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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.

 

 

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Feed Your Brain

We eat for many reasons:  hunger, boredom and nourishment, to name a few.  The choices of WHAT we eat are becoming increasingly important as research is finding more and more connections between certain foods and their effect on our bodies.  Everyone, especially children, should be trying to fuel our brains to assist with concentration and memory.   The following article by Web MD discusses how we can use food to balance that training and keep our minds in tip top shape.  Remember, you are what you eat.

Web MD: Brain Foods That Help You Concentrate

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I Always Called it Dumb-Ball

Football lovers beware, this post will offend you.

I have never liked football, in fact I have always called it dumb-ball. Why? Because I could not, and do not, understand the appeal of watching big dudes, many of them grossly out of shape, run into each other with their heads. I never saw this as sport, and recognize that in a three hour game, each player actually moves for about 6 minutes. How athletic (I mean pathetic).

Okay, okay, simmer down. I can see that some of them are sweating under those helmets, and to be honest I don’t even understand the game. I should not knock something I have not tried, take no interest in, and don’t get, but alas I will continue.I think the recent NFL player award of $765 million for those with brain injury resulting from football proves my point. According to one article, “under the settlement, individual awards would be capped at $5 million for men with Alzheimer’s disease; $4 million for those diagnosed after their deaths with a brain condition called chronic traumatic encephalopathy; and $3 million for players with dementia”. They indicate that there are 18,000 players affected (http://www.nfl.com/news/story/0ap1000000235494/article/nfl-explayers-agree-to-765m-settlement-in-concussions-suit).

Other articles talk about this as a “drop in the bucket” and an award very unlikely to have any impact on the NFL at all. I know that the economy lives on supply and demand, and it somewhat saddens me that there remains a “demand” for this type of sport via spectators that pay big bucks and derive pleasure from watching this idiocy.

I love this article from Grantland: What Would the End of Football Look Like? (http://www.grantland.com/story/_/id/7559458/cte-concussion-crisis-economic-look-end-football). In this, they speak of pending football lawsuits and that the end result is that “more and more modern parents will keep their kids out of playing football, and there tends to be a “contagion effect” with such decisions; once some parents have second thoughts, many others follow suit.”

I can tell you that I work with people with brain injury, Alzheimer’s Disease, concussions and post-concussion syndrome. These are not easy injuries to live with, or to treat. Dizziness, visual disturbance, excessive fatigue, cognitive difficultly, physical and emotional challenges…not fun. Why as a parent would I sign my kids up for that, or the likelihood of that, when there are other sports like tennis, volleyball, swimming, baseball and golf that are more classy, often more athletic, and clearly more safe?

What is interesting is that a few years back I was at a conference on Spinal Cord Injury. At my table, there was a researcher from the US. He was talking about impact data being collected from sensors inside football helmets. He said they were astonished at the high velocity of impacts being measured, and said the numbers were so severe they “could not even release the data as the outcome would result in public outcry and a drastic change to the sport”. Well, we wouldn’t want an outcry, would we?

The bottom line is that society’s values are changing. Parents are going to be less and less interested in exposing their children to sports that are more likely to cause injury, and to have long-term disabling effects. Sorry dumb-ball, I think your days are numbered. Golf anyone?

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Weekly Mind Bender

Two mothers and two daughters go shopping. They have $21, which they split equally between them. How can this be possible?

 

Answer

There are only three people. One of them is both a mother and a daughter. So there is a grandmother, a mother and a daughter. They each get $7 exactly.

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A Lesson on Leafy Greens

How much do you know about the many different greens you may pass over at the grocery store?  Are you lacking any essential nutrients, vitamins or minerals?  Chances are there’s a leafy green to solve what ails you!  The following info graphic created by Live Eat Green, gives you a lesson on the many types of leafy greens, including some powerhouse super foods and how they can boost your health!

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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.

 

 

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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 (http://www.alzheimertoronto.org/ad_Statistics.htm).

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.

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Weekly Mind Bender

The first is needed to make quotes you see, and it often sticks up when it’s time for noon tea.
The second’s biggest distinction is found, bearing the symbol of love that is bound.
The third should be biggest but that can depend, never standing alone or it may offend.
The fourth is oft used when making a selection, or if you should need a gun for protection.
The fifth is the fattest and oddest by far, and can sometimes be found in a wrestling war.
What are they?

Answer

The digits of the hand! (The order on the poem is pinky, ring finger, middle finger, index or pointer finger, and thumb)

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Julie’s Picks

I will be honest.  Most of my “leisure” reading is in the form of MBA textbooks, online research, and class notes.  However, every once in a while I get the chance to pick up a book that I would consider “interesting” even if still relating to my job as a health professional, my interest in wellness, or my role as a business owner.  Instead of trying to summarize these books in a book report, I thought I would provide “Julie’s Picks” for great reading about business, health, and keeping things in perspective.

 

How Will You Measure Your Life – Clayton Christensen.  My entrepreneurship prof recommended this book to our class.  And what a treasure.  This is a quick read, and relates business strategy to relationships.  My favorite part is when the author talks about how as parents we need to make “deposits” into the bank account that is our children.  Without regular “deposits” we will have nothing to withdrawal when we need it.  We cannot expect our bank account to be plentiful if we have not added to this over many years.  This is a lesson I have carried forward into my own life – even if it is just pennies a day, I need to build my fortune with my children and spouse now, so my relationships are rich later.

 

Lean In – Sheryl Sandberg.  This is a wonderful book about women in business. And not a girly book.  Sheryl has experienced immense business success in the male-dominated corporate world and talks about how women need to “sit at the table” and “lean in” to their careers while encouraging husbands, dads and partners to “lean in” at home.

 

The Fire Starter Sessions – Danielle Laporte.  A friend, and fellow entrepreneur, suggested this book.  Not only is it funny, informative, and forthcoming, it has worksheets after each chapter that encourage reflection, goal setting, and some deep thought.  The quotes in this book are inspirational, while also being somewhat unconventional and often “hit you in the head” obvious.  Danielle asks you to explore how you want to feel in life and then encourages you to do those things that make you feel that way.

 

A New Earth – Eckhart Tolle.  This book was the topic of an earlier blog.  As the book used for a post-program study for Hamilton’s Chronic Pain Program, I witnessed the impact this book had on people who were experiencing significant disability.  I read this in awe.  While having some very heavy content, this is mixed with practical and real stories that explain the importance of “presence” and highlight how people need to transform negative into positive thinking in order end conflict and suffering.

 

I will continue to share my picks as I find them.  Please feel free to also share yours.