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Archive for category: Original Posts

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Sensory Sensitivity

In our previous post, Can’t Sit Still?  Could It Be Sensory Seeking? we discussed sensory processing with a focus on the sensory seeking child.

Today we are focusing on another sensory-related concern that leads parents to seek OT treatment for their child – children experiencing sensitivity to sensory input.   On the other end of the spectrum from sensory seeking is the sensory defensive child. Unlike sensory seekers who have high thresholds for sensory input, sensory sensitive children have very low sensory thresholds. Due to these low thresholds, they experience sensory input much more intensely or notice sensory input much more often than their peers. This means that sensory input that may not bother you and I (for example the feel of jeans, brushing our teeth, or the sound of an alarm going off) may be very aversive, distracting, threatening, or even painful for that child.

Take a look at our OT-V video which further discusses sensory sensitivity, how Occupational Therapists can assist children and their families, and tips for families dealing with sensory sensitivity.

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Can’t Sit Still? Could It Be Sensory Seeking?

One common reason that parents seek OT treatment for their child is because their child demonstrates sensory processing concerns.  Sensory processing is complex, however, often there are simple home-based strategies that can be very helpful in meeting a child’s sensory needs.

The following video from our OT-V (Occupational Therapy Video) series discusses one of the most troubling sensory related concerns for parents– when their child is a “sensory seeker,” meaning they seem to be constantly looking for additional sensory input and constantly “on the go” as they are attempting to obtain the sensory input that their bodies crave.

Watch the video to learn how an Occupational Therapist can help sensory seeking children and their families.

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The Work-Life Balance Myth

What is your impression of work-life balance? A lot of people find it a completely unrealistic goal that is impossible to achieve. Many people find life demands are simply keeping them too busy to take time to relax. As we talked about in a previous episode, stress can cause heart disease, stroke, high blood pressure, and immunity issues. Statistics Canada says that 1 in 4 adults reported high stress in 2013, and high stress means that your mental and physical health are declining.

The good news is that this is preventable. For a lot of people, their expectation of work-life balance is NOT realistic. You can’t expect to go to the gym 7 days a week, get 8 hours of sleep every night, meet every work deadline, and have the time to home-cook every meal. A common misconception of work-life balance is that it needs to happen every day, and that simply isn’t realistic. A more realistic goal may be to try to have a balanced week or month of work and leisure; it doesn’t need to happen all in one day.

We also need to change the way we think about work; instead of work-life balance we’ll be using the term stress-life balance. People that are unemployed by choice, students, and caregivers still experience stress-life balance, so we can’t attribute all stress to work even though it’s a common stressor for many.

One of the strategies OT’s use to make stress-life balance possible is to set SMART goals. A good goal should be:

  • Specific
  • Measureable
  • Achievable
  • Realistic
  • Time-bound

First, figure out what stresses you. This may seem simple, but get really specific. Does your job stress you out? What ABOUT your job stresses you out? When do your kids stress you out most? Make a list of what can be changed, and what can’t. Don’t say that nothing can be changed!

Next, understand what helps you de-stress. This is different for everyone. Some people need passive or relaxing leisure where they can shut their brains off; common examples of passive leisure are watching television, yoga, or going to the theatre. Some people need active leisure to de-stress, like going for a run, socializing with friends, or reading a favourite book.

Lastly, make a plan for how you can integrate more of those de-stressors into your life on a weekly or monthly basis. Also make a plan for how to reduce your stressors. Make sure this plan is a SMART plan, and you should be on your way to improving your mental and physical health. Occupational therapists know the evidence behind de-stressing, and which activities give you the most bang for your buck when you’re low on time.

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New Ontario Autism Program – Did the Government Get it Wrong?

According to Autism Speaks, Autism now affects 1 in 88 children and 1 in 54 boys. The 2012 numbers reflect a 78% increase in reported prevalence in the last 6 years.  This is a growing problem, impacting more and more families each year.

With growing numbers of affected children, wait times in Ontario for assessment and treatment have increased to an unacceptable level.  Recently, the Ontario Government made changes to its policy on Autism care in hopes to reduce wait times for those families seeking assistance.  While these changes may be beneficial for children aged 2-4 seeking diagnosis and treatment, those 5 and older will no longer be eligible for government funded Intensive Behavioural Intervention services, even if they have been on a wait list for years.

Intensive Behavioural Intervention (IBI) is the application of the principles of Applied Behaviour Analysis (ABA) in an intensive, highly structured format. It is a comprehensive approach that is used to teach a broad range of skills, such as communication, socialization, self-help, pre-academics, and play.   All IBI programs are individualized to the strengths and needs of each child and therapy decisions are based on a comprehensive review of program data. The goal of IBI is to help young children with Autism catch up developmentally to their peers. This means that IBI aims to increase the rate of a child’s learning, to bring their skills closer to those of typically-developing children, to decrease their symptoms, and to prepare them for an appropriate school setting.

The government will be providing a one-time payment of $8000 to families with children 5 and over, however, it is only a drop in the bucket for the amount of money required for this type of vital treatment.

The following from CTV News shows the frustration and abandonment families with Autistic children 5 and over are feeling:

How can you stand up for the rights of the affected families?  Let the Ontario Government know that they have gotten it wrong by signing the petition to Oppose the new Ontario Autism Program’s elimination of IBI eligibility for Children over 5.

To learn more about the changes and how you may be affected please visit the Ontario Autism Program website.

And please, tell us what you think:  did the government get it wrong?

 

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The Role of OT in Suicide Prevention

Sometimes occupational deprivation, as a result of illness or injury, can be a catalyst for suicidal thoughts, or even actions. While this may be a heavy topic, we’re here to talk about how Occupational Therapists can make a positive difference in the lives of people who are struggling with thoughts of suicide.

The Canadian Association for Suicide Prevention reports that 1 out of every 10 Canadians experience thoughts of suicide at some point in their lives. Occupational Therapists work with people who have experienced a loss of ability to complete everyday life tasks. When a person can no longer work, care for their children, or even go to the bathroom independently, it is easy to understand how thoughts of suicide can seem like an option. The good news is that Occupational Therapists are in the perfect role for addressing these types of situations, and inspiring positive outcomes.

When people have experienced a sudden disability onset like in a motor vehicle accident, we often hear statements like:

·        “I can’t do anything anymore”

·        “This isn’t how it was supposed to be”

·        “I’m missing out”

·        “I’m lost”

·        “I don’t know what to do”

The common thread in all of these statements is that people feel hopeless, and are experiencing occupational deprivation. Occupational deprivation is when a person feels that they can’t participate in meaningful activities due to factors beyond their control.  If this feeling gets strong enough, some people begin to feel that they may be better off ending their lives.  Occupational Therapists are skilled at enabling occupation, so it is easy to see how OT’s  play an integral role in addressing suicide.

One strategy proposed by Kim Hewitt, a leading OT in suicide prevention, is to ask the following question:  “Do you want to die, or do you not want to live like this anymore?”

This question fosters hope in people who are struggling, and it also leads to action; if a person does not want to live like this anymore, they simply need help to make some changes in their lives.  Occupational Therapists can then use their skills in occupational engagement to bring hope into the suicide discussion, and to try to address some of the negative thoughts and emotions the person is feeling.

Remember that occupations are defined not just as paid jobs, but also as things we do that occupy our time.  Occupations can include cooking a meal, going to the bank, or reading a book.  Occupational Therapists therefore give people solutions for living, so that they have all the skills and tools necessary to re-engage in these meaningful life activities. This type of therapy takes time, and sometimes trial and error, but in the end it can help people get back to feeling like themselves again.  These positive feelings can help to combat thoughts of suicide.

Not everyone has training in suicide prevention, but it is a responsibility we all share; someone may approach you about it whether you’re ready or not.  Here are some basic strategies to consider if someone brings up suicide with you:

  • If a person discloses thoughts of suicide to you, they want help, or else they wouldn’t have talked to you about it. This is a compliment – don’t be afraid.
  • Listen to what the person is telling you. Don’t try to relate, or offer false promises like “you’ll feel better tomorrow.” Just listen to them.
  • It’s okay if you don’t know what to do at first. You can tell the person that you want to help because you care about them, but you’re not sure how. Offer to stay with them, call a crisis line with them, or call 911 for professional assistance.
  • Remember this is a medical emergency, just like a heart attack or loss of consciousness – you need to do something.

Our motto at Entwistle Power Occupational Therapy is hope, empower, succeed, and I can’t think of any better population this applies to than people struggling with mental illness and suicidal thoughts.

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Occupational Therapy and Cancer Recovery

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

When my mom was diagnosed with breast cancer, she was required to have a mastectomy.  Feeling helpless but wanting to support her, I sent her a list of the things we could do together pre-surgery.  This included anything from loading up an iPod with her favorite tunes and stand-up comedic acts, sorting my ridiculous stack of family photos, scrapbooking, and of course some retail and spa therapy.  I figured the less time she spent just waiting for surgery, thinking and processing what was to come, the less this diagnosis would impact her now and into the future.  She responded to my ideas with something along the lines of “you should help people through tough times for a living” and I reminded her that my job as an OT allowed me to do just that.

The yellow daffodils in April signify that this is the month of Cancer Awareness.  Defined, the word “Cancer” is a blanket term used to describe the abnormal growth of cells in any part of the body.  There are more than 100 types of cancer, which may affect specific tissues, organs, blood, or lymphatic systems. Cancer remains the leading cause of death in Canada, responsible for about 30% of all deaths in our country.  Many of us have been affected by cancer, either personally, through friends or a loved one. My mom is only one example of how cancer has affected my family, and sadly I have countless other stories of friends and colleagues who have also been impacted.

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. Some of the things occupational therapists can help with include:

  • Education on management of activities of daily living (ADLs) such as bathing and dressing through adaptations to the activity and environment, and/or the use of assistive devices.
  • Sleep and fatigue management such as education in and demonstration of energy conservation and relaxation management techniques to support health and the ability to participate in purposeful roles.
  • Cognitive strategies to address memory, organizational executive function deficits, and low-energy tasks that focus on restoring engagement in daily occupations such as sitting in the park, reading a newspaper, or conversing with a friend.
  • Therapeutic exercise and positioning to maintain functional range of motion, mobility, and strength such as home exercise programs, splinting, wheelchair fitting, bed positioning, etc. to provide support and comfort.
  • Mental health treatment to encourage the return to life roles that will help increase mood, reduce depression, restore hope, and lessen anxiety.

Other roles for occupational therapy also include return to work involvement post-treatment, education on general health issues, and training on use of a prosthetic if an amputation was required.  Some therapists are also specifically trained to provide lymphatic drainage to reduce the swelling and pain that can result from the disease, its’ surgery or treatment.

So, for the month of April let’s honor those fighting and remember those that fought.  Buy some daffodils, donate, wear a ribbon, or call or visit with someone you know that has been impacted by this prevalent disease.

References

American Association of Occupational Therapists (2011).

Canadian Cancer Society (2013).

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The Handicapped Parking Police

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

One of my former clients was a teenager when he broke his neck falling out of a truck.  As a result, he was required to use a wheelchair for all mobility.  One day I arrived and he was wearing a t-shirt that said “I am in it for the parking”.

We are all aware of handicap parking spots.  These wider spots are conveniently located at the front of a parking lot, near an entrance to the building, close to a sidewalk with a curb cut, and are typically marked with bright yellow and blue paint or a sign reminding you the spot has special use.

In the news this week I read two very different stories about these parking spaces:

The first  was about a woman who parked in a handicap spot to enter Tim Horton’s.  When she returned to her vehicle she was confronted by a man about her choice of parking spot.  In the altercation she threw her coffee at him.  He recorded the interaction and posted the video online and it went viral – over a million views in a few days.   See the full story here.

The second describes the challenges a young woman frequently faces when using her handicap permit.  Recently she returned to her vehicle to find a note saying “stupidity is not a disability” and has had other similar messages left on her car in the past.  Yet in her case she has a condition that justifies her use of the pass, but the condition is not one that other people can see and thus understand.   See the full story here.

As an occupational therapist that is frequently requested to complete Accessible Parking Permit Applications, let me explain how this works.  To receive a permit, you must complete a Service Ontario application and this needs to be signed by a physician, occupational therapist, nurse, physiotherapist, chiropractor or chiropodist.  The form outlines the types of disabilities that qualify including those that cause mobility, breathing or cardiac impairments, or poor vision.  As some people with significant ailments like these can’t drive, they can still get a permit to be used as a “passenger”.  The professional signing the form is asked to indicate if the condition is “permanent”, “subject to change” or “temporary”.  This allows professionals to indicate that someone with a leg fracture, for example, may only need the pass for three months, or that is it “subject to change” if they have a condition that is likely to improve.  If you are curious about this form, and how it works, you can access it here.

So what happens when you don’t have a permit and you park in a handicap spot?  First of all, in the absence of an urgent situation, you are a jerk.  If caught, the fine is steep at $450.00.  In one article, The Toronto Star reported that the City had issued over 5,000 tickets since 2005 for one particular handicapped spot, totalling $1.9M.  Second, you may be subject to comments, ridicule or confrontation by others who judge you harshly for what most would consider an ignorant decision.  Third, you have just made life a little bit harder for someone that could use a break.  These spots are designed to reduce the physical risk of prolonged walking for people that might not be able to walk far, that might struggle to manage a wheelchair or walker over uneven terrain or a curb, or for those that are at risk of injury or falls when walking outdoors.  For people that struggle to leave the house and have difficulty managing in the community, being able to park close to a store may mean the difference between going out or not.  Your ignorance may reduce their confidence to venture out again.  Shame on you.

And what about the opposite?  What happens when you judge and ridicule someone that has a permit when you, apparently an expert in disability, feels that this is not required?  You are still being a jerk.  Not only are you making someone who already struggles to feel worse about their condition, but you are also passing judgement on the process that is in place to qualify people, including the professional that decided they met the criteria in the first place.  While I can appreciate that some people may feel they are being helpful to “police” these spots, it is important to trust the process and to respect that people may have these permits for reasons that are unseen.  Instead of taking your time to write a degrading note, perhaps consider two other options:

1.      Say nothing, do nothing, and don’t react emotionally.  The situation is none of your business.  If they stole their grandmother’s parking permit to try and skirt the drive-thru, well Karma is a bitch.

2.      Have compassion.  If someone went through the process of getting a pass, then they need it and have struggles that you don’t understand.

Have I ever turned down an application for a parking pass?  Yes, because someone didn’t qualify.  I trust my colleagues also do the same.  And no, my experience is that people with mobility, vision, breathing or heart problems are not “in it for the parking”.

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Money Matters – Occupational Therapy and Disability Finance

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

One very important subject that affects 100% of the clients I see is financial stress.

We all have been advised to save money for a “rainy day”, but the harsh reality is that people generally can’t or don’t.  And there is a huge difference between saving money to replace an appliance, or car, and saving for the costs that might be associated with ill health.  Yet, I can tell you first hand that the cost of disability is significant and comes from lost work time, medications, equipment, costs of personal care, and therapy to name a few.  When struggling to make ends meet, people encounter stress, anxiety, panic, excessive worry, loss of sleep, relationship issues, poor decision making, and can result in addictions as a form of poor coping.  You can imagine how hard it would be to heal from injury or trauma when significant money stressors are created as a result!

Occupational Therapy fits into the problem of disability and money in two ways.  First, we are often involved in quantifying injury and loss into a Future Cost of Care Report, and second, we provide direct treatment to help people manage their finances more effectively.

A Future Cost of Care Report, or Life Care Plan is the process of and calculating the current and future costs associated with your disability.  This report is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research.  The report provides an organized, concise plan for current and future needs, with associated costs, for individuals who have experienced catastrophic injury or have chronic health needs.  This includes children born with a disability or anyone that acquires a disability, ailment or impairment over their lifetime.  Most often used in medical-legal domains, these are also helpful for families that are working to quantify costs to help someone with a disability to have funding for their future.

From a treatment perspective, occupational therapists are also involved in helping people to re-balance their financial situation, or to reduce the risks and consequences of poorly coping in the face of money problems.  We work with people to establish budgets, to understand and track spending habits, to link the person to their money behavior, to help people develop a plan for better money management, to achieve financial goals, and to prioritize spending to ensure key expenses are not overlooked.  When people become stressed, anxious and depressed we treat those symptoms too and provide strategies and solutions to help people reduce their concerns and reengage in productive activities.

Occupational therapists are also well networked and help connect clients to a banker, creditor, financial advisor or financial social worker.  We might introduce them to tax or savings programs that will help them to recoup expenses or budget for future costs, and often help them to complete and submit the required paperwork to expedite access to public resources.  We are aware of funding programs in the community that can help bridge expenses and income, can fund home modifications, equipment or therapy, or can direct people to community programs that can support them for food, shelter, or other living essentials.

Occupational therapists recognize the significant impact that money problems can have on someone’s recovery and understand that if someone does not have food, shelter or safety, few other goals can or will be achieved.

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OT Helps Develop Fine Motor Skills

A common reason that parents seek OT treatment for their child is because their child demonstrates problems with fine motor skills beyond just printing difficulties.

Fine motor skills involve the use of smaller muscles in the hands.  Children with fine motor skill deficits often will have difficulties printing, managing zippers, laces, or buttons, picking up small objects, are messy when eating or coloring, and struggle to use scissors or to manipulate parts of small toys.  It is important that these skills are developed to promote independence and self-esteem in children is as they age.

In the following video from our OT-V series, we discuss some of the ways OT’s help children develop these important fine motor skills.

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Ouch! The Occupational Therapy Role with Chronic Pain

Guest Blogger Jessica VandenBussche, 2015

Pain is a common occurrence following an injury, illness, or traumatic event like a motor vehicle accident. While pain does play an important role in alerting us to potential dangers, injury, or an impending problem, it can also become a significant barrier to function as it can often continue long after the dangerous situation resolves.  Our brain can also change such that the pain message gets so used to being sent, these can start being sent faster and easier, even in non-threatening situations.

Chronic pain is difficult to treat and manage because of all the different factors that contribute to its intensity, frequency, and the many variables that can make it better or worse. Stress, depression, feelings of loss of control, pressures at work or home, and other mental or emotional factors affect pain perception.  Further, currently, there is no objective way for medicine to quantify pain which can make it even more difficult to measure, treat, and to understand the pain experience that varies between people.

The experience of pain then remains subjective.  And as this changes frequently under the presence of other factors such as secondary injury, low mood, stress, and other environmental pressures, pain can still increase even in the face of conservative therapeutic or medical management.  Whether or not tissue damage is found, it is difficult for someone who is experiencing pain to complete activities of daily life and to fulfill the roles that make them who they are (e.g. mother, father, worker, student, athlete).  For any of us that lose the ability to manage in an important life role, this can cause significant mental and emotional losses and anguish.  If the change in roles is sustained for too long without resolution, people can develop an altered sense of self, causing more psychological hardship which can lead to higher perceptions of pain.  Then the cycle continues.  The current best practice for addressing chronic pain is a multi-method approach that addresses mental, physical and emotional issues plus the effect of pain on daily function, roles, and identity.

Occupational Therapists play a pivotal role in the assessment and treatment of physical and psycho-emotional issues including chronic pain. Through our involvement, we analyze function, work to provide solutions and help break the pain-disability cycle.  We connect people to other providers that are necessary and impactful members of the treatment team.  Occupational therapists are also well-versed in strategies to help people sleep better, move differently, and adapt to disability to reduce the limitations that result from any condition, including pain.

In short, any injury, including a car accident, can cause pain. Whether this pain is primarily physical or emotional, visible or invisible, it is important to remember that the pain experience is real and can be debilitating.  Occupational therapists are qualified to identify the psychological, cognitive and physical needs of the individual and to provide treatment to improve function in daily activities. With appropriate treatment, pain and daily function can improve, helping the individual participate in meaningful activities and to regain or maintain their sense of self.

Useful Resources

Michael G. DeGroote Pain Clinic (Formerly Chedoke Chronic Pain Management Unit), treatment option for multidimensional approach to chronic pain

The American Academy of Pain Medicine, videos to understand pain, its reasons and its effects

Entwistle Power Occupational Therapy:  Chronic Pain a Problem?  Try OT