Polly is so right about seeing each person as an individual and being positive and encouraging as you work with them. If you assume to fit your patients into statistics you will cause the statistics to stay the same, when your goal should be to change them to more positive numbers. Learn all you can about EVERY kind of OT/PT available for any kind of physical disability so you have a huge portfolio to choose from, then always think "outside the portfolio". Be creative, consider new ideas, listen to patients and their families, try stuff that sounds crazy. And know that insurance companies, including governmental insurance, does not pay for nearly enough therapy or equipment, so you'll have to be creative about that too. Like Al said, you'll be happier, although poor, having your own practice. Look at combining with others to provide a holistic practice including massage therapy, acupuncture, complimentary herbal/medicine. Know how to find and write grant requests (see the Pespi Challenge website or CRPF), make friends with local donors who will fund programs, tell the story of your work wherever you go and accept donations).
I was most disappointed when my 71 year old mom was discouraged from going to a top SCI rehab facility because of her age, although she was in good health when she was injured, a C3-4-5 incomplete. The doctors told her that whatever abilities she had after 3-6 months was all she could expect, and she doesn't have even that much 8 years later. When she and my dad were discouraged from trying to do more by the decision to send her to a general type rehab facility instead of the specialized SCI one because of her age, her motivation to recover was gone and never returned.
However, having learned from that, when my 88 year old mother-in-law with Alzheimer's had a below the leg amputation because of a clot, she was fitted with a prosthesis and given a walker, we pushed for her rehab to be aggressive, even though the therapists didn't think she'd be able to learn to use it. The figured she'd never be able to remember what to do, and she'd not be strong enough to walk with it. We were a determined family who worked with her three times a day on our own, and she was one tough woman. She didn't remember what to do, but over months, her body learned the process because it had been repeated over and over. And when we realized she was having trouble with her prosthesis because the people at the facility didn't know how to put it on correctly, and she didn't know how to tell them or us what was bothering her about the way it fit, and we didn't always understand how to help her, we talked the therapist into doing the physical therapy FOR us to HELP her. The therapist told us it was the first time she'd ever done that, but it so worked. We made a page by page instruction guide for the nursing facility on the care and feeding of the prosthesis; we worked with each new CNA to show them how it went on and came off; we had wall diagrams on how it was used; we learned how to help her use her walker and wheel chair properly, how to prop her in the chair and bed to protect her from pressure sores, how to help with transfers - stuff they didn't usually teach because they didn't work with SCI type patients and they didn't teach the family, they only taught the patient. It helped so much because we all had to be her memory.
Because you are asking you will be terrific at what you do. We all want people like you helping our families. Keep using your sense of caring, interest and the intensity in doing your job. That passion will be the best motivation for your patients, their families and you. And you already have a great fan club, so keep coming back for support and encouragement. Deborah