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Tag Archive for: safety

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Don’t Put Your Feet On the Dashboard

All passengers love to get comfortable on a long car ride.  I often see passengers in passing cars stretched out with their feet up on the dashboard.  Did you know this is a very dangerous thing to do?  Check out the following article which shows just how dangerous this can be.

She Was Just Putting Her Feet on the Dashboard — And It Was One of the Biggest Mistakes of Her Life

 

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Top Pool Safety Tips

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

In celebration of summer, I wanted to repost our popular blog on pool safety. These helpful tips and tools are good things to review and consider…especially this time of year.

I was a fortunate child who grew up with an in-ground pool. As the only house on the street with a pool in our yard, the neighborhood kids would loiter around our home hoping for an invite. My mom developed a wonderful system using a Canada flag. If the flag on our fence was up – everyone was welcome for a swim. The only rule was that the kids needed to bring a parent. Mandatory. And despite the kids that would sit on our lawn whining about not having an adult to join them, my mom was firm to the rule.

We have a pool in our yard. This is separately fenced. As our kids are getting older, and have been able to swim for years, we are giving them more freedom around the pool. As long as an adult is home, they are welcome to swim. However, last year I was reminded of an important lesson – just because my kids can swim, that is not necessarily true for others of the same age. We had a pool party for our twins’ birthday and all the kids arrived and proceeded to jump in the pool. One child was hanging around the shallow end and I asked her if she could swim – nope. I was surprised that in dropping her off to a pool party, her parents would not mention this very important fact.

A few summers ago on a street very close to mine an 18 month old child drowned when he was able to get outside while his father had a 15 minute nap. Drowning is the second most common cause of accidental death among children aged 14 and under in Ontario, after motor vehicle accidents. Yet, like many risks, drowning is absolutely preventable. Here are some safety precautions to consider:

1.  Constant and vigilant supervision. Supervision of any child is a full-time job. Most drowning’s occur when a child is playing near the water and falls in – not while “swimming”. So, when it comes to kids, the “within arm’s reach” rule should always apply – whether they are in, or around, water.

2.  Using safety devices for the pool. These could include:

o Poolside Alarm– A motion sensor is installed along the pool edge, which sounds an alarm when waves are detected from a body falling into the water.

o Child Immersion Alarm– A wristband worn by a child, which will sound an alarm when they come into contact with water.

o Pool Fences– Fences should be at least four feet tall, surround the entire pool and have self-latching gates out of the reach of children. Speclocks prevent children from entering the pool area, as they are complex or require adult strength to open. Gate alarms can also be installed to alert when the gate is unexpectedly opened.

o Pool Covers– A cover built to fit your pool dimensions will act as a barrier for a falling body, as they will not enter the water.

o Door locks – special locks, difficult for children to open and installed at the top of a door, prevent kids from being able to get into the yard without an adult.

3.  Use life jackets, not just floaties. If your child is not a strong swimmer, they should always be wearing a life jacket – in a pool, at the beach, or on a boat. Like wearing a seat-belt and helmet, children should be taught from a young age that wearing a life jacket is necessary around water. From a functional standpoint, life jackets are safer than floaties. Floaties can develop small holes that actually fill with water, or can deflate, causing the child to slowly sink lower into the water. A well-fitting life jacket is designed to keep a child’s head above water, and to flip a child over onto their back to facilitate breathing. They cannot deflate. It also provides something for an adult to grasp if they need to pull the child out of the water.

4.  Know the signs of drowning. Contrary to popular belief, drowning does not happen when people are flailing their arms, yelling and calling for help. It is actually the opposite. People that are getting into trouble in the water often look like they are climbing an invisible ladder. They can’t yell or cry for help as their body is low on oxygen and is focused on trying to keep air in, not yell it out. Know the signs – check out this link for the “8 Quiet Signs of Drowning.”

5.  Knowledge of first aid. Parents should always consider having knowledge of CPR or basic water rescue. This could prove handy for many situations beyond just water safety.

6.  Swimming lessons. Give your kids a head start by helping them to become comfortable in the water from a young age. Every minute they can stay afloat could save their life.

But remember, when it comes to children, nothing is safer than diligent and attentive supervision.

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

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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An Ounce of Prevention…

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

“An ounce of prevention is worth a pound of cure.”  Benjamin Franklin

In recognition of Brain Injury Awareness month, I thought it would be fitting to start at the very beginning. PREVENTION. Really, it is the best medicine. For now, let’s forget about the symptoms of brain injury and its’ impact on work, home, school, and quality of life. Let’s not talk about how it is assessed and treated. Instead, let’s focus on trying to stop it from happening in the first place.

But even before that, we need to know what we are dealing with. It is well known that brain Injury is the leading cause of death and disability worldwide. In Canada, Traumatic Brain Injury (TBI) is more common than breast cancer, spinal cord injury, HIV/AIDS, and multiple sclerosis (MS) combined. There are approximately 18,000 TBI hospitalizations annually. In the province of Ontario, 25% of the two million people diagnosed with a neurological condition have suffered from a TBI. In 2000-2001 brain injuries accounted for $151.7-million in direct costs to Canadians (1).

By way of distribution, TBI is most common in children (0-19) at 30%, followed by seniors (60+) at 29%. In kids, falls are the most common cause followed by motor vehicle accidents and then sports. In adults, motor vehicle accidents cause the most TBI’s, and in seniors the causes include falls (76%) followed by car accidents (2).

Knowing the causes helps to look at how we can engage in preventative strategies. As an occupational therapist with a background in health promotion, a parent of four, and athlete, here are my thoughts:

Falls

Kids fall all the time, so how can we prevent that? Well, there is a difference between a child falling when walking, running or jumping, versus falling from, say, a shopping cart, off of a playground structure, or from a tree they tried to climb. Falls from bikes, skateboards and scooters are going to happen – and a helmet can mean the difference between a head injury and not. The bottom line is that falls in kids are best prevented by proper adult supervision. Yes, it is that simple.

In seniors, falls take on a different form. They are not from carefree or reckless behavior, but often happen when someone is just trying to go about their day by having a shower, coming down the stairs, or taking a leisurely walk. Seniors need to be attuned to the physical, balance and vision changes they are experiencing as they age, and need to consider the importance of anti-slip mats in the bathroom, removing scatter mats, installing grab bars or railings, and the benefits of a walking stick or cane when outdoors. Seniors need to engage in regular exercise and activity to maintain bone density, mobility and intact balance. They have to be very careful when living with pets or when trying to negotiate places that are cluttered or dark. Awareness of declining abilities is the first key to addressing these properly such that a prevention plan can be developed that will ultimately improve safety and reduce the risks. Note that the services of an occupational therapist can be pivotal in creating this safety plan.

Check out our OT-V episode “Fall Prevention” for more helpful information.

Motor Vehicle Accidents

Like falls, despite our best intentions, these can and do happen. The issue here is trying to minimize the risk and optimize the outcome. Safe drivers are attentive, undistracted, and alert. They travel at safe speeds, approach intersections with caution, stop behind the line, pass when appropriate, and recognize that rushing to get somewhere on time is useless if it means you never get there at all. Safe drivers don’t text or hold a phone to their ear, don’t eat a hamburger and steer with their knees, and don’t drive when tired. If you are one of these drivers you are going to increase your chances of avoiding a collision, and lower your chances of being the cause. Unfortunately, however, not everyone is a safe driver. So, all the rest of us can do is wear our seat belt, buy a car with a good safety rating, make sure everyone in the car is buckled properly, make sure the headrest is at a proper height, put loose belongings in the trunk (I know of a child who got a head injury from a flying jar of pickles that escaped the grocery bag during a collision), and follow the rules for child seats.

Sports

I am an avid athlete and have pretty much played or tried every sport. There are very few sports I dislike and I honestly feel that sports can be the most positive and influential outlet for young people, and one of the most engaging and social outlets for adults. The issue is that sports seem to be becoming more and more competitive, kids and adults are getting bigger and stronger, and the culture of some sports has changed from friendly competition to all-out war. Preventing head injury in sport can include outfitting your kids with proper equipment (many hockey parents spend more on a stick than a helmet), ensuring they are playing at their level, monitoring the coaching influence and team culture to make sure this is appropriate, and my favorite is from the book “The Secrets of Successful Families” and includes that the only job of a parent in organized sport is to “shut up and cheer”. No parent should be on the sidelines encouraging reckless, mean or harmful behavior. The results can be devastating. And if you are concerned about your child’s risk of head injury in sport, know that there are many other sports that reduce the risk but are equally as challenging, competitive, fun and have the same physical, cognitive and developmental benefits.

So, let’s start our recognition of Brain Injury Awareness Month by practicing prevention. It does not have to be easier said than done.

 

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“Auto” Mobiles: Cars that Drive Themselves

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

It was years ago that I saw a picture of a new prototype Mercedes.  No steering wheel, no gas, brake or clutch – just a joystick that did it all.  My instant thought was of how many of my clients would be able to drive a car like that – it would just take one working upper limb.  No more bulky hand controls, complicated steering apparatus, or wires and cords connecting it all.

More recently I read an article on “cars that drive themselves”.  Amazing.  Imagine that.  Assuming the technology works, these would eliminate accidents, injuries, and the human problems of driving distracted, tired, while texting, eating, putting on mascara, being under the influence, or even getting lost.  It would be like having a driver or a limo every day.  No more tragedies of injury and death at the hands of neglect or mistake.  This has huge potential to help make transportation time both safer and more productive. 

What struck me, however, was that the article I read was written from the perspectives of Ontario insurance companies and body shops. They were expressing concern that “cars that drive themselves” will result in fewer accidents which will lower insurance rates (less insurance profit) and will reduce auto-body repairs.  Sorry, what?  REDUCING accidents is a problem?  I don’t see any health care professionals writing articles or blogs on how devastating it would be to have a reduction in clients who were severely or catastrophically injured in a car accident.  Clearly a health professional would look like a schmuck if they voiced that opinion, as do these deep-pocket and greedy insurers and the body shops they are in bed with.

It just goes to reinforce the problem in Ontario.  Insurance companies cry fraud, losses and keep suffocating benefits without reducing rates.  The government adds restrictions and fees for billing insurance companies and starts to “license” providers.  They blame lawyers, providers, tow-truck drivers, and claimants without looking in house at how they are running their “business”.  Then they show up with an opinion that expresses concern over lost revenue if people stop getting hurt.  Wow.  Disappointing.

I have said it before and will say it again – I would be happy to be out of work if it meant people would stop getting injured in car accidents.  If insurers truly cared about the people they insured they should be all for it.  But then again the incidence of car accidents and resulting injuries have been decreasing for years and our rates have not.  Enough said.

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Slippery Slopes: The Great Tobogganing Debate

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

Growing up as a kid in the era of “go outside and find something to do”, I always tobogganed in the winter.  We lived on the top of the escarpment with some great hills behind us.  I would venture out with my GT Snow Racer, and usually my dogs, and would find some great runs.  The combination of speed, fresh air and exercise made for a fun afternoon.

While we didn’t have social media at the time, the news would tell stories of people hurt tobogganing.  I remember one story in particular of a young Reverend who died tobogganing at the Burlington Golf and Country Club when he hit a tree.  I believe he was tobogganing at night with some kids in his congregation.  Other stories of broken bones, head injury and the like would circulate, but with all things slightly dangerous, these stories didn’t seem to change the fact that kids would still venture out to toboggan as a favorite Canadian past-time.

This winter has brought considerable debate regarding the tobogganing ban in Hamilton and other cities across Canada.  Many are outraged that enjoying this fun winter activity could come with a hefty fine.   As my own kids approach the age where the little “bunny hills” near our house are no long “fun enough”, and I consider the work I do in Brain Injury, I do find myself re-evaluating this pastime.

So let’s review the dangers: experts state that tobogganing is considered the 4th riskiest sport for catastrophic brain and spine injuries, behind diving, snowmobiling and parachuting.    A 2008 Ontario study showed that the instance of long term disability or permanent injury was 38 of 100 000 people with a death rate of 2.4.  (http://news.nationalpost.com/2015/01/05/national-post-editorial-board-the-freedom-to-toboggan/).  There are different types of toboggans that need different positions – from head first to feet first, lying to sitting, some take more than one person, and all go at varying speeds.  The risks are real and will depend on many factors including the hill and its surroundings, the number of people also sharing the space, the type of sled, the position, age, experience, and size of the rider.

So how can we balance these risks with the acknowledged fact that tobogganing is a fun, enjoyable, and a great form of winter exercise?  Here are some tips:

1.       Supervision.  The risks of injury with tobogganing will increase, not decrease, as kids get older.  The older they are, the more likely they are to make poor decisions, to go fast, to try and be “cool” around friends, or to forgo the use of safety equipment.  Supervising your child (at any age) while they partake in this activity is recommended so you can act as their “second brain” and can provide them with cuing and guidance away from poor decisions.

2.       Wear a Helmet.  Like skating and skiing, choose a CSA approved helmet that fits properly.  You don’t have to hit a tree to sustain a head injury – even just banging heads with another person, impacting the ground, or coming to a very sudden stop can cause the brain to be rattled.  A helmet adds protection and reduces the risks.

3.       Choose a “safe” location.  Consider that some locations are now illegal for tobogganing and so do your research before you arrive.  Find a hill that is not too crowded, that has lots of open space and plenty of room to stop at the bottom that is away from trees, roads or other hazards.  Ramps and obstacles, while fun, increase the dangers so teach your kid to avoid these.

4.       Use a proper sled.  Find a toboggan that allows for steering and stopping and requires your child to sit upright, feet forward, where they have a clear line of sight and can easily bail if things are going amiss.

5.       Feet first.  Teach your child to toboggan with their feet, never their head, leading their body down the hill.  A broken leg, while still a serious injury, is less life threatening than massive head or neck trauma.  Much like going down a slide, teach them the safest technique.

6.       When in doubt… bail out.  Tell your kids to forgo the sled and bail to the side if they are going too fast, are approaching a person or obstacles, or if they are losing control.  Just like all the training we give our kids – we need to teach them that if they are going to fail or fall, do it properly and safely.

My family has a secret spot for tobogganing.  It is a private golf course that we have permission to use.  The slopes are wide open with varying runs to choose from.  The trees surrounding the hills provide shelter from the wind without creating unsafe obstacles.   No one else is ever there.  We bring our dogs who enjoying running the hills with our girls.  Everyone comes home exhausted.  We were there last weekend and noticed that some other kids have also been using the hills.  But these kids seemed to have snowboards and had made a trail up into the forest with jumps and turns.  I walked those trails with my kids and we talked about how unsafe they were.  Too steep, too narrow, too many trees and a massive jump at the end.  It was refreshing for me to realize that my girls understood the safety risks involved and that I was there to help them make better decisions about what hills to descend.  While they were sledding I baked in some winter sun, threw snowballs to my dogs, helped my girls bring their sleds up the hills, and even took in a few runs.  We had a great time and followed it up with some hot chocolate.   That is how we enjoy our winter and I hope that in lieu of a ban or fines that cities can find a way to facilitate safe participation in this winter pastime, recognizing the value this brings to our culture as a country that spends a few months of the year in the cold and snow.

How do you feel about the tobogganing ban?  Will you and your family continue to hit the slopes for the remainder of the winter and moving forward?  If you do, please be safe!

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Shovelling Safety

There are many wonderful things to enjoy in the winter, however, shovelling is not often one of them.  Shovelling can be a daunting (and sometimes never ending) task that when done properly can provide an opportunity for fresh air and exercise, however, when done incorrectly can do a host of damage to your muscles, your back and even your heart.  Follow these great tips from Sunnybrook health and ensure you shovel safely for the remainder of the winter.

Sunnybrook Your Health Matters:  5 Tips for Safer Snow Shovelling

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Bathroom Safety

To help provide resources for safety during “Senior’s Safety Week” we want to discuss the most dangerous room in the home: the bathroom. For those with limited mobility, or seniors, it is important to consider the fall risks that exist in the bathroom to ensure that people are safely able to go about daily routines. In this episode we will review bathroom hazards and will discuss the many suggestions an Occupational Therapist may make after a home assessment. These might include mats, bars, lifts, benches or even home modifications – of course the solutions will depend on your condition, age, and the layout of your home.

We hope you enjoy this video from our Occupational Therapy Video (OT-V) series and can use some of our tips to stay safe at home!

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Concussions – Bungee Jumping Meets My Face

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

Brain injury awareness month continues…next stop – concussions!

If you ask a crowd of people if they have ever had a concussion, about 1/3 will raise their hand. Direct hits to the head, and closed head injuries, are not uncommon in children and young adults, decrease in frequency in adulthood, but increase again in seniors. My last blog on prevention discussed the statistics and outlined that the most common causes are falls, motor vehicle accidents and sports.

Personally, while I didn’t know it at the time, my own concussion experience comes from a high school graduation trip where I decided (against my mother’s advice) to try bungee jumping. I was jumping over water and the goal was that I would dip my hands in the water as the rope became taught – just before it would fling me back into the air. They told me to “tuck my chin and close my eyes” as I approached the water “just in case” I get submerged. So, I am flying through the air, have no concept of distance to the water (it comes up fast when you are free falling), and think “oh I better tuck my chin and close my eyes” but of course doing so not only reduces the thrill of the experience, but causes you to become further disoriented. So, eventually I think I have missed the water and open my eyes, lift my head up to look around and SPLAT – smack the water with my face. Awesome. For the next few days I was in a bit of a fog, had some bruising around my eyes, and a headache. Soon after I developed vertigo – a condition I have been living with ever since. At the time, the word “concussion” was not the buzz word it is today, but I hindsight I think my bungee-face episode qualified (oh, and for the record my mom was only half right – she said I my ovaries would end up around my ears and they didn’t – four kids proved her reproduction theory wrong, but I guess vertigo proved her caution right).

The good news is that over the last few years the media has exploded the discussion of concussions and these are now strongly on health care, sports, and motor vehicle accident radars. The bad news is that I think many people have become confused by the lingo, types, symptoms, and management.
With the help of fellow Occupational Therapist Jayne May who has special interest and training in concussion assessment and management, we will do our best to provide some clarity as follows:

Concussion – a traumatically induced physiological disruption of brain function, as manifested by one or more of the following:

• Any period of loss of consciousness for up to 30 minutes.
• Any loss of memory for events immediately before or after the accident for as much as 24 hours.
• Any alteration of mental state at the time of the event (e.g., feeling dazed, disoriented or confused).
• Focal neurological deficit(s) that may or may not be transient (e.g., poor balance, blurred vision, headache).

Post-concussion syndrome – diagnosed 4 weeks after a concussion when 3 or more of the following symptoms remain: fatigue, disordered sleep, headaches, vertigo or dizziness, irritability or aggression, anxiety, depression or affective instability, changes in personality, apathy or lack of spontaneity.

Chronic traumatic encephalopathy (CTE) – a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity.

Second-impact syndrome (SIS) – when the brain swells rapidly, and catastrophically, after someone suffers a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days or weeks after an initial concussion, and even the mildest grade of concussion can lead to SIS. The condition is often fatal, and almost all people not killed by this are severely disabled (1).

With medical definitions aside, it is important to look at the clinical signs, and the ways that these can be managed through occupational therapy. To highlight what we experience as therapists, our clients with concussions or PCS often say:

• I have frequent headaches.
• I have pain behind my eyes.
• I find shopping difficult.
• I feel foggy.
• I am sensitive to light.
• Loud noises that never bothered me before now make me irritable.
• I can’t focus long enough to enjoy a movie, conversation, or to read.
• I feel sick when I am a passenger in a car.
• My balance is terrible and I bump into walls and furniture all the time.
• It takes me hours to fall asleep. I may get 4 hours of sleep a night.
• I am always tired.
• I feel like I am floating.
• I keep losing things, forgetting events, and missing appointments.
• I feel worse after I exercise or exert myself.
• Technology (computers, TV) bothers my eyes and makes my headache worse.

As you can see, these types of complaints and symptoms dramatically impact on someone’s ability to work, drive, go to school, manage daily routines, or even participate in social or leisure activities.

So, as occupational therapists, what do we do to help our clients through this? The first step is always education. Rest, rest and rest are so important to give the brain the time it needs to recover. Our job is to help people achieve the balance of cognitive and physical rest, while still helping them to manage their important life roles. This involves pacing education, trial and error, and tracking of activities so people can strike the right balance now, while increasing demands slowly as symptoms improve. Often, we are responsible for setting return to work / school / sports / fun guidelines for clients and employers, teachers, and parents.

We are also integral at helping to address the specific concussion and PCS symptoms that clients find so troublesome. This includes how to manage head pain (ice, rest, facilitate medical consults), noise and light sensitivity (noise reducing headphones, ear buds in public, dark glasses or shades or blinds in the house), dizziness / floating (suspenders, weighted vest, tight underclothing), memory strategies (smartphones, calendars, planners, lists, drop spots), visual changes (bi-nasal occlusion, vision therapy), fatigue (timers, sleep strategies, scheduling changes), to name a few.

The role of occupational therapy in helping people to manage concussions or post-concussion syndrome is becoming more and more recognized by both the medical and rehabilitation communities. So, if you are struggling to recover from a concussion, or insure or represent a client that has these problems and is struggling to participate in important life roles, consider occupational therapy for helping them to return to work / home / school / fun!

(1) Wikipedia