Tag Archive for: occupational therapy


Intimacy Following Injury or Illness

Sexuality is an incredibly important part of being human. Yet, when we are injured, ill, or suffering from physical, cognitive, emotional or behavioral difficulties, this too can suffer.

The following article, care of the Neurology Centre of Toronto, discusses some commonly reported sexual issues that occur after brain injury.  If you have issues with sexuality after an injury or illness, know that this can be common and can be improved.  Contact an Occupational Therapist, we can help.

Neurology Centre of Toronto:  Sex after Brain Injury: What does this look like for me?


Provider Consent in Health Care – No Also Means No

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

In my previous blog, “Client Consent in Health Care — No Means No,” I spoke of the importance of client consent.   No means no.  But what is often forgotten in health care, is that consent goes both ways.  While a client has the right to “choose their provider,” this just means they can decline to be treated by, say, me. Or the next person.  But that doesn’t mean they can go down a random roster of professionals to find the best fit.  Why?  Because their ability to “choose their provider” is trumped by the provider also being able to “choose” them as well.

There are three main situations when a provider may say “no” to a client:

Skills and Availability – The provider would be expected to decline if they lack the skills, knowledge, or expertise (“the competencies”) to treat the clients’ presenting problems.   Taking on a client outside their skillset is unsafe for them professionally and for the client and their outcomes.  This also applies to them already having a full complement of clients such that they don’t have the space to do the work within what is needed or expected.

Conflict – Providers cannot consent to provide services to someone if this places them in a conflict, which can happen if they know the individual, or if being their provider would violate an employment agreement or contract (i.e. if you meet them at Company A, you can’t then work with them at Company B).  If the provider indicates a conflict, even if it seems minor to others (i.e. “I knew them in high school”), this must be respected.  Note that the nature of the conflict does not need to be disclosed.  Saying “I am in conflict” is enough.

Safety – The provider can also decline if providing services would be unsafe for them (physically, emotionally, environmentally).  While some jobs are inherently unsafe by nature, health professionals are not required to put themselves at risk when working.  This is especially true in the community where we are isolated and not protected by the surroundings of say a hospital or clinic space, where there are others (and buttons) to aid us quickly if needed.

As I said before, consent is a deal-breaker.  Always.  As occupational therapists, there are rules, laws, and regulatory matters to consider before taking on any client.  Working with vulnerable and exposed people (emotionally, mentally and physically) requires providers to take consent seriously and this goes both ways when clients choose us, and when we choose them.


Client Consent in Health Care – No Means No

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

My grandmother is in her 90’s and up until recently, lived in a retirement home.  She is legally blind and deaf, so communication is very difficult for her, but where she lacks in sight and hearing she excels in cognition, missing little and being able to direct her own needs.

As with many people of advancing age, while she can bathe herself, this is a safer process with an attendant.  She has been fortunate to be eligible for public services and receives care in the mornings.  During a recent review of her care schedule, the facilitator asked her if she was comfortable with a male attendant.  She responded with a “no” and that her “late husband was the only man to see her undressed and she would like to keep it that way.”

The next day two care providers showed up.  One was “in training” and he was a man.  My grandmother was upset by this, but like many people of her generation that feel that public services are such a “gift,” she felt that for “training purposes” she would compromise her comfort and tolerate the presence of a man during her shower.

The next day the same man showed up alone.  “I am here to shower you today.”  I am not sure how the conversation went, but it ended with her deciding to let the man shower her, with her telling him “well, this is probably just as uncomfortable for you as this is for me, so let’s get this over with.”

As an occupational therapist, but also as her granddaughter, this is upsetting.  She was asked for consent regarding a male provider and declined.  This should be in her record.  They proceeded anyway.  As a business owner, I understand that staffing and capacity are challenging and based on my own work experience with finding and keeping personal care workers for clients, the human resource issues are real.  But consent is consent and she did not provide it.  One could argue that “in the moment” consent was “implied” (she didn’t ask the man to leave), or “provided” (she let him proceed), but an “in the moment” comment of “let’s get this over with” is not consent but surrender.  She was vulnerable, confronted, and knew that a “no” meant “no shower today.”  Showers, like privacy, are also important to her.

The ability to “Consent” (to anything) is an important human right.  Exercising this is our duty to ourselves.  We are reminded of this quite topically in the “#MeToo” movement, but the reach of the “no means no” concept needs to be wider.  In health care especially, consent is paramount in the acceptance and deliverance of services.  No must mean no.

Consent is a deal-breaker.  Always.  Not only are there preferences and “feelings” about this important topic, but there are rules, laws, and regulatory matters to consider.  Working with vulnerable and exposed people (emotionally, mentally and physically) requires providers to take consent seriously and this goes both ways when clients choose us, and when we choose them.

For my grandmother, we contacted the agency and reminded them of her preferences.  We asked that no men arrive for showering and that they need to do better to not put her in these vulnerable and uncomfortable situations.  If they cannot accommodate, we will need to elect another service agency, or fund private care for her such that we are not exposing her to these experiences, even if “free.”

Stay tuned for my next blog on this topic, where I will review the second side of consent as yes; providers get to consent too.



Snow Removal O-Tip of the Week: Snowblower Safety Considerations

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

If you are fortunate enough to have a snow blower you have less heaving lifting to do, however, there are still dangers that this more efficient method can pose.   Here are some tips to ensure you are being safe while blowing snow:

  • Do not let children operate the machine
  • Do not wear loose clothing which could get caught in the machinery
  • Pace yourself – even when snow blowing you can overexert yourself in the cold, leading to the risk of heart attack
  • Operate the machine only outside as inside a shed or garage could put you at risk for carbon monoxide poisoning
  • Add fuel outdoors, before starting, and never add fuel while the machine is running
  • Never leave it unattended when it is running

Reducing Risk of Strain Due to Repetitive Movements

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

Repetitive activity using improper posture and body mechanics can result in excess energy expenditure, fatigue, pain and even injury or damage to muscles and joints over time.  Therefore, it’s important to know the proper body mechanics required when completing everyday tasks and activities, at home, at play or at work or school.

The following episode of our Occupational Therapy Video Series:  OT-V discusses how to ensure you are using proper body mechanics with respect to:

·    workspace design

·    lifting and repetitive muscle use

·    excessive standing

·    excessive sitting

·    hand movements

·    excessive energy output.

Take a look to learn how an OT can help you improve body mechanics and reduce the risk of injury and pain in the long-term.  Remember to subscribe to our YouTube channel for access to this and other great OT-V videos!


How Emotionally Intelligent Are You?

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

I have four daughters – three in high school and one in University.  That is a lot of estrogen in our house.  Yet it is an interesting time for our family – as our girls are navigating the perils of adolescence, I too am finding myself in a stage I am calling “adultescence” whereby my thoughts, feelings, and emotions are changing as theirs are.  This creates an interesting ebb and flow of all of us learning together what it all means as a teen girl to “grow up” and as an adult to start “letting go”.

I had one of those adultescent “aha” moments the other day with one of my teen daughters.  She is very socially driven and relationships are very important to her.  Over the last few months, as school has resumed, she has been struggling with some of her friendships.  One girl just suddenly stopped responding to messages, one takes pleasure in forwarding hurtful messages, and another treats my daughter as the weekend “last resort”.  In talking to my daughter about these events, my “aha” moment came when I realized that my daughter, already, is highly emotionally intelligent.  She has the ability to put herself in the position of others and regulates her own behavior (so far) on how she would feel as the recipient.  This is a gift for her but puts her at a relationship disadvantage as many of her peers are not there yet.   She “feels” in a relationship like she is 25, but is trying to rationalize the emotional behavior of kids 16 and 17.

According to psychology today, Emotional Intelligence includes three skills:

1. Emotional awareness, including the ability to identify your own emotions and those of others;

2. The ability to harness emotions and apply them to tasks like thinking and problem solving;

3. The ability to manage emotions, including the ability to regulate your own emotions, and the ability to cheer up or calm down another person.

Emotional intelligence then includes:  self-awareness, self-regulation, motivation, empathy, and social skills.  It can affect: personal relationships, workplace (or school) performance, physical and mental health, and how you deal with situations such as loss or disability.

The good news is that experts believe that emotional intelligence can be learned, even in adults.  How do you know if you are emotionally intelligent?  Perhaps reflect on your relationships – are you able to sustain positive and loving bonds with others?  Can you empathize and relate to people during their struggles, and do they know that you “get it” and are emotionally available to them?  Do you regulate your own behavior based on how others might feel if you act a certain way, or say certain things?  Before sending that text, email or calling someone in anger do you consider how you want them to “feel” following your interaction?  Do you take pleasure in being right even if that makes others feel bad?  If you want to test your level of emotional intelligence, or raise your emotional IQ, take a quiz to see where you’re at:  Emotional Intelligence Quotient Quiz.

Do you think you need to improve in this area?  Some suggestions include:

·    practice mindfulness – in social situations, at work, at home with family relationships.

·    Stay in touch with your feelings through journaling or meditation “check-ins”.

·    Connect your feelings to the situation and try to separate the person from their behavior.

·    Check your thoughts – how you think can become how you feel, and the good news is you can change how you think!

·    Communicate with others and don’t be afraid to be vulnerable to those close to you to help sort through feelings, thoughts and emotions.

·    And if you can, don’t take the comments of others personally.  Their thoughts about you do not need to become the thoughts you have about yourself.


Originally posted November 2016


Occupational Therapy and Heart Health

Being diagnosed with heart disease is a life-altering event, often requiring permanent lifestyle changes.    Occupational therapists can help people to recover from the initial incident, to rebuild a life of function, and to promote change that will help with prevention.

Learn more about how Occupational Therapy can assist those recovering from heart disease in the following infographic:




Snow Removal O-Tip of the Week: Don’t Wait for the Storm to Subside

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

Snow shoveling can be very strenuous work, especially when dealing with large amounts.  Therefore, as long as it is safe to be outside, it is suggested that you try to tackle the snow in stages.  This may mean going out and shoveling multiple times throughout a snowfall.  Waiting until all the snow has fallen will make the snow harder to move, which can increase the chance of injury.  Set yourself a timer and go out every 2 hours or so and reward yourself with a cup of hot cocoa each when you finish!


Breaking the Stigma: Sexuality and Disability

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

Co-written by Lauren Halliwushka, Occupational Therapist

Unfortunately, in the ongoing quest for an inclusive and equal-opportunity society, “sex” still sells. What used to be in printed material (magazines, newspapers, and fliers) has turned into an online buffet of images that are posted by people of themselves (often filtered, patched and “enhanced”), by people of others (with and without consent), and by photographers, companies and others whose job is to capture the attention of, and entice millions of people, to buy a product, service or idea. The goal of these “sexy” images is to tap into our intrinsic human need and desire for sexuality by adhering to the societal expectations of what is attractive. 

It has only been in the last few years that the concept of “attractive” is changing. Models are increasingly featured in many different shapes, sizes, ethnicities and some campaigns (thank you Dove) are about “natural” beauty.  But despite this small move in the direction of selling with images of “various types of people” presented as “real”, there is one more similarity in advertising that we often overlook. The models are able-bodied, or to use a totally arbitrary term, they would be considered “normal”. 

Why then do we rarely see individuals with disabilities featured in sexually enticing advertisements? It goes back to society’s assumptions of what beautiful and sexy is. Disabled people, through their history of being marginalized, institutionalized, segregated, or otherwise pitied have not been routinely associated with ‘attractive” as a concept. We need to work together to continue to change this perception and to remove the stigma.

Individuals with disabilities are sexual beings. Like you and me, they also have urges, desires, needs, and fantasies. However, a subset of the general population doesn’t think so. According to a systematic review of qualitative articles, a prominent misconception among a sample of the general public is that individuals with disabilities are asexual. Biologically this is odd because individuals with disabilities undergo the same maturation processes as everyone including puberty, reproduction and hormonal surges. Yes, approximately 1% of individuals are asexual but this is all people, not just those with disabilities. Another common misconception is that individuals with disabilities are only attracted to other individuals with disabilities. Inter-abled couples do exist, and relationships can form before or after a disabling event. Compared to inter-racial couples, however, inter-abled are not as common. Why? Well, it is thought that individuals with disabilities may be unconsciously internalizing the stigma and perspectives of society, which further negatively impacts their self-esteem, self-efficacy, motivation, and perceived sexual autonomy. This claim is supported by a qualitative study that gained the perspectives of individuals with disabilities on the topic of sexuality. A significant theme that emerged is the innate belief that their sexuality was not equal to or desired by individuals without disabilities. As such, they were reluctant to pursue inter-abled relationships due to fear of rejection, the partner resenting their disability and the possibility of the partner falling into a caregiver role.

In addition, stigma unknowingly creates various systemic barriers that further reinforce societal and self-stigma among individuals with disabilities, creating a negative counter-productive cycle. There is plenty of literature that highlights the ineffectiveness or inaccessibility of sexual education within secondary schools for individuals with both visible and invisible disabilities. Sexual education focuses on “normal” (that ugly word again) people. Hence, from a young age, we are setting up individuals with disabilities for failure by reinforcing self-stigma and neglecting to acknowledge their sexual being.

Regarding the healthcare system, a study suggests that only 6% of licensed health care professionals engage in frequent discussions about sexuality with patients/clients with half of them stating they avoid the topic due to embarrassment. Keep in mind, this statistic is regarding all individuals, disability or not, which is even more surprising given that sexuality is a crucial component of someone’s health and – more importantly – intrinsic to human nature. No wonder individuals with disabilities are adopting self-stigma if health care professionals shy away from this topic.

This is not about changing what you see as attractive. This is about challenging the opinion that individuals with disabilities are not capable of being sexy and can’t (or shouldn’t or don’t) engage in sexual behaviors. Not only are all people, disabled or not, able to engage in any and all sexual behaviors, but they also have wants, needs and desires like the rest of us. Healthcare professionals that shy away from, or avoid, this topic should consider discussing this aspect of health with patients/clients when appropriate by adopting a comfortable strategy (such as the ex-PLISSIT model).

If you have personally felt, or still feel, the self-stigma surrounding sexuality, please discuss it with a trusted family member, friend or healthcare professional. Specifically, Occupational Therapists are trained to be open about this concept and to problem solve the barriers to sexuality and engagement in sexual activity as a very important “occupation (aka life role)” for all of us.

If you are interested in reading more, I recommend The Ultimate Guide to Sex and Disability by Dr. Miriam Kaufman.

Remember: Disability is extremely broad and can impact people in multiple ways. As with all people, consent is always required when engaging in any sexual activity.




1 Sinclair, J., Unruh, D., Lindstrom, L., & Scanlon, D. (2015). Barriers to Sexuality for Individuals with Intellectual and Developmental Disabilities: A Literature Review. Education and Training in Autism and Developmental Disabilities, 50(1), 3-16. Retrieved June 18, 2018.

2Miller, A. M. (2015, May 4). Asexuality: The Invisible Orientation? Retrieved from

3Esmail, S., Darry, K., Walter, A., & Knupp, H. (2010). Attitudes and perceptions towards disability and sexuality. Disability and Rehabilitation, 32(14), 1148-1155. doi:10.3109/09638280903419277

4McDaniels, B., & Fleming, A. (2016). Sexuality Education and Intellectual Disability: Time to Address the Challenge. Sexuality and Disability, 34(2), 215-225. doi:10.1007/s11195-016-9427-y

5Jones, L., Bellis, M., Wood, S., Hughes, K., McCoy, E., Eckley, L., . . . Officer, A. (2012). Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies. The Lancet, 380, 899-907. doi:10.1016/S0140-6736(12)60692-8.

6Dukes, E., & McGuire, B. E. (2009). Enhancing capacity to make sexuality-related decisions in people with an intellectual disability. Journal of Intellectual Disability Research, 53(8), 727-734. doi:10.1111/j.1365-2788.2009.01186.x

7Haboubi, N. ,. J., & Lincoln, N. (2003). Views of health professionals on discussing sexual issues with patients. Disability and rehabilitation, 25(6), 291-296

8 Taylor, B., & Davis, S. (2006). Using the Extended PLISSIT model to address sexual healthcare needs. Nursing Standard, 21(11), 35-40. doi:10.7748/ns2006.


Snow Removal O-Tip of the Week: A Lesson on Lifting

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

For the month of February, our O-Tip series will help you to practice safe and efficient snow removal this winter.

Clearing snow is a necessity to ensure safety for yourself, visitors and passersby.  Shoveling can be strenuous work, therefore it’s important to use the proper tools and techniques to reduce the risk of injury.

Whenever possible, push the snow rather than lifting. When lifting is needed, follow these tips:

  • Do not try to lift large amounts at one time
  • Hold the shovel close to your body
  • Ensure you keep a slight bend in your knees
  • Lift with your legs while maintaining the natural curve in your back.
  • Always move your feet to ensure your body will face the direction to where you are dumping the snow.
  • Avoid twisting your back
  • Avoid dumping snow over your shoulders