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Tag Archive for: occupational therapy

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O-Tip of the Week: Simple Medication Management

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living.   

This week’s O-Tip of the Week focuses on ways to effectively manage your medications, ensuring each dose is taken at the correct time.  There are many effective ways to assist including the use of a dossette, smart phone alarm reminders, printable checklists and more. 

Learn more ways to help you manage multiple medications in our previous post, Medication Management.  

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The OT Role with Medicinal Marijuana Use

Guest Blogger: Carolyn Rocca, Occupational Therapist

The current legislation on medical marijuana use in Canada greatly shapes our role as health professionals. Under the Access to Cannabis for Medical Purposes Regulations (ACMPR), Canadians who have been authorized by a physician to access cannabis for medical purposes can purchase safe, quality-controlled cannabis from the 52 authorized licenced producers in Canada (Health Canada, 2017). With the legalization of marijuana in Canada being on the horizon, we can anticipate that many more of our clients may turn to it when seeking relief.

But first, it is important to consider why people are turning to cannabis for medicinal use. While some risks do exist, evidence suggests that the use of marijuana can offer several benefits including: reductions in nausea, decreased pain intensity, and improved sleep quality (Health Canada, 2013; Whiting, et al., 2015). Additionally, some clients report experiencing reductions in anxiety, increased relaxation, and relief from tension, headaches, and migraines. With these benefits and relatively mild side effects, this paints quite an enticing picture for those who may be consuming much more potent medications with more serious risks and side-effects.

If more clients are beginning or continuing to turn to cannabis as a source of relief, we as healthcare providers need to identify what role we play in supporting their decision to do so, including the role of Occupational Therapy which is explored as follows:

  1. Focus on safe use of cannabis: As part of the OT role, it is important that we ensure that clients are utilizing medicinal cannabis under the care of a physician, and are using it within the parameters set out in their prescription. Clients should be advised to discuss their cannabis use with her physician, as they would with any medication, as this falls outside of our OT scope. However, OTs can be involved in the process of helping clients track their relief from symptoms and potential side effects, according to the strain, dosage, and time of day and can help people to direct certain questions / concerns to their physician as appropriate.
  2. Monitor the impact of cannabis on daily activities: Our role is to be aware of the potential risks and benefits of medicinal cannabis use, to identify when cannabis use may be impacting clients’ abilities to perform day to day activities, and to subsequently provide strategies as needed. For example, if a client typically becomes drowsy when taking cannabis which may then impact their safety in the kitchen, an OT may be able to recommend strategies such as the use of kitchen timers, or help to schedule cannabis use at safer times of the day.
  3. Review available pain management strategies: As cannabis use is only one option for pain management, our role is to ensure that clients are aware of other available pain management strategies. Some strategies include: pacing activities to conserve energy, resting, massage, exercising, stretching, other medications, staying active (counterintuitive but true!) as well as compensatory strategies. Our focus as OTs is on helping clients to resume increased function by utilizing the pain management strategies they are open to given all the options available and the training we can provide for each.
  4. Assist in navigating resources: For clients who wish to produce medicinal cannabis for personal use, our role is to ensure that clients are aware of the guidelines set out in the ACMPR. We may also have a role in assisting clients in completing required application forms (found here) and planning for safe production, use, and storage of cannabis if they become registered to do so with Health Canada. Further, under the ACMPR, it is a client’s responsibility to make sure that all medicinal marijuana plants or cannabis products in their possession are secure, and that other people, including children, cannot access them. Therefore, OTs can assist in developing strategies to ensure they can meet the grow, safety and storage requirements.
  5. Consider affordability: As clients can expect to spend about $7-$12 per gram of medical marijuana (Medical Marijuana, 2016), it will be important to consider if their prescribed cannabis is covered under insurance funds, or whether they require budgeting strategies for this expense. An OT can also assist in this process, along with ensuring that the affordability is monitored and budgeted for long term.

Considering how imminent changes to Canada’s cannabis legalization are, being aware of the legislation changes in our society is highly valuable in our line of work. The OT profession is well-positioned to support clients in navigating their medical marijuana options in the most safe and functional manner possible. Seek the assistance and guidance of your healthcare team, including an OT, if you are thinking about, or currently incorporating, medicinal cannabis into your healthcare routine.

Resources & References

Government of Canada (2016). Information bulletin: safety and security considerations when producing cannabis for your own medical purposes. Retrieved from https://www.canada.ca/en/health-canada/services/information-bulletin-safety-security-considerations-producing-cannabis-for-own-medical-purposes.html

Health Canada (2013). Information for health care professionals: Cannabis (marihuana, marijuana) and the cannabinoids. Retrieved from http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/med/infoprof-eng.pdf

Health Canada (2016). Drugs and health products: Information for health care practitioners. Retrieved from http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/index-eng.php

Health Canada (2017). Authorized licensed producers of cannabis for medical purposes. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/licensed-producers/authorized-licensed-producers-medical-purposes.html

Medical Marijuana (2016). Frequently asked questions. Retrieved from https://medicalmarijuana.ca/resource-center/faq-2/

Minister of Justice (2017). Access to cannabis for medical purposes regulations. Retrieved from http://laws.justice.gc.ca/PDF/SOR-2016-230.pdf

Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., … & Schmidlkofer, S. (2015). Cannabinoids for medical use: A systematic review and meta-analysis. Jama, 313(24), 2456-2473. doi:10.1001/jama.2015.6358

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O-Tip of the Week: Save Time and Energy in the Kitchen

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

This week’s O-Tip of the Week focuses on ways to conserve energy in the kitchen by saving you time and effort.

When preparing meals we recommend that you gather ALL necessary  ingredients before beginning.  Doing so will save you time and energy by reducing trips back and forth from the pantry or refrigerator, and avoiding a last minute run to the grocery store for that missing ingredient!

Learn more about how to conserve energy in the kitchen in the following episode from our OT-V series:  Smart Solutions to Make Life Simpler (and Safer!) in the Kitchen.

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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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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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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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The Fidget Spinner – Useful or Distracting?

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

Co-written with Student Occupational Therapist Elizabeth Fallowfield

Last spring my daughter brought home a “fidget spinner” that she purchased off a kid at school.  She showed me how this worked as I had not seen it before.  After watching her use this I had flash backs to my pen-twirling days from University.  When I started my undergrad at the University of Waterloo, I noticed other students (many foreign) that would twirl or spin their pen in their hand during lectures.  I decided I too wanted to master this, and spent many-a-lecture working more on my pen-twirling skills than absorbing the worldly lessons of my professor.  Eventually, after launching a few pens rows ahead of me, or losing them altogether, I mastered the twirl, flip and spin with both my dominant and non-dominant hands.  Sometimes I would even get daring and twirl two pens at once (only in the really boring lectures of course).  To me, the fidget spinner serves the same purpose – give your hands something to do when you should otherwise be focusing and attending to something else.  But is this really the case?

The History of the Fidget Spinner…

The fad fidget spinners we saw in classrooms everywhere are a specific type of “fidget”, which can also include things like stress balls, fidget cubes, putty or smooth stones. The purpose of these “fidgets” are to allow for movement and sensory input – which then helps to either calm the body, or allow it to become more alert based on the sensory profile of the person, as assessed by a qualified therapist, such as an Occupational Therapist. The sensory profile is a depiction of the way that a person seeks, processes and organizes sensory input. It is this sensory profile which would determine for example, whether movement and fidgeting is beneficial – allowing someone to calm their body in order to stay seated throughout a lesson, or whether it would be overloading, or distracting.

For these reasons, fidgets were originally used as part of therapy for children with ADHD or Autism, who often have trouble regulating themselves in a classroom setting. However, the popular spinners we see in classrooms today are not a design of fidget commonly used for therapeutic treatment. A fidget cube is an example of a more therapeutic fidget that would provide tactile or touch stimulation without the visual distraction of spinning.

What Does the Research Say?

The Occupational Therapy profession is a leader in sensory processing assessment and research, and while these specific types of spinners are too new to have been researched specifically, the research on other types of spinners is clear – they can be equally helpful, harmful or neutral to a person’s focus depending on their unique sensory needs – which can only be accurately assessed by an Occupational Therapist or healthcare provider with training and experience in sensory processing theory and assessment.

The Bottom Line: Fidget Spinners are a Better Toy than a Therapy…

Parents and the general public should be cautious of the claims that fidget spinners are a broad and successful therapy tool for managing ADHD and Autism, or that they are globally effective at increasing attention and focus, or have a calming influence.  Truthfully, fidget spinners could be either an outlet to provide stimulation and to increase attention, or a distraction from something that is likely more important to be attending to (i.e. expensive University lectures). So, perhaps unless prescribed, these are best left at home this coming September.

 

References:

Barton, E., Reichow, B., Schnitz, A., Smith, I., Sherlock, D. (2015).  A systematic review of sensory‐based treatments for children with disabilities.  Research in Developmental Disabilities, 37, 64‐80.

Foss-Feig, J. H., Tadin, D., Schauder, K. B., & Cascio, C. J. (2013). A substantial and unexpected enhancement of motion perception in autism. Journal of Neuroscience, 33(19), 8243-8249.

Stalvey, S. and Brasell, H. (2006). Using Stress Balls to Focus the Attention of Sixth-Grade Learners. Journal of At-Risk Issues, 12, 2, 7-16.

Zimmer, M., Desch, L., Rosen, L. D., Bailey, M. L., Becker, D., Culbert, T. P., … & Adams, R. C. (2012). Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics, 129(6), 1186‐1189.

 

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Book Review: Enabling Positive Change – Coaching Conversations in Occupational Therapy

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

I always love a good book, but have never been one for those fiction novels complete with wizards, sorcerers, love affairs and who-done-it (and some have all four!).  So, the books I read are ones that teach me something, help me to grow personally, or at the least are readable one slow chapter at a time to encourage reflection.

This summer, I have enjoyed reading Enabling Positive Change – Coaching Conversations in Occupational Therapy by Pentland, Isaacs-Young, Gash and Heinz.  By way of background, I have always found coaching fascinating.  My first experience with a business / life coach was probably 10 years ago when I was looking for some guidance and insight on how to run my business better.  A few years later I connected with a different coach who helped me confirm that the path I was on (I had doubts) and allowed me to realize that I was exactly where I wanted to be.  Then, as my business grew and I felt isolated as an owner, I participated in more of a group coaching process that helped me for several years to build business confidence, to make some great decisions and all of this helped me to take my business to the next level.  Most recently, my business partner and I worked with an amazing coach who facilitated very deep conversations about where we are at, where we are going, and what we are truly trying to create – with insight on how to get there.

In reflecting on my experience with coaching further, I now understand that it really is a form of “occupational therapy” for people with desires and wants to do, manage, or live differently or better.  So, with this insight I was thrilled to see the combination of these two concepts:  coaching and occupational therapy in Enabling Positive Change:  Coaching Conversations in Occupational Therapy.

The book is chaptered by Occupational Therapists all over the world that use a coaching approach in their practice, and each chapter speaks to how coaching adds immense value to the OT profession.  The book first describes the coaching process, relates this to OT theory, practice and research, uses case and client examples to show the reader what coaching really looks like.  Then, it moves to worldly examples of OT and coaching that speak to the core of the OT profession and those of us that practice it.  I particularly enjoyed OT’s personal accounts of using coaching and OT to help them in their own journey, but to also assist clients with many aspects of returning to function: managing chronic pain, going back to work, helping children and their families, facilitating groups, improving mental health, getting discharged from hospital, navigating the insurance process, and developing new programs to name a few.  My favorite chapters, however (as these speak to my phase of life), were the chapters on coaching and mid-life, coaching executives and professionals, and using coaching to prevent burnout of health professionals (like OT’s!).  The book concludes with two very helpful sections about coaching education and training for OT’s, and the future possibilities for coaching and OT.

Honestly this book has a chapter for every OT at every stage and phase of career and really life. While I have always had an interest in coaching, this book has heightened my awareness as to why I have always found it personally helpful, and has also inspired me to look at coaching and coaching training more seriously as the next stage for me in my journey as an OT.  I recommend this as a “must read” for OT’s all over the globe.

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Back to School: OT’s Help Kids Succeed in the Classroom

As it’s back to school time we wanted to shed some light on the awesome work Occupational Therapists do to help children succeed in the school system.  From helping with IEP’s, to modifying the classroom environment, an Occupational Therapist can help to enhance the learning experience based on the individual needs of the child they are working with.  Learn more about how OT’s help kids in schools in the following care of the Ontario Society of Occupational Therapists. 

OSOT:  How can I benefit from OT?  Succeed at School