OTNotes Greatest Hits Volume I: 2008-2012

As part of my blogiversary, I wanted to celebrate entries that have gotten lots of views, lots of comments, or that I felt were particularly good writing. I've tried to group these thematically to make for best reading. If there is an entry that you remember and isn't listed, or something you wanted to say about one of the pieces listed, please feel free to share your thoughts in the comments!

Entries for Students - I started this blog originally to help people in OT school, so it should be no surprise that I have lots of popular entries for students.

Writing goals -I need to update this since my approach has changed somewhat since I wrote it
Case example with goals - This is an acute care joint replacement case
NBCOT study tips -please take note: this was written several years ago, has no info on simulation questions, and I cannot legally update it until 2014.
giving an inservice - should help you pick a topic and some basic presenting tips
searching for an OT job - short plug here, I have gotten 3 jobs from AOTA's OTJoblink. Consider it.
interviewing tips 
the importance of asking questions

Acute Care - How many hours have I spent in the hospital? A lot. Sometimes people in this area are very reductionist, but there is a lot to learn and improve upon if you're an OT in acute care.
How to compile a relevant past medical history
prioritizing evaluations - a few different methods
Acute Care Tips and Tricks - some essential tips learned after many years
who gets to go home? - 3 short case studies of "similar" people who all discharged to different locations
Adventures in serial casting - this is a review of the research surrounding serial casting efficacy
Patterns - a couple of patterns observed in admissions based on weather and other external factors

Pediatric- I'm still getting my sea legs in the land of peds, but here are a couple of good entries. As I start to feel more confident, there will probably be an uptick in this category
Mat Man  -maybe my favorite photo entry
infant toddler trauma awareness  -a lot of really good information on trauma training
starting in Early Intervention: assessment -how I picked my EI assessment

Energy Conservation- this is a fondness of mine. At one point I had a whole EC series planned... may still do something along those lines sometime.
energy conservation in the summer
energy conservation for holidays

Professional Issues- Various issues that I think are relevant to the profession in an overarching way
collaboration with Girl Scouts - I really want to see a greater connection between OTs and Girl Scouts
Malcolm Gladwell thoughts - remember when Malcolm Gladwell's books were really popular? here are some of his ideas applied to OT
OT twitter chat - some advice on getting started in twitter chat, which I would definitely encourage. Check out #OTalk2US if you haven't yet
thoughts on a Glee episode -the OT connections mirror version of this got picked up by AOTA's 1 minute update and really exploded. People were very opinionated over this issue, or just the show.

Personal Issues: glimpses of my more inner life
struggling to be an ot for family
reading without getting carsick -there really should be more information online about how to accomplish this
unanticipated blessings related to presenting at conference

Uncategorized- some of the randomness that is truly me
chicken dance - a little inspirational story that showcases my favorite strategy- make a fool out of yourself.
OT quotes -these are not quotes from OTs, but more meant to be generally inspirational. I should have renamed this or actually found real OT quotes, but it is what it is.
podcast with AOTA presenter -I did my very first podcast!
aquatic exercises -specific treatments for aerobic pool exercises. I now do several of these myself since I am doing prenatal water exercises
metacognitive analysis- how I approach puzzles

I think this is a pretty good list and definitely shows that I have some seriously diverse interests that I've been writing about the past five years. I think that I will probably make this an annual event, and reflect back on the best posts of the year. 


#10minTues - an office lament

I've moaned and groaned before about having a cute little OT lab coat that will likely never get worn. This is a similar vein about office space.

Realistically, I should have known there would be office space inequality from the very first job interview I ever had. My future boss was showing me around the outpatient office, and started in the PT office- nice hardwood floors, large comfy office chairs, large full-size wooden desks. Not crowded, and very nice. Then we went to the OT office, which may or may not have been a closet in a previous life, with pieces of formica attached to the walls and mismatched chairs that needed to be shared with the treatment space. 

The hospital side was a little better... PTs all shared the gym area and a computer or two in there while the OT had co-opted a closet (complete with washing machine!) to shove a couple of desks and phone into. This worked out alright until we had multiple OTs and not enough desks or chairs. My luck turned around when a spare desk was found in surplus. It had belonged to a little person, but a couple of wooden blocks under the legs allowed me to just slide my legs under the keyboard tray. This was a good ergonomic solution for me and so unworkable for anyone else that I got some private space there. (being petite has its advantages!!)

I had a couple of jobs with cubicles which allowed a little customization and privacy, but the vast majority of my workplaces have just had a shared zone with limited seating and workspace, and no area for personalization.

This is a little frustrating, because I had this image of being a professional and having a "real office," probably stemmed from watching my mom work in her office as a child. I want a space to hang diplomas and plaques that are gathering dust, somewhere for my books to be instead of a milk crate, well organized folders. When we bought our house and had a legitimate office area which I then needed to use frequently as an independent contractor (not frequently enough for a tax discount, but that is another topic) I thought this might finally become my dream office. But it is definitely still "shared space" and my husband has put the squash on most of my ideas. We have upgraded from a kitchen table to a legitimate desk, but I have to fight for drawer space and the right to keep my most-needed references nearby. I lost the diploma battle completely.

Will I ever get a "real" office? Maybe if I take a teaching job or open my own business. Until then, everything will just continue to get pushed into boxes in stray corners instead of sitting out. It's not a life necessity, certainly, but it would be nice to have some "me" space.

To end with a laugh- here's a photo of my college desk (on the right) which may explain why I need some space. :-)


Analyzing Functional Movement

(Editor's note: I wrote this several years ago and it just never made it to be posted. I think that it's still valid, but that will explain some of the references to my commute and we'll blame any errors on that too)

One of the skills learned in occupational therapy school is how to analyze functional movement, both in patterns and specific observations. While this is a skills that is taught in refined in school, you may have already intuitively noted some analyses of your own. Therapists are rather notorious for noting differences in movement patterns while out at the mall or other public spaces, but before schooling, people often notice when they spot a task occurring in an odd or different way. 

For example, I am frequently amused during my morning commute. There are 5-7 escalators that I take each day, and I usually walk up them to save time and musculature. But the amusing part comes in watching people step on and off the escalator. Some people pause in their usual cadence to get the timing right, but others come to a dead stop near the edge of the steps. Others take small, short steps and keep their pace the same. 

There is also a mechanical door that is on my path, and watching people either learn the pattern and change their pace (faster or slower) to appropriately interact or fail to learn the pattern and end up stopping the door is notable, if annoying (hey, who wants to be stuck in a mechanical door, even if you are studying movement?).

Everyone has their own movement quirks that they're likely unaware of. Maybe not as  involved as Robert Barone's food to chin behavior (video), but there nonetheless. Until we had our functional movement class and had to watch each other perform different tasks, I was unaware that every time I pour a liquid or focus intently, I tilt my head to the side of the movement. Do I subconsciously think that tilting my head as the liquid flows will keep me from spilling? I don't know, but it is what I do. 

The analysis of movement is a skill, and not just a fun party trick. If you don't know HOW a person goes about a movement, how can you expect to return them to their normal functioning? (Obviously WHY is also important, but that's another entry) Because each person is unique in their movements, you have to individualize the treatment they get so that it is relevant to their situation. 

One example is a woman I have seen multiple times on the orthopedic floor. Unfortunately, she has required multiple washouts and revisions of her LE joint replacements. She also has severe Rheumatoid Arthritis in all extremities. Typically, therapists approach a pt. s/p a hip or knee surgery with a walker, however, this lady is unable to use a walker due to her wrists and hands. So she usually throws new therapists with limitations in ROM, strength and weight bearing in all extremities. But with crutches and modified technique, she was able to transfer effectively.

Another great example of this was a wonderfully pleasant gentleman that I worked with after his hip fracture for several weeks on the transitional care unit. He had Parkinson's Disease, and several adaptations to achieve movement when he was un-injured. Prior to his hospitalization, he needed arm rails on his chairs and a lot of rocking to be able to stand up. This need didn't disappear after his injury, and in fact he had greater difficulties with movement not just because he now had a broken hip with lots of pain, but because his medication schedule got messed up in the hospital. So we needed to coordinate a.m. ADLs with pain and other medications, needed to use the toilet in the shower room across the hall instead of his room to allow better placement of grab bars, shoes before standing (NOT socks) and extra time to complete all tasks. If we hadn't carefully individualized his treatment and looked for solutions that fit his abilities, he likely would have required a much longer stay and been frustrated by the lack of independence.

Movement analysis and activity analysis are key to basic occupational therapy practice. Have you noticed a unique movement pattern on yourself or someone else? Feel free to share.


#10minTues - things pregnant therapists say

Yes, I am aware it's not Tuesday... but since that's one of my working days and I have been busting it to catch up on all the paperwork, blogging on that day is not so easy. In the style of the "s--- (fill in the blank) people say," here's some things that I think are unique to pregnant therapists. Not all said by me, but all have been overheard in my different places of employ.

- "I can't find my ASIS anymore!"

- "I'm going to take this reacher home... maybe the sock aid too"

- "You're getting really lordotic" (truthfully, I'm pretty lordotic to start with, but since I got a larger curve my back has actually felt better)

- "I haven't been reading What to Expect, but I got out my neurodevelopment notes and have been following along that way"

- "Can you bring Miss Cheryl that (stool/cube/ball) to sit on while you play on the floor?"

- "It's much easier to put TED hose on yourself than someone else"

- "Is that toy really developmentally appropriate?"

- "Sorry, Miss Cheryl can't (hang like a monkey/pick you up/crawl through the tunnel) today"

- "Which of these is the most ergonomic baby carrier?"

- "No, I don't think we need a Bumbo seat"

- "Let's go use the ICU ultrasound and look at the baby" (not me!)

- "I just need a minute to put my SI back in and then I can help you"

- "This scrub top used to have a lot more room in it..."

Anyone else have any funnies related to pregnancy and therapy or healthcare?


Pregnant in Healthcare: diseases to avoid

This is a hard article to entitle. Obviously, no one wants to be exposed to contagious diseases at any time, but by virtue of working in a hospital, there will be sick people around. This is a list of infections and diseases that should be avoided by pregnant women working in healthcare that was compiled by a former coworker of mine. Explanations of some of the possible effects of exposure to the fetus are directly from the links and citations noted. It's not my intention to cause anyone to worry, but just to give a little information to be used when building your caseload.

Please don't debate with me about the frequency of these complications or ask whether your child is at risk- I'm not a doctor, you should definitely discuss your concerns with your own OB. But this is information that I think is hard to find in one place and beneficial to many women trying to work while pregnant.

Herpes varicella/ Herpes Zoster (chicken pox, shingles) – exposure in the first 20 weeks or last 5 days of pregnancy can cause congenital varicella syndrome with a spectrum of musculoskeletal and visual birth defects.

Rubella (German measles) – Early exposure can cause congenital rubella syndrome, characterized by eye defects, heart defects, and mental retardation. Also raises the risk of miscarriage or stillbirth. This is covered by the MMR vaccine so you should be immune if you received it as a child.

Toxoplasmosis – early exposure is less likely transmitted but can mean more serious results, late exposure is more likely transmitted but has less serious results. This can cause eye, hearing, and learning problems.

Cytomegalovirus – transmission is rare, but possible effects of CMV on a baby include learning disabilities, mental retardation, and vision or hearing loss after delivery.

Parvovirus (slapped-cheek disease, fifth disease) – Can cause severe anemia which raises the risk of miscarriage or stillbirth.

Herpes Simplex – (STD) Exposure at birth may result in brain damage, blindness or death for the newborn.

Hepatitis B – this infection can be passed to the infant at birth, which poses the risk for developing chronic Hep B.

Pt with AIDS with mental status change (can be Cryptococcal Meningitis or "crypto") - this is a fungal, opportunistic infection. It can be transmitted to the baby and both of you could need to be treated. Certain drugs to treat this can cause miscarriage, so obviously inform your doctor if you are pregnant.

Bacterial Meningitis – can cause brain damage, hearing loss, or learning disabilities.

It has also been recommended to me that pregnant women avoid contact with people who have the flu. And it's always good practice to avoid contact with anyone with a fever or new unexplained vomiting or diarrhea. This article from Nursing Center has some additional information on risks that pregnant healthcare workers are exposed to, with some suggestions for how to mitigate these risks.

As a currently pregnant, currently recovering from very mild illness person, I can attest that it's pretty miserable being sick when you don't have many options for medication, are already tired, are at greater risk for dehydration, and are worried about the development of your child.

Knowledge is power- hope this list helps you feel more empowered as a pregnant healthcare worker!

Blogiversary Winners!

I should seriously know better by now about announcing plans... as soon as I had great ideas for the blogiversary, everything else blew up. I had started my new job, which had a lot of intense time in the up-front, reevals and the like. Hospital census exploded and they needed help, at the same time that the outpatient center needed extra coverage. Still balancing the early intervention caseload also, though trying to transition them to new therapists. I had to take the four hour glucose test, and then I got ill. So clearly, this month was just not meant to happen. Promised entries will still be coming, but just on a delayed schedule.

At any rate, we do have winners for our giveaways!

Sarah wins the Geriatric Grab-bag with great gifts from Maddak, The Pencil Grip, Handybar, Tactus Therapy, and AOTA!

Our Pediatric Playthings winner was commenter #12 Jenny M! She gets gifts from  Maddak, The Pencil Grip, Tactus Therapy,  AOTA, Miss Awesomeness, and me!

Our Student Stuffs giveway winner was commenter #6 OT Girl! She wins prizes mostly from me, but also from AOTA and The Pencil Grip! (note that the # of possibilities represents the number of unique commenters, some duplicates snuck in)

I solicited these gifts based on products that I like and use, and hope that you will love them!

Commenters named in this post have 1 week to comment here with your email address (name AT source DOTCOM to prevent spam) so I can contact you since none of you left contact info! If I do not hear from you by 8am EST Friday February 8, I'm picking new people!

Thanks to everyone for commenting, re-tweeting, and pinning! I love hearing from readers and hope to get more input from you all on normal entries too! We had a couple of other bloggers stop by: Abby from Notes of a Pediatric Therapist; Heather from Heather's Creative Concoctions; and Christie from Mama OT -- be sure to check out their blogs too!