Bilingual Practice, International Perspectives on OT, OT & Communication

Developing Bilingual Advanced Clinical Practice Skills & Building International Communication on Neurorehabilitation Practice

Student name: Madeleine Donovan
Name of Mentors: Sra. María de la Carrera Lantaron, Dra. Elisabet Huertas-Hoyas & Dr. Parul Bakhshi
School: Washington University School of Medicine
Setting and location: Polibea Centro de Rehabilitación Daño Cerebral & Universidad Rey Juan Carlos; Madrid, Spain
Virtual / In-person / Hybrid: In-person


  • Broadly: To facilitate our understanding of occupational therapy on an international front – to put our perceptions of OT culture as American occupational therapists into perspective, as our field is growing across the globe, and within our own diverse country.
  • Personally: To build a skillset in preparation to work in neurorehabilitation on an international level, with a life-long dedication to self-evaluation and critical appraisal of my role as an occupational therapist in different contexts.


  • Worked as occupational therapist, as part of which completed 4 case studies focused on individuals with significant communication deficits
  • Interviewed representatives with multiple perspectives on the role and scope of healthcare, neurorehabilitation, and occupational therapy within Spain
  • Presented on the role and scope of OT in the United States to graduating OT students, held informal charlas with students and educators
  • Aided in preparing and translating a research article for URJC investigation team

Dissemination for Understanding:

  • The current limitations and future opportunities given the relatively isolated post of occupational therapists in the United States, as well as the extent to which the English language limits us in that our words shape who we are and what we do as a profession

  • The limitations of a private healthcare system – in particular, the potential for humanization of each individual when documentation is not at the forefront

  • The unethical and dangerous system under which knowledge is currently shared, such as with article publication and conferences – will good research be published? Or just research with money behind it? Will international conferences really include multiple perspectives? Or just perspectives of those who can afford to go?

Dissemination for Awareness

  • The potential role of occupational therapy in helping individuals with communication disorders. I am beginning to build a model with researchers of aphasia.

Ideas for next steps to build on this topic:
I hesitate to aim for sustainability regarding this capstone, as any international capstone project is not for one to go in and solve problems. It’s to be curious and to learn, and to do whatever needs to be done. Rather than continue my work, I would encourage future capstone students to engage in critical evaluation of our profession, to step outside traditional practice settings (which doesn’t necessitate leaving the country), and bring back different perspectives to help us grow.

2-3 tips for students undertaking a similar project:

  • You’ll go through a lot of planning before capstone begins. However, it was vital for me to be flexible, listen, and adjust to the priorities of my mentors and site, and adapt my capstone and project accordingly. Opportunities arose that I simply could not have predicted. Focus on the personal reflection part of any capstone prep course – the skills you want to develop, the population you want to work with, the sense of purpose you hope to feel, the help you hope to offer. Then go in recognizing that your plans will change.
  • Engage in comparison of healthcare systems - the numbers do not back our privatized system. I find The World Bank, World Health Organization, the Organization for Economic Cooperation and Development, and this overview helpful:

Deliverables: Eng - MCD Capstone

First off, @madeleine1 I loved your reflections on your website- and it was so well structured!

I’m so glad you called out the inequitable sharing of information. That is something I think about a lot. I stumbled on this issue myself, when I first launched the Club, it was was at a super low price point (because I didn’t have much info in here yet) but I had a large international adoption- and still have therapists from 41 countries! But, as I’ve raised the price due to offering CEUs, my international adoption has shrunk.

Right now, I am thinking of a way to return to offering a lower price point for countries that don’t require CEUs (which is actually most countries). I feel like there is a appetite around the globe for best practice information- but it needs to be offered at a realistic price?

Do you think I am on the right track? (I know this isn’t exactly what you were thinking through with your capstone, but I think we are seeing the same problem from different angles? :slight_smile: )

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Thank you so much! Yes, it is still a work in progress, but I am proud of that - these endeavors are life-long, and I plan to continue adding to it over the years.

I am not at all surprised to hear that most countries don’t require CEUs - I did not come across them in Spain, nor in my discussions with other occupational therapists from multiple countries.

I think that the lower price point for countries that don’t require CEUs is a good balance. The system in place require you to pay up front for these CEUs, and that must be accounted for. But I agree, the limited international access is a great loss in opportunity.

I would even encourage you to consider putting that membership fee (non-CEU), as the “standard,” or “normal,” fare, and to make it clear when individuals sign up that the United States is in the minority in requiring this additional expense. That way, perhaps we can begin to spread awareness of different approaches to the profession’s growth.

Would there be an option to choose a membership without access to CEUs, even if the individual is from a country that requires them? Perhaps, for example, their workplace already covers these (I’m not sure how common this is), and they need not spend more to access the other resources on your site?

I hope this helps, and this absolutely relates to my capstone! I’m all for open dialogue, that is the first step to seeing change!

I’ve been thinking about this for so long, so we finally just made the change yesterday. We only half accomplished your idea… but I like the fact that our lowest tier (The Club) feels like the foundational membership. It does still make the CEU option the most prominent…

How does the change hit you?

I think that looks good. I especially like that you highlighted “Perfect for Students or Professionals who don’t need CEU certificates.” If you find that “Most Popular” isn’t necessary, then I would remove that part. Or, another slight adjustment I would make is to make all 3 columns equal in size.

No matter what you choose to do or not do, it is already wonderful that you have these options!

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Oh, thank you for looking at this with me! I agree on the “most popular” especially because I can see our lowest tier becoming our most popular! @mitchell-lyon, I want to make sure you see this exchange!

Thank you again, @madeleine1! You gave me a needed push!