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Archive for category: Seniors Health

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The Benefits of Hydrotherapy

Guest Blogger: Carolyn Rocca, Occupational Therapist

Water has long been associated with health and healing, making it an excellent tool for rehabilitation. Hydrotherapyalso referred to as pool therapy or aquatic therapy, is one way in which water can be used for therapeutic purposes following injury or illness.

Hydrotherapy refers to water-based treatments or exercises aimed to enable physical rehabilitation, fitness, and relaxation for therapeutic purposes. Treatments and exercises are performed while floating, partially submerged, or fully submerged in water, usually in specialized temperature-controlled pools. The key difference between this form of therapy and land therapy is that movement is facilitated by the physical properties of water, particularly it’s density and specific gravity, hydrostatic pressure, buoyancy, viscosity, and thermodynamics (Becker, 2009).

Due to the specific facilitating properties of water, hydrotherapy can have several benefits for people who have loss or restriction of joint motion, strength, mobility, or function as a result of a specific disease or injury. Aquatic therapies are beneficial in the management of musculoskeletal issues, neurological conditions, and cardiopulmonary problems. More specifically, there is evidence to support that people with fibromyalgia, arthritis, multiple sclerosis, cerebral palsy, stroke, and chronic pain, as well as people who have undergone surgeries such as total knee and total hip replacements, can significantly benefit from aquatic therapy (CARI, 2014).

The benefits of hydrotherapy will depend on the purpose of why it is being used in your rehabilitation plan, what it is aiming to target, and the type of exercise being completed in the water. In general, there is evidence to support that within a wide range of ages and abilities, hydrotherapy may help people to increase their endurance and strength, improve balance and postural control, reduce perceived pain and muscle spasms, reduce joint pain and stiffness, aid in gait retraining, and improve functional mobility. Additional benefits can include the facilitation of relaxation, improved quality of life, as well as providing opportunities for socialization (CARI, 2014).

A key to the success of many hydrotherapy procedures is the constant attendance and guidance provided by a trained therapist. This can be any rehabilitation professional, such as a physical therapist, occupational therapist, PTA/OTA, etc., who has taken additional and specific training in basic or advanced aquatic physical therapy. The rehab professional’s expertise will be able to match your abilities with the appropriate properties of water to achieve an optimum balance between facilitation and challenge. By adjusting the immersion temperature, type, and intensity of activity, level of resistance, use of equipment, and treatment duration the therapist will be able to assist your recovery by gradually increasing the amount of challenge to eventually help you to transition to land exercises.

An added bonus to the therapeutic benefits of aquatic therapy is that it can help to introduce or re-connect you to a leisure interest, and can offer a social outlet. For example, a current client of mine has recently begun pool therapy following injuries sustained in a motor-vehicle collision. Not only will this help in her recovery while she begins to regain strength and function in her legs, but will also re-connect her to her passion for swimming, as this was something she loved to do with friends prior to her accident. Additionally, there is evidence to support that infants and toddlers with mobility impairments that engaged in aquatic therapy can experience significant functional gains in mobility compared to children who solely received land therapy, and that their parents noticed an increase in their socialization and enjoyment while in the pool. In this particular study, the children’s parents then reported an increased willingness and comfort in bringing their children to community pools following aquatic therapy (McManus, & Kotelchuck, 2007), therefore further increasing their future leisure and social opportunities.

Thus, hydrotherapy has the potential to improve physical function, as well as increase community involvement, socialization opportunities, and participation in physical activities. Additionally, this form of therapy can be appropriate and beneficial for all ages and abilities. If you feel that hydrotherapy may be a great addition to your rehabilitation and recovery, speak to your rehabilitation professional about some of the opportunities available in your community.

References & Resources

Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R, 1(9), 859-872.

Canadian Aquatic Rehab Instructors (CARI) website: http://www.aquaticrehab.ca/

Canadian Aquatic Rehab Instructors (CARI) website link to research (2014). Retrieved from http://www.aquaticrehab.ca/research

McManus, B. M., & Kotelchuck, M. (2007). The effect of aquatic therapy on functional mobility of infants and toddlers in early intervention. Pediatric Physical Therapy, 19(4), 275-282.

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Pedestrian Safety for Older Adults

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

The other day I was driving through a busy parking lot.  I noticed an elderly man who parked his car, got out, and proceeded to walk through the parking lot without ever surveying his surroundings.  He did not see my vehicle approaching him, and did not appear to notice the other cars that had to stop to let him pass.  The other drivers looked both annoyed and perplexed that he could be so clueless.

According to the CDC Increasing frailty may leave the elderly more vulnerable to being hit by traffic. Age-linked declines in mental function, vision and physical disabilities might place older adult pedestrians at greater risk for being struck by a vehicle.

With this man, what I noticed was quite telling.  He was looking at his feet.  Many seniors do this when walking.  Why?  Because they are afraid to fall.  With a decline in physical ability comes problems negotiating uneven terrain.  Parking lots and sidewalks are full of holes, stones, and cracks that could be problematic for someone with declining mobility.  So, they stare at the ground to avoid falling, the entire time being unable to also look around at other risks in the environment.  And when you combine this with reduced peripheral vision, they may not notice vehicles approaching. 

Society expects seniors to “know better” in that they have been trained, over a lifetime, about the perils of traffic.  With children, we don’t expect them to know better because they are carefree and often move before thinking.  As driver’s, we watch for children and take extra care when we see them around roads or in parking lots.  We also tend to take the same precautions when we notice someone who is more visibly disabled using a wheelchair, or white cane.  But disabilities are not always visible and we have to be careful to not make assumptions – especially with seniors who may have an unnoticeable visual, cognitive, physical or auditory problem.  

My message here is that drivers should be cautious with all pedestrians, but need to be especially mindful of seniors – much like they are with children or other people with visible disabilities.  Seniors deserve our patience and the extra time it might take to help them safely go about their day and negotiate the sometimes challenging outdoor environment.

Previously posted July 2013

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Screen Time: How Much is Too Much and How to Change It

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

I was enjoying a nice dinner with a friend (also an occupational therapist) and we started a great conversation about phone use with our children.  She asked me “how much screen time is too much”?  Of course, there isn’t really an academic answer, but we talked from a professional perspective about the behavior of phones, the social risks and benefits, and from the parent side of our fears and worries about how these have become a staple in the lives of our kids. Then, she changed my world by introducing me to the concept of screen time (more on that below).

Parents have very polarized views on phones, so I get that how I manage this in my household may not fit with the values of others.  To recap, I have four teen daughters ages 14-18.  Our phone philosophy is that we provide our girls a phone for their 14th Birthday (Grade 9) and pay for this until their 18th Birthday.  After that, they are on their own to fund this expense (and can get as many gigs as they want).  On our plan, they have 2 gigs each and do not get an extension if they run out.  Their access to Wi-Fi at home is scheduled and is not limitless.  They are not allowed to have their devices in their bedrooms (concessions are made sometimes but they already have “old school alarm clocks” to negate the “I need it to wake up” argument) and they know that if this is beside their bed it needs to be in airplane mode to not disrupt their sleep.

Too strict?  Perhaps, but I see phones like every other “potentially harmful” thing I keep my kids from.  Sedentary time, junk food and pop consumption (tip – just don’t buy it!), and of course we do not serve them alcohol or buy them cigarettes.  I ensure they are all engaged in something active and encourage them to make decent food choices, even if they don’t.  Those things are easy for me to “parent about” because it is well established that “sitting disease” is a thing, “diabetes and obesity” are a problem, and alcohol and drugs are horrible for developing brains (not to mention illegal for my kids based on age).  But screen time?  How much is “too much”?  We don’t really know that yet.  We know that phones are highly addictive – more addictive than cocaine – and cause a whole host of behaviors that, like addictions, are hard to break.  They also promote highly sedentary behavior (they are typically used while sitting). So, here is how I handled this (and note this is for iPhones with a family plan, I don’t know how this works with any other devices):

  • Go to: “settings, screen time”.  To get to know how this works, the top shows your usage.  Push on that and you have the option to look at Today or the Last 7 Days.  Below that is a list of all the things you do on your phone and for how long.
  • Go back to “screen time” and you will see somethings below your usage:

o   Downtime (schedule time away from the screen)

o   App Limits (set time for apps)

o   Always Allowed (things you want to always have access to)

o   Content and Privacy (blocking inappropriate content

  • Then below that, you will see “Family” and a list of those “underage” as per your family plan.

Now for the cool parent stuff.  You can click on any one of your children’s devices and you can see for each of them what you can also see for yourself.  Patterns, usage behavior, time on certain things, and you can also put limits to the above (Downtime, Apps, Always Allowed and Content).  It asks you for a password so as a parent you can pick something that the kids won’t know.  They can’t change their limits on their own.

I don’t recommend arbitrarily just going in and setting limits as I think the best part of the “screen time” feature is the conversation that can happen around figuring out what is “reasonable”.  With my kids, I chatted with each of them about their usage pattern (something they never looked at).  We talked about the time on their Apps, and for some, questions like: “4 hours on Rodeo Stampede”?  This brought their awareness to their habits and allowed me to understand their insight into whether this was “good, bad or ugly”.  And honestly, it was a mix of all three.  After we understood their patterns, we decided on our “screen time limit” (for us three hours / day) and went through to give permission for all the “good” to continue, the “bad” to be limited, and the “ugly” to stop.  And the best thing is that these limits apply regardless of data or Wi-Fi – so even if they have unlimited Wi-Fi in public places, they can’t use their devices more than programmed.

Since implementing this several weeks ago, their screen time has dropped significantly, and they don’t even use their devices to their limits (which were set lower than their averages to start with).  In fact, three hours might be more than they need.

All of this brings me back to a popular concept in my profession of occupational therapy:  behavior change starts with being able to track and understand it in the first place.  Once you know where behavior is at, you can make a conscious and concerted effort to modify it to improve your own health.  Even if you drop your usage by 30 minutes a day and maintain that for several weeks, you just returned yourself 3.5 hours per week to do other (healthier?) things.

What’s next Apple?  An iFridge?

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What is Growth Mindset?

When it comes to “mindset” Carol Dweck, a professor of psychology, states that people have either a fixed or a growth mindset and states that:

  • With a fixed mindset, one believes their qualities and abilities are fixed and therefore cannot change even with practice.
  • With a growth mindset, one believes their qualities and abilities will continue to change with time, effort and experience.

The term “Growth Mindset” is used frequently when talking about children and youth pertaining to education, however, it is not just for kids.  As clinicians who work with people of all ages who have sustained life-altering injuries, we often come across fixed mindsets and work to help clients reframe their thoughts and form goals based on a growth mindset.   Learn more about growth mindset in this TedTalk featuring Carol Dweck.

 

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Self-Care for Caregivers: Put Yourself First

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

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

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

 

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

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Being a Life-Long Learner Can Help You Age Well

As we’ve mentioned before when discussing how to support optimal aging, the old cliché is true when we talk of cognition – “use it or lose it”.  Just as we need to exercise our bodies for physical health, we must do so for our brain to support cognitive health.  Learning something new is a great way to flex the muscles in your brain, and the great news is you don’t have to sit in a classroom to do so.  Take a look at the following from the McMaster Optimal Aging Portal which discusses how online learning can support you as you age.

McMaster Optimal Aging Portal:  How online learning can support optimal aging

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Accessible Emojis Coming Soon to a Device Near You 👍

Cheers to Apple 👍 for working with multiple organizations to create new emojis that “better represent individuals with disabilities.”  Though it will take some time for these emojis to be available on your device, it is a great step forward for inclusivity in our daily lives.

photo care of Emojipedia Photo

Learn more about the new emojis in the following care of Time Magazine.

Time:  Prosthetics, Guide Dogs and Wheelchairs: Here Come Apple’s Proposed Accessibility Emoji

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How Anxiety and Depression Can Impact Cognition

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

As a student working with an Occupational Therapist in the community, I realized early in my placement that many clients struggle with anxiety and depression in combination with cognitive challenges like decreased attention, concentration and focus, difficulties with memory, and slower information processing abilities. This spiked my interest, as I was unaware of the possible impact anxiety and depression could have on cognition and how these symptoms could be related.  I decided to look into this further, and am sharing my findings below.

Occupational Therapists work in a wide variety of settings including the community. As the hospitals become less and less able to accommodate people long-term, community-based occupational therapy services are becoming more and more common. Working in the community allows occupational therapists to reach a wide variety of clients, and therapists utilize a strength-based approach to build on the client’s current strengths to promote wellness and productivity.

Depression and anxiety are the most common types of mental illness throughout the world, including Canada. From my community placement experience as a student Occupational Therapist, I have found that the majority of the clients I have seen are experiencing depression and/or anxiety, often in combination with other primary diagnoses.

Interestingly, depression and anxiety can negatively impact the way the brain thinks, learns, and processes information and thus how it functions.  However, the relationship is complicated as a decrease in cognition may also lead to an increase in depression and/or anxiety which can then perpetuate the cycle.

Research has highlighted how anxiety and depression can negatively impact several aspects of cognition including:

  • Psychomotor speed
  • Attention
  • Executive functioning
  • Problem-solving
  • Attentional switching
  • Cognitive flexibility
  • Visual learning
  • Memory

The result for most people tends to be poor functional outcomes in their daily lives. Additionally, the brain regions believed to be responsible for these functions have been shown to be abnormal in people that also suffer from anxiety and depression  (e.g. hippocampus, amygdala, temporal lobes, and prefrontal cortex). Decreased memory, slowed information processing, and issues with verbal communication can negatively impact multiple areas of people’s lives. This information demonstrates the importance of the need to detect and treat anxiety and depression as early as possible as well as the need for early cognitive interventions for clients with anxiety and depression.

As a student Occupational Therapist, I wanted to further investigate how Occupational Therapists can help. I found evidence that Occupational Therapists can help clients in reducing functional decline, while also reducing the probability of relapse by treating cognitive deficits. Occupational Therapist’s target these areas by teaching client’s cognitive remediation and compensation strategies during their interventions and treatment monitoring.

Examples of remediation interventions may include:

  • Retraining higher-level cognitive skills (e.g. strategy use, self-monitoring, self-correction, problem-solving, self-evaluation)
  • Education
  • Relaxation and stress management techniques to regain control
  • Divided attention training (e.g. learn tasks separately and then combine tasks)
  • Imagery
  • Rehearsal strategies

Examples of compensatory interventions may include:

  • Modifying the environment (e.g. dim lights, reduce distractions)
  • Altering the task, (e.g. use of rest breaks, breaking the task into smaller components, repetition of instructions)
  • Use of both internal and external cueing/reminders (e.g. use of mnemonics, post-it notes, organizers, applications)

With both, often, a cognitive behavioural approach is taken.  Cognitive behavioural therapy (CBT) works to change clients thought structure to allow positive mood change, enhance coping strategies/problem solving, and help challenge faulty beliefs.

Anxiety and depression are common and are known to negatively impact a person’s cognition.  Worsening cognition then can deteriorate anxiety and depression further.  Early intervention is key to break this cycle and to promote function and wellness.   Occupational therapists play a vital role in providing interventions for those with anxiety and/or depression by implementing interventions for these issues, as well as treating the common resulting cognitive deficits.  Both remediation and compensatory techniques are used, often through cognitive behavioral therapy.  If you, or someone you know, is struggling with anxiety or depression this may present as cognitive difficulty, or if cognitive issues are present, anxiety and depression may also surface.  Consider occupational therapy if you would like support and strategies to improve these symptoms and to reduce their effect on your daily life.

 

References:

1. Carrier, A., & Raymond, M. H. Community occupational therapy practice in Canada: A diverse and evolving practice.

2. McRae, L., O’Donnell, S., Loukine, L., Rancourt, N., & Pelletier, C. (2016). Report summary-Mood and Anxiety Disorders in Canada, 2016. Health promotion and chronic disease prevention in Canada: research, policy and practice, 36(12), 314.

3. Statistics Canada (2014) Survey on Living with Chronic Diseases in Canada (SLCDC). Retrieved from http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5160

4. Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of affective disorders, 140(2), 113-124.

5. Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry research, 145(1), 39-48.

6. Bora, E., Fornito, A., Pantelis, C., & Yücel, M. (2012). Gray matter abnormalities in major depressive disorder: a meta-analysis of voxel based morphometry studies. Journal of affective disorders, 138(1), 9-18.

7. Femenía, T., Gómez-Galán, M., Lindskog, M., & Magara, S. (2012). Dysfunctional hippocampal activity affects emotion and cognition in mood disorders. Brain research, 1476, 58-70.

8. Lorenzetti, V., Allen, N. B., Fornito, A., & Yücel, M. (2009). Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. Journal of affective disorders, 117(1), 1-17.

9. Fleming, J. (2017). An occupational approach to cognitive rehabilitation. Workshop presented through the Canadian Association of Occupational Therapists, Toronto, ON.

10. Grieve, J. I., & Gnanasekaran, L. (2008). Intervention for Cognitive Impairments. Grieve, JI, & Gnanasekaran, L.(3rd ed. ed.). Neuropsychology for occupational therapists: cognition in occupational performance. Oxford. Malden, Mass.: Blackwell.

11. Haran, D. (2009). Cognitive-behavioral therapy for depression. The Israel journal of psychiatry and related sciences, 46, 269.

12. Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models,  applications and research. Revista Brasileira de Psiquiatria, 30, s54-s64.

 

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Safe Ways for Seniors to Remain Active in the Winter

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

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

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Social Outings Rx

We’ve said this before and we will say it again… being social is good for your health.  Occupational Therapists recognize the importance of social interaction within leisure activities for persons with and without disabilities. We work with clients to explore their interests to help find activities that offer opportunities for social interaction and, if needed, find ways to address the different barriers to engaging in these meaningful past times.

Great news!  Your family doctor can help with this too. There is now a pilot program in Ontario that allows physicians to write prescriptions for social activities and the ROM is assisting with this initiative.  Learn more in the following care of CBC News.

CBC News:  Doctor’s orders: ‘Social prescriptions’ have been shown to improve health