Mind warp

I was very confused when I woke up this morning (about 10 minutes ago). I said to myself, "ok, it's Thursday, what do you need to do?" Then I realized, it's not Thursday, I'm just not working. a little more after the click ->

I think most of the tears are over now. I am trying to get excited about my new exciting job, but first I have to get through the aggravating task of moving. Moving is very frustrating to me for all the questions it raises- How did we get so much stuff? Why are we moving here? Where is this/that/the other in our new place? How will we move again if we get any more stuff?! After seeing the apartment, I know that we have to get more lamps, as there are 3 rooms w/o overhead lighting.I am also unsure how the laundry situation will work out as our washer is approximately the size needed for a week's worth of socks. UGH.

It's also interesting that we are moving into a predominantly Jewish area, judging by the multiple synagogues, kosher eateries, and the "Kosher Assisted Living" across the street. The kosher Subway is down the street, but I think that this is the oddest restaurant that I noticed near the apartment, just for the combination of different cuisines.

Ok, got a little sidetracked from OT things, but this is bringing a change in my OT-ness too. I have 300 unread messages from the pediatric AOTA listserv that I have been putting off addressing since I know I won't be using it so much. Need to unsubscribe from that. I have to get everything ready for my license to be reviewed, since this state only reviews once a month. It's good to take a good look at the license requirements before you give your start date to your new job, FYI. I've done all I can do, now I'm just trying to facilitate other organizations doing what they need to as well. Got to change address for all my subscriptions and such. Very busy in box-town.

Have plenty to update about if I ever sit down to do it. Last week was too emotional, hopefully this week won't be too busy. Have to figure out how to transport my violets, which are fragile and blooming again.

Oh, and free giveaway- I have AJOTs from 2005, I think, to now. I will mail them wherever, if not, they're heading to the recycling center. So if you want them drop me an email with your address and I'll gladly send them to a new happy home.

Chapter 2

I haven't done the late-night blogging entry since junior or senior year of college, especially since I started working and had to start going to bed at a reasonable hour. But I've had a lot of things on my mind of late and can't sleep anyway, so might as well. Go ahead and grab a snack before you click, I expect this will be a long post.


Over the past few months, I had decided to leave my current job. I had toyed with a lot of different choices for what to do next, looked pretty seriously into early intervention, also thought pretty seriously about moving back across the state to where the families are. In a serendipitous manner, many things came together to lead me to pursuing a new opportunity at a hospital in Baltimore, and that will be my new home shortly.

Like many of the children I have worked with, I struggle with transitions. My husband prodded me into completing an initial application, I was eager for an official offer, but now the emotions are in full swing. I am having a hard time adjusting to leaving, a lot harder time than I thought I would. I entered this job knowing that my time would be transient, but the attachment got well formed anyway. I've had the pleasure of working with several intelligent coworkers who have taught me some of their tricks of the trade and helped me see where my education was lacking. The group of inpatient therapists who've been working together for 20 years and more have worked hard to help me be less stressed by the job. It's taken awhile, but I feel like I have good friends that I work with, and boxing up those cards and photographs is really hurting... more than leaving high school, more than leaving OT school.

Though the decision to leave was fully my own, and did not make (most of) my coworkers happy, I believe it probably prevented some tough times for the department. Our SNF unit had a massive audit several months ago and we had all been waiting on tenterhooks for the professionals' suggestions to improve the quality and profitability of our unit. I was actually looking forward to this as I saw it as a chance for us to make some really positive OT changes. However, the powers that be have decided that it is best to shut the unit down within the year. A lot of really superb nurses and techs are out of a job and the rehab department is going to have to do some restructuring for things to stay copesetic. This all got announced the day before I gave my notice, and I think it contributed to my pregnant coworker deciding that she would leave as well. The future is still uncertain for the world of inpatient therapy... will they decide to make a very small inpatient rehab facility that can hopefully be more profitable? If not, the focus turns entirely to acute care, and it will take some major marketing before that can sustain the current employees for a full time workweek. I'm kind of sad that there's finally some change taking place and not only will I not get to be part of it, but my opinion in the matter is a moot point. All the changes are theoretical now though... no telling what will actually happen or how stressful it will be to get there.

As mentioned, my COTA coworker is leaving too. We were the entirety of the pediatric OT treatment team. Leaving the kids is literally tearing me in two. I would not have held onto this job this long if not for the kids. Pediatrics is the area I had the least skill and experience in when I started the job and it's the area that I have invested a lot of time in so that I could grow. And I do feel that I have grown as a pediatric therapist... I feel a lot more confident now in an evaluation, in spotting sensory processing problems, and in planning treatment sessions. I have spent numerous off the clock hours writing up sensory profiles (though I didn't get them all done today), reworking the computerized evaluation, and scouting the bargain stores for the perfect toys to elicit the just right challenge.

I have learned so much from the group of kids and parents that I have worked with, and have really become attached to them. I told Bob (a parent) at one point that working with his child and 2 specific others that are long-time consumers was very grounding for my life. No matter what else was happening in work, I could count on those specific 30 minute sessions to give me a routine that was often more fulfilling than the rest of the day, week, month. I have been worried sick about leaving the kids, especially since there will be a limbo time between therapists. My coworker talked about feeling territorial and resentful when an interviewee was brought in recently, because she didn't want to be replaced. I think I would feel better if I knew that there was someone starting right when I left (instead of 3 months later) and that I could talk to them and show them where everything was and present what I'd been doing with the kids and know that they would be ok, that there was someone to take care of everything after I go. I know it sounds terribly narcisstic- they will survive just fine without me and many will never remember me- but I just wish I could be assured that they would all be taken care of. In a selfish way, I also wish I could know that all the parts of the program that I have tried to build up would continue to build and not crumble. I don't want to feel like everything I did will be erased and of no consequence.

I don't worry about the adult patients in the same way. There is a revolving door on the hospital, many will be back again, and there will be a time that they don't recover. That is just something that I think you have to accept when working with that population. I do worry that with the shuttering of the transitional care unit that there will be people who get unwillingly pushed into a 'nursing home' stay and get very upset by that label. There were a lot of people who refused to go to an inpatient rehab facility or a long term community skilled facility until they had given rehab a try for a few weeks on the TCU floor. We took in a lot of joint replacement patients who would not meet requirements for an IRF, and who knows how many complications were prevented by allowing these folks with 'basic' surgeries a few extra days of supervised recovery. Enough that the orthopedic surgeons are not happy with the decision. To sum up, I worry in general about the adult patients, but their stays are so transient that I usually only worry my mind over them specifically while they are present or just recently discharged. There's no one adult who's fate will keep me up at nights, hopefully they will all be taken care of well despite the current flux.

There are other things I will miss... my COTA coworker gets more pregnant by the day, which is amusing and interesting, and I probably won't hear much about her baby. The SLP is finally getting settled into her humongus house, and I won't get a repeat visit there. Other babies are growing, my pediatric PT buddy is just coming off a honeymoon, my acute care PT buddy is growing a business and buying a house, there's a lot of personal things that I will miss. During my time here, I was able to see that when other employees left, their shadow did not remain... their names and antics were forgotten. It does hurt to know that people you've been close to will not remember you, and if they do, they will probably not care that much about the course of your life. It's normal, I know, because how could any person function if they were weighed down with the irrelevant future of every person from their past that they once were close to? That's why we facebook people we went to elementary school with, instead of writing detailed letters to them.

2 goofy things that I will miss:
- I am a number freak, always watching my car odometer and clock for palindromes and other patterns. It has always brought me a distinct feeling of success when our medical record numbers grows by a hundred thousand. I started working with people who were in the 1960000's, recently I have had a pt who had a 1999000 number. I will be really bummed if I don't see someone in the 2 millions.
- After a winter of carefully watching my step and dodging the nastiest smelling berries (?) from a tree in front of the door I use twice daily, hoping that I didn't step on one and bring the stench of vomit in on my shoes, they finally cut that darn tree down.

I know I am blessed to be leaving on my own terms, to another job, where my husband can keep his job, especially in the current economic situation. Truthfully, though I had talked of going home, it would have made it very hard to find 2 new jobs and a new place to live and go through that kind of transition in a recession. I likely would have had to be the sole provider for awhile, and I have seen the stress that has put on my coworkers. I wasn't forced to leave due to cutbacks, terrible treatment, or a need for more money, and I am thankful for that, and know that I am a little spoiled to be worried about these insignifcant things at a time when others are worried about having a job at all.

I feel that I did make the right decision, though it was very hard, and is making me do hard things like move, learn new things, and start all over in a big city. I will get some good opportunities at the new hospital, and be able to rotate to different areas every 3 months or so, which should help quell potential boredom/burnout. I will get my chance at a 'big place,' without having to move to Chicago, Atlanta, LA, etc... and see if that, which has always been something that I talked about wanting to do, is actually something that I enjoy doing. I will be able to get some more critical cases as city hospitals do get more of compared to their rural counterparts. I will get to be part of a large team of therapists who seem to be committed to personal improvement. Hopefully they are not reading this and wondering what kind of neurotic person is joining their team... I'm sure they will all find out soon enough firsthand. :-P

I do feel better now that this is all finally out in the open. I'll still be emotional, but hopefully the thoughts will slow down in my head enough for me to get to sleep. My last day at work is next week, I will follow that up by moving, acquiring a new OT license, and starting Chapter 2. Wish me luck.

I live in the Procrastination Station

I am up to my eyeballs in stuff to do... need to be writing up 2 sensory profiles and 2 sensory diets for Monday and Tuesday. Have to leave town this weekend, which will make that harder. Lots of other things to do, but I feel that shouldn't really be discussed until I can write a major entry here, which I have also been putting off. I have difficulty with transitions, and currently with organization. My thoughts have also been very transient, jumping to inane topics such as how death is dealt with in Dexter and Pushing Daisies, 2 shows that I like and which have nothing in common.The randomness and procrastination are possibly my coping strategies for stress, but it's making it hard to do what I have to do. Hopefully I will get all I need to done (finally) and can address some of these important issues soon. It's 4... can I get that stuff written up by 6? I hope so...

Energy Crisis

Made it back from Florida alive... my husband caught a lot of stuff while we were down there and I am still dealing with some sinus stuffiness and feel like my ears are all plugged up. Between taking care of him and working an exceptionally long Tuesday, whatever brain cells made it back from vacation have been more than occupied. I have some major things to write about, but have not been formulating sentences very well. (true example: "we am canceling my membership") For someone who is internally outraged when there's confusion over your/you're or their/there/they're, it's been more than a bit frustrating. I will update soon, once this mental problem is resolved and the pile of Sensory Profiles is graded. I did at least 1 intelligent thing yesterday though... saw in the nurses notes that a man who had a knee replacement and had later had some cardiac issues had a bad night and asked the COTA not to see him that morning... he wound up in the ICU later that day. Yikes, but at least we didn't push him into it.

OT WebGems- Manipulate the Brain Edition

I love brain stuff. Here's a few pieces on how that great organ works and changes, also a couple of behavioral modification pieces thrown in.

Starting off, research shows that even mild concussions can have effects years into the future, which has got to be troublesome news to anyone involved in contact sports. Go go helmet developers!

An fMRI study looked at how older and younger individuals processed negative images, and the researchers concluded that the older women were able to cope with these problems better. So hopefully one can become less stressed over time, that's what I'm hoping for anyway.

This piece has been floating around my bookmarks page for a long time (note that the subtitle discusses the election season) but it's an interesting look at irrational behavior and why humans take offense.

Researchers at Johns Hopkins found that controlled doses of carbon monoxide can prevent damage after a stroke, which makes sense after hearing about it, but who is smart enough to think this up ahead of time? Still seems to have a short window to operate, but I love seeing the new advances.

On another stroke note, here are some of the gender differences in care before and after CVA.

This was an interesting study involving deep brain stimulation in patients w/ Parkinsons, which I found fascinating.

Behavior modification is always useful, not least when used on ourselves. This article discusses how the fear of being labeled a hypocrite will lead people to make lifestyle changes. This ADVANCE piece discusses the benefit of actually accomplishing things even when they're hard. And this is a more detailed piece, also from ADVANCE about learning emotional awareness and control.

That's it for today, as my brain is currently hoping for no micro-trauma from roller-coaster riding!

Shoe Tying

I saw this "Rubes" cartoon and had to laugh considering the amount of time that I have spent working on other people's shoe tying skills. My little boy with dyspraxia continues to struggle... I don't even attempt it every week since I don't want breakdowns every week. I have been to this site on shoe tying, but continue to struggle. I have tried the 2 loops method, the 1 loop wrap method, and have tried teaching an alternate way to make loops (weave lace under index finger, over middle finger, under ring finger and then squeeze ring and index finger together). I also routinely do knots using wikki stix with 2 differently colored stix, but this doesn't always transfer to laces.

It's a struggle. I love the new Sketchers shoes that have the elastic laces and just slip on- little miss S has those and some velcro mary janes and I think they both rock. She has autism and is always super well dressed, but part of that is because they don't have to worry about laces.

Anybody have an absolutely FREE method for shoe tying that works?

OT WebGems- Geriatric Issues

I am by nature, a total packrat in real life. I am even worse on the internet, as my bookmarks folder is now overflowing waterfall style! So here come the WebGems- with a focus on geriatric issues.

First off, some good news- TKRs do improve I/ADL function for elderly individuals! So it will be worthwhile in the end- but remember, it will HURT!!

This an ADVANCE piece on Elderspeak. It can be a hard habit to break, and usually requires me to write down all my patients' names until they're familiar to me, but I think people respond better when talked to appropriately. Different facilities have different policies... when I was on my Level II's we were on a first name basis with all the clients, to the point where one place had first names, last initial, on all the wheelchairs. At my current employment we're supposed to use Mr/Ms Last Name, but usually when I ask people what they would like to be called, they give their first names. My only confusion has been with having priests as patients... the ones that I have had (who knew each other, ironically) both asked to be called by their first names, but then I got dirty looks from people who thought I should be addressing them as Father X.

This Medline article implies that they're getting better testing for evaluating a person's driving ability. (Hope it's better than the Portoglare!) No mention of OT driving rehab or Carfit. This test is pretty extensive though, and the main problem is that they're describing it as a test for people with Alzheimer's Disease. It would be hard enough to get a person to agree to take this once, but they're certainly not going to want to keep taking it every year to satisfy that they're capable.

In other AD news, there are reports of a lot of caregiver abuse. This should add to the case for better respite programs and support systems for elderly aging in place and caregivers in general.

Romance is an issue from birth to death. This editorial reflects on falling in love after aging. And this piece is an interesting look at love in an ALF and the complications involving the family and staff.

And lastly, this editorial by an internist looks at how complicated it has become to die in a world of MPOAs, full codes, and feeding tubes.

Vacation!

If all goes according to plan, today I am boarding a flight for Florida! Hello Disney! Relaxing days of sun and fun! I have scheduled a few entries for the break, but won't be my usual speedy self at replying to emails, approving comments, etc. Supposed to be 80* on Saturday... yum!!

Caution! You have computers at work!

A brief cautionary reminder

I consider myself fairly 'tech-savvy' but I feel that I am sort of on the upper age bracket of the facebook generation. To be more specific, I grew up with computers, had the internet and IM through adolescence, but was already old in techno-world once myspace and facebook came along. But this is a relevant topic for anyone living in the computer age, because I think we all take the machines for granted.

Everyone familiar w/ computers knows that emails, IMs, blog posts, etc can live (basically) forever on servers and be accessed later by other parties. Most everyone has a tale of someone seeing something they wrote that was never intended for their eyes, with embarrassing consequences. At work, they can be more than embarrassing. Any employee accessing a work computer nowadays has to sign an agreement about what can and can't be done on that computer. Most companies have filters that prevent you from accessing certain websites- our hospital has a particularly annoying filter that blocks anything with the word "store" in the title or address, which makes it really hard to print out pictures of devices for our patients. You can get in trouble for coming up against the block too often, though fortunately I haven't.

If you have access to medical records on your computer, then confidentiality agreements and especially HIPAA hold you to a certain standard for how you access that information. You will undoubtedly sign contracts that indicate that you will only access the charts which you NEED to know medical details about. And to ensure this, your facility can do an audit at any time, of any chart, they will also do this if there is a specific complaint of someone breaching the agreement. While any chart can be audited, charts belonging to other workers at the facility or VIPs are more likely to be checked. A coworker recently got written up for doing what a lot of people do- looking up records on family members. No OT orders, so no "need to know," and a violation.

Another tool that can be used is a keystroke recorder. That means that ALL your emails can be monitored and reread, that the website addresses you enter are all recorded, anything. A friend of mine who works in a non-healthcare industry recently had a problem with this and lost a job. What was the offense? Typing an offensive word, and then deleting it. That's right, no clients or bosses saw this typed on any papers or walked by the computer screen, and it was still enough to lose a job.

So be careful, because it's not just probability anymore, at least not in my world.

ASD on TV

Thoughts on a couple of TV shows

I recently read an article about one of my favorite new TV shows, The Big Bang Theory. I have been watching this show since its premiere, partly because I am admittedly dorky, friends with others who share my dorkitude, and married to an engineer. I know those guys on the show through my interactions with my friends in college and love that the show isn't making fun of geekiness, but making it fun to be geeky! In the article that I read, they were debating about whether Sheldon has Asperger's Syndrome, and apparently there is a large following that believes it is so. If you're not familiar with the show, check out his flowchart for making friends. It's not something that I had given a lot of thought to while watching, because I just considered each character an exaggeration, and it is often thought that 'typical geeks' have several spectrum characteristics without a diagnosis. Is Sheldon diagnosable? Almost certainly. Is it purposeful? Chuck Lorre says no, and that's believable. We're all a little bit on the spectrum... I took this quiz (no endorsement, just the first one I found) and came out favoring the autistic side more than the 'neurotypical' side, which is probably no surprise to anyone who knows any of my numerous sensory issues.

Another show that I have just started watching is Dexter. He is a sociopathic killer who has a day job at the Miami police department. Dexter has severely decreased emotional responses, usually nonexistant. He likely has antisocial personality disorder, though he goes to great lengths to fit in. It has been comical for me to watch his foster father teach him how to fit in, how to pretend, how to be one of the crowd. Halfway through season 1, he has absorbed the instructions to fake social skills pretty well though he does give off some telltale signs of personality disorder that the rest of the cast conveinently ignores. I suspect he has a few additional undiagnosed issues, possibly some OCD, or his attention to detail might be significant of a spectrum disorder.

Not that I think you'll see OT on TV anytime soon, but it is interesting that we are getting a broader range of characters on shows. There was a pretty cool poster presentation at the '05 AOTA conference about disability as presented on TV and movies, you can find many of those movies here. Have you spotted any TV/movie characters that were displaying significant symptoms but not 'outed' as having a disability?

Smarter than I look!

Finally figured out how to join groups in OT Connections... I feel so much better now. When I clicked on the name of the (private) group on someone's page, I kept getting "you are not permitted to access this page." Had to click on "view all groups" on the right column and then go through the pages to find mine, and then click "apply to join." I'm glad I don't feel technologically impaired anymore.

Wild in the Halls

There is a not-so-well-known, not-so-good movie called Wild in the Streets for which the play on words for the title is from. In the land of that movie, my day definitely would not have happened since the elderly were shunted off into communes, but since we don't really live there, feel free to continue reading about the craziness that has been Wednesday.

Wednesday starts for our purposes when the evening nursing shift came on at 7pm. In 12 hours, Mr. L will cause enough disturbance that there will be 15 different nurses notes written about his exploits. He will be found wandering in the hallway carrying a sheet and/or the room's courtesy curtain. He will dismantle 2 bedchecks, take the bolts off a geri chair, and also climb out of a geri chair with the tray attached without a scratch. His mini-mental scores are stable, at the very lowest regions of the Moderate Cognitive Impairment range. He has been speaking very tangentially, somewhat in nursery rhymes, and has identified our president as "Muhammad." He has been very emotional and has yelled at the PT several times this week, today he was pleasant with me for 25/30 minutes while he petted his dog (not a real dog). Mr. L decided to take a walk while I was present, and I barely had time to throw a walker in front of him and couldn't get to the gait belt... had to walk side by side with my arm around his waist to keep him on his feet. He has been in this fugue of confusion since his most recent surgery- he has no history of dementia. Hopefully someone can figure out a cause and reverse this process.

Ms I is 96 and has advanced dementia with the delightful combination of severely decreased vision (macular degeneration) and decreased hearing. She is disturbed by visual hallucinations and is terribly frightened of being left alone. She has been in a geri chair by the nurses station for the better part of 2 days so that she has 'company.' She started sundowning today really badly, calling out in a cat voice about being left alone during shift change. Her new roommate has had cancer and uses a kerchief to cover her head. Roommate said to me that Ms I thought she was a man when she took off her hat, but roommate was perplexed, since Ms I wears a wig and/or kerchief too. Roommate told nurses at some point last night "either give her a tranquilizer or give me one."

New admit today... (I forget her name, I did 5 evals this afternoon and hers was the last at 415) we'll call her Mrs T who also has dementia but is oriented, sees Ms I in the hallway and during those 5 minutes that they were around each other Mrs T got at least 75% more confused. I did the home safety cards with her yesterday, she had some interesting responses. She could spot some of the simple stuff, but when I asked, "Should she take this medicine that expired 10 years ago?" she didn't really know. This lady has been in acute care and thought that she was going home for the past 3 days... hope that she adjusts ok to the SNF floor. She may have to adjust to placement, but we'll hope for the best.

Twice I had to intercept the same pt. in the hallway this morning... once he was pushing a chair out in the hallway ("to get it out of the way") without his oxygen when he should be wearing 4 liters. He has no diagnosed cognitive impairments but lacks insight into his deficits and consequences. We barely made it back to his room without falling, and he made a grab for the curtain and I thought we were going down for sure then. 20 minutes later, I walk by and he hands me a "sputum sample" on a piece of gauze. The nurses didn't want it, I certainly didn't want it... BLEH.

Bad enough to have seriously cognitively impaired patients that require constant supervision for everything... adding in those who are just overly demanding or lacking in insight has made it hard to get much done. Did manage to discharge a couple of patients today, which is fortunate, because this has been a difficult week for the nursing staff and for meaningful therapy interactions. I have some time off, followed by some more time off soon, so hopefully everything will be on the upswing.

On a totally random note, I consider myself pretty "with it" in terms of technology, in fact, I am the resident computer dork of the rehab staff. (Fun fact- I had my first website when I was 15 and still remember random pieces of HTML code) I have a facebook account and utilize other internet technologies with ease, but I am having major difficulty figuring out OT Connections. I can't seem to join groups and am not finding other people that I know are on there. Perplexing. Also, I do continue to have issues making the cut links work well on this blog, but I am working to fix that since it makes my main page look all weird.

New Toys!

Thank you Civitan Club! Our grant went through, our fun new products have arrived and the response from the kids is overwhelmingly positive! Hooray!

First- Sensory Profile... so long overdue. Handed out 2 long and 1 short, next week will be quite busy with writeups.

Second- Ball Pit. Not a huge one, but large enough for one child. Balls plus tough foamy noodles that are nice and resistive when squeezed. Little Miss S, one of our regulars who has autism got to encounter it today. She is largely nonverbal and has difficulties w/ any purposeful expression, but one step in the ball pit and she instantly said "WHOA" with a great big grin on her face. It was super cute. We will need to make a cover for it to keep it out of sight and out of mind... does anyone have cleaning procedures for an inflatable ball pit? Hand scrubbing 500 plastic balls does not sound like a good time to me.

Third- Bolster Swing. This has been universally loved by all who have experienced it, but especially by those with low tone. Same little miss S had great posture while straddling it, and then in prone she calmed down better than she ever has from any other sensory technique. After which, she donned her shoes independently FOR THE FIRST TIME EVER in clinic. Shoe donning is usually where the session falls to bits if it hasn't already. What a sweet success. Also, the bolster can be adjusted to where it is just taller than the peanut ball, making a steamroller, which is almost as worthwhile as the swing itself.

Also, I started a book that I should have ordered a long time ago- Is it Sensory or is it Behavior? It has been worthwhile thus far and I hope to really gain from this. It is so frustrating to not know exactly how to respond to parents about different behaviors. Will share any cool tips from that one... been a little slow on the updates lately.

Never.

Never write anything on snow. You will be inundated by an ice blizzard and be the only therapist for the entire hospital. If you survive, you will definitely regret writing about snow.

OT WebGems- Snow Driving Edition

I loved snow days as a kid (who doesn't?) but as someone who spent an extra hour today scraping the windshield before and after work plus the 'commute' I am not in such a friendly mood toward snow. (I do prefer it, however to the days where I go to work in the dark and come home in the dark.) At any rate, snowy days always seem to make you realize how many people don't know how to drive in the snow. I was going to list my favorite tips, but why reinvent the wheel. After the jump are some good little tip sheets on snow driving, PLUS my addition of the #1 to #3 most needed tips.

Sorry, no cute writeups today. However, as promised, the tips that people really should remember:
#1- If you don't HAVE to drive, then don't. If you work outpatient, call and see if you have cancellations, or tell them you can't make it in initially. If you do home visits, such as early intervention or home health, cancel in bad weather. Even if it will be difficult for your coworkers, trust me, they'd rather have you late than dead.

#2- Learn to drive by practicing. It should be part of everyone's learn to drive experience to take the car into a snow covered parking lot and learning how to handle the car. Practice the tips in the following articles, figure out how it feels when the car skids so you don't panic.

#3- Drive on main roads. Surprisingly, this tip is not included in the other articles, and perhaps they were written in more urban areas. If you can avoid a backroad, even a lesser used road in town, by taking a more frequented (also hopefully flatter and wider) path, then you will likely have less difficulty.

http://www.edmunds.com/ownership/howto/articles/45193/article.html

http://www.weather.com/activities/driving/drivingsafety/drivingsafetytips/snow.html

http://car-reviews.suite101.com/article.cfm/how_to_drive_in_the_snow

http://chicagoweekendfun.com/2008/12/01/how-to-drive-in-snow-and-ice-chicago-winter-blizzard-style-winter-driving-tips-saftey/

http://www.safemotorist.com/articles/winter_driving.aspx

Mini Sensory Success

I am seeing a 3 y.o. girl with PDD who is wonderfully high functioning and has very involved parents. She has some sensory issues and particularly HATES having her hair brushed. During our session, even though she was hyped up on sugar following speech therapy, after some deep pressure through shoulders and head (GENTLY, GENTLY, GENTLY! HAVE AN OT SHOW YOU FIRST!) she sat there and let me brush and do her hair. Then we took it out and had mom repeat the process w/o difficulty, and mom was really happy to have learned something she could directly apply at home. If kid and parent leave feeling happy and more knowledgable, then I feel like I did my job well that day.

Giving an Inservice

I got an email recently asking for tips on picking a topic for an inservice presentation, which is usually a requirement for students during fieldwork. Here are some tips.


Selecting a topic- some sites or supervisors will save you the thought of this step by already spelling it out in your fieldwork documents, usually in the form of "You will do a case study." Otherwise, you will have to choose. My advice is to pick something that falls into one or more of these categories:
-Something you are interested in
-Something you would like to learn more about
-Something that your coworkers have expressed interest about

If you do a case study, pick out one special client and tell what you did that was special or innovative to their treatment. If you helped to develop a tool or a really different treatment with any client, overcome a difficulty in their treatment that you didn't think you could, that's a good case study.

If there's a frame of reference or new treatment idea that you learned at school that your coworkers haven't heard of and haven't had time to research, that's always a possibility. Some places still haven't been exposed to the practice framework language and are continuing to use uniform terminology. An update on the new language with examples of how to apply that to documentation is a good way to bring your site up to speed.

If you get a lot of clients with the same diagnosis, try to find a systematic review of the evidence and then showing how that research can be applied to client treatments. That would be helpful as many practitioners don't have or make the time to do evidence searches and often don't have access to all the awesome library resources you do as a student.

Other planning tips- take note during other students' presentations, as well as those done by paid workers. This gives you a better idea of the kind of presentation expected- do they want a full powerpoint or just an informal discussion? If you can't discern this from observation or asking your supervisor, then opt to be more formal.

It's good to plan on technological mishaps. Be able to give your powerpoint presentation in an effective way even if someone breaks the projector the day before. Minimize potential malfunctions by being familiar with the hardware (your computer or the staff computer, the projector, etc). Remember that powerpoints created on newer versions of microsoft office don't play the same on old versions- a better option instead of just opening the file from a disk or thumb drive is to Pack and Hold your presentation to a CD. This enables you to drop the CD into any computer (I don't think it even needs office on it) and your presentation should run just fine.

Don't forget to leave time for questions... I've found that often people don't have any, but if they do and you don't address them, it could lead to a poor reception of your overall project.

Above all, be relaxed and confident in your information... an inservice is usually the sign that your fieldwork is drawing to a close, so just think that you are addressing your colleagues instead of being graded by a supervisor.

Before you go go

There's definitely an adjustment period to working in a hospital. Figuring out all the codes to the different supply rooms, learning the tricks to manhandling trays and hospital beds... it's those kinds of skills that come with practice. But until it becomes second nature, you still have a lot of things to check at the end of session. Here's some things that you should remember to check before leaving a pt after a treatment session to keep them safe and happy. Applicable to hospital and SNF rooms, a good checklist if you're new to the environment.


Ideally, you should just be reversing everything from your session so that the person is in the same condition as you found them, however, it's good to remember these things as there are often moments a person is without a crucial item.

• Bed brakes locked, bed height lowered
  
• Top 2 siderails up (some facilities have a policy against this, mine is all for it. If your individual had all four rails up, recreate that)
• Bed/chair check applied (as applicable)
• Tray table either parallel to bed or across pt's lap (helps keep everything within reach)
• Call bell in reach (can tie to bedrail or clip to sheets)
• Phone in reach, attached to bedrail
• Urinal in reach (I try not to put these on the tray... germy)
  
• Restraints applied (as applicable- generally if the person has UE restraints I only have one arm out at a time. Also remember those bedrail covers)
• Abduction pillow and other braces applied (as needed)
• Oxygen on person and turned on at wall (as applicable)
• Empty BSC or bedpan if it was part of your tx
  
• Any changes in status or other requests reported to nursing

That's about all I can think of now... it's actually easier when in the room instead of at a computer. If I forgot something major, just add it in the comments.

I shall return!

Ack, sorry about the delay in postings. It is a goal today to post about the job site eval I did (once I finish writing it up!). I also have 7 partially written updates, and one really important one that I need to get written, and they will be finished at some point. Have to go run some errands now, but I will get back to blog life soon. :)

Hopefully prepared

Tomorrow is my very first jobsite analysis... hopefully I am fully prepared. Have read up on diagnosis, reviewed info on repetitive strain injury, and taken notes from my old textbook "Ergonomics and the Management of Musculoskeletal Disorders" (this is why you keep the books). Have to make copies, get camera, get measuring tape, and find a goniometer before meeting up with my worker at the far too early time of 730 am. So it will have to be an early night... wish me luck!

Some new unexpected opportunities

Past few days have brought about some new unexpected opportunities (TITLE ALERT!).

Our current SNF floor crowd has several back breaking patients who are MAX-DEP A 1-2 for bed mobility (none of whom have actually made it into standing yet). Hopefully my body mechanics will go well... I have some proprioception impairments. We've also got a fresh batch of people who place a high priority on their naps, instead of rehab. Another challenge to productivity. :-/

My one coworker who has been the resident expert on FCEs and work hardening (much to his chagrin, as he is also the resident expert on hands. and lymphedema. and thus, rather busy) casually mentioned that he had a worksite evaluation to do as a courtesy for another hospital employee. I didn't even know that we did that! At any rate, I have had an interest in ergonomics and other work hardening things, and this is a cool easy way to dabble in it a little bit. I know that I can't do FCEs and the pediatric tx at the same time... I think it would put me into some terrible personality issues going from one extreme to the other like that.

Also, I have decided to add a new little feature in here. Energy conservation/work simplification is one of the relatively few things that I enjoy about the SNF environment, and I have a lot of good tips for multiple situations since I use so many myself. So look for up to a dozen pieces in the coming year on energy conservation in different situations.

And in the "I knew it was coming, but now? Already?!" category, my one coworker near my age (actually a couple years younger) announced that she is pregnant(!). And for the moment she says that she'll be sticking around through the delivery and afterward as well, so it will be interesting to work so closely with someone as they go through this life transformation. I've never really had that kind of close contact with someone for the day by day updates. My first fieldwork supervisor was 6-8 months pregnant during my time with her, and it did not slow her down in the least. It'll be interesting to see how this goes with my coworker, and to theorize how it could go in my future... far future, preferably!

Success Stories

Therapists, parents, teachers- Have some pediatric success stories? Your Therapy Source Inc is soliciting these for inclusion on their website and possibly elsewhere. Feel free to share here.

ALSO! Please fill out the poll on the right by picking your favorite features you'd like to see more of in 2009, and if what you want isn't there, drop it in a comment or email.

An Unwelcome Challenge

I consider myself to be socially conscious and try to donate time/money/items to various program that assist those in need. But a recent event over my break challenged some of those concepts in my mind.
So owing to a 1-time forgetting to lock the car doors, someone decided to hop in our car and smoke a cigarette and take a few items. There was obvious rummaging through the glovebox and some in the rest of the car, wiped dog poop on some not-so-important papers. It is significant to note that since we are so fortunate and do have many things that it took us awhile to figure out exactly what had gone missing.

The final tally appears to be:
-Some food (crasins, miniature candy bars, lifesavers; the cookies from subway remained)
-Shelter (a sleeping bag)
-Some really random stuff (Led Zepellin CD, headphones, sunglasses and holder, and my husband's rx glasses)

Fortunately, we didn't have any money taken, wallets were in the house and even the spare change remained in the ashtray. And the only Christmas gifts that were taken were the CD and the candy bars. Nothing was of sentimental value and the most expensive pieces (glasses and sleeping bag) will not be an undo hardship to replace. However, there is the feeling of having your security violated. I had already been a little on edge since I had narrowly avoided a pickpocketing/purse snatching before we left on the trip. I don't consider the towns that I live in to be dangerous (or at least THAT dangerous) and it's a rude awakening when an unfortunate event that so often happens to others hits close to home. I was also struck by the random items that were taken, and I question how they can be potentially useful to someone. The lack of logic just confuses me, I expect rational behavior from others.

I was hurt by the fact that this did happen at Christmastime... also because I do routinely reach out and try to help those who are less fortunate. My husband and I participate in charity for our church, the salvation army, goodwill, coats for kids, planet aid. I used to be part of a school of medicine outreach to the homeless. I guess I felt like I deserved not to be affected by this kind of crime due to the charitable actions we take. But I was thinking about this today, and I guess that if there is one person in the community, country, or world that has to resort to theft to meet their most basic needs, then there's obviously more that we all should be doing. And this is relevant to OT as every OT (really every person at all, but everyone in the profession founded on helping others maximize their lives) should champion social justice causes. There are very few among us who cannot do more, and likely very many that just need to do something. Plenary sessions at previous AOTA Conferences have focused on OT and community involvement, and it is something that I believe our profession could easily reach into. But until then, we'll just have to do what we each can to try to help.

Shower Remodel

So one of my first OT moments while at home was at my grandmother's house. She had a tub to shower conversion done about a month ago to replace the 19 y.o. metal stool she had been using as a tub chair. Sounds great, but there is more after the link...

this is what the new shower looks like-

and in theory, it is the 100% solution. However, my gram is 5'2" and only her toes can touch the floor while sitting on the built in bench. She knew this when the guy was installing, but he said it was as low as it could go and he couldn't do anything and there wasn't anyone there to make a suggestion. My thought was that during the install he could have rotated the seat 180*... this would have kept the piece aligned with the studs, and though we would have lost a small shelf, it would have lowered the seat. Where it is now prohibits the use of any other shower chair, especially because the rest of the floor is slanted for the drain. I really can't think of what to put down on the floor so that she can gain some more stability and not slip off the seat. We thought of those shallow crates they use for 2-liter bottles, which are about the correct width to fit in the shower base, however those things would hurt your feet!

So I'm calling out to the OT world, especially those who are in home mods- how would you fix a shower that's supposed to have already been fixed? I can't think of the solution- what do you think?

The return!

I am back from my whirlwind holiday trip around the state, visiting with friends and family from afar. Ate lots of delicious foods (hopefully did not upset my chances in the "Maintain, Don't Gain" holiday challenge at work), watched lots of college football (after a promising start, I am definitely out of the running), and generally just enjoyed the down time. Very little computer time, and that was good too.

You can never take a full vacation from OT though, so my little brain wheels were turning throughout the time. Lots of thoughts related to the family and using OT to help them, some of which I will share as I catch up on updates. Also been thinking a lot about my personal career path... directions that I want to take and changes that will have to be made.

My shoulder is trying to act like it's going to get that impingement pain again, hopefully it will not so that after the unpacking and cleaning I can continue to have some computer time. Hope to have updates soon, depending on amount of work to do at home and amount of total procrastination :)