April is Parkinson’s Awareness Month – #Take6forPD

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According to the Parkinson’s Foundation, every six minutes someone is diagnosed with Parkinson’s Disease in the United States.

April is Parkinson’s Disease (PD) Awareness Month and along with the PD Community, we are encouraging everyone to take six minutes in an effort to raise awareness, advance the research, and become knowledgeable of the available treatments for this disease. With someone being diagnosed every six minutes, that totals 90,00 people per year in the United States alone.  Let’s be advocates.

Beyond awareness comes treatment. At Tx:Team, we have Physical, Occupational, and Speech Therapists who are trained and certified in treating patients with PD. One treatment program which has been proven beneficial is the LSVT BIG® and LOUD® Program.

How do the LSVT programs benefit Parkinson’s patients?

Parkinson’s can impact function in everything a person does at home, at work, and in their community recreational pursuits. The LSVT programs help patients to maintain movement and voice for normal function in everyday life beyond medication and repetitive, non-direct task training exercises utilizing principles of neuroplasticity backed by years of research. It takes all 16 visits (four times per week for four weeks) to achieve carry over so that by the end of one month, patients know how to move BIGGER and be LOUDER all the time.   

A unique feature of LSVT BIG® and LOUD® is that it recognizes there is an internal cuing proprioceptive issue in individuals with Parkinson’s such as softer voice and smaller movements, in people that are unable to recognize their deficits the majority of the time.   

What is the focus of LSVT BIG®?

  • Faster speed  
  • Greater arm swing   
  • Longer steps  
  • Overcoming difficulty getting through the doorway  
  • Longer distance  
  • Faster clothing donning  
  • Grasping materials during meal preparation  
  • Legible handwriting  
  • Amplitude of movement when showering  

What is the focus of LSVT LOUD®?

  • Louder voice that is not hoarse  
  • Improved facial expression   
  • Reduction of monotone speech  
  • Improved emotion  
  • Using more words  

Who would benefit from BIG® and LOUD®?  

Patients who have a decline in the amplitude of their movement, voice, posture, and balance in addition to reduced speech intelligibility are motivated to participate in all required sessions.  

Why are these programs so important to this patient population?  

LSVT BIG® and LOUD® assists this patient population in maintaining, enhancing, and slowing progression of Parkinson’s Disease, which in return facilitates their ability to maintain a level of independence with the following skill sets essential for daily living:   

  • Changes in cognitive function. People with PD can still learn, but it might take longer and require more repetition of practice. As a patient progresses, the therapist will work on dual tasking so you can keep moving bigger and being louder while doing something else at the same time. For example, getting dressed and talking, walking while carrying something, or tapping your leg while reading.
  • Changes in movement amplitude. Commonly, people with PD have difficulty with activities they didn’t before. As a patient progresses, utilizing larger movements helps patients return to these activities without cues and assistance. 
  • Changes in communication. People who have PD have soft speech and feel that they are talking WNL while others “need a hearing aid.” However, people may begin to feel embarrassed with social isolation. As a patient progresses with continuous use of a loud voice, they are able to participate in conversations without feeling excluded while maintaining their dignity.
  • Changes in emotional regulation, pacing, attention, cardiovascular health, sleep, and confidence can also be seen!  

If you have any more questions about the LSVT program for BIG® or LOUD®, find a certified therapist in your area or visit this website.

 

Nidhi, Alita, and Johanna are all experienced therapists in the Outpatient Clinic setting in Frederick, MD.  They work collaboratively together to support and treat patients with a variety of neurological diagnoses. Nidhi, Alita, and Johanna enjoy the relationships they foster with their patients, and they love to help them achieve their functional goals.

Nidhi Talpade, PT, DPT, BIG® Certified
Alita Borkar, MA, OTRL, BIG® Certified
Johanna Ebbs, MS, CCC-SLP, LOUD® Certified.

“Home is Where the Heart Is” and the Place Where My Patients Heal

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“The magic thing about home is that it feels good to leave, and it feels even better to come back.” – Unknown
“Home is a shelter from storms – all sorts of storms.”-William J. Bennett

For many of us, our home is the place we most want to be, especially while we are recovering from surgery, a hospitalization, or experiencing a decline in our ability to care for ourselves. In-home rehabilitation services have been offered through home health agencies for years. Patients are being discharged from hospitals sooner and sicker, and more patients are declining rehab placements after discharge from the hospital. The home health team becomes an important step in the care continuum. As an Occupational Therapist in home health, I am an important player on that team.

How Does Occupational Therapy Work

As an Occupational Therapist, I work on all those things that occupy your time, from getting dressing, getting up and down from the toilet, taking a shower, making a meal, doing the laundry, driving, working, and enjoying your hobbies or leisure activities. After I assess someone’s abilities, I determine the areas that need to be improved and design a program that addresses those areas. The program could involve interventions in many different areas such as, therapeutic exercise, self-correcting balance training strategies or cognition/thinking skills.

I address Activities of Daily Living (ADLs) and mobility in the home, sometimes recommending adaptive devices to improve independence. Think of me as the “gadget girl.”  I especially enjoy seeing how the right piece of equipment can make all the difference with someone’s independence. Equipment recommendations include the trialing and training on the use of the equipment, which is an important part of the job in the home. No matter how good a simulation in a clinic is, it can never replicate their home. Trialing the equipment in the patient’s actual home ensures the appropriate piece of equipment is obtained.

The Role of Home Health Occupational Therapy

Home Health OT plays a huge role in the prevention of re-hospitalization. Home health clinicians wear many hats. I am an OT but at any given moment, I may have to function as a PT, Social Worker or RN. Some days it seems that I spend half of my time talking to physicians, other clinicians and family members trying to problem solve what will work best for my patient.

As with anything, there are aspects of my job that I love as well as the ongoing challenges that require creative resourcefulness to complete my job to the best of my abilities. I enjoy the intimacy that comes being in someone’s home, connections seem easier to establish. I enjoy seeing people’s family photographs, the things they collect, from stamps, vintage Pyrex, perfume bottles, or teapots. I enjoy being able to use things like pet or plant care in my treatment sessions. I am happy that my personal confidence with driving, navigation and parking has improved. The challenges of my days include scheduling, finding clean bathrooms, communication with coworkers who I rarely see, traffic woes, and caring for an increasingly sick population.

I feel that the rubber meets the road in home health. I see how people actually live, not just what they or their family report. When my primary care provider and I have talked shop during my visits, I have told her that if she could make home visits it would change the way she practices medicine. Seeing patients in their home, is that powerful, and for an OT, is completely natural and just makes sense.

“Home is where the heart is,” and it is where my patients heal.

Monica Laird is an Occupational Therapist in the Home Health setting in Frederick, MD.  In her 35 years as an OT, Monica has worked in a variety of settings including subacute rehab, outpatient rehabilitation, acute care, and now home health. She is married, has 2 adult sons, and a 14 year old carnival goldfish. When she isn’t on the road seeing her patients, she enjoys crafting, traveling, and going out to dinner with friends. She does not enjoy gardening or yard work and avoids those activities as much as possible.

O Comes Before P But Not Always in Therapy

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Typically, most places will list departments in alphabetical order; however, not in the therapy world.

Though “O” alphabetically comes before “P,” you will rarely see Occupational Therapy before Physical Therapy. I believe this is because the majority of the public is more aware of what PT actually is. I have jokingly referred to OT as being the “other” therapy. I get so excited when I meet someone who actually understands what OT is and what I do.

I’m a bit jealous that my fellow PTs don’t have to constantly explain what they do or feel the need to justify the benefits of their services. The name itself, occupational therapy, really doesn’t give the average person a good idea of what OT encompasses. I have worked in the geriatric setting for over 25 years and have heard it all. “Oh, honey, I’m retired. I don’t need you.” Well, actually you do, and let me tell you why!

What is Occupational Therapy?

OT focuses on the whole person with the ultimate goal of maximizing a person’s independence. Trying to get someone to view their occupation of living, what does that entail? What physical aspects (mobility, vision, limited ROM, or neurological movements) are preventing someone from being more independent?  What cognitive aspects (STM deficits, dementia, perceptual deficits) are holding them back? Are there any environmental factors, such as a cluttered area, poor spacing, fall hazards, or ergonomics? There are so many things that we do on a daily basis that we automatically perform. However, when someone is sick or injured, that is when these “occupations” get challenged.

How Can Occupational Therapists Help?

As occupational therapists, it is our job to help identify the factors that limit our patients to perform their daily routines. Whether that includes simple ADLs, figuring out ways for the patient to continue employment, or problem solving ways to continue to pursue activities of interest. To be a part of someone’s success in improving their independence and quality of life is one of the reasons that I love being an OT.

Sometimes all it takes are adaptations to make life easier. Use of adapted equipment, modifying the environment, and compensatory strategies are all techniques specific to OTs. Having been in the assisted living/independent living setting for almost four years now, I have been able to grow relationships with my clients and have enjoyed watching them in their daily occupations. Even after discharge from OT, it is great to be able to engage with them and make sure they are succeeding. However, it is also great to be able to observe any regressions and to help them identify when therapy may be warranted again.

I love it when I receive referrals from my former clients regarding other residents. Not only did I help one person improve, that person is now more aware of what OT is and looks out for others. I feel like I am doing my best to let others know what OT is and how it can potentially improve someone’s independence and quality of life. Now, if only I can get the “O” to come before the “P.” Okay, okay….now that’s just crazy talk!

Kate Beaty, OTR, is an Occupational Therapist in the Senior Living setting for Tx:Team.  She has spent the majority of her career in the geriatric setting, whether in nursing homes, assisted livings or sub-acute rehabilitation.  She really enjoys the relationships that she fosters with her clients and loves to help them achieve their functional goals.

Low Vision: Helping You See a Brighter Day

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Low vision can cause difficulty in seeing detailed letters and numbers when reading, recognizing the slope of a curb, steps, or facial features, and distinguishing between similar colors, such as black and blue. Adults who have one of these problems may have trouble maintaining their independence and completing typical day-to-day activities.

Occupational Therapists can help people with low vision to continue living in their own homes and complete daily tasks, such as showering, dressing, cooking, grocery shopping, managing finances, and getting around in the community.

How can an Occupational Therapist help?

OTs will evaluate a person’s environment at work and at home to determine how it can be altered to make the most out of a person’s remaining vision.

  • Optimize lighting on areas and objects that present risks for falls.
  • Reduce clutter in rooms to increase safety while moving around.
  • Educate on how to use other senses to compensate for vision loss.
  • Recommend assistive devices that aid in completing daily tasks.

What can friends and family or a person with low vision do?

  • Support them by adapting their home to keep it safe and functional.
  • Help them access community resources, including talking books, audio reader services, and centers for the blind.
  • Keep up to date about the person’s vision ability.

 

April is Occupational Therapy Month

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Written by Carroll Nelligan, Tx:Team President and Chief Operating Officer

“You know that occupational therapy is more than a profession—it’s a passion, and it’s about people.”  AOTA

It’s April, an entire month dedicated to promote and create more awareness around the great field of Occupational Therapy. I encourage all of our Occupational Therapists to carve out some time to reflect on the great work you do and recharge yourselves with empowerment and inspiration. Here’s what inspires me about our profession:

OT is Creative. I had the pleasure of attending the Quarterly OT meeting with OTRs and COTAs from our Bridge region and our Indiana hospitals. We opened with a sharing activity, “What is a favorite Therapeutic Activity that you use in your practice?”  The inventive and resourceful list included making overnight oatmeal, packing a suitcase, selecting and wrapping a gift and many others. OTs have the training and expertise to select an activity and break it down into all of the required motor, cognitive, visual, and perceptual components to help our patients achieve meaningful occupation based goals. As we were sharing, my first supervisor at Good Samaritan Hospital Georgina Miller’s words echoed in my brain. “If you are doing straight exercise with a patient, you are NOT an occupational therapist.” OTs are creative experts in therapeutic activity!

OT is Evidence Based. Occupational therapy is a science-driven, evidence-based profession that enables people of all ages to participate in daily living or live better with injury, illness, or disability. This is accomplished through designing strategies for everyday living and customizing environments to develop and maximize potential. An independent study published in Medical Care Research found that “occupational therapy is the only spending category that has significantly lowered hospital readmission rates.”  What were the OT interventions that drove this?  Recommendations and training for caregivers, assistive devices, home safety assessments, assessing cognition around medication management, and functional mobility. Tx:Team Occupational Therapists and Certified Occupational Therapy Assistants in the hospital environment are impacting readmission rates each and every day!

OT is Holistic. We do with people not to people. We are about helping people live life to the fullest, regardless of what their life is like or who they are. By taking the full picture into account—a person’s psychological, physical, emotional, and social make-up—occupational therapy assists people in:

  • Achieving their goals
  • Functioning at the highest possible level
  • Concentrating on what matters most to them
  • Maintaining or rebuilding their independence
  • Participating in the everyday activities that they need to do or that simply make life worth living

We are experts in helping people perform the occupations they need and want to do every day.

Forever an OT.  Every weekend I visit my Mom at her senior living campus to spend time with her and help her with household tasks. On my most recent trip, I arrived at her apartment only to I realize I had left an item on my kitchen counter that was meant for her. Honestly, I was a bit frustrated, and I hurriedly exited the building to return (for yet another trip) to CVS.  It was then I saw a car door open in the parking lot and a resident was on the pavement. Her rolling walker (tennis balls in the air!) was turned over and she was struggling to get up. God works in small mysterious ways by sending a frustrated OT out to the parking lot at just at the right time. Occupational therapists (no matter what we are doing) are OTs at heart and are indispensable healthcare professionals within our communities.

Thank you to all of our talented, creative, smart, and dedicated Occupational Therapists and Certified Occupational Therapy Assistants. Take the time this month to celebrate and recognize our fabulous OTRs and COTAs for the passionate professionals that they are.

Occupational Therapy Awareness Amid Stay at Home Guidelines

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During Occupational Therapy Awareness Month, therapists are asking “what does Occupational Therapy look like amid coronavirus and stay at home guidelines?”

“The philosophy of Occupational Therapy focuses on improving performance in all areas of occupation to facilitate health and promote growth through change &/or adaptation.  The ultimate goal is the achievement of health, well-being and participation in life through engagement in occupation.”  (AOTA 2014).

“Occupational Therapy has a fundamental belief that a healthy lifestyle reflects the balance between work, play/leisure, self-care and rest activities.”  (Journal of OT in Mental Health, Crist et al, Sept. 25, 2008).

A return to a balance in daily occupations can be achieved with Occupational Therapy through therapeutic exercise, therapeutic activities, activity modification and adaptation,  when one is affected by undue stress, illness or injury, and by applying a similar philosophy in one’s own self care practices.

During this pandemic, how are we occupying our time?  Everyone is currently affected by a significant amount of change, which requires the ability to adapt in a positive manner to maintain our own optimal health.  This is a good time to take stock of our physical, mental, spiritual, as well as financial health.  We have had to adapt the way that we are performing our daily routines.  And by taking good care of ourselves, we are then able to engage with compassion toward others who need it…if you have 20 rolls of toilet paper and your neighbor only has 2 rolls left…kindly share!

April is Occupational Therapy Awareness Month.  Occupational Therapy problem solves to help people adapt to change.  Currently, everyone’s lives are disrupted in one way or another and all are forced to adapt to the changes.  By now, most of us have found ways to adapt and fill the increased hours spent at home, or you may be running out of ideas.  There are many resources available online to combat the anxiety, depression, boredom, and the “couch potato” syndrome that is being experienced related to the Stay at Home guidelines.

The following are some resources and strategies to help adapt and remain positively engaged while staying at home:

  • The W.H.O is having a Health at Home Challenge on Twitter, go to Twitter.com/WHO/Status#HealthyatHome.
  • Tao-Well.com – Tai chi & Qigong fit videos, focus on mindfulness, reducing stress, while promoting strength, flexibility and balance.
  • Down Dog Yoga App – health care providers can get free access to their apps through July 1st.
  • Woebot – free app to promote positive mental health.
  • NHS.uk – sofa workout, as well as many other types of exercise videos.
  • Spotify” app – has a variety of uplifting song playlists as well as podcasts.
  • ”themodernproper” on Instagram – therapeutic and creative cooking ideas. A new recipe is shared daily on Instagram

Rather than binging on TV shows, we find ourselves coming up with other activities to occupy our time.  Utilizing social media and video games, assembling puzzles, playing games, yard work, walking, biking, running, cooking, baking, arts & crafts, board games and cards have become increasingly popular, and quality time with family has become more important. Trying to maintain a sense of humor at this time, will also help to combat anxiety and depression.  YouTube videos are a great source of humor.  Even though at times it may seem like too much togetherness at home, we should cherish every minute that we have with our loved ones.

Change the way you look at things and the things you look at change.

Contributed by Erin Winters, OTR/L, PTA

Erin Winters, OTR/L, PTA

Erin is an Occupational Therapist with Tx:Team at Putnam County Hospital.  She is a graduate of the Indiana University Occupational Therapy Program.  Erin has extensive experience in the treatment of adults with a variety of diagnoses from neurological, orthopedics of the upper extremity and hand, as well as chronic or acute conditions.

The Lymphedema Superheroes among us

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Today, Tx:Team celebrates Lymphedema Day and the work of therapists to serve those living with Lymphedema. Physical Therapists and Occupational Therapists perform really incredible work so that their patients regain the strength and confidence to live a life they thought was out of reach. One of our own therapists, Amy Rutherford, pursued a specialty in Lymphedema therapy early in her career, and today, we highlight the care and compassion that she provides to the residents of Frankfort, Indiana.

Amy works at IU Health Frankfort Hospital, located about an hour northwest of the state’s capitol, Indianapolis, in its more rural Clinton County. In her area, she mostly sees Lymphedema patients coming in with swelling of the lower extremities from COPD and diabetes. For Amy, she appreciates how simple lifestyle changes can greatly affect her patients and reduce the burden of Lymphedema on their lives.

What’s Lymphedema?

Lymphedema is a diagnosis of body swelling that is caused from damage to the lymphatic system. Whereas healthy bodies can manage their fluids and dispose of waste properly, bodies with damaged lymph nodes can build up the fluid that would normally be filtered out. On the outside, we see that buildup of fluid looking like an arm or leg that’s been blown up like a balloon.

In early stages, Lymphedema is easily treatable and reversible. However, the signs of this stage are so subtle that they can be very difficult to detect. A patient might feel tight in clothing or they’ll need to loosen the notch of their wristwatch. By the time the body is noticeably swelling, Lymphedema has typically progressed into a lifelong chronic condition that can significantly interfere with someone’s quality of life.

How does Lymphedema affect a person’s life?

A swollen arm or leg can make it difficult for a person to get dressed in the morning because their body is heavier, and they might not fit in the clothes they usually wear. It can be more difficult to do some of life’s basic routines, like bathing, for example. Little things that we don’t think about in our everyday lives- like washing our feet- can suddenly become near impossible because it’s too straining to reach passed the swelling to the feet.

It’s not just a physical condition. You can imagine that not being able to fit in your normal clothes and going out in public with a large swollen arm could affect your self-confidence. And if you can no longer wash your feet, you probably feel less clean than you’d like to be. For these reasons, Lymphedema can take a toll on a person’s mental health. Feelings of embarrassment and depression can creep in and linger throughout the day.

Just about all superheroes don’t wear capes.

Day in and day out, Amy is committed to making her patients feel healthy and great about themselves. She provides not only her expertise, but also compassion for her patients’ lives. When a patient arrived unable to properly clean himself, she knelt down to wash his feet. Really wash his feet of likely weeks of grime. “Cleaning a patient,” she says, “is work that really creates a bond. It’s work that reminds you of the biblical act of washing feet to show your care for another.” Encouraging patients to use proper soap and lotions, like Dove and Eucerin, and getting them to be a little more active in their day has undoubtedly improved the lives of many. We remember how simple, yet genuine care can impactfully change lives.

So today, we thank Amy Rutherford for almost twenty years of work in her field. Lymphedema is a debilitating and frustrating condition that can bring a lot of pain into patients’ lives. Therapists like Amy, who have committed themselves to treating Lymphedema, offer support that restores independence and dignity to those they serve.

Amy is just one of our Certified Lymphedema Therapists. We are thankful for all our CLTs and the work they do.

 

Cabin Fever? Beat the Winter Doldrums

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“I’m bored.”  In the middle of winter, this phrase can make any mom or dad break out in a sweat.  And a snowy winter day with children who cannot find anything to do may seem to last centuries.  A long day at home or a lengthy winter vacation is the perfect time for children to participate in fun activities that will build their skills, as well as put a stop to the classic complaints of boredom.  Coming up with creative ideas in a variety of skill areas, along with ideas for adaptations for children with special needs, can be a daunting task for parents as well.  Consider the child’s age and/or developmental level, safety, needs, and preferences to help you select appropriate activities to bust those cries of boredom!

 

Plan Ahead

To avoid being put on the spot in coming up with a fun activity when the famous “I’m bored…” complaint erupts, put together a “boredom box” with ideas from which the children can select.  Assist your child with coming up with his or her own ideas of what to include.  This can be a good strategy to use whenever your child has more ideas of things to do than time.  Include skill building activities that are developmentally appropriate and are “just the right challenge” with a fun twist so that the activity is not viewed as work.  To avoid having to scramble for materials for activities at the last minute, organize an additional “supply box” with basic craft supplies (e.g., construction paper, crayons or markers, cardboard tubes, paper plates and bags, glue, glitter or other decorations).   Consider including small craft sets with instructions, puzzles, and small travel games that are new or seldom-used.  Examine the skill categories below and adapt the following activities to your child’s skill level and safety needs.

 

Make Dressing and Self-Care Fun!

Winter break, snow days, and weekends afford plenty of opportunities for children to master the art of getting dressed, due to the extra time to get ready, and the extra seasonal clothing, such as snowsuits and boots.  If your child needs additional practice mastering fasteners, or resists getting dressed without assistance, incorporate fasteners and dressing into a game.  When multiple children are present, have a suitcase race where children don clothes (over their own clothing) as quickly as they can to win a prize—this can be done as a relay race for more than two children.  Institute a fashion show where the children can practice putting together their own outfits from old clothes (including parents’ clothing), or a doll or stuffed animal fashion show.

 

Visual and Fine Motor Skills

As visual and fine motor skills are an integral part of the school day from an early age, incorporating some of the fun activities below at home will help to boost skills

  • Make some homemade Valentines or birthday cards.
  • Write letters to family or friends on personalized letterhead.
  • Design scrapbook pages from a recent vacation or holiday to incorporate cutting, coloring, and handwriting.
  • Dust off the jigsaw puzzles, legos, lincoln logs, or travel editions of games (these have smaller parts).
  • Encourage building from a model made by a parent or older sibling, or if appropriate, building from instructions on the box. In addition to visual motor skills, word finds or crossword puzzles build vocabulary, and your child can design his or her own puzzle for someone else to solve.
  • For imaginary play, set up a pretend office with supplies such as paper clips, binder clips, old folders, or junk mail to practice manipulating common items. Get messy with squirt bottles (to spray a window or shower), hole punches, or clay tools and presses to strengthen fingers.
  • You can make handwriting fun by designing a secret code to write with fun squiggly pens, bathtub or window markers, or invisible ink markers.
  • Institute a “no-talking, only writing” time to communicate for fifteen minutes or so to encourage writing (this also might help to calm a noisy household).

 

Gross Motor Skills

After spending too much time indoors due to inclement weather, children will need to find a safe way to move around and expend some energy.

  • In a large, open area (basement, family room), provide your children with common household items, such as chairs, plastic juice bottles, a broom handle, hula hoops, or jump rope to design an obstacle course (with adult supervision for safety).
  • Hang up an over-the-door basketball hoop, or design one from a box with the top and bottom cut out to play rag basketball (from knotted up towels or t-shirts), or use a lightweight sponge ball.  Using these homemade toys or games can be more fun than purchased ones, and this will encourage their creative development.
  • If your child enjoys dance or aerobic exercise, consider renting or purchasing an inexpensive exercise or dance video for kids, use a dance pad video game, or have your own dance choreography contest.
  • Consider games from birthday parties or gym class, such as “Twister,” hopscotch (many toy stores offer foam mats), hula hoops, jump rope, “Simon Says,” or “charades” to encourage development of certain movement skills and physical activity.  By playing these games in a fun, friendly atmosphere, rather than being graded in gym class, or being concerned with winning a prize in sports, children who have difficulties with coordination may become more comfortable with motor planning.

 

Cognitive and Social Skills

We all continue to build our cognitive and social skills throughout life, establishing systems to do things and how we appear to other people; therefore, these are very important skills to practice.

  • If your child has difficulties interpreting emotions from facial expressions and body language, try body language charades (what is this person telling you?) or making an emotions collage of people from magazines with a designated facial expression or body language.
  • Practice teamwork by building something together or use an obstacle course as a relay race.
  • Work on sequencing via the oldie but goodie “follow directions game” by having children write down the directions to make a peanut butter and jelly sandwich, then have someone else make the sandwich following the directions exactly (use your *clean* hands if the directions don’t specify a knife)!

 

Sensory Skills

For children who have difficulties interpreting and processing sensory information, winter may be a difficult time to get used to seasonal changes in sensory input, and less access to outdoors (where many calming strategies might be located).

  • You can put clean snow in a dishpan or large plastic container for some table play inside to adjust to the sensation and temperature of snow prior to immersing the child in snow outside.
  • For a slightly easier to clean up sensory experience, place rice, beans, flax, or popcorn kernels into a bowl/bin/container with some of those summer sand toys!
  • Also, pull out the summer mini child’s pool, and fill with lightweight plastic balls (available at many toy stores) to create your own ball pit.
  • To create an indoor quiet area, your children may enjoy draping old sheets or blankets over two chairs to create a tent or use a large (appliance) box for a calming space with cushions or pillows for resting.
  • Children may enjoy spending a day inside making pretzels, kneading bread dough, rolling out cookie dough, or making “slime” as a tactile sensory experience.
  • Some household heavy work can be calming to children with “cabin fever,” such as pushing or pulling a vacuum, pushing a shopping cart, shoveling snow, pushing a wagon or wheelbarrow—all of these should be of appropriate size/weight (toy or regular), depending on the child’s size/abilities.

 

Seeking Expert Assistance

If your child has significant difficulties with dressing/fasteners, fine motor or handwriting skills, visual motor skills, motor planning, or sensitivity to tactile experiences, he or she may benefit from a physician’s referral for a pediatric therapy evaluation.  A pediatric therapist working in an outpatient center can determine if your child could benefit from skilled services and home exercise programs that build on these skills.

Navigating the Experience Spectrum

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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?

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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 Disney’s, “Magic Kingdom”, we must increase awareness and educate those around us of the Autism population’s needs.