NBCOT Study Tips

Ah, summertime! Time for students to rejoice, workers to lament, and OT grads to panic in preparation for the dreaded NBCOT exam. I have promised to put up some words of advice about this trial for my friends that are graduating this year. The first thing to note is that you should not panic. Yes, it is a pretty miserable experience, but you can (and likely will) pass. This doesn't mean that you'll feel good when the test is over... I spent 2 hours crying in the car and another friend spent the rest of the day violently demolishing parts of her house. Despite that set of awful feelings, we both passed, as did most of our classmates. Here's some tips to make the whole experience a little easier for you.

• Decide the basics- When do you want to take your test? If you've already accepted a job, you'll need to do this relatively soon after graduation. If you have busy/stressful post-graduation plans (wedding, moving, etc) you may want to delay the test a bit. You should also consider what kind of studier you are and what situations will make you more stressed. If you're a perpetual procrastinator, it might be better to take the test earlier just to force yourself to study and keep things fresh in your mind. Make sure that you follow the earlier advice about licensure and registration so that you can minimize snags in the process.
  
• Make a plan- If you don't want to get overwhelmed, you need to plan out your study strategy. Are you going to commit to studying for a set time each day, or just commit to reviewing certain concepts each day? What study tools are you going to use? If you're going to buy special things, do it well in advance so that you can get the full benefit of them before the test. Here's a brief review of items that I used/looked into:
• NBCOT Examination Readiness Tool (cost= free!) This allows you to rate your strengths in the areas tested by the exam. It's a free pdf, just print and go.
• NBCOT Official Study Guide (cost ~$45) The prime selling point of this study guide is the 100 question sample test. The reasoning for correct answers is given, which can be very helpful when working independently. Before the test, there is a section on basic study skills, which I found to be unneeded. One of these questions was on my actual test. I did not take the online tests ($45-185) because I heard that there was some repeat of questions and I was already familiar with taking tests on computer.
• OT Study Cards in a Box (Sladyk) (cost ~$45) My school had a copy of these, which I browsed and ultimately decided not to purchase. Each card has a diagnosis or theory with brief related information. I decided that my notes from classes were just as good.
• Quick Reference Dictionary to OT (cost ~$35) This is not a study tool. I keep one in my desk at work, and have used it more for Spanish translations than anything else.
• Occupational Therapy Examination Review Guide(Johnson) (cost ~$40) I did not use the guide, but did use the CD. 200 questions set up on the computer similarly to the real exam. There are explanations of the reasoning behind the answers at the conclusion of the test. You can also choose to break down your score into how you did by question domain or area of practice. I thought that these questions were a little easier than the real NBCOT questions, but good for practice on the reasoning.
  
• IER Practice Exam or Guide (cost free-$80+) These people offer a "free practice exam" of 50 questions with answers given. The questions are rather irrelevant and far more specific to diagnoses than will be on the test. They also offer a guide and an intense review course. I would not consider paying money to these people unless you are retaking the exam.
  
• Your own textbooks and notes (cost= thousands of dollars but you probably don't want to think about that) The resource that I used the most. Hopefully you didn't sell ALL your books.
  
• Know what you know- If you have more than one practice exam in your collection at this point, take one. This will show you where some of your weak spots are. If you don't have this luxury, list out the varying areas of OT practice and types of clients/treatments encountered (orthopedics, pediatrics, hands, etc). If you had good Level II fieldworks, you shouldn't need to study those areas in depth. Rank your knowledge of the other domains and you can also jot down if there are specific things you know you need to review. (for example, I knew that I was weaker in mental health, and that since schizophrenia is a main diagnosis, I really needed to review that). You can also do this by looking at the tables of contents of your main textbooks.
  
• Start with the reading- hit the chapters of the textbooks that you've decided to review. Start with the basics- review frames of reference before progressing to diagnoses or treatments. See something that you know so well you're getting bored? Skip it and go on. If there are things that remain difficult to remember or understand, jot it down and go on.
• Take a practice test- 1-2 weeks before your test, take your final practice test. Review your answers and pay attention to WHY they are wrong. What are these questions telling you?
  
• Specific material you didn't know (specifics about precautions, diagnoses, equipment)
• Practice domains you are unfamiliar with
• Faulty reasoning / second guessing
  
• Not taking enough time / taking too much time
  
• Know when to hold 'em- Do not try to reread an entire textbook. As you get closer to your exam date (last week prior), make a final list of things to review. What do you need to review, based on your analysis of your last test results? This should include things that you have less interest in or are consistently weak in. For me, I knew that I needed to review nerves of the hand, feeding & swallowing. I made a 1 page review of the main concepts and concentrated on that during the final days before the test.
• Know when to fold 'em- At the end, there's only so much information your brain can hold. Since this is more of a critical thinking test than a memorization/regurgitation test, cramming is not going to help. Make sure you have all your documents that the testing center requires. Do something relaxing the night before the test, and get a good night's sleep. (Sleep is really important. I stayed on a friend's floor, they came back late and woke me up... not a good sleep environment. If you can't stay at home, pony up the money for a hotel.) On the day of the test, eat a good breakfast, take a snack with you to the testing center. Wear something comfortable and layered. Take a deep breath, and go for it!
• During the test- Don't be afraid to take breaks. They've given you 4 hours, go eat your snack, go stretch, move around in your PNF diagonals, whatever. Resist the urge to second guess, just use your good critical thinking skills. One of my teachers liked to say that rarely did the answer choices match what you would do in a situation, you just needed to pick the "least offensive answer."

Hope this is helpful! Any other questions, just hit me up.

OT and Girl Scouts: A Great Collaboration in the Making

(LGT Girl Scouts of USA homepage)

A recent topic on an AOTA listserv made me think about how Girl Scouting and Occupational Therapy could really benefit from a partnership. This is something that I've thought mildly about myself, and taken action to enact in my own life. To give a little background, I was a 10 year girl scout from 3rd grade until I graduated high school. I went to Florida, Canada, and Mexico primarily from cookie sales and have always known that I would want to give back to a program that was very beneficial to me. Now, as an OT professional, I feel that I am in a great position to do so- and so are you. Both of these groups stand to benefit from a collaboration... here is why:
1. Gender Issues. Yes, there are male OTs and even male GS leaders, but both fields are dominated by women. Why fight it? Why not reach out to a female community to join causes? I'm not saying that we should undermine the role of men in the profession or not actively recruit men, but there is something to be said for directed advertising. Plus, a good female role model in a girl's life is virtually irreplaceable.
2. Understaffing. We know that this is a somewhat tenuous time for OT. We're looking to the Centennial Vision. We want OT to be viable in all realms, yet we wonder if there will be enough OTs to make this dream a reality and keep the collective paws of other professions off our domain. (For example, we can't claim to be the definitive experts on UE splinting if there aren't enough OTs that are proficient and practicing in splint construction) At the same time, Girl Scouting is stepping into an uncertain future. The levels are reorganizing, the badgework requirements are changing, and councils are consolidating. Leaders and general volunteers are always needed to recruit girls and help them explore a well rounded set of activities. In turn, older girls can do volunteer opportunities at hospitals or clinics, various OT sponsored events.
3. Background. In my opinion, OTs have a great general education and unique splinter skills. There are a wide variety of people attracted to OT (as anyone who has attended AOTA conference should be able to attest). This includes musicians, athletes, artists, all of whom can share their talents and help girls explore different activities and earn badges. Everyone who made it through OT school also has great organizational skills which can be applied to any meeting, badge plan, or event.
4. Promoting Development. OTs have special skills in activity analysis and grading. We go into this career to help others achieve more in their lives. We work with individuals, families, and communities to make the impossible dream a possible reality in a world more accessible for anyone and everyone. Even in a group of typically developing girls, there will always be various skill levels for different tasks, and an OT can do a great job at helping all participants discover their strengths through activities.
5. Promoting Tolerance. Not much to be said to expand this point, but OTs should be experts in inclusion. There are also ample opportunities to pass on a message of tolerance to developing kids. I think that this is an important value to pass on, and it is a main tenet of girl scouting.

To me, there are such opportunities to involving OTs and girl scouts. Though I don't have a troop right now, I have been active in my new council and will be running the cadette/senior unit of an evening camp this summer. I have posted a list of badges that OTs could be facilitators for as an OT-Advantage file, look for me as "cheryldotot." Incidentally, I've also posted by Alert Program based "engine handwriting" sheet for download there, and will try to add in different study materials that I still have floating around on my computer. What do you think about an increased involvement between OT and GS? Would it be a community involvement that you would enjoy? Should I try to make it an RA motion for next year? Speak up! Happy Thursday!

Deja Vu

On my final fieldwork, I was helping a woman work on standing tolerance while doing her laundry in the teeny tiny rehab laundry room. This room was not large enough for Ms. C's extended width wheelchair, and barely wide enough for her walker. We had walked the 2 steps from the wheelchair and turned to face the laundry machine when Ms. C started saying "I'm gonna fall!" in an increasingly hysterical fashion. At this point, she could not or would not respond to instructions to turn to get closer to the wheelchair. All I could do was push her up against the wall and help her slide to the floor. After adjusting her legs, I was stuck in the back of the laundry room with her on the floor in front of me and her wheelchair in the doorway. I remained calm, managed to get attention of a passing nurse, and couldn't do much to help as a posse arrived to lift Ms. C back to her wheelchair. At this point, my supervisor walked by and ordered me outside for a break as my hands were visibly shaking.

I did recover, my supervisor empowered me, as did a PT coworker who had a similar incident with the same woman in the following week. But patient falls are never fun. Not only is there a heap of paperwork, but there's a personal 'second guessing' which can undermine your professional confidence. Even though there's factors in a fall that you might have been able to foresee or change in some way, usually, it's no one's fault. It's just hard to remember that at the time.

I hadn't had to think about Ms. C for awhile, since that incident was over a year ago. But there's always something that takes you back to those situations you'd rather forget. Last Friday, I was seeing Mrs. W for ADLs. She had been doing progressively well that week, and had even taken a shower the previous day, so I figured that we'd have no difficulty with a basin bath and walking to the sink to do grooming. We were doing fine at the sink, brushed teeth, brushed hair, and were ready to return to the bedside chair for the actual bathing/dressing activity. As we turn she cries, "I'm going down!" I couldn't get her to stand up any longer, and lowered her to the floor with the gait belt. She can't hold her torso up while sitting, so I sit down behind her to help prop her up. We get her roommate to use her call bell, and sit there on the floor having a very nice chat. Eventually, I get the attention of the nursing staff through the 4 inch opening left in the door and they help her back to her feet and to her chair. We did the rest of her bath, and though she was tired later in the day, she walked again w/ PT and didn't have any major problems. By Monday, however, she wasn't allowed out of bed and went into A-Fib from renal insufficiency. She was discharged upstairs to the cardiac telemetry floor. I felt pretty cruddy about that turn of events, but she is doing better now and will probably be back down to our SNF floor soon.

Of course, the worst part of Friday came later, when another patient lost control of the front wheels of her walker while I was helping her to the bathroom and almost fell. If I would have had 2 falls in one day when I hadn't had any for a year, I probably would have gone home early. Sheesh.

Let's talk about... eeek!

As an OT, I am involved with many different people's intimate occupations. Before fieldwork, I hadn't counted on how often I would be immersed into the land of bodily liquids. I assumed that I could just call for nursing to assist with things that were outside my tolerance. Laughingly, I know that I now cannot count the number of bedpans applied, commode transfers, and assists with hygiene. There is a particular child I see who never ceases to slobber over both my arms and my shirt. My tolerance for such events has had to improve, or I wouldn't be able to help people with what they are struggling with. You can't want someone to practice cooking with you but turn them over to nursing when they have an accident and need help with hygiene. On a cleaner note, even the outpatient side of therapy can bring you to a point of TMI from a client. People tend to open up about things over an ultrasound machine, including things you didn't need/want to know. Several of my final days as a job shadower at the outpatient OT clinic had me distracting a young girl that needed whirlpool debridement of 2nd & 3rd degree burns. It was my job to chat with her so that the OT could do his job. She shared numerous things that I am sure her mother (in the room) did not want to be known outside of the family, including her father's suicide and how often mom's boyfriend stayed at the house.

Despite how deeply thrust we are into clients' personal lives, there is a topic that we often shy away from... despite it being a Basic ADL. That's right, it's sex. There's an unfortunate stereotype that many of our clients- the elderly, those with developmental delay, people with severe physical or mental disabilities- aren't sexual beings. I remember being somewhat shocked in high school when a classmate (12 years s/p TBI) made comments about wanting to make out with someone. The movie Murderball addressed this head-on in a way you could expect from MTV. But still, sex isn't something that we often address with clients unless they gather the courage to speak first and persist until they get information. There are handouts, books, and videos addressing sexual techniques for people with various injuries and disabilities. And now, there's a dedicated edition of Savage Love, with a coauthor from the book The Ultimate Guide to Sex and Disability. (Warning: this site is not safe for work and should probably be considered R-rated) While it's a very short article, just let it serve as a reminder that you can't assume anything about a client, they probably do have questions, and that there are important resources available. I especially enjoyed the emphasis that a depressed person with a disability has community resources and needs to get out of the house and into the world, but that's another story. The article also links to Independent Living USA, which is a site that has numerous links for pretty much anything disability-related.

So be warned, future OTs, the issue will surface. On my level 1 fieldwork, a young man in his 20's w/ a SCI wanted to know more about masturbation, dating, and general issues. And the OT did her job- she pointed him toward good resources, brainstormed possible adaptations, and made herself available if he had more questions. I sincerely hope that I would handle such a question with the same grace.

Scariest Graphic on Childhood Obesity

LGT an interactive graphic showing the effects of obesity on kids... we really need to get some more wellness programs in the works!

Sensory Clashes at Work

This may not be welcome news to parents who have children with sensory issues, but you should know that they will likely grow up to be adults with sensory issues. Hopefully, as an adult, they will have a better understanding of their own preferences, better articulation of their needs to others, and less intense reactions than the tantrums you may be used to. But the sensory preferences will be present in adulthood. As previously mentioned, I continue to have sensory situations that frustrate me everyday, perhaps moreso since I started take on kids w/ SPD on my caseload. I give into my sensory needs even when I know it is to my own benefit not to. For example, each entry on this blog has been constructed on a laptop while sitting on my couch, as opposed to the desktop computer with ergonomic desk chair, proper mouse, and keyboard position less likely to give me carpal tunnel syndrome. I also use this pesky laptop to do all of my internetting (facebook, crosswords, fantasy baseball...) because I must have the noise and distraction from the TV to maintain my attention, and there is no TV in the 'computer room.' 90% or better of my college study time was spent in front of TV and/or computer, or talking to my friends about unrelated issues, because I need the noise to maintain alertness.

And that is where we transition to my little story. On my outpatient days, I share an office with an older coworker with ADD. While working at my desk, she entered the room, closed the door, and turned on the office tracklighting. To her, she has created the bright, quiet working environment that she needs to be productive. To me, the room instantly turns bright, hot, stuffy, and I have now been cut off from the quiet radio playing 'lite hits' or some such thing. I won't be able to hear my overhead page when my patient shows up. I have been imprisoned! I had to get up, leave the office, move around and postpone what I had been working on. Because our sensory needs are completely incompatible, we are completely incompatible as coworkers. We frequently bicker and rarely occupy the same area by choice. Yes, we have personal and professional disagreements as well, but I feel that the sensory clashes are exacerbating these problems. One day, we will probably go round and round about this.

I can't be the only one in this situation. I know that there are colleges who give the MMPI to incoming freshmen to determine personality matches for roommates, perhaps the Adolescent/Adult Sensory Profile should be added to the battery. Oh, imagine the possibilities if we used sensory profiles in workplaces, couples counseling, family therapy... it is a sensory world after all.

Blog Update

A short little update on the sidebar... I managed to take the blogs that I subscribe to from Google RSS Reader and auto link them. This will be a lot easier than trying to continually update the links list as I keep finding new and interesting OT bloggers. When I get some time, I'm going to update the resource links as well and try to categorize them... I've been finding some good peds sites and still have a good deal of home mod/universal design links floating around in my bookmarks. I also will try to attend to some of those 'upcoming entries'... apparently I missed "Blogging Against Disablism Day" (probably because I live in the wrong country) but I will update with something along those lines soon. And, per comment from Karen, I may add a bit more personal information. I just want to be true to my original reasons for this and not clutter it up with my unrelated stories.

I've been finding a lot of references to "web 2.0" which strikes me as somewhat funny. My husband and I were watching a show called "Download: the history of the Internet" which we found strange and intriguing. They were discussing what I suspect others are referring to as "web 2.0"... beyond email- using blogs, facebook, webpages, bulletin boards, etc. It was strange, because this show was being narrated as historical/informative/ground breaking... and it was all stuff that we use everyday. My first foray into web design was back in '99 (suffice it to say that was LONG before my OT days), so it's an interesting vantage point as others are discovering the capabilities of mass connectivity. I'm not super experienced w/ this program for blogging yet, but I do have familiarity with other parts of the internet and various programs. I figure the best way for OTs to expand into the web is to share our knowledge so that everyone can learn the ins and outs quicker.

Not trying to brag, but if anyone needs tips on the following, just let me know: Basic HTML, Basic Microsoft Office (all apps), Intermediate Google Applications, Advanced Microsoft Publisher, Advanced SOLE, Advanced Netscape Composer.

OT SPD course

I just got back from a course on best practice for SPD by Delana Honaker (title link goes to her website) and felt that it was a really worthwhile experience. I may share some notes from the presentation at a later time, but just wanted to jot out a few thoughts I had.

First off, as I alluded to earlier, this was an excellent course. Dr. DeLana was a great presenter, embodying what anyone would want from a professor or lecturer. She brings energy and extensive knowledge to her topic. As I was sitting there, I had one of those semi-common (for me) semi-remorseful thoughts of, "why didn't I go to that school? It would have been great to have her for a teacher." If she was my teacher, I might have been more interested in peds. Don't get me wrong- I love my university and have great pride in my program. But I've been to enough conferences that have professors presenting to have that thought more than once. I'm concluding that 1) we have some super awesome OT instructors in the world (!!!) and 2) that this is a similar feeling to spending the day with your friend's parent and wishing you'd been in that household. It's not that your own parents weren't good and loving, and you secretly understand that the situation wouldn't actually be perfectly rosy all the time. After all, if you hang out with that adored parent/professor long enough, you'll see the less-public behaviors that drive the insiders crazy.

Secondly, as I was waiting for the program to begin (and thus, didn't know that it would be awesome), I had a panicked thought. I had previously attended several conferences and symposiums where you could pick and choose individual courses, as well as leave if a particular course turned out to be crummy. The tradeoff with the conference aspect is that you don't get to delve deeply into a topic, since you're usually limited to 30 mins - 3 hours. When registering for just one course though, you don't know exactly what you'll get for your money. I hadn't thought excessively about it prior to sitting down this morning, and fortunately, my fears proved to be irrational in this case. IDEA: wouldn't it be helpful to have a database online of peoples' evaluations of different CEs? Sounds like a project for a techie.

Third, I will admit a personal shortcoming evidenced today. I sometimes have major problems with the networking aspect of business, which is actually something that I really wanted to do today. Despite my online-persona, I am a total introvert, so it is hard to just walk up to people and chat. I managed to talk to some people today, but struck out (5x) for making a worthwhile connection, especially one that would be suitable to offer at least some minor guidance in my situation. Bummer.

And finally, I think that the professional wisdom is starting to bear out that OTs who treat kids with sensory problems have all their own sensory issues exacerbated. I know that is the case with me (and believe me, I have ISSUES). After finally feeling like some of those behaviors were sinking away, the past few months have brought them back to a elementary school level. Granted, I have a better understanding of them and more control over my reactions now, but it's still kind of annoying.

Yoga and PTSD

Title LGT article in the Washington Post about vets w/ PTSD using yoga to alleviate their symptoms. I hope that they can gather some evidence to support it and keep the good progress going at Walter Reed. Unrelated- I also like their program to get soldiers into new sports experiences.

Metablogging and questions about the future

Through some recent exploration on the internet and making some new online OT friends, I have seen that there is a larger online OT presence than I originally expected. This was pretty foolish, since I do consider myself to be technologically aware. I have discovered numerous OT/student blogs, websites, listservs... there is a gigantic presence out there. My own listing of blogs to the right is drastically limited and will probably be removed... I have had to employ an RSS reader just to stay on top of things (which, by the way, has proven so far to be a worthwhile time investment that I highly recommend). At any rate, these discoveries have shown that there are a lot of other people in the OT world who have been at this longer than I have and appear to be leading more interesting professional lives than I am, which makes me question if this blog will ever become what I had hoped. Hopefully, all our efforts will be worthwhile to the whole and create a greater connectivity between all of us professionals.

My debate about the possible future of the blog has also reminded me of the lifelong debate over the possible future of me. Specifically, for "OT me," there is a lot of uncertainty. Prior to college, I was tossing up careers in architecture or OT. During a college tour, I explained this debate to a professor (Diana, for my peeps) who encouraged me to look into home modifications. That was my first area of OT that I found particularly exciting, and it stayed that way for the first years of OT school, right up until my Level II fieldwork approached in said field. That was a pretty crummy experience, and I haven't done any work in that field since I left that internship. I had become very interested in intensive rehab for SCI/TBI. I was scared off of taking my second fieldwork at RIC due to the distance and the intense atmosphere, so I settled instead for the Healthsouth rehab center close to home and was on the SCI/Orthopedics team. I quickly learned that team saw FAR more knee replacements than SCIs, so while I learned (A LOT) about how to be an OT, I didn't get to learn a lot more about the specialized treatments for more intense injuries. I have held onto an interest in stroke treatment, and still hold out for another rehab job to learn more of those things. And now I have had my first job for 9(?) months, working acute care, SNF, and peds. This is not a combination that I anticipated, and I am unsure of where I am going.

I was taught never to do things halfway, and to actually go above and beyond whenever possible. (this may be obvious from the previous entry where I admitted to doing something OT related outside of work every week... there are some weeks when I am actually doing that everyday.) I put a lot of work into my previous interests (neuro, SCI, home mods) but didn't spend much time on peds since didn't see myself as 'that type of person.' Now, I'm probably overcompensating, but I would like to think of myself as somewhat competent in my practice area. I've been working w/ handwriting w/o tears materials, the Alert program, and will be going to a sensory processing conference this week (anyone going to Harrisburg?). I seem to have a pattern of going all or nothing with my personal continuing ed, and the switch has been flipped to peds. This makes me seriously question the future.

Do I want to keep looking for peds jobs? Do I want to go after a tough rehab job? If so, do I go the path of neuro or orthopedic? Will I be ready for the intense environment? I know that the experience I am getting is worthwhile... it's important to have the time out in the field and continuing to learn. But I can't help worrying that when I try for another job, I won't have the experience level in their field that would be required. The uncertainties of the future are making it hard for me to plan the present.

I find it appropriate to close with a portion of a well-known quote by Thomas Merton. Best of luck to everyone else as they contemplate personal/professional development.

My Lord God, I have no idea where I am going. I do not see the road ahead of me. I cannot know for certain where it will end. Nor do I really know myself, and the fact that I think I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you. And I hope I have that desire in all that I am doing.

The Cruelest Month

I haven't gone through the official new month process of crossing off the old month with sharpie, so I am still writing about April. I have survived April, and will definitely keep in mind the terrible tricks that this month specializes in regarding the pediatric population. Namely, that everyone needs a letter. At least 5 out of my six 3 year olds are applying to a special needs preschool. Fortunately, I have sensory profile writeups from all of those, but I do feel compelled to write at least a 1 page cover letter to give a little more context. (I am currently procrastinating on one of these right now, which I must finish and fax tomorrow). In addition, there have been annual MD appointments, IEP meetings- it has been a little exhausting, and I don't even have that many patients! I've been looking forward to summer so that I can do some fun things away from work, but with the full weight of the peds caseload, I am now a little worried about the coming summer. It could actually mean a large enough influx of new/returning patients to double my caseload, possibly pushing it to 30 kids. Jeez.

I have had some sad discharges lately. Mrs U was a sweet older lady who had survived an aggressive breast cancer and mastectomy some years earlier, only to have it recur in the same location. She was an enjoyable patient, friendly and motivated. For reasons unknown to me, her family decided to admit her to our TCU and have her restart radiation therapy. I watched her go downhill daily over the course of 3 weeks. Finally, she stood up to the family and asked to end radiation treatment. She went to her daughter's home with hospice care, but left before I said goodbye. I really enjoyed getting to know her, and I hope that she has some peace.

We also graduated another cancer patient who was a treat to work with. Mrs V was the life of our floor. She wanted to participate in every group activity, and compelled the therapists to have more than usual. She made us homemade spaghetti and meatballs. One of the PTAs threw her a party for her 50th anniversary. I saw her at the outpatient center yesterday and I hope that she continues to have a good recovery.

Little Mr W is also on the countdown to graduation. His mother was glowing yesterday... she is certain that he aced his interview for the special needs preschool, and thus will qualify for free school services and get some of the extra socialization and attention that he needs. He is such a little ray of sunshine that I will really miss seeing him each week.

Spring is a time for new beginnings... I just have to get through the endings first.

Always wear your helmet

Title link goes to a Washington Post article on wearing different helmets for different activities. I'm a big fan of helmet promotion and our SOTA had a really fun collaboration with a Harley store to do a bicycle rodeo every year. The store did all the promo work to get kids to come and learn bike safety, and we got to tag along as volunteers and promote OT as well. Anyone else do creative things for helmet promotion?

AOTA update

Skills for the Job of Living has become... Living Life to its Fullest! Despite my exclamation mark, I'm not sure how excited I really am about this development. The sample ad in OT Practice is nice enough, but I don't know that this slogan on its own will really help define OT to consumers. Plus it contains a problematic pronoun plural which is very often misspelled, so I worry about the credibility as this passes into the hands of the general OT public. Of course, if it isn't marketed correctly and heavily enough, none of that will matter anyway.

I'm probably being hard on the "new brand" due to my disappointment in another realm. I was fairly certain that next year's conference was going to be back in DC, just a stone's throw from my current locale. I had already planned to reunite with classmates, enjoy the conference, grab all my CE's needed, etc. But the 2009 conference has been announced... for Houston, TX! Far away and out of reach for me, I believe.

Perhaps this is secretly an unexpected good development. Perhaps my research project that tortured me for so long will be invited to a conference elsewhere, and that would be fun too.

I need to put it in a frame

My first picture from a patient... made the whole day worthwhile and I almost cried :)

How do you build a caseload?

I've been trying to come up with ways to decrease my running between the hospital and outpatient center. Right now, I see peds 3 afternoons a week after working a full to almost full day at the hospital, and it's wearing me out. My husband's idea was to try to build up the caseload a bit so that I could have 2 days strictly peds and that would leave the other 2 days to be strictly hospital. I even think that it would be ok to have peds until 1 or 2 pm, and then just do evals or fill in at the hospital. But to make this sort of schedule work, I would need to drum up my caseload a bit. I'm expecting some patients to return when school gets out, but is there an ethical way to get more? What methods have others used to promote their outpatient business that can be applied to this population? Is it appropriate to present oneself to pediatricians as a CHT does to surgeons? If anyone has any advice in this arena it would be greatly appreciated...

Finally, a little respect

It is OT month, though you wouldn't know it at my facility. Lately I've been feeling pretty bogged down by my coworkers... from the PTA who thinks I'm an activities director to the case managers who complain about OT performance during team meetings. The complacency of my fellow OTs in this regard is not helping, and rather, is wearing me down too. I haven't felt the "OT vs the World" mentality since I was in school, and I haven't missed it. I really enjoy the good collaborative relationships that I had on my fieldwork and still have with some of my coworkers. It's easier to come to work everyday when it's an environment of mutual respect and responsibility instead of latent hostility.

But this week, I got a rare compliment and decided to pass it along to bolster the OT community. Mrs L is in her lower 90's and came into the hospital with a hip fracture. She had done well through the ORIF procedure, but during her acute care OT/PT eval, she had a cerebral event (don't know whether they've decided it was a TIA or CVA) which has affected the opposite side as her fracture. This pt. has an involved family (I've never seen fewer than 3 relatives in her room at any given time) who have placed some strain on the TCU unit but genuinely care about maximizing her recovery and getting her home with their support. Mobility gains have been minimal since her admission 2 weeks ago. But she has really gained w/ her RUE. We've been addressing FMC, crossing midline, and basic grooming activities with this dominant hand. We're now able to start more involved ADL tasks.

Yesterday, we had planned to have a large cooking group w/ 7-8 participants. Despite encouragement, only 2 agreed to come down and participate. (We have others that would benefit but they are on multiple precautions, so that was quite prohibitive.) Mrs L was sitting in a geri-chair in the kitchen/day room with her daughter, just looking out the window. I asked her if she would want to join the other ladies in making some cookies, and she was agreeable to that. Since our group had turned into a very small group, we decided to let the COTA run the group while I ran off to get some evals done. Mrs L's daughter caught me in the hallway, almost in tears, and stated that she was happy with the care her mother had received here, but she was most impressed with the OT department. She said that she really valued the gains that her mom had made w/ OT and was pleased with all of the OT personnel that had worked with the family. This woman actually helped the COTA with the group, to the point of cleaning up at the end, saying, "you guys do such good work, you need to be doing your jobs instead of this. God bless you."

The other inpatient OT and the COTA have done more of the treatments with this woman than I have, but I am so glad that someone recognizes that OT is important and can make a difference.

How does your engine run?

(LGT the Alert Program website)

So this is the question I will be asking my kiddies this week as we begin the Alert Program. I am very hopeful that this will work well for the initial clients in the appropriate age range- Lil Misters M and J, respectively, both 7-8 yrs old. Mr. J is probably close to ideal for this program- he has ADD that has (recently) become medicated and a history of problems in school. He has sensory issues and increased self-regulation has always been part of the treatment plan. He's very intelligent. I'm actually not aware of Mr. M's official diagnosis... he is not verbal, but has a communication device that he strongly dislikes to use. Sensory issues prevail and he has major regulating problems as well. I also have some questions about his overall intelligence... I know for a fact that he does not comprehend the differences in past/present/future.

Since I operate in an outpatient 1:1 setting, I will be compressing things a bit. The first session for both kids will be learning the engine vocabulary, us marking levels together, and an engine level handwriting worksheet (which I made this evening). If there's enough time, we'll make engine thermometers/speedometers and have a 'homework' sheet of identifying engine levels at home. It sounds a little ambitious now that I have it all written out, but that's the kind of plans I come up with. I've had to work hard to squelch thinking about running alert program groups in the summertime- I have a way of getting ahead of myself.

Hopefully this will all start out well. I've been putting a lot of extra time into learning things to use in my peds practice and it's been wearing me down a bit (that and the long unexpected hours, but that's another story). If anyone has worked with the Alert Program or general sensory regulation, please feel free to send some helpful tips. And if anyone wants a copy of the engine levels handwriting sheet, I'll gladly pass that along too.

Don't forget to vote!

Deadline for feedback on RA motions is March 28- that's next Friday, AOTA members.

You can find info about the RA motions in the March 10 issue of OT Practice, or this page which has links to all the papers and reports. You can voice your concerns to your state rep by filling out this survey.

I attended part of an RA meeting as part of my stint as a student delegate. Honestly, I find meetings in general to be pretty boring and this was no exception. I am not willing to learn parliamentary procedure and hash out word by word details of various motions that I find to be soporific. Thankfully, there are some people who are willing to take on this responsibility, but without feedback, they are on their own for decisions. While some consider most of the RA motions to be of no concern, it should be noted that there has been a lot of heated debate on the Phys-Dys listserv about Motion 1. These motions can affect the future of OT practice, so it's worth taking 20-30 minutes to give your rep some feedback about what you want for your future. Do it soon though!

the Downside

So the other major downside of working with both the hospitalized elderly and the school age outpatients is that I have been catching pretty much every cold that has gone around. Flu (despite the flu shot), URIs, head colds... I have had enough! It is pretty hard to time your hospital treatments around the 90 minutes that dayquil is working, and then I had to take a backseat far away from my medically fragile kids. Is my immune system ever going to catch up with this environment?

Dueling Jobs

I work, as some of you know, for a hospital of a smaller city (population: under 20,000). Our entire OT department is comprised of 4 OTs and a COTA and we cover acute hospital cases, short term SNF rehabilitation, and outpatient therapy. The outpatient department has built up a thriving practice focused on hand therapy and work hardening; the inpatient department has its ups and downs of census and minutes needed each week. Different documentation, different mindsets, different world. Inpatient and outpatient are in separate buildings, approximately 300 feet apart, and few employees cross over at any time.

I am one of the few exceptions. I cross over 3/4 days a week at different times due to the (continually growing) caseload. It is a challenge, and a balancing act. I have to be very motivated in the hospital so that I can get my adult caseload seen, but I have to be careful not to be so motivated that I take on extra evals and don't have time to finish paperwork before heading to OP. If I don't, that just adds to my documentation docket for after my 2-5 peds appointments. Other OP people are MUCH better at time management for documentation than I am, but my kids require full hands-on and mind-on concentration during their session.

Since I haven't been able to strike a good balance yet between the dueling demands of the job, I've wound up staying late most nights. As I discussed earlier, I also try to put in a little work each week, reading OT Practice, listservs or relevant books. There is also a lack of balance here, as my at-home continuing ed has been focused almost solely on developing my peds skills. (Or writing up reports for these kids' MDs, as I am today). I worry that I will let my other skills just sort of coast, instead of working harder to be better at neuro and ortho. But I am limited. There is only so much time in the day, and only so much that I can bear to devote solely to OT.

Anyone else have tips from living in this dueling lifestyle? And how on earth does anyone manage to do this when they have a family?!

More support for occupation

The title link goes to a story by the Washington Post about creative stimulation helping geriatric clients stay healthier, take fewer medications and improve their quality of life. It is one of those "common sense" things that we are taught in OT school, but I love to see people outside the profession actually acknowledging the benefits of occupation, even if they don't word it in those terms. I had a hard time recently getting a middle aged woman to understand WHY she should continue to let her mother in law participate in I/ADLs when she would need to be supervised and might not be able to do the whole task. This article seems to be more in reference to activities at a nursing home or adult day care, but it is a principle that we use in practice and has been well validated (SEE: Lifestyle Redesign / USC Well Elderly Study). I know from experience that it can be hard to find funding for OTs to work in an adult day care, and you certainly don't want to be only seen as an activity planner, but occupation can be very beneficial to the participants. There is a thread on the AOTA phys-dys SIS listserv right now running about occupation based tx vs. OTs being UE specialists. Hopefully since my SNF half of my job started slowing down this week, I'll be able to have clients doing some more involved, occupation based things instead of some of the more boring and rote things that seem to happen on a busy day.

OT books

In a random browsing of amazon, I came across this list of "Important Books for EVERY Occupational Scientist." Odd anyway, since there aren't a lot of OT lists, but the author of this is Charles Christiansen, well-known OT author and also the new executive director of AOTF. Admittedly, I've read none of these books, though I did make an attempt at Zen and the Art of Motorcycle Maintenance a few years ago. But I thought that I would share what made his list with my fellow OTs.

Work after hours

One of my coworkers recently was talking about how her parents were accustomed to a 'teacher's lifestyle of leisure' where they left work at 3, had summers off, and did not spend time outside of school working on lesson plans or grades. I thought this was ironic because my father is a teacher, yet he spends untold hours reworking lesson plans, adding technology into the classroom, and generally trying to improve his teaching and the environment for the students. It is uncommon for him to have a day, let alone a whole summer, where he is not working to take things to a higher level. To me, this highlights a basic difference in mindset about ones work. Does your job merely require effort from 9-5? I know that there have been lots of days where I come home from work exhausted, and all I can bear to do is try to make it to the couch or defrost something for dinner. If it's been a particularly stressful day at work, I might not want to even think about going back. But I try to spend some time every week working on something, be it reading OT Practice, looking up some diagnoses on the internet. This is what I see as the difference between a job and a professional career. If you see your job as 'just a job,' then there's no problem if you aren't spending extra time working to develop yourself or your position. But when you become a member a of profession, I feel that you have a duty to yourself, the other members of the profession, and those consumers that are affected by the profession. This duty compels you work on improving yourself and your station for the benefit for all involved. This is why continuing education is required of OTs, because it is a professional duty to continue improving yourself. If you just 'turn off' everyday after work because OT is 'just a job,' then you are going to become stagnant and your coworkers and clients will suffer. There's always something to work on for self improvement- learn more about a new diagnosis, learn a new treatment for an old diagnosis, learn about a new practice area. If you have an expertise, then share it and help others improve. If you stop learning, then you will stop growing, and I believe your practice and your person will suffer as an end result.

Chicken Dance!

I realized that I haven't had very many inspirational stories to share lately, so I decided to dig into the vault to start the week off with a pleasant reminiscence. On my last level 2 fieldwork, we got a particularly challenging patient into our rehab. Ms P had recently had a shoulder arthroplasty, but she had a complicated medical history. She was intellectually disabled and mostly nonverbal. My supervisor was cotreating her with PT, trying to get PROM done on her sore arm, which didn't work out very well, ever. She would resist and scream at them, sometimes she would just get up and walk out of the gym. When my supervisor left on vacation, Ms P's rehab fell to me. I tried a few activities, trying to get her to use her arm functionally since she was so resistant to painful PROM. One day I had the idea to try to teach her the chicken dance. The wing motion would get the shoulder abduction I needed and I substituted in a holding hands motion that got some shoulder flexion and extension. Ms P let me assist her arm through the different movements as we danced and sang in the rehab gym. We may have looked goofy, but we finally had a reliable way to get those exercises done. Always great when you can take a new look at old treatments. Happy new week, everyone :)

Are therapists the worst patients?

I know my updates have been a little rare lately, I have, unfortunately been having a lot of pain recently. Muscles in the low back, upper back, neck and shoulders have all be yelling for some attention lately. This leads me (aka- biggest worrier in the world) wondering what actions from my occupations at home or work have played a role in the pains, whether I'm using bad body mechanics trying to transfer people, whether I'm sleeping wrong, whether my computer station is setup wrong etc etc.

Outside of my worries related specifically to pain, I have started to ponder about therapists who find themselves in the role of patient. It has been well researched that patients do not like or follow an extensive home exercise program. I'd say that there is also a strong anecdotal base at least that indicates that medical professionals (including PT/OT) will often put off getting help for physical ailments in favor of self-diagnosis. I know that this is a habit of mine that I'm halfheartedly trying to break, but it's a lot easier to grab the ultrasound machine and rub it on your knee for ten minutes than to get an official referral for someone else to do it.

But there are occasions when the medical professional finds themselves at the hands of their peers. You've seen the retired nurse admitted to the hospital who often bemoans the current staff. But how does the therapist react to being the therapy patient? Are they more likely to participate, follow their HEP to the letter, and use equipment for ADLs? Do they refuse OT treatment? Or are the largest changes seen after a person has been on the receiving end- do they change their practice in some way after a revelation of what treatment is really like?

The only time I had therapy for myself was in high school, for a twisted ankle. I can recall several exercises that I only did once. At the point that I got basic function back and was off my crutches, exercises became a faint memory. Years later, as the ankle routinely tightens up, I wish I had done the exercises. Yet even now, I know pilates/yoga/therapy exercises that would help my back if I did them everyday, I have a membership at the wellness center and a customized weightlifting plan, I have access to a warm water pool. I haven't (as of yet) started vigorously persuing any of these. It's hard to work out when you are tired after work, in pain, or just want to relish your minimal down time. Hopefully I will break the cycle.