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Archive for category: Occupational Therapy At Work

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Occupational Therapy and Autism

According to Autism Speaks, Autism now affects 1 in 88 children and 1 in 54 boys. The 2012 numbers reflect a 78% increase in reported prevalence in the last 6 years.  This is a growing problem, impacting more and more families each year.

Autism is a spectrum disorder, meaning that the signs, symptoms and severity can vary, making this difficult to diagnose and sometimes treat.  Yet through therapy, children with Autism can learn to function and communicate as independently as possible at home, school and with their peers.  The following from WebMD discusses the vital role Occupational Therapy plays in helping those with Autism.

This Saturday, April 2nd, is World Autism Day.  Take the pledge to Light it Up Blue for Autism.

WebMD:  Benefits of Occupational Therapy for Autism

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Money Matters – Occupational Therapy and Disability Finance

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

One very important subject that affects 100% of the clients I see is financial stress.

We all have been advised to save money for a “rainy day”, but the harsh reality is that people generally can’t or don’t.  And there is a huge difference between saving money to replace an appliance, or car, and saving for the costs that might be associated with ill health.  Yet, I can tell you first hand that the cost of disability is significant and comes from lost work time, medications, equipment, costs of personal care, and therapy to name a few.  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!

Occupational Therapy fits into the problem of disability and money in two ways.  First, we are often involved in quantifying injury and loss into a Future Cost of Care Report, and second, we provide direct treatment to help people manage their finances more effectively.

A Future Cost of Care Report, or Life Care Plan is the process of and calculating the current and future costs associated with your disability.  This report is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research.  The report provides an organized, concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health needs.  This includes children born with a disability or anyone that acquires a disability, ailment or impairment over their lifetime.  Most often used in medical-legal domains, these are also helpful for families that are working to quantify costs to help someone with a disability to have funding for their future.

From a treatment perspective, occupational therapists are also involved in helping people to re-balance their financial situation, or to reduce the risks and consequences of poorly coping in the face of money problems.  We work with people to establish budgets, to understand and track spending habits, to link the person to their money behavior, to help people develop a plan for better money management, to achieve financial goals, and to prioritize spending to ensure key expenses are not overlooked.  When people become stressed, anxious and depressed we treat those symptoms too and provide strategies and solutions to help people reduce their concerns and reengage in productive activities.

Occupational therapists are also well networked and help connect clients to a banker, creditor, financial advisor or financial social worker.  We might introduce them to tax or savings programs that will help them to recoup expenses or budget for future costs, and often help them to complete and submit the required paperwork to expedite access to public resources.  We are aware of funding programs in the community that can help bridge expenses and income, can fund home modifications, equipment or therapy, or can direct people to community programs that can support them for food, shelter, or other living essentials.

Occupational therapists recognize the significant impact that money problems can have on someone’s recovery and understand that if someone does not have food, shelter or safety, few other goals can or will be achieved.

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Accessibility — There’s an App For That!

Check out the great new app, Access Now, created by Maayan Ziv, a young photographer and entrepreneur from Toronto who lives with muscular dystrophy.  Maayan created Access Now to help others learn about access to places across the world.  Anyone can use the app to search and learn about the accessibility offered at public spaces and to post and share information about the accessibility of places you have visited.  Check it out now!

Access Now

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OT Helps Develop Fine Motor Skills

A common reason that parents seek OT treatment for their child is because their child demonstrates problems with fine motor skills beyond just printing difficulties.

Fine motor skills involve the use of smaller muscles in the hands.  Children with fine motor skill deficits often will have difficulties printing, managing zippers, laces, or buttons, picking up small objects, are messy when eating or coloring, and struggle to use scissors or to manipulate parts of small toys.  It is important that these skills are developed to promote independence and self-esteem in children is as they age.

In the following video from our OT-V series, we discuss some of the ways OT’s help children develop these important fine motor skills.

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Ouch! The Occupational Therapy Role with Chronic Pain

Guest Blogger Jessica VandenBussche, 2015

Pain is a common occurrence following an injury, illness, or traumatic event like a motor vehicle accident. While pain does play an important role in alerting us to potential dangers, injury, or an impending problem, it can also become a significant barrier to function as it can often continue long after the dangerous situation resolves.  Our brain can also change such that the pain message gets so used to being sent, these can start being sent faster and easier, even in non-threatening situations.

Chronic pain is difficult to treat and manage because of all the different factors that contribute to its intensity, frequency, and the many variables that can make it better or worse. Stress, depression, feelings of loss of control, pressures at work or home, and other mental or emotional factors affect pain perception.  Further, currently, there is no objective way for medicine to quantify pain which can make it even more difficult to measure, treat, and to understand the pain experience that varies between people.

The experience of pain then remains subjective.  And as this changes frequently under the presence of other factors such as secondary injury, low mood, stress, and other environmental pressures, pain can still increase even in the face of conservative therapeutic or medical management.  Whether or not tissue damage is found, it is difficult for someone who is experiencing pain to complete activities of daily life and to fulfill the roles that make them who they are (e.g. mother, father, worker, student, athlete).  For any of us that lose the ability to manage in an important life role, this can cause significant mental and emotional losses and anguish.  If the change in roles is sustained for too long without resolution, people can develop an altered sense of self, causing more psychological hardship which can lead to higher perceptions of pain.  Then the cycle continues.  The current best practice for addressing chronic pain is a multi-method approach that addresses mental, physical and emotional issues plus the effect of pain on daily function, roles, and identity.

Occupational Therapists play a pivotal role in the assessment and treatment of physical and psycho-emotional issues including chronic pain. Through our involvement, we analyze function, work to provide solutions and help break the pain-disability cycle.  We connect people to other providers that are necessary and impactful members of the treatment team.  Occupational therapists are also well-versed in strategies to help people sleep better, move differently, and adapt to disability to reduce the limitations that result from any condition, including pain.

In short, any injury, including a car accident, can cause pain. Whether this pain is primarily physical or emotional, visible or invisible, it is important to remember that the pain experience is real and can be debilitating.  Occupational therapists are qualified to identify the psychological, cognitive and physical needs of the individual and to provide treatment to improve function in daily activities. With appropriate treatment, pain and daily function can improve, helping the individual participate in meaningful activities and to regain or maintain their sense of self.

Useful Resources

Michael G. DeGroote Pain Clinic (Formerly Chedoke Chronic Pain Management Unit), treatment option for multidimensional approach to chronic pain

The American Academy of Pain Medicine, videos to understand pain, its reasons and its effects

Entwistle Power Occupational Therapy:  Chronic Pain a Problem?  Try OT

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Travelling With Disabilities

Travelling with a disability is not easy.  It requires planning, a supportive attendant, and an open mind.  March break is around the corner and for months my clients have been asking me about travelling with a disability.  Here are some pointers:

1.    Book the trip with a travel agent who specializes in disability, either by interest or circumstance (some have disabilities themselves), if you can.  These agents understand that “accessibility” is not an inclusive term, and with personal experience, or feedback from other patrons, they can customize the trip to meet the needs of your unique situation.  Check out www.accessholidays.ca as an example.

2.    Planning goes a long way.  Send pictures of your equipment, measurements, and get pictures and measurements in return.  Disclose the nature of your disability if you are comfortable with that, and be clear about what you can and cannot do.

3.    Travel with an attendant.  On a trip to Alaska there was a man from our town also on the boat who had a mobility impairment.  He did not have an attendant with him and was constantly asking other patrons to help him.  They were willing to comply, but at times his needs were not met, and it would have been best for him and the other travellers if he had someone with him who understood these and was trained to assist him with the same.

4.    Look at all your equipment options.  Can you rent something smaller or lighter that might be easier to lift, will fit into narrower places, or can you rent devices when you arrive?  I just provided a client with photos of devices, different from the ones he uses daily, that he could consider renting to facilitate his upcoming overnight to a waterpark with his children.

5.    Become informed.  Check out these government resources. Did you know that in Canada, if you have a disability and are flying domestically, you may be eligible for extra seating, support, or your attendant can fly for free? Learn more from Westjet.  Or that Easter Seals offers a Disability Travel Card for buses and trains?  Also, if you have a disability and require someone to assist you through an airport to the gate, or at the gate through security and customs, there are special passes that can be obtained for this.  In Florida there is a rehabilitation program for people with spinal cord injuries that includes “project airport” and this takes wheelchair uses through an airport, onto a plane, and helps them understand how they can successfully manage this despite a physical impairment.  Many magazines (Abilities for one) often has articles on accessible travel and these highlight many different places that are great to visit, and some of the things to think about before you leave or when you arrive.

6.    Talk to an Occupational Therapist.  Occupational therapists have a wealth of knowledge about how people with different conditions can adapt their environment or equipment to manage.  Consider seeking our expertise if you are embarking on a journey outside of your typical space.  Together we can discuss strategies and solutions that can help ensure your vacation is successful.

Safe travels!

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Hoarding and Decluttering: 10 Suggestions to Free your Home and Mind

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

We all have keepsakes that are difficult to throw away. Personally, I still have a bag of stuffed animals from when I was a kid (downsized from the four garbage bags of stuffies I had when I got married), and also have a box called “sentimental stuff” that is filled with cards, letters, and keepsakes that I just can’t emotionally part with (poems from my great-grandmother, the last card my grandparents sent me before they passed away, etc).

While these items and “stuff” may be taking up some closet space, they do not significantly affect my ability to function.  That is when being a “pack rat” can cross a line and refers to the subset of the population whose life is significantly impacted from ‘stuff’ building up in their homes. In 2013 “hoarding disorder” officially became a clinical diagnosis, and it is estimated to affect 3-5% of the population.

Hoarding is defined as “persistent difficulty discarding or parting with possessions, regardless of the value others may attribute to these possessions. People with this problem accumulate a large number of possessions that often fill up or clutter active living areas of the home or workplace to the extent that their intended use is no longer possible” (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).

This is a real disorder that has a negative impact on an individual’s emotional, physical, social, financial and even legal aspects of life. Hoarding can get in the way of a person’s ability to participate in daily meaningful occupations, which can result in a deterioration in health and wellness.

It is important for individuals struggling with hoarding to seek treatment. The two current “best treatments” for hoarding disorder are pharmacological and cognitive behavioral therapy (CBT). CBT recognizes that a person’s thoughts and feelings and behaviors are interconnected and influence one another. Occupational Therapists can use CBT to help someone with hoarding disorder address their disruptive thoughts and feelings to decrease the behavior of hoarding.

While the majority of the population does not struggle from hoarding disorder, the build-up of clutter in a home can sneak up on all of us, and lead to negative consequences such as a disorganized home, feeling discouraged and overwhelmed, and the frustration of misplacing or taking time to find items, to name a few. Here are some unique ways to decrease clutter in the home:

1. Start with 5 minutes. It can be overwhelming to start the process of decluttering, therefore, start with 5 minutes a day and be satisfied with your accomplishments at the end of this time.

2. Give one item away every day for a year. Check out www.365lessthings.com, a blog about a woman who gives away one item a day.

3. Start by filling one bag. Whether it is a donation bag or a trash bag see how quickly you can fill one bag of items to give away or throw out.

4. Do the “Closet Hanger Experiment”. Hang all your clothes with hangers in one direction. After you wear an item replace the hanger in the closet facing the other way. After one year throw away all the clothes on hangers facing the original side – you did not wear these items for a whole year!

5. Do the “12-12-12” challenge. Find 12 things to throw out, 12 things to donate and 12 things to be returned to their proper place in your home.

6. Use the “Four-Box Method”. Systematically go through each room in the house and assign every item to one of four boxes: trash, give away, keep, or relocate. Every item must be assigned something! Remember – you do not have to do this all at once, take your time to go through each room!

7. Make a list and set a time. Make a list of areas in your house you want to clean/declutter then set a time for each one (i.e. 10 minutes, 20 minutes, 40 minutes). Start with the first thing on the list and then STOP when time is up. If you did not finish that area within the given time, set a new time and try again later!

8. Try the “Travelers Method”. Think about how small a suitcase is and how you have to prioritize items when packing for a trip. Use the same mindset when decluttering.

9. Rearrange the room. Every few months rearrange furniture in major rooms (i.e. couches, desks, shelves). This will force you to find the junk that has been collecting throughout your home.

10. Play “Musical Chairs” with your closet. Remove all your clothes and hangers from the closet. Take away 5-10 hangers. Start to put your clothes back one at a time, each time assessing whether to keep the clothing item. STOP once you run out of hangers and donate remaining clothes.

A few other useful tips can include calling a friend to come to help – then reciprocate the offer, or call for a free pick-up of household items and once this is on the calendar make sure you fill a box to donate!  Diabetes and Cerebral Palsy are a few local (Ontario) programs that turn your unneeded items into charity.

Decluttering can seem like a daunting process, but using these strategies, and setting small attainable goals, can help you have a peaceful, clutter-free home and mind!

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How’s Your Posture?

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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OT Can Help with Visual Impairment

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

My grandmother is legally blind.  She first lost her hearing in her 60’s but managed this well with hearing aids and the ability to lip read.  She also learned some sign language.  Then, in her 70’s, her sight also started to fail her.  This progressed until she was left with what she calls “cheese cloth” and shadow vision in her right eye and minimal, if any, vision in her left.  While adjusting to failing sight was of course difficult for her, adjusting to also losing the ability to lip read and communicate with people was an even bigger challenge.  She had always used her vision to compensate for her hearing loss and this was no longer an option.

As an occupational therapist I have worked with people who have low vision, and can say that no two people will experience this the same.  First of all, vision loss, and legal blindness, do not mean total blindness, so the first step is always trying to understand what people can see and the ways their vision continues to work (or not) for them.   This of course involves multiple professionals, but as occupational therapy is about “function” we need to look at how their vision works, and doesn’t work, in the environments in which they live and access.

Of course, safety is always the primary concern when dealing with vision loss.  Safety in the home involves looking at fall risk, ease of mobility, cooking and meal preparation, and of course the ability to respond to an emergency.  In the community this involves how someone with vision loss can negotiate roads and streets, manage around other people, complete paperwork at stores and offices, and avoid compromising situations such as becoming victimized or managing money transactions.  Transportation is also an issue and getting from A to B usually involves the use of an attendant, taxi, or walking via a service dog or with the use of a white cane (which is mainly used to notify others of a visual impairment and to detect obstacles).

So as an occupational therapist, what type of strategies do we employ?  Well, of course it will vary depending on the amount of vision someone has and of course the functional tasks they want to achieve.  But here are the main ways we help:

Sleep – insomnia is a significant problem for people with vision loss.  Lack of sight can impact the sleep / wake cycle and restlessness is a common problem.  Yet, with poor sleep comes poor physical, emotional and cognitive function in the days following so addressing sleep issues is very important.  For this we can help by suggesting sleep and relaxation CD’s, mindfulness methods to reduce anxiety and mental unrest, and positioning aids to promote comfort.  Helping people to creating predictable sleep / wake cycles is also important.  Some audiobooks are also helpful provided they promote cognitive rest, and not cognitive stimulation.  We also discourage television or computer use, or listening to news or world events before bed as this can also stimulate the mind making sleep more difficult.

Personal Care – it is very important that someone with a visual impairment have a consistent personal care routine.  This helps to promote sleep / wake cycles and keeps the body on a predictable schedule.  The bathroom can be a very unsafe place if equipment is not provided to ensure transfers in / out of the shower or tub are safe, it is easy to get on / off the toilet without grabbing the towel rack, and to prevent falls that can be common in this space.  Organization is key to ensuring that the individual can find the items they need when they need them, without unnecessary and timely searching.  Lighting and contrast on bottles or counters, and using shapes to identify objects is helpful.

Cooking – there are many ways to address function in the kitchen, but the main ingredient is always organization.  People with visual impairment need things to be consistently placed where they expect to find them.  Their ability to search and locate is impaired, and thus it is inefficient (and unsafe) for them to be rummaging through drawers or cupboards to find cooking utensils or other items.  Color contrast is also important.  Using tape, foam, Dycem, stickers, markers, or even shelf paper we can adjust surfaces to promote contrast or to re-label items in larger print.  Items can also be purchased in different colors or shapes, depending on what is easier for the individual to see.  There are several other devices and tools that can also be used to help someone with a visual impairment to know when they have filled a pot or glass, to know the buttons on the microwave, to more safely chop or cut, and lighting in the space is very important (but note that too bright and too dark can both be problematic).

Technology – there are many technology aids and devices that can promote the function of someone who is visually impaired.  Voice recognition software, text to talk technology, closed circuit readers, and Siri-managed phones and tablets.  Using a computer, someone who is visually impaired can order groceries online, do their banking, shop, communicate with others, read the paper, and interact with the world.  This allows them to function in needed and purposeful ways, but safely and independently.

As you can tell, most of these suggestions involve the environment and modifying this to promote function.  That is really the heart of occupational therapy – if we can’t change the person or the impairments they experience, we can at least adjust their environment to accommodate their needs, compensate for any deficits and promote independence.  But this of course also requires the by-in from other people using the space as without the entire family on board, the strategies could get lost after implementation.

My grandmother functions extremely well for someone with both hearing and vision loss.  She is probably the smartest person I know at 88 years old.  I fully believe that she now compensates for her deficits with her extremely sharp mind that allows her to retain and remember everything.  As my dad says “she is blind in one eye and sharp as a tack in the other”.  She is an inspiration and has managed to adjust to some significant challenges in her later years.  However, I do get concerned when I visit and she wants me to read her scale so she knows how much she weighs.  I always ask her what she wants to hear and her response is something along the lines of “you are a rotten kid”…something her and my grandfather always called me – especially when I took a quarter off them playing cribbage.

 

Originally posted February 2015