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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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Purple Day for Epilepsy Awareness

If you happen to be anywhere near the downtown Toronto area or Niagara Falls on March 26th, you may be seeing the colour purple. That’s because March 26th has been designated Purple Day across the globe in honour of epilepsy awareness. Individuals are encouraged to wear purple clothing, local organizations host events, and this year two of our nation’s biggest landmarks will also be bathed in purple light to increase awareness of the need for research about epilepsy.

One in one hundred Canadians are affected by epilepsy and it is currently estimated that 300,000 Canadians are living with the disorder. The term epilepsy is derived from a Greek term for possession, as the Greeks believed the person affected was being overcome, seized or attacked. It is now understood that epilepsy is a neurological disorder that leads to brief disturbances in the typical electrical functions of the brain. These disturbances are characterized by sudden and brief seizures, which may vary in form or intensity for each person. For example, a seizure may appear as a brief stare, an unusual body movement, altered awareness or a convulsion.

Epilepsy is a chronic medical problem, but for many people it can be successfully treated through medication, a special diet regimen, or surgery. However, treatment is unique for each individual and must be tailored to their needs in order to be effective. Because of the unpredictable nature of epilepsy, it can disrupt a person’s routine and their ability to participate in their desired daily activities. For some, they may experience changes in their thinking, energy levels, coping skills, or feelings of self-esteem and in some cases, postural deformities such as contractures may develop.

Occupational therapists can assist those with epilepsy and their families to improve their independence and enhance their participation in daily tasks. Occupational therapists may provide advice or education in regards to safety such as how to adapt potentially unsafe areas of the home like the kitchen and bathroom or support medication adherence and management. They can also recommend equipment and devices that can be used at home and in the community to enhance safety.  OTs can assist with developing social skills and coping strategies that may be affected as a result of epilepsy and can also help by examining and addressing sensory integration challenges like sensitivity to light or noise. Another common area occupational therapists address involves developing strategies to increase organization and enhance routines to support a person’s performance at home, school or in the community. Using their task analysis skills and their holistic and individualized approach, Occupational Therapists are well suited to help individuals with epilepsy and their families find a variety of options and ways to be able to achieve their goals and fully engage in everyday life.

Resources

www.epilepsyontario.org

www.epilepsy.ca

 

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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 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

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How’s Your Posture?

Repetitive activity using improper posture and body mechanics can result in excess energy expenditure, fatigue, pain and even injury or damage to muscles and joints over time.  Therefore, it’s important to know the proper body mechanics required when completing everyday tasks and activities, at home, at play or at work or school.

The following episode of our Occupational Therapy Video Series:  OT-V discusses how to ensure you are using proper body mechanics with respect to:

  • workspace design
  • lifting and repetitive muscle use
  • excessive standing
  • excessive sitting
  • hand movements
  • excessive energy output.

Take a look to learn how an OT can help you improve body mechanics and reduce the risk of injury and pain in the long-term.  Remember to subscribe to our YouTube channel for access to this and other great OT-V videos!

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Occupational Therapy’s Important Role in Heart Attack Recovery

February is Heart Month and while many of our blog posts will focus on prevention through good health habits, we want to also provide you with some tips for recovery.  Below is some excellent information from the Canadian Association of Occupational Therapists (CAOT) on the role of Occupational Therapy in heart attack recovery.  As a heart attack is a life-altering event, often requiring permanent lifestyle changes, occupational therapists can help people to recover from the initial incident, to rebuild a life of function, and to promote change that will help with prevention.  Thanks to CAOT for your great description of how we help:

Take Heart. You can still do what’s important to you!

Heart disease has a major impact on an individual’s quality of life. It can lead to discomfort or chronic pain, activity limitations, disability and unemployment. “An estimated 345,000 Canadians aged 35 to 64 reported living with heart disease. More than a third (36%) of these reported needing help with household tasks or personal care” (Heart and Stroke Foundation of Canada, 1999). Heart disease requires lifestyle changes to prevent progression of the disease, further cardiac events and activity restrictions.

An occupational therapist in conjunction with other team members will help you determine what activities you can safely perform and how to modify activities to decrease the amount of energy required. This is important in achieving the maximum result from limited exercise capacity.

Try these occupational therapy strategies…

1. Use body mechanics: Smooth, rhythmic and repetitive motions are easier on your heart. Remember to breathe regularly. Avoid lifting or carrying heavy objects. Sit to work whenever possible, for example when ironing or chopping vegetables. Avoid lifting or carrying heavy objects. Slide objects or use a cart if possible. Change position frequently; this allows different muscles to work, increases circulation and prevents fatigue.

2. Simplify tasks: Break the activity into small steps, i.e. preparation, activity, clean-up and final phase. Take frequent small breaks throughout the activity rather than fewer long rest periods. Adjust work heights and areas to fit you. The most frequently used items should be located between waist and chest heights. Avoid working with arms above shoulder level.

3. Remember physical conditioning: Follow a regular cardiovascular exercise program as approved by your physician. An important element in maintaining cardiovascular activities is enjoyment; be creative – park a distance from work and walk in, join a mall walking program, exercise with a friend.

4. Recognize emotions: Anger, frustration, anxiety, and stress all increase the heart rate. Be aware of what creates stress for you and how you handle it. Try not to bottle up feelings – build your supports and talk to them. Decide on your priorities and learn when to say “No”. Pay attention to the activities that are stressful and schedule yourself accordingly, i.e. avoid unnecessary driving in rush hour and bad weather. Get enough sleep, rest, and maintain healthy eating habits. Work off tension appropriately.

http://www.caot.ca/default.asp?pageid=3703

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OT Can Help with Visual Impairment

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

My grandmother is legally blind.  She first lost her hearing in her 60’s but managed this well with hearing aids and the ability to lip read.  She also learned some sign language.  Then, in her 70’s, her sight also started to fail her.  This progressed until she was left with what she calls “cheese cloth” and shadow vision in her right eye and minimal, if any, vision in her left.  While adjusting to failing sight was of course difficult for her, adjusting to also losing the ability to lip read and communicate with people was an even bigger challenge.  She had always used her vision to compensate for her hearing loss and this was no longer an option.

As an occupational therapist I have worked with people who have low vision, and can say that no two people will experience this the same.  First of all, vision loss, and legal blindness, do not mean total blindness, so the first step is always trying to understand what people can see and the ways their vision continues to work (or not) for them.   This of course involves multiple professionals, but as occupational therapy is about “function” we need to look at how their vision works, and doesn’t work, in the environments in which they live and access.

Of course, safety is always the primary concern when dealing with vision loss.  Safety in the home involves looking at fall risk, ease of mobility, cooking and meal preparation, and of course the ability to respond to an emergency.  In the community this involves how someone with vision loss can negotiate roads and streets, manage around other people, complete paperwork at stores and offices, and avoid compromising situations such as becoming victimized or managing money transactions.  Transportation is also an issue and getting from A to B usually involves the use of an attendant, taxi, or walking via a service dog or with the use of a white cane (which is mainly used to notify others of a visual impairment and to detect obstacles).

So as an occupational therapist, what type of strategies do we employ?  Well, of course it will vary depending on the amount of vision someone has and of course the functional tasks they want to achieve.  But here are the main ways we help:

Sleep – insomnia is a significant problem for people with vision loss.  Lack of sight can impact the sleep / wake cycle and restlessness is a common problem.  Yet, with poor sleep comes poor physical, emotional and cognitive function in the days following so addressing sleep issues is very important.  For this we can help by suggesting sleep and relaxation CD’s, mindfulness methods to reduce anxiety and mental unrest, and positioning aids to promote comfort.  Helping people to creating predictable sleep / wake cycles is also important.  Some audiobooks are also helpful provided they promote cognitive rest, and not cognitive stimulation.  We also discourage television or computer use, or listening to news or world events before bed as this can also stimulate the mind making sleep more difficult.

Personal Care – it is very important that someone with a visual impairment have a consistent personal care routine.  This helps to promote sleep / wake cycles and keeps the body on a predictable schedule.  The bathroom can be a very unsafe place if equipment is not provided to ensure transfers in / out of the shower or tub are safe, it is easy to get on / off the toilet without grabbing the towel rack, and to prevent falls that can be common in this space.  Organization is key to ensuring that the individual can find the items they need when they need them, without unnecessary and timely searching.  Lighting and contrast on bottles or counters, and using shapes to identify objects is helpful.

Cooking – there are many ways to address function in the kitchen, but the main ingredient is always organization.  People with visual impairment need things to be consistently placed where they expect to find them.  Their ability to search and locate is impaired, and thus it is inefficient (and unsafe) for them to be rummaging through drawers or cupboards to find cooking utensils or other items.  Color contrast is also important.  Using tape, foam, Dycem, stickers, markers, or even shelf paper we can adjust surfaces to promote contrast or to re-label items in larger print.  Items can also be purchased in different colors or shapes, depending on what is easier for the individual to see.  There are several other devices and tools that can also be used to help someone with a visual impairment to know when they have filled a pot or glass, to know the buttons on the microwave, to more safely chop or cut, and lighting in the space is very important (but note that too bright and too dark can both be problematic).

Technology – there are many technology aids and devices that can promote the function of someone who is visually impaired.  Voice recognition software, text to talk technology, closed circuit readers, and Siri-managed phones and tablets.  Using a computer, someone who is visually impaired can order groceries online, do their banking, shop, communicate with others, read the paper, and interact with the world.  This allows them to function in needed and purposeful ways, but safely and independently.

As you can tell, most of these suggestions involve the environment and modifying this to promote function.  That is really the heart of occupational therapy – if we can’t change the person or the impairments they experience, we can at least adjust their environment to accommodate their needs, compensate for any deficits and promote independence.  But this of course also requires the by-in from other people using the space as without the entire family on board, the strategies could get lost after implementation.

My grandmother functions extremely well for someone with both hearing and vision loss.  She is probably the smartest person I know at 88 years old.  I fully believe that she now compensates for her deficits with her extremely sharp mind that allows her to retain and remember everything.  As my dad says “she is blind in one eye and sharp as a tack in the other”.  She is an inspiration and has managed to adjust to some significant challenges in her later years.  However, I do get concerned when I visit and she wants me to read her scale so she knows how much she weighs.  I always ask her what she wants to hear and her response is something along the lines of “you are a rotten kid”…something her and my grandfather always called me – especially when I took a quarter off them playing cribbage.

 

Originally posted February 2015

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Christmas Gifts That Are OT Approved!

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

If you’re a keen and organized shopper, I’m sure you have the majority of your holiday gifts already purchased, and if you’re anything like my Mother had everything done and wrapped in August! However, if you’re anything like my husband, you are waiting until the 24th to think about Christmas.

Although Santa and his Elves are hard at work building the toys your children put on their Christmas wish list, there may be a few items you still need to purchase.

We consulted our talented team of Pediatric Occupational Therapists and are happy to provide you with some fun but functional gift inspiration. These are gifts that are educational and stimulate child development:

1. BOOKS: Although technically not toys, books make an excellent gift. Fostering a love of reading in children from an early age is essential in development of language and literacy skills, while building creativity and imagination. And so many types of books exist! Beyond regular books, pop-up books, and interactive books, there are even books where you can record your voice, or the voice of a loved one into the story so that person is “reading” to your child. This is great for those people in your life who are out of town and are not able to “read” bedtime stories in person.

2. TOYS THAT MAKE THEM THINK: Look for puzzles, games, shaper sorters, science kits and more. Problem solving through play is fantastic for the mind and will help them become independent problem solvers in life. But be prepared to explore and learn with them. Interactive parent-child time through new learning is also essential to development!

3. TOYS THAT GET THEM MOVING: We’re living in the sedentary age of technology where obesity is on the rise. Try some active toys like a skipping rope, scooter, ride on toy, a bike or winter sports gear like skates, skis or snowshoes. But with all riding toys, include the helmet too! Keeping kids active is extremely important for both their physical and mental health!

4. TOYS THAT BRING OUT THEIR CREATIVE SIDE: Fostering creativity in kids at an early age is important for their development. Looks for gifts that will encourage them to be creative like art kits, dress up clothes or crafts and supplies.

5. AN EXPERIENCE THEY WON’T FORGET: Too many toys to choose from? Why not treat the children to an experience instead. Consider tickets to a sporting event, a play, or musical or a child-appropriate concert. Special events like these create fantastic memories and can strengthen family bonds.

We hope you find some gift inspiration from our tips and with you very Happy Holidays!

 

Originally posted December 8, 2014