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Archive for category: Occupational Therapy At Work

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Recovery from Trauma and the Vital Role of Occupational Therapy

Guest Blogger: Carolyn Rocca, Occupational Therapist

Motor vehicle accidents account for countless injuries annually and are one of the most common traumas individuals experience. Trauma can be understood as one’s unique experience of an extremely stressful event or enduring conditions that overwhelms their ability to cope. These experiences can often disconnect us from our sense of safety, resourcefulness, and coping. As a result, survivors of severe and traumatic motor vehicle accidents are at increased risk for experiencing mental health difficulties, with posttraumatic stress disorder, depression, and anxiety being the most common.

Post-traumatic stress disorder (PTSD) is a mental health condition that can follow a traumatic event involving actual or threatened death, serious injury, or threat to the physical integrity of oneself or others. Although every individual experiences PTSD differently, following a motor vehicle accident PTSD symptoms can involve:

·       Psychologically re-experiencing the trauma through distressing thoughts or dreams about the accident,

·       Avoidance of thoughts or situations associated with the accident, including a reluctance to return to driving,

·       Extremes in emotional responsiveness, by either having greatly reduced or heightened emotions, and

·       Increased physical arousal, such as hypervigilance, exaggerated startle, irritability, and disturbed sleep (Beck & Coffey, 2007).

The symptoms associated with PTSD can leave individuals to feel emotionally, cognitively, and physically overwhelmed. Naturally, this can result in difficulties in one’s daily functioning, including one’s ability to care for themselves and others, as well as their ability to successfully engage in their life roles of being a spouse, parent, employee, student, or volunteer, to name a few. For these reasons it is recommended that those experiencing PTSD seek help from a team of healthcare providers and consider occupational therapy.

Using a trauma-informed care approach, occupational therapists can support clients through the following three Phases of Trauma Recovery:

Phase I – Safety-stabilization:

Since trauma often results in a sense of helplessness, isolation, and loss of control, the aim is to restore a sense of safety and empowerment. Following trauma, creating a sense of safety is the foundation of one’s recovery process.

The first step to building and creating safety is to first identify things that help us feel safer. Occupational therapists can help their clients to identify objects that bring about a personal sense of safety and imbed them into their daily routines. These safety objects may include: special people such as a trusted friend, engaging in certain activities like looking at photographs or making crafts, or being in a certain place, such as being outdoors in the sunlight.

Occupational therapists can also assist in establishing safety through practices such as meditation, mindfulness, deep breathing exercises, yoga, and Thai chi, as these approaches have been shown to be effective at decreasing stress and soothing the nervous system (Manitoba Trauma Information & Education Centre, 2013).

Phase 2 – Remembrance and Mourning:

A traumatic event like a motor vehicle accident is often associated with a form of loss. One might feel they have lost their independence, sense of identity, or purpose following a car accident.

Counselors and occupational therapists are well-equipped to guide individuals on their recovery by allowing them time to grieve and morn their own personal losses. This is often achieved through individual or group-based therapy by processing the trauma, putting words and emotions to it, and making meaning of it.

Phase 3 – Reintegration:

The goal of the third stage of recovery is that the person affected by trauma recognizes the impact of their experience but is now ready to take concrete steps towards a lifestyle that is no longer controlled by the trauma. Recovery and reintegration will look different for everyone, but often involves resuming important life roles and responsibilities, and returning to a lifestyle that is meaningful to them.

Occupational therapists can assist during this phase of recovery by supporting their clients in re-establishing healthy routines, building strong support systems, learning and practicing coping strategies during their day to day activities, and gradually increasing their exposure to anxiety provoking triggers, ultimately enabling them to reintegrate into their communities and preferred lifestyles.

For more information about PTSD, trauma-informed care, and how healthcare professionals can support someone following trauma, be sure to take a look at the Trauma Toolkit or call an Occupational Therapist to start the process of recovery.

 

References & Resources:

Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations. Professional Psychology: Research and Practice, 38(6), 629.

Manitoba Trauma Information & Education Centre (2013). Retrieved from http://trauma-recovery.ca/

The Trauma Toolkit: A resource for service organizations and providers to deliver services that are trauma-informed (2013). Retrieved from http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf

 

Previously Posted April 2017

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Understanding Elder Abuse

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

Co-written by Darren Schutten, MSc (OT)

Today, June 15th is World Elder Abuse Awareness Day. Elder abuse has been a growing concern worldwide. In fact, it is estimated that 16% of older adults have been abused in the community setting in the past year.  This number jumps to a staggering 64% within institutional settings.  However, it is felt that these figures are unrepresentative of the true problem, as only 4% of elder abuse gets reported due to fear of retaliation, worry about getting the abuser in trouble, mental incapability, or feelings of shame and embarrassment.

The World Health Organization defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.”   This type of abuse typically occurs when there is an imbalance of control between the abuser and the elderly individual.  The concept of elder abuse has evolved over time to include: physical, psychological, sexual, neglect, and financial abuse.

I’m sure most of us have seen examples of this happening.  When I worked at the bank, we had a senior who was repeatedly withdrawing money for a roofer. We contacted her family with concern, and they determined that the client was in fact being taken advantage of. Or, in another example, I am aware of an elderly woman who went to buy a coffee and discovered that she no longer had money in her bank account. Her daughter was managing her finances and through review, it was discovered that these had been squandered through gambling and the purchase of things such as a “money-making machine” off the internet (true story!). Or, of course, there are the stories whereby a senior is scammed on the phone, or the news shares examples and videos of elder mistreatment by staff in long term care. Or, what about those seniors you may know or worked closely with who refused to take their prescribed medications, refuse help, and try to take care of themselves? This behaviour is considered self-neglect and actually falls under the umbrella of elder abuse.

As occupational therapists (OTs), we work closely with seniors both at home and in the community. We assist people with self-management of things like personal care, finances, homemaking, and of course symptom management and the overall ability to function. Through our work, we may see or hear about all types of elder abuse.  For example, we may notice unexplained injuries such as bruises, bumps, or grip marks on a senior client’s arm indicating potential physical abuse. Or, maybe we may notice a sudden change in the senior’s psyche such as increased fearfulness or nervousness during an OT treatment session that was not present during prior sessions. This may be a sign of recent psychological abuse. Or, it is quite possible that an OT who works in an institutional setting may be told by residents that they are feeling neglected in their care. These are just a few examples of how an OT may encounter elder abuse in their practice, but regardless it is important for all OTs to learn about the different signs of elder abuse as they may be a key stakeholder in preventing the abuse from continuing. And whatever type of elder abuse we may be exposed to as OTs, it is important to know our reporting obligations.

In Ontario, anyone who knows or has reasonable grounds to suspect that a senior resident in a long term care home or retirement home has been, or might be abused, it is mandatory for that person to report the abuse.  The same obligation to report applies for seniors with developmental disabilities.  Reports can be made by calling the police or relevant support agencies.  Support agencies can be located by calling a local helpline (e.g. Seniors Safety Line).  However, OTs are not required to report abuse if the senior lives in their own home or in any setting other than what was mentioned above.  Seniors have the right to live at risk and refuse help with the abusive situation they are involved in, and as OTs, as long as the client is competent to make their own personal care or financial decisions, those rights need to be respected.  As OTs who may be put in these types of situations, we can still help by staying in contact with the senior on a regular basis. Overall, whatever practice setting we work in or the company we work for, it is important as OTs that we know the relevant legislation, policies, and codes of ethics that we are bound to in order to practice as competent OTs.

References

  1. World Health Organization. (2016). Elder abuse: The health sector role in prevention and response. Retrieved from https://www.who.int/violence_injury_prevention/violence/elder_abuse/Elder_abuse_infographic_EN.pdf?ua=1
  2. Elder Abuse Ontario. (2018). Elder abuse prevention (ON). Retrieved from https://www.elderabuseontario.com/
  3. Ontario Human Rights Commission. (n.d.). Elder abuse & neglect. Retrieved from http://www.ohrc.on.ca/en/time-action-advancing-human-rights-older-ontarians/elder-abuse-neglect
  4. Canadian Association of Occupational Therapists. (2012). CAOT position statement: Elder abuse prevention and management and occupational therapy (2012). Ottawa, ON: CAOT Publications ACE.
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Brain Injury: Caring for the Caregiver

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

We cannot (or should not) discuss brain injury awareness without spending time recognizing the family and friends that take on the caregiving role after someone they love has an injury of this nature. A few years ago I co-facilitated a workshop for caregivers of brain injury survivors. What a great event! Not only was this well attended, but the speakers provided an amazing amount of education, skills and insight into how to both cope, manage, and achieve success as the care provider of someone with a brain injury. I wanted to take a moment to highlight my personal takeaways from this event:

Everyone has a story. As someone who lost a brother-in-law to the effects of a catastrophic brain injury, I understand how telling our story – be it about loss, change, remorse, guilt, fear, or triumph can bring people together and has immense therapeutic benefit. Caregivers benefit from collaborating, talking, sharing, laughing, crying and growing together. Our health system needs to create these opportunities, or caregivers need to find ways to make this happen.

Grieve. In my undergrad, I studied grief and loss and even worked in hospice. What I realized at our workshop, however, is that the permanence of death allows people to grieve their loss, achieve acceptance, and eventually move on. When dealing with survival from a traumatic event, however, grief is not always experienced as our loved one is still present, albeit different. Yet, our speakers emphasized the importance of grieving: the life that once was, the life that may never be, and the changes and adjustments that have occurred. Caregivers need to let this grief process happen, or should seek support from a trained professional to experience this important emotion.

Find a new normal. Clients, caregivers, and health care professionals need to always consider that the old “normal” may never return. In that case, we all need to collaboratively look ahead to creating a “new normal”. Different does not always have to be bad, and it requires an open and optimistic mind to think that way. For OT’s that means taking the abilities of the individual, considering their resources, and helping them to create that new life of function, fulfillment, meaning, and productivity.

Put on your own oxygen mask first. We spoke extensively about the importance of caregivers taking the time to attend to their own personal needs, to have positive coping mechanisms and sources of support. Then, at break I was speaking with a man whose wife suffered a brain injury. He talked about the “airplane analogy” and how this applies to caregivers – put on your own mask before helping another. I smiled and told him that I wrote a blog on that exact topic, with that exact title last year. As he found that analogy practical and helpful, I thought I would share the contents of that previous blog here, to highlight this important third point:

Posted September 25, 2013

If you have ever travelled 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 wellbeing 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.

I hope the caregivers that attended our workshop felt that by spending a day focusing on themselves, expanding their knowledge, and learning the keys to success, that this was one step towards them being able to put their own mask on first. This was highlighted at the end of the day when the caregiver of a survivor, whose loved one was injured 13 years ago gave this advice: “If I could do it again, my priorities would be self, family, then my loved one with a brain injury”. What a great lesson for me to take forward in my practice.

For more posts related to brain injury please visit our Brain Health Archive.

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Provider Consent in Health Care – No Also Means No

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

In my previous blog, “Client Consent in Health Care — No Means No,” I spoke of the importance of client consent.   No means no.  But what is often forgotten in health care, is that consent goes both ways.  While a client has the right to “choose their provider,” this just means they can decline to be treated by, say, me. Or the next person.  But that doesn’t mean they can go down a random roster of professionals to find the best fit.  Why?  Because their ability to “choose their provider” is trumped by the provider also being able to “choose” them as well.

There are three main situations when a provider may say “no” to a client:

Skills and Availability – The provider would be expected to decline if they lack the skills, knowledge, or expertise (“the competencies”) to treat the clients’ presenting problems.   Taking on a client outside their skillset is unsafe for them professionally and for the client and their outcomes.  This also applies to them already having a full complement of clients such that they don’t have the space to do the work within what is needed or expected.

Conflict – Providers cannot consent to provide services to someone if this places them in a conflict, which can happen if they know the individual, or if being their provider would violate an employment agreement or contract (i.e. if you meet them at Company A, you can’t then work with them at Company B).  If the provider indicates a conflict, even if it seems minor to others (i.e. “I knew them in high school”), this must be respected.  Note that the nature of the conflict does not need to be disclosed.  Saying “I am in conflict” is enough.

Safety – The provider can also decline if providing services would be unsafe for them (physically, emotionally, environmentally).  While some jobs are inherently unsafe by nature, health professionals are not required to put themselves at risk when working.  This is especially true in the community where we are isolated and not protected by the surroundings of say a hospital or clinic space, where there are others (and buttons) to aid us quickly if needed.

As I said before, consent is a deal-breaker.  Always.  As occupational therapists, there are rules, laws, and regulatory matters to consider before taking on any client.  Working with vulnerable and exposed people (emotionally, mentally and physically) requires providers to take consent seriously and this goes both ways when clients choose us, and when we choose them.

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Client Consent in Health Care – No Means No

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

My grandmother is in her 90’s and up until recently, lived in a retirement home.  She is legally blind and deaf, so communication is very difficult for her, but where she lacks in sight and hearing she excels in cognition, missing little and being able to direct her own needs.

As with many people of advancing age, while she can bathe herself, this is a safer process with an attendant.  She has been fortunate to be eligible for public services and receives care in the mornings.  During a recent review of her care schedule, the facilitator asked her if she was comfortable with a male attendant.  She responded with a “no” and that her “late husband was the only man to see her undressed and she would like to keep it that way.”

The next day two care providers showed up.  One was “in training” and he was a man.  My grandmother was upset by this, but like many people of her generation that feel that public services are such a “gift,” she felt that for “training purposes” she would compromise her comfort and tolerate the presence of a man during her shower.

The next day the same man showed up alone.  “I am here to shower you today.”  I am not sure how the conversation went, but it ended with her deciding to let the man shower her, with her telling him “well, this is probably just as uncomfortable for you as this is for me, so let’s get this over with.”

As an occupational therapist, but also as her granddaughter, this is upsetting.  She was asked for consent regarding a male provider and declined.  This should be in her record.  They proceeded anyway.  As a business owner, I understand that staffing and capacity are challenging and based on my own work experience with finding and keeping personal care workers for clients, the human resource issues are real.  But consent is consent and she did not provide it.  One could argue that “in the moment” consent was “implied” (she didn’t ask the man to leave), or “provided” (she let him proceed), but an “in the moment” comment of “let’s get this over with” is not consent but surrender.  She was vulnerable, confronted, and knew that a “no” meant “no shower today.”  Showers, like privacy, are also important to her.

The ability to “Consent” (to anything) is an important human right.  Exercising this is our duty to ourselves.  We are reminded of this quite topically in the “#MeToo” movement, but the reach of the “no means no” concept needs to be wider.  In health care especially, consent is paramount in the acceptance and deliverance of services.  No must mean no.

Consent is a deal-breaker.  Always.  Not only are there preferences and “feelings” about this important topic, but there are rules, laws, and regulatory matters to consider.  Working with vulnerable and exposed people (emotionally, mentally and physically) requires providers to take consent seriously and this goes both ways when clients choose us, and when we choose them.

For my grandmother, we contacted the agency and reminded them of her preferences.  We asked that no men arrive for showering and that they need to do better to not put her in these vulnerable and uncomfortable situations.  If they cannot accommodate, we will need to elect another service agency, or fund private care for her such that we are not exposing her to these experiences, even if “free.”

Stay tuned for my next blog on this topic, where I will review the second side of consent as yes; providers get to consent too.

 

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Snow Removal O-Tip of the Week: Snowblower Safety Considerations

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

If you are fortunate enough to have a snow blower you have less heaving lifting to do, however, there are still dangers that this more efficient method can pose.   Here are some tips to ensure you are being safe while blowing snow:

  • Do not let children operate the machine
  • Do not wear loose clothing which could get caught in the machinery
  • Pace yourself – even when snow blowing you can overexert yourself in the cold, leading to the risk of heart attack
  • Operate the machine only outside as inside a shed or garage could put you at risk for carbon monoxide poisoning
  • Add fuel outdoors, before starting, and never add fuel while the machine is running
  • Never leave it unattended when it is running
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Reducing Risk of Strain Due to Repetitive Movements

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Repetitive activity using improper posture and body mechanics can result in excess energy expenditure, fatigue, pain and even injury or damage to muscles and joints over time.  Therefore, it’s important to know the proper body mechanics required when completing everyday tasks and activities, at home, at play or at work or school.

The following episode of our Occupational Therapy Video Series:  OT-V discusses how to ensure you are using proper body mechanics with respect to:

·    workspace design

·    lifting and repetitive muscle use

·    excessive standing

·    excessive sitting

·    hand movements

·    excessive energy output.

Take a look to learn how an OT can help you improve body mechanics and reduce the risk of injury and pain in the long-term.  Remember to subscribe to our YouTube channel for access to this and other great OT-V videos!

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How Emotionally Intelligent Are You?

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

I have four daughters – three in high school and one in University.  That is a lot of estrogen in our house.  Yet it is an interesting time for our family – as our girls are navigating the perils of adolescence, I too am finding myself in a stage I am calling “adultescence” whereby my thoughts, feelings, and emotions are changing as theirs are.  This creates an interesting ebb and flow of all of us learning together what it all means as a teen girl to “grow up” and as an adult to start “letting go”.

I had one of those adultescent “aha” moments the other day with one of my teen daughters.  She is very socially driven and relationships are very important to her.  Over the last few months, as school has resumed, she has been struggling with some of her friendships.  One girl just suddenly stopped responding to messages, one takes pleasure in forwarding hurtful messages, and another treats my daughter as the weekend “last resort”.  In talking to my daughter about these events, my “aha” moment came when I realized that my daughter, already, is highly emotionally intelligent.  She has the ability to put herself in the position of others and regulates her own behavior (so far) on how she would feel as the recipient.  This is a gift for her but puts her at a relationship disadvantage as many of her peers are not there yet.   She “feels” in a relationship like she is 25, but is trying to rationalize the emotional behavior of kids 16 and 17.

According to psychology today, Emotional Intelligence includes three skills:

1. Emotional awareness, including the ability to identify your own emotions and those of others;

2. The ability to harness emotions and apply them to tasks like thinking and problem solving;

3. The ability to manage emotions, including the ability to regulate your own emotions, and the ability to cheer up or calm down another person.

Emotional intelligence then includes:  self-awareness, self-regulation, motivation, empathy, and social skills.  It can affect: personal relationships, workplace (or school) performance, physical and mental health, and how you deal with situations such as loss or disability.

The good news is that experts believe that emotional intelligence can be learned, even in adults.  How do you know if you are emotionally intelligent?  Perhaps reflect on your relationships – are you able to sustain positive and loving bonds with others?  Can you empathize and relate to people during their struggles, and do they know that you “get it” and are emotionally available to them?  Do you regulate your own behavior based on how others might feel if you act a certain way, or say certain things?  Before sending that text, email or calling someone in anger do you consider how you want them to “feel” following your interaction?  Do you take pleasure in being right even if that makes others feel bad?  If you want to test your level of emotional intelligence, or raise your emotional IQ, take a quiz to see where you’re at:  Emotional Intelligence Quotient Quiz.

Do you think you need to improve in this area?  Some suggestions include:

·    practice mindfulness – in social situations, at work, at home with family relationships.

·    Stay in touch with your feelings through journaling or meditation “check-ins”.

·    Connect your feelings to the situation and try to separate the person from their behavior.

·    Check your thoughts – how you think can become how you feel, and the good news is you can change how you think!

·    Communicate with others and don’t be afraid to be vulnerable to those close to you to help sort through feelings, thoughts and emotions.

·    And if you can, don’t take the comments of others personally.  Their thoughts about you do not need to become the thoughts you have about yourself.

 

Originally posted November 2016

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Occupational Therapy and Heart Health

Being diagnosed with heart disease is a life-altering event, often requiring permanent lifestyle changes.    Occupational therapists can help people to recover from the initial incident, to rebuild a life of function, and to promote change that will help with prevention.

Learn more about how Occupational Therapy can assist those recovering from heart disease in the following infographic:

 

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Breaking the Stigma: Sexuality and Disability

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written by Lauren Halliwushka, Occupational Therapist

Unfortunately, in the ongoing quest for an inclusive and equal-opportunity society, “sex” still sells. What used to be in printed material (magazines, newspapers, and fliers) has turned into an online buffet of images that are posted by people of themselves (often filtered, patched and “enhanced”), by people of others (with and without consent), and by photographers, companies and others whose job is to capture the attention of, and entice millions of people, to buy a product, service or idea. The goal of these “sexy” images is to tap into our intrinsic human need and desire for sexuality by adhering to the societal expectations of what is attractive. 

It has only been in the last few years that the concept of “attractive” is changing. Models are increasingly featured in many different shapes, sizes, ethnicities and some campaigns (thank you Dove) are about “natural” beauty.  But despite this small move in the direction of selling with images of “various types of people” presented as “real”, there is one more similarity in advertising that we often overlook. The models are able-bodied, or to use a totally arbitrary term, they would be considered “normal”. 

Why then do we rarely see individuals with disabilities featured in sexually enticing advertisements? It goes back to society’s assumptions of what beautiful and sexy is. Disabled people, through their history of being marginalized, institutionalized, segregated, or otherwise pitied have not been routinely associated with ‘attractive” as a concept. We need to work together to continue to change this perception and to remove the stigma.

Individuals with disabilities are sexual beings. Like you and me, they also have urges, desires, needs, and fantasies. However, a subset of the general population doesn’t think so. According to a systematic review of qualitative articles, a prominent misconception among a sample of the general public is that individuals with disabilities are asexual. Biologically this is odd because individuals with disabilities undergo the same maturation processes as everyone including puberty, reproduction and hormonal surges. Yes, approximately 1% of individuals are asexual but this is all people, not just those with disabilities. Another common misconception is that individuals with disabilities are only attracted to other individuals with disabilities. Inter-abled couples do exist, and relationships can form before or after a disabling event. Compared to inter-racial couples, however, inter-abled are not as common. Why? Well, it is thought that individuals with disabilities may be unconsciously internalizing the stigma and perspectives of society, which further negatively impacts their self-esteem, self-efficacy, motivation, and perceived sexual autonomy. This claim is supported by a qualitative study that gained the perspectives of individuals with disabilities on the topic of sexuality. A significant theme that emerged is the innate belief that their sexuality was not equal to or desired by individuals without disabilities. As such, they were reluctant to pursue inter-abled relationships due to fear of rejection, the partner resenting their disability and the possibility of the partner falling into a caregiver role.

In addition, stigma unknowingly creates various systemic barriers that further reinforce societal and self-stigma among individuals with disabilities, creating a negative counter-productive cycle. There is plenty of literature that highlights the ineffectiveness or inaccessibility of sexual education within secondary schools for individuals with both visible and invisible disabilities. Sexual education focuses on “normal” (that ugly word again) people. Hence, from a young age, we are setting up individuals with disabilities for failure by reinforcing self-stigma and neglecting to acknowledge their sexual being.

Regarding the healthcare system, a study suggests that only 6% of licensed health care professionals engage in frequent discussions about sexuality with patients/clients with half of them stating they avoid the topic due to embarrassment. Keep in mind, this statistic is regarding all individuals, disability or not, which is even more surprising given that sexuality is a crucial component of someone’s health and – more importantly – intrinsic to human nature. No wonder individuals with disabilities are adopting self-stigma if health care professionals shy away from this topic.

This is not about changing what you see as attractive. This is about challenging the opinion that individuals with disabilities are not capable of being sexy and can’t (or shouldn’t or don’t) engage in sexual behaviors. Not only are all people, disabled or not, able to engage in any and all sexual behaviors, but they also have wants, needs and desires like the rest of us. Healthcare professionals that shy away from, or avoid, this topic should consider discussing this aspect of health with patients/clients when appropriate by adopting a comfortable strategy (such as the ex-PLISSIT model).

If you have personally felt, or still feel, the self-stigma surrounding sexuality, please discuss it with a trusted family member, friend or healthcare professional. Specifically, Occupational Therapists are trained to be open about this concept and to problem solve the barriers to sexuality and engagement in sexual activity as a very important “occupation (aka life role)” for all of us.

If you are interested in reading more, I recommend The Ultimate Guide to Sex and Disability by Dr. Miriam Kaufman.

Remember: Disability is extremely broad and can impact people in multiple ways. As with all people, consent is always required when engaging in any sexual activity.

 

References:

 

1 Sinclair, J., Unruh, D., Lindstrom, L., & Scanlon, D. (2015). Barriers to Sexuality for Individuals with Intellectual and Developmental Disabilities: A Literature Review. Education and Training in Autism and Developmental Disabilities, 50(1), 3-16. Retrieved June 18, 2018.

2Miller, A. M. (2015, May 4). Asexuality: The Invisible Orientation? Retrieved from https://health.usnews.com/health-news/health-wellness/articles/2015/05/04/asexuality-the-invisible-orientation

3Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

4McDaniels, B., & Fleming, A. (2016). Sexuality Education and Intellectual Disability: Time to Address the Challenge. Sexuality and Disability, 34(2), 215-225. doi:10.1007/s11195-016-9427-y

5Jones, L., Bellis, M., Wood, S., Hughes, K., McCoy, E., Eckley, L., . . . Officer, A. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. The Lancet, 380, 899-907. doi:10.1016/S0140-6736(12)60692-8.

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