A Comparison of Neuro-Focused Certifications with Shanon Macintyre, OTR/L, NDT, CNS, CBIS, BCPR, CSRS

Shanon attended OT school at Dominican University of California, graduated in 1998 and has been practicing for 23 years! She worked mainly in the ICU and acute care settings, though sometimes works in inpatient rehab and outpatient rehab. Some fun facts about her are that she loves the water and anything to do with swimming, scuba, snorkeling, fishing, boating, etc. She lives in Northern California with her husband, and their two kids have left the nest and started their own families out East.

Why did you choose OT?

My older sister is a physical therapist. I saw that she loved her job and she was really helping people. I looked into PT, but my brain doesn’t operate that way. I didn’t have the greatest biomechanical mind and didn’t do great in anatomy or kinesiology. When I learned about OT, it suddenly clicked. It was art and science. Helping people and healing people. Suddenly it all clicked.   

Why and when did you choose the certifications you did?

To be honest, I didn’t pursue certifications until later in my career. I’ve always heard that they didn’t really make a difference. But I think it really depends on the certification and the courses you take. I wish I started some certifications earlier. I got NDT a while back…around 20 years ago. It was very helpful to my practice and I loved how hands-on it was. I recently became BCPR. That took a really long time because the portfolio process is long and arduous. I held off on it because it was expensive, time-consuming, and I heard it doesn’t really make a difference in terms of professional growth if you’re “only a clinician” vs. a professor or administrator. I’m glad it’s something I have now, but the process almost killed me (LOL)! I got my CNS certification about two years ago. I also have my CBIS and CSRS, which I got late last year (end of 2020).  

Can you briefly explain each certification?

Sure! All of them are related to physical rehab or neuro in some way. NDT focuses on rehabilitating the motor system via handling (facilitation) techniques. Really meant for the stroke population or for those with abnormal tone. Very hands-on certification and probably the most well known in the world of neuro.

BCPR is a certification by AOTA. You basically have to have experience in Physical Rehabilitation and compile a portfolio of all your experiences to become “Board Certified.” It’s more of a self-reflective process vs. actual course learning.

CSRS stands for Certified Stroke Rehab Specialist. This was an online course that gave an overview of stroke rehabilitation.

CBIS stands for Certified Brain Injury Specialist. You basically have to submit hours of experience and take their certification exam. There’s no actual course that’s tied to this certification (or if there is a course, it’s not required). I’ll speak more on this later on.

CNS stands for Certified Neuro Specialist. This is probably my favorite certification because I’m a big fan of neuro. It looks at all the different systems (i.e. dynamic systems) and teaches you how to rehabilitate all of these different things: motor control, perception, cognition, etc. My favorite part of this certification is becoming familiar with all the new technologies and devices.

What settings have you worked in? Do you have a favorite? Why?

I’ve worked in pretty much every setting related to physical rehab: ICU, acute, inpatient, outpatient, etc. My favorite is ICU/acute. I like being part of that initial recovery process. Just really making sure my patients get quality therapy right off the bat in order to set the stage for the recovery. I want them to know what intense therapy is…so when they get to another setting, they’re expecting to work even harder. 

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

It really depends! Especially because of the acuity and severity of some of these conditions! There can be a full day where every patient in my unit is comatose, or another day where everyone is up and moving around. If there’s any consistency, it’s the amount of rounds I have to do with the medical team, and the dozens and dozens (and DOZENS) of ICU lines I have to deal with. In terms of my schedule…about 10-12 patients a day at the start, but many of them are on hold. So that number usually goes down to 7-9 per day.

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

It can be difficult in the ICU setting. We’re limited in terms of what the patient can do based on their level of consciousness and their overall endurance. We also don’t want to push too hard, too early because they can easily code or have an adverse event. In the ICU, it can be hard to work on occupations or IADLs, so we have to do a lot of simulations. I’m still able to keep things client-centered, especially when I make the patient part of the goal-setting process. I don’t work on anything the patient doesn’t want to work on or doesn’t have a say in.

How often do you use the skills you learned from acquiring these certifications in your practice?

It really depends. Not all of these certifications are created equally. While I love the fact I have BCPR, I don’t know if I added to my skill set. As I mentioned, it was a self-reflective process and I guess it helped reinforce what I already know. NDT I use all the time, and it’s the one I’ve had the longest and have the most experience in. CNS was really helpful as well. I definitely learned new things which I incorporate all the time.  

Does each certification require taking a course? Or do they just require proof that you have practiced with a neuro population?

BCPR and CBIS did not require courses. They just verified experience hours. So no major skills were really gained.

I definitely learned new skills with NDT and CNS. Both were intense but very helpful. You don’t need to work with a certain population as a prerequisite, but having that prior knowledge is useful.

CSRS was another CE course. I can’t say I learned much there since they just covered very basic information, and because it was an online course, it certainly did teach me anything hands-on. 

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

All of them have different requirements…some a lot more arduous than others. But basically, they either require a certification exam or portfolio. And all of them have a renewal process. This is important because therapists need to demonstrate ongoing competency. 

Do you get paid more for having any one of the certifications?

With NDT, I did not. And I had that for 20+ years! I actually got a raise after BCPR, and another raise after CNS. Nothing so far with CBIS and CSRS, since those are fairly new on my resume. It really depends on the facility and how they weigh the certifications. In my facility, HR prioritizes BCPR and CNS. We’ve encountered some really good therapists who are either BCPR or CNS, and we hired more of them.  

Do you believe acquiring the credentials is worth it? Which ones and why? Are these certifications equal in value?

I’ll answer both of these questions here.

It really depends on what you want to get out of them. I’ve talked a lot about BCPR. If there was a course tied to it, I think it would have been more worthwhile. Same with CBIS. It sounds bad, but sometimes I feel that I “bought” those certifications instead of earning them.

In terms of worth and value, NDT and CNS are at the top of my list. NDT is extremely expensive today (not as bad 20 years ago), but I’ve learned so much and I still use those skills today. NDT hasn’t gotten me a raise, but the knowledge and skills gained are worth the price of admission. CNS is simply incredible. So entertaining and a lot of different labs. I was an NDT disciple for a long time, but CNS changed the way I view neuro. I no longer focus on motor control alone, but I look at the entire system. We just hired several CNS therapists. As I mentioned, HR prioritized them because 1. it’s pretty rare to find a CNS therapist (they don’t offer courses very often), and 2. Our neurologists really like their clinical frame of reference and started requesting more CNS therapists.

In terms of CSRS, I was actually really disappointed. It’s a popular certification and it’s so difficult to get into the course because it always sells out. I was so excited when I finally had the opportunity to take it, but all it did was provide a basic overview of stroke rehab (which I already knew), and there was NOTHING hands-on about the course (which is absurd when it comes to stroke rehab). The most frustrating thing is they charge a lot of money for an online course, and when it was all said and done, they emailed me a notification that said they no longer have a partnership with the American Stroke Association (which is why many of us wanted the certification in the first place). Honestly, I think they care more about enrolling as many therapists as possible vs. the actual certification itself. I know my opinion here will probably be unpopular, but this is just my opinion (which I’m allowed to have), and I feel I should give a truthful account. 

Do you have any other OT interests, or do you have any other certifications that you are pursuing?

I’m really interested in emerging practice areas. For example, serving abused women or youth in high-risk areas, etc. Something I’m looking into but I don’t have a lot of traction in. I don’t have any other certification interests at the moment, but I can’t wait to read your blog to find out what I should look into! 

Do you have any words of advice for someone wanting to pursue any of these credentials?

Yes! Do your research and homework! Talk to therapists who have these certifications and get their honest opinions. They take time and cost money, so please make sure you’re an informed consumer! 


Thank you so much, Shanon for taking the time to answer my questions and provide great insight to these various certifications!

2 thoughts on “A Comparison of Neuro-Focused Certifications with Shanon Macintyre, OTR/L, NDT, CNS, CBIS, BCPR, CSRS

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