Self Behavior Modification

So as I work on getting in shape, I worry about maintaining motivation. There have been a number of failed attempts prior in my (not that long) life and I'd rather not fail again. So I am busting out behavior modification all over myself to make it work. There are some great tips here, and I've listed out some of my other methods of personal mind control.

(not necessarily in any order)

1) Visibility-I want to be reminded of my goals and what I know I should be doing. So everything stays visible. My box of exercise gear (yoga stuff, balance stuff, aerobics shoes) is right beside the TV, so I always see it. If there's an exercise DVD that I want to concentrate on, I'll prop the case up by the xbox so it's easily seen. We have no garage at the moment, so the bikes are sitting right beside the table. I bought anti-chlorine shampoo for post-swim workouts and put it in the front of my shampoo container so I see it every time I walk in the bathroom. You could also place motivational notes to yourself in various places.

2) Ease of access- Since most things are visible, they're easily accessed. I have Netflix streaming and leave all the workout routines in a block so they're easier to locate. The running shoes stay near the door and untied. I keep my water bottle filled and in the fridge. All the workout clothes are in the same drawer, and if I'm planning on going to the pool I'll put all that stuff in a bag together. Generally keeping necessary accessories (say that 3x fast) together makes life easier, for example, the bike helmet is on the handlebars. I'm a bum, the easier it is, the more likely it is to be done.

3) Guilt- Is this a healthy motivator? I don't know. But I use it. Thinking about the cost of items, and that I really should use them, is sometimes helpful. Thinking about how long it has been since doing an activity is also something I do. And in the part guilt/part competition factor, if my husband/workout buddy is doing something, I will try to go along and keep up.

4) Mental monitoring- A recent study showed that people who just mentally asked themselves "how often will I work out this week?" worked out more often than the control group. (sorry, no link) So I try to think about my exercise schedule, and try to think how I will fit things in for the following day. I also am trying to keep a journal with short entries about what I did and how I feel. Keeping a written record gives me something to look back at for motivation.

5) Rewards- I am all for cheap, easy thrills as rewards. I have a smart phone and use the free CardioTrainer app for my exercise recording. Every time I turn it on, I can see a little activity figure for each day that week I did any kind of exercise. I like the little stick figures and think that they're cute, and like to see a variety of them on that screen. It keeps a full history, so I can look back and see how many total miles I have gone since starting the app and the calories for each. I can also see the maps of my outdoor exercise, which I think is cool. Finally, there's a widget for my screen that turns different colors based on # calories burned/week. I see it frequently when using my phone and always try to keep it in the gold/silver/bronze range. I definitely get a little emotional boost when I see a good color.

So that's a few of the ways that I've been manipulating myself lately. Nice to see that I'm making use of my education. Any other good tricks that you use? Feel free to share in the comments.

Disability or Ability- TV's Alphas

I watch a fair amount of TV. Now that I'm home 2 extra days, I keep it on for noise during the day. One of the shows i have started watching is Alphas from the SyFy channel.

Alphas so far appears to be a fairly standard superheroes kind of show in the line of XMen, Heroes, etc mixed in with some espionage and spy work. I like those kind of shows, so I can tolerate some of the less-than-awesome dialogue and recycled plots. Of the 5 types of Alphas described, even mild comic book or superhero fans could list other characters that fit these types.

What spiked my interest in the show was the character who is a "transducer" and able to act as an antenna to intercept and decode messages. "Gary" is able to read all wavelengths- TV, cell phones, computer traffic on the internet, etc. This is an astounding amount of information to absorb, but he is able to help break codes and find information for the rest of his Alpha team. In daily life however, he appears to be on the autism spectrum (some episodes more severe than others), getting assist from his mom or team members for many daily tasks. In a follow up episode, a new character is introduced who is a human "Rosetta Stone," capable of understanding and translating any language, but also considered autistic by those not familiar with Alpha-skills, since she is unable to make eye contact or communicate except by making seemingly random scratches on her hairbrush and other materials.

I won't say that the depictions offered on TV of a person with autism are entirely realistic. I've only seen 2 episodes, but even within that time frame, Gary's eye contact, speech patterns, social skills, and repetitive motions have changed considerably. Some of this is likely due to the actor becoming comfortable with the character, and the changing demands for different episodes. But I particularly like the concept that a person considered disabled in the context of average humans is valued as a superhuman by those "in the know." Which makes labels like "disabled" or "dysfunctional" worthless, since the ability (especially in this case) is all in how the person is treated and enabled. A not too deep encouragement for us to look past labels and prognoses and focus on abilities.

PS- I believe that Modern Family features a character with autism as well, but despite some of my friends liking the show I have never seen it.

thoughts on starting exercise

So I've gotten on the exercise train for a first time in a long time. And I have boarded a new train heading somewhere quite outrageous...

This is my first announcement in a public forum, but here goes. I intend to compete in a (sprint distance) triathlon next year. I'm not particularly fit at the moment, and can't yet do any of the distances for the 3 disciplines on their own, let alone consecutively. It's a process. My husband has decided to join in the fun, so we are both engaged in these struggles that can be both harrowing and ridiculously funny. There would be plenty of material for a knee-slapping gut-busting book or stand alone blog, but I just don't have time for that (how can I, when I already neglect this blog too often?) so I may share some of these stories in this forum.

On our journey to becoming athletes, we have already had a bike push (definitely couldn't be considered a ride) up and down a rain soaked clay hillside; a 2 hour hike into a canyon that required fording a river and another 2.5 hours to get OUT of the canyon; and a realization on my husband's part that swimming after a long bike ride is puke worthy. He has a serious strength advantage on me, and much greater skills in biking by extension, but I have the advantage in swimming thanks to years of lessons at the YMCA (thanks mom & dad!). So I learned a lot of technique as a child that I am now trying to impart to him as an adult. It makes for an interesting take on the difference between learning styles based on age.

The biggest technique piece so far has been introducing rotary breathing. It's a difficult concept for a novice swimmer. Those words were like poison to me for the entirety of 1994. It took me what seemed like a lifetime of 1x/week screaming by unpleasant swim instructors to be able to put my face in the water and master this concept. So even as an adult, when I (prior to the past few weeks) swim only 1x/year, I still can pull that out easily, like riding a bike. Since my husband wants to be able to finish the triathlon too, it was a skill he needed to learn.

As a child, (obviously I wasn't paying the greatest attention to instructional detail at the time) the instructors specialized in breaking down the steps to the task and repeating the practice in various ways. Blocked practice. First, kicking on the side and blowing bubbles. Then, kicking with the kickboard and doing head turns to one side. Then putting it all together into the crawl stroke, which you now have to do since we've thrown you into the deep end of the pool. (I'm having terrible flashbacks trying to write this, even now). Ultimately, until I got a new teacher and went from weekly practices to daily practices, progress was minimal at best.

My husband doesn't really have the attention span to do nothing but work on breathing for an entire hour in the pool, and approaching this from that angle might mean that he would never master it. So I gave him a few tips about how to turn his head while taking a stroke. (In retrospect, this probably shouldn't have taken place in the ocean, but like I said, we are having quite the funny journey). Then I would either answer his questions ("am I supposed to breathe out at some point?") that I hadn't covered earlier or offer some technique feedback. More of a contemporary motor control theory for learning, letting him practice and try on his own. After a few sessions (<5) he feels like he has a rhythm, and even if it doesn't look perfect, he is still able to crank out lots of laps while taking in more air than water.

So what did we learn here? Obviously, having an OT for an instructor is terrific! :) Personally, I think that learning the skills as a child made them well ingrained into my muscle memory and expect that to be unforgettable. It took a lot longer time for me to be able to learn and integrate that skill though as a child than it took my husband as an adult. But I think that the longer time to learn will make it harder to forget. It was easier for me to teach refinements to an adult than for Ms Pam to teach basics to a scared child who could barely stand up in the shallow end. I could compare this to different motor learning theories, but my books are all in boxes anyway. :-/

Well that was a bit rambling.

Personally, I am trying to take a balanced approach in this fitness plan. I really don't want to get an injury or derail this plan in the first month. Trying to add in workouts for flexibility, core, and overall strengthening into this plan. It's really hard to find time and motivation for all of this (and I have no kids and a 3 day/week job) so the ultimate goal seems very daunting at this time. Hopefully I can pull this into line (along with the rest of my life... house shopping, OT presentations, new job, other endeavors etc). And if I come up with things that are potentially interesting or tangentially related to OT, I'll try to share.

In the throes of ... lots of non-OT stuff

Life goes marching on...

Since the move, we have been trying to focus on more family time, and that has transitioned into an increase in athletic endeavors, which has been also going along with work on healthier eating. So there have been a lot of changes that we are trying to turn into healthy habits... a personal "lifestyle redesign" project, if you will. I'm not being super smart about things though since I've made lots and lots of goals, too many to focus on all at once, and no time frames. Also trying to buy a house, which is an insanely-detailed process.

I've only worked 4 days at my new job (a 3 day week and a week long vacation does make it hard to accumulate time, haha) but I feel like I'm starting to get the hang of things. There are computer and written portions of the documentation. It's a new computer program for me, and it will be interesting to see how all the documentation moves to computer (I consider it only a matter of time for all sites... it is the 21st century after all). There have definitely been some great moments with the residents and I hope that things will go well.

Ultimately, I would like to start a Lifestyle Redesign styled program in the assisted living facility. I have gathered some research to use in marketing, but need to review how to do a needs analysis, decide whether to pursue grants, etc etc. I would REALLY LOVE FEEDBACK on getting this started.

I've been keeping busy on my "off" days, which is kind of bad since I have plenty of OT things to be doing during that time, but there is a lot of ebb and flow right now. things will likely get done, just a little off the ideal schedule.

I'm Alive!

It has been WAY too long since I last wrote. Here is an abbreviated update:
1. I moved
2. I'm starting a new job
3. I have irons in the fire.
For more details...
I had to say goodbye to Baltimore. Logically, I know it's the right choice, but it has been crummy. I love the friends that I have made and the excitement that Baltimore offers, and there were so many cool OT opportunities as well. But from a personal and family standpoint, it was just not sustainable in the long term. Commutes were too long (60+ for me and 85+ for my husband) and we needed 3 days off to get home and back since we were so far away. So with potentially wanting to start our own family (in the next few years) something had to change. But knowing that logically doesn't mean that it's been easy or something that makes me happy the whole time, so I have been withdrawing a bit and trying not to put my foot in my mouth.

By extension, since we are moving a significant distance, I have to change jobs. I am at a point of conflict, since I feel like I've learned a lot from working in the hospital and am good at what I do, but it doesn't always make me happy. I don't always get to spend the time I would like to with the patients, and fighting for the appropriate recommendations really wears me down. Sometimes, there's this feeling of standing in a vacuum screaming without anyone hearing. With such little time to work with people, sometimes I wonder about making a difference. This had been better lately on the neuro floor, but it's still frustrating. I still like the hospital environment, but I don't see myself returning to it full time, maybe just prn sometime in the future.

So in thinking about what I'd like to do long term and think that an outpatient environment might be a better fit. I hate making this change without my awesome outpatient buddy from my last 2 jobs directly by my side but hope that we'll be able to keep in touch. The job I'll be starting is a unique outpatient setting that is small relatively new- only been in existence for a few months. I'm excited to help with growing the program and learning how to navigate the new environment. It's a part time job, so that will be flexible enough to let me have time to keep up with my OT extracurriculars and other activities.

On the irons in the fire list, I submitted to 3 conferences in June. 2 presentations will be similar, so that will be helpful. I get to work with an awesome group of OTs for the AOTA presentation on social media, so I hope that will work well. I have been dealing with the whole host of lame stuff that has to be done when you move, including living out of suitcases and sleeping bags for awhile, cleaning, unboxing, tons of laundry. Definitely not my favorite things to do, and having to mooch internet from Cosi was not particularly convenient for updates. I had a crushing crescendo of activities and deadlines that culminated with my last day of work and a week at the beach, and I was so wiped out. Disconnecting from the computer and internet was needed so I could recharge physically and mentally. I am feeling better now.

I intend to have at least 1 post per week now that I have some scheduled days independent of work. I hope to cover some of the following topics, and if interest is expressed I can try to speed it up:

new acute care book on AOTA press

portrayal of mental illness in Broadway's Next to Normal

new shows with characters who have disabilities

thoughts about Lifestyle Redesign program

random thoughts of an insomniac OT

Can't sleep and it's before six a.m. on a day I have off. Awesome. But here are some of my thoughts on things that have been happening recently.

First off, and rather obviously to anyone who has been with me in person, I am under a lot of stress lately. For an OT, I certainly exhibit a lot of poor patterns in dealing with stress when it gets to a high level. I retreat into comfortable things, procrastinate on other tasks (hello blog), and have a thousand questions running through my head all the time. I'm also increasingly more distracted, which feeds back into the procrastination. I've been waking up around 5 for the past several weeks, but for the most part I just stay in bed in a semi-dozing anxiety spree until the alarm actually goes off. Very stressed. Likely to get worse before it gets better.

Since I'm not concentrating well, I haven't been reading as much lately. But I have been attempting to get through a couple books that may be of interest to others. One is strictly a book for work: Yes/No Medical Spanish. I haven't had a chance to use it in person, but I love the concept and found just about everything I would need for an eval (adult or pediatric) included. Since I haven't had the time/motivation/follow through to sit and intensely improve my Spanish (and it would take a lot of classes before I could be fluent for medical things) this is a great resource. I may eventually make a master sheet out of several sections so that I could just carry a small paper for home setup and basic questions and hopefully by that time the interpreter would show up! But definitely a useful book, though not therapy based. The other book I picked up because I saw an interview on Daily Show or Colbert and thought it would be thoroughly interesting: Beyond Boundaries: The New Neuroscience of Connecting Brains with Machines---and How It Will Change Our Lives. The interview was very interesting, and the scientist discussed his research using brain-machine interfaces and talking about how they would make it possible for paralyzed people to walk using their brain power, really innovative stuff. I don't think it's only due to my attention problems, but I have been really struggling through this book both with the reading level and finding things that are interesting in it. I have renewed it twice at the library, it's do or die time now. I finally just skipped several chapters and am reading only about the actual experiments, so it's a little better that way.

I feel proud since 2 of my completely not related to OT goals that I set for myself are coming along nicely. I am progressing well as a user of chopsticks (still much better with wooden ones than smoother surfaces) and I have been able to complete 3 medium difficulty sum sudoku puzzles. Everyone needs something to aspire to and in this instance, something that has nothing to do with a career. But yay... good achievements thus far since I started as a complete novice with both this year.

I had a really interesting person s/p TBI the past few weeks, and he would make a great case study if I can strip enough identifiers eventually. I had a man with a severe hemorhage that was hospitalized for several weeks and made terrific progress exponentially near the end of his stay. I also saw a man with an intriguing stroke presentation (basically a subtly expanding stroke over >1 week) who is now at the local IRF and doing wonderful per report. These people made me actually sad when they were discharged, since they were great people and their cases were interesting. It's difficult in acute care since stays are so short, ability to do treatments is rare, and you get no follow up on what has happened to the person. It's nice when you get to see someone make progress. And speaking as someone who has interests across the lifespan, it's nice to have something so interesting because I need some beacons to figure out where I need to go and focus with my career.

Some odd moments of feeling out the boundaries between therapy comrades. I was scheduled to see a child with torticollis and was interested to try out a new approach I had seen online. But then I found myself wondering if there was good OT justification for that approach. Usually, I don't feel that I'm the 'infringer' so to speak on the other practice domains, but that case made me wonder if it was a treatment true to OT practice. I think there are probably some ways that it potentially could be (use as a feeding position, etc) but it was odd to get that squeamish feeling. Kid never showed up anyway, so really a moot point, but made for some pondering.

I had several moments lately that made me proud to be an OT and do what I do. Despite being the 'young pup' of our current floor group, I am pretty much the only one with an interest in neuro, and people have been counting on me to various degrees for their own education, which makes me feel really great to have that level of respect from others. I got a nice sincere thank you from an elderly man whose wife had a stroke... he had been disappointed that I couldn't see her daily in the hospital but so grateful that I came back. I was not expecting it since the session had been very difficult for the pt and he had watched her struggle along with BADLs. I spent a lot of time with the family of the man with TBI, and they seemed appreciative of the resources given, and even mentioned to the SLP that they felt really prepared following our sessions. I was able to make a connection with a young Hispanic couple really unfamiliar with the health care system and things like inpatient rehab, and I could tell that they were happy to see me even passing in the hallway, so that was great.

I'm trying to really enjoy these happy and proud moments, really appreciate the little things. I have a tendency to be so pessimistic and do want to remember that there are good moments even when I'm in the midst of mounds of work and disappointing myself on other fronts. I'll get a semi-needed computer respite this long weekend and see if that helps things. Words of encouragement appreciated, and I hope to be through the rough spot soon. :)

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.

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.

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.

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!