It's a Christmas Miracle!

So at rounds today, I was rushing in late and trying to get my computer set up to look things up. They had already started on the first patient (not one of mine) and wanted to know if OT and PT agreed on discharge plans. I asked for a minute to get everything settled, and in that time, the resident looked up the notes and had the answers. I was shocked! I said, "wow, I didn't think you guys ever read our notes!" and got rousing responses from around the table (resident, PA, social work and case management) who stated that they DO read them (even if it's just the summary paragraph at the bottom). It was like a present with a big red bow.

phew...

Life's been pretty busy lately...

I've been working on notes at home almost every night, and have also started trying to track my work day in 15 minute increments so that I can become more efficient.

Enjoyed Harry Potter. Holidays are coming up, as are the family travels over hither and yon. We are planning a trip to New York soon, I have never been there so I am really excited.

Recently got a Nook and have been pretty excited trying to put journal articles (and tons of novels) on it. OT Practice does download as a pdf file but it doesn't come out quite right... will have to play around with it.

I have officially added 1 OT activity to my life... a special welcome to any MOTA members.

I definitely have plans to write more soon, but I'm trying to get upbeat... it's been a very difficult rotation, we've lost a lot of patients on caseload, I feel like I should be a representative for the hospice service. I will have an entry on hospice coming up, and do have others planned/half-started as well.

Struggling as an OT for my family

Any medical professional can tell you the hardest patients are the ones you're related to. Once you express interest in a degree, the health questions start coming in from all sides. I remember using my special tests book to r/o fracture after my brother punched a wall, digging through an orthopedic text to find the painful ROM arc of my mom's shoulder over the phone, and trying to diagnose a no-longer-present-but-still-bothersome-that-it-had-ever-appeared nodule for my dad- incredulous that this didn't involve a trip to the doctor. But there are limits to what anyone can do, especially from far away.

My dad had a heart attack after I finished my final OT fieldwork. I had several weeks that I was able to spend at home while he recovered. I don't recall doing much during that time except for just trying to keep a close watch on the recovery process, driving him to appts, and encouraging a gradual return to activity. I do remember questioning the MD about the quality of the hospital's cardiac rehab- I didn't want him doing dowel exercises to 90* and 20 mins UBE only- but they had a very good program able to help him return to playing football, teaching full time, etc.

My mom had an injury lately that exacerbated chronic back pain and forced a laminectomy. While I could answer some questions about spinal precautions, home adaptations, I couldn't help her with the insurance issues or prognostic questions like when she could go back to work. It was very hard for me to to counsel her by phone after her surgery despite the fact that I do that for non-relatives everyday.

But the most difficult has been my grandmother-in-law. I can't remember whether it was before or after the wedding that she asked her MD about Aricept because she felt she had memory problems. She had self-diagnosed Alzheimer's Disease (AD) correctly, unfortunately. Our visits were limited due to time and travel constraints, and initially she appeared to have only mild deficits. However, when the disease began to progress, I felt it moved quickly. Environmental modifications went from un-needed to un-beneficial quickly. We made some changes later, like raising the table legs so a wheelchair could fit underneath and relaying ramp specifications for her son to install. The home health agency actually responsible for her care got her a toilet seat with arms and a shower chair. I sent lots of activities and descriptions of how to grade tasks for her caregivers, but they were often too strapped for time to engage.

I got her a bright flowered walker bag as soon as she required a mobility device. However, she never could master the walker usage, and would lean backwards precariously while someone held the walker in front of her- very frightening. It is strange to transfer a family member. Sometimes I tell my patients that OT is "up close and personal" because of the lack of distance required for some activities. Anyway, despite initially being regarded as 'the expert' her caregivers and family that were there everyday were much more effective at her transfers than I was, even if I had to bite my tongue as they were less safe.

I had multiple discussions with my father-in-law about her ongoing need for care- pushing for 24 hour daily caregivers to relieve family and be safest. When her MD pushed for outpatient PT (WHY?!), I tried to relay that home health therapy was invented for the homebound and that bumping her in a wheelchair down a flight of stairs constituted excessive burden. We discussed that PT was not a cure all and that ambulation was getting unrealistic (despite what the doctor thought), but they pushed ahead. It was still sad for me when I heard she was d/c from PT due to plateauing, though I knew it was coming.

From there, the decline moved rapidly. She was already unable to hold a phone conversation, but became unable to stay awake for any activity in front of her. She had a few back-to-back hospitalizations and was sent home on hospice. A few short weeks later, one of the most loving and vibrant individuals I have ever known succumbed to one of the worst diseases of our time. Even though this outcome was expected and in fact certain, I still felt that I had failed along the way. I hadn't been able to adapt the walker to make it easier to use, conduct training with the caregivers, or give her a robust home program so that she could continue to participate. I can't even say that I did my best, as usually I had forgotten planned efforts- like sending her one of my violets. And I felt like I had failed the sweet and loving woman who gladly accepted me into the family.

My best efforts overall were probably with the rest of the family. I tried to encourage my stressed and overworked father-in-law to take care of his health and take time for himself, educate him on resources that were available in the community. I tried to address the frustration of my mother-in-law and explain behaviors that were related to the disease process and no longer under grandma's control. I tried to add perspective in general since the person we had loved was already gone due to AD. But I often felt more like an outside intruder than anything. Her daily caregivers, who had received some minimal education on working with the elderly, were able to handle the entire family's needs very well. Knowing that she was comfortable with "the girls" and the hospice workers is of great comfort and another testament that you should never consider yourself 'above' anyone, they have much to teach you and much that they are capable of beyond you.

I know that failure is a strong word, but I have always been a tough critic of my work. And in this case, where I know that I could've done better and that she deserved better, the sting is especially sharp. It's hard to be the therapist in the family and walk the line between personal and professional. It's hard to do all that should be done and still maintain roles. This is a difficult topic for me since I know the situation will only increase in frequency as the years go by. The health stability of the family is always tenuous, and I just hope each day that my expertise won't be needed.

Site Updates

I have been slowly making some changes to the overall site layout.I have moved all the multitude of links to one single page (sadly without targets) which can be accessed on the right side of the page, also near an extended version of "about me." I am keeping the 3 bar layout for now so I can spread out the remaining objects. If you have already used the subscribe buttons to the right so that you can read these updates through RSS, kudos, and if not, I would consider getting a feed reader to save yourself some time and clicks. I am also considering adding a widget that would allow for the feed to be turned into PDF format, which would be more helpful for someone using a Kindle or other non-computer device to read the blog- is anyone interested in that?

As a sidenote, I think I will have to retract some of my previous statements on the Kindle. There are free and discounted books available (though many are pre-1923) and some library e-book downloads are compatible (though the e-book portion of my library is much smaller than the actual book portion). Most importantly for the OT world, because the Kindle can access PDF files, it IS capable of reading AJOT and OT Practice. There are also a few loopholes that allow for access to RSS feeds and I think that the new version can access email similar to a phone. It also allows for highlighting and notetaking, which I wanted for blogging use. I continue to think that it is a good tool for those with low vision, and a better tool than a standard monitor setup for reading without causing eyestrain. Not a pitch for the device (and certainly not a paid ad), but I'm thinking of getting one for myself and seeing that I was wrong about some of my insinuations.

There is a new call for applications to the Emerging Leaders Development Program (v. 2.o) and I have made a promise to myself not to screw the application up this year. Also will try to have posts a little more frequent, I am almost through with most recent promised post and do take requests. I'm waiting on a new computer to arrive, but since most of my documents are either cloud based or just floating in the transom of my mind, it shouldn't cause any delays with updating. January will mark the 3 year anniversary of the blog and I was considering taking a poll of the readers, but please feel free to comment, email, or find me on OTConnections to let me know what is interesting to you.

Coming Soon- World OT Day!

When I saw this link listing the schedule of online speakers for World OT Day (10/27/10) I started to get really excited!
There are some very famous OTs on this lineup, including Karen Jacobs, Kit Sinclair, Erik Johnson, Michael Iwama, and the current president of the World Federation of Occupational Therapists, Sharon Britnell. Props to Merrolee Penman, who appears to be behind the effort.

I am always seeking to learn more about occupational therapy and think that seeing the world perspective will be very interesting. I'm not sure if these sessions can be accessed at a later time- I will be working and sleeping through most of them. However, here's what I plan to catch (times EST):

2pm: Erik Johnson "Occupational therapy within a military setting" I got to see a short video from Erik during the 2010 AOTA Conference and follow his blog, so I think this will be a pretty interesting and worthwhile session. I'm going to see if we can get a group together to watch at work, and if that doesn't fly, I'm going to take a late lunch and break out the headphones.

5pm: Michael Iwama "The Kawa model: Heralding a new paradigm in occupational therapy" I don't know a lot about the River Model and think this will be a good introduction.

The following presentation 6pm "Re-Connecting: Using Facebook for Social Networking after an Acquired Brain Injury" looks interesting, but I have to get on the bus and get home sometime, so I'll probably have to miss it. (Same goes for 2, 3, 4, 7, 8, 9 which all occur during sleepytime)

7pm: Lindsay Eales & Roxanne Ulanicki "iDance: Transformative Occupations" Looks very unique and awesome, I expect to see many more OTs involved in dance, gymnastics, and other wellness outlets in the future.

8pm: Annette Rivard "The power of professional commitment" self explanatory

9pm: Sharon Brintnell "Images of now and visions for the future" also self explanatory. If you've ever been to an AOTA conference and felt the energizing rush following the president's speech, you know how instrumental that can be for taking momentum home with you and putting new learning into practice. I expect nothing less from our WFOT leader.

It seems that watching these sessions would count towards renewal through NBCOT under "attending workshops/courses/independent learning" (refer to renewal PDF) and depending on your state may count for license renewal as well.

Don't forget that week is also the time for OT Wikiflash, a time for mass editing of Wikipedia to better reflect Occupational Therapy. If you're new to wiki editing, get registered and play in the sandbox now so you can be ready. This is a great way to achieve our Centennial Vision goal of being "widely recognized." I've previously lauded a pediatric blogger for her prolific work on Ehow; Claire Hayward, Anita Hamilton and Will Wade have been active in promoting this event.

Neuro floor humor

Saw this was today's Crankshaft comic and couldn't help cracking a smile. If you come into a hospital with a headache, be prepared for neuro checks Q4!

Working on the neuro floor means that I have to suppress my natural propensity to be a worrywart- I start thinking about word finding problems, clumsiness/tripping, and hope that I'm not ignoring signs of a tumor or aneurysm! It's hard to listen to all my patients' stories of symptom onset w/o getting a little paranoid.

Just finished a biography of neurosurgeon Keith Black who has very compelling personal narrative and his life story is certainly an object lesson in encouraging the learning interests of your children. He described that his parents got him a dissection kit and chemistry set from a young age and encouraged curiosity in a number of ways- it's certainly a great story of parents helping a child achieve exceptional outcomes.

Thanks for being patient with the slow updates- had a very withdrawn week and have also finally resumed regular workouts (plus it's FOOTBALL SEASON), so time has been spread.

OT Web Gems- yet another random edition

OT Web Gems is back! (because I'm aimless and have collected a lot of links!) Some of the absolutely random things (with emphasis on a few blogs) that have caught my eye recently.

-CPR performed by those with physical disabilities- yes, it is possible, I'm glad that the author posted it as there seems to be a dearth of info on the topic. I've just found the blog through twitter and will be following her posts with interest- she's an OT, you should too!

-Fidget toys explained- I have been following this blog with interest for some time now and really respect that the author is prolific not just in blogging but also on wikis, really helping to get the word out about OT related issues. I'm a little bummed because I've had a script and everything ready to make a video on fidget toys for 2 years or more and just kept putting it off- scooped again! Oh well, I may still make it anyway, and this is definitely another OT blog you should be following.

-TherExtras- another blog I have only recently discovered with lots of interesting topics, author is an OT/PT/PhD

-World OT Day Poster- Mark your calendar: OT Wikiflash October 25-29

-What's happening in Obama's brain? -an interesting little piece which I find more interesting due to my current neuro-related reading, The Shallows: What the Internet is Doing to our Brains. I won't start talking about that now, but it's been an exciting little spur to my curiosity and knowledge quest.

-Motor Skills Games- a good resource if you need some fresh ideas, gross and fine motor included

-"Socially Awkward Like Me" -I really identified with this blog post that I found through someone else's twitter feed, discussing how she sees shades of her own behaviors in her autistic child's behaviors

-Backpack tips from PTs- Is it wrong that I feel that PTs are horning in on Backpack Day? I've been feeling under attack lately anyway and this just frosted my cookies in all the wrong ways. This was also featured in the WaPo, with no comment on the OT event. :(

-Tots-n-Tech- I stumbled across this newsletter and thought it was very well written with good ideas. Some great, simple, kid-friendly AE included. I will have to be following them in the future as well.

tips?

So this is just a very brief thought I had over dinner tonight. OT is by definition a service profession, we are paid to provide a service to others. Waitstaff who provide good service receive (in theory) increased compensation from their customers, and those who provide subpar service are not as well compensated. However, OT is basically "flat-rate" pay, with some increased compensation for experience, but no financial recognition of competence or above average performance. (at least in my experience- is anyone being compensated for specialty certification or other signs of advanced practice??) The only fiscally-related judgment of competence is whether you continue to be employed. We've had a lot of cuts at our hospital lately, particularly in the employee recognition department, and I think it's fair to say that morale is down. We have ways for patients to recognize excellent staff, but one of those methods is tied to the Press-Ganey survey, which doesn't go out to the patient until they have already been discharged for several weeks. By that time, I feel that our impression on the pt. and family may have faded a bit. Anyway, my idea is that during the discharge session with the RN, the pt. and family were handed a paper asking them which services they had received that had a checklist of various ancillary hospital services, and then gave them an imaginary$10-$20 to spend on "tips" for the staff members/departments they felt offered good service. Accumulating "tip money" could either result in an incentive reward or an actual dollar reward, which I think would be cool. I've never worked in another service profession that gets tips, but I have to imagine that it is somewhat motivating to see a reward immediately after your service was provided. Good feedback and all. Any thoughts?

Just breathe

I'm in a little bit of a rut right now, with an associated (OT related) writers' and readers' block. I'm working on a couple of entries, but it's moving slowly. I usually never have an unread OT Practice for longer than a day, given my 2 hour commute is so conducive to reading, but I now have 2 piled up along with the latest 2 AJOTs. My google reader list has been perpetually overflowing for months now, causing me to unsubscribe to several items just to decrease the counts. I know we all get behind on that stuff, and that I used to get much more behind on it when I didn't have scheduled reading time. But I'm in a little bit of a funk right now, so patience is requested and encouragement would be appreciated. :)

Adventures in Serial Casting, Part I

Image from BBC

I recently worked on serial casts for a patient with brain injury to improve PROM and tone of the ankle. Here is the case study which will be followed by an entry of some of my own research into the topic.

Pt. is a ~60 y.o. female s/p multiple CVAs who was referred to OT for splinting assessment while in the neuro ICU. Pt. was connected to typical ICU monitors plus arterial line, was breathing comfortably on room air. She presents at a Rancho 3-4 level, depending on the day. Her L foot demonstrates increased tone, plantarflexion, and inversion. I was not able to passively stretch her ankle into neutral position and she demonstrated no AROM. I did not splint her per normal protocols (pre-fabricated multi-podus boot or individualized foot boot constructed from splinting material and cushioning as necessary) because I worried that she would not fit well into even an individualized splint due to the inversion and would be at risk for skin breakdown. I asked the doctors to consult PM&R at rounds, and the PM&R doctor injected the patient with a phenol nerve block (I'm not going to go into the differences between phenol and botox because I really don't know anything about it and that decision lies outside the OT realm. There is research on it if you're interested) which he said would be effective for 2-3 months.

After the nerve block, I was able to range pt's foot out of extreme inversion but not quite to neutral and she still had deficits in dorsiflexion PROM. At this time we were able to begin serial casting of the ankle. I can't say that I had experience with the specific technique, my previous casting experiences involved the elbow (in retrospect, this is much easier to cast in my opinion). However, I did take an athletic training class back in high school which involved many sessions of ankle taping (and after spraining my own ankle I got several years of experience taping my own ankle daily) so I did feel that I had a good concept of the necessary design (stirrups, figure 8s, heel locks and a general circumferential wrap).

Our first cast was applied after 15 minutes of a heat pack. Pt. was positioned on her non-affected side with L knee in flexion and L great toe in extension to inhibit tone and allow for the PT to get best stretch from her ankle. Gel pads were applied to bony prominences, cast padding was applied to the whole lower leg, and 3 layers of plaster were applied. This first cast was applied on a Friday, (only because I was on day 2 of 8 working days and would be there over the weekend to monitor) and removed on Monday with gains in PROM noted. I had forgotten the confidence that you need to operate a cast saw, but it came back. Her inversion problem was gone after this first cast. A second cast was applied on Monday afternoon and removed the following Friday by another therapist who decided to try out a standard multipodus boot at this time as the pt. could be ranged to neutral. However, when I saw her on Sunday, she still had the PROM to get to neutral but her increased tone was still pushing her into plantarflexion and thus she was pushing herself out of the boot.

We decided to do 1 additional cast in attempt to reduce the spasticity, but something was not right about this attempt. When following up the next day, there was an indentation on the medial portion of the leg that was concerning for increased pressure, and it was unreachable by tools to attempt to correct, so it had to be cut off. It still seemed wet, and I don't know why, but that made it harder to cut. I bivalved it in the hope that I would be able to fix it from the inside and make a long term splint. This was my last day before vacation and afterward they tried kinesiotaping to reduce tone as well but I was not present for that part. Thus ends the chronicle of the serial casting.

(Please stay tuned for an entry focusing on the research behind serial casting)

Bye bye July

So July should probably just be labeled the month that got out of control.
I had an additional 5 days off on top of regular weekends, (I did work a holiday) and had lots of days switched from normal schedule. It makes for an interesting new rotation when life is all topsy-turvy. I'm not sure that my coworkers would say the same, but don't worry buds I'll be back with a vengeance in August.

So I switched to neuro coming off my vacation, had some personal issues come up mid-month and then capped off by entertaining friends last week. In addition to trying to make some changes in my personal life and reading extra novels, that has made less time to update on here. (sidenote- I read The Eyre Affair by Jasper Fforde and am completely hooked on the Thursday Next novels) But there's been plenty of interesting happenings. Neuro is always a challenging rotation since the deficits can be minute or mind-blowing and you truly have to fight to get your patients into the right rehab setting on discharge. I have been trying to improve my skills in evaluating visual deficits and splint fabrication. I finally made a hand cone without getting the orthoplast stuck on the plastic cone, which was a victory in itself.

I return to work tomorrow after several days off which were much needed. My caseload has been taking a turn for the worst lately. A patient that had been improving coded and recoded. Several are hanging in limbo- stable but not improving. My strongest candidate for acute rehab wound up getting a femoral line placed and landing on bedrest. I regretfully had to recommend inpatient rehab for a young lady due to safety concerns. I've spent a lot of energy fighting for TBI rehab for a patient only to have the family refuse. I've had a patient that has made me terribly homesick and I know that she is going to be one of the people whose life sticks with me for a long time (shout out to MM and all my peds) so I've been very emotional over her case. We have many very very sick people on the unit right now so it has been a bit depressing.

Upcoming Entries (if any of these interest you, please comment and I'll try to move it along quicker)
- Adventures in Serial Casting
- Failures in being an OT for the family
- A case study for a patient with multiple CVAs

I hope to have some more good case studies in the near future, but people need to start improving. Any well wishes much appreciated.

Energy Conservation for Summer and Vacations

As I have written before, Energy Conservation is a topic that I really enjoy and love to educate about. It's close to my mind often, since I love for tasks to be efficient and simplified. In this post, I want to discuss energy conservation tips applicable to the summer months and also to vacations. Though technically the first day of summer here was a couple of weeks ago, it's been in the high 80s and 90s for what feels like several months. Energy conservation is especially important in the summer months because for many folks who need to think about conserving energy, life gets harder in the heat. Harder to breathe and easier to fatigue are typical signs of the summer, and especially among those with cardiac and respiratory diseases and also the well elderly (If you are having these symptoms in summer or anytime, talk to your doctor!). That doesn't mean that life has to take a backseat during the summer months- just that conserving energy should come into play so you can enjoy and participate in all desired occupations.

Here are some tips:

• --Minimize time in the heat- try to be outdoors in the mornings and evenings, when it's cooler, and stay out of the sun and hottest part of the day when you can
  
• --Don't live on grueling pace in vacation spots- So many people take a trip somewhere exciting (such as Disneyworld) and then run themselves to death during the trip. Don't be afraid to take breaks and naps, you'll enjoy whatever trip you're on more if you're not run down. Also make sure to take some seated breaks in the shade during your outdoor adventures.
  
• --Take stretch breaks while traveling- Try to avoid driving for overly long stretches. Take a break every hour or 2 to keep yourself fresh and cramp-free.
  
• --Rotate driving- in the same vein, try to rotate the driving responsibilities so that no one person is worn out from the stress
  
• --Plan small, close trips- shorter trips can be less stress to plan and easier on the family
  
• --Go to places that are air conditioned- trips to museums and movie theaters can be easier to tolerate in the heat.
  
• --Get your exercise in the morning or evening- summer isn't an excuse to stop exercising, but try to do it in the cooler times of the day
  
• --Use a scooter at parks- if you're planning a big trip at an outdoor park, consider using a scooter or transport chair to save energy. Make sure you spend time in the shade as well
  
• --Use a backpack (well adjusted) or rolling cooler to transport water and snacks
  
• --Plan day trips for times when you have the most energy- run your errands and take your trips at the time of day that you have the most energy. For many people, this is the morning.
  
• --Nap after pool time- swimming always seems to wear me out extra, so I just allot time afterwards to take a nap
  
• --Consider making smaller meals that are simpler and have less to prepare- saves you energy and prevents any extra heat from accumulating in the house
  
• --Know your limits, and how to cool down- recognize what you need to do after activity to cool down. Sometimes, a seated rest break is insufficient, and you may need to drink or coat yourself with water, or lay down in a cool room. Lifehacker ran a piece on using your pulse points to assist in quick cooling.
  

What are some other tips you have to get the most out of summer while conserving energy?

I know I haven't been posting a lot... it's been a super stressful time at work, with the surgical rotation and covering outpatients. The stress has definitely been getting to me in my interactions with others and I dislike that a lot. I do have some nice things to reflect on... including the AOTA conference which I still haven't really got to fully process. But I am taking a MUCH NEEDED vacay and will be away from the computer as well. I am taking a couple of OT things- a big NICU course book and all my conference stuff- but my goal is rest and relaxation, so my predominant packing is puzzle books and novels. I also joined a softball league since my last posting, and it feels really good to get some balance back in my life.

PS- could I get a comment or 2 that ISN'T a spam written in Chinese? I'm moderating them out but it's been a little depressing that they're the only comments popping up in the email.

1 happy thing

A very quick note...
I have been bothered lately by the number of times that I get asked the really tough questions, which can really bog and depress you in acute care. I have also had some of these moments with my outpatients, when I spot a cognitive deficit that is going to cause difficulty for the kids as they progress through school (e.g.- 1st grader unable to phonetically read 3 letter words; 3rd grader unable to add and subtract). I was mentioning one of these misgivings to a parent, asking about possible summer schooling and mom mentioned that "B" would be attending art camp this summer. She said she would still do some worksheets at home, but wasn't going to let him be burned out and unhappy when he had other interests. Obviously, everyone parents and advises differently, but I was definitely happy to say, "One of the great things about 'B' is his imagination and creativity. I bet he'll really enjoy that." In this fast paced, high scheduled, high achievement world, enjoyment of childhood should count too.

Yikes!

Holy cow... it's been almost a month since conference. Where has the time gone?
I would say that I want to go back... but the time since the conference has been pretty rough as evidenced by the scarce/nonexistent updates. And at such a terrible time, after handing out those nice business cards haha. So, some brief updates.

- I took no time off after the conference, and that was not smart. Next year, I take a day to recuperate and absorb info. I still need to print out handouts- both for sessions that I attended and others that looked interesting- and then compile my notes.

- I went to some great sessions and met more "famous" OTs than ever before. I think that the quality of presentations was very high this year.

- I hope to get a submission in so that I might present next year in Philadelphia, Pennsylvania, April 14–17. I've had a gigundously large and cruddy list of things to do lately, and it's been pushed aside, but I really must do it.

- Speaking of cruddy things to do, I have been documenting at home almost every night, including tonight. I continually wonder how people meet productivity standards and get documentation done.

- April and May definitely kicked off my season of concerts and travel. I have had 1 weekend at home since conference and will not have another uncluttered weekend until July. Obviously I am mixing in some fun times, but it's wearing me out.

- had my first pt. with what I consider a contemporary popular name. I have been mildly wondering what it will be like when nursing facilities have hoardes of Jennys, Kelseys, Chelseas, Kaitlins, Stephanies, Kimberlys and Lindsays... not to mention when the following phase of names ages, leaving us with Tylers, Taylors, Collins', Houstons, Austins and the like as patients.

- I got a really nice bag at conference... messenger bag in a pretty blue with lots of cool features. Got it on the last day of conference. Went to pack it in the taxi to the airport the next day and a clip snapped off. Packed it to work the following day and the snaps holding the strap broke. I was so mad at the people, I said to myself, "I'll show you, I'll go back to my crappy tote bag from before." I noticed later that day that the tote bag, which I had gotten at previous AOTA conference, was from the same darned nursing home. And the zipper is trying to break. Darn you unnamed NURSING HOME!

- Posted on the Acute CareOT Forum about ICU evals. Hope to see that forum stay active. I have been tardy in adding friends I made at conference to my OTC list, but it is very hard to search for people. Feel free to add me.

- Less than a month left of doing outpatient pediatric work. As it was before, part-time peds work is difficult. Been reading up on Developmental Coordination Disorder, want to take our unit blocks (small, interlocking squares) and make lego-like designs with picture instructions to use as a clinic tool.

So, times have been busy and will only continue to get busier. The blogging break was good, if unplanned and ill-timed. I will try to be a little more active before my real vacation comes. Things I intend to do before then (OT related):
-write proposal for AOTA conference
-post more videos from conference
-post all 80-some photos from conference
-write a post on energy conservation for summer travel

Until then... here's hoping there's not too many more late nights documenting from home!

Reflection of the week

A few reflections from the past week, which has been very hard.
First off, I would just like to say that the AOTA conference was great, but I was very foolish to stay for the entire time and then head right back to work the next day. Because as fun as it is, it is also exhausting, and I didn't get any time to process the new information before heading right back into my crazy daily life. I was looking forward to today, my day off, to do some of that. However, I neglected to remember that we're traveling AGAIN this weekend. So that has added to the stress, and I won't really get a "me day" to process stuff until next Saturday. Very difficult on a personal level, and also because I would like to do some recaps about the cool sessions I attended and to give a glimpse of conference awesomeness to the holdouts who didn't make it this year.
In my stress, I decided to let go of thinking about presenting at a state conference this year, since all the deadlines were very close. However, I will be applying to present at next year's AOTA conference in Philadelphia. I will be trying to do a Tech Day session on hands-on optimization of OT Connections and the web in general using tools such as RSS readers, email filters, and aggregators. Basically an in-depth and hands-on version of my presentation to WVOTA last year. I feel like many people shy away from using online OT tools because they don't know the ways to make it less time-consuming. Any thoughts, or people who want to join in?
This week, work has over-dominated my life, preventing a normal occupational balance. Carved out some time for friends, but it went poorly too. So I'm trying to focus on some of the more positive or interesting things of the week.

- With the brainstorming help of some PT buds, I made a really cool splint. Our plastic surgery dept has been writing some crazy orders of late, and this time they got a crazy splint as a result, but they liked it. A woman had a skin graft on the anterior and posterior sides of her calf, and they wanted all pressure off of this to heal. However, she only had about an inch from the sole of her foot before the graft started, and then it was almost to her knee. So if you think about supporting an entire leg from those 2 points, and you've had basic physics, you know that's just not an awesome idea considering the stress and strain that would be present. And thinking about orthoplastic splint construction, I was really at a loss of how to create a solid object to accomplish this. Then the idea of using an abduction pillow came up, cutting a large piece out of the blue foam and reorganizing the straps so that no part of the graft would touch, but greater support would be available to the leg. Not having a knife, or razor blade, (either of which would have been better, more appropriate tools) I set out with scissors and my BARE HANDS to rip the foam as needed, providing a much-needed laugh to my pt. And it worked! Props to combined creativity!

- I spent a fair amount of time explaining standard developmental tasks for 3 year olds this week. They just aren't made to be perfect yet at that point.

- Happened to have the AE cabinet open, which sparked some ideas during an outpatient session. Gave a teenager a rocker knife, which she absolutely loved. Steak is a favorite food. We spent several minutes chopping up theraputty with me hovering nearby to save the other hand. Obviously, she'll have to use it with supervision, but I think that it was truly helpful for her to have a tangible skill at the end of the therapy session. (This is part of a much larger thought process right now, but that will be a very long blog post at another time)

- Spent time crying the other night over one of my pts who went home instead of to rehab because his wife is dying. Lately our sessions have just been getting him to a wheelchair so he could go visit her in another part of the hospital. Very sad situation, but luckily they have family support to make the end of life time better.

- I think the newborn nursery can sense when I'm overstressed AND happen to be the only one to cover the area. Got 2 referrals yesterday, but got my second really conscientious and involved family in 3 weeks, which is really nice. It makes up for the stress of getting everything else covered when the parents really want to get your opinion.

And that's about it. I'm behind on my online readings, but am just simplifying things by deleting several that are either too frequently posted or not compelling enough. I went from 300 unread to 74 through that method. I'm behind on my library books... really can't get into the current book and am more excited about the other one I checked out, which is about Asperger's Syndrome. I'm behind on my professional reading- I ordered a book about developmental coordination disorder and am now afraid that the child I'm treating will be out of visits before I even get it open, and I borrowed a NICU book from a colleague several weeks ago that has not even been flipped through yet. And now I have piles of notes from conference to compile, and also have to print out my handouts before they expire off the site. I also promised to add new acute people on OT Connections and work on making some awesome acute-related posts but I haven't been able to start yet. Can anyone spare some extra eyeballs and brains to help me with all that? lol. I did read a very good post by "the OT Nerd" about the worth of conference for re-energizing, and I hope that I haven't wasted that feeling by rushing back to work.

Time to jet off on another trip... I will get to everything eventually!

Joan Rogers' Award during Conference opening ceremonies

To start the first of many shared media files from Conference, I present to you Joan Rogers accepting the Presidents' Commendation during the Opening Ceremony. Video is in the full post. While the technical quality is not superb, the content certainly is.

Still to come- video compilation from opening ceremony dancing, video from Penny Moyers Cleveland's farewell address, photos and videos from expo, photos from conference classes and events. Full uploading to be done at OT Connections.

Almost Over

Our conference time is almost at an end...
Saturday was a long day, but still had some highlights. I got some good videos and pictures, which will all be uploaded to the OT Connections Conference Gallery either at the airport or Monday after I get home. So if you're not already on OT Connections... get there! I have been talking especially to acute care practitioners at conference trying to get them involved w/ OTC because I feel that we are very isolated in our practice and need to connect so we can determine what is best practice and what is just "facility tradition." It's hard after conference to maintain the same energy and excitement, and I feel that using OTC can help keep that feeling alive longer in the face of everyday work.

Time to go to my last workshop... these Sunday sessions are hard to get motivated for since all the fun and most of the people have gone. Then the exciting time of 6 hours at the airport!

Notes from Friday

Friday was VERY busy
I think my longest break between everything was built at 30 minutes... one presentation ended early so I wound up with 45 minutes at one point. Chatting with several different people, most of whom I did not know. Had a good conversation about the evolution of the Slagle lectureship with a 50+ year member, which will get written up eventually. Had a good SIS discussion on issues with oncology and a great NICU course.

On today's slate is either a course on acute management of TBI/SCI or a discussion on the AOTA guidelines for CVA/TBI care which are unfortunately opposite one another. Also of course is the address from incoming president Florence Clark. Trying to decide whether to go to the business meeting... I am anti-meeting in general (and this is run in parli-pro style so even more dry than a staff meeting) but they have occasionally been lively with debate. Unsure if they will ratify RA decisions during the meeting. I heard Thursday from multiple reliable sources that the suggestions from the Participation Ad Hoc committee did not pass in whole, though the COOL and other options for increasing leadership will still proceed. A new committee has been formed to deal with restructure of the organization. Some people are obviously happy about this decision, I saw RA members and several folks I recognize from message boards discussing this happily, but there's still a long road to hoe in increasing participation, and I hope someone in the RA is sitting on some good ideas at how to make it work. More on all that later, got to get out the door.

Thoughts from Thursday

Not only am I attending, I'm here!
Here's some of the cool things that happened on Thursday...
One of the fun parts of conference is that you can meet people I call your "OT heroes," people that you have read about or heard of that are fairly famous in the OT world. Yesterday I ran into Chuck Willmarth and Tim Nanof from AOTA, Paul Fontana of industrial rehab and lately elected to AOTA position, The editor from OT Practice whose name has unfortunately slipped my brain, Ingrid Kanics of play center fame, and Salvador Bondoc and the other leaders of my PDSIS. And of course, Frank Gainer was ever-present, I always consider him the conference guru because any time I've ever had a question during conference, I could find him and he would have the answer.

Went to some interesting sessions yesterday and got some good pictures from wandering around and also during opening ceremonies. Opening was awesome, with the floor literally bouncing up and down as people danced in the aisles. Seated next to me was a woman from the Netherlands, who was astounded at all the action and the great turnout. I have some videos of different parts of the opening fol-de-rol and also took a fairly good video of Joan Rogers (sp?) receiving the Wilma West Award from AOTA & AOTF. Hopeful to get that up for viewing soon, just need a slightly more stable internet connection.

Got to get going now- have a workshop on the NICU, SIS roundtable to discuss outpatient oncologic rehab, and some other cool things in the afternoon which have slipped my mind.

Blogging Against Disablism Day

May 1, 2010 is this year's Blogging Against Disablism Day. Though I will be at the AOTA Conference (and I hope you will be too) I will try to set up an entry in advance.

Blogging Against Disablism day will be on Saturday, 1st May. This is the day where all around the world, disabled and non-disabled people will blog about their experiences, observations and thoughts about disability discrimination. In this way, we hope to raise awareness of inequality, promote equality and celebrate the progress we've made. ... At the same time, do not feel you have to use the same language that I do, even to talk about "disablism". If you prefer to blog against disability discrimination, ableism or blog for disability equality, then feel free to do so.

For more info: Diary of a Goldfish

Pre-Conference Plugs

It's almost time for Conference and I am super excited! In case you're doing some last-minute planning, here are some services that I have used with good results that may come in handy for those attending conference. Some of these things are FREE, so a browse should be worthwhile to all.

Transportation: If you're looking for a ride to/from the airport, I would highly recommend John's Transportation. My husband and I had the pleasure of meeting John on our recent trip to Disneyworld. He was a great professional, very accommodating. Our plane was delayed for 4 hours (which he called and alerted us to) and he was still very prompt at the airport to greet us very very very late at night though I'm sure we ravaged his schedule. Prices were reasonable and I had a great experience with his family business.

Address Labels: I was very jealous of the people who brought address labels to the expo last time I went to conference. Everyone wants to fill out their names to enter drawings and win freebies, but it can be a lot of writing with so many exhibitors! Address labels on a roll, custom made with email address as well, save so much time. I used Superior Labels because they came up quick on a google search. I got plenty of opportunities to check the order, and shipping was quick. 300 labels for $10.

Email: As an addendum to the above expo information, if you don't want your email account to be overloaded with job offers and newsletters, consider getting a second (third, fourth...) email account. GMail accounts are free and the best service that I've found. Great filtering of messages, search capability of messages, and you never have to delete anything again. The Labs features for gooogle products are a great bonus to customize your capabilities. I'd consider switching if you have anything else, but even if you don't want to do that it will make a great secondary.

Business Cards: I liked the selection of designs offered for cards designed by FedEx. Link goes to those with a keyword of "therapy" which has several nifty backgrounds including one with a reacher. Ironically, you cannot order these at a FedEx store, only online. I would recommend being comfortable with concepts used in microsoft word & publisher such as manipulating text boxes since that's what you'll need to get any kind of custom look. Shipping was pretty quick, but 500 for $30 is a little more expensive than I have seen at some local stores, so you may be able to scout a better deal in your neighborhood. I'm a little bummed because I forgot to add my twitter link on my cards, but otherwise they look pretty spiffy.

Shoes: First, a free tip that saved my feet in Las Vegas. I always thought that there was one right way to lace shoes, but recently I've been having a problem with too-tight forefoot sections causing pain and numbness in my feet. When I came across the suggestions from Dick's Sporting Goods for lacing depending on the type of foot, it changed my sneaker-wearing self forever. I am a believer, and have no more problems from the shoes. So when you say, "hey your sneakers look funny," I will say, "thank you, they feel great!"

Secondly, the curved sole shoes have really become a fad in recent years... not quite to the point of heelies, but still causing a stir. I got interested in them when I saw MBT shoes on the Rachel Ray show a few years ago, but couldn't bear to spend >$200 on a pair of shoes. (Their website never works on my computer, so I won't link it, however I will do this) I was willing however, to spend about $30 for this Curves Sandal from Avon, and also to buy some knockoff sneakers from some place on Ebay. (Regarding the sneakers, it was a bit of a mistake for me not to notice that they were being shipped from halfway around the world, which did take a considerable amount of extra time.) I don't know that they work my calves more or give me more of a workout than any other sneaker. They suck for climbing stairs, and you'd have to be a fool to exercise in them (running, machines, etc). I know that I have to consciously work on a heel-toe gait pattern to avoid stepping with the largest part of the curve. Best part of these shoes for me (and a legitimate factor in calorie-burning) is that I can move while standing still, getting in some fidgeting and vestibular input. If you've never worn these kind of shoes before, don't get them before conference because your feet will regret it. Work up to it at a different time.

Please note, these are unpaid and unrequested endorsements of products and services that I have personally used.

Podcast with AOTA Presenter Kelly Casey

Welcome to the First-Ever OTNotes podcast!


Featuring Kelly Casey, Occupational Therapist from The Johns Hopkins Hospital in Baltimore, who is presenting multiple topics at the AOTA Conference. (Get it? That's why we're using the special "speakers-only" badge for this entry) The audio is 22 minutes, please forgive the technical quality and instead focus on the awesome discussion points offered.



Here are some links to helpful information in case you're not taking notes:

Kelly's Topics:

Thu, Apr 29, 9:00 - 10:30 AM Short Course 105

Culture Change In Acute Care: An Interdisciplinary Approach to Creating Respect For Therapies

Thu, Apr 29, 1:00 - 3:00 PM Poster 207

Movement Towards The Centennial Vision: Steps Of Post-professional And Entry Level OTDs

Fri, Apr 30, 2:00 - 3:30 PM Short Course 223

Assessing Cognitive Disorders: Integrating Standardized Assessments In Acute Care

Cognitive assessments discussed:
- Cognitive Assessment of Minnesota
- Executive Function Performance Test
- JFK Coma Recovery Scale


Centennial Vision Statement

We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs.

Crazy Life

Been going through some crazy busy times lately.

So, work kinda blew up recently (2 weeks ago? I don't know it's getting hard to keep up), going from a manageable, reasonable, daily activity to a "what the heck happened here" type experience. Earliest I left all week was 1 hour overtime. YIKES. Here's a little recap. Got my first Level 1 student, and I think we had a pretty good week. Tried to arrange for some interesting stuff everyday (hard to do when we started the week with 5/5 pts having severe dementia). Most amusing moment may have been the kitchen assessment with the man who required step by step instructions and multiple interventions for safety. He wanted to make oatmeal by pouring milk into the oats canister, then tried to fill the pot with water while the pot still had a lid on it, then had to burn it a bit... fun stuff. A good time to demonstrate how hard it is to remember all the details of your treatment.

It was also my first week with the pediatric outpatients, which went pretty well. But it was a little awkward getting to know them both, do a reassessment on the first day. I had prepared for the time that outpatients would take, but I hadn't counted in the other pediatric crew- the NICU. I've been moonlighting up there a bit, and the OT that normally covers left for vacation with a very large caseload left behind. Had to weasel out a few hours each day for babies, and also antepartums on Friday.

Now I'm looking at my outpatient peds caseload growing EXPONENTIALLY in the coming days. I'm turning into a morning inpatient / afternoon outpatient person again. I even got swept over to take a hand patient last week (definitely not my thing) which at least wasn't hard, but did prove that OP is starting to climb into my schedule a lot. It's odd, like reliving my old job... deja vu all over again. We're also switching floor teams again soon and I will be moved to surgery, which is ok for a switch but I worry about seeing all their priority patients (especially when they don't even end rounds until after 9, 930) and then making all my OP appts. There is also a limit to how much I can write in a day, as evidenced by me STILL working on an eval from Friday. I'm out of practice, and the templates for kids are very un-helpful. I will basically have to make my own peds template before Wednesday. I had just wanted to help out a little... I just forgot that with school ending the outpatient caseload would grow grow grow... oy.

In other OT news, I have been actively observing the continued RA-related debates on OTC, and hope that others are too. I'm disappointed to see that many people are choosing to abandon the discussion for one reason or another. I did start a group for Millennial-aged students/practitioners in support of the Participation Committee's suggestions, primarily as a way for newer members to voice their opinions on the matter. I've also been working on arranging an interview and podcast for the blog, I suspect it will be harder to schedule a time than to do the editing and whatnot. Kinda fun to branch out in that way.

Other demands on my time lately have been: trips to play with friends' babies (so big compared to my guys in the NICU); the NCAA basketball tournament; Healthcare reform; seeking out concerts for the summer; and planning a fun weekend getaway. I believe we're coming into a time where I will be traveling or at an event almost every weekend, which does make it hard to get other stuff done. Got to have that occupational balance though ;)

Pre-CI Jitters

I'm getting my first Level 1 student and trying to beat a case of the pre-CI jitters.

I'm growing out of the "new practitioner" label. I'm on my second job, practiced in multiple settings (sometimes daily) and I'm pretty sure that I pay "big girl" OT prices for AOTA membership now. But of course there are still "firsts," and I am now, finally, getting my first real OT student. I've played hostess to several job-shadow candidates before, but those were usually just for a couple hours. Most of those also came from the local high school and had to rotate through multiple healthcare jobs and were not particularly interested in OT. I missed out on students at my last job because state law required that you have 1 year experience before being a supervisor (or Clinical Instructor... same dif) and the offers for students after that first year didn't coincide with my availability. My current job requires that employees have 1 year experience at the hospital before taking a Level 2 student, and I definitely feel that it is a complex enough environment to learn in the year allotted without additional pressures. But now I feel pretty confident in my navigation of the hospital, finding the right people, getting the right supplies. Onto the next challenge!

I was to get 2 students, one for 1 week straight and another just once a week for several weeks. But we had some shuffling of schedules going around to best allow for shared responsibility and best experiences for students, so now I will just have the one. It does make me a little nervous... the feeling of having to bring the A GAME all day (especially early morning, ugh), be on my best behavior, be smart, and most importantly facilitate learning for the student. I don't usually have a problem with imposter syndrome, but the thought of having a person watching my every move and asking me to then JUSTIFY each one is a bit frightening. There are many things that I understand that I don't know well enough to teach.

So I borrowed a book- a handbook for acute care PT (I know, I KNOW, but there aren't any OT ones available to my knowledge) to brush up on things and try to feel more mastery on the material. It did make me feel better... as my supervisor says "you know more than you know" but there were some frustrating points. I brushed up on causes of common ailments and meanings of lab values since those sorts of imbalances (plus weakness and dementia) make up most of my medicine-floor caseload. I know that I came across a lot of that information in biology classes and physiology class but I didn't retain ALL the implications of certain things. Was I not paying attention the first time or did I just need something practical to relate the knowledge to? Is this comparable to suffering through higher level math with no explanation offered except "you'll use it in calculus/physics," which -while true- is not really a motivating factor? It was a relief to know that I did know the concepts in the book... I'm not just faking it everyday :)

I think that being a CI will be a good time for me to question my skills in a constructive way. Am I educating patients and staff on the role of OT? Am I conducting a thorough evaluation? Are my goals client centered, SMART, and varied? Are my patients getting what they need to facilitate the best possible discharge? It will be a good exercise, but undoubtedly a stressful one.

High levels of critique and reflection would be enough, BUT I'm also changing my schedule again for a short time. I will be covering 2 outpatient pediatric clients while another OT is on leave. It will be good to revive those skills, but it's hard acting as a fill-in. These clients are also older than my former clients (who I still miss *sniff*) so it will be tapping into different occupations- chores, computer use, hair care instead of blocks, buttons, and 1 step commands.

Wish me luck! I hope that I am smarter and more capable than I sometimes think I am. If not, I'm sure my student will let me know :-/ haha

Metacognitive Analysis- How I Approach Puzzles

I have been spending more time on a recently semi-neglected occupation of mine- puzzles. I enjoy all sorts of puzzles- jigsaw, crossword, sudoku, logic, and plenty of variants. I got an awesome daily calendar this year of MENSA puzzles, bought myself a subscription to GAMES magazine after discovering an issue at an airport, and have been making more time for some jigsaw puzzles in an effort to minimize computer time. Because these are quiet pursuits and I am an introspective person by nature, I have been spending some time thinking about my thinking as it relates to these different puzzles. (As a disclaimer, this is not me trying to sound smart, this is simple analysis of activities I enjoy)

Jigsaw puzzles- I think most everyone approaches these in the same way, namely, edge pieces first. I do this begrudgingly only because it makes sense, not because it is my preferred way. This came to an end when I started a puzzle entitled "The Edge" where all pieces have an edge. (I also have a Borders puzzle which I expect to be similar) Anyway, with the edges removed, I searched for pieces of the larger buttons, which is again fairly logical. But what I found myself doing was saying "ok, I am only looking for yellow background with black writing" and then, I would notice "oh! here is the blue with white writing that goes over here... and here is the pink that goes over here..." significantly more matches on unrelated pieces than those I was looking for. Another part of this puzzle played to my strengths- having lots of written words to connect. I have a good memory for different lettering styles and messages, and didn't have a hard time knowing when I saw a piece that fit in with something else. Allowing myself to make these free associations instead of truly focusing progressed the puzzle very quickly.

---What does this say about me? Attention or processing difference? I know that I have sensory deficits in some areas but never considered myself as having visual processing a strength (I can get quite visually overloaded). Perhaps my skills are more attuned to observations of the written word, and could that be related to good reading comprehension skills?

Crosswords- My style for crossword puzzles is similarly erratic. I prefer to casually gaze through all the clues to see if anything sticks out. In particular, clues with a _____ always catch my eye and are often first filled in. There are a large number of uncommon words and names commonly used in crosswords (e.g., Oola, Orel, Erle) and mastering those over years of puzzling provides a certain advantage. After I do my initial scan, I proceed to 1 intense round of reading all the across and then all the down clues. Anything I am not sure of gets penciled in beside the clue, not in the spaces. After this first round, I tell myself that I will go through again in an organized pattern (much like searching for certain puzzle pieces in jigsaws) but then find myself drawn to areas where I have many words congregated to see if I can make more sense of nearby clues, see if I have any penciled in words that would be appropriate. Once I get one of the main clues (these are usually puns or related to a central theme) the others fall in place quickly.

---Except for the determination of the main clues, much of the rest of the puzzle is remembering what you already know and using context clues. The key is learning from each puzzle to better performance in the next. I am trying to move into cryptic crosswords, but they are REALLY hard! I prefer written crosswords, but can do computer based if the puzzles are easier.

Sudoku- I don't do typical sudoku puzzles anymore because they are not generally challenging to me. The ones that are have moved beyond logic and require you to guess a number and see whether it fits or not, which I do not enjoy. So I work multiple variants- overlapping puzzles, odd/even sudoku, 10/12 square sudoku, diagonal sudoku, sum sudoku. However, often these extra rules make the puzzle easier to solve, since there are more conditions a number must meet to be included. I often browse through by each number to see if there are any spots I can fill quickly, see if there are numbers that can only go in 2-3 boxes per square. (This almost never goes in order from 1-9) Then I proceed to what makes sense- trying to find the boxes that have the most numbers around them and can be filled by exclusion. This gives way to the logic tricks that are learned when doing multiple sudokus (just like the word tricks learned from crosswords), so setting those up can occupy much of the board. Then, when the whole board is narrowed to <4 possibilities per square, I step back and look for what's missing. The eureka moment will come, it just has to be found.

---Sudoku is a rather pure logic puzzle, it's just about channeling the right reasoning skills and seeing how it all connects. I received a Sudoku board as a gift, where you can place wooden tiles instead of writing in the board. I've been trying to examine the effect of the tactile input, but I do like writing, as I have my special symbols to add to the numbers to try to better organize my thoughts. This is similar to the crossword puzzles. Does a learning style preference 'count' as a cognitive strategy?

Paint by Number- Also called Hanjie or Nonograms, a puzzle that I was introduced to at a young age and have been hooked to ever since. These I absolutely cannot do on a computer, I must have pencil and paper. Strategy here starts with finding the largest numbers and getting any spaces colored in that is possible. Filling in spots along the edges is also key to a great start. Then I start to look for patterns. Numbers in different rows of similar length that can help you infer placement of others. I love watching these come together.

---I recently tried a variant of these called Paint by Pairs, which I really don't like as well. For one, it's not a pure x/y axis experience. The other disappointing part is that in most of these puzzles the picture is in the empty spots, not those that are colored in, and I don't like that use of negative space.

Overall, I do enjoy the filling of empty spaces, be they in jigsaws, crosswords or any other grid. I've talked before about my love of patterns, and do enjoy logic in general. I used to be disappointed in my left-brained side, wanting to be more creative and skilled in right-brained pursuits. But now I've decided that one doesn't exclude the other, and strengths should be used. My word memory skills that work so well in crosswords also make me a good test grader for my dad's classes- I remember the letter patterns for the answer sheet, and also have a good memory for when I see 2 that are too similar for coincidence. My verbal skills also gave me a good advantage for journalism class, correcting grammar without a lot of formal training in that department. Haven't really found an OT-related outlet for the logic skills (they do NOT translate into effective performance at meetings) and the closest I have gotten to that is developing different documentation templates.

Acute Care Courses at AOTA Conference

I feel that it's difficult to find OT courses on acute care topics. It's also hard to apply evidence from those courses to the everyday fast paced world. Here are some parts of the AOTA conference especially for Acute Care OTs (places where you're almost guaranteed to find me!)
Links go to full course description on the Create Itinerary page for conference.

Poster PO 623. The Role of Occupational Therapy With Pediatric Oncologic Patients Who Undergo Complex Orthopedic Procedures in the Acute Care Setting Sat, May 1, 12:30 - 2:30 PM

Poster PO 408. An Interdisciplinary Approach to Acute Care Using Standardized Patients and Human Patient Simulators Fri, Apr 30, 3:00 - 5:00 PM

Poster PO 226. Mind-Body Interventions for the Inpatient Acute Care Oncology Population Thu, Apr 29, 1:00 - 3:00 PM

Short Course SC 105. Culture Change in Acute Care: An Interdisciplinary Approach To Creating Respect for Therapies Thu, Apr 29, 9:00 - 10:30 AM

Short Course SC 223. Assessing Cognitive Disorders: Integrating Standardized Assessments in Acute Care Fri, Apr 30, 2:00 - 3:30 PM

Short Course SC 338. Acute Care Management of Shoulder Replacement Patients Sat, May 1, 3:30 - 5:00 PM

Short Course SC 306. The Acute Care Perspective: Occupational Therapy's Role in Early Management of Traumatic Brain Injury and Spinal Cord Injury Sat, May 1, 9:00 - 10:30 AM

Workshop WS 205. Doing With Not To...Occupational Therapy in the Newborn Intensive Care Unit (NICU) Fri, Apr 30, 8:00 - 11:00 AM

What a week

What a long strange week it's been...

It was a busy, and sometimes downright lousy week. I had 2 people that I was asked to see, cleared for home with family supervision, and then neither family would take them home. It is really sad to see someone who could be in an assisted living or adult day care go to a facility due to the lack of help at home. I hate being put in the middle of these family power plays where the caregiver child just doesn't want to do it anymore but won't say anything until the person is hospitalized. In a strangeness typical of this topsy-turvy week, I also had a lot of people insisting that they would take their parent home when they were very debilitated and largely dependent. The only bright spot for me was getting time to do some follow ups on Friday and changing a rec(ommendation) from rehab to home. That lady had cleared up physically and cognitively and did great in our gym, she was so happy to go home.

One of my fellows with dementia was interesting, but frustrating to work with. Terrible short term memory and executive function to follow through with tasks. Getting dressed took us a very long time. Mod assist x2 for LE dressing. After he was already dressed, he needed to use the bathroom... got him sat down, specifically said DO NOT GET UP and then positioned myself outside the door to detect movement since those directions are so rarely followed. I heard him up and moving toward the sink, so I went in to find him walking with his underwear pulled up but pants still around the ankles, totally oblivious to any lack of completion of the task.

This has been a frustrating week as well since it has felt multiple times like different groups were trying to undermine our therapy recs. Obviously, we're all part of the team trying to facilitate best d/c plans for the pt. However, it's hard to feel appreciated by the rest of the staff when you're doing an eval and the home care coordinator walks in to set up home therapy and oxygen OR the doctor comes in to review discharge instructions OR the case manager has already stated the plan is for rehab. It makes you feel like an ancillary service that doesn't really matter to people. That is a feeling that I truly hate. I've also been at odds with people lately who can't respect my decisions NOT to see pts. The most recent of these was a gentleman who had a blood sugar of 500+ and was off the floor for testing for several hours. I was told, Oh, they've treated him and tested him since then, it'll be much better than that. With all due respect, prove it. This is similar to when someone tells me to see a pt. who has dopplers pending to rule out DVT, because "we don't really think they have a DVT." I need to know that my pts are stable to work with, and need for people to respect my judgment when they don't appear so.

I've long been angry at my apartment complex for their slow response to ice and snow, worried that my elderly neighbor ladies would fall and break a hip on the poorly maintained sidewalks. Leaving the house Tuesday, I caught on some significant ice and did a "Home Alone" style slip and caught 4 steps on my back. Extremely unpleasant, especially as a user of bouncy public transportation. Was finally starting to feel better on Friday, and then I think I strained my back a little doing a 2-person lift. And then we went skiing on Saturday.

A note about skiing- I cannot do it. My husband loves it and progressed in one season from terrible beginner to black diamond goer (to my extreme worry). I have tried it once and spent the whole time falling. But I went, and it was really hard since I was already dealing with nagging pains. and then I remembered exactly how hard skiing is on your knees! Pizza wedging, turning, constant bends- it is no wonder you hear about these Olympians s/p ACL surgery and everything else. For me, it was very taxing mentally and physically, but an interesting learning experience (I can say that now that I am safely on the couch again).


It is an interesting time to be an AOTA member. I did the responsible thing and voted for all the positions (elections close March 3) and I also tried to review the proposals from all the candidates. It was interesting to see how many of the candidates had included a blog (many on the OT Connections service) and the number and kinds of updates they had. The truly interesting thing will be to observe how many people continue their efforts after the election. One of the great things about OTC has been getting more insight into the organization. President Penny Moyers is excellent about blogging and responding to forums, I also find posts by Brent Braveman (speaker of the RA) and "Ask" Molly (from OT Practice) to be good to follow. And with this continued debate on the future of the organizational structure based on the recommendations of the Participation Ad Hoc Committee, there have been some very informative responses from the decision makers. Incidentally, there have been several people who have initiated involvement on OTC to be part of this discussion, and the differences between experienced users of social network and others also provides interesting points for contemplation.

What this discussion is missing is input from the new generation of AOTA members. To my observation, these new developments with the COOL and the VLDC are designed especially for the newer OT practitioner members to enhance the member experience and offer leadership opportunities for unrecognized, busy members. There is a lot of uproar over these changes, and the decision makers need to hear ALL the voices in this discussion. So PLEASE express yourselves in the forum so that our demographic is represented.

Don't miss the early registration deadline for AOTA 2010!

March 3rd is the early registration deadline for the 2010 AOTA Conference! Save money and get in early. Still wavering on attending? Here are some considerations for a few common excuses...

"But I would rather only take courses in my specialty"
I think anyone would be hard pressed not to find some relevant topics in the conference program, despite their specialty. 3 hour workshops are offered in a wide range of topics and are quite detailed. While in-depth courses are good, seeking a variety of learning opportunities is a good change. Surely it is not anyone's goal to only learn more and more about less and less. Who knows what new ideas you could be exposed to and how it could make a difference in your career? (Also, if you don't feel that the conference offers enough courses in your specialty, why not consider presenting on the topic? That counts for credits too, and helps build the profession)

"Travel is too expensive"
There are LOTS of ways to save money attending conference. At least 100 students attend the ASD, and their income is substantially less than any employed OT. Use the Conference Connections board to find roommates- a hotel room split 4 ways is considerably cheaper than going it alone. Wear an OT shirt on your flight and you're almost guaranteed to meet a friend who will share a cab with you. Book flights early, and consider using credit card points to redeem for a discount on your ticket. Put yourself on a budget for meals. See if continental breakfast is offered at your hotel. I also frequently pack snacks and mini-meals- protein bars, shakes, pepperoni rolls (non-WV folk, you don't know what you're missing by refusing to put meat and bread together)- which saves money on lunches. Also, consider what your employer may offer you for attendance. Could you get paid education days? Could you get part of your registration paid for? Would they consider pitching in on travel expenses for an inservice after conference? ASK! The worst they can do is say no.

"But I could get CE credits cheaper elsewhere"
Yes, there are cheaper ways to find CEUs. Student supervision is free, but limited to a certain number of hours. There are journal articles that can be read, but many journals require a professional membership. And there are certain sites that offer free CE classes or offer to customize your class on "_____ for OT" for anywhere between 1-6 hours. But what is the overall quality of learning in those classes? What feedback do you get from the instructor or other learners? How will your professional life change following those classes? Let me assure you, it is different at the AOTA Conference.

"But I don't like to travel to fun places"
Just pretend that spring in Orlando is like winter in wherever you are, trapped under 3 feet of snow with only beenie weenies for nourishment. Or maybe seek treatment for anhedonia.

New Feature: AJOT Thots

To help keep myself accountable to keep reading AJOT on my metro rides and have an easy way to track what I have read to prevent another NBCOT renewal panic attack, I have decided to do little write-ups on the articles I read. To best facilitate this, I've decided to create a feature! Having a feature makes me feel more like a "real author," like I wanted to be as a kid. This is only bimonthly, so hopefully I can keep up with it and also help schedule some posts. If this is a feature you'd like to see more of on the blog, comment or email and let me know. Read on for the overview of what I've been reading, be warned, it's long.

AJOT January/February 2010 (members only link)

Research Scholars Initiative--Randomized Controlled Trial of the Breast Cancer Recovery Program for Women With Breast Cancer--Related Lymphedema
Marjorie K. McClure-OTR/L, CLT--LANA, Richard J. McClure-PhD, Richard Day-PhD, Adam M. Brufsky-MD, PhD
-- I was impressed with this program as it didn't seem complicated, and it could probably be easily reproduced in other hospitals or outpatient centers that have an oncology service and a therapist providing lymphedema service. Unlike some support groups, since this one is structured around exercise, it seems like it would be relatively easy to schedule.

Telerehabilitation and Electrical Stimulation: An Occupation-Based, Client-Centered Stroke Intervention
Valerie Hill Hermann-MS, OTR/L, Mandy Herzog-OTR/L, Rachel Jordan-OTR/L, Maura Hofherr-OTR/L, Peter Levine-PTA, Stephen J. Page-FAHA
-- I thought this was cool since I haven't used the FES-Nes for CVA rehab but have been curious about the product from the ads I see. This looked like a promising pilot study for tele-rehab, hopefully this was all able to be billed as an outpatient. I think it will be awhile before telerehab can really take off due to the general level of computer skills of the population we serve, but it is promising. Off topic, I felt that there were a lot of vague, uncited phrases ("In recent years, telemedicine has been used considerably for medical treatment of stroke.") and had flashbacks of my marked up manuscript from my research advisor, a strong proponent of justifying every statement.

Documenting Progress: Hand Therapy Treatment Shift From Biomechanical to Occupational Adaptation
Jada Jack-OTR/L, Rebecca I. Estes-PhD, OTR/L, ATP
--OA has always been my favorite frame of reference. Hand therapy is tough practice, lots of protocols to follow, surgeons expecting certain results, it's very hard to break away from the biomechanical model. But it can be done, and I'm glad that these therapists were able to provide their client with increased satisfaction from the model. I would advocate for any hand therapist to at least be eclectic enough to tap into other models besides biomechanical if not for great client satisfaction and improved independence, then to retain our claim on OCCUPATION which is what makes us unique. Props to my hands teacher, who always emphasized occupation based treatment; and to Todd, the hand therapist I worked with who in addition to his goals would have the client keep a diary of activities they could resume as tx went along.

Grasping Naturally Versus Grasping With a Reacher in People Without Disability: Motor Control and Muscle Activation Differences
Kinsuk K. Maitra-PhD, OTR/L, Katherine Philips-MS, OTR/L, Martin S. Rice-PhD, OTR/L
--Glad that someone put down in writing that you can't just hand someone a reacher and be done with the interaction. (This has been a deterrent to us putting AE on the floors in the supply rooms, a fear that non-therapists will give them out without any training) This also reminded me of the study I wanted to do looking at cognitive level (through MMSE or MOCA) and how well clients could "grasp" (how punny) the use of the reacher, because there is definitely an anecdotal cutoff point and I would like to see what that amounts to in real life.

Near-Vision Acuity Levels and Performance on Neuropsychological Assessments Used in Occupational Therapy
Linda A. Hunt-PhD, OTR/L, FAOTA, Carl J. Bassi-PhD
--The trailmaking test is still effective for people with uncorrected 20/100 vision... good to know. Not that I've ever had anyone actually complete the test effectively yet, but hopefully someday it will happen. Also reiterated the good point that you can't give out a magnifier to correct blur, and you need to do the best, most accurate evaluation of the client to help them be independent.

Relationship Between Handwriting and Keyboarding Performance Among Fast and Slow Adult Keyboarders
Naomi Weintraub-PhD, OTR, Naomi Gilmour-Grill-OT, MSc, Patricia L. (Tamar) Weiss-OT, PhD
--A study after my own heart, since I am a "fast adult keyboarder." I feel that the researchers missed out on not studying the normal speed keyboarders, especially since they kept emphasizing the point that keyboarding is often suggested to poor handwriters in school. It seems logical to me that the kids with poor handwriting who have been told to type may fall into that broad range of 'average' typists, not the extreme fast or slow. I also thought that it was strange they had so few touch-typists in their study- is this not being taught anymore? All due respect to Mavis Beacon, but I had an actual person forcing me to learn to type and covering my hands, which is why I am a fast typist now. A skill that I sometimes curse, due to the RSI I am continually trying to avoid. Even though my work computer is a tablet with a pen, my typing is MUCH faster than my writing, especially my decipherable writing. When I take notes in handwriting, it is printed, and my own crazy shorthand (example- K means children, beh= behavior, dem=dementia, dep= depression, w/sp/2st/3STE/Lr= lives with spouse in 2 story home with 3 steps to enter and a left ascending handrail). Anyway, the study was interesting, could be expanding, and OTs should definitely look at the child's overall motor skills before scrapping handwriting in favor of typing.

Doing, Being, and Becoming: A Family’s Journey Through Perinatal Loss
Mary Forhan-MHSc, OT Reg (Ont)
--This was a heart-wrenching, but poignant inside look at the effect of perinatal loss on the author's family. I found it interesting that the older children continue to discuss the child, despite not meeting their baby brother. In the families that I have known who have suffered perinatal loss, usually it was a firstborn child, or the elder child was too young to comprehend the loss.

The Issue Is ... Facilitating Evidence-Based Practice: Process, Strategies, and Resources
Susan H. Lin-ScD, OTR/L, Susan L. Murphy-ScD, OTR/L, Jennifer C. Robinson-PhD, RN
-- There were some good concrete suggestions for clinicians, employers, educators, researchers, payers, and I think students as well in this article. Well worth a read, and not too long.


Remember- if you're reading journal articles or textbook chapters, it does count for continuing education credits for NBCOT. You are supposed to keep a summary of how it applies to your practice. How's that for some motivation to read?

And please, share your thoughts on "AJOT Thots" or any of the articles contained herewith.