When working with clients who have been injured in a car or other accident, most times we work alongside a lawyer who is representing them to ensure they are able to receive the financial compensation necessary to allow them to have the best treatment and care. The following from personal injury lawyer Roger Foisy discusses how Occupational Therapists assist beyond the recovery, to help clients receive the funds they require to pay for the costs they incur as a result of their loss.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
In honour of Parkinson’s Awareness Month we are re-sharing our popular post from last April: “My Grandma Versus Parkinson’s Disease.”
I can’t remember how old I was when I was told that my grandmother had been diagnosed with Parkinson’s disease. I was very close to my grandmother and, selfishly, was most worried about how long she would live. We were told around 10-15 years. To a kid that seemed like a really long time, but as an adult I now recognize those years can, and will, pass in a heartbeat.
Parkinson’s results when the brain is not able to absorb dopamine – the neurotransmitter that helps to control movement and movement patterns. Often, this presents as tremors, difficulty initiating movement when walking, slowness, and loss of balance. Diagnosis is often by exclusion of other problems, treatment is offered via medication and therapy, and the life expectancy can vary based on many, often unpredictable, factors.
For my grandmother, her Parkinson’s was not really noticeable for many years. But eventually, her tremors became more pronounced and the ataxic and shuffling gait more obvious as her medications became less and less effective. What seemed to help her immensely though was a positive attitude, stubborn drive to be independent, and the decision to stay active. My grandmother loved jokes, was quick witted, and was always one for a funny story. I remember helping her off the toilet one day and she said “I have the privacy of a goldfish”. She was remarkably independent – my favorite was when she stuck the gum she was chewing to her back-scratcher so she could get a piece of paper off the floor. She stayed active by continuing to curl and golf for as long as she could, then turned to water exercises and found Tai Chi. Within a few months of Tai Chi she was raving about how much better her balance and flexibility were, despite making jokes that in her classes she was always the one facing the wrong direction. She was always trying to teach me her moves (see photo of her and I when I was 16 – apparently perms, Cotton Ginny Track Pants, and Mickey Mouse t-shirts with your name on them were cool back then). I ended up taking Tai Chi myself in University for a while and we would often share the “art” together.
Yet, despite her best efforts, eventually the disease took its toll. Her desire to be independent resulted in a strong aversion to using a wheelchair which meant several falls that caused two broken hips (six months apart), and a year later a skull fracture and brain surgery. She survived these, but her capacity to physically manage would deteriorate after each event and subsequent hospitalization. Eventually her and my grandfather found a wonderful nursing home that provided many social and recreational outlets for both of them. One day I was visiting her and she told me she had been petting a lama the day prior. I went to the nurse’s station to ask them if she had been hallucinating and they said “no, there was a lama in here the other day”.
But the final display of her true character was the day she died. Told she was in congestive heart failure, she used her walker (forbidden by the family) to walk to the end of the hall where she sat down and passed away on the couch. It was her last display of independence, stubbornness and determination – the traits that had actually allowed her to happily live life “her way” despite Parkinson’s.
Today we celebrate Parkinson’s awareness. While my grandmother had this during a time when it was relatively unknown, this has become better understood and studied thanks to people like Michael J Fox who has turned his diagnosis into a crusade for a cure. I see many similarities between how Michael J Fox approaches his illness and how my grandmother did. Sense of humor and a positive attitude (see his books “Always Looking Up” and “Lucky Man”), and continuing to live his life by creating a new “normal”.
If you, or someone you know, has been diagnosed with Parkinson’s disease, stay informed. Contact the Parkinson’s Society of Canada for local supports and information. Stay active in your community through modified programs, Tai Chi , or even Dance for Parkinson’s offered through the National Ballet School or locally at places like the Hamilton City Ballet.
And consider – if you or someone you know has Parkinson’s (or any disability for that matter) and needs creative and proactive strategies for managing well at home and in the community, consider calling an Occupational Therapist. We can, through education and equipment, help you or them to manage as safely and independently as possible.
Taking the leap to go out on your own and begin your own practice is a big step. But with proper planning and a positive outlook, this decision can be extremely rewarding. I invite you to listen to the following Podcast, on StartATherapyPractice.com where I share the story of my decision to open my own practice which eventually lead to my current firm, Entwistle Power.
One of the main reasons we started our blog 2 years ago was to bring awareness to the general population about the profession of Occupational Therapy and to be able to connect with OT’s all over the world. A fellow OT, Dr. Frederick Covington, of “Ask The OT” recently reached out to the global OT community requesting collaboration such that he could create a song and video to spark OT awareness. The video features OT’s from across the globe, representing over 5 continents and Entwistle Power is happy to be representing Canada in Dr. Covington’s “I Am OT.”
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.
Guest Blogger: Samantha Langan, Occupational Therapist
Today people around the world will be wearing red ribbons to support World AIDS Day. This day of recognition started in 1988 to provide people with an opportunity to unite in the fight against Human Immunodeficiency Virus (HIV), show support for those who are living with HIV and to also commemorate those who have died. According to the Joint United Nations Programme on HIV/AIDS, 34 million people were living with HIV worldwide in 2011. In 2012, The Public Health Agency of Canada reported 2062 new cases of HIV, but it is expected that others are also living with the condition, not yet knowing they have been infected. There continues to be many myths and stereotypes around how HIV is transmitted and stigma remains for those living with HIV. Unfortunately, there isn’t yet a cure for this, but the disease is preventable.
Human Immunodeficiency Virus is a virus that attacks our body’s immune system, and over time, weakens our immune system to the point where it can no longer fight off bacteria, viruses, parasites, and even cancers. These diseases, known as opportunistic infections, can progress in the body of a person living with HIV and become what is known as Acquired Immune Deficiency Syndrome, or AIDS. While those living with HIV do experience difficulties, HIV is now considered a long-term chronic illness that can be treated to help prolong and improve quality of life for those living with HIV/AIDS.
HIV is known to health professionals as an “episodic disability”, which means that for people living with the virus, symptoms can fluctuate unpredictably. Some common symptoms include muscle weakness, fatigue, changes in sensation in the hands and feet, decreased concentration and thinking, digestive problems, chronic pain as well as depression or anxiety. As symptoms can vary, people with HIV / AIDS can experience difficulty carrying out everyday activities like taking care of themselves, managing at home and attending work.
Occupational therapists support and empower people with all forms of disabilities and can assist people living with HIV to better manage in their desired activities despite unpredictable and on-going symptoms. In fact, occupational therapists work with those living with HIV by helping them to: manage their energy despite pain and fluctuating symptoms, find ways to adapt to tasks to make them more manageable, obtain devices that can improve safely and independence when completing daily tasks. Occupational therapists can also help people manage the emotional consequences associated with the condition, and can develop strategies to assist with cognitive changes should these exist. Another great way occupational therapists are helping those with HIV is through education and by providing strategies for them to be able to self-manage their disease. This is essential since HIV is a long-term illness. For more information about HIV/AIDS, check out the links below, or talk to an Occupational Therapist about how we help.
Recently on our blog we discussed the important occupation of sexuality in our post: “Occupation Is: Sexuality.” As issues of sexual dysfunction, or impaired intimacy, can be common for people with disabilities, we wanted to share a valuable resource that addresses just that: The Rose Centre. “The Rose Centre is a charitable organization that focuses on positive representations of love sex and disability. We recognize the multiple barriers to participation in love sex and relationships for disabled people and the lack of positive discussion around disability and sexuality. We also believe that sex and relationships can be fun and enjoyable for anyone. The organization provides programming and events which support this mission and that are open and welcoming to everyone.”
We encourage you to check out their programming and use this resource if and when you need it.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Remember: Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living (again, therapy for living, who knew?). In keeping with my theme for October, in celebration of OT month, I will continue to explore the journey of “occupation” from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
Okay, so you are up, out of bed, heading to the bathroom. “Occupation” is also the process of managing personal care tasks involved in toileting, grooming, showering or bathing, and dressing.
Assume you have reached the bathroom. What happens if your back is too sore to bend you towards the sink, or the toilet is too low and you don’t have the lower extremity mobility or strength to crouch to that level? Or, maybe you have lost bowel and bladder abilities and you are required to toilet differently? What if when you look in the mirror your thoughts start racing to negative, derogatory or harmful comments about yourself? You want to shower or take a bath, but you can’t stand that long, can’t get your cast wet, or have hypersensitivity to the water hitting your skin. Maybe you can’t get to the bottom of the bathtub, or even if you sit to shower, can’t reach your shower head, lift your shampoo bottle, or lack the arm, hand and finger abilities to scrub your body or your hair. If you are using a wheelchair or commode, maybe you can’t even get into the bathroom in the first place, or if you can, can’t get into the shower, under the sink, or can’t see yourself in the mirror. Or, perhaps your depression limits your motivation to shower, or to brush your teeth or hair in the first place.
Maybe you have managed to do your grooming, toileting and washing. What if you can’t get dressed? Perhaps you are on the main floor because you can’t do the stairs, but all your clothes are in your upper bedroom. Or, your clothes are not clean because you lack the ability to do so. Maybe you dresser is too high, or too low, or you can’t reach the shelves in your closet due to pain, limited strength or mobility. Putting on a bra requires significant shoulder movements and putting on socks requires flexion and external rotation of the hips, or bending, and you can’t do any of that?
Occupation is all of that, and these things are addressed in occupational therapy. If you can’t use the toilet, perhaps you need education, supplies or help to manage briefs, urinals, catheterizations, bed pans, disimpaction, a colostomy, ileostomy, or suppositories. Maybe you need a commode beside the bed because your bathroom is not accessible, or you don’t have a toilet on the level of the home you are required to sleep on due to limited mobility. What if the commode you do have won’t fit over the toilet, or even through the bathroom door? If you can get in the bathroom, but the toilet and sink are not usable for you, perhaps devices would help to correct this, or you need education on alternatives. Perhaps your shower or bath needs some adjustments to help you transfer into / out, to sit to shower, or to reach the shower head. Maybe the shampoo and soap bottles need to be changed or relocated. A reacher may help you to access some of your clothing, or you need education and support to rearrange your things to promote your independence. Education and equipment for dressing may help to reduce your need for assistance with dressing your upper and lower body. No motivation to do these things in the first place? Solutions can include cognitive, emotional and behavioral strategies and supports to change thinking patterns, reengage the psyche, and to restore normal routines.
Spoken quite simply – occupation is going to the washroom, grooming, showering and dressing, and if these things are a challenge for you, occupational therapists treat that.
Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Back by popular demand and in recognition of Occupational Therapy Month we are re-running our series “Occupation Is.” I will be spending the month of October defining the word “occupation”. Why? Because, contrary to the traditional understanding of the word, occupational therapists define this differently. For us, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for this month, I will explore the journey of “occupation” complete from morning to night, highlighting how OT’s help when things breakdown along the continuum that is living.
I assume the routine for most of us is the same. Morning hits, we hear the alarm clock, snooze it a few times, and eventually swing our legs over the bed, stand, stretch and head to the washroom. Sounds easy, right? But what if it isn’t?
What if you have had a terrible sleep? Perhaps you live with chronic pain and cannot get comfortable in your bed. Or, you have an acute injury and are trying to sleep on broken ribs, while wearing a cast or sling, or with bruises, scrapes, or swollen body parts. Maybe you live with anxiety, depression, or have trouble controlling your thoughts when you try to drift off. You have restless legs, or are on medication that makes you sleep too much, or causes insomnia. You are worried about something, someone, or have a child, spouse, or family member in your home that might need you during the night. Tomorrow is a big day and you are excited or nervous. You have neighbors that are too loud, or are spending the night in a shelter because you have nowhere else to go. Really, obtaining a restful sleep is actually difficult.
Assuming you have slept, and recognize the alarm is going off, what if you can’t just “throw your legs over the bed, stand and stretch”. Then what? Do you have or need support or devices to make the transition from lying to sitting, from sitting to standing, to a walker, cane or onto a wheelchair or commode? Perhaps your depression or anxiety makes it extremely difficult to transition out of bed to face the day, or to start your morning routine. Maybe you need to stay in bed for an extra hour because the amount of sleep you got just won’t cut it for challenges that day will bring.
Occupation is all of that and as such, these things are addressed in occupational therapy. Why are you not sleeping? Can we assist you to obtain a better sleep surface? Can we educate you on how to obtain a restful sleep position by suggesting changes to how you are lying, or through the use of pillows or wedges? Can we help you to shut your mind off through progressive muscle relaxation, meditation, natural sleep remedies, or by assisting you to obtain medical assessment and intervention? Can we aid in reducing your stress such that you are more at ease when trying to fall asleep, or so you won’t wake as much during the night? If you are sleeping through your alarm, or can’t motivate yourself out of bed in the morning, perhaps we can provide you with cognitive and behavioral strategies to re-frame that process to enhance your success. If there are physical barriers to positioning in bed, sitting, transferring or standing, we can prescribe equipment, aids, tools and support to ensure this part of your morning routine is safe, to promote independence, or to assist your caregiver.
Spoken quite simply – occupation is getting out of bed in the morning, and if this is a challenge for you, occupational therapists treat that.
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.
American Association of Occupational Therapists (2011). https://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/MH/Facts/Oncology%20fact%20sheet.pdf
Canadian Cancer Society (2013). http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=on