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Archive for category: Original Posts

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Emergency Preparedness

The storm in Toronto last week hit hard and fast.  The flooding in Calgary was severe.   Parts of Barrie were leveled many years ago from a tornado.  In 2004 some of Ontario suffered a power outage that lasted for days in the heat of summer.  A few winters ago there was a significant snow storm in London and Sarnia that trapped people in their cars for hours and even overnight.  Ontario and Quebec have also suffered from severe ice storms that have caused power outages in the coldest and darkest days of winter. 

 
While I don’t like to be “doom and gloom”, I do believe in being prepared for an emergency.  I have three kits I keep in my car.  One for the car (jumper cables etc), one for first aid, and one for us should we be stranded.  When we take our kids into busy public places we take a photo of them on our phone so that we know what they are wearing when we arrived (flashback to my panicked parenting moment when we lost a twin for 45 minutes at an amusement park and could not remember what she was wearing to tell the paramedics and police).  In the “olden days” (okay, 8 years ago) we would carry walkie-talkies with us when out with our kids so we could easily communicate about which parent had which kids (flashback to the time when my husband was frantically looking for a kid who was with me the entire time).  Now, we use our cells for this.  Our pool is separately fenced from our already fenced yard and when our kids were small we had safety locks on all the doors to prevent them from leaving the house independently.  The list goes on…

I recently finished a course in Risk Management.  In this, students had to consider the many risks that face an organization, prioritize how significant those risks are to the business should they happen, and determine ways to protect a business from these, or how they should react to “stop the bleeding”following.

 
The same risk management process can be applied to us personally – regardless of our situation.  This is especially important for persons with disabilities who may have special equipment, housing, medical, or dietary needs that reduces the time they can safely tolerate emergency, or their physical or functional ability to react.  To look at your own risk profile consider the following:  What if you become stranded in your car?  Could not find a child?  Suffer a significant power outage?  Hear of a tornado alert?  Need to evacuate your home?  Have a failure in life-sustaining or mobility equipment?  
 
I believe it is valuable time spent, and could be lifesaving, to outline the risks facing you and your family (including your pets) should disaster strike.  Is there anything you can do to prepare for your identified risks ahead of time?  Are there kits you can make or buy for your car, home or work (blankets, food, water, candles, first-aid, etc.)?  Do you have back-up options if you cannot heat your home, cool your home, store or prepare food for several days?  What if you have special equipment and if this fails do you have battery options, other non-power devices to use, or an emergency response number to call?  
Like many things, perhaps an ounce of prevention is worth a pound of cure.  Not to mention the fact that panicking in an emergency situation is rarely the right response, and having a plan in place for the emergency will reduce the likelihood of you responding poorly, making the situation worse.  
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Still Don’t Get OT? Try This:

My previous post outlined the value of OT and spoke about a recent article that highlighted how OT’s are underutilized, but provide great value in healthcare.  I could not agree more.  And I would hope that anyone that has encountered a good OT would also agree.  One of our biggest challenges as we try to become a “household name” is the fact that people still struggle to understand what we do, and how we do it.  With OT there is no magic formula so we can’t publish the recipe for our secret sauce.  Besides, we don’t see disability in a vacuum where a diagnosis determines the treatment.  Rather, we look at each disability in the context of that person, in that environment, and this makes it impossible to really give people the goods on how we help.  OT then is the definition of healthcare “customization”.  Perhaps you really need to experience an OT to understand and appreciate the scope of what we do. 

 
However, I always love spreading creative and fun ways to explain our profession.  These two You Tube videos are well done, and explain OT in a way that you can’t put on paper.  Take a look, enjoy and hopefully you too will be saying to someone someday “maybe you need an OT”?
 
 
 


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Does OT Work? Absolutely!

I am not shy about loving my profession.  I think occupational therapy is one of the most creative, compassionate, client-centered and “bang for your buck” health professions as we are trained to help people with a variety of disabilities (physical, cognitive, emotional and behavioral) to function as effectively and independently as possible.  While none of us will claim our profession is “rocket science”, I hope all of us have move passed thinking our knowledge is “common sense”.  As a profession, I feel that we continue to be behind our peers in shouting our skills from the rooftops, and while we have been around for a really long time, I still get asked “oh, so you are a physio”?

I was thrilled to read a recent article in Healthcare Quarterly (Vol. 16 No. 1) on the value of OT.  This article indicates that “occupational therapy interventions are cost-effective in treating or preventing injury and improving outcomes”, and clearly states that “occupational therapists are underused and not working to their full scope of practice” (page 69).  The article further outlines that there are “clear, cost-effective opportunities for occupational therapists to use their expertise and full scope of practice in the areas of:  case management, chronic disease management, injury prevention, caregiver education, intervening at the point of hospitalization or to reduce hospital stays, community or caregiver support to reduce re-hospitalization, rehabilitation and palliative care” (page 71).  In the end, the article concludes that “there is a strong foundation of evidence indicating positive health outcomes in occupational therapy intervention, with good value from an economic perspective” (page 72).

Perhaps, with research and articles such as these, the systems that fund healthcare (public and private alike) can more fully understand why occupational therapists are a necessary part of the rehabilitation continuum and are a cost benefit, not just a cost.  However, in the world of auto insurance, one of our current struggles is getting other members of our own profession to understand this, and to support occupational therapy treatment when an insurer disputes the need.  I hope this article will help other OT’s to feel that evidence does exist to support our worth, and they will join the crusade to advocate for, and support, our profession as a valuable, contributing and essential service in the public and private sectors.  Go OT!

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Want Feedback? Ask for it!

McMaster University’s Occupational Therapy program was very much grounded in the concept of feedback.  While sometimes contrived, and definitely awkward, giving and receiving feedback is an essential skill in relationships, parenting, work and school.  

 
Recently I was in one of my MBA classes and the professor circulated feedback forms to the class asking for our input on how the course was going.  In my many years of university, I have never had a professor ask for feedback during the course.  Usually the instructor evaluation forms are circulated at the end, when a) the feedback does not directly benefit the people that provide it (the class is over anyway), and b) the students never know if their feedback has value or elicits change.  

 
In the case of this particular class, the professor, at the start of the following lecture, summarized the feedback he received.  He commented on what people liked and did not like about the class so far and told us how he was going to adjust his sails to meet the needs of his audience.  Brilliant.  

 
Reflecting on this reminded me of the recent times when I have asked for feedback and benefited from the outcome.  At home, we engaged in a Stop, Start, Continue exercise with our four daughters.  We all had six pieces of paper with our own, and each other’s, names at the top.  Our job was to comment on what we felt that we each needed to stop doing, start doing, and continue doing in our own mind, and then also for each other.  Basically, we were giving and receiving feedback on our skills as mom, dad, daughter or sister.  The result was amazing.  The kids took the exercise seriously and we all learned more about ourselves through the eyes of the people closest to us.   It was a valuable exercise for them and us, and something we will continue to do going forward. 

 
At work, I also asked for feedback from colleagues, clients and customers.  I circulated a questionnaire via email that allowed people to anonymously let me know how I was performing in my job.  Then, I also engaged in a self-initiated 360 review that provided those closest to me the opportunity to highlight, from their perspective, my personal strengths and weaknesses.  

 
Why is feedback so important to me?  I am not as much interested in ensuring I am living up to the expectations of others, as I am interested in ensuring I am not naïve to my own faults.  It is always easier to see the faults in others and yet how often do we really reflect on our own skills?  I believe that the path to achieving my personal best involves understanding myself through my eyes and the eyes of those around me.  So, if you want feedback, just ask for it!   How is my blog by the way?

 

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Golf FORE All

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 last year 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.

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Pedestrian Safety – Senior’s and Traffic

The other day I was driving through a busy parking lot.  I noticed an elderly man who parked his car, got out, and proceeded to walk through the parking lot without ever surveying his surroundings.  He did not see my vehicle approaching him, and did not appear to notice the other cars that had to stop to let him pass.  The other drivers looked both annoyed and perplexed that he could be so clueless.

According to the CDC “Increasing frailty may leave the elderly more vulnerable to being hit by traffic. Age-linked declines in mental function, vision and physical disabilities might place older adult pedestrians at greater risk for being struck by a vehicle.” (http://www.nlm.nih.gov/medlineplus/news/fullstory_136049.html).


With this man, what I noticed was quite telling.  He was looking at his feet.  Many seniors do this when walking.  Why?  Because they are afraid to fall.  With a decline in physical ability comes problems negotiating uneven terrain.  Parking lots and sidewalks are full of holes, stones, and cracks that could be problematic for someone with declining mobility.  So, they stare at the ground to avoid falling, the entire time being unable to also look around at other risks in the environment.  And when you combine this with reduced peripheral vision, they may not notice vehicles approaching. 


Society expects seniors to “know better” in that they have been trained, over a lifetime, about the perils of traffic.  With children, we don’t expect them to know better because they are carefree and often move before thinking.  As driver’s we watch for children and take extra care when we see them around roads or in parking lots.  We also tend to take the same precautions when we notice someone who is more visibly disabled using a wheelchair, or white cane.  But disabilities are not always visible and we have to be careful to not make assumptions – especially with seniors who may have an unnoticeable visual, cognitive, physical or auditory problem.  


My message here is that drivers should be cautious with all pedestrians, but need to be especially mindful of seniors – much like they are with children or other people with visible disabilities.  Seniors deserve our patience and the extra time it might take to help them safely go about their day and negotiate the sometimes challenging outdoor environment.

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O’ Canada

“There are no limits to the majestic future which lies before the mighty expanse of Canada with its virile, aspiring, cultured, and generous-hearted people.” – Sir Winston Churchill

I love this country.  In Canada we are polite and apologize for everything.  We have beautiful seasons that give us plenty of opportunity to be outdoors.  We leave our doors and cars unlocked because we trust each other.  We have gun laws and want it that way.  We let people live how they want, love how they want, dress how they want, and be who they are.  We appreciate cultural and religious diversity.  We have great health care and strong educational institutions.  Are we perfect? Nope.  But nothing is and complaining without action will get us nowhere.  As a fellow Canadian I encourage others in this great country to solve problems, get involved, pay it forward, advocate, speak out, and live with integrity.   If everyone could everyday do one nice thing for this country, or the people in it, we will all be better off.  Pick up a piece of garbage, help a neighbor, donate blood, support a charity, donate time to a worthy cause, or just make someone smile.  It all helps.  Happy Canada Day!

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A "Splash" of Inspiration

Inspiration can come from anywhere.  In the past, this blog has profiled the stories of many people who have not let a disability stop them from living.  However, stories of survival, humanity and inspiration also exist in nature, as we witnessed in the incredible tale of Winter the Dolphin. 

Winter was just a baby when she was found stranded on a beach in 2005, severely injured.  She had become lost from her pod and became entangled in a crab trap.  Winter was rescued, but the injuries she sustained to her tail became life threatening, leading to an amputation.  This was successful; however, overtime the way she adapted to swimming was injuring her spinal cord causing her further harm. 

Marine doctors struggled with solutions to save her, but their quest eventually led to the successful creation of a prosthetic tail.  The tail helped Winter to swim properly again and today she is living and thriving at Clearwater Marine Aquarium in Florida. 

Winter has become an inspiration to many across the world and thousands of people with disabilities have gone to meet winter to gain inspiration and hope from her amazing journey.   You can view her live on webcam at www.seewinter.com.   But Winter’s story is bigger than that.  In trying to create a prosthetic tale for a Dolphin, new products were created that have greatly improved prosthetic comfort and fit for humans. 

The movie “Dolphin Tale,” based on her story, describes her journey and in doing so highlights how hope, creativity and persistence can help to overcome barriers.  Young or old, you need to watch this family friendly “tale” that warms the heart and will certainly leave you smiling.
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Computer or Car Insurance…Gigabytes or IRB…

It is widely known in my industry that the people of Ontario generally don’t understand their auto insurance coverage – until they need it.  For example, when buying a new computer you might look at screen size, megabytes, RAM, GIGs, processor, operating system, anti-virus software and extended warranty.  But when buying car insurance do you look at the coverage for housekeeping, NEB, IRB, attendant care, med/rehab, liability, and care giving?  No?  So, it begs the question: why are you paying for something you don’t understand?

In a brilliant display of smoke and mirrors, your auto insurance company (via the Insurance Bureau of Canada – IBC) pulled some tomfoolery in 2010.  They didn’t increase your car insurance premiums, but dropped your coverage significantly.  So, in essence at renewal you got half (or less) of the coverage for the same price.  That is like spending the same money on your previous computer to now only get the monitor.  

So, being an educated consumer, I “bought up” and paid extra for the same coverage I had before the changes.  I am one of less than 1% of the population that did so.  Now, IBC is saying they are going to drop rates by 15%.  Well thank you oh noble insurers.  That will give me the same coverage I had before 2010 (because I bought up) for the same price (because of the rate reduction).  So, I am back to where I started, but the other 99% of the population are getting 50% of the coverage for 85% of the price.  They are still at a significant loss. 

In a recent MBA class we talked about risk.   Driving a motor vehicle is the # 1 most unsafe activity when compared to 29 other activities people perceive to be risky (including smoking, drinking, extreme sports, risky professions, flying, etc.).  So, if driving is our riskiest activity, signifying a high probability of injury, why are consumers so unaware of their coverage?   Is it because we don’t think we will get in an accident (the “it won’t happen to me phenomenon”), or because insurance is “mandatory” we just purchase on price?  

I find it strange that people take the process of buying a computer more seriously than the process of renewing insurance – especially when driving is the riskiest thing we do daily.  In a PC World survey (2012), 63% of people indicated they bought a computer “extended warranty” yet research repeatedly shows that the $16B spent yearly on extended warranties is a waste of money.  Compare this to the less than 1% of people that bought an “extended warranty” (i.e. extra coverage) on their car insurance.  Buyer Beware!  It is time that Ontario drivers start to understand the product that is car insurance so they can ensure they have appropriate coverage for an appropriate price.
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Memory Mantras

Being an Occupational Therapist can also be a curse when it comes to parenting.  As an OT, the goals are always functional independence.  As a parent, I am no different.  I remember a video I watched in OT school.  This was of a boy (young adult) with cerebral palsy and he was putting his coat on.  The video was probably 20 minutes (or it felt that long).  As I watched this boy struggle with his coat for what seemed liked eternity, I wanted to jump through the TV to help him.  Clearly with some help this could be done faster and easier.  But in the end, it was not about that.  It was about independence. 


As parents, it is often faster and easier to do things for our kids.  Or, we feel the need to continuously protect our kids from failure by ensuring that we are their second brain.  But is this the right choice when the goal is to create people that can manage on their own? 


I have created two memory mantras that are used in our house to ensure my kids are seeing the big picture and are developing some executive functioning (note I also use these mantras with my clients who suffer from memory impairment):


When leaving the house our mantra is:  WHERE AM I GOING AND WHAT DO I NEED?  When my children ask themselves this question, they need to stop and think “I am going to X and thus need Y (water, shoes, birthday present, tennis racquet, money)”.  This prevents them from showing up at X unprepared. 


When leaving a place in the community our mantra is:  WHAT DID I COME WITH AND WHAT DO I HAVE?  By asking themselves this question, they quickly realize that they came with X and thus need to bring X home (coat, shoes, water, bag, lunch).  This prevents them from leaving things behind.


The success is in hearing my children repeat this to themselves when on their way out the door.  Recently, at a sporting event, we heard a teenage boy blame his mother for forgetting his water.  She was profusely apologetic and rushed out to find him a drink.  My children (younger) turned to me and said “shouldn’t he remember his own water”?  My thoughts exactly.