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Archive for category: Occupational Therapy At Work

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Let’s Talk About Sex… and Education

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

Sexuality is an integral part of being human and is another one of those concepts that exists on a spectrum.  It contains with it physical, emotional, social, behavioral and relational elements that impact us all at various levels and times in our lives.  As an occupational therapist, I have had many conversations with clients about changes in sexual activity post-disability, injury or trauma.  Some of these conversations are as simple as “sex is the last thing on my mind” to “I would just like to sleep beside my spouse again”…to “do you have any resources or devices you can suggest to help me re-engage sexually”…

It was in 2000 when, during my OT training, we had a lecture designed to educate and inform us about adaptive sexuality and sexual activity.  The lecturer was perfect – he was a social worker, openly gay, and owned a retail store for adult intimacy items.  He was very knowledgeable about the topic of adaptive sexuality, counselled people at his store, and the topic clearly did not make him at all uncomfortable.  But that was not true of our class.  Soon after he started his lecture and produced some adaptive items that his clients have found helpful, half of our class got up and left (in fairness, he told us all if the topic made us uncomfortable he would not be offended if we left).  I was amazed and disappointed at the same time.  Here we were, in the process of being trained to help people function in all areas of life after disability, and some members of my class were not open to learning about this.  I guess that explains why the spectrum exists – because we all have various levels of comfort with such a vulnerable, intrusive and often “taboo” topic.  

Fast forward almost 20 years to the first weeks of school, I can understand the current debate in Ontario over the topic of sex and sex education and fully appreciate both sides of the argument.  But as a parent of four teenage girls, I must ask: “what is best for the kids”?  Well, that answer too will be complicated – for some, it will be best for them to learn from their parents and for others, the school will do a better job of educating them in a way that is respectful, honest, inclusive and forthcoming.  What I think we don’t want as parents, educators, or as a society, is for kids to “figure it out on their own” and turn to the internet and social media to get answers to their important questions.  As we all know, the internet contains a lot of harmful images, video, and opinions that could negatively impact them if they go looking.

Of greatest concern, however, is the mental health of the kids who have thoughts, feelings, emotions or experiences with sexuality that are unconventional, confusing, violating or just plain scary.  If these kids are not given the proper channels, at home or school, to talk and sort-through, understand, cope with and manage these, how will they adjust?  We know kids today are increasingly anxious and depressed, we know suicidal ideation and risk is high in youth, so how can we best support them?  I personally don’t think that is through undermining research that tells us these conversations need to happen, or by resurrecting outdated anything that we know is obsolete to appease those (like half of my OT class) who find these topics, and the evolution of sexuality over the last 20 years, uncomfortable.  Kids are smart and instinctive – if adults are fighting over this, the entire concept of helping them through the many phases of sexual development may become something they won’t allow any caring and responsible adult to be a part of.  That would be a poor outcome for us all.

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How Technology is Ruining Your Good Night’s Sleep

Did you know that the use of technology, even having a television on in the bedroom, can disturb the amount and quality of sleep you achieve?  Could our reliance on devices be part of the reason one third of the Canadian population isn’t getting enough sleep?  Learn more about the effects of technology on your sleep in the following from the Sleep Help Institute.

Sleep Help Institute:  How Technology Impacts Your Sleep and What to do About it

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Game… Set… Cerebellum

Co-authored by Meredyth Bowcott, Student Occupational Therapist

The 2018 Rogers Cup has just wrapped up in Montreal and Toronto, and once again spectators in Canada and around the world were dazzled by the likes of top-ranked tennis players such as Rafael Nadal and Simona Halep. If you’ve ever tried your hand at the sport, you know it requires great speed, agility, endurance, and of course coordination.

So how do these players prepare to return a serve that can clock in at speeds of over 160 km/hour? Well, they do it with a little help from a part of the brain called the cerebellum.

The Mighty Cerebellum

The cerebellum registers the serving player’s movement pattern, along with the speed and trajectory of the tennis ball, and predicts the outcome of these movements. As the returning player makes a split-second decision about how to get into position to hit the ball back, the cerebellum is still hard at work. It receives instructions for how the body should be positioned in order to return the serve, simultaneously comparing the body to the actual position of joints and muscles. The cerebellum sends signals to adjust the position of the body in real time, giving the player the best shot at returning the serve.

We can’t all be tennis superstars, but we do all rely on our cerebellum in our day to day lives. Truly, any intentional movement that you accomplish in a smooth and predictable manner, from watering your plants to drinking a cup of coffee, is brought to you in part by your cerebellum.

Ataxia

So, what happens when this crucial brain structure becomes damaged and isn’t working as it should? One of the symptoms of cerebellar dysfunction is ataxia. Ataxia is characterized by a loss of muscle control and coordination, and can affect the whole body or only specific parts (upper extremity, lower extremity, trunk, etc.). Individuals with ataxia may have difficulty initiating movements, movements may appear jerky and imprecise, and they may have poor sitting or standing balance. Others may have difficulty swallowing or experience rapid back and forth eye-movements.

Ataxia has a pronounced impact on how people go about the activities in their day. Without adequate muscle control and coordination, tasks like getting dressed, walking, and preparing a meal become more challenging.

How Occupational Therapy Helps

It’s important for medical teams to determine the cause of the ataxia and see whether it is due to an underlying issue that can be treated. When symptoms persist, occupational therapists (OTs) focus on ways to help individuals with ataxia compensate for their symptoms. Some of the ways an OT might help someone with ataxia are:

Energy conservation: Fatigue can exacerbate symptoms of ataxia, therefore it’s important to think about how to conserve energy throughout the day.  We do this with the four P’s:

  • Prioritizing: OTs can help establish a list of priority activities, that is which tasks throughout the day are more important for the individual to be able to get done. Focusing attention on what’s most important contributes to a more rewarding day.
  • Pacing: It’s important to take regular breaks – before fatigue sets in – and practice proper pacing technique. OTs can help create a realistic daily schedule that allows time for productivity and rest.
  • Planning: OTs are skilled in task analysis and can help individuals find the most efficient way to accomplish an activity. This reduces unnecessary expenditures of energy, and can reduce frustration.
  • Positioning: OTs consider how the individual interacts with their environment while accomplishing a task. For example, ensuring everything needed to make dinner is within reach limits unnecessary movement.

Joint stabilization: If muscle incoordination occurs in the upper extremity, it can be beneficial to stabilize the arm when accomplishing gross and fine motor movements. For example, stabilizing one’s elbow by leaning it on a table can help create a smoother movement when drinking from a cup.

Adaptive equipment: OTs can recommend equipment to make certain tasks easier. In some cases, the use of weighted utensils may help reduce jerky arm movements. Self leveling spoons can also help minimize spills during mealtime. Lining work surfaces in the kitchen with a non-slip mat such as Dycem © can provide traction to compensate for muscle incoordination.

Every person with ataxia is different, and occupational therapists have the skills to develop individualized plans to help them lead active and fulfilling lives. For more information on these and other ways occupational therapy plays a part in treating ataxia, contact an OT!  In the meantime, if you like sports, watch the cerebellum in action at the upcoming US Open!

 

References:

Anderson Preston, L. (2013). Evaluation of Motor Control. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 461-488). St. Louis, Missouri: Elsevier Mosby.

Foti, D. & Koketsu, J.S. (2013). Activities of Daily Living. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 157-232). St. Louis, Missouri: Elsevier Mosby.

Mayo Clinic. (2018). Ataxia. Retrieved from:

https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652

Tipton-Burton, M., McLaughlin R, & Englander, J. (2013). Traumatic Brain Injury. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 881-915). St. Louis, Missouri: Elsevier Mosby.

UBC Medicine – Educational Media. (2014, February 18). The Cerebellum – UBC Neuroanatomy – Season 1 – Ep 8 [Video File]. https://www.youtube.com/watch?v=17mxfO9nklQ

 

 

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What to Look for in a Backpack

Backpacks are a staple for every student. They travel back and forth between home and school, lugging books and school supplies. They are put through the unavoidable daily abuse of being thrown on the ground, trampled on, stuffed into a cubby or locker, saving a spot in line, and become over-stretched and over-used with the necessities of school. They are a necessary part of your child’s education, yet how much thought do you really put into the backpack your child wears aside from maybe price or color?  Have you considered the health implications of an improperly worn, fitted, or poorly supportive backpack?

Learn what to look for in a backpack to ensure optimal support in the following infographic:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more information on how to select a backpack, proper fit and use watch our OT-V episode, Backpack Safety Guidelines.

 

Summer Programming Note:

Summer vacation is here and we will be taking a break from our regular schedule.  We will be posting some of our popular seasonal blogs just once a week throughout the summer but will resume our regular three weekly posts in September, filled with new and exciting content including our popular O-Tip of Week series.

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Golf FORE All

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

I don’t quite understand why hitting a stationary ball is so difficult but alas, golf is one of my favorite sports.  I started playing as a teenager and spent years figuring out that my old baseball swing aimed lower would hit a golf ball far, but not really straight.  With practice I have removed the sway, slowed down my tempo, and learned that trying to kill the white-dimpled-target does not work out either, and voila, I am hooked.

But beyond my love of the sport as an athlete, I also love how adaptable it is.  Growing up I remember playing with my grandfather who had polio.  He would swing a club with one arm while his other arm held his crutch to keep him standing.  Yet, even with one arm, he could hit the ball consistently far and straight – skills foreign to most amateurs.  As an occupational therapist, I now suggest golf as one way to re-integrate clients into the athletic world following an accident or injury.  How?  By breaking the sport into its component parts, and structuring participation around ability. 

Many people start with putting.  While putting can be boring to practice, it is the most important part of the game as you are likely going to put at least 18 times a round.  Putting requires neck flexion but can be done in sitting or standing.  Mats can be purchased to putt at home that will eject the ball back to your feet if your putt is successful.  At times, I have even used putting with clients at their home to test for visual-spatial deficits which makes it a great exercise to also practice if deficits are noted.

From putting, people can slowly increase the club speed through chipping, pitching and low wedge shots.  In these cases, there is little body movement and reduced torque through lowered club speed that would cause pain if the ground, not the ball, was impacted.  Then, if feeling good around the greens, the player can start with low irons on the range and work backwards to full swings.  Eventually, they can try a few holes with a cart to pace the walking, then consider a pull cart with walking later if that is within their abilities.

What is also great about golf, however, is how this is getting attention in the world of modified sport.  Now, some courses have Solo Riders (www.solorider.com) that can be used by people who have deficits in independent standing.  These Solo Riders position the golfer in swing distance from the ball, then elevate them into a standing position to facilitate the swing.  These carts can go on the tees and greens as they only distribute 70 pounds for force through each tire – less than a person’s foot so they don’t damage the course.  I played in a tournament recently where a local golf pro, who had a spinal cord injury, demonstrated the use of a Solo Rider on a par 3 from the tee and hit the ball within a few feet of the pin.  Apparently, for the group before us, he hit a hole in one.

I also remember reading an article a few years ago about physiotherapy programs that were focusing on golf-related skills in therapy such as balance, trunk control, pelvic rotation, and fluidity of movement to help golfers return to the game.  Other activities, such as yoga and Tai Chi are also now known as ways golfers can improve flexibility, strength, endurance, and muscle control in the off-season.

My parents vacation in Florida all winter, and while there met Judy Alvarez who instructs and assists disabled people to learn, enjoy and excel at the game of golf.  I read her book (Broken Tees, Mended Hearts) on a recent holiday.  What is most compelling in her book is not about the physical benefits of golfing, but rather the emotional and participatory value golf has for her disabled clients.  Through participation in a challenging but modifiable sport, people can regain passion for sport, competition and can work to achieve personal bests.  Golf really is FORE all and I hope you will consider hitting the links.

Originally posted July, 2013.

Summer Programming Note:

Summer vacation is here and we will be taking a break from our regular schedule.  We will be posting some of our popular seasonal blogs just once a week throughout the summer but will resume our regular three weekly posts in September, filled with new and exciting content including our popular O-Tip of Week series.

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Reporting Unsafe Drivers: The New Role of Occupational Therapists in Ontario

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

Co-written with Samantha Hunt, Student Occupational Therapist

My father-in-law was terminally ill and suffered from dementia.  Eventually, his decline became significant and his doctor filed a mandatory report with the Ministry of Transportation (MTO) to suspend his license pending a driver’s exam.  He refused to attend the exam yet continued to drive even without a valid license.  He still paid for car insurance because he knew this was important but was not well enough to connect his own disabilities to his safety and the safety of others.  The family planned to remove his vehicle from his possession but before we could he ventured out one night, got lost, and the police found him 8 hours later driving in a farmer’s field.  The good news was that no one got hurt and his car was beyond repair.  Now, he could no longer drive even if he wanted to.

Driving is an important daily activity for many and provides drivers with an independent means to get around and to manage our own needs outside of the home.  It reduces our reliance on others and provides us with freedom and control.  But it is a privilege, not a right, and sometimes people reach a point where driving is no longer safe, but yet they don’t voluntarily stop.

Up until recently, the ownness to report unsafe drivers has fallen to the legal responsibility of doctors, nurse practitioners and optometrists.  However, on July 1, 2018 the legislation will change to add a new class of “discretionary” reporting, and occupational therapists will be included in the list of professionals that can submit these “discretionary” reports. 

Considering this major change to the Highway Traffic Act (HTA), and the significance of this on OT practice in Ontario, we wanted to provide a brief overview of the key facts and guidelines for the OT’s that this may impact.

Background on Medical Reporting Legislation

Mandatory medical reporting for physicians and optometrists in Ontario has been in place since 1968 and was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive. Mandatory reporting is a legal requirement to report that pertains to physicians, nurse practitioners, and optometrists, outlined in the HTA. The legislation states that every prescribed person shall report to the MTO “any person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a prescribed medical condition, functional impairment or visual impairment that may impair driving ability.”

What’s New

In 2015, amendments were passed that allowed for a new reporting model to be introduced in Ontario and were approved in February 2018. These include:

·       A combination of mandatory and discretionary reporting

·       Authority to add additional healthcare professionals

·       Specific requirements regarding what must be reported

Resulting from these amendments, the MTO regulations state that as of July 1, 2018, occupational therapists are identified as discretionary reporters. Discretionary reporting is not a legal requirement but gives authority for reporting to occupational therapists, physicians, nurse practitioners and optometrists for: “any person who is at least 16 years old who, in the opinion of the prescribed person, has, or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle”. Discretionary reporting therefore allows OTs to report concerns about a client’s fitness to drive if they choose.

With respect to consent and confidentiality, OTs are protected from legal action for breaking confidentiality when making a discretionary report; the HTA states that the authority of a prescribed medical professional making a report to the MTO overrides the duty of that professional to maintain a client’s confidentiality. Nevertheless, an OT making a report would be expected to advise the client of this decision.

Summary of Discretionary Reporting Rules for OTs

·       OTs can report concerns about a client’s fitness to drive directly to the MTO.  There will be a standard MTO form to be used for this purpose.

·       OTS may report a driver but are not legally required to do so.

·       OTs can make a report without client consent to prevent or reduce risk of harm.

·       OTs can only make a report if they have met the client for assessment or service delivery.

·       OTs can report on both prescribed conditions and any other medical conditions, functional impairments or visual impairment that may make it dangerous for a client to drive.

Prescribed medical conditions include the following:

1.     Cognitive Impairment: a disorder resulting in cognitive impairment that,

                 i.      Affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and,

                 ii.     Results in substantial limitation of the person’s ability to perform activities of daily living.

2.     Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.

3.     Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.

4.     Visual impairment:

                 i.      A best corrected visual acuity that is below 20/50 with both eyes open and examined together.

                  ii.     A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.

                 iii.    Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.

5.     Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.

6.     Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.

·       OTs who make a report in good faith are protected from legal action but failing to report when they should have could be a breach of professional obligations.

OTs are NOT expected to report on conditions that, in their opinion, are of:

·       A transient or non-recurrent nature

·       Modest or incremental changes in ability

Lastly, although OTs are not legally required to make discretionary reports, a professional obligation to identify a potential safety issue with a client (such as a concern about fitness to drive) and, taking action to address this concern, is expected of the OT. Taking action may or may not include making a discretionary report to the MTO.

Next Steps

Reporting, Intake, and Review Process

The three types of approaches for assessing fitness to drive include a General Functional Assessment, Driving Specific Functional Assessment, and/or a Comprehensive Driving Evaluation (more information can be found in the resources below). Once an assessment has been completed or a concern has been identified, an OT may fill out a report. A new standardized form that OTs (along with physicians and nurse practitioners) must use when making a report has been approved and will be available online as of July 1, 2018. Once reports are received by the ministry, they will be reviewed and the MTO is to take appropriate action following within 30 business days.  When an OT is reporting to the ministry, this does not mean the OT is taking the person’s license away. The licensing body has the responsibility to make this decision or to decide if more information is required.

For more information and resources, the College of Occupational Therapists of Ontario has created an Interim Guide to Discretionary Reporting of Fitness to Drive, which can be found at:  https://www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

Resources

www.coto.org/news/changes-to-medical-reporting-of-drivers-gives-ots-new-reporting-authority

www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

www.mto.gov.on.ca/english/safety.medical-review.shtml

www.youtube.com/watch?v=dOIJ7CrDTT0

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Concussion Recovery: An OT Can Help!

If you ask a crowd of people if they have ever had a concussion, about 1/3 will raise their hand. Direct hits to the head and closed head injuries are not uncommon in children and young adults, decrease in frequency in adulthood, but increase again in seniors.

Symptoms of concussion range and some can dramatically impact someone’s ability to work, drive, go to school, manage daily routines, or even participate in social or leisure activities.  Occupational Therapists can help those who have suffered a concussion manage symptoms and for those who are struggling to participate in important life roles, we can help them to return to work / home / school / fun! 

Learn more about Occupational Therapy’s vital role in our OT-V Episode:  Managing a Concussion

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Stay Sharp with the 30 Day Healthy Brain Challenge

June is Brain Injury Awareness Month and, in recognition, Solutions for Living created the 30 Day Healthy Brain Challenge.  We challenge you to complete these 30 simple activities and tips which, when incorporated into your lifestyle, can help improve memory, boost mental health, prevent brain injury and reduce cognitive decline.

Try the 30 Day Healthy Brain Challenge and after the month let us know how many activities you were able to complete!