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Archive for category: Original Posts

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Solutions for Disability-Related Financial Stress

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

I can say with certainty that 100% of my clients suffer from financial difficulty when faced with disability, trauma or injury.  It is just not common for people to plan for the “rainy day” that could be ill health.  Yet, the impact of financial strain is significant.  Stress, anxiety, panic, excessive worry, loss of sleep, relationship issues, poor decision making, and maladaptive coping are all common reactions to feeling that you are unable to survive a change in income or increased expenses from medication, devices or therapy.

In the following video from our OT-V series, we discuss how an Occupational Therapist uses strategies to help you through financial difficulties and to help manage the negative effects to your health.

 

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The Healthy Menu Choices Act – Will This Trim your Waistline?

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

Here is some rocket science: being obese is a well-known contributor to poor health.  The secret to not being or becoming obese?  If you are obese, it is “move more and eat less”. If you aren’t, it is “keep moving and eat well”.  I was at the gym today and heard someone make a great comment “just show up and do something”.  Is it that simple?

In the interest of public health, Ontario has a new law effective January 1, 2017:  the Healthy Menu Choices Act.  In this, all food-service chains with 20 or more locations in must now post calorie information on menus for the food and drink items they sell.  Further, as of January 1, 2018, all menus must post the following statement:

Adults and youth (ages 13 and older) need an average of 2,000 calories a day, and children (ages 4 to 12) need an average of 1,500 calories a day. However, individual needs vary (1).

So, will this help continue to the better health of Ontarians?  People are complicated and behaviors ingrained, so do we know if having more information about calories will contribute to different choices? 

First, let’s define a calorie – it is actually “the energy needed to raise the temperature of 1 gram of water through 1 °C (now usually defined as 4.1868 joules).”  Huh?  So why does that matter?  Because in nutrition calories refer to energy consumption through eating and drinking, and energy usage through physical activity.  For example, an apple may have 80 calories, while a 1 mile walk might use up about 100 calories.  Our body uses calories as our energy source to breath, digest, circulate our blood, etc.  So, these are important and we get them from foods and beverages (2).  But knowing how many calories one person needs to maintain their weight and be at optimal health will depend on several factors including metabolism, level of activity during the day, age, and even genetics.  I need way less calories as a middle-aged active woman than the 12,000 calories per day consumed by Michael Phelps when he is training for the Olympics. 

So, to the common consumer that knows little about nutrition, but is interested in trying to eat well, will the calorie information on menus help?  Well, the math will be simple.  If the sign says I need an average of 2000 calories per day, and my Big Mac, Biggie Coke and fries is 1200 calories, I will consciously know that I have 800 left (for weight maintenance).  But when I go home, will I check labels, pull out a scale, and put together my remaining meals to not exceed 800?  Probably not because the common consumer does not tend to behave that way because if they did, we would not have an obesity problem in the first place.  However, for the educated consumer things might be different.  Personally, having fitness, health and body composition goals, I have already changed my food choices at fast food places because the calories in what I really wanted was starring me in the face, making me feel guilty already.  And I was still able to enjoy what I did order, recognizing that another element of health is “consistently making good choices” when most of the options out there (for convenience food anyway) are poor.  So I felt good (emotionally) making a better choice.  But when dealing with people and behavior, it is much more complicated than simple math.

It is also important to look at the stages of change when considering whether having transparent information about calories will actually lead to people making better decisions.  There are five stages of change – precontemplation, contemplation, preparation for action, action and maintenance (3).  Described briefly, in the first stage people don’t know they have a problem and the behaviors are risky and potentially life-threatening (like stress-eating, overeating and becoming obese).  In the second stage the person identifies they have a problem, or there are signs of the problem worsening (the number on the scale, bloodwork results, Diabetes starting etc).  In Preparation for Action, the person is ready to make a change and is seeking information and guidance.  This is when someone might start to understand what a calorie is, and how that relates to them.  In Action, the person starts actively changing.  This is where I see the Healthy Menu Choices Act being helpful.  It will provide people the information they need to make choices that are better than others, as part of their “action” towards improved health.  The Healthy Menu Choices Act will also be helpful in the last stage of Maintenance as people can use the calorie information to make choices that align with their desire to maintain the gains they have made, or to be healthily mindful in selecting foods.

From a health perspective, I think that the more information people can have about the choices they are making, the better.  Even if they don’t yet understand it, or choose not to use it, or it does not result in behavior change, it is there when they are ready for “Action”.  From a business perspective, restaurants and establishments might want to review their menus and look at the balance between their healthy and not-healthy choices.  Further, they will also want to look at how orders change with this new act.  If people stop ordering the White Chocolate Crème Frappuccino (at 510 calories) and instead sales of Iced Skinny Flavored Lattes (at 80 calories) soar, your consumers are telling you something.

Honestly, I am all for a nice bucket of poutine once a year, but beyond that I will pick the healthy options on a menu, if these exist.  If they don’t, I will go elsewhere.  It is that simple.  So I appreciate the added information the Healthy Menu Choices Act provides, and will use the calorie information in my meal decision making.

Resources:

(1)   https://www.ontario.ca/page/calories-menus

(2)   http://www.medicalnewstoday.com/articles/263028.php

(3)   http://www.activebeat.com/your-health/women/the-5-stages-of-behavioral-change/5/

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Solutions for Simple Decision Making

Making decisions can be difficult.  Whether big or small, the decisions we make often affect not only our own lives, but the lives of others.  For those who struggle with anxiety and other mental health issues, or who have suffered a brain injury decision making can become increasingly problematic.

If you are struggling with decision making, we recommend using our free printable decision maker to help you thoroughly weigh the options and help you reach the best conclusion.

For each decision you need to make, simply list the pros and cons of deciding YES vs deciding NO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more helpful tools visit our Printable Resources Page.

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The Role of Occupational Therapy in Adolescent Eating Disorders

Guest Blogger: Carolyn Rocca, Student Occupational Therapist, 2017

According to Statistics Canada, in 2012 over 130,000 Canadians over the age of 15 years old reported that they have been diagnosed by a health professional as having an eating disorder. Considering these high rates, and the likely underestimation of reported diagnoses, eating disorders remain a form of mental illness that are not openly talked about.

Eating disorder is an umbrella term for several categories of diagnoses, with anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorders not otherwise specified being the most common. Although symptoms vary based on the diagnosis, some overall symptoms experienced with eating disorders include a pre-occupation with body weight, body dissatisfaction, behaviours to prevent weight gain, perfectionism, emotional dysregulation, depressed mood (including suicidality), anxiety, and low self-esteem. Naturally, these symptoms can lead to secondary impacts such as physical adverse effects, social isolation, and a compromise of occupation in the areas of self-care, daily living, leisure, and productivity (NCCMH, 2004).

The treatment and recovery of adolescents with eating disorders involves the collective work of many healthcare professionals including physicians, dietitians, nurses, psychiatrists, psychologists, social workers, teachers, child and youth counselors, and, yes, occupational therapists (Norris et al., 2013). Each of these team members works collaboratively to deliver the best practice approaches of pharmacotherapy, nutritional rehabilitation, and psychosocial interventions, including cognitive behavioural, dialectical behavioural, interpersonal, and family based therapies, among others (APA, 2006; NCCMH, 2004). Several of the healthcare professionals working with adolescents with eating disorders can deliver these therapies, including occupational therapists.

This means that occupational therapists work effectively with several disciplines to deliver best practice approaches, while also integrating their unique focus on occupational functioning to the team. Occupational therapists’ unique contribution is their ability to holistically address the physical, cognitive, behavioural, and psychosocial aspects of adolescent eating disorders through occupation-based approaches to improve adolescents’ self-worth and self-esteem (Kloczko & Ikiugu, 2006). As mentioned previously, eating disorders commonly have a substantial impact on adolescents’ function in the areas of leisure, self-care, daily living, and productivity (NCCMH, 2004), meaning many youth have difficulty balancing their family and social lives, education, employment, extra-curricular participation, ability to regulate their own activities, and thus overall health.

Occupational therapists have the expertise to work closely with adolescents and their family to help them with their goals around succeeding in school, work, leisure, and overall re-engagement in meaningful activities. In fact, Occupational Therapists are skilled at using meaningful activities as a vessel to get to the underlying problem of the eating disorder.  Sessions don’t focus on eating, food or binging behavior, but on being productive, enjoying life, and accomplishing things that matter.  The indirect influence is better choices in other areas (including diet) and recognizing the link between mental and physical health, quality of life and wellness.

If you know a teen (or adult for that matter) that may be dealing with an eating disorder, encourage them get help.  There is a team of professionals, including occupational therapy, that are skilled at assisting teens to recover from these, and other mental health issues.

 

References & Resources:

American Psychiatric Association (APA). (2006). Practice guideline for the treatment of patients with eating disorders (3rd ed). Retrieved from https://www.guideline.gov/summaries/summary/9318/practice-guideline-for-the-treatment-of-patients-with-eating-disorders

Kloczko, E., & Ikiugu, M. N. (2006). The role of occupational therapy in the treatment of adolescents with eating disorders as perceived by mental health therapists. Occupational Therapy in Mental Health, 22(1), 63-83. doi:10.1300/J004v22n01_05

National Collaborating Centre for Mental Health (NCCMH). (2004). Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Retrieved from https://www.nice.org.uk/guidance/cg9/evidence

Norris, M., Strike, M., Pinhas, L., Gomez, R., Elliott, A., Ferguson, P., & Gusella, J. (2013). The Canadian eating disorder program survey–exploring intensive treatment programs for youth with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22(4), 310.

Statistics Canada: http://www.statcan.gc.ca/pub/82-619-m/2012004/sections/sectiond-eng.htm

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Accessible Travel 101

Many travel companies, packages, hotels and airlines claim to be “accessible” which is often a blanket term for “we try”.  After all, nothing can be fully “accessible” as each disability is different, requiring varying levels of accommodation.

Travelling with a disability can be difficult, but with thorough planning it can be a wonderful experience.  Our free E-Book on Accessible Travel is full of helpful information, tips and checklists to help you plan, pack and prepare for a fantastic getaway.

Solutions for Living:  Accessible Travel E-Book

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OT Success at the LAT

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

For those working in the personal injury and medical-legal fields, you will be familiar with the new License Appeal Tribunal (LAT)This LAT, effective April 1, 2016 was FSCO’s solution to long wait lists in the previous SABS mediation process whereby insurers and claimants essentially try to resolve disputes about claimant’s benefits, rehabilitation, or other denials and discrepancies. 

Recently, we received one of those “feel good” emails from a lawyer that was able to successfully argue for a client at the LAT – because of the information they received from the treating occupational therapist.

The email read like this:

…[the OT] prepared an attendant care comparison report for us, which we fully relied on at a LAT case conference today.  The client was also put under surveillance and [the OT] was able to extensively rebut all their findings, which we also relied on today at the case conference.  I truly believe we were successful today because of her hard work.”

I am biased, but occupational therapists are generally pretty awesome.  Where lawyers speak “legalese”, insurers speak “SABS ease”, doctors speak “medical ease”, occupational therapists speak “functional ease”.  We work hard to make sense of things – for our clients and our customers.  We want to help the client be understood and for others to know the true impact that an accident or illness has had on their day to day ability to manage important activities.  Chronic Pain, Depression, or even a broken leg does not really equate to much unless it is in the context of what that means for that person: for Mr. X, chronic pain means they can’t walk their kids to school, or assist them with homework, for Ms. Y her depression has resulted in her dropping out of her post-secondary program, losing her scholarship, for Mr. Z his broken leg is preventing him from working at both of his jobs and as a result he is unable to afford his housing and food for his family….

Sure, lawyers and insurers can put things into context without an occupational therapist, but I would argue that we are trained to ask different questions – questions that get to the heart of disability and dysfunction, while at the same time helping people to tell their story from a place of vulnerability and honesty.  We strip things down to be simple, but yet impactful in explaining what disability means to that one person.

We still find that some lawyers don’t involve an occupational therapist early enough.  They wait until the client is several years post injury to see if it is “needed”.  But guess what?  It was often needed the entire time, and waiting so long only served to leave the impression that the client was “functioning fine” because there would be little practical or functional data or evidence to indicate otherwise.  Have you seen doctor’s notes?  “Back pain, off work X 3 months”….not enough to explain the context of disability.

Occupational therapy is greatly important in the recovery, rehabilitation, medical-legal and personal injury domain.  And if we can’t help your client to live, manage or function better, at the least we can provide the information and evidence to help you to be successful in other areas of the claim, including at the LAT. 

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Smart Solutions for Travelling with a Disability

Let’s be honest, as fun as vacations are, travelling is stressful. The planning, packing, confirming all the details, getting from A to B, preparing to be away from work or home, keeping paperwork organized…it takes a significant amount of time and effort to put a trip together.   Yet, if you have a disability, travelling becomes even more complicated.

March break is approaching and for months my clients have been asking me about travelling with a disability.  I enjoy these discussions because I do believe that anything is possible – take a look at our latest OT-V episode all about accessible travel including tips for travelling with a disability.

Bonus—download our free Accessible Travel booklet which includes helpful checklists and tips for your travel!

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Take Heart– OT’s Provide Solutions for Living with Heart Disease

February is Heart Month and while many of our blog posts will focus on prevention through good health habits, we want to also provide you with some tips for recovery.

Heart disease has a major impact on an individual’s quality of life. It can lead to discomfort or chronic pain, activity limitations, disability and unemployment. “An estimated 345,000 Canadians aged 35 to 64 reported living with heart disease. More than a third (36%) of these reported needing help with household tasks or personal care” (Heart and Stroke Foundation of Canada, 1999). Heart disease requires lifestyle changes to prevent progression of the disease, further cardiac events and activity restrictions.

An occupational therapist, in conjunction with other team members, will help you determine what activities you can safely perform and how to modify activities to decrease the amount of energy required.  Learn more about the solutions an Occupational Therapist can provide in the following infographic.

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Monitoring Your Mood

In our previous post, Blue Monday and Beyond – Tips to Beat the Winter Blues we discussed how some research suggests that up to 15% of people in Ontario experience the “winter blues” and 2-3% of the population suffer from Seasonal Affective Disorder (SAD).

If you are suffering from depression, anxiety, SAD or simply the “winter blues” being aware of your feelings, thoughts, emotions and overall mood can help you to understand and cope.  The following printable “Mood Diary” will help you to track when you are feeling a certain emotion, the intensity of it, the situational aspects and the effectiveness of your coping mechanisms.  Doing so will give you and your healthcare professionals a better understanding of the problem.

For more helpful tools visit our Printable Resources Page.

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Flexible Work Arrangements: No Longer Working “9 to 5”

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

Co-written by Occupational Therapy student Carolyn Rocca

I have several commutes.  If I bring my laptop home, one commute is to my dining room table.  If I leave my laptop at the office, I have a seven-minute drive (eight in traffic) before I am sitting at my desk.  If I am required to be in Toronto for 8:30am, my commute starts at 6:00am for a drive that in “good traffic” would only take me 50 minutes.

With more and more people living away from work so they can afford more sizable housing, more property, or even perhaps a desire or need to stay close to extended family and child care, Flexible Work Schedules are becoming more valued, and dare I say, necessary.

Flexible work schedules are arrangements that allow employees the opportunity to better juggle their family and personal responsibilities that typically conflict with the traditional Monday-to-Friday, 9-to-5 work week. These arrangements can take several forms, including: working a set number of hours with flexible and agreed upon start and end times, working longer days in exchange for a day off, or requesting time off for personal reasons and offering to make it up by working longer hours on another day.

According to Statistics Canada, in 2014 69% of couple families with at least one child were dual-earner families, representing quite an increase from 36% in 1976. As the number of dual-earner families continues to rise, the option of flexible work schedules will become increasingly enticing for such families who struggle to get their kids on the school bus in time for their lengthy commute. In 2012, an estimated 36% of Canadian employees with caregiving responsibilities had flexible hours, and this value will likely continue to rise. As they say, times have changed, and this seems to be a change for the better.

Canada’s 2012 General Social Survey reports that having a flexible schedule that allows employees to choose when their work day starts and ends was associated with slightly greater satisfaction. In fact, 79% of employees with a flexible work schedule reported that they were satisfied or very satisfied with their work–life balance, compared to 73% of those whose schedule was not flexible.

More specifically, studies that have explored the benefits of flexible work schedules for employees suggest that they improve overall work-life balance, reduce workplace stress and health-related symptoms, and increase job satisfaction and organizational commitment, ultimately maintaining their connection to the labor market. These advantages go both ways, as these arrangements benefit employers by enhancing recruitment and retention, reducing absenteeism, and increasing productivity, naturally leading to reduced costs.

So what does this shift towards flexible work options mean for you if you have a disability, and me as an occupational therapist?  If you need to return to work following injury or illness, an occupational therapist is well-equipped to help you and your employer devise workplace accommodations to gradually resume your full-time duties, and flexible hours makes this transition more feasible and likely to be successful.  For example, if sitting for long periods is challenging, but sitting is a necessary part of your job, then we don’t want your “sitting clock” to be “ticking” while you are stuck in traffic.  If flexible work hours can get you at your desk faster, allowing you more time to work and less time to aggravate your symptoms in the car, then a supportive employer should see the benefit of that – for you and them.  Also, if as part of your recovery you continue to require medical oversight or treatment by other providers, a flexible work schedule will allow you the freedom to maintain your treatment schedule, while still gradually resuming job duties.

If flexible work hours can benefit both employer and employee, both within and outside of a rehabilitation process, then I say “just ask for it”….and work with your employer to develop a program and schedule that works for both of you.