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Occupation Is: Doing Fun Stuff

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, what are your plans after work?  How do you like to spend your evenings?  What do you do for fun?  Given the choice, how do you spend free time?  While being productive is essential for the human psyche, so is being unproductive.  Well, sort of, because even a lack of productivity is productive.  Deep, I know.

Personally, I love a good funny movie, dinner with friends, time with nature, getting out with my kids, exercising, playing sports, reading, blogging, and going on vacation.  Those are my “fun”.  For others, this could be creative hobbies or outlets, museums, live theatre or music, antiquing, collecting, photography, being online, or a thousand other things that I don’t even know exist.

So what if I was injured, suffered from a mental health problem, have a medical issue, or brain injury?  Perhaps I would lack the ability to sit through a movie, or could no longer understand the nuances of humor.  Maybe my personality would change and my friends would have a hard time relating to the “new me”.  Or, I could no longer physically handle my nature walks, exercising or playing sports.  If my vision was impaired, I could not read anymore.  If I struggled with cognitive communication, or attention problems, putting together a blog article might also be off the table.  And vacations?  Those are incredibly difficult to plan and organize at the best of times.

Occupational therapists are very skilled at helping people resume the occupation of fun.  There are multiple ways we do this, as we recognize that our “fun” defines much of who we are, and why we work so hard in the first place.  For example, if I had to rehab myself from the problems above, I might start with suggesting sit-coms as these require less physical tolerances for sitting, and a shorter attention span.  I could view these with another person, and discuss the humor, sarcasm, and recall the best one liners.  Perhaps I would need education and support to understand how my personality changes are impacting my relationships, so I can try to make some changes.  If my physical abilities were limited, my OT could help me find new ways to enjoy nature (bird watching, photography as examples), and could help me discover new sports and forms of exercise within my abilities (yoga, Tai Chi, and many modified sports have become very popular for people with disabilities).  If I can’t read a standard book, maybe I could use an iPad or e-reader so I can change the font size, or switch to audio-books.  For my blogs, I could learn new ways to move from a blog idea to a full article, by breaking down the topic into paragraphs or chunks, or learning how to dictate if written communication is my challenge.  Vacations could take the form of day trips, short overnights, and eventually out of the country through the help of a travel agent that specializes in planning accessible vacations.  I would probably learn that in Canada my attendant can fly for free (with approved paperwork), and that many places (Disney included) are highly accessible.

So if a disability is stopping you from enjoying the occupation of fun, OT’s treat that.

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Occupation Is: Eating

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

So, we have slept, are out of bed, groomed and dressed.  Now what?  Typically we head to the kitchen to grab something to eat.  Admittedly, I am a terrible cook.  And on top of this I am leery of ready-made foods, and think the microwave is the root of all cancer.  So, let’s just say I struggle with everything that is meal preparation.  Many of my clients struggle with this also, but for much more legitimate reasons…

For most of us, breakfast is typically simple.  Cereal, toast, maybe eggs, pancakes, granola or fruit.  Lunch slightly more complicated, and dinner is an effort.  So what if you have a brain injury and have difficulty planning meals?  Or, you cannot drive, or can no longer access public transit so you have problems getting items at the store?  Maybe you are on a strict budget and can only get food from a food bank.  Perhaps you have food in the house, but your appetite is supressed from medication, depression, or some other physiological or mental illness.  The dishes might be too heavy to lift if you have upper extremity problems, or you have one hand you can’t use at all which makes cutting, peeling, and carrying heavy pots very difficult.  If you have a special diet, or cannot consume foods by mouth, meals take on another form – pureed, soft, smoothies, Ensure, or even through a feeding tube.  If the meal is made, perhaps you just can’t carry it to the table as you use a wheelchair, or cane, and the last time you tried the meal ended up on the floor.  If you have tremors, shakes or dizziness, walking carrying anything is a challenge.  Once you are at the table with your food, an upper extremity or visual problem might make it hard to get the food onto the fork, spoon, or into your mouth.  Chewing could be another problem if you have oral-motor difficulties.  Then you have to swallow and choking or aspiration are possible.

Occupational therapy treats all that.  We provide strategies and supports to enable shopping, and aids that might help get the groceries into the car, into the house, and into the cupboard, fridge or freezer.  Or to improve memory we can help to set up systems that enable people to shop efficiently and effectively, including meal planning, creation of lists, mapping out products in isles, and providing strategies on ways to prevent visual and auditory overload common to most stores.  When cooking, occupational therapists look at safety around appliances, provide strategies to reduce bending, standing, or reaching, or even aids to reduce bilateral (two-handed) tasks if necessary.  If there are dietary concerns, occupational therapy can provide aids and education, and can work with a speech therapist or dietitian to make people are able to manage nutritional needs.  If there are negative eating behaviors, we can treat that through cognitive and behavioral therapy, tracking, and helping people access other resources and programs.  For consuming food, there are several devices that we can use to address a visual-perceptual neglect, a dominant hand impairment, and train people how to eat with a prosthetic.  We can make customized utensils and splints to bridge the gap between a hand and mouth if the two can’t connect.

Spoken quite simply – occupation is everything that is eating: from planning what to eat, getting the food from the store to the house, preparing this safely, and making sure the food meets the mouth, or the stomach.  If these things are a challenge for you, occupational therapists treat that.

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Occupation Is: Managing Toileting, Grooming, Showering and Dressing

Remember:  Occupational Therapists define the word “occupation” as the way people “occupy” their time.  So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?).  In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

Okay, so you are up, out of bed, heading to the bathroom.  “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.

Assume you have reached the bathroom.  What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level?  Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently?  What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself?  You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin.  Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair.  If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror.  Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place.

Maybe you have managed to do your grooming, toileting and washing.  What if you can’t get dressed?  Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom.  Or, your clothes are not clean because you lack the ability to do so.  Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility.  Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?

Occupation is all of that, and these things are addressed in occupational therapy.  If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catherizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories.  Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility.  What if the commode you do have won’t fit over the toilet, or even through the bathroom door?  If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives.  Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head.  Maybe the shampoo and soap bottles need to be changed or relocated.  A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence.  Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body.  No motivation to do these things in the first place?   Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines.

Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.

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Occupation Is: Getting out of bed in the morning

In celebration of Occupational Therapy Month, I am spending October defining the word “occupation”. Why? Because, contrary to the traditional understanding of the word, occupational therapists define this differently. For us, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for this month, I will explore the journey of “occupation” complete from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.

I assume the routine for most of us is the same. Morning hits, we hear the alarm clock, snooze it a few times, and eventually swing our legs over the bed, stand, stretch and head to the washroom. Sounds easy, right? But what if it isn’t?

What if you have had a terrible sleep? Perhaps you live with chronic pain and cannot get comfortable in your bed. Or, you have an acute injury and are trying to sleep on broken ribs, while wearing a cast or sling, or with bruises, scrapes, or swollen body parts. Maybe you live with anxiety, depression, or have trouble controlling your thoughts when you try to drift off. You have restless legs, or are on medication that makes you sleep too much, or causes insomnia. You are worried about something, someone, or have a child, spouse, or family member in your home that might need you during the night. Tomorrow is a big day and you are excited or nervous. You have neighbors that are too loud, or are spending the night in a shelter because you have nowhere else to go. Really, obtaining a restful sleep is actually difficult.

Assuming you have slept, and recognize the alarm is going off, what if you can’t just “throw your legs over the bed, stand and stretch”. Then what? Do you have or need support or devices to make the transition from lying to sitting, from sitting to standing, to a walker, cane or onto a wheelchair or commode? Perhaps your depression or anxiety makes it extremely difficult to transition out of bed to face the day, or to start your morning routine. Maybe you need to stay in bed for an extra hour because the amount of sleep you got just won’t cut it for challenges that day will bring.

Occupation is all of that and as such, these things are addressed in occupational therapy. Why are you not sleeping? Can we assist you to obtain a better sleep surface? Can we educate you on how to obtain a restful sleep position by suggesting changes to how you are lying, or through the use of pillows or wedges? Can we help you to shut your mind off through progressive muscle relaxation, meditation, natural sleep remedies, or by assisting you to obtain medical assessment and intervention? Can we aid in reducing your stress such that you are more at ease when trying to fall asleep, or so you won’t wake as much during the night? If you are sleeping through your alarm, or can’t motivate yourself out of bed in the morning, perhaps we can provide you with cognitive and behavioral strategies to re-frame that process to enhance your success. If

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there are physical barriers to positioning in bed, sitting, transferring or standing, we can prescribe equipment, aids, tools and support to ensure this part of your morning routine is safe, to promote independence, or to assist your caregiver.

Spoken quite simply – occupation is getting out of bed in the morning, and if this is a challenge for you, occupational therapists treat that.

 

 

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I Always Called it Dumb-Ball

Football lovers beware, this post will offend you.

I have never liked football, in fact I have always called it dumb-ball. Why? Because I could not, and do not, understand the appeal of watching big dudes, many of them grossly out of shape, run into each other with their heads. I never saw this as sport, and recognize that in a three hour game, each player actually moves for about 6 minutes. How athletic (I mean pathetic).

Okay, okay, simmer down. I can see that some of them are sweating under those helmets, and to be honest I don’t even understand the game. I should not knock something I have not tried, take no interest in, and don’t get, but alas I will continue.I think the recent NFL player award of $765 million for those with brain injury resulting from football proves my point. According to one article, “under the settlement, individual awards would be capped at $5 million for men with Alzheimer’s disease; $4 million for those diagnosed after their deaths with a brain condition called chronic traumatic encephalopathy; and $3 million for players with dementia”. They indicate that there are 18,000 players affected (http://www.nfl.com/news/story/0ap1000000235494/article/nfl-explayers-agree-to-765m-settlement-in-concussions-suit).

Other articles talk about this as a “drop in the bucket” and an award very unlikely to have any impact on the NFL at all. I know that the economy lives on supply and demand, and it somewhat saddens me that there remains a “demand” for this type of sport via spectators that pay big bucks and derive pleasure from watching this idiocy.

I love this article from Grantland: What Would the End of Football Look Like? (http://www.grantland.com/story/_/id/7559458/cte-concussion-crisis-economic-look-end-football). In this, they speak of pending football lawsuits and that the end result is that “more and more modern parents will keep their kids out of playing football, and there tends to be a “contagion effect” with such decisions; once some parents have second thoughts, many others follow suit.

I can tell you that I work with people with brain injury, Alzheimer’s Disease, concussions and post-concussion syndrome. These are not easy injuries to live with, or to treat. Dizziness, visual disturbance, excessive fatigue, cognitive difficultly, physical and emotional challenges…not fun. Why as a parent would I sign my kids up for that, or the likelihood of that, when there are other sports like tennis, volleyball, swimming, baseball and golf that are more classy, often more athletic, and clearly more safe?

What is interesting is that a few years back I was at a conference on Spinal Cord Injury. At my table, there was a researcher from the US. He was talking about impact data being collected from sensors inside football helmets. He said they were astonished at the high velocity of impacts being measured, and said the numbers were so severe they “could not even release the data as the outcome would result in public outcry and a drastic change to the sport”. Well, we wouldn’t want an outcry, would we?

The bottom line is that society’s values are changing. Parents are going to be less and less interested in exposing their children to sports that are more likely to cause injury, and to have long-term disabling effects. Sorry dumb-ball, I think your days are numbered. Golf anyone?

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Put On Your Own Oxygen Mask First

If you have ever traveled by air you are familiar with the drill. Instructions on how to buckle and unbuckle your seatbelt, where the life vest is located, emergency exits, and “should cabin pressure change, an oxygen mask will fall from the overhead compartment…passengers should always put on his or her own mask before assisting children, or a disabled passenger”.

 

I read a mommy blog the other day that called this the “airplane example” and the writer related this to how moms should approach motherhood. Ultimately the message is this: as a mom, put your own health first because you are useless to your kids and spouse if you ignore your own needs. Really, you can’t help a child with an emergency escape from a crashing plane if you pass out helping them with their mask.

While I do agree that mothers (and fathers for that matter) need to consider their own needs in providing for the family, this is also true of people that provide care to a disabled person. My experience is that often caregivers do not really “elect” that role. They are not trained to be a caregiver, and really just try to do their best with the skills and resources they possess. However, where many fall short is maintaining their own health and well-being in dedicating their physical and emotional time to another person: a person with challenging and multiple needs. The job of a caregiver is often 24 hours, and resources don’t often permit, nor does the government provide, sufficient relief from this responsibility. Caregivers are often sleep deprived, suffer from muscle and joint pain in fulfilling their role, and can become isolated and depressed due to the changes they have made to take on these new responsibilities. Sound familiar? This very closely mimics motherhood (especially for new moms).

 

The answer? Put on your own oxygen mask first. What can you do to breathe easier? What helps you to feel clear-headed, energetic and optimistic? What gives you that ability to stay positive, appreciate and take on your responsibilities with some enthusiasm? The answers are often different for all of us. In the end, figuring out how to wear your oxygen mask first requires you to be honest about your abilities and skills, to utilize the resources available, and to ultimately ask for help if this is needed.

 

And for us health care professionals? We need to be very careful of the responsibilities we place on caregivers. This is especially true in the medical community where we repeatedly discharge people into the care of family, without family really knowing what the responsibilities will entail. As health care

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providers our responsibility is always to the client, yet we need to take that extra time to check in with the caregiver, talk about how they are coping and managing and if needed, offer them an oxygen mask.

 

 

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Alzheimer’s Disease

I learned early in life about the perils of impaired cognition.  I worked for Scotiabank for many years as a customer service agent.  In this role, I would assist many clients who I now assume had dementia with their finances.  I remember having to call family when one elderly woman replaced her visa card six times in one month.  The family found them all in the lettuce compartment.  Or, the other lady that paid the same roofer three times.  She was being taken advantage of.  In school, I read the book “The Man That Mistook His Wife for a Hat”.  What a great way to understand dementia and Alzheimer’s disease.  

 
It is national Alzheimer’s week so I thought I would take some time to talk about this very sad and difficult illness.  Alzheimer’s disease, or related dementias, impact 1 in 11 Canadian’s over the age of 65, with three quarters of these being females.  It is expected that within a generation, this will double, to around 1.3 million people (http://www.alzheimertoronto.org/ad_Statistics.htm).  

 
Signs of Alzheimer’s disease, or dementia include: 

 

Judgment: such as forgetting how to use household appliances.

 

Sense of time and place: getting lost on one’s own street; being unable to recognize or find familiar areas in the home.

 

Behavior: becoming easily confused, suspicious or fearful.

 

Physical ability: having trouble with balance; depending upon a walker or wheelchair to get around.

 

Senses: experiencing changes in vision, hearing, sensitivity to temperatures or depth perception.

 

Assessment of this is often done medically by eliminating other factors that could explain these problems (such as poor sleep, medication use, other conditions, stress, etc).  Also, an Occupational Therapy Assessment in the home is very helpful at determining how the noted problems are impacting function, how these can be addressed or treated, if the person is safe to be at home (with or without supports), and what care is required.  Following the assessment, the Occupational Therapist can make recommendations regarding devices, strategies, and supports that can help to reduce the impacts of the disability, improve safely, promote independence, and ensure the caregiver is trained to provide the necessary support.  Such suggestions could include ways to: 

  •          Remove hazards at home.
  •          Prevent unwanted wandering.
  •          Safeguard medications.
  •          Reduce physical barriers that impact mobility.
  •          Improve visual perception through aids, devices and care techniques.
  •          Reduce against risks of unsafe food and beverage preparation or consumption.

 As with most things, early diagnosis and intervention is key.  Seek medical attention and ask for an OT in-home assessment to gather information about how to improve function, and to safely prevent premature losses that can result from lack of information about the condition and its management.  
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Julie’s Picks

I will be honest.  Most of my “leisure” reading is in the form of MBA textbooks, online research, and class notes.  However, every once in a while I get the chance to pick up a book that I would consider “interesting” even if still relating to my job as a health professional, my interest in wellness, or my role as a business owner.  Instead of trying to summarize these books in a book report, I thought I would provide “Julie’s Picks” for great reading about business, health, and keeping things in perspective.

 

How Will You Measure Your Life – Clayton Christensen.  My entrepreneurship prof recommended this book to our class.  And what a treasure.  This is a quick read, and relates business strategy to relationships.  My favorite part is when the author talks about how as parents we need to make “deposits” into the bank account that is our children.  Without regular “deposits” we will have nothing to withdrawal when we need it.  We cannot expect our bank account to be plentiful if we have not added to this over many years.  This is a lesson I have carried forward into my own life – even if it is just pennies a day, I need to build my fortune with my children and spouse now, so my relationships are rich later.

 

Lean In – Sheryl Sandberg.  This is a wonderful book about women in business. And not a girly book.  Sheryl has experienced immense business success in the male-dominated corporate world and talks about how women need to “sit at the table” and “lean in” to their careers while encouraging husbands, dads and partners to “lean in” at home.

 

The Fire Starter Sessions – Danielle Laporte.  A friend, and fellow entrepreneur, suggested this book.  Not only is it funny, informative, and forthcoming, it has worksheets after each chapter that encourage reflection, goal setting, and some deep thought.  The quotes in this book are inspirational, while also being somewhat unconventional and often “hit you in the head” obvious.  Danielle asks you to explore how you want to feel in life and then encourages you to do those things that make you feel that way.

 

A New Earth – Eckhart Tolle.  This book was the topic of an earlier blog.  As the book used for a post-program study for Hamilton’s Chronic Pain Program, I witnessed the impact this book had on people who were experiencing significant disability.  I read this in awe.  While having some very heavy content, this is mixed with practical and real stories that explain the importance of “presence” and highlight how people need to transform negative into positive thinking in order end conflict and suffering.

 

I will continue to share my picks as I find them.  Please feel free to also share yours.

 

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Terry Fox – The Legacy Continues

“It took cancer to realize that being self-centered is not the way to live. The answer is to try and help others.” Terry Fox

 

I was 5 when Terry Fox began his epic journey across Canada. I remember watching this on a television with bunny ears and no remote. He would run in the rain, fog, and cold, with his prosthetic limb and very distinguishable gait. Even in a world without the internet, Facebook, email and Twitter, news of his journey spread and touched millions of Canadians. Unfortunately, Terry died before he could complete his journey, at the way-too-young age of 22.

 

What I find so incredible about Terry’s story, however, is that it didn’t die with him. Even 33 years later Canada remains committed to continuing his legacy through education about Terry, his disease and his mission, and by continuing to promote and encourage others to run as Terry did, and to donate. My children will again participate in the Terry Fox Run this September, as I did in school before them.

 

According to the Terry Fox Foundation, to date they have raised over $600M for cancer research. But above the massive amounts of money raised, and the heroic action of being one man, all alone, dedicated to

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raising funds and awareness for an important cause, Terry set an example. He became a poster-boy for overcoming challenges and to have hope. He paved the way for others (Rick Hansen included) to do epic things to raise awareness, and money, to fight for important causes. He demonstrated, as his quote indicates, that being self-centered does not progress a Nation, nor does it raise a generation of loving youth committed to the greater good. The answer is to help others. In some way, or some form, to give back and make your existence matter. This can be as simple as a kind word or friendly gesture, or as significant as donating time, money or careers to worthy causes. We have a lot to learn from Terry Fox – still – even if he is only here in spirit to teach us.