OT & JA

Today is one of the most important days of the whole year. Why, you ask? Today is the 241st birthday of one of the greatest (arguably THE greatest) author of all time. I mean, of course, Jane Austen. As if you needed clarification. And what does Jane Austen have to do with OT? Um, basically everything. No big deal.

First of all, Jane Austen wrote books. Literature. For reading. Reading, as you know, is an occupation. One of my favorite leisure occupations. But, there is actually a deeper connection to OT than that. Let's first take a look at the use of the word "occupations" in occupational therapy. We take it to mean anything and everything that takes up your time. However, in the non-OT world, "occupation" simply means your profession, where you work. Here's the thing: it's only in the past 50 or so years that the word has become so specific in the non-OT world. OT officially became a thing in 1917, back when occupation still meant any activity that takes up time. And, as Jane wrote long before that, in the 18th century, it applies to her writing as well. Which, as you will see, is important. In every single one of her six primary novels, she mentions occupations. And not just mentioning it in passing, but the importance of occupations to health and leading a meaningful life. (Note: I will not be covering all the novels in this post, but you can take my word for it that occupations are in all of them. Or even better, don't take my word for it, and read the books for yourself!)

If you have not read Jane Austen before, I now charge you to do so. However, until such time as you do, I will give you a quick overview of what she wrote and who she wrote about. Though sometimes placed in the "Romance" literary genre, that is about as accurate as saying that OT's only address people's professional occupations. The actual categorization is "comedy of manners", which is a fancy way of saying that Jane specialized in witty satire, often aimed at various aspects of society in the late 18th century. And believe me, it is funny. Unlike this blog, it will actually make you laugh out loud. While also being incredibly well-written, and featuring some of the most brilliant and relatable characters you will ever have the privilege of reading about.

In Mansfield Park, we hear of the importance of reading, to the heroine, Fanny, in distracting her from her current unhappy state in life. "There is nothing like employment, active indispensable employment, for relieving sorrow. Employment, even melancholy, may dispel melancholy, and her occupations were hopeful."

In Emma, occupation is used in the context of that important ADL, eating, and to describe those thrilling activities that ladies were expected to engage in in the late 18th century. "Women's usual occupations of hand and mid will be as open to me then as they are no; or with no important variation. If I draw less, I shall read more; if I give up music, I shall take to carpet-work." This is Emma, our heroine, describing how age does not have to change one's occupations. So very accurate.

In Persuasion, the concept of occupations takes on a more mental health-centered meaning. " You have always a profession, pursuits, business of some sort or other, to take you back into the world immediately, and continual occupation and change soon weaken impressions." Meaning that staying occupied is a way to cope with stress and depression.

And it is in Persuasion that I would like to take a closer look at a minor character, who, while not an OT in title (obviously, because OT hadn't been officially "invented" yet), definitely fits the description of an OT. She is a nurse, filling the qualification of providing medical care, and she cares for one particular woman who is quite ill and has lost the use of her legs. I explain it all in my own words, but Jane's are infinitely superior. The following is spoken by the woman who is receiving care:

"As soon as I could use my hands, she (the nurse) taught me to knit, which has been a great amusement; and she put me in the way of making these little thread-cases, pin-cushions, and card-racks, which you will always find me so busy about..." 

So, she is helping her client, who has a disability, occupy her time with a meaningful occupation, in addition to helping her find a way to earn a little income. All as part of the healing, recovery, and coping process. Guys, Jane Austen wrote about OT. Over a hundred years before it was even a thing. Which goes to show, that although our profession is only just now approaching its 100th birthday, the values and concepts of our foundation have been around for much longer. Probably forever, really. But I don't have the time to do that kind of research.

A Farewell to the Classroom

And we are back after a brief hiatus. The hiatus being somewhat unplanned, but not unexpected due to the whole being-in-the-last-few-weeks-of-grad-school-thing. And apparently, as I have found, being in the final weeks of grad school is a constant battle between lack of motivation and extreme panic about one's lack of motivation. Being so completely over sitting in class and listening to lectures, but also slightly horrified at the thought of being out in the field and entrusted with others' well-being. An emotional roller coaster is, I think, how one of my classmates described it. Which is really quite appropriate, because, graduate school as an entity is (or has been), an emotional roller coaster. Only fitting that the last few weeks should encompass that characteristic.

Thus, because the end is near, and I am a naturally-nostalgic person, I have decided to dedicate this post to a summary of the OT graduate school experience. Also, because we are a less-well-known profession, most people don't know what our graduate experience is like. And, especially in the area of healthcare, it's always nice to know what your doctor, therapist, nurse, etc. had to go through to be able to provide you with care. Gives you a better appreciation for them, I would think. 

My first semester of graduate school started in June of 2015. Because we are a 2-year program, we have three semesters a year (Spring, Summer, and Fall). As much as I would love to go through and detail every course we took, I am just going to highlight a few...

I would be remiss, of course, if I did not touch on our wonderful adventure with Gross Anatomy our first semester. Gross Anatomy is your regular Anatomy course, with cadavers added into the mix. We learned and memorized every organ, muscle, bone, blood vessel, and nerve, both on paper, and on the six cadavers in the lab. So the majority of my summer was spent in the lab with dead bodies, no big deal. It was great. Not only do we know the functions and locations of all the muscles, blood vessels, organs, and bones, but we can also visualize them on our patients. That sort of thing is invaluable.

The following semester, Fall 2015, we took our first official "OT lab". We learned transfers to and from all surfaces (bed, toilet, shower, chair, etc.) for multiple diagnoses. We also learned adaptive dressing techniques for a variety of different diagnoses. All of these skills were then put to the test through lab practicals, in which we were given a case scenario, with one of our professors playing the part of the patient, and we had to perform all or some of the skills I have just listed. Lab practicals are the most terrifying thing about OT school. All the pressure, all the stress. Because it's pretty much giving you an indication of how you would function as a therapist in the real world, with a real patient. But, the beautiful thing is, after you're finished with the practical, you have this surge of confidence in yourself and your abilities as an OT. It's very encouraging. Throughout the program, we took about 12 lab practicals.

It is also important to mention our psychosocial courses. OT's focus on the whole person; mind, body, and soul, therefore, it's important to have an understanding of the role psychology plays in our profession. In fact, it's so important that we had both a lecture class and a lab dedicated to the subject. There, we received a thorough overview of various psychological diagnoses, detailed training on interview techniques, as well as the opportunity to run our own group therapy sessions.

Along with the psychosocial aspects, it's also important to mention our focus on the musculoskeletal part of OT. After this most recent semester, I now know all the things (theoretically all the things) about various upper body injuries such as carpal tunnel, tennis elbow, golfer's elbow, shoulder impingement, and about 30 other diagnoses. All the things being what each one is, signs and symptoms, causes, prognoses, diagnostic testing, and treatment. We also learned splint fabrication, and I now have three custom-made splints that are the result of much blood, sweat, and tears on my part (The sweat part is real. Splinting requires boiling the material to make it moldable, so it was pretty hot in the classroom that day.).

I would really love to cover a few more things, but as I am already testing your reading endurance, I will just mention one more aspect of the program that is particularly important. And that would be my classmates. There's something about spending every waking hour in a lab inspecting dead bodies, while all of your non-OT friends are on summer vacation, that tends to bring people together. There's nothing quite like waiting in line outside the room to perform your lab practical, pacing back and forth, and babbling about random topics like The Office, with people who are experiencing the same pre-practical anxiety. Or sitting in class after a professor sped through 100 Powerpoint slides in an hour and a half, and the professor asks "Are there any questions?", and you can almost hear the crickets chirping in reply. And not just the classmates, but the professors themselves are an integral part of the experience. Where else would your professor invite your project group to her house and make you a delicious homemade meal? Or, let's talk about the fact that we have each one of our professors' personal phone numbers. What I'm really trying to get at, with all of this rambling, is that there is no way I could have been successful in grad school had I not had 38 other people going through the same thing with me. There is no way I would have recovered (psychologically and academically) from a few disappointing grades without the support of my professors, who are just as concerned about my success as I am.

Although I am extremely excited to move on to the next stage of my OT adventure, fieldwork, I can't help but be a bit melancholy when I think about all the wonderful people I won't be seeing everyday anymore. But, once again, knowing that all 38 of my classmates are going through this transition too, gives me comfort and confidence. Because I know that each one of them (including me) are going to be stellar OT practitioners. 

Thankful for OT

As it is Thanksgiving, I thought I would take this time to reflect on an OT experience that I had earlier this year, that I am endlessly thankful for. Of course, I am thankful for every OT experience I have had, but I thought this one might offer a somewhat unique view of the profession. Thus, I present to you a (rather long) summary of my time in Ecuador this past summer, where I worked with individuals with Hansen's Disease...

(Names of patients have been withheld to uphold HIPAA)

“You are all beautiful flowers. You are a lovely garden.” These are the words of M. Said to us after we took him through his exercise program to help with his lower back pain. The beauty of the moment was somewhat lessened by one of my teammates looking around for the flowers. It took a moment to explain the nature of metaphors and but understanding was eventually attained by all. Nevertheless, these were not the first nor the last poetic words of gratitude that we heard those five days we were at the Damien House. The kindness, love, and thankfulness that we experienced that week were unlike anything I had experienced before. 

The Damien House provides inpatient services to around 20 residents with Hansen’s Disease (leprosy), as well as outpatient services to non-residents with Hansen’s Disease. It is located near downtown Guayaquil, Ecuador. The group from our university consisted of 9 OT students, 9 PT students, and an OT faculty member and a PT faculty member. During our time there, we provided OT and PT services to both the inpatients and the outpatients of Damien House. 

A typical day in the clinic started around 8:30 am. We walked the couple of blocks from our hotel to Damien House. Upon arriving at the Damien House, we were immediately greeted by the gatekeeper, who was usually one of the residents that we had treated, or were going to treat. They unlocked the gate and let us into the courtyard. Every day, without fail, our second greeting came from an elderly man named S. S is also one of the residents at the Damien House and he was there every day to greet us with a hug and a kiss on the cheek, the typical greeting in South American cultures. 

For working in the clinic, our rather large group was divided into teams of four—two OT students and two PT students. This gave us the awesome opportunity to work with the professionals we will most likely be working with when we graduate and plunge into the real world. And of course, we had to have team names, mine being Team Zapatos. Zapatos, the Spanish word for shoe, used by us because our first task as a team was to sort the donated shoes our group had brought for the patients. And, we soon found out that our zapatos work was not over. My team’s job on Monday, the first day of clinic, was solely to distribute shoes to each of the inpatient residents at Damien House. Which proved, in some ways, to be a more difficult job than we had imagined. Some of our patients decided very quickly which shoes they wanted. We had one man, J, who came in requesting a pair of “zapatos amarillos”, or, yellow shoes. As luck would have it, we did have one pair of yellow shoes; some snazzy banana-colored Converse with red laces. J was ecstatic. Others took time to deliberate and try on many different options before finally making a decision. E tried on many pairs of tennis shoes before she decided that she would like sandals instead. After many pairs of sandals, she settled upon a silver pair, which she pronounced “muy sexy”. 

Although it was fun helping find new shoes for everyone on Monday, we were excited to be in the clinic for the next few days, finally putting our school smarts to good use (more or less). Needless to say, there were triumphs and there were letdowns. I wish I could tell you about every single patient that we saw here, but that would take a book. So, I will relate just a few important and meaningful points at this time. 

Overall, many of the patients’ complaints were similar. Hansen’s Disease (HD) is a bacterial disease that affects primarily the skin, nerves, and eyes. So, we dealt with a lot of neuropathic pain and loss of sensation in the clinic. Although many of our assessments and treatment interventions were similar from patient to patient, it never felt repetitive. Because each person we worked with was unique and different. For the most part, the outpatients traveled around 2-3 hours to come to Damien House. That trip usually included both walking and bus rides. They got to the clinic around 8:30, and would wait there until we were able to see them, sometimes not until the afternoon. Thankfully, the Damien House serves lunch to all inpatients and outpatients that are there that day, but that doesn’t detract from the fact that they have to take a day off work and wait for possibly a long time until they can see us. It’s rather intimidating for someone who’s still just a student! But any intimidation is lost once we interact with the patient. Each person we treated was incredibly kind, patient, and grateful for whatever services we could provide. I can make that generalization without any worry of exceptions. 

Often, as an OT, I was teaching the patients energy conservation strategies and ways to relieve pain, and assessing sensation and performance of functional tasks. At one point, I did get the chance to take range of motion measurements for a patient’s fingers. When I learned it in class, I was not a fan, and therefore never thought I would be excited about something like that, but I was ecstatic. It makes such a difference to see the practical application in action! We had also recently learned about using support hose (TED hose) for patients with swelling and pain in their legs. TED hose are notoriously difficult to put on, because they are extremely tight. When I did a week of fieldwork at a skilled nursing facility, I heard at least one patient complain about wearing TED hose at least once a day. I ended up providing two patients at the Damien House with TED hose, teaching them how to put them on and when to wear them. The first man said, “My legs feel so fresh, so much better!” The second woman started crying and explained that she often feels down about herself because she feels like she can’t walk well because of the pain, but she felt so much better with the TED hose. 

My other notable triumph was the successful building of a rolling walker. And by building, I mean taking all the parts out of the box and following the directions to put them together. For someone who has not built many things and avoided building things, it was very exciting. Even more exciting because I put together the walker for an elderly resident of the Damien House, A. He had used a walker in the past, but it broke. Since then, he had been walking with a cane, but had fallen multiple times. A had a lot of anxiety following the falls, and had been using a wheelchair since. We taught him how to use his shiny new red walker, and then took him out for a trial walk around the courtyard. “Ready to sit down?” we asked him after taking a lap. He responded with an enthusiastic “no”, and informed us that he wanted to keep walking. Which ended up lasting for another 20 minutes. It was beautiful.

I would be remiss if I didn’t mention the wonderful leisure opportunities the residents at the Damien House provided us with. On Wednesday, we spent an hour and a half in the afternoon playing Dominoes with R. Every time, R counted up the dominoes that had been played, and the amount of dominoes left, and was able to accurately identify who the winner would be. On Thursday, we played a lively game of “ladder golf” (or “escaladra”, as they call it at the Damien House) with G and M. Escaladra is a huge hit at the Damien House, and we had quite the little crowd cheering us on during the game. 

Throughout the week, I had moments where I realized just how difficult it would be to leave all these wonderful people. This feeling increased as the week wore on, and on Friday, our final day at the clinic, I realized just how fast our time there went by. It had seemed like we had just got there, but in reality that was about 50 pairs of shoes, 100 patients, and 100 SOAP notes ago. We had accomplished so much, but there was still so much to do. There will always be so much to do. The difficulty is choosing what is most important and focusing on that in what little time we are given. Which I just realized is basically a rewording of Gandalf’s famous “all we have to decide is what to do with the time that is given to us”, but that only makes it all the more true.

On Friday, the residents of the Damien House threw us a party to thank us for our work. They showered us with gifts, and each resident had the opportunity to say a few words of gratitude. There were very few dry eyes in the room. It also seemed incongruous, because I think we all felt like we should be the ones thanking them. Our work there seemed small compared to the outpouring of love we received from them. Thankfully, we also got a chance to express our gratitude to the people at the Damien House. It was difficult to put into just a few words everything that they had done for us. One of my classmates said to them, “We came to serve you, but you ended up being the ones to serve us, and change our lives.” I think this expresses some of those feelings very well. It was sad to leave all our new friends, but there was so much love and meaning in the relationships that we had formed, that it felt like we would bringing them all with us. They promised us that they would never forget us, and I can very easily say that I will never forget them. 

The Importance of People

And we come to our final week of Areas of Occupation: Social Participation.

While this can be considered a part of many of the other areas of occupation, OT's recognize that, because social participation is so important, it deserves its own category.

Humans are, by nature, social beings. Some of us may not always think of ourselves as social. I, for one, would much rather stay in and watch a movie and eat cheese puffs, than go out clubbing on a Friday night. But just because we enjoy periods of solitude does not mean that we are necessarily anti-social, and it especially does not mean that we do not need socialization at any time ever. Quite the opposite, in fact.

I think that all of us can admit that, while there might be moments where we wish there were no other people in the world, that to be alone without human contact would be incredibly lonely and debilitating, in many ways.

The American Occupational Therapy Association breaks social participation down into three parts: community, family, and peers/friends. Therefore, as OT's, we concern ourselves with how our clients are able to socialize in these three areas, and what we can do to facilitate that socialization, if it is lacking in any way.

This is significant, because we work with people who are experiencing, or recovering from an illness, or have a disability. And, so often, these are the individuals who are forgotten, or separated from friends or family, or unable to get out in the community to visit and socialize. Think about someone in the hospital, and after a while, people visit them less and less frequently. Or an elderly person who is unable to drive, and therefore cannot leave their home to visit their friends. Or a child with Autism who does not have the social skills their peers have, and are consequently left out and ignored.

I don't this to be a downer, but I do want you to think about the importance of having people who care in your life! Which, we all know, and it's super cliche, but sometimes it's good to take a moment and think about it. Especially a week before Thanksgiving.

Anyway, here's the great part. Helping the people in each of these situations is part of an OT's job! (Like you needed me to tell you that.) OT's recognize the importance, and the healing benefits, of social participation. Thus, we can organize group activities for individuals during long-term hospital stays, giving them opportunities to socialize and make friends. For those who struggle with getting out in the community, we can help them find alternate ways, such as using public transportation, or helping them organize it so that their bridge club meets at their own apartment. For a child who struggles with social skills, we can develop a program to help them practice, and figure out strategies for recognizing social cues.

Aaaaand, that's all the time we have for today, folks! My busiest week ever is drawing to a close, and tomorrow my group and I will present the results of our year-long research project. Cheers until next week!

All Social Participation occupation area information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.T

The Right to Play

Today's post is very awesome and very important, because it is about the areas of occupation that are Play and Leisure. The same, you say? Well, yes. The term Play is usually used only when talking about children, while Leisure is used only with adults.

Play is the most important area of occupation for infants and children, which is really fun to think about, and important to remember. Of course, ADL's and academics make an eventual appearance, but play is first and foremost until then, and still plays an important role afterward. And, as if having play as an area of occupation wasn't enough, OT's go even further and break it down into two categories: play exploration and play participation. Play exploration means making choices about how to play, what to play, and who to play with. It also involves the discovery process of using your imagination and coming up with new ways of playing. Play participation is the actual act of playing.

In 2008, the American Occupational Therapy Association (AOTA) released their "Societal Statement on Play". And in this document are a few points that I'd like to touch on regarding children, play, and OT. The first is every child as the right to play. This is so important, because not only should kids be allowed to be kids, but "play is the context for children’s development and is fundamental to their growth and learning from infancy through adolescence, contributing to their physical, cognitive, social, and emotional development". And this right to play is put at risk by so many things in today's world, whether it be passive electronic entertainment, unsafe outdoor and playground spaces, neighborhood violence, and elimination of school recess, to name a few.

So what can OT's do with play? It would be better to ask what can't OT's do with play? As previously mentioned, there are many factors in today's world that put children's opportunities for play at risk. As OT's, we have to be advocates for our pediatric clients who may not have appropriate opportunities for play. In school settings, we can collaborate with teachers and staff to make sure that healthy recreational activities are a part of every school day. In the community, we can offer events and clubs that offer opportunities for play. We can help parents find ways to engage their children in activities that promote playfulness.

In other service areas, OT's do a lot of work in what is known as Early Intervention, which is for children ages 0-3. And, since we're OT's, and since play is the primary occupation for a child that age, that is what we focus on in therapy. An OT might provide treatment for a child with low vision, helping them explore, learn, and play in their environment using senses other than vision. Or work with a child with developmental disabilities and develop toys and games that will facilitate playful behavior. Or partner with the parks and recreation department of a city to develop and build a playground that is completely wheelchair-accessible.

On to Leisure, the more grown-up-sounding word for "play". Funny enough, we divide that into Leisure Exploration and Leisure Participation, just like we did for play. And they are basically the same, exploration being finding and choosing activities that bring us joy, and participation being taking part in those activities.

And though we don't put as much emphasis on leisure as we do for play, leisure is just as important for our lives as healthy adults. It's important to have those hobbies and activities that bring us joy and add meaning to our lives. Many times, when people become sick, or have a disability, this affects their participation in their hobbies. As OT's, we might be working with them to address the medical aspects of their condition, and focusing on mostly on ADL's to get them back to their necessary activities of life. BUT, we also have to think about the other parts of their lives, like their leisure interests. OT is inherently a profession of creativity and resourcefulness, and thus we will often make adaptations or create adaptive equipment for our patients. This is no different in the area of leisure.

An OT might make a card holder for someone who loves playing cards with their friends, but no longer has the ability to grasp the cards due to arthritis. Or help a patient with quadriplegia build their muscle tone and develop the skills to play wheelchair rugby. Or help someone who uses a wheelchair develop a plan and strategies for taking a fishing trip on the river. The list truly is endless.

Thanks to everyone who has been reading--I very much appreciate it!! Also, next week will be a short post, due to the fact that I have a lab practical, 2 exams, a quiz, and then our final capstone presentation on our yearlong research project.

AOTA (2008). AOTA’s societal statement on play. American Journal of Occupational Therapy, 62 (6), 707

All Play & Leisure occupation areas information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

From School to The Office

"So, occupational therapy. Is that, like, helping people find jobs?"
I cannot tell you how many times I have had someone respond in kind when I say I'm in school for OT. Because, these days, you hear the word occupation and you immediately think jobs, professions, all that good stuff. Buuuut, as you are learning (by reading this blog), that isn't exactly accurate.

Well, today is the day for all those who thought occupations only meant the things you do everyday to earn money to support yourself. Today, we are looking at the areas of occupations that are Work & Education. Technically separate, but they pair together well.

Education is fairly self-explanatory. School, learning, you get the idea. School-based OT is a huge part of OT practice. In fact, it comprises one of the top three settings OT's work in. School-based OT is all about helping students achieve success in the school environment and curriculum. This includes working with children from preschool through high school, and on into college. And, as always WHAT we do in therapy depends on the needs of the student! Because I highly interested in school-based OT, I have been doing some volunteer-consultative-OT work at a preschool. (Which sounds way more pompous than it is. Basically, my classmate and I, in addition to one of our professors, have been meeting with the teacher and education coordinator to develop some tools and strategies to help the students prepare for kindergarten. It's lots of fun!) Thus far, we've evaluated the current skills of the students, and made a few things to help improve various fine motor skills (i.e. using tongs to pick up pom-poms, which helps develop the grip strength they'll need for grasping writing utensils, using a few basic shapes made out of felt to form all the letters of the alphabet, etc.).

And, again, school-based OT is that it's not just one thing! Sometimes it's fine motor for handwriting, other times it's gross motor for participating in more physical activities like P.E. and recess. Sometimes it's making modifications to the classroom environment to make it less distracting and increase a student's ability to stay focus. Other times it might be helping students with disabilities transition from elementary to middle school, high school to college. The list is endless!!!!!!

And, because it's endless, I should probably move along to the next area of occupation.

When it comes to work, OT's can end up working with people at many different stages and situations in their professional lives. OT's have extensive knowledge and expertise about life transitions, so they may be found helping their clients find jobs. OT's are also instrumental to getting people back to work after an injury or illness, and are often the ones to carry out work comp assessments and make recommendations for rehab based on their findings (and then, of course, carrying out that rehab, usually in conjunction with a PT).

Companies are continuing to recognize the importance of preventative care for their employees. Which is brilliant, and great, because, in the long run, it is more cost-effective to spend funds on preventative measures than on medical care after employees are injured or ill. Of course, it shouldn't be about money. So we'll ignore that part. The reality is that it's just better health practice to prevent decline, rather than waiting for it to happen before stepping in! And, while OT's treat health decline that has already happened, it is also part of our job to work in the prevention aspect. So, many factories keep an OT on staff for that purpose.

Offices also hire OT's to do environmental assessments of their workspaces. (And this always makes me giggle, because I think of that episode of The Office.) But, for real, carpal tunnel is no joke! And neither are back and neck problems! In an environmental assessment, OT's look at all aspects of the environment, in addition to the employees working in that environment. And, using their findings, they come up with modifications (more supportive chairs, better lighting to reduce strain on the eyes, etc.) and strategies to promote general health among employees (exercise programs to combat obesity, healthier options in the vending machines, etc.).
Further proof that OT's can be at home just about anywhere!!

All Education &Work occupation areas information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

A Snooze-worthy Subject

Happy World OT Day!!
October 27th, in case you're like me and can't keep track of what day we're on.

And, today we also return to the world of occupations! As promised, this week is Rest & Sleep. Two beautiful words. Beautiful, but often elusive.

Most people have, at some point, experienced difficulties with sleeping. Whether that be problems with falling asleep, problems with not waking up on time, problems with sleep quality--the list goes on and on. And, many people don't think about the ways they can change their sleep patterns or prevent/eliminate some of these issues. Lots of healthcare professionals can help with this. As OT's, we aren't able to prescribe medications or sleep devices. But, we can empower our clients by helping them pinpoint the problem and think of functional and accessible ways to improve their sleep quality. And, of course, as OT's, these strategies often involve occupations.

You're having problems falling asleep? An OT might go through your nightly routine step-by-step. (This is called activity analysis, and OT's do it all. the. time. Sounds simple, but it's actually quite complex. More about that another day!) As a result of this activity analysis, your OT might recommend you stop using your phone an hour before going to bed. Or do some deep breathing and stretching exercises.

Maybe you have a lot of aches and pains when you wake up. An OT might show you alternative sleeping positions that will put the least amount of stress on your body.

What if you're an elderly person with low vision and poor balance and you get up at night to use the bathroom? An OT might do an environmental assessment of your home and recommend you rearrange your furniture to make your nighttime adventures safe. (Yes, this falls under the home mobility section of ADL's, but it flows into this area of occupation as well.)

And, what if you're in a Nightmare on Elm Street movie and Freddie Krueger is terrorizing your dreams? An OT would definitely fight Freddie for you. 100%.
(Sorry, what with the proximity to Halloween, and my love of horror films, I couldn't help myself.)

What about rest? Don't worry, I hadn't forgotten about it. Also, it's not the same as sleep, although the two words are often used interchangeably. In OT world, rest is composed of two things. The first part is recognizing the need for withdrawal from activities in order to recharge your batteries (both mentally and physically), so to speak. The second part is the occupation that you choose in order to recharge. And, like all things, it's different for everybody! Reading, watching Netflix, listening to music, exercising, coloring--the list is infinite!

Here's a cool thing. The role of OT in rest activities is also extensive. We might help a client find restful activities in order to improve their mental health. We might help someone participate in their favorite restful activities after something has happened that makes it difficult for them to do so. For example, take someone who has experienced a spinal cord injury and is unable to hold a paintbrush, and painting is their favorite restful activity. An OT could figure out alternative ways for them to hold the paintbrush. Pretty cool, right?

Happy resting (and snoozing)!!

All Rest & Sleep occupation areas information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

A Necessary Tangent

I have debated, at length, with myself about the topic of today's blog. I had something I really wanted to share, but I wasn't sure if my readers would be ready for (or interested in) a more personal post. And then I figured, after all, this is my blog. I can do whatever the heck I want! Otherwise, I was going to be talking about sleep & rest. Which, as thrilling as that sounds, can wait for another week. While today is, in fact, the perfect day to talk about what I am about to talk about...

And that is bullying. Of course, how it relates to OT (of course), but, more importantly what anyone and everyone should do to combat this.

October is National Bullying Prevention Month. It's something that I have a lot of strong feelings about (just ask my family, they've been audience to my righteous fury on the subject more than once). I'm not here to vent or rage, but to speak about this honestly and seriously.

The relation between OT and bullying is quite simple, really. When a child is bullied, or bullies, it has a huge effect on their performance in, well, all areas of occupation. Which, obviously, we haven't covered all of them yet, so here's a list:

• Activities of Daily Living
• Instrumental Activities of Daily Living
• Sleep & Rest
• Social Participation
• Education & Work
• Leisure & Play

And not just short term effects. Bullying creates permanent changes in how people view themselves and the world around them. I would love to go through each area of occupation and how each can be affected by bullying, but this would end up being an incredibly long--and, quite frankly, depressing--post.

Honestly, I'm having a really difficult time writing this post. There are so many things that I want to say, and I want to give this subject the full attention it deserves. But, at the same time, I would probably go on and on, metaphorically forever if I did that. And it still wouldn't be enough. 

So, I'm going to ask two things of you. 

First of all, I want you to take a look at this website and educate yourself:

https://www.stopbullying.gov/ 

Educate yourself so that you can recognize bullying and know the proper steps to take in order to put a stop to it. 

Second is a request for kindness. As with everything else (and to quote Zootopia), change starts with you. It's important to examine our own actions and thoughts before trying to change those of others. And for the issue of bullying, it can be as simple as being kind. Kind in all things, to everyone that we meet. Making sure everyone feels loved, respected, and included. If we can do that, we are on our way to changing the world. Which, I understand, is a super cliche thing to say, but I firmly believe it to be true.

Cookies & Cars

Last week I talked a bit about Activities of Daily Living, or, ADL's. All of those foundational things you do to maintain your health and well-being, and function in daily life. Like brushing your teeth, tying your shoes, all that good stuff. Yes, of course, you remember, you're not stupid, I get it. Just thought a review would make a good segue into the focus of this week...

...Instrumental Activities of Daily Living. IADL's. Yes, I know, it's so completely different from ADL's, because we added an I (for instrumental, if you follow me). Very complex and fancy. And, actually, IADL's can be fairly complex and fancy.

IADL's also happen on a daily basis, like ADL's. However, they are more complex than ADL's, and consequently require more thought. They're difficult to define, but easy to give examples of. Here are a few:

• Cooking & cooking clean-up
• Child rearing
• Caring for a pet
• Talking on the phone, sending emails, anything that involves communication
• Managing finances
• Shopping
• Community mobility (driving, using public transportation, etc.)

So, basically, we're still talking about those necessary activities that keep you successful in your daily life, but we're widening the scope into those areas that require more steps, more resources, and (often) more work (mental and/or physical). You can differentiate them from ADL's by thinking about the amount of thought you put into something like tying your shoes, in contrast to balancing your checkbook. Caring for just yourself, versus caring for your child. Getting around your apartment, versus getting around the city.

And, here's a big surprise: OT's are all over the IADL business. This can take an infinite number of forms, but one of my personal favorites in the IADL biz is community mobility. As alluded to above, this means getting around the community. An OT focusing on community mobility with a client may help them learn how to use the bus system, taking bus trips with them to practice. For someone who uses a wheelchair, an OT might help them map out the wheelchair-accessible spots in town, and devise plans for navigating those that are less-accessible.

Another quickly growing area is driving education and re-education. Currently, I am completely enamored with this last one. I never really thought about how much of a privilege driving is, until I spent time with some people who were waiting to be cleared to drive again after having a stroke. When they were finally able to get back behind the wheel, it was like passing the driving test in high school all over again. Going out to lunch was a big event, because they could drive themselves. If they wanted to make cookies, they could get in the car and drive to the grocery store to get the ingredients. They could go visit their friends and family whenever they wanted. It was huge. 

Of course, this got me thinking about how not being able to drive would be. And I don't mean before taking the driving test in high school, because if you haven't driven before, then you don't really know what you're missing. But being able to drive, and then suddenly not being able to drive. It would mean giving up a huge amount of independence. Relying on other people for errands of any kind. Relying on other people to visit you, instead of you visiting them. Having to stay at home alone because no one's available to drive you to your book club meeting. You get the idea.

So, imagine the thrill of being able to help someone regain that independence! Whether it's helping them re-learn driving, or helping them figure out the public transportation system. Pretty awesome, right?

All IADL information borrowed & adapted from: Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

The Complexity of Daily Activities

New direction for this blog! The first few posts will be mainly OT-educational, for those readers who may not know what OT is, or what OT's do. Those of you who know all the things about OT can skip these first few weeks, or follow along for kicks and giggles, and the satisfaction of reading stuff that you already know!

First, I will be covering the "areas of occupation", as delineated by the Occupational Therapy Practice Framework, 3rd ed. (American Occupational Therapy Association, 2014). Yes, "occupation" refers to your job/profession, but it also means So. Much. More. As occupational therapists, we use the term "occupation" to refer to any activity or task that occupies a person's time. Think about that for a minute.
If you became overwhelmed just thinking about that, then you're on the right track!

And, fear not, because OT has your back when it comes to the vast territory of occupations!
OT has them all nicely grouped into categories (called "areas") of occupation.
And that is what I will be covering in the coming weeks.

We'll start off with the building blocks: Activities of Daily Living. We refer to them as ADL's, because, of course, everything's cooler when it has an abbreviation. Now, I want you to visualize your morning routine. For me, it takes a good 10 minutes to get out of bed because the will is weak in the morning. But once up, I use the bathroom, brush my teeth, get dressed, eat breakfast, make coffee, and stumble out the door. Or some variation of that. If I'm feeling particularly daring, I might eat breakfast before getting dressed, or even, *gasp* go without coffee.
But that's beside the point.
All of you probably have some similar variation of morning behaviors. And it's a pretty simple deal, right?
Those are your ADL's. Self-care, like brushing your teeth, showering, brushing your hair, etc. Dressing, as in buttoning a shirt, putting on socks, that sort of thing. For the sake of being concise, I'll abridge. Eating = ADL! Getting around your house or apartment = ADL! Sex = ADL!
ADL's are the building blocks of our lives. They are necessary to survive and thrive in this world.

Pretty simple, right? Many of these things we may do without thinking about them. They become part of our routine, and that's about it. These activities are nothing special, they just are.

Now, I want you to imagine that you've experienced a stroke, and one whole side of your body is affected. That arm, leg, trunk, and side of your face isn't working.
Now, think about brushing your teeth. How would that task change, if you lost functioning in half of your body?
Fairly drastically, I would imagine. At first, you'd probably need to sit in a chair at the sink, rather than stand. With support, because your trunk control may not be very good. You'd have to figure out a way to unscrew the toothpaste and apply it to the toothbrush with one hand. What about the faucet? Are you able to reach from a seated position to turn the water on? What about getting to and from the sink? What if you lived alone and had no one to help you?
It's not quite so simple now, is it?

It's incredibly easy to take ADL's for granted, until something happens and you're forced to completely change the way you perform these activities. And that's where OT's come in! We're there to collaborate with our clients to creatively problem-solve and find new ways of performing ADL's. We're there to help them regain the strength and skills to return to their original ADL routine. We're there to educate them on use of adaptive equipment like shower benches, and transfer boards for toileting. Aaaaand, I could go on and on. But you get the idea.

So, to wrap-up, I hope this gives you a bit of a new perspective. If you have a slightly greater appreciation for your morning routine after reading this, then I will be quite happy. I also hope this wasn't completely dull and yawn-worthy. But ADL's are pretty cool, so I'm guessing not. Tune in next week for coverage of another thrilling, exhilarating area of occupation! Thanks for reading!

Occupational Therapy Practice Framework: Domain and Process (3rd Edition). American Journal of Occupational Therapy 2014;68(Supplement_1):S1-S48. doi: 10.5014/ajot.2014.682006.

And so it begins...

One really doesn't know quite where to begin with things like this. The obvious answer is to begin at beginning. But what is the beginning? If I knew that, I wouldn't have rambled incoherently for the  previous two sentences.
I suppose the polite thing to do is start by introducing myself. My name is Audrey. I hail from St. Louis, Missouri. I could give you a cute list of my favorite things, but I have a feeling that you'll get a good idea of my likes and dislikes as this whole blogging thing progresses. So I'll leave you in suspense for a bit. One "like" that I will immediately mention is my current course of study. I am in my final year of obtaining my Master's degree in occupational therapy. It's not really a "like", per se, more of a love, a passion, and a lifestyle.
I would imagine that my readers (if any) are probably quite familiar with OT, as they are most likely my family and friends. If that is not the case, however, I am quite prepared to give my official definition of OT. Really, it's super official. It's one of the first assignments in graduate school--coming up with our own definition--because it's usually the first question we hear when we introduce ourselves and mention our profession. (Side note, anyone already familiar with OT can feel free to skip the next paragraph and continue on to the "purpose" section of this post.)
"What is occupational therapy?"
Occupational therapists work with people across the lifespan to help them live life to the fullest. This takes on a unique meaning for each person. Our overarching focus is occupations. An occupation is, very simply, anything that occupies your time. We might do anything from helping someone who has had a spinal cord injury become independent with driving their car, to teaching a child sensory strategies and techniques to help them focus and perform better in school. We practice in many settings; hospitals, schools, nursing homes, outpatient clinics, home health, community programs--just to name a few. In some settings, we work on teams with physical therapists, speech therapists, and social workers. In other settings we might collaborate mostly with nurses, or teachers.
The thing is, OT has such a wide-reaching net, that I could go on and on about what OT is and isn't. But, I'm going to exercise self-control, with the understanding that through this blog, many of these things will be covered eventually.
It's only fair that I should provide some rationale as to why I have suddenly decided to share my opinions with the world through this blog. I'm not even a licensed OT practitioner yet, so isn't it a bit pretentious and presumptuous to put myself in this role? I would say absolutely yes. But, I want to explain why I'm still doing it, despite this. First, this blog is a project for a class. My professional development class. We are supposed to choose a project that will use our strengths and challenge our weaknesses. I love writing and ideas and finding out things. Things I'm not so hot at? Sharing my opinions and putting myself out there. Is writing a blog putting myself out there? It is for me. Despite my love of writing, only close friends, family members, and professors are ever allowed to read it.
At the same time, I don't want you to think that I am writing this blog to pass a class. Because I am, first and foremost, writing it for my own learning and enjoyment. Enjoyment of writing, in general, but also finding and sharing cool stuff about OT.
This is a weekly blog, posted on Thursday or Friday. Academic OT topics will be covered, in addition to other fun things like literature and films that relate to OT, or lesser-known therapy techniques (like my favorite, pet therapy). Most often, topics will be based on research, but there may  be a couple where I draw on personal experiences. And, as this is already a much longer post than I had anticipated, and probably much longer than you want to read, I will create a conclusion. I promise that, in the future, I will try to be more concise! If you are not already bored to death, I invite you to return to this site at the end of this week, by which time I will have posted the first official entry of "A Preoccupation with Occupations". Thanks for reading!