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OT or PT? Both or Neither?

Guest Blogger: Carolyn Rocca, Student Occupational Therapist

The differences and similarities between Occupational Therapy and Physiotherapy have long been confused. This makes sense, especially since both professions ultimately started as “POT”, meaning people studied to be a Physical and Occupational Therapist and worked in a dual role, providing both. However, since the mid-1970’s the roles have been separated and yet people still confuse the two. I am still often asked “oh, so you are like a physiotherapist”…followed typically by a question about some ailing body part.

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.

There is no single way to define or categorize each profession. However, the Canadian Association of Occupational Therapists (CAOT) describes OT as the art and science of enabling engagement in everyday living by empowering people to participate to their potential in the daily occupations that foster health and well-being (Townsend & Polatajko, 2013, p. 380). In the OT profession, the term occupation is considered everything that people do throughout the course of their lives that is considered essential to their health and well-being (i.e. how people “occupy” their time). For example, an occupation can range from one’s ability to shower and groom themselves, to their ability to carry out their role as a parent, spouse, or employee.

Therefore, OTs are trained to assess and help clients identify areas in their lives that have been impacted following injury or illness, such as their ability to care for themselves, care for their families, manage their households, perform at work or school, and participate in volunteer or leisure activities. An OT would then assist their clients in building goals around those areas that are important to them, and to then provide recommendations, strategies, assistive devices, and education in order to find solutions to these day to day challenges.

Whereas, the Canadian Physiotherapy Association (CPA) describes PT as a client-focused health profession dedicated to improving quality of life by: promoting optimal mobility, physical activity, and overall health and wellness, and improving and maintaining optimal functional independence and physical performance (CPA, 2012). Therefore, PTs are experts in human anatomy and the functioning of the many systems within our bodies.

Their role involves conducting detailed and holistic assessments of their clients’ movement, mobility, and functioning, creating rehabilitation goals for recovery with their clients, followed by developing personalized intervention plans. PT intervention can include education, individualized therapeutic exercise geared towards increasing strength and range of motion, manual therapy techniques such as massage and manipulation, the use of modalities including ultrasound and electrical stimulation, and the prescription of assistive equipment.

While both professions consider the physical, social, psychological and emotional well-being of their clients, one primary difference between the professions is that PTs are trained to recognize when there is a need for specialized mental health treatment, and subsequently refer their client to an appropriate healthcare provider, whereas OTs are trained to assess and provide treatment for mental health conditions. This treatment can consist of teaching and practicing coping strategies by providing counselling and psychoeducation. Further, while a PT may recognize and understand how someone being unable to walk impacts work and home, the OT will help people to “manage in the meantime”.  So, while you are building your strength and endurance on that broken leg through physio, your OT will help you to manage other important tasks in a modified fashion when at home, work, school or in the community.

Nevertheless, perhaps the largest difference between the professions is that a PT tends to treat the client’s actual impairment, while an OT tends to help the client complete everyday tasks with the impairment. For example, consider a client who has undergone surgery for a hip replacement. Throughout their recovery, a PT might prescribe an individualized at home exercise program to gradually stretch and strengthen the hip in order to prevent deconditioning and to rebuild the muscles needed for walking. A PT will also be vital in terms of educating them on the proper use of crutches in order to safely move around their environment. Meanwhile, an OT will be an essential part of this client’s recovery as they likely require specialized bath equipment for safe showering, adaptive devices for putting on socks and shoes, and education in terms of strategies to transfer safely into and out of their car. Essentially the OT would focus on getting the client back to their day to day tasks and life roles despite the limitations presented by their impairment.

All in all, even with their unique roles, the OT and PT professions do have similarities. Both OTs and PTs can be accessed in hospitals, community care, private practice, rehabilitation centres, family health teams, long term care centres, and school health. Additionally, both professions are client-centred, meaning they focus on what is important to the client, and on maximizing their independence, safety, and function. Neither require a referral, so people can ask for, and receive these therapies without a referral. Despite these similarities, their above highlighted differences allow each profession to offer distinct roles, meaning PT or OT, both or neither may be most appropriate for you. Overall, both OTs and PTs are vital members of healthcare teams and together they offer many needed services throughout the rehabilitation process.

 

Resources & References

Canadian Association of Occupational Therapists (CAOT) website: http://www.caot.ca/default_home.asp?pageid=2412

Canadian Physiotherapy Association (CPA) website: https://physiotherapy.ca/

Canadian Physiotherapy Association (CPA) (2012). Description of physiotherapy in Canada. Retrieved from https://physiotherapy.ca/sites/default/files/site_documents/dopen-en.pdf

Townsend, E. A., & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, ON: CAOT Publications ACE.

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The Secrets to Successfully Managing Your Time

Time is precious.  As we all try to cram more into our days, weeks, and nights we are creating unsustainable expectations for ourselves and for those that rely on each of us to get stuff done.  Whether working on a specific project or working to keep home, family and career running smoothly, the tips in the following infographic “Secrets to Successfully Managing Your Time” can help you to stay organized, stay focused and get things done!

 

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Wash Your Car – Save a Life!

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

Previously posted February 2014

Working in auto insurance makes me slightly paranoid about issues of vehicle safety.  Ideally, it would be great if car accidents could become extinct and people could go about their business without running the risk of becoming injured in their travels, but currently these remain one of the main causes of adult and child injury, death and disability.  May is National Car Care Month and maximizing car safety should be on the top of everyone’s list year-round.

Years ago, in the middle of winter, I was driving home from seeing a client at night.  I was on back roads that were not lit.  My headlights were on, but I could barely see the road in front of me.  I struggled with this, assuming I had a headlight out, and managed to get to a gas station.  There, I investigated the problem and realized my headlights were just covered in the road sludge so common in Ontario winters.  I cleaned up my headlights with a window squeegee and voila!  I could see again

Prior to this, the thought of washing my headlights never occurred to me.  Why would it?  Unless you encounter a problem, this is not something I remember being taught in driver’s ed, nor something my parents mentioned to look for as I was learning to drive.  Some things we just learn in life the hard way – hoping to not be hurt in the process.

I remember when cars started to be manufactured to have headlights on automatically and all the time.  I said to my brother “I don’t get why headlights should be on during the day, they won’t help a driver to see better” and he responded with “it is so other people can see you better”, I am sure adding a brotherly “dummy” in there too.

The other day I was reminded of these lessons again.  It was a sunny day, but the roads had been a mess a few days prior.  I was driving in the right lane and needed to change into the left lane to make an upcoming left turn.  I glanced in my dirty side mirror and my rear mirror which was looking out my dirty back window, and I didn’t see anyone.  I checked my side mirror again, and noticed something that looked odd.  I focused more clearly and realized that there was another car to the left of me after all.  This was a black car, covered in the grey muck from the roads.  The lights weren’t on, and what struck me was how much this car was essentially the color of the road.   The road was a grey, dirt covered mess, and this car blended right in.  Had the lights been on, or the car clean, I would have spotted this easily.

Really, both these issues with visibility when driving – to see and be seen – could be tackled with a simple car wash.  Even if this seems futile with changing weather conditions, the short-term benefits are immense.  A clean car is easier for others to see, gives you better visibility when the windows and side mirrors are clear, and washes your headlights to make sure these are most effective.  Besides, of course, the other benefits of washing road salt and dirt from your paint job.  Many gas stations have a quick car wash adjacent to the pump, and allow you to pay at the pump for convenience.  Or, some car washes are even a drive-thru format and you don’t even have to leave your car.  In the end, when it comes to road and driving safety, the added expense of giving your car a rinse could be “priceless”.

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Aquatic Therapy: Is it Right for you?

Guest Blogger: Carolyn Rocca, Student Occupational Therapist

Water has long been associated with health and healing, making it an excellent tool for rehabilitation. Aquatic therapy, also referred to as pool therapy or hydrotherapy, is one way in which water can be used for therapeutic purposes following injury or illness.

Aquatic therapy refers to water-based treatments or exercises aimed to enable physical rehabilitation, fitness, and relaxation for therapeutic purposes. Treatments and exercises are performed while floating, partially submerged, or fully submerged in water, usually in specialized temperature-controlled pools. The key difference between this form of therapy and land therapy is that movement is facilitated by the physical properties of water, particularly it’s density and specific gravity, hydrostatic pressure, buoyancy, viscosity, and thermodynamics (Becker, 2009).

Due to the specific facilitating properties of water, aquatic therapy can have several benefits for people who have loss or restriction of joint motion, strength, mobility, or function as a result of a specific disease or injury. Aquatic therapies are beneficial in the management of musculoskeletal issues, neurological conditions, and cardiopulmonary problems. More specifically, there is evidence to support that people with fibromyalgia, arthritis, multiple sclerosis, cerebral palsy, stroke, and chronic pain, as well as people who have undergone surgeries such as total knee and total hip replacements, can significantly benefit from aquatic therapy (CARI, 2014).

The benefits of hydrotherapy will depend on the purpose of why it is being used in your rehabilitation plan, what it is aiming to target, and the type of exercise being completed in the water. In general, there is evidence to support that within a wide range of ages and abilities, hydrotherapy may help people to increase their endurance and strength, improve balance and postural control, reduce perceived pain and muscle spasms, reduce joint pain and stiffness, aid in gait retraining, and improve functional mobility. Additional benefits can include the facilitation of relaxation, improved quality of life, as well as providing opportunities for socialization (CARI, 2014).

A key to the success of many aquatic therapy procedures is the constant attendance and guidance provided by a trained therapist. This can be any rehabilitation professional, such as a physical therapist, occupational therapist, PTA/OTA, etc., who has taken additional and specific training in basic or advanced aquatic physical therapy. The rehab professional’s expertise will be able to match your abilities with the appropriate properties of water to achieve an optimum balance between facilitation and challenge. By adjusting the immersion temperature, type and intensity of activity, level of resistance, use of equipment, and treatment duration the therapist will be able to assist your recovery by gradually increasing the amount of challenge to eventually help you to transition to land exercises.

An added bonus to the therapeutic benefits of aquatic therapy is that it can help to introduce or re-connect you to a leisure interest, and can offer a social outlet. For example, a current client of mine has recently begun pool therapy following injuries sustained in a motor-vehicle collision. Not only will this help in her recovery while she begins to regain strength and function in her legs, but will also re-connect her to her passion for swimming, as this was something she loved to do with friends prior to her accident. Additionally, there is evidence to support that infants and toddlers with mobility impairments that engaged in aquatic therapy can experience significant functional gains in mobility compared to children who solely received land therapy, and that their parents noticed an increase in their socialization and enjoyment while in the pool. In this particular study, the children’s parents then reported an increased willingness and comfort in bringing their children to community pools following aquatic therapy (McManus, & Kotelchuck, 2007), therefore further increasing their future leisure and social opportunities.

Thus, aquatic therapy has the potential to improve physical function, as well as increase community involvement, socialization opportunities, and participation in physical activities. Additionally, this form of therapy can be appropriate and beneficial for all ages and abilities. If you feel that aquatic therapy may be a great addition to your rehabilitation and recovery, speak to your rehabilitation professional about some of the opportunities available in your community.

 

References & Resources

Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R, 1(9), 859-872.

Canadian Aquatic Rehab Instructors (CARI) website: http://www.aquaticrehab.ca/

Canadian Aquatic Rehab Instructors (CARI) website link to research (2014). Retrieved from http://www.aquaticrehab.ca/research

McManus, B. M., & Kotelchuck, M. (2007). The effect of aquatic therapy on functional mobility of infants and toddlers in early intervention. Pediatric Physical Therapy, 19(4), 275-282.

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Cognition and Aging – Use it or Lose it

Our brains are made of billions of neurons, which interact with each other to complete specific tasks. Signals are sent from one neuron to another along neural pathways, and these determine our thoughts, emotions, insights, and so much more. Each task relies on a different neural pathway, so the pathway for reading a book is different than the pathway for putting on our shirt. The more we use a pathway, the stronger the connection becomes.

These neurons have the ability to physically change themselves when faced with new and difficult experiences. This ability is called neuroplasticity. As we are exposed to new areas, tasks, information or experiences, neural pathways are formed and existing ones are reshaped. This will continue throughout our entire lives as we learn. As we have experienced through practicing a musical instrument, memorizing our shopping list, or recalling a friend’s phone number, if we consciously focus and train our brains in a certain area, they will become faster and more efficient at performing those tasks.

So, how can we use this knowledge to try and combat age-related cognitive decline?  Check out our latest episode of OT-V:  Cognition and Aging – Keeping the Mind Sharp to learn some proven strategies. 

 

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Parents Alert! The Signs of Mental Health Challenges in Children and Teens

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

I was recently reviewing my daughter’s school handbook and noticed the section on child and youth mental health.  According to this (and the Canadian Mental Association) 1 in 5 children and youth struggle with mental health problems.  While great strides have been made over the last several years to destigmatize and demystify mental health problems in both adults and kids, I feel this remains generally misunderstood.  In my practice, I still see the common misperceptions that people with anxiety don’t leave the house or appear nervous and anxious in public, or that people with depression sleep all day, don’t attend to their appearance, and sit around crying and feeling sorry for themselves.  The truth is that mental health is a spectrum, or a continuum if you will.  It can vary and no one’s experience will be the same.  In children, mental health problems can present differently.  As per the handbook I was reading, the signs might include:

·        Anxiety and fear that does not go away

·        Frequent crying and weepiness

·        Loss of interest in activities that were a source of pleasure in the past

·        Difficulty concentrating

·        Lack of energy or motivation

·        Problems at school with falling marks

·        Withdrawal from family, friends and school activities

·        Increased school absences

·        Loss or increase in appetite

·        Sleeping too much or too little

·        Increased irritability, anger or aggression

·        Neglect of personal appearance

·        Frequent stomach aches or headaches

·        Increased alcohol or drug use

In general, parents should be able to monitor most of these and overt changes might be obvious (suddenly disconnecting from friends, drastic changes in grades, behavior change at home, quitting enjoyed activities, not eating food or participating in meal times, etc).  But like with the continuum of mental health in adults, some of these might present some days and not others, or be so subtle that they deteriorate very slowly over time.   As parents of teens we need to be the barometer for our kids as they may lack the ability to relate some of these signs to mental health or internal struggle.

Luckily, in Southern Ontario anyway, I see the mental health problems of kids being taken seriously and there are publicly funded community supports available.  But getting your child connected with these can be the challenge.  It can be hard to convince a teen to do anything they don’t agree with, let alone getting them to the myriad of appointments with doctors and clinicians that can help.

Occupational therapy plays many roles in helping kids and teens address issues with mental health.  While some occupational therapists are trained to provide psychotherapy, others use meaningful and enjoyable tasks to help with mood elevation, reactivation and reengagement.  We are skilled at looking beyond the obvious to get a better sense of what might help at home, school or in the community to get your child or teen on track.  Sometimes it is as simple as helping them to reorganize their school work, create a process for managing assignments and tests, teaching them how to study in a way that works for them based on their learning style, or even looking at how their week is managed to make changes.  Occupational therapists tackle things like sleep / wake schedules, eating and diet, activity participation, grades and school success, managing friends and relationships, motivation through engagement, and dealing with negative pressures that create more stress and anxiety.

My advice if you are concerned about your child?  Start with your family doctor and discuss your concerns, even if your child won’t attend with you.  Involve the school in your concerns to get their support and guidance, after all your child spends several hours a day in their supervision and care.  Teachers can be a great resource and form of support as well, but you need to open those lines of communication.  Don’t expect the school to come to you – often they don’t.  If your child is in crisis, call your local Crisis Outreach and Support Team (COAST) and ask them for help.  They can (and should) also connect you and your child to other community programs.

If you have coverage for mental health treatment for your teen (extended benefits, other insurance funding, out-of-pocket), including occupational therapy, consider enlisting a private therapist.  Private therapy often provides a larger scope of service, is more specialized, and can be provided over a prolonged period if appropriate.  Any good private therapist will try to work themselves out of a job by getting your child on track as quickly as possible and they will want you to immediately feel the benefit of their involvement.  Also, if you have private dollars or insurance coverage, I would suggest a psycho-educational assessment.  These are extremely thorough “brain tests” that look at all aspects of how your child processes information, manages cognitive tasks, and addresses the complicated relationship between our brain and our emotions.  The outcome of these assessments can be extremely helpful, and will provide both you as a family, and the school, with suggestions for how to best help your child to succeed.

I have always said watching my kids grow up is the best and worst part of parenting.  It is especially heart-wrenching if your child is struggling.  Watch for the signs, talk to your child and get them (and you!) support if they need it.

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Struggling with Sleep? Try This Helpful Tool

Proper sleep is vital to our mental and physical health, and lack of sleep can negatively affect productivity and function.  If you suffer from poor sleep, know that you are not alone.  Statistics Canada estimates that approximately 3.5 million Canadians struggle with sleep.  There are many ways to get help and in all of these, tracking your sleep is an important tool.  Use our free printable Two-Part Weekly Sleep Diary to help you track and identify what helps and what hinders your sleep habits.  Simply print and fill in your diaries before bed each night and when you wake up each morning.

Also check out our video Improving Sleep to learn some solutions from Occupational Therapists that can help.

For more helpful tools and checklists please visit our Printable Resources page.

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Living with Cancer and the Role of OT

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:

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The Role of Occupational Therapy in Trauma Recovery

Guest Blogger: Carolyn Rocca, Student Occupational Therapist, 2017

Motor vehicle accidents account for countless injuries annually and are one of the most common traumas individuals experience. Trauma can be understood as one’s unique experience of an extremely stressful event or enduring conditions that overwhelms their ability to cope. These experiences can often disconnect us from our sense of safety, resourcefulness, and coping. As a result, survivors of severe and traumatic motor vehicle accidents are at increased risk for experiencing mental health difficulties, with posttraumatic stress disorder, depression, and anxiety being the most common.

Post-traumatic stress disorder (PTSD) is a mental health condition that can follow a traumatic event involving actual or threatened death, serious injury, or threat to the physical integrity of oneself or others. Although every individual experiences PTSD differently, following a motor vehicle accident PTSD symptoms can involve:

·       Psychologically re-experiencing the trauma through distressing thoughts or dreams about the accident,

·       Avoidance of thoughts or situations associated with the accident, including a reluctance to return to driving,

·       Extremes in emotional responsiveness, by either having greatly reduced or heightened emotions, and

·       Increased physical arousal, such as hypervigilance, exaggerated startle, irritability, and disturbed sleep (Beck & Coffey, 2007).

The symptoms associated with PTSD can leave individuals to feel emotionally, cognitively, and physically overwhelmed. Naturally, this can result in difficulties in one’s daily functioning, including one’s ability to care for themselves and others, as well as their ability to successfully engage in their life roles of being a spouse, parent, employee, student, or volunteer, to name a few. For these reasons it is recommended that those experiencing PTSD seek help from a team of healthcare providers and consider occupational therapy.

Using a trauma-informed care approach, occupational therapists can support clients through the following three Phases of Trauma Recovery:

Phase I – Safety-stabilization:

Since trauma often results in a sense of helplessness, isolation, and loss of control, the aim is to restore a sense of safety and empowerment. Following trauma, creating a sense of safety is the foundation of one’s recovery process.

The first step to building and creating safety is to first identify things that help us feel safer. Occupational therapists can help their clients to identify objects that bring about a personal sense of safety and imbed them into their daily routines. These safety objects may include: special people such as a trusted friend, engaging in certain activities like looking at photographs or making crafts, or being in a certain place, such as being outdoors in the sunlight.

Occupational therapists can also assist in establishing safety through practices such as meditation, mindfulness, deep breathing exercises, yoga, and Thai chi, as these approaches have been shown to be effective at decreasing stress and soothing the nervous system (Manitoba Trauma Information & Education Centre, 2013).

Phase 2 – Remembrance and Mourning:

A traumatic event like a motor vehicle accident is often associated with a form of loss. One might feel they have lost their independence, sense of identity, or purpose following a car accident.

Counselors and occupational therapists are well-equipped to guide individuals on their recovery by allowing them time to grieve and morn their own personal losses. This is often achieved through individual or group-based therapy by processing the trauma, putting words and emotions to it, and making meaning of it.

Phase 3 – Reintegration:

The goal of the third stage of recovery is that the person affected by trauma recognizes the impact of their experience but is now ready to take concrete steps towards a lifestyle that is no longer controlled by the trauma. Recovery and reintegration will look different for everyone, but often involves resuming important life roles and responsibilities, and returning to a lifestyle that is meaningful to them.

Occupational therapists can assist during this phase of recovery by supporting their clients in re-establishing healthy routines, building strong support systems, learning and practicing coping strategies during their day to day activities, and gradually increasing their exposure to anxiety provoking triggers, ultimately enabling them to reintegrate into their communities and preferred lifestyles.

For more information about PTSD, trauma informed care, and how healthcare professionals can support someone following trauma, be sure to take a look at the Trauma Toolkit or call an Occupational Therapist to start the process of recovery.

 

References & Resources:

Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations. Professional Psychology: Research and Practice, 38(6), 629.

Manitoba Trauma Information & Education Centre (2013). Retrieved from http://trauma-recovery.ca/

The Trauma Toolkit: A resource for service organizations and providers to deliver services that are trauma-informed (2013). Retrieved from http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf