Art Contest

I read about this contest on the Your Therapy Source blog and it's pretty cool... definitely a fun thing to work into a school, EI or outpatient pediatric therapy session. Most of my kids weren't using adaptive devices for our work though, just better designed products.

I am off tomorrow and excited about it! Once I get the house cleaned up for a weekend visitor, I am going to sleep and relax and update some posts. :)


OT Quotes

This little entry was gathering dust in my drafts queue, and though it's past OT month and likely past many graduations, here are some randomly collected semi-inspirational quotes. Feel free to share additional gems in the comments.

"Great leaders are almost always great simplifiers" -Colin Powell

"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm

"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium

"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf

"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb

"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning

"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips

"Everyone has a moment in history which belongs particularly to him." -A Separate Peace

"It's what you learn after you know it all that counts the most." -Phil Jackson

"The time to hesitate is through." -The Doors

"In valor, there is hope." -Police Officers Memorial

"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy

"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf

"The journey is the reward" -Greg Norman

"Stone walls do not a prison make, nor iron bars a cage." -Lovelace

"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks

"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach

"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King

"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher

(if this collection does not deserve the adjective "random," then I don't know what would)


Interesting OT Connections threads

I've been trying to spend a little more time on OT Connections, especially in the posting department as opposed to lurking. Here's some topics that I have found interesting in the past few days.

You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!

Food for Thought- a really good student project involving nursing home residents having greater control over meal time

Documentation on PDAs- a home health group is going paperless

OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there

Oncology Research Articles
- I am looking for good rehab research relating to pts w/ cancer

Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread

SI for Geriatrics- some good information about bringing sensory strategies to the older adult population

Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?


Things I am currently thinking about...

Longer updates to come soon, I've had a couple of busy weeks and have to work this Sunday. But here's some thing's I've been thinking about.
  • Contemporary Motor Control theory
  • Best practices for home residing people w/ dementia
  • The kid on Breaking Bad
  • Reading more AJOTs
  • Branching into NICU?
  • A couple of interesting case studies- pt. w/ ABI and another w/ multiple complex brain issues
  • Customer service
  • Energy Conservation
  • Changing layout on the blog?
Might have some free time tomorrow, hope to get some updates on here soon.



One of the amusing things about working in a field that lets you interact with lots of different people is simply the stories that you come across. It is a well known adage that to be a writer, you must read, but I think that listening to other people's original stories is the way to go- you can't make stuff like this up.

For instance, a man with COPD and schizophrenia had a vision that if he smoked more, he would get healthier. He was later admitted to the ER with persistent cough and shortness of breath.

I've had several people who've had quick reentries to the hospital, which is always lousy. I had one lady that I evaluated in my first week of real work, and I remember her because I have an aunt with the same name. Most people, in meeting someone, would be at least mildly interested by that sort of anecdote, but this lady was thoroughly not amused. She needed to go to short term rehab since she'd had compression fractures and a pacemaker placed. 2 days after she got home from rehab, she fell at home and was even less happy to see me the second time around.

One of the downsides of working in acute care is that you see SO many people that it's hard to remember all the stories. The COTA has asked me once or twice about Mrs Soandso and I'll say 'can you refresh my memory?' Even with the response, 'yeah she's the frail little lady' I am usually struggling to remember. :)

An old story from my last job
that I never got around to writing up- 102 year old man was taking a mini-mental. I stick out my arm and say, "what's this on my wrist?" trying to get the response "watch." Instead he says, "oh that's some kind of growth. A mole. I big mole."

Recently evaluated a man w/ very advanced Alzheimer's and Parkinson's diseases. Per the chart review, he was basically wheelchair bound at home, largely nonverbal. Yet he somehow managed to 'take his family hostage' (though no weapon was mentioned) and he was brought to the ER in handcuffs. He was far too combatitive on day 1 for me to work with- throwing things and slapping at people. When I saw him on Day 2 he was a little more calm and the PT and I were able to get him into a chair, he was able to state his first and last names, but other than that we couldn't get him to follow any simple commands or tell us anything else. Later that day, while working with his roommate, he had decided to remove all his clothing and sheets and was requiring one person's complete attention to keep him from crawling out of the bed.

I do not envy our case managers and some of the placements that they have had to pursue recently. It is probably just 'the way things are' but it is very difficult having people with lousy home or medical situations come in, but not have rehab needs to qualify them to go elsewhere. I am trying not to get overly bummed out about that part, since I end up with a role in the drama. It also makes me think about what choices I would make in some of these situations, which is also a downer.

Though I have tried to hide it, my coworkers have figured it out (even quicker than last time) that I am a techie. We are encouraged to do point-of-care documentation and get notes in ASAP after an eval, so we all have little tablet laptops. I had been using mine as a regular laptop, but using a touchpad all day at work and then at home was making my wrists go into agony. So I resolved to figure out how to manipulate the tablet software (despite not having regular access to preferences) so that it would suit my needs, and for the most part, I have. I attempted a few evals Friday using this strategy to document in the room, and plan to hit it hard next week and make it work. Even with just trying it out on Friday, I got comments from a lot of excited coworkers who wanted to learn how to do it too. I may need to prepare a how-to guide since I don't mind sharing but definitely didn't get out on time on Friday. My current home computer is too newly purchased to talk about such things, but a tablet wouldn't be a horrible next purchase, however, the only thing I can see it really helping with is blog entries, so it's not really worth it as yet. Suppose I could eventually look into a tablet PDA, but the smaller screen would take a longer time to make work. I may also have a problem with mine at work since one section of the screen seems to have difficulty responding to my inputs... might have a dead zone.

Some of my coworkers are very resistant to the computer documentation, I am still surprised that a lot of the departments at the hospital do not do computer documentation. Everything was computerized at my last hospital, and this one is considerably larger, so I assumed they would be more 'with the times' so to speak. I remember way-back-when, first year OT school when potential research topics were brimming in my brain and I had thought of doing a project on whether therapists with computer documentation were faster, now I am glad I didn't since it is such a hot-button issue for some. Can of worms, though it would still be interesting to see the results. Anyone else use tablet computers for point-of-care documenting?

My current metro-reading strategy of reading a paragraph as the train slows down and stops at a station is going well. Since I can't seem to time the shuttle departure right (don't know if it's possible to) I am also picking up 10-20 minutes reading time there too. I am officially CAUGHT UP on all my OT Practices that had piled up during the transition time and actually eagerly awaiting new ones since I have time to read!! I am working on responses to some articles too, hopefully will be ready to post those soon.


May is Stroke Awareness Month

Read the CDC feature on stroke

Make sure your friends and family know the signs of stroke so that they can be prepared to act in an emergency.

Check out these sites for more info:
American Stroke Association (a division of the American Heart Association)
Internet Stroke Center


OT by PT

Addressing the problem of professional crossover.

One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.

One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.

I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.

I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'

I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.

Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.


Sharing a Brain

I did not submit this card to Postsecret, but I share the sentiment...

I'm a metro girl though, not light rail.

My only complaint about the new way of commuting is that when I was driving if I left for work early in the morning and/or left work early in the afternoon, I could cut my driving time. Now the time is constant, but often longer than if I had been driving and not had traffic problems.

Other potential problems include that I have to leave by a certain time or my shuttle bus won't take me to the metro; and that it does not run on Sundays, and I work 2 of those a month. No major progress on the overcoming motion-sickness front either. Latest strategy is to read 1 paragraph at each metro stop, which is a little better.


Recession Job Market

For the third part in the little mini-series on job hunting (here's the links in case you missed searching or interviewing for an OT job) I would like to address the topic of job-hunting in the midst of a recession.

The recession is not making big headlines this week, perhaps because the doomsayers have realized that we are probably not going to end up in another great depression or a post-apocalyptic nation focused solely on survival. However, it is still a topic on people's minds, especially when discussing a job search.

Occupational therapy made the headlines by landing on Time's 150 Recession-Proof Jobs list. OTRs come in at #18, and OTAs at #72. Rehab/Healthcare jobs in general were well represented on this list- PTs, PTAs, Therapy Aides, SLPs, and also RNs, LPNs, Athletic trainers, Massage and Respiratory therapists were all in the top 120.

We now interrupt this entry with a quick little note about political advocacy here. It's likely that athletic trainers have climbed their way onto the 'recession proof' list through their efforts to redefine their scope of practice on a political level. Since any individual can now be considered an "athlete," they now have a much wider base of clients to work with and places to seek employment- like outpatient rehab clinics. Recreational therapists, on the other hand, are not on this list, perhaps because they have been cut out of some Medicare legislation affecting reimbursement and their necessity to be employed in certain environments. Right now, they're trying to become a covered, required service under Medicare for additional settings. Just a little word about how you can't live as a therapist in isolation- political action is required if you'd like to continue having a job and being relevant to the rehab world. As one of my teachers said, if you don't have the time to do it, at least kick some money to the people that are working on it at your state and national associations. We now return you to your scheduled blog entry.

One thing that surprises me about the job list is that OTAs are not higher on the list, or even higher than OTs. I would think using more OTAs could be more profitable for many organizations, as long as there are not a superfluous amount of evaluations to be done as opposed to treatments. My current job is obviously one of those places since we get about 1200-1500 orders for OT/PT/SLP evals each month, so there are only 2 OTAs and 1 PTA. OT Practice recently had an article celebrating 50 years of OTA education, and the associate's degree remains a cost-effective way to get into occupational therapy.

Despite the accolades the profession has been garnering, I think that the only people who say that OT is 'recession proof' are those not currently working in healthcare. Many sites are in the midst of a soft or full-on hiring freeze. Some hospital units are closing completely, orthopedic units are trying to step up the service due to decreased elective surgeries- My old hospital was trying to see acute orthopedic surgery pts 3x for PT and 2x for OT everyday; a friend at a hospital-based SNF was trying to see subacute ortho pts 2x for PT and 1x for OT each day, which is causing their depleted staff to work overtime everyday. (Obviously the second group is salaried, keep that in mind during your job search.) PRN (as needed) nurses and therapists are seeing a dramatic cutback in use of their services, which used to be a pretty lucrative way to earn money without a full time commitment.

Though it may be callous to gripe about cutbacks on perks, that too has become the reality. Sign-on bonuses (taxed very high anyway) are getting cut. CE money is often getting cut, which is a shame, because high intesity courses that give a lot of hours are more expensive. It stands to reason that therapists might choose to stick close to home and maybe go for something based less on the knowledge they will receive and more within their price range. I don't know that it's technically fradulent to pursue CEs outside your realm of practice, but it is professionally discouraged. It wouldn't fly in my current state, since they have to preapprove everything you go to. Money for therapy supplies is likely getting slashed in budgets, so you may have to appeal to grants to get the fancy new equipment. Another cutback is in the retirement arena- matching 401K funds are dwindling. My current company still has a pension plan, which I thought had all gone kaput long ago, but they are keeping that and tossing out the matching funds.

If you work for a hospital, then at least your healthcare benefits are fairly safe. After all, they can't just deny you admission to the hospital. However, I have heard of some places charging an extra fee if your spouse's employer also offers health insurance but you chose instead to go with the hospital's plan. The wording was that the hospital couldn't afford to subsidize the rest of the county's healthcare costs. The other issue related to healthcare is that it can be hard to job-swap since a person would face up to 3 months without any benefits, especially if you have a spouse or family depending on you for coverage. If you're single with a chronic health condition (especially including pregnancy) then the issue has to be weighing into your decision as well. Related to that, it's good to pick an area that has multiple job offerings, so that you don't have to pick up and move if you want to work somewhere new. In a related situation, it would be very difficult for my husband to find a new job, so when I accepted my new position, we had to live somewhere that would be a reasonable commute for both of us. Part of the reason that we chose to move to Baltimore instead of back where our parents live is so that he could keep his job- trying to move and find 2 new jobs is stress that we're not ready for yet.

Though this post is a bit of a downer, don't be mistaken, there are OT jobs out there. You may have to take a position that isn't your dream job, but there will likely be plenty of positions available in hospitals, SNFs, and large facilities. There will probably be fewer openings in schools (these are usually limited anyway since people tend to keep those jobs when they get them) and small private practice facilities. There are also likely to be fewer openings in OT college towns since there is always a fresh supply of therapists available. But when there is a legitimate opening at any location, the current therapists will likely be stressed by trying to deal with the workload and they will want to fill their position. And if you're just starting OT school, don't be put off by the cost of the degree. Student loan debt is better to have than other types, people have used those loans for international travel and buying cars and still come out ahead. And since there will be some type of OT job available when you graduate (not necessarily a perfect one, or one that pays $100,000/year) you will be able to pay back your loans.

The jobs are out there, good luck to everyone that's looking. I have to guess that they will be a little harder to land in May or December, so you may want to start your search pre-graduation if you're expecting to get a job right after school is out. Happy hunting, everyone!