Close

Archive for category: Original Posts

by

A "Splash" of Inspiration

Inspiration can come from anywhere.  In the past, this blog has profiled the stories of many people who have not let a disability stop them from living.  However, stories of survival, humanity and inspiration also exist in nature, as we witnessed in the incredible tale of Winter the Dolphin.

Winter was just a baby when she was found stranded on a beach in 2005, severely injured.  She had become lost from her pod and became entangled in a crab trap.  Winter was rescued, but the injuries she sustained to her tail became life threatening, leading to an amputation.  This was successful; however, overtime the way she adapted to swimming was injuring her spinal cord causing her further harm.

Marine doctors struggled with solutions to save her, but their quest eventually led to the successful creation of a prosthetic tail.  The tail helped Winter to swim properly again and today she is living and thriving at Clearwater Marine Aquarium in Florida.

Winter has become an inspiration to many across the world and thousands of people with disabilities have gone to meet winter to gain inspiration and hope from her amazing journey.   You can view her live on webcam at www.seewinter.com.   But Winter’s story is bigger than that.  In trying to create a prosthetic tale for a Dolphin, new products were created that have greatly improved prosthetic comfort and fit for humans.

The movie “Dolphin Tale,” based on her story, describes her journey and in doing so highlights how hope, creativity and persistence can help to overcome barriers.  Young or old, you need to watch this family friendly “tale” that warms the heart and will certainly leave you smiling.

by

Computer or Car Insurance…Gigabytes or IRB…

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

It is widely known in my industry that the people of Ontario generally don’t understand their auto insurance coverage – until they need it.  For example, when buying a new computer you might look at screen size, megabytes, RAM, GIGs, processor, operating system, anti-virus software and extended warranty.  But when buying car insurance do you look at the coverage for housekeeping, NEB, IRB, attendant care, med/rehab, liability, and care giving?  No?  So, it begs the question: why are you paying for something you don’t understand?

In a brilliant display of smoke and mirrors, your auto insurance company (via the Insurance Bureau of Canada – IBC) pulled some tomfoolery in 2010.  They didn’t increase your car insurance premiums, but dropped your coverage significantly.  So, in essence at renewal you got half (or less) of the coverage for the same price.  That is like spending the same money on your previous computer to now only get the monitor.  

So, being an educated consumer, I “bought up” and paid extra for the same coverage I had before the changes.  I am one of less than 1% of the population that did so.  Now, IBC is saying they are going to drop rates by 15%.  Well thank you oh noble insurers.  That will give me the same coverage I had before 2010 (because I bought up) for the same price (because of the rate reduction).  So, I am back to where I started, but the other 99% of the population are getting 50% of the coverage for 85% of the price.  They are still at a significant loss.

In a recent MBA class we talked about risk.   Driving a motor vehicle is the # 1 most unsafe activity when compared to 29 other activities people perceive to be risky (including smoking, drinking, extreme sports, risky professions, flying, etc.).  So, if driving is our riskiest activity, signifying a high probability of injury, why are consumers so unaware of their coverage?   Is it because we don’t think we will get in an accident (the “it won’t happen to me phenomenon”), or because insurance is “mandatory” we just purchase on price?

I find it strange that people take the process of buying a computer more seriously than the process of renewing insurance – especially when driving is the riskiest thing we do daily.  In a PC World survey (2012), 63% of people indicated they bought a computer “extended warranty” yet research repeatedly shows that the $16B spent yearly on extended warranties is a waste of money.  Compare this to the less than 1% of people that bought an “extended warranty” (i.e. extra coverage) on their car insurance.  Buyer Beware!  It is time that Ontario drivers start to understand the product that is car insurance so they can ensure they have appropriate coverage for an appropriate price.

by

Memory Mantras

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

Being an Occupational Therapist can also be a curse when it comes to parenting.  As an OT, the goals are always functional independence.  As a parent, I am no different.  I remember a video I watched in OT school.  This was of a boy (young adult) with cerebral palsy and he was putting his coat on.  The video was probably 20 minutes (or it felt that long).  As I watched this boy struggle with his coat for what seemed liked eternity, I wanted to jump through the TV to help him.  Clearly with some help this could be done faster and easier.  But in the end, it was not about that.  It was about independence.

As parents, it is often faster and easier to do things for our kids.  Or, we feel the need to continuously protect our kids from failure by ensuring that we are their second brain.  But is this the right choice when the goal is to create people that can manage on their own?

I have created two memory mantras that are used in our house to ensure my kids are seeing the big picture and are developing some executive functioning (note I also use these mantras with my clients who suffer from memory impairment):

When leaving the house our mantra is:  WHERE AM I GOING AND WHAT DO I NEED?  When my children ask themselves this question, they need to stop and think “I am going to X and thus need Y (water, shoes, birthday present, tennis racquet, money)”.  This prevents them from showing up at X unprepared.

When leaving a place in the community our mantra is:  WHAT DID I COME WITH AND WHAT DO I HAVE?  By asking themselves this question, they quickly realize that they came with X and thus need to bring X home (coat, shoes, water, bag, lunch).  This prevents them from leaving things behind.

The success is in hearing my children repeat this to themselves when on their way out the door.  Recently, at a sporting event, we heard a teenage boy blame his mother for forgetting his water.  She was profusely apologetic and rushed out to find him a drink.  My children (younger) turned to me and said “shouldn’t he remember his own water”?  My thoughts exactly.

by

Lessons of Confidence from an Overhand Serve

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

I see a huge similarity between coaches and therapists.  Are therapists not just coaches of rehabilitation?  A recent experience with organized sport reminded me that as coaches (and therapists) we need to believe in our clients and often we believe in them more than they do.  Yet, it is only through believing in them will they be able to develop the confidence to succeed.

I was at a provincial volleyball tournament with my daughter.  She is 12.  All season she has been working on her overhand serve.  She is the tiniest kid on the team and all year was continuing to build the strength required to execute this serve successfully.  Just before the tournament she starts landing these in practice.  All tournament she was getting her overhand serve over and in.  Then, they are playing the bronze medal game.  She gets to serve twice and misses both times.  Two points for the other team.  Game point and she is serving.  Knowing her struggles, she serves underhand, they win the point and the first game.  In the second game she tries her overhand serve again and misses.  The score is now 23/22 for them and she is serving again.  She looks at her coach and he says “give’er” (code for serve overhand and give it all you have).  She does, and lands her serve and one point later they have won the game and the medal.

I was brought to tears reflecting on this.  Her coach had more faith in her than she had in herself.  Given the choice, she would have played it safe and served underhand.  But he knew she could do it, and was more interested in her own development as a player, then in the impact of a missed serve on the game.  That is a great coach.

As a therapist, I use this as a reminder regarding my role.  I find that my clients will thank ME for “everything” and I have to remind them that I didn’t do anything, THEY did.  I just believed in them and provided them with encouragement, strategies and tools to be successful. My daughter’s coach did not serve overhand in the final seconds of an important game, but he gave her the strength to believe that she could. That is our role as parents, coaches and therapists:  believe in those we are leading and they will obtain the ability to believe in themselves and later in others.  That is truly paying it forward.  

by

So I Guess Your Kid Doesn’t Wear A Seat Belt Either?

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

I get very confused when I see children riding bikes without helmets.  Over the last many years the safety benefits of a helmet for biking, skiing, skateboarding, ice skating (and many other sports) has been well studied.  Research shows that helmets can be extremely effective in preventing head injuries and ¾ of all cycling fatalities are the result of head trauma.  You don’t even have to hit a car or tree to sustain a head injury – the ground or even your handlebars are often enough.

The laws in Ontario are clear:  since October 1, 1995 anyone under the age of 18 is required to ride a helmet on a road or sidewalk (http://www.toronto.ca/cycling/safety/helmet/helmet_law.htm).  Based on an increasing number of adult cycling deaths by head injury, it is likely that this law will soon be extended to adults as it is in other provinces.

So, considering the laws and the well-publicised risks, why are children (including young children) still seen riding bikes without helmets?

As adults, I recognize that we were not raised to wear helmets.  Adopting this practice has been difficult as we find it unnatural, maybe uncomfortable, and probably uncool.  However, most of us likely wear seatbelts when in a vehicle.  Why?  BECAUSE WE WERE RAISED THAT WAY.  Seatbelt laws in Ontario were passed in 1976 and so many of us were raised in the era of this as mandatory.  Many of us probably don’t even have to think about our seatbelt anymore as it is part of our regular “get-in-the-car” routine and we feel naked and exposed without it.  We need to apply the same concept of “normal” to our children regarding helmets. 

There are two main reasons why children need to wear helmets.  1. They are safe and have been shown to save lives and reduce disability.  2.  IT IS THE LAW.  As a parent, by not requiring that your child wear a helmet on their bike you are not only putting them at risk, but are also teaching them that laws don’t matter.  And I am not talking about the diligent parents whose children leave the house with a helmet on, to later have this on their handlebars or undone on their head.   I am mostly talking about the young kids in my neighbourhood who are out on their bikes without helmets, often under the supervision of their parents, and are thus not being taught that helmets are law, mandatory, and safe.

I am going to hazard a guess that no parent would put their child in a car without a seat-belt.  Heck, child seats are also law and until a certain age these are five point and offer more protection than the adult restraint.  So, for the same reasons you put your child in a seatbelt (protection and law) you need to ensure they are wearing a helmet for biking (skating, skiing, skateboarding).  And lead by example – get a helmet for yourself and model the appropriate behavior.  And be firm: no helmet should equal no bike.  No discussion.

by

The Goal is Improved Executive Functioning

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

As a caring professional, I refuse to believe that my clients are not motivated.  All of my clients have goals or I would not be treating them.  However, their ability to achieve their goals independently remains the reason that they require active therapy.  Previously, I wrote about executive functioning, and used the example of moving to highlight how people with executive dysfunction may feel on a regular basis when completing relatively simple tasks.

Treatment for executive dysfunction is as broad as it is specific.  It is broad because everyone experiences brain injury differently, and comes into that type of trauma with varying levels of ability to start with.  However, treating problems with executive function is really as simple as taking a goal and breaking this down into component parts, manageable chunks, and smaller goals within the whole.

So, returning to the moving example, assisting someone with executive dysfunction with a pending move will involve making checklists, with time frames, and checking on progress frequently.  Personally, I like to take a project approach:  calling the goal “Operation Move” and mapping out – start to finish – the metrics for success.  Perhaps in month one an “apartment hunting worksheet” is created to help a client summarize all the places they are looking at, the pros / cons, address, and list of questions that need to be answered (price, utilities included, length of lease etc.).  Often I encourage my clients to use a smartphone to take photos of the options then we cross reference these and catalog them to keep things organized.  From there, the process continues with checklists for calls to make, addresses to change, ways to organize packing and management of belongings.  Ensuring the client is responsible for follow-up via “homework” between sessions and holding them accountable for completion of this aids to developing independence.  Really, the therapeutic goal is more than just ensuring the client is able to move successfully.  Rather, it is demonstrating a model and method that can be used for any future transitions, goals or tasks.  This ensures success that is transferable to other events at later dates. 

by

June is Brain Injury Awareness Month: How Is Your Executive Functioning?

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

Last month, I spoke at a conference with my colleague Tamara Forbes (www.forbeshealth.ca) on the topic of executive dysfunction.  Executive dysfunction is a common problem following brain injury.  Simply defined, executive functions are the capacities we require to achieve a goal.  They are commonly referred to as the “CEO” of the brain because they provide the higher order processes that allow us to plan, organize, initiate and complete tasks successfully.

Practically, think about the last time you moved.  Moving, as an example, is a simple goal of just wanting to relocate from one place to another. The goal is not the problem: it is the processes and thinking required to manage the transition effectively.  Several months before moving you are searching for a suitable place, weighing the pros and cons of each location, checking your budget.  Then you make the decision of where to move and you need to deal with your existing location.  When do you need to notify your landlord, or when should you list your house?  Then, months and weeks before you move there are calls to make to utility companies, mail to redirect, insurance to organize, movers to book and packing to do.  What belongings are you moving?  What should be sold, donated, discarded?  The day of the move is chaotic, stressful, and exhausting.  Then for months after you continue to unpack, move things around, find ways to arrange and store your stuff.

Your level of executive functioning, or your ability to delegate and enlist support for your areas of weakness, will determine the outcome of your move.  Now imagine, with brain injury, that you feel the same sense of stress, fatigue and frustration with more simple daily tasks, such as planning a meal, sorting your mail, or scheduling your time.  This is often how people with brain injury will feel on a regular basis.   The goal then of occupational therapy will be to simplify daily tasks and help a client break activities down into smaller and more manageable chunks.  More on this to come…

by

Occupational Therapist Sued Over a Reacher

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

I am getting increasingly frustrated at the failure of other OT’s to understand the value of education when prescribing equipment.  While it might seem on the surface that use of a reacher, tub scrubber or bath mat are “common sense”, my experience is that common sense is not common, and I don’t want my license on the line.

Take a reacher for example.  I have seen people use them as a cane.  Or people who have one that is too short and almost fall out of their chair trying to access that item that is “just a little further”.  Maybe they think that reacher can handle the over-sized glass jar of pickles and when it doesn’t the jar ends up shattering on the counter in front of them, landing on their lap, or worse, their head.  To send something to someone in the mail, and to indicate that “education is not necessary” exposes the OT to liability and the client to risk.

Why don’t OT’s hear about stories of devices gone array?  Mainly because when an OT is sued over a piece of equipment, the case can take years to resolve and when it does, the OT is sworn to secrecy about the outcome, otherwise they can be sued for breach of settlement.  So OT’s: don’t think these lawsuits don’t happen!

In the world of insurance there is funding for equipment and funding for education to ensure that the equipment is appropriate and the client can safely and independently demonstrate its use.  I have had to return many-a-things that I thought looked great on paper to find out they don’t actually work for that client in that case.  As OT’s we need to take our prescription responsibilities seriously and should never jeopardize our education, training or experience under the assumption that someone will properly use an item we consider “low risk”.

So, when I prescribe devices, and ask an insurer to fund time for an OTA or myself to provide them, it is because that is part of my judiciary duty to my client, my college, my license, my training, and my sense of responsibility.  If another OT feels the device is suitable, but says education is not required, then they can feel free to order those devices themselves and run the direct liability risk of being sued over a reacher.

 

by

Just Get Er Done

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

Often I am asked by others how I balance the many aspects of my busy life.  My answer is that I just “get er done”.  In fact “get er done” is a mantra I use regularly to motivate me to knock things off my list.

For example, if I am driving and realize I will arrive at my destination 20 minutes early, often something (or several things) will pop into my head about how I should spend that extra time (stop into the bank, drop by the post office, grab that birthday present, stop at the store for some fresh veggies etc.).  Then, my head starts negotiating with itself (“no, just keep driving and you can check email for 20 minutes in the parking lot”, or “I don’t feel like doing that right now”, or “I don’t need that present until next week anyway”).  Really, we can talk ourselves out of anything (mostly healthy eating, getting out of bed earlier, and exercise), but success comes from being able to hear through the noise to make the best decision.

In my case, when my head is conflicted by the devil and angel arguing on my shoulders, I apply the mantra:  “Julie, just get er done”.   Every time I say this, it springs me into action.

I remember watching a You Tube video by Mel Robbins that clearly explained that thoughts are just thoughts and to turn them into action, we need to attach a physical component.  We have five seconds to turn a thought into an action or it won’t happen.  So, when hearing the alarm, we have five seconds to throw off the covers and put our feet on the ground, or the “thought” of getting up will turn into the action of not.  Same with the thought of exercising:  if, within five seconds of thinking “I should go for a good walk” you have not gotten up and moved towards putting your runners on, chances are another thought will tell you to stay put.

So, turn those thoughts into action.  Use mantras and physical responses to your thoughts to just “get er done”.  

 

by

Achieve Better Sleep for Better Health

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

Sleep is one of the most important determinants of health.  Proper sleep helps to restore our minds and bodies so that we are able to effectively tackle another day.  However, it is estimated that 1 in 7 people suffer from sleep problems, and non-restorative sleep is a common complaint I hear from my clients. 

As an occupational therapist there are several strategies I utilize with my clients to help them improve sleep: 

Sleep Surfaces – a good mattress can ensure that your body is aligned when sleeping whether you sleep on your side, back or front.  Often when we work with people to replace a bad mattress, they are actually more uncomfortable for the first several days or weeks.  This is often the result of their body being required to re-align when sleeping, when previously it was resting in awkward positions.  If your mattress is too soft, or sagging, and you are not able to get another, consider using a board under the mattress to provide support.  A good pillow is also very helpful, but the purchase of this should be based on personal preference (not on a therapist or sales person telling you which one you should have).  I have a great Ergocentric Pillow, but previous to that enjoyed my Medi-Flow water-based pillow that allowed me to adjust the water volume for different amounts of support.

Sleep Habits – a consistent sleep routine is essential to teaching your mind and body how to effectively shut down at the end of the day.  Shift workers can have a terrible time with sleep because of the unpredictability of their sleep schedule.  If you consider that you need a certain amount of sleep per day (which can vary by individual), then you should try to get into a routine around those hours.  I read years ago that sleep cycles are 20 minutes so if you need to nap during the day, consider setting a timer for 20 minutes so your nap will be restorative, but not too long that it will impact your sleep at night.  If you are in a routine of napping for long periods during the day, and cannot fall asleep at a decent evening hour, then consider shortening your nap daily by small increments to achieve a better balance.

Mind Distractions – often it is the mind that won’t shut off and this prevents us from falling or staying asleep.  Counting sheep is not always effective.  Consider using a sleep CD (I recommend Eli Bay), or meditation, relaxation or mindfulness app on your phone to help your mind focus on a restful place.  Some natural remedies like certain decaffeinated teas can also help to make us feel groggy before bed.

Tracking Sleep – often when helping clients to develop a new routine, I will ask them to track their sleep cycles.  This can be done simply on paper.  Often, through this exercise, I find there is no routine and if we can develop and implement a sleep schedule, improvements in energy, mood, and cognitive function follow.  Personally, I use a Sleep Cycle app (.99 cents) to track my sleep habits.  This uses sensors in my cell, when placed above my pillow, to tell me how many hours I slept for, if I achieved deep sleep, and how my sleep ranks against other recent nights.  But what is even better about the Sleep Cycle app is that when you sent an alarm, it works to wake you up when it senses you are in a light sleep.  This reduces “snoozing” and awakens you when you are more likely to actually get up.  This app helped me develop a new schedule of getting up an hour earlier so that I could achieve my goal of getting my four legged beast his exercise bright and early!