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The A to Z of OT: A is For… Aging in Place

Occupational therapists are trained to assess the person, their environment and the tasks they need to complete in the places they live and work.  Therefore, when it comes to helping older adults make the decision to age in place or move, Occupational Therapists are the experts. 

Learn some of the ways occupational therapy can be involved in the aging well and aging in place process in our post, Occupational Therapy and Aging in Place.

 

October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along with The A to Z of OT and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

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Introducing… The A to Z of OT!

October is Occupational Therapy Month and to celebrate we will be sharing a new series called The A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living!

Starting tomorrow we encourage you to follow along with The A to Z of OT and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!

Happy Occupational Therapy Month!

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The Experience of Occupational Therapy

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

Many people still don’t know what occupational therapy is and the benefits it can provide.  If you are a subscriber to this blog, hopefully we have helped you over the last many years to get a better understanding about our profession.  But I have always said that the best way to understand occupational therapy is to experience it.  Here in our practice lawyers and insurers “experience” occupational therapy through recognizing that we can help move people through a recovery or trauma process and they entrust us to do so honestly, ethically and professionally.  Families also “experience” occupational therapy through watching their loved one hopefully “do and manage better” because of our involvement.  But what about the clients themselves?  Those people that need our services and who build lasting relationships with us as we assist them through some very difficult and trying times?  What do they experience?

Well, the regulated health professions act does not allow us to use “testimonials” in “advertising” because these are not verifiable and are often biased.  This act is from 1991, long before the internet allowed us to “rate our anything” and review everything from face cream to shoelaces to our local restaurant using one to five stars.   We know we can’t tell you the stories of the people we help, but last October for OT Month we followed the lead of the Ontario Society of Occupational Therapists (OSOT) by embracing the challenge of asking the people we treat two very important questions:

“What do you value most about occupational therapy so far?”

 “How do you feel I have helped you the most in our work together?”

The answers from our clients were helpful, insightful and rewarding.  And while I can’t repeat them verbatim here, I can tell you the themes of people’s experiences with occupational therapy as noted by us:

The Most Value

A common response under “what do you value most about occupational therapy” was that we help clients to add “tools to the toolbox”.  Clients seem to appreciate that occupational therapy has provided them with new skills and strategies that they can put in their back pocket to retrieve when needed.  We have taught them how to help themselves and have given them the resources and support to do so.  And when they are not able to help themselves, we grab the tool for them and show them the way.  The tools they learn from us help them to expedite recovery and get them there faster.  Kind of like an accountant or bookkeeper doing your taxes – using a professional gets the job done faster and with greater accuracy.  We don’t know what we don’t know.

A second value related to the support we provide in helping them to navigate some very difficult systems.  The insurance system is complicated enough, but when two or more systems get pitted against each other the client is caught in the crossfire.  Insurers will argue they are the third payer after OHIP and extended health.  The CCAC will argue they are the third payer and “don’t provide service to people that have insurance”.  Extended health will say “we can’t talk to you, only the client” and then the client will be told “there is no coverage for occupational therapy” but the other insurer needs to have a denial from them to be sure.  How do you submit for services you are told you don’t have?  You can’t so the cycle continues.  Our clients value our role in helping them to get the services they need when they need them.  We understand these complicated systems and help to prevent people from falling through the cracks.  We also identify gaps in services and bridge these through connecting clients to other providers, services, supports and resources.

The Most Impact

The answers to the question about impact varied on a spectrum of education regarding injuries and symptoms to “you literally saved my life”. But the common thread included the more human aspects of the occupational therapist providing validation, understanding and teaching a recovery-minded thought process that people would not necessarily develop on their own.  People valued being heard and the unique approach the occupational therapist took to be practical, relatable, and progressive.  The value came in the customization – from person to person and visit to visit. 

My favorite quote from this qualitative gathering of feedback was this:

And don’t be fooled by the title occupational therapist. My occupation at the time of my injury was “retired” and it’s a lifetime job I take very seriously.

Occupation for us is about how you spend your time – all of your time – from sleeping to “retiring” it is all important for you and to you.  (check out our Occupation Is series to learn more)  If injury or disability is preventing you from spending your time the way you want, consider occupational therapy.

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Game… Set… Cerebellum

Co-authored by Meredyth Bowcott, Student Occupational Therapist

The 2018 Rogers Cup has just wrapped up in Montreal and Toronto, and once again spectators in Canada and around the world were dazzled by the likes of top-ranked tennis players such as Rafael Nadal and Simona Halep. If you’ve ever tried your hand at the sport, you know it requires great speed, agility, endurance, and of course coordination.

So how do these players prepare to return a serve that can clock in at speeds of over 160 km/hour? Well, they do it with a little help from a part of the brain called the cerebellum.

The Mighty Cerebellum

The cerebellum registers the serving player’s movement pattern, along with the speed and trajectory of the tennis ball, and predicts the outcome of these movements. As the returning player makes a split-second decision about how to get into position to hit the ball back, the cerebellum is still hard at work. It receives instructions for how the body should be positioned in order to return the serve, simultaneously comparing the body to the actual position of joints and muscles. The cerebellum sends signals to adjust the position of the body in real time, giving the player the best shot at returning the serve.

We can’t all be tennis superstars, but we do all rely on our cerebellum in our day to day lives. Truly, any intentional movement that you accomplish in a smooth and predictable manner, from watering your plants to drinking a cup of coffee, is brought to you in part by your cerebellum.

Ataxia

So, what happens when this crucial brain structure becomes damaged and isn’t working as it should? One of the symptoms of cerebellar dysfunction is ataxia. Ataxia is characterized by a loss of muscle control and coordination, and can affect the whole body or only specific parts (upper extremity, lower extremity, trunk, etc.). Individuals with ataxia may have difficulty initiating movements, movements may appear jerky and imprecise, and they may have poor sitting or standing balance. Others may have difficulty swallowing or experience rapid back and forth eye-movements.

Ataxia has a pronounced impact on how people go about the activities in their day. Without adequate muscle control and coordination, tasks like getting dressed, walking, and preparing a meal become more challenging.

How Occupational Therapy Helps

It’s important for medical teams to determine the cause of the ataxia and see whether it is due to an underlying issue that can be treated. When symptoms persist, occupational therapists (OTs) focus on ways to help individuals with ataxia compensate for their symptoms. Some of the ways an OT might help someone with ataxia are:

Energy conservation: Fatigue can exacerbate symptoms of ataxia, therefore it’s important to think about how to conserve energy throughout the day.  We do this with the four P’s:

  • Prioritizing: OTs can help establish a list of priority activities, that is which tasks throughout the day are more important for the individual to be able to get done. Focusing attention on what’s most important contributes to a more rewarding day.
  • Pacing: It’s important to take regular breaks – before fatigue sets in – and practice proper pacing technique. OTs can help create a realistic daily schedule that allows time for productivity and rest.
  • Planning: OTs are skilled in task analysis and can help individuals find the most efficient way to accomplish an activity. This reduces unnecessary expenditures of energy, and can reduce frustration.
  • Positioning: OTs consider how the individual interacts with their environment while accomplishing a task. For example, ensuring everything needed to make dinner is within reach limits unnecessary movement.

Joint stabilization: If muscle incoordination occurs in the upper extremity, it can be beneficial to stabilize the arm when accomplishing gross and fine motor movements. For example, stabilizing one’s elbow by leaning it on a table can help create a smoother movement when drinking from a cup.

Adaptive equipment: OTs can recommend equipment to make certain tasks easier. In some cases, the use of weighted utensils may help reduce jerky arm movements. Self leveling spoons can also help minimize spills during mealtime. Lining work surfaces in the kitchen with a non-slip mat such as Dycem © can provide traction to compensate for muscle incoordination.

Every person with ataxia is different, and occupational therapists have the skills to develop individualized plans to help them lead active and fulfilling lives. For more information on these and other ways occupational therapy plays a part in treating ataxia, contact an OT!  In the meantime, if you like sports, watch the cerebellum in action at the upcoming US Open!

 

References:

Anderson Preston, L. (2013). Evaluation of Motor Control. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 461-488). St. Louis, Missouri: Elsevier Mosby.

Foti, D. & Koketsu, J.S. (2013). Activities of Daily Living. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 157-232). St. Louis, Missouri: Elsevier Mosby.

Mayo Clinic. (2018). Ataxia. Retrieved from:

https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652

Tipton-Burton, M., McLaughlin R, & Englander, J. (2013). Traumatic Brain Injury. In H. McHugh Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction, 7th Edition. (pp. 881-915). St. Louis, Missouri: Elsevier Mosby.

UBC Medicine – Educational Media. (2014, February 18). The Cerebellum – UBC Neuroanatomy – Season 1 – Ep 8 [Video File]. https://www.youtube.com/watch?v=17mxfO9nklQ

 

 

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Golf FORE All

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

I don’t quite understand why hitting a stationary ball is so difficult but alas, golf is one of my favorite sports.  I started playing as a teenager and spent years figuring out that my old baseball swing aimed lower would hit a golf ball far, but not really straight.  With practice I have removed the sway, slowed down my tempo, and learned that trying to kill the white-dimpled-target does not work out either, and voila, I am hooked.

But beyond my love of the sport as an athlete, I also love how adaptable it is.  Growing up I remember playing with my grandfather who had polio.  He would swing a club with one arm while his other arm held his crutch to keep him standing.  Yet, even with one arm, he could hit the ball consistently far and straight – skills foreign to most amateurs.  As an occupational therapist, I now suggest golf as one way to re-integrate clients into the athletic world following an accident or injury.  How?  By breaking the sport into its component parts, and structuring participation around ability. 

Many people start with putting.  While putting can be boring to practice, it is the most important part of the game as you are likely going to put at least 18 times a round.  Putting requires neck flexion but can be done in sitting or standing.  Mats can be purchased to putt at home that will eject the ball back to your feet if your putt is successful.  At times, I have even used putting with clients at their home to test for visual-spatial deficits which makes it a great exercise to also practice if deficits are noted.

From putting, people can slowly increase the club speed through chipping, pitching and low wedge shots.  In these cases, there is little body movement and reduced torque through lowered club speed that would cause pain if the ground, not the ball, was impacted.  Then, if feeling good around the greens, the player can start with low irons on the range and work backwards to full swings.  Eventually, they can try a few holes with a cart to pace the walking, then consider a pull cart with walking later if that is within their abilities.

What is also great about golf, however, is how this is getting attention in the world of modified sport.  Now, some courses have Solo Riders (www.solorider.com) that can be used by people who have deficits in independent standing.  These Solo Riders position the golfer in swing distance from the ball, then elevate them into a standing position to facilitate the swing.  These carts can go on the tees and greens as they only distribute 70 pounds for force through each tire – less than a person’s foot so they don’t damage the course.  I played in a tournament recently where a local golf pro, who had a spinal cord injury, demonstrated the use of a Solo Rider on a par 3 from the tee and hit the ball within a few feet of the pin.  Apparently, for the group before us, he hit a hole in one.

I also remember reading an article a few years ago about physiotherapy programs that were focusing on golf-related skills in therapy such as balance, trunk control, pelvic rotation, and fluidity of movement to help golfers return to the game.  Other activities, such as yoga and Tai Chi are also now known as ways golfers can improve flexibility, strength, endurance, and muscle control in the off-season.

My parents vacation in Florida all winter, and while there met Judy Alvarez who instructs and assists disabled people to learn, enjoy and excel at the game of golf.  I read her book (Broken Tees, Mended Hearts) on a recent holiday.  What is most compelling in her book is not about the physical benefits of golfing, but rather the emotional and participatory value golf has for her disabled clients.  Through participation in a challenging but modifiable sport, people can regain passion for sport, competition and can work to achieve personal bests.  Golf really is FORE all and I hope you will consider hitting the links.

Originally posted July, 2013.

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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Reporting Unsafe Drivers: The New Role of Occupational Therapists in Ontario

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

Co-written with Samantha Hunt, Student Occupational Therapist

My father-in-law was terminally ill and suffered from dementia.  Eventually, his decline became significant and his doctor filed a mandatory report with the Ministry of Transportation (MTO) to suspend his license pending a driver’s exam.  He refused to attend the exam yet continued to drive even without a valid license.  He still paid for car insurance because he knew this was important but was not well enough to connect his own disabilities to his safety and the safety of others.  The family planned to remove his vehicle from his possession but before we could he ventured out one night, got lost, and the police found him 8 hours later driving in a farmer’s field.  The good news was that no one got hurt and his car was beyond repair.  Now, he could no longer drive even if he wanted to.

Driving is an important daily activity for many and provides drivers with an independent means to get around and to manage our own needs outside of the home.  It reduces our reliance on others and provides us with freedom and control.  But it is a privilege, not a right, and sometimes people reach a point where driving is no longer safe, but yet they don’t voluntarily stop.

Up until recently, the ownness to report unsafe drivers has fallen to the legal responsibility of doctors, nurse practitioners and optometrists.  However, on July 1, 2018 the legislation will change to add a new class of “discretionary” reporting, and occupational therapists will be included in the list of professionals that can submit these “discretionary” reports. 

Considering this major change to the Highway Traffic Act (HTA), and the significance of this on OT practice in Ontario, we wanted to provide a brief overview of the key facts and guidelines for the OT’s that this may impact.

Background on Medical Reporting Legislation

Mandatory medical reporting for physicians and optometrists in Ontario has been in place since 1968 and was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive. Mandatory reporting is a legal requirement to report that pertains to physicians, nurse practitioners, and optometrists, outlined in the HTA. The legislation states that every prescribed person shall report to the MTO “any person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a prescribed medical condition, functional impairment or visual impairment that may impair driving ability.”

What’s New

In 2015, amendments were passed that allowed for a new reporting model to be introduced in Ontario and were approved in February 2018. These include:

·       A combination of mandatory and discretionary reporting

·       Authority to add additional healthcare professionals

·       Specific requirements regarding what must be reported

Resulting from these amendments, the MTO regulations state that as of July 1, 2018, occupational therapists are identified as discretionary reporters. Discretionary reporting is not a legal requirement but gives authority for reporting to occupational therapists, physicians, nurse practitioners and optometrists for: “any person who is at least 16 years old who, in the opinion of the prescribed person, has, or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle”. Discretionary reporting therefore allows OTs to report concerns about a client’s fitness to drive if they choose.

With respect to consent and confidentiality, OTs are protected from legal action for breaking confidentiality when making a discretionary report; the HTA states that the authority of a prescribed medical professional making a report to the MTO overrides the duty of that professional to maintain a client’s confidentiality. Nevertheless, an OT making a report would be expected to advise the client of this decision.

Summary of Discretionary Reporting Rules for OTs

·       OTs can report concerns about a client’s fitness to drive directly to the MTO.  There will be a standard MTO form to be used for this purpose.

·       OTS may report a driver but are not legally required to do so.

·       OTs can make a report without client consent to prevent or reduce risk of harm.

·       OTs can only make a report if they have met the client for assessment or service delivery.

·       OTs can report on both prescribed conditions and any other medical conditions, functional impairments or visual impairment that may make it dangerous for a client to drive.

Prescribed medical conditions include the following:

1.     Cognitive Impairment: a disorder resulting in cognitive impairment that,

                 i.      Affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and,

                 ii.     Results in substantial limitation of the person’s ability to perform activities of daily living.

2.     Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.

3.     Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.

4.     Visual impairment:

                 i.      A best corrected visual acuity that is below 20/50 with both eyes open and examined together.

                  ii.     A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.

                 iii.    Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.

5.     Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.

6.     Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.

·       OTs who make a report in good faith are protected from legal action but failing to report when they should have could be a breach of professional obligations.

OTs are NOT expected to report on conditions that, in their opinion, are of:

·       A transient or non-recurrent nature

·       Modest or incremental changes in ability

Lastly, although OTs are not legally required to make discretionary reports, a professional obligation to identify a potential safety issue with a client (such as a concern about fitness to drive) and, taking action to address this concern, is expected of the OT. Taking action may or may not include making a discretionary report to the MTO.

Next Steps

Reporting, Intake, and Review Process

The three types of approaches for assessing fitness to drive include a General Functional Assessment, Driving Specific Functional Assessment, and/or a Comprehensive Driving Evaluation (more information can be found in the resources below). Once an assessment has been completed or a concern has been identified, an OT may fill out a report. A new standardized form that OTs (along with physicians and nurse practitioners) must use when making a report has been approved and will be available online as of July 1, 2018. Once reports are received by the ministry, they will be reviewed and the MTO is to take appropriate action following within 30 business days.  When an OT is reporting to the ministry, this does not mean the OT is taking the person’s license away. The licensing body has the responsibility to make this decision or to decide if more information is required.

For more information and resources, the College of Occupational Therapists of Ontario has created an Interim Guide to Discretionary Reporting of Fitness to Drive, which can be found at:  https://www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

Resources

www.coto.org/news/changes-to-medical-reporting-of-drivers-gives-ots-new-reporting-authority

www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

www.mto.gov.on.ca/english/safety.medical-review.shtml

www.youtube.com/watch?v=dOIJ7CrDTT0

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Occupational Therapy and Physical Therapy: Key Differences and Similarities

The differences and similarities between Occupational Therapy and Physiotherapy have long been confused.  Although both Occupational Therapy (OT) and Physiotherapy (PT) are registered healthcare professions specifically in the domain of rehabilitation, each profession has it’s unique role and purpose in one’s recovery following injury or illness, as well as in the prevention of disease, further injury, and disability. 

Learn more about the key differences and similarities of these two extremely valuable therapies in the following infographic:

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Living with Cancer: OT Can Help

Cancer and cancer treatment can lead to changes in how we do our daily activities due to physical, cognitive or emotional changes resulting from the diagnosis, resulting surgery, medications, chemo and radiation. For a cancer patient sometimes just doing daily activities leaves little energy for leisure, social, or work-related tasks.  Common side effects of cancer or its treatment include fatigue, pain, weakness, cognitive difficulties, anxiety or depression, and changes in self-esteem or self-image. Each person diagnosed with cancer will experience different challenges in his or her participation in various daily activities and life roles over the course of the disease.

Occupational therapists have knowledge and expertise to allow individuals with cancer to do the things they want and need to do to maintain their level of independence and quality of life. Occupational therapy services are helpful for individuals throughout the continuum of cancer care, including those who are newly diagnosed, undergoing treatment, receiving hospice or palliative care, or who are survivors reintegrating into previous roles. Caregivers also benefit from the training and education provided by OT’s as this arms them with the essential tools to offer support and assistance to their loved ones when performing daily, important, and meaningful activities.

Take a look at the following infographic to learn more about how Occupational Therapists can help:

Previously posted April 2017.

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Sexual Harassment and Sexual Abuse: OT Can Help

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

The pendulum has surely shifted on what society will and will not tolerate when it comes to sexual harassment and sexual abuse.  For those that remain confused on these two overlapping but very different concepts, here are simple definitions from Wikipedia:

Sexual Harassment:  bullying or coercion of a sexual nature, or the unwelcome or inappropriate promise of rewards in exchange for sexual favors.

Sexual Abuse:  undesired sexual behavior by one person upon another.

Sexual harassment has often been related to the workplace and women tend to be the most common recipients.  It also tends to involve a power imbalance whereby one person is in a position of authority over the other, but by definition, this does not have to be the case.  With the current societal shifts, it is now recognized that harassment can extend beyond the workplace, and is not gender specific.  Sexual abuse, on the other hand, has always been more of a global term, applying to anyone, anywhere, anytime, who is forced into sexual activity without their consent.  It has always been socially unacceptable, even when sexual harassment was more of a commonality.

Truth be told, I have been a victim of both.  I can say that harassment is easier to talk about but at the time I was being harassed it was not as socially unacceptable as it has become.  In fact, it almost seemed common that a young woman working (and in my case playing sports) who was exposed to men in more senior positions would be solicited, propositioned, flirted with or asked on dates or to social events.  I was fortunate in that none of these experiences turned into sexual abuse and I trust (hope) that men today behave much more professionally around women in general.  Sexual abuse, on the other hand, is much harder to talk about, and my experience with this is not one I am comfortable sharing publicly.  I do know though that victims of sexual abuse often need therapy to help them recover from their trauma, and I am hopeful that the recent media attention to this will encourage victims to come forward and seek help should they need it.

Occupational therapy can be one form of treatment for people who have suffered from sexual harassment or abuse.  When people are off work or struggling with work, our therapy helps people to discover functional barriers, develop solutions, proactively engage in problem solving, and then assists people to forward in their new chosen direction (albeit return to work, seeking new work, or addressing retraining).  With sexual abuse some occupational therapists are trained in psychotherapy and work with people directly to address the results of their trauma.  Occupational therapy also helps people to rebuild the elements of their life that have been lost because of their trauma.  Sometimes victims of sexual abuse develop maladaptive ways to cope (addictive behaviors, inactivity, social isolation to name a few) and these can be addressed in treatment.  It is also common that depression and anxiety surface following sexual abuse, and these too can be tackled through activation at home and in the community.  Occupational therapists work very well with other providers who may also be involved – social workers, psychologists, and the medical team, helping to create a cohesive and impactful approach to recovery.

If the media attention to these problems results in positive societal and behavioral change, then we all need to be thankful and grateful to the people that have come forward and for the stories that have been shared.  And if sexual harassment or abuse have caused problems for you and impact how you manage your day-to-day activities including work, taking care of yourself, enjoying leisure, or managing important elements of how you want to spend your time, consider occupational therapy as one element of your recovery team.

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Thinking Big: The Impact OT Services Can Have on the Healthcare System  

Guest Blogger Lauren Heinken, Student Occupational Therapist

Recently we reviewed the book Better Now: Six Big Ideas to Improve Healthcare for All Canadians, written by Dr. Danielle Martin.  While the book is excellent, it did omit to include how Occupational Therapy (OT) services may impact Canada’s Healthcare system, and this blog will fill this gap. I believe that an increase in OHIP funded OT services has the potential to have a positive economic impact on the healthcare system as a whole. This is mainly due to OT being a proactive form of therapy that may help in preventing individuals from requiring more reactive forms of care following an acute bout of illness/injury.

An aging population has the potential to place strain on our healthcare system; however, this can be minimized through strategies that: decrease the number of episodes of acute illness/injury experienced by this population, and improve the management of the chronic conditions they face. These strategies require that a proactive approach to healthcare be undertaken. OTs are well positioned to provide preventative care due to their focus on helping individuals find ways to safely engage in their daily occupations despite limitations that they may have. The OT focus on helping clients to maintain independence and through empowering clients to be accountable for the management of their own health aligns well with a preventative approach. So why does OHIP coverage (and even private coverage) for OT services remain so limited? By limiting the number of individuals who can access these services, aren’t we missing out on an opportunity to reduce costs to the healthcare system in the future?

The answers to these questions lie in the fact that our healthcare system remains highly focused on reactive care. It is no secret that Canada’s healthcare system is much more effective in providing urgent and acute medical services than it is in providing services to those with health conditions that cause functional decline, but not to the point of being imminently life-threatening.  Although having these acute services is essential, making cutbacks to services that have the potential to reduce these acute events, is shortsighted. Because acute medical services are necessary, increasing funding for preventative services will initially result in an increased cost to the system. However, as these preventative services become utilized it can be expected that acute costs will decrease to a greater extent than the cost of preventative services in the first place. This is especially true if these services can be administered in a group setting, and OTs are trained to provide educational self-management interventions in this manner.

OTs are also well positioned to provide transitional services that can help to bridge the gaps between care settings, for example when transitioning from acute hospital care to the care received afterwards in the community. Problems can arise during this transition especially if information is not communicated effectively between care sources. This can lead to hospital readmissions and complications in the recovery process, which lead to further healthcare costs. OTs can be effective coordinators and can help to arrange the necessary community care following the acute phase of recovery in the hospital. OT’s understand the demands required for someone to perform their daily living activities at home and are uniquely positioned to assess if returning to these activities is possible, or what assistance might be needed.  If patients are given the appropriate assistance during their recovery process, their health outcomes will naturally be more positive. Additionally, since occupational therapists are trained to address all factors that can influence a person’s well being, they are more likely to pick up on additional challenges an individual may face when returning home post hospitalization. Maybe their home environment is poorly suited to their current needs, or maybe they have little social support available to them; whatever the situation, OTs know how best to solve these problems.

Considering the role OT’s can play in improving the lives of Canadians, and in reducing long term costs, as a profession they need to continue to advocate for their services, particularly those that may be considered preventative in nature.  Outcome studies do exist that showcase how OT reduces costs and prevents re-institutionalization.  This is the data we need, combined with qualitative case studies and stories of client experiences, to promote change.  But in the end, it is a paradigm shift that is required in the minds of all Canadians – the “it won’t happen to me” needs to become “it is happening to me and I need help” before people will be able to reshape their activities and get the support and answers required to result in more positive health outcomes.