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The GOS-E and Catastrophic Determination – Gathering EVIDENCE of Pre-Accident Function

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

Over the last few months we have had the privilege of presenting to a multitude of Personal Injury Lawyers on the June 1, 2016 changes to catastrophic determination, most specifically on the Glascow Outcome Scale Extended (GOS-E).  If you are working in motor vehicle accident (MVA) rehabilitation or personal injury law, this scale is one you need to be familiar with.

To qualify for catastrophic under the GOS-E, it speaks openly about changes to QUALITY and FREQUENCY of participation in pre-accident tasks under the facets of independence in and outside the home, travelling locally and abroad, productivity, social / leisure participation and relationships.  Within this, it considers HOW OFTEN someone did something, but even bigger than that is FOR HOW LONG and at WHAT INTENSITY.

As OT’s working in this sector, it is important that we gather this information in great detail during our initial assessment to not only get a better picture of pre-accident lifestyle and function, but to create early records that could relate to catastrophic determination at 6 months, 1 or 2 years’ post-accident.

During a presentation, one lawyer questioned the “qualitative way” by which pre-accident information is usually gathered (by asking family or through client self-report).  He asked if there was better evidence, “proof” if you will, that could speak objectively to “pre-accident function”.  This was a great question because right now the only pre-accident “evidence” the industry tends to gather are medical records and these speak to health, not function (and the two can be very different).  Function is best outlined by finding out how people spent their time – something that one would think would be difficult to objectively measure for the purpose of “evidence”, but let’s think again.

The evidence of how people spend their time is actually everywhere.  My morning dog walk and sleep habits are tracked on my fit bit and transferred to my computer and phone.  My car logs the kilometers I drive, and the repair shop inputs these with every oil change.  The gym tracks my attendance.  My phone apparently stalks me by recording everywhere I take it, the websites I visit, the apps I use and the people I speak to, text and email.  The photos in my phone also tell the story of my life and where my time is spent.  My computer records the number of emails I send and receive and the places I visit online.   My emails are sorted and can detail the time I spend organizing and taking trips (local and abroad), socializing, and even my relationship communication habits.  If I had a personal Facebook account this would detail for you the people I chat with, how often, and the places I visit, take photos and upload.  Twitter, Instagram and Snapchat would do the same.  But honestly most of the information about my time spent would be easily revealed through my financial records.  Most of the things I do cost money.  My credit card and bank statements will show you the frequency by which I get a latte, the costs for my gym program, the amount of shopping I do, the people I pay to help manage aspects of my house, the places I eat or indulge, the number of times I visit the movies or do something fun, the things I enroll my children in, etc.  These will even tell you the therapies or treatments I might get privately that my doctor doesn’t even know about.

We know that being involved in the insurance system exposes aspects of people’s lives that they may not want to share.  All privacy is forgone when you want and need help from an insurer, or when you want and need to sue someone who was at-fault for causing you injury and harm.  Unfortunately, with the changes to Catastrophic Determination, the gap just widened in terms of the information that needs to be gathered and the “proof” that needs to be provided to access the benefits an injured person may need.  However, the information is out there – little is sacred or private anymore. 

If this is helpful, here is a list of information that could be gathered to support changes to FREQUENCY and QUALITY of participation in most activities before and after an accident.   Getting someone’s personal records for the year prior to an accident, and then for the first-year post, will be highly informative, helpful and revealing…if they are agreeable to share:

Bank Statements / Financial Records will show MOST purchases related to social / leisure activities:

Memberships / clubs / subscriptions
Dinners / coffees / movies
Vacations
Shopping habits
Sports / fitness
Gas / driving / parking habits

Other places will also have records:

Gym / rec center attendance
Schools / school records
Employment records
Evidence of trips / vacations / social events on SM – FB, Twitter etc (before the accident)
Car / vehicle records – how often the car was driven based on KM’s
Points cards for anything like movies, Starbucks, Airlines, etc
Call / cell records and communication habits
Medical records

I hope this helps the lawyers and injured people of the insurance system to find the “evidence” they might need to really demonstrate to an insurer how their life has been impacted following an accident.  And for the OT’s gathering similar data subjectively, be specific and thorough in your questioning under the GOS-E spheres.  Your reports are highly important and may become the difference between someone being deemed catastrophic or not.

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No Excuses: Daily Healthy Activity Tracking Tool

In our busy day to day lives it can be difficult to make time to put yourself first.  Healthy habits such as hydration, exercise, sleep and “me time” often get put on the back-burner or forgotten as we spend our time getting stuff done.  However, to achieve optimal mental and physical health you need to put yourself first!  Use our printable Daily Health Tracker to help create healthy habits and keep yourself accountable to ensure you are getting daily physical activity, drinking enough water, achieving a proper sleep, and making time to do the things that make you happy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more helpful tools for both children and adults visit our Printable Resources Page.

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Tech Support: Learning Made Simple

In the digital age we live in if you are not fluent with the latest technology you can get left behind or struggle to keep up if you don’t know how to use it.  Those with cognitive difficulties and older adults who do not frequently use technology may find themselves needing some extra assistance to learn to use helpful apps and software.  Our colleagues at Lawlor Therapy Services have launched a series, Tuesday Tech Tips, providing how-to videos on some of the most frequently used and helpful pieces of technology.  If you could benefit from extra assistance maximizing the use of your computer, tablet or smart phone, this series is for you!

Lawlor Therapy Services:  Tuesday Tech Tips Series

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Understanding Your Rehab Therapy Professionals

Navigating the world of rehab therapists can be confusing – there are multiple types of therapists, whose abilities may seem similar when taken at face value based on general terms like “supporting rehabilitation goals” or “providing treatment”. However, when you compare these professionals based on their educational backgrounds and requirements, as well as their defined roles and responsibilities as set out by each profession’s respective college, professional association, or employer, it can become clearer which professional is best suited to help serve your personal needs.

Below is a simple summary guide of the hierarchy of educational backgrounds and core roles of each therapist/professional- please contact your healthcare provider or Occupational Therapist if you have further questions or think the services of these professionals may benefit you.

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Mental Health at Work: How to Seek Help

While minor accidents are common in the workplace and quickly addressed, higher instances of stress, mental illness, and workplace bullying are being seen across all industries.  If you are suffering where do you go to get help?  If you see signs of mental distress in a fellow employee, how can you help?  The following from The Globe and Mail discusses how and where to seek help if you are concerned.

The Globe and Mail:  Where to get help when you’re concerned with your mental health

Learn more about strategies to improve mental health in the workplace in the following episode from our OT-V series:

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The “Other” Rehabilitation Therapy: OT

We came across the following article in the Huffington Post which helps to shed more light onto the value of OT.  Occupational Therapists strive to help people recover from accidents and illnesses by working with those affected to create and achieve meaningful goals.  We especially love how the article distinguishes between Physical Therapy (PT) and Occupational Therapy (OT), two extremely valuable therapies, helping the public to learn more about OT– The “Other” Rehabilitation Therapy.

The Huffington Post:  Following Surgery, Injury or a Disabling Disease, Occupational Therapists Provide a Bridge to Normal Life—and Hope

To learn more about the differences between PT and OT refer to our previous post, “OT or PT? Both or Neither?

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Tragedy and Terror are Everywhere – What Do You Say to Your Kids?

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

Co-authored by Angie Kingma, OT at 

Every generation is said to be shaped, influenced and molded by the major world events that they experience.  These events hit us so deeply that most of us can remember where we were when we “heard the news”, how we felt in the moment, and the way the world changed following the event.  Today is the anniversary of 9/11 and marks a day of mourning for those of us that still feel deeply connected to the senseless tragedy that remains the world’s worst terrorist attack.  But the threats aren’t over and the connected world we live in exposes all of us, including our children, to these events in gory detail complete with photos, video and even the live streaming of things as they unfold.  If parents are not careful, these events can have a negative, harmful and life-lasting impact on children especially if we don’t help them process what they are seeing or hearing. 

So, in the spirit of both mourning and hope, today I wanted to try and provide some suggestions on ways we can talk to our children about events like 9/11, the bombing at the Ariana Grande concert, North Korea testing missiles, the terrorism in Paris and London, attacks on Parliament Hill, or even the recent suffering caused by hurricane Harvey and the wildfires in Western Canada.  Despite the fact that I am a mom of four, I still struggle to have these conversations with my kids, and as such reached out to an Occupational Therapist friend and colleague skilled in mindfulness (Angie Kingma www.mindfulnessforhealth.ca) to get her take on how all parents can try and manage these conversations better.  Here is what Angie had to say:

Some parents take the stance that they’d rather shield their kids from the disturbing events that continue to happen daily around the world.  These parents are well-meaning, assuming that talking about these grim facts will not only upset their kids but perhaps also cause harm.  However, literature shows quite the opposite. What happens is that these kids are denied the opportunity to develop the resilience that is necessary to become a healthy, fully functioning adult. There are other parents who would like to discuss these issues but just don’t know what to say or where to start.

Mindful parenting can greatly enhance our ability to be skillful when talking to our kids about the world’s hard truths.  So, what exactly is mindful parenting? It involves the intention to bring a particular quality of attention to the interactions with our children, as they unfold moment-by-moment. To do this, we choose to consciously pay attention to what is arising in the present moment, becoming aware of what’s happening internally for both the parent and the child, as well as what’s happening externally. Mindful attention is enveloped by attitudes of non-judgment, gentle curiosity, open-heartedness (kindness and compassion), as well as acceptance.  We are especially interested in the child’s thoughts, feelings and bodily sensations, as well as our own. We practice mindful listening, which just means listening with full attention, staying present, conveying to your child that you are truly listening and care about their experience.   This quality of focused attention and awareness goes beyond just listening to the words, and includes awareness of facial expressions and body language.

Here are some mindful communication tips when talking to kids about life’s difficulties:

Don’t avoid the conversation. Depending on your own comfort level, let kids know that darkness, misfortune, evil, natural catastrophes and other unpleasant life pressures do exist.

Explain issues to kids in an honest and age-appropriate manner.

Keep it simple. Kids don’t need the gruesome details, just the gist of the event.  Find out what they know about it first and then fill in the gaps with the basics of what happened.

Remind your child that you might not have all the answers but that you know it’s important to have these types of discussions. Sometimes they aren’t looking for answers, our kids just need to feel “seen” and “heard”, and to feel a sense of safety.

Stay level-headed when you’re discussing difficult news. Practice ‘radical acceptance’ of these realities, which simply means acknowledging the truth of things (radical acceptance doesn’t mean we that we have to like it or approve).

Pay attention to your own feelings.  Since events like terrorist attacks evoke strong emotions in us and our kids, be aware of what feelings are coming up in you before the conversation and during. Pay attention to your feeling(s) and observe them, breathing with them, without having to act on or get overwhelmed by them. When we can regulate our own feelings, it can help your child to regulate their own feelings (a term called “co-regulation”).

Share with your child what strategies you use to deal with distressing situations.

Seek professional assistance if you’re having feelings that are too difficult to manage on your own or your coping strategies are unhealthy or ineffective.

Pay attention to your child’s feelings.  Help them name what they are feeling, which tips us in the direction of emotional regulation. Ask them if they can describe where in their body they feel their emotion, ex. tightening in chest, butterflies in the tummy, tension around their head.

Listen open-heartedly to your child’s feelings about the situation. Ask open-ended questions such as “How does hearing about this make you feel?” or “Is there anything else that you’d like to talk about?”

Validate your child’s feelings, even if you don’t understand them yourself. Say “Of course you’d feel that way. That makes total sense to me”.

If you notice a significant increase in fear and anxiety in your child that begins to affect their daily functioning, report this to your family doctor as soon as possible and consider getting a referral to a children’s mental health specialist.

Respect it if your child will simply not talk about certain topics. Some children, particularly kids who already have anxiety, won’t be able to tolerate the conversation so don’t force it. Other kids will have a lot to say and want to discuss it at length. Neither response is better than the other.

Difficulty helps to build our resilience. Let your child know that the things that we go through in life make us stronger and teach us important lessons.  Point out specific stories of heroism, survivors, first responders or people coming together to help one another during times of need.

Teach the concept of impermanence, meaning that while difficulties in the world do exist in the present moment, things are always changing. There is hope that things will change for the better. Practice modelling attitudes of hope and optimism and discuss the importance of these with your child.

Not only does mindful parenting and communication strengthen the parent-child bond and facilitate a strong attachment, it also cultivates emotional awareness and self-regulation, which our world so desperately needs.

“Your mindful presence is the most valuable and precious gift you can give to yourself and to your children.”