keep staff current on evidence-based resources for best practices in brain injury rehabilitation. A workgroup in this committee generated the idea of developing a protocol of better practices for patients with traumatic brain injuries who are in a state of PTA.
Coordinator of MossRehab Occupational Therapy Fellowship Program
As coordinator, I developed and implement the curriculum for this advanced therapy practice training program for occupational therapists. This one-year program offers clinical and didactic experiences for a deeper understanding of treating adults in physical rehabilitation. Every July, we select two OTs for the fellowship program. Working alongside MossRehab clinicians in several clinical rotations, they learn about inpatient and outpatient therapy for adults with many diagnoses such as traumatic brain injury, stroke, amputation, spinal cord injury, etc. The program is just five years old, but we had to take this year off due to COVID.
Coordinator of Career Development Committee
The therapy staff is organized using a clinical ladder, with advancing roles and responsibilities over time. With experience and education, some therapists seek a higher clinical ladder level to serve as a resource/expert in a specific area. The Career Development Committee helps those therapists create plans to advance their practice and become experts in identified areas. The Career Development Committee is just one of several resources for clinicians to advance their practice on the clinical Ladder.
Clinical Knowledge Translation and Communication Coordinator for the MossRehab TBI Model System
The Drucker Brain Injury Center at MossRehab has held a designation as a Traumatic Brain Injury Model System (TBIMS) for almost 25 years. We are one of 16 institutions across the country that are model systems. Amanda Rabinowitz, PhD, and Thomas Watanabe, MD, direct the TBIMS that conducts research studies and provides a continuum of care for patients treated at MossRehab for traumatic brain injury. My role supports communication with research participants through bi-annual newsletters and consumer conferences (every five years). I also interact with clinicians to ensure best practices from rehabilitation therapies.
Why Stay at MossRehab for 35 Years?
I think that MossRehab is a very unique place where research and clinical practice are very much supported. I’m also inspired by my colleagues at all different levels regarding their interest and ability to dive deep into problems to help patients with an injury or disability.
What is the New Protocol Developed for Patients with PTA?
In my role as an educational coordinator on the brain injury unit, I address clinical practice issues. During a workgroup session with interdisciplinary team leaders, we talked about the most challenging patients and how we could serve them better. Patients with memory problems were identified as needing more consistent interaction from different caregivers for a better experience.
To give some background, patients in a state of PTA have a hard time communicating as they can’t draw on memories. During rehabilitation, the care team asks a lot of questions for various reasons that can confuse and agitate patients as they can’t provide ready answers. It helps to have the team be consistent when working with this group of patients. Instead of quizzing patients, staff should provide information in a supportive way (Introduce themselves each time instead of asking “Do you remember me?”).
Once we identified the clinical problem, the workgroup connected with the MossRehab TBI Model System researchers at MRRI to help us find a better way to serve patients with PTA using a unified approach. That’s how we developed the PTA protocol.
The primary mission of the PTA protocol is not to challenge patients as they can’t pull information from their explicit memory to answer questions. We don't want to keep taxing these patients on something they can't recall, which breaks down communications and causes frustration for all parties. Instead of asking them to recall information from the past, questions are posed in the “here and now”.
Once finalizing the protocol, we published training materials in the Fall to educate staff on the challenges with patients with PTA and train them in new methods of engagement. We also created a “do's and don'ts” video. The success of the project depended on clinicians’ understanding and their consistency in implementing new practices to improve patient care. Once alerted that a patient is in PTA, the care team now knows they must treat them differently. Following the protocol, clinicians take a more deliberate approach to their interactions. They not only limit questions but pose them in the present tense (“how do you feel right now?” instead of “how did you sleep last night?”). Working together, the healthcare team maintains a more unified approach to patient treatment following the same care protocols.
After training clinicians, we did a study tracking the questions and the interactions with patients. We found that clinicians asked fewer questions. That’s a real success because it shows that clinicians changed their behavior for better interaction with these patients.
What inspires you?
I've learned a lot from patients over the years. They have taught me about life and priorities.
What is your life motto?
Right now, I think my life motto would be to pick your battles and figure out what is the priority for someone to participate in life and what they want to do.
Learn more about Dr. Ferraro's work with the MossRehab PTA protocol.