Archive for category: Original Posts


Achieve Better Sleep for Better Health

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

Sleep is one of the most important determinants of health.  Proper sleep helps to restore our minds and bodies so that we are able to effectively tackle another day.  However, it is estimated that 1 in 7 people suffer from sleep problems, and non-restorative sleep is a common complaint I hear from my clients. 

As an occupational therapist there are several strategies I utilize with my clients to help them improve sleep: 

Sleep Surfaces – a good mattress can ensure that your body is aligned when sleeping whether you sleep on your side, back or front.  Often when we work with people to replace a bad mattress, they are actually more uncomfortable for the first several days or weeks.  This is often the result of their body being required to re-align when sleeping, when previously it was resting in awkward positions.  If your mattress is too soft, or sagging, and you are not able to get another, consider using a board under the mattress to provide support.  A good pillow is also very helpful, but the purchase of this should be based on personal preference (not on a therapist or sales person telling you which one you should have).  I have a great Ergocentric Pillow, but previous to that enjoyed my Medi-Flow water-based pillow that allowed me to adjust the water volume for different amounts of support.

Sleep Habits – a consistent sleep routine is essential to teaching your mind and body how to effectively shut down at the end of the day.  Shift workers can have a terrible time with sleep because of the unpredictability of their sleep schedule.  If you consider that you need a certain amount of sleep per day (which can vary by individual), then you should try to get into a routine around those hours.  I read years ago that sleep cycles are 20 minutes so if you need to nap during the day, consider setting a timer for 20 minutes so your nap will be restorative, but not too long that it will impact your sleep at night.  If you are in a routine of napping for long periods during the day, and cannot fall asleep at a decent evening hour, then consider shortening your nap daily by small increments to achieve a better balance.

Mind Distractions – often it is the mind that won’t shut off and this prevents us from falling or staying asleep.  Counting sheep is not always effective.  Consider using a sleep CD (I recommend Eli Bay), or meditation, relaxation or mindfulness app on your phone to help your mind focus on a restful place.  Some natural remedies like certain decaffeinated teas can also help to make us feel groggy before bed.

Tracking Sleep – often when helping clients to develop a new routine, I will ask them to track their sleep cycles.  This can be done simply on paper.  Often, through this exercise, I find there is no routine and if we can develop and implement a sleep schedule, improvements in energy, mood, and cognitive function follow.  Personally, I use a Sleep Cycle app (.99 cents) to track my sleep habits.  This uses sensors in my cell, when placed above my pillow, to tell me how many hours I slept for, if I achieved deep sleep, and how my sleep ranks against other recent nights.  But what is even better about the Sleep Cycle app is that when you sent an alarm, it works to wake you up when it senses you are in a light sleep.  This reduces “snoozing” and awakens you when you are more likely to actually get up.  This app helped me develop a new schedule of getting up an hour earlier so that I could achieve my goal of getting my four legged beast his exercise bright and early!


Occupational Therapy is Functional Creativity

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

The profession of occupational therapy is all about creativity in solving barriers to function.  However, often we come across problems for which no solution currently exists.  In those cases we need to customize a solution that works for the client, their environment or care providers.

Personally, I have had great success with the local Tetra Society for developing creative solutions to problems that need a custom approach.  In one situation, my client who suffered from quadriplegia had the goal of feeding himself.  His elbow and shoulder flexion did not allow for his hand to reach his mouth.  With the help of his physiotherapist and Tetra engineer we were able to create a custom splint and modified utensils that bridged the gap between his hand and his mouth.  The material costs were $40.00 and the engineer was a volunteer.  In another situation my client, mobility impaired, wanted to attach his walker to his scooter so he could park his scooter and walk into the places he was visiting.  Tetra was able to custom mold a bracket for his walker at a cost of $10.00.  Another client also used Tetra under my encouragement to develop a bracket that would allow her to mount her camera so she could take photos from her power wheelchair.

Occupational therapy is about custom solutions to sometimes complicated problems.  But I believe that every problem has a solution and that as professionals we need to stay apprised of the options in the community that can help us to create customized solutions.  Take a look online for your local Tetra Society.


Making Martial Arts More Accessible


I previously wrote about Martial Arts and the immense benefits of this for both children and adults.  However, in highlighting this, I am cognisant that some people will have physical, financial, and geographical barriers to participating in a Martial Arts program.  As such, I wanted to provide some more information to make Martial Arts more accessible.

From a physical perspective, like all activities, Martial Arts can be modified to meet any level of physical ability.  Personally, I have vertigo so I cannot engage in ground techniques.  So, I stay on my feet working on kicks, punches, forms, and self-defense.  Erik Kondo ( has paraplegia and is a third degree black belt.  He has posted several videos online about self-defense from a wheelchair, and has also published an online resource on the 5 D’s of self-defense (  Michael Sirota ( runs an entire Martial Arts program for people with disabilities and structures each program individually.  With a creative Sensei and a motivated participant, anything can be done.  Tai Chi is also a Martial Art, but is grounded in slow, sequential movements that can be done in sitting or standing.  My grandmother had Parkinson’s Disease and practiced Tai Chi for years as a way to prevent the decline of her balance and mobility.  There are many local chapters of Taoist Tai Chi (

Financially, like many organized sports or activities, Martial Arts can be considered expensive.  However, as a parent, I have found Martial Arts to be less expensive than the organized volleyball, basketball, tennis, cheer and dance my girls have participated in.  In the world of rehab, a one year Martial Arts Program could be easily justified on a treatment plan.  Or, if you are funding this yourself, there are different dojos with different fee structures so calling around can help you to find one within your budget.  Our local YMCA offers Martial Arts as part of the family membership, and a family membership at the Y has multiple benefits for a reasonable fee.  I also believe the Y’s offer membership rates that can be geared to income.  Some dojos offer Martial Arts on a monthly basis, and others require a contract.  You can decide through speaking with different programs which option works best for you.  Also, some community centers offer Martial Arts for very low prices, or again are geared to income.  I have also experienced Sensei’s coming into physical education classes to demonstrate some of the skills and techniques at no charge.

Geographically there may be barriers to finding a local dojo, or transportation problems prevent easy access the community.  Perhaps looking for videos, online resources, books or even using video games to teach some of the skills could be possible.  Or, perhaps there is a carpooling opportunity with another family in the same area.  Explaining access issues to the Sensei at the nearest dojo may result in some solutions.

The bottom line is that as with anything, where there is a will, there is a way.  And the benefits of engaging in Martial Arts are so immense that taking some time to research local opportunities and to ask questions to make this accessible to you or your child will be well worth the effort. 


Martial Arts is All That…

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

I started Martial Arts at a time in my life when I was discontent with my emotional, physical and cognitive health.  I was unhappy with myself and listed all the reasons I felt that way to come to a very solid conclusion – I was not getting enough exercise.  After having four kids in five years, my exercise and sports were naturally not at the forefront of my time.  My solution?  Karate.  Why?  It would provide me with the physical outlet I needed, would be a cognitive challenge, and would feed my emotional need to do something for “me”.  Also, I considered self-defence, like CPR and First Aid, a tool I wanted in my “just in case” tool box.  But what I found through Martial Arts was much more than I expected.  I always struggled to explain this to others until I read a wonderful post from Sensei Master Michael Sirota (  Sensei Sirota lives in British Columbia and has created an entire Martial Arts program for people with disabilities.  He is heavily involved in the Para-Olympics and is, in my mind, a pillar in the Martial Arts Community.  I was fortunate enough to meet Michael in person last year.

In his post “Why Martial Arts”, Sensei Sirota highlighted the benefits:

Self-Defense:  “practice the fight so you don’t have to”.  This speaks to the fact that Martial Artists develop a quiet confidence that is seen but not heard.  This confidence makes them less vulnerable as a target of violence, and teaches them to identify potentially dangerous situations early to promote avoidance.

Athletic Enhancement and Fitness:  Many athletes combine their sports training with Martial Arts to maintain endurance, flexibility, coordination and swiftness.  Being able to strike, kick and move quickly mimics the explosive, fluid and coordinated movements needed in sport.  There are few other activities that burn as many calories, or result in such an overall body workout.

Other Health Benefits:  Martial Artists tend to take diet and exercise seriously.  This is part of the intensity of their training and their commitment to wellness.  Martial Arts requires concentration and focus, things relatable to all areas of life.  Martial Arts is a commitment with the built in motivation of moving through belt levels to achieve the goal of Sensei.

Respect and Courtesy: Contrary to popular belief, Martial Arts is about restraint and playing nicely in the sand box.  It has been proven that children (and adults) trained in martial arts tend to be disciplined, composed and respectful.  This is beneficial in all areas of life, especially relationships, school and work.

So, if you are looking for fitness, emotional strength, confidence, and cognitive stimulation, there are few other activities that will provide more bang for your buck.  And, fortunately, there are many forms of Martial Arts to choose from, making it likely that you can connect with a style and form that aligns with your interests.


What Behaviors Do You Want to Modify?

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

One of the best courses I took in university was Behavior Modification.  Our main project was to modify one of our own behaviors over a four month period.  Personally, I had a dog and wanted to develop a better walking routine.  So, over the four months I mapped out several walking routes that increased my time spent walking on a weekly basis.  By the end of the four months, I was walking my dog two hours and twelve kilometers a day.  Research indicates that it takes four months to develop a new habit, so by the end of the course my new walking routine became standard practice and something I did religiously with my dog (and then dogs) until I had my family and needed to develop a new routine.

Often, when our regular routines are interrupted by disability bad habits develop.  While not immediate, over time days can become more and more unproductive until soon very little is getting accomplished.  This has a drastic impact on mental health and impacts all areas of physical, cognitive and emotional functioning, let alone the impact on those that we live with.

The best way I have been able to help clients to break such routines is to simply have them track how they spend their time.  Once this is documented, people can quickly identify the problems areas and then together we discuss how to fix them.  For example, through tracking for a week, one client discovered that she does not shower, one found that he watches ten hours of TV per day, and another learned that she does not eat during the day, but consumes junk food all evening.  In every case, people discovered something about their routine that drove them into action for change.

So, if you are concerned that your routine is lacking in productivity, self-care or leisure, or there are activities you would like to resume or goals to achieve, just keep a log of how you spend your time.  After a week, reflect on your log and make a list of the problem areas.  Commit to making small changes (start with the easiest changes first) and over time, you will see huge improvements in how you feel about yourself and your routines.  Or, for a more structured approach, consider hiring a professional to assess your suitability for the Progressive Goal Attainment Program.  This program involves using time tracking over 10 weeks to completely revamp routines to reduce psychosocial barriers to recovery, improve mental health and reduce disability caused by chronic pain.


Will You Choose Wood or Water?

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

Often people talk about “fighting fires” in trying to manage the day to day events of life.  If this is your life most of the time, how stressful!  But, as with all situations, we have a choice.  

In a fire, do we want to be Wood or Water?  Wood, of course, will burn and burn quickly.  Do we want to grow this fire by providing it with the fuel it needs to be bigger and stronger?  Or, do we want to be water?  Water that can reduce the effects of the fire and bring this under control?  The ultimate choice is ours. 

If we are wood we react, blame, accuse, yell, and jump to conclusions.  If we are water we seek to understand, ask questions, and remain calm.  It is not always easy to make a choice, especially when a situation is fraught with urgency and we have other people adding to the fire by being wood themselves.  Perhaps the simple solution is to quickly ask the question:  is my reaction here helping or hindering?  Do I understand?  I have been guilty of sending emails, or making phone calls that were accusing in nature, to only realize I don’t have the entire story.  Whoops, my bad and I have learned my lesson.  Seek to understand so you can later be understood.  I think someone famous said that.  



Weight Management and Disability – You can’t eat what you don’t buy…

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

I find that while many of my clients initially lose weight following trauma (hospital food diet); eventually the net impact of a disability is often weight gain.  This is often the result of many factors – most interacting to make the solution difficult to isolate.  Medication side-effects, altered routines, reactive eating, friends and family that provide unhealthy sympathy foods, increased use of fast food because preparing meals is difficult, inactivity, depression, and even hormonal and physiological changes to the body as a result of the trauma.

But we do know that 70% of weight management is diet and assuming this is true, then the solution to weight management should be simple – you can’t eat it if you don’t buy it.  Purchasing unhealthy food is the first step to a weight problem.  And weight problems in disabled people are exponential.  Everything becomes harder – transfers, walking, completion of daily tasks, care giving, and many pieces of equipment have weight limits that when exceeded result in equipment failure.

What is even more problematic is the role of the care giver in the maintenance of weight in the person they are caring for.  When people cannot shop for food and cannot cook, then helping them to maintain weight becomes the job of the caregiver.  Just buy and prepare healthy foods – perhaps food prescribed by a nutritionist or dietician.  However, often caregivers rely on the disabled person to dictate the food choices but if people are emotionally eating, or eating out of boredom, then the caregiver cannot always rely on the individual to make the best decisions.  Often raising awareness about healthy eating starts with asking people to track what and when they are eating and drinking.  Then, problems can be identified and a list of doable solutions can be developed.

In one instance, in helping a client with weight loss as a functional goal, we discovered through tracking that she was barely eating breakfast and lunch but was consuming all of her calories from 5-10pm.  We made the goal that, over time, she would consume breakfast, lunch, two snacks and dinner, and would stop eating after 7pm.  Within a few short months she lost 30 pounds and this greatly improved her mobility and tolerances for activity.  Another client discovered through tracking that he was consuming far too many large bottles of pop a day.  By changing his large bottle to a smaller one, and eventually to only one pop per day and the rest water, he was able to drop 20 pounds.  In both cases, the problems, solutions, and commitment to change were made by my clients (with my guidance and support), making the results far more meaningful and lasting.  Further, the client was shown a framework for how to check and modify eating habits should they deteriorate again in the future.


The Rehabilitation of Organization

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

Previously on our blog I outlined the importance of organization in helping people with limited energy reserves to make sure their energy is spent on enjoyable or purposeful tasks and is not wasted looking for things that should be easy to find.

Helping clients to become more organized can take many forms, depending on the client, the nature of their problems, and how they previously organized their stuff and their time.  What I tend to witness is the time lost and sheer frustration that clients experience looking for cell phones, wallets and keys.  Often, cell phones become used as a “second brain” assisting people to maintain a schedule and make appointments (calendar), remember things (task lists), have access to support systems (contacts, calls, text, email), and negotiate their environment (maps and GPS).  If this gadget is so important, it is even more important that people know where it is.  Having a catch tray by the front door, in their room, or a standard docking station can be helpful.  Wallets and keys should also be left in a consistent location.  I am sure we can all relate to that feeling of looking for our keys in their usual spot to find they are missing.  But if you lack the ability to efficiently look for these, or the energy, it could completely derail your plans.

After the day to day items have a place, then as a therapist we can work with our clients to simplify other spaces that are barriers to function.  Perhaps the kitchen has become too cluttered to allow for efficient meal preparation, or the bills are piling up because these become forgotten in a stack of papers.  In the world of insurance I find that clients become overwhelmed by the paperwork and this results in them missing appointments, not responding to time sensitive material, or failing to submit for expense reimbursement.

Slowly, over time and with suggestions and tools (filing cabinets, labels, folders) clients will be able to more efficiently spend their units of energy on things that are more important, or more fun.



You Can’t Afford to be Disorganized

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

We all have different levels of energy, tolerance and mental attention.  If suffering from chronic pain, brain injury, or another chronic condition, chances are the DD battery that you used to have has been replaced with some AAA’s.  This means that daily activities will take more time, more energy, and you will need to recharge sooner.  So, considering this, do you really want to spend your valuable energy looking for stuff? 

Consider that you have 10 units of energy when you wake in the morning.  Every activity you have on your “to do” list takes one unit.  Going for a walk, preparing supper, managing the laundry, responding to emails, attending an appointment, completing personal care, and having coffee with a friend all drain your battery.  Some of these activities are necessary, some can be put off, and others are enjoyable.  So what if you spend one unit of energy looking for your phone, that bill that needs to be paid, your agenda, or those new runners you bought yesterday?  What activity will come off your list when you have spent your energy to find something that with some organization would have taken you no time at all?  Maybe you will call your friend to cancel, or order supper in again.  Maybe the laundry will wait to tomorrow, or those emails will just keep accumulating. But this is unnecessary because you had the energy, it just became misdirected.

Often the focus of occupational therapy becomes helping people to organize their activities, their stuff or their time.  Schedules and consistency are keys to helping people to understand the size of their battery and the amount of units each activity takes.  This can be difficult when working with clients who did not need to be organized before an injury or illness, but the necessity of this following cannot be ignored.   Even small steps to help people to be more organized can have a huge impact.



The Five Whys as a Practical Tool for Problem Solving

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

Being fully aware of a situation requires reflection and inquiry.  Yet, often what we see and feel on the surface is not necessarily what is truly going on.  Think of those times where you have become upset at your spouse, child, or parent to later realize that what you thought were upset about was really grounded in something else.  I know personally, I use long walks with my dog and music to try and understand any sources of discontent.  I find my walks enlightening and always try to ensure that I don’t speak too soon about a problem until I have taken that time to reflect.

At a recent seminar, we discussed the value of using the Five Whys to develop awareness.  This technique is grounded in the manufacturing industry to find the root cause of a problem.  For example, a conversation might go something like this:















Why did a screw get missed on that tire?



That was missed by John.






Why did John miss that?



The line is moving too fast and he is missing every 15th tire.






Why is the line moving too fast?



We have deadlines that we are not sure we will make.






Why can’t we meet the deadlines?



We have three staff off right now.






Why are they off?



They are injured and have not been replaced.



By the fifth why, the relationship between the current problem and the root problem is determined.  Now, consider the use of that in daily life.  Why am I angry?  Because the kitchen is a mess.  Why is the kitchen a mess?  Because the kids ate and didn’t clean up.  Why didn’t they clean up?  Because they were going to be late for practice.  Why were they going to be late for practice?  Because they forgot about the practice.  Why?  Because it was not written on the calendar.  So, we can get angry at our kids for not cleaning the kitchen, or realize the root cause was our fault when we failed to use the strategy (the calendar) that helps them to manage their time.

Try using the Five Whys in practice when trying to solve a problem.  See if that helps you to truly succeed in understanding situations, getting to the root cause, and being able to make change to prevent the problem from reoccurring.