ImPACT Certification with Jeanette Barajas, OTR/L, LSVT, ITOT

Welcome back to the Occupational Therapy Specialties and Certifications series! For today’s installment, we are talking about the ImPACT certification, a certification focused on concussion management. I had never heard of this certification until Jeanette reached out to me to share her experience as an ITOT (ImPACT Trained OT). After looking into it, it seems like such a valuable certification and very attainable too! So here is a brief overview of the certification and links to find more info:

The ImPACT Trained OT program aims to help OTs learn best practices in concussion rehabilitation and management. Course content includes: Clinical Trajectories, OT Post-Concussion Intervention, Vision Therapy, Vestibular Therapy and Return to Learn for the OT.

According to the CDC, the leading causes of concussion include: falls, motor vehicle-related injury, unintentionally being struck by or against an obstacle, assaults and playing sports (CDC, 2010).

Total Estimated Time to Acquire Certification: 6.5 hours

Total Estimated Cost: $249

Method of Learning: Online

You can find more about the ITOT certification here and here.

The course website it here.


Jeanette Barajas OTR/L, LSVT, ITOT, a Southern California native, attended Sacred Heart University in Fairfield, Connecticut and graduated in 2018. She currently works in a skilled nursing facility in Arizona. Jeanette is the oldest of three and a proud first-generation daughter of immigrants. She enjoys playing soccer, running, sewing, reading, camping and bike riding!

Why did you choose OT? 

I always knew I wanted to be in healthcare, but I also knew I wanted to have a career in which I could be creative. I love that OT gives me the opportunity to work with any age group in various settings. OT is constantly evolving so there is always a need for OTs in emerging niches.

Why did you choose to become an ImPACT Trained OT? 

I became an ImPACT Trained OT because I wanted to learn how to apply my skills as an OT to address different aspects of concussion management. Being a soccer player growing up, I experienced at least 2 concussions that I am aware of. However, I feel like I was not taken seriously because I had not gotten hit on the head…we now know that it does not take a blow to the head to suffer a TBI. I feel like I could have benefited from other medical professionals besides my primary physician. I know I am still struggling with a few things since those concussions (15 years later!) that I know would have been addressed if an interdisciplinary team had managed it.

What settings have you worked in? Do you have a favorite, and why? 

I have worked only in skilled nursing facilities so far. As a new graduate, I decided that I mentally could not handle an acute setting at the time, however, I still wanted to see a variety of conditions and populations. Skilled nursing seemed to be the perfect fit for me, and it still is. I have the opportunity to treat patients recovering from orthopedic surgeries, neurological conditions, amputations, falls, and other medical complications. I also enjoy working at SNFs because I have plenty of flexibility with my schedule. 

What does a typical day with clients look like for you? 

I usually start my work day between 7 or 8. If I have new admissions (varies between 2-4), I try to come in at 7 am to complete the evaluations and complete morning ADLs to inform the nursing team on how much assistance the patient requires. Breakfast at my facility is between 8 and 9 am, so I take this time to write up as many evaluations as possible. Around 9:15, I head back to the skilled floor and continue any evaluations I didn’t get to earlier, or begin my daily treatments. I typically see 6-8 patients, plus the evaluations. My treatment times range from 30 minutes to 55 minutes, depending on patient needs. Evaluations take me anywhere from 60 to 90 minutes depending on complexity. Around 12, I take a 30 minute lunch. I try to power through my morning so I don’t have more than 1 or 2 patients left after lunch. I spend the rest of the afternoon completing evaluations, progress reports, discharge summaries, and daily notes. 

Mondays are the only days I don’t clock out for lunch because we use our lunch time to have our rehab meeting, in which OT, PT, and SLP discuss each patient on caseloads, their progress, and discharge planning. 

How do you stay client-centered and occupation-based in your practice?

During the initial evaluation, I ask the patient if there is anything in particular they want to focus on or that they would like to resume doing. When appropriate, I talk to caregivers and family members to get to know more about the patients and what they enjoy doing if the patient is unable to provide specific goals or concerns. 

I love occupation-based interventions and encourage them as much as possible. It all starts from the day of evaluation, I use task analysis to breakdown any meaningful occupations that the patient is having a difficult time participating in and establish goals appropriately. It gives me peace of mind knowing whether or not a patient can complete specific occupations upon discharge. For example, can they complete hygiene and grooming with the one-handed techniques they were educated on? Or can they safely maintain their balance while managing their clothes for toileting?

I am not a fan of therapeutic exercises, unless it is absolutely necessary, but I feel like many practitioners rely on them to give them a break to complete documentation. Some of my evaluations don’t even include therapeutic exercises if UE/UB strength is within functional limits. Even when core strength is a deficit, I would rather facilitate postural control during functional tasks rather than have the patient doing modified sit-ups (and yes I have seen this). It’s more fun for patients engaging in a meaningful activity than counting repetitions. It also allows me as the therapist to continue building a rapport because we can still have conversations while they complete occupation-based activities. 

How often do you use the skills you learned from acquiring this certification in your practice?

I use the skills I learned with ImPACT on a regular basis. Much of the population I see is recovering from falls so I am equipped in addressing cognitive performance, vestibular processing, and visual deficits that are impacting functional task performance. 

What are the steps to acquiring the credentials? Is there a renewal process?

To acquire the credentials, OTs need to complete the OT credential program. It is a self-paced, and there is a quiz after each pre-recorded lecture. Credential programs require 1 CE course every year offered by ImPACT. 

Do you get paid more for having this certification?

I do not get paid more for this certification (at the moment). I am hoping to eventually branch out to outpatient neuro rehab and will use this certification when it comes to negotiate compensation.

Do you believe the credentials are worth it? (Worth the money/time it takes to acquire it). How has having this certification impacted your practice?

It was worth it for me because of the path I am taking and what I am working towards. This certification has allowed me to hone in on my activity analysis and address body structures and functions affected in order to determine intervention planning. 

What are some settings that an ITOT could work in?

Some settings ITOTs can work in are schools, outpatient, SNFs, and work rehabilitation.

Do you have any other OT interests that you would like to pursue?

I am interested in eventually venturing into outpatient neurological rehabilitation. Now I am working towards becoming a Certified Brain Injury Specialist (CBIS) and completing the Biofeedback Certification International Alliance (BCIA). 

Do you have any words of advice for someone wanting to pursue the ImPACT certification?

Don’t be intimidated! OTs are surprisingly still newer to the table in regards to concussion management in an interdisciplinary team. As OTs we have the skills and can break tasks down in order to address the cognitive, emotional, and physical signs of concussions.


You can find Jeanette on her Instagram or on her blog:

IG: jeanette.otr

Blog: opportuneot.wordpress.com

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