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Archive for category: Original Posts

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The Ultimate Guide to Backpack Safety

Backpacks are a staple for every student. They travel back and forth between home and school, lugging books and school supplies. They are put through the unavoidable daily abuse of being thrown on the ground, trampled on, stuffed into a cubby or locker, saving a spot in line, and become over-stretched and over-used with the necessities of school. They are a necessary part of your child’s education, yet how much thought do you really put into the backpack your child wears aside from maybe price or color?  Have you considered the health implications of an improperly worn, fitted, or poorly supportive backpack?

Take a look at our newest OT-V video, Backpack Safety Guidelines, to learn how to select and fit a proper backpack and tips on reducing the strain caused by daily use.

 

Learn more healthy solutions for living in our informative OT-V video series.

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Personal Injury Advertising – A Picture is Worth….

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

I was recently at a stoplight in Hamilton, stuck behind three busses spanning three of the four lanes in front of me.  All three were covered in ads for three different law firms, all personal injury.  Drive another block and there are anywhere between four to eight billboards again advertising personal injury services.  Some are soft, subtle and warm.  Others are creative, catchy and cleaver.  Then there are those that are more fear-mongering, “in your face”, and aggressive.  Whatever the style, message or format, clearly these ads represent the culture of the advertising firm, leaving the “buyer” to choose the approach that best might meet their needs.

Now the focus of this blog is to not bash the way lawyer advertising has evolved.  If signs in parking garages, washrooms, bars, hospitals, or on busses, benches and billboards work, go for it.   Lawyers are intelligent people, if the ROI on these investments is not paying off, I assume they would find an alternative.  However, I do know that within their own community, through events I have attended and articles I have read, that many firms are being criticized for the approach they are taking with the more aggressive “you don’t pay until we win” mentality.  Also, the fear-mongering approach directed at a population of vulnerable and often disadvantaged people can be viewed by many as distasteful.  Honestly, I think the public are becoming somewhat desensitized to the vast number of ads marketing the same thing and the more these ads surface, the less impactful they become.  But as a business owner, I can understand the intense competition in the industry and respect any professional who invests in their business, or themselves, to make a buck.

Where I think these ads need to improve, however, is in the representation of people with disabilities.  Some ads get this perfectly.  They show everyday survivors (presumably “real” past clients) doing the things they love, or “living” after their tragedy.  That, to me, hits the nail on the head.  Others though use images that are transparently “fake” and confuse the message.  Taking a photo of a fit, young(ish) person in Lululemon clothing who looks like they are ready for the Paralympics but is sitting in a clunker wheelchair from the 70’s just doesn’t jive.  The image is flawed and the message is lost.

As an advocate for people with disabilities, I would like to see a movement of “real” people with “real” disabilities center-stage for these ads, and in any ad for that matter, that is trying to represent this population.  Why?  Because it is easy for a non-disabled person to sit in a wheelchair for a photo, but the reverse is not true in that a person who actually uses a wheelchair cannot just “stand-up” to pose as a “non-disabled person” for a photo shoot.  So, let’s give the money spent on stock-photos, modeling and the resulting income to the population of people that “live” these problems, not to regular people who don’t truly represent.

And yes, I am guilty of this as well.  In searching for website stock photos we found several where the person in a wheelchair is standing in the next image.  Or, the one where you see the back of my husband sitting in a wheelchair to capture the image of a once real, but now needed-to-be-simulated, client-Julie interaction.

In searching for a way to better support the community of disabled persons, and to ensure the photos we use in our own media align with “real” people, we came across these sites which sell “true” stock images:

Lawyers working in personal injury – I hope you will join the movement to improve the representation of “disabled people” in your ads to, if nothing else, better support that community financially, realistically and appropriately in your advertising.

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Trouble Sleeping? We Have Solutions For You!

Do you have trouble sleeping at night?  You’re not alone!  There are many factors that can lead to sleep difficulties including: stress, work, family, lifestyle, diet and medical conditions.   Sleep is vital to our mental and physical health, and lack of sleep negatively affects productivity and function.  Check out our OT-V video “Improving Sleep” for OT recommended tips to achieve a better sleep.

 

 

Learn more helpful solutions for living in our OT-V video series.

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Pokémon Safety– To “GO”, or Not to “GO”

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

While I am not a fan of technology (especially for kids), I do like technology that gets people moving.  Personally, I am the new owner of a FitBit Blaze and have found that my level of physical output has certainly increased since I can now track and monitor my heart rate, sleep and overall level of activity.  I have discovered that my ritual morning dog walk is over 7,500 steps and my preferred bike ride is 30km and keeps my heart rate at an average of 120 beats per minute.  That is all great feedback for someone that likes to keep upping the exercise ante.

So, considering my love of all things that encourages mobility, I would like to embrace Pokémon GO, except for the host of challenges this has created since it started.  Tabloids have reported that Pokémon GO players have been walking into traffic, falling off cliffs, venturing illegally over the border, and trespassing, all in pursuit of Pikachu.  I also know that “text neck” is becoming increasingly problematic the more we are all looking down constantly at a screen and interacting with that instead of the world in front of us.  Toronto is looking to make “texting and walking” illegal due to the inherent risks this causes with people not paying attention, veering into others, and generally being oblivious to their surroundings.  If we need to make laws to stop people from looking down while walking, how can Pokémon GO be a “good thing”?

Yet other data has indicated that people playing walk 30% more than “most people” (not sure how they figure out how much “most people” walk, but regardless…) and in some cases the game can be used as a helpful parenting and family tool to get outside, connect, play a virtual game of “hide and seek” and learn about road safety, property boundaries, and how to respectfully interact with strangers who might also be playing.  I also hear that the game has a way of keeping you playing (like all addictive games) in that the more you walk, the more Pokémon you can locate.  This might be a good addiction (encourages exercise), provided of course, it is safe.  So, I am still unsure whether “to Go, or not to Go”.

As an occupational therapist that helps people who are injured by or in cars, or who break bones falling, I am concerned about the aftermath of obsessive and oblivious Pokémon play if this leads people into unsafe territory.  So, whether I decide to “Go”, or decide to let my children “Go”, I have created this list of safety suggestions to consider:

  1. Always be aware of your surroundings and play in groups.

  2. When watching your screen and walking, try to stop when looking down, see what you need to see, then look up and continue.  If you need to look down and walk, try to look out in front of you, not at your feet.  Look on the horizon like people do when driving.  That way you can reduce the risk of text neck and have a better visual of your path.

  3. Always pay attention to road and traffic signals.

  4. Drivers, be aware that kids may be playing and that kids are carefree, not careless, and that they may wander in front of a moving car if their game is leading them somewhere exciting.  Make eye contact with the player, or slow down the car if eye contact does not occur.

  5. Don’t trespass.  That upsets people and not everyone is going to be thrilled that you are standing on their lawn chasing a virtual gremlin.

  6. Watch for pets and signs that warn of animals that might not be friendly.  Dogs are not going to know what you are doing, and may see anyone on their property as a threat.

  7. Stick to daylight.  It is always safer to walk when others can see you, but if you must be out at night, wear light or reflective clothing and carry or wear a bright light.

  8. Bring water and perhaps a snack.  People can lose serious track of time when gaming is involved.

And remember, that even without a device, you can still “Go” or create outdoor games for you and your children.  All Pokémon GO essentially is, is a virtual Scavenger Hunt.  So, really there is little difference (minus the text neck) between finding Pikachu and friends, and looking for a feather, rock in the shape of an arrow, or an Oak tree.  Keep it simple and remember that you don’t need technology to go for a walk.

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The Role of Occupational Therapy in Professional-Assisted Death

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

Co-written with Pauline Tran, Student Occupational Therapist

Warning – sensitive topic!  Whether you agree or not with the moral, ethical and even religious implications of professional-assisted dying, the emerging laws about this are here and are a hot topic in health care.

Professional-Assisted Death (PAD) Explained

PAD includes both physician-assisted suicide and voluntary euthanasia.

Physician- assisted suicide (PAS) is defined as the process by which a physician (of a sick and/or disabled individual), provides the patient with the medical means or knowledge which directly or indirectly leads to the death of the individual (Radbruch et al., 2015). In this, the authority then lies within the patient who has the choice and ability to either perform the final act themselves, or they can choose to terminate treatments and allow natural disease progression to take its final path.

Euthanasia, on the other hand, is defined as the process of which a medical professional intentionally ends a person’s life through the administration of drugs at the patient’s voluntary and competent request (Radbruch et al., 2015). In this, the authority lies with the medical professional administering the lethal drug.  Euthanasia can only be voluntary as medicalized killing without consent would be considered murder. With voluntary euthanasia, there are 2 types that apply to the involvement of medical professionals and their client(s):

o   Active Euthanasia- refers to when a medical profession or another person engages in an act that causes the patient to die

o   Passive Euthanasia – refers to when a medical professional either withdraws or withholds life- prolonging treatments or medications  leading to the death of the patient

Clearly, with the general healthcare mandate to “do no harm” and to essentially try and preserve life, there are significant ethical, professional and moral considerations and implications for all professionals involved.

The Canadian Government Legalized PAS:  What does this mean?

Bill C-14 (which actually amends the Criminal Code and makes related amendments to other Acts such as medical assistance in dying) was passed by the house of commons of Canada on April 14, 2016. Essentially this Bill legalises physician- assisted death in Canada. However, the following eligibility criteria must be met for those who wish to pursue medical assistance in dying:

a)      Adults must be eligible for health services funded by a government in Canada.

b)     Adults ages 18 years or older who are capable of making decisions in relation to their health.

c)      Have a grievous and irremediable medical condition outlined as:

a.      In the advanced state of a serious incurable disease, illness or disability

b.      Declining in functional capacity

c.      Moving towards end of life

d.      Does not have a specific prognosis or predicted time period for their death

d)     Have made a voluntary request for medical assistance in dying which was not made as a result from external pressure.

e)     They are provided with informed consent to receive medical assistance.

To summarize, Bill C-14 approves the act of medically assisted death for adults who meet the eligibility criteria above.

Motivation behind medical assisted death?

Before being involved in the creation or implementation of an end-of-life plan, it is important that all people understand the purpose behind the person’s desire to contemplate end-of-life options.  As a friend, family member, or healthcare professional, understanding the background and foundation for the person’s desire to die is pivotal to being able to provide helpful support, resources and assistance.

The following are some reasons why patients request help with assisted suicide:

  • Illness- related experiences

o   They suffer from physical, psychological, social or spiritual sufferings.

o   Side effects of medications and treatments

o   Unacceptable and unmanageable symptoms

  • Fear of future

o   Fear of future pain, suffering and pain management

o   Decreased quality of life

  • Sense of self and desire to have control over end of life decisions

o   Loss of control, function, independence

o   Being a burden to family members and others

o   Loss of identity, essence

Understanding the motivation behind requesting or asking about medically assisted death allows for all parties to understand where the patient is coming from and to help identify what they underlying issues the patient may be facing as a result of their illness or disability. This way, the request can be explored further truly client-centered care can be provided.

Occupational Therapy and Assisted Death

As Occupational Therapists (OT), we have a large role in assisting people to obtain a desired quality of life, and to function safely and independently.  However, we are also a client-centered profession that witnesses firsthand the often devastating impact of some illnesses, diseases and disabilities.  As such, we already play an important role in palliative care, and this involvement can extend into end-of-life planning as well.  For example, OT’s can enable people who are dying to engage in meaningful activities, roles, and occupations. OT’s can explore a client’s wish to die, can be part of the team of professionals helping to provide alternatives to end of life decisions, or can move forward with assisting the client to coordinate the process.  Our therapy can involve analyzing, reflecting, and exploring an individual’s life though their past roles and relationships to help bring peace and closure to the dying process.

Occupational Therapists can improve the assisted dying process across Canada as they are equipped agents of change. OT’s contribution to assisted dying care plans include:

o   Assisting with typing up lifetime occupational roles

o   Capacity assessments

o   Exploring alternatives

o   Creating meaningful memories

Through the help of OT, people will be more able to have a meaningful and thoughtful death experience, and can leave a coordinated and chosen legacy following.  OT’s have the skills to offer considerable contribution to end of life care and can help people to create meaningful occupation in death itself.

 

Resources and References

Salubre, J. A. T. (2015). Physician Assisted Suicide.

Pearlman, R. A., Hsu, C., Starks, H., Back, A. L., Gordon, J. R., Bharucha, A. J., … & Battin, M. P. (2005). Motivations for Physician‐assisted Suicide.Journal of general internal medicine, 20(3), 234-239.

assets.documentcloud.org/documents/2803276/C-14-Medical-assistance-in-dying.pdf

www.ncbi.nlm.nih.gov/pmc/articles/PMC1490083/

www.caot.ca/conference/2015/presentations/t26.pdf

onlinelibrary.wiley.com.libaccess.lib.mcmaster.ca/doi/10.1002/oti.89/pdf

www.osot.on.ca/imis15/TAGGED/News/Ontario_Commits_to_Policy_Design_for_Physician-Assisted_Dying.aspx

www.caot.ca/otnow/sept15/otnow_9_15.pdf

www.caot.ca/conference/2015/presentations/t26.pdf

mediasite.otn.ca/Mediasite/Play/3b224828e91740bbb16b7152138cdd381d?catalog=fd668812d87c47f9b1ba6d979fed9af421

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Paying More For Less

As of June 1, 2016 the Statutory Accident Benefits Schedule (SABS) has changed again.  I say “again” because in my relatively short sixteen-year lifespan working in auto, the industry has gone through some major plastic surgery.  It is becoming less and less recognizable as it is nipped and tucked once more, becoming almost unrecognizable as the mandatory product we all purchase to be covered in the event of an accident.

Learn more about how these changes will negatively impact those who are catastrophically injured in automobile accidents and options to protect yourself in the following from the Globe and Mail.  You can also learn more about the changes in our previous post “The Government Gets it Wrong—Again!”

The Globe and Mail:  Ontario’s benefit cuts profoundly affect car accident victims

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The CNE Disability Policy Change – What the CNE Did Wrong

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

For years the CNE has allowed people with disabilities and their attendants free admission.  Last year they announced that the policy would end for 2016 in that those with disabilities would be required to pay.  Attendants would remain “free”.

Recently the Toronto Star published an article confirming the change in policy.  The CNE explains that the new policy will: respect “the dignity and independence of all of our guests, including those with disabilities.” However, advocates note that people with disabilities can struggle to earn competitive wages which limits both resources and opportunities, and can result in social and community isolation.  Those advocates give this change a “thumbs down”.

As an occupational therapist and business owner, I think the CNE has made a few mistakes in making this change, and in articulating it.  Here’s why…

I love this comic sent to me by Occupational Therapist Jacquelyn Bonneville:

comic

 

 

 

 

 

 

 

 

 

 

 

 

 

So, if equality is about “sameness” then the CNE has wrongly lumped the community of people with disabilities into the “equal” category.  Yet, it is easy to understand that people with disabilities can have increased difficulties making competitive wages and can be marginalized and secluded based on reduced resources and opportunities for participation in many aspects of daily life.  So, by the CNE saying that the policy respects “the dignity and independence of all our guests” they have wrongly lumped “all guests together” when not “all guests” are equal.  The previous policy was more equitable in that it leveled the playing field in a sense by allowing a more “equitable” experience for people of different means.

Essentially, then, the human issue is that the CNE may now be financially excluding a community who needs leisure more than the average person.  Literature supports leisure participation for all, but even more so for people that have reduced options to take on other commonly productive roles like paid work, volunteering, or even school or parenting.  The previous policy was compassionate and fair, the new policy is not.

From a business perspective, the CNE made another mistake.  They failed to make a logical argument for the change and opened themselves to greater scrutiny.  If they wanted to change the policy because that was a sound business decision (like expenses could no longer support it, they were having a hard time administering the policy, there were privacy and disclosure issues for customers in asking for the free admission, or felt the policy only met the needs of physically disabled people and not people with more “invisible disabilities” etc), then that is different.  In that case, the CNE should have simply said “we have reviewed the policy and while we understand and apologize for the impact this change may have on certain members of our community, our board felt it was in the best interest of the operations and sustainability of the CNE to no longer offer free admission for some customers”.  Or something.  Then, they could have used the announcement as an opportunity to advertise that they will continue to offer the $6 after 5pm fare on Monday to Thursday to keep it financially accessible to a wide range of consumers and that attendants of people with disabilities would remain free.

Of course, they could have been more creative in the first place by developing a “middle ground” policy similar to Hamilton’s Affordable Transit Pass (supports people receiving ODSP or Ontario Works), or could have progressed the policy for a year to “voluntary pay” for people with disabilities to recognize that some can afford it, and may want to pay like “everyone else” at entry.

So, knowing that my readership includes people with disabilities, if the CNE is no longer in the cards for you, or you feel the need to boycott because of the policy change, here are some other “disability friendly” places to consider:

·        Check out all the places that are included in the Easter Seals Access2 Card including:   The Royal Botanical Gardens, The AGO, The ROM, Ontario Science Center, Ripley’s Aquarium, The CN Tower, Great Wolf Lodge and more.

·        The Toronto Zoo offers 50% off admission for people with disabilities.

·        Canada’s Wonderland also has disability-friendly policies, contact them directly for discount information.

·        This resource includes other Toronto Attractions that offer a discount for disabled persons.

I am sure there are others, and if you might qualify for discounts or attendant admissions, consider contacting any park or location before you go to inquire.  I hope that these links will provide my readers with disabilities, or their friends and families, a good start for summer exploring. 

 

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Swimming Pool Safety

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

In celebration of summer, I wanted to repost our popular blog on pool safety. These helpful tips and tools are good things to review and consider…especially this time of year.

I was a fortunate child who grew up with an in-ground pool. As the only house on the street with a pool in our yard, the neighborhood kids would loiter around our home hoping for an invite. My mom developed a wonderful system using a Canada flag. If the flag on our fence was up – everyone was welcome for a swim. The only rule was that the kids needed to bring a parent. Mandatory. And despite the kids that would sit on our lawn whining about not having an adult to join them, my mom was firm to the rule.

We have a pool in our yard. This is separately fenced. As our kids are getting older, and have been able to swim for years, we are giving them more freedom around the pool. As long as an adult is home, they are welcome to swim. However, recently I was reminded of an important lesson – just because my kids can swim, that is not necessarily true for others of the same age. We had a pool party for our twins’ birthday and all the kids arrived and proceeded to jump in the pool. One child was hanging around the shallow end and I asked her if she could swim – nope. I was surprised that in dropping her off to a pool party, her parents would not mention this very important fact.

A few summers ago on a street very close to mine an 18 month old child drowned when he was able to get outside while his father had a 15 minute nap. Drowning is the second most common cause of accidental death among children aged 14 and under in Ontario, after motor vehicle accidents. Yet, like many risks, drowning is absolutely preventable. Here are some safety precautions to consider:

1.  Constant and vigilant supervision. Supervision of any child is a full-time job. Most drowning’s occur when a child is playing near the water and falls in – not while “swimming”. So, when it comes to kids, the “within arm’s reach” rule should always apply – whether they are in, or around, water.

2.  Using safety devices for the pool. These could include:

  • Poolside Alarm– A motion sensor is installed along the pool edge, which sounds an alarm when waves are detected from a body falling into the water.
  • Child Immersion Alarm– A wristband worn by a child, which will sound an alarm when they come into contact with water.
  • Pool Fences– Fences should be at least four feet tall, surround the entire pool and have self-latching gates out of the reach of children. Speclocks prevent children from entering the pool area, as they are complex or require adult strength to open. Gate alarms can also be installed to alert when the gate is unexpectedly opened.
  • Pool Covers– A cover built to fit your pool dimensions will act as a barrier for a falling body, as they will not enter the water.
  • Door locks – special locks, difficult for children to open and installed at the top of a door, prevent kids from being able to get into the yard without an adult.

3.  Use life jackets, not just floaties. If your child is not a strong swimmer, they should always be wearing a life jacket – in a pool, at the beach, or on a boat. Like wearing a seat-belt and helmet, children should be taught from a young age that wearing a life jacket is necessary around water. From a functional standpoint, life jackets are safer than floaties. Floaties can develop small holes that actually fill with water, or can deflate, causing the child to slowly sink lower into the water. A well-fitting life jacket is designed to keep a child’s head above water, and to flip a child over onto their back to facilitate breathing. They cannot deflate. It also provides something for an adult to grasp if they need to pull the child out of the water.

4.  Know the signs of drowning. Contrary to popular belief, drowning does not happen when people are flailing their arms, yelling and calling for help. It is actually the opposite. People that are getting into trouble in the water often look like they are climbing an invisible ladder. They can’t yell or cry for help as their body is low on oxygen and is focused on trying to keep air in, not yell it out. Know the signs – check out this link for the “8 Quiet Signs of Drowning.”

5.  Knowledge of first aid. Parents should always consider having knowledge of CPR or basic water rescue. This could prove handy for many situations beyond just water safety.

6.  Swimming lessons. Give your kids a head start by helping them to become comfortable in the water from a young age. Every minute they can stay afloat could save their life.

But remember, when it comes to children, nothing is safer than diligent and attentive supervision.

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A Practical Guide to Barrier Free Design

There is a greater awareness in society that our buildings and spaces must be more accessible to all.  In Ontario, the Accessibility for Ontarians with Disabilities Act (AODA) is ensuring that all businesses are accessible by 2025 in many ways, including design of public spaces.

Today we focus on the physical environment.  This is where barrier free design comes into focus.  What is barrier free design? It involves designing spaces, both public and private, to allow access for the greatest majority of people.

Some common barriers include:

  •  Curbs
  •  Uneven sidewalks
  •  Stairs
  •  Heavy doors
  •  Absence of handrails

In the following video from our OT-V series we discuss these obstacles and how occupational therapists promote accessibility, and assist individuals and businesses with creating a barrier free environment.

 

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The Power of Self-Advocacy

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

Occupational therapists play an important role in helping people of all ages to function independently, to engage in meaningful activity, and to experience joy in life regardless of disability.  In this role, we are often in a position of advocate as we aim to help people achieve their most promising outcomes.  But even better than an OT swinging for the fences to help a client, are those clients that can metaphorically pick up the bat and hit it out of the park themselves.

Recently I read an article highlighting the power of self-advocacy.  The article spoke of a boy named Peter who has cerebral palsy.  Peter, as a result of reduced fine and gross motor control, was struggling to use the standard Play Station Controller.  He took it upon himself to email Sony’s support team to ask for help.  To his surprise, not only did he receive a response, but Sony’s team built and sent him a modified controller to use.  That is self-advocacy at work, and kudos to Sony for working with Peter to accommodate his needs.  (See the article here.)

Self-Advocacy

This story provides a great example of the power of self-advocacy. Self-advocacy refers to an individual’s ability to effectively communicate, convey or assert their own interests, desires, needs and rights. It’s the ability to speak up on your own behalf to ask for what you need.

Self advocacy skills can be broken down into 3 steps:

1.     Understanding your individual strengths and weaknesses,

2.     Knowing what supports or resources are available in order to succeed

3.     Communicating these needs to other people

Why is Self-Advocacy Important?

Self-advocacy is a vital part of being human and is a great skill to harness and utilize as it helps people to:

  •         Create solutions for challenges that they experience
  •         Develop independence and self-empowerment skills
  •         Ask for help and clarification
  •         Build self confidence
  •         Take risks and try new things
  •         Learn the benefits of effective communication
  •         Creates a sense of ownership, power and control over their situation and needs.

How Can OT’s help?

OT’s can assist in promoting self-advocacy in multiple ways.  First, OT’s recognize the importance of facilitating client independence and strive to help people to develop the confidence and skills to communicate their own needs and wants.  Often we can identify where people can be successful here, and where help might be needed.  We model appropriate advocacy behavior on behalf of our clients during interactions with other providers or stakeholders.  Or, when necessary, we advocate on a client’s behalf until they develop the skills to do this independently.

In the end, advocacy is becoming more and more important in the climate of restricted healthcare dollars.  So whether we are helping people access an important health service, to address a new problem, or sending an email to a major manufacturer about a video game console, assisting people to have a voice, or to develop a voice is a paramount part of great OT.