Never write anything on snow. You will be inundated by an ice blizzard and be the only therapist for the entire hospital. If you survive, you will definitely regret writing about snow.


OT WebGems- Snow Driving Edition

I loved snow days as a kid (who doesn't?) but as someone who spent an extra hour today scraping the windshield before and after work plus the 'commute' I am not in such a friendly mood toward snow. (I do prefer it, however to the days where I go to work in the dark and come home in the dark.) At any rate, snowy days always seem to make you realize how many people don't know how to drive in the snow. I was going to list my favorite tips, but why reinvent the wheel. After the jump are some good little tip sheets on snow driving, PLUS my addition of the #1 to #3 most needed tips.

Sorry, no cute writeups today. However, as promised, the tips that people really should remember:
#1- If you don't HAVE to drive, then don't. If you work outpatient, call and see if you have cancellations, or tell them you can't make it in initially. If you do home visits, such as early intervention or home health, cancel in bad weather. Even if it will be difficult for your coworkers, trust me, they'd rather have you late than dead.

#2- Learn to drive by practicing. It should be part of everyone's learn to drive experience to take the car into a snow covered parking lot and learning how to handle the car. Practice the tips in the following articles, figure out how it feels when the car skids so you don't panic.

#3- Drive on main roads. Surprisingly, this tip is not included in the other articles, and perhaps they were written in more urban areas. If you can avoid a backroad, even a lesser used road in town, by taking a more frequented (also hopefully flatter and wider) path, then you will likely have less difficulty.






Mini Sensory Success

I am seeing a 3 y.o. girl with PDD who is wonderfully high functioning and has very involved parents. She has some sensory issues and particularly HATES having her hair brushed. During our session, even though she was hyped up on sugar following speech therapy, after some deep pressure through shoulders and head (GENTLY, GENTLY, GENTLY! HAVE AN OT SHOW YOU FIRST!) she sat there and let me brush and do her hair. Then we took it out and had mom repeat the process w/o difficulty, and mom was really happy to have learned something she could directly apply at home. If kid and parent leave feeling happy and more knowledgable, then I feel like I did my job well that day.


Giving an Inservice

I got an email recently asking for tips on picking a topic for an inservice presentation, which is usually a requirement for students during fieldwork. Here are some tips.

Selecting a topic- some sites or supervisors will save you the thought of this step by already spelling it out in your fieldwork documents, usually in the form of "You will do a case study." Otherwise, you will have to choose. My advice is to pick something that falls into one or more of these categories:
-Something you are interested in
-Something you would like to learn more about
-Something that your coworkers have expressed interest about

If you do a case study, pick out one special client and tell what you did that was special or innovative to their treatment. If you helped to develop a tool or a really different treatment with any client, overcome a difficulty in their treatment that you didn't think you could, that's a good case study.

If there's a frame of reference or new treatment idea that you learned at school that your coworkers haven't heard of and haven't had time to research, that's always a possibility. Some places still haven't been exposed to the practice framework language and are continuing to use uniform terminology. An update on the new language with examples of how to apply that to documentation is a good way to bring your site up to speed.

If you get a lot of clients with the same diagnosis, try to find a systematic review of the evidence and then showing how that research can be applied to client treatments. That would be helpful as many practitioners don't have or make the time to do evidence searches and often don't have access to all the awesome library resources you do as a student.

Other planning tips- take note during other students' presentations, as well as those done by paid workers. This gives you a better idea of the kind of presentation expected- do they want a full powerpoint or just an informal discussion? If you can't discern this from observation or asking your supervisor, then opt to be more formal.

It's good to plan on technological mishaps. Be able to give your powerpoint presentation in an effective way even if someone breaks the projector the day before. Minimize potential malfunctions by being familiar with the hardware (your computer or the staff computer, the projector, etc). Remember that powerpoints created on newer versions of microsoft office don't play the same on old versions- a better option instead of just opening the file from a disk or thumb drive is to Pack and Hold your presentation to a CD. This enables you to drop the CD into any computer (I don't think it even needs office on it) and your presentation should run just fine.

Don't forget to leave time for questions... I've found that often people don't have any, but if they do and you don't address them, it could lead to a poor reception of your overall project.

Above all, be relaxed and confident in your information... an inservice is usually the sign that your fieldwork is drawing to a close, so just think that you are addressing your colleagues instead of being graded by a supervisor.

Before you go go

There's definitely an adjustment period to working in a hospital. Figuring out all the codes to the different supply rooms, learning the tricks to manhandling trays and hospital beds... it's those kinds of skills that come with practice. But until it becomes second nature, you still have a lot of things to check at the end of session. Here's some things that you should remember to check before leaving a pt after a treatment session to keep them safe and happy. Applicable to hospital and SNF rooms, a good checklist if you're new to the environment.

Ideally, you should just be reversing everything from your session so that the person is in the same condition as you found them, however, it's good to remember these things as there are often moments a person is without a crucial item.

  • Bed brakes locked, bed height lowered
  • Top 2 siderails up (some facilities have a policy against this, mine is all for it. If your individual had all four rails up, recreate that)
  • Bed/chair check applied (as applicable)
  • Tray table either parallel to bed or across pt's lap (helps keep everything within reach)
  • Call bell in reach (can tie to bedrail or clip to sheets)
  • Phone in reach, attached to bedrail
  • Urinal in reach (I try not to put these on the tray... germy)
  • Restraints applied (as applicable- generally if the person has UE restraints I only have one arm out at a time. Also remember those bedrail covers)
  • Abduction pillow and other braces applied (as needed)
  • Oxygen on person and turned on at wall (as applicable)
  • Empty BSC or bedpan if it was part of your tx
  • Any changes in status or other requests reported to nursing
That's about all I can think of now... it's actually easier when in the room instead of at a computer. If I forgot something major, just add it in the comments.


I shall return!

Ack, sorry about the delay in postings. It is a goal today to post about the job site eval I did (once I finish writing it up!). I also have 7 partially written updates, and one really important one that I need to get written, and they will be finished at some point. Have to go run some errands now, but I will get back to blog life soon. :)


Hopefully prepared

Tomorrow is my very first jobsite analysis... hopefully I am fully prepared. Have read up on diagnosis, reviewed info on repetitive strain injury, and taken notes from my old textbook "Ergonomics and the Management of Musculoskeletal Disorders" (this is why you keep the books). Have to make copies, get camera, get measuring tape, and find a goniometer before meeting up with my worker at the far too early time of 730 am. So it will have to be an early night... wish me luck!


Some new unexpected opportunities

Past few days have brought about some new unexpected opportunities (TITLE ALERT!).

Our current SNF floor crowd has several back breaking patients who are MAX-DEP A 1-2 for bed mobility (none of whom have actually made it into standing yet). Hopefully my body mechanics will go well... I have some proprioception impairments. We've also got a fresh batch of people who place a high priority on their naps, instead of rehab. Another challenge to productivity. :-/

My one coworker who has been the resident expert on FCEs and work hardening (much to his chagrin, as he is also the resident expert on hands. and lymphedema. and thus, rather busy) casually mentioned that he had a worksite evaluation to do as a courtesy for another hospital employee. I didn't even know that we did that! At any rate, I have had an interest in ergonomics and other work hardening things, and this is a cool easy way to dabble in it a little bit. I know that I can't do FCEs and the pediatric tx at the same time... I think it would put me into some terrible personality issues going from one extreme to the other like that.

Also, I have decided to add a new little feature in here. Energy conservation/work simplification is one of the relatively few things that I enjoy about the SNF environment, and I have a lot of good tips for multiple situations since I use so many myself. So look for up to a dozen pieces in the coming year on energy conservation in different situations.

And in the "I knew it was coming, but now? Already?!" category, my one coworker near my age (actually a couple years younger) announced that she is pregnant(!). And for the moment she says that she'll be sticking around through the delivery and afterward as well, so it will be interesting to work so closely with someone as they go through this life transformation. I've never really had that kind of close contact with someone for the day by day updates. My first fieldwork supervisor was 6-8 months pregnant during my time with her, and it did not slow her down in the least. It'll be interesting to see how this goes with my coworker, and to theorize how it could go in my future... far future, preferably!


Success Stories

Therapists, parents, teachers- Have some pediatric success stories? Your Therapy Source Inc is soliciting these for inclusion on their website and possibly elsewhere. Feel free to share here.

ALSO! Please fill out the poll on the right by picking your favorite features you'd like to see more of in 2009, and if what you want isn't there, drop it in a comment or email.


An Unwelcome Challenge

I consider myself to be socially conscious and try to donate time/money/items to various program that assist those in need. But a recent event over my break challenged some of those concepts in my mind.
So owing to a 1-time forgetting to lock the car doors, someone decided to hop in our car and smoke a cigarette and take a few items. There was obvious rummaging through the glovebox and some in the rest of the car, wiped dog poop on some not-so-important papers. It is significant to note that since we are so fortunate and do have many things that it took us awhile to figure out exactly what had gone missing.

The final tally appears to be:
-Some food (crasins, miniature candy bars, lifesavers; the cookies from subway remained)
-Shelter (a sleeping bag)
-Some really random stuff (Led Zepellin CD, headphones, sunglasses and holder, and my husband's rx glasses)

Fortunately, we didn't have any money taken, wallets were in the house and even the spare change remained in the ashtray. And the only Christmas gifts that were taken were the CD and the candy bars. Nothing was of sentimental value and the most expensive pieces (glasses and sleeping bag) will not be an undo hardship to replace. However, there is the feeling of having your security violated. I had already been a little on edge since I had narrowly avoided a pickpocketing/purse snatching before we left on the trip. I don't consider the towns that I live in to be dangerous (or at least THAT dangerous) and it's a rude awakening when an unfortunate event that so often happens to others hits close to home. I was also struck by the random items that were taken, and I question how they can be potentially useful to someone. The lack of logic just confuses me, I expect rational behavior from others.

I was hurt by the fact that this did happen at Christmastime... also because I do routinely reach out and try to help those who are less fortunate. My husband and I participate in charity for our church, the salvation army, goodwill, coats for kids, planet aid. I used to be part of a school of medicine outreach to the homeless. I guess I felt like I deserved not to be affected by this kind of crime due to the charitable actions we take. But I was thinking about this today, and I guess that if there is one person in the community, country, or world that has to resort to theft to meet their most basic needs, then there's obviously more that we all should be doing. And this is relevant to OT as every OT (really every person at all, but everyone in the profession founded on helping others maximize their lives) should champion social justice causes. There are very few among us who cannot do more, and likely very many that just need to do something. Plenary sessions at previous AOTA Conferences have focused on OT and community involvement, and it is something that I believe our profession could easily reach into. But until then, we'll just have to do what we each can to try to help.


Shower Remodel

So one of my first OT moments while at home was at my grandmother's house. She had a tub to shower conversion done about a month ago to replace the 19 y.o. metal stool she had been using as a tub chair. Sounds great, but there is more after the link...

this is what the new shower looks like-

and in theory, it is the 100% solution. However, my gram is 5'2" and only her toes can touch the floor while sitting on the built in bench. She knew this when the guy was installing, but he said it was as low as it could go and he couldn't do anything and there wasn't anyone there to make a suggestion. My thought was that during the install he could have rotated the seat 180*... this would have kept the piece aligned with the studs, and though we would have lost a small shelf, it would have lowered the seat. Where it is now prohibits the use of any other shower chair, especially because the rest of the floor is slanted for the drain. I really can't think of what to put down on the floor so that she can gain some more stability and not slip off the seat. We thought of those shallow crates they use for 2-liter bottles, which are about the correct width to fit in the shower base, however those things would hurt your feet!

So I'm calling out to the OT world, especially those who are in home mods- how would you fix a shower that's supposed to have already been fixed? I can't think of the solution- what do you think?

The return!

I am back from my whirlwind holiday trip around the state, visiting with friends and family from afar. Ate lots of delicious foods (hopefully did not upset my chances in the "Maintain, Don't Gain" holiday challenge at work), watched lots of college football (after a promising start, I am definitely out of the running), and generally just enjoyed the down time. Very little computer time, and that was good too.

You can never take a full vacation from OT though, so my little brain wheels were turning throughout the time. Lots of thoughts related to the family and using OT to help them, some of which I will share as I catch up on updates. Also been thinking a lot about my personal career path... directions that I want to take and changes that will have to be made.

My shoulder is trying to act like it's going to get that impingement pain again, hopefully it will not so that after the unpacking and cleaning I can continue to have some computer time. Hope to have updates soon, depending on amount of work to do at home and amount of total procrastination :)