a human behavior refresher

The recent moving situation has been giving my empathy organ a refresher.
Basic psych/neuro instructs that our brain forms schemas to help us understand situations. Tied in there are the motor plans for different actions and the mental maps to help navigate the environment. When these systems work perfectly, we perform actions without even thinking about it- like sitting down in a chair, touch typing, or walking to the bathroom. This is how most people spend the majority of their days, performing routine tasks without being mentally or physically challenged in the least, not devoting even 1 additional brain cell to the task.

However, the people that I see in the hospital are experiencing disruptions in these schemas. It's easy for staff to forget that their patients are not always disoriented x2, struggling to sit down, struggling with walker usage, and just generally getting confused. But this is often just a variation of a person thrown into an unfamiliar situation. Example: I moved. Everything is in a different place. Our bathrooms have a marble threshold, which I am terribly worried about breaking my toes on. Because when you wake up in the middle of the night and walk without turning the light on, you're relying on those old brain maps to get around. And my brain map does not include marble thresholds!

Another recent situation is reminiscent of what pts with joint replacement are going through. I have started exercising again, and hopefully will stick with it, or else my friend may drive out here just to kick my butt. I have been in the Contemplation stage of the Transtheoretical Model of Change for some time, but have spent the past 2 days in Action! Action is a phase that makes muscles hurt and act in different ways... and trying to motor plan simple actions like sitting down, getting out of bed, or going down stairs when your quadriceps have failed to respond in a normal manner is very difficult! So as I require 2 handholds and a dramatically increased amount of time to accomplish sitting or navigating stairs, I think of those who have had surgeons hands pulling their muscles apart and shoving in new bone parts in the last 24 hours.

So I am resolving to start my new job with a renewed sense of empathy, considering that like my pts, I will be in an unfamiliar environment and unsure of things.


Product Review- Forearm Forklift

The big part of the move is over! Though the unpacking and organizing continues, the heavy lifting is done. And so follows the review for the assistive device we bought- The Forearm Forklift (as seen on TV!).

We bought our Forearm Forklift through Amazon.com, and had no trouble with payment or shipping. The straps are compact and can easily fit in a large toolbox. The basic premise is that you have 2 straps that go under your furniture, and you and a friend slip your arms into the straps to lift objects more ergonomically. That is pretty much all of the instructions that you will receive... we got one sheet of paper with back protection techniques and a few pictures of the product in use.

The straps are designed for objects that are large enough to require 2 people to carry, but they really only work well with a certain shape- either tall/long and thin. Short and squat things (non flat-screen TVs, rubbermaid tubs) don't work very well. Though there are pictures of people carrying mattresses, we had no luck with this. And though the instructions show people moving objects with their wrists in extension and hands flat against the object, we were never able to carry something with stability without grasping our hands around the edges.
There was some minor pain and bruising from where the strap hits the forearm. Considering the rows of bruises I incurred on my legs from the move, they were VERY minor. They also tended to slip off our forearms and down to the wrists, which made it difficult to use.

The instructions also showed people carrying items up and down stairs, but this was particularly problematic. Our old apartment had 15 steps (no landings, thank goodness) but a very short ceiling. This is where the straps first failed, because we couldn't lift large objects very far off the ground due to the low clearance. The straps did a little better in our new place since we had fewer steps and higher clearance, but in our situation, it was easier to push things down the stairs in a controlled manner than to try to lift them.

We have 3 dressers, and to load them into the truck we carried each drawer individually and then carried the frame. Doubling the trips that took 2 people, this resulted in 20 total trips! To unload them, we tried the straps, and were able to carry fully loaded dressers using 2 people for a total of 6 trips. A definite time-saver, especially since some of the drawers were poorly made and falling apart when we tried to move them separately, causing us to take more time to adjust them later.

Using the straps increases the prep time for each object. It's hard to get used to the motion required by the strap, even if you're familiar with body mechanics. My brother and husband aren't great with body mechanics, and there were definitely times that they used inappropriate methods with or without the straps despite warnings from their resident OT. But my brother stated that he did feel that the straps kept his back from being "destroyed" during the moving process (he is a little dramatic). My husband reported that they were useful and would use again. He had an alternative way of using them, actually lifting by the straps, which he reported hurt less than grabbing sharp edges to lift.

So, overall, it wasn't a panacea, it won't force you to use proper body mechanics, and doesn't always work as you would like. But it's cheap, and for heavy stuff, it provides some extra assist and security. There were some comments on another site from people who use it regularly and get good results, fortunately, I don't have to move THAT often so it will take a little longer to get used to it. Even if the assist and security provided wasn't all I'd hoped for, it was enough to make it worth the low price. I have linked some other sources, and a couple of other products that other people referred to in those comments. I haven't fully evaluated those, but I included them in case anyone else is looking for a good moving solution.

Official Site
More Reviews from Amazon
Other Products: Shoulder Dolly and Teamstrap Moving Straps


Not mad at Obama.

I haven't really ever done a post in response to another, and not a lot on specific political events. But here is my take on the recent Obama Special Olympics comment.

First of all, let me say that yes, it was inappropriate for him to compare his lack of bowling skills to the Special Olympics. I think we all know that, and there's no need to start a flame war over that. And his comparison was quite off the mark- there's been several posts about athletes in the Special Olympics who bowl MUCH better than he does, my uncle-in-law being one of them. If anything, he should have compared himself to my friend Joanna, who regularly scores in the 20-50 pt range if not using bumpers (love you Jo!).

I read Chris's post, and he is understandably upset about the fact that someone in a leadership position would make a disparaging comment about a disability group. But I cannot condemn Obama for the comment, nor do I believe that this is revealing his "true world-view" and I also don't extrapolate this to how the administration will respond to disability issues. Why not? Because I have said stupid things too. I can think of several times that I said hurtful things to people who were my close friends because I just said the wrong thing. These statements didn't cost me those friendships because it wasn't a long term pattern and wasn't indicative of how I routinely treated them.

I don't think that this slip of the tongue, inappropriate and regrettable though it was, is evidence of the overall disability policy. The quick turnover in news cycles has turned every comment and minute action of politicians and celebrities into major news, which is great news for Jon Stewart, but a pain for those seeking sanity. At this point, I think it's more logical to wait and see how Obama acts on disability related policy than to rush to condemn him for one off comment. I would think that the recent stem cell decision fits into that column. Actions speak louder than words, or at least they should.


Doonesbury and Disability

Doonesbury is a comic strip that I read occasionally, waiting on an interesting storyline. Well, they just found one.
Doonesbury deals frequently with war and issues affecting soldiers, including disability. Awhile back, there was a series where B.D. lost his leg and was going through rehab, I remember an exchange where his OT was trying to get him to motor plan taking out the trash and his plan was to let the wife do it. How often does OT make it into the comics? and in a situation that is similar to what we deal with everyday, no less.

Anyway, the current storyline features Toggle, a soldier who incurred a TBI and continues to struggle with aphasia, entering a relationship with Alex Doonesbury. I don't really know the characters very well, but I am interested to see how this plays out. (Story starts 3/14/09, you can follow it here)

My only gripe is that there was a little rip on Toggle using facebook to meet people, but I think that the internet is one of the most valuable tools for a young person with a new disability. A guy that I worked with while on fieldwork was a 24 y.o. war veteran who had an SCI after returning home. His wife left him, he had to move back into his parent's house, but he was able to get online, find information about the personal/physical/emotional problems that he was dealing with, and make friends that way. It's hard to get out when you can't drive, and though he was working toward that with outpatient OT and PT, he needed to have those personal connections with other people. This was also pre-facebook times... nowadays, I have a hard time disconnecting from the internet for any length of time, it is the tool for most everything. OK, off the geek girl rant.

I think that there have been several realistic depictions of disability in comic strips. The other example that I can think of off the top of my head is when the grandfather in For Better or For Worse had a stroke. (Story starts 9/26/06, you can read month by month here) They continued to touch on issues of hospital care, rehab, caregiving, and patient frustration right up to the end of the strip when he was rehospitalized. Lynn Johnston also worked with her niece to construct the character of Shannon Lake, who has a learning disability, though I'm not sure of all the particulars since I didn't read that series all the way through.


Interesting Idea for Travelers

Traveling therapists, that is, and the kind that hop state to state as opposed to place to place within a big town. I am not a traveling therapist, though the boxes in my living room might suggest otherwise. But I was reading unclutterer and they were discussing Earth Class Mail, a virtual P.O. box that will scan your mail to your email account and then allow you to choose what to do with it- shred, send to you, archive, whatever. You can check out the prices here... I don't know how that compares to other mail forwarding options, but it sure sounds better than the cruddy service I've had at this apartment (numerous pieces lost or delayed up to 3 weeks).

Packing a moving truck today, which will be tiring, but I should also have enough info for a product review of the supposedly ergonomic Forearm Forklift (as seen on TV)!


Mind warp

I was very confused when I woke up this morning (about 10 minutes ago). I said to myself, "ok, it's Thursday, what do you need to do?" Then I realized, it's not Thursday, I'm just not working. a little more after the click ->

I think most of the tears are over now. I am trying to get excited about my new exciting job, but first I have to get through the aggravating task of moving. Moving is very frustrating to me for all the questions it raises- How did we get so much stuff? Why are we moving here? Where is this/that/the other in our new place? How will we move again if we get any more stuff?! After seeing the apartment, I know that we have to get more lamps, as there are 3 rooms w/o overhead lighting.I am also unsure how the laundry situation will work out as our washer is approximately the size needed for a week's worth of socks. UGH.

It's also interesting that we are moving into a predominantly Jewish area, judging by the multiple synagogues, kosher eateries, and the "Kosher Assisted Living" across the street. The kosher Subway is down the street, but I think that this is the oddest restaurant that I noticed near the apartment, just for the combination of different cuisines.

Ok, got a little sidetracked from OT things, but this is bringing a change in my OT-ness too. I have 300 unread messages from the pediatric AOTA listserv that I have been putting off addressing since I know I won't be using it so much. Need to unsubscribe from that. I have to get everything ready for my license to be reviewed, since this state only reviews once a month. It's good to take a good look at the license requirements before you give your start date to your new job, FYI. I've done all I can do, now I'm just trying to facilitate other organizations doing what they need to as well. Got to change address for all my subscriptions and such. Very busy in box-town.

Have plenty to update about if I ever sit down to do it. Last week was too emotional, hopefully this week won't be too busy. Have to figure out how to transport my violets, which are fragile and blooming again.

Oh, and free giveaway- I have AJOTs from 2005, I think, to now. I will mail them wherever, if not, they're heading to the recycling center. So if you want them drop me an email with your address and I'll gladly send them to a new happy home.


Chapter 2

I haven't done the late-night blogging entry since junior or senior year of college, especially since I started working and had to start going to bed at a reasonable hour. But I've had a lot of things on my mind of late and can't sleep anyway, so might as well. Go ahead and grab a snack before you click, I expect this will be a long post.

Over the past few months, I had decided to leave my current job. I had toyed with a lot of different choices for what to do next, looked pretty seriously into early intervention, also thought pretty seriously about moving back across the state to where the families are. In a serendipitous manner, many things came together to lead me to pursuing a new opportunity at a hospital in Baltimore, and that will be my new home shortly.

Like many of the children I have worked with, I struggle with transitions. My husband prodded me into completing an initial application, I was eager for an official offer, but now the emotions are in full swing. I am having a hard time adjusting to leaving, a lot harder time than I thought I would. I entered this job knowing that my time would be transient, but the attachment got well formed anyway. I've had the pleasure of working with several intelligent coworkers who have taught me some of their tricks of the trade and helped me see where my education was lacking. The group of inpatient therapists who've been working together for 20 years and more have worked hard to help me be less stressed by the job. It's taken awhile, but I feel like I have good friends that I work with, and boxing up those cards and photographs is really hurting... more than leaving high school, more than leaving OT school.

Though the decision to leave was fully my own, and did not make (most of) my coworkers happy, I believe it probably prevented some tough times for the department. Our SNF unit had a massive audit several months ago and we had all been waiting on tenterhooks for the professionals' suggestions to improve the quality and profitability of our unit. I was actually looking forward to this as I saw it as a chance for us to make some really positive OT changes. However, the powers that be have decided that it is best to shut the unit down within the year. A lot of really superb nurses and techs are out of a job and the rehab department is going to have to do some restructuring for things to stay copesetic. This all got announced the day before I gave my notice, and I think it contributed to my pregnant coworker deciding that she would leave as well. The future is still uncertain for the world of inpatient therapy... will they decide to make a very small inpatient rehab facility that can hopefully be more profitable? If not, the focus turns entirely to acute care, and it will take some major marketing before that can sustain the current employees for a full time workweek. I'm kind of sad that there's finally some change taking place and not only will I not get to be part of it, but my opinion in the matter is a moot point. All the changes are theoretical now though... no telling what will actually happen or how stressful it will be to get there.

As mentioned, my COTA coworker is leaving too. We were the entirety of the pediatric OT treatment team. Leaving the kids is literally tearing me in two. I would not have held onto this job this long if not for the kids. Pediatrics is the area I had the least skill and experience in when I started the job and it's the area that I have invested a lot of time in so that I could grow. And I do feel that I have grown as a pediatric therapist... I feel a lot more confident now in an evaluation, in spotting sensory processing problems, and in planning treatment sessions. I have spent numerous off the clock hours writing up sensory profiles (though I didn't get them all done today), reworking the computerized evaluation, and scouting the bargain stores for the perfect toys to elicit the just right challenge.

I have learned so much from the group of kids and parents that I have worked with, and have really become attached to them. I told Bob (a parent) at one point that working with his child and 2 specific others that are long-time consumers was very grounding for my life. No matter what else was happening in work, I could count on those specific 30 minute sessions to give me a routine that was often more fulfilling than the rest of the day, week, month. I have been worried sick about leaving the kids, especially since there will be a limbo time between therapists. My coworker talked about feeling territorial and resentful when an interviewee was brought in recently, because she didn't want to be replaced. I think I would feel better if I knew that there was someone starting right when I left (instead of 3 months later) and that I could talk to them and show them where everything was and present what I'd been doing with the kids and know that they would be ok, that there was someone to take care of everything after I go. I know it sounds terribly narcisstic- they will survive just fine without me and many will never remember me- but I just wish I could be assured that they would all be taken care of. In a selfish way, I also wish I could know that all the parts of the program that I have tried to build up would continue to build and not crumble. I don't want to feel like everything I did will be erased and of no consequence.

I don't worry about the adult patients in the same way. There is a revolving door on the hospital, many will be back again, and there will be a time that they don't recover. That is just something that I think you have to accept when working with that population. I do worry that with the shuttering of the transitional care unit that there will be people who get unwillingly pushed into a 'nursing home' stay and get very upset by that label. There were a lot of people who refused to go to an inpatient rehab facility or a long term community skilled facility until they had given rehab a try for a few weeks on the TCU floor. We took in a lot of joint replacement patients who would not meet requirements for an IRF, and who knows how many complications were prevented by allowing these folks with 'basic' surgeries a few extra days of supervised recovery. Enough that the orthopedic surgeons are not happy with the decision. To sum up, I worry in general about the adult patients, but their stays are so transient that I usually only worry my mind over them specifically while they are present or just recently discharged. There's no one adult who's fate will keep me up at nights, hopefully they will all be taken care of well despite the current flux.

There are other things I will miss... my COTA coworker gets more pregnant by the day, which is amusing and interesting, and I probably won't hear much about her baby. The SLP is finally getting settled into her humongus house, and I won't get a repeat visit there. Other babies are growing, my pediatric PT buddy is just coming off a honeymoon, my acute care PT buddy is growing a business and buying a house, there's a lot of personal things that I will miss. During my time here, I was able to see that when other employees left, their shadow did not remain... their names and antics were forgotten. It does hurt to know that people you've been close to will not remember you, and if they do, they will probably not care that much about the course of your life. It's normal, I know, because how could any person function if they were weighed down with the irrelevant future of every person from their past that they once were close to? That's why we facebook people we went to elementary school with, instead of writing detailed letters to them.

2 goofy things that I will miss:
- I am a number freak, always watching my car odometer and clock for palindromes and other patterns. It has always brought me a distinct feeling of success when our medical record numbers grows by a hundred thousand. I started working with people who were in the 1960000's, recently I have had a pt who had a 1999000 number. I will be really bummed if I don't see someone in the 2 millions.
- After a winter of carefully watching my step and dodging the nastiest smelling berries (?) from a tree in front of the door I use twice daily, hoping that I didn't step on one and bring the stench of vomit in on my shoes, they finally cut that darn tree down.

I know I am blessed to be leaving on my own terms, to another job, where my husband can keep his job, especially in the current economic situation. Truthfully, though I had talked of going home, it would have made it very hard to find 2 new jobs and a new place to live and go through that kind of transition in a recession. I likely would have had to be the sole provider for awhile, and I have seen the stress that has put on my coworkers. I wasn't forced to leave due to cutbacks, terrible treatment, or a need for more money, and I am thankful for that, and know that I am a little spoiled to be worried about these insignifcant things at a time when others are worried about having a job at all.

I feel that I did make the right decision, though it was very hard, and is making me do hard things like move, learn new things, and start all over in a big city. I will get some good opportunities at the new hospital, and be able to rotate to different areas every 3 months or so, which should help quell potential boredom/burnout. I will get my chance at a 'big place,' without having to move to Chicago, Atlanta, LA, etc... and see if that, which has always been something that I talked about wanting to do, is actually something that I enjoy doing. I will be able to get some more critical cases as city hospitals do get more of compared to their rural counterparts. I will get to be part of a large team of therapists who seem to be committed to personal improvement. Hopefully they are not reading this and wondering what kind of neurotic person is joining their team... I'm sure they will all find out soon enough firsthand. :-P

I do feel better now that this is all finally out in the open. I'll still be emotional, but hopefully the thoughts will slow down in my head enough for me to get to sleep. My last day at work is next week, I will follow that up by moving, acquiring a new OT license, and starting Chapter 2. Wish me luck.


I live in the Procrastination Station

I am up to my eyeballs in stuff to do... need to be writing up 2 sensory profiles and 2 sensory diets for Monday and Tuesday. Have to leave town this weekend, which will make that harder. Lots of other things to do, but I feel that shouldn't really be discussed until I can write a major entry here, which I have also been putting off. I have difficulty with transitions, and currently with organization. My thoughts have also been very transient, jumping to inane topics such as how death is dealt with in Dexter and Pushing Daisies, 2 shows that I like and which have nothing in common.The randomness and procrastination are possibly my coping strategies for stress, but it's making it hard to do what I have to do. Hopefully I will get all I need to done (finally) and can address some of these important issues soon. It's 4... can I get that stuff written up by 6? I hope so...