Archive for category: Occupational Therapy At Work


Occupation Is: Doing Fun Stuff

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, what are your plans after work?  How do you like to spend your evenings?  What do you do for fun?  Given the choice, how do you spend free time?  While being productive is essential for the human psyche, so is being unproductive.  Well, sort of, because even a lack of productivity is productive.  Deep, I know.

Personally, I love a good funny movie, dinner with friends, time with nature, getting out with my kids, exercising, playing sports, reading, blogging, and going on vacation.  Those are my “fun”.  For others, this could be creative hobbies or outlets, museums, live theatre or music, antiquing, collecting, photography, being online, or a thousand other things that I don’t even know exist.

So what if I was injured, suffered from a mental health problem, have a medical issue, or brain injury?  Perhaps I would lack the ability to sit through a movie, or could no longer understand the nuances of humor.  Maybe my personality would change and my friends would have a hard time relating to the “new me”.  Or, I could no longer physically handle my nature walks, exercising or playing sports.  If my vision was impaired, I could not read anymore.  If I struggled with cognitive communication, or attention problems, putting together a blog article might also be off the table.  And vacations?  Those are incredibly difficult to plan and organize at the best of times.

Occupational therapists are very skilled at helping people resume the occupation of fun.  There are multiple ways we do this, as we recognize that our “fun” defines much of who we are, and why we work so hard in the first place.  For example, if I had to rehab myself from the problems above, I might start with suggesting sit-coms as these require less physical tolerances for sitting, and a shorter attention span.  I could view these with another person, and discuss the humor, sarcasm, and recall the best one liners.  Perhaps I would need education and support to understand how my personality changes are impacting my relationships, so I can try to make some changes.  If my physical abilities were limited, my OT could help me find new ways to enjoy nature (bird watching, photography as examples), and could help me discover new sports and forms of exercise within my abilities (yoga, Tai Chi, and many modified sports have become very popular for people with disabilities).  If I can’t read a standard book, maybe I could use an iPad or e-reader so I can change the font size, or switch to audio-books.  For my blogs, I could learn new ways to move from a blog idea to a full article, by breaking down the topic into paragraphs or chunks, or learning how to dictate if written communication is my challenge.  Vacations could take the form of day trips, short overnights, and eventually out of the country through the help of a travel agent that specializes in planning accessible vacations.  I would probably learn that in Canada my attendant can fly for free (with approved paperwork), and that many places (Disney included) are highly accessible.

So if a disability is stopping you from enjoying the occupation of fun, OT’s treat that.


Occupational Therapy Works: Ask For It!


This October, Occupational Therapy Month, the Canadian Association of Occupational Therapists (CAOT) is kicking off a national campaign to increase exposure about the benefits of OT and asking the public to help make OT more accessible to all.  CAOT is asking you to “ask for OT” to your doctors, health insurance companies and employers.  The following link from CAOT shows how OT can help you or someone you care about.  Check it out and don’t be afraid to “Ask For It!”

CAOT: How Does OT Help?



Occupation Is: Productivity

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 we have slept, gotten up, groomed, dressed and in the last post consumed some food.  Now what?  Well, this is where the rubber meets the road and we get to be productive.  But let’s not put productivity in the “job” box.  There are a multitude of ways that people spend their time during the day, all equally important.

For those of us that “work” (in a paid capacity), this often dictates when we leave the house, and requires some kind of commute.  When we arrive we need to negotiate our way to where we need to be and the next eight hours (or more) are determined largely by the demands and requirements of others.  If we don’t work for money, perhaps our form of meaningful activity is child care, or care giving in general.  Parents with disabled kids, or adults with disabled parents, spend a considerable amount of time in this capacity.  Maybe we volunteer and that fills our day.  For children, meaningful and productive activity are in the form of play or school.  For young adults, this too is often education, socializing, or a job that is part time with varying hours.  Some people spend their day on hobbies, sports, or exploring creative outlets that are “free time”.  Some enjoy reading, and others watching television, going online, or managing the affairs of a household (errands, housekeeping, meals etc).

So you can imagine the issues that are created by a disability.  What if you can’t drive, or tolerate public transit and now you are unable to get to work.  Some disabilities extend the time required to complete a morning routine, and people with these problems are not able to get anywhere before 10am.  Maybe you can get to work (and on time) but your office is not accessible, or your job requires abilities you no longer possess.  Or if you suffer from significant fatigue, maybe being able to manage a full day, or the stresses of working, are an ongoing struggle.  In your role as caregiver you are required to engage in physical activities of lifting or transferring, or this requires emotional stamina that you no longer have.  As a volunteer you defined yourself by the way you were “giving back” and now this has changed.  You are left feeling disappointed, discouraged and need to find a new purpose.  For children that cannot play and explore their world, they need to learn alternative ways to negotiate and learn from their environment.  Or, if productivity is in the form of other outlets, visual, hearing, dexterity or mobility problems can limit one’s ability to engage in those passions.  Sometimes, productivity is hindered by many things, including physical, cognitive, and emotional and the barriers in each domain need to be analyzed before problems can be solved.

Again, this is all occupational therapy.  For example, when my visually and hearing impaired grandmother was having back problems, I was able to align this with her “productivity” which consists of sporadic computer use and occasional television (both modified to meet her needs).  What we discovered was that her significant leaning into the screens to “see” was the root of her problem.  We were able to bring her computer monitor closer to her face, make changes to her computer chair, and later designed a cabinet that allowed her to get under the units to prevent leaning. Or, for another client that suffered from significant mental illness, we were able to making significant rehabilitation headway by first re-engaging her in her previous passion for making stained glass.  For another client, a business owner, his treatment took the form of setting up guidelines, systems and processes at work that reduced distractions and interruptions so he could effectively work through and resolve priority items.  But my favorite story is helping a friend with his neck pain by watching him use his computer.  I just told him to stop being a chicken pecker and to learn how to type.  Voila, neck pain gone!

The bottom line is that feeling productive and being productive are two of the most important aspects of the human psyche.  Just knock something off your “to do list” and see how that feels.  To become unable to be productive by virtue of physical, cognitive, emotional or behavioral problems creates a long list of secondary disability that is equally, or even more, damaging than the primary disability in the first place.  Productivity following an accident or illness often takes new forms – and modifying ways to play, go to school, work, volunteer, or engage in other meaningful tasks is at the forefront of occupational therapy.  Problems with productivity?  OT’s treat that.


Occupation Is: Eating

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, we have slept, are out of bed, groomed and dressed.  Now what?  Typically we head to the kitchen to grab something to eat.  Admittedly, I am a terrible cook.  And on top of this I am leery of ready-made foods, and think the microwave is the root of all cancer.  So, let’s just say I struggle with everything that is meal preparation.  Many of my clients struggle with this also, but for much more legitimate reasons…

For most of us, breakfast is typically simple.  Cereal, toast, maybe eggs, pancakes, granola or fruit.  Lunch slightly more complicated, and dinner is an effort.  So what if you have a brain injury and have difficulty planning meals?  Or, you cannot drive, or can no longer access public transit so you have problems getting items at the store?  Maybe you are on a strict budget and can only get food from a food bank.  Perhaps you have food in the house, but your appetite is supressed from medication, depression, or some other physiological or mental illness.  The dishes might be too heavy to lift if you have upper extremity problems, or you have one hand you can’t use at all which makes cutting, peeling, and carrying heavy pots very difficult.  If you have a special diet, or cannot consume foods by mouth, meals take on another form – pureed, soft, smoothies, Ensure, or even through a feeding tube.  If the meal is made, perhaps you just can’t carry it to the table as you use a wheelchair, or cane, and the last time you tried the meal ended up on the floor.  If you have tremors, shakes or dizziness, walking carrying anything is a challenge.  Once you are at the table with your food, an upper extremity or visual problem might make it hard to get the food onto the fork, spoon, or into your mouth.  Chewing could be another problem if you have oral-motor difficulties.  Then you have to swallow and choking or aspiration are possible.

Occupational therapy treats all that.  We provide strategies and supports to enable shopping, and aids that might help get the groceries into the car, into the house, and into the cupboard, fridge or freezer.  Or to improve memory we can help to set up systems that enable people to shop efficiently and effectively, including meal planning, creation of lists, mapping out products in isles, and providing strategies on ways to prevent visual and auditory overload common to most stores.  When cooking, occupational therapists look at safety around appliances, provide strategies to reduce bending, standing, or reaching, or even aids to reduce bilateral (two-handed) tasks if necessary.  If there are dietary concerns, occupational therapy can provide aids and education, and can work with a speech therapist or dietitian to make people are able to manage nutritional needs.  If there are negative eating behaviors, we can treat that through cognitive and behavioral therapy, tracking, and helping people access other resources and programs.  For consuming food, there are several devices that we can use to address a visual-perceptual neglect, a dominant hand impairment, and train people how to eat with a prosthetic.  We can make customized utensils and splints to bridge the gap between a hand and mouth if the two can’t connect.

Spoken quite simply – occupation is everything that is eating: from planning what to eat, getting the food from the store to the house, preparing this safely, and making sure the food meets the mouth, or the stomach.  If these things are a challenge for you, occupational therapists treat that.


Occupation Is: Managing Toileting, Grooming, Showering and Dressing

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.

Okay, so you are up, out of bed, heading to the bathroom.  “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.

Assume you have reached the bathroom.  What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level?  Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently?  What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself?  You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin.  Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair.  If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror.  Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place.

Maybe you have managed to do your grooming, toileting and washing.  What if you can’t get dressed?  Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom.  Or, your clothes are not clean because you lack the ability to do so.  Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility.  Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?

Occupation is all of that, and these things are addressed in occupational therapy.  If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catherizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories.  Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility.  What if the commode you do have won’t fit over the toilet, or even through the bathroom door?  If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives.  Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head.  Maybe the shampoo and soap bottles need to be changed or relocated.  A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence.  Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body.  No motivation to do these things in the first place?   Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines.

Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.


Occupation Is: Getting out of bed in the morning

In celebration of Occupational Therapy Month, I am spending October defining the word “occupation”. Why? Because, contrary to the traditional understanding of the word, occupational therapists define this differently. For us, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for this month, I will explore the journey of “occupation” complete from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

I assume the routine for most of us is the same. Morning hits, we hear the alarm clock, snooze it a few times, and eventually swing our legs over the bed, stand, stretch and head to the washroom. Sounds easy, right? But what if it isn’t?

What if you have had a terrible sleep? Perhaps you live with chronic pain and cannot get comfortable in your bed. Or, you have an acute injury and are trying to sleep on broken ribs, while wearing a cast or sling, or with bruises, scrapes, or swollen body parts. Maybe you live with anxiety, depression, or have trouble controlling your thoughts when you try to drift off. You have restless legs, or are on medication that makes you sleep too much, or causes insomnia. You are worried about something, someone, or have a child, spouse, or family member in your home that might need you during the night. Tomorrow is a big day and you are excited or nervous. You have neighbors that are too loud, or are spending the night in a shelter because you have nowhere else to go. Really, obtaining a restful sleep is actually difficult.

Assuming you have slept, and recognize the alarm is going off, what if you can’t just “throw your legs over the bed, stand and stretch”. Then what? Do you have or need support or devices to make the transition from lying to sitting, from sitting to standing, to a walker, cane or onto a wheelchair or commode? Perhaps your depression or anxiety makes it extremely difficult to transition out of bed to face the day, or to start your morning routine. Maybe you need to stay in bed for an extra hour because the amount of sleep you got just won’t cut it for challenges that day will bring.

Occupation is all of that and as such, these things are addressed in occupational therapy. Why are you not sleeping? Can we assist you to obtain a better sleep surface? Can we educate you on how to obtain a restful sleep position by suggesting changes to how you are lying, or through the use of pillows or wedges? Can we help you to shut your mind off through progressive muscle relaxation, meditation, natural sleep remedies, or by assisting you to obtain medical assessment and intervention? Can we aid in reducing your stress such that you are more at ease when trying to fall asleep, or so you won’t wake as much during the night? If you are sleeping through your alarm, or can’t motivate yourself out of bed in the morning, perhaps we can provide you with cognitive and behavioral strategies to re-frame that process to enhance your success. If

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there are physical barriers to positioning in bed, sitting, transferring or standing, we can prescribe equipment, aids, tools and support to ensure this part of your morning routine is safe, to promote independence, or to assist your caregiver.

Spoken quite simply – occupation is getting out of bed in the morning, and if this is a challenge for you, occupational therapists treat that.




Put On Your Own Oxygen Mask First

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

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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.




Alzheimer’s Disease

I learned early in life about the perils of impaired cognition.  I worked for Scotiabank for many years as a customer service agent.  In this role, I would assist many clients who I now assume had dementia with their finances.  I remember having to call family when one elderly woman replaced her visa card six times in one month.  The family found them all in the lettuce compartment.  Or, the other lady that paid the same roofer three times.  She was being taken advantage of.  In school, I read the book “The Man That Mistook His Wife for a Hat”.  What a great way to understand dementia and Alzheimer’s disease.

It is national Alzheimer’s week so I thought I would take some time to talk about this very sad and difficult illness.  Alzheimer’s disease, or related dementias, impact 1 in 11 Canadian’s over the age of 65, with three-quarters of these being females.  It is expected that within a generation, this will double, to around 1.3 million people (

Signs of Alzheimer’s disease or dementia include:

  • Judgment: such as forgetting how to use household appliances.
  • Sense of time and place: getting lost on one’s own street; being unable to recognize or find familiar areas in the home.
  • Behavior: becoming easily confused, suspicious or fearful.
  • Physical ability: having trouble with balance; depending upon a walker or wheelchair to get around.
  • Senses: experiencing changes in vision, hearing, sensitivity to temperatures or depth perception.

Assessment of this is often done medically by eliminating other factors that could explain these problems (such as poor sleep, medication use, other conditions, stress, etc).  Also, an Occupational Therapy Assessment in the home is very helpful at determining how the noted problems are impacting function, how these can be addressed or treated, if the person is safe to be at home (with or without supports), and what care is required.  Following the assessment, the Occupational Therapist can make recommendations regarding devices, strategies, and supports that can help to reduce the impacts of the disability, improve safely, promote independence, and ensure the caregiver is trained to provide the necessary support.  Such suggestions could include ways to:  

  • Remove hazards at home.
  • Prevent unwanted wandering.
  • Safeguard medications.
  • Reduce physical barriers that impact mobility.
  • Improve visual perception through aids, devices and care techniques.
  • Reduce against risks of unsafe food and beverage preparation or consumption.

As with most things, early diagnosis and intervention is key.  Seek medical attention and ask for an OT in-home assessment to gather information about how to improve function, and to safely prevent premature losses that can result from lack of information about the condition and its management.


Evolve or Die

A few years ago I volunteered at Hamilton’s Chronic Pain program by assisting with the after-program book study.  This involved a group of program graduates getting together weekly to read and discuss the book A New Earth by Eckhart Tolle.  I was amazed at the transformations in attitude, beliefs and thoughts that came from people reading and discussing this very impactful novel.  In fact, some of the benefits we witnessed, and the things people discussed were revolutionary, and I would even argue evolutionary.


Recently I picked up this book again.  Despite some heavy content, some of the examples are life-changing and the messaging vital.  In one section of the book, Eckhart talks about the need to “evolve or die”.  How true.  In fact, this is always our choice when faced with any change, uncertainty, or interruption in how we manage.  People seem to so strongly fight change, but change is both constant and inevitable.  Why resist?


I have witnessed hundreds of people in my career that were faced with this same challenge – evolve or die.  The ones that were able to overcome adversity, who could find, cherish and expand on ability, who were open to suggestions, coaching and change, faired far better than those that resisted, clung to the past, and refused to adapt.  I remember one client, many years after her accident, talking to me about her chronic pain, depression, and physical appearance.  She said “I used to be a gymnast”.  My response was, “So was I – 30 years ago”.  She laughed.  Identifying that she continued to live in the very distant past helped me (and her) to understand where she was getting stuck, and explained why she was not progressing in the rehabilitation process.  Once she could accept her new “normal”, she started to make significant progress in resuming things she used to enjoy, while also finding new meaningful and productive activities she never imagined trying.


Here is an example that relates strongly to my role as an OT who works with people who are suddenly and significantly injured in an auto accident (page 57): “whenever tragic loss occurs, you either resist or you yield.  Some people become bitter or deeply resentful; others become compassionate, wise and loving.  Yielding means inner acceptance of what is.  You are open to life.  Resistance is an inner contraction, a hardening of the shell of the ego.  You are closed.  Whatever action you take in a state of inner resistance (which we could also call negativity) will create more outer resistance, and the universe will not be on your side; life will not be helpful.  If the shutters are closed, the sunlight cannot come in”.


So, given the choice between evolve or die, let’s not only choose “evolve”, but let’s also make an effort to live that way.  Evolution is difficult – it requires an open mind, hard work, and a positive and accepting attitude.  It often needs people to accept new opinions, ideas and even help.  This is not our nature, but if we can wrap our head around the fact that we are “evolving”, it makes challenges seem surmountable.  It can let the light in.