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Archive for category: Occupational Therapy At Work

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Getting around: Transportation Made Easier

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

Have you ever wondered why the design of the objects we use and spaces around us are getting better and seem to relate to our bodies or the way we do things in a much more obvious way than ever before?

Barrier-Free Design allows the greatest majority of people equal access to the private and public spaces of our built environment. The aim is to minimize or eliminate physical, cognitive, and sensory barriers in our homes, businesses, and public spaces and even our streets.  

Consider the front entrance of a building. Sidewalk curbs, uneven walkways, multiple stairs, heavy doors, and lack of handrails. All these can prevent access because they can create barriers for individuals.

Universal design methods such as curb cuts, level and slip-resistant walkway surfaces, properly designed ramps, accessible washrooms, automatic doors, lifts, and colour-contrasted handrails are all examples of ways to support increased and barrier-free access not just for folks with a physical disability but for all of us, including children, the elderly, parents with strollers and many others.

Occupational Therapy promotes a wide range of barrier-free design and universal design principles that have helped to make better buildings and spaces in our communities.

There is a greater awareness in society that our buildings and spaces must be more accessible to the greatest majority of people. There are far more products and methods for creating barrier-free environments today than ever before which can be great for finding the right product or design solution for an individual. On the other hand, the vast and ever-growing range of products and design solutions can also be confusing, making choosing the right product a difficult one.  Occupational Therapists have the knowledge and experience to help facilitate the right approach by drawing on current research and best practices for creating barrier-free spaces.

Occupational Therapists provide helpful information and design advice to architects, designers, and contractors when it comes to creating barrier-free spaces inside homes, businesses, gardens, and even public spaces. And since there is a wide range of barriers that can contribute to preventing an individual from completing an activity such as reaching or bending, OTs help by determining what the barriers are for an individual and facilitating products and design strategies that can help surmount these barriers.

As OTs, we have the privilege to serve the needs of many people in the community and using our skills and practices to help people meet their individual needs of daily living and have productive and rewarding life experiences. For many, this may only be accomplished by implementing a barrier-free experience in their homes, businesses, and places they like to visit.

For example:

  • For individuals with visual impairments, spaces should have adequate lighting, colour contrasting surfaces where appropriate, tactile cueing and signage as well as audible alarm systems. For individuals with auditory impairments, visual signage and alarm systems (for example, flashing lights) are necessary.
  • For someone in a wheelchair, a barrier-free experience may include modifications to their workplace kitchens and washrooms. Fixtures such as light switches, sinks, paper towel dispensers, toilet paper dispensers and grab bars must be installed at a height that can be reached from a seated position.

Ultimately, the goal of barrier-free design is to promote equal access and participation for everyone. There have been many steps taken toward ensuring this type of design prevails in our communities. There are new laws supporting improved accessibility within Ontario as of January of 2015.  Is your building up to code? Consulting an occupational therapist can help to ensure your space meets the new criteria.

 

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A Place Called Vertigo

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

I am not sure what the word “vertigo” refers to in U2’s hit song, but as someone living with vertigo, I can tell you it is not a place you want to be.  Vertigo is highly unpleasant and can be caused by multiple factors including visual or auditory problems, or more commonly, head injury.  I best describe my vertigo as my eyes and ears sending different messages to my brain regarding the position of my body in space.  So, while my eyes tell me I am sitting still in a chair, my ears tell me I am on a boat in the middle of a hurricane.  The result of these mixed messages is spinning, nausea, dizziness, problems walking, and ultimately dysfunction.

For me, my benign positional vertigo (BPV) lives in my right ear.  As a result, I cannot lie on my right side, laterally flex my head to the right, lie flat with my neck extended, or look down into extreme flexion.    While I can tolerate these movements momentarily, I cannot hold these positions for more than a few seconds otherwise I am sent into a spin that can last for days.  I am fortunate to know my triggers and do my best to avoid them (no yoga for me).  I have also learned, after living with this problem for two decades, how to catch my symptoms early to prevent a slight episode of dizziness from turning into days of bed rest.

When my clients experience vertigo and describe this to me, I can fully appreciate where they are coming from.  The story is a book I too could write.   But, like other “hidden” ailments, I get concerned when the medical community does not take this complaint seriously.  This is especially true in my industry where insurers and their assessors often want “proof” of a health problem to support someone’s recovery. While I recognize that people can be dishonest, my experience is that people don’t make this stuff up.  Health professionals need to give people the benefit of the doubt, including insurance situations. To understand, or better yet, support someone with any “invisible” problem like vertigo, health professionals need to be compassionate and should care enough to listen, to research and learn, and ultimately believe.  Empathy, TRUST, and understanding will go a long way to support those that need it. I can only imagine how frustrating, devastating and angering it would be for someone to assume or opine that my “place called vertigo” is not a place at all: because, believe me, I live here.

 

previously posted August 2013

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The Cost of Disability

The cost of disability due to injury or illness is significant and stems from lost work time, medications, equipment, costs of personal care, therapy and more.

When struggling to make ends meet, people encounter stress, anxiety, panic, excessive worry, loss of sleep, relationship issues, poor decision making, and can result in addictions as a form of poor coping.  You can imagine how hard it would be to heal from injury or trauma when significant money stressors are created as a result!

Our OT-V episode below provides insight into how an Occupational Therapist can help you or someone you love plan for future costs related to the specific disability, provide treatment to help you manage your finances more efficiently, and deal with any associated symptoms.

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The Lifechanging Magic of Tidying Up

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

I was raised in a very tidy family.  My grandfather had polio and thus my father was raised in a home where clutter was not an option, because if my grandfather tripped on something “lying around” he could be seriously hurt.  My grandmother took it to some extremes (like waxing her garage floor), but the net result was a tidy dad that instilled the benefits of being organized on me.

I am very environmentally driven.  I have a hard time being productive or functional if my space is uncomfortable.  I keep my office, home and car reasonably organized.  I know where the bills are that I need to pay, the ones that I have already paid, where my spare car keys are, and what I have in the fridge and freezer that could pass as dinner.  I can usually answer the “mom, where is the ???” question and keep commonly used items in consistent places.  I label things to make search and locate easier, and so that I can blame the kid responsible to avoid the “wasn’t me” response (when they were little they had one color each for bowls, plates and cups and they still have different colored towels). Having four teens and four pets, sure our house is in constant need of tidying, and getting my kids on the tidy train hasn’t always been easy.  I try to give them some freedom over their bedroom, but once a week it needs to be “cleanable” and we have a special needs dog with an affinity for smelly socks (not clean ones), so at the least, they need to keep their dirty clothes safely stored in their “dog-can’t-reach” laundry bin.

I believe though that being organized is more than a skill, it is also a lifestyle.  Like being active, or being a non-smoker, deciding to be organized is a conscious choice, then it requires commitment to get and stay there.

But like all “lifestyle choices”, this too can get derailed.  As an occupational therapist “organization” often is incorporated into our treatment of clients, and this takes many forms.  Sometimes it is organizing items into reachable places from a mobility device, or to conserve energy and reduce the pain caused from lifting the heavy pots from the bottom cupboard. Sometimes it is mail, email, and paperwork to ensure urgent items get addressed and bills continue to get paid.  Maybe it is just putting like items together to make it easier and more efficient to find things (especially with cognitive impairment or depression that can make initiation, motivation, and memory impaired).  If we are gearing up for a home renovation to address accessibility needs, sometimes purging, sorting and storing or discarding items is necessary to make room for the upcoming changes.

Marie Kondo (www.konmari.com) has become a Netflix, YouTube and internet sensation with her “Life Changing Art of Tidying Up” book and series.  She coaches only keeping items that “bring joy” and offers some suggestions on how to sort, fold and emotionally process keeping things we love, and letting go of the things we don’t. While I am not sure filing a utility bill, organizing my doggie poop bags, or emptying the overflowing bathroom garbage are things and items that “bring me joy”, I love her approach to folding and agree that your home should be filled with items that reduce, not increase, your level of stress. In the end, being organized is efficient because when you can find things you are not spending that emotional, cognitive and physical energy “looking around aimlessly” all the while getting frustrated, or worse, tired and angry.  The time you save by being able to navigate and find the things in your own home quickly can be spent on other meaningful, purposeful and joyful activities.  And that is where I agree with Marie that organizing can help us to “choose joy”.

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Self-Care for Caregivers: Put Yourself First

Caregiving is a job.  A job most people don’t apply for, aren’t trained for, do not get paid for, and receive little to no time off from.  When a loved one is injured or ill often the job of full-time caregiver falls on the spouse, adult children, or other family and friends.  Though many are happy to give as much love and support as possible in their loved one’s time of need, the job of caregiver can be isolating, exhausting and can often result in caregiver burnout and additional health-related concerns for the caregiver themselves.

Remember that you cannot take care of someone else if you are not taking care of yourself.  You may risk becoming useless to your loved ones if you do not first take care of yourself.

The following infographic provides more information about the caregiving role and solutions to help reduce the mental and physical health-related issues that often stem from the job of caregiver.

 

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To learn more about how to care for yourself or a loved one as a caregiver take a look at our previous post, “Put on Your Own Oxygen Mask First.

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My Child is a Picky Eater… Help!

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

Do you have a child that is a picky eater?  You are definitely not alone!  Picky eating is a common issue, and while it is normal for kids to have food preferences and dislikes, it can be quite concerning for parents.  The good news is an Occupational Therapist can help!

Occupational Therapists can work with families to create solutions tailored to the individual child. Some general suggestions may include some of the following tips:

  • Remove the pressure
  • Allow the child to “play with their food”
  • Encourage food exploration on their own terms
  • Maintain a consistent meal-time routine
  • Introduce changes and new foods slowly – overcoming picky eating is a very gradual process

Watch our popular video below to learn more about how an Occupational Therapist can help families overcome the picky eating problem and raise healthy, happy eaters.

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Occupational Therapy Approaches for Substance Use in Clients with Brain Injuries

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written by Ashley Best, Student Occupational Therapist

In our previous blog post titled “Brain Injury and Substance Use”, we discussed how the cognitive and emotional changes associated with brain injury can overlap with substance use.  But what wasn’t covered was the role of the Occupational Therapist when working with clients who have these challenges.  While our role is complex in cases like these, we have tried to simplify how we use function and meaningful activity in combination with direct treatment to address some common themes as outlined below.

1. Harm Reduction

Arguably the most important strategy of any professional working with someone who uses substances is Harm Reduction. An Occupational Therapist can work with a client to better understand the process of using a substance with the same skill used for analyzing other daily activities. By breaking down what a client’s substance use looks like, from the trigger to being under the influence, the OT can identify areas of potential harm or danger. Some common concerns with substance use, and some OT intervention examples are:

 

 

 

 

 

 

 

 

 

 

It is important to recognize that the above strategies are not meant to encourage substance use but ensure the safety of the client when they are not willing or able to stop.  Sometimes just reducing the harm is all we can offer until the harm can be eliminated.

Clinical Example: A man with previous regular alcohol use prior to an accident, now has seizures when he does not have alcohol in his system. Thus, it is actually more harmful to ask this client to not use alcohol. Instead, monitoring the amount he drinks and ensuring he has regular supports at home are two strategies that can reduce the harm that alcohol may cause.

2. Recognizing Substance Use as a Barrier to Goals

The financial, behavioural, and health effects of substance use often negatively impact a client’s ability to reach their goals. An occupational therapist can help a client to understand and hopefully address the gap between substance use and being able/unable to move forward in other areas of life. An OT may also strategize ways to achieve goals despite substance use by planning use around occupations and this, in turn, may help decrease use over time.

Clinical Example: An individual with a brain injury has a goal to return to work but does not have the insight to recognize how using narcotics would impact their success on the job. Thus, helping the client break down the requirements of a job, recognize poor fits, and then implementing strategies to change substance use behaviour so that it doesn’t impact work (in the case that abstaining from use is not an option) could be an intervention focus.

3. Using Activity to Avoid Triggers

Often, substance use is time-consuming between acquiring, using, and coming down from the influence. This becomes a major challenge when people stop using because there is a lot of free time that may lead to boredom and relapse. This is an important place for occupational therapists to intervene by helping the client identify meaningful activities to engage in when they are feeling an urge to use. This could involve interests and values, or just discussing past activities that the client would like to resume.

In the case of someone with a brain injury, more guidance may be required to identify triggers (if the client has low insight what is triggering). In addition, activities that the client can perform may be different following a brain injury, and thus they may need support in finding new meaningful activities to fill the time that was previously taken up with substance use.

What is the take-home message?

As the above indicates, implementing any of these strategies will require the client to exercise a high level of control over their addiction. Thus, an OT can help support and accommodate each client’s unique situation by providing remedial and compensatory strategies to help clients transition from the occupation of substance use, to other, ideally more meaningful and healthy alternatives.

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Brain Injury and Substance Use

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written with Ashley Best, Student Occupational Therapist

As clinicians working in the community with clients who have a brain injury, we all too often see the challenges of recovery impacted by the use of illicit drugs and alcohol.  And while we treat both the brain injury and substance use as they impact function and the ability to participate in life roles, we often wonder, which came first? 

Statistics show that individuals with brain injuries have higher rates of substance use than the general population. However, statistics also show that individuals with brain injuries have higher pre-injury rates of substance use.  While this does not explain a “causal relationship” or answer the “which came first” question, we know the interplay is complicated and that acquiring a brain injury can change the way the brain processes information which may influence substance use behaviours and patterns.

Here are some examples of how this can happen:

  1. Cognitive Changes: Having a brain injury can result in cognitive changes from mild to severe difficulties with memory and concentration, communication, processing speed, problem-solving, and more.
  2. Emotional and Personality Changes: A brain injury can also result in emotional and personality changes such as impulsivity, irritability, and lack of insight.

The changes and symptoms mentioned above occur as a result of injury to the brain’s frontal lobe. The frontal lobe is responsible for more complicated cognitive processes. It helps us to problem solve everyday challenges and consider the positive and negative impacts of our decisions. When a person hits their head or is jolted quickly, the frontal lobe will often impact against the skull – bruising, damaging, and disrupting the connections between the brain cells in this region.

So how does this relate to substance use?

Well, there are reward pathways in the brain which react and process substance use triggers and the associated emotional response. These pathways respond to the positive feelings associated with substance use and strengthen the more the substance is used, telling the brain to seek more. These pathways recognize triggers of substance use and respond by sending the “craving” to the frontal lobe. The frontal lobe determines whether or not the substance will be sought after, and if so, how the substance will be obtained and used.

When we think about individuals with brain injuries and associated cognitive and emotional challenges, we can see how if a person has difficulty with impulsivity, for example, then ignoring a craving may be more difficult than it would be pre-accident. In addition, when a person with a brain injury decides to engage in substance use, challenges such as poor planning and problem-solving may make the use even more unsafe.

Though we may not have evidence to connect brain injury to substance use directly, the cognitive changes in the brain are likely to make managing, using and even recovering from substance use much more difficult.

So now that we have talked about how substance use behaviours and patterns may change after acquiring a brain injury, the question remains, What can be done to help an individual who has both a brain injury and problems with substance use?  This question will be answered in part 2 of our blog post: The Comorbidity of Substances and ABI – the Role of the OT…stay tuned!

 

References:

Bjork, J. M. & Grant, S. J. (2009). Does traumatic brain injury increase risk for substance abuse. Journal of Neurotrauma, 26, 1077 – 1082.

Ilie, G., Adlaf, E. M., Mann, R. E., Ialomiteanu, A., Hamilton, H., Rehm, J.,… Cusimano, M. D. (2015). Associations between a history of traumatic brain injuries and current cigarette smoking, substance use, and elevated psychological distress in a population sample of Canadian adults. Journal of Neurotrauma, 32, 1130 – 1134.

West, S. L. (2011). Substance use among persons with traumatic brain injury: A review. Neurorehabilitation, 29, 1 – 8.

WETA. (2017). Facts about concussion and brain injury. Retrieved from https://www.brainline.org/article/facts-about-concussion-and-brain-injury

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Safe Ways for Seniors to Remain Active in the Winter

Winter has fully arrived in Ontario bringing with it freezing cold temperatures, icy surfaces and lots of snow!  If you don’t enjoy any of the these, that’s okay.  Though you may not be able to safely or comfortably enjoy the great outdoors there are still great ways to remain active during the Winter season.  The following care of the McMaster Option Aging Portal discusses some great ways for seniors to stay active without the dangers that can arise when trying to brave the elements.

McMaster Optimal Aging Portal:  Four ways to stay active this winter