Energy Crisis

Made it back from Florida alive... my husband caught a lot of stuff while we were down there and I am still dealing with some sinus stuffiness and feel like my ears are all plugged up. Between taking care of him and working an exceptionally long Tuesday, whatever brain cells made it back from vacation have been more than occupied. I have some major things to write about, but have not been formulating sentences very well. (true example: "we am canceling my membership") For someone who is internally outraged when there's confusion over your/you're or their/there/they're, it's been more than a bit frustrating. I will update soon, once this mental problem is resolved and the pile of Sensory Profiles is graded. I did at least 1 intelligent thing yesterday though... saw in the nurses notes that a man who had a knee replacement and had later had some cardiac issues had a bad night and asked the COTA not to see him that morning... he wound up in the ICU later that day. Yikes, but at least we didn't push him into it.


OT WebGems- Manipulate the Brain Edition

I love brain stuff. Here's a few pieces on how that great organ works and changes, also a couple of behavioral modification pieces thrown in.

Starting off, research shows that even mild concussions can have effects years into the future, which has got to be troublesome news to anyone involved in contact sports. Go go helmet developers!

An fMRI study looked at how older and younger individuals processed negative images, and the researchers concluded that the older women were able to cope with these problems better. So hopefully one can become less stressed over time, that's what I'm hoping for anyway.

This piece has been floating around my bookmarks page for a long time (note that the subtitle discusses the election season) but it's an interesting look at irrational behavior and why humans take offense.

Researchers at Johns Hopkins found that controlled doses of carbon monoxide can prevent damage after a stroke, which makes sense after hearing about it, but who is smart enough to think this up ahead of time? Still seems to have a short window to operate, but I love seeing the new advances.

On another stroke note, here are some of the gender differences in care before and after CVA.

This was an interesting study involving deep brain stimulation in patients w/ Parkinsons, which I found fascinating.

Behavior modification is always useful, not least when used on ourselves. This article discusses how the fear of being labeled a hypocrite will lead people to make lifestyle changes. This ADVANCE piece discusses the benefit of actually accomplishing things even when they're hard. And this is a more detailed piece, also from ADVANCE about learning emotional awareness and control.

That's it for today, as my brain is currently hoping for no micro-trauma from roller-coaster riding!


Shoe Tying

I saw this "Rubes" cartoon and had to laugh considering the amount of time that I have spent working on other people's shoe tying skills. My little boy with dyspraxia continues to struggle... I don't even attempt it every week since I don't want breakdowns every week. I have been to this site on shoe tying, but continue to struggle. I have tried the 2 loops method, the 1 loop wrap method, and have tried teaching an alternate way to make loops (weave lace under index finger, over middle finger, under ring finger and then squeeze ring and index finger together). I also routinely do knots using wikki stix with 2 differently colored stix, but this doesn't always transfer to laces.

It's a struggle. I love the new Sketchers shoes that have the elastic laces and just slip on- little miss S has those and some velcro mary janes and I think they both rock. She has autism and is always super well dressed, but part of that is because they don't have to worry about laces.

Anybody have an absolutely FREE method for shoe tying that works?


OT WebGems- Geriatric Issues

I am by nature, a total packrat in real life. I am even worse on the internet, as my bookmarks folder is now overflowing waterfall style! So here come the WebGems- with a focus on geriatric issues.

First off, some good news- TKRs do improve I/ADL function for elderly individuals! So it will be worthwhile in the end- but remember, it will HURT!!

This an ADVANCE piece on Elderspeak. It can be a hard habit to break, and usually requires me to write down all my patients' names until they're familiar to me, but I think people respond better when talked to appropriately. Different facilities have different policies... when I was on my Level II's we were on a first name basis with all the clients, to the point where one place had first names, last initial, on all the wheelchairs. At my current employment we're supposed to use Mr/Ms Last Name, but usually when I ask people what they would like to be called, they give their first names. My only confusion has been with having priests as patients... the ones that I have had (who knew each other, ironically) both asked to be called by their first names, but then I got dirty looks from people who thought I should be addressing them as Father X.

This Medline article implies that they're getting better testing for evaluating a person's driving ability. (Hope it's better than the Portoglare!) No mention of OT driving rehab or Carfit. This test is pretty extensive though, and the main problem is that they're describing it as a test for people with Alzheimer's Disease. It would be hard enough to get a person to agree to take this once, but they're certainly not going to want to keep taking it every year to satisfy that they're capable.

In other AD news, there are reports of a lot of caregiver abuse. This should add to the case for better respite programs and support systems for elderly aging in place and caregivers in general.

Romance is an issue from birth to death. This editorial reflects on falling in love after aging. And this piece is an interesting look at love in an ALF and the complications involving the family and staff.

And lastly, this editorial by an internist looks at how complicated it has become to die in a world of MPOAs, full codes, and feeding tubes.



If all goes according to plan, today I am boarding a flight for Florida! Hello Disney! Relaxing days of sun and fun! I have scheduled a few entries for the break, but won't be my usual speedy self at replying to emails, approving comments, etc. Supposed to be 80* on Saturday... yum!!


Caution! You have computers at work!

A brief cautionary reminder

I consider myself fairly 'tech-savvy' but I feel that I am sort of on the upper age bracket of the facebook generation. To be more specific, I grew up with computers, had the internet and IM through adolescence, but was already old in techno-world once myspace and facebook came along. But this is a relevant topic for anyone living in the computer age, because I think we all take the machines for granted.

Everyone familiar w/ computers knows that emails, IMs, blog posts, etc can live (basically) forever on servers and be accessed later by other parties. Most everyone has a tale of someone seeing something they wrote that was never intended for their eyes, with embarrassing consequences. At work, they can be more than embarrassing. Any employee accessing a work computer nowadays has to sign an agreement about what can and can't be done on that computer. Most companies have filters that prevent you from accessing certain websites- our hospital has a particularly annoying filter that blocks anything with the word "store" in the title or address, which makes it really hard to print out pictures of devices for our patients. You can get in trouble for coming up against the block too often, though fortunately I haven't.

If you have access to medical records on your computer, then confidentiality agreements and especially HIPAA hold you to a certain standard for how you access that information. You will undoubtedly sign contracts that indicate that you will only access the charts which you NEED to know medical details about. And to ensure this, your facility can do an audit at any time, of any chart, they will also do this if there is a specific complaint of someone breaching the agreement. While any chart can be audited, charts belonging to other workers at the facility or VIPs are more likely to be checked. A coworker recently got written up for doing what a lot of people do- looking up records on family members. No OT orders, so no "need to know," and a violation.

Another tool that can be used is a keystroke recorder. That means that ALL your emails can be monitored and reread, that the website addresses you enter are all recorded, anything. A friend of mine who works in a non-healthcare industry recently had a problem with this and lost a job. What was the offense? Typing an offensive word, and then deleting it. That's right, no clients or bosses saw this typed on any papers or walked by the computer screen, and it was still enough to lose a job.

So be careful, because it's not just probability anymore, at least not in my world.



Thoughts on a couple of TV shows

I recently read an article about one of my favorite new TV shows, The Big Bang Theory. I have been watching this show since its premiere, partly because I am admittedly dorky, friends with others who share my dorkitude, and married to an engineer. I know those guys on the show through my interactions with my friends in college and love that the show isn't making fun of geekiness, but making it fun to be geeky! In the article that I read, they were debating about whether Sheldon has Asperger's Syndrome, and apparently there is a large following that believes it is so. If you're not familiar with the show, check out his flowchart for making friends. It's not something that I had given a lot of thought to while watching, because I just considered each character an exaggeration, and it is often thought that 'typical geeks' have several spectrum characteristics without a diagnosis. Is Sheldon diagnosable? Almost certainly. Is it purposeful? Chuck Lorre says no, and that's believable. We're all a little bit on the spectrum... I took this quiz (no endorsement, just the first one I found) and came out favoring the autistic side more than the 'neurotypical' side, which is probably no surprise to anyone who knows any of my numerous sensory issues.

Another show that I have just started watching is Dexter. He is a sociopathic killer who has a day job at the Miami police department. Dexter has severely decreased emotional responses, usually nonexistant. He likely has antisocial personality disorder, though he goes to great lengths to fit in. It has been comical for me to watch his foster father teach him how to fit in, how to pretend, how to be one of the crowd. Halfway through season 1, he has absorbed the instructions to fake social skills pretty well though he does give off some telltale signs of personality disorder that the rest of the cast conveinently ignores. I suspect he has a few additional undiagnosed issues, possibly some OCD, or his attention to detail might be significant of a spectrum disorder.

Not that I think you'll see OT on TV anytime soon, but it is interesting that we are getting a broader range of characters on shows. There was a pretty cool poster presentation at the '05 AOTA conference about disability as presented on TV and movies, you can find many of those movies here. Have you spotted any TV/movie characters that were displaying significant symptoms but not 'outed' as having a disability?


Smarter than I look!

Finally figured out how to join groups in OT Connections... I feel so much better now. When I clicked on the name of the (private) group on someone's page, I kept getting "you are not permitted to access this page." Had to click on "view all groups" on the right column and then go through the pages to find mine, and then click "apply to join." I'm glad I don't feel technologically impaired anymore.

Wild in the Halls

There is a not-so-well-known, not-so-good movie called Wild in the Streets for which the play on words for the title is from. In the land of that movie, my day definitely would not have happened since the elderly were shunted off into communes, but since we don't really live there, feel free to continue reading about the craziness that has been Wednesday.

Wednesday starts for our purposes when the evening nursing shift came on at 7pm. In 12 hours, Mr. L will cause enough disturbance that there will be 15 different nurses notes written about his exploits. He will be found wandering in the hallway carrying a sheet and/or the room's courtesy curtain. He will dismantle 2 bedchecks, take the bolts off a geri chair, and also climb out of a geri chair with the tray attached without a scratch.
His mini-mental scores are stable, at the very lowest regions of the Moderate Cognitive Impairment range. He has been speaking very tangentially, somewhat in nursery rhymes, and has identified our president as "Muhammad." He has been very emotional and has yelled at the PT several times this week, today he was pleasant with me for 25/30 minutes while he petted his dog (not a real dog). Mr. L decided to take a walk while I was present, and I barely had time to throw a walker in front of him and couldn't get to the gait belt... had to walk side by side with my arm around his waist to keep him on his feet. He has been in this fugue of confusion since his most recent surgery- he has no history of dementia. Hopefully someone can figure out a cause and reverse this process.

Ms I is 96 and has advanced dementia with the delightful combination of severely decreased vision (macular degeneration) and decreased hearing. She is disturbed by visual hallucinations and is terribly frightened of being left alone. She has been in a geri chair by the nurses station for the better part of 2 days so that she has 'company.' She started sundowning today really badly, calling out in a cat voice about being left alone during shift change. Her new roommate has had cancer and uses a kerchief to cover her head. Roommate said to me that Ms I thought she was a man when she took off her hat, but roommate was perplexed, since Ms I wears a wig and/or kerchief too. Roommate told nurses at some point last night "either give her a tranquilizer or give me one."

New admit today... (I forget her name, I did 5 evals this afternoon and hers was the last at 415) we'll call her Mrs T who also has dementia but is oriented, sees Ms I in the hallway and during those 5 minutes that they were around each other Mrs T got at least 75% more confused. I did the home safety cards with her yesterday, she had some interesting responses. She could spot some of the simple stuff, but when I asked, "Should she take this medicine that expired 10 years ago?" she didn't really know. This lady has been in acute care and thought that she was going home for the past 3 days... hope that she adjusts ok to the SNF floor. She may have to adjust to placement, but we'll hope for the best.

Twice I had to intercept the same pt. in the hallway this morning... once he was pushing a chair out in the hallway ("to get it out of the way") without his oxygen when he should be wearing 4 liters. He has no diagnosed cognitive impairments but lacks insight into his deficits and consequences. We barely made it back to his room without falling, and he made a grab for the curtain and I thought we were going down for sure then. 20 minutes later, I walk by and he hands me a "sputum sample" on a piece of gauze. The nurses didn't want it, I certainly didn't want it... BLEH.

Bad enough to have seriously cognitively impaired patients that require constant supervision for everything... adding in those who are just overly demanding or lacking in insight has made it hard to get much done. Did manage to discharge a couple of patients today, which is fortunate, because this has been a difficult week for the nursing staff and for meaningful therapy interactions. I have some time off, followed by some more time off soon, so hopefully everything will be on the upswing.

On a totally random note, I consider myself pretty "with it" in terms of technology, in fact, I am the resident computer dork of the rehab staff. (Fun fact- I had my first website when I was 15 and still remember random pieces of HTML code) I have a facebook account and utilize other internet technologies with ease, but I am having major difficulty figuring out OT Connections. I can't seem to join groups and am not finding other people that I know are on there. Perplexing. Also, I do continue to have issues making the cut links work well on this blog, but I am working to fix that since it makes my main page look all weird.


New Toys!

Thank you Civitan Club! Our grant went through, our fun new products have arrived and the response from the kids is overwhelmingly positive! Hooray!

First- Sensory Profile... so long overdue. Handed out 2 long and 1 short, next week will be quite busy with writeups.

Second- Ball Pit. Not a huge one, but large enough for one child. Balls plus tough foamy noodles that are nice and resistive when squeezed. Little Miss S, one of our regulars who has autism got to encounter it today. She is largely nonverbal and has difficulties w/ any purposeful expression, but one step in the ball pit and she instantly said "WHOA" with a great big grin on her face. It was super cute. We will need to make a cover for it to keep it out of sight and out of mind... does anyone have cleaning procedures for an inflatable ball pit? Hand scrubbing 500 plastic balls does not sound like a good time to me.

Third- Bolster Swing. This has been universally loved by all who have experienced it, but especially by those with low tone. Same little miss S had great posture while straddling it, and then in prone she calmed down better than she ever has from any other sensory technique. After which, she donned her shoes independently FOR THE FIRST TIME EVER in clinic. Shoe donning is usually where the session falls to bits if it hasn't already. What a sweet success. Also, the bolster can be adjusted to where it is just taller than the peanut ball, making a steamroller, which is almost as worthwhile as the swing itself.

Also, I started a book that I should have ordered a long time ago- Is it Sensory or is it Behavior? It has been worthwhile thus far and I hope to really gain from this. It is so frustrating to not know exactly how to respond to parents about different behaviors. Will share any cool tips from that one... been a little slow on the updates lately.