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Archive for category: Occupational Therapy At Work

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Always Forgetting Where You Put Your Keys? Tips To Improve Your Memory

Do you have trouble remembering where you left your keys?  Is it hard for you to remember the name of the person you were just introduced to?  We live in an age of information overload and it is becoming increasingly difficult for many to keep their memory sharp.  This article by Good Housekeeping discusses excellent tips to keep your mind sharp and improve your memory.

Good Housekeeping: Tips To Boost Your Memory

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Memory Mantras

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

Being an Occupational Therapist can also be a curse when it comes to parenting.  As an OT, the goals are always functional independence.  As a parent, I am no different.  I remember a video I watched in OT school.  This was of a boy (young adult) with cerebral palsy and he was putting his coat on.  The video was probably 20 minutes (or it felt that long).  As I watched this boy struggle with his coat for what seemed liked eternity, I wanted to jump through the TV to help him.  Clearly with some help this could be done faster and easier.  But in the end, it was not about that.  It was about independence.

As parents, it is often faster and easier to do things for our kids.  Or, we feel the need to continuously protect our kids from failure by ensuring that we are their second brain.  But is this the right choice when the goal is to create people that can manage on their own?

I have created two memory mantras that are used in our house to ensure my kids are seeing the big picture and are developing some executive functioning (note I also use these mantras with my clients who suffer from memory impairment):

When leaving the house our mantra is:  WHERE AM I GOING AND WHAT DO I NEED?  When my children ask themselves this question, they need to stop and think “I am going to X and thus need Y (water, shoes, birthday present, tennis racquet, money)”.  This prevents them from showing up at X unprepared.

When leaving a place in the community our mantra is:  WHAT DID I COME WITH AND WHAT DO I HAVE?  By asking themselves this question, they quickly realize that they came with X and thus need to bring X home (coat, shoes, water, bag, lunch).  This prevents them from leaving things behind.

The success is in hearing my children repeat this to themselves when on their way out the door.  Recently, at a sporting event, we heard a teenage boy blame his mother for forgetting his water.  She was profusely apologetic and rushed out to find him a drink.  My children (younger) turned to me and said “shouldn’t he remember his own water”?  My thoughts exactly.

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The Goal is Improved Executive Functioning

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

As a caring professional, I refuse to believe that my clients are not motivated.  All of my clients have goals or I would not be treating them.  However, their ability to achieve their goals independently remains the reason that they require active therapy.  Previously, I wrote about executive functioning, and used the example of moving to highlight how people with executive dysfunction may feel on a regular basis when completing relatively simple tasks.

Treatment for executive dysfunction is as broad as it is specific.  It is broad because everyone experiences brain injury differently, and comes into that type of trauma with varying levels of ability to start with.  However, treating problems with executive function is really as simple as taking a goal and breaking this down into component parts, manageable chunks, and smaller goals within the whole.

So, returning to the moving example, assisting someone with executive dysfunction with a pending move will involve making checklists, with time frames, and checking on progress frequently.  Personally, I like to take a project approach:  calling the goal “Operation Move” and mapping out – start to finish – the metrics for success.  Perhaps in month one an “apartment hunting worksheet” is created to help a client summarize all the places they are looking at, the pros / cons, address, and list of questions that need to be answered (price, utilities included, length of lease etc.).  Often I encourage my clients to use a smartphone to take photos of the options then we cross reference these and catalog them to keep things organized.  From there, the process continues with checklists for calls to make, addresses to change, ways to organize packing and management of belongings.  Ensuring the client is responsible for follow-up via “homework” between sessions and holding them accountable for completion of this aids to developing independence.  Really, the therapeutic goal is more than just ensuring the client is able to move successfully.  Rather, it is demonstrating a model and method that can be used for any future transitions, goals or tasks.  This ensures success that is transferable to other events at later dates. 

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June is Brain Injury Awareness Month: How Is Your Executive Functioning?

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

Last month, I spoke at a conference with my colleague Tamara Forbes (www.forbeshealth.ca) on the topic of executive dysfunction.  Executive dysfunction is a common problem following brain injury.  Simply defined, executive functions are the capacities we require to achieve a goal.  They are commonly referred to as the “CEO” of the brain because they provide the higher order processes that allow us to plan, organize, initiate and complete tasks successfully.

Practically, think about the last time you moved.  Moving, as an example, is a simple goal of just wanting to relocate from one place to another. The goal is not the problem: it is the processes and thinking required to manage the transition effectively.  Several months before moving you are searching for a suitable place, weighing the pros and cons of each location, checking your budget.  Then you make the decision of where to move and you need to deal with your existing location.  When do you need to notify your landlord, or when should you list your house?  Then, months and weeks before you move there are calls to make to utility companies, mail to redirect, insurance to organize, movers to book and packing to do.  What belongings are you moving?  What should be sold, donated, discarded?  The day of the move is chaotic, stressful, and exhausting.  Then for months after you continue to unpack, move things around, find ways to arrange and store your stuff.

Your level of executive functioning, or your ability to delegate and enlist support for your areas of weakness, will determine the outcome of your move.  Now imagine, with brain injury, that you feel the same sense of stress, fatigue and frustration with more simple daily tasks, such as planning a meal, sorting your mail, or scheduling your time.  This is often how people with brain injury will feel on a regular basis.   The goal then of occupational therapy will be to simplify daily tasks and help a client break activities down into smaller and more manageable chunks.  More on this to come…

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Occupational Therapist Sued Over a Reacher

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

I am getting increasingly frustrated at the failure of other OT’s to understand the value of education when prescribing equipment.  While it might seem on the surface that use of a reacher, tub scrubber or bath mat are “common sense”, my experience is that common sense is not common, and I don’t want my license on the line.

Take a reacher for example.  I have seen people use them as a cane.  Or people who have one that is too short and almost fall out of their chair trying to access that item that is “just a little further”.  Maybe they think that reacher can handle the over-sized glass jar of pickles and when it doesn’t the jar ends up shattering on the counter in front of them, landing on their lap, or worse, their head.  To send something to someone in the mail, and to indicate that “education is not necessary” exposes the OT to liability and the client to risk.

Why don’t OT’s hear about stories of devices gone array?  Mainly because when an OT is sued over a piece of equipment, the case can take years to resolve and when it does, the OT is sworn to secrecy about the outcome, otherwise they can be sued for breach of settlement.  So OT’s: don’t think these lawsuits don’t happen!

In the world of insurance there is funding for equipment and funding for education to ensure that the equipment is appropriate and the client can safely and independently demonstrate its use.  I have had to return many-a-things that I thought looked great on paper to find out they don’t actually work for that client in that case.  As OT’s we need to take our prescription responsibilities seriously and should never jeopardize our education, training or experience under the assumption that someone will properly use an item we consider “low risk”.

So, when I prescribe devices, and ask an insurer to fund time for an OTA or myself to provide them, it is because that is part of my judiciary duty to my client, my college, my license, my training, and my sense of responsibility.  If another OT feels the device is suitable, but says education is not required, then they can feel free to order those devices themselves and run the direct liability risk of being sued over a reacher.

 

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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.

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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.

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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.  

 

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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.

 

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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.