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'm Attending! 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.

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

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

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).

I Voted in the AOTA Elections!
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!

I'm Attending! 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.


Job Search at AOTA Conference Expo

I'm Attending!
Have you considered spending time at the AOTA Conference Expo to conduct a job search?
If not... why not? The Expo is a place BRIMMING with hustle & bustle activity, giveaways, companies looking to sell and employers looking to hire. Taking advantage of this last group can reap major benefits. Here are some groups that I speculate will be present and anticipating your resume:

- Companies that operate nationwide will be there. So staffing companies that hire travel therapists and chains of facilities will be well represented. I'm sure Genesis will be there, along with Club Staffing (they're still sending me emails from 2004), Progressus, etc. This also includes the US Military.

- Nationally recognized facilities will be there. This includes Rehab Institute of Chicago, Rancho Los Amigos, Shepherd Center in Atlanta.

- Facilities local to the conference will be there. Do you live (or plan to relocate) within 150 miles of the conference location? There should be a wealth of local employers.

- Volunteer Organizations will be there. This includes Rebuilding Together

As a student, I was so excited to explore all these job opportunities. In some cases, you can feel out the facility for potential fieldwork placement as well. Slow times at the Expo are great times to talk 1:1 with the recruiter about what the company has to offer. and of course there will be enticing raffles and freebie items too. So bring a resume, or at least some business cards, and be prepared to explore some new opportunities.


Snowy Day Thoughts

I am pretty well trapped here at home under several feet of snow.
I felt a little bad calling off work, but they haven't plowed my parking lot and barely touched the street outside the apartment. I really didn't want to walk 2 miles through the snow on the ground (and still coming down hard) to get to the metro (which is running on a delayed schedule) to get to my shuttle bus (also on a delayed schedule) to get to work and then possibly not be able to get back. And now they've actually pulled buses from the roads, and SNOWPLOWS due to dangerous conditions. It's just a little over the top.

I do feel like I made the right decision yesterday though... instead of my usual drive-metro-shuttle bus trip, I got up EARLY (I've been waking up at 5am for a few weeks unintentionally), drove to work and paid to park. Despite driving 30 miles instead of 4, I got home before the worst of the snow started. It was already pretty bad driving at that point, several of the roads having large piles in the middle of the road that got caught on my car's undercarriage, and turns being made hazardous by snow piles taller than my car.

So I'm taking my day off to try to catch up on some fun stuff... reading, finishing my puzzle, but I had a couple OT things to share.

Been trying to come up with some fun OT Month things to do... we are talking about having a carnival at work to promote awareness and need to come up with fun events, favors, etc. I would like to have some ways to increase interest in OT outside of the hospital staff too. I thought about wearing my OT t-shirts to work, but I try to keep all but my scrubs from the germs of hospital-land (to the point that my scrubs are kept in a separate hamper and washed separately from all other clothes). I just got a cute little OTR pin from NBCOT, but it may be a little too little to attract attention. Thoughts?

The other thing that I am currently finding interesting is the proposed restructure of the AOTA governance. This is found in the previous issue of OT Practice (here for members) and causing quite a stir. The theory is that the current structure of the RA and ~dozen large committees is unwieldy and not encouraging quick action, leadership development, or involvement from the membership. The plan is to dramatically shrink the RA, and get more participation from the membership at large through volunteer opportunities and ad hoc committees.

As I said, people are up in arms. This is an interesting OTC thread on the topic with a few people "in the know" in the fray. Here's another, it just hasn't developed much yet.

Personally, I have no attachment to the RA. I observed a portion of a meeting as a student delegate and was not impressed (bored out of my skull might have been more accurate). However, my conference roommate thought that it was really cool and wanted to become a member someday. Elections to the RA in my state were almost always unopposed and run by the same person. I don't recall getting any updates on RA progress at conferences or through state association newsletters. Since I didn't have a close back and forth relationship with my RA rep (not a bad thing necessarily either) I don't know that I will miss out on anything by decreasing the number of members.

I do agree with the theory that it's hard to break into the AOTA leadership... you see a lot of big name people running for offices again and again. So opportunities within the new COOL program that are easy access will make it easier to get feedback from some new blood. From a casual observance of AOTA releases and annual meeting conduct, I could tell that a lot of the work was being done by ad hoc committees instead of standing committees, so I don't know that we're losing much in that department either. I don't know that having the ASD classified as an organizational advisor makes much sense either. As a former member of the ASD, my involvement was limited to one day of mostly being presented to, not really involved with anything until we started the Centennial Vision talks. I'm sure the steering committee is more involved, but some of them aren't even students.

Lots to think about and bring forward to your reps before the AOTA Conference at end of April. Read up on the issue. Talk it out online, especially on OTC. And don't forget to vote in the AOTA elections before March 3.



"What we call chaos is just patterns we haven't recognized. What we call random is just patterns we cant decipher. What we can't understand we call nonsense. What we can't read we call gibberish. There is no free will. There are no variables. There is only the inevitable."
Chuck Palahniuk

(That guy wrote Fight Club. Thank you Google.)

I am a person who appreciates patterns. I often find myself examining tile floors to analyze the pattern or lack of. Routines, a valuable part of life, are just patterns of actions and behaviors. While my appreciation of patterns may just be deep enough to cross (slightly?) into the spectrum, it has also proved interesting at work.

I've only been working since 2007, so I don't have scores of case examples yet, but I have been interested to see the patterns in hospital admissions (and thus, therapy referrals) throughout the year. Here are some that I have noticed:
  • Wintertime > Icy conditions > hip fractures (we begin with the obvious. However, if you have an elderly female with osteoporosis, you may also get the concurrent FOOSH wrist or humerus fracture on the same side as the hip, one of my least favorite combinations)
  • Wintertime > Food oriented holiday > CHF exacerbation/volume overload (everyone goes off their cardiac diets, eats salty food, and starts retaining fluid)
  • Wintertime > Hazardous conditions (e.g. 30 inches of snow in Baltimore UGH) > Exacerbation of ESRD /Volume overload (when the buses won't run and the dialysis centers close down, sessions get missed and fluid builds up)
  • Wintertime > Snow shoveling > MI (most demanding household chore?)
  • Wintertime > space heater use > burns
  • Summertime > Heat wave > CVA
  • Summertime > reckless outdoor activity > TBI, SCI, multi trauma, GSW
  • Summertime > school vacation > joint replacements for teachers (3 months of hip precautions and outpatient PT? No problem)
  • 3 days before a major holiday > elective surgeries for people who have 1) limited time off work, 2) no attachment to holiday, 3) no family or 4) unrealistic expectations

There's a few I can think of off the top of my head. Any other patterns that you notice?


AOTA Conference 2010

I'm Attending!
The debate is over- I'm Attending!!

I've got plane tickets, a hotel room, and a conference registration... Orlando here I come!

I'm very excited, already went through the conference program and started highlighting interesting topics... did I mention being excited?! I haven't been to conference since Charlotte and was disappointed I couldn't go to Houston, so I do feel a little overdue. I've posted before about why everyone should go to Conference, but there's dozens of reasons to go- comment away with yours!

If you're following me through RSS feeds, you're missing out on the new link section that will point you to my posts on the topic and a twitter search so you can track the conference trends. You're also missing out on voting about whether this blog will be "syndicated" to OT Connections. I will be crossposting all the relevant conference posts to OTC, maybe more depending on the feedback I get. (psst- so send that feedback!)

I will be making frequent posts on the Conference, partially because I have been asked to do so by AOTA as a consultant reporter. I am disclosing this working relationship, and will mark all relevant posts with the conference badge to identify them. But honestly, I'd be doing it anyway, as I have always been pro-AOTA and truly love the conference experience.

It's all a few months away, but thinking about warm sunny Orlando while I'm under an avalanche of snow in Baltimore may just help get me through the winter.


Jewelry for those with Arthritis

This is my grandma, showing off the stretchy ring BLING she got for Christmas. She's always had an extensive jewelry collection, but in recent years her arthritis has made it too painful to wear her rings and too difficult to operate some clasps. Read on for some of the options for people who love their jewelry and hate their arthritis.

Stretchy rings/bracelets (Potpourri) - these rings have made their way into my grandma's regular rotation. There's matching bracelets for some and they slip on easily. (We got her the pearls and the ones with the single gem in the bottom right, not the crazy ones made of sticks) The ones from Potpourri are fairly inexpensive, I have seen similar ones in specialty stores MUCH more expensive so do some comparison shopping.

Magnetic clasp converters (shopping search) - I saw these on TV ads. They look like a person with arthritis might need assist with initial setup but then they should be independent to doff/don. I haven't personally tried them, so I can't speak to the strength of the magnets, but they're probably not strong enough to hold up heavy jewels like pearls.

Wire chokers/bracelets - These are pretty common, if you can convince an adult to shop with the preteens to get jewelry. Just look for the necklaces without clasps in U shape.

Bracelet fastener (bracelet buddy) - I was intrigued by this device when it first came out, but it may be too complicated as adaptive equipment now that other stuff has come out.