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Tag Archive for: occupational therapy

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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

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Occupational Therapy Explained

Most people think Occupational Therapy is about getting people back to work following an injury, or designing functional work spaces and workstations because of the word “occupation” in the term.  While this is an important part of what Occupational Therapists do, their scope is actually much broader.

The following, written by Najma Rashid for the Ontario Trial Lawyers Association does a great job of explaining Occupational Therapy and the OT role in the litigation process.

Ontario Trial Lawyers Association Blog:  What is an Occupational Therapist?

For more information about the solutions for living Occupational Therapists provide, check out our OT-V episode, “What is Occupational Therapy?“

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Summer Stress Reduction Strategies

As Canadians, we are well-known for making the most of our short summer months! We often fill them with day trips, weekends away, and vacations with family or friends. However,  this summer fun can also bring on “summer stress” with all of the errand running, planning, organization and co-ordination that’s required to make that summer fun possible. Everyone sees and defines “stress” differently, but whether you recognize these additional demands as being “stressful” or not, they certainly weigh on our minds and add to the mental list of things we need to accomplish and manage in our days.

So what can Occupational Therapy do to help? Stress management is one area where Occupational Therapists can make suggestions that are helpful.  These suggestions can help you to get the most fun from your summer, while preventing and managing the inevitable summer stress. Below you will find some general examples of the kinds of Occupational Therapy strategies that can help you limit and manage your summer stressors.

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OT or PT? Both or Neither?

Guest Blogger: Carolyn Rocca, Student Occupational Therapist

The differences and similarities between Occupational Therapy and Physiotherapy have long been confused. This makes sense, especially since both professions ultimately started as “POT”, meaning people studied to be a Physical and Occupational Therapist and worked in a dual role, providing both. However, since the mid-1970’s the roles have been separated and yet people still confuse the two. I am still often asked “oh, so you are like a physiotherapist”…followed typically by a question about some ailing body part.

Although both Occupational Therapy (OT) and Physiotherapy (PT) are registered healthcare professions specifically in the domain of rehabilitation, each profession has it’s unique role and purpose in one’s recovery following injury or illness, as well as in the prevention of disease, further injury, and disability.

There is no single way to define or categorize each profession. However, the Canadian Association of Occupational Therapists (CAOT) describes OT as the art and science of enabling engagement in everyday living by empowering people to participate to their potential in the daily occupations that foster health and well-being (Townsend & Polatajko, 2013, p. 380). In the OT profession, the term occupation is considered everything that people do throughout the course of their lives that is considered essential to their health and well-being (i.e. how people “occupy” their time). For example, an occupation can range from one’s ability to shower and groom themselves, to their ability to carry out their role as a parent, spouse, or employee.

Therefore, OTs are trained to assess and help clients identify areas in their lives that have been impacted following injury or illness, such as their ability to care for themselves, care for their families, manage their households, perform at work or school, and participate in volunteer or leisure activities. An OT would then assist their clients in building goals around those areas that are important to them, and to then provide recommendations, strategies, assistive devices, and education in order to find solutions to these day to day challenges.

Whereas, the Canadian Physiotherapy Association (CPA) describes PT as a client-focused health profession dedicated to improving quality of life by: promoting optimal mobility, physical activity, and overall health and wellness, and improving and maintaining optimal functional independence and physical performance (CPA, 2012). Therefore, PTs are experts in human anatomy and the functioning of the many systems within our bodies.

Their role involves conducting detailed and holistic assessments of their clients’ movement, mobility, and functioning, creating rehabilitation goals for recovery with their clients, followed by developing personalized intervention plans. PT intervention can include education, individualized therapeutic exercise geared towards increasing strength and range of motion, manual therapy techniques such as massage and manipulation, the use of modalities including ultrasound and electrical stimulation, and the prescription of assistive equipment.

While both professions consider the physical, social, psychological and emotional well-being of their clients, one primary difference between the professions is that PTs are trained to recognize when there is a need for specialized mental health treatment, and subsequently refer their client to an appropriate healthcare provider, whereas OTs are trained to assess and provide treatment for mental health conditions. This treatment can consist of teaching and practicing coping strategies by providing counselling and psychoeducation. Further, while a PT may recognize and understand how someone being unable to walk impacts work and home, the OT will help people to “manage in the meantime”.  So, while you are building your strength and endurance on that broken leg through physio, your OT will help you to manage other important tasks in a modified fashion when at home, work, school or in the community.

Nevertheless, perhaps the largest difference between the professions is that a PT tends to treat the client’s actual impairment, while an OT tends to help the client complete everyday tasks with the impairment. For example, consider a client who has undergone surgery for a hip replacement. Throughout their recovery, a PT might prescribe an individualized at home exercise program to gradually stretch and strengthen the hip in order to prevent deconditioning and to rebuild the muscles needed for walking. A PT will also be vital in terms of educating them on the proper use of crutches in order to safely move around their environment. Meanwhile, an OT will be an essential part of this client’s recovery as they likely require specialized bath equipment for safe showering, adaptive devices for putting on socks and shoes, and education in terms of strategies to transfer safely into and out of their car. Essentially the OT would focus on getting the client back to their day to day tasks and life roles despite the limitations presented by their impairment.

All in all, even with their unique roles, the OT and PT professions do have similarities. Both OTs and PTs can be accessed in hospitals, community care, private practice, rehabilitation centres, family health teams, long term care centres, and school health. Additionally, both professions are client-centred, meaning they focus on what is important to the client, and on maximizing their independence, safety, and function. Neither require a referral, so people can ask for, and receive these therapies without a referral. Despite these similarities, their above highlighted differences allow each profession to offer distinct roles, meaning PT or OT, both or neither may be most appropriate for you. Overall, both OTs and PTs are vital members of healthcare teams and together they offer many needed services throughout the rehabilitation process.

 

Resources & References

Canadian Association of Occupational Therapists (CAOT) website: http://www.caot.ca/default_home.asp?pageid=2412

Canadian Physiotherapy Association (CPA) website: https://physiotherapy.ca/

Canadian Physiotherapy Association (CPA) (2012). Description of physiotherapy in Canada. Retrieved from https://physiotherapy.ca/sites/default/files/site_documents/dopen-en.pdf

Townsend, E. A., & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, ON: CAOT Publications ACE.

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Aquatic Therapy: Is it Right for you?

Guest Blogger: Carolyn Rocca, Student Occupational Therapist

Water has long been associated with health and healing, making it an excellent tool for rehabilitation. Aquatic therapy, also referred to as pool therapy or hydrotherapy, is one way in which water can be used for therapeutic purposes following injury or illness.

Aquatic therapy refers to water-based treatments or exercises aimed to enable physical rehabilitation, fitness, and relaxation for therapeutic purposes. Treatments and exercises are performed while floating, partially submerged, or fully submerged in water, usually in specialized temperature-controlled pools. The key difference between this form of therapy and land therapy is that movement is facilitated by the physical properties of water, particularly it’s density and specific gravity, hydrostatic pressure, buoyancy, viscosity, and thermodynamics (Becker, 2009).

Due to the specific facilitating properties of water, aquatic therapy can have several benefits for people who have loss or restriction of joint motion, strength, mobility, or function as a result of a specific disease or injury. Aquatic therapies are beneficial in the management of musculoskeletal issues, neurological conditions, and cardiopulmonary problems. More specifically, there is evidence to support that people with fibromyalgia, arthritis, multiple sclerosis, cerebral palsy, stroke, and chronic pain, as well as people who have undergone surgeries such as total knee and total hip replacements, can significantly benefit from aquatic therapy (CARI, 2014).

The benefits of hydrotherapy will depend on the purpose of why it is being used in your rehabilitation plan, what it is aiming to target, and the type of exercise being completed in the water. In general, there is evidence to support that within a wide range of ages and abilities, hydrotherapy may help people to increase their endurance and strength, improve balance and postural control, reduce perceived pain and muscle spasms, reduce joint pain and stiffness, aid in gait retraining, and improve functional mobility. Additional benefits can include the facilitation of relaxation, improved quality of life, as well as providing opportunities for socialization (CARI, 2014).

A key to the success of many aquatic therapy procedures is the constant attendance and guidance provided by a trained therapist. This can be any rehabilitation professional, such as a physical therapist, occupational therapist, PTA/OTA, etc., who has taken additional and specific training in basic or advanced aquatic physical therapy. The rehab professional’s expertise will be able to match your abilities with the appropriate properties of water to achieve an optimum balance between facilitation and challenge. By adjusting the immersion temperature, type and intensity of activity, level of resistance, use of equipment, and treatment duration the therapist will be able to assist your recovery by gradually increasing the amount of challenge to eventually help you to transition to land exercises.

An added bonus to the therapeutic benefits of aquatic therapy is that it can help to introduce or re-connect you to a leisure interest, and can offer a social outlet. For example, a current client of mine has recently begun pool therapy following injuries sustained in a motor-vehicle collision. Not only will this help in her recovery while she begins to regain strength and function in her legs, but will also re-connect her to her passion for swimming, as this was something she loved to do with friends prior to her accident. Additionally, there is evidence to support that infants and toddlers with mobility impairments that engaged in aquatic therapy can experience significant functional gains in mobility compared to children who solely received land therapy, and that their parents noticed an increase in their socialization and enjoyment while in the pool. In this particular study, the children’s parents then reported an increased willingness and comfort in bringing their children to community pools following aquatic therapy (McManus, & Kotelchuck, 2007), therefore further increasing their future leisure and social opportunities.

Thus, aquatic therapy has the potential to improve physical function, as well as increase community involvement, socialization opportunities, and participation in physical activities. Additionally, this form of therapy can be appropriate and beneficial for all ages and abilities. If you feel that aquatic therapy may be a great addition to your rehabilitation and recovery, speak to your rehabilitation professional about some of the opportunities available in your community.

 

References & Resources

Becker, B. E. (2009). Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM&R, 1(9), 859-872.

Canadian Aquatic Rehab Instructors (CARI) website: http://www.aquaticrehab.ca/

Canadian Aquatic Rehab Instructors (CARI) website link to research (2014). Retrieved from http://www.aquaticrehab.ca/research

McManus, B. M., & Kotelchuck, M. (2007). The effect of aquatic therapy on functional mobility of infants and toddlers in early intervention. Pediatric Physical Therapy, 19(4), 275-282.