It is always important to remember this time of year the importance of pausing and just enjoying the moments of the season. This blog captures that concept beautifully. It is hard to hit a moving target.
HandsFreeMama.com: No Moving Target December
OT Approved Christmas Gifts
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
If you’re a keen and organized shopper, I’m sure you have the majority of your holiday gifts already purchased, and if you’re anything like my Mother had everything done and wrapped in August! However, if you’re anything like my husband, you are waiting until the 24th to think about Christmas.
Although Santa and his Elves are hard at work building the toys your children put on their Christmas wish list, there may be a few items you still need to purchase.
We consulted our talented team of Pediatric Occupational Therapists and are happy to provide you with some fun but functional gift inspiration. These are gifts that are educational and stimulate child development:
1. BOOKS: Although technically not toys, books make an excellent gift. Fostering a love of reading in children from an early age is essential in development of language and literacy skills, while building creativity and imagination. And so many types of books exist! Beyond regular books, pop-up books, and interactive books, there are even books where you can record your voice, or the voice of a loved one into the story so that person is “reading” to your child. This is great for those people in your life who are out of town and are not able to “read” bedtime stories in person.
2. TOYS THAT MAKE THEM THINK: Look for puzzles, games, shaper sorters, science kits and more. Problem solving through play is fantastic for the mind and will help them become independent problem solvers in life. But be prepared to explore and learn with them. Interactive parent-child time through new learning is also essential to development!
3. TOYS THAT GET THEM MOVING: We’re living in the sedentary age of technology where obesity is on the rise. Try some active toys like a skipping rope, scooter, ride on toy, a bike or winter sports gear like skates, skis or snowshoes. But with all riding toys, include the helmet too! Keeping kids active is extremely important for both their physical and mental health!
4. TOYS THAT BRING OUT THEIR CREATIVE SIDE: Fostering creativity in kids at an early age is important for their development. Looks for gifts that will encourage them to be creative like art kits, dress up clothes or crafts and supplies.
5. AN EXPERIENCE THEY WON’T FORGET: Too many toys to choose from? Why not treat the children to an experience instead. Consider tickets to a sporting event, a play, or musical or a child-appropriate concert. Special events like these create fantastic memories and can strengthen family bonds.
We hope you find some gift inspiration from our tips and with you very Happy Holidays!
HIV/AIDS and OT
Guest Blogger: Samantha Langan, Occupational Therapist
Today people around the world will be wearing red ribbons to support World AIDS Day. This day of recognition started in 1988 to provide people with an opportunity to unite in the fight against Human Immunodeficiency Virus (HIV), show support for those who are living with HIV and to also commemorate those who have died. According to the Joint United Nations Programme on HIV/AIDS, 34 million people were living with HIV worldwide in 2011. In 2012, The Public Health Agency of Canada reported 2062 new cases of HIV, but it is expected that others are also living with the condition, not yet knowing they have been infected. There continues to be many myths and stereotypes around how HIV is transmitted and stigma remains for those living with HIV. Unfortunately, there isn’t yet a cure for this, but the disease is preventable.
Human Immunodeficiency Virus is a virus that attacks our body’s immune system, and over time, weakens our immune system to the point where it can no longer fight off bacteria, viruses, parasites, and even cancers. These diseases, known as opportunistic infections, can progress in the body of a person living with HIV and become what is known as Acquired Immune Deficiency Syndrome, or AIDS. While those living with HIV do experience difficulties, HIV is now considered a long-term chronic illness that can be treated to help prolong and improve quality of life for those living with HIV/AIDS.
HIV is known to health professionals as an “episodic disability”, which means that for people living with the virus, symptoms can fluctuate unpredictably. Some common symptoms include muscle weakness, fatigue, changes in sensation in the hands and feet, decreased concentration and thinking, digestive problems, chronic pain as well as depression or anxiety. As symptoms can vary, people with HIV / AIDS can experience difficulty carrying out everyday activities like taking care of themselves, managing at home and attending work.
Occupational therapists support and empower people with all forms of disabilities and can assist people living with HIV to better manage in their desired activities despite unpredictable and on-going symptoms. In fact, occupational therapists work with those living with HIV by helping them to: manage their energy despite pain and fluctuating symptoms, find ways to adapt to tasks to make them more manageable, obtain devices that can improve safely and independence when completing daily tasks. Occupational therapists can also help people manage the emotional consequences associated with the condition, and can develop strategies to assist with cognitive changes should these exist. Another great way occupational therapists are helping those with HIV is through education and by providing strategies for them to be able to self-manage their disease. This is essential since HIV is a long-term illness. For more information about HIV/AIDS, check out the links below, or talk to an Occupational Therapist about how we help.
Resources
http://www.worldaidsday.org/about-world-aids-day.php
http://www.phac-aspc.gc.ca/aids-sida/publication/survreport/2012/dec/index-eng.php
http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/hiv-vih-eng.php
The Occupation of Sexuality…
Recently on our blog we discussed the important occupation of sexuality in our post: “Occupation Is: Sexuality.” As issues of sexual dysfunction, or impaired intimacy, can be common for people with disabilities, we wanted to share a valuable resource that addresses just that: The Rose Centre. “The Rose Centre is a charitable organization that focuses on positive representations of love sex and disability. We recognize the multiple barriers to participation in love sex and relationships for disabled people and the lack of positive discussion around disability and sexuality. We also believe that sex and relationships can be fun and enjoyable for anyone. The organization provides programming and events which support this mission and that are open and welcoming to everyone.”
We encourage you to check out their programming and use this resource if and when you need it.
Picky Eaters: Making Mealtime Manageable
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
As a mother of four kids, meal times can be stressful. While I raised in the era of “finish everything on your plate”, I realized early that this is not an approach that would work for my family. I think the first time I tried the “eat everything approach” it went something like this:
ME: “Abby, you can eat everything on your plate, or you can go to bed”.
ABBY: “Well, that’s a goodnight” as she pushed her plate away and went to bed at 5pm.
Okay, mission failed. But this and other experiments with Abby over time made me realize that she has some texture sensitivities and what I will call “visual food distortions” that absolutely impact her eating. She cannot manage the texture of most meat (unless greasy) and won’t eat anything that looks like a dog’s breakfast (most casseroles, soups and even lasagna included). She likes some pasta shapes but not others, and most days refuses her favorite omelette because it is…not cooked enough, cooked too much, too golden brown, not flipped properly…yes, some days I think Abby survives on air.
However, while I don’t have the time, patience, or cooking knowledge to cater to the specific food preferences of each of my children, I have developed ways to ensure they are getting their nutrition while making meals slightly different. For example, I can still make pasta, sandwiches, and even meat and vegetables while remembering that within these meals each child is more likely to eat what I have prepared if I make some concessions. Some don’t want sauce so I prepare an extra vegetable, some won’t have cheese so I put yogurt on the side, and some need gravy to manage the texture of their potatoes while others leave them plain. The point is that I know the importance of nutrition, and recognize that if I am willing to be flexible, creative, and marginally accommodating, meal time is more enjoyable for us all.
In keeping with the National Child Day on November 20, I wanted to focus on this important parenting topic of picky eating. With the help of pediatric Occupational Therapist Jana Maich, we wanted to provide education and tools for parents on this important topic as follows:
The act of eating is an important part of the daily routine for both children and adults. In addition to being critical for healthy growth and development, eating is also a social activity and often an important part of the family routine. While it is normal for kids to have certain food preferences and dislikes, having a child who is a picky eater can be very concerning for parents, especially when this “pickiness” leads to food refusal, tantrums, or other behaviours. For these families, preparing meals, enjoying dinner as a family, or going out to eat can be unenjoyable due to the very specific preferences of their picky eaters.
There are varying degrees of severity when it comes to picky eating, ranging from an avoidance of certain textures (e.g. not liking “mushy” foods like bananas) to refusal of entire food groups. In addition to working with a pediatrician and nutritionist, occupational therapists can help to address this common issue. In this blog post I will talk about some of the strategies occupational therapists use to help expand a child’s food repertoire and make mealtime enjoyable again.
First and foremost, remove the pressure! A child should never be forced to eat anything. Forcing a child to consume a certain food item reinforces a negative association with meal time and with food. All meal time experiences should be kept positive to allow for the development of a positive association with food. Keep meal time playful and fun with no coercion or pressure to consume anything. Role model exploration of new foods and talk about foods as you eat them (e.g. “wow this apple is so crunchy and sweet!”) A positive meal time environment creates the necessary foundation for food exploration.
Allow your child to explore new foods on his or her own terms. You know the expression “never play with your food?” Ignore it! Exploring the sensory properties of food is a critical component to becoming comfortable with eating. In fact, a children’s comfort with food follows a sequential progression of sensory acceptance. Broadly, this continuum goes as follows: accepting/tolerating the food on their plate, exploring the food with a utensil (e.g. touching with a fork but not with their hand), smelling the food, touching the food with their hand (or allowing you to touch them with the food), bringing the food to their lips, tasting the food, putting the new food item in their mouth (they may spit it out at this point… that is ok!), chewing the food, and finally swallowing a bite. It can take multiple exposures at each level before a child feels ready to move on to the next step. An occupational therapist can help determine where your child is on this sequence and develop fun, play-based activities to move your child along the continuum.
Set a consistent meal-time routine. A predictable routine prior to and during meals can help ease anxiety about mealtime and positively prepare your child for a meal. For example, set a timer prior to the meal where your child will wash their hands, help set the table, and sit down. Make the routine work for you and your family. Involve your child as much as possible in the preparation and serving of meals as this helps increase exposure and comfort with food.
Introduce changes slowly. Start with your child’s preferred foods and gradually make changes to those. For example, if your child likes pizza try adding a small amount of a vegetable to the sauce. When considering what new food items to try, think about keeping the properties of the new food similar to a preferred food. For example, if your child loves peas, try green beans as they are similar in colour and texture. If presenting something new, don’t overwhelm your child with a large portion of a new or non-preferred food – ensure to always have a preferred food on the plate with the new, non-preferred food to make it less overwhelming. Remember – even if your child doesn’t eat it, the fact that it is on the plate counts as EXPOSURE and is a step in the right direction. If tolerated by your child, try and present a new food with a preferred food at all meals to increase exposure and encourage exploration of new foods.
Most importantly, check your expectations. Expanding a child’s food repertoire is a slow process, as the thought of new foods can actually be very overwhelming and scary for some children. Take it day by day, keep it positive, and take pride in small victories while making sure your child feels proud too!
We hope you find this post helpful! For more insightful parenting tips check out some of our past articles on Children’s Health.
Bathroom Safety
To help provide resources for safety during “Senior’s Safety Week” we want to discuss the most dangerous room in the home: the bathroom. For those with limited mobility, or seniors, it is important to consider the fall risks that exist in the bathroom to ensure that people are safely able to go about daily routines. In this episode we will review bathroom hazards and will discuss the many suggestions an Occupational Therapist may make after a home assessment. These might include mats, bars, lifts, benches or even home modifications – of course the solutions will depend on your condition, age, and the layout of your home.
We hope you enjoy this video from our Occupational Therapy Video (OT-V) series and can use some of our tips to stay safe at home!
Put On Your Own Oxygen Mask First
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
In celebration of National Caregivers Month we wanted to re-share one of our popular caregiving posts:
If you have ever traveled by air you are familiar with the drill. Instructions on how to buckle and unbuckle your seatbelt, where the life vest is located, emergency exits, and “should cabin pressure change, an oxygen mask will fall from the overhead compartment…passengers should always put on his or her own mask before assisting children, or a disabled passenger”.
I read a mommy blog the other day that called this the “airplane example” and the writer related this to how moms should approach motherhood. Ultimately the message is this: as a mom, put your own health first because you are useless to your kids and spouse if you ignore your own needs. Really, you can’t help a child with an emergency escape from a crashing plane if you pass out helping them with their mask.
While I do agree that mothers (and fathers for that matter) need to consider their own needs in providing for the family, this is also true of people that provide care to a disabled person. My experience is that often caregivers do not really “elect” that role. They are not trained to be a caregiver, and really just try to do their best with the skills and resources they possess. However, where many fall short is maintaining their own health and well-being in dedicating their physical and emotional time to another person: a person with challenging and multiple needs. The job of a caregiver is often 24 hours, and resources don’t often permit, nor does the government provide, sufficient relief from this responsibility. Caregivers are often sleep deprived, suffer from muscle and joint pain in fulfilling their role, and can become isolated and depressed due to the changes they have made to take on these new responsibilities. Sound familiar? This very closely mimics motherhood (especially for new moms).
The answer? Put on your own oxygen mask first. What can you do to breathe easier? What helps you to feel clear-headed, energetic and optimistic? What gives you that ability to stay positive, appreciate and take on your responsibilities with some enthusiasm? The answers are often different for all of us. In the end, figuring out how to wear your oxygen mask first requires you to be honest about your abilities and skills, to utilize the resources available, and to ultimately ask for help if this is needed.
And for us health care professionals? We need to be very careful of the responsibilities we place on caregivers. This is especially true in the medical community where we repeatedly discharge people into the care of family, without family really knowing what the responsibilities will entail. As health care providers our responsibility is always to the client, yet we need to take that extra time to check in with the caregiver, talk about how they are coping and managing and if needed, offer them an oxygen mask.
Occupation Is: Sexuality
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Don’t worry, this post is rated G.
Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
So far this month we have slept, gotten out of bed, completed our morning routine, had something to eat, been productive, managed our finances and our home. That’s it, right? Well, not exactly. There is one final piece of “living” that I feel compelled to include.
Sexuality is an incredibly important part of being human. Yet, when we are injured, ill, or suffering from physical, cognitive, emotional or behavioral difficulties, this too can suffer. Many of my clients report a reduced libido, erectile dysfunction, have significant physical barriers to intimacy, or issues with body image post-surgery, amputation, or after gaining weight from inactivity. With lack of sleep, medication side-effects, low mood, and hormonal changes post-trauma, being able to achieve or enjoy intimacy is not always easy.
Believe it or not, but part of Occupational Therapy training includes the occupation of sexual activity. I remember it clearly: I was in my last year of OT school and one of the owners of “Come as You Are” in Toronto was invited to run a lecture on adapted sexuality. When the topic and scope were announced that day, to my surprise, half of the students left before the lecture even started. I suppose not every student was willing to be as open about, and versed in, this sensitive topic. However, I personally found the session extremely helpful. The class openly discussed why sexuality is so important as an occupation, how as future therapists we could be open with clients about this topic without breaking professional boundaries, we reviewed adaptive sexual aids, and also talked about how certain diagnoses impact sexual abilities and how creative positioning can facilitate participation.
Recently, I had a client with a spinal cord injury attend a session at Lyndhurst on sexuality and intimacy. She found the session extremely helpful. The session was hosted by two OT’s and some spinal cord injury survivors. During the session, the OT’s demonstrated how they have been able to creatively adapt different sexual tools so they could be used by people with physical limitations to participation. Other topics around the psychology of intimacy and positioning were also covered, and my client found the session extremely helpful. I also am aware of the information on both sexuality and fertility for people with spinal cord injury at SCI-U. Of course, this topic stretches far beyond just spinal cord injury, and every diagnosis and problem to sexual participation needs to be treated uniquely. Also, while OT’s can address barriers to sexual activity from a functional perspective, often medical and psychological intervention is also needed to help people return to their previous “normal”.
So, if you have issues with sexuality after an injury or illness, know that OT’s can help with this too. After all, we consider sexuality to be an important occupation.
Check out more posts from our “Occupation Is” series.
Occupation Is: Managing a Household
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
Let’s just assume that we have done all the important stuff. We have slept, are out of bed, groomed, dressed, fed, are done being productive, and did some fun stuff in between. Eventually, like it or not, we need to tackle the not-fun stuff.
The interesting thing about “not-fun stuff” is that everyone defines this so differently. Each of us has our own unique interests, abilities, and standards when it comes to groceries, laundry, cleaning and managing our yard and property. Personally, I loathe grocery shopping (and anything that is meal preparation) and would rather cut the lawn then use a vacuum. My kids do their own laundry as of age 10 because it has a wonderful built in consequence. No laundry = no clothes to wear and I don’t need to say a thing. Besides, I don’t think asking them to start doing this at 16 will go as well. With six of us in our house, and two animals, the meal responsibilities, cleaning, and shopping tasks are time consuming. However, all off these things are another layer in my lasagna of “occupations”.
Imagine you are in a car accident and spend a few weeks in hospital. Your spouse, friend, mother, brother, someone, has to swoop in and help with your children, pets or house. Eventually you come home and find that things have not been done to your standards, if done at all, and it will be months before you will have the ability to get back to these tasks independently. The look of your home and property is stressful for you, the meals are different, and you are home all day to notice. Or maybe you weren’t in a car accident, but have a progressive illness or medical condition that renders you to be no longer able to complete heavier tasks, but you try diligently to manage the smaller tasks within your abilities but this too is now declining. Perhaps you have sustained a brain injury and your memory is lacking for when things were last accomplished, or when you try to go to the store you end up missing half of the items on your list, if you even take one. Or worse, the store is an overwhelming place for you considering the visual and auditory stressors from any busy shopping environment. Maybe mood is the problem: depression and anxiety can be significant barriers to getting things done, but yet the more things are not done, the more depressed and anxious you become. The cycle continues.
Managing a household and all the tasks included in this, is very much an occupation. It is a separate set of demands from personal care, earning an income, or managing our productive time. Occupational therapists routinely help clients to return to the occupation that is managing a home. There are multiple strategies that can be used for people with brain injuries, chronic pain, or social phobias to return successfully to grocery shopping. There are also multiple aids available that makes light and heavy cleaning easier. We often need to help people break down tasks into smaller chunks, or educate people on pacing as a means to get things accomplished. Education on proper body mechanics is also very useful at reducing strain on recovering shoulders, necks and backs for things like lifting, carrying, reaching, and bending. Outdoor tasks are more difficult to resume, simply because they are heavier, but many of the same principles apply. If behavior, mood or avoidance are the problem, we have strategies and tools to help with that also. We believe that most functional problems have a solution.
Occupations are therefore all the things included in managing your home. These tasks can be heavy, time consuming, and “not-fun”, but they are a necessary part of living. If you are struggling to get these things done, or know someone else who is, occupational therapy can help.
Check out more posts from our “Occupation Is” series.
Occupation Is: Managing Your Finances
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
It is no secret that there are physical, mental and emotional consequences of stress. Access to money is a basic human need as food, shelter, and emotional security are all impacted by our ability to provide for ourselves and our family. As such, the stress created from a lack of money, or drastic and sudden loss of income, is significant. In the economic crisis of 2008, there was mounting evidence that financial issues were causing a whole host of associated health problems including a rise in reports of headaches, backaches, ulcers, increased blood pressure, depression and anxiety (http://www.frbsf.org/community-development/files/choi.pdf). Therefore, it is no secret that financial security is a determinant of health.
I can say that 100% of my clients suffer from financial problems after their traumatic event. How could you not? If you think your income is “insured” against illness or disability, check again. If you are fortunate you have private disability or health coverage. Or, you might have a good short or long term disability plan at work and in that case, you might get 80% of your income covered at the time of claim. However, this usually only lasts for two years before the “test” changes and most people find their income loss benefits end. In the world of auto insurance, without other coverage, the maximum income replacement is $400 / week, regardless of what you made before (unless you “bought up” which no one does). And just think – three years ago the Financial Services Commission of Ontario wanted to lower this to $300 / week to put more money back in the pockets of insurers. Could you live on $1200 / month? I digress…
So, you are in an accident, suffer an illness or can no longer work. How will you manage? How will you be able to afford the medications you are now required to take (these aren’t covered 100% either folks), the equipment you need (the government might fund 75% for some items, but when a prosthetic limb is $60,000 that is still a lot out of pocket), the treatment you require (even with extended benefits, $350 in PT won’t get you very far), and your regular expenses that won’t dwindle unless you make major lifestyle changes? The answer is stress, worry, concern, sleepless nights, borrowing, illegal activity, and brutal attempts to unsafely return to work because you “have to”.
Believe it or not, managing your finances is what we call another “occupation”. Working with an occupational therapist, a disabled person can create a new budget around the change in income, get support to make decisions about spending, and gain access to other potential sources of financial support. Perhaps you qualify for the Disability Tax Credit, or the Registered Disability Savings Plan? Maybe you need to apply for the Ontario Disability Support Program, or can access funding for devices through the Assistive Devices Program? Perhaps your home modifications qualify for the new Tax Credit, or you can apply to the March of Dimes under their Home and Vehicle Modification Program? Maybe without other coverage the local Community Care Access Center can provide you with home care, treatment or equipment? Can your medications be covered by Trillium? Are you maximizing the coverage available to you under auto insurance policy or work benefits? Is there a local food bank, or disabled transportation program? These are all things we look at.
Then of course, there is the process of returning to work. What if you cannot manage the demands of your previous job or this is no longer available to you based on a long absence? Perhaps the jobs you are trained for no longer match your abilities? Occupational therapists can help with identifying previous job demands, outlining new job interests, and comparing these to the abilities you have. We can set up structured work programs, gradual re-entry plans, and connect you with people and programs in the community that help people get back into the work force.
Occupation is managing your finances and making sure you can get by. If this is impacted by a disability, Occupational Therapists’ treat that.
Check out previous posts from our “Occupation Is” series.