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Archive for category: Solutions For Living

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Caring for the Brain Injury Caregiver

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

We cannot (or should not) discuss brain injury awareness without spending time recognizing the family and friends that take on the caregiving role after someone they love has an injury of this nature. Two years ago I co-facilitated a workshop for caregivers of brain injury survivors. What a great event! Not only was this well attended, but the speakers provided an amazing amount of education, skills and insight into how to both cope, manage, and achieve success as the care provider of someone with a brain injury. I wanted to take a moment to highlight my personal takeaways from this event:

Everyone has a story. As someone who lost a brother-in-law to the effects of a catastrophic brain injury, I understand how telling our story – be it about loss, change, remorse, guilt, fear, or triumph can bring people together and has immense therapeutic benefit. Caregivers benefit from collaborating, talking, sharing, laughing, crying and growing together. Our health system needs to create these opportunities, or caregivers need to find ways to make this happen.

Grieve. In my undergrad I studied grief and loss and even worked in hospice. What I realized at our workshop, however, is that the permanence of death allows people to grieve their loss, achieve acceptance, and eventually move on. When dealing with survival from a traumatic event, however, grief is not always experienced as our loved one is still present, albeit different. Yet, our speakers emphasized the importance of grieving: the life that once was, the life that may never be, and the changes and adjustments that have occurred. Caregivers need to let this grief process happen, or should seek support from a trained professional to experience this important emotion.

Find a new normal. Clients, caregivers, and health care professionals need to always consider that the old “normal” may never return. In that case, we all need to collaboratively look ahead to creating a “new normal”. Different does not always have to be bad, and it requires an open and optimistic mind to think that way. For OT’s that means taking the abilities of the individual, considering their resources, and helping them to create that new life of function, fulfillment, meaning and productivity.

Put on your own oxygen mask first. We spoke extensively about the importance of caregivers taking the time to attend to their own personal needs, to have positive coping mechanisms and sources of support. Then, at break I was speaking with a man whose wife suffered a brain injury. He talked about the “airplane analogy” and how this applies to caregivers – put on your own mask before helping another. I smiled and told him that I wrote a blog on that exact topic, with that exact title last year. As he found that analogy practical and helpful, I thought I would share the contents of that previous blog here, to highlight this important third point:

Posted September 25, 2013

If you have ever travelled 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 wellbeing 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.

I hope the caregivers that attended our workshop felt that by spending a day focusing on themselves, expanding their knowledge, and learning the keys to success, that this was one step towards them being able to put their own mask on first. This was highlighted at the end of the day when the caregiver of a survivor, whose loved one was injured 13 years ago gave this advice: “If I could do it again, my priorities would be self, family, then my loved one with a brain injury”. What a great lesson for me to take forward in my practice.

For more posts related to brain injury please visit our Brain Health Archive.

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Back to the Basics: Brain Injury

June is Brain Injury Awareness Month and as we strive to educate you on the prevention and treatment solutions for brain injury, we want to bring you back to the basics.  What is a brain injury?  Much like our fingerprints, no two brain injuries are completely the same.  Learn more about the human brain and how it can be affected by brain injury care of the Brain Injury Society of Toronto.

Brain Injury Society of Toronto:  Brain Injury 101

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Protect Your Noggin: Wear A Helmet

The warm weather has arrived and kids will soon be on summer vacation.  One of the best forms of exercise, modes of transportation and fun leisure activity for kids and adults is riding a bicycle.  While riding a bike is great for your health and the environment there are dangers that come with it, and it’s imperative to know the rules of the road and to protect yourself with a helmet.  In a previous post, “So I Guess Your Kid Doesn’t Wear a Seat Belt Either,” we discussed how, as professionals who see the detrimental effects of brain injuries, we are amazed at how many kids and adults still do not wear a helmet.

Education is key!  Please remember to be a role model for your kids, stay safe, ride properly and share these safety tips with those you care about.  Check out the following from Parachute Canada to learn how to properly fit a helmet and for further bicycle safety tips.

Parachute:  Follow The 2V1 Rule To Make Sure Your Helmet Fits Right

Parachute:  Helmet FAQ

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Preventing Brain Injury

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

Previously posted June1, 2015

“An ounce of prevention is worth a pound of cure.”  Benjamin Franklin

In recognition of Brain Injury Awareness month, I thought it would be fitting to start at the very beginning. PREVENTION. Really, it is the best medicine. For now, let’s forget about the symptoms of brain injury and its’ impact on work, home, school, and quality of life. Let’s not talk about how it is assessed and treated. Instead, let’s focus on trying to stop it from happening in the first place.

But even before that, we need to know what we are dealing with. It is well known that brain Injury is the leading cause of death and disability worldwide. In Canada, Traumatic Brain Injury (TBI) is more common than breast cancer, spinal cord injury, HIV/AIDS, and multiple sclerosis (MS) combined. There are approximately 18,000 TBI hospitalizations annually. In the province of Ontario, 25% of the two million people diagnosed with a neurological condition have suffered from a TBI. In 2000-2001 brain injuries accounted for $151.7-million in direct costs to Canadians (1).

By way of distribution, TBI is most common in children (0-19) at 30%, followed by seniors (60+) at 29%. In kids, falls are the most common cause followed by motor vehicle accidents and then sports. In adults, motor vehicle accidents cause the most TBI’s, and in seniors the causes include falls (76%) followed by car accidents (2).

Knowing the causes helps to look at how we can engage in preventative strategies. As an occupational therapist with a background in health promotion, a parent of four, and athlete, here are my thoughts:

Falls

Kids fall all the time, so how can we prevent that? Well, there is a difference between a child falling when walking, running or jumping, versus falling from, say, a shopping cart, off of a playground structure, or from a tree they tried to climb. Falls from bikes, skateboards and scooters are going to happen – and a helmet can mean the difference between a head injury and not. The bottom line is that falls in kids are best prevented by proper adult supervision. Yes, it is that simple.

In seniors, falls take on a different form. They are not from carefree or reckless behavior, but often happen when someone is just trying to go about their day by having a shower, coming down the stairs, or taking a leisurely walk. Seniors need to be attuned to the physical, balance and vision changes they are experiencing as they age, and need to consider the importance of anti-slip mats in the bathroom, removing scatter mats, installing grab bars or railings, and the benefits of a walking stick or cane when outdoors. Seniors need to engage in regular exercise and activity to maintain bone density, mobility and intact balance. They have to be very careful when living with pets or when trying to negotiate places that are cluttered or dark. Awareness of declining abilities is the first key to addressing these properly such that a prevention plan can be developed that will ultimately improve safety and reduce the risks. Note that the services of an occupational therapist can be pivotal in creating this safety plan.

Check out our OT-V episode “Fall Prevention” for more helpful information.

Motor Vehicle Accidents

Like falls, despite our best intentions, these can and do happen. The issue here is trying to minimize the risk and optimize the outcome. Safe drivers are attentive, undistracted, and alert. They travel at safe speeds, approach intersections with caution, stop behind the line, pass when appropriate, and recognize that rushing to get somewhere on time is useless if it means you never get there at all. Safe drivers don’t text or hold a phone to their ear, don’t eat a hamburger and steer with their knees, and don’t drive when tired. If you are one of these drivers you are going to increase your chances of avoiding a collision, and lower your chances of being the cause. Unfortunately, however, not everyone is a safe driver. So, all the rest of us can do is wear our seat belt, buy a car with a good safety rating, make sure everyone in the car is buckled properly, make sure the headrest is at a proper height, put loose belongings in the trunk (I know of a child who got a head injury from a flying jar of pickles that escaped the grocery bag during a collision), and follow the rules for child seats.

Sports

I am an avid athlete and have pretty much played or tried every sport. There are very few sports I dislike and I honestly feel that sports can be the most positive and influential outlet for young people, and one of the most engaging and social outlets for adults. The issue is that sports seem to be becoming more and more competitive, kids and adults are getting bigger and stronger, and the culture of some sports has changed from friendly competition to all-out war. Preventing head injury in sport can include outfitting your kids with proper equipment (many hockey parents spend more on a stick than a helmet), ensuring they are playing at their level, monitoring the coaching influence and team culture to make sure this is appropriate, and my favorite is from the book “The Secrets of Successful Families” and includes that the only job of a parent in organized sport is to “shut up and cheer”. No parent should be on the sidelines encouraging reckless, mean or harmful behavior. The results can be devastating. And if you are concerned about your child’s risk of head injury in sport, know that there are many other sports that reduce the risk but are equally as challenging, competitive, fun and have the same physical, cognitive and developmental benefits.

So, let’s start our recognition of Brain Injury Awareness Month by practicing prevention. It does not have to be easier said than done.

 

 

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Brain Injury Survivors Want you to Know That…

As Occupational Therapists we work with a lot of people who have sustained a brain injury.  Brain Injuries are often deemed as “invisible” or “hidden” disabilities, as the effects may not be obvious to others.  June is Brain Injury Awareness month and to start the month we’d like to share some of the top things brain injury survivors would like others to know.

Daily Health News:  What Brain Injury Survivors Want You to Know #Top 10 Things

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The Busy Community OT – Top Healthy and Fast Grab-and-Go Lunches Under 300 Calories

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

As a newer vegetarian, and someone who spends most days on the road, I am always looking for quick, but decent, lunch options.  While in an ideal world I would prepare my lunches and snacks ahead of time (including hand sanitizer!), sometimes life takes over and I am rushing out the door unprepared.  On some days that may result in me being undernourished and not eating again until dinner, on other days it does have me searching for healthy stuff en route.  So here is my list of the healthiest but fast meal options that are under 300 calories but can be grabbed quickly, as listed by restaurant name:

SUBWAY

Veggie Delight (whole wheat bread without cheese or mayonnaise) 230 Calories

MCDONALDS

Side Garden Salad (no dressing) 40 calories

Chipotle Chicken Snack Wrap® with Grilled Chicken 230 calories

Grilled Chicken Snack Wrap® 230 calories

WENDY’S

Full Asian Cashew Chicken Salad (no dressing) 190 calories

Chicken Go Wrap Grilled 260 calories

PITA PIT

Garden Pita (no cheese or condiments, whole wheat pita) 227 calories

Tuna Pita (no cheese or condiments, whole wheat pita) 285 calories

Turkey Breast (no cheese or condiments, whole wheat pita) 286 calories

STARBUCKS

Perfect Oatmeal (plain) 140 calories

Spinach, Roasted Tomato, Feta and Egg White Wrap 280 calories (my personal favorite with the nutrition value quickly wasted by my latte add-on).

TIM HORTONS

Chicken Ranch or Salad Wrap Snacker 190 calories

Chipotle Chicken Wrap Snacker 200 calories

Chili 290 calories

Soups (no bun) 80 – 230 calories

HARVEYS

Warm Grilled Chicken Salad (no dressing) 150 calories

Warm Grilled Chicken BLT Salad (no dressing) 210 calories

Grilled Chicken Sandwich (no cheese or condiments) 280 calories

BURGER KING

Tendergrill Caesar Salad (no dressing) 250 calories

Hamburger (no cheese or condiments) 260 calories

Veggie Burger (no cheese or condiments) 270 calories

QUIZNOS

No under 300 calorie meals.

Of course, calories are not the only consideration when consuming a healthy lunch.  However, this measure can provide an easy metric when looking for something fast while trying to avoid the unnecessary calories found in heavy carbs and bad-fat common to fast food meals.  For drinks, stick to water as not only is this often free (tap water) with your meal, but it provides an opportunity to rehydrate which is also important.

I hope this list helps you to also pick healthier options when on the road.

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Treating Auditory Processing Disorder

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
In my previous post, What is Auditory Processing Disorder, I explained that auditory processing disorder (APD) is like a game of “Operator” where a message is misinterpreted when travelling between the ears and brain.  This causes problems with communicating in noisy environments, following multi-step instructions, and wrongly hearing words, sounds and sentences.    The good news is that APD can be improved organically and through modifications to the functional environment.

Personally, my daughter was diagnosed in Grade 3 (age 8).  To understand her problems, I read several books on APD and copied some chapters for family.  I disclosed fully to my daughter the results of her testing and explained that sometimes her ears and her brain are hearing different things.  I wanted her to understand that at times, when things people say might seem funny, confusing or strange to her, she might have heard them wrong.  She was encouraged to ask questions about her ADP, and to never be shy about asking people to repeat themselves if needed.

At school, the teacher started wearing an FM unit to help best deliver instructions and teachings to my daughter who wore corresponding headphones.  The teacher and I put tennis balls on the classroom chairs to reduce noise.  My daughter was relocated near the teacher’s desk and away from the busy hall.  The door was closed (reducing background noise) during lectures.  She was allowed to write tests in the quiet resource room.  The teacher was provided a list of other classroom modifications to implement, including ways to breakdown instructions into smaller chunks to improve her retention and follow-through.  I talked to the teacher about the fact that when my daughter was reading in class (when she was supposed to do other things) to tune out classroom noise and / or because she missed the directions.

In sports, we noticed an issue with her playing basketball.  The sound of the balls bouncing on the floor made it difficult for her to hear her coach and the background noise in the gym during practice was a struggle for her.  At Karate, she would look around to see what the other kids were doing as she would miss instructions.  All of her coaches and Sensei’s were advised of her APD and started speaking more directly to her, asked her to repeat instructions, and tried to reduce background noise when possible.

We also made changes at home.  We took extra time to reduce background noise (difficult in a family with four kids), would reduce the number of instructions we gave her at one time, had her repeat these back to us, and developed a “roger that” mantra that she would say to indicate she got her instructions.  Our audiologist recommended Fast Forward, an online game designed to help improve APD.  While research does not conclusively confirm that this is helpful for APD, we decided to give it a try and she found it very helpful.  Ultimately, and for reasons other than just her APD, we moved her to a small school with very low class sizes and she is now thriving.  We still notice her APD at times, but she is very aware of this and is mature enough to understand that if something sounds wrong (i.e. turtle twins) she should politely ask for clarification.

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The Business of AODA

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

As an occupational therapist, business owner, and MBA, I can’t help but to reflect on the colossal legislation that is the Accessibility for Ontarians with Disabilities Act, or AODA.  If you are not familiar, the AODA is Ontario’s way of making the province accessible by 2025 by addressing the following key areas so that people with disabilities can more fully participate in their communities:  customer service, employment, information and communication, transportation, and design of public spaces.

Here are some real examples of poor service that demonstrate why such a legislation is needed:

  • A few months back I was taking an ailing relative to an appointment at a lawyer’s office.  We arrived and the building was poorly marked.  We tried a couple of entrances and walked around the building a few times.  We finally found the entrance and were met with three flights of long and windy stairs.  We climbed these slowly and when greeted by the lawyer he said “you should have told me stairs were a problem and I could have met you at home”.  My response was “how could we have known that your office was on the third floor of a commercial building that lacked and elevator, and if a home visit was an option, this was never explained to us”.  NOT AODA compliant.
  • The other day I was at the bank waiting for an appointment.  A patron with a cane ventured in and promptly tripped on the scatter rug that was not lying flat on the floor.  Two staff quickly ran to her side and started reefing on her shoulders to get her back into standing.  The teller told me that people trip on those mats “all the time”.  NOT AODA compliant.
  • Or, the story of a client of mine who uses a wheelchair and ventures into a large department store where a “greeter” puts a sticker on him that says “I am special”.  NOT AODA compliant.

Would you, or the people of your organization, make these mistakes?  Do you even know what the mistakes are?  Does your organization know how to manage these situations better, with tact, and preventatively?

My business hat tells me that business owners will respond to the AODA in one of three ways: “it won’t happen to me”, “tick the box” or “this is important”.

It Won’t Happen to Me

These are the group of owners that will ignore the legislation and not fear the result.  They won’t care about the impression they leave on people that may try to access their services but can’t.  Or the people that may try to get into their building and can’t.  Or the people that will try to use their website and can’t.  They won’t concern themselves with the comments lost consumers may spread about how they felt or how unfortunate it was to encounter such correctable barriers.   These owners feel confident in the fact that not being able to meet the needs of a disabled customer will not impact their reputation or bottom line.  They sleep well and don’t concern themselves morally or ethically with the possible ill experience of one lost consumer who really just wanted to have equal access.

Tick the Box

These owners will review the legislation and will make sure they do the bare minimum.  They will send someone from HR, or one employee, to a one hour seminar on how to provide service to people with disabilities and that person will return and teach the rest of the team.  They will “tick the box” that they did some AODA customer service training and will hope that this is enough.  These owners do care about potential customers with disabilities and recognize that while 15% of people in Ontario have a disability, even more are caregivers, parents of a disabled child, or that the demographic shift with the aging population will make AODA even more important.  While they care, they don’t care enough to actually ensure they get it right.  They feel the bare minimum will be better than nothing, and will hope that their staff at the least don’t upset or hurt someone that may try to access their building, or their services.

This is Important

This is the group of concerned owners that want to hit the nail on the head.  They don’t believe in doing the bare minimum because they are interested in providing amazing service to all customers.  These owners are forward thinkers that recognize the growing number of disabled consumers, and see how the ripple effect from one person’s great experience can transfer to a story told to many.  These owners want to have caring and compassionate staff that are comfortable helping a visually impaired client sign forms, or a client with a hearing impairment to get information over the phone.  They embrace everyone that enters their building and know how to offer great service without saying the wrong thing or without the fear of coming across as condescending or ignorant.

I guess what box you fit into will ultimately depend on your:

1. Risk tolerance – can you tolerate a bad reputation, poor social media reviews or comments, or the threat of being sued over failure to comply?

2.  Values – do you care about people with disabilities and the experience they get from your organization?  Do you value being seen as caring, compassionate, and accommodating?

3.  Resources – do you have the time, interest or resources to invest in thorough and proactive solutions?  Will you take the time to explore the options and to provide your team with the most practical and useful training?

4.  Goals – is one of your goals to provide exceptional service to all?  Do you see a customer as a customer, all having equal value and an equal opportunity to not only benefit from your service, but to also benefit your bottom line?  If your goal is business success then the AODA is nothing to ignore.

Let me demystify how my examples earlier could have been handled better:

  • When we called the lawyer to book our appointment, his receptionist could have simply indicated “please be aware that we have three flights of stairs to our office and the building is not equipped with an elevator.  If that may pose a challenge for you or your relative, please be aware that we can also meet you at home”.
  • When the lady fell at the bank, the staff could have asked “do you need us to call 911 for help, are you okay to try and stand, or how can we help you”?  Then, before lifting her by the arms they should have asked “how can we best help you back into standing, will holding your arms to help you rise be okay for you”?
  • The “greeter” at the department store could have simply greeted my client in the wheelchair to say “I hope our store is easy for you to manage and that you can access all the things you are looking for.  If you need any assistance, or would like to consider using one of our scooters, I am here to help”.

What kind of owner are you?

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Pedestrian Safety

In cities across Ontario pedestrian deaths are on the rise, and statistics are showing the elderly are affected most.  A report from the Ontario Coroner in 2012 found that those older than 65 accounted for 36% of pedestrian deaths in Ontario, while the population of those age 65 and older is only 13%.  This is an alarming statistic.  Many blame distracted driving, the prevalence of larger vehicles and city design for this increase.  Whatever the cause, something must be done.  Do you think the new traffic laws under the “Making Ontario Roads Safer Act” can make a difference?

Metro News:  Elderly pedestrian deaths on the rise in Toronto