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.