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Archive for category: Original Posts

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Put On Your Own Oxygen Mask First

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

In celebration of National Caregivers Month we wanted to re-share one of our popular caregiving posts:

If you have ever traveled by air you are familiar with the drill. Instructions on how to buckle and unbuckle your seatbelt, where the life vest is located, emergency exits, and “should cabin pressure change, an oxygen mask will fall from the overhead compartment…passengers should always put on his or her own mask before assisting children, or a disabled passenger”.

I read a mommy blog the other day that called this the “airplane example” and the writer related this to how moms should approach motherhood. Ultimately the message is this: as a mom, put your own health first because you are useless to your kids and spouse if you ignore your own needs. Really, you can’t help a child with an emergency escape from a crashing plane if you pass out helping them with their mask.

While I do agree that mothers (and fathers for that matter) need to consider their own needs in providing for the family, this is also true of people that provide care to a disabled person. My experience is that often caregivers do not really “elect” that role. They are not trained to be a caregiver, and really just try to do their best with the skills and resources they possess. However, where many fall short is maintaining their own health and well-being in dedicating their physical and emotional time to another person: a person with challenging and multiple needs. The job of a caregiver is often 24 hours, and resources don’t often permit, nor does the government provide, sufficient relief from this responsibility. Caregivers are often sleep deprived, suffer from muscle and joint pain in fulfilling their role, and can become isolated and depressed due to the changes they have made to take on these new responsibilities. Sound familiar? This very closely mimics motherhood (especially for new moms).

The answer? Put on your own oxygen mask first. What can you do to breathe easier? What helps you to feel clear-headed, energetic and optimistic? What gives you that ability to stay positive, appreciate and take on your responsibilities with some enthusiasm? The answers are often different for all of us. In the end, figuring out how to wear your oxygen mask first requires you to be honest about your abilities and skills, to utilize the resources available, and to ultimately ask for help if this is needed.

And for us health care professionals? We need to be very careful of the responsibilities we place on caregivers. This is especially true in the medical community where we repeatedly discharge people into the care of family, without family really knowing what the responsibilities will entail. As health care providers our responsibility is always to the client, yet we need to take that extra time to check in with the caregiver, talk about how they are coping and managing and if needed, offer them an oxygen mask.

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Occupation Is: Sexuality

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Don’t worry, this post is rated G.

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So far this month we have slept, gotten out of bed, completed our morning routine, had something to eat, been productive, managed our finances and our home. That’s it, right? Well, not exactly. There is one final piece of “living” that I feel compelled to include.

Sexuality is an incredibly important part of being human. Yet, when we are injured, ill, or suffering from physical, cognitive, emotional or behavioral difficulties, this too can suffer. Many of my clients report a reduced libido, erectile dysfunction, have significant physical barriers to intimacy, or issues with body image post-surgery, amputation, or after gaining weight from inactivity. With lack of sleep, medication side-effects, low mood, and hormonal changes post-trauma, being able to achieve or enjoy intimacy is not always easy.

Believe it or not, but part of Occupational Therapy training includes the occupation of sexual activity. I remember it clearly: I was in my last year of OT school and one of the owners of “Come as You Are” in Toronto was invited to run a lecture on adapted sexuality. When the topic and scope were announced that day, to my surprise, half of the students left before the lecture even started. I suppose not every student was willing to be as open about, and versed in, this sensitive topic. However, I personally found the session extremely helpful. The class openly discussed why sexuality is so important as an occupation, how as future therapists we could be open with clients about this topic without breaking professional boundaries, we reviewed adaptive sexual aids, and also talked about how certain diagnoses impact sexual abilities and how creative positioning can facilitate participation.

Recently, I had a client with a spinal cord injury attend a session at Lyndhurst on sexuality and intimacy. She found the session extremely helpful. The session was hosted by two OT’s and some spinal cord injury survivors. During the session, the OT’s demonstrated how they have been able to creatively adapt different sexual tools so they could be used by people with physical limitations to participation. Other topics around the psychology of intimacy and positioning were also covered, and my client found the session extremely helpful. I also am aware of the information on both sexuality and fertility for people with spinal cord injury at SCI-U.   Of course, this topic stretches far beyond just spinal cord injury, and every diagnosis and problem to sexual participation needs to be treated uniquely. Also, while OT’s can address barriers to sexual activity from a functional perspective, often medical and psychological intervention is also needed to help people return to their previous “normal”.

So, if you have issues with sexuality after an injury or illness, know that OT’s can help with this too. After all, we consider sexuality to be an important occupation.

Check out more posts from our “Occupation Is” series.

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Occupation Is: Managing a Household

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

Let’s just assume that we have done all the important stuff. We have slept, are out of bed, groomed, dressed, fed, are done being productive, and did some fun stuff in between. Eventually, like it or not, we need to tackle the not-fun stuff.

The interesting thing about “not-fun stuff” is that everyone defines this so differently. Each of us has our own unique interests, abilities, and standards when it comes to groceries, laundry, cleaning and managing our yard and property. Personally, I loathe grocery shopping (and anything that is meal preparation) and would rather cut the lawn then use a vacuum. My kids do their own laundry as of age 10 because it has a wonderful built in consequence. No laundry = no clothes to wear and I don’t need to say a thing. Besides, I don’t think asking them to start doing this at 16 will go as well. With six of us in our house, and two animals, the meal responsibilities, cleaning, and shopping tasks are time consuming. However, all off these things are another layer in my lasagna of “occupations”.

Imagine you are in a car accident and spend a few weeks in hospital. Your spouse, friend, mother, brother, someone, has to swoop in and help with your children, pets or house. Eventually you come home and find that things have not been done to your standards, if done at all, and it will be months before you will have the ability to get back to these tasks independently. The look of your home and property is stressful for you, the meals are different, and you are home all day to notice. Or maybe you weren’t in a car accident, but have a progressive illness or medical condition that renders you to be no longer able to complete heavier tasks, but you try diligently to manage the smaller tasks within your abilities but this too is now declining. Perhaps you have sustained a brain injury and your memory is lacking for when things were last accomplished, or when you try to go to the store you end up missing half of the items on your list, if you even take one. Or worse, the store is an overwhelming place for you considering the visual and auditory stressors from any busy shopping environment. Maybe mood is the problem: depression and anxiety can be significant barriers to getting things done, but yet the more things are not done, the more depressed and anxious you become. The cycle continues.

Managing a household and all the tasks included in this, is very much an occupation. It is a separate set of demands from personal care, earning an income, or managing our productive time. Occupational therapists routinely help clients to return to the occupation that is managing a home. There are multiple strategies that can be used for people with brain injuries, chronic pain, or social phobias to return successfully to grocery shopping. There are also multiple aids available that makes light and heavy cleaning easier. We often need to help people break down tasks into smaller chunks, or educate people on pacing as a means to get things accomplished. Education on proper body mechanics is also very useful at reducing strain on recovering shoulders, necks and backs for things like lifting, carrying, reaching, and bending. Outdoor tasks are more difficult to resume, simply because they are heavier, but many of the same principles apply. If behavior, mood or avoidance are the problem, we have strategies and tools to help with that also. We believe that most functional problems have a solution.

Occupations are therefore all the things included in managing your home. These tasks can be heavy, time consuming, and “not-fun”, but they are a necessary part of living. If you are struggling to get these things done, or know someone else who is, occupational therapy can help.

Check out more posts from our “Occupation Is” series.

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Occupation Is: Managing Your Finances

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

It is no secret that there are physical, mental and emotional consequences of stress. Access to money is a basic human need as food, shelter, and emotional security are all impacted by our ability to provide for ourselves and our family. As such, the stress created from a lack of money, or drastic and sudden loss of income, is significant. In the economic crisis of 2008, there was mounting evidence that financial issues were causing a whole host of associated health problems including a rise in reports of headaches, backaches, ulcers, increased blood pressure, depression and anxiety (http://www.frbsf.org/community-development/files/choi.pdf). Therefore, it is no secret that financial security is a determinant of health.

I can say that 100% of my clients suffer from financial problems after their traumatic event. How could you not? If you think your income is “insured” against illness or disability, check again. If you are fortunate you have private disability or health coverage. Or, you might have a good short or long term disability plan at work and in that case, you might get 80% of your income covered at the time of claim. However, this usually only lasts for two years before the “test” changes and most people find their income loss benefits end. In the world of auto insurance, without other coverage, the maximum income replacement is $400 / week, regardless of what you made before (unless you “bought up” which no one does). And just think – three years ago the Financial Services Commission of Ontario wanted to lower this to $300 / week to put more money back in the pockets of insurers. Could you live on $1200 / month? I digress…

So, you are in an accident, suffer an illness or can no longer work. How will you manage? How will you be able to afford the medications you are now required to take (these aren’t covered 100% either folks), the equipment you need (the government might fund 75% for some items, but when a prosthetic limb is $60,000 that is still a lot out of pocket), the treatment you require (even with extended benefits, $350 in PT won’t get you very far), and your regular expenses that won’t dwindle unless you make major lifestyle changes? The answer is stress, worry, concern, sleepless nights, borrowing, illegal activity, and brutal attempts to unsafely return to work because you “have to”.

Believe it or not, managing your finances is what we call another “occupation”. Working with an occupational therapist, a disabled person can create a new budget around the change in income, get support to make decisions about spending, and gain access to other potential sources of financial support. Perhaps you qualify for the Disability Tax Credit, or the Registered Disability Savings Plan? Maybe you need to apply for the Ontario Disability Support Program, or can access funding for devices through the Assistive Devices Program? Perhaps your home modifications qualify for the new Tax Credit, or you can apply to the March of Dimes under their Home and Vehicle Modification Program? Maybe without other coverage the local Community Care Access Center can provide you with home care, treatment or equipment? Can your medications be covered by Trillium? Are you maximizing the coverage available to you under auto insurance policy or work benefits? Is there a local food bank, or disabled transportation program? These are all things we look at.

Then of course, there is the process of returning to work. What if you cannot manage the demands of your previous job or this is no longer available to you based on a long absence? Perhaps the jobs you are trained for no longer match your abilities? Occupational therapists can help with identifying previous job demands, outlining new job interests, and comparing these to the abilities you have. We can set up structured work programs, gradual re-entry plans, and connect you with people and programs in the community that help people get back into the work force.

Occupation is managing your finances and making sure you can get by. If this is impacted by a disability, Occupational Therapists’ treat that.

Check out previous posts from our “Occupation Is” series.

 

 

 

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Occupation Is: Doing Fun Stuff

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, what are your plans after work? How do you like to spend your evenings? What do you do for fun? Given the choice, how do you spend free time? While being productive is essential for the human psyche, so is being unproductive. Well, sort of, because even a lack of productivity is productive. Deep, I know.

Personally, I love a good funny movie, dinner with friends, time with nature, getting out with my kids, exercising, playing sports, reading, blogging, and going on vacation. Those are my “fun”. For others, this could be creative hobbies or outlets, museums, live theatre or music, antiquing, collecting, photography, being online, or a thousand other things that I don’t even know exist.

So what if I was injured, suffered from a mental health problem, have a medical issue, or brain injury? Perhaps I would lack the ability to sit through a movie, or could no longer understand the nuances of humor. Maybe my personality would change and my friends would have a hard time relating to the “new me”. Or, I could no longer physically handle my nature walks, exercising or playing sports. If my vision was impaired, I could not read anymore. If I struggled with cognitive communication, or attention problems, putting together a blog article might also be off the table. And vacations? Those are incredibly difficult to plan and organize at the best of times.

Occupational therapists are very skilled at helping people resume the occupation of fun. There are multiple ways we do this, as we recognize that our “fun” defines much of who we are, and why we work so hard in the first place. For example, if I had to rehab myself from the problems above, I might start with suggesting sit-coms as these require less physical tolerances for sitting, and a shorter attention span. I could view these with another person, and discuss the humor, sarcasm, and recall the best one liners. Perhaps I would need education and support to understand how my personality changes are impacting my relationships, so I can try to make some changes. If my physical abilities were limited, my OT could help me find new ways to enjoy nature (bird watching, photography as examples), and could help me discover new sports and forms of exercise within my abilities (yoga, Tai Chi, and many modified sports have become very popular for people with disabilities). If I can’t read a standard book, maybe I could use an iPad or e-reader so I can change the font size, or switch to audio-books. For my blogs, I could learn new ways to move from a blog idea to a full article, by breaking down the topic into paragraphs or chunks, or learning how to dictate if written communication is my challenge. Vacations could take the form of day trips, short overnights, and eventually out of the country through the help of a travel agent that specializes in planning accessible vacations. I would probably learn that in Canada my attendant can fly for free (with approved paperwork), and that many places (Disney included) are highly accessible.

So if a disability is stopping you from enjoying the occupation of fun, OT’s treat that.

Check out more posts from our “Occupation Is” series.

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Occupation Is: Productivity

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So far we have slept, gotten up, groomed, dressed and in the last post consumed some food. Now what? Well, this is where the rubber meets the road and we get to be productive. But let’s not put productivity in the “job” box. There are a multitude of ways that people spend their time during the day, all equally important.

For those of us that “work” (in a paid capacity), this often dictates when we leave the house, and requires some kind of commute. When we arrive we need to negotiate our way to where we need to be and the next eight hours (or more) are determined largely by the demands and requirements of others. If we don’t work for money, perhaps our form of meaningful activity is child care, or care giving in general. Parents with disabled kids, or adults with disabled parents, spend a considerable amount of time in this capacity. Maybe we volunteer and that fills our day. For children, meaningful and productive activity are in the form of play or school. For young adults, this too is often education, socializing, or a job that is part time with varying hours. Some people spend their day on hobbies, sports, or exploring creative outlets that are “free time”. Some enjoy reading, and others watching television, going online, or managing the affairs of a household (errands, housekeeping, meals etc).

So you can imagine the issues that are created by a disability. What if you can’t drive, or tolerate public transit and now you are unable to get to work. Some disabilities extend the time required to complete a morning routine, and people with these problems are not able to get anywhere before 10am. Maybe you can get to work (and on time) but your office is not accessible, or your job requires abilities you no longer possess. Or if you suffer from significant fatigue, maybe being able to manage a full day, or the stresses of working, are an ongoing struggle. In your role as caregiver you are required to engage in physical activities of lifting or transferring, or this requires emotional stamina that you no longer have. As a volunteer you defined yourself by the way you were “giving back” and now this has changed. You are left feeling disappointed, discouraged and need to find a new purpose. For children that cannot play and explore their world, they need to learn alternative ways to negotiate and learn from their environment. Or, if productivity is in the form of other outlets, visual, hearing, dexterity or mobility problems can limit one’s ability to engage in those passions. Sometimes, productivity is hindered by many things, including physical, cognitive, and emotional and the barriers in each domain need to be analyzed before problems can be solved.

Again, this is all occupational therapy. For example, when my visually and hearing impaired grandmother was having back problems, I was able to align this with her “productivity” which consists of sporadic computer use and occasional television (both modified to meet her needs). What we discovered was that her significant leaning into the screens to “see” was the root of her problem. We were able to bring her computer monitor closer to her face, make changes to her computer chair, and later designed a cabinet that allowed her to get under the units to prevent leaning. Or, for another client that suffered from significant mental illness, we were able to making significant rehabilitation headway by first re-engaging her in her previous passion for making stained glass. For another client, a business owner, his treatment took the form of setting up guidelines, systems and processes at work that reduced distractions and interruptions so he could effectively work through and resolve priority items. But my favorite story is helping a friend with his neck pain by watching him use his computer. I just told him to stop being a chicken pecker and to learn how to type. Voila, neck pain gone!

The bottom line is that feeling productive and being productive are two of the most important aspects of the human psyche. Just knock something off your “to do list” and see how that feels. To become unable to be productive by virtue of physical, cognitive, emotional or behavioral problems creates a long list of secondary disability that is equally, or even more, damaging than the primary disability in the first place. Productivity following an accident or illness often takes new forms – and modifying ways to play, go to school, work, volunteer, or engage in other meaningful tasks is at the forefront of occupational therapy. Problems with productivity? OT’s treat that.

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Occupation Is: Eating

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, we have slept, are out of bed, groomed and dressed. Now what? Typically we head to the kitchen to grab something to eat. Admittedly, I am a terrible cook. And on top of this I am leery of ready-made foods, and think the microwave is the root of all cancer. So, let’s just say I struggle with everything that is meal preparation. Many of my clients struggle with this also, but for much more legitimate reasons…

For most of us, breakfast is typically simple. Cereal, toast, maybe eggs, pancakes, granola or fruit. Lunch slightly more complicated, and dinner is an effort. So what if you have a brain injury and have difficulty planning meals? Or, you cannot drive, or can no longer access public transit so you have problems getting items at the store? Maybe you are on a strict budget and can only get food from a food bank. Perhaps you have food in the house, but your appetite is supressed from medication, depression, or some other physiological or mental illness. The dishes might be too heavy to lift if you have upper extremity problems, or you have one hand you can’t use at all which makes cutting, peeling, and carrying heavy pots very difficult. If you have a special diet, or cannot consume foods by mouth, meals take on another form – pureed, soft, smoothies, Ensure, or even through a feeding tube. If the meal is made, perhaps you just can’t carry it to the table as you use a wheelchair, or cane, and the last time you tried the meal ended up on the floor. If you have tremors, shakes or dizziness, walking carrying anything is a challenge. Once you are at the table with your food, an upper extremity or visual problem might make it hard to get the food onto the fork, spoon, or into your mouth. Chewing could be another problem if you have oral-motor difficulties. Then you have to swallow and choking or aspiration are possible.

Occupational therapy treats all that. We provide strategies and supports to enable shopping, and aids that might help get the groceries into the car, into the house, and into the cupboard, fridge or freezer. Or to improve memory we can help to set up systems that enable people to shop efficiently and effectively, including meal planning, creation of lists, mapping out products in isles, and providing strategies on ways to prevent visual and auditory overload common to most stores. When cooking, occupational therapists look at safety around appliances, provide strategies to reduce bending, standing, or reaching, or even aids to reduce bilateral (two-handed) tasks if necessary. If there are dietary concerns, occupational therapy can provide aids and education, and can work with a speech therapist or dietitian to make people are able to manage nutritional needs. If there are negative eating behaviors, we can treat that through cognitive and behavioral therapy, tracking, and helping people access other resources and programs. For consuming food, there are several devices that we can use to address a visual-perceptual neglect, a dominant hand impairment, and train people how to eat with a prosthetic. We can make customized utensils and splints to bridge the gap between a hand and mouth if the two can’t connect.

Spoken quite simply – occupation is everything that is eating: from planning what to eat, getting the food from the store to the house, preparing this safely, and making sure the food meets the mouth, or the stomach. If these things are a challenge for you, occupational therapists treat that.

 

 

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Occupation Is: Managing Toileting, Grooming, Showering and Dressing

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

Okay, so you are up, out of bed, heading to the bathroom. “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.

Assume you have reached the bathroom. What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level? Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently? What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself? You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin. Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair. If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror. Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place.

Maybe you have managed to do your grooming, toileting and washing. What if you can’t get dressed? Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom. Or, your clothes are not clean because you lack the ability to do so. Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility. Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?

Occupation is all of that, and these things are addressed in occupational therapy. If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catheterizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories. Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility. What if the commode you do have won’t fit over the toilet, or even through the bathroom door? If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives. Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head. Maybe the shampoo and soap bottles need to be changed or relocated. A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence. Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body. No motivation to do these things in the first place? Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines.

Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.

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Occupation Is: Getting Out of Bed in the Morning

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Back by popular demand and in recognition of Occupational Therapy Month we are re-running our series “Occupation Is.”   I will be spending the month of October defining the word “occupation”. Why? Because, contrary to the traditional understanding of the word, occupational therapists define this differently. For us, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for this month, I will explore the journey of “occupation” complete from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

I assume the routine for most of us is the same. Morning hits, we hear the alarm clock, snooze it a few times, and eventually swing our legs over the bed, stand, stretch and head to the washroom. Sounds easy, right? But what if it isn’t?

What if you have had a terrible sleep? Perhaps you live with chronic pain and cannot get comfortable in your bed. Or, you have an acute injury and are trying to sleep on broken ribs, while wearing a cast or sling, or with bruises, scrapes, or swollen body parts. Maybe you live with anxiety, depression, or have trouble controlling your thoughts when you try to drift off. You have restless legs, or are on medication that makes you sleep too much, or causes insomnia. You are worried about something, someone, or have a child, spouse, or family member in your home that might need you during the night. Tomorrow is a big day and you are excited or nervous. You have neighbors that are too loud, or are spending the night in a shelter because you have nowhere else to go. Really, obtaining a restful sleep is actually difficult.

Assuming you have slept, and recognize the alarm is going off, what if you can’t just “throw your legs over the bed, stand and stretch”. Then what? Do you have or need support or devices to make the transition from lying to sitting, from sitting to standing, to a walker, cane or onto a wheelchair or commode? Perhaps your depression or anxiety makes it extremely difficult to transition out of bed to face the day, or to start your morning routine. Maybe you need to stay in bed for an extra hour because the amount of sleep you got just won’t cut it for challenges that day will bring.

Occupation is all of that and as such, these things are addressed in occupational therapy. Why are you not sleeping? Can we assist you to obtain a better sleep surface? Can we educate you on how to obtain a restful sleep position by suggesting changes to how you are lying, or through the use of pillows or wedges? Can we help you to shut your mind off through progressive muscle relaxation, meditation, natural sleep remedies, or by assisting you to obtain medical assessment and intervention? Can we aid in reducing your stress such that you are more at ease when trying to fall asleep, or so you won’t wake as much during the night? If you are sleeping through your alarm, or can’t motivate yourself out of bed in the morning, perhaps we can provide you with cognitive and behavioral strategies to re-frame that process to enhance your success. If there are physical barriers to positioning in bed, sitting, transferring or standing, we can prescribe equipment, aids, tools and support to ensure this part of your morning routine is safe, to promote independence, or to assist your caregiver.

Spoken quite simply – occupation is getting out of bed in the morning, and if this is a challenge for you, occupational therapists treat that.

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Kitchen Safety – Hidden Hazards

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

I think I spend about three hours a day in my kitchen. Just when I get a meal or snack prepared, served and cleaned-up, it seems to be time to eat again. I guess that is the norm for busy families that are constantly on the go.

Yet, while the kitchen is one of the most lived-in rooms in the house, there are many hazards here that are often overlooked. These hazards can result in illness or injury if not addressed. For example, did you know that the dish cloth or sponge is the most dangerous item in your kitchen? That a child’s shirt can catch on fire while stirring something on a gas stove? That there are all sorts of bacteria (including fecal matter) on the rinds of lemons and limes (but we squeeze these and throw them in our drink!).

My blog today is going to highlight some of the under-estimated hazards in the kitchen, including:

1. Dirty Dish Sponges: Did you know that a dirty dish sponge can harbour and spread disease-causing bacteria? A study completed at the University of Arizona detected salmonella in 15% of sponges that were examined. As we age, it becomes more difficult for our bodies to fight off disease, making it important to be aware of how bacteria spreads and how to prevent it. A simple way to get rid of bacteria on sponges is to wet the sponge and zap it in the microwave for about one minute. Or for dish cloths, rotate and wash these regularly using bleach if available.

2. Cross-contamination of food: Ensure to thoroughly wash your hands, surfaces, and utensils after handling meat, poultry, or seafood to avoid spreading bacteria. Keep two cutting boards – one for meat products, and one for other food items. Purchasing cutting boards in different colours or labelling them can make it easier to discriminate between the two. Considering putting your cutting boards in the dishwasher after use to increase sanitation.

3. Spoiled Food and Storing Leftovers: Never leave raw meat, poultry, seafood or leftovers on the counter for longer than two hours. If defrosting food, defrost in the refrigerator or immerse in cold water. When storing food in the fridge, the temperature should be set to 4° C (40°F) or lower and your freezer at -18°C (0° F) or lower to avoid growth of bacteria. Ensure to keep meat, poultry, and seafood in sealed bags separate from the rest of your food items. The best place for these items is on the bottom shelf, so that juices can’t drip onto other food. If you are storing leftovers, use labels to record when each product was prepared. General guidelines for storing items in the fridge are as follows:

• Bacon: 1 week
• Lunch meat: 3-5 days
• Fresh beef, veal, lamb, and pork: 3-5 days
• Cooked meat, poultry, pizza, stews: 3-4 days
• Fresh poultry, ground meats, or raw sausage: 1-2 days

Go through your fridge weekly to throw out anything outdated or questionable. Always remember – when in doubt, throw it out!

4. Forgetting to Turn-off the Oven or Stovetop: This is extremely dangerous and can lead to fires or burns. To avoid this, stay close to anything cooking and use a timer or alarm. If you worry about forgetting to turn things off, consider using a visual checklist to remind you to check the stove. Place this at the exit to your kitchen, or post it at the door you use to leave your home. If you must leave the kitchen area while cooking for any reason (e.g. to answer the phone or the door), wear an oven mitt or carry a kitchen utensil with you to serve as a visual reminder to return to the kitchen as soon as you can. If using the oven, always wear long sleeved oven mitts to avoid burns. Alternatively, slow cookers are an easy and safe substitute to using the stovetop when preparing meals.

5. Supervise Children. Getting children involved in cooking and baking is a great way to increase their willingness to try new foods, and teaches them valuable life skills. But as with all things involving children, close supervision is mandatory. A child standing on a stool to stir something on the stove can lose their balance falling onto the burners and loose clothing can catch on fire. All knives (dull, sharp, large or small) can be difficult for children’s coordination, and small hands may have a hard time lifting heavier and hot baking pans. Even using a knife to get a piece of toast from a plugged in toaster is dangerous. So, supervise children in the kitchen and teach them the safe and proper way to prepare food and work around kitchen tools and appliances.

Although this is not an exhaustive list of kitchen safety hazards, the above are some of the most common and the easiest to avoid. Of course, there are other kitchen safety hazards that are created when people have physical, cognitive, emotional or behavioral disabilities. But the good news is there are many aids, devices and strategies that can help people to improve their independence and safety during meal tasks. Consider consulting an occupational therapist for suggestions on ways to be successful in the kitchen.

References:
1) http://www.chow.com/food-news/54707/10-kitchen-hazards/
2) http://healthycanadians.gc.ca/eating-nutrition/safety-salubrite/safety_home-maison_salubrite-eng.php#Refridgerator
3) http://www.foodsafety.gov/keep/charts/storagetimes.html