Kennedy Center Show

LGT a recent show at the Kennedy Center on disability. Seems like it would have been cool to go to, had I 1) known about it and 2) not been working all day Saturday. Ironically, the review was buried in the depths of the Washington Post site, which certainly won't help it draw attention. More thoughts at a later date, as I am behind in my work for the girl scouts...

The long week is over...

It's been a long week, but it is finally over. And, thanks to a 5-hour day today, I am actually caught up on *everything*! All the minutes for Monday are done, and suggestions for treatments left for my coworker. Emails have been answered. All the weekly notes, all the COTA cosigning... DONE. Couldn't bring myself to do it yesterday at 430 since I was so tired, but it is all actually done now. I still have a few things to do this weekend- particularly, writing up treatment goals relevant to the Alert Program- and I will have a few calls to make on Monday, but work is remarkably on target right now.

I'm feeling some peace with finishing everything today. I know that I won't be caught up for long, but it is a good feeling nonetheless. Perhaps I'm getting better at leaving work behind. I follow a job advice columnist from the Washington Post, and her latest entry is relevant to that feeling when I was getting so overwhelmed at work. Do your best while you're there, and don't worry about it when you've left it behind. There will be days when we won't get enough minutes for patients to meet their RUG levels, or all the evals don't get done, or a paper is left unfinished, but it will be OK anyway. Have yourself a peaceful easy feeling about the coming work week.

Merging back in...

I am still alive...
Vacation was wonderful. Things that are tough: 1. trying to merge back into work after vacation 2. being shorthanded this week due to others' vacations 3. trying to leave work early each night so that I can drive 30 minutes to instruct 2 year olds in vacation Bible school. So, I've been getting home at 9 and quite tired all week.

A few quick positives from the week:

• My new peds schedule does let me leave on time, a joy not felt for many months.
• Our SNF and acute floors are discharging several patients this week
• My six 2 y.o.'s are learning sign language and social behaviors!
  
• A member of a community organization (not sure if I can name it or not) stopped by ask what pediatric equipment we wanted for our outpatient clinic so that they could donate it. (AWESOME!!)
• After the false starts with younger children and the Alert Program, I have two older kids who I will be trying this approach with over the summer. One is an 11 y.o. girl with a lot of anxiety-related oral stimulation behaviors, and the other is a 13 y.o. boy with Asperger's and some difficulties with sensory regulation.

More updates as I get life back together :)

How to get into OT school

Many OT programs require applications, interviews, and/or test scores for admission, and do not accept all applicants. Here is a brief walk-through of things to do to better your chances of acceptance. For the purposes of this entry, we will assume that the prospective student has already done intelligent things to determine if OT is the right career path, and has decided upon a specific university.

• Read Carefully- Upon admission to a college, you should get a guide with information about all the different majors offered and brief descriptions of classes. This guide is akin to a school's contract with you. This will have the information you need about prerequisite classes and general education requirements that you will need to graduate. In many cases, you will need to finish your liberal arts/general ed classes before starting in the OT curriculum. Also be sure to carefully examine the admissions packet from your OT school at least a semester in advance of when you would apply. This gives you a chance to pick up anything you would be missing prior to your application.
  
• Schedule Smart- The college adviser... an appointed watchdog to make sure you graduate on time and according to plan. Warning- if you believe that is the adviser's job, you are likely to have problems. I won't say that all advisers are overworked and ill-informed, but those types of people do exist. College advisers have to sort schedules for hundreds or thousands of people each semester, and they most likely won't have the extensive contact with you to be familiar with your detailed career aspirations. So if it's important to you to apply to OT school in a specific year, finish your coursework on time, or take the required classes, you need to be your own advocate. Use the program guides to sketch out a framework of what classes you will need each year, where you have space for electives, etc. Your adviser may be able to help you in making sure that your planning reflects the university schedule (ie, if you Chemistry before Physiology, but they are both only offered in fall semester, you will need to do chem early).
  
• Make Contact- contact faculty at your OT program. Be friendly. Let them know that you're out in the world and interested in their program. They'll be familiar with you when you apply, and can also help you if you get confused during the admissions process. If you can, make friends with a current student or recent grad. They can give you inside information about what to expect from the program that can be invaluable. In my program, we pass on a "buddy CD" of study guides and notes from classes year to year.
  
• Volunteer- Get to work at a local center that provides OT. Job shadow OTs, and remember, these people will be your future references. At these times, always dress and act professionally. Be courteous and curious. Take an active role and try to help out where you can (be aware, this will not be in direct patient care). Volunteering in other fields is also a great idea and shows commitment to helping others.
  
• Review Your Resume- Make sure your resume contains information about your skills and your volunteer and work experiences. You should include anything that could be related to a career in healthcare- babysitting, coaching, and tutoring are all great to include, especially if those experiences gave you exposure to kids with special needs. Do you have a CNA or rehab aide job? Have you done any detailed volunteering projects through scouting or another organization? It's great to include an activity that shows long term commitment and dedication to a cause, as well as any unique interests. Have a friend or parent review to check spellings and make sure that your resume reflects all your relevant abilities.
  
• Boost Your Awareness- If you want to be an OT, you need to know about OT. Review the AOTA website as well as your program's OT website. Get a general grasp of the different settings that OTs work in, the clients OTs see, and some basic treatment ideas. Your job shadowing is a great time to gather this information. Look at your program's website and see if you can find what interests your future faculty have. You should expect some general questions about OT, disability, and your reason for choosing OT as a career in an interview. No one expects you to know everything, but they will expect you to be familiar with the basic concepts of your future profession.
  

There's probably no 'best time' for this entry as OT programs are notoriously unique, including their times of admission. (Of course, they are each unique within the frame of meeting ACOTE standards for accreditation, but that's another story) Disclaimer: I am not guaranteeing your acceptance into any school, and make no endorsements or condemnations of any OT program at this time. Also, I am from the USA, and do not currently know anything about admissions to OT schools in other countries.

Wish upon a star

I'm now at that momentous 1-year-since-graduation mark. Still close enough to remember being a student (which is why I try to post tips and helpful things) but also wanting to be a full-fledged totally-awesome practitioner. I've always been a little critical on myself, and don't like to just sit back and relax, as I'm afraid of waking up one day and finding that I'm actually terrible at what I do. So though I recognize that it's way too early to be a 100% awesome OT, I know that there are things that I should be doing more of to be my best. So, as a 'year in review,' here's a list of things that I would like to be doing more or generally better at.

• Transfers/Independently Ambulating New Pts- Since I left my rehab fieldwork, my transfer skills have seriously declined. I always doubted my general strength and body mechanics, but I used to be able to do a DEP transfer alone (and had to, as there was no support staff!). Now I've grown lax, since there are helpful nurses/techs, rehab aides, and PT staff abounding. I often hold off on my evals if I can tag team w/ PT, which is not a totally bad thing but I should have more confidence in getting pts up on my own. I have gotten a lot better about that, but do try to play it safe when possible.
• Stroke Treatments- compared to my fieldwork, we get absolutely zero CVAs, so I haven't had a chance to really hone my treatment skills for this diagnosis. This would include the following:
• Scapular mobilizations
• Neuro-reeducation
• Motor control theory- my husband was swift enough to spy an old textbook w/ pictures of Brunnstrum and Rood movement methods at a yard sale. I haven't had a chance to review this, and I know that I don't have a solid practice base in old principles of motor recovery or the new motor control theory, and really need to.
  
• Time Management- this has improved greatly since fieldwork, but I still find myself struggling to get everything done in a day
• Pediatric Goal Writing- admitted bad habit: I often delay writing my pediatric pt's goals and have a hard time making them SMART, as they say. Sensory goals are especially challenging and I've been trying to get some advice on that.
• Occupation-Based Sessions for Adults- I am good at incorporating BADLs into treatment, but I should be getting my adults to do some more fun things.
  
• Laying Down the Law- it seems that a lot of my pediatric pt's parents do things that make my life a lot harder, such as no-show'ing, leaving the waiting room while the child is in therapy, etc. I need to be better at drawing the line with people when necessary.
• Explaining OT to Adults- I know, this should be second nature and part of my eval spiel, but I do get in a hurry. Sometimes it seems like there's no way to make people care about what we do, no matter what is offered.
  
• Sensory-based treatments- I would really like to have a better plan about conducting these during pediatric sessions so that things go smoothly more often. I have some materials to help, but I need time to review everything and make changes.
• Turning it all off- I need to get better at compartmentalizing work away from the rest of my life. I also need to de-stress better, do more ME time things. I get in a habit of just relaxing and watching tv, but I need to work out more, get back into pilates, read books for fun, spend time with friends.
  

When you spend many days stretched to complete treatments and documentation, it's easy to fall into a routine and forget about where you want to change and develop. Any suggestions on improving my practice would be appreciated. I won't be able to return comments immediately, as I am on vacation (!!!) but I do appreciate the feedback :)

30 Days in a Wheelchair

I have been a fan of Morgan Spurlock's for awhile, though not rabid enough to catch every show or appearance. But I was interested to see the episode of 30 days that had football player Ray Crockett spend 30 days in a wheelchair. I was interested to see how this would play out. I have read several articles from different members of the disabled online community that were outraged by disability simulation experiences held in schools or other groups. But I feel that this show made a good effort to stray away from the stereotypical simulation experience. For one thing, Ray's experience lasted a full month, which is at least 29 days longer than the average. This gave him a longer time to feel the effects of his situation on himself and his family, and gave him time to grow.

Another key point was that Ray was part of a community of legitimate wheelchair users. He played wheelchair rugby (with some of the most famous and skilled American players), worked with people at a rehab center, and had support from a counselor that has been a quadriplegic for several years. We weren't left with only Ray's opinions of what being in a wheelchair was like for him, and neither was he. Ray turned a corner after meeting the rugby team, and started lifting weights in his own gym again. I'm paraphrasing here, but he basically said that he had thought that since he was in a chair, he was supposed to be frail. If he hadn't met people living vibrant lives, he would have felt confined and isolated, and portrayed a very biased picture of what living in a wheelchair is like.

I liked Murderball, and I liked this show too. I thought it was very telling when Ray was sharing videos of his rugby sessions with his family and trying to correct some of their misconceptions about quadriplegics and disability in general. My mom has always had lots of friends in our community that have different disabilities, so I had a lot of experiences growing up with people who walked or talked differently, and I like to think that I learned to treat people equally and with respect at all times. But some people don't have those kind of experiences in their everyday life (or rather, haven't YET), and I feel that shows that are done well can provide a window into another world for those people. A window that allows someone to think: "huh. that person drives a car, goes to work, and spends time with his family just like I do. Maybe we're not so different after all."

Here's some of my random thoughts I had while watching the episode. There are videos of portions of the episode online here if you missed it.

• One of the first people Ray gets to meet is Kenny the OT!! I was very excited.
• The doctor talked to Ray about the risk for blood clots from being in a wheelchair, but didn't even give him a stinking pair of drugstore knockoff TED hose?
• I found it both interesting and ironic that they chose a football player to be in a wheelchair, as they walk the line between athlete and injury everyday
  
• The family has a very nice home that was obviously built with no thought to universal design. 5 steps to enter the house, sunken and raised rooms throughout, sunken shower, steps to the backyard... I wish they had time to touch on that concept, but it's only a 60 minute show.
  
• Ray was lucky enough to have the cash to plunk down a bunch of ramps all over his poorly designed house, but if he's seriously interested in keeping his buddies from the show close, he better look into making the house visitable
• I liked watching Ray playing basketball with his kids, it also demonstrates that he was an exceptionally strong person before the show. I played basketball for years and years, and hurt my ankle late in high school, keeping me from ankle plantar flexion but not from standing. I couldn't even shoot a form shot. Try sitting down on the court next time you're playing and see how much arm strength it really takes to push a ball over 10' in the air.
• Woo! Justin Dart! I met him :)
• After all the growing that Ray had done, he still admits that he would want to help the girl in rehab do her BADL and mobility tasks.
  
• As the girl was 'graduating' from rehab, they did touch on how close the staff and patients can become when working so closely for so long. It's an odd relationship though, which I may have to go more in-depth in another time.

Respect for OT from... an MD!!

I was working with one of the ladies on orthopedics, introducing her to the AE for lower body dressing. She was struggling, as she has some cognitive deficits, but we were plugging along. A knock on the door, and I saw young Dr. McDreamy (not his real name, but it might as well be. Another pt. stated that if he got any closer to her, she was going to reach up and give him "a great big kiss!"). I said to my pt, "ok, let's take a break so you can talk to your doctor," and he interrupts me, saying- "No, no, you keep going! You're doing the important work! I'll come back later." I was flabbergasted... this is not how the therapist-doctor-patient relationship usually works. Made me feel pretty awesome and just added another checkmark to my opinion of Dr. McDreamy.

Semi-unrelated, but people should consider asking hospital employees for opinions of physicians when making choices. We see the doctors more often than patients usually do, and see how they treat multiple people. We know which surgeons are good at which surgeries, which ones have had multiple revisions, how they treat their patients. Something to think about when choosing your next physician.

Surveys

The AOTA listservs that I subscribe to frequently feature online surveys from research students. Please take time to contribute to any that are appropriate to your situation. I make no claims supporting any university or project, this is just a friendly pass-along of info with wording direct from the author when available.

" Contribute to OT research aimed at improving Level II FW education. Must be 1-3 years post graduation and had a Level II fieldwork in rehab. Click on the link below for 33 question survey. 5
participants chosen will each win $50.00. Approved Doc project of Rosalyn Lipsitt, Temple U."

"You are invited to participate in a survey for OTs in the physdys field. I am investigating treatment media choices of practicing OTs and what is influencing these choices. It doesn’t matter if you are a new grad or a veteran; I want to hear from you! You can find the survey at this site:" (I am not sure that this one is working 100% properly)

" Please follow the link below to participate in an online survey about occupational therapy and LOW VISION rehabilitation."

"I am a post-professional master's student and Virginia Commonwealth University attempting to complete my thesis research. If you are an OT who is NDT-trained (formerly NDT-Certified) in Adult Hemiplegia, please take a few minutes to click on the following link and complete a brief survey"

"The Westchester Institute for Human Development in New York is conducting a survey to determine what consumers know about the newborn screening process. Our goal is to improve consumer education on newborn screening. If you are 18 years of age or older, please visit http://wihd.org and take our anonymous online survey, which will take approximately 5-10 minutes of your time. It is in the upper right corner of the page."

It begins...

Today was Day #1 of the new summer schedule. The new plan has me in outpatient Mondays from 815-?; Wednesdays 8-830 (only because this is literally the only time the family can come); and Fridays from 8-130. I spent a good portion of this time confused, as I couldn't remember who was coming when or where I was supposed to be. My first pt (an eval) canceled (for the 3rd time) so I ran across the street to evaluate some orthos. Then I had to run back to give a Peabody, had several peds to see, worked through lunch and didn't notice that my 1230 hadn't shown up until 1 o'clock. Also had an extended power outage in there that scared a child and destroyed one of my evals. Had a surprise videotaped session, and closed w/ a peds eval. Finally finished up the outpatients at 330 and had time to run back across the street and eval a lady on the observation unit before my brain was totally shot. Between the heat and lack of sleep, I developed a pounding headache and was quite ready for the day to end.

I've had a hard time sleeping on Sunday nights, likely due to the stress and anxiety of seeing the peds. Hopefully, the new schedule will get me out of work earlier so that I can stop working random 11.5 hour days. I spoke to 2 more parents today about starting OT for their kids, so the caseload is definitely growing. I can't tell if this will make things overall better or worse for the sleep situation. Part of the stress (ironically) is my impending vacation. I will be taking next week off to be a beach bum, thus leaving my colleagues shorthanded all week. When I return, another inpatient OT will be taking her week off, making week 2 of short staff and (almost assuredly) short tempers. To make matters extra fun, I have to work that Saturday and have an evening commitment every day that week. Vacation should not be this stressful! I need to learn to just turn it all off in my head, or I'm not going to be able to enjoy my vacation because of the stressors that are following it.

Here's hoping I can finally get some rest.

Deadlines

I remember the euphoric feelings when my school semesters and fieldworks were over... at last, no more papers, no more due dates, no more deadlines hanging over me. How untrue. After missing work on Friday due to general misery, I had a large stack of paperwork that needed to be done last week waiting for me this morning. Co-signing COTA notes, weekly progress notes, and I didn't even begin to address the mounting discharges. And then, I arrive home, only to have a Sensory Profile School Companion that must be written up tonight, as I have put it off for 2 weeks and I am seeing the patient again tomorrow. I was really not excited about that as the teacher rated the child as overresponsive in EVERY area measured, so I had to add in a bunch of disclaimers and my usual tidy 1-page summary became a 3 page monstrosity.

So, the homework still exists. But I am a little excited to see this child again as he has dyspraxia (by my diagnosis- is that good enough?) and I will be testing him on our fancy Balance Master machine with assist of PT. The Balance Master is like a WiiFit for professionals who want statistical output. I haven't used it yet, and hope that he will be cooperative and that it will be fun and revealing.