To help keep myself accountable to keep reading AJOT on my metro rides and have an easy way to track what I have read to prevent another NBCOT renewal panic attack, I have decided to do little write-ups on the articles I read. To best facilitate this, I've decided to create a feature! Having a feature makes me feel more like a "real author," like I wanted to be as a kid. This is only bimonthly, so hopefully I can keep up with it and also help schedule some posts. If this is a feature you'd like to see more of on the blog, comment or email and let me know. Read on for the overview of what I've been reading, be warned, it's long.
AJOT January/February 2010 (members only link)
Research Scholars Initiative--Randomized Controlled Trial of the Breast Cancer Recovery Program for Women With Breast Cancer--Related Lymphedema
Marjorie K. McClure-OTR/L, CLT--LANA, Richard J. McClure-PhD, Richard Day-PhD, Adam M. Brufsky-MD, PhD
-- I was impressed with this program as it didn't seem complicated, and it could probably be easily reproduced in other hospitals or outpatient centers that have an oncology service and a therapist providing lymphedema service. Unlike some support groups, since this one is structured around exercise, it seems like it would be relatively easy to schedule.
Telerehabilitation and Electrical Stimulation: An Occupation-Based, Client-Centered Stroke Intervention
Valerie Hill Hermann-MS, OTR/L, Mandy Herzog-OTR/L, Rachel Jordan-OTR/L, Maura Hofherr-OTR/L, Peter Levine-PTA, Stephen J. Page-FAHA
-- I thought this was cool since I haven't used the FES-Nes for CVA rehab but have been curious about the product from the ads I see. This looked like a promising pilot study for tele-rehab, hopefully this was all able to be billed as an outpatient. I think it will be awhile before telerehab can really take off due to the general level of computer skills of the population we serve, but it is promising. Off topic, I felt that there were a lot of vague, uncited phrases ("In recent years, telemedicine has been used considerably for medical treatment of stroke.") and had flashbacks of my marked up manuscript from my research advisor, a strong proponent of justifying every statement.
Documenting Progress: Hand Therapy Treatment Shift From Biomechanical to Occupational Adaptation
Jada Jack-OTR/L, Rebecca I. Estes-PhD, OTR/L, ATP
--OA has always been my favorite frame of reference. Hand therapy is tough practice, lots of protocols to follow, surgeons expecting certain results, it's very hard to break away from the biomechanical model. But it can be done, and I'm glad that these therapists were able to provide their client with increased satisfaction from the model. I would advocate for any hand therapist to at least be eclectic enough to tap into other models besides biomechanical if not for great client satisfaction and improved independence, then to retain our claim on OCCUPATION which is what makes us unique. Props to my hands teacher, who always emphasized occupation based treatment; and to Todd, the hand therapist I worked with who in addition to his goals would have the client keep a diary of activities they could resume as tx went along.
Grasping Naturally Versus Grasping With a Reacher in People Without Disability: Motor Control and Muscle Activation Differences
Kinsuk K. Maitra-PhD, OTR/L, Katherine Philips-MS, OTR/L, Martin S. Rice-PhD, OTR/L
--Glad that someone put down in writing that you can't just hand someone a reacher and be done with the interaction. (This has been a deterrent to us putting AE on the floors in the supply rooms, a fear that non-therapists will give them out without any training) This also reminded me of the study I wanted to do looking at cognitive level (through MMSE or MOCA) and how well clients could "grasp" (how punny) the use of the reacher, because there is definitely an anecdotal cutoff point and I would like to see what that amounts to in real life.
Near-Vision Acuity Levels and Performance on Neuropsychological Assessments Used in Occupational Therapy
Linda A. Hunt-PhD, OTR/L, FAOTA, Carl J. Bassi-PhD
--The trailmaking test is still effective for people with uncorrected 20/100 vision... good to know. Not that I've ever had anyone actually complete the test effectively yet, but hopefully someday it will happen. Also reiterated the good point that you can't give out a magnifier to correct blur, and you need to do the best, most accurate evaluation of the client to help them be independent.
Relationship Between Handwriting and Keyboarding Performance Among Fast and Slow Adult Keyboarders
Naomi Weintraub-PhD, OTR, Naomi Gilmour-Grill-OT, MSc, Patricia L. (Tamar) Weiss-OT, PhD
--A study after my own heart, since I am a "fast adult keyboarder." I feel that the researchers missed out on not studying the normal speed keyboarders, especially since they kept emphasizing the point that keyboarding is often suggested to poor handwriters in school. It seems logical to me that the kids with poor handwriting who have been told to type may fall into that broad range of 'average' typists, not the extreme fast or slow. I also thought that it was strange they had so few touch-typists in their study- is this not being taught anymore? All due respect to Mavis Beacon, but I had an actual person forcing me to learn to type and covering my hands, which is why I am a fast typist now. A skill that I sometimes curse, due to the RSI I am continually trying to avoid. Even though my work computer is a tablet with a pen, my typing is MUCH faster than my writing, especially my decipherable writing. When I take notes in handwriting, it is printed, and my own crazy shorthand (example- K means children, beh= behavior, dem=dementia, dep= depression, w/sp/2st/3STE/Lr= lives with spouse in 2 story home with 3 steps to enter and a left ascending handrail). Anyway, the study was interesting, could be expanding, and OTs should definitely look at the child's overall motor skills before scrapping handwriting in favor of typing.
Doing, Being, and Becoming: A Family’s Journey Through Perinatal Loss
Mary Forhan-MHSc, OT Reg (Ont)
--This was a heart-wrenching, but poignant inside look at the effect of perinatal loss on the author's family. I found it interesting that the older children continue to discuss the child, despite not meeting their baby brother. In the families that I have known who have suffered perinatal loss, usually it was a firstborn child, or the elder child was too young to comprehend the loss.
The Issue Is ... Facilitating Evidence-Based Practice: Process, Strategies, and Resources
Susan H. Lin-ScD, OTR/L, Susan L. Murphy-ScD, OTR/L, Jennifer C. Robinson-PhD, RN
-- There were some good concrete suggestions for clinicians, employers, educators, researchers, payers, and I think students as well in this article. Well worth a read, and not too long.
Remember- if you're reading journal articles or textbook chapters, it does count for continuing education credits for NBCOT. You are supposed to keep a summary of how it applies to your practice. How's that for some motivation to read?
And please, share your thoughts on "AJOT Thots" or any of the articles contained herewith.
2.15.2010
2.12.2010
Job Search at AOTA Conference Expo
Have you considered spending time at the AOTA Conference Expo to conduct a job search?
If not... why not? The Expo is a place BRIMMING with hustle & bustle activity, giveaways, companies looking to sell and employers looking to hire. Taking advantage of this last group can reap major benefits. Here are some groups that I speculate will be present and anticipating your resume:
- Companies that operate nationwide will be there. So staffing companies that hire travel therapists and chains of facilities will be well represented. I'm sure Genesis will be there, along with Club Staffing (they're still sending me emails from 2004), Progressus, etc. This also includes the US Military.
- Nationally recognized facilities will be there. This includes Rehab Institute of Chicago, Rancho Los Amigos, Shepherd Center in Atlanta.
- Facilities local to the conference will be there. Do you live (or plan to relocate) within 150 miles of the conference location? There should be a wealth of local employers.
- Volunteer Organizations will be there. This includes Rebuilding Together
As a student, I was so excited to explore all these job opportunities. In some cases, you can feel out the facility for potential fieldwork placement as well. Slow times at the Expo are great times to talk 1:1 with the recruiter about what the company has to offer. and of course there will be enticing raffles and freebie items too. So bring a resume, or at least some business cards, and be prepared to explore some new opportunities.
2.10.2010
Snowy Day Thoughts
I am pretty well trapped here at home under several feet of snow.
I felt a little bad calling off work, but they haven't plowed my parking lot and barely touched the street outside the apartment. I really didn't want to walk 2 miles through the snow on the ground (and still coming down hard) to get to the metro (which is running on a delayed schedule) to get to my shuttle bus (also on a delayed schedule) to get to work and then possibly not be able to get back. And now they've actually pulled buses from the roads, and SNOWPLOWS due to dangerous conditions. It's just a little over the top.
I do feel like I made the right decision yesterday though... instead of my usual drive-metro-shuttle bus trip, I got up EARLY (I've been waking up at 5am for a few weeks unintentionally), drove to work and paid to park. Despite driving 30 miles instead of 4, I got home before the worst of the snow started. It was already pretty bad driving at that point, several of the roads having large piles in the middle of the road that got caught on my car's undercarriage, and turns being made hazardous by snow piles taller than my car.
So I'm taking my day off to try to catch up on some fun stuff... reading, finishing my puzzle, but I had a couple OT things to share.
Been trying to come up with some fun OT Month things to do... we are talking about having a carnival at work to promote awareness and need to come up with fun events, favors, etc. I would like to have some ways to increase interest in OT outside of the hospital staff too. I thought about wearing my OT t-shirts to work, but I try to keep all but my scrubs from the germs of hospital-land (to the point that my scrubs are kept in a separate hamper and washed separately from all other clothes). I just got a cute little OTR pin from NBCOT, but it may be a little too little to attract attention. Thoughts?
The other thing that I am currently finding interesting is the proposed restructure of the AOTA governance. This is found in the previous issue of OT Practice (here for members) and causing quite a stir. The theory is that the current structure of the RA and ~dozen large committees is unwieldy and not encouraging quick action, leadership development, or involvement from the membership. The plan is to dramatically shrink the RA, and get more participation from the membership at large through volunteer opportunities and ad hoc committees.
As I said, people are up in arms. This is an interesting OTC thread on the topic with a few people "in the know" in the fray. Here's another, it just hasn't developed much yet.
Personally, I have no attachment to the RA. I observed a portion of a meeting as a student delegate and was not impressed (bored out of my skull might have been more accurate). However, my conference roommate thought that it was really cool and wanted to become a member someday. Elections to the RA in my state were almost always unopposed and run by the same person. I don't recall getting any updates on RA progress at conferences or through state association newsletters. Since I didn't have a close back and forth relationship with my RA rep (not a bad thing necessarily either) I don't know that I will miss out on anything by decreasing the number of members.
I do agree with the theory that it's hard to break into the AOTA leadership... you see a lot of big name people running for offices again and again. So opportunities within the new COOL program that are easy access will make it easier to get feedback from some new blood. From a casual observance of AOTA releases and annual meeting conduct, I could tell that a lot of the work was being done by ad hoc committees instead of standing committees, so I don't know that we're losing much in that department either. I don't know that having the ASD classified as an organizational advisor makes much sense either. As a former member of the ASD, my involvement was limited to one day of mostly being presented to, not really involved with anything until we started the Centennial Vision talks. I'm sure the steering committee is more involved, but some of them aren't even students.
Lots to think about and bring forward to your reps before the AOTA Conference at end of April. Read up on the issue. Talk it out online, especially on OTC. And don't forget to vote in the AOTA elections before March 3.
I felt a little bad calling off work, but they haven't plowed my parking lot and barely touched the street outside the apartment. I really didn't want to walk 2 miles through the snow on the ground (and still coming down hard) to get to the metro (which is running on a delayed schedule) to get to my shuttle bus (also on a delayed schedule) to get to work and then possibly not be able to get back. And now they've actually pulled buses from the roads, and SNOWPLOWS due to dangerous conditions. It's just a little over the top.
I do feel like I made the right decision yesterday though... instead of my usual drive-metro-shuttle bus trip, I got up EARLY (I've been waking up at 5am for a few weeks unintentionally), drove to work and paid to park. Despite driving 30 miles instead of 4, I got home before the worst of the snow started. It was already pretty bad driving at that point, several of the roads having large piles in the middle of the road that got caught on my car's undercarriage, and turns being made hazardous by snow piles taller than my car.
So I'm taking my day off to try to catch up on some fun stuff... reading, finishing my puzzle, but I had a couple OT things to share.
Been trying to come up with some fun OT Month things to do... we are talking about having a carnival at work to promote awareness and need to come up with fun events, favors, etc. I would like to have some ways to increase interest in OT outside of the hospital staff too. I thought about wearing my OT t-shirts to work, but I try to keep all but my scrubs from the germs of hospital-land (to the point that my scrubs are kept in a separate hamper and washed separately from all other clothes). I just got a cute little OTR pin from NBCOT, but it may be a little too little to attract attention. Thoughts?
The other thing that I am currently finding interesting is the proposed restructure of the AOTA governance. This is found in the previous issue of OT Practice (here for members) and causing quite a stir. The theory is that the current structure of the RA and ~dozen large committees is unwieldy and not encouraging quick action, leadership development, or involvement from the membership. The plan is to dramatically shrink the RA, and get more participation from the membership at large through volunteer opportunities and ad hoc committees.
As I said, people are up in arms. This is an interesting OTC thread on the topic with a few people "in the know" in the fray. Here's another, it just hasn't developed much yet.
Personally, I have no attachment to the RA. I observed a portion of a meeting as a student delegate and was not impressed (bored out of my skull might have been more accurate). However, my conference roommate thought that it was really cool and wanted to become a member someday. Elections to the RA in my state were almost always unopposed and run by the same person. I don't recall getting any updates on RA progress at conferences or through state association newsletters. Since I didn't have a close back and forth relationship with my RA rep (not a bad thing necessarily either) I don't know that I will miss out on anything by decreasing the number of members.
I do agree with the theory that it's hard to break into the AOTA leadership... you see a lot of big name people running for offices again and again. So opportunities within the new COOL program that are easy access will make it easier to get feedback from some new blood. From a casual observance of AOTA releases and annual meeting conduct, I could tell that a lot of the work was being done by ad hoc committees instead of standing committees, so I don't know that we're losing much in that department either. I don't know that having the ASD classified as an organizational advisor makes much sense either. As a former member of the ASD, my involvement was limited to one day of mostly being presented to, not really involved with anything until we started the Centennial Vision talks. I'm sure the steering committee is more involved, but some of them aren't even students.
Lots to think about and bring forward to your reps before the AOTA Conference at end of April. Read up on the issue. Talk it out online, especially on OTC. And don't forget to vote in the AOTA elections before March 3.
2.09.2010
Patterns
"What we call chaos is just patterns we haven't recognized. What we call random is just patterns we cant decipher. What we can't understand we call nonsense. What we can't read we call gibberish. There is no free will. There are no variables. There is only the inevitable."
Chuck Palahniuk
(That guy wrote Fight Club. Thank you Google.)
I am a person who appreciates patterns. I often find myself examining tile floors to analyze the pattern or lack of. Routines, a valuable part of life, are just patterns of actions and behaviors. While my appreciation of patterns may just be deep enough to cross (slightly?) into the spectrum, it has also proved interesting at work.
I've only been working since 2007, so I don't have scores of case examples yet, but I have been interested to see the patterns in hospital admissions (and thus, therapy referrals) throughout the year. Here are some that I have noticed:
- Wintertime > Icy conditions > hip fractures (we begin with the obvious. However, if you have an elderly female with osteoporosis, you may also get the concurrent FOOSH wrist or humerus fracture on the same side as the hip, one of my least favorite combinations)
- Wintertime > Food oriented holiday > CHF exacerbation/volume overload (everyone goes off their cardiac diets, eats salty food, and starts retaining fluid)
- Wintertime > Hazardous conditions (e.g. 30 inches of snow in Baltimore UGH) > Exacerbation of ESRD /Volume overload (when the buses won't run and the dialysis centers close down, sessions get missed and fluid builds up)
- Wintertime > Snow shoveling > MI (most demanding household chore?)
- Wintertime > space heater use > burns
- Summertime > Heat wave > CVA
- Summertime > reckless outdoor activity > TBI, SCI, multi trauma, GSW
- Summertime > school vacation > joint replacements for teachers (3 months of hip precautions and outpatient PT? No problem)
- 3 days before a major holiday > elective surgeries for people who have 1) limited time off work, 2) no attachment to holiday, 3) no family or 4) unrealistic expectations
There's a few I can think of off the top of my head. Any other patterns that you notice?
2.06.2010
AOTA Conference 2010
The debate is over- I'm Attending!!
I've got plane tickets, a hotel room, and a conference registration... Orlando here I come!
I'm very excited, already went through the conference program and started highlighting interesting topics... did I mention being excited?! I haven't been to conference since Charlotte and was disappointed I couldn't go to Houston, so I do feel a little overdue. I've posted before about why everyone should go to Conference, but there's dozens of reasons to go- comment away with yours!
If you're following me through RSS feeds, you're missing out on the new link section that will point you to my posts on the topic and a twitter search so you can track the conference trends. You're also missing out on voting about whether this blog will be "syndicated" to OT Connections. I will be crossposting all the relevant conference posts to OTC, maybe more depending on the feedback I get. (psst- so send that feedback!)
I will be making frequent posts on the Conference, partially because I have been asked to do so by AOTA as a consultant reporter. I am disclosing this working relationship, and will mark all relevant posts with the conference badge to identify them. But honestly, I'd be doing it anyway, as I have always been pro-AOTA and truly love the conference experience.
It's all a few months away, but thinking about warm sunny Orlando while I'm under an avalanche of snow in Baltimore may just help get me through the winter.
2.05.2010
Jewelry for those with Arthritis
This is my grandma, showing off the stretchy ring BLING she got for Christmas. She's always had an extensive jewelry collection, but in recent years her arthritis has made it too painful to wear her rings and too difficult to operate some clasps. Read on for some of the options for people who love their jewelry and hate their arthritis.Stretchy rings/bracelets (Potpourri) - these rings have made their way into my grandma's regular rotation. There's matching bracelets for some and they slip on easily. (We got her the pearls and the ones with the single gem in the bottom right, not the crazy ones made of sticks) The ones from Potpourri are fairly inexpensive, I have seen similar ones in specialty stores MUCH more expensive so do some comparison shopping.
Magnetic clasp converters (shopping search) - I saw these on TV ads. They look like a person with arthritis might need assist with initial setup but then they should be independent to doff/don. I haven't personally tried them, so I can't speak to the strength of the magnets, but they're probably not strong enough to hold up heavy jewels like pearls.
Wire chokers/bracelets - These are pretty common, if you can convince an adult to shop with the preteens to get jewelry. Just look for the necklaces without clasps in U shape.
Bracelet fastener (bracelet buddy) - I was intrigued by this device when it first came out, but it may be too complicated as adaptive equipment now that other stuff has come out.
1.25.2010
Kindle
A couple of thoughts on the Kindle
In the reading world, I've been halfheartedly thinking about getting a Kindle (or similar device, I am not owned by a company). I'd love to try it, if even to have an opinion on its benefit for low-vision consumers, but I just don't think it's worth it yet.
Can you make a cheap and demanding person change their mind on the Kindle? Got an opinion of its usefulness for a person with low vision?
In the reading world, I've been halfheartedly thinking about getting a Kindle (or similar device, I am not owned by a company). I'd love to try it, if even to have an opinion on its benefit for low-vision consumers, but I just don't think it's worth it yet.
- expensive, and does nothing on its own... you still have to buy books and subscriptions. Just entices you to spend more money.
- things I would subscribe to are things I'm currently reading online for free. I also get most of my books from library, borrow them from a friend, or at cheap used stores, cheaper than the advertised $10 price of most books.
- I have serious doubts that OT Practice or AJOT will be available in ebook form anytime in the next several years (there's still a large portion of our Wilma West library that is only available in hard copy form, not even in pdf) if ever at all, and my metro rides do help me read a lot of OT related stuff.
- I am visual. I enjoy the newspaper most for comics and browsing to find interesting stories, I certainly don't read right though. I do crosswords, which I can do on the computer or print out, but not on a device. Though I have a list of books I would like to read, I far more frequently walk through the stacks and pick out interesting looking items.
- I am demanding. If I am going to have an electronic device to read, then it also needs to be able to access my RSS account, my email, and should be able to let me clip from what I'm reading to an email to enable a blog post.
Can you make a cheap and demanding person change their mind on the Kindle? Got an opinion of its usefulness for a person with low vision?
1.23.2010
One other thing
Hey, I forgot to ask about whether anyone was interested in seeing this blog copied to OT Connections. It can be viewed from my OTC page as a shared feed, but not as a blog. If you have a preference, please vote in the poll on this page on the left and feel free to comment about your answer here or in an email.
Aimless Thoughts
Took a bit of an OT break with a vacay to Las Vegas and reading some novels instead of OT stuff pretty much since Thanksgiving. Now I'm back and ready to play! Been working on a few entries off and on, but this is mostly unstructured.
My NBCOT was due to be renewed this year, which caused a minor panic attack the other day. Not that I've been slacking on licensure or anything, I've been going to conferences, but there was a wrinkle I didn't anticipate. I graduated in May '07, but didn't test until Aug '07. My original state license did not require first year graduates to submit continuing ed to be recertified. And unlike the first 2 years of my OT schooling, I didn't pick up any CEUs in my final year due to silly things like fieldwork, graduation, getting married, etc. Somewhere in the back of my head, I had this idea that I wouldn't renew NBCOT until NEXT year, or at least until Aug of this year. WRONG-O. All 36 hours needed to be complete as of 12/31/09. I was tweaking out quite a bit, until I reread the guidelines for all activities that count (can't link it since NBCOT is rather difficult to navigate, but it should be readily accessible if you're due to renew) which includes staff inservices, fieldwork student supervision, and reading journal or textbook articles. In the past 2 years, I have actually read 40 textbook chapters afresh and over 20 journal articles. I had to go back and count though, because I was stupid and hadn't been writing it down. So major props to Your Therapy Source, HeathSkills, and ABC Therapeutics, who all either cite their resources for posts or write specifically about certain articles, because at least they can keep track of what they've read. I hope to start doing that. Usually the journals just pile up beside my laptop though, they don't actually make it into posts.
Switched some days around at work, I am on 11 of the next 12. ugh. but I am starting to get into a groove on the medicine floor. I think the biggest challenge is just striking a balance between evals and priority follow ups. We don't have as many people going to acute rehab as on the other floors, so the regulation for most recent note is a little more lax. Few happy stories on the medicine floor... you don't get to watch people making dramatic recoveries like on the other floors, there are a lot of repeat admissions and people just getting generally sicker.
Had a couple of people competing for saddest story before I left for vacation. Lady A has cancer and has been having seriously miserable orthostatic hypotension. She has been existing by running to her destinations in hope to make it there before passing out, and was admitted s/p fall on one occasion where that didn't work out superbly. I believe we had a standing BP in the 60/40 range (NOT GOOD). When I was getting her history, it was very sad, because she said she knew she wasn't going to live through her current chemo regimen. However, she at least had plenty to live for. "I want to make it to July," she said. She had relatives graduating college and high school, another getting married, and a major milestone anniversary coming up with her husband. I almost cried. I am a big believer in the power of things to live for though, so I really hope she makes it.
Lady B was a sad case as well, same day. She was majorly depressed, and in some cases very rightfully so. From her description, it sounded like her husband had dementia and she had been very hurt by him commenting about how he didn't love her anymore and some of the barriers that the healthcare machine had placed between them. However she also had some episodes of paranoia and visual hallucinations, as well as frequent falls (her admitting dx). I was thoroughly confused. 80 years old is pretty late in life for a schizophrenic break. An experienced PT pointed out that sometimes Parkinson's Disease presents with psychosis, and that seemed to make things make more sense. Sometimes I wonder if I will just know stuff like that off the bat.
Ms N was bumming me out the other day as well. I saw her before for a home safety evaluation, which was very unstructured and not super fun as her normal pleasantly confused affect turned into nasty and aggressive when asked to take part. She is normally very nice, saying hello to all who pass her room and wandering the hallways with supervision. But the other day she was walking and crying her eyes out, calling for her mother, totally inconsolable for the duration of the day. I was very sad for her, and for a lot of people in general. Dementia is such a harrowing disease.
Even as an OT I often feel helpless in my own family, where a grandmother is in the mod-severe stages of Alzheimer's Disease. I have tried to make suggestions where I can, but I'm not there 24 hours a day and really can tell that everyone is getting emotionally and physically worn out just trying to do their best. We're also beyond the point of many environmental adaptations, which is where my strength is. I think that it's overall better for her quality of life and her husband's to have them in their home, but it's hard. Right now, the major issue is her walking. She didn't learn to use a walker before AD, and has never been able to really grasp it since. Right now they are walking with handheld assist but she leans backward A LOT. It is scary to watch. Scary enough that when I was there I transferred her to a wheelchair to move her 15' to the dining room. Even then she almost fell out of the dining room chair that didn't have arms. I don't really know what to suggest to help with this gait problem. We did go out and get bed risers and cut them down to fit the dining room table so the wheelchair arms will fit under the table, and make eating a little safer. I had to leave strict instructions though that wheelchair was for meals and to the porch ONLY, she was not to sit in it all day. Need to check in and see how this is going. Any suggestions welcome.
Back to a few less depressing random notes-
I was reading an article about a guy who has motivating himself to lose weight by pledge drives and donating all the money to cancer research. Great idea I think, because sometimes it is not enough to be doing something "for your health." Saying "it's good for you" does not always make you do the right thing, but if you have that extra motivator of someone counting on you, it can make it worth it. In the comments section, a poster (#47) was asking for weight loss advice and I am sure she would take your suggestions:
That article led me to a blog I hadn't seen before discussing Fat Prejudice in Health Care. These are stories that people have emailed in, so there is a lot of raw language, you probably shouldn't read it at work. However, it would be good to talk about at work, because I know there is a lot of prejudice in the OT/PT world. (Here is a PT related story) As a professional who is expected to transfer any patient, it can be intimidating to walk into some rooms. Yet I will say that the gastric bypass patients we see are among the most mobile of all referrals, usually welcome a little adaptive equipment to restore some independence, and are often good to go after 1-2 sessions. Obviously as OTs we need to make sure that we're treating all clients with dignity and respect. It's still good to challenge your thinking about your practice and make sure that's happening.
My NBCOT was due to be renewed this year, which caused a minor panic attack the other day. Not that I've been slacking on licensure or anything, I've been going to conferences, but there was a wrinkle I didn't anticipate. I graduated in May '07, but didn't test until Aug '07. My original state license did not require first year graduates to submit continuing ed to be recertified. And unlike the first 2 years of my OT schooling, I didn't pick up any CEUs in my final year due to silly things like fieldwork, graduation, getting married, etc. Somewhere in the back of my head, I had this idea that I wouldn't renew NBCOT until NEXT year, or at least until Aug of this year. WRONG-O. All 36 hours needed to be complete as of 12/31/09. I was tweaking out quite a bit, until I reread the guidelines for all activities that count (can't link it since NBCOT is rather difficult to navigate, but it should be readily accessible if you're due to renew) which includes staff inservices, fieldwork student supervision, and reading journal or textbook articles. In the past 2 years, I have actually read 40 textbook chapters afresh and over 20 journal articles. I had to go back and count though, because I was stupid and hadn't been writing it down. So major props to Your Therapy Source, HeathSkills, and ABC Therapeutics, who all either cite their resources for posts or write specifically about certain articles, because at least they can keep track of what they've read. I hope to start doing that. Usually the journals just pile up beside my laptop though, they don't actually make it into posts.
Switched some days around at work, I am on 11 of the next 12. ugh. but I am starting to get into a groove on the medicine floor. I think the biggest challenge is just striking a balance between evals and priority follow ups. We don't have as many people going to acute rehab as on the other floors, so the regulation for most recent note is a little more lax. Few happy stories on the medicine floor... you don't get to watch people making dramatic recoveries like on the other floors, there are a lot of repeat admissions and people just getting generally sicker.
Had a couple of people competing for saddest story before I left for vacation. Lady A has cancer and has been having seriously miserable orthostatic hypotension. She has been existing by running to her destinations in hope to make it there before passing out, and was admitted s/p fall on one occasion where that didn't work out superbly. I believe we had a standing BP in the 60/40 range (NOT GOOD). When I was getting her history, it was very sad, because she said she knew she wasn't going to live through her current chemo regimen. However, she at least had plenty to live for. "I want to make it to July," she said. She had relatives graduating college and high school, another getting married, and a major milestone anniversary coming up with her husband. I almost cried. I am a big believer in the power of things to live for though, so I really hope she makes it.
Lady B was a sad case as well, same day. She was majorly depressed, and in some cases very rightfully so. From her description, it sounded like her husband had dementia and she had been very hurt by him commenting about how he didn't love her anymore and some of the barriers that the healthcare machine had placed between them. However she also had some episodes of paranoia and visual hallucinations, as well as frequent falls (her admitting dx). I was thoroughly confused. 80 years old is pretty late in life for a schizophrenic break. An experienced PT pointed out that sometimes Parkinson's Disease presents with psychosis, and that seemed to make things make more sense. Sometimes I wonder if I will just know stuff like that off the bat.
Ms N was bumming me out the other day as well. I saw her before for a home safety evaluation, which was very unstructured and not super fun as her normal pleasantly confused affect turned into nasty and aggressive when asked to take part. She is normally very nice, saying hello to all who pass her room and wandering the hallways with supervision. But the other day she was walking and crying her eyes out, calling for her mother, totally inconsolable for the duration of the day. I was very sad for her, and for a lot of people in general. Dementia is such a harrowing disease.
Even as an OT I often feel helpless in my own family, where a grandmother is in the mod-severe stages of Alzheimer's Disease. I have tried to make suggestions where I can, but I'm not there 24 hours a day and really can tell that everyone is getting emotionally and physically worn out just trying to do their best. We're also beyond the point of many environmental adaptations, which is where my strength is. I think that it's overall better for her quality of life and her husband's to have them in their home, but it's hard. Right now, the major issue is her walking. She didn't learn to use a walker before AD, and has never been able to really grasp it since. Right now they are walking with handheld assist but she leans backward A LOT. It is scary to watch. Scary enough that when I was there I transferred her to a wheelchair to move her 15' to the dining room. Even then she almost fell out of the dining room chair that didn't have arms. I don't really know what to suggest to help with this gait problem. We did go out and get bed risers and cut them down to fit the dining room table so the wheelchair arms will fit under the table, and make eating a little safer. I had to leave strict instructions though that wheelchair was for meals and to the porch ONLY, she was not to sit in it all day. Need to check in and see how this is going. Any suggestions welcome.
Back to a few less depressing random notes-
I was reading an article about a guy who has motivating himself to lose weight by pledge drives and donating all the money to cancer research. Great idea I think, because sometimes it is not enough to be doing something "for your health." Saying "it's good for you" does not always make you do the right thing, but if you have that extra motivator of someone counting on you, it can make it worth it. In the comments section, a poster (#47) was asking for weight loss advice and I am sure she would take your suggestions:
Comments do require an extremely short registration. My initial thought was that there are exercise videos for people with Prader Willi Syndrome, but these are marketed mostly for children and teens.
That article led me to a blog I hadn't seen before discussing Fat Prejudice in Health Care. These are stories that people have emailed in, so there is a lot of raw language, you probably shouldn't read it at work. However, it would be good to talk about at work, because I know there is a lot of prejudice in the OT/PT world. (Here is a PT related story) As a professional who is expected to transfer any patient, it can be intimidating to walk into some rooms. Yet I will say that the gastric bypass patients we see are among the most mobile of all referrals, usually welcome a little adaptive equipment to restore some independence, and are often good to go after 1-2 sessions. Obviously as OTs we need to make sure that we're treating all clients with dignity and respect. It's still good to challenge your thinking about your practice and make sure that's happening.
1.05.2010
Starting the New Year
New Year, but Same Old?
Starting a new year in January really cramps my style. Like Caulfield in Frazz, I usually can't make resolutions at that time, and like most all people who actually set resolutions, I usually don't keep them either. Would I like to exercise more? Yes... but not in 20* weather. Would I like to eat better? Yes... but not when there's delicious comfort food leftovers in the fridge. Would I like to set detailed achievable goals for myself? No way! I get paid for that! I thought this was a cute little goal tracker, thought of some ways to use this personally/professionally, but I know myself. I'd start getting little red x's and it would be the last time I ever went to the site.
I am a little apathetic about this current new year business. I am back on the medicine floor again, the land of triage occasionally in war-zone conditions. Walked in on Monday to a gigantic list of consults, which was narrowed to 18 after we weeded out discharged and already seen patients who just didn't get taken out of the computer system. Still a little excessive. Very full house right now, and most of our medicine patients on caseload are waiting for placement in subacute rehab.
This rotation is the first (of many) on a familiar floor, since I started the job on the medicine floor. I know all the case managers, most of the stable medical staff (not students/interns), and lots of friendly faces from the nursing staff. I remember most of the codes to the supply rooms and such. But it's not a particularly exciting time for me. The revolving door of the hospital is most evident on the medicine floor, so its an unfortunate but likely prospect that the people I am evaluating this week will be evaluated again in the coming months. Part of our nation's healthcare crisis, on so many levels. But usually there's no new interesting diagnoses to investigate, no cool techniques going on, just a battle to get people out the door to the least restrictive living environment.
While meeting and talking with my patients is interesting, there's not a lot of extra things for me to learn and do, so I will have to find other ways to occupy my time. We are revising some of our documentation, to make it quicker (!!!) and better. I'd like to write an ICU/low level eval since we are asking for early level consults in all the ICUs which often leads us to patients who don't fit the "general evaluation" template.
Other current OT to-dos... renewing NBCOT certification so I can keep my R... get back to reading my books on acute early childhood interventions... emailing a bunch of OT people detailed conversations that I owe them... deciding whether or not to go to the AOTA Conference this year. I had planned to go to the conference and have a semi-reunion with some of my fellow OT graduates, but now my best friend will be having a baby around that time. Need to decide if we want to adapt the trip, if I want to go by myself, if I want to drag my husband along, if he would want an expo pass to go pick up free pens and fidget toys, etc. I enjoyed presenting at the state conference this year and will probably do that again... also thinking of a writeup for OT Practice on some similar concepts but unsure of how to go about doing that.
My outside of OT to-dos are a super long list as well. In addition to the dozens of unfinished projects, I am going to be trying out some new hobbies... knitting... playing guitar... cooking (ha! just kidding on that one!). I've also been reading at a faster pace again, hearkening back to my youth of a novel or 2 a day, which is fun in its own little introverted way.
Starting a new year in January really cramps my style. Like Caulfield in Frazz, I usually can't make resolutions at that time, and like most all people who actually set resolutions, I usually don't keep them either. Would I like to exercise more? Yes... but not in 20* weather. Would I like to eat better? Yes... but not when there's delicious comfort food leftovers in the fridge. Would I like to set detailed achievable goals for myself? No way! I get paid for that! I thought this was a cute little goal tracker, thought of some ways to use this personally/professionally, but I know myself. I'd start getting little red x's and it would be the last time I ever went to the site.
I am a little apathetic about this current new year business. I am back on the medicine floor again, the land of triage occasionally in war-zone conditions. Walked in on Monday to a gigantic list of consults, which was narrowed to 18 after we weeded out discharged and already seen patients who just didn't get taken out of the computer system. Still a little excessive. Very full house right now, and most of our medicine patients on caseload are waiting for placement in subacute rehab.
This rotation is the first (of many) on a familiar floor, since I started the job on the medicine floor. I know all the case managers, most of the stable medical staff (not students/interns), and lots of friendly faces from the nursing staff. I remember most of the codes to the supply rooms and such. But it's not a particularly exciting time for me. The revolving door of the hospital is most evident on the medicine floor, so its an unfortunate but likely prospect that the people I am evaluating this week will be evaluated again in the coming months. Part of our nation's healthcare crisis, on so many levels. But usually there's no new interesting diagnoses to investigate, no cool techniques going on, just a battle to get people out the door to the least restrictive living environment.
While meeting and talking with my patients is interesting, there's not a lot of extra things for me to learn and do, so I will have to find other ways to occupy my time. We are revising some of our documentation, to make it quicker (!!!) and better. I'd like to write an ICU/low level eval since we are asking for early level consults in all the ICUs which often leads us to patients who don't fit the "general evaluation" template.
Other current OT to-dos... renewing NBCOT certification so I can keep my R... get back to reading my books on acute early childhood interventions... emailing a bunch of OT people detailed conversations that I owe them... deciding whether or not to go to the AOTA Conference this year. I had planned to go to the conference and have a semi-reunion with some of my fellow OT graduates, but now my best friend will be having a baby around that time. Need to decide if we want to adapt the trip, if I want to go by myself, if I want to drag my husband along, if he would want an expo pass to go pick up free pens and fidget toys, etc. I enjoyed presenting at the state conference this year and will probably do that again... also thinking of a writeup for OT Practice on some similar concepts but unsure of how to go about doing that.
My outside of OT to-dos are a super long list as well. In addition to the dozens of unfinished projects, I am going to be trying out some new hobbies... knitting... playing guitar... cooking (ha! just kidding on that one!). I've also been reading at a faster pace again, hearkening back to my youth of a novel or 2 a day, which is fun in its own little introverted way.
12.24.2009
End of year wrap up
Things have been pretty crazy lately. Here are some recent and end-of-year reflections, semi-structured, semi-sensible.
I should begin with an apology. I have been terribly behind and under-participatory in the online realm since October. I attribute this in part to an over-focus on getting my conference presentation ready. I am a terrible procrastinator and felt that I had to restrict my access to other endeavors to ensure that it would get done. After that, getting back on the horse, over the various RSI, over the burnout and back into the swing became a mountain I couldn't climb. My google reader page is finally down to 0 unread items for the first time in months... sweet success. I have some good trips coming up- family time for Christmas and a Vegas vacation in January. My husband may be going to France in February... don't know if I can swing that one too. At any rate, it's good to have things to look forward to, it's helping me keep my mind out of the dingy early winter blahs that try to seep in.
The job change this year was a new experience that defined most of my year. I've never left a job before that wasn't already predetermined by the end of a semester. I could have handled a lot of things better, however I do feel that this was a good choice. There have been lots of good opportunities that opened up at this position. I've already gotten to work with people who had unique diagnoses, lots of people in more critical condition than I was used to, gotten to learn a lot. I've also gotten to eat LOTS of Greek and some Indian, some Egyptian food, which we do not have back home. Hummus is my new goto snack... I really don't think I've ever seen any in the grocery stores before. Also, there are franchises of many more different chains than I've had access to before. I get a little obsessed about the food sometimes.
I feel that the blog has grown well this year. I like getting feedback from readers and statcounter tells me that there have been more than 10,000 MORE page views than last year. So, THANKS!! I do occasionally look to statcounter for what people have searched for to get to the blog to get ideas, but if you have something you're curious about or want to see, dropping an email is more likely to get a response. I had hoped to do more entries and different topics, but inspiration is fickle. Room for improvement to be sure.
So life goes on and hopefully things will get a little more under control in the upcoming year, but I won't count on it. I'm working Christmas day and then off for over a week... couple weeks off until the Vegas trip. Happy new year everyone!
I should begin with an apology. I have been terribly behind and under-participatory in the online realm since October. I attribute this in part to an over-focus on getting my conference presentation ready. I am a terrible procrastinator and felt that I had to restrict my access to other endeavors to ensure that it would get done. After that, getting back on the horse, over the various RSI, over the burnout and back into the swing became a mountain I couldn't climb. My google reader page is finally down to 0 unread items for the first time in months... sweet success. I have some good trips coming up- family time for Christmas and a Vegas vacation in January. My husband may be going to France in February... don't know if I can swing that one too. At any rate, it's good to have things to look forward to, it's helping me keep my mind out of the dingy early winter blahs that try to seep in.
The job change this year was a new experience that defined most of my year. I've never left a job before that wasn't already predetermined by the end of a semester. I could have handled a lot of things better, however I do feel that this was a good choice. There have been lots of good opportunities that opened up at this position. I've already gotten to work with people who had unique diagnoses, lots of people in more critical condition than I was used to, gotten to learn a lot. I've also gotten to eat LOTS of Greek and some Indian, some Egyptian food, which we do not have back home. Hummus is my new goto snack... I really don't think I've ever seen any in the grocery stores before. Also, there are franchises of many more different chains than I've had access to before. I get a little obsessed about the food sometimes.
I feel that the blog has grown well this year. I like getting feedback from readers and statcounter tells me that there have been more than 10,000 MORE page views than last year. So, THANKS!! I do occasionally look to statcounter for what people have searched for to get to the blog to get ideas, but if you have something you're curious about or want to see, dropping an email is more likely to get a response. I had hoped to do more entries and different topics, but inspiration is fickle. Room for improvement to be sure.
So life goes on and hopefully things will get a little more under control in the upcoming year, but I won't count on it. I'm working Christmas day and then off for over a week... couple weeks off until the Vegas trip. Happy new year everyone!
12.17.2009
Additional clock drawings
Sometimes I think these clock drawings are revealing, sometimes just plain confusing.
This one is from a man with dementia. I don't remember much else about the case since it was awhile ago. I do remember leaving him tucked in bed, call bell in hand, last words out of mouth "call the nurse, don't get up on your own" and before I could wash my hands he was already up on his feet on the way to the bathroom. I don't remember what time I asked for, but I have to assume that it was 7:40 and we get the numbers instead of hands.
This was my first experience with the Montreal Cognitive Assessment, which is becoming my preferred pencil/paper tool. However, it does start off with alternating trailmaking and has a 5 words after 5 minutes recall section, both of which are rather difficult for many people. But it's free and more discriminating than the Mini-Mental. The MDs wanted a KELS on this lady to determine if she could go home or not, but our manual was missing so I went with a basic functional eval and the MOCA. (could have stopped after the functional eval... if you can't get your pants on, you can't go home) This lady got 2/3 points for the clock since she does have numbers and a full circle, but again has just drawn a location on the rim of the clock for the time.
Finally, my most recent, which was another attempt at the MOCA but the woman almost swung at me when I brought out the paper. So we administered the test by walking around the unit and intermittently asking questions. I find it interesting that the numbers here are counterclockwise, also semi-dyslexic with the 10 as a 01. She kept becoming confused at the time... first it was 11:10, then 3:00, then 5:30 and her hands are closer to that than anything. Ironically, she was wearing a dial watch at the time.
This one is from a man with dementia. I don't remember much else about the case since it was awhile ago. I do remember leaving him tucked in bed, call bell in hand, last words out of mouth "call the nurse, don't get up on your own" and before I could wash my hands he was already up on his feet on the way to the bathroom. I don't remember what time I asked for, but I have to assume that it was 7:40 and we get the numbers instead of hands.
This was my first experience with the Montreal Cognitive Assessment, which is becoming my preferred pencil/paper tool. However, it does start off with alternating trailmaking and has a 5 words after 5 minutes recall section, both of which are rather difficult for many people. But it's free and more discriminating than the Mini-Mental. The MDs wanted a KELS on this lady to determine if she could go home or not, but our manual was missing so I went with a basic functional eval and the MOCA. (could have stopped after the functional eval... if you can't get your pants on, you can't go home) This lady got 2/3 points for the clock since she does have numbers and a full circle, but again has just drawn a location on the rim of the clock for the time.
Finally, my most recent, which was another attempt at the MOCA but the woman almost swung at me when I brought out the paper. So we administered the test by walking around the unit and intermittently asking questions. I find it interesting that the numbers here are counterclockwise, also semi-dyslexic with the 10 as a 01. She kept becoming confused at the time... first it was 11:10, then 3:00, then 5:30 and her hands are closer to that than anything. Ironically, she was wearing a dial watch at the time.
12.13.2009
Overcoming my Sensory Battle with Lotion
Is "Sensory Battle" a phrase yet? If not, you heard it here first! As a person who lives on the spectrum for Sensory Processing Disorder, and has experience working with children in the field, I can easily admit that my life has been full of sensory battles. Here's the story of one such encounter with lotion.
I have been fortunate in my life in that I have had pretty good skin. Sometimes oily, but since I don't wear makeup, I would say that I have had only a moderate amount of breakouts (lifetime average). But in the past few years, since I have been employed and in a dry hospital environment for the duration of the winter, my skin has gotten drier. Last year I had to start using a facial moisturizer, which was difficult but made easier by the fact that I could wash my hands off to rid of any extra lotion-feeling. This year the dryness is spreading... meaning more lotion all over my hands and body. Best summed up as: EWWWWW
I am very sensitive to tactile stimulation. Velvet=good. Tags=bad. Sweatshirt=good. Lotion=AWFUL!!! The cold, slimy, gooey feeling makes my skin crawl all over. And then it sinks in and it sticks and you can't get it off... ack. My husband and I got massages last year for our anniversary and the lotion almost ruined it for me... laying flat, unable to run or scream as lotion was poured all over me was a very tense experience.
Imagine for a moment, the strain that my struggles placed on my parents. If you have a child with SPD, you are probably familiar with the scene. Your child needs to put on sunscreen but screams, pulls away, and starts crying in hysterics when the goop is applied. Maybe you give in and don't put on so much sunscreen, then the child gets burnt and has to have aloe gel applied and the whole scene is repeated again. (Of course, this is not my only tactile difficulty, and I have processing difficulties in multiple sensory arenas).
But now I am older and understand my sensory needs better. I have managed to make great strides out of necessity- I am now able to apply chapstick multiple times per day (I find that lots of lip smacking afterward makes it better), and apply the facial moisturizer every morning (winter only). I have sought out the least flavored and scented of all products. I spent 10 minutes in the drugstore yesterday sniffing multiple "unscented" lotions trying to find the most agreeable one. The texture is impossible to try out. I am trying to start small... only apply a small amount to a controlled area and then leave my arms free to wipe off all excess. It has been a struggle thus far, but getting better. By concentrating on mastering this, I think I can finally suppress the EWWW and add another item to my List of Can-Dos: lotion.
I have been fortunate in my life in that I have had pretty good skin. Sometimes oily, but since I don't wear makeup, I would say that I have had only a moderate amount of breakouts (lifetime average). But in the past few years, since I have been employed and in a dry hospital environment for the duration of the winter, my skin has gotten drier. Last year I had to start using a facial moisturizer, which was difficult but made easier by the fact that I could wash my hands off to rid of any extra lotion-feeling. This year the dryness is spreading... meaning more lotion all over my hands and body. Best summed up as: EWWWWW
I am very sensitive to tactile stimulation. Velvet=good. Tags=bad. Sweatshirt=good. Lotion=AWFUL!!! The cold, slimy, gooey feeling makes my skin crawl all over. And then it sinks in and it sticks and you can't get it off... ack. My husband and I got massages last year for our anniversary and the lotion almost ruined it for me... laying flat, unable to run or scream as lotion was poured all over me was a very tense experience.
Imagine for a moment, the strain that my struggles placed on my parents. If you have a child with SPD, you are probably familiar with the scene. Your child needs to put on sunscreen but screams, pulls away, and starts crying in hysterics when the goop is applied. Maybe you give in and don't put on so much sunscreen, then the child gets burnt and has to have aloe gel applied and the whole scene is repeated again. (Of course, this is not my only tactile difficulty, and I have processing difficulties in multiple sensory arenas).
But now I am older and understand my sensory needs better. I have managed to make great strides out of necessity- I am now able to apply chapstick multiple times per day (I find that lots of lip smacking afterward makes it better), and apply the facial moisturizer every morning (winter only). I have sought out the least flavored and scented of all products. I spent 10 minutes in the drugstore yesterday sniffing multiple "unscented" lotions trying to find the most agreeable one. The texture is impossible to try out. I am trying to start small... only apply a small amount to a controlled area and then leave my arms free to wipe off all excess. It has been a struggle thus far, but getting better. By concentrating on mastering this, I think I can finally suppress the EWWW and add another item to my List of Can-Dos: lotion.
12.03.2009
Fighting Frustration and Fatigue
This has been a hard 2 weeks.
It is my impression that the hospital staff was stressed and unpleasant last week due to the impending holiday and just wanting to leave work and go eat copious amounts of gravy laden food. However, they seemed to bring their bad moods BACK with them after Thanksgiving, which is just not fair. Get a grip people- it's holiday season for everyone, not just you. I'm working Christmas day, so that leaves 16 more working days before I can really rest. I'm already so tired... spent this a.m. in a fog since I fell asleep on the bus, and then was ok until I walked through my apt door where I have now crumpled into a semi-lifeless blob. My eyes and brain are fatigued... I can't even begin to think about learning more about Google Wave even though I have OT buddies on there now because it is literally overwhelming to me at this moment.
A vast majority of my pts on the cardiopulmonary unit this week have been people with volume overload following dietary indiscretions over the holiday. COPD and CHF exacerbations as well for related reasons. Interesting how things move in patterns. Unfortunately, since ice and snow is coming up there will be more broken hips and the like.
The next thing I write will probably be about the difficulty getting an IRF/ACIR placement for a pt... we've been discussing this a lot at work, there are new insurance rules going into effect, our documentation has extra scrutinization coming its way. It's a detailed issue that I care a lot about but I need to be a little more coherent before I try to address that. So I'm taking some time to rest, though that time does include traveling to a football game on Saturday and likely Christmas shopping (possibly even at crazy IKEA, yikes) on Sunday.
Just trying to keep afloat...
It is my impression that the hospital staff was stressed and unpleasant last week due to the impending holiday and just wanting to leave work and go eat copious amounts of gravy laden food. However, they seemed to bring their bad moods BACK with them after Thanksgiving, which is just not fair. Get a grip people- it's holiday season for everyone, not just you. I'm working Christmas day, so that leaves 16 more working days before I can really rest. I'm already so tired... spent this a.m. in a fog since I fell asleep on the bus, and then was ok until I walked through my apt door where I have now crumpled into a semi-lifeless blob. My eyes and brain are fatigued... I can't even begin to think about learning more about Google Wave even though I have OT buddies on there now because it is literally overwhelming to me at this moment.
A vast majority of my pts on the cardiopulmonary unit this week have been people with volume overload following dietary indiscretions over the holiday. COPD and CHF exacerbations as well for related reasons. Interesting how things move in patterns. Unfortunately, since ice and snow is coming up there will be more broken hips and the like.
The next thing I write will probably be about the difficulty getting an IRF/ACIR placement for a pt... we've been discussing this a lot at work, there are new insurance rules going into effect, our documentation has extra scrutinization coming its way. It's a detailed issue that I care a lot about but I need to be a little more coherent before I try to address that. So I'm taking some time to rest, though that time does include traveling to a football game on Saturday and likely Christmas shopping (possibly even at crazy IKEA, yikes) on Sunday.
Just trying to keep afloat...
11.22.2009
Energy Conservation for the Holidays
Energy Conservation is a favorite topic of mine. It involves a combination of strategies designed to let you save your energy on the multitude of tasks in a day so that you can save it for the things that matter most in your life. Holidays can be very draining, but here are some ways to save your energy. Please add your own suggestions in the comments section.
Tips for Family Get-togethers
-Try to limit excessive travel (I speak from experience- last year was a 10 day 8 location trip).
-When you do travel, make sure to take rest breaks at least every 2 hours to get out of the car and stretch. Rotating driving responsibilities is also a good idea
-Rotate hosting responsibilities within the group so that no one person has to bear the brunt of continual entertaining
-Consider meeting friends at a restaurant or other gathering place
-If you're doing the entertaining, ask for setup and cleanup help
-Try to take a nap before any gathering that will go into the evening hours
Tips for Meal Prep
-Spread the responsibilities around the family or group. Have people volunteer to make a specific dish so that the host is not saddled with the entire meal
-Prepare some dishes ahead of time if possible
-Use tools to save you time and effort. This includes mixers, microwave, and the crockpot
-Try to prepare more foods in the crockpot or bake them in the oven instead of cooking stovetop, since it requires less tending
-Keep a stool or extra chair in the kitchen so you can take breaks during cooking time. A higher stool can be pulled up directly to the stovetop for stirring pots, or to the sink to wash dishes
-Oven Bags can cut the cooking time for a turkey down substantially and decrease basting needs
-Perform prep tasks seated at table if possible
-Split large tasks between a group
Food Substitutions
-Several stores offer completely catered meals
-A rotisserie chicken can be substituted for making a full turkey
-Steam n' Mash Potatoes by Ore Ida are pre-cut potato pieces that you add to your own milk, butter, and spices. Saves the trouble of peeling and cutting the potatoes.
-Betty Crocker and Bob Evans both have instant mashed potatoes that can be heated up in the microwave. They also offer sweet potatoes and stuffing.
-Many schools offer cookie batter in large buckets as fundraisers, making cookies into a scoop & bake operation
As always, I have no relationship, financial or otherwise, with any of the aforementioned companies or products. However, I have used them myself frequently.
Tips for Family Get-togethers
-Try to limit excessive travel (I speak from experience- last year was a 10 day 8 location trip).
-When you do travel, make sure to take rest breaks at least every 2 hours to get out of the car and stretch. Rotating driving responsibilities is also a good idea
-Rotate hosting responsibilities within the group so that no one person has to bear the brunt of continual entertaining
-Consider meeting friends at a restaurant or other gathering place
-If you're doing the entertaining, ask for setup and cleanup help
-Try to take a nap before any gathering that will go into the evening hours
Tips for Meal Prep
-Spread the responsibilities around the family or group. Have people volunteer to make a specific dish so that the host is not saddled with the entire meal
-Prepare some dishes ahead of time if possible
-Use tools to save you time and effort. This includes mixers, microwave, and the crockpot
-Try to prepare more foods in the crockpot or bake them in the oven instead of cooking stovetop, since it requires less tending
-Keep a stool or extra chair in the kitchen so you can take breaks during cooking time. A higher stool can be pulled up directly to the stovetop for stirring pots, or to the sink to wash dishes
-Oven Bags can cut the cooking time for a turkey down substantially and decrease basting needs
-Perform prep tasks seated at table if possible
-Split large tasks between a group
Food Substitutions
-Several stores offer completely catered meals
-A rotisserie chicken can be substituted for making a full turkey
-Steam n' Mash Potatoes by Ore Ida are pre-cut potato pieces that you add to your own milk, butter, and spices. Saves the trouble of peeling and cutting the potatoes.
-Betty Crocker and Bob Evans both have instant mashed potatoes that can be heated up in the microwave. They also offer sweet potatoes and stuffing.
-Many schools offer cookie batter in large buckets as fundraisers, making cookies into a scoop & bake operation
As always, I have no relationship, financial or otherwise, with any of the aforementioned companies or products. However, I have used them myself frequently.
11.18.2009
Post from the Alzheimer's Reading Room
The Alzheimer's Reading Room is not my favorite blog, but I do follow it regularly. I was impressed at this recent entry that described the author's change in his caregiving style as he learned about Alzheimer's Disease. The emphasis on the power of DOING is great, and I wish that this would become well-known. The case is similar for adults with Alzheimer's, people with disabilities, children, ANYBODY- "Let me do."
11.17.2009
A "very special" episode of Glee
I have been occasionally watching "Glee" and trying to decide whether it's worth my viewing time. However the most recent episode and its after-school-special sugaryness has exposed a lot of controversy.
There are 2 main issues here, one with the show for casting a non-disabled actor to play a student in a wheelchair, and one with the episode itself, which featured terribly contrived dialogue to try to make the other glee-clubbers understand Artie's plight of being in a wheelchair.
Let's start with the immersion exercise episode where the self-centered glee clubbers were relegated to spend a few hours each day in a wheelchair. The students' teacher rolls out wheelchairs that he supposedly bought at a tag sale from a local nursing home. Of course these were all sleek, more stylish chairs than that bear no resemblance to the standard industrial type chairs seen in hospitals and nursing homes. A nitpick, admittedly, but that's how I am. The whole episode was painful to watch as the glee geeks were more mistreated than usual now that they were wheelchair users. Cool kids are now... uncool! Feeling left out over a week leads to... increased empathy 4-evar! We even had time to learn that ex-quarterback kid couldn't manage to find a job... until he was in a wheelchair and had pity and fear of litigation from an employer! It just didn't feel like an empowering week. And this may also be part of a commentary on how poorly defined this show is... is it made for children and tweens or is it made for adults? The fake pregnancy pentagon storyline is surely not made for the young crowd, but you'd expect older viewers to rant about the terrible plotlines in general. Confusing.
However, the meat of this discussion should be about the casting of the role of Artie, and some of the controversy was addressed in the USA Today. Why wasn't a legitimate actor-singer-wheelchair user cast to play Artie, glee club geek in a wheelchair? Here's a second, perhaps more telling question- how many such actor-singer-wheelchair users auditioned? From the way that actor Kevin McHale describes his audition, I find it questionable that the role was ever advertised to indicate that the actor would be in a wheelchair. It sounds like this was a plot twist to increase diversity that got thought of after the casting and got shoved onto an already created character. I have the impression that the role was created around the actor, so perhaps the casting calls were not worded in a way to invite wheelchair users to audition.
sidenote- if you watch the McHale interview, how does a kid who plays an adolescent have no idea what time schools are in session? "From 8 to 12 or whenever"?
I don't think that the character of Artie is a great ambassador of teenage wheelchair users anyway. As a member of the glee club, he is often hanging out on the sidelines with the band instead of participating in the show. If he is worked into the routine, it often involves another character pushing him around. The writers went out of their way to end this episode with a big musical number that had everyone swooshing around in wheelchairs, but did they consult a wheelchair dancer for choreography tips? I have my doubts. And if my earlier suppositions about the wheelchair being thrust onto a character after the actor had already been selected, why not put Mark Salling, who plays buff ne'er do well football star Puck into a wheelchair, to be a buff ne'er do well wrestling star? Artie could have continued to be the geeky guy who plays the guitar, he also could have been the much-mocked kicker on the football team. Wouldn't that have made for some better, more original storylines than putting the dorky kid in the wheelchair?
Should an able-bodied actor ever play a character that has a disability? That is the main question. In one sense, all acting is fakery. Hollywood does not always hire sports stars, drug addicts, or serial killers to play themselves. But certainly a capable actor who has the same abilities as his character would have a better understanding of how to play the role well. The real issues in this question are-1. are disabled actors being considered? and 2. are non-disabled actors giving an unfair portrayal to disabled characters? The Iris Center, out of Vanderbilt University, has a catalogue of movies about disability or featuring disabled characters. Some of these movies feature great performances, but are they demeaning? One mother in the UK is starting a group
criticizing portrayals of characters with mental or neurological impairments (nothing about physical impairments, oddly) who are played by actors who do not have a disability. One thing that I worry about though is if there becomes a taboo on non-disabled actors playing disabled characters, will disabled actors ever be allowed to just be actors, and not be identified first by a disability?
There are 2 main issues here, one with the show for casting a non-disabled actor to play a student in a wheelchair, and one with the episode itself, which featured terribly contrived dialogue to try to make the other glee-clubbers understand Artie's plight of being in a wheelchair.
Let's start with the immersion exercise episode where the self-centered glee clubbers were relegated to spend a few hours each day in a wheelchair. The students' teacher rolls out wheelchairs that he supposedly bought at a tag sale from a local nursing home. Of course these were all sleek, more stylish chairs than that bear no resemblance to the standard industrial type chairs seen in hospitals and nursing homes. A nitpick, admittedly, but that's how I am. The whole episode was painful to watch as the glee geeks were more mistreated than usual now that they were wheelchair users. Cool kids are now... uncool! Feeling left out over a week leads to... increased empathy 4-evar! We even had time to learn that ex-quarterback kid couldn't manage to find a job... until he was in a wheelchair and had pity and fear of litigation from an employer! It just didn't feel like an empowering week. And this may also be part of a commentary on how poorly defined this show is... is it made for children and tweens or is it made for adults? The fake pregnancy pentagon storyline is surely not made for the young crowd, but you'd expect older viewers to rant about the terrible plotlines in general. Confusing.
However, the meat of this discussion should be about the casting of the role of Artie, and some of the controversy was addressed in the USA Today. Why wasn't a legitimate actor-singer-wheelchair user cast to play Artie, glee club geek in a wheelchair? Here's a second, perhaps more telling question- how many such actor-singer-wheelchair users auditioned? From the way that actor Kevin McHale describes his audition, I find it questionable that the role was ever advertised to indicate that the actor would be in a wheelchair. It sounds like this was a plot twist to increase diversity that got thought of after the casting and got shoved onto an already created character. I have the impression that the role was created around the actor, so perhaps the casting calls were not worded in a way to invite wheelchair users to audition.
sidenote- if you watch the McHale interview, how does a kid who plays an adolescent have no idea what time schools are in session? "From 8 to 12 or whenever"?
I don't think that the character of Artie is a great ambassador of teenage wheelchair users anyway. As a member of the glee club, he is often hanging out on the sidelines with the band instead of participating in the show. If he is worked into the routine, it often involves another character pushing him around. The writers went out of their way to end this episode with a big musical number that had everyone swooshing around in wheelchairs, but did they consult a wheelchair dancer for choreography tips? I have my doubts. And if my earlier suppositions about the wheelchair being thrust onto a character after the actor had already been selected, why not put Mark Salling, who plays buff ne'er do well football star Puck into a wheelchair, to be a buff ne'er do well wrestling star? Artie could have continued to be the geeky guy who plays the guitar, he also could have been the much-mocked kicker on the football team. Wouldn't that have made for some better, more original storylines than putting the dorky kid in the wheelchair?
Should an able-bodied actor ever play a character that has a disability? That is the main question. In one sense, all acting is fakery. Hollywood does not always hire sports stars, drug addicts, or serial killers to play themselves. But certainly a capable actor who has the same abilities as his character would have a better understanding of how to play the role well. The real issues in this question are-1. are disabled actors being considered? and 2. are non-disabled actors giving an unfair portrayal to disabled characters? The Iris Center, out of Vanderbilt University, has a catalogue of movies about disability or featuring disabled characters. Some of these movies feature great performances, but are they demeaning? One mother in the UK is starting a group
criticizing portrayals of characters with mental or neurological impairments (nothing about physical impairments, oddly) who are played by actors who do not have a disability. One thing that I worry about though is if there becomes a taboo on non-disabled actors playing disabled characters, will disabled actors ever be allowed to just be actors, and not be identified first by a disability?
11.14.2009
Some sad times
My time at work has been sad lately.
My current rotation has been a mighty mishmash of cardiopulmonary pts on intensive and progressive care units, orthopedic pts, and frequent floating back to the neuro floor and ICU. In short, my pts have been much more acutely ill than on my other rotations.
It's very depressing seeing pts on multiple admissions for severe COPD or CHF exacerbations. People who are far past where cardiopulmonary rehab can be beneficial. I've had several pts travel back and forth from the regular floor to the ICU, but I have a couple that I'm concerned aren't likely to come out. I've had to get much more diligent about checking with nurses even for follow up sessions since my pts fluctuate considerably from day to day. Got as close as I care to get to a pt coding... me throwing on a contact isolation gown and slapping a vitals machine onto a lady who was hyperventilating, desatting, and gasping in pain. Fortunately the doctor and charge nurse were right behind me, so I was able to excuse myself and let them perform the rapid response and take her to the ICU.
My neurology pts aren't faring much better. Someone I evaluated several weeks ago while on that rotation is now nearing a full 2 months hospitalized and has just gotten progressively functionally worse. I wonder if she would have been happier if the surgeons left her brain tumor in and let her live out the rest of her life still able to walk and talk and recognize her family. Her shoulder now has a finger width subluxation that I feel personally responsible for.
She is one of several people we've had with GBMs lately, a particularly nasty type of brain tumor with very poor prognosis. Also had the readmission of a young CA pt that I worked with prior, who was intubated, had to get a PEG tube, and generally declining. I couldn't even look toward the back corner of the unit without choking up.
I've also had some personal disappointment lately, and have felt pretty bad for being swayed by that at all, having any negative emotions over this minor speed bump in life when I still have life and many of my pts are losing theirs. So it's been a very emotional time, a lot of tears at home, some at work. Not such a great time lately, but it will improve, I hope.
My current rotation has been a mighty mishmash of cardiopulmonary pts on intensive and progressive care units, orthopedic pts, and frequent floating back to the neuro floor and ICU. In short, my pts have been much more acutely ill than on my other rotations.
It's very depressing seeing pts on multiple admissions for severe COPD or CHF exacerbations. People who are far past where cardiopulmonary rehab can be beneficial. I've had several pts travel back and forth from the regular floor to the ICU, but I have a couple that I'm concerned aren't likely to come out. I've had to get much more diligent about checking with nurses even for follow up sessions since my pts fluctuate considerably from day to day. Got as close as I care to get to a pt coding... me throwing on a contact isolation gown and slapping a vitals machine onto a lady who was hyperventilating, desatting, and gasping in pain. Fortunately the doctor and charge nurse were right behind me, so I was able to excuse myself and let them perform the rapid response and take her to the ICU.
My neurology pts aren't faring much better. Someone I evaluated several weeks ago while on that rotation is now nearing a full 2 months hospitalized and has just gotten progressively functionally worse. I wonder if she would have been happier if the surgeons left her brain tumor in and let her live out the rest of her life still able to walk and talk and recognize her family. Her shoulder now has a finger width subluxation that I feel personally responsible for.
She is one of several people we've had with GBMs lately, a particularly nasty type of brain tumor with very poor prognosis. Also had the readmission of a young CA pt that I worked with prior, who was intubated, had to get a PEG tube, and generally declining. I couldn't even look toward the back corner of the unit without choking up.
I've also had some personal disappointment lately, and have felt pretty bad for being swayed by that at all, having any negative emotions over this minor speed bump in life when I still have life and many of my pts are losing theirs. So it's been a very emotional time, a lot of tears at home, some at work. Not such a great time lately, but it will improve, I hope.
11.03.2009
Back From Conference
State OT conference was this weekend and I had both an enjoyable time and very energizing time.
Finishing and presenting my topic at the state conference were both great feelings. I haven't given a formal presentation since school, and it was even longer since I'd given one in front of (mostly) strangers. I felt a bit like a motormouth and know that I set out to cover too much for my 30 minutes, but it was a good experience. The official title was "Growing as an OT Through Online Resources" but it was basically a quick overview of multiple types of online tools (with several plugs for OT Connections, haha). Only bummer was that my presentation was last so people were tired and quiet by the time I came up to talk.
Got to spend some good time catching up with fellow alumnae of my program, quick chats with a couple of professors as well. Serendipitous moment was seeing a car with license plate "OTHELPS" as we were driving back.
Love the energizing feeling that comes from being with other OTs, hearing about legislative victories, hearing some inspirational stories of rehab at its best. Have some ideas about helping our conference continue to grow, and I enjoyed presenting and think I can do that again with less stress. Have another project that I'm working on this week and then will be working the next 3 Sundays due to holiday scheduling so life continues to be very busy. Learning a lot on the cardiopulmonary floor and will be passing it along soon! :)
Finishing and presenting my topic at the state conference were both great feelings. I haven't given a formal presentation since school, and it was even longer since I'd given one in front of (mostly) strangers. I felt a bit like a motormouth and know that I set out to cover too much for my 30 minutes, but it was a good experience. The official title was "Growing as an OT Through Online Resources" but it was basically a quick overview of multiple types of online tools (with several plugs for OT Connections, haha). Only bummer was that my presentation was last so people were tired and quiet by the time I came up to talk.
Got to spend some good time catching up with fellow alumnae of my program, quick chats with a couple of professors as well. Serendipitous moment was seeing a car with license plate "OTHELPS" as we were driving back.
Love the energizing feeling that comes from being with other OTs, hearing about legislative victories, hearing some inspirational stories of rehab at its best. Have some ideas about helping our conference continue to grow, and I enjoyed presenting and think I can do that again with less stress. Have another project that I'm working on this week and then will be working the next 3 Sundays due to holiday scheduling so life continues to be very busy. Learning a lot on the cardiopulmonary floor and will be passing it along soon! :)
10.30.2009
On my way to WVOTA 09
I know I haven't posted much this month, mostly because I was trying to finish my presentation for the annual conference. I'm going to be presenting on social networking and OT and I am really excited. Wish me luck!!
10.12.2009
Virtual Reality Survey
Passing along a survey for student research, link on the full post.
I am a student at Thomas Jefferson University and I am currently doing my master's research project on virtual reality program usage in therapy. Whether or not you use these systems, I would really appreciate if you were able to complete the following survey and pass it along to any OTs you know!
Survey link:
http://www.surveymonkey.com/s.aspx?sm=l12ANB490U1A2oAercLlpQ_3d_3d
Thank you in advance!
Sara Jasin, OT/S
I am a student at Thomas Jefferson University and I am currently doing my master's research project on virtual reality program usage in therapy. Whether or not you use these systems, I would really appreciate if you were able to complete the following survey and pass it along to any OTs you know!
Survey link:
http://www.surveymonkey.com/s.aspx?sm=l12ANB490U1A2oAercLlpQ_3d_3d
Thank you in advance!
Sara Jasin, OT/S
10.04.2009
Tis the season for changing
3 months has gone by, neuro rotation is over.
This month, I begin on a new floor, the last "new" floor possible (NICU/peds does not count into the rotation). So I will now be working with cardiopulmonary pts, some in ICUs, and orthos. I don't find any of these superbly interesting but hope to find some fun stuff to do. Little worried from a productivity standpoint since I suspect we'll be taking a lot of rest breaks, lots of breaks to check vitals, and probably a lot of advance planning to separate OT/PT sessions into morning/afternoon. I haven't ventured fully into the ICUs yet... we are starting an effort for early mobility and decreased sedation (similar to this) so that will be interesting but it is also stressful to make sure that I know enough about what is going on and protecting my pts, not pushing them too far.
My neuro rotation was good... it was split with surgery, which was not so much fun. Rounds for both are kind of demanding, and first thing in the morning which can make it hard to get a jump start on the day. I did learn a lot on the rotation... I am no longer scared to be in the neuro ICU despite intra-ventricular catheters and pts who have to be monitored very closely. Worked with one lady for 5-6 weeks in total over 2 admissions, she might make a good case study later. I got over my splinting fears for the basic stuff- had a period of 2 weeks where I felt like I made at least one splint everyday. Luckily there are good experienced people around me who are willing to give advice on whether to splint or not, whether adaptations need to be made. even made a resting hand splint around an arterial line.
Had several interesting cases, but lately it's been more sadness and disappointment. Some people really stick with you and it's hard to leave at the end of the day knowing that there's really no reason your pt wound up in the hospital, and that same freak accident/diagnosis that happened to them could just as easily happen to you. Life can seem random when otherwise healthy people wind up hospitalized for something no one could have seen coming. I had a lady in her 80s who had never had any illness before, but had neuro symptoms, came to the ER, and found that she has had a large brain aneurysm that was leaking. What are the odds? It's not right, but there's other diagnoses where you assign a fault, make yourself feel better- I won't get this, I don't smoke/use drugs/I wear a seatbelt- but too many things on this rotation could happen to anyone. It's a scary world out there, and unpleasant to have to contemplate mortality so often.
The switch has me working with some new OTs/PTs that I'm not familiar with so that is interesting. At least one is working on clinical ladder for cardiopulmonary, so I expect to learn a lot. I am reminded of when I was playing on a basketball team with 9 players and I was the 5th player, so there were times when I was the worst player on the court, and times when I was the best player on the court. I remember asking my dad about that situation and he said not to feel bad about being the worst player because everyone around you can teach you and make you better. So that's sometimes how I feel right now, being the newest OT hire and only 2 years experience, but I do feel that I'm learning and getting better.
I've gotten better at writing goals for ICU pts and conducting tx sessions, suspect that will continue to improve during this rotation and hopefully I will have a good update with ideas for everyone.
This month, I begin on a new floor, the last "new" floor possible (NICU/peds does not count into the rotation). So I will now be working with cardiopulmonary pts, some in ICUs, and orthos. I don't find any of these superbly interesting but hope to find some fun stuff to do. Little worried from a productivity standpoint since I suspect we'll be taking a lot of rest breaks, lots of breaks to check vitals, and probably a lot of advance planning to separate OT/PT sessions into morning/afternoon. I haven't ventured fully into the ICUs yet... we are starting an effort for early mobility and decreased sedation (similar to this) so that will be interesting but it is also stressful to make sure that I know enough about what is going on and protecting my pts, not pushing them too far.
My neuro rotation was good... it was split with surgery, which was not so much fun. Rounds for both are kind of demanding, and first thing in the morning which can make it hard to get a jump start on the day. I did learn a lot on the rotation... I am no longer scared to be in the neuro ICU despite intra-ventricular catheters and pts who have to be monitored very closely. Worked with one lady for 5-6 weeks in total over 2 admissions, she might make a good case study later. I got over my splinting fears for the basic stuff- had a period of 2 weeks where I felt like I made at least one splint everyday. Luckily there are good experienced people around me who are willing to give advice on whether to splint or not, whether adaptations need to be made. even made a resting hand splint around an arterial line.
Had several interesting cases, but lately it's been more sadness and disappointment. Some people really stick with you and it's hard to leave at the end of the day knowing that there's really no reason your pt wound up in the hospital, and that same freak accident/diagnosis that happened to them could just as easily happen to you. Life can seem random when otherwise healthy people wind up hospitalized for something no one could have seen coming. I had a lady in her 80s who had never had any illness before, but had neuro symptoms, came to the ER, and found that she has had a large brain aneurysm that was leaking. What are the odds? It's not right, but there's other diagnoses where you assign a fault, make yourself feel better- I won't get this, I don't smoke/use drugs/I wear a seatbelt- but too many things on this rotation could happen to anyone. It's a scary world out there, and unpleasant to have to contemplate mortality so often.
The switch has me working with some new OTs/PTs that I'm not familiar with so that is interesting. At least one is working on clinical ladder for cardiopulmonary, so I expect to learn a lot. I am reminded of when I was playing on a basketball team with 9 players and I was the 5th player, so there were times when I was the worst player on the court, and times when I was the best player on the court. I remember asking my dad about that situation and he said not to feel bad about being the worst player because everyone around you can teach you and make you better. So that's sometimes how I feel right now, being the newest OT hire and only 2 years experience, but I do feel that I'm learning and getting better.
I've gotten better at writing goals for ICU pts and conducting tx sessions, suspect that will continue to improve during this rotation and hopefully I will have a good update with ideas for everyone.
9.16.2009
Exodus
There have been so many farewells here lately, and it's quite frustrating!
In the space of ~1-2 months, we are losing a lot of people at work. One of the front office staffers, 3 PTs (who all sit in my cubicle row) and likely 3 great rehab techs. Also, one girl from my row is likely to go out on maternity leave any day now. I don't want it to get quiet and lonely in my area, or lose contact with good friends. And now, I'm seeing goodbyes in the blogosphere. One of the leaders from Hospital Impact is onto other projects, though the blog will continue. OT Advocacy made what was to me a shocking announcement of retirement, after a relatively short but productive run and a feature in OT Practice. And debate continues for the future of OT Students... though understandable, I would hate to lose access to the outlook of a cherished virtual friend.
And another thing! What happened to our OT Blog Carnival?! 2-3 issues and then poof?
I don't really think of fall as a time for changes... more as a time to hunker down and stay the course. Plus, I'm usually too distracted by football season to want to shake up life in any other way. Maybe some new and interesting things will pop up, but it's no fun to be saying goodbye all the time.
In the space of ~1-2 months, we are losing a lot of people at work. One of the front office staffers, 3 PTs (who all sit in my cubicle row) and likely 3 great rehab techs. Also, one girl from my row is likely to go out on maternity leave any day now. I don't want it to get quiet and lonely in my area, or lose contact with good friends. And now, I'm seeing goodbyes in the blogosphere. One of the leaders from Hospital Impact is onto other projects, though the blog will continue. OT Advocacy made what was to me a shocking announcement of retirement, after a relatively short but productive run and a feature in OT Practice. And debate continues for the future of OT Students... though understandable, I would hate to lose access to the outlook of a cherished virtual friend.
And another thing! What happened to our OT Blog Carnival?! 2-3 issues and then poof?
I don't really think of fall as a time for changes... more as a time to hunker down and stay the course. Plus, I'm usually too distracted by football season to want to shake up life in any other way. Maybe some new and interesting things will pop up, but it's no fun to be saying goodbye all the time.
9.10.2009
My First WiiHab
So our hospital has a Wii (actually 2, one lives solely in the burn unit) which I have thought was interesting since I didn't know how well it could be used in acute care. I missed the inservice but figured I could go ahead with my session since I have a Wii at home and am somewhat familiar with the games.
The way I see it, for the Wii to be used in acute care, you have to have a client who is sticking around for a few days, has the required cognitive capabilities to understand the system, and has deficits that can be addressed using the system. We currently have 3 games- the basic sports game, Wii Play, and Wii Fit. The first client that I had who would have been appropriate (since the program starting) was a cute little lady who was extrememly active prior to her stroke- walking 3 miles a day. Her only deficits were upper-level balance issues, but I was off after her evaluation so I didn't get to implement that plan. But I was able to use the Wii with another lady on the stroke floor. Sorry the case study isn't more in-depth, but several weeks have passed now...
Ms Z was getting an extensive neuro workup for several symptoms, including visual dysfunctions, L-sided paralysis, mental status changes, seizures. Original possible diagnoses were PRES vs an unlikely conversion disorder. Her visual problems were very odd, starting out where she could only see shadows, then she could identify broad swaths of color and light/dark, to where her acuity was markedly improved at which time the optometrist diagnosed a L hemianopsia. She also had a L hemiparesis. As our sessions progressed, she regained hand movement progressing to intermittant elbow and shoulder control. She also progressed to verbal cues only for supine to sit, and was then able to transfer to a chair with min assist of 2, needing her L knee blocked. Once we could transfer her to an appropriate chair, she could come down to our gym to use the Wii.
I thought she would be a good Wii candidate since her controlled ROM of the LUE was intermittant. I hoped that given a distracting BUE task that the control might become more consistent. This was my plan on Friday... when I came in on Monday we had to cut the session short due to LP, and then on Tuesday Ms Z had full ROM of her LUE! Not from anything I did, but just part of the strange waxing and waning of symptoms. She then had some RUE control deficits. I decided that since her coordination was still off that the Wii session could continue. We worked on Wii boxing to address standing balance, endurance, and UE ROM control. Our first day, Ms Z was unable to tolerate a full "round" vs the computer opponent (3 minutes) while standing. However, she persevered while seated and did complete 2 bouts. Our second day, she was able to complete a full bout while standing (10 minutes in parallel bars with contact guard support from PT). We then added in additional challenges, using different punches (inspired by TurboJam), and trying to better facilitate weight shifting both front-back and right-left.
I was happy with how the boxing activity worked out... my next session was going to be more visually-spatial based and require more refined isometric control of the shoulder, but Ms Z was discharged that night to rehab. Even though her initial reaction to the wii was "this doesn't apply to me because I do not play sports," she did get very active and involved in the activity, progressing on performance components she needed for independence. The novelty of the activity was also good since she was getting frustrated with an extended hospital stay. It was a worthwhile therapy experience for both of us.
I feel that I learned a lot from these sessions, and I went home and reevaluated my wii games (sports and play... don't have a wii fit). That brought me to a gigantic list of things that could be better about the games from a therapy perspective. It is a LONG list, I will share it hopefully this week and would love to hear others' thoughts on using the Wii in rehab. For more thoughts on the subject, you can check out a blog dedicated to WiiHab here.
The way I see it, for the Wii to be used in acute care, you have to have a client who is sticking around for a few days, has the required cognitive capabilities to understand the system, and has deficits that can be addressed using the system. We currently have 3 games- the basic sports game, Wii Play, and Wii Fit. The first client that I had who would have been appropriate (since the program starting) was a cute little lady who was extrememly active prior to her stroke- walking 3 miles a day. Her only deficits were upper-level balance issues, but I was off after her evaluation so I didn't get to implement that plan. But I was able to use the Wii with another lady on the stroke floor. Sorry the case study isn't more in-depth, but several weeks have passed now...
Ms Z was getting an extensive neuro workup for several symptoms, including visual dysfunctions, L-sided paralysis, mental status changes, seizures. Original possible diagnoses were PRES vs an unlikely conversion disorder. Her visual problems were very odd, starting out where she could only see shadows, then she could identify broad swaths of color and light/dark, to where her acuity was markedly improved at which time the optometrist diagnosed a L hemianopsia. She also had a L hemiparesis. As our sessions progressed, she regained hand movement progressing to intermittant elbow and shoulder control. She also progressed to verbal cues only for supine to sit, and was then able to transfer to a chair with min assist of 2, needing her L knee blocked. Once we could transfer her to an appropriate chair, she could come down to our gym to use the Wii.
I thought she would be a good Wii candidate since her controlled ROM of the LUE was intermittant. I hoped that given a distracting BUE task that the control might become more consistent. This was my plan on Friday... when I came in on Monday we had to cut the session short due to LP, and then on Tuesday Ms Z had full ROM of her LUE! Not from anything I did, but just part of the strange waxing and waning of symptoms. She then had some RUE control deficits. I decided that since her coordination was still off that the Wii session could continue. We worked on Wii boxing to address standing balance, endurance, and UE ROM control. Our first day, Ms Z was unable to tolerate a full "round" vs the computer opponent (3 minutes) while standing. However, she persevered while seated and did complete 2 bouts. Our second day, she was able to complete a full bout while standing (10 minutes in parallel bars with contact guard support from PT). We then added in additional challenges, using different punches (inspired by TurboJam), and trying to better facilitate weight shifting both front-back and right-left.
I was happy with how the boxing activity worked out... my next session was going to be more visually-spatial based and require more refined isometric control of the shoulder, but Ms Z was discharged that night to rehab. Even though her initial reaction to the wii was "this doesn't apply to me because I do not play sports," she did get very active and involved in the activity, progressing on performance components she needed for independence. The novelty of the activity was also good since she was getting frustrated with an extended hospital stay. It was a worthwhile therapy experience for both of us.
I feel that I learned a lot from these sessions, and I went home and reevaluated my wii games (sports and play... don't have a wii fit). That brought me to a gigantic list of things that could be better about the games from a therapy perspective. It is a LONG list, I will share it hopefully this week and would love to hear others' thoughts on using the Wii in rehab. For more thoughts on the subject, you can check out a blog dedicated to WiiHab here.
9.07.2009
Thoughts Spurred by Malcolm Gladwell
At the suggestion of my dad, I read Malcolm Gladwell's books over the summer, and have some OT-related thoughts from them.
As a disclaimer, before someone jumps in to attack my lack of critical reading skills, I am well aware that none of the concepts in Gladwell's books are his own research, but there is a limit to how many individual research articles any one person is going to read in a given lifetime. So these are distilled stories with ready-made inferences, but interesting and thought provoking nonetheless. Here are some OT-related thoughts from the books The Tipping Point (TP), Blink (B), and Outliers (O).
Reading the Face (B 197) The final chapter of Blink discusses the work of Paul Ekman and ability to read emotions through expressions and micro-expressions. While I think it would be interesting to see when people are lying, frustrated, or scared, I think I would have better use to just be more aware of my own expressions and the message that I am subconsciously sending.
Fusiform vs Temporal gyrus (B 219)- After discussing visual tracking during a movie between persons w/ and w/o autism, he touches on a study indicating that most people picture and view faces using the fusiform gyrus. However, an autistic individual uses the inferior temporal gyrus to view faces, which is the same location that most people use only for objects. I wasn't really aware of that specific neurological difference but think that it would make an interesting principle to guide treatment.
10,000 hour rule (O 35)- This concept is presented as one of the precursors to mis-named overnight success. Several examples were given of people who started working in an unpopular field and had logged 10,000 hours of practice by the time that the field was ready for rapid growth. This number is referred to as the number of hours of practice needed to become an expert in the field. This would be a little over 5 years of full time work. How many OTs work their first 5 years uninterrupted, let alone in the same practice area? Just a thought. Also makes the hours needed for board and specialty certification seem almost doable.
Culture of Honor (O 161)- There was a mention of how a cultural importance of honor in highland areas has continued into the Appalachian region, giving some reasoning behind the number of feuds in the past century. This concept is also of high importance to many urban residents, especially in places where gang culture is rampant. I just thought it was an important tip to promote developing rapport with your clients and deferring to be more formal and respectful until you have a well developed relationship with your client and can be more informal.
Parenting styles (O 104)- A study is referenced that talks about 2 parenting styles: "concerted cultivation" vs "accomplishment of natural growth." I don't have full definitions for these, but they are associated with high and low SES families, respectively. The former is where the parent would encourage social skills and talent development through modeling and empowering the child. This was associated with higher confidence and better interactions with adults. The latter is a style that is more passive, leaving some of the development left up to teachers, coaches, therapists, etc. I definitely saw both types of parents when I was working with peds. In my experience, the latter style makes it hard to have home program carryover.
Levels of mitigation in speech (O 194)- The levels are restated here, and were discussed in the book in relation to studies about plane crashes. The author of that link also references an article from a person in a different power-index culture, which was interesting. I would be very interested to see a study on what terminology was used in ERs for trauma or in ICUs in critical moments between the various staff members. I may write up my observations on the language that is used at the interdisciplinary care meetings. But as far as client-therapist interactions, I think you have to balance your styles based on the client and family cultural and learning preferences. As an OT I want to give options, not take them away, however as safety concerns become larger, I do get more commanding.
Transactive Memory (TP 187) I scoured my in-depth books on cognition and found no mention of this concept, however, there is some research on this concept in the fields of relationship studies and also in computer science. This is where a couple or a group have certain tacitly designated tasks or things to remember. I never know where the various charger cords or electronic devices are, but/because my husband always does. This can happen sometimes in workplaces as well, where you have specialists and go-to guys/gals for specific tasks or theories. I think this also accounts for some of the memory impairment that I see in hospital patients as well. If you're used to sharing memory tasks it's not the same when you're out of your environment and out of touch with those you are close to.
The Tipping Point (TP 9)- Obviously this is the main idea of the first book, the idea that at some point change becomes unstoppable due to the momentous force behind it. My question here is- when is OT going to reach a tipping point? When are we going to be highly demanded in multiple fields? When are we going to be the go-to professionals for daily living, low vision, home mods, driving rehab, etc etc ad nauseum? When are we going to be respected by legislation, hospital policies, and other professions? I AM READY TO TIP! I know this is implicit in the Centennial Vision, and I would love for us as a profession to tip by that time. So I guess I'm still at the phase of tipping that I am becoming the best OT I can be so that when consumers have my services they come away with a great message about the purpose and power of OT. Just important to try your best every day since you don't know who you encounter that will be talking about you later.
Hope that's enough inspiration to help me get through the week! Anyone else have Gladwell-related thoughts?
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