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Exercise During Pregnancy

Amelia Iams, DPT

aquatic exercise during pregnancy

Exercise is important to include in everyone’s daily life, but it becomes even more important when you are pregnant. Pregnancy causes many changes in a woman’s body.  Hormone changes in the body cause softening of the ligaments, joint laxity, and instability in the ankles.  Hormones and anxiety can be the reason for increased mood swings.  Changes in the center of gravity due to a growing belly can cause increased occurrence of back pain.  Increased retention of fluid in the body causes swelling in both the hands and feet and can amplify complaints of constipation.

Exercise during pregnancy provides similar benefits to your body as it does during other times in your life, but it also can prevent and minimize changes in the body and pain or discomfort that occurs when you are pregnant. Some of the proven benefits that exercise during pregnancy includes are:

  • Avoidance of excessive weight gain
  • Maintenance or improvement in endurance, muscle strength, and flexibility
  • Reduction of the likelihood of gestational diabetes
  • Decrease or reduction in symptoms of low back pain or pelvic girdle pain
  • Reduction in occurrence of preeclampsia
  • Decrease in the risk of cesarean delivery
  • Reduction in psychological stress

The American College of Obstetricians and Gynecologists (ACOG) states “for healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.”  That is equal to about 30 minutes 5 times a week of moderate exercise.  Research also indicates that including both strengthening and aerobic exercise to your routine is important to help support the changes that occur in your body with pregnancy.

Despite all the benefits to exercising while pregnant, most women do not begin an exercise program and those who were exercising prior to pregnancy actually decrease their activity during pregnancy.   Through several studies and surveys, women have stated various reasons for decreasing their activity during pregnancy.  The two most common reasons are: not enough time and pain with movement associated with the pregnancy.

Choosing an exercise program that is safe, can be maintained during the entire 40 weeks of pregnancy, and can fit into a busy work and family schedule is a difficult task.   It is recommended that pregnant women avoid high contact sports and activities that have an increased risk for falls or impact, such as soccer, basketball, hockey, snow skiing, water skiing, and off road cycling.  Exercises that require jumping and quick changes in directions, such as Zumba, Cross fit, and trail running, are not recommended due to joint instability brought on by hormones.  Also high impact aerobics can be difficult to and uncomfortable to perform later in pregnancy.

An underutilized exercise avenue is aquatic exercise programs. Several research studies have advocated the use of pool exercises for women who are pregnant.  The natural properties of water help alleviate many of the adverse changes associated with pregnancy.  The buoyancy of the water will help to eliminate the stresses on the joints and to support the abdomen.  Women have reported feeling more comfortable moving in the water and able to assume better postures as a result of the additional support.  Hydrostatic pressure is an additional benefit when exercising in the water.  The pressure that the water exerts on the body helps to decrease the swelling in the limbs brought on by pregnancy.

Aquatic exercise is non-weight bearing and low impact, so stress on the joints is minimized. Water provides natural resistance to movement which helps to strengthen muscles and thereby incorporating both strengthening and aerobic exercise into one session.  This can help you meet both suggestions for a healthy body during pregnancy without increasing the time you spend at the gym.  Many women stop exercising as their pregnancy progresses because of decreased balance, increased swelling in their feet, or pain and discomfort in their back.  The water helps to support the body, and it is not likely that you will be injured falling in the water. Several studies have proven that exercising in the water during pregnancy helps to decrease low back pain and reduce time off from work due to pain and discomfort.  There are many benefits to exercising in the pool that cannot be achieved with land based exercise, therefore making it an excellent option for women during pregnancy.

There are many fitness centers as well as physical therapy centers that offer aerobic exercise classes in a pool and individualized pool exercise sessions. Choosing the right one for you should be based on several factors, such as cost, location, available time, and expertise of the instructor.  In some cases aquatic therapy can be covered through your health insurance when provided by a physical therapist.  A physical therapist can help design an exercise program that is individualized to you.  Other options to consider when choosing a pool are temperature of the water, depth of the water, and air temperature of the pool area.  Exercising in the water decreases your ability to sweat but there is increased loss of heat through skin contact with both the water in the pool and the air temperature difference in the pool room.  It is recommended that pools utilized for aerobic exercise for pregnant individuals be at about 80-86 degrees Fahrenheit.  Most pools at a gym are cooler to allow for longer time and more intense exercise while therapeutic pools at rehabilitation clinics will be warmer and offer increased comfort for those suffering from back pain.

Safety and monitoring your exercise regimen in the pool is important. The properties of water will naturally decrease the heart rate by increasing the volume the heart pumps out.  If you use your heart rate to gauge your exercise, it is suggested that you decrease your heart rate guidelines by 15 beats per minute.  When exercising in a pool is better to gauge your exercise intensity by using a scale called Borg Rating of Perceived Exertion.  A physical therapist can provide you with the scale and educate you on how to use it.  Dehydration with exercise can occur in the pool as easily as it can on land.  Having access to water during exercise can be important to avoiding any complications with exercise.

All exercise programs are most effective when you can choose an activity they enjoy and a program that is individualized to your needs and goals. We highly recommend water aerobics or any aquatic exercise for women during pregnancy. Aquatic exercise is an exercise program that women would be able to follow throughout the entire 40 weeks of pregnancy.

 

Amelia Iams, DPT is a Physical Therapist at FMH Rehabilitation Aspen Ridge in the treatment and management of sports related and orthopedic injuries.


Aquatic Therapy Can Help Get You Back to…

There is no worse feeling than the aching pain that won’t go away, prevents you from accomplishing everyday tasks, and keeps you from doing the activities you love. If you have recently been injured or identified with having a debilitating diagnosis, aquatic therapy may be your answer to a pain-free lifestyle and get back to the activities you enjoy.

Diagnoses for Patients who benefit from Aquatic Rehabilitationaquatic therapy

Spinal Issues: Thoracic, Cervical, and Lumbar Spine Issues, Posture Issues, Spine Compression Fractures, Herniated Discs, and Spinal Stenosis

Imagine you are floating vertically in the pool using a floatation device. Since you are not touching the bottom, the water decreases the effect of gravity on the spine and creates traction. This process removes the pain you are feeling so you can now focus on learning the therapist’s exercises and doing them appropriately. Core stabilization will be the focal point of your exercises as it permits increased trunk/back movement with less pain due to the warmth, buoyancy, and pressure of the water.

Lymphedema Issues

If you have lymphedema issues, you may be experiencing swelling in your extremities. When you find yourself in the SwimEx Pool, you will notice a decrease in the swelling due to the hydrostatic pressure, making it easier and less painful to do strength exercises. This decrease in swelling will also make walking much easier.

Foot and Ankle Issues: Achilles Tendon Repairs or Tears and Toe, Foot, or Ankle Fractures

Typically, your doctor will give you weight bearing restrictions and you will most likely need a device to assist you while you walk and/or a boot. However, due to the anti-gravity properties of the water, you would not have to adhere to the restrictions. Other positive effects would be a decrease in swelling and less painful side effects. The pool helps you recover much faster because it allows you to work on balance in the early stages of recovery. Normally, patients have a hard time working on this if they are not in the pool due to the stress and pain of their foot or ankle.

Knee or Hip Replacements: ACL Repairs, Arthroscopic Repairs of Hip/Knee, and Patellar Tendon Repairs

The water provides a good environment to work on range of motion, stretching, and strengthen of these tender areas. An important distinction between aquatic and land therapy is the level of soreness associated with each, with aquatic causing much less soreness. Also, aquatic therapy allows you to perform most exercises sooner than on land with much less pain, getting you back to normal in much less time.

Fibromyalgia and Chronic Pain patients

Normally physical therapy is the last straw for this type of diagnosis. However, physical therapy in the pool should be one of the first choices since it will help you build stamina, endurance, and strength and manage your pain.

There are many more diagnoses that can be treated utilizing aquatic therapy. If you are not able to tolerate the pain associated with land therapy, aquatic therapy is an excellent alternative due to the anti-gravity environment. You will feel less pain and pressure in the pool and be able to make progress sooner than typical land therapy.

Get the therapy you need so that you can get back to your day-to-day routine and the actives you love. The goal of any rehabilitation team is to get you back to doing the activities you enjoy. Swinging a tennis racket. Walking through the woods. Peddling a bike around town. Pushing a cart down the grocery aisle. Even folding laundry! No matter the activity, enjoy life!

The ultimate goal of any therapy program is to get you back to _______ .   What is your blank?

Contributors: Morgan Thompson, Amelia Iams, DPT, Cynthia Brendle, PTA

 


Does your Bladder Dictate your Life? Let’s talk.

May 8th through the 13th is Women’s Health Week and the goal is to empower women to make their health a top priority and educate on the steps women can take to improve their health.  During the week, you can get the answers to top questions that are asked about Women’s Health. 

~Lynne Schill, Physical Therapist, Guest Author
Lynne Schill is a Women’s Health Physical Therapist at FMH Rehabilitation Women’s Center Crestwood. She has experience in treating women’s health diagnoses and has found this work to be extremely rewarding because of how significantly it can improve quality of life. Her compassionate nature coupled with an incredibly warm bedside manner inspires confidence, determination and empowers the individual to become proactive in their own recovery.

Does your bladder dictate your life? Do you have to plan your day around where the next bathroom is?  restroom signAre you afraid to leave your home for fear of not making it to the next bathroom or leaking? Do you feel something bulging in your vagina or have you been diagnosed with pelvic prolapse? Do you suffer from pelvic pain which affects your lifestyle and intimacy? Do you skip the jumping jacks or walk instead of run during your exercise routine?

May 8th through the 13th is National Women’s Health Week with the goal to empower women to make their health a top priority and to educate women on the steps to take to improve their health.   Women’s issues are important and most women suffer needlessly because they are not aware of the rehabilitation programming designed especially for women.

So, did you answer yes to any of the questions above? If so, you may be a candidate for women’s health physical therapy!  Physical therapy (PT) is a great alternative for women who don’t want to take medication and want to avoid surgery for incontinence, pelvic pain, and pelvic prolapse. Don’t let your bladder dictate your life or continue to suffer from pelvic pain, which can affect your lifestyle and intimacy.

Women often suffer in silence, not mentioning these problems to their healthcare provider and think they just have to “live with it”. However, there is hope—and help available, with physical therapists who have been specially trained to treat these conditions.

According to the National Association for Continence (NAFC), 26% of women between the ages of 18-59 have involuntary leakage, 20% of women over 40 also have overactive bladder, and 66% of women and men ages 30-70 have never discussed their bladder health with a healthcare provider.

It’s time to start the conversation!

My incontinence…

There are three types of incontinence: urge, stress, and mixed (which is combination of the first two).

Urge incontinence is when there are strong urges to urinate even though the bladder may not be full and there is an increased frequency of urination. Physical therapy treatment approaches include filling out a detailed three-day bladder log. Information gathered in this log includes the number of voids per day and night, how much is voided, what the patient was doing at the time, determining if the patient is drinking enough water, and identifying any dietary triggers.  Often, eliminating bladder irritants from the diet including caffeine, alcohol, citrus, carbonated beverages, and artificial sweeteners can help decrease or stop the problem.  Smoking can also be a factor, as can constipation.

Running to the bathroom and frequent emptying ‘just in case’ can actually make the problem worse. Teaching patients urge control techniques including standing or sitting quietly, doing a few quick Kegel contractions, and deep breathing can help decrease the urge. Another mistake women make is restricting their fluid intake.  This can not only lead to dehydration, but it can also cause the urine to be more concentrated, which can be irritating to the bladder lining and lead to further urgency.

Urge incontinence and overactive bladder sufferers can benefit from physical therapy relaxation techniques including deep breathing and nervous system quieting in order to help calm the bladder.

Stress incontinence happens with coughing, sneezing, laughing, exercising, or lifting. The increased pressure in the lower abdominal and pelvic region can cause leakage because of weakened pelvic floor muscles.  Pelvic floor muscles provide support to the pelvis and pelvic organs.  One exercise many women know that can help strengthen the pelvic floor is Kegels. However, it might be surprising to know that more than 50% of women perform Kegels incorrectly! A physical therapist can educate you further on pelvic floor anatomy to help identify which muscles you need to be contracting, how to isolate the contraction in order to do a correct Kegel, and then advise you on a home exercise program.   Strengthening the pelvic floor and lower abdominal muscles is especially important for this type of incontinence.  Also, modifying activities and exercise by avoiding a lot of heavy lifting, jumping and running can decrease symptoms.

My pelvic prolapse diagnosis…

Pelvic Prolapse is when a pelvic organ—such as your bladder, rectum or cervix—drops from its normal position. If you suffer from pelvic prolapse, you may benefit from postural education, strengthening of the pelvic floor muscles, activity modification, and positioning techniques to help reduce prolapse symptoms. Eliminating constipation is also important; a physical therapist can teach strategies to achieve regularity in order to avoid bearing down hard, which can potentially increase prolapse.

My pelvic pain…

Pelvic pain can be another life-changing problem for women—causing problems with simple daily activities and affecting intimacy. Pelvic pain and pelvic discomfort can be associated with menopause, post hysterectomy and other surgeries, trauma/injury, pregnancy/child birth, and pelvic malalignment. A physical therapist performs a thorough assessment and develops a program to meet individual needs.  Treatment may include hands on soft tissue techniques, biofeedback, and/or relaxation techniques.

Biofeedback is a valuable tool that is used to assess the muscle activity of the pelvic floor muscles and helps patients recognize when their pelvic floor is relaxed versus in a contracted state. While being coached by a physical therapist, the patient can become more aware of the pelvic floor muscles and how to use them via visual feedback.

Ask yourself, “Would I like to improve my pelvic health and quality of life without surgery or medication?” It’s time to do something about it and Women’s Health Week is the perfect time to start!

A Physical Therapist trained in treating pelvic floor dysfunction is available for your specific needs and diagnosis. Your bladder doesn’t have to dictate your daily routine; you don’t have to live with pelvic pain in silence. You deserve your life back!

Tx:Team Women’s Health Physical Therapy programs can be found at FMH Rehabilitation in Frederick, MD, St. Vincent Frankfort Hospital in Frankfort, IN, and St. Vincent Jennings Hospital in North Vernon, IN. Ladies, it’s time to take the steps to improve your health and Women’s Health Week is the perfect time to start!

 

 


Empower Yourself…Break the Silence on Women’s Health

May 8th through the 13th is Women’s Health Week and the goal is to empower women to make their health a top priority and educate on the steps women can take to improve their health.  During the week, you can get the answers to top questions that are asked about Women’s Health. Let’s continue the conversation…

 

How can Women’s Health therapy help?

This type of therapy is a conservative treatment approach which is an alternative to taking medications or even having surgery. Women’s health therapy can help you decrease pain, urinary or fecal leakage, and strength deficits.  Often being educated about lifestyle changes, addressing musculoskeletal factors, identifying and treating weakness or tightness in the pelvic floor muscles can have a big impact on a patient’s symptoms.

What if I feel embarrassed about my condition and it’s hard to talk about?SLP flyer web

It’s completely normal to feel embarrassed when talking about sensitive issues. Just remember, many women feel the same way.  Your therapist has a lot of experience in treating pelvic floor conditions and she will put you at ease about your evaluation and treatment.  The problem you are having is not uncommon, it’s just that people don’t talk about it.  It’s time to get the conversation started!

We don’t have to discuss everything the first day. If you need time to really get to know your therapist that is fine!  Sometimes, we just start with measurements until you become comfortable with your therapist. Being open and honest with your therapist will better help her to help you achieve your goals.

 

Tx:Team Women’s Health Physical Therapy programs can be found at FMH Rehabilitation in Frederick, MD, St. Vincent Frankfort Hospital in Frankfort, IN, and St. Vincent Jennings Hospital in North Vernon, IN. Ladies, it’s time to take the steps to improve your health and Women’s Health Week is the perfect time to start!


Playing with Purpose: A Pediatric Speech Therapist’s Perspective

With holidays and birthdays, come many toys that cycle in and out of your home. They come in many different brands and styles but all have the same underlying potential for developing your child’s communication skills. Here are just a few commonly found toys that I use as a Pediatric Speech Therapist with the children I work with in order to develop and expand their speech and language abilities.

 

toy farmToy Farm: This toy is loaded with opportunities for you to model early developing speech sounds to your child. Some of the first sounds acquired by infants and toddlers are made with their lips such as “b” “p” and “m”. When playing with this toy with your child, exaggerate these target sounds while modeling animal names and noises.  Some of the target words I use include: “baaa”, “moo”, “pig” with exaggerating the initial sound of each word. Try to have your child watch your mouth while you are saying these words. Allow wait time after saying a target word to give your child an opportunity for imitation.

Cause and Effect Toys: These toys come in many varieties but all have the same underlying theme.popup They are toys that allow a child to “cause” an event to occur. In the case of the pictured toy, when your child pushes a button, the window opens and an animal appears. Communication is founded in cause-effect. Even before a child learns to speak, they understand that when they cry, it results in an event. This event can be a diaper change, a feeding, or attention from their caregiver. When a child understands this relationship, the door for purposeful communication is opened.

Kitchen Set: Pretend play is a huge component of a child’s language development. It is their way of taking scenes from their environment and re-enacting them using language they hear daily. When you listen to your child play, you may hear some familiar phrases!

Kitchen play

This is a great toy for children of all ages. When playing with this toy, help your child to pretend. Model actions such as: stirring with a spoon, putting food in the oven, or turning the sink on and off. While performing these tasks, keep your language SIMPLE.  Phrases such as “too hot”, “all done”, “more please”, and “all gone” are simple beginning phrases that can be used in many situations throughout the day.

While these are just a few suggestions for your holiday and birthday gift list, there are many other options of toys and play that stimulate communication. Any toy that encourages an opportunity for interaction between you and your child is a learning opportunity!

When you go shopping, look for toys that encompass interaction. Although there are several toys on the market that light up or make noise, many of these toys only have a visual component, but do not allow your child to manipulate or physically engage in active play. Much of our early language consists of “active” words that rely on motion or position. Some of the best toys set the scene for using words such as “go”, “stop”, “up”, “down”, “in”, “out”, “on” and “off”.

Why is this type of play important? Young children understand much more than they can verbally express. Even before your child says their first word, they are acquiring and understanding of multiple vocabulary terms daily. By the age of 2, a typical child understands 200-300 vocabulary terms! This makes your task of modeling these early vocabulary terms during play that much more meaningful.

If you are concerned about your child’s speech and language development, below are a few warning signs that may warrant assessment by a Speech Language Pathologist:

  • reduced eye contact
  • disinterest for communication
  • does not respond to their name or sounds in their environment
  • frequent ear infections
  • limited babbling or verbal output
  • difficulty understanding simple commands
  • For toddlers who have speech that is very difficult to understand, resulting in frequent anger outbursts and temper tantrums

There is no “right” age for seeking help for your child’s speech and language. Speech and language development varies for every child. A child who is behind may catch up on their own without intervention, especially when developing their speech sounds. With that being said, do not ignore your parental instincts. It never hurts to seek assistance or an expert opinion.

Michelle Keenan, SLP-CCC is a Tx:Team Speech Language Pathologist treating the Pediatric population at FMH Rose Hill Outpatient Clinic. You may contact Michelle at 240-566-3132 or find out more about Speech Language Therapy go to www.fmh.org/Rehabilitation

 


Navigating the Experience Spectrum

fork in the road webIn a world where changing technology and demographics have forced some careers to rapidly evolve or even go extinct, the therapist’s job description has largely gone unchanged.  So many of our Tx:Team clinicians, whether 30 days out of school or 30 years on the job, find that their passion for treating patients is very similar to someone who’s been treating for far longer or far less than they have.  Often times, academic backgrounds are identical, but clinicians are treating on polar opposite ends of the spectrum when it comes to clinical experience.

With all attention focused on the patient, it’s always very exciting for a therapy company to find instances where clinicians, either experienced or inexperienced, are relying on their counterparts for advice and opportunities to collaborate on patient care.  The clinical experience component that is so vital to any clinician’s career is helped by the teamwork and collaboration that seems to come naturally to the associates in our facilities.

We’ve paired two clinicians from the same discipline but with different experience levels to get a sense of their team interactions.

We’re appreciative of their input and really proud of their interactions and contributions to their respective teams.

Kelly, OTR, treats in the Assisted Living setting in Charleston, SC.  Kelly is a 1992 graduate of Towson State University.  She specializes in dementia, low vision, neuromuscular, orthopedics, and urinary incontinence.

Q: As an experienced clinician, what do you feel is one thing that you bring to your team?

The knowledge of my past trial and error situations which have worked for some and not for others.  Even with experience, you will run into challenges and need to realize that it’s ok and necessary to try another approach or technique to get the optimal outcome.

Q: What’s one thing you feel you gain from the younger clinicians on your team?

The excitement and energy of being a new therapist.

Q: What advice would you or do you give to new members of your team?

Sometimes there will be some really stressful days, but just take a deep breath and take one patient at a time.  Positive energy in a clinic goes a long way.  Also, it’s ok to not know something.  That’s what other team members, resources, etc. are there for.

Q: Has the role of an OT evolved at all in the time you’ve been treating?

I don’t know how much the role of OT has evolved versus me evolving as an OT. When I started, the focus was self-care and craft based activities. Now, I feel like OT’s have the opportunity to take on more specialized areas at a more technical and educational level such as low vision, urinary incontinence, and power mobility devices.  I know in the past, my co-workers (especially PT’s) would joke around about doing needle-work and wood working projects. I haven’t heard that for a long time.  Maybe we have earned a little more respect from even within the interdisciplinary team.

Q: What’s one thing you know now that you wish you would have when you started treating?

The education and value of using modalities. My college only offered 1 day for modality education for estim, u/s, and paraffin.  I sort of shied away from it for the first several years as an OT.  There are certain areas of OT which modalities can make a world of difference.  I would have started off much earlier taking courses and getting hands on experience.

Q: Have you found the change to the EMR system difficult?  In what ways did you rely on your team in making the transition?

First of all, I had to look up what EMR stands for…guess a new grad would know that.  Electronic Medical Records (EMR) was fairly easy for me.  I actually learned the most by helping others with their questions and we often figured things out together before asking for help.

Q: The nature of the documentation you’re required to do today, in what ways is it better and worse than when you started treating?

With EMR, I have used a lot more objective functional and pain/disability assessments than I used in the past.  It actually helps validate the necessity and makes goal writing more objective like it is supposed to be.  With the forms being right on the computer, there is no need to carry around or anticipate the appropriate forms. It also cues you in areas that you may have forgotten to address.  The only negative to EMR is when computer systems are down or unavailable for use when you need it.  That’s when you wish you could just grab an eval form and a pen.

Q: Could you give an example of a technique that you learned on-the-job and not as a part of your formal clinical education?

In 1997, I worked in a facility where I was assigned to only wheelchair seating and positioning.  I knew almost nothing in this area and was so nervous.  An experienced OT taught me an unbelievable amount over that year and, without that on-the-job training, I don’t know if I would have ever known what I do now.

Q: What was some of the advice or things you learned from the experienced clinicians back when you started treating?

I was always told to constantly look at the whole person.  Whether you are working with UI, low vision, pain, ADL’s, weakness, whatever it is, always step back and look at who that person is, what is important to them and what they want to gain from you. 

Q: Why do you think certain techniques of occupational therapy have gone unchanged despite changes in types of medication and imaging that may have taken place in other areas of healthcare?

We work with people.  People still have the same bones and muscles, the same brain, and overall, the same physical, cognitive and psychological needs to live, work and play.

 

Leslie, OTR has been treating at Frederick Memorial Hospital and the outpatient FMH Rose Hill clinic, both in Frederick, MD.  Leslie came to Tx:Team following her recent graduation from Bridgewater College and Shenandoah University where she completed her clinical education in two and a half years.  Leslie treats both geriatric and pediatric populations, and is a gifted writer, having written a blog on pediatric patients with autism for the company website.

Q: As a younger clinician, what do you feel is one thing that you bring to your team?

I think being a new clinician right out of school, I have a lot of knowledge in regards to current evidence-based practice and new interventions to use with different diagnoses.  So, where as an older clinician may have a lot of experience, I’m bringing forward that new research and new evidence-based information to the clinic.

Q: What’s one thing you feel you gain from the experienced clinicians on your team?

It’s really cool that this job has the opportunity for me to work both in the outpatient setting and in the acute setting.  I don’t have as much experience in the acute setting, but the OTs there have really taken me under their wing.  One of the big things that I picked up over there was the verbiage they would use to educate patients.  It was very concise and to the point and it really got the message across in that setting, especially in regards to orthopedics and precautions as far as final preparations to really educate their patients and keep them safe before going home.

Q: What advice would you or do you give to new members of your team in terms of relying on more experienced clinicians?

I know a lot of therapists, myself included, who want to get everything done and learn everything in the first day, but it really is a learning experience.  It is a process where you’re going to make a few mistakes along the way, but it’s okay.  It’s been instilled in me that I’m still new, and I’m still learning, and they can fix documentation mistakes.  Learning a new EMR system is hard for anyone, and so when you’re starting out of school and you’re a new clinician, you’re not only learning to be a new therapist and learning a new job, you’re learning all the procedures along with it, so just be patient and know that it will become routine and everything will fall into place.

Q: How valuable have you found clinical experience to be in your career thus far?

Experience is very important and, even in the evaluation itself, you pick up verbiage when you’re around certain clinicians it’s really helpful and it kind of becomes a script for you to use as you’re going through your evaluation.  When you’re used to the same verbiage and repeating yourself with every new evaluation that you do, asking the same questions, it becomes habit and routine.  You make sure you’re covering all your bases thoroughly, evaluating all different areas of need for the patient.

Q: Do you feel like using an EMR system is easier for you as a newer clinician?

Our EMR system is pretty unique, and I feel I’m getting a lot of support from the older clinicians as far as navigating through the EMR system just because it has many layers.  However, in terms of technology, I do feel that I am able to help other clinicians find those evidence-based research articles by going through a lot of the university databases.  I think in that aspect, I’m helpful.

Q: What’s one thing you know now that you wish you would have when you started treating?

I think for any career you’re still learning each day and, when I’m treating a patient, it sparks my interest to research further.  I know as I continue to grow and gain more years of experience, I’m going to continue to have to go back to my research and my textbooks to find some of the answers to the questions that my patients spark in me or other questions that I may find interesting as far as diagnoses go and interventions.

Q: Did you have a certain fear coming out of therapy school?

There was some apprehension in that working with the geriatric population, there’s that age difference and although I am young, I appear a lot younger to some of my patients that I’m working with and it’s really important to establish that rapport with your patients, and fill that gap or that bridge between the two of you.  And I think through my first few days of working, I really felt comfortable building that rapport with my patients and treating them individually and making sure my therapy is very client-centered.

Q: Could you give an example of a technique that you learned on-the-job and not as a part of your formal clinical education?

I think some of the educational components I’ve learned in working with the orthopedic patients at the hospital and in the acute care setting, and also along the lines of orthopedics, at FMH Rose Hill, we have a certified hand therapist, so I’ve been doing my best to pick up tidbits from him as far as splinting, to strengthen knowledge in my area of practice.

Q: What do you think you may be learning ten years from now from an incoming therapist?

Manual Therapy techniques change often, so I can imagine looking to them for the most current Manual Therapy techniques and, again, the evidence-based research because it’s so important to our field.

Q: Why do you think certain techniques of occupational therapy have gone unchanged in comparison to some of the career types that have evolved over time within and outside of healthcare?

I think, in general, occupational therapists are really unique. I think we all have a passion for the humanities.  What drew me to occupational therapy is that it incorporates a lot of my different loves: the health field, architecture and modeling, art, working with children and the education component there.  It’s a very creative field and I feel that all OTs have the passion for a lot of different fields in life.  I don’t really think that our field has changed much, of course, there’s new research that comes out that helps change how we treat our patients a little bit, but at the same time, I think our roots of occupational therapy, based in psychology and the basis of educating and adapting ways to complete purposeful and meaningful activities.  I think that’s where the core of occupational therapy is and I don’t think it’s changed so much in that regard.


Is Love an Open or Closed Door for Children with Autism?

Leslie Crawford is an Occupational Therapist with Tx:Team treating Pediatric patients in Frederick, Maryland.

 

If you are a parent of a school aged child, or have recently viewed YouTube’s top viral videos of 2014, you may have already heard Disney’s hit song “Love Is An Open Door,” from the PG rated flick Frozen.  However, with the warm sun and a plethora of outdoor activities in mid summer, the only thing with icicles in July may be your own AC unit, on the brink!

With the enticing outdoor activities summer offers and the rise of children away from their normal routines of school, it is important to raise awareness regarding wandering and elopement of children with Autism and take a minute to second guess that “open door.”  Children with Autism, or an autism spectrum disorder (ASD), are often known to wander away from safe places and familiar environments resulting in increased danger and sometimes tragedy.  Particularly in the summertime, wandering behaviors contribute to increased risks of drowning and emergency medical service calls.  Therefore, preparedness by both parents, the community and first responders is essential.

Try “walking a mile”in the shoes of a child with ASD.  If an adult were to actually wear a child’s size 4 shoe all day, they would most likely have throbbing feet by their workday’s end!  I know I would!  Think of this throbbing as the continued discomfort and hypersensitivity that a child with Autism experiences on a daily basis.  Not only may children with Autism be hypersensitive to tight shoes, but to clothing in general with itchy tags around their collars, environmental temperatures, lights, sounds and vestibular motion.

While sensory processing in the brain is quite complex and can vary from person to person, we can all agree that when we are overwhelmed by a specific sensation, it is hard to filter out the extraneous input and attend to the task at hand. If you can’t relate to this experience, I challenge you to go to your local convenience store and buy a bag of “Pop-Rocks”or sour “Warheads” candy.  Next, open the candy and place some in your month.  Now, simultaneously begin a crossword puzzle.  How long will it take you to complete this task?  Are you having difficulty?  As I place candy in my own mouth while typing this blog, my mind is concentrated on the explosion of candy in my mouth: at my left cheek, now gums, now right cheek!

To promote Autism awareness in your community, help others to identify characteristics and potential behaviors a child with ASD may demonstrate.  Aforementioned, try the simulation above with random community members to help them understand sensory integration difficulties.  Further educate the community on communication difficulties children with Autism may experience, such as their ability to accurately interpret help, or those able to help them, their ability to identify danger, and their need for extra sensory, gestural and communication processing time.  With more knowledge regarding pervasive developmental disorders, the easier and safer it will be for all involved to respond to a situation regarding wondering or elopement.  Additionally, while some behaviors may prove to be challenging during a crisis situation, remind members of the community and first responders that certain behaviors may be self-soothing to the individual, and halting this behavior may exacerbate stress and increase the present danger to a child with Autism.

If your child has ASD, I encourage you to establish a plan and be proactive in anticipation of wandering and elopement.  Alert neighbors and your local EMS squad of you child’s diagnosis, as well as provide EMS with contact information of family members to be reached in case of emergency.  Know your neighborhood and preferred places your child may like to visit.  Occupational therapists can assist children and a family establish sensory diets and strategies to manage challenging behaviors, as well as their overall health, wellness and functional independence.  Many resources are available to practitioners and parents to help plan for wandering and elopement, such as The Big Red Toolkits for caregivers, clinicians and first responders.  This resource, developed by the Autism Wandering Awareness Alerts Response Education team, helps establish safe occupational engagement in the community.  The Big Red Toolkits are available online and contain educational materials, caregiver resources, tip-sheets, social stories to help child habituate to common events.

With the appeal of water in community pools, lakes and rivers, the risk of drowning associated with elopement and wandering is highly prevalent.  Ask your community pool about sensory supported swimming classes lead by an Occupational Therapist, who can provide aquatic training techniques to instructors to interact and teach children with ASD.

In order to make our community like Disneys, “Magic Kingdom”, we must increase awareness and educate those around us of the Autism population’s needs.

 

 

 


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Indispensible workers who are willing to do what it takes to help the company succeed even in the most difficult times.  Those who pick up the slack when the organization is forced to cut back; those whose ideas save time, money, and effort; those with a positive outlook who help keep the organization moving forward. Read more