hiatus

No updates this weekend, I'm visiting with my family! Have to get my webcam working so that some other things can get done too. :)

Long term care calculator

Saw this calculator (thanks to the Alzheimer's Reading Room) to figure up long term care expenses for different regions. I can't seem to make it work since I can't select cities, but this may be a function of firefox, hopefully not of the program. Anybody who can work it, let me know if it's a reasonable estimate compared to the real world.

Adaptive Equipment- a different view

I've had a few thoughts about Adaptive Equipment (AE) lately
I saw this post on OT Advocacy and read the second reference, a diatribe on the lack of utility of a sandwich holder which the author's OT wanted her to use. This was interesting to me on 2 counts, first: this entry reflects an unfortunate client-therapist relationship, since there is no point in forcefully recommending devices that the client does not want, and this should have come up during a session; second: I consider myself well versed in various AE items, even some that are obscure, thanks to a tech-based fieldwork and my mother's old texts (1977?) on facilitating independence in homemakers, yet I do not believe that I had ever heard of the sandwich holder. My first reaction was "how pointless," and I had been thinking of devices that could be permanently put out to pasture. Other nominees would include the button hook (how often do you really have to wear a shirt with buttons on it?) and the oven stick (hello microwave).But instead of starting a chronicle of useless devices, I had a second thought. Just as it does a client injustice to insist upon their purchase and use of a device, it is also inappropriate to know of AE that could be potentially helpful and desireable and not allow the choice to be theirs. Despite my knowledge of AE, I am a minimalist and a Mcgyver-ist as well. Never a reacher and a dressing stick when the reacher will suffice. Never a sock aid if we can put socks on using a footstool. But if someone expresses an interest or a problem that I know of an AE solution for, no matter how outlandish, then I feel obliged to discuss it with the client and let them make the final choice. For example, I had been working with a lady in her 80s who had a tibial plateau fx and was either non or toe-touch weightbearing. So her main transport was going to be a wheelchair, using a walker for transfers. She really, really, really wanted wheelchair gloves. I didn't think that it was necessary for her to spend money on those, but she enjoyed being able to propel herself around the facility at her own will.

Another story that comes to mind is from my very first fieldwork, when an OT had constructed what she termed "claws" out of splinting material and strapping that compensated for decreased grip in a pt who'd had a spinal cord injury. The specific pt that it was crafted for loved being able to use the claws to pull up his pants. My supervisor tried the same idea with one of her outpatient clients (who'd also had a high level SCI) but was in his 20s and wanted nothing to do with pink claws. I guess what I am taking a long time to say is 'different strokes for different folks'- there will be devices that are appropriate and wanted by some clients that will not be appropriate or wanted by others. And that should be a choice left up to the client.

On a PS note, the picture above is from one of my mom's texts, of which I believe the copyright is long expired. I may look through the collection and see what other illustrations and instructions can be shared for homemade adaptations, just in case anyone is curious.

What I'm Reading Now

Current reading pile

• Mansfield Park, Jane Austen- trying to finish this so I can get on with everything else. The first 200 pages were not particularly exciting, but now it's picking up
• The Tipping Point, Malcolm Gladwell- borrowed this from my dad and my husband now picked up the audio book. I'm a little competitive, so I'll have to keep up while he's reading.
• Stroke Rehabilitation: A function-based approach- I bought this quite a while ago, but now need to get around to reading it since I will be on the neuro side of the floor quite soon.
  
• OT Practice 7/13- did take a break from the novel to go through that. Have to browse the OT Connections Forum to see what the conversations are about that... the main article was interesting, I just need to process it in relation to my own life.
• Rehabilitation of Traumatic Brain Injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches (Archives of Physical Medicine and Rehabilitation Vol 89, Dec 2008)- Saw this referenced in the previous OT Practice and it referred to 2 different treatment approaches that I wanted more information on. Haven't set out to tackle it yet.
• Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational "categories" (Canadian Journal of Occupational Therapy April 2009 Vol 6 Num 2)- Saw the abstract on Karen's blog and had my library buds pull it for me. Should be an interesting challenge to daily practice.
• Validation of a New Coma Scale: The FOUR Score (Annals of Neurology 2005; 58:585-593)- I saw this in our new employee handbook in the 'preparing for neuro' section. I can't remember if I learned about this before or not. I know that we did the Glasgow Coma Scale and the Rancho Los Amigos Scale for Brain Injury, but I thought I would look into this. Not sure if it is used on our floor or not, but it's worth learning about.
• 17 files from my neuro professor/coworker- piles of powerpoints, buckets of documents, all in preparation for the scary neuro floor. eeep!
  

So that's what I'm up to. I love reading, but sometimes there is too much... this doesn't even take into account my Google Reader list or daily newspaper browsing. Anyone know an electronic reader that will transport the information into my mind?

information overload

As usual, I panicked over the wrong thing, this time, it was continuing education, of all things!

Earlier this year, as I contemplated job changes and whatnot, continuing ed was far away on my back burner. But when I had to get a license in a new state, I had different, more confusing rules to learn. The main, biggest, worst difference in the 2 states is that you cannot "roll over" CE hours in Maryland. But in February, that was not my concern. The worry was how I would manage to fill in the hours well, and options seemed limited. I did get 2 hours from my jurisprudence exam (required for license) and had a coupon from AOTA for a free CE article (1 hour, but not as of yet cashed) and prospects for further ed looked bleak. I am saving my monies for the 2010 AOTA conference as a dual education/reunion opportunity with some of my classmates and know that I can pull a whole year's worth (and some) of CEUs at that event. So knowing that, and knowing that I get no roll over (Grr grr grr) that just left me with 10 hours to figure out for this year.

My main difficulty was balancing educational benefit and financial cost. I attended a seminar on stroke at the facility (couldn't beat the rates and a friend wanted to go) which was good. I will be presenting at a local state conference as well, so I will get credit to attend and to prepare, but I have to look into the rules to see how that will shake out. So everything appeared to be taken care of... however...

That's when cool offers started pouring in. First was the guilt that I should attend 1 state conference and not another. That would be an extra event in November. Then our NICU therapist introduced me to the Developmental Therapists in the NICU conference which would be in Phoenix this year. I got an offer for 13 hours to learn therapy Spanish over 2 days... I got another NICU conference pamphlet in the mail today (16 hours w/ optional pre-conferences) which also advertises an online CE library... enticing. The quality of solicitations that I am getting is improving, which is bad, since there's already too many choices!

The 2 NICU conferences are tempting... one since it comes recommended by a coworker who has NICU-know-how, the other since it is close by. But as to be expected with a conference that earns you so many hours, they are each quite expensive. It's also a bit prohibitory in my mind, since there are only so many things I can keep in my head at once and I don't know if it's worthwhile to expend a lot of effort on NICU learning when I probably won't get to practice it much.

Therapy Spanish hits me in a sore spot... I feel like languages are one of my strong suits, however, my language skills (other than English) are really underdeveloped. 2 years of concurrent Latin and Spanish in high school was fun, but didn't give me a strong basis in either language, and college Latin proved even more futile. ASL was fun, and I can still sign Journey songs, but I don't have a functional usage. While I can cheat while reading Latin/Spanish and decipher somewhat, there's no way to do that in sign. And there's no way to learn any language without a lot of practice... which I just haven't set aside the full time for.

It's hard thinking about all the things you could learn, all that you could use, all that you could grow to be... especially on days when time seems limited even for the daily mundane tasks. So much potential, and too many other things in the way. Sigh.

(by the way, I have no experience w/ any of these CE companies or the specific courses, so I can't offer any comment on their overall worth. I have no relationship with any of them, monetary or otherwise and this is not an endorsement.)

As if people needed excuses NOT to use mass transit

hearing loss? back injury? and what else?

A medline release about subway stations being loud enough to damage hearing has been heavy on my mind of late. I notice that I can often hear the music from my fellow travelers MP3 players- they are cranking it up to hear it over the other noise, which only feeds into this probability of hearing loss. It's also pretty commonly acknowledged that bus/truck drivers are at risk for chronic back pain from the vibrations of the vehicles (here, here, here for a few quickly obtained (if not most definitive) sources). A student project looked at vibrations as well as "measuring “impulsive shocks,” which occur when a bus driver hits a speed bump or a pothole." I have been starting to wonder seriously about the effects of constant vibrations from the metro and the forceful impact of "impulsive shocks" from Baltimore's potholes.

Personally, I feel like I am rolling the dice enough against sustaining an injury in some way: Recent AJOT article highlighted potential for work-related injuries in OTs; I am constantly dancing on the edge of RSI in my wrists, elbows, and shoulders; and I have yet to see the effect from my sports playing, but the possibility of hip, back, ankle or shoulder OA remain highly in the future. Lousy to be thinking about this in my 20s. It's a scary world out there.

first day back

First day back... first day on the surgery floor.

It's hard returning from vacay anyway, but trying to get a feel for a brand new floor at the same time is double hard. Added into that is a factor I had not previously considered- July 1 marked the transition from classroom medical students to residents. So not only do I not know the ropes, but the people who are writing the orders don't know the ropes either. I didn't realize when I accepted a job at a teaching hospital that part of my job would be teaching doctors. But we are all teachers, and we are all students...

I had a sad realization today when I realized that a PT student who was present before I left must have completed her rotation. Already in just three months there have been 3 different OT/PT students in the office that have come and gone, I've had minimal contact with any of them. I've never had my own fieldwork student yet since I hadn't been licensed long enough to take one at my previous job and now at my current job they have a (needed and appreciated) requirement that you have to work a year in the facility before taking a student. I have had several job-shadows before, but it's different, being that they were all just for a few hours and all high school students except for one pre-OT.

Anyway, first day was a comedy of errors and minor misfortunes. First eval of the new rotation, a (thank goodness) cotreat w/ PT was of a gentleman who was quite agitated and upset, who basically tried to run down the hallway away from us and was working very hard at pulling out his IV and chest tube. He later left AMA, though he did allow someone to remove the tube properly before running off. Second guy kept having low O2 sats and no rebound despite cranking up the oxygen. Saw a lady before lunch who was quite limited in cognitive and physical abilities. Mod assist for feeding, Max assist for grooming. Nice though, and later walking by I saw her son, which was crucial since no one has been able to get ahold of family members. So I had to go on a mad dash to find the MD and case manager so that discharge plans could be made, but that actually worked out well.

Last guy, I had tried to see multiple times throughout the day to no avail. Half started an eval twice and had to leave for different reasons. Finally came back to finish it following a wound vac replacement, at which time the new docs announce that he has to go to the OR tomorrow for surgery. I say, what are you doing? and the response is "we don't know yet." It apparently will start as a wound debridement and then based on the amount of muscle loss and damage to the fascia may have to be an ampuation of his leg. Which is, of course, majorly distressing for him and effectively renders my evaluation useless, since he will need new orders and a reassessment once he's medically stable following the procedure. Pretty impossible to make reasonable goals or discharge plan when you don't even know the impairments yet.

Hopefully it'll get a little easier tomorrow.

back in the saddle

It was so nice to have some time off from everything!!
I love the beach, and I did some real disconnecting this year, only checked email twice and facebook once in a week, and did not bring any OT materials either. Left my phone turned off for several days (no one to call me anyway since I was at the beach w/ all my top callers). My husband was not as prudent and accepted a call from my office... ack. But other than that slip, a total unplug. I so often feel out of balance in my occupations, a point brought sharply home by realizing that I opened up all my puzzle books this week for the first time since LAST year's vacation, despite the fact that I really enjoy that. I read a good novel and a crummy nonfiction book, played Rock Band with the family, just relaxed. It was good to be away from everything. This evening I got to check my mail (so satisfying to have a whole box full for a change!). I cleared through a list of 354 google reader items pretty quickly this evening (skimming many, real reading a few, and just deleting a bunch including 125 medline notes).

So Monday takes me back to the day-to-day worklife, since I did not hit the lottery and cannot as yet retire to my own beach house. This may be difficult since I am naturally nocturnal and have slipped closer to that schedule in the past week... waking up at 6 is going to be harder than usual. I really need a job on afternoon shift... too bad no one wants to do therapy at night. I have ended my medicine rotation and am moving to the neuro/surgery floor, so that will be new and interesting.

I did start a twitter account before vacation which I will be primarily using to share interesting articles right away instead of letting them languish for ages in my bookmarks until I find enough similar for a webgems post. I held out on twitter for a long time, but I need to figure it out since I will be presenting on using social media effectively and efficiently as an OT for a state conference this fall (!!yay!!). For now, these updates will be funnelled into the much too long sidebar... I am looking into getting a new layout, 3 bar or otherwise and maybe more specific to OT if possible.

First twittered link is an article from Gretchen Rubin about how to make meetings better. Different sites have vastly different numbers/types/procedures for meetings. My last job held monthly OT meetings, and sporadic as-needed meetings for the inpatient and outpatient staff, all of which were informal. My inpatient rehab fieldwork felt like there was a meeting everyday at lunch. We had inservices, all rehab, all OT, specific team meetings, strategic planning from the upper management, etc. And during my 3 months I think we tried to do rounds reports 3 different ways. My other fieldwork supervisor was a consultant, so there were LOTS of meetings we went to during that time. Currently I have daily rounds (depending on the floor), a monthly OT meeting, a monthly acute care meeting, a weekly floor meeting, and a bimonthly all rehab meeting. With the exception of the dailies, it's not too bad. It's hard to balance the good you can do by being at a meeting and representing OT and advocating for various clients vs actually being able to go see and treat and document those clients instead. It's no secret that I am not a big fan of meetings, so anything to make them a little better is appreciated.


Happy 4th!!

Aerobic Exercises in the Pool

I've had interest in aquatics since I finally conquered the water (6th grade?). My research project in OT school was on aquatic therapy for CVA pts at a local rehab, and I also spent a fair amount of time lifeguarding. But the spur for this article is more personal... my dad had a heart attack 2 years ago at a young age and has been working hard at galvanizing the men around him to be proactive about heart health. My uncle has been resistant, saying that he can't do regular cardio due to his knee replacement... so here's some low impact cardio exercises you can do in a family sized pool. As always, consult a doctor before beginning an exercise regimen of any kind, especially if you have risk factors for cardiac disease. Seriously. Also, be careful in the heat, since that could aggravate a cardiac condition. Again with the checking with doctors.

Treading Water- an easy exercise that can be done for a long time. For variation, try arms only, legs only, or holding a weight above your head.

Walk Laps- good for a shallow pool, you can add resistance through leg bands, such as these from Speedo

Jumps/Skips/ Bobs- simple enough, more demanding than just walking. Jumps or skips in the shallow end, you can do bobs up and down in the deep end trying to get high into the air and deep to the bottom of the pool. Be careful not to over exert, especially if you are holding your breath.

Underwater Laps- build lung capacity by swimming progressively farther underwater. Slow your breathing during your rest breaks.

Side push ups- plant your hands on the pool wall and practice lifting yourself out of the pool. Be careful with this, keep your head back and away from the wall or your teeth are in peril. As an alternative, if you have a diving board, you can do pull ups while in the pool, you can also do these from starting blocks if your local pool has them and allows them to be used for this purpose.

Crunches- with your back to the pool wall, stretch your arms so they support you and let your feet dangle straight down. (this is 90* shoulder abduction for those who are anatomically inclined) Then, you can do oblique (side to side) crunches.

Stepping- if you have an aerobic stepping program that you are familiar with but have a hard time tolerating the impact level, weighted steps can be used in a shallow pool.

If you have access to a lap pool in your community, swimming laps is good cardiovascular exercise and can also help you work on expanding lung capacity and strengthening. To mix up the routine, consider using a buoy to force you to swim only with your arms, or a kickboard for the opposite. Also, many local community centers offer aqua aerobics... if you're already paying for membership, you can take advantage of the class.

Some resources:
http://www.exercisegoals.com/water-aerobic-exercises.html
http://squidkid.org/2008/03/19/water-aerobics-for-very-smart-dummies-pool-workouts-101/

ps- again, go to the doctor!! use these tips at your own risk.