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Archive for category: Occupational Therapy At Work

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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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How Confident Are You?

Self-Confidence is defined as “a feeling of trust in one’s abilities, qualities, and judgment.”  Many equate this confidence to how we look on the outside, but it is only once we move past our outer positives and negatives and look inward that true self-confidence can be achieved.  Take a look at the following from Best Health Magazine that provides great tips on improving your self-confidence and learn more in our previous post “Lessons of Confidence from and Overhand Serve.”

Best Health Magazine:  4 Habits That Will Help You Develop Killer Self-Confidence 

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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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Text Neck—Are You Guilty?

The posture adopted by many people when leaning over a cellphone while reading and texting is becoming a problem. This bad posture that can put up to 60 pounds of pressure on the upper spine — sometimes for several hours a day, is a growing concern with long-term consequences.  Learn more in the following from The Washington Post and if you are suffering from text neck contact an OT for an individualized solution.

The Washington Post:  Digital disabilities — text neck, cellphone elbow — are painful and growing

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#Access4All

The Rick Hansen Foundation, in partnership with the Government of Canada, has launched a great way to celebrate Canada’s 150th Birthday– creating a Canada that has Access4All.  Learn more about this awesome initiative below.   Together we can make a difference!

Rick Hansen Foundation:   Celebrate Canada’s 150th birthday by giving the gift of accessibility!

 

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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.

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Organization and Recovery From Brain Injury

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

Last stop for Brain Injury Awareness Month – my favorite topic – organization!

photo 1

Yes, this is my drawer system to store pens, pencils, and markers. And if I find a pencil in the pen drawer look out! Perhaps being organized and knowing how to find what I need when I need it is one of the many ways I manage the demands of being a business owner and mother of four. But the reality is that we all have different levels of energy, tolerance and mental attention and these things can become depleted after a brain injury. So, if you were an energizer bunny with a DD battery before your injury, chances are your new batteries have 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 brain capacity and 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, keys, 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 and cognitive ability to manage these things, 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.

Helping clients with brain injury 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, it could completely derail your day.

After the day to day items have a place, then we can work to simplify other spaces that are identified barriers to function. Perhaps the kitchen has become too cluttered to allow for efficient meal preparation, or the bills are piling up because these are lost in a stack of papers. In the world of insurance I find that clients become overwhelmed by paperwork and this results in missed appointments, non-response to time sensitive material, or failure to submit for expense reimbursement. Slowly, over time and with suggestions and tools (filing cabinets, labels, folders, a pen drawer!) clients become able to more efficiently spend their units of energy on things that are more important, or more fun and ideally, learn to transfer these strategies into other life areas independently – like work, school or parenting.

Originally posted June 30 2014

To read more of our articles on brain injury check out our section on Brain Health.

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Lesbian, Gay, Bisexual, Transgender, and Queer – Three Strategies to Make Your Business More Inclusive

Co-written by Jacquelyn Bonneville, Occupational Therapist and proud member of the LGBTQ community

Have you ever been on vacation to Jamaica, Dominica, or St. Lucia? Have you ever Googled pictures of the beautiful Maldives? Did you know that all of these countries, and some 70 others, have anti-homosexuality laws punishable by fine, imprisonment, or death? Globally we still have a long way to go, but like all progress, we must remain proud of the steps forward we are taking in regards for Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) awareness and rights.

Pride month is celebrated in June in every year in honour of the 1969 Stonewall riots in Manhattan, USA; a turning point for LGBTQ activism. If you don’t identify with this culture you may not feel that pride month is relevant to you, however the spirit of pride month is to embrace diversity and peace, which all of us should celebrate, especially as proud Canadians.  This point, and the concept of peace, is even more prominent today considering the recent events in Orlando that resulted in the senseless killing of 49 innocent people as they attended a nightclub frequented by the LGBTQ community.

In honour of pride month, we’d like to offer 3 simple ways you can make your business more LGBTQ friendly:

1. Challenge your assumptions.

It can be easy to assume that everyone is straight; when you ask a man if he has a wife, or a woman if she has a husband, you could be unintentionally making an awkward scenario for a non-straight person. If you have an intake form that only has two gender options (male or female), you could be instantly excluding someone, or causing them to feel uncomfortable about your services.

As therapists we are often in a position of asking about our client’s social supports. Instead of making assumptions, ask more open-ended questions such as “Are you in relationship with someone right now”, “who is your main source of support”, or “do you have a significant other?” Have an “other” option for gender on intake forms, or include sex as well as gender if someone’s sexual organs are relevant to your medical field. Consider expanding “married” on your intake process to include “common law” and “long term relationship”.  You’ll still get the information you need, but in a more inclusive way.

2. Don’t be afraid you’ll use the wrong terminology.

My husband’s name is Kelly.  Many times people have assumed he would be female:  he has been put on the girls’ draw in tennis tournaments, rendered us to win the prize for the “ladies best foursome” in a golf event, and often our mail and solicitation calls are directed to Mrs. Kelly. We’ve all called someone by the wrong name / gender accidentally before. It’s embarrassing – usually they correct us, we apologize, and chances are you’ll never forget their name again. It happens, but in the grand scheme of things it isn’t a big deal.

Gay, lesbian, queer, bisexual, bigender, cisgender, gender fluid, asexual, feminine/masculine of center, intersex, MSM/WSM, pansexual, trans*, two-spirit, ze – what does it all mean? If you are not part of any particular minority group, it can be difficult to know if you’re wording something ‘correctly’ and it may make you uncomfortable. You may even be afraid to offend someone – isn’t ‘queer’ an offensive term? It all comes down to individual preference – and you won’t know until you ask.

Instead of assuming a person is Sir or Ma’am, Mr. or Mrs. based on your assumption of their gender, get used to asking more inclusive, generalized questions as part of your daily routine. There is nothing wrong with asking a client/patient, “What’s your preferred name?” or “How should I address you?” And if you slip and use the wrong pronoun or term in addressing them, simply apologize, correct yourself, and move on. Besides, a good businessperson should have a healthy dose of humility – your clients will respect you more for trying to use their preferred terminology, even if you make a mistake. Don’t worry.

3. Understand some of the systemic barriers LGBTQ persons may face in your system.

Knowledge of some of the challenges in your own business that directly affects persons of various sexual orientations and genders will only make your business more inclusive. Some questions that may be relevant to health care professions include: Can a bisexual person donate blood in your city? Is a transperson legally able to give emergency medical consent if their loved one is unconscious? Will a queer person be safe in a shared hospital room if their partner comes to visit them?

Health care isn’t as easily accessible as you may think. It can be very challenging to find competent medical and rehabilitation practitioners that are educated on health factors more common in certain minority populations, and so not all people feel they can be open with their family doctor or access health care without judgment. Knowledge is power – keep an eye out for changing laws, trends, or factors affecting the LGBTQ population in your area.

In the end, consider adopting some of these strategies into your everyday life, and you’ll be making maximum impact with minimal effort. To quote a Futurama cartoon episode:

“When you do things right, people won’t be sure you’ve done anything at all.”

No one may notice you changed your language, or thank you for making the change – but to that client who needs to know that they’re safe with you, I guarantee you that your choice of inclusive words will make all the difference.

As Occupational Therapists we are lucky to be able to assess our clients holistically, and to consider all of the factors that may be affecting their occupational performance including sexual orientation, gender, sex, and social support networks. We can constantly challenge our assumptions to help develop into even better practitioners.

Happy pride month!