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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-publicised 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 seatbelts when in a vehicle.  Why?  BECAUSE WE WERE RAISED THAT WAY.  Seatbelt 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 seatbelt 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 seatbelt (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.

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Weekly Mind Bender

You put a coin into an empty bottle and insert a cork into the neck. How can you remove the coin without removing the cork or breaking the bottle?

 

Answer

Push the cork into the bottle and shake the coin out.

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The Goal is Improved Executive Functioning

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

As a caring professional, I refuse to believe that my clients are not motivated.  All of my clients have goals or I would not be treating them.  However, their ability to achieve their goals independently remains the reason that they require active therapy.  Previously, I wrote about executive functioning, and used the example of moving to highlight how people with executive dysfunction may feel on a regular basis when completing relatively simple tasks.

Treatment for executive dysfunction is as broad as it is specific.  It is broad because everyone experiences brain injury differently, and comes into that type of trauma with varying levels of ability to start with.  However, treating problems with executive function is really as simple as taking a goal and breaking this down into component parts, manageable chunks, and smaller goals within the whole.

So, returning to the moving example, assisting someone with executive dysfunction with a pending move will involve making checklists, with time frames, and checking on progress frequently.  Personally, I like to take a project approach:  calling the goal “Operation Move” and mapping out – start to finish – the metrics for success.  Perhaps in month one an “apartment hunting worksheet” is created to help a client summarize all the places they are looking at, the pros / cons, address, and list of questions that need to be answered (price, utilities included, length of lease etc.).  Often I encourage my clients to use a smartphone to take photos of the options then we cross reference these and catalog them to keep things organized.  From there, the process continues with checklists for calls to make, addresses to change, ways to organize packing and management of belongings.  Ensuring the client is responsible for follow-up via “homework” between sessions and holding them accountable for completion of this aids to developing independence.  Really, the therapeutic goal is more than just ensuring the client is able to move successfully.  Rather, it is demonstrating a model and method that can be used for any future transitions, goals or tasks.  This ensures success that is transferable to other events at later dates. 

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"You Only Get One Brain; Treat it Well!"

Concussions are a hot topic in sport.  Yet the management of these continues to vary.  It is now felt that if someone sustains a head injury during sports, they should not return to the game and should be checked by a professional.  Take a look at this article about concussions and the changing guidelines for treatment.  In the article, an expert, Dr. Jeffrey Kutcher, states:  “If in doubt, sit it out,” and points out the important fact that “you only get one brain; treat it well!”

CBC News Health: “If in Doubt, Sit it Out”

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June is Brain Injury Awareness Month: How Is Your Executive Functioning?

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

Last month, I spoke at a conference with my colleague Tamara Forbes (www.forbeshealth.ca) on the topic of executive dysfunction.  Executive dysfunction is a common problem following brain injury.  Simply defined, executive functions are the capacities we require to achieve a goal.  They are commonly referred to as the “CEO” of the brain because they provide the higher order processes that allow us to plan, organize, initiate and complete tasks successfully.

Practically, think about the last time you moved.  Moving, as an example, is a simple goal of just wanting to relocate from one place to another. The goal is not the problem: it is the processes and thinking required to manage the transition effectively.  Several months before moving you are searching for a suitable place, weighing the pros and cons of each location, checking your budget.  Then you make the decision of where to move and you need to deal with your existing location.  When do you need to notify your landlord, or when should you list your house?  Then, months and weeks before you move there are calls to make to utility companies, mail to redirect, insurance to organize, movers to book and packing to do.  What belongings are you moving?  What should be sold, donated, discarded?  The day of the move is chaotic, stressful, and exhausting.  Then for months after you continue to unpack, move things around, find ways to arrange and store your stuff.

Your level of executive functioning, or your ability to delegate and enlist support for your areas of weakness, will determine the outcome of your move.  Now imagine, with brain injury, that you feel the same sense of stress, fatigue and frustration with more simple daily tasks, such as planning a meal, sorting your mail, or scheduling your time.  This is often how people with brain injury will feel on a regular basis.   The goal then of occupational therapy will be to simplify daily tasks and help a client break activities down into smaller and more manageable chunks.  More on this to come…

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Occupational Therapist Sued Over a Reacher

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

I am getting increasingly frustrated at the failure of other OT’s to understand the value of education when prescribing equipment.  While it might seem on the surface that use of a reacher, tub scrubber or bath mat are “common sense”, my experience is that common sense is not common, and I don’t want my license on the line.

Take a reacher for example.  I have seen people use them as a cane.  Or people who have one that is too short and almost fall out of their chair trying to access that item that is “just a little further”.  Maybe they think that reacher can handle the over-sized glass jar of pickles and when it doesn’t the jar ends up shattering on the counter in front of them, landing on their lap, or worse, their head.  To send something to someone in the mail, and to indicate that “education is not necessary” exposes the OT to liability and the client to risk.

Why don’t OT’s hear about stories of devices gone array?  Mainly because when an OT is sued over a piece of equipment, the case can take years to resolve and when it does, the OT is sworn to secrecy about the outcome, otherwise they can be sued for breach of settlement.  So OT’s: don’t think these lawsuits don’t happen!

In the world of insurance there is funding for equipment and funding for education to ensure that the equipment is appropriate and the client can safely and independently demonstrate its use.  I have had to return many-a-things that I thought looked great on paper to find out they don’t actually work for that client in that case.  As OT’s we need to take our prescription responsibilities seriously and should never jeopardize our education, training or experience under the assumption that someone will properly use an item we consider “low risk”.

So, when I prescribe devices, and ask an insurer to fund time for an OTA or myself to provide them, it is because that is part of my judiciary duty to my client, my college, my license, my training, and my sense of responsibility.  If another OT feels the device is suitable, but says education is not required, then they can feel free to order those devices themselves and run the direct liability risk of being sued over a reacher.