Occupational Therapy Notes

HWT Webinar

2012-01-15T22:14:00.002-05:00

I've enjoyed using the Handwriting Without Tears products this year at school. In case you aren't aware, they are offering a few free webinars that may be helpful to your practice. I have signed up to attend the Response to Intervention one since that is a concept I am still learning about and would like to see develop more in our district. It is being given by 2 OTs, and while it does not specifically say so, there's no reason that it shouldn't count for continuing education on some level, just check through your state guidelines when submitting. I like to pass on good CE resources, and especially those that are free and appear to have some thought put into them, since unfortunately "you get what you pay for" in many free courses. Hopefully this one will be well done, there's no reason it shouldn't be given the overall quality of the company, IMO.

2012-01-08T21:11:00.003-05:00

After a few wondrous days of ease in December, I made the transition to a new caseload. I say "made," but clearly I am still only "making" a transition.

Jumping up from pre-K to teaching cursive writing and higher level praxis skills has been fun, but definitely an adjustment. I would like to have a time machine to go back and tell Miss Wilson that I would someday be helping others learn cursive handwriting- she might faint from the shock! I used a dodgeball on Friday for praxis skills, teaching novel dribbling drills I haven't done since high school. I also reinforced that if you want to really impress a young child, you should give them a behind the back pass. Kids eat that up. :)

I had a kid who was having a bad day, really slumped in his desk and didn't want to come to therapy on his first day with me.
I introduced myself in the hallway, saying, "Hi (kiddo), my name is Miss Cheryl."
He repeated "Miss Cheryl?" and then followed with "I don't like that name."
I took a breath, and a page out of Karen's book, and said, "you can either call me Miss Cheryl or Miss Awesome, but we're going to therapy now."
Later in the session, after our fun time, he said, "I love you Miss Awesome."
:-D kids can be very fun.

I need an activity using calendars... my grandma gave me about a dozen calendars and I need to find something to do with them. I definitely am going to take a few to the schools where I have students very intent on having their normal therapist back so that they can mark down the days to her return. When I say, "she had a baby and needs to be at home for awhile" the answer is almost invariably, "she'll be back tomorrow?" (unless it's to ask me an inappropriate question about the baby process- talk about a nightmare!)

I'm really enjoying my school system job, and despite the meetings and scheduling snafus, it's really not overly stressful. The school schedule itself can be a little challenging, we have several Mondays off this week and a lot of time off in April as well that makes it hard to make up visits. My personal schedule will get more complicated soon with the legislative session starting up again and time drawing nearer for conference (109 days! eek!)

Photo Phriday- creative style

2011-12-30T13:25:00.000-05:00

I have always liked the idea if the SticKids program for making sensory plans and handouts, and now I actually get to use it! While I do have some issues with how the SticKids software works, I still think they make my job easier with the products I can create for students. Sometimes though, only your own picture will do. (this was an activity we had safety tested in the classroom)

Photo Phriday: Mat Man

2011-12-16T07:09:00.000-05:00

I love the Handwriting Without Tears products (fortunately my district has plenty) and the concept of Mat Man particularly. I think there is a huge advantage to be gained in spatial awareness, prewriting, and body awareness from teaching Mat Man. There's even a cute online game that even includes the song (requires a free login). I've used the manipulatives and drawing sheets for individuals and groups of preschoolers this fall.

Here's some photo results from kids who used the manipulatives or interactive game first and drew pictures onto frames second. I love the repetition to cement the ideas, and the progressively more empty drawing frames to chain the task.

This drawing is by a child with autism in a 3 year old classroom with just a few prompts for parts. She drew fingers independently. She so often refuses to attempt anything on paper or try anything herself but she loved doing her drawing on her own. I enjoyed the pig nose and muppet eyes, personally.

This one is by a little 4 year old with autism in a special education classroom. He had a couple of cues as well and could write his name on the back too.

This one is by a 5 year old in general education preschool. I only interfered after he drew the first hand. Undoubtedly, this Mat Man will be an excellent piano player.

This one may be my favorite, just because I know the child. He is a 4 year old with autism and severe behavioral issues in a special education class. He loved building the Mat Man and worked really hard to make it match the picture perfectly. And he drew this with only cues for ears. Granted, he has fingers without hands, but I think this is pretty stunning given that he previously would not copy a circle. It was so great to see him calm, happy, and attentive throughout the activity, and he was proud of his work.

I was really pleased with the reception that the Mat Man activity had with the kids, and also with the results. Not everyone had such terrific results, but all these are after one session only, and I think there is great face validity to the concept.

Simulations of Learning Disabilities

2011-12-12T08:55:00.000-05:00

It can be very difficult to understand what it's like for a child with a learning disability to participate in classroom activities, especially for a child who can't articulate all they are dealing with. I find it hard sometimes to plan treatments for kids to address some compensation methods or remediation of skills since I am still getting my feet wet. It's also hard to see preschoolers with simultaneous severe physical, visual, and communication impairments as they struggle to pick up on concepts such as identifying themselves, choosing an object, using a switch, etc. Some kids work EXTRA hard to learn, and if you were a good student and good at understanding the system (playing the game, as my Dad said) it's hard to see how something so easy for you can be so hard for someone else. So I encourage you to explore these sites' simulations a bit and try to work through the trials they have set up. Honestly, I could not make it through many of the sections. Just a short exercise to better understand struggling learners- appropriate for teenagers and older.

PBS Site for Misunderstood Minds. Thanks to Teaching Every Student for the link.

Children's Vision Network site for Vision and Reading

Photo Phriday!

2011-12-09T09:54:00.000-05:00

So I finally got some pictures off my phone! Here are some OT-related pics that you may find amusing.

It's totally unnecessary for parents to tally scoresheets themselves, but that doesn't mean I don't appreciate it!

Can you tell this backpack belongs to a pediatric OT? This is an awesome dragon puppet that has a multitude of fasteners along his tail. Everyone loves Danny Dragon.

This is a shot of the beading dowel. The little guy who did this had no problem matching colors but was just randomly lucky on getting the right shape (30% or less, all trials. Pretty sure that was the only purple bead too).

This is a picture that the students made after reading "Dog's Colorful Day" where Dog encounters 1 different colored blob during each part of the adventure. Can you tell which child worked on her picture as part of an OT session? And also had a bit of a perseveration problem? lol

Visual Motor Freebie

2011-12-04T09:35:00.000-05:00

I found this I Spy sheet on Scribd which can be downloaded for free. Some of the images are a little odd, but whatever. I added a document on Google Docs (here) which has a list of the items in the sheet (notations about which ones look a little odd and might be hard to identify) and has a few searches listed out to better make it into an activity. There's a screen to check the 4 quadrants, a listing of animals, and a few common letters listed out.

Happy visual hunting!

Moving into winter

2011-12-03T15:51:00.002-05:00

I'm coming up on my third month of being a school therapist and a homeowner, and had a few other interesting things happen recently. Here's a bit of a recap.

I was feeling very over my head in the past 2 months about the conference presentations I had applied to do. I had my usual procrastination battles and feelings of not being qualified for one reason or another, really kinda getting down about it all. In summary, I was a lot more excited about presenting when I signed up in the spring than when it came time to present in the fall. But things turned around and I think they both went over well. I talked about some options when beginning a pediatric practice in a hospital based on my Baltimore experience getting mentored in the NICU, newborn nursery, pediatrics and antepartum units. I had a crowd of mostly students but there was some interest. I felt kinda old since there were a number of students from my alma mater and I knew none of them, though there was a "small world" I-know-who-you-know moment.

Second presentation was meant to be more of a discussion on social media tools and ethics than an actual presentation. I was expecting 10 or less and I think there were about 30 by the time we ended- it definitely changes the dynamics of your discussion. Based on the audience, we covered things on a much more basic level than I had intended, and it would have been better received with more in-depth time to cover the basics. My favorite tools are in the Google brand of (free) products so if you want to get started in social media and exploring the online world, that's my first suggestion. Get yourself a gmail account and then we'll move from there. And for social media with other OTs, you can't beat OTConnections (also free).<

The final presentation (AOTA '12 !!) is just in the beginning stages right now. I was a little stressed prior to our first discussion (coordinating 5 people across a continent does seem challenging!) but now I think that things will fall into place. I'm excited because we will all get to talk about our specialties and favorite online tools, the "why bother" of social media and what we're passionate about. I also think there will be some good ethical discussions and that is interesting in its own right. We used a Google+ hangout to video chat, which worked really well.

I've been getting used to the school system job, and it has been going pretty well. I have been working primarily with preschoolers, most of whom are in a special education classroom. I feel like things have worked out so well in the past few months. The caseload was very manageable, which was great since I am new to the school system and both IEP and IFSP thinking. I have been privileged to get to spend a lot of time in class with 2 superb special ed teachers who truly love what they do and are excellent at it. I've learned a lot from them and it's been great to be able to push-in for most of those treatments. I'm really going to miss the group of teachers, IAs, and kids that I've gotten so attached to. So I'll be leaving this group and getting older kids with regimented treatment times and all pull outs in the next 2 weeks. I'm trying to build up a good supply of activities for a group that is not so easily entertained by blocks and construction paper.

I hope to get a pinterest account soon to more easily share some of the resources I find- I think that will be a better medium than twitter has been. I love the visuals. (Here are a few cool OT-related pin boards to get you interested if you haven't been over there yet: Funkist, Your therapy source, pediastaff)

So I'll be unpacking and repacking a therapy bag (they gave us rolling duffels, which I think is cool). That means cleaning out the Handwriting Without Tears manipulatives (maybe, have to check ages of kids), the switch toys, the tactile puzzles, the nesting blocks and maybe some of the chewelry. In their place, I can add in some tinier toys for advanced fine and visual motor skills, some things I've made from File Folder Fun, and lots of paper. I'm trying not to freak out about January where there are 3 Mondays without school, the month-ish when I'll be covering 2 caseloads at the same time, or April where there is spring break plus AOTA plus possibly NBCOT. Trying not to freak out, but getting pretty anxious anyway. Change is hard.

I have been using the IPad off and on, we only have 20 apps but I hope to have a review of those soon. I also put some free apps on my Android phone so when I get to do an app entry, I will be able to touch a little on both platforms. There will also be an upcoming entry where I can share some of my phone photos I've taken, mostly of the Mat Men kids have drawn.

We're getting ready for the Maryland legislative session to start again in January, our annual Lobby Night event, and months of hard nosed defense of our scope of practice! It is hard work, but great people on the team, and very worthwhile.

The house has been coming along fairly well. There's been some repair work but it seems mostly under control. My family came out for Thanksgiving and it was nice that the 7 of us didn't have to cram into my Grandmother's 1 bedroom duplex for the first time... maybe ever. Just sent out some cute little holiday cards and hopefully will find the energy to get the tree up today. Wintertime always zaps me a bunch. Been off running since Thanksgiving thanks to a repetitive strain on my IT band that's still aching and I haven't made it back to the pool yet either. Maybe someday I'll find that teleporter or a pause button to get a few extra hours a day, but until then the busy-ness just keeps coming :)

Wooo!

2011-11-09T20:10:00.003-05:00

Ben, AKA OTA_Stolinski is the winner of the Dycem giveaway! Congratulations! I see a turtle mat in your future! Email me at otnotes at gmail. I will definitely consider doing more giveaways in the future, (should I have items to do that with) but hopefully there will be more legitimate comments and fewer advertisements for fake universities and/or job search engines.

The Biggest OH NO Moment Yet

2011-11-04T16:32:00.002-04:00

Worst moment yet of this job:

We have a high number of kids transitioning out of early intervention and into the IEP system. More than usual. So that has led to tons o' evals, IEPs, and meetings. I've been proud of staying ahead of all that needs done. Monday, I finished up all of the evals and the entirety of the IEPs. And today, at 330pm, I discover everything has been obliterated for 2 IEPs. Completely and utterly gone. And due on Monday.

Tangentially Job-Related Goals

2011-11-01T22:31:00.001-04:00

Clearly, with my job in a new field and situation I've never been in before, I have goals. I want to be competent (and if possible, awesome) at what I do. But since there are a whole host of other things going on, here are my goals that are only somewhat related to the job.

Learn to Navigate the County: I have never been great at finding my way. GPS was essential in Baltimore since I would likely still be driving around North Street trying to get home. My husband does most of the driving when we're together, so I didn't get a lot of practice. Now we've bought a home in a larger-than-I-thought county and I want to know how to get everywhere. Today I went to the extreme East end, and I will regularly be covering points West and South as well. I want to know short cuts (or at least the basics). Ideally, I will be able to out-navigate my husband. We'll see.
Find Awesome Eateries: I still pack my lunch a good bit, or hit the grocery store salad bar. But I want to find cool little unique small business eateries. I want to be a regular at the best dives in the nooks and crannies of town that can provide lunch in 30 minutes or less.
Improve Time Management/Job Separation: A major problem at my last job was working extra hours and not being able to "turn off" at the end of the day. A prime factor in our decision to move from Baltimore was to have more family time and take up worthwhile activities during the down time. So this is a crucial personal well being step.
Dress Like an Adult: I've worn solely scrubs to work for 4 years. This includes not just cute little outfits, but t-shirts, items scrounged from yard sales, and shirts from my Grammy's own collection. Most people would not consider this wardrobe very fashionable, or even always the right size. Now I wear nice pants and shirts... time to be a grown up and look professional! Also, I get to fix my hair nicely on occasion instead of keeping it pinned back constantly.
Find Time for Physical Activity: It's never easy to fit in everything you want to do in a day. So I really want to focus on making time to be active. So far, I've been able to walk to the school closest to my house, and work in some school laps during lunches/breaks. On days that I am at a "campus" or several nearby schools, I hope to be able to walk or bike. Incorporating the activity at work is something I'd like to do, and it demands that I pack efficiently and prepare well for the day, so it's a lot to work on. Ideally, I will also do some things before or after work, but I'm still ironing that out.

The more things change...

2011-10-28T22:36:00.003-04:00

So I have been working tonight on an entry about the indecision I have right now about the future and the convoluted OT path I have taken up to now. At one point, it started to seem familiar. I felt as if I had quoted Thomas Merton before, and it turns out, I have, 3 years ago when I was equally wondering what the heck I was going to do with my life. Oh goodness... that's a sign it's time to stop thinking for a little while. :) Sudoku here I come!

Don't forget- World OT Day!

2011-10-26T08:18:00.001-04:00

October 27 is World OT Day! Sponsored by WFOT (now on Facebook), it's a great day to proudly raise awareness about the profession. I would rock my Super OT shirt, but I have formal meetings, so I'll wear inner-OT-awesomeness instead. :)

This is the sophomore year for the OT Virtual Exchange and they have once again put together a powerhouse group of speakers for a 24 hour time frame. There is a theme of "Pay It Forward," so you should enjoy the quality talks for free and then share your OT knowledge out in the world as well! Check out the schedule here, and be prepared to tweet using the tag #ot24vx.

Linda from the great blog Daily Living Skills is also running a blog carnival to celebrate! It's been way too long since we had an OT blog carnival, I'm excited to see the entries, and I hope we can keep the energy going.

Our OT Identity

2011-10-25T22:10:00.001-04:00

In celebration of World OT Day, we are discussing the Global Identity of Occupational Therapy. It's an interesting topic since there has been a lot of discussion about our national OT identity with the approaching Centennial. I think the best thing that I can share for this topic is my summary of two of the best AOTA sessions from the 2011 conference (and maybe from ever).

Last spring, there were two talks that best fit with the presidential address and stood out as completely awesome. One was "OT Survivor: Protecting Your Turf in a Competitive Healthcare Market" by Pam Toto and the other was "Practicing Authentic OT: Strategies for Becoming a Reflective and Reflexive Practitioner" by Debbie Amini. These ladies are both well recognized in the field. Energy was definitely palpable in both rooms, and I even got to meet (again) Suzanne Peloquin during one session. (If a Slagle lecturer shows up in your room- you know the topic is superb!) By discussing what was reviewed in these sessions, I think we can get great input into our OT Identity.

"What is occupational therapy?"

How often do we hear those words?! Yet Toto points out that each OT area has its own definition. What I do on a daily basis in the school system is nothing like what I used to do in the hospital and that would look nothing like the life of a hand therapist. Even within the hospital, my practice could vary widely from the NICU to the Neuro ICU to the orthopedic floor and so on ad nauseum. Toto said this was like blind men describing an elephant- we tend to describe our practice in a reductionist way of what we regularly do, sometimes missing the big picture of OT. This can lead to confusion from consumers, referrers, and payors. Amini points out that if we want to achieve the Centennial Vision goal of a consistent recognizable image, we much EACH take it as a personal responsibility. The "Authentic" version of OT is client centered and occupation based, with occupation as both an outcome and a treatment. Amini pointed out that this is often an espoused belief of practitioners, but not necessarily an enacted one.

A person may not even realize that they aren't enacting their beliefs until there is an additional level of reflection involved. Amini described reflection as thinking and critically examining yourself, skills, and practice. Reflexive practice takes reflection further by then comparing reflected behavior to espoused beliefs, determine any incongruence, and then act to change the behavior or the belief. This process can be done by personal journaling, mentoring, using the AOTA professional development tool, creating a portfolio, or joining a community of practice. Toto states that one of the best ways to advocate for OT is to practice consistency in areas you address, services provided, assessments and intervention approaches. In doing so, you create an image that others will remember and identify as occupational therapy.

There are perceived challenges to authentic and reflective practice. Amini includes corporate policies, reimbursement, productivity, supply cost, time, and decreased support from peers or supervisors. Toto described threats to our practice: complacency in our documentation (failing to specify our unique practice), viewing OT as a job instead of a career, moving from ADLs to preparatory/adjunctive treatments, accepting the status quo (including that laid down by the boss), and allowing any other service to be a "gatekeeper" to OT. Don't allow other professions to represent you. If your services are special and unique, NO ONE can say OT isn't needed! Remember that documentation is important. It's hard to remember that when you're writing 6 evals a day and don't think they're ever read. But think back to being in school when you learned about how each note was a legal document, the only proof of what really happened with a client. Toto discussed that it is important to use our practice framework language and reference evidence in our documentation. The most skilled part of a person's OT session may not have been the hands-on portion, but the clinical reasoning and decision making you engaged in. And speaking of clinical reasoning- don't short sell our value by saying that it's just "common sense!"

Toto discussed at length the importance of advocacy for OT. We're great at being advocates for our clients to get the best care, but more reluctant to stand up for ourselves. There are a limited number of healthcare dollars, and other groups would love to take our share. We can't be timid and "nice." As Dr. Clark said in her presidential address, if you let others take OT for granted, "it's not playing nice, it's playing dead!" Remember, there is no mysterious "they" who will advocate for you. AOTA and your state association may be able to take action on a government level to defend OT, but without your membership, they are hard pressed to do so. And they certainly won't be coming to all your referrers and coworkers and asserting the OT scope of practice. That falls to each of us. Amini reminds us (especially those AOTA members) to use the official documents as leverage during advocacy efforts.

Toto described that there are two ways to make light- you can be the candle or the mirror. When your client is successful, they need to understand who you were, what you did, and how your intervention has impacted their occupations and participation in life. Discuss and hand out goals. Hand out a business card. Make sure that you identify yourself as an Occupational Therapist and not just an OT or OTA. Have several elevator pitches for different audiences that include evidence. Most importantly, let everyone know the good that you do, so that others may receive your awesome authentic services.

I hope you find these points useful for your daily practice. The field of Occupational Therapy and our consumers will definitely benefit from authentic practitioners. Let's all strive for that in the coming week.

Dycem Product Review

2011-10-22T22:48:00.001-04:00

The good folks over at Dycem were kind enough to send me some free samples in exchange for a review. Click through to read (and win a prize!)

Dycem products have expanded since I was in school, learning about their use. They have even made a special section on their website just for OTs. I got a few products and started trying them out in my practice and handing them out to others.

I was a little confused by the mat that had a peel off on both sides. I am 80% sure that it was just like that for easy distribution and cleanliness, not to be adhesive. (There are adhesive strips/mats as well) I tossed one of these in my utensil drawer, because the force from me closing the drawer kept knocking the silverware tray back into the depths. I put it in a few weeks ago, and despite me purposefully slamming the drawer, the tray does not move. The silverware itself keeps trying to run away, but I digress. We will also use some for either the drawer holding baggies or for where the wine glasses are.

One of the rifton chairs at school has a piece of Dycem on the seat to help keep the child from sliding. This does work, but you have to be very conscious that you are positioning the child properly and with a good pelvic tilt since it will be hard for them to readjust themselves.

I like the coaster a lot. It doesn't slide on the surface and the glass doesn't slide either. The downside is that it cannot absorb any liquid, so the glass will get pretty drippy if you have a lot of condensation. I tried to use this in the car to hold my phone (illegally) on the dashboard, but it couldn't quite hold the phone during the turns.

The pediatric mats are quite cute. However, the shape cutouts can make it difficult to get the absolute best fit for the object getting stabilized. I have used the Turtle while in the schools, stabilizing slant boards, the Ipad, blocks etc while on the wheelchair tray or tabletop. The kids seem to like it, but it can be a little distracting. I sent the hippo to my grandma because her little fat dachshund dog is so eager to get her daily food portions that she attacks them and pushes them under the toe kick for the kitchen cabinets. This is annoying for my grandma, who really shouldn't be bending over and digging under the cabinet or all across the floor for these bowls. She swapped the old mat for the dycem one and has not had a problem with the bowls moving at all. I got a text message ("from the dog") that reads- "Dear Cheryl, I like my new mat. I don't have 2 chase my food dish. It is easy for my maid 2 pick up and clean. It doesn't take up as much space. Thank u for thinking of me. love, Annie"

The jar and bottle openers are my favorites by far. The jar opener has worked on everything I could try, and my elderly patients have always liked it. It is listed at $12.75, but really high quality. It is much better than the rubber or silicone trivets/openers I've tried before. The bottle opener is a little redundant, but lets me open my adult beverages without assistance.

Keep in mind, when using any of these products, your results are much better if the surface and the product are both clean and dry. I have to keep the portable mats in boxes so that they can be transported without getting nasty. It just takes soap and water to clean. I tried to use the placemat "off label" as a trivet. I wouldn't recommend it for that. It's better than a towel, but does still transfer the heat as time goes on. I actually checked the specs and material is supposed to be OK up to 50*C, but I like my silicone trivets better for this purpose.

Things I didn't try:

- On the website, you can see small furniture disks to keep chairs from slipping. I would be interested to know whether this provides enough stabilization to someone who is really pushing back hard on the chair (like a person with Parkinson's). I suspect it would depend on the angle of the push- might be ok for a person who pushes straight backward, but most are at an angle that causes the chair to tip back.

- Also on the website, they have a picture of a sheet of Dycem on a hospital bed presumably to keep a person from sliding down the bed. Would this really work? Soft surface of sheet plus either soft hospital gown or skin? I don't know that I would try it.

- I didn't have one of those mats to try out with sit-stand transfers. It would probably work with some, but the ability to adjust the person's feet is sometimes needed. Could still be useful.

If it were me, I would expand the product features in a few ways. I think the openers and the coaster could be more accessible if there was a magnet or clip to attach to the fridge or cabinet drawer. The jar opener could probably be made into a ring only and attached to a keyring for tailgating purposes. Some products could be integrated with others to increase their function. A silverware drawer with Dycem lining on the bottom and insides would be helpful. A coaster that could somehow have a cork middle to be absorbent while still retaining the non-skid would be great. Anything that could tolerate high temperatures, microwaving, or going through the dishwasher would be helpful. And more color choices are always enjoyed.

I really don't know of an alternative better to Dycem. It just works.

Free Giveaway!

Thanks for reading this far! Please leave a comment regarding this entry or the blog in general (polite only please, no email addresses, no spam plugging fake universities, etc). Get these in by 11:59pm (EST) Sunday November 6 and I will use a random number generator to pick a winner(s) and mail you a slightly used but not damaged Dycem product. You can also get brochures and free samples here.

Life is what happens when you're busy making other plans

2011-09-27T18:46:00.002-04:00

So, I work in the school system now.

I know, it's a big change. But it's not like I had anything else going on, what with the moving, quitting another job, buying a house, and moving again. Late summer of 2011 is rivaling the entire summer of 2007 for most stressful time of my life... it has already surpassed spring/summer of 2002 and that is really saying something. (sidenote- why does all my stress come in the summertime?!) So to sum up, we moved from Baltimore to have a more stable home/family life, I tried to make it work at a job, and I finally got an offer I had been waiting for, so I made the switch. And I now know that you should NOT EVER switch jobs while trying to purchase a house. Loan people don't like that. It also ended up being a much more prolonged departure from one job to the next.

In 2002, or even 2004, or probably even much of 2007 if someone had told me that I would be working in the school system I would not have believed them. Until I had already taken my first job and kind of fell into the world of outpatient pediatrics, I really didn't know that I could find working with kids interesting, important, and fulfilling. I liked kids in short doses, but it wasn't something that I thought about doing for a career. That opinion played a BIG role in selecting the University I went to for OT... I was completely turned off by a big-time program because of what I felt was an overemphasis on pediatrics. I liked outpatient well enough, but never thought that I'd move to school-based therapy.

For the record, I'm pretty sure my mom brought up school system therapy back when I was still in high school, so as usual, YES Mom, you're right.

I haven't been working in the current situation very long, but so far I have just loved it. Great therapy staff and everyone has been very helpful as I get my feet under me. About a month in and I'm starting to get the rhythm. I think the biggest challenge is the scheduling... I have preschoolers that are only present 2 days/week, and then only for mornings or afternoons, travel between locations, meetings, all that jazz. It's coming together.

I love the resources that are available at work. Lots of different assessments, and multiple copies of the popular ones so you don't have to fight with anyone else to schedule testing. A variety of adapted writing tools and alternate seating surfaces that you can just give away as warranted. I think it's great not to have to jump through hoops to get things ordered or recommend something to the parent and make them have to order it.

Had a great weekend with the NBCOT crew, working on simulation questions. We literally go through each word to make sure that the questions are clear, not trivial, not tricky, and not biased. It can be intense, but I am glad to be with such a good group of people. I enjoyed the time in Memphis, particularly running by the Mississippi river, which I had not seen before. My only regret is not getting to go on a sternwheeler, but I didn't see the Proud Mary anywhere, so it's not like opportunities were abounding.

he house purchase process was overwhelming... which is an entirely separate post. (coming someday! I promise! Already started!) But I have been keeping with the recent change in focusing more on personal health and non-OT stuff for a change. I am still running (mostly regularly) with a 5K at the end of October. We've been hanging out with friends during the week more and settling into our crazy fall routine of traveling almost every weekend. Serious miles are in the near future at a time when rest would be most welcome... oh well. At least there should be fun times with friends upcoming.

I'm going to try not to neglect the blog too much, especially since people have been introducing me as the blog girl, and it would be bad form not to update. :) But patience is always appreciated.

Self Behavior Modification

2011-08-19T09:09:00.000-04:00

So as I work on getting in shape, I worry about maintaining motivation. There have been a number of failed attempts prior in my (not that long) life and I'd rather not fail again. So I am busting out behavior modification all over myself to make it work. There are some great tips here, and I've listed out some of my other methods of personal mind control.

(not necessarily in any order)

1) Visibility-I want to be reminded of my goals and what I know I should be doing. So everything stays visible. My box of exercise gear (yoga stuff, balance stuff, aerobics shoes) is right beside the TV, so I always see it. If there's an exercise DVD that I want to concentrate on, I'll prop the case up by the xbox so it's easily seen. We have no garage at the moment, so the bikes are sitting right beside the table. I bought anti-chlorine shampoo for post-swim workouts and put it in the front of my shampoo container so I see it every time I walk in the bathroom. You could also place motivational notes to yourself in various places.

2) Ease of access- Since most things are visible, they're easily accessed. I have Netflix streaming and leave all the workout routines in a block so they're easier to locate. The running shoes stay near the door and untied. I keep my water bottle filled and in the fridge. All the workout clothes are in the same drawer, and if I'm planning on going to the pool I'll put all that stuff in a bag together. Generally keeping necessary accessories (say that 3x fast) together makes life easier, for example, the bike helmet is on the handlebars. I'm a bum, the easier it is, the more likely it is to be done.

3) Guilt- Is this a healthy motivator? I don't know. But I use it. Thinking about the cost of items, and that I really should use them, is sometimes helpful. Thinking about how long it has been since doing an activity is also something I do. And in the part guilt/part competition factor, if my husband/workout buddy is doing something, I will try to go along and keep up.

4) Mental monitoring- A recent study showed that people who just mentally asked themselves "how often will I work out this week?" worked out more often than the control group. (sorry, no link) So I try to think about my exercise schedule, and try to think how I will fit things in for the following day. I also am trying to keep a journal with short entries about what I did and how I feel. Keeping a written record gives me something to look back at for motivation.

5) Rewards- I am all for cheap, easy thrills as rewards. I have a smart phone and use the free CardioTrainer app for my exercise recording. Every time I turn it on, I can see a little activity figure for each day that week I did any kind of exercise. I like the little stick figures and think that they're cute, and like to see a variety of them on that screen. It keeps a full history, so I can look back and see how many total miles I have gone since starting the app and the calories for each. I can also see the maps of my outdoor exercise, which I think is cool. Finally, there's a widget for my screen that turns different colors based on # calories burned/week. I see it frequently when using my phone and always try to keep it in the gold/silver/bronze range. I definitely get a little emotional boost when I see a good color.

So that's a few of the ways that I've been manipulating myself lately. Nice to see that I'm making use of my education. Any other good tricks that you use? Feel free to share in the comments.

Disability or Ability- TV's Alphas

2011-08-10T19:27:00.000-04:00

I watch a fair amount of TV. Now that I'm home 2 extra days, I keep it on for noise during the day. One of the shows i have started watching is Alphas from the SyFy channel.

Alphas so far appears to be a fairly standard superheroes kind of show in the line of XMen, Heroes, etc mixed in with some espionage and spy work. I like those kind of shows, so I can tolerate some of the less-than-awesome dialogue and recycled plots. Of the 5 types of Alphas described, even mild comic book or superhero fans could list other characters that fit these types.

What spiked my interest in the show was the character who is a "transducer" and able to act as an antenna to intercept and decode messages. "Gary" is able to read all wavelengths- TV, cell phones, computer traffic on the internet, etc. This is an astounding amount of information to absorb, but he is able to help break codes and find information for the rest of his Alpha team. In daily life however, he appears to be on the autism spectrum (some episodes more severe than others), getting assist from his mom or team members for many daily tasks. In a follow up episode, a new character is introduced who is a human "Rosetta Stone," capable of understanding and translating any language, but also considered autistic by those not familiar with Alpha-skills, since she is unable to make eye contact or communicate except by making seemingly random scratches on her hairbrush and other materials.

I won't say that the depictions offered on TV of a person with autism are entirely realistic. I've only seen 2 episodes, but even within that time frame, Gary's eye contact, speech patterns, social skills, and repetitive motions have changed considerably. Some of this is likely due to the actor becoming comfortable with the character, and the changing demands for different episodes. But I particularly like the concept that a person considered disabled in the context of average humans is valued as a superhuman by those "in the know." Which makes labels like "disabled" or "dysfunctional" worthless, since the ability (especially in this case) is all in how the person is treated and enabled. A not too deep encouragement for us to look past labels and prognoses and focus on abilities.

PS- I believe that Modern Family features a character with autism as well, but despite some of my friends liking the show I have never seen it.

thoughts on starting exercise

2011-08-08T10:26:00.001-04:00

So I've gotten on the exercise train for a first time in a long time. And I have boarded a new train heading somewhere quite outrageous...

This is my first announcement in a public forum, but here goes. I intend to compete in a (sprint distance) triathlon next year. I'm not particularly fit at the moment, and can't yet do any of the distances for the 3 disciplines on their own, let alone consecutively. It's a process. My husband has decided to join in the fun, so we are both engaged in these struggles that can be both harrowing and ridiculously funny. There would be plenty of material for a knee-slapping gut-busting book or stand alone blog, but I just don't have time for that (how can I, when I already neglect this blog too often?) so I may share some of these stories in this forum.

On our journey to becoming athletes, we have already had a bike push (definitely couldn't be considered a ride) up and down a rain soaked clay hillside; a 2 hour hike into a canyon that required fording a river and another 2.5 hours to get OUT of the canyon; and a realization on my husband's part that swimming after a long bike ride is puke worthy. He has a serious strength advantage on me, and much greater skills in biking by extension, but I have the advantage in swimming thanks to years of lessons at the YMCA (thanks mom & dad!). So I learned a lot of technique as a child that I am now trying to impart to him as an adult. It makes for an interesting take on the difference between learning styles based on age.

The biggest technique piece so far has been introducing rotary breathing. It's a difficult concept for a novice swimmer. Those words were like poison to me for the entirety of 1994. It took me what seemed like a lifetime of 1x/week screaming by unpleasant swim instructors to be able to put my face in the water and master this concept. So even as an adult, when I (prior to the past few weeks) swim only 1x/year, I still can pull that out easily, like riding a bike. Since my husband wants to be able to finish the triathlon too, it was a skill he needed to learn.

As a child, (obviously I wasn't paying the greatest attention to instructional detail at the time) the instructors specialized in breaking down the steps to the task and repeating the practice in various ways. Blocked practice. First, kicking on the side and blowing bubbles. Then, kicking with the kickboard and doing head turns to one side. Then putting it all together into the crawl stroke, which you now have to do since we've thrown you into the deep end of the pool. (I'm having terrible flashbacks trying to write this, even now). Ultimately, until I got a new teacher and went from weekly practices to daily practices, progress was minimal at best.

My husband doesn't really have the attention span to do nothing but work on breathing for an entire hour in the pool, and approaching this from that angle might mean that he would never master it. So I gave him a few tips about how to turn his head while taking a stroke. (In retrospect, this probably shouldn't have taken place in the ocean, but like I said, we are having quite the funny journey). Then I would either answer his questions ("am I supposed to breathe out at some point?") that I hadn't covered earlier or offer some technique feedback. More of a contemporary motor control theory for learning, letting him practice and try on his own. After a few sessions (<5) he feels like he has a rhythm, and even if it doesn't look perfect, he is still able to crank out lots of laps while taking in more air than water.

So what did we learn here? Obviously, having an OT for an instructor is terrific! :) Personally, I think that learning the skills as a child made them well ingrained into my muscle memory and expect that to be unforgettable. It took a lot longer time for me to be able to learn and integrate that skill though as a child than it took my husband as an adult. But I think that the longer time to learn will make it harder to forget. It was easier for me to teach refinements to an adult than for Ms Pam to teach basics to a scared child who could barely stand up in the shallow end. I could compare this to different motor learning theories, but my books are all in boxes anyway. :-/

Well that was a bit rambling.

Personally, I am trying to take a balanced approach in this fitness plan. I really don't want to get an injury or derail this plan in the first month. Trying to add in workouts for flexibility, core, and overall strengthening into this plan. It's really hard to find time and motivation for all of this (and I have no kids and a 3 day/week job) so the ultimate goal seems very daunting at this time. Hopefully I can pull this into line (along with the rest of my life... house shopping, OT presentations, new job, other endeavors etc). And if I come up with things that are potentially interesting or tangentially related to OT, I'll try to share.

In the throes of ... lots of non-OT stuff

2011-08-03T20:35:00.001-04:00

Life goes marching on...

Since the move, we have been trying to focus on more family time, and that has transitioned into an increase in athletic endeavors, which has been also going along with work on healthier eating. So there have been a lot of changes that we are trying to turn into healthy habits... a personal "lifestyle redesign" project, if you will. I'm not being super smart about things though since I've made lots and lots of goals, too many to focus on all at once, and no time frames. Also trying to buy a house, which is an insanely-detailed process.

I've only worked 4 days at my new job (a 3 day week and a week long vacation does make it hard to accumulate time, haha) but I feel like I'm starting to get the hang of things. There are computer and written portions of the documentation. It's a new computer program for me, and it will be interesting to see how all the documentation moves to computer (I consider it only a matter of time for all sites... it is the 21st century after all). There have definitely been some great moments with the residents and I hope that things will go well.

Ultimately, I would like to start a Lifestyle Redesign styled program in the assisted living facility. I have gathered some research to use in marketing, but need to review how to do a needs analysis, decide whether to pursue grants, etc etc. I would REALLY LOVE FEEDBACK on getting this started.

I've been keeping busy on my "off" days, which is kind of bad since I have plenty of OT things to be doing during that time, but there is a lot of ebb and flow right now. things will likely get done, just a little off the ideal schedule.

I'm Alive!

2011-07-14T08:17:00.002-04:00

It has been WAY too long since I last wrote. Here is an abbreviated update:
1. I moved
2. I'm starting a new job
3. I have irons in the fire.
For more details...
I had to say goodbye to Baltimore. Logically, I know it's the right choice, but it has been crummy. I love the friends that I have made and the excitement that Baltimore offers, and there were so many cool OT opportunities as well. But from a personal and family standpoint, it was just not sustainable in the long term. Commutes were too long (60+ for me and 85+ for my husband) and we needed 3 days off to get home and back since we were so far away. So with potentially wanting to start our own family (in the next few years) something had to change. But knowing that logically doesn't mean that it's been easy or something that makes me happy the whole time, so I have been withdrawing a bit and trying not to put my foot in my mouth.

By extension, since we are moving a significant distance, I have to change jobs. I am at a point of conflict, since I feel like I've learned a lot from working in the hospital and am good at what I do, but it doesn't always make me happy. I don't always get to spend the time I would like to with the patients, and fighting for the appropriate recommendations really wears me down. Sometimes, there's this feeling of standing in a vacuum screaming without anyone hearing. With such little time to work with people, sometimes I wonder about making a difference. This had been better lately on the neuro floor, but it's still frustrating. I still like the hospital environment, but I don't see myself returning to it full time, maybe just prn sometime in the future.

So in thinking about what I'd like to do long term and think that an outpatient environment might be a better fit. I hate making this change without my awesome outpatient buddy from my last 2 jobs directly by my side but hope that we'll be able to keep in touch. The job I'll be starting is a unique outpatient setting that is small relatively new- only been in existence for a few months. I'm excited to help with growing the program and learning how to navigate the new environment. It's a part time job, so that will be flexible enough to let me have time to keep up with my OT extracurriculars and other activities.

On the irons in the fire list, I submitted to 3 conferences in June. 2 presentations will be similar, so that will be helpful. I get to work with an awesome group of OTs for the AOTA presentation on social media, so I hope that will work well. I have been dealing with the whole host of lame stuff that has to be done when you move, including living out of suitcases and sleeping bags for awhile, cleaning, unboxing, tons of laundry. Definitely not my favorite things to do, and having to mooch internet from Cosi was not particularly convenient for updates. I had a crushing crescendo of activities and deadlines that culminated with my last day of work and a week at the beach, and I was so wiped out. Disconnecting from the computer and internet was needed so I could recharge physically and mentally. I am feeling better now.

I intend to have at least 1 post per week now that I have some scheduled days independent of work. I hope to cover some of the following topics, and if interest is expressed I can try to speed it up:

new acute care book on AOTA press

portrayal of mental illness in Broadway's Next to Normal

new shows with characters who have disabilities

thoughts about Lifestyle Redesign program

random thoughts of an insomniac OT

2011-05-27T05:49:00.003-04:00

Can't sleep and it's before six a.m. on a day I have off. Awesome. But here are some of my thoughts on things that have been happening recently.

First off, and rather obviously to anyone who has been with me in person, I am under a lot of stress lately. For an OT, I certainly exhibit a lot of poor patterns in dealing with stress when it gets to a high level. I retreat into comfortable things, procrastinate on other tasks (hello blog), and have a thousand questions running through my head all the time. I'm also increasingly more distracted, which feeds back into the procrastination. I've been waking up around 5 for the past several weeks, but for the most part I just stay in bed in a semi-dozing anxiety spree until the alarm actually goes off. Very stressed. Likely to get worse before it gets better.

Since I'm not concentrating well, I haven't been reading as much lately. But I have been attempting to get through a couple books that may be of interest to others. One is strictly a book for work: Yes/No Medical Spanish. I haven't had a chance to use it in person, but I love the concept and found just about everything I would need for an eval (adult or pediatric) included. Since I haven't had the time/motivation/follow through to sit and intensely improve my Spanish (and it would take a lot of classes before I could be fluent for medical things) this is a great resource. I may eventually make a master sheet out of several sections so that I could just carry a small paper for home setup and basic questions and hopefully by that time the interpreter would show up! But definitely a useful book, though not therapy based. The other book I picked up because I saw an interview on Daily Show or Colbert and thought it would be thoroughly interesting: Beyond Boundaries: The New Neuroscience of Connecting Brains with Machines---and How It Will Change Our Lives. The interview was very interesting, and the scientist discussed his research using brain-machine interfaces and talking about how they would make it possible for paralyzed people to walk using their brain power, really innovative stuff. I don't think it's only due to my attention problems, but I have been really struggling through this book both with the reading level and finding things that are interesting in it. I have renewed it twice at the library, it's do or die time now. I finally just skipped several chapters and am reading only about the actual experiments, so it's a little better that way.

I feel proud since 2 of my completely not related to OT goals that I set for myself are coming along nicely. I am progressing well as a user of chopsticks (still much better with wooden ones than smoother surfaces) and I have been able to complete 3 medium difficulty sum sudoku puzzles. Everyone needs something to aspire to and in this instance, something that has nothing to do with a career. But yay... good achievements thus far since I started as a complete novice with both this year.

I had a really interesting person s/p TBI the past few weeks, and he would make a great case study if I can strip enough identifiers eventually. I had a man with a severe hemorhage that was hospitalized for several weeks and made terrific progress exponentially near the end of his stay. I also saw a man with an intriguing stroke presentation (basically a subtly expanding stroke over >1 week) who is now at the local IRF and doing wonderful per report. These people made me actually sad when they were discharged, since they were great people and their cases were interesting. It's difficult in acute care since stays are so short, ability to do treatments is rare, and you get no follow up on what has happened to the person. It's nice when you get to see someone make progress. And speaking as someone who has interests across the lifespan, it's nice to have something so interesting because I need some beacons to figure out where I need to go and focus with my career.

Some odd moments of feeling out the boundaries between therapy comrades. I was scheduled to see a child with torticollis and was interested to try out a new approach I had seen online. But then I found myself wondering if there was good OT justification for that approach. Usually, I don't feel that I'm the 'infringer' so to speak on the other practice domains, but that case made me wonder if it was a treatment true to OT practice. I think there are probably some ways that it potentially could be (use as a feeding position, etc) but it was odd to get that squeamish feeling. Kid never showed up anyway, so really a moot point, but made for some pondering.

I had several moments lately that made me proud to be an OT and do what I do. Despite being the 'young pup' of our current floor group, I am pretty much the only one with an interest in neuro, and people have been counting on me to various degrees for their own education, which makes me feel really great to have that level of respect from others. I got a nice sincere thank you from an elderly man whose wife had a stroke... he had been disappointed that I couldn't see her daily in the hospital but so grateful that I came back. I was not expecting it since the session had been very difficult for the pt and he had watched her struggle along with BADLs. I spent a lot of time with the family of the man with TBI, and they seemed appreciative of the resources given, and even mentioned to the SLP that they felt really prepared following our sessions. I was able to make a connection with a young Hispanic couple really unfamiliar with the health care system and things like inpatient rehab, and I could tell that they were happy to see me even passing in the hallway, so that was great.

I'm trying to really enjoy these happy and proud moments, really appreciate the little things. I have a tendency to be so pessimistic and do want to remember that there are good moments even when I'm in the midst of mounds of work and disappointing myself on other fronts. I'll get a semi-needed computer respite this long weekend and see if that helps things. Words of encouragement appreciated, and I hope to be through the rough spot soon. :)

still learning to deal...

2011-05-08T21:11:00.002-04:00

I've been feeling pretty stressed lately, so I've been spending more time away from the computer. Plus, I did get to have a crazy amount of fun in April (1-2 awesome things per week) but things are finally calming down for May. Several entries in the works, but it's going to take some time to bring them online and keep me sane. MOTA readers (anyone?) can now check out the MOTA website for the updated legislative advocacy page.

OT in HD: Presidential Address

2011-04-23T21:40:00.000-04:00

AOTA President Florence Clark opened the 2011 AOTA Conference with an excellent presidential address describing the need for OTs to compete.

(Photo credit to Cheryl Crow, videographer extraordinaire, from the OT Connections Gallery)

We live in a world of competition. Especially now, in a time of health care reform where decisions are being made about what services are necessary in the future, we as occupational therapy practitioners need to be engaging competition with (not against) others to ensure our role in promoting occupational fulfillment to the public. Competition needs to be acknowledged. It drives innovation and can improve practice. It's not going away, so get comfortable with it. Victories are won often by teamwork, but always by competition. But, as Dr. Clark said, "let's face it- we're nice." OT attracts people who are cooperative and kind. But if you let others take OT for granted, "it's not playing nice, it's playing dead!"

"HD OT" requires power, and we as a profession need to embrace our collective power. We can't stand alone, but together, we have a power that can't be ignored. As a group, we are witnesses to the "transformative power of occupation" and this must be shared with the public! The public mindset is shifting toward wellness and participation, which is a foundation concept to OT. One example is the case of Congresswoman Giffords. Per Dr. Clark, it was not so much of a question of 'would she walk again?' but one of 'would she run again- for Congress?' People are concerned with the ability to fulfill a role- one of the things that makes life worth living!

Dr. Clark drew some analogies to Rocky, who demonstrates caring and competitiveness, sensitivity and toughness. We have to be "in the ring" during the healthcare debates. We have to bring our "playbook." That includes evidence on our effectiveness, increased grants, decreased hospital readmissions and documentation. Our documentation should not over-emphasize motor-based components, but embrace our multifaceted approach dedicated to the whole person, environment, and occupation. We need to be intensely involved in advocacy to make the message heard- that Occupational Therapy helps people LIVE LIFT TO ITS FULLEST!

A recurring theme of President Clark's address was to strive for "arete," an ancient Greek concept referring to excellence, effectiveness, fulfillment. We each need to strive for everyday excellence in our work, with our clients, and how we represent ourselves. Fire up your competitive juices!

Dr. Clark's message goes hand in hand with 2 other excellent sessions I attended and will share at a later date. I hope that the call to "arete" resonates with you.

AOTA Conference 2011

2011-04-15T22:51:00.000-04:00

The 2011 AOTA Conference: OT in HD is in full swing!

Wow. This has been a truly awesome experience thus far. I know people want updates, and it's so hard to encapsulate because there are a million wonderful things going on in all facets of OT practice. Deciding where to begin is difficult.

First off, I think it has been great to be able to come with a friend. My best friend (also an OT, how convenient) got to come this year and this is her first conference, so it's been exciting to see things through her eyes and have someone to bounce ideas off of and be interested in similar things. It's also nice to have someone to sit in the big sessions with and go out in the evening together. So her presence has made this conference an improvement over others in that regard.

Another "people power" effect is that since I have become more involved in OTConnections, my state association, and NBCOT, I have met a lot of people and it's very fun to get to meet them in person or see them again. I also have at least a fair memory for names and faces, so I will see someone's name badge or recognize them from a photo and say hello. I've had a couple of people spot my badge and ask about various people at the hospital and life in Baltimore and I enjoy those chance meetings. I have gotten to see several of my former professors and had time to catch up with them, which is great. There are such terrific people in the field that by just talking to others in your sessions you can find out great things and see that there are OT revolutionaries all around.

I have been to some very informative sessions on a wide range of topics thus far. Started with a course on Infant Driven Feeding in the NICU, also got to see some ground breaking research on Contemporary Motor Control with guidelines for practice. Today I had GREAT sessions which have warranted their own posts at a later date- a session on being a Survivor in a tough market which segued well into the presidential address outlining benefits of being competitive. I got to be part of an intensive discussion on telehealth with (dare I say it?) other OT geeks, and then the Slagle lecture was terrific. Tomorrow is very up in the air... I have 3 sessions that are interesting in the morning and 3 in the afternoon that all overlap. I don't have a 3 sided coin. and we are planning on going to the AOTPAC night which judging by last year's pictures should be a lot of fun.

I've got a lot of notes from the various sessions and I'm really glad that I took off Monday to process everything.

Looking at the conference program, I realize I saw several of the "pixel people" at sessions today... I've also been able to match up the color photos with the grayscale on the cover... totally dweeby of me.

The updates on twitter under #AOTA11 have been interesting to follow, but I'm only getting them sporadically given the spotty wifi and cheap cell phone coverage. It's exciting to see so many people posting. I hope that people will also go back and use OTConnections more post-conference to make some dynamic SIS-type interactions.

Sorry this is so random, but that's the way of things during this time of sensory overload and OT-awesomeness. There's a lot of excitement tomorrow and I need my beauty sleep! More updates to come after I get home for sure.

An Introduction

2011-04-03T21:27:00.000-04:00

Hello OT Practice Readers!
Thanks for reading Molly's article on Social Media. (You're already ahead of me, since I haven't read the previous issue yet). If you haven't been to my blog before, welcome, and please feel free to see the About Me pages or the manifesto I wrote when starting this blog 3 years ago.

Things you may want to know... I am a real OT, though I don't necessarily know what I want to be "when I grow up" so to speak. I write and rewrite material a lot (and do try to have a social life) so postings can be infrequent. I don't intend to come off as an expert about most OT-related things, I am still learning and plan to keep learning. That being said, I work hard at staying involved in OT on multiple levels. I read a lot of research articles and texts during my commute. I care about our profession and want it to grow, and me to grow with it. This blog helps me share that goal with the OT world at large.

If you're wondering what I'm doing in the upcoming months when I'm not doing something OT-related, it would include going to several concerts and shows, repotting my violets, getting outdoors, playing with my first smart phone, or reading (most current books: Thirteen Days, The Girl with the Dragon Tattoo, and The Count of Monte Cristo).

Please feel free to comment or email me with your input, questions, encouragement, or suggestions for future posts. You can also find me on Twitter (otnotes) and OTConnections. If you're interested in other things I have written recently outside of the blog, check out the AOTA State Affairs newsletter, the MOTA newsletter, or the legislative section of the MOTA website (not up yet, but forthcoming). I will be at the upcoming AOTA Conference in Philadelphia and would be THRILLED to meet and talk with anyone who will admit to having read any portion of this blog.

Intended upcoming entries: OT-relevant smart phone applications; kitchen reorganization for energy conservation; caregiving tales; and a special shoutout to my twitter followers.

Again, thanks for reading!

New roles & responsibilities

2011-03-26T21:00:00.001-04:00

I have taken on some additional OT tasks this year, and it's getting to be an interesting balancing act.

A flashback to begin the story: when I was in high school (not all that long ago) I often had this feeling of being overextended, existing in a state of mild panic at most times. Totally unassigned time (especially that which was not merely procrastination) was rare. Looking back, I was doing A LOT. Probably too much. As a sampling (just of items I can quickly remember, which probably neglects a few) I was involved in 2 sports, at least 5 extracurriculars (not including special events such as talent show) and a part time job while carrying a not-wussy list of classes. I say this not to brag, but to give some perspective of who I was/am. My freshman year of college was completely opposite- I went to class, I goofed off with my friends, I took midday naps, maintained my (very) part time job, and I did not care about much else. This actually had a reverse effect of sometimes making me feel anxious and somewhat empty at times.

I added activities back in and out around the MOT program. I added in AOTA and SOTA my first year in the program and my state association soon after. Responsibilities grew over time. After graduation, I was again pretty inactive at first, which was justified in my mind by moving to a new town, starting a new job, and getting married all in quick succession. But again, I added items back in, even doing extra program development for work in my free time.

So as the years have passed, I have added activities in and out as it suits me. Things tapered off with the move to Baltimore but have increased again now that I've been settled awhile. The most noticeable time commitment is work, which with my poor balancing act between productivity and completing notes has led to me taking work home frequently.Inpatient staff is doing more covering of outpatients while also handling staffing shortages of our own. This has created a baseline level of stress for me, trying to stay on top of the daily grind and being unhappy that I can't seem to squeeze it all into an 8 hour day. I also had a level I student recently, which was fun despite the time involved and seemed to work out even a little better than last time. Just leaving me at a baseline level of exhausted.

In addition to work, I have taken a more active role in my state association. I was 'elected' as VP of Advocacy Relations for MOTA and have been involved in monthly business meetings and bimonthly legislative reviews with our bill review team and our lobbyist. It is a great group of individuals, I feel like we have a diversity on the group that allows to have insight into almost all the issues. It seems that no matter what the bill of concern, if we say, how do the OTs in that field feel, we will always have a representative. Our Lobby Night event went well, we've also had several members present testimony to various committees in support of bills. Legislative activity rolls by quickly, so it's kept me quite busy trying to keep the pace.

My other new OT activity is very concentrated in the amount of effort but will only be officially meeting twice a year. I got to go to California last week for a 2 day NBCOT conference developing simulation questions. First of all, I did not even know that they had added these type of questions to the exam since I took it. It is truly a challenge for your critical thinking skills. Looking at the example I was sent, I wasn't sure that I could take the test, let alone write it. I met a great group of OTs, in and out of academia and in all ranges of practice. Everyone I met was intelligent, friendly, and committed to giving back to the OT community. If it's any consolation to the students out there, as hard as you will work studying to take the exam, others are working just as hard to write it according to the blueprint and keep it fair for entry level OTs. I haven't had the feeling of brain jello for a long time, but we worked to exhaustion on those items.

Last major OT activity is the upcoming AOTA Conference. I am certainly looking forward to it, but I've got enough stuff on my plate that I'm not frequently thinking of it as a 'getaway' or anything like that. I'm excited because it's close enough to drive, and I will get to go with my best friend. I've gone to 3 conferences in past years, but never with a buddy, so that will be nice. I'm trying to cool it on the overscheduled program and see if I can take things at a calmer pace for once. I think that it's interesting in how things are scheduled at the conference. Last year, I felt like there were more NICU courses, so it's hard to tell if that was a passing trend, more people holding out for the NANT conference, or just a random event. This year, I saw 4 interesting acute care courses- all scheduled at the same time, so that's a major bummer. I've noticed that I selected more stroke related courses this year, including one that I tried to attend LAST year and the presenter didn't show up for. I'm disappointed that I didn't do more with my new-found knowledge last year, so I'm going to take off the day after to see if I can synthesize some things before heading right back into the workplace.

With all these new roles and responsibilities, I have had difficulty keeping up with other tasks. My google reader has completely overflowed to something like 500 unread items, I haven't been able to get the state association legislative webpage up and running yet, and I won't even tell you how long this post has been sitting in drafts. I have 2 AJOTs that haven't even been opened, let alone read. I have about 300 pages left in The Count of Monte Cristo and really would like to spend a solitary day finishing that. Concert season is coming up too. Obviously, there will be things that get left behind. I'm trying to prioritize and find a dozen extra hours in the day. Until then, I'm just doing what I can and hopefully will stumble into some occupational balance.

Who gets to go home? 3 short case studies

2011-03-04T18:58:00.002-05:00

One of my biggest responsibilities from a hospital standpoint is providing discharge recommendations. Hospital stays are notoriously short and it is a priority of the case management staff and doctors to determine discharge location, for which they recruit OTs and PTs to assist. But determining discharge readiness and placement is more of an art than a science, no flow chart can be easily developed to guide a novice through the process. So here are 3 case examples of similar patients and situations, whom I saw on the same day, and my rationale for their discharge locations.

All three of the individuals were over 80 years old, with moderate dementia. They were all admitted with altered mental status caused by pneumonia and concurrent urinary tract infections. They were all living with family members prior to admission, who have each made a goal to keep the individual at home as long as possible. They are each oriented only to person at this time, but recognize their family members who were at bedside. Each person required max assist for bed-chair transfer and max assist for ADLs during OT eval.

Patient “Alan” lives with his also elderly brother. They have been living together almost their entire lives, and until about 5 years ago were very active in several community activities. I think it is fair to say that they are brothers and also best friends. Alan has been declining in recent years however. He is normally able to walk at home but is very unsteady, requires a lot of assist on the steps to the upper floor, and has had multiple falls at home endangering him and his brother. Alan's brother tearfully states that he is unable to help him after falling, which is becoming more frequent. Alan has not been able to leave the house for some time, and his brother is only able to go out for short trips to the grocery store, which he recognizes still poses a safety risk by leaving Alan alone. They have a 2 story home, good DME setup, and some rare support from friends (no remaining family).

Patient “Betty” is a very pleasant woman, always smiling, happy and friendly. Her daughter is a retired pediatric nurse, but is frustrated with herself for not knowing more about geriatric care. She noticed a cough developing earlier in the week but did not expect that illness would cause such a drastic change in her mother's personality and abilities. Normally Betty is able to walk w/o device and perform ADLs with supervision. However, Betty is very afraid of falling in the hospital environment, actually fighting the transfer, and requires max assist of 2 for chair to bed. She is still able to follow 1 step commands as long as they are not about transfers. Betty's daughter is well educated on devices, but has a bad back and cannot lift >10 pounds. Per pt's daughter, Betty did well in rehab previously after a hip replacement.

Patient “Carol” is lethargic and minimally responsive during the evaluation. She responds best to her daughter, and will follow 1 step commands from her. She has severe retropulsion in sitting. I could not transfer her, but her daughter was able to in a less than fully safe method. Daughter reports that there are multiple family members that live in the home with Carol, and others that assist in rotating care duties. They have good DME setup at home and 24 hour assist with various caregivers. Carol clearly responds best to her family members over the staff at the hospital.

Who gets to go where? There are few hard and fast rules in discharge planning. Because OT is committed to being client and family-centered (and because care for a person with moderate dementia requires a high level of commitment from the family), discussions regarding each option were provided to the families of the patients. These are the decisions we made together, though it is certainly possible that other therapists or case managers may have tried to elicit a different response.

Alan was recommended for a trial of inpatient rehabilitation at a subacute level to attempt to progress in ADLs and transfers. The plan was to select a facility that also provides long term care, as Alan's brother could no longer care for him at home. Special consideration was given to make this place close to their home so that Alan's brother could make frequent visits.

Betty was recommended for inpatient rehab at a subacute level at a facility she had been to previously. Betty's daughter would not be able to care for her currently, but was open to the idea of family training and purchase of lifting devices if needed to allow for her to return home after rehab. She also had a good connection with home therapists as well.

Carol was recommended to return home with home health therapy to address safety in transfers and additional adaptive equipment assessment for best safety at home for her and the family. She was unlikely to fare well in any facility cognitively or with physical progress. The family was ready to continue 24 hour assist and try whatever was necessary to provide for Carol.

Discharge planning is not always easy. Therapists, MDs, case managers and the family do not always reach agreement. But this was a situation where even though there were difficult decisions, each family unit got what was best for them, I think.

OT Web Gems- Nationwide Statistics and AD edition

2011-02-05T20:06:00.000-05:00

Welcome to another edition of OT Web Gems, AKA "Cheryl has too many tabs open of cool articles, so let's update." Some of these are pretty hefty reading, but it can be worth it depending on your field. Several related to Alzheimer's Disease as well.

Food Environment Map- it's easy to talk about making the right nutritional choices, but understanding the reasons why these aren't followed through is very important. For clients living within a "food desert" where there is little access to fresh produce, groceries, or low-cost healthy foods, this can be especially difficult. Map allows you to break down multiple statistics on a county level. Could be very useful if you are considering implementing a program for childhood wellness.

CDC Health Disparities and Inequalities Report- this lengthy report is broken down into several important subsections, such as access to health insurance, air quality, housing, and preventable hospitalizations. Another tool that could be very useful if you're looking for materials to justify OT services for an area.

Alzheimer's Association "Baby Boomer" report- Lastly, some statistics regarding the past decade or so regarding demographics of AD in association with research money and other costs. Some scary stats on their main page, the full report requires you to sign up with email, I haven't read the original report. Again, this would be helpful if you're looking for support in a program designed to assist those with AD or their caregivers.

Financial Skills Decline in those w/ AD- another Alzheimer's Reading Room post regarding the quick financial decline in those with even mild AD. This is an important ADL to test- it may be helpful diagnostically. Moreso if done within an established testing protocol such as EFPT or KELS. (Sidenote- I looked up the AMPS tasks and they do not have a money-management task. However this is also widely called for in my workplace when trying to assess cognitive decline. If you're AMPS certified, there are a lot of good resources on their website to make things faster or form a research project)

Tips to Prevent Wandering- A Geriatric Care Manager wrote some nice tips on strategies to decrease wandering in those with AD. I thought of some other environmental and behavioral modifications that we use as OTs. If you frequently work with adults with dementia in the home setting, I highly recommend Occupational Therapy and Dementia Care: the Home Environmental Skill-Building Program, which I found to be a very helpful text and has many useful home modification ideas. (Link is to amazon.com since AOTA site is down this weekend but I believe there is a reduced price on AOTA.com for members.)

Lifehacker Top 10 brain-training tricks- on a more upbeat note, here is a quick list of brain-training activities. Nothing here is groundbreaking, should be familiar to most but might be a good jumping off place for cognitive rehab.

Concussion/mTBI Detector- such a cool idea. Tests a blood sample for biomarkers indicative of brain injury. This could be revolutionary in the diagnostics (and thus treatment of) mTBI, which is a very big deal for OTs in cognitive rehab.

AOTA NEWS:

Procedural Change- make sure you get your feedback to your RA member on the proposed changes to the organization. There is a video, written documents, and a message board on OT Connections to review.

General Elections- review candidates and cast your vote- closes at 11:59 pm EST on Sunday, February 27

Philly Convention Center- if you're planning on attending the AOTA conference (which you totally should!) then there are some good resources at the convention center website. Maybe I'll be able to not wander around empty halls looking for the group unlike last year (I have such poor spatial skills, lol).

An Open Letter to Nintendo

2011-01-26T20:55:00.001-05:00

Dear Nintendo Wii,

As an occupational therapist, I enjoy your products and have been excited about their potential applications for rehabilitation. I own a system myself, and while experimenting with it, noticed some features that could easily be improved to better suit the Wii's use in rehab. WiiFit, WiiPlay, and WiiSports are the games considered for this review.

Therapists love being able to control and alter activities and the environment to provide the "just-right" challenge for their clients. Wii games would be much more usable by therapists if there was more input to grade the activities. This could be automatic grading within the game, where it would adapt to the skill level of the user, or ability to manually adjust sensitivity, speed, and degree of difficulty for games. Additionally, having either a "low vision/contrast enhanced" option for games or ability to decrease some of the visual stimulation would often be helpful.

In general, it would be more efficient to be able to set up multiple games in Sports or WiiFit prior to a session. It would be best if new profiles and avatars were not required to setup and save routines, since this takes up extra valuable therapy time and is a potential privacy violation. Being able to set a timer for specific games, such as making a 5 minute boxing session, would also assist in achieving aerobic status during activity.

I love the balance board for WiiFit. A user can get an objective report of balance that can be reviewed from session to session, and the devices marketed to rehab professionals for this are MUCH more expensive than a Wii system. But a bariatric board would be very beneficial for those who practice with adults in the hospital or SNF. Also, an optional bar to provide support while standing would be appreciated by many adults while they are trying to feel secure in standing. I don't know if the hardware could be altered to allow for better tests of sitting balance while the board was supported on an adjustable mat, but this is a common intervention for a neurological population who would likely appreciate being able to participate in the games as if they were standing.

In closing, I appreciate that these products have great applicaiton to rehabilitation. The system has surely benefitted from all the positive press regarding its use for therapy and activity for people with disabilities. There are endless possibilities for improvement into the therapy arena, and I would encourage you to partner with some pediatric and geriatric therapy practitioners to maximize your products' usefulness and appeal. And given that the Kinect is getting a lot of attention but you could provide a more affordable solution for clinics everywhere, I think it would be worth your time.

Thank you and I hope you will show a renewed interest in collaboration with rehabilitation services in the future.

Cheryl OT

Adventures in Serial Casting Part II: Review of the Evidence

2011-01-17T21:41:00.003-05:00

The term "serial casting" refers to the use of plaster casts applied over time to gradually increase PROM, decrease abnormal tone, and hopefully therefore increase functioning. Typical population for this intervention is either for children with cerebral palsy or adults post stroke or TBI. This (really long) entry aims to examine the evidence behind the intervention by answering multiple questions regarding the intervention.

For this review, I looked at 3 systematic reviews and 1 prospective uncontrolled intervention that was not included in the prior reviews. Of the reviews, one was from an OT publication, one from a PT publication, and one from a physiatry publication, so I feel that all relevant parties were represented. I focused only on articles that emphasized adults, and preferably the lower extremity since that was most relevant to my case. Annotated bibliography at bottom of page.

WHAT IS THE RATIONALE FOR SERIAL CASTING?
There are multiple theories for the effectiveness of serial casting and as per Lannin, Novak & Cusick, there is no strong evidence to state clearly which is the correct reasoning. (Categories by Lannin, Novak & Cusick though 1 or more are expressed in each article, further references as noted)
1. Neurophysiological (includes NDT)- casting prevents changes in muscle length, which eliminates excitatory input of muscle spindles and decreases spasticity. The concepts of neutral warmth, proprioceptive input to the limb, and even/constant pressure are also considered to play a part (Saracco Preissner). Per Mortenson & Eng, little evidence exists for the concept of neutral warmth providing the decreased spasticity.
2. Biomechanical- a low-load, long-duration stretch can prevent or correct contractures. By stretching, the Golgi Tendon Organs are stimulated, which stimulate the Ib afferent fibers and then inhibit the alpha motor neurons (Mortenson & Eng).
3. Motor Learning- support proximal joints until control is gained distally. Per Mortenson & Eng, no evidence to support this. I question how this can be applied to LE casts, since they are predominantly applied to the ankle and toe ROM is not a desired outcome. Also, though I have never casted a knee, it seems that if you were working off of this principle to give support proximally until distal control is given, then it might be easier to apply a bledsoe brace locked in position than a serial cast.

WHAT OUTCOMES ARE EXPECTED TO IMPROVE WITH SERIAL CASTING?
Mortenson & Eng outlined these well as: reducing abnormal tone, increasing ROM/reducing contracture (usually PROM is what is measured), and function. Measurement of these effects has been inconsistent across studies. Some studies give a very subjective therapist rating of tone, others use tools such as the Ashworth Scale. ROM was typically measured using standard goniometry, though Mortenson & Eng bemoaned the reliability of ankle goniometry. Mortenson & Eng also disucssed that increases in ROM do not necessarily correlate with increases in function, similarly, Saracco Preissner mentioned that abnormal tone did not necessarily indicate lack of function. "Function" is defined very loosely between studies and various outcome measures are used. Singer et al used the Transfer Dependency Scale, and other studies referenced the FIM. From my own limited experience in research, it would make sense that you would need an adequately sensitive measure and control for confounding factors (concurrent therapy, practice effect, time) to truly indicate whether improvement would be due to casting. I can think of several appropriate measures for UE functional improvement but don't know what has been researched in this direction arleady.

WHAT IS THE ACCEPTED PROTOCOL FOR SERIAL CASTING?
As indicated in the systematic review articles, there is no consistent protocol for serial casting. Lannin, Novak & Cusick identifies a key problem in a consistent protocol- namely that your background rationale will affect your decisions regarding casting time and limb positions. This article listed known indicators and contraindications to tx along with the level of evidence for each, however, a confounding variable to this information is that some factors that were exclusion criteria for some studies were inclusion criteria for others. Given the wide variability, comparison of RCTs was unable to be performed in this review.

Timing is a decision that has wide variability in each study. Saracco Preissner states (but does not reference) that there is no indication how long after injury casting is effective or when a person is too far removed from injury to benefit. It is stated that "most" advocate casting sooner for increased effectiveness, but again this is unreferenced. Length of time wearing the cast was highly variable as well, with the most relevant results being from a study by Pohl in 2002 (referenced in the following section) that showed no difference in results when casts were worn 1-4 days vs 5-7 days.

Protocol was specified for the Singer et al study, and stated to be "standard guideline." Briefly, casts were applied by 2 therapists w/ pt. in prone and knee flexed to 90* after gel pads were applied to bony prominences at risk for breakdown. They were able to insert a custom molded support for metatarsals if clawing of the toes was present. Casting was postponed if pressure areas or skin breakdown was present. Casts were discontinued when no change in PROM was seen over 3 casts, skin breakdown present, or if there was a need to emphasize other treatment prior to discharge.

INDIVIDUAL STUDIES AND RESULTS OF NOTE:
*Singer et al performed a prospective uncontrolled intervention with 16 adults after aquired brain injury. Statistically significant increases in PROM were noted, and 13/16 improved their transfer ability. However, transfer skills were measured by "4 randomly selected scores" not admission/discharge scores, and could have been affected by concurrent cognitive increases. Of note, 3/4 patients who had limited response had brainstem dysfunction and decerebrate positioning. I believe it is clinically accepted that decerebrate and decorticate positioning is an indicator of poor prognosis medically and with therapy, but I can understand including these patients in this study to just add to that evidence. The authors suggested that the severity of injury rather than the severity of the ankle deformity was the more important predictor of success.

(The following articles were referenced in one or more of the main articles, but I did not follow up to read the full article. Slightly irresponsible, I know, so just take this info at that level)
*Pohl 2002- this study compared 2 groups who were casted for different lengths of time between cast changes- 1-4 days vs 5-7 days. All groups showed an increase in PROM with no difference between groups. Gains were maintained 1 month after cast removal. The Lannin, Novak & Cusick review stated that since there were slightly fewer complications with the group who got casts changed more frequently, there might be an advantage to more frequent changes, however, cost does not appear to have been considered as a factor.

*Mosley 2006- this was an RCT focused on adults with serial elbow casts vs PROM for 1 hr/day. The casting group decreased contracture 22* compared to stretchers when casts were removed, but this decreased to 11* the next day, and the improved effect had almost disappeared by 42 days.

*Booth 1983- This was a retrospective study of 39 patients who had casts s/p head injury. 37% showed and increase in ROM and decreased tone. They observed that pts with brainstem lesions got their casts longer out from injury and took longer to show progress than those who had cortical lesions. Per this study, traditional treatments (PROM, splinting, weight bearing, and PAMs) did not do enough to make an impact on spasticity compared to casting. I'm not sure why this study was given such prominence in the Saracco Preissner article since it was a retrospective study, a bit dated at this time, and its rather unclear how they drew such sweeping consclusions, but again, I did not review the actual article

*Hill 1994- a double-crossover design between traditional tx (PROM, static stretching, splinting) and casting. Improvements were seen for ROM in 14/15 participants and spasticity in 11/15. Stated conclusion is that casting was more effective than the traditional tx, but the gains did not translate into functional gains.

WHAT ARE THE OVERALL RECOMMENDATIONS FOR SERIAL CASTING?
Per Lannin, Novak & Cusick, "There is insufficient evidence to either support or refute the effectiveness of upper limb casting ... There is no evidence of long-term benefits or long-term adverse effects." But this article also stated that there is Level Ib evidence that casting an adult's elbow s/p brain injury increases available extension 1 day after cast removal.

Per Sarraco, since immobilization (such as with spasticity) can cause physiological changes that would impair ADLs, and these changes are reversible, we should treat as able for spasticity. Serial casting has shown some effectiveness in improving ROM and spasticity.

Mortenson & Eng issued "grade" ratings for practice, which I am not familiar with. They say that there are inconsistent measures of "function," so no recommendation can be made on that front. A "Grade C" rating is given to using casts to reduce spasticity secondary to decreased rigor in measurement tools. A "Grade B" rating is given to using casting to improve or prevent loss of PROM, and they state that this is the only outcome with enough evidence to be considered a "best practice." Their studies showed gains of 10.4-26* improvement in ankle ROM, which is statistically significant, however they cautioned that ankle goniometry is not always reliable.

WHAT SHOULD BE ADDRESSED IN FUTURE RESEARCH RELATED TO SERIAL CASTING?
As with nearly all therapy research, there are many questions that need to be addressed. A summary from all articles would include the following, but it is not an exhaustive list:
How does casting work? Is it a biomechanical effect, neurological effect, or both?
What is the best protocol for serial casting? Included in this would be inclusion criteria, positioning of casts, length of time worn, concurrent therapy, post-casting program (including splints and exercises).
What is the comparison to other treatments or lack thereof (especially no stretching)?
How long are gains maintained?
How do improvements after casting translate into function? What specific functinoal gains are seen? Are these gains cost effective and best practice?
Randomized controlled trials comparing the above are also needed.

FULL DISCLOSURE: I am not a professor or professional researcher and do not claim that this is an exhaustive review of the literature surrounding this topic, but a review that I undertook relevant to a specific case. I am not an expert clinician. I do not intend to diminish the efforts or quality of research produced by any of the referenced articles. I would encourage you to do your own review and get necessary training prior to performing this intervention, which may not constitute entry-level practice for all practitioners. Please feel free to comment on additonal relevant research.

References
Singer, B. J., Jegasothy, G. M., Singer, K. P., & Allison, G. T. (2003). Evaluation of Serial Casting to Correct Equinovarus Deformity of the Ankle After Acquired Brain Injury in Adults. Archives of Physical Medicine and Rehabilitation, 84, 483-491.
A single study in Australia looking specifically at casted ankles in an adult brain injury unit.

Lannin, N. A., Novak, I., & Cusick, C. (2007). A systematic review of upper extremity casting for children and adults with central nervous system motor disorders. Clincal Rehabilitation, 21, 963-976.
A review focusing on UE casts but somewhat confounding as it includes many studies on children with CP

Mortenson, P. A. & Eng, J. J. (2003). The use of casts in the management of joint mobility and hypertonia following brain injury in adults: a systematic review. Physical Therapy, 83(7), 648-658.
Looks at adults after TBI and CVA only but includes studies involving wrist and elbow casting as well.

Preissner, K. S. (2001). The effecs of serial casting on spasticity: a literature review. Occupational Therapy in Health Care, 14(2), 99-106.
This review focuses mainly on management of spasticity, less on ROM gains.

Looking forward to 2011

2011-01-07T22:00:00.001-05:00

Goodbye 2010. I don't have the energy for a LONG year in review, but...
I will touch on a few ups and downs of the year.

Firstly, let me thank all readers. I really appreciate the comments (that aren't plugging fake universities or spam in other languages) because I like to see that there has been an effect from my efforts. I don't look at the stats often, but glancing today, I see that since I started tracking in 2008, pageloads have increased by 20,000- more than 300%! WOW! And the cross-posts in the sister blog on OT Connections have brought in an extra 50-350 viewers each time, with one anomaly (thank you 1-minute update). It's really exciting to see how this blog has grown and spread, and gets me thinking about some plans for the future (more on that later). So a BIG THANK YOU to each of you, and please always feel free to comment or email me with suggestions.

Most popular pages on this site continue to be Writing Goals and a Case Study With Goals, which is understandable since this is one of the more difficult skills in OT that is not hands-on. I do intend to spend some time getting back to the 'roots' of this blog and posting about decision making, goal writing, and treatment plans. Perplexingly, a rather random What a Week post is the most read on the mirror site, with the exception of my post about Glee that got picked up by 1-minute update. Ironically, some of the posts I spent the MOST time on (e.g. Metacognition and Serial Casting Case Study) don't seem to be as popular, but I don't have tracking to that degree so I can't be positive. I did get several thoughtful comments on my most emotional post (Struggling as an OT for my Family) so I appreciate that deeply.

2010 was the first AOTA Conference I've been to as a practitioner, and even the first I saw after fieldwork. It was great to re-energize and network with other therapists. I think that as you are in the profession longer, you become more aware of others in the field, so I spotted dozens of OT Celebrities this year and got to talk with many, which was awesome.

It was interesting to see all the uproar in AOTA this past year with the potential organizational changes. As we are heading into election season again I see the new blogs and OTC memberships cropping up and it's always notable to see who sticks with it. Props to Bill Wong for continuing to post, and also to Florence Clark for taking up the mantle of the President's Blog.

There were some serious downers last year. We lost my husband's grandmother to Alzheimer's Disease in the summer, which was very difficult for the family. Then over the holidays, we had several additional hospitalizations of our family members, which have yet to completely resolve. Health is so very fragile and some families are like a house of cards... I am learning to take pleasure in contentment and tranquility, because it can all be very fleeting.

I struggled on my final rotation of the year on the cardiopulmonary floor, made extra difficult by the chronic nature of those diseases. It is hard to watch others' independence fade as their bodies fail, and I felt like the efforts I made brought about little change. There were some truly tragic stories in the ICUs that even made attending rounds difficult. I did my best for them, but I am so thankful to be back with a more stable patient base.

As the year ended, I realized that I am no longer really a "new practitioner." Granted, most of my experience is consolidated in one practice area, and I certainly don't know all there is to know about the acute care setting, but I now have a valuable level of skill. I feel like I could go to any adult hospital confidently and be a skilled member of their team. I caught multiple strokes and other medical problems, which makes me feel bad at the time (I hate to see people doing poorly) but it makes me feel that I am a competent professional doing my best to look out for my patients. I progressed with treating pediatrics by taking on outpatients for a few months and doing some feeding interventions for the infants. I was really proud to recognize self-soothing in the baby I evaluated my last day, because even though it's simple, it shows that I am retaining what I've learned though my time to practice is sporadic. I also had my first true fieldwork student, and I don't think I screwed up too badly or she would not have sent beignets. :)

I have a lot to look forward to for 2011. My goal is to spend less time typing notes at home (which is awful!) and more time being able to participate in my "OT extracurriculars"- this blog, OTC, twitter, association stuff. I am now the VP of Advocacy Relations for the Maryland OT Association and things are already in full swing. We are planning for Lobby Night in Annapolis, and would certainly love your company if you're able to attend. I am looking forward to the AOTA Conference in Philly (a mere 2 hours away) and the MOTA Conference (a mere 15 minutes away). I really enjoy how close Baltimore is to fun and excitement, so I know there will be more trips to DC and NY this year too.

Happy, healthy, awesome new year to all.

It's a Christmas Miracle!

2010-12-22T19:44:00.002-05:00

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...

2010-12-05T21:52:00.002-05:00

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

2010-10-16T21:06:00.001-04:00

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

2010-10-12T19:17:00.002-04:00

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!

2010-10-09T18:08:00.002-04:00

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

2010-09-25T19:06:00.002-04:00

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

2010-08-20T21:21:00.002-04:00

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?

2010-08-15T21:28:00.002-04:00

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

2010-08-09T20:50:00.002-04:00

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

2010-08-07T09:21:00.002-04:00

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

2010-08-01T21:20:00.000-04:00

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

2010-07-11T15:21:00.001-04:00

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?

2010-06-23T22:22:00.003-04:00

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

2010-06-09T22:14:00.002-04:00

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!

2010-06-01T21:14:00.003-04:00

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

2010-05-07T10:52:00.000-04:00

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

2010-05-03T21:26:00.005-04:00

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

2010-05-02T07:12:00.002-04:00

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

2010-05-01T07:31:00.002-04:00

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

2010-04-30T07:16:00.003-04:00

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

2010-04-22T07:12:00.002-04:00

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

2010-04-17T22:55:00.000-04:00

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

2010-04-09T14:30:00.003-04:00

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

2010-03-28T19:46:00.002-04:00

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

2010-03-10T20:55:00.003-05:00

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

2010-02-28T08:38:00.000-05:00

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

2010-02-26T08:09:00.001-05:00

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 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

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 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 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 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

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

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

2010-02-21T20:35:00.000-05:00

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!

2010-02-18T09:53:00.000-05:00

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

2010-02-15T17:42:00.000-05:00

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

2010-02-12T09:14:00.001-05:00

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

2010-02-10T15:05:00.000-05:00

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.

Patterns

2010-02-09T21:08:00.000-05:00

"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

2010-02-06T07:43:00.006-05:00

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

2010-02-05T17:36:00.002-05:00

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.

Kindle

2010-01-25T10:09:00.001-05:00

A couple of thoughts on the Kindle
In the reading world, I've been halfheartedly thinking about getting a Kindle (or similar device, I am not owned by a company). I'd love to try it, if even to have an opinion on its benefit for low-vision consumers, but I just don't think it's worth it yet.

expensive, and does nothing on its own... you still have to buy books and subscriptions. Just entices you to spend more money.
things I would subscribe to are things I'm currently reading online for free. I also get most of my books from library, borrow them from a friend, or at cheap used stores, cheaper than the advertised $10 price of most books.
I have serious doubts that OT Practice or AJOT will be available in ebook form anytime in the next several years (there's still a large portion of our Wilma West library that is only available in hard copy form, not even in pdf) if ever at all, and my metro rides do help me read a lot of OT related stuff.
I am visual. I enjoy the newspaper most for comics and browsing to find interesting stories, I certainly don't read right though. I do crosswords, which I can do on the computer or print out, but not on a device. Though I have a list of books I would like to read, I far more frequently walk through the stacks and pick out interesting looking items.
I am demanding. If I am going to have an electronic device to read, then it also needs to be able to access my RSS account, my email, and should be able to let me clip from what I'm reading to an email to enable a blog post.

From what I have seen in person of the device, I do think it could be helpful for certain readers with low vision. The screen does not glare, I believe you can adjust the amount of back light as well and the font size. I haven't really played with the buttons or ever used the interface to download new books, so I can't comment on those features for low vision users. Depending on your vision needs, you may be better off with good lighting, a closed circuit TV magnifier, or any of a large assortment of devices. (An OT can help!! Get a referral to a low vision specialist OT from your ophthalmologist or primary physician) Also, don't forget that there are audiobooks (if you can tolerate that) at the library and available for free from Library of Congress for the blind.

Can you make a cheap and demanding person change their mind on the Kindle? Got an opinion of its usefulness for a person with low vision?

One other thing

2010-01-23T22:21:00.003-05:00

Hey, I forgot to ask about whether anyone was interested in seeing this blog copied to OT Connections. It can be viewed from my OTC page as a shared feed, but not as a blog. If you have a preference, please vote in the poll on this page on the left and feel free to comment about your answer here or in an email.

Aimless Thoughts

2010-01-23T22:05:00.001-05:00

Took a bit of an OT break with a vacay to Las Vegas and reading some novels instead of OT stuff pretty much since Thanksgiving. Now I'm back and ready to play! Been working on a few entries off and on, but this is mostly unstructured.

My NBCOT was due to be renewed this year, which caused a minor panic attack the other day. Not that I've been slacking on licensure or anything, I've been going to conferences, but there was a wrinkle I didn't anticipate. I graduated in May '07, but didn't test until Aug '07. My original state license did not require first year graduates to submit continuing ed to be recertified. And unlike the first 2 years of my OT schooling, I didn't pick up any CEUs in my final year due to silly things like fieldwork, graduation, getting married, etc. Somewhere in the back of my head, I had this idea that I wouldn't renew NBCOT until NEXT year, or at least until Aug of this year. WRONG-O. All 36 hours needed to be complete as of 12/31/09. I was tweaking out quite a bit, until I reread the guidelines for all activities that count (can't link it since NBCOT is rather difficult to navigate, but it should be readily accessible if you're due to renew) which includes staff inservices, fieldwork student supervision, and reading journal or textbook articles. In the past 2 years, I have actually read 40 textbook chapters afresh and over 20 journal articles. I had to go back and count though, because I was stupid and hadn't been writing it down. So major props to Your Therapy Source, HeathSkills, and ABC Therapeutics, who all either cite their resources for posts or write specifically about certain articles, because at least they can keep track of what they've read. I hope to start doing that. Usually the journals just pile up beside my laptop though, they don't actually make it into posts.

Switched some days around at work, I am on 11 of the next 12. ugh. but I am starting to get into a groove on the medicine floor. I think the biggest challenge is just striking a balance between evals and priority follow ups. We don't have as many people going to acute rehab as on the other floors, so the regulation for most recent note is a little more lax. Few happy stories on the medicine floor... you don't get to watch people making dramatic recoveries like on the other floors, there are a lot of repeat admissions and people just getting generally sicker.

Had a couple of people competing for saddest story before I left for vacation. Lady A has cancer and has been having seriously miserable orthostatic hypotension. She has been existing by running to her destinations in hope to make it there before passing out, and was admitted s/p fall on one occasion where that didn't work out superbly. I believe we had a standing BP in the 60/40 range (NOT GOOD). When I was getting her history, it was very sad, because she said she knew she wasn't going to live through her current chemo regimen. However, she at least had plenty to live for. "I want to make it to July," she said. She had relatives graduating college and high school, another getting married, and a major milestone anniversary coming up with her husband. I almost cried. I am a big believer in the power of things to live for though, so I really hope she makes it.

Lady B was a sad case as well, same day. She was majorly depressed, and in some cases very rightfully so. From her description, it sounded like her husband had dementia and she had been very hurt by him commenting about how he didn't love her anymore and some of the barriers that the healthcare machine had placed between them. However she also had some episodes of paranoia and visual hallucinations, as well as frequent falls (her admitting dx). I was thoroughly confused. 80 years old is pretty late in life for a schizophrenic break. An experienced PT pointed out that sometimes Parkinson's Disease presents with psychosis, and that seemed to make things make more sense. Sometimes I wonder if I will just know stuff like that off the bat.

Ms N was bumming me out the other day as well. I saw her before for a home safety evaluation, which was very unstructured and not super fun as her normal pleasantly confused affect turned into nasty and aggressive when asked to take part. She is normally very nice, saying hello to all who pass her room and wandering the hallways with supervision. But the other day she was walking and crying her eyes out, calling for her mother, totally inconsolable for the duration of the day. I was very sad for her, and for a lot of people in general. Dementia is such a harrowing disease.

Even as an OT I often feel helpless in my own family, where a grandmother is in the mod-severe stages of Alzheimer's Disease. I have tried to make suggestions where I can, but I'm not there 24 hours a day and really can tell that everyone is getting emotionally and physically worn out just trying to do their best. We're also beyond the point of many environmental adaptations, which is where my strength is. I think that it's overall better for her quality of life and her husband's to have them in their home, but it's hard. Right now, the major issue is her walking. She didn't learn to use a walker before AD, and has never been able to really grasp it since. Right now they are walking with handheld assist but she leans backward A LOT. It is scary to watch. Scary enough that when I was there I transferred her to a wheelchair to move her 15' to the dining room. Even then she almost fell out of the dining room chair that didn't have arms. I don't really know what to suggest to help with this gait problem. We did go out and get bed risers and cut them down to fit the dining room table so the wheelchair arms will fit under the table, and make eating a little safer. I had to leave strict instructions though that wheelchair was for meals and to the porch ONLY, she was not to sit in it all day. Need to check in and see how this is going. Any suggestions welcome.

Back to a few less depressing random notes-
I was reading an article about a guy who has motivating himself to lose weight by pledge drives and donating all the money to cancer research. Great idea I think, because sometimes it is not enough to be doing something "for your health." Saying "it's good for you" does not always make you do the right thing, but if you have that extra motivator of someone counting on you, it can make it worth it. In the comments section, a poster (#47) was asking for weight loss advice and I am sure she would take your suggestions:

Weight loss experts, I NEED YOUR HELP!! I'm the elder sister of a developmentally disabled adult (36) who is at least 200+ lbs overweight. Given his relatively small stature, we're talking about a dangerous level of obesity. My question is this: does anyone have any recommendations for programs, procedures, etc. for those with cognitive disabilities? Since his impairment (a mild form of Down's) is related to both motor and impulse control the usual advise of "eat less and exercise more" doesn't work. His impairment is sufficiently mild that he would be discomforted by placement in a program with very disabled individuals. His doctors have warned us that a stroke or heart attack are not unheard of in his age group and, obviously, further impairment would prevent him from even enjoying the limited amount of independence he now has. Any help would be very very welcome.

Comments do require an extremely short registration. My initial thought was that there are exercise videos for people with Prader Willi Syndrome, but these are marketed mostly for children and teens.

That article led me to a blog I hadn't seen before discussing Fat Prejudice in Health Care. These are stories that people have emailed in, so there is a lot of raw language, you probably shouldn't read it at work. However, it would be good to talk about at work, because I know there is a lot of prejudice in the OT/PT world. (Here is a PT related story) As a professional who is expected to transfer any patient, it can be intimidating to walk into some rooms. Yet I will say that the gastric bypass patients we see are among the most mobile of all referrals, usually welcome a little adaptive equipment to restore some independence, and are often good to go after 1-2 sessions. Obviously as OTs we need to make sure that we're treating all clients with dignity and respect. It's still good to challenge your thinking about your practice and make sure that's happening.

Starting the New Year

2010-01-05T20:52:00.002-05:00

New Year, but Same Old?
Starting a new year in January really cramps my style. Like Caulfield in Frazz, I usually can't make resolutions at that time, and like most all people who actually set resolutions, I usually don't keep them either. Would I like to exercise more? Yes... but not in 20* weather. Would I like to eat better? Yes... but not when there's delicious comfort food leftovers in the fridge. Would I like to set detailed achievable goals for myself? No way! I get paid for that! I thought this was a cute little goal tracker, thought of some ways to use this personally/professionally, but I know myself. I'd start getting little red x's and it would be the last time I ever went to the site.

I am a little apathetic about this current new year business. I am back on the medicine floor again, the land of triage occasionally in war-zone conditions. Walked in on Monday to a gigantic list of consults, which was narrowed to 18 after we weeded out discharged and already seen patients who just didn't get taken out of the computer system. Still a little excessive. Very full house right now, and most of our medicine patients on caseload are waiting for placement in subacute rehab.

This rotation is the first (of many) on a familiar floor, since I started the job on the medicine floor. I know all the case managers, most of the stable medical staff (not students/interns), and lots of friendly faces from the nursing staff. I remember most of the codes to the supply rooms and such. But it's not a particularly exciting time for me. The revolving door of the hospital is most evident on the medicine floor, so its an unfortunate but likely prospect that the people I am evaluating this week will be evaluated again in the coming months. Part of our nation's healthcare crisis, on so many levels. But usually there's no new interesting diagnoses to investigate, no cool techniques going on, just a battle to get people out the door to the least restrictive living environment.

While meeting and talking with my patients is interesting, there's not a lot of extra things for me to learn and do, so I will have to find other ways to occupy my time. We are revising some of our documentation, to make it quicker (!!!) and better. I'd like to write an ICU/low level eval since we are asking for early level consults in all the ICUs which often leads us to patients who don't fit the "general evaluation" template.

Other current OT to-dos... renewing NBCOT certification so I can keep my R... get back to reading my books on acute early childhood interventions... emailing a bunch of OT people detailed conversations that I owe them... deciding whether or not to go to the AOTA Conference this year. I had planned to go to the conference and have a semi-reunion with some of my fellow OT graduates, but now my best friend will be having a baby around that time. Need to decide if we want to adapt the trip, if I want to go by myself, if I want to drag my husband along, if he would want an expo pass to go pick up free pens and fidget toys, etc. I enjoyed presenting at the state conference this year and will probably do that again... also thinking of a writeup for OT Practice on some similar concepts but unsure of how to go about doing that.

My outside of OT to-dos are a super long list as well. In addition to the dozens of unfinished projects, I am going to be trying out some new hobbies... knitting... playing guitar... cooking (ha! just kidding on that one!). I've also been reading at a faster pace again, hearkening back to my youth of a novel or 2 a day, which is fun in its own little introverted way.

End of year wrap up

2009-12-24T16:49:00.000-05:00

Things have been pretty crazy lately. Here are some recent and end-of-year reflections, semi-structured, semi-sensible.

I should begin with an apology. I have been terribly behind and under-participatory in the online realm since October. I attribute this in part to an over-focus on getting my conference presentation ready. I am a terrible procrastinator and felt that I had to restrict my access to other endeavors to ensure that it would get done. After that, getting back on the horse, over the various RSI, over the burnout and back into the swing became a mountain I couldn't climb. My google reader page is finally down to 0 unread items for the first time in months... sweet success. I have some good trips coming up- family time for Christmas and a Vegas vacation in January. My husband may be going to France in February... don't know if I can swing that one too. At any rate, it's good to have things to look forward to, it's helping me keep my mind out of the dingy early winter blahs that try to seep in.

The job change this year was a new experience that defined most of my year. I've never left a job before that wasn't already predetermined by the end of a semester. I could have handled a lot of things better, however I do feel that this was a good choice. There have been lots of good opportunities that opened up at this position. I've already gotten to work with people who had unique diagnoses, lots of people in more critical condition than I was used to, gotten to learn a lot. I've also gotten to eat LOTS of Greek and some Indian, some Egyptian food, which we do not have back home. Hummus is my new goto snack... I really don't think I've ever seen any in the grocery stores before. Also, there are franchises of many more different chains than I've had access to before. I get a little obsessed about the food sometimes.

I feel that the blog has grown well this year. I like getting feedback from readers and statcounter tells me that there have been more than 10,000 MORE page views than last year. So, THANKS!! I do occasionally look to statcounter for what people have searched for to get to the blog to get ideas, but if you have something you're curious about or want to see, dropping an email is more likely to get a response. I had hoped to do more entries and different topics, but inspiration is fickle. Room for improvement to be sure.

So life goes on and hopefully things will get a little more under control in the upcoming year, but I won't count on it. I'm working Christmas day and then off for over a week... couple weeks off until the Vegas trip. Happy new year everyone!

Additional clock drawings

2009-12-17T21:37:00.000-05:00

Sometimes I think these clock drawings are revealing, sometimes just plain confusing.

This one is from a man with dementia. I don't remember much else about the case since it was awhile ago. I do remember leaving him tucked in bed, call bell in hand, last words out of mouth "call the nurse, don't get up on your own" and before I could wash my hands he was already up on his feet on the way to the bathroom. I don't remember what time I asked for, but I have to assume that it was 7:40 and we get the numbers instead of hands.

This was my first experience with the Montreal Cognitive Assessment, which is becoming my preferred pencil/paper tool. However, it does start off with alternating trailmaking and has a 5 words after 5 minutes recall section, both of which are rather difficult for many people. But it's free and more discriminating than the Mini-Mental. The MDs wanted a KELS on this lady to determine if she could go home or not, but our manual was missing so I went with a basic functional eval and the MOCA. (could have stopped after the functional eval... if you can't get your pants on, you can't go home) This lady got 2/3 points for the clock since she does have numbers and a full circle, but again has just drawn a location on the rim of the clock for the time.

Finally, my most recent, which was another attempt at the MOCA but the woman almost swung at me when I brought out the paper. So we administered the test by walking around the unit and intermittently asking questions. I find it interesting that the numbers here are counterclockwise, also semi-dyslexic with the 10 as a 01. She kept becoming confused at the time... first it was 11:10, then 3:00, then 5:30 and her hands are closer to that than anything. Ironically, she was wearing a dial watch at the time.

Overcoming my Sensory Battle with Lotion

2009-12-13T20:00:00.000-05:00

Is "Sensory Battle" a phrase yet? If not, you heard it here first! As a person who lives on the spectrum for Sensory Processing Disorder, and has experience working with children in the field, I can easily admit that my life has been full of sensory battles. Here's the story of one such encounter with lotion.

I have been fortunate in my life in that I have had pretty good skin. Sometimes oily, but since I don't wear makeup, I would say that I have had only a moderate amount of breakouts (lifetime average). But in the past few years, since I have been employed and in a dry hospital environment for the duration of the winter, my skin has gotten drier. Last year I had to start using a facial moisturizer, which was difficult but made easier by the fact that I could wash my hands off to rid of any extra lotion-feeling. This year the dryness is spreading... meaning more lotion all over my hands and body. Best summed up as: EWWWWW

I am very sensitive to tactile stimulation. Velvet=good. Tags=bad. Sweatshirt=good. Lotion=AWFUL!!! The cold, slimy, gooey feeling makes my skin crawl all over. And then it sinks in and it sticks and you can't get it off... ack. My husband and I got massages last year for our anniversary and the lotion almost ruined it for me... laying flat, unable to run or scream as lotion was poured all over me was a very tense experience.

Imagine for a moment, the strain that my struggles placed on my parents. If you have a child with SPD, you are probably familiar with the scene. Your child needs to put on sunscreen but screams, pulls away, and starts crying in hysterics when the goop is applied. Maybe you give in and don't put on so much sunscreen, then the child gets burnt and has to have aloe gel applied and the whole scene is repeated again. (Of course, this is not my only tactile difficulty, and I have processing difficulties in multiple sensory arenas).

But now I am older and understand my sensory needs better. I have managed to make great strides out of necessity- I am now able to apply chapstick multiple times per day (I find that lots of lip smacking afterward makes it better), and apply the facial moisturizer every morning (winter only). I have sought out the least flavored and scented of all products. I spent 10 minutes in the drugstore yesterday sniffing multiple "unscented" lotions trying to find the most agreeable one. The texture is impossible to try out. I am trying to start small... only apply a small amount to a controlled area and then leave my arms free to wipe off all excess. It has been a struggle thus far, but getting better. By concentrating on mastering this, I think I can finally suppress the EWWW and add another item to my List of Can-Dos: lotion.

Fighting Frustration and Fatigue

2009-12-03T19:57:00.002-05:00

This has been a hard 2 weeks.
It is my impression that the hospital staff was stressed and unpleasant last week due to the impending holiday and just wanting to leave work and go eat copious amounts of gravy laden food. However, they seemed to bring their bad moods BACK with them after Thanksgiving, which is just not fair. Get a grip people- it's holiday season for everyone, not just you. I'm working Christmas day, so that leaves 16 more working days before I can really rest. I'm already so tired... spent this a.m. in a fog since I fell asleep on the bus, and then was ok until I walked through my apt door where I have now crumpled into a semi-lifeless blob. My eyes and brain are fatigued... I can't even begin to think about learning more about Google Wave even though I have OT buddies on there now because it is literally overwhelming to me at this moment.

A vast majority of my pts on the cardiopulmonary unit this week have been people with volume overload following dietary indiscretions over the holiday. COPD and CHF exacerbations as well for related reasons. Interesting how things move in patterns. Unfortunately, since ice and snow is coming up there will be more broken hips and the like.

The next thing I write will probably be about the difficulty getting an IRF/ACIR placement for a pt... we've been discussing this a lot at work, there are new insurance rules going into effect, our documentation has extra scrutinization coming its way. It's a detailed issue that I care a lot about but I need to be a little more coherent before I try to address that. So I'm taking some time to rest, though that time does include traveling to a football game on Saturday and likely Christmas shopping (possibly even at crazy IKEA, yikes) on Sunday.

Just trying to keep afloat...

Energy Conservation for the Holidays

2009-11-22T07:00:00.003-05:00

Energy Conservation is a favorite topic of mine. It involves a combination of strategies designed to let you save your energy on the multitude of tasks in a day so that you can save it for the things that matter most in your life. Holidays can be very draining, but here are some ways to save your energy. Please add your own suggestions in the comments section.

Tips for Family Get-togethers
-Try to limit excessive travel (I speak from experience- last year was a 10 day 8 location trip).
-When you do travel, make sure to take rest breaks at least every 2 hours to get out of the car and stretch. Rotating driving responsibilities is also a good idea
-Rotate hosting responsibilities within the group so that no one person has to bear the brunt of continual entertaining
-Consider meeting friends at a restaurant or other gathering place
-If you're doing the entertaining, ask for setup and cleanup help
-Try to take a nap before any gathering that will go into the evening hours

Tips for Meal Prep
-Spread the responsibilities around the family or group. Have people volunteer to make a specific dish so that the host is not saddled with the entire meal
-Prepare some dishes ahead of time if possible
-Use tools to save you time and effort. This includes mixers, microwave, and the crockpot
-Try to prepare more foods in the crockpot or bake them in the oven instead of cooking stovetop, since it requires less tending
-Keep a stool or extra chair in the kitchen so you can take breaks during cooking time. A higher stool can be pulled up directly to the stovetop for stirring pots, or to the sink to wash dishes
-Oven Bags can cut the cooking time for a turkey down substantially and decrease basting needs
-Perform prep tasks seated at table if possible
-Split large tasks between a group

Food Substitutions
-Several stores offer completely catered meals
-A rotisserie chicken can be substituted for making a full turkey
-Steam n' Mash Potatoes by Ore Ida are pre-cut potato pieces that you add to your own milk, butter, and spices. Saves the trouble of peeling and cutting the potatoes.
-Betty Crocker and Bob Evans both have instant mashed potatoes that can be heated up in the microwave. They also offer sweet potatoes and stuffing.
-Many schools offer cookie batter in large buckets as fundraisers, making cookies into a scoop & bake operation

As always, I have no relationship, financial or otherwise, with any of the aforementioned companies or products. However, I have used them myself frequently.

Post from the Alzheimer's Reading Room

2009-11-18T11:11:00.002-05:00

The Alzheimer's Reading Room is not my favorite blog, but I do follow it regularly. I was impressed at this recent entry that described the author's change in his caregiving style as he learned about Alzheimer's Disease. The emphasis on the power of DOING is great, and I wish that this would become well-known. The case is similar for adults with Alzheimer's, people with disabilities, children, ANYBODY- "Let me do."

A "very special" episode of Glee

2009-11-17T21:09:00.001-05:00

I have been occasionally watching "Glee" and trying to decide whether it's worth my viewing time. However the most recent episode and its after-school-special sugaryness has exposed a lot of controversy.

There are 2 main issues here, one with the show for casting a non-disabled actor to play a student in a wheelchair, and one with the episode itself, which featured terribly contrived dialogue to try to make the other glee-clubbers understand Artie's plight of being in a wheelchair.

Let's start with the immersion exercise episode where the self-centered glee clubbers were relegated to spend a few hours each day in a wheelchair. The students' teacher rolls out wheelchairs that he supposedly bought at a tag sale from a local nursing home. Of course these were all sleek, more stylish chairs than that bear no resemblance to the standard industrial type chairs seen in hospitals and nursing homes. A nitpick, admittedly, but that's how I am. The whole episode was painful to watch as the glee geeks were more mistreated than usual now that they were wheelchair users. Cool kids are now... uncool! Feeling left out over a week leads to... increased empathy 4-evar! We even had time to learn that ex-quarterback kid couldn't manage to find a job... until he was in a wheelchair and had pity and fear of litigation from an employer! It just didn't feel like an empowering week. And this may also be part of a commentary on how poorly defined this show is... is it made for children and tweens or is it made for adults? The fake pregnancy pentagon storyline is surely not made for the young crowd, but you'd expect older viewers to rant about the terrible plotlines in general. Confusing.

However, the meat of this discussion should be about the casting of the role of Artie, and some of the controversy was addressed in the USA Today. Why wasn't a legitimate actor-singer-wheelchair user cast to play Artie, glee club geek in a wheelchair? Here's a second, perhaps more telling question- how many such actor-singer-wheelchair users auditioned? From the way that actor Kevin McHale describes his audition, I find it questionable that the role was ever advertised to indicate that the actor would be in a wheelchair. It sounds like this was a plot twist to increase diversity that got thought of after the casting and got shoved onto an already created character. I have the impression that the role was created around the actor, so perhaps the casting calls were not worded in a way to invite wheelchair users to audition.
sidenote- if you watch the McHale interview, how does a kid who plays an adolescent have no idea what time schools are in session? "From 8 to 12 or whenever"?

I don't think that the character of Artie is a great ambassador of teenage wheelchair users anyway. As a member of the glee club, he is often hanging out on the sidelines with the band instead of participating in the show. If he is worked into the routine, it often involves another character pushing him around. The writers went out of their way to end this episode with a big musical number that had everyone swooshing around in wheelchairs, but did they consult a wheelchair dancer for choreography tips? I have my doubts. And if my earlier suppositions about the wheelchair being thrust onto a character after the actor had already been selected, why not put Mark Salling, who plays buff ne'er do well football star Puck into a wheelchair, to be a buff ne'er do well wrestling star? Artie could have continued to be the geeky guy who plays the guitar, he also could have been the much-mocked kicker on the football team. Wouldn't that have made for some better, more original storylines than putting the dorky kid in the wheelchair?

Should an able-bodied actor ever play a character that has a disability? That is the main question. In one sense, all acting is fakery. Hollywood does not always hire sports stars, drug addicts, or serial killers to play themselves. But certainly a capable actor who has the same abilities as his character would have a better understanding of how to play the role well. The real issues in this question are-1. are disabled actors being considered? and 2. are non-disabled actors giving an unfair portrayal to disabled characters? The Iris Center, out of Vanderbilt University, has a catalogue of movies about disability or featuring disabled characters. Some of these movies feature great performances, but are they demeaning? One mother in the UK is starting a group
criticizing portrayals of characters with mental or neurological impairments (nothing about physical impairments, oddly) who are played by actors who do not have a disability. One thing that I worry about though is if there becomes a taboo on non-disabled actors playing disabled characters, will disabled actors ever be allowed to just be actors, and not be identified first by a disability?

Some sad times

2009-11-14T17:00:00.002-05:00

My time at work has been sad lately.
My current rotation has been a mighty mishmash of cardiopulmonary pts on intensive and progressive care units, orthopedic pts, and frequent floating back to the neuro floor and ICU. In short, my pts have been much more acutely ill than on my other rotations.

It's very depressing seeing pts on multiple admissions for severe COPD or CHF exacerbations. People who are far past where cardiopulmonary rehab can be beneficial. I've had several pts travel back and forth from the regular floor to the ICU, but I have a couple that I'm concerned aren't likely to come out. I've had to get much more diligent about checking with nurses even for follow up sessions since my pts fluctuate considerably from day to day. Got as close as I care to get to a pt coding... me throwing on a contact isolation gown and slapping a vitals machine onto a lady who was hyperventilating, desatting, and gasping in pain. Fortunately the doctor and charge nurse were right behind me, so I was able to excuse myself and let them perform the rapid response and take her to the ICU.

My neurology pts aren't faring much better. Someone I evaluated several weeks ago while on that rotation is now nearing a full 2 months hospitalized and has just gotten progressively functionally worse. I wonder if she would have been happier if the surgeons left her brain tumor in and let her live out the rest of her life still able to walk and talk and recognize her family. Her shoulder now has a finger width subluxation that I feel personally responsible for.

She is one of several people we've had with GBMs lately, a particularly nasty type of brain tumor with very poor prognosis. Also had the readmission of a young CA pt that I worked with prior, who was intubated, had to get a PEG tube, and generally declining. I couldn't even look toward the back corner of the unit without choking up.

I've also had some personal disappointment lately, and have felt pretty bad for being swayed by that at all, having any negative emotions over this minor speed bump in life when I still have life and many of my pts are losing theirs. So it's been a very emotional time, a lot of tears at home, some at work. Not such a great time lately, but it will improve, I hope.

Back From Conference

2009-11-03T22:00:00.000-05:00

State OT conference was this weekend and I had both an enjoyable time and very energizing time.
Finishing and presenting my topic at the state conference were both great feelings. I haven't given a formal presentation since school, and it was even longer since I'd given one in front of (mostly) strangers. I felt a bit like a motormouth and know that I set out to cover too much for my 30 minutes, but it was a good experience. The official title was "Growing as an OT Through Online Resources" but it was basically a quick overview of multiple types of online tools (with several plugs for OT Connections, haha). Only bummer was that my presentation was last so people were tired and quiet by the time I came up to talk.

Got to spend some good time catching up with fellow alumnae of my program, quick chats with a couple of professors as well. Serendipitous moment was seeing a car with license plate "OTHELPS" as we were driving back.

Love the energizing feeling that comes from being with other OTs, hearing about legislative victories, hearing some inspirational stories of rehab at its best. Have some ideas about helping our conference continue to grow, and I enjoyed presenting and think I can do that again with less stress. Have another project that I'm working on this week and then will be working the next 3 Sundays due to holiday scheduling so life continues to be very busy. Learning a lot on the cardiopulmonary floor and will be passing it along soon! :)

On my way to WVOTA 09

2009-10-30T10:04:00.001-04:00

I know I haven't posted much this month, mostly because I was trying to finish my presentation for the annual conference. I'm going to be presenting on social networking and OT and I am really excited. Wish me luck!!

Virtual Reality Survey

2009-10-12T21:21:00.002-04:00

Passing along a survey for student research, link on the full post.
I am a student at Thomas Jefferson University and I am currently doing my master's research project on virtual reality program usage in therapy. Whether or not you use these systems, I would really appreciate if you were able to complete the following survey and pass it along to any OTs you know!

Survey link:

http://www.surveymonkey.com/s.aspx?sm=l12ANB490U1A2oAercLlpQ_3d_3d

Thank you in advance!

Sara Jasin, OT/S

Tis the season for changing

2009-10-04T18:17:00.000-04:00

3 months has gone by, neuro rotation is over.
This month, I begin on a new floor, the last "new" floor possible (NICU/peds does not count into the rotation). So I will now be working with cardiopulmonary pts, some in ICUs, and orthos. I don't find any of these superbly interesting but hope to find some fun stuff to do. Little worried from a productivity standpoint since I suspect we'll be taking a lot of rest breaks, lots of breaks to check vitals, and probably a lot of advance planning to separate OT/PT sessions into morning/afternoon. I haven't ventured fully into the ICUs yet... we are starting an effort for early mobility and decreased sedation (similar to this) so that will be interesting but it is also stressful to make sure that I know enough about what is going on and protecting my pts, not pushing them too far.

My neuro rotation was good... it was split with surgery, which was not so much fun. Rounds for both are kind of demanding, and first thing in the morning which can make it hard to get a jump start on the day. I did learn a lot on the rotation... I am no longer scared to be in the neuro ICU despite intra-ventricular catheters and pts who have to be monitored very closely. Worked with one lady for 5-6 weeks in total over 2 admissions, she might make a good case study later. I got over my splinting fears for the basic stuff- had a period of 2 weeks where I felt like I made at least one splint everyday. Luckily there are good experienced people around me who are willing to give advice on whether to splint or not, whether adaptations need to be made. even made a resting hand splint around an arterial line.

Had several interesting cases, but lately it's been more sadness and disappointment. Some people really stick with you and it's hard to leave at the end of the day knowing that there's really no reason your pt wound up in the hospital, and that same freak accident/diagnosis that happened to them could just as easily happen to you. Life can seem random when otherwise healthy people wind up hospitalized for something no one could have seen coming. I had a lady in her 80s who had never had any illness before, but had neuro symptoms, came to the ER, and found that she has had a large brain aneurysm that was leaking. What are the odds? It's not right, but there's other diagnoses where you assign a fault, make yourself feel better- I won't get this, I don't smoke/use drugs/I wear a seatbelt- but too many things on this rotation could happen to anyone. It's a scary world out there, and unpleasant to have to contemplate mortality so often.

The switch has me working with some new OTs/PTs that I'm not familiar with so that is interesting. At least one is working on clinical ladder for cardiopulmonary, so I expect to learn a lot. I am reminded of when I was playing on a basketball team with 9 players and I was the 5th player, so there were times when I was the worst player on the court, and times when I was the best player on the court. I remember asking my dad about that situation and he said not to feel bad about being the worst player because everyone around you can teach you and make you better. So that's sometimes how I feel right now, being the newest OT hire and only 2 years experience, but I do feel that I'm learning and getting better.

I've gotten better at writing goals for ICU pts and conducting tx sessions, suspect that will continue to improve during this rotation and hopefully I will have a good update with ideas for everyone.

Exodus

2009-09-16T19:55:00.000-04:00

There have been so many farewells here lately, and it's quite frustrating!

In the space of ~1-2 months, we are losing a lot of people at work. One of the front office staffers, 3 PTs (who all sit in my cubicle row) and likely 3 great rehab techs. Also, one girl from my row is likely to go out on maternity leave any day now. I don't want it to get quiet and lonely in my area, or lose contact with good friends. And now, I'm seeing goodbyes in the blogosphere. One of the leaders from Hospital Impact is onto other projects, though the blog will continue. OT Advocacy made what was to me a shocking announcement of retirement, after a relatively short but productive run and a feature in OT Practice. And debate continues for the future of OT Students... though understandable, I would hate to lose access to the outlook of a cherished virtual friend.

And another thing! What happened to our OT Blog Carnival?! 2-3 issues and then poof?

I don't really think of fall as a time for changes... more as a time to hunker down and stay the course. Plus, I'm usually too distracted by football season to want to shake up life in any other way. Maybe some new and interesting things will pop up, but it's no fun to be saying goodbye all the time.

My First WiiHab

2009-09-10T14:06:00.000-04:00

So our hospital has a Wii (actually 2, one lives solely in the burn unit) which I have thought was interesting since I didn't know how well it could be used in acute care. I missed the inservice but figured I could go ahead with my session since I have a Wii at home and am somewhat familiar with the games.

The way I see it, for the Wii to be used in acute care, you have to have a client who is sticking around for a few days, has the required cognitive capabilities to understand the system, and has deficits that can be addressed using the system. We currently have 3 games- the basic sports game, Wii Play, and Wii Fit. The first client that I had who would have been appropriate (since the program starting) was a cute little lady who was extrememly active prior to her stroke- walking 3 miles a day. Her only deficits were upper-level balance issues, but I was off after her evaluation so I didn't get to implement that plan. But I was able to use the Wii with another lady on the stroke floor. Sorry the case study isn't more in-depth, but several weeks have passed now...

Ms D was getting an extensive neuro workup for several symptoms, including visual dysfunctions, L-sided paralysis, mental status changes, seizures. Original possible diagnoses were PRES vs an unlikely conversion disorder. Her visual problems were very odd, starting out where she could only see shadows, then she could identify broad swaths of color and light/dark, to where her acuity was markedly improved at which time the optometrist diagnosed a L hemianopsia. She also had a L hemiparesis, which initially was 1/5 UE and 1 to 2/5 LE for MMT. As our sessions progressed over 2 weeks, she regained hand movement progressing to intermittant elbow and shoulder control. She also progressed to verbal cues only for supine to sit, and was then able to transfer to a chair with min assist of 2, needing her L knee blocked. Once we could transfer her to an appropriate bariatric chair, she could come down to our gym to use the Wii.

I thought she would be a good Wii candidate since her controlled ROM of the LUE was intermittant. I hoped that given a distracting BUE task that the control might become more consistent. This was my plan on Friday... when I came in on Monday we had to cut the session short due to LP, and then on Tuesday Ms D had full ROM of her LUE! Not from anything I did, but just part of the strange waxing and waning of symptoms. She then had some RUE control deficits. I decided that since her coordination was still off that the Wii session could continue. We worked on Wii boxing to address standing balance, endurance, and UE ROM control. Our first day, Ms D was unable to tolerate a full "round" vs the computer opponent (3 minutes) while standing. However, she persevered while seated and did complete 2 bouts. Our second day, she was able to complete a full bout while standing (10 minutes in parallel bars with contact guard support from PT). We then added in additional challenges, using different punches (inspired by TurboJam), and trying to better facilitate weight shifting both front-back and right-left.

I was happy with how the boxing activity worked out... my next session was going to be more visually-spatial based and require more refined isometric control of the shoulder, but Ms D was discharged that night to rehab. Even though her initial reaction to the wii was "this doesn't apply to me because I do not play sports," she did get very active and involved in the activity, progressing on performance components she needed for independence. The novelty of the activity was also good since she was getting frustrated with an extended hospital stay. It was a worthwhile therapy experience for both of us.

I feel that I learned a lot from these sessions, and I went home and reevaluated my wii games (sports and play... don't have a wii fit). That brought me to a gigantic list of things that could be better about the games from a therapy perspective. It is a LONG list, I will share it hopefully this week and would love to hear others' thoughts on using the Wii in rehab. For more thoughts on the subject, you can check out a blog dedicated to WiiHab here.

Thoughts Spurred by Malcolm Gladwell

2009-09-07T21:36:00.000-04:00

At the suggestion of my dad, I read Malcolm Gladwell's books over the summer, and have some OT-related thoughts from them.

As a disclaimer, before someone jumps in to attack my lack of critical reading skills, I am well aware that none of the concepts in Gladwell's books are his own research, but there is a limit to how many individual research articles any one person is going to read in a given lifetime. So these are distilled stories with ready-made inferences, but interesting and thought provoking nonetheless. Here are some OT-related thoughts from the books The Tipping Point (TP), Blink (B), and Outliers (O).

Reading the Face (B 197) The final chapter of Blink discusses the work of Paul Ekman and ability to read emotions through expressions and micro-expressions. While I think it would be interesting to see when people are lying, frustrated, or scared, I think I would have better use to just be more aware of my own expressions and the message that I am subconsciously sending.

Fusiform vs Temporal gyrus (B 219)- After discussing visual tracking during a movie between persons w/ and w/o autism, he touches on a study indicating that most people picture and view faces using the fusiform gyrus. However, an autistic individual uses the inferior temporal gyrus to view faces, which is the same location that most people use only for objects. I wasn't really aware of that specific neurological difference but think that it would make an interesting principle to guide treatment.

10,000 hour rule (O 35)- This concept is presented as one of the precursors to mis-named overnight success. Several examples were given of people who started working in an unpopular field and had logged 10,000 hours of practice by the time that the field was ready for rapid growth. This number is referred to as the number of hours of practice needed to become an expert in the field. This would be a little over 5 years of full time work. How many OTs work their first 5 years uninterrupted, let alone in the same practice area? Just a thought. Also makes the hours needed for board and specialty certification seem almost doable.

Culture of Honor (O 161)- There was a mention of how a cultural importance of honor in highland areas has continued into the Appalachian region, giving some reasoning behind the number of feuds in the past century. This concept is also of high importance to many urban residents, especially in places where gang culture is rampant. I just thought it was an important tip to promote developing rapport with your clients and deferring to be more formal and respectful until you have a well developed relationship with your client and can be more informal.

Parenting styles (O 104)- A study is referenced that talks about 2 parenting styles: "concerted cultivation" vs "accomplishment of natural growth." I don't have full definitions for these, but they are associated with high and low SES families, respectively. The former is where the parent would encourage social skills and talent development through modeling and empowering the child. This was associated with higher confidence and better interactions with adults. The latter is a style that is more passive, leaving some of the development left up to teachers, coaches, therapists, etc. I definitely saw both types of parents when I was working with peds. In my experience, the latter style makes it hard to have home program carryover.

Levels of mitigation in speech (O 194)- The levels are restated here, and were discussed in the book in relation to studies about plane crashes. The author of that link also references an article from a person in a different power-index culture, which was interesting. I would be very interested to see a study on what terminology was used in ERs for trauma or in ICUs in critical moments between the various staff members. I may write up my observations on the language that is used at the interdisciplinary care meetings. But as far as client-therapist interactions, I think you have to balance your styles based on the client and family cultural and learning preferences. As an OT I want to give options, not take them away, however as safety concerns become larger, I do get more commanding.

Transactive Memory (TP 187) I scoured my in-depth books on cognition and found no mention of this concept, however, there is some research on this concept in the fields of relationship studies and also in computer science. This is where a couple or a group have certain tacitly designated tasks or things to remember. I never know where the various charger cords or electronic devices are, but/because my husband always does. This can happen sometimes in workplaces as well, where you have specialists and go-to guys/gals for specific tasks or theories. I think this also accounts for some of the memory impairment that I see in hospital patients as well. If you're used to sharing memory tasks it's not the same when you're out of your environment and out of touch with those you are close to.

The Tipping Point (TP 9)- Obviously this is the main idea of the first book, the idea that at some point change becomes unstoppable due to the momentous force behind it. My question here is- when is OT going to reach a tipping point? When are we going to be highly demanded in multiple fields? When are we going to be the go-to professionals for daily living, low vision, home mods, driving rehab, etc etc ad nauseum? When are we going to be respected by legislation, hospital policies, and other professions? I AM READY TO TIP! I know this is implicit in the Centennial Vision, and I would love for us as a profession to tip by that time. So I guess I'm still at the phase of tipping that I am becoming the best OT I can be so that when consumers have my services they come away with a great message about the purpose and power of OT. Just important to try your best every day since you don't know who you encounter that will be talking about you later.

Hope that's enough inspiration to help me get through the week! Anyone else have Gladwell-related thoughts?

Layout Updates Complete (?)

2009-08-31T13:54:00.003-04:00

I think, for the most part, that the layout updates are complete. There were a lot of trials, especially since I was reluctant to check and re-add each link on these pages one at a time, but hopefully there is a better collection of links now and a more efficient design. May have to update my photo, but it's hard to get an OT-relevant pic. So, thoughts on the 3 column design? I wanted to go totally custom but haven't been able to get that going yet. Haven't put the code back in to shorten all the entries again- do people find that useful?

Now that the drama of recreating the homepage is over I hope to get some more regular entries going, but one reason I'm not sad they've been slow is that I have been trying to get a better balance to life. So we've been going to some concerts, getting ready for football games this fall and visiting family over the holidays. Nice to have some fun stuff to look forward to. Also, I've been working on my presentation for the state conference, since I can't very well just show up and say, "yeah... I have a blog." Not going to cut it :)

New find from twitter

2009-08-19T19:00:00.002-04:00

Twitter time has been semi productive!
Found a link to an OT blog I hadn't been following- Info Spot 4 the Special Tot. The author also has a website on sensory processing in infants. I haven't had time to explore the whole thing yet, but the author has definitely been profuse in publishing and has also acted on something that I had discussed with another blogger- producing entries for wiki-how related to OT. So, props for that. It is on my list of things to do, but ... in unrelated news, I am getting a few other things adding up on my list. My research from school is actually getting near to being published (!!) and so I have some things to finish up for that. I have been reading my stroke textbook 1 chapter at a time on the metro rides, when I'm not falling asleep from exhaustion. And I am swinging my occupational imbalance in another direction, going to be attending several upcoming concerts and 1-2 football games before Christmas, hope to keep peppering my sometimes dull life with a little fun :)

Trying for a better week

2009-08-16T20:33:00.004-04:00

Goals this week are a little morbid.
So I had multiple pt deaths last week, 2 expected, but 1 not. None due to receiving OT services or lack thereof but still not a pleasant thing. I did get one lady up to the chair about 5 hours before she coded, didn't do much else since her O2 sats were not stellar. So I've been a little depressed and I would just like for people to stay alive this week.

Saw a cute-as-a-button 89 y.o. lady on Friday who had a pontine CVA (blessedly mild) but told me "I've never been sick all my life, so if I die it's ok" and I am just thinking NOOOOOOOOOO!!!!!!!!! The COTA saw her yesterday and she met all her OT goals, but after that she transfered into intermediate care for continually BAD blood pressures (222/101 etc) which is not good. Went in and talked to her today...hopefully they will get her heart under control. She is totally asymptomatic and does great from a functional standpoint, however she keeps having these skyrocketing BPs. Everything would probably be under better control if she had come to the ER right away but she arrived 4 days s/p onset of symptoms and only came in when her MD called and noticed her slurred speech. Worse- she lives with an adult child... how can you not notice that your mom has major weakness on one side, slurring speech, and struggling to walk? Seriously, better to come in sooner than later.

Saw a bunch of pts with multi-trauma today... one guy I saw OOB for the first time in 3-4 weeks, an older lady with dementia who we presume fell down the stairs and refused to put on her TLSO, and a man who was involved in a head-on car crash- now in the ICU only seen for splinting. He has BUE intrinsic plus/resting hand splints and BLE foot boots now. Probably has a TBI as well that can't be evaluated yet so he will have a long recovery road ahead. Been learning (and relearning) a lot of stuff about splinting lately.

Really hope week 2 on neuro floor is better than week 1. Not making a lot of progress on the stroke textbook but I have gone through several AJOTs and other research articles, hope to have a summary post soon. Also still working on a Malcolm Gladwell related post. In other work news, am now on the documentation committee following our strategic planning meeting so I hope to make that both comprehensive and quicker, if possible. Added a bunch of new 'tweepz' on twitter, hopefully that won't cause any brain overload but may be helpful resources, so if you do the tweet thing, go ahead and check it out. :)

Miracle Treat Day

2009-08-12T20:50:00.003-04:00

August 13, 2009- Dairy Queen Miracle Treat Day!! Since you can't eat those paper balloons that get hung up in stores.

drawings from a client w/ impaired vision post CVA

2009-08-09T19:24:00.001-04:00

These pictures were drawn by a client with an interesting and complex history of CVA.
Mr. R presented to our general medicine floor a few months ago after a fall, and had been unable to stay home unattended during the day without problems. He had experienced a stroke 1 month prior to admission, outside the US, and as far as we learned had received nothing but the most basic treatment to stabilize him, no rehabilitation whatsoever. While this gentleman had virtually no motor involvement, he had MAJOR deficits in short term memory, to the point where he had what I would call "5 questions a day," which varied slightly day-to-day, but would be repeated for the duration of that day no matter how they were answered. He retained very little of the answers that were provided, though this ability waxed and waned. This would have been a great enough barrier to home discharge, however, he also had severe visual involvement. I appealed for a neuro-ophthalmology consult but they declined to participate since this was not an acute event. So I did what I could to evaluate this issue.

Clock Drawing: I found this interesting since the numbers are running counterclockwise, and he did draw them in descending order. I couldn't find any information on other cases with the numbers running backwards.
These pictures are his attempts to reproduce the above drawings. He was able to describe the shapes in the drawings somewhat, but unable to figure out what the whole picture was.

We had a similar issue when he was trying to '"cross out the m's" or reproduce written letters. He could write letters accurately but couldn't read them effectively unless directly cued to trace the example and trace the letter in question.

Mr R's decreased vision was really a secondary problem to the decreased short term memory. He would occasionally report new, altered visual symptoms which made evaluation difficult, and functionally, his vision was less limiting than other deficits. For instance, he needed help to find his way to the bathroom, but needed only verbal cues for perseveration to shave his face. I believe the family had to pursue nursing placement since they couldn't provide 24 hour supervision, which is sad, but between his memory and visual deficits he did need that level of care.

Progressing in Pediatrics

2009-08-05T21:30:00.001-04:00

Got my official badge access to the OB/pediatric/NICU areas today, now I can stop annoying security by paging them every time I want on or off the floor.
Got to observe a baby with a pronounced cleft palate again today, this time made it in time to watch the feeding process. I learned about the Haberman feeder, which is a special nipple that requires you to squeeze along with the baby's attempts to suck. Very interesting and I got to hold the baby for awhile. Also saw a girl admitted for preterm labor today... have to get less nervous on the new floor, I heard myself talking extremely fast when doing her eval. It's hard to absorb all this new specialty information for peds, especially since I am starting on the neuro floor next week and will have to be ready for that. Trying to learn fast and not have my brain explode...

Did my first real ADL in a long while... 7 units with the same lady. Didn't have an excess # of orders today anyway and almost all of my evals and followups were cancelled for one reason or another. We'll see what tomorrow brings... hard to tell what will happen

How to prioritize a full day and other stories

2009-08-03T21:52:00.002-04:00

9 hours today, and it was JAM packed. So much so that it will span into tomorrow morning.
Mondays are always difficult for me since every name and face is fresh. To top it off, we were shorthanded today which adds the task of prioritization into the mix. There are many methods for this, some of which are mutually exclusive, and some of which aren't applicable when you need them to bed. Regardless of what I choose, it is hard to pick and know that a certain amount will not get done.
Here are a few of the ways that you can prioritize evals-

- Pathway patients first- this is an overriding rule in my facility. Gastric bypass, new stroke, spinal surgery, and joint replacement patients are on a "pathway" and need to be seen on day 1.
- Highest priority first- this is common sense, but we have a box on the referral form to indicate whether the pt is supposed to discharge in 24 hours. These pts become top priority, however, these forms are not always marked to facilitate this. You can meet with the medical team though, and ask them who is the biggest priority (and also ask which referral was inappropriate and can wait another day). I have been told that I can say, "I can only see X# of your pts today, who should it be?" if there is no distinguishing factor between them.
- Oldest orders first- this is what I did today since it's the first day after the weekend. We try to see everyone within a certain # of hours of the referral being written, so I just started with oldest orders.
- Divide and conquer- when we are swamped as a department, sometimes I find it best to meet with the PT in my area and split our mutual list. This way ALL the pts are seen today by at least 1 discipline and have a discharge recommendation.
- Least likely to leave last- as a corollary to highest priority first, the patients who are sickest and least likely to be discharging soon can usually wait a day. So pts in the intensive care units are lower priority for evaluation unless the need is for splinting.
- Most complicated first- sometimes it makes the day better if the most difficult pt is tackled first. Plus if this pt requires a time-consuming eval or intervention such as splinting, at least it's done and out of the way.

Does that cover it? I don't know. There will still be days when there are so many evaluations in the box that your eyes begin to spin and glaze over. I had a few weeks like that on the medical floor where I went through each day in battle mode- just taking the 6 evals I could handle and throwing my hands up at the rest. The other thing that these models don't take into effect is the need to do follow-ups. I don't know how to get a good balance there, and need to figure it out pronto since people stick around longer on the neuro floor, and I will be there in .. a week? Any tips on managing the mix of evals/followups?

So after sorting today, I started off at 930ish with pt #1 who had a gastric bypass. #2 was an older lady who was a turnaround discharge/admission, both times with pneumonia. #3 got derailed since he was meeting with his boss. #4 was in the ICU but also got derailed since he was moving to the floor that second. #5 was supposed to be a quick re-eval of a lady that I didn't even pick up pre-op, but she is doing much worse now and required over an hour. She had to have the wound care nurse come see her before our treatment could continue, so I grabbed a sandwich in that time and also went to see a little newborn w/ cleft palate. #6 was an ICU followup that didn't work out very well but was done at request of a PT I was working with. Then I hopped back upstairs to see pt #4 which went ok, and finished the day with pt #3 which was fair. In the midst of this, I also had to do another 2 chart reviews that didn't turn into actual billable events. Wound up with great productivity but will still be typing up #5 and #6 tomorrow morning. That will probably be a slow starting day since it is my turn in rounds and we have our weekly team meeting right after.

(By the way, I'm not trying to be patronizing about my patients by numbering them, but it's hard work to come up with aliases for everyone, and I don't anticipate touching on any of these stories again.)

hiatus

2009-07-31T10:53:00.001-04:00

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

Long term care calculator

2009-07-28T20:09:00.002-04:00

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

Adaptive Equipment- a different view

2009-07-25T22:10:00.000-04:00

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

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

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

What I'm Reading Now

2009-07-18T10:28:00.000-04:00

Current reading pile

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

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

information overload

2009-07-13T21:17:00.001-04:00

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

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

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

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

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

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

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

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

As if people needed excuses NOT to use mass transit

2009-07-08T22:24:00.001-04:00

hearing loss? back injury? and what else?

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

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