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Archive for category: Sports and Leisure

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What is Recreation Therapy?

Recreation therapists are certified professionals who work along with a team of health professionals to assist people in achieving optimal quality of life through participation in leisure and recreation.

Therapeutic Recreation Ontario defines Recreation therapy as “a process that utilizes functional intervention, education, and recreation participation to enable persons with physical, cognitive, emotional and/or social limitations to acquire and/or maintain the skills, knowledge, and behaviours that will allow them to enjoy their leisure optimally, function independently with the least amount of assistance and participate as fully as possible in society.”

February is Recreation Therapy Month.  Learn more about this helpful therapy and how it can benefit those struggling with mental illness in the following care of CAMH.

CAMH:  Enhancing life with meaningful activity

 

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My Animals Support Me, But Are Not Support Animals

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Every day I benefit from the love of my animals.  In fact, being an animal owner is not only part of my lifestyle, but has absolutely become part of who I am.  My animals provide me with love, comfort, they calm me and make me smile and laugh.  I have one at my feet right now and he is the one that tends to keep an eye on me – never too far away, watching, waiting, and looking for moments to connect with me, steal some cuddles or give me a quick wag to show his support.  My animals also provide comfort and security to my children and it is not uncommon to see a kid doing homework or relaxing in her room while surrounded by her four-legged beasts much like Snow White.  However, like children, animals are not always easy and at times can be all-consuming, frustrating, and difficult to manage.  Pets are not for everyone, especially during times of trauma, transition, or change.  In the end, my dogs provide me and my family with a “service”, but these are far from “service animals”.  I will explain.

Pets are animals that we keep inside to provide us all the comforts and joys that animals can provide.  Sure, we take them outside, but that is equally for their benefit as it is for ours (dog parks, nature walks, doggie play dates).  Maybe to the vet, groomers or to visit with dog-friendly friends.  But pets are typically a hot mess in public spaces.  My dogs are wonderful at home and are trained to be good here, but If I took one of them to a restaurant he would pretend to be looking for some affection while simultaneously snatching the steak off my plate, or diving to grab that roll that landed on the floor.  He would be underfoot and anxious, nervous of the chaos and commotion.  And in getting him into the restaurant he would not hesitate to chase a squirrel across the road while dragging me as the leash holder into traffic with him.  After all he is a pet; he is not trained in how to properly manage public spaces.

True service animals are pets, sure, because they provide all the supports of an animal at home.  But they are also exceptionally well trained to behave in public.  They can navigate public spaces with focus, comfort and ease because they have experience here, and know what is expected.  They are not distracted by squirrels or steak and get used to being so attentive to their owners such that affection from strangers when out of the home is not something they crave.  They are trained to react to situations with consistency and based on what the owner needs – they will not jump on someone in an elevator, bark, urinate in the lobby, or wrap their leash around someone’s leg.  They won’t bite anyone because they are screened as non-aggressive and are trained to have restraint (unless they are a trained guard dog in which case they provide owner protection on appropriate command).  Service animals provide just that – a “service” to someone in need.  They are not just “pets in a vest out in public.”

In Ontario, owners of service animals, in addition to donning the animal in a vest, are required to carry a “prescription” to explain that they need the dog in public spaces.  This “prescription” can be written by a health professional, and to protect the privacy of the animal owner, is often discrete and vague (“requires the service animal for medical reasons or reasons of mental health”).  Many people with these scripts won’t look or act disabled on the surface, hence the need for supporting documentation.  Unfortunately, with service and support dog vests available online, the note becomes necessary to prove a need and to allow the owner of an establishment to be comfortable having the animal inside.

As occupational therapists, we can provide these scripts and notes to owners of service and support animals.  In many settings, we also assist people to obtain funding for the animal and its training.  What we need to understand, however, is the responsibility that comes with this.  Should the animal misbehave at home or in public and harms someone or the owner, the prescriber of the animal could prove liable as the one indicating the animal was needed and was suitable for the purposes of service and support.  To protect ourselves from this, there are things we should consider:

1.      Ensure the animal is not a pet in the first place.  Confirm that the animal is trained, has been vetted to be suitable, and can handle the important responsibilities that come with wearing a service animal vest.  The best way to do this is to ensure the animal was provided by a reputable facility that works with animals for this purpose.  A list of such facilities in Ontario is included below.

2.      Ensure your note has an expiry date.  An open-ended script that could be carried for years or decades does not ensure that you are referring to “this animal” at “this time”.  Consider dating your script to ensure it is reviewed perhaps annually like other processes that involve our signature (parking permits, tax forms, etc.).

3.      Recognize that supporting the funding for someone to obtain or purchase an animal could also be considered a “script” whereby you are taking ownership for this animal as a service dog.  If you complete a letter of recommendation, complete with funding support, that could be enough for someone to carry with them, written by an “occupational therapist” as proof of the need.

4.      In the cases of mental health, consider the value of having this prescribed by a psychologist, psychiatrist or psychotherapist if warranted.  Consider your own knowledge, skills, and experience with the client and their disability in recommending this type of need.  Ensure there is an appropriate diagnosis of mental health which is best obtained from a registered mental health professional.

In researching for this blog, I was provided a very informative and helpful document written by a Psychologist, Registered Dog Breeder, and Executive Director of Hope Heels Service Dogs: Dr. Aanderson.  This resource is also included below.  This document explains service animal laws across Canada, and clearly outlines the differences between a guide dog, service or support dog and pet.  It provides a decision tree to help professionals like myself navigate the important conversation with clients regarding the use of a service dog, and how this differs from a pet, in deciding whether to “prescribe” this or not.

I am sure many of us have witnessed an animal in a public space that was wearing a vest and misbehaving.  In one instance, someone in an elevator with me said to the owner of a vested “support animal” that was climbing on people “there is no way that is a service dog.”  The owner just exited the elevator without responding.  Service animal or not, it is an abuse of process and blatant disregard to the training and time that goes into true service animals to try and present a pet in this way.  Service animals provide an immense amount of support to those they are trained to help.  As professionals, we have a responsibility to continue to safeguard the true use of these animals, the programs that train them and the people that need them.  Consider using Dr. Aanderson’s guide before providing written support for these valuable four-legged aids to daily living.

Resources:

Aanderson Service Dog Prescriber Guidelines

Service Dog Providers in Ontario – Current as of October 2019

 

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Enabling Clients in Lower-Risk Cannabis Use

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

Co-written by Kyra Posterski, MSc (OT) Candidate 2019 at McMaster University

 

In October of 2018, the Government of Ontario legalized cannabis in an effort to keep cannabis out of the hands of youth, keep profits out of the hands of criminals, and protect the public health and safety by allowing adults access to legal cannabis.

The number of Canadians who report using cannabis has increased since legalization. However, cannabis use is not without both short and long-term risks. These risks include cognitive and psychomotor impairments, hallucinations, impaired driving, and dependency, as well as mental health, pulmonary/bronchial, and reproductive problems.  One advantage of legalization is that it allows for a more open discussion of risk behaviours, and the steps that can be taken to reduce these.

Given that cannabis is being increasingly used by Canadians, it is likely that OT’s will continue to encounter clients that use this regularly as part of our practice. Knowing the actions that client’s can take to reduce their risk when using cannabis is thus important for clinicians to realize and understand.  The Lower-Risk Cannabis Use Guidelines has been developed as an evidence-based tool that offers recommendations for users of cannabis products to reduce risks and improve their health. Using these guidelines, occupational therapists are well-positioned to educate clients on the actions they can take to reduce their risk, enabling clients to engage in lower-risk cannabis use behaviours. These conversations are especially important for occupational therapists working with clients that are at an increased risk, such as adolescents, pregnant women and people with a family history of psychosis or substance use disorder.

These guidelines present 10 major recommendations for lower-risk use:

# 1 ABSTINANCE.  As with any risky behaviour, the most effective way to reduce risk is avoiding the behaviour.

# 2 START LATER.  Using cannabis at a young age (i.e. before age 16) increases the risks for adverse health and social outcomes.  It is recommended that usage not start until at LEAST the legal age.

# 3 and 4 PRODUCT CHOICES. It is recommended to use cannabis products with a low tetrahydrocannabinol (THC) content and to avoid using those with synthetic cannabinoids.

# 5 and 6 METHODS AND PRACTICES. Smoking combusted cannabis negatively affects respiratory health; therefore alternative, lower-risk methods, are recommended (e.g. vaporizers or edibles). Practices such as “deep-inhalation” or breath-holding should also be avoided since these practices increase the intake of toxic materials.

# 7 LIMIT USE TO OCCASIONAL (e.g. once a week). More frequent or intense cannabis use is associated with a number of health problems.

# 8 DON’T DRIVE. It is suggested that people refrain from operating a motorized vehicle for at least six hours or longer after using cannabis. Cannabis impairs skills that are critical for driving (e.g. attention) and driving while impaired from cannabis increases the risk of being involved in a motor vehicle accident.

# 9 CONSIDER YOUR UNIQUE SITUATION.  Some populations who are at a higher risk for cannabis-related health problems should abstain from using cannabis altogether. This includes pregnant women and people with a family history of psychosis or substance use disorder.

# 10 DON’T COMBINE.  Avoid combining cannabis use with other higher-risk behaviours—like those described already, as this may further amplify risks.

For more information about this topic, OT’s are encouraged to access the references below or to encourage clients to contact their treating physician for more information about safe use.

 

References

Centre for Addictions and Mental Health. (2017). Canada’s lower-risk cannabis use guidelines:  https://www.camh.ca/-/media/files/lrcug_professional-pdf

Fischer, B., Russell, C., Sabioni, P., Van Den Brink, W., Le Foll, B., Hall, W., … & Room, R. (2017). Lower-risk cannabis use guidelines: A comprehensive update of evidence and recommendations. American Journal of Public Health107(8), e1-e12.

Government of Canada. (2019). Cannabis act [PDF file]. Retrieved from https://laws-lois.justice.gc.ca/PDF/C-24.5.pdf

Statistics Canada. (2019, May 2). National cannabis survey, first quarter 2019. https://www150.statcan.gc.ca/n1/daily-quotidien/190502/dq190502a-eng.htm

 

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Stay Active for Good Health No Matter Your Age or Ability

Being physically active is one of the most important things you can do for your mental, physical and cognitive health.  It is recommended that adults have 150 minutes per week of heart-pumping activity and the good news is that no matter your age or ability there are activities anyone can engage in.  Take a look at the following care of Participaction that provides some great resources on how anyone can be active.

Participaction:  Activity is for Everyone– How to Get Active at any Age or Ability

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The Accessible Playground

How does your local playground stack up when it comes to access for all?  Is it accessible?  Older playgrounds were not built with accessibility in mind; however, newer builds are breaking barriers for users with not only physical disabilities but invisible disabilities such as autism and sensory processing disorders.  In the following article learn more about how the universal design of playgrounds is becoming standard, creating more welcoming spaces for children and youth of all abilities.

The Globe and Mail: Playgrounds can alienate children with disabilities. Now, they’re being built with accessibility in mind

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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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Try Yoga for Improved Focus and Self-Regulation in Children

Guest Blogger Jana Maich, Occupational Therapist

Working as an occupational therapist in pediatrics, I am always on the lookout for simple strategies I can offer to parents and classroom teachers that can be easily be implemented. One of the main difficulties expressed to me by concerned parents or teachers is that a child is having difficulty controlling their activity level, focusing or attending, or controlling emotional outbursts. In other words, a child is having difficulty self-regulating.

What does this mean? Self-regulation is our ability to monitor and control our body’s arousal level (in other words, our level of alertness) in order to remain in an optimal state that is appropriate for the current situation. Self-regulation is critical to being able to attend, focus, and learn (1). When our body’s arousal level gets too “high,” we may feel anxious, nervous, or stressed. When our body’s arousal level gets too “low,” we may feel lethargic, sluggish, or tired. Often unconsciously, adults participate in a variety of self-regulation strategies to remain in an optimum state throughout our day. For example, in a boring meeting where your level of alertness may be “low,” you may tap your pencil, shift in your chair, apply pressure to your mouth or chin with your hands, or drink water in order to bring your arousal level up. After an intense day of work when you may be feeling too “high,” you may take a bath, read a book, or participate in some other sort of relaxation promoting activity (1). There are many ways to regulate ourselves, and just as adults require self-regulation strategies, children do too. Yet, in today’s changing and fast-passed society, children are more stressed than ever before. School demands have increased, daily schedules are jam-packed, and they don’t have as much play or “down” time as kids once did. Unfortunately, unstructured play activities that are critical to a child’s innate self-regulation needs have been replaced by TV and electronics. All of this has ultimately stressed our young generations, resulting in disrupted self-regulation.

Yoga is one activity that has become recognized as a suitable and helpful regulation activity – for people of all ages. (2). For children, yoga offers many potential benefits – both physically and emotionally. Benefits include improved postural control, immune functioning, body awareness, strength and flexibility, emotional control, attention, sleep, and a decrease in stress and anxiety. Yoga is a simple strategy with a variety of exercises that can be completed anywhere including at home, when on vacation, while lying in bed, or as a group in the classroom. Depending on the current needs of the child, there are various poses and breathing exercises designed to bring arousal levels up or down as appropriate. Over time, children begin to develop an enhanced mind-body connection and an improved ability to monitor and manage their own levels of arousal (2).

In my personal experience, using simple breathing strategies and poses in my practice, has demonstrated firsthand how yoga can positively affect children with both physical and mental disabilities including autism, ADHD, emotional difficulties, mental health conditions, and motor coordination difficulties. In older children, learning how to control their own emotions and arousal levels empowers them and creates both self-esteem and self-control.

So what are you waiting for? Search out local yoga programs for you or your child. Try these links: www.yoga4classrooms.com or www.childlightyoga.com. Consider that many places will let you try a class without a commitment, or offer great starter incentives. Or, buy a CD or DVD, or check out some poses and breathing exercises via online videos to see if this might work for you or your family.

Originally posted July 2014

(1) Williams, M., & Shellenberger, S. (2012). “How does your engine run?” A leader’s guide to the Alert Program for self-regulation.” Albuquerque, NM: Therapy Works

(2) Flynn, L. (2010). Yoga 4 classrooms. Tools for learning, lessons for life. Dover, NH: Yoga 4 Classrooms.

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So I Guess Your Kid Doesn’t Wear a Seat Belt Either?

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

I get very confused when I see children riding bikes without helmets.  Over the last many years the safety benefits of a helmet for biking, skiing, skateboarding, ice skating (and many other sports) has been well studied.  Research shows that helmets can be extremely effective in preventing head injuries and ¾ of all cycling fatalities are the result of head trauma.  You don’t even have to hit a car or tree to sustain a head injury – the ground or even your handlebars are often enough.

The laws in Ontario are clear:  since October 1, 1995 anyone under the age of 18 is required to ride a helmet on a road or sidewalk (http://www.toronto.ca/cycling/safety/helmet/helmet_law.htm).  Based on an increasing number of adult cycling deaths by head injury, it is likely that this law will soon be extended to adults as it is in other provinces.

So, considering the laws and the well-publicized risks, why are children (including young children) still seen riding bikes without helmets?

As adults, I recognize that we were not raised to wear helmets.  Adopting this practice has been difficult as we find it unnatural, maybe uncomfortable, and probably uncool.  However, most of us likely wear seat belts when in a vehicle.  Why?  BECAUSE WE WERE RAISED THAT WAY.  Seat belt laws in Ontario were passed in 1976 and so many of us were raised in the era of this as mandatory.  Many of us probably don’t even have to think about our seat belt anymore as it is part of our regular “get-in-the-car” routine and we feel naked and exposed without it.  We need to apply the same concept of “normal” to our children regarding helmets. 

There are two main reasons why children need to wear helmets. 

1. They are safe and have been shown to save lives and reduce disability.

2.  IT IS THE LAW.

As a parent, by not requiring that your child wear a helmet on their bike you are not only putting them at risk, but are also teaching them that laws don’t matter.  And I am not talking about the diligent parents whose children leave the house with a helmet on, to later have this on their handlebars or undone on their head.   I am mostly talking about the young kids in my neighbourhood who are out on their bikes without helmets, often under the supervision of their parents, and are thus not being taught that helmets are law, mandatory, and safe.

I am going to hazard a guess that no parent would put their child in a car without a seat belt.  Heck, child seats are also law and until a certain age, these are five-point and offer more protection than the adult restraint.  So, for the same reasons you put your child in a seat belt (protection and law) you need to ensure they are wearing a helmet for biking (skating, skiing, skateboarding).  And lead by example – get a helmet for yourself and model the appropriate behavior.  And be firm: no helmet should equal no bike.  No discussion.

 

Previously posted June 2016

 

Summer Programming Note:

Summer vacation is here and we will be taking a break from our regular schedule.  We will be posting some of our popular seasonal blogs just once a week throughout the summer but will resume our regular three weekly posts in September, filled with new and exciting content including our popular O-Tip of Week series.

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Accessible Travel Destinations Across Canada

Summer vacation is here!  For those looking to get away or those looking for fun day trips as part of a staycation, the possibilities may seem endless, however, for someone with a disability they may be limited.  The good news is that there are many fully accessible destinations, activities, and adventures across Canada!  Take a look at the following care of the Rick Hansen Foundation to explore ideas for fun in the sun experiences that are available to all.

Rick Hansen Foundation:  Vacation Ideas for Travelers with Disabilities

Learn more about accessible travel in our previous post, Vacation Plans? Consult our Accessible Travel Guide.

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Ergonomic and Safety Tips for Pain-Free Gardening

Do you have, or are aspiring to have, a “green thumb?”  Or do you simply enjoy beautifying your home or spending time connecting with nature?  Whether you garden for pleasure or purpose you may be reaping many of the health benefits, however, you may also from time to time suffer from a sore back and achy muscles brought on by the hard work and bending involved.  Take a look at the following article from Sunnybrook which discusses simple ways to prevent aches, pains, and injury when gardening so you can enjoy your garden all season long. 

Sunnybrook– Your Health Matters:    How to avoid pain or injury while gardening