5.08.2011
still learning to deal...
I've been feeling pretty stressed lately, so I've been spending more time away from the computer. Plus, I did get to have a crazy amount of fun in April (1-2 awesome things per week) but things are finally calming down for May. Several entries in the works, but it's going to take some time to bring them online and keep me sane. MOTA readers (anyone?) can now check out the MOTA website for the updated legislative advocacy page.
4.23.2011
OT in HD: Presidential Address
AOTA President Florence Clark opened the 2011 AOTA Conference with an excellent presidential address describing the need for OTs to compete. 
(Photo credit to Cheryl Crow, videographer extraordinaire, from the OT Connections Gallery)
We live in a world of competition. Especially now, in a time of health care reform where decisions are being made about what services are necessary in the future, we as occupational therapy practitioners need to be engaging competition with (not against) others to ensure our role in promoting occupational fulfillment to the public. Competition needs to be acknowledged. It drives innovation and can improve practice. It's not going away, so get comfortable with it. Victories are won often by teamwork, but always by competition. But, as Dr. Clark said, "let's face it- we're nice." OT attracts people who are cooperative and kind. But if you let others take OT for granted, "it's not playing nice, it's playing dead!"
"HD OT" requires power, and we as a profession need to embrace our collective power. We can't stand alone, but together, we have a power that can't be ignored. As a group, we are witnesses to the "transformative power of occupation" and this must be shared with the public! The public mindset is shifting toward wellness and participation, which is a foundation concept to OT. One example is the case of Congresswoman Giffords. Per Dr. Clark, it was not so much of a question of 'would she walk again?' but one of 'would she run again- for Congress?' People are concerned with the ability to fulfill a role- one of the things that makes life worth living!
Dr. Clark drew some analogies to Rocky, who demonstrates caring and competitiveness, sensitivity and toughness. We have to be "in the ring" during the healthcare debates. We have to bring our "playbook." That includes evidence on our effectiveness, increased grants, decreased hospital readmissions and documentation. Our documentation should not over-emphasize motor-based components, but embrace our multifaceted approach dedicated to the whole person, environment, and occupation. We need to be intensely involved in advocacy to make the message heard- that Occupational Therapy helps people LIVE LIFT TO ITS FULLEST!
A recurring theme of President Clark's address was to strive for "arete," an ancient Greek concept referring to excellence, effectiveness, fulfillment. We each need to strive for everyday excellence in our work, with our clients, and how we represent ourselves. Fire up your competitive juices!
Dr. Clark's message goes hand in hand with 2 other excellent sessions I attended and will share at a later date. I hope that the call to "arete" resonates with you.
4.15.2011
AOTA Conference 2011
The 2011 AOTA Conference: OT in HD is in full swing!
Wow. This has been a truly awesome experience thus far. I know people want updates, and it's so hard to encapsulate because there are a million wonderful things going on in all facets of OT practice. Deciding where to begin is difficult.
First off, I think it has been great to be able to come with a friend. My best friend (also an OT, how convenient) got to come this year and this is her first conference, so it's been exciting to see things through her eyes and have someone to bounce ideas off of and be interested in similar things. It's also nice to have someone to sit in the big sessions with and go out in the evening together. So her presence has made this conference an improvement over others in that regard.
Another "people power" effect is that since I have become more involved in OTConnections, my state association, and NBCOT, I have met a lot of people and it's very fun to get to meet them in person or see them again. I also have at least a fair memory for names and faces, so I will see someone's name badge or recognize them from a photo and say hello. I've had a couple of people spot my badge and ask about various people at the hospital and life in Baltimore and I enjoy those chance meetings. I have gotten to see several of my former professors and had time to catch up with them, which is great. There are such terrific people in the field that by just talking to others in your sessions you can find out great things and see that there are OT revolutionaries all around.
I have been to some very informative sessions on a wide range of topics thus far. Started with a course on Infant Driven Feeding in the NICU, also got to see some ground breaking research on Contemporary Motor Control with guidelines for practice. Today I had GREAT sessions which have warranted their own posts at a later date- a session on being a Survivor in a tough market which segued well into the presidential address outlining benefits of being competitive. I got to be part of an intensive discussion on telehealth with (dare I say it?) other OT geeks, and then the Slagle lecture was terrific. Tomorrow is very up in the air... I have 3 sessions that are interesting in the morning and 3 in the afternoon that all overlap. I don't have a 3 sided coin. and we are planning on going to the AOTPAC night which judging by last year's pictures should be a lot of fun.
I've got a lot of notes from the various sessions and I'm really glad that I took off Monday to process everything.
Looking at the conference program, I realize I saw several of the "pixel people" at sessions today... I've also been able to match up the color photos with the grayscale on the cover... totally dweeby of me.
The updates on twitter under #AOTA11 have been interesting to follow, but I'm only getting them sporadically given the spotty wifi and cheap cell phone coverage. It's exciting to see so many people posting. I hope that people will also go back and use OTConnections more post-conference to make some dynamic SIS-type interactions.
Sorry this is so random, but that's the way of things during this time of sensory overload and OT-awesomeness. There's a lot of excitement tomorrow and I need my beauty sleep! More updates to come after I get home for sure.
Wow. This has been a truly awesome experience thus far. I know people want updates, and it's so hard to encapsulate because there are a million wonderful things going on in all facets of OT practice. Deciding where to begin is difficult.
First off, I think it has been great to be able to come with a friend. My best friend (also an OT, how convenient) got to come this year and this is her first conference, so it's been exciting to see things through her eyes and have someone to bounce ideas off of and be interested in similar things. It's also nice to have someone to sit in the big sessions with and go out in the evening together. So her presence has made this conference an improvement over others in that regard.
Another "people power" effect is that since I have become more involved in OTConnections, my state association, and NBCOT, I have met a lot of people and it's very fun to get to meet them in person or see them again. I also have at least a fair memory for names and faces, so I will see someone's name badge or recognize them from a photo and say hello. I've had a couple of people spot my badge and ask about various people at the hospital and life in Baltimore and I enjoy those chance meetings. I have gotten to see several of my former professors and had time to catch up with them, which is great. There are such terrific people in the field that by just talking to others in your sessions you can find out great things and see that there are OT revolutionaries all around.
I have been to some very informative sessions on a wide range of topics thus far. Started with a course on Infant Driven Feeding in the NICU, also got to see some ground breaking research on Contemporary Motor Control with guidelines for practice. Today I had GREAT sessions which have warranted their own posts at a later date- a session on being a Survivor in a tough market which segued well into the presidential address outlining benefits of being competitive. I got to be part of an intensive discussion on telehealth with (dare I say it?) other OT geeks, and then the Slagle lecture was terrific. Tomorrow is very up in the air... I have 3 sessions that are interesting in the morning and 3 in the afternoon that all overlap. I don't have a 3 sided coin. and we are planning on going to the AOTPAC night which judging by last year's pictures should be a lot of fun.
I've got a lot of notes from the various sessions and I'm really glad that I took off Monday to process everything.
Looking at the conference program, I realize I saw several of the "pixel people" at sessions today... I've also been able to match up the color photos with the grayscale on the cover... totally dweeby of me.
The updates on twitter under #AOTA11 have been interesting to follow, but I'm only getting them sporadically given the spotty wifi and cheap cell phone coverage. It's exciting to see so many people posting. I hope that people will also go back and use OTConnections more post-conference to make some dynamic SIS-type interactions.
Sorry this is so random, but that's the way of things during this time of sensory overload and OT-awesomeness. There's a lot of excitement tomorrow and I need my beauty sleep! More updates to come after I get home for sure.
4.03.2011
An Introduction
Hello OT Practice Readers!
Thanks for reading Molly's article on Social Media. (You're already ahead of me, since I haven't read the previous issue yet). If you haven't been to my blog before, welcome, and please feel free to see the About Me pages or the manifesto I wrote when starting this blog 3 years ago.
Things you may want to know... I am a real OT, though I don't necessarily know what I want to be "when I grow up" so to speak. I write and rewrite material a lot (and do try to have a social life) so postings can be infrequent. I don't intend to come off as an expert about most OT-related things, I am still learning and plan to keep learning. That being said, I work hard at staying involved in OT on multiple levels. I read a lot of research articles and texts during my commute. I care about our profession and want it to grow, and me to grow with it. This blog helps me share that goal with the OT world at large.
If you're wondering what I'm doing in the upcoming months when I'm not doing something OT-related, it would include going to several concerts and shows, repotting my violets, getting outdoors, playing with my first smart phone, or reading (most current books: Thirteen Days, The Girl with the Dragon Tattoo, and The Count of Monte Cristo).
Please feel free to comment or email me with your input, questions, encouragement, or suggestions for future posts. You can also find me on Twitter (otnotes) and OTConnections. If you're interested in other things I have written recently outside of the blog, check out the AOTA State Affairs newsletter, the MOTA newsletter, or the legislative section of the MOTA website (not up yet, but forthcoming). I will be at the upcoming AOTA Conference in Philadelphia and would be THRILLED to meet and talk with anyone who will admit to having read any portion of this blog.
Intended upcoming entries: OT-relevant smart phone applications; kitchen reorganization for energy conservation; caregiving tales; and a special shoutout to my twitter followers.
Again, thanks for reading!
Thanks for reading Molly's article on Social Media. (You're already ahead of me, since I haven't read the previous issue yet). If you haven't been to my blog before, welcome, and please feel free to see the About Me pages or the manifesto I wrote when starting this blog 3 years ago.
Things you may want to know... I am a real OT, though I don't necessarily know what I want to be "when I grow up" so to speak. I write and rewrite material a lot (and do try to have a social life) so postings can be infrequent. I don't intend to come off as an expert about most OT-related things, I am still learning and plan to keep learning. That being said, I work hard at staying involved in OT on multiple levels. I read a lot of research articles and texts during my commute. I care about our profession and want it to grow, and me to grow with it. This blog helps me share that goal with the OT world at large.
If you're wondering what I'm doing in the upcoming months when I'm not doing something OT-related, it would include going to several concerts and shows, repotting my violets, getting outdoors, playing with my first smart phone, or reading (most current books: Thirteen Days, The Girl with the Dragon Tattoo, and The Count of Monte Cristo).
Please feel free to comment or email me with your input, questions, encouragement, or suggestions for future posts. You can also find me on Twitter (otnotes) and OTConnections. If you're interested in other things I have written recently outside of the blog, check out the AOTA State Affairs newsletter, the MOTA newsletter, or the legislative section of the MOTA website (not up yet, but forthcoming). I will be at the upcoming AOTA Conference in Philadelphia and would be THRILLED to meet and talk with anyone who will admit to having read any portion of this blog.
Intended upcoming entries: OT-relevant smart phone applications; kitchen reorganization for energy conservation; caregiving tales; and a special shoutout to my twitter followers.
Again, thanks for reading!
3.26.2011
New roles & responsibilities
I have taken on some additional OT tasks this year, and it's getting to be an interesting balancing act.
A flashback to begin the story: when I was in high school (not all that long ago) I often had this feeling of being overextended, existing in a state of mild panic at most times. Totally unassigned time (especially that which was not merely procrastination) was rare. Looking back, I was doing A LOT. Probably too much. As a sampling (just of items I can quickly remember, which probably neglects a few) I was involved in 2 sports, at least 5 extracurriculars (not including special events such as talent show) and a part time job while carrying a not-wussy list of classes. I say this not to brag, but to give some perspective of who I was/am. My freshman year of college was completely opposite- I went to class, I goofed off with my friends, I took midday naps, maintained my (very) part time job, and I did not care about much else. This actually had a reverse effect of sometimes making me feel anxious and somewhat empty at times.
I added activities back in and out around the MOT program. I added in AOTA and SOTA my first year in the program and my state association soon after. Responsibilities grew over time. After graduation, I was again pretty inactive at first, which was justified in my mind by moving to a new town, starting a new job, and getting married all in quick succession. But again, I added items back in, even doing extra program development for work in my free time.
So as the years have passed, I have added activities in and out as it suits me. Things tapered off with the move to Baltimore but have increased again now that I've been settled awhile. The most noticeable time commitment is work, which with my poor balancing act between productivity and completing notes has led to me taking work home frequently.Inpatient staff is doing more covering of outpatients while also handling staffing shortages of our own. This has created a baseline level of stress for me, trying to stay on top of the daily grind and being unhappy that I can't seem to squeeze it all into an 8 hour day. I also had a level I student recently, which was fun despite the time involved and seemed to work out even a little better than last time. Just leaving me at a baseline level of exhausted.
In addition to work, I have taken a more active role in my state association. I was 'elected' as VP of Advocacy Relations for MOTA and have been involved in monthly business meetings and bimonthly legislative reviews with our bill review team and our lobbyist. It is a great group of individuals, I feel like we have a diversity on the group that allows to have insight into almost all the issues. It seems that no matter what the bill of concern, if we say, how do the OTs in that field feel, we will always have a representative. Our Lobby Night event went well, we've also had several members present testimony to various committees in support of bills. Legislative activity rolls by quickly, so it's kept me quite busy trying to keep the pace.
My other new OT activity is very concentrated in the amount of effort but will only be officially meeting twice a year. I got to go to California last week for a 2 day NBCOT conference developing simulation questions. First of all, I did not even know that they had added these type of questions to the exam since I took it. It is truly a challenge for your critical thinking skills. Looking at the example I was sent, I wasn't sure that I could take the test, let alone write it. I met a great group of OTs, in and out of academia and in all ranges of practice. Everyone I met was intelligent, friendly, and committed to giving back to the OT community. If it's any consolation to the students out there, as hard as you will work studying to take the exam, others are working just as hard to write it according to the blueprint and keep it fair for entry level OTs. I haven't had the feeling of brain jello for a long time, but we worked to exhaustion on those items.
Last major OT activity is the upcoming AOTA Conference. I am certainly looking forward to it, but I've got enough stuff on my plate that I'm not frequently thinking of it as a 'getaway' or anything like that. I'm excited because it's close enough to drive, and I will get to go with my best friend. I've gone to 3 conferences in past years, but never with a buddy, so that will be nice. I'm trying to cool it on the overscheduled program and see if I can take things at a calmer pace for once. I think that it's interesting in how things are scheduled at the conference. Last year, I felt like there were more NICU courses, so it's hard to tell if that was a passing trend, more people holding out for the NANT conference, or just a random event. This year, I saw 4 interesting acute care courses- all scheduled at the same time, so that's a major bummer. I've noticed that I selected more stroke related courses this year, including one that I tried to attend LAST year and the presenter didn't show up for. I'm disappointed that I didn't do more with my new-found knowledge last year, so I'm going to take off the day after to see if I can synthesize some things before heading right back into the workplace.
With all these new roles and responsibilities, I have had difficulty keeping up with other tasks. My google reader has completely overflowed to something like 500 unread items, I haven't been able to get the state association legislative webpage up and running yet, and I won't even tell you how long this post has been sitting in drafts. I have 2 AJOTs that haven't even been opened, let alone read. I have about 300 pages left in The Count of Monte Cristo and really would like to spend a solitary day finishing that. Concert season is coming up too. Obviously, there will be things that get left behind. I'm trying to prioritize and find a dozen extra hours in the day. Until then, I'm just doing what I can and hopefully will stumble into some occupational balance.
A flashback to begin the story: when I was in high school (not all that long ago) I often had this feeling of being overextended, existing in a state of mild panic at most times. Totally unassigned time (especially that which was not merely procrastination) was rare. Looking back, I was doing A LOT. Probably too much. As a sampling (just of items I can quickly remember, which probably neglects a few) I was involved in 2 sports, at least 5 extracurriculars (not including special events such as talent show) and a part time job while carrying a not-wussy list of classes. I say this not to brag, but to give some perspective of who I was/am. My freshman year of college was completely opposite- I went to class, I goofed off with my friends, I took midday naps, maintained my (very) part time job, and I did not care about much else. This actually had a reverse effect of sometimes making me feel anxious and somewhat empty at times.
I added activities back in and out around the MOT program. I added in AOTA and SOTA my first year in the program and my state association soon after. Responsibilities grew over time. After graduation, I was again pretty inactive at first, which was justified in my mind by moving to a new town, starting a new job, and getting married all in quick succession. But again, I added items back in, even doing extra program development for work in my free time.
So as the years have passed, I have added activities in and out as it suits me. Things tapered off with the move to Baltimore but have increased again now that I've been settled awhile. The most noticeable time commitment is work, which with my poor balancing act between productivity and completing notes has led to me taking work home frequently.Inpatient staff is doing more covering of outpatients while also handling staffing shortages of our own. This has created a baseline level of stress for me, trying to stay on top of the daily grind and being unhappy that I can't seem to squeeze it all into an 8 hour day. I also had a level I student recently, which was fun despite the time involved and seemed to work out even a little better than last time. Just leaving me at a baseline level of exhausted.
In addition to work, I have taken a more active role in my state association. I was 'elected' as VP of Advocacy Relations for MOTA and have been involved in monthly business meetings and bimonthly legislative reviews with our bill review team and our lobbyist. It is a great group of individuals, I feel like we have a diversity on the group that allows to have insight into almost all the issues. It seems that no matter what the bill of concern, if we say, how do the OTs in that field feel, we will always have a representative. Our Lobby Night event went well, we've also had several members present testimony to various committees in support of bills. Legislative activity rolls by quickly, so it's kept me quite busy trying to keep the pace.
My other new OT activity is very concentrated in the amount of effort but will only be officially meeting twice a year. I got to go to California last week for a 2 day NBCOT conference developing simulation questions. First of all, I did not even know that they had added these type of questions to the exam since I took it. It is truly a challenge for your critical thinking skills. Looking at the example I was sent, I wasn't sure that I could take the test, let alone write it. I met a great group of OTs, in and out of academia and in all ranges of practice. Everyone I met was intelligent, friendly, and committed to giving back to the OT community. If it's any consolation to the students out there, as hard as you will work studying to take the exam, others are working just as hard to write it according to the blueprint and keep it fair for entry level OTs. I haven't had the feeling of brain jello for a long time, but we worked to exhaustion on those items.
Last major OT activity is the upcoming AOTA Conference. I am certainly looking forward to it, but I've got enough stuff on my plate that I'm not frequently thinking of it as a 'getaway' or anything like that. I'm excited because it's close enough to drive, and I will get to go with my best friend. I've gone to 3 conferences in past years, but never with a buddy, so that will be nice. I'm trying to cool it on the overscheduled program and see if I can take things at a calmer pace for once. I think that it's interesting in how things are scheduled at the conference. Last year, I felt like there were more NICU courses, so it's hard to tell if that was a passing trend, more people holding out for the NANT conference, or just a random event. This year, I saw 4 interesting acute care courses- all scheduled at the same time, so that's a major bummer. I've noticed that I selected more stroke related courses this year, including one that I tried to attend LAST year and the presenter didn't show up for. I'm disappointed that I didn't do more with my new-found knowledge last year, so I'm going to take off the day after to see if I can synthesize some things before heading right back into the workplace.
With all these new roles and responsibilities, I have had difficulty keeping up with other tasks. My google reader has completely overflowed to something like 500 unread items, I haven't been able to get the state association legislative webpage up and running yet, and I won't even tell you how long this post has been sitting in drafts. I have 2 AJOTs that haven't even been opened, let alone read. I have about 300 pages left in The Count of Monte Cristo and really would like to spend a solitary day finishing that. Concert season is coming up too. Obviously, there will be things that get left behind. I'm trying to prioritize and find a dozen extra hours in the day. Until then, I'm just doing what I can and hopefully will stumble into some occupational balance.
3.04.2011
Who gets to go home? 3 short case studies
One of my biggest responsibilities from a hospital standpoint is providing discharge recommendations. Hospital stays are notoriously short and it is a priority of the case management staff and doctors to determine discharge location, for which they recruit OTs and PTs to assist. But determining discharge readiness and placement is more of an art than a science, no flow chart can be easily developed to guide a novice through the process. So here are 3 case examples of similar patients and situations, whom I saw on the same day, and my rationale for their discharge locations.
All three of the individuals were over 80 years old, with moderate dementia. They were all admitted with altered mental status caused by pneumonia and concurrent urinary tract infections. They were all living with family members prior to admission, who have each made a goal to keep the individual at home as long as possible. They are each oriented only to person at this time, but recognize their family members who were at bedside. Each person required max assist for bed-chair transfer and max assist for ADLs during OT eval.
Patient “Alan” lives with his also elderly brother. They have been living together almost their entire lives, and until about 5 years ago were very active in several community activities. I think it is fair to say that they are brothers and also best friends. Alan has been declining in recent years however. He is normally able to walk at home but is very unsteady, requires a lot of assist on the steps to the upper floor, and has had multiple falls at home endangering him and his brother. Alan's brother tearfully states that he is unable to help him after falling, which is becoming more frequent. Alan has not been able to leave the house for some time, and his brother is only able to go out for short trips to the grocery store, which he recognizes still poses a safety risk by leaving Alan alone. They have a 2 story home, good DME setup, and some rare support from friends (no remaining family).
Patient “Betty” is a very pleasant woman, always smiling, happy and friendly. Her daughter is a retired pediatric nurse, but is frustrated with herself for not knowing more about geriatric care. She noticed a cough developing earlier in the week but did not expect that illness would cause such a drastic change in her mother's personality and abilities. Normally Betty is able to walk w/o device and perform ADLs with supervision. However, Betty is very afraid of falling in the hospital environment, actually fighting the transfer, and requires max assist of 2 for chair to bed. She is still able to follow 1 step commands as long as they are not about transfers. Betty's daughter is well educated on devices, but has a bad back and cannot lift >10 pounds. Per pt's daughter, Betty did well in rehab previously after a hip replacement.
Patient “Carol” is lethargic and minimally responsive during the evaluation. She responds best to her daughter, and will follow 1 step commands from her. She has severe retropulsion in sitting. I could not transfer her, but her daughter was able to in a less than fully safe method. Daughter reports that there are multiple family members that live in the home with Carol, and others that assist in rotating care duties. They have good DME setup at home and 24 hour assist with various caregivers. Carol clearly responds best to her family members over the staff at the hospital.
Who gets to go where? There are few hard and fast rules in discharge planning. Because OT is committed to being client and family-centered (and because care for a person with moderate dementia requires a high level of commitment from the family), discussions regarding each option were provided to the families of the patients. These are the decisions we made together, though it is certainly possible that other therapists or case managers may have tried to elicit a different response.
Alan was recommended for a trial of inpatient rehabilitation at a subacute level to attempt to progress in ADLs and transfers. The plan was to select a facility that also provides long term care, as Alan's brother could no longer care for him at home. Special consideration was given to make this place close to their home so that Alan's brother could make frequent visits.
Betty was recommended for inpatient rehab at a subacute level at a facility she had been to previously. Betty's daughter would not be able to care for her currently, but was open to the idea of family training and purchase of lifting devices if needed to allow for her to return home after rehab. She also had a good connection with home therapists as well.
Carol was recommended to return home with home health therapy to address safety in transfers and additional adaptive equipment assessment for best safety at home for her and the family. She was unlikely to fare well in any facility cognitively or with physical progress. The family was ready to continue 24 hour assist and try whatever was necessary to provide for Carol.
Discharge planning is not always easy. Therapists, MDs, case managers and the family do not always reach agreement. But this was a situation where even though there were difficult decisions, each family unit got what was best for them, I think.
All three of the individuals were over 80 years old, with moderate dementia. They were all admitted with altered mental status caused by pneumonia and concurrent urinary tract infections. They were all living with family members prior to admission, who have each made a goal to keep the individual at home as long as possible. They are each oriented only to person at this time, but recognize their family members who were at bedside. Each person required max assist for bed-chair transfer and max assist for ADLs during OT eval.
Patient “Alan” lives with his also elderly brother. They have been living together almost their entire lives, and until about 5 years ago were very active in several community activities. I think it is fair to say that they are brothers and also best friends. Alan has been declining in recent years however. He is normally able to walk at home but is very unsteady, requires a lot of assist on the steps to the upper floor, and has had multiple falls at home endangering him and his brother. Alan's brother tearfully states that he is unable to help him after falling, which is becoming more frequent. Alan has not been able to leave the house for some time, and his brother is only able to go out for short trips to the grocery store, which he recognizes still poses a safety risk by leaving Alan alone. They have a 2 story home, good DME setup, and some rare support from friends (no remaining family).
Patient “Betty” is a very pleasant woman, always smiling, happy and friendly. Her daughter is a retired pediatric nurse, but is frustrated with herself for not knowing more about geriatric care. She noticed a cough developing earlier in the week but did not expect that illness would cause such a drastic change in her mother's personality and abilities. Normally Betty is able to walk w/o device and perform ADLs with supervision. However, Betty is very afraid of falling in the hospital environment, actually fighting the transfer, and requires max assist of 2 for chair to bed. She is still able to follow 1 step commands as long as they are not about transfers. Betty's daughter is well educated on devices, but has a bad back and cannot lift >10 pounds. Per pt's daughter, Betty did well in rehab previously after a hip replacement.
Patient “Carol” is lethargic and minimally responsive during the evaluation. She responds best to her daughter, and will follow 1 step commands from her. She has severe retropulsion in sitting. I could not transfer her, but her daughter was able to in a less than fully safe method. Daughter reports that there are multiple family members that live in the home with Carol, and others that assist in rotating care duties. They have good DME setup at home and 24 hour assist with various caregivers. Carol clearly responds best to her family members over the staff at the hospital.
Who gets to go where? There are few hard and fast rules in discharge planning. Because OT is committed to being client and family-centered (and because care for a person with moderate dementia requires a high level of commitment from the family), discussions regarding each option were provided to the families of the patients. These are the decisions we made together, though it is certainly possible that other therapists or case managers may have tried to elicit a different response.
Alan was recommended for a trial of inpatient rehabilitation at a subacute level to attempt to progress in ADLs and transfers. The plan was to select a facility that also provides long term care, as Alan's brother could no longer care for him at home. Special consideration was given to make this place close to their home so that Alan's brother could make frequent visits.
Betty was recommended for inpatient rehab at a subacute level at a facility she had been to previously. Betty's daughter would not be able to care for her currently, but was open to the idea of family training and purchase of lifting devices if needed to allow for her to return home after rehab. She also had a good connection with home therapists as well.
Carol was recommended to return home with home health therapy to address safety in transfers and additional adaptive equipment assessment for best safety at home for her and the family. She was unlikely to fare well in any facility cognitively or with physical progress. The family was ready to continue 24 hour assist and try whatever was necessary to provide for Carol.
Discharge planning is not always easy. Therapists, MDs, case managers and the family do not always reach agreement. But this was a situation where even though there were difficult decisions, each family unit got what was best for them, I think.
2.05.2011
OT Web Gems- Nationwide Statistics and AD edition
Welcome to another edition of OT Web Gems, AKA "Cheryl has too many tabs open of cool articles, so let's update." Some of these are pretty hefty reading, but it can be worth it depending on your field. Several related to Alzheimer's Disease as well.
CDC Health Disparities and Inequalities Report- this lengthy report is broken down into several important subsections, such as access to health insurance, air quality, housing, and preventable hospitalizations. Another tool that could be very useful if you're looking for materials to justify OT services for an area.
Alzheimer's Association "Baby Boomer" report- Lastly, some statistics regarding the past decade or so regarding demographics of AD in association with research money and other costs. Some scary stats on their main page, the full report requires you to sign up with email, I haven't read the original report. Again, this would be helpful if you're looking for support in a program designed to assist those with AD or their caregivers.
Financial Skills Decline in those w/ AD- another Alzheimer's Reading Room post regarding the quick financial decline in those with even mild AD. This is an important ADL to test- it may be helpful diagnostically. Moreso if done within an established testing protocol such as EFPT or KELS. (Sidenote- I looked up the AMPS tasks and they do not have a money-management task. However this is also widely called for in my workplace when trying to assess cognitive decline. If you're AMPS certified, there are a lot of good resources on their website to make things faster or form a research project)
Tips to Prevent Wandering- A Geriatric Care Manager wrote some nice tips on strategies to decrease wandering in those with AD. I thought of some other environmental and behavioral modifications that we use as OTs. If you frequently work with adults with dementia in the home setting, I highly recommend Occupational Therapy and Dementia Care: the Home Environmental Skill-Building Program, which I found to be a very helpful text and has many useful home modification ideas. (Link is to amazon.com since AOTA site is down this weekend but I believe there is a reduced price on AOTA.com for members.)
Lifehacker Top 10 brain-training tricks- on a more upbeat note, here is a quick list of brain-training activities. Nothing here is groundbreaking, should be familiar to most but might be a good jumping off place for cognitive rehab.
Concussion/mTBI Detector- such a cool idea. Tests a blood sample for biomarkers indicative of brain injury. This could be revolutionary in the diagnostics (and thus treatment of) mTBI, which is a very big deal for OTs in cognitive rehab.
AOTA NEWS:
Procedural Change- make sure you get your feedback to your RA member on the proposed changes to the organization. There is a video, written documents, and a message board on OT Connections to review.
General Elections- review candidates and cast your vote- closes at 11:59 pm EST on Sunday, February 27
Philly Convention Center- if you're planning on attending the AOTA conference (which you totally should!) then there are some good resources at the convention center website. Maybe I'll be able to not wander around empty halls looking for the group unlike last year (I have such poor spatial skills, lol).
1.26.2011
An Open Letter to Nintendo
Dear Nintendo Wii,
As an occupational therapist, I enjoy your products and have been excited about their potential applications for rehabilitation. I own a system myself, and while experimenting with it, noticed some features that could easily be improved to better suit the Wii's use in rehab. WiiFit, WiiPlay, and WiiSports are the games considered for this review.
Therapists love being able to control and alter activities and the environment to provide the "just-right" challenge for their clients. Wii games would be much more usable by therapists if there was more input to grade the activities. This could be automatic grading within the game, where it would adapt to the skill level of the user, or ability to manually adjust sensitivity, speed, and degree of difficulty for games. Additionally, having either a "low vision/contrast enhanced" option for games or ability to decrease some of the visual stimulation would often be helpful.
In general, it would be more efficient to be able to set up multiple games in Sports or WiiFit prior to a session. It would be best if new profiles and avatars were not required to setup and save routines, since this takes up extra valuable therapy time and is a potential privacy violation. Being able to set a timer for specific games, such as making a 5 minute boxing session, would also assist in achieving aerobic status during activity.
I love the balance board for WiiFit. A user can get an objective report of balance that can be reviewed from session to session, and the devices marketed to rehab professionals for this are MUCH more expensive than a Wii system. But a bariatric board would be very beneficial for those who practice with adults in the hospital or SNF. Also, an optional bar to provide support while standing would be appreciated by many adults while they are trying to feel secure in standing. I don't know if the hardware could be altered to allow for better tests of sitting balance while the board was supported on an adjustable mat, but this is a common intervention for a neurological population who would likely appreciate being able to participate in the games as if they were standing.
In closing, I appreciate that these products have great applicaiton to rehabilitation. The system has surely benefitted from all the positive press regarding its use for therapy and activity for people with disabilities. There are endless possibilities for improvement into the therapy arena, and I would encourage you to partner with some pediatric and geriatric therapy practitioners to maximize your products' usefulness and appeal. And given that the Kinect is getting a lot of attention but you could provide a more affordable solution for clinics everywhere, I think it would be worth your time.
Thank you and I hope you will show a renewed interest in collaboration with rehabilitation services in the future.
Cheryl OT
As an occupational therapist, I enjoy your products and have been excited about their potential applications for rehabilitation. I own a system myself, and while experimenting with it, noticed some features that could easily be improved to better suit the Wii's use in rehab. WiiFit, WiiPlay, and WiiSports are the games considered for this review.
Therapists love being able to control and alter activities and the environment to provide the "just-right" challenge for their clients. Wii games would be much more usable by therapists if there was more input to grade the activities. This could be automatic grading within the game, where it would adapt to the skill level of the user, or ability to manually adjust sensitivity, speed, and degree of difficulty for games. Additionally, having either a "low vision/contrast enhanced" option for games or ability to decrease some of the visual stimulation would often be helpful.
In general, it would be more efficient to be able to set up multiple games in Sports or WiiFit prior to a session. It would be best if new profiles and avatars were not required to setup and save routines, since this takes up extra valuable therapy time and is a potential privacy violation. Being able to set a timer for specific games, such as making a 5 minute boxing session, would also assist in achieving aerobic status during activity.
I love the balance board for WiiFit. A user can get an objective report of balance that can be reviewed from session to session, and the devices marketed to rehab professionals for this are MUCH more expensive than a Wii system. But a bariatric board would be very beneficial for those who practice with adults in the hospital or SNF. Also, an optional bar to provide support while standing would be appreciated by many adults while they are trying to feel secure in standing. I don't know if the hardware could be altered to allow for better tests of sitting balance while the board was supported on an adjustable mat, but this is a common intervention for a neurological population who would likely appreciate being able to participate in the games as if they were standing.
In closing, I appreciate that these products have great applicaiton to rehabilitation. The system has surely benefitted from all the positive press regarding its use for therapy and activity for people with disabilities. There are endless possibilities for improvement into the therapy arena, and I would encourage you to partner with some pediatric and geriatric therapy practitioners to maximize your products' usefulness and appeal. And given that the Kinect is getting a lot of attention but you could provide a more affordable solution for clinics everywhere, I think it would be worth your time.
Thank you and I hope you will show a renewed interest in collaboration with rehabilitation services in the future.
Cheryl OT
1.17.2011
Adventures in Serial Casting Part II: Review of the Evidence
The term "serial casting" refers to the use of plaster casts applied over time to gradually increase PROM, decrease abnormal tone, and hopefully therefore increase functioning. Typical population for this intervention is either for children with cerebral palsy or adults post stroke or TBI. This (really long) entry aims to examine the evidence behind the intervention by answering multiple questions regarding the intervention.
For this review, I looked at 3 systematic reviews and 1 prospective uncontrolled intervention that was not included in the prior reviews. Of the reviews, one was from an OT publication, one from a PT publication, and one from a physiatry publication, so I feel that all relevant parties were represented. I focused only on articles that emphasized adults, and preferably the lower extremity since that was most relevant to my case. Annotated bibliography at bottom of page.
WHAT IS THE RATIONALE FOR SERIAL CASTING?
There are multiple theories for the effectiveness of serial casting and as per Lannin, Novak & Cusick, there is no strong evidence to state clearly which is the correct reasoning. (Categories by Lannin, Novak & Cusick though 1 or more are expressed in each article, further references as noted)
1. Neurophysiological (includes NDT)- casting prevents changes in muscle length, which eliminates excitatory input of muscle spindles and decreases spasticity. The concepts of neutral warmth, proprioceptive input to the limb, and even/constant pressure are also considered to play a part (Saracco Preissner). Per Mortenson & Eng, little evidence exists for the concept of neutral warmth providing the decreased spasticity.
2. Biomechanical- a low-load, long-duration stretch can prevent or correct contractures. By stretching, the Golgi Tendon Organs are stimulated, which stimulate the Ib afferent fibers and then inhibit the alpha motor neurons (Mortenson & Eng).
3. Motor Learning- support proximal joints until control is gained distally. Per Mortenson & Eng, no evidence to support this. I question how this can be applied to LE casts, since they are predominantly applied to the ankle and toe ROM is not a desired outcome. Also, though I have never casted a knee, it seems that if you were working off of this principle to give support proximally until distal control is given, then it might be easier to apply a bledsoe brace locked in position than a serial cast.
WHAT OUTCOMES ARE EXPECTED TO IMPROVE WITH SERIAL CASTING?
Mortenson & Eng outlined these well as: reducing abnormal tone, increasing ROM/reducing contracture (usually PROM is what is measured), and function. Measurement of these effects has been inconsistent across studies. Some studies give a very subjective therapist rating of tone, others use tools such as the Ashworth Scale. ROM was typically measured using standard goniometry, though Mortenson & Eng bemoaned the reliability of ankle goniometry. Mortenson & Eng also disucssed that increases in ROM do not necessarily correlate with increases in function, similarly, Saracco Preissner mentioned that abnormal tone did not necessarily indicate lack of function. "Function" is defined very loosely between studies and various outcome measures are used. Singer et al used the Transfer Dependency Scale, and other studies referenced the FIM. From my own limited experience in research, it would make sense that you would need an adequately sensitive measure and control for confounding factors (concurrent therapy, practice effect, time) to truly indicate whether improvement would be due to casting. I can think of several appropriate measures for UE functional improvement but don't know what has been researched in this direction arleady.
WHAT IS THE ACCEPTED PROTOCOL FOR SERIAL CASTING?
As indicated in the systematic review articles, there is no consistent protocol for serial casting. Lannin, Novak & Cusick identifies a key problem in a consistent protocol- namely that your background rationale will affect your decisions regarding casting time and limb positions. This article listed known indicators and contraindications to tx along with the level of evidence for each, however, a confounding variable to this information is that some factors that were exclusion criteria for some studies were inclusion criteria for others. Given the wide variability, comparison of RCTs was unable to be performed in this review.
Timing is a decision that has wide variability in each study. Saracco Preissner states (but does not reference) that there is no indication how long after injury casting is effective or when a person is too far removed from injury to benefit. It is stated that "most" advocate casting sooner for increased effectiveness, but again this is unreferenced. Length of time wearing the cast was highly variable as well, with the most relevant results being from a study by Pohl in 2002 (referenced in the following section) that showed no difference in results when casts were worn 1-4 days vs 5-7 days.
Protocol was specified for the Singer et al study, and stated to be "standard guideline." Briefly, casts were applied by 2 therapists w/ pt. in prone and knee flexed to 90* after gel pads were applied to bony prominences at risk for breakdown. They were able to insert a custom molded support for metatarsals if clawing of the toes was present. Casting was postponed if pressure areas or skin breakdown was present. Casts were discontinued when no change in PROM was seen over 3 casts, skin breakdown present, or if there was a need to emphasize other treatment prior to discharge.
INDIVIDUAL STUDIES AND RESULTS OF NOTE:
*Singer et al performed a prospective uncontrolled intervention with 16 adults after aquired brain injury. Statistically significant increases in PROM were noted, and 13/16 improved their transfer ability. However, transfer skills were measured by "4 randomly selected scores" not admission/discharge scores, and could have been affected by concurrent cognitive increases. Of note, 3/4 patients who had limited response had brainstem dysfunction and decerebrate positioning. I believe it is clinically accepted that decerebrate and decorticate positioning is an indicator of poor prognosis medically and with therapy, but I can understand including these patients in this study to just add to that evidence. The authors suggested that the severity of injury rather than the severity of the ankle deformity was the more important predictor of success.
(The following articles were referenced in one or more of the main articles, but I did not follow up to read the full article. Slightly irresponsible, I know, so just take this info at that level)
*Pohl 2002- this study compared 2 groups who were casted for different lengths of time between cast changes- 1-4 days vs 5-7 days. All groups showed an increase in PROM with no difference between groups. Gains were maintained 1 month after cast removal. The Lannin, Novak & Cusick review stated that since there were slightly fewer complications with the group who got casts changed more frequently, there might be an advantage to more frequent changes, however, cost does not appear to have been considered as a factor.
*Mosley 2006- this was an RCT focused on adults with serial elbow casts vs PROM for 1 hr/day. The casting group decreased contracture 22* compared to stretchers when casts were removed, but this decreased to 11* the next day, and the improved effect had almost disappeared by 42 days.
*Booth 1983- This was a retrospective study of 39 patients who had casts s/p head injury. 37% showed and increase in ROM and decreased tone. They observed that pts with brainstem lesions got their casts longer out from injury and took longer to show progress than those who had cortical lesions. Per this study, traditional treatments (PROM, splinting, weight bearing, and PAMs) did not do enough to make an impact on spasticity compared to casting. I'm not sure why this study was given such prominence in the Saracco Preissner article since it was a retrospective study, a bit dated at this time, and its rather unclear how they drew such sweeping consclusions, but again, I did not review the actual article
*Hill 1994- a double-crossover design between traditional tx (PROM, static stretching, splinting) and casting. Improvements were seen for ROM in 14/15 participants and spasticity in 11/15. Stated conclusion is that casting was more effective than the traditional tx, but the gains did not translate into functional gains.
WHAT ARE THE OVERALL RECOMMENDATIONS FOR SERIAL CASTING?
Per Lannin, Novak & Cusick, "There is insufficient evidence to either support or refute the effectiveness of upper limb casting ... There is no evidence of long-term benefits or long-term adverse effects." But this article also stated that there is Level Ib evidence that casting an adult's elbow s/p brain injury increases available extension 1 day after cast removal.
Per Sarraco, since immobilization (such as with spasticity) can cause physiological changes that would impair ADLs, and these changes are reversible, we should treat as able for spasticity. Serial casting has shown some effectiveness in improving ROM and spasticity.
Mortenson & Eng issued "grade" ratings for practice, which I am not familiar with. They say that there are inconsistent measures of "function," so no recommendation can be made on that front. A "Grade C" rating is given to using casts to reduce spasticity secondary to decreased rigor in measurement tools. A "Grade B" rating is given to using casting to improve or prevent loss of PROM, and they state that this is the only outcome with enough evidence to be considered a "best practice." Their studies showed gains of 10.4-26* improvement in ankle ROM, which is statistically significant, however they cautioned that ankle goniometry is not always reliable.
WHAT SHOULD BE ADDRESSED IN FUTURE RESEARCH RELATED TO SERIAL CASTING?
As with nearly all therapy research, there are many questions that need to be addressed. A summary from all articles would include the following, but it is not an exhaustive list:
How does casting work? Is it a biomechanical effect, neurological effect, or both?
What is the best protocol for serial casting? Included in this would be inclusion criteria, positioning of casts, length of time worn, concurrent therapy, post-casting program (including splints and exercises).
What is the comparison to other treatments or lack thereof (especially no stretching)?
How long are gains maintained?
How do improvements after casting translate into function? What specific functinoal gains are seen? Are these gains cost effective and best practice?
Randomized controlled trials comparing the above are also needed.
FULL DISCLOSURE: I am not a professor or professional researcher and do not claim that this is an exhaustive review of the literature surrounding this topic, but a review that I undertook relevant to a specific case. I am not an expert clinician. I do not intend to diminish the efforts or quality of research produced by any of the referenced articles. I would encourage you to do your own review and get necessary training prior to performing this intervention, which may not constitute entry-level practice for all practitioners. Please feel free to comment on additonal relevant research.
References
Singer, B. J., Jegasothy, G. M., Singer, K. P., & Allison, G. T. (2003). Evaluation of Serial Casting to Correct Equinovarus Deformity of the Ankle After Acquired Brain Injury in Adults. Archives of Physical Medicine and Rehabilitation, 84, 483-491.
A single study in Australia looking specifically at casted ankles in an adult brain injury unit.
Lannin, N. A., Novak, I., & Cusick, C. (2007). A systematic review of upper extremity casting for children and adults with central nervous system motor disorders. Clincal Rehabilitation, 21, 963-976.
A review focusing on UE casts but somewhat confounding as it includes many studies on children with CP
Mortenson, P. A. & Eng, J. J. (2003). The use of casts in the management of joint mobility and hypertonia following brain injury in adults: a systematic review. Physical Therapy, 83(7), 648-658.
Looks at adults after TBI and CVA only but includes studies involving wrist and elbow casting as well.
Preissner, K. S. (2001). The effecs of serial casting on spasticity: a literature review. Occupational Therapy in Health Care, 14(2), 99-106.
This review focuses mainly on management of spasticity, less on ROM gains.
For this review, I looked at 3 systematic reviews and 1 prospective uncontrolled intervention that was not included in the prior reviews. Of the reviews, one was from an OT publication, one from a PT publication, and one from a physiatry publication, so I feel that all relevant parties were represented. I focused only on articles that emphasized adults, and preferably the lower extremity since that was most relevant to my case. Annotated bibliography at bottom of page.
WHAT IS THE RATIONALE FOR SERIAL CASTING?
There are multiple theories for the effectiveness of serial casting and as per Lannin, Novak & Cusick, there is no strong evidence to state clearly which is the correct reasoning. (Categories by Lannin, Novak & Cusick though 1 or more are expressed in each article, further references as noted)
1. Neurophysiological (includes NDT)- casting prevents changes in muscle length, which eliminates excitatory input of muscle spindles and decreases spasticity. The concepts of neutral warmth, proprioceptive input to the limb, and even/constant pressure are also considered to play a part (Saracco Preissner). Per Mortenson & Eng, little evidence exists for the concept of neutral warmth providing the decreased spasticity.
2. Biomechanical- a low-load, long-duration stretch can prevent or correct contractures. By stretching, the Golgi Tendon Organs are stimulated, which stimulate the Ib afferent fibers and then inhibit the alpha motor neurons (Mortenson & Eng).
3. Motor Learning- support proximal joints until control is gained distally. Per Mortenson & Eng, no evidence to support this. I question how this can be applied to LE casts, since they are predominantly applied to the ankle and toe ROM is not a desired outcome. Also, though I have never casted a knee, it seems that if you were working off of this principle to give support proximally until distal control is given, then it might be easier to apply a bledsoe brace locked in position than a serial cast.
WHAT OUTCOMES ARE EXPECTED TO IMPROVE WITH SERIAL CASTING?
Mortenson & Eng outlined these well as: reducing abnormal tone, increasing ROM/reducing contracture (usually PROM is what is measured), and function. Measurement of these effects has been inconsistent across studies. Some studies give a very subjective therapist rating of tone, others use tools such as the Ashworth Scale. ROM was typically measured using standard goniometry, though Mortenson & Eng bemoaned the reliability of ankle goniometry. Mortenson & Eng also disucssed that increases in ROM do not necessarily correlate with increases in function, similarly, Saracco Preissner mentioned that abnormal tone did not necessarily indicate lack of function. "Function" is defined very loosely between studies and various outcome measures are used. Singer et al used the Transfer Dependency Scale, and other studies referenced the FIM. From my own limited experience in research, it would make sense that you would need an adequately sensitive measure and control for confounding factors (concurrent therapy, practice effect, time) to truly indicate whether improvement would be due to casting. I can think of several appropriate measures for UE functional improvement but don't know what has been researched in this direction arleady.
WHAT IS THE ACCEPTED PROTOCOL FOR SERIAL CASTING?
As indicated in the systematic review articles, there is no consistent protocol for serial casting. Lannin, Novak & Cusick identifies a key problem in a consistent protocol- namely that your background rationale will affect your decisions regarding casting time and limb positions. This article listed known indicators and contraindications to tx along with the level of evidence for each, however, a confounding variable to this information is that some factors that were exclusion criteria for some studies were inclusion criteria for others. Given the wide variability, comparison of RCTs was unable to be performed in this review.
Timing is a decision that has wide variability in each study. Saracco Preissner states (but does not reference) that there is no indication how long after injury casting is effective or when a person is too far removed from injury to benefit. It is stated that "most" advocate casting sooner for increased effectiveness, but again this is unreferenced. Length of time wearing the cast was highly variable as well, with the most relevant results being from a study by Pohl in 2002 (referenced in the following section) that showed no difference in results when casts were worn 1-4 days vs 5-7 days.
Protocol was specified for the Singer et al study, and stated to be "standard guideline." Briefly, casts were applied by 2 therapists w/ pt. in prone and knee flexed to 90* after gel pads were applied to bony prominences at risk for breakdown. They were able to insert a custom molded support for metatarsals if clawing of the toes was present. Casting was postponed if pressure areas or skin breakdown was present. Casts were discontinued when no change in PROM was seen over 3 casts, skin breakdown present, or if there was a need to emphasize other treatment prior to discharge.
INDIVIDUAL STUDIES AND RESULTS OF NOTE:
*Singer et al performed a prospective uncontrolled intervention with 16 adults after aquired brain injury. Statistically significant increases in PROM were noted, and 13/16 improved their transfer ability. However, transfer skills were measured by "4 randomly selected scores" not admission/discharge scores, and could have been affected by concurrent cognitive increases. Of note, 3/4 patients who had limited response had brainstem dysfunction and decerebrate positioning. I believe it is clinically accepted that decerebrate and decorticate positioning is an indicator of poor prognosis medically and with therapy, but I can understand including these patients in this study to just add to that evidence. The authors suggested that the severity of injury rather than the severity of the ankle deformity was the more important predictor of success.
(The following articles were referenced in one or more of the main articles, but I did not follow up to read the full article. Slightly irresponsible, I know, so just take this info at that level)
*Pohl 2002- this study compared 2 groups who were casted for different lengths of time between cast changes- 1-4 days vs 5-7 days. All groups showed an increase in PROM with no difference between groups. Gains were maintained 1 month after cast removal. The Lannin, Novak & Cusick review stated that since there were slightly fewer complications with the group who got casts changed more frequently, there might be an advantage to more frequent changes, however, cost does not appear to have been considered as a factor.
*Mosley 2006- this was an RCT focused on adults with serial elbow casts vs PROM for 1 hr/day. The casting group decreased contracture 22* compared to stretchers when casts were removed, but this decreased to 11* the next day, and the improved effect had almost disappeared by 42 days.
*Booth 1983- This was a retrospective study of 39 patients who had casts s/p head injury. 37% showed and increase in ROM and decreased tone. They observed that pts with brainstem lesions got their casts longer out from injury and took longer to show progress than those who had cortical lesions. Per this study, traditional treatments (PROM, splinting, weight bearing, and PAMs) did not do enough to make an impact on spasticity compared to casting. I'm not sure why this study was given such prominence in the Saracco Preissner article since it was a retrospective study, a bit dated at this time, and its rather unclear how they drew such sweeping consclusions, but again, I did not review the actual article
*Hill 1994- a double-crossover design between traditional tx (PROM, static stretching, splinting) and casting. Improvements were seen for ROM in 14/15 participants and spasticity in 11/15. Stated conclusion is that casting was more effective than the traditional tx, but the gains did not translate into functional gains.
WHAT ARE THE OVERALL RECOMMENDATIONS FOR SERIAL CASTING?
Per Lannin, Novak & Cusick, "There is insufficient evidence to either support or refute the effectiveness of upper limb casting ... There is no evidence of long-term benefits or long-term adverse effects." But this article also stated that there is Level Ib evidence that casting an adult's elbow s/p brain injury increases available extension 1 day after cast removal.
Per Sarraco, since immobilization (such as with spasticity) can cause physiological changes that would impair ADLs, and these changes are reversible, we should treat as able for spasticity. Serial casting has shown some effectiveness in improving ROM and spasticity.
Mortenson & Eng issued "grade" ratings for practice, which I am not familiar with. They say that there are inconsistent measures of "function," so no recommendation can be made on that front. A "Grade C" rating is given to using casts to reduce spasticity secondary to decreased rigor in measurement tools. A "Grade B" rating is given to using casting to improve or prevent loss of PROM, and they state that this is the only outcome with enough evidence to be considered a "best practice." Their studies showed gains of 10.4-26* improvement in ankle ROM, which is statistically significant, however they cautioned that ankle goniometry is not always reliable.
WHAT SHOULD BE ADDRESSED IN FUTURE RESEARCH RELATED TO SERIAL CASTING?
As with nearly all therapy research, there are many questions that need to be addressed. A summary from all articles would include the following, but it is not an exhaustive list:
How does casting work? Is it a biomechanical effect, neurological effect, or both?
What is the best protocol for serial casting? Included in this would be inclusion criteria, positioning of casts, length of time worn, concurrent therapy, post-casting program (including splints and exercises).
What is the comparison to other treatments or lack thereof (especially no stretching)?
How long are gains maintained?
How do improvements after casting translate into function? What specific functinoal gains are seen? Are these gains cost effective and best practice?
Randomized controlled trials comparing the above are also needed.
FULL DISCLOSURE: I am not a professor or professional researcher and do not claim that this is an exhaustive review of the literature surrounding this topic, but a review that I undertook relevant to a specific case. I am not an expert clinician. I do not intend to diminish the efforts or quality of research produced by any of the referenced articles. I would encourage you to do your own review and get necessary training prior to performing this intervention, which may not constitute entry-level practice for all practitioners. Please feel free to comment on additonal relevant research.
References
Singer, B. J., Jegasothy, G. M., Singer, K. P., & Allison, G. T. (2003). Evaluation of Serial Casting to Correct Equinovarus Deformity of the Ankle After Acquired Brain Injury in Adults. Archives of Physical Medicine and Rehabilitation, 84, 483-491.
A single study in Australia looking specifically at casted ankles in an adult brain injury unit.
Lannin, N. A., Novak, I., & Cusick, C. (2007). A systematic review of upper extremity casting for children and adults with central nervous system motor disorders. Clincal Rehabilitation, 21, 963-976.
A review focusing on UE casts but somewhat confounding as it includes many studies on children with CP
Mortenson, P. A. & Eng, J. J. (2003). The use of casts in the management of joint mobility and hypertonia following brain injury in adults: a systematic review. Physical Therapy, 83(7), 648-658.
Looks at adults after TBI and CVA only but includes studies involving wrist and elbow casting as well.
Preissner, K. S. (2001). The effecs of serial casting on spasticity: a literature review. Occupational Therapy in Health Care, 14(2), 99-106.
This review focuses mainly on management of spasticity, less on ROM gains.
1.07.2011
Looking forward to 2011
Goodbye 2010. I don't have the energy for a LONG year in review, but...
I will touch on a few ups and downs of the year.
Firstly, let me thank all readers. I really appreciate the comments (that aren't plugging fake universities or spam in other languages) because I like to see that there has been an effect from my efforts. I don't look at the stats often, but glancing today, I see that since I started tracking in 2008, pageloads have increased by 20,000- more than 300%! WOW! And the cross-posts in the sister blog on OT Connections have brought in an extra 50-350 viewers each time, with one anomaly (thank you 1-minute update). It's really exciting to see how this blog has grown and spread, and gets me thinking about some plans for the future (more on that later). So a BIG THANK YOU to each of you, and please always feel free to comment or email me with suggestions.
Most popular pages on this site continue to be Writing Goals and a Case Study With Goals, which is understandable since this is one of the more difficult skills in OT that is not hands-on. I do intend to spend some time getting back to the 'roots' of this blog and posting about decision making, goal writing, and treatment plans. Perplexingly, a rather random What a Week post is the most read on the mirror site, with the exception of my post about Glee that got picked up by 1-minute update. Ironically, some of the posts I spent the MOST time on (e.g. Metacognition and Serial Casting Case Study) don't seem to be as popular, but I don't have tracking to that degree so I can't be positive. I did get several thoughtful comments on my most emotional post (Struggling as an OT for my Family) so I appreciate that deeply.
2010 was the first AOTA Conference I've been to as a practitioner, and even the first I saw after fieldwork. It was great to re-energize and network with other therapists. I think that as you are in the profession longer, you become more aware of others in the field, so I spotted dozens of OT Celebrities this year and got to talk with many, which was awesome.
It was interesting to see all the uproar in AOTA this past year with the potential organizational changes. As we are heading into election season again I see the new blogs and OTC memberships cropping up and it's always notable to see who sticks with it. Props to Bill Wong for continuing to post, and also to Florence Clark for taking up the mantle of the President's Blog.
There were some serious downers last year. We lost my husband's grandmother to Alzheimer's Disease in the summer, which was very difficult for the family. Then over the holidays, we had several additional hospitalizations of our family members, which have yet to completely resolve. Health is so very fragile and some families are like a house of cards... I am learning to take pleasure in contentment and tranquility, because it can all be very fleeting.
I struggled on my final rotation of the year on the cardiopulmonary floor, made extra difficult by the chronic nature of those diseases. It is hard to watch others' independence fade as their bodies fail, and I felt like the efforts I made brought about little change. There were some truly tragic stories in the ICUs that even made attending rounds difficult. I did my best for them, but I am so thankful to be back with a more stable patient base.
As the year ended, I realized that I am no longer really a "new practitioner." Granted, most of my experience is consolidated in one practice area, and I certainly don't know all there is to know about the acute care setting, but I now have a valuable level of skill. I feel like I could go to any adult hospital confidently and be a skilled member of their team. I caught multiple strokes and other medical problems, which makes me feel bad at the time (I hate to see people doing poorly) but it makes me feel that I am a competent professional doing my best to look out for my patients. I progressed with treating pediatrics by taking on outpatients for a few months and doing some feeding interventions for the infants. I was really proud to recognize self-soothing in the baby I evaluated my last day, because even though it's simple, it shows that I am retaining what I've learned though my time to practice is sporadic. I also had my first true fieldwork student, and I don't think I screwed up too badly or she would not have sent beignets. :)
I have a lot to look forward to for 2011. My goal is to spend less time typing notes at home (which is awful!) and more time being able to participate in my "OT extracurriculars"- this blog, OTC, twitter, association stuff. I am now the VP of Advocacy Relations for the Maryland OT Association and things are already in full swing. We are planning for Lobby Night in Annapolis, and would certainly love your company if you're able to attend. I am looking forward to the AOTA Conference in Philly (a mere 2 hours away) and the MOTA Conference (a mere 15 minutes away). I really enjoy how close Baltimore is to fun and excitement, so I know there will be more trips to DC and NY this year too.
Happy, healthy, awesome new year to all.
I will touch on a few ups and downs of the year.
Firstly, let me thank all readers. I really appreciate the comments (that aren't plugging fake universities or spam in other languages) because I like to see that there has been an effect from my efforts. I don't look at the stats often, but glancing today, I see that since I started tracking in 2008, pageloads have increased by 20,000- more than 300%! WOW! And the cross-posts in the sister blog on OT Connections have brought in an extra 50-350 viewers each time, with one anomaly (thank you 1-minute update). It's really exciting to see how this blog has grown and spread, and gets me thinking about some plans for the future (more on that later). So a BIG THANK YOU to each of you, and please always feel free to comment or email me with suggestions.
Most popular pages on this site continue to be Writing Goals and a Case Study With Goals, which is understandable since this is one of the more difficult skills in OT that is not hands-on. I do intend to spend some time getting back to the 'roots' of this blog and posting about decision making, goal writing, and treatment plans. Perplexingly, a rather random What a Week post is the most read on the mirror site, with the exception of my post about Glee that got picked up by 1-minute update. Ironically, some of the posts I spent the MOST time on (e.g. Metacognition and Serial Casting Case Study) don't seem to be as popular, but I don't have tracking to that degree so I can't be positive. I did get several thoughtful comments on my most emotional post (Struggling as an OT for my Family) so I appreciate that deeply.
2010 was the first AOTA Conference I've been to as a practitioner, and even the first I saw after fieldwork. It was great to re-energize and network with other therapists. I think that as you are in the profession longer, you become more aware of others in the field, so I spotted dozens of OT Celebrities this year and got to talk with many, which was awesome.
It was interesting to see all the uproar in AOTA this past year with the potential organizational changes. As we are heading into election season again I see the new blogs and OTC memberships cropping up and it's always notable to see who sticks with it. Props to Bill Wong for continuing to post, and also to Florence Clark for taking up the mantle of the President's Blog.
There were some serious downers last year. We lost my husband's grandmother to Alzheimer's Disease in the summer, which was very difficult for the family. Then over the holidays, we had several additional hospitalizations of our family members, which have yet to completely resolve. Health is so very fragile and some families are like a house of cards... I am learning to take pleasure in contentment and tranquility, because it can all be very fleeting.
I struggled on my final rotation of the year on the cardiopulmonary floor, made extra difficult by the chronic nature of those diseases. It is hard to watch others' independence fade as their bodies fail, and I felt like the efforts I made brought about little change. There were some truly tragic stories in the ICUs that even made attending rounds difficult. I did my best for them, but I am so thankful to be back with a more stable patient base.
As the year ended, I realized that I am no longer really a "new practitioner." Granted, most of my experience is consolidated in one practice area, and I certainly don't know all there is to know about the acute care setting, but I now have a valuable level of skill. I feel like I could go to any adult hospital confidently and be a skilled member of their team. I caught multiple strokes and other medical problems, which makes me feel bad at the time (I hate to see people doing poorly) but it makes me feel that I am a competent professional doing my best to look out for my patients. I progressed with treating pediatrics by taking on outpatients for a few months and doing some feeding interventions for the infants. I was really proud to recognize self-soothing in the baby I evaluated my last day, because even though it's simple, it shows that I am retaining what I've learned though my time to practice is sporadic. I also had my first true fieldwork student, and I don't think I screwed up too badly or she would not have sent beignets. :)
I have a lot to look forward to for 2011. My goal is to spend less time typing notes at home (which is awful!) and more time being able to participate in my "OT extracurriculars"- this blog, OTC, twitter, association stuff. I am now the VP of Advocacy Relations for the Maryland OT Association and things are already in full swing. We are planning for Lobby Night in Annapolis, and would certainly love your company if you're able to attend. I am looking forward to the AOTA Conference in Philly (a mere 2 hours away) and the MOTA Conference (a mere 15 minutes away). I really enjoy how close Baltimore is to fun and excitement, so I know there will be more trips to DC and NY this year too.
Happy, healthy, awesome new year to all.
12.22.2010
It's a Christmas Miracle!
So at rounds today, I was rushing in late and trying to get my computer set up to look things up. They had already started on the first patient (not one of mine) and wanted to know if OT and PT agreed on discharge plans. I asked for a minute to get everything settled, and in that time, the resident looked up the notes and had the answers. I was shocked! I said, "wow, I didn't think you guys ever read our notes!" and got rousing responses from around the table (resident, PA, social work and case management) who stated that they DO read them (even if it's just the summary paragraph at the bottom). It was like a present with a big red bow.
12.05.2010
phew...
Life's been pretty busy lately...
I've been working on notes at home almost every night, and have also started trying to track my work day in 15 minute increments so that I can become more efficient.
Enjoyed Harry Potter. Holidays are coming up, as are the family travels over hither and yon. We are planning a trip to New York soon, I have never been there so I am really excited.
Recently got a Nook and have been pretty excited trying to put journal articles (and tons of novels) on it. OT Practice does download as a pdf file but it doesn't come out quite right... will have to play around with it.
I have officially added 1 OT activity to my life... a special welcome to any MOTA members.
I definitely have plans to write more soon, but I'm trying to get upbeat... it's been a very difficult rotation, we've lost a lot of patients on caseload, I feel like I should be a representative for the hospice service. I will have an entry on hospice coming up, and do have others planned/half-started as well.
10.16.2010
Struggling as an OT for my family
Any medical professional can tell you the hardest patients are the ones you're related to. Once you express interest in a degree, the health questions start coming in from all sides. I remember using my special tests book to r/o fracture after my brother punched a wall, digging through an orthopedic text to find the painful ROM arc of my mom's shoulder over the phone, and trying to diagnose a no-longer-present-but-still-bothersome-that-it-had-ever-appeared nodule for my dad- incredulous that this didn't involve a trip to the doctor. But there are limits to what anyone can do, especially from far away.
My dad had a heart attack after I finished my final OT fieldwork. I had several weeks that I was able to spend at home while he recovered. I don't recall doing much during that time except for just trying to keep a close watch on the recovery process, driving him to appts, and encouraging a gradual return to activity. I do remember questioning the MD about the quality of the hospital's cardiac rehab- I didn't want him doing dowel exercises to 90* and 20 mins UBE only- but they had a very good program able to help him return to playing football, teaching full time, etc.
My mom had an injury lately that exacerbated chronic back pain and forced a laminectomy. While I could answer some questions about spinal precautions, home adaptations, I couldn't help her with the insurance issues or prognostic questions like when she could go back to work. It was very hard for me to to counsel her by phone after her surgery despite the fact that I do that for non-relatives everyday.
But the most difficult has been my grandmother-in-law. I can't remember whether it was before or after the wedding that she asked her MD about Aricept because she felt she had memory problems. She had self-diagnosed Alzheimer's Disease (AD) correctly, unfortunately. Our visits were limited due to time and travel constraints, and initially she appeared to have only mild deficits. However, when the disease began to progress, I felt it moved quickly. Environmental modifications went from un-needed to un-beneficial quickly. We made some changes later, like raising the table legs so a wheelchair could fit underneath and relaying ramp specifications for her son to install. The home health agency actually responsible for her care got her a toilet seat with arms and a shower chair. I sent lots of activities and descriptions of how to grade tasks for her caregivers, but they were often too strapped for time to engage.
I got her a bright flowered walker bag as soon as she required a mobility device. However, she never could master the walker usage, and would lean backwards precariously while someone held the walker in front of her- very frightening. It is strange to transfer a family member. Sometimes I tell my patients that OT is "up close and personal" because of the lack of distance required for some activities. Anyway, despite initially being regarded as 'the expert' her caregivers and family that were there everyday were much more effective at her transfers than I was, even if I had to bite my tongue as they were less safe.
I had multiple discussions with my father-in-law about her ongoing need for care- pushing for 24 hour daily caregivers to relieve family and be safest. When her MD pushed for outpatient PT (WHY?!), I tried to relay that home health therapy was invented for the homebound and that bumping her in a wheelchair down a flight of stairs constituted excessive burden. We discussed that PT was not a cure all and that ambulation was getting unrealistic (despite what the doctor thought), but they pushed ahead. It was still sad for me when I heard she was d/c from PT due to plateauing, though I knew it was coming.
From there, the decline moved rapidly. She was already unable to hold a phone conversation, but became unable to stay awake for any activity in front of her. She had a few back-to-back hospitalizations and was sent home on hospice. A few short weeks later, one of the most loving and vibrant individuals I have ever known succumbed to one of the worst diseases of our time. Even though this outcome was expected and in fact certain, I still felt that I had failed along the way. I hadn't been able to adapt the walker to make it easier to use, conduct training with the caregivers, or give her a robust home program so that she could continue to participate. I can't even say that I did my best, as usually I had forgotten planned efforts- like sending her one of my violets. And I felt like I had failed the sweet and loving woman who gladly accepted me into the family.
My best efforts overall were probably with the rest of the family. I tried to encourage my stressed and overworked father-in-law to take care of his health and take time for himself, educate him on resources that were available in the community. I tried to address the frustration of my mother-in-law and explain behaviors that were related to the disease process and no longer under grandma's control. I tried to add perspective in general since the person we had loved was already gone due to AD. But I often felt more like an outside intruder than anything. Her daily caregivers, who had received some minimal education on working with the elderly, were able to handle the entire family's needs very well. Knowing that she was comfortable with "the girls" and the hospice workers is of great comfort and another testament that you should never consider yourself 'above' anyone, they have much to teach you and much that they are capable of beyond you.
I know that failure is a strong word, but I have always been a tough critic of my work. And in this case, where I know that I could've done better and that she deserved better, the sting is especially sharp. It's hard to be the therapist in the family and walk the line between personal and professional. It's hard to do all that should be done and still maintain roles. This is a difficult topic for me since I know the situation will only increase in frequency as the years go by. The health stability of the family is always tenuous, and I just hope each day that my expertise won't be needed.
My dad had a heart attack after I finished my final OT fieldwork. I had several weeks that I was able to spend at home while he recovered. I don't recall doing much during that time except for just trying to keep a close watch on the recovery process, driving him to appts, and encouraging a gradual return to activity. I do remember questioning the MD about the quality of the hospital's cardiac rehab- I didn't want him doing dowel exercises to 90* and 20 mins UBE only- but they had a very good program able to help him return to playing football, teaching full time, etc.
My mom had an injury lately that exacerbated chronic back pain and forced a laminectomy. While I could answer some questions about spinal precautions, home adaptations, I couldn't help her with the insurance issues or prognostic questions like when she could go back to work. It was very hard for me to to counsel her by phone after her surgery despite the fact that I do that for non-relatives everyday.
But the most difficult has been my grandmother-in-law. I can't remember whether it was before or after the wedding that she asked her MD about Aricept because she felt she had memory problems. She had self-diagnosed Alzheimer's Disease (AD) correctly, unfortunately. Our visits were limited due to time and travel constraints, and initially she appeared to have only mild deficits. However, when the disease began to progress, I felt it moved quickly. Environmental modifications went from un-needed to un-beneficial quickly. We made some changes later, like raising the table legs so a wheelchair could fit underneath and relaying ramp specifications for her son to install. The home health agency actually responsible for her care got her a toilet seat with arms and a shower chair. I sent lots of activities and descriptions of how to grade tasks for her caregivers, but they were often too strapped for time to engage.
I got her a bright flowered walker bag as soon as she required a mobility device. However, she never could master the walker usage, and would lean backwards precariously while someone held the walker in front of her- very frightening. It is strange to transfer a family member. Sometimes I tell my patients that OT is "up close and personal" because of the lack of distance required for some activities. Anyway, despite initially being regarded as 'the expert' her caregivers and family that were there everyday were much more effective at her transfers than I was, even if I had to bite my tongue as they were less safe.
I had multiple discussions with my father-in-law about her ongoing need for care- pushing for 24 hour daily caregivers to relieve family and be safest. When her MD pushed for outpatient PT (WHY?!), I tried to relay that home health therapy was invented for the homebound and that bumping her in a wheelchair down a flight of stairs constituted excessive burden. We discussed that PT was not a cure all and that ambulation was getting unrealistic (despite what the doctor thought), but they pushed ahead. It was still sad for me when I heard she was d/c from PT due to plateauing, though I knew it was coming.
From there, the decline moved rapidly. She was already unable to hold a phone conversation, but became unable to stay awake for any activity in front of her. She had a few back-to-back hospitalizations and was sent home on hospice. A few short weeks later, one of the most loving and vibrant individuals I have ever known succumbed to one of the worst diseases of our time. Even though this outcome was expected and in fact certain, I still felt that I had failed along the way. I hadn't been able to adapt the walker to make it easier to use, conduct training with the caregivers, or give her a robust home program so that she could continue to participate. I can't even say that I did my best, as usually I had forgotten planned efforts- like sending her one of my violets. And I felt like I had failed the sweet and loving woman who gladly accepted me into the family.
My best efforts overall were probably with the rest of the family. I tried to encourage my stressed and overworked father-in-law to take care of his health and take time for himself, educate him on resources that were available in the community. I tried to address the frustration of my mother-in-law and explain behaviors that were related to the disease process and no longer under grandma's control. I tried to add perspective in general since the person we had loved was already gone due to AD. But I often felt more like an outside intruder than anything. Her daily caregivers, who had received some minimal education on working with the elderly, were able to handle the entire family's needs very well. Knowing that she was comfortable with "the girls" and the hospice workers is of great comfort and another testament that you should never consider yourself 'above' anyone, they have much to teach you and much that they are capable of beyond you.
I know that failure is a strong word, but I have always been a tough critic of my work. And in this case, where I know that I could've done better and that she deserved better, the sting is especially sharp. It's hard to be the therapist in the family and walk the line between personal and professional. It's hard to do all that should be done and still maintain roles. This is a difficult topic for me since I know the situation will only increase in frequency as the years go by. The health stability of the family is always tenuous, and I just hope each day that my expertise won't be needed.
10.12.2010
Site Updates
I have been slowly making some changes to the overall site layout.I have moved all the multitude of links to one single page (sadly without targets) which can be accessed on the right side of the page, also near an extended version of "about me." I am keeping the 3 bar layout for now so I can spread out the remaining objects. If you have already used the subscribe buttons to the right so that you can read these updates through RSS, kudos, and if not, I would consider getting a feed reader to save yourself some time and clicks. I am also considering adding a widget that would allow for the feed to be turned into PDF format, which would be more helpful for someone using a Kindle or other non-computer device to read the blog- is anyone interested in that?
As a sidenote, I think I will have to retract some of my previous statements on the Kindle. There are free and discounted books available (though many are pre-1923) and some library e-book downloads are compatible (though the e-book portion of my library is much smaller than the actual book portion). Most importantly for the OT world, because the Kindle can access PDF files, it IS capable of reading AJOT and OT Practice. There are also a few loopholes that allow for access to RSS feeds and I think that the new version can access email similar to a phone. It also allows for highlighting and notetaking, which I wanted for blogging use. I continue to think that it is a good tool for those with low vision, and a better tool than a standard monitor setup for reading without causing eyestrain. Not a pitch for the device (and certainly not a paid ad), but I'm thinking of getting one for myself and seeing that I was wrong about some of my insinuations.
There is a new call for applications to the Emerging Leaders Development Program (v. 2.o) and I have made a promise to myself not to screw the application up this year. Also will try to have posts a little more frequent, I am almost through with most recent promised post and do take requests. I'm waiting on a new computer to arrive, but since most of my documents are either cloud based or just floating in the transom of my mind, it shouldn't cause any delays with updating. January will mark the 3 year anniversary of the blog and I was considering taking a poll of the readers, but please feel free to comment, email, or find me on OTConnections to let me know what is interesting to you.
As a sidenote, I think I will have to retract some of my previous statements on the Kindle. There are free and discounted books available (though many are pre-1923) and some library e-book downloads are compatible (though the e-book portion of my library is much smaller than the actual book portion). Most importantly for the OT world, because the Kindle can access PDF files, it IS capable of reading AJOT and OT Practice. There are also a few loopholes that allow for access to RSS feeds and I think that the new version can access email similar to a phone. It also allows for highlighting and notetaking, which I wanted for blogging use. I continue to think that it is a good tool for those with low vision, and a better tool than a standard monitor setup for reading without causing eyestrain. Not a pitch for the device (and certainly not a paid ad), but I'm thinking of getting one for myself and seeing that I was wrong about some of my insinuations.
There is a new call for applications to the Emerging Leaders Development Program (v. 2.o) and I have made a promise to myself not to screw the application up this year. Also will try to have posts a little more frequent, I am almost through with most recent promised post and do take requests. I'm waiting on a new computer to arrive, but since most of my documents are either cloud based or just floating in the transom of my mind, it shouldn't cause any delays with updating. January will mark the 3 year anniversary of the blog and I was considering taking a poll of the readers, but please feel free to comment, email, or find me on OTConnections to let me know what is interesting to you.
10.09.2010
Coming Soon- World OT Day!
When I saw this link listing the schedule of online speakers for World OT Day (10/27/10) I started to get really excited!
There are some very famous OTs on this lineup, including Karen Jacobs, Kit Sinclair, Erik Johnson, Michael Iwama, and the current president of the World Federation of Occupational Therapists, Sharon Britnell. Props to Merrolee Penman, who appears to be behind the effort.
I am always seeking to learn more about occupational therapy and think that seeing the world perspective will be very interesting. I'm not sure if these sessions can be accessed at a later time- I will be working and sleeping through most of them. However, here's what I plan to catch (times EST):
2pm: Erik Johnson "Occupational therapy within a military setting" I got to see a short video from Erik during the 2010 AOTA Conference and follow his blog, so I think this will be a pretty interesting and worthwhile session. I'm going to see if we can get a group together to watch at work, and if that doesn't fly, I'm going to take a late lunch and break out the headphones.
5pm: Michael Iwama "The Kawa model: Heralding a new paradigm in occupational therapy" I don't know a lot about the River Model and think this will be a good introduction.
The following presentation 6pm "Re-Connecting: Using Facebook for Social Networking after an Acquired Brain Injury" looks interesting, but I have to get on the bus and get home sometime, so I'll probably have to miss it. (Same goes for 2, 3, 4, 7, 8, 9 which all occur during sleepytime)
7pm: Lindsay Eales & Roxanne Ulanicki "iDance: Transformative Occupations" Looks very unique and awesome, I expect to see many more OTs involved in dance, gymnastics, and other wellness outlets in the future.
8pm: Annette Rivard "The power of professional commitment" self explanatory
9pm: Sharon Brintnell "Images of now and visions for the future" also self explanatory. If you've ever been to an AOTA conference and felt the energizing rush following the president's speech, you know how instrumental that can be for taking momentum home with you and putting new learning into practice. I expect nothing less from our WFOT leader.
It seems that watching these sessions would count towards renewal through NBCOT under "attending workshops/courses/independent learning" (refer to renewal PDF) and depending on your state may count for license renewal as well.
Don't forget that week is also the time for OT Wikiflash, a time for mass editing of Wikipedia to better reflect Occupational Therapy. If you're new to wiki editing, get registered and play in the sandbox now so you can be ready. This is a great way to achieve our Centennial Vision goal of being "widely recognized." I've previously lauded a pediatric blogger for her prolific work on Ehow; Claire Hayward, Anita Hamilton and Will Wade have been active in promoting this event.
There are some very famous OTs on this lineup, including Karen Jacobs, Kit Sinclair, Erik Johnson, Michael Iwama, and the current president of the World Federation of Occupational Therapists, Sharon Britnell. Props to Merrolee Penman, who appears to be behind the effort.
I am always seeking to learn more about occupational therapy and think that seeing the world perspective will be very interesting. I'm not sure if these sessions can be accessed at a later time- I will be working and sleeping through most of them. However, here's what I plan to catch (times EST):
2pm: Erik Johnson "Occupational therapy within a military setting" I got to see a short video from Erik during the 2010 AOTA Conference and follow his blog, so I think this will be a pretty interesting and worthwhile session. I'm going to see if we can get a group together to watch at work, and if that doesn't fly, I'm going to take a late lunch and break out the headphones.
5pm: Michael Iwama "The Kawa model: Heralding a new paradigm in occupational therapy" I don't know a lot about the River Model and think this will be a good introduction.
The following presentation 6pm "Re-Connecting: Using Facebook for Social Networking after an Acquired Brain Injury" looks interesting, but I have to get on the bus and get home sometime, so I'll probably have to miss it. (Same goes for 2, 3, 4, 7, 8, 9 which all occur during sleepytime)
7pm: Lindsay Eales & Roxanne Ulanicki "iDance: Transformative Occupations" Looks very unique and awesome, I expect to see many more OTs involved in dance, gymnastics, and other wellness outlets in the future.
8pm: Annette Rivard "The power of professional commitment" self explanatory
9pm: Sharon Brintnell "Images of now and visions for the future" also self explanatory. If you've ever been to an AOTA conference and felt the energizing rush following the president's speech, you know how instrumental that can be for taking momentum home with you and putting new learning into practice. I expect nothing less from our WFOT leader.
It seems that watching these sessions would count towards renewal through NBCOT under "attending workshops/courses/independent learning" (refer to renewal PDF) and depending on your state may count for license renewal as well.
Don't forget that week is also the time for OT Wikiflash, a time for mass editing of Wikipedia to better reflect Occupational Therapy. If you're new to wiki editing, get registered and play in the sandbox now so you can be ready. This is a great way to achieve our Centennial Vision goal of being "widely recognized." I've previously lauded a pediatric blogger for her prolific work on Ehow; Claire Hayward, Anita Hamilton and Will Wade have been active in promoting this event.
9.25.2010
Neuro floor humor
Saw this was today's Crankshaft comic and couldn't help cracking a smile. If you come into a hospital with a headache, be prepared for neuro checks Q4!Working on the neuro floor means that I have to suppress my natural propensity to be a worrywart- I start thinking about word finding problems, clumsiness/tripping, and hope that I'm not ignoring signs of a tumor or aneurysm! It's hard to listen to all my patients' stories of symptom onset w/o getting a little paranoid.
Just finished a biography of neurosurgeon Keith Black who has very compelling personal narrative and his life story is certainly an object lesson in encouraging the learning interests of your children. He described that his parents got him a dissection kit and chemistry set from a young age and encouraged curiosity in a number of ways- it's certainly a great story of parents helping a child achieve exceptional outcomes.
Thanks for being patient with the slow updates- had a very withdrawn week and have also finally resumed regular workouts (plus it's FOOTBALL SEASON), so time has been spread.
8.20.2010
OT Web Gems- yet another random edition
OT Web Gems is back! (because I'm aimless and have collected a lot of links!) Some of the absolutely random things (with emphasis on a few blogs) that have caught my eye recently.
-CPR performed by those with physical disabilities- yes, it is possible, I'm glad that the author posted it as there seems to be a dearth of info on the topic. I've just found the blog through twitter and will be following her posts with interest- she's an OT, you should too!
-Fidget toys explained- I have been following this blog with interest for some time now and really respect that the author is prolific not just in blogging but also on wikis, really helping to get the word out about OT related issues. I'm a little bummed because I've had a script and everything ready to make a video on fidget toys for 2 years or more and just kept putting it off- scooped again! Oh well, I may still make it anyway, and this is definitely another OT blog you should be following.
-TherExtras- another blog I have only recently discovered with lots of interesting topics, author is an OT/PT/PhD
-World OT Day Poster- Mark your calendar: OT Wikiflash October 25-29
-What's happening in Obama's brain? -an interesting little piece which I find more interesting due to my current neuro-related reading, The Shallows: What the Internet is Doing to our Brains. I won't start talking about that now, but it's been an exciting little spur to my curiosity and knowledge quest.
-Motor Skills Games- a good resource if you need some fresh ideas, gross and fine motor included
-"Socially Awkward Like Me" -I really identified with this blog post that I found through someone else's twitter feed, discussing how she sees shades of her own behaviors in her autistic child's behaviors
-Backpack tips from PTs- Is it wrong that I feel that PTs are horning in on Backpack Day? I've been feeling under attack lately anyway and this just frosted my cookies in all the wrong ways. This was also featured in the WaPo, with no comment on the OT event. :(
-Tots-n-Tech- I stumbled across this newsletter and thought it was very well written with good ideas. Some great, simple, kid-friendly AE included. I will have to be following them in the future as well.
-CPR performed by those with physical disabilities- yes, it is possible, I'm glad that the author posted it as there seems to be a dearth of info on the topic. I've just found the blog through twitter and will be following her posts with interest- she's an OT, you should too!
-Fidget toys explained- I have been following this blog with interest for some time now and really respect that the author is prolific not just in blogging but also on wikis, really helping to get the word out about OT related issues. I'm a little bummed because I've had a script and everything ready to make a video on fidget toys for 2 years or more and just kept putting it off- scooped again! Oh well, I may still make it anyway, and this is definitely another OT blog you should be following.
-TherExtras- another blog I have only recently discovered with lots of interesting topics, author is an OT/PT/PhD
-World OT Day Poster- Mark your calendar: OT Wikiflash October 25-29
-What's happening in Obama's brain? -an interesting little piece which I find more interesting due to my current neuro-related reading, The Shallows: What the Internet is Doing to our Brains. I won't start talking about that now, but it's been an exciting little spur to my curiosity and knowledge quest.
-Motor Skills Games- a good resource if you need some fresh ideas, gross and fine motor included
-"Socially Awkward Like Me" -I really identified with this blog post that I found through someone else's twitter feed, discussing how she sees shades of her own behaviors in her autistic child's behaviors
-Backpack tips from PTs- Is it wrong that I feel that PTs are horning in on Backpack Day? I've been feeling under attack lately anyway and this just frosted my cookies in all the wrong ways. This was also featured in the WaPo, with no comment on the OT event. :(
-Tots-n-Tech- I stumbled across this newsletter and thought it was very well written with good ideas. Some great, simple, kid-friendly AE included. I will have to be following them in the future as well.
8.15.2010
tips?
So this is just a very brief thought I had over dinner tonight. OT is by definition a service profession, we are paid to provide a service to others. Waitstaff who provide good service receive (in theory) increased compensation from their customers, and those who provide subpar service are not as well compensated. However, OT is basically "flat-rate" pay, with some increased compensation for experience, but no financial recognition of competence or above average performance. (at least in my experience- is anyone being compensated for specialty certification or other signs of advanced practice??) The only fiscally-related judgment of competence is whether you continue to be employed. We've had a lot of cuts at our hospital lately, particularly in the employee recognition department, and I think it's fair to say that morale is down. We have ways for patients to recognize excellent staff, but one of those methods is tied to the Press-Ganey survey, which doesn't go out to the patient until they have already been discharged for several weeks. By that time, I feel that our impression on the pt. and family may have faded a bit. Anyway, my idea is that during the discharge session with the RN, the pt. and family were handed a paper asking them which services they had received that had a checklist of various ancillary hospital services, and then gave them an imaginary$10-$20 to spend on "tips" for the staff members/departments they felt offered good service. Accumulating "tip money" could either result in an incentive reward or an actual dollar reward, which I think would be cool. I've never worked in another service profession that gets tips, but I have to imagine that it is somewhat motivating to see a reward immediately after your service was provided. Good feedback and all. Any thoughts?
8.09.2010
Just breathe
I'm in a little bit of a rut right now, with an associated (OT related) writers' and readers' block. I'm working on a couple of entries, but it's moving slowly. I usually never have an unread OT Practice for longer than a day, given my 2 hour commute is so conducive to reading, but I now have 2 piled up along with the latest 2 AJOTs. My google reader list has been perpetually overflowing for months now, causing me to unsubscribe to several items just to decrease the counts. I know we all get behind on that stuff, and that I used to get much more behind on it when I didn't have scheduled reading time. But I'm in a little bit of a funk right now, so patience is requested and encouragement would be appreciated. :)
8.07.2010
Adventures in Serial Casting, Part I
Image from BBCPt. is a ~60 y.o. female s/p multiple CVAs who was referred to OT for splinting assessment while in the neuro ICU. Pt. was connected to typical ICU monitors plus arterial line, was breathing comfortably on room air. She presents at a Rancho 3-4 level, depending on the day. Her L foot demonstrates increased tone, plantarflexion, and inversion. I was not able to passively stretch her ankle into neutral position and she demonstrated no AROM. I did not splint her per normal protocols (pre-fabricated multi-podus boot or individualized foot boot constructed from splinting material and cushioning as necessary) because I worried that she would not fit well into even an individualized splint due to the inversion and would be at risk for skin breakdown. I asked the doctors to consult PM&R at rounds, and the PM&R doctor injected the patient with a phenol nerve block (I'm not going to go into the differences between phenol and botox because I really don't know anything about it and that decision lies outside the OT realm. There is research on it if you're interested) which he said would be effective for 2-3 months.
After the nerve block, I was able to range pt's foot out of extreme inversion but not quite to neutral and she still had deficits in dorsiflexion PROM. At this time we were able to begin serial casting of the ankle. I can't say that I had experience with the specific technique, my previous casting experiences involved the elbow (in retrospect, this is much easier to cast in my opinion). However, I did take an athletic training class back in high school which involved many sessions of ankle taping (and after spraining my own ankle I got several years of experience taping my own ankle daily) so I did feel that I had a good concept of the necessary design (stirrups, figure 8s, heel locks and a general circumferential wrap).
Our first cast was applied after 15 minutes of a heat pack. Pt. was positioned on her non-affected side with L knee in flexion and L great toe in extension to inhibit tone and allow for the PT to get best stretch from her ankle. Gel pads were applied to bony prominences, cast padding was applied to the whole lower leg, and 3 layers of plaster were applied. This first cast was applied on a Friday, (only because I was on day 2 of 8 working days and would be there over the weekend to monitor) and removed on Monday with gains in PROM noted. I had forgotten the confidence that you need to operate a cast saw, but it came back. Her inversion problem was gone after this first cast. A second cast was applied on Monday afternoon and removed the following Friday by another therapist who decided to try out a standard multipodus boot at this time as the pt. could be ranged to neutral. However, when I saw her on Sunday, she still had the PROM to get to neutral but her increased tone was still pushing her into plantarflexion and thus she was pushing herself out of the boot.
We decided to do 1 additional cast in attempt to reduce the spasticity, but something was not right about this attempt. When following up the next day, there was an indentation on the medial portion of the leg that was concerning for increased pressure, and it was unreachable by tools to attempt to correct, so it had to be cut off. It still seemed wet, and I don't know why, but that made it harder to cut. I bivalved it in the hope that I would be able to fix it from the inside and make a long term splint. This was my last day before vacation and afterward they tried kinesiotaping to reduce tone as well but I was not present for that part. Thus ends the chronicle of the serial casting.
(Please stay tuned for an entry focusing on the research behind serial casting)
8.01.2010
Bye bye July
So July should probably just be labeled the month that got out of control.
I had an additional 5 days off on top of regular weekends, (I did work a holiday) and had lots of days switched from normal schedule. It makes for an interesting new rotation when life is all topsy-turvy. I'm not sure that my coworkers would say the same, but don't worry buds I'll be back with a vengeance in August.
So I switched to neuro coming off my vacation, had some personal issues come up mid-month and then capped off by entertaining friends last week. In addition to trying to make some changes in my personal life and reading extra novels, that has made less time to update on here. (sidenote- I read The Eyre Affair by Jasper Fforde and am completely hooked on the Thursday Next novels) But there's been plenty of interesting happenings. Neuro is always a challenging rotation since the deficits can be minute or mind-blowing and you truly have to fight to get your patients into the right rehab setting on discharge. I have been trying to improve my skills in evaluating visual deficits and splint fabrication. I finally made a hand cone without getting the orthoplast stuck on the plastic cone, which was a victory in itself.
I return to work tomorrow after several days off which were much needed. My caseload has been taking a turn for the worst lately. A patient that had been improving coded and recoded. Several are hanging in limbo- stable but not improving. My strongest candidate for acute rehab wound up getting a femoral line placed and landing on bedrest. I regretfully had to recommend inpatient rehab for a young lady due to safety concerns. I've spent a lot of energy fighting for TBI rehab for a patient only to have the family refuse. I've had a patient that has made me terribly homesick and I know that she is going to be one of the people whose life sticks with me for a long time (shout out to MM and all my peds) so I've been very emotional over her case. We have many very very sick people on the unit right now so it has been a bit depressing.
Upcoming Entries (if any of these interest you, please comment and I'll try to move it along quicker)
- Adventures in Serial Casting
- Failures in being an OT for the family
- A case study for a patient with multiple CVAs
I hope to have some more good case studies in the near future, but people need to start improving. Any well wishes much appreciated.
I had an additional 5 days off on top of regular weekends, (I did work a holiday) and had lots of days switched from normal schedule. It makes for an interesting new rotation when life is all topsy-turvy. I'm not sure that my coworkers would say the same, but don't worry buds I'll be back with a vengeance in August.
So I switched to neuro coming off my vacation, had some personal issues come up mid-month and then capped off by entertaining friends last week. In addition to trying to make some changes in my personal life and reading extra novels, that has made less time to update on here. (sidenote- I read The Eyre Affair by Jasper Fforde and am completely hooked on the Thursday Next novels) But there's been plenty of interesting happenings. Neuro is always a challenging rotation since the deficits can be minute or mind-blowing and you truly have to fight to get your patients into the right rehab setting on discharge. I have been trying to improve my skills in evaluating visual deficits and splint fabrication. I finally made a hand cone without getting the orthoplast stuck on the plastic cone, which was a victory in itself.
I return to work tomorrow after several days off which were much needed. My caseload has been taking a turn for the worst lately. A patient that had been improving coded and recoded. Several are hanging in limbo- stable but not improving. My strongest candidate for acute rehab wound up getting a femoral line placed and landing on bedrest. I regretfully had to recommend inpatient rehab for a young lady due to safety concerns. I've spent a lot of energy fighting for TBI rehab for a patient only to have the family refuse. I've had a patient that has made me terribly homesick and I know that she is going to be one of the people whose life sticks with me for a long time (shout out to MM and all my peds) so I've been very emotional over her case. We have many very very sick people on the unit right now so it has been a bit depressing.
Upcoming Entries (if any of these interest you, please comment and I'll try to move it along quicker)
- Adventures in Serial Casting
- Failures in being an OT for the family
- A case study for a patient with multiple CVAs
I hope to have some more good case studies in the near future, but people need to start improving. Any well wishes much appreciated.
7.11.2010
Energy Conservation for Summer and Vacations
As I have written before, Energy Conservation is a topic that I really enjoy and love to educate about. It's close to my mind often, since I love for tasks to be efficient and simplified. In this post, I want to discuss energy conservation tips applicable to the summer months and also to vacations. Though technically the first day of summer here was a couple of weeks ago, it's been in the high 80s and 90s for what feels like several months. Energy conservation is especially important in the summer months because for many folks who need to think about conserving energy, life gets harder in the heat. Harder to breathe and easier to fatigue are typical signs of the summer, and especially among those with cardiac and respiratory diseases and also the well elderly (If you are having these symptoms in summer or anytime, talk to your doctor!). That doesn't mean that life has to take a backseat during the summer months- just that conserving energy should come into play so you can enjoy and participate in all desired occupations.
Here are some tips:
Here are some tips:
- --Minimize time in the heat- try to be outdoors in the mornings and evenings, when it's cooler, and stay out of the sun and hottest part of the day when you can
- --Don't live on grueling pace in vacation spots- So many people take a trip somewhere exciting (such as Disneyworld) and then run themselves to death during the trip. Don't be afraid to take breaks and naps, you'll enjoy whatever trip you're on more if you're not run down. Also make sure to take some seated breaks in the shade during your outdoor adventures.
- --Take stretch breaks while traveling- Try to avoid driving for overly long stretches. Take a break every hour or 2 to keep yourself fresh and cramp-free.
- --Rotate driving- in the same vein, try to rotate the driving responsibilities so that no one person is worn out from the stress
- --Plan small, close trips- shorter trips can be less stress to plan and easier on the family
- --Go to places that are air conditioned- trips to museums and movie theaters can be easier to tolerate in the heat.
- --Get your exercise in the morning or evening- summer isn't an excuse to stop exercising, but try to do it in the cooler times of the day
- --Use a scooter at parks- if you're planning a big trip at an outdoor park, consider using a scooter or transport chair to save energy. Make sure you spend time in the shade as well
- --Use a backpack (well adjusted) or rolling cooler to transport water and snacks
- --Plan day trips for times when you have the most energy- run your errands and take your trips at the time of day that you have the most energy. For many people, this is the morning.
- --Nap after pool time- swimming always seems to wear me out extra, so I just allot time afterwards to take a nap
- --Consider making smaller meals that are simpler and have less to prepare- saves you energy and prevents any extra heat from accumulating in the house
- --Know your limits, and how to cool down- recognize what you need to do after activity to cool down. Sometimes, a seated rest break is insufficient, and you may need to drink or coat yourself with water, or lay down in a cool room. Lifehacker ran a piece on using your pulse points to assist in quick cooling.
6.23.2010
I know I haven't been posting a lot... it's been a super stressful time at work, with the surgical rotation and covering outpatients. The stress has definitely been getting to me in my interactions with others and I dislike that a lot. I do have some nice things to reflect on... including the AOTA conference which I still haven't really got to fully process. But I am taking a MUCH NEEDED vacay and will be away from the computer as well. I am taking a couple of OT things- a big NICU course book and all my conference stuff- but my goal is rest and relaxation, so my predominant packing is puzzle books and novels. I also joined a softball league since my last posting, and it feels really good to get some balance back in my life.
PS- could I get a comment or 2 that ISN'T a spam written in Chinese? I'm moderating them out but it's been a little depressing that they're the only comments popping up in the email.
PS- could I get a comment or 2 that ISN'T a spam written in Chinese? I'm moderating them out but it's been a little depressing that they're the only comments popping up in the email.
6.09.2010
1 happy thing
A very quick note...
I have been bothered lately by the number of times that I get asked the really tough questions, which can really bog and depress you in acute care. I have also had some of these moments with my outpatients, when I spot a cognitive deficit that is going to cause difficulty for the kids as they progress through school (e.g.- 1st grader unable to phonetically read 3 letter words; 3rd grader unable to add and subtract). I was mentioning one of these misgivings to a parent, asking about possible summer schooling and mom mentioned that "B" would be attending art camp this summer. She said she would still do some worksheets at home, but wasn't going to let him be burned out and unhappy when he had other interests. Obviously, everyone parents and advises differently, but I was definitely happy to say, "One of the great things about 'B' is his imagination and creativity. I bet he'll really enjoy that." In this fast paced, high scheduled, high achievement world, enjoyment of childhood should count too.
I have been bothered lately by the number of times that I get asked the really tough questions, which can really bog and depress you in acute care. I have also had some of these moments with my outpatients, when I spot a cognitive deficit that is going to cause difficulty for the kids as they progress through school (e.g.- 1st grader unable to phonetically read 3 letter words; 3rd grader unable to add and subtract). I was mentioning one of these misgivings to a parent, asking about possible summer schooling and mom mentioned that "B" would be attending art camp this summer. She said she would still do some worksheets at home, but wasn't going to let him be burned out and unhappy when he had other interests. Obviously, everyone parents and advises differently, but I was definitely happy to say, "One of the great things about 'B' is his imagination and creativity. I bet he'll really enjoy that." In this fast paced, high scheduled, high achievement world, enjoyment of childhood should count too.
6.01.2010
Yikes!
Holy cow... it's been almost a month since conference. Where has the time gone?
I would say that I want to go back... but the time since the conference has been pretty rough as evidenced by the scarce/nonexistent updates. And at such a terrible time, after handing out those nice business cards haha. So, some brief updates.
- I took no time off after the conference, and that was not smart. Next year, I take a day to recuperate and absorb info. I still need to print out handouts- both for sessions that I attended and others that looked interesting- and then compile my notes.
- I went to some great sessions and met more "famous" OTs than ever before. I think that the quality of presentations was very high this year.
- I hope to get a submission in so that I might present next year in Philadelphia, Pennsylvania, April 14–17. I've had a gigundously large and cruddy list of things to do lately, and it's been pushed aside, but I really must do it.
- Speaking of cruddy things to do, I have been documenting at home almost every night, including tonight. I continually wonder how people meet productivity standards and get documentation done.
- April and May definitely kicked off my season of concerts and travel. I have had 1 weekend at home since conference and will not have another uncluttered weekend until July. Obviously I am mixing in some fun times, but it's wearing me out.
- had my first pt. with what I consider a contemporary popular name. I have been mildly wondering what it will be like when nursing facilities have hoardes of Jennys, Kelseys, Chelseas, Kaitlins, Stephanies, Kimberlys and Lindsays... not to mention when the following phase of names ages, leaving us with Tylers, Taylors, Collins', Houstons, Austins and the like as patients.
- I got a really nice bag at conference... messenger bag in a pretty blue with lots of cool features. Got it on the last day of conference. Went to pack it in the taxi to the airport the next day and a clip snapped off. Packed it to work the following day and the snaps holding the strap broke. I was so mad at the people, I said to myself, "I'll show you, I'll go back to my crappy tote bag from before." I noticed later that day that the tote bag, which I had gotten at previous AOTA conference, was from the same darned nursing home. And the zipper is trying to break. Darn you unnamed NURSING HOME!
- Posted on the Acute CareOT Forum about ICU evals. Hope to see that forum stay active. I have been tardy in adding friends I made at conference to my OTC list, but it is very hard to search for people. Feel free to add me.
- Less than a month left of doing outpatient pediatric work. As it was before, part-time peds work is difficult. Been reading up on Developmental Coordination Disorder, want to take our unit blocks (small, interlocking squares) and make lego-like designs with picture instructions to use as a clinic tool.
So, times have been busy and will only continue to get busier. The blogging break was good, if unplanned and ill-timed. I will try to be a little more active before my real vacation comes. Things I intend to do before then (OT related):
-write proposal for AOTA conference
-post more videos from conference
-post all 80-some photos from conference
-write a post on energy conservation for summer travel
Until then... here's hoping there's not too many more late nights documenting from home!
I would say that I want to go back... but the time since the conference has been pretty rough as evidenced by the scarce/nonexistent updates. And at such a terrible time, after handing out those nice business cards haha. So, some brief updates.
- I took no time off after the conference, and that was not smart. Next year, I take a day to recuperate and absorb info. I still need to print out handouts- both for sessions that I attended and others that looked interesting- and then compile my notes.
- I went to some great sessions and met more "famous" OTs than ever before. I think that the quality of presentations was very high this year.
- I hope to get a submission in so that I might present next year in Philadelphia, Pennsylvania, April 14–17. I've had a gigundously large and cruddy list of things to do lately, and it's been pushed aside, but I really must do it.
- Speaking of cruddy things to do, I have been documenting at home almost every night, including tonight. I continually wonder how people meet productivity standards and get documentation done.
- April and May definitely kicked off my season of concerts and travel. I have had 1 weekend at home since conference and will not have another uncluttered weekend until July. Obviously I am mixing in some fun times, but it's wearing me out.
- had my first pt. with what I consider a contemporary popular name. I have been mildly wondering what it will be like when nursing facilities have hoardes of Jennys, Kelseys, Chelseas, Kaitlins, Stephanies, Kimberlys and Lindsays... not to mention when the following phase of names ages, leaving us with Tylers, Taylors, Collins', Houstons, Austins and the like as patients.
- I got a really nice bag at conference... messenger bag in a pretty blue with lots of cool features. Got it on the last day of conference. Went to pack it in the taxi to the airport the next day and a clip snapped off. Packed it to work the following day and the snaps holding the strap broke. I was so mad at the people, I said to myself, "I'll show you, I'll go back to my crappy tote bag from before." I noticed later that day that the tote bag, which I had gotten at previous AOTA conference, was from the same darned nursing home. And the zipper is trying to break. Darn you unnamed NURSING HOME!
- Posted on the Acute CareOT Forum about ICU evals. Hope to see that forum stay active. I have been tardy in adding friends I made at conference to my OTC list, but it is very hard to search for people. Feel free to add me.
- Less than a month left of doing outpatient pediatric work. As it was before, part-time peds work is difficult. Been reading up on Developmental Coordination Disorder, want to take our unit blocks (small, interlocking squares) and make lego-like designs with picture instructions to use as a clinic tool.
So, times have been busy and will only continue to get busier. The blogging break was good, if unplanned and ill-timed. I will try to be a little more active before my real vacation comes. Things I intend to do before then (OT related):
-write proposal for AOTA conference
-post more videos from conference
-post all 80-some photos from conference
-write a post on energy conservation for summer travel
Until then... here's hoping there's not too many more late nights documenting from home!
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