CBIST Spotlight: Todd Levy

Todd Levy, M.S., OTR/L, CBIST, is a Clinical Specialist in Occupational Therapy at the Children’s Hospital of Philadelphia (CHOP) where his efforts include direct clinical care, clinical quality improvement, research investigation, program development, and knowledge translation. Mr. Levy is the founder and program coordinator of CHOP’s Bimanual Therapy Program for pediatric hemiparesis and primary occupational therapist for CHOP’s Pediatric Stroke Program. Mr. Levy is a member of the Hand Transplantation Program at CHOP where he is involved in numerous endeavors to study the outcomes of the first pediatric bilateral hand transplantation and to develop methods to maximize and measure functional and psychosocial outcomes of hand transplantation. He contributed to the development of the Healthy Weight Program and concussion rehabilitation services at CHOP. In 2018, Mr. Levy founded the Pediatric Stroke Task Force under the American Congress of Rehabilitation Medicine (ACRM) and currently co-chairs the task force. He also serves on the ACRM Conference Planning Committee, the BI-SIG Pediatric & Adolescent Task Force, and the Pediatric Networking Group. Mr. Levy is a founding member and Vice-Chairman of the International Pediatric Stroke Organization’s Education Committee. His interests include pediatric stroke and traumatic brain injury, hand therapy, and improving patient-caregiver engagement in the healthcare process.

Mr. Levy has worked with children with brain injuries and their caregivers from acute care, to inpatient rehabilitation, to outpatient and school settings. He began his career at Washington University in St. Louis studying the effects of neonatal hypoxic-ischemic brain injury, neuroprotective agents, and environmental enrichment on neurodevelopmental outcomes. Mr. Levy has been involved in brain injury education and prevention endeavors through the Brain Injury Association of America. He served on the Board of Governors of the Academy of Certified Brain Injury Specialists and continues to serve on the Advanced Practice Committee of the Association.

What inspired you to specialize in pediatrics as an OT?

My childhood dream of becoming a veterinarian evolved into working with children as I began to appreciate my mother’s role as a kindergarten teacher. I was surrounded by a family who valued children. Undergraduate classes in developmental psychology and biopsychology cemented my academic interest in the developing brain.  While working in Dr. C. Robert Almli’s Developmental Neuropsychobiology Lab at Washington University School of Medicine I was influenced by a diverse group of students, clinicians, and researchers studying neuroscience, occupational therapy, neuropsychology, and developmental psychology. There were many people and experiences along the way that led me to focus on a field that would allow me to spend most of my time helping children to realize their goals. Working with children is simply fun!

What has changed in the field of neuro-pediatrics since you have been practicing?

Everything and nothing. About 6 years ago I had the privilege of serving on a team that completed the first successful bilateral hand transplantation in a child. I had not dreamed of this 20 years ago as a new therapist. I was involved in assessing how the child’s skills and brain changed in response to his hands and his therapeutic interventions. We compared used data from skill-based assessments, patient-and parent-reported outcome measures, and functional brain imaging.  That said,  over the past decade, the research brought me back around to basic OT theory. Now, we know that therapies centered around engaging children in meaningful activity, self-problem-solving, and skill-based training result in greater benefit as compared to interventions focused on the impairment level. The more obvious technological advances in things like prosthetics and brain priming certainly keep me on the edge of my seat, but good old-fashioned goal-oriented therapy grounded in principles of motor learning is imperative. I think the relatively new focus on brain injury as a chronic condition is also very important and we have a long way to go towards improving the transition of children with brain injury into their adulthood. 

What impact has COVID played in the field of neuro-pediatrics?

Pediatric brain injury specialists often talk about important experiences and milestones children miss out on due to their injury. I’m afraid for children of the pandemic who missed educational and social experiences during lockdowns. I think the impact of the pandemic on children with disabilities was especially bad. Many of them missed specialized educational and therapy services. Sometimes, when working with infants I think about how masks might be impacting their opportunities to learn facial expressions and develop social skills with an extended community.  There were some silver linings. For example, in some cases, telehealth services created new opportunities. For example, I was able to engage some families in weekly telehealth who, because of distance, I typically see only once per year. Telehealth has unique advantages for brain injury rehabilitation.  The flexibility allowed me to schedule breakfast, lunch, and dinner visits with a client working on self-feeding. When it became clear the child learned much better earlier in the day, I was able to convince her mother to focus efforts on therapy and education goals early in the day. Once the child solidified a new skill in the morning, we had better chances to generalize the skill later in the day. 

How has being a CBIS played a role in your career as an OT?

The Academy has been a constant source of inspiration and camaraderie. This takes me back to my point that research is taking us back to the roots of Occupational Therapy. There seems to be a renewed focus on the Activity-level and Participation-level of the ICF, coupled with a shift towards thinking about brain injury as a chronic health condition. To me, the interdisciplinary academy that is ACBIS is the place to be as a professional in this field. It takes true interdisciplinary efforts to help clients achieve goals at the level of participation. People who understand the importance of interdisciplinary care and research, people like Drew Nagele and Eric Spier, are the people to be around. I believe this is a key ingredient to advancing our field. I am very excited about the new ACBIS advanced practice certification!