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Archive for category: Occupational Therapy At Work

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Sensory Sensitivity

In our previous post, Can’t Sit Still?  Could It Be Sensory Seeking? we discussed sensory processing with a focus on the sensory seeking child.

Today we are focusing on another sensory-related concern that leads parents to seek OT treatment for their child – children experiencing sensitivity to sensory input.   On the other end of the spectrum from sensory seeking is the sensory defensive child. Unlike sensory seekers who have high thresholds for sensory input, sensory sensitive children have very low sensory thresholds. Due to these low thresholds, they experience sensory input much more intensely or notice sensory input much more often than their peers. This means that sensory input that may not bother you and I (for example the feel of jeans, brushing our teeth, or the sound of an alarm going off) may be very aversive, distracting, threatening, or even painful for that child.

Take a look at our OT-V video which further discusses sensory sensitivity, how Occupational Therapists can assist children and their families, and tips for families dealing with sensory sensitivity.

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Life is a Terminal Disease – Palliative Care and Occupational Therapy

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

Originally posted May 4, 2014

It was a life-changing experience. I was 19 and essentially never stopped. I had goals, drive, energy, and big plans for my future. I was a varsity athlete, had three jobs, was a full time university student, owned a student house, and had bought myself a dog. Knowing I wanted to work in healthcare, and after strongly connecting to some school courses in death and dying, I decided to pursue a volunteering opportunity at the local Hospice Society. This required a comprehensive training program followed by placement in the home of someone who had a terminal disease. My first (and only) placement was with a mom, age 37, who was dying of cancer. She had a 7 year old daughter and a husband who was also ill. I would attend their home once a week to spend time with the daughter, help to prepare meals, and would even assist with running errands and groceries. I provided emotional support and mentoring to a scared little girl, and was an extra set of hands for a dad and desperate husband. I was fortunate enough to be involved with the family for many years as the mother passed about a month after my wedding – four years after I met them. My husband and I tried to stay in touch with the daughter following, but dad really struggled and eventually his phone was disconnected.

The impact of this experience on me personally was huge. The things my parents had been telling me were true: “stop to smell the roses”, “don’t sweat the small stuff”, “make sure you have fun too”…I was intense and driven to the point of missing it. My experience in Hospice changed my outlook, my appreciation for my health, family and all those blessings that we take for granted daily.

Recognizing it is National Hospice Palliative Care Week, I wanted to showcase the role of Occupational Therapy in this challenging but rewarding field. To do this, I reached out to a colleague who has spent many years practicing occupational therapy in palliative care settings. Her reflections are as follows:

What I have learned is that Palliative Care is not particularly a specific intervention but rather a perspective of care that can be provided in a multitude of settings where end of life is faced such as our homes, hospitals, hospices or long term care facilities.

The Canadian Hospice Palliative Care Association defines End-of-life care as aiming to relieve suffering and improve the quality of living while dying for persons diagnosed with an advanced or terminal illness or who are bereaved.

Who defines how the client is suffering (physically, emotionally, spiritually) or that what we as healthcare providers do is indeed improving quality of living while dying? In a truly client centered approach, it is the client or their substitute decision maker that determines this. A collaborative interprofessional team has the potential to honour the client’s hopes and decisions in an identified plan of care.

The Canadian Association of Occupational Therapists identifies various interventions in palliative care, based upon clinical setting, that the therapist can provide including addressing activities of daily living (ADLs), psychological and emotional issues (including stress and anxiety), exercise programs, splinting and positioning, energy conservation, relaxation techniques, seating and mobility, comfort, adaptive and assistive equipment, support and education for the family caregivers, connecting the client with community services and supports, and conducting home assessments.

What this can look like is, for example, providing mobility devices such as a walker or wheelchair to address declining physical abilities while maintaining engagement with family in a safe manner. Considerations also include provision of therapeutic surfaces whether on a bed, wheelchair or favourite recliner to help reduce the development of pressure ulcers once time spent sitting or lying in bed increases. It can be planning and preparing with the client and the team to assist the client attend a final function such as a family wedding where comfort, endurance and being relatively symptom free are the goals.

Ultimately, as roles in life are challenged due to losses with life limiting illnesses, the Occupational Therapist attempts to facilitate meaningful engagement that reflects a client’s goals in a dignified manner.

Carla Floriani, OT Reg Ont

I want to thank Carla for providing this insight and for guest-blogging on our site. Personally, I miss my volunteer work in Hospice but know that this is something I will eventually return to as it impacted me in a way I have not forgotten. The harsh reality is that life is a terminal disease – but we should not need to be given a deadline to act that way.

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Can’t Sit Still? Could It Be Sensory Seeking?

One common reason that parents seek OT treatment for their child is because their child demonstrates sensory processing concerns.  Sensory processing is complex, however, often there are simple home-based strategies that can be very helpful in meeting a child’s sensory needs.

The following video from our OT-V (Occupational Therapy Video) series discusses one of the most troubling sensory related concerns for parents– when their child is a “sensory seeker,” meaning they seem to be constantly looking for additional sensory input and constantly “on the go” as they are attempting to obtain the sensory input that their bodies crave.

Watch the video to learn how an Occupational Therapist can help sensory seeking children and their families.

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Hurting Hands? OT Can Help!

Arthritis is a painful and often debilitating condition that, according to The Arthritis Society, affects over 4.6 million Canadian Adults.  Pain, inflammation, stiffness, and reduced range of motion can affect your ability to function at work, at home and at play.  Occupational Therapy can help with many types of arthritis by providing education, adaptations, exercises, pain management techniques and more.  The following from the Advance Healthcare Network discusses some of the ways OT can help when dealing with arthritis in the hands.

Advance Healthcare Network:  Occupational Therapy for Arthritic Hand Pain

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The Benefits of OT For Parkinson’s Disease

April is Parkinson’s Awareness Month.  Occupational Therapists help to provide creative and proactive strategies for managing well at home and in the community for a variety of illnesses and disabilities, including Parkinson’s Disease.  The following from The Parkinson’s Disease Foundation discusses some of the many benefits Occupational Therapy provides for those living with Parkinson’s Disease.

The Parkinson’s Disease Foundation:  Occupational Therapy Can Benefit People with Parkinson’s Disease

To learn more about Occupational Thearpy and Parkinson’s Disease check out our blog:  My Grandma Versus Parkinson’s Disease

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Tax Time: Is OT An Eligible Expense?

April means tax time in Canada!  Many, especially those with disability, chronic illness or advancing age, often pay a great deal in out-of-pocket medical expenses each year.  While these expenses can add up, the good news is that many can give you a break on your income tax.  The following from The Globe and Mail provides a list of 10 medical expenses you may not have realized are deductible.  And YES, Occupational Therapy is one of them!  

The Globe and Mail:  These ten medical expenses could give you a tax break

 

For more help with money management check out our recent post:  Money Matters:  Occupational Therapy and Disability Finance

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The Role of OT in Suicide Prevention

Sometimes occupational deprivation, as a result of illness or injury, can be a catalyst for suicidal thoughts, or even actions. While this may be a heavy topic, we’re here to talk about how Occupational Therapists can make a positive difference in the lives of people who are struggling with thoughts of suicide.

The Canadian Association for Suicide Prevention reports that 1 out of every 10 Canadians experience thoughts of suicide at some point in their lives. Occupational Therapists work with people who have experienced a loss of ability to complete everyday life tasks. When a person can no longer work, care for their children, or even go to the bathroom independently, it is easy to understand how thoughts of suicide can seem like an option. The good news is that Occupational Therapists are in the perfect role for addressing these types of situations, and inspiring positive outcomes.

When people have experienced a sudden disability onset like in a motor vehicle accident, we often hear statements like:

·        “I can’t do anything anymore”

·        “This isn’t how it was supposed to be”

·        “I’m missing out”

·        “I’m lost”

·        “I don’t know what to do”

The common thread in all of these statements is that people feel hopeless, and are experiencing occupational deprivation. Occupational deprivation is when a person feels that they can’t participate in meaningful activities due to factors beyond their control.  If this feeling gets strong enough, some people begin to feel that they may be better off ending their lives.  Occupational Therapists are skilled at enabling occupation, so it is easy to see how OT’s  play an integral role in addressing suicide.

One strategy proposed by Kim Hewitt, a leading OT in suicide prevention, is to ask the following question:  “Do you want to die, or do you not want to live like this anymore?”

This question fosters hope in people who are struggling, and it also leads to action; if a person does not want to live like this anymore, they simply need help to make some changes in their lives.  Occupational Therapists can then use their skills in occupational engagement to bring hope into the suicide discussion, and to try to address some of the negative thoughts and emotions the person is feeling.

Remember that occupations are defined not just as paid jobs, but also as things we do that occupy our time.  Occupations can include cooking a meal, going to the bank, or reading a book.  Occupational Therapists therefore give people solutions for living, so that they have all the skills and tools necessary to re-engage in these meaningful life activities. This type of therapy takes time, and sometimes trial and error, but in the end it can help people get back to feeling like themselves again.  These positive feelings can help to combat thoughts of suicide.

Not everyone has training in suicide prevention, but it is a responsibility we all share; someone may approach you about it whether you’re ready or not.  Here are some basic strategies to consider if someone brings up suicide with you:

  • If a person discloses thoughts of suicide to you, they want help, or else they wouldn’t have talked to you about it. This is a compliment – don’t be afraid.
  • Listen to what the person is telling you. Don’t try to relate, or offer false promises like “you’ll feel better tomorrow.” Just listen to them.
  • It’s okay if you don’t know what to do at first. You can tell the person that you want to help because you care about them, but you’re not sure how. Offer to stay with them, call a crisis line with them, or call 911 for professional assistance.
  • Remember this is a medical emergency, just like a heart attack or loss of consciousness – you need to do something.

Our motto at Entwistle Power Occupational Therapy is hope, empower, succeed, and I can’t think of any better population this applies to than people struggling with mental illness and suicidal thoughts.

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Occupational Therapy and Cancer Recovery

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

When my mom was diagnosed with breast cancer, she was required to have a mastectomy.  Feeling helpless but wanting to support her, I sent her a list of the things we could do together pre-surgery.  This included anything from loading up an iPod with her favorite tunes and stand-up comedic acts, sorting my ridiculous stack of family photos, scrapbooking, and of course some retail and spa therapy.  I figured the less time she spent just waiting for surgery, thinking and processing what was to come, the less this diagnosis would impact her now and into the future.  She responded to my ideas with something along the lines of “you should help people through tough times for a living” and I reminded her that my job as an OT allowed me to do just that.

The yellow daffodils in April signify that this is the month of Cancer Awareness.  Defined, the word “Cancer” is a blanket term used to describe the abnormal growth of cells in any part of the body.  There are more than 100 types of cancer, which may affect specific tissues, organs, blood, or lymphatic systems. Cancer remains the leading cause of death in Canada, responsible for about 30% of all deaths in our country.  Many of us have been affected by cancer, either personally, through friends or a loved one. My mom is only one example of how cancer has affected my family, and sadly I have countless other stories of friends and colleagues who have also been impacted.

Cancer and cancer treatment can lead to changes in how we do our daily activities due to physical, cognitive or emotional changes resulting from the diagnosis, resulting surgery, medications, chemo and radiation. For a cancer patient sometimes just doing daily activities leaves little energy for leisure, social, or work-related tasks.  Common side effects of cancer or its treatment include fatigue, pain, weakness, cognitive difficulties, anxiety or depression, and changes in self-esteem or self-image. Each person diagnosed with cancer will experience different challenges in his or her participation in various daily activities and life roles over the course of the disease.

Occupational therapists have knowledge and expertise to allow individuals with cancer to do the things they want and need to do to maintain their level of independence and quality of life. Occupational therapy services are helpful for individuals throughout the continuum of cancer care, including those who are newly diagnosed, undergoing treatment, receiving hospice or palliative care, or who are survivors reintegrating into previous roles. Caregivers also benefit from the training and education provided by OT’s as this arms them with the essential tools to offer support and assistance to their loved ones when performing daily, important, and meaningful activities. Some of the things occupational therapists can help with include:

  • Education on management of activities of daily living (ADLs) such as bathing and dressing through adaptations to the activity and environment, and/or the use of assistive devices.
  • Sleep and fatigue management such as education in and demonstration of energy conservation and relaxation management techniques to support health and the ability to participate in purposeful roles.
  • Cognitive strategies to address memory, organizational executive function deficits, and low-energy tasks that focus on restoring engagement in daily occupations such as sitting in the park, reading a newspaper, or conversing with a friend.
  • Therapeutic exercise and positioning to maintain functional range of motion, mobility, and strength such as home exercise programs, splinting, wheelchair fitting, bed positioning, etc. to provide support and comfort.
  • Mental health treatment to encourage the return to life roles that will help increase mood, reduce depression, restore hope, and lessen anxiety.

Other roles for occupational therapy also include return to work involvement post-treatment, education on general health issues, and training on use of a prosthetic if an amputation was required.  Some therapists are also specifically trained to provide lymphatic drainage to reduce the swelling and pain that can result from the disease, its’ surgery or treatment.

So, for the month of April let’s honor those fighting and remember those that fought.  Buy some daffodils, donate, wear a ribbon, or call or visit with someone you know that has been impacted by this prevalent disease.

References

American Association of Occupational Therapists (2011).

Canadian Cancer Society (2013).

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The Handicapped Parking Police

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

One of my former clients was a teenager when he broke his neck falling out of a truck.  As a result, he was required to use a wheelchair for all mobility.  One day I arrived and he was wearing a t-shirt that said “I am in it for the parking”.

We are all aware of handicap parking spots.  These wider spots are conveniently located at the front of a parking lot, near an entrance to the building, close to a sidewalk with a curb cut, and are typically marked with bright yellow and blue paint or a sign reminding you the spot has special use.

In the news this week I read two very different stories about these parking spaces:

The first  was about a woman who parked in a handicap spot to enter Tim Horton’s.  When she returned to her vehicle she was confronted by a man about her choice of parking spot.  In the altercation she threw her coffee at him.  He recorded the interaction and posted the video online and it went viral – over a million views in a few days.   See the full story here.

The second describes the challenges a young woman frequently faces when using her handicap permit.  Recently she returned to her vehicle to find a note saying “stupidity is not a disability” and has had other similar messages left on her car in the past.  Yet in her case she has a condition that justifies her use of the pass, but the condition is not one that other people can see and thus understand.   See the full story here.

As an occupational therapist that is frequently requested to complete Accessible Parking Permit Applications, let me explain how this works.  To receive a permit, you must complete a Service Ontario application and this needs to be signed by a physician, occupational therapist, nurse, physiotherapist, chiropractor or chiropodist.  The form outlines the types of disabilities that qualify including those that cause mobility, breathing or cardiac impairments, or poor vision.  As some people with significant ailments like these can’t drive, they can still get a permit to be used as a “passenger”.  The professional signing the form is asked to indicate if the condition is “permanent”, “subject to change” or “temporary”.  This allows professionals to indicate that someone with a leg fracture, for example, may only need the pass for three months, or that is it “subject to change” if they have a condition that is likely to improve.  If you are curious about this form, and how it works, you can access it here.

So what happens when you don’t have a permit and you park in a handicap spot?  First of all, in the absence of an urgent situation, you are a jerk.  If caught, the fine is steep at $450.00.  In one article, The Toronto Star reported that the City had issued over 5,000 tickets since 2005 for one particular handicapped spot, totalling $1.9M.  Second, you may be subject to comments, ridicule or confrontation by others who judge you harshly for what most would consider an ignorant decision.  Third, you have just made life a little bit harder for someone that could use a break.  These spots are designed to reduce the physical risk of prolonged walking for people that might not be able to walk far, that might struggle to manage a wheelchair or walker over uneven terrain or a curb, or for those that are at risk of injury or falls when walking outdoors.  For people that struggle to leave the house and have difficulty managing in the community, being able to park close to a store may mean the difference between going out or not.  Your ignorance may reduce their confidence to venture out again.  Shame on you.

And what about the opposite?  What happens when you judge and ridicule someone that has a permit when you, apparently an expert in disability, feels that this is not required?  You are still being a jerk.  Not only are you making someone who already struggles to feel worse about their condition, but you are also passing judgement on the process that is in place to qualify people, including the professional that decided they met the criteria in the first place.  While I can appreciate that some people may feel they are being helpful to “police” these spots, it is important to trust the process and to respect that people may have these permits for reasons that are unseen.  Instead of taking your time to write a degrading note, perhaps consider two other options:

1.      Say nothing, do nothing, and don’t react emotionally.  The situation is none of your business.  If they stole their grandmother’s parking permit to try and skirt the drive-thru, well Karma is a bitch.

2.      Have compassion.  If someone went through the process of getting a pass, then they need it and have struggles that you don’t understand.

Have I ever turned down an application for a parking pass?  Yes, because someone didn’t qualify.  I trust my colleagues also do the same.  And no, my experience is that people with mobility, vision, breathing or heart problems are not “in it for the parking”.