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.
2.26.2010
Acute Care Courses at AOTA Conference
I feel that it's difficult to find OT courses on acute care topics. It's also hard to apply evidence from those courses to the everyday fast paced world. Here are some parts of the AOTA conference especially for Acute Care OTs (places where you're almost guaranteed to find me!)Links go to full course description on the Create Itinerary page for conference.
|
| Poster PO 408. An Interdisciplinary Approach to Acute Care Using Standardized Patients and Human Patient Simulators Fri, Apr 30, 3:00 - 5:00 PM |
| Poster PO 226. Mind-Body Interventions for the Inpatient Acute Care Oncology Population Thu, Apr 29, 1:00 - 3:00 PM |
| Short Course SC 105. Culture Change in Acute Care: An Interdisciplinary Approach To Creating Respect for Therapies Thu, Apr 29, 9:00 - 10:30 AM |
| Short Course SC 223. Assessing Cognitive Disorders: Integrating Standardized Assessments in Acute Care Fri, Apr 30, 2:00 - 3:30 PM |
| Short Course SC 338. Acute Care Management of Shoulder Replacement Patients Sat, May 1, 3:30 - 5:00 PM |
| Short Course SC 306. The Acute Care Perspective: Occupational Therapy's Role in Early Management of Traumatic Brain Injury and Spinal Cord Injury Sat, May 1, 9:00 - 10:30 AM |
| Workshop WS 205. Doing With Not To...Occupational Therapy in the Newborn Intensive Care Unit (NICU) Fri, Apr 30, 8:00 - 11:00 AM |
2.21.2010
What a week
What a long strange week it's been...
It was a busy, and sometimes downright lousy week. I had 2 people that I was asked to see, cleared for home with family supervision, and then neither family would take them home. It is really sad to see someone who could be in an assisted living or adult day care go to a facility due to the lack of help at home. I hate being put in the middle of these family power plays where the caregiver child just doesn't want to do it anymore but won't say anything until the person is hospitalized. In a strangeness typical of this topsy-turvy week, I also had a lot of people insisting that they would take their parent home when they were very debilitated and largely dependent. The only bright spot for me was getting time to do some follow ups on Friday and changing a rec(ommendation) from rehab to home. That lady had cleared up physically and cognitively and did great in our gym, she was so happy to go home.
One of my fellows with dementia was interesting, but frustrating to work with. Terrible short term memory and executive function to follow through with tasks. Getting dressed took us a very long time. Mod assist x2 for LE dressing. After he was already dressed, he needed to use the bathroom... got him sat down, specifically said DO NOT GET UP and then positioned myself outside the door to detect movement since those directions are so rarely followed. I heard him up and moving toward the sink, so I went in to find him walking with his underwear pulled up but pants still around the ankles, totally oblivious to any lack of completion of the task.
This has been a frustrating week as well since it has felt multiple times like different groups were trying to undermine our therapy recs. Obviously, we're all part of the team trying to facilitate best d/c plans for the pt. However, it's hard to feel appreciated by the rest of the staff when you're doing an eval and the home care coordinator walks in to set up home therapy and oxygen OR the doctor comes in to review discharge instructions OR the case manager has already stated the plan is for rehab. It makes you feel like an ancillary service that doesn't really matter to people. That is a feeling that I truly hate. I've also been at odds with people lately who can't respect my decisions NOT to see pts. The most recent of these was a gentleman who had a blood sugar of 500+ and was off the floor for testing for several hours. I was told, Oh, they've treated him and tested him since then, it'll be much better than that. With all due respect, prove it. This is similar to when someone tells me to see a pt. who has dopplers pending to rule out DVT, because "we don't really think they have a DVT." I need to know that my pts are stable to work with, and need for people to respect my judgment when they don't appear so.
I've long been angry at my apartment complex for their slow response to ice and snow, worried that my elderly neighbor ladies would fall and break a hip on the poorly maintained sidewalks. Leaving the house Tuesday, I caught on some significant ice and did a "Home Alone" style slip and caught 4 steps on my back. Extremely unpleasant, especially as a user of bouncy public transportation. Was finally starting to feel better on Friday, and then I think I strained my back a little doing a 2-person lift. And then we went skiing on Saturday.
A note about skiing- I cannot do it. My husband loves it and progressed in one season from terrible beginner to black diamond goer (to my extreme worry). I have tried it once and spent the whole time falling. But I went, and it was really hard since I was already dealing with nagging pains. and then I remembered exactly how hard skiing is on your knees! Pizza wedging, turning, constant bends- it is no wonder you hear about these Olympians s/p ACL surgery and everything else. For me, it was very taxing mentally and physically, but an interesting learning experience (I can say that now that I am safely on the couch again).
It is an interesting time to be an AOTA member. I did the responsible thing and voted for all the positions (elections close March 3) and I also tried to review the proposals from all the candidates. It was interesting to see how many of the candidates had included a blog (many on the OT Connections service) and the number and kinds of updates they had. The truly interesting thing will be to observe how many people continue their efforts after the election. One of the great things about OTC has been getting more insight into the organization. President Penny Moyers is excellent about blogging and responding to forums, I also find posts by Brent Braveman (speaker of the RA) and "Ask" Molly (from OT Practice) to be good to follow. And with this continued debate on the future of the organizational structure based on the recommendations of the Participation Ad Hoc Committee, there have been some very informative responses from the decision makers. Incidentally, there have been several people who have initiated involvement on OTC to be part of this discussion, and the differences between experienced users of social network and others also provides interesting points for contemplation.
What this discussion is missing is input from the new generation of AOTA members. To my observation, these new developments with the COOL and the VLDC are designed especially for the newer OT practitioner members to enhance the member experience and offer leadership opportunities for unrecognized, busy members. There is a lot of uproar over these changes, and the decision makers need to hear ALL the voices in this discussion. So PLEASE express yourselves in the forum so that our demographic is represented.
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.
2.18.2010
Don't miss the early registration deadline for AOTA 2010!
March 3rd is the early registration deadline for the 2010 AOTA Conference! Save money and get in early. Still wavering on attending? Here are some considerations for a few common excuses..."But I would rather only take courses in my specialty"
I think anyone would be hard pressed not to find some relevant topics in the conference program, despite their specialty. 3 hour workshops are offered in a wide range of topics and are quite detailed. While in-depth courses are good, seeking a variety of learning opportunities is a good change. Surely it is not anyone's goal to only learn more and more about less and less. Who knows what new ideas you could be exposed to and how it could make a difference in your career? (Also, if you don't feel that the conference offers enough courses in your specialty, why not consider presenting on the topic? That counts for credits too, and helps build the profession)
"Travel is too expensive"
There are LOTS of ways to save money attending conference. At least 100 students attend the ASD, and their income is substantially less than any employed OT. Use the Conference Connections board to find roommates- a hotel room split 4 ways is considerably cheaper than going it alone. Wear an OT shirt on your flight and you're almost guaranteed to meet a friend who will share a cab with you. Book flights early, and consider using credit card points to redeem for a discount on your ticket. Put yourself on a budget for meals. See if continental breakfast is offered at your hotel. I also frequently pack snacks and mini-meals- protein bars, shakes, pepperoni rolls (non-WV folk, you don't know what you're missing by refusing to put meat and bread together)- which saves money on lunches. Also, consider what your employer may offer you for attendance. Could you get paid education days? Could you get part of your registration paid for? Would they consider pitching in on travel expenses for an inservice after conference? ASK! The worst they can do is say no.
"But I could get CE credits cheaper elsewhere"
Yes, there are cheaper ways to find CEUs. Student supervision is free, but limited to a certain number of hours. There are journal articles that can be read, but many journals require a professional membership. And there are certain sites that offer free CE classes or offer to customize your class on "_____ for OT" for anywhere between 1-6 hours. But what is the overall quality of learning in those classes? What feedback do you get from the instructor or other learners? How will your professional life change following those classes? Let me assure you, it is different at the AOTA Conference.
"But I don't like to travel to fun places"
Just pretend that spring in Orlando is like winter in wherever you are, trapped under 3 feet of snow with only beenie weenies for nourishment. Or maybe seek treatment for anhedonia.
2.15.2010
New Feature: AJOT Thots
To help keep myself accountable to keep reading AJOT on my metro rides and have an easy way to track what I have read to prevent another NBCOT renewal panic attack, I have decided to do little write-ups on the articles I read. To best facilitate this, I've decided to create a feature! Having a feature makes me feel more like a "real author," like I wanted to be as a kid. This is only bimonthly, so hopefully I can keep up with it and also help schedule some posts. If this is a feature you'd like to see more of on the blog, comment or email and let me know. Read on for the overview of what I've been reading, be warned, it's long.
AJOT January/February 2010 (members only link)
Research Scholars Initiative--Randomized Controlled Trial of the Breast Cancer Recovery Program for Women With Breast Cancer--Related Lymphedema
Marjorie K. McClure-OTR/L, CLT--LANA, Richard J. McClure-PhD, Richard Day-PhD, Adam M. Brufsky-MD, PhD
-- I was impressed with this program as it didn't seem complicated, and it could probably be easily reproduced in other hospitals or outpatient centers that have an oncology service and a therapist providing lymphedema service. Unlike some support groups, since this one is structured around exercise, it seems like it would be relatively easy to schedule.
Telerehabilitation and Electrical Stimulation: An Occupation-Based, Client-Centered Stroke Intervention
Valerie Hill Hermann-MS, OTR/L, Mandy Herzog-OTR/L, Rachel Jordan-OTR/L, Maura Hofherr-OTR/L, Peter Levine-PTA, Stephen J. Page-FAHA
-- I thought this was cool since I haven't used the FES-Nes for CVA rehab but have been curious about the product from the ads I see. This looked like a promising pilot study for tele-rehab, hopefully this was all able to be billed as an outpatient. I think it will be awhile before telerehab can really take off due to the general level of computer skills of the population we serve, but it is promising. Off topic, I felt that there were a lot of vague, uncited phrases ("In recent years, telemedicine has been used considerably for medical treatment of stroke.") and had flashbacks of my marked up manuscript from my research advisor, a strong proponent of justifying every statement.
Documenting Progress: Hand Therapy Treatment Shift From Biomechanical to Occupational Adaptation
Jada Jack-OTR/L, Rebecca I. Estes-PhD, OTR/L, ATP
--OA has always been my favorite frame of reference. Hand therapy is tough practice, lots of protocols to follow, surgeons expecting certain results, it's very hard to break away from the biomechanical model. But it can be done, and I'm glad that these therapists were able to provide their client with increased satisfaction from the model. I would advocate for any hand therapist to at least be eclectic enough to tap into other models besides biomechanical if not for great client satisfaction and improved independence, then to retain our claim on OCCUPATION which is what makes us unique. Props to my hands teacher, who always emphasized occupation based treatment; and to Todd, the hand therapist I worked with who in addition to his goals would have the client keep a diary of activities they could resume as tx went along.
Grasping Naturally Versus Grasping With a Reacher in People Without Disability: Motor Control and Muscle Activation Differences
Kinsuk K. Maitra-PhD, OTR/L, Katherine Philips-MS, OTR/L, Martin S. Rice-PhD, OTR/L
--Glad that someone put down in writing that you can't just hand someone a reacher and be done with the interaction. (This has been a deterrent to us putting AE on the floors in the supply rooms, a fear that non-therapists will give them out without any training) This also reminded me of the study I wanted to do looking at cognitive level (through MMSE or MOCA) and how well clients could "grasp" (how punny) the use of the reacher, because there is definitely an anecdotal cutoff point and I would like to see what that amounts to in real life.
Near-Vision Acuity Levels and Performance on Neuropsychological Assessments Used in Occupational Therapy
Linda A. Hunt-PhD, OTR/L, FAOTA, Carl J. Bassi-PhD
--The trailmaking test is still effective for people with uncorrected 20/100 vision... good to know. Not that I've ever had anyone actually complete the test effectively yet, but hopefully someday it will happen. Also reiterated the good point that you can't give out a magnifier to correct blur, and you need to do the best, most accurate evaluation of the client to help them be independent.
Relationship Between Handwriting and Keyboarding Performance Among Fast and Slow Adult Keyboarders
Naomi Weintraub-PhD, OTR, Naomi Gilmour-Grill-OT, MSc, Patricia L. (Tamar) Weiss-OT, PhD
--A study after my own heart, since I am a "fast adult keyboarder." I feel that the researchers missed out on not studying the normal speed keyboarders, especially since they kept emphasizing the point that keyboarding is often suggested to poor handwriters in school. It seems logical to me that the kids with poor handwriting who have been told to type may fall into that broad range of 'average' typists, not the extreme fast or slow. I also thought that it was strange they had so few touch-typists in their study- is this not being taught anymore? All due respect to Mavis Beacon, but I had an actual person forcing me to learn to type and covering my hands, which is why I am a fast typist now. A skill that I sometimes curse, due to the RSI I am continually trying to avoid. Even though my work computer is a tablet with a pen, my typing is MUCH faster than my writing, especially my decipherable writing. When I take notes in handwriting, it is printed, and my own crazy shorthand (example- K means children, beh= behavior, dem=dementia, dep= depression, w/sp/2st/3STE/Lr= lives with spouse in 2 story home with 3 steps to enter and a left ascending handrail). Anyway, the study was interesting, could be expanding, and OTs should definitely look at the child's overall motor skills before scrapping handwriting in favor of typing.
Doing, Being, and Becoming: A Family’s Journey Through Perinatal Loss
Mary Forhan-MHSc, OT Reg (Ont)
--This was a heart-wrenching, but poignant inside look at the effect of perinatal loss on the author's family. I found it interesting that the older children continue to discuss the child, despite not meeting their baby brother. In the families that I have known who have suffered perinatal loss, usually it was a firstborn child, or the elder child was too young to comprehend the loss.
The Issue Is ... Facilitating Evidence-Based Practice: Process, Strategies, and Resources
Susan H. Lin-ScD, OTR/L, Susan L. Murphy-ScD, OTR/L, Jennifer C. Robinson-PhD, RN
-- There were some good concrete suggestions for clinicians, employers, educators, researchers, payers, and I think students as well in this article. Well worth a read, and not too long.
Remember- if you're reading journal articles or textbook chapters, it does count for continuing education credits for NBCOT. You are supposed to keep a summary of how it applies to your practice. How's that for some motivation to read?
And please, share your thoughts on "AJOT Thots" or any of the articles contained herewith.
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.
2.12.2010
Job Search at AOTA Conference Expo
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.
2.10.2010
Snowy Day Thoughts
I am pretty well trapped here at home under several feet of snow.
I felt a little bad calling off work, but they haven't plowed my parking lot and barely touched the street outside the apartment. I really didn't want to walk 2 miles through the snow on the ground (and still coming down hard) to get to the metro (which is running on a delayed schedule) to get to my shuttle bus (also on a delayed schedule) to get to work and then possibly not be able to get back. And now they've actually pulled buses from the roads, and SNOWPLOWS due to dangerous conditions. It's just a little over the top.
I do feel like I made the right decision yesterday though... instead of my usual drive-metro-shuttle bus trip, I got up EARLY (I've been waking up at 5am for a few weeks unintentionally), drove to work and paid to park. Despite driving 30 miles instead of 4, I got home before the worst of the snow started. It was already pretty bad driving at that point, several of the roads having large piles in the middle of the road that got caught on my car's undercarriage, and turns being made hazardous by snow piles taller than my car.
So I'm taking my day off to try to catch up on some fun stuff... reading, finishing my puzzle, but I had a couple OT things to share.
Been trying to come up with some fun OT Month things to do... we are talking about having a carnival at work to promote awareness and need to come up with fun events, favors, etc. I would like to have some ways to increase interest in OT outside of the hospital staff too. I thought about wearing my OT t-shirts to work, but I try to keep all but my scrubs from the germs of hospital-land (to the point that my scrubs are kept in a separate hamper and washed separately from all other clothes). I just got a cute little OTR pin from NBCOT, but it may be a little too little to attract attention. Thoughts?
The other thing that I am currently finding interesting is the proposed restructure of the AOTA governance. This is found in the previous issue of OT Practice (here for members) and causing quite a stir. The theory is that the current structure of the RA and ~dozen large committees is unwieldy and not encouraging quick action, leadership development, or involvement from the membership. The plan is to dramatically shrink the RA, and get more participation from the membership at large through volunteer opportunities and ad hoc committees.
As I said, people are up in arms. This is an interesting OTC thread on the topic with a few people "in the know" in the fray. Here's another, it just hasn't developed much yet.
Personally, I have no attachment to the RA. I observed a portion of a meeting as a student delegate and was not impressed (bored out of my skull might have been more accurate). However, my conference roommate thought that it was really cool and wanted to become a member someday. Elections to the RA in my state were almost always unopposed and run by the same person. I don't recall getting any updates on RA progress at conferences or through state association newsletters. Since I didn't have a close back and forth relationship with my RA rep (not a bad thing necessarily either) I don't know that I will miss out on anything by decreasing the number of members.
I do agree with the theory that it's hard to break into the AOTA leadership... you see a lot of big name people running for offices again and again. So opportunities within the new COOL program that are easy access will make it easier to get feedback from some new blood. From a casual observance of AOTA releases and annual meeting conduct, I could tell that a lot of the work was being done by ad hoc committees instead of standing committees, so I don't know that we're losing much in that department either. I don't know that having the ASD classified as an organizational advisor makes much sense either. As a former member of the ASD, my involvement was limited to one day of mostly being presented to, not really involved with anything until we started the Centennial Vision talks. I'm sure the steering committee is more involved, but some of them aren't even students.
Lots to think about and bring forward to your reps before the AOTA Conference at end of April. Read up on the issue. Talk it out online, especially on OTC. And don't forget to vote in the AOTA elections before March 3.
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.
2.09.2010
Patterns
"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?
2.06.2010
AOTA Conference 2010
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.
2.05.2010
Jewelry for those with Arthritis
This is my grandma, showing off the stretchy ring BLING she got for Christmas. She's always had an extensive jewelry collection, but in recent years her arthritis has made it too painful to wear her rings and too difficult to operate some clasps. Read on for some of the options for people who love their jewelry and hate their arthritis.Stretchy rings/bracelets (Potpourri) - these rings have made their way into my grandma's regular rotation. There's matching bracelets for some and they slip on easily. (We got her the pearls and the ones with the single gem in the bottom right, not the crazy ones made of sticks) The ones from Potpourri are fairly inexpensive, I have seen similar ones in specialty stores MUCH more expensive so do some comparison shopping.
Magnetic clasp converters (shopping search) - I saw these on TV ads. They look like a person with arthritis might need assist with initial setup but then they should be independent to doff/don. I haven't personally tried them, so I can't speak to the strength of the magnets, but they're probably not strong enough to hold up heavy jewels like pearls.
Wire chokers/bracelets - These are pretty common, if you can convince an adult to shop with the preteens to get jewelry. Just look for the necklaces without clasps in U shape.
Bracelet fastener (bracelet buddy) - I was intrigued by this device when it first came out, but it may be too complicated as adaptive equipment now that other stuff has come out.
1.25.2010
Kindle
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.
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?
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.
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?
1.23.2010
One other thing
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
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:
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.
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:
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.
1.05.2010
Starting the New Year
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.
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.
12.24.2009
End of year wrap up
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!
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!
12.17.2009
Additional clock drawings
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.
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.
12.13.2009
Overcoming my Sensory Battle with Lotion
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.
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.
12.03.2009
Fighting Frustration and Fatigue
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...
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...
11.22.2009
Energy Conservation for the Holidays
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.
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.
11.18.2009
Post from the Alzheimer's Reading Room
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."
11.17.2009
A "very special" episode of Glee
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?
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?
11.14.2009
Some sad times
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.
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.
11.03.2009
Back From Conference
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! :)
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! :)
10.30.2009
On my way to WVOTA 09
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!!
10.12.2009
Virtual Reality Survey
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
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
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