Archive for category: Original Posts

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.

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.

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.

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, catherizations, 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.