Search the Hub

Let's face it, when we are in pain and we slow down to notice what's present, we just notice more pain! Yet, there is good evidence out there that having a mindfulness practice can improve quality of life for people living with pain. I've experienced it. I've seen my clients and students experience it. When we practice mindfulness regularly, it can help calm the nervous system . We can be more aware of when we are bracing in response to pain (or anticipated pain). It can also allow us to be more aware of the negative self-talk , guilt and shame that we're piling on top of the physical pain. When we are in pain, our awareness of our bodies decreases (because we all want to avoid unpleasant sensations). But that also means that we decrease our awareness of the pleasant sensations. One of the benefits of practicing mindfulness is that we can start to notice the pleasant sensations again, without getting flooded by the unpleasant ones. As we become more aware of what's going on with our body, breath, emotions and thoughts, we can start to make wiser decisions about our lives. Over time, we can move towards living well, despite the pain. Again and again, I've seen clients with pain increase their participation in their lives after 4-8 weeks of mindfulness practice. Once again, they are able to live well, despite their pain. And once the negative emotions and self-talk decrease, the pain probably goes down too! For more information, you can check out these resources: Body Scan Meditation guide, under Free Resources of my website Your Are Not Your Pain , by Viyamala Burch

Occupational therapists (OTs) play a crucial role as leaders, in ensuring collaboration and fostering working relationships, when delegating tasks to rehabilitation support workers. Although occupational therapists may not directly supervise these workers, they can significantly improve task delegation, by applying a few key principles. Using a structured delegation model is key to enhancing the effectiveness of this process. This is particularly true in situations where the rehabilitation support worker operates independently, either through a community or private agency. One such delegation model is the 5 Rights of Delegation , developed by the American Nurses Association and the National Council of State Boards of Nursing. This comprehensive framework ensures that tasks are delegated appropriately and effectively. This model emphasises five key elements that are crucial for successful task management:

Technology has impacted the field of health care in numerous ways. Health care practitioners who practised a century ago would be amazed by the capabilities of technology in mainstream medicine and specifically in the field of rehabilitation. This article explains the various types of technology occupational therapists (OTs) can utilise in their practice. It describes the context in which it is used and provides an overview - to current and future occupational therapy practitioners - on the impact technology can have on patient/client functionality . The term 'rehabilitative technology' is an overarching term, that encompasses both adaptive and assistive technology . As per the Occupational Therapy Practice Framework: Domain and Process (4th ed; AOTA, 2020), occupational therapists are responsible for the selection, positioning and use of devices, to enhance a client’s function in everyday occupations.

By Anthony Yuill - specialist rehabilitation Occupational Therapist Introduction As health professionals our role is to assess and treat people holistically. Yet, there is still the debate in healthcare as to what to treat first: physical disability or mental health? As Occupational Therapists we recognise that any assessment is not only the physical presentation that we see but one that also encompasses the mental and emotional health and wellbeing of our clients. With the holistic approach at the forefront of many health professions, the question should be 'Why not simultaneously treat them both?' In 2016, the Mental Health Foundation published a document that stated more than 15 million people (30% of the UK population) have long term physical disabilities with more than 4 million of these people also developing mental health problems. There is numerous research and publications, inclusive of the Mental Health Foundation document (2016) that suggest those with physical health problems are at an increased risk of also developing mental health problems . Thus suggesting a direct link between physical disability and mental health. However, it is helpful to explore this link and understand why physical disability and mental health go hand-in-hand.

In the worlds of education, health, recreation, business and many other sectors, one element of design is popping up where it was often once absent: gardens ! Lush, lively greenery, that pampers the senses of sight, touch, sound, smell - and sometimes even taste! Beyond the enjoyment of 'taking in the outdoors', studies have highlighted a variety of health and wellbeing benefits. For example, The American Heart Association recommends spending time in nature to quell stress and anxiety.

Did you know that, in 2022, close to a million people took sick leave due to stress, anxiety and/or depression in the UK? These alarming figures would appear to indicate a growing need to find effective strategies to reduce sick leave and increase the wellbeing of workers. The following article provides an explanation of occupational therapy and mindfulness and the relationship between them. There is strong evidence in favour of the use of mindfulness in reducing burnout in the workplace amongst health professionals and teachers (Luken and Sammons, 2016). On the other hand, mindfulness is frequently used in social health care settings as an effective treatment for patients.

Students with learning disabilities face social challenges in education . This is because these students generally need extra help, support and supervision by professionals. The good thing is that there are inclusive programs and special education services they can be eligible to avail of. One of them is an individualised education program (IEP) . This program is offered for free to families of kids in public schools. To better understand IEPs, their benefits and how to maximise this opportunity for students with special education needs, to achieve success in this area, we’ve listed down important facts in this article. Let’s continue reading!

N.B. A Hub collaborative partnership; elements of marketing content [no paid sponsorship] All health professionals, wherever they serve, will come across people with eating disorders in their day-to-day clinical work. These are complex illnesses, with high levels of morbidity and mortality. They create significant emotional distress , affect relationships and the ability to function in society . They have an impact upon the person’s education and employment - and in many cases, they can be a real threat to life. It is now over five years since the UK's Parliamentary and Health Service Ombudsman published the report ' Ignoring the alarms: How NHS eating disorder services are failing patients' (PHSO, 2017). Having carefully investigated the tragic death of Averil Hart, as a result of anorexia nervosa , and having identified multiple times when her life could have been saved, the PHSO report called for more training on eating disorders for health professionals .

One of many symptoms that can result from physical trauma or injury to the brain, ataxia is a term that encompasses a group of debilitating disorders, primarily affecting co-ordination, balance and speech. This article will explore ways that occupational therapy professionals can support those affected by ataxia. According to the NHS (2022), any part of the body can be affected by this disorder, but common difficulties arise with balance and walking, speaking and swallowing. Ataxia also compromises tasks that require a high degree of control , such as writing, eating and vision. The graphic below illustrates the physiology and symptoms (ProtoKinetics, 2019):

If you are a practitioner, or are studying to become one, you will likely spend countless hours exploring the concepts of activity analysis (1) , purposeful activity , treatment strategies and various methods of assessment . However, definitions of occupational therapy often state that we work with the 'whole' patient. In our current medical environment, with its emphasis on productivity , do we actually take the time to treat the 'whole patient'? As I pass through the 38th year of my career as an occupational therapist (OT), it is a question that I frequently ask myself. I entered our field as a 'non-traditional' student - having spent four years in the military, followed by six more as a school counsellor, before discovering the field, quite by accident one day. Why do I see working with the ' whole patient ' as being so very important in delivering quality occupational therapy? Clients don't suddenly wake up one day thinking "Gee, I think I’ll go see an OT."  They are sent to us - usually not of their own choice . They are often in pain and frightened of the long term consequences of an injury, condition, or state in the ageing process. Most would rather be anywhere other than sitting in with us.  In the years I spent as an associate professor, I always advised my students to be conscious of the following: In those first few minutes of contact, TWO assessments are taking place. You are assessing the diagnosis and its impact on your client's activities of daily living (ADLs). But they are also assessing you.  Do you seem interested in them as a person, or do you come across as in a hurry to finish with them and get onto the next patient? Do they feel they can trust you - both in terms of your skills, as well as concern for them? In truth, not all of this flows from altruism on my part. One of the issues we frequently have with clients is engagement with the home program we provide them. I want my clients to understand that, for each 45-60 minute session I spend with them, they are the most important person in the room. It's this involvement that supports with their attendance to their care plan and recovery. Occupational Therapy is a collaborative approach, which supports with engagement in goals and recovery through purposeful activity. Plus, in all honesty, I want them to feel a bit guilty if they are not doing that home program. Sneaky yes, but I’ve found that it works! Developing a therapeutic relationship (2) has always been important to me, but building rapport is just as important. The process of developing that rapport does not even have to be intentional; it should be a part of who you are, how you treat anyone who walks through the doors of your clinic.  One of the faculty in our program was an older psychiatric occupational therapist, who came to us from the UK. Her name was Patricia O'Kane, so we assumed she was Irish. Most of her career had likely been in the 1950s-60s, based on her stories of work in various psychiatric hospitals. She had been 'classically trained', meaning that she proceeded from a psychoanalytic framework.  She related a story that has stayed with me across the years (even though I primarily work in physical disabilities)... Early in her career she worked in locked wards and she would remove the ring of keys that staff wore around their neck to enter a ward. Almost immediately, when entering one women's ward, she would encounter a naked patient, who lay with her head and most of her torso under a cast iron heater. We will call the woman 'Gloria'. She would always greet the patient with a "Good morning Gloria!"   Gloria never replied, or acknowledged this greeting. Months passed, the first psychotherapeutic medications (likely lithium), began to appear in these hospitals. A short number of days later, a young woman entered Patricia's office fully clothed and neatly groomed. To Pat’s surprise, the young woman addressed her, stating: "Ms O’Kane, my name is Gloria and I wanted you to know that the greeting and sight of your ankles every morning for the past year was what helped me maintain some semblance of sanity." Now this is what I mean by unintentionally building rapport. Gloria was not one of Dr. O'Kane's patients. Rather, out of her own caring, Patricia had reached out to this woman, on a daily basis. As an occupational therapist, I want to establish some medium of rapport with any patient or family member I meet in the hospital. I will make a special effort to help my clients feel comfortable and valued when working with me. But I also want that effort to extend to the elderly gentleman I run into in the hallway if he appears lost. What do you know of your patient's lives?  What have they experienced so far?  Gaining the trust of your clients will further your education. I assure you of that.  A few examples of how rapport-building and earning clients' trust can do this: My African-American clients have revealed to me what it was like to grow up here in the American South in the 'old days'. A Puerto Rican client told me of the history of indigenous people in his former country. An older woman - approaching the end of her life - told me that she had absolutely no interest in her own ADLs, as she knew she was dying . I asked her what she might want to do instead. She agreed to trade a bit of her remaining time doing ADLs, if I were willing to listen to her reminisce about her life as a concert pianist, performing all over the world. A World War Two (WWII) aviator, described initially as the 'laziest man you will ever meet', told me of his experiences in the Pacific in WWII. He shared how he came to decide that he would spend the remainder of his life flying in and out of remote locations in South America, bringing dentistry and religion to the inhabitants he met. I believe that occupational therapy can be one of the most fascinating occupations possible. After nearly four decades in the field, I continue to be fascinated by the stories of patients who 'walk' beside me for a time, as we work together to maximise their ability to perform ADLs and IADLs. I understand that productivity is what 'keeps the doors open', in the facilities in which I have worked. But for the 45 minutes I work with a client, it is the client who is the most important entity in the world for me . Further Reading and Resources The Occupational Therapy Hub (2024) Occupational Therapy - Activity Analysis . In 'Hub Store', on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/product-page/occupational-therapy-activity-analysis . Abson, D. (2019) Therapeutic Use of Self . In 'Therapy Articles', on The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/therapeutic-use-of-self . The OT Practice (2019) Mental and Physical Health: Why they go hand in hand . In 'Therapy Articles', on The Occupational Therapy Hub (online).  Available from: https://www.theothub.com/article/mental-and-physical-health-why-they-go-hand-in-hand .

N.B. A Hub collaborative partnership: Some marketing elements; no paid sponsorship I f you are an occupational therapy (OT) practitioner or student, you will be familiar with the multifaceted challenges your patients and clients face. The intricate interplay between physical and mental health - intertwined with lifestyle and social factors - requires a holistic approach . OT assessment and intervention considers and seeks to address the whole person; sometimes there is a need for additional self-care practices, to help transform lives. Enter yoga - a versatile tool, offering a complement to OT intervention, with evidence that supports its physical and mental health benefits. A 2018 research paper  (1) found that: 'Occupational therapists reported that yoga increased self-awareness, including the development of self-efficacy, self-regulation and self-care. Participants noted that the practice of yoga was motivating and elicited a sense of empowerment, that resulted in positive perceptions of health-related quality of life and overall well-being.' Yoga's versatility for Occupational Therapists Yoga provides occupational therapists with a set of invaluable skills applicable to a broad spectrum of individuals - both to patients and to fellow clinicians. Beyond the well-recognised physical benefits, yoga contributes significantly  (2) to mental health and well-being . In a systematic review  (3), discussing yoga therapy as a modality in occupational therapy practice for adults experiencing mood disorders, researchers concluded: 'Yoga therapy may be a promising method to integrate into care plans, to reduce the impact of mood disorders such as depressive symptomatology.' Yoga and yoga therapy is also cost-effective, compared with some other methods. As a healing modality, it can be adapted in most client-care settings , with approaches and techniques that are simple and easily translated to multiple populations, for both short and long-term management of chronic conditions. How can yoga practices be shared by Occupational Therapists in a real life setting?  With suitable grading and positioning guidance , basic and fundamental yoga practices can be incorporated into daily routines. They can include breathing and relaxation techniques. With sufficient activity analysis , they can also be applied to specific conditions that Occupational Therapists handle on a regular basis.  Two such conditions are irritable bowel syndrome (IBS) and fibromyalgia . One recent, interesting, state-of-the-art 2023 narrative review article  (4) looked specifically at the benefits of mind-body techniques for these coexisting conditions. These conditions share common pathophysiological mechanisms ; sensitisation of peripheral and central pain pathways and autonomic dysfunction. The review found that: 'On an individual basis, mind-body interventions have been reported to benefit both the conditions and influence central pain syndromes and autonomic dysregulation.' Such health conditions are also seen by Yoga Therapists , who undergo two years of training. You can read about the concept of yoga therapy here : What is Yoga Therapy? (7). Rising yoga practices - for both Occupational Therapists and patients As a busy clinician (with a non-work life to prioritise too), the likelihood is that you have no additional time on your hands to study yoga in-depth for two years. However, simple key postures - including standing poses, forward and back bends, twists, sun salutations and simple inversions - support healing and recovery on both physical and psychological levels. It is essential to apply specific techniques safely of course, emphasising the importance of postural alignment alongside breath awareness and mindfulness. These techniques can be learnt in a relatively short time frame. Specifically, there is a growing trend in the practice of chair yoga (8), which is a safe and accessible way to integrate yoga into a patient-Occupational Therapist relationship . Supporting patients with chair yoga gives an accessible practice, which can also be continued outside of traditional OT/clinical settings. A 2023 study  (5) supported this rise, finding that: 'Chair yoga therapy can enable older adults with knee osteoarthritis to adopt and practice the therapy at home as part of their daily life, lessening the risk of their disease progressing to disability.' Chair yoga is designed to make yoga accessible to everyone, regardless of ability. The practice is one that many occupational therapists already use as a treatment adjunct with their patients. It is worth acknowledging the growing acceptance of chair yoga in healthcare settings, offering a practical solution for patients with varying physical capabilities. Accessibility of yoga instruction for Occupational Therapists? A recent study  (6) found healthcare professionals are motivated to recommend yoga to patients, but face barriers , due to lack of information about how patients can access appropriate and affordable yoga instruction... In light of this, Liz Oppedijk - Yoga Therapy Educator at The Minded Institute   and Founder/CEO of Accessible Chair Yoga - is offering a one-day online course: Basic Yoga Techniques for Health Professionals leaves participants with the ability to weave foundational yoga skills into their work immediately. As a valued Member of The Occupational Therapy Hub, you are entitled to a 10% discount on the full price of this course. Simply click the link above, add the course to your basket and enter the discount code OTHUB10 at checkout. Please contact marketing@themindedinstitute.com  with any questions or queries.  Empower yourself, empower your patients. Why not elevate your practice with yoga? References and further reading Graham, J. and Plummer, T. (2018) Perceptions of Occupational Therapists and Yoga Practitioners of the Effects of Yoga on Health and Wellness. Annals of International Occupational Therapy . 1 (3): 127-138. Available from: https://journals.healio.com/doi/10.3928/24761222-20180620-01 . Bös, C., Gaiswinkler, L., Fuchshuber, J., Schwerdtfeger, A. and Unterrainer, H.F. (2023) Effect of Yoga involvement on mental health in times of crisis: A cross-sectional study. Frontiers in Psychology . 2023; 14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074601/ . Crooks, C., Toolsiedas, H., McDougall, A. and Nowrouzi-Kia, B. (2024) Systematic review protocol of yoga therapy as a modality in occupational therapy practice for adults experiencing mood disorders. British Medical Journal (Open). 14 (1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773392/ . Majumdar , V. and Manjunath , N.K. (2023) Editorial: New insights into yoga and mental health. Frontiers in Human Neuroscience . 2023 (17). Available from: https://www.frontiersin.org/articles/10.3389/fnhum.2023.1239411/full . Yao, C.T., Lee, B.O., Hong, H. and Su, Y.C. (2023) Effect of Chair Yoga Therapy on Functional Fitness and Daily Life Activities among Older Female Adults with Knee Osteoarthritis in Taiwan: A Quasi-Experimental Study. Healthcare (Basel) . 2023; 11 (7): 1024. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10094373/ . Smit , C. and Cartwright, T. (2023) Recommending yoga for health: A survey of perceptions among healthcare practitioners in the UK. Complementary Therapies in Clinical Practice . 2023 (52): 101765. Available from: https://www.sciencedirect.com/science/article/pii/S1744388123000464 . The Minded Institute (2024) What is Yoga Therapy? The Minded Institute (online). Available from: https://themindedinstitute.com/what-is-yoga-therapy-2 . The Minded Institute (2023) Chair Yoga, Accessible to Everyone, from Simple to Profound. The Minded Institute  (online). Available from: https://themindedinstitute.com/chair-yoga-accessible-to-everyone-from-intense-to-simple/ .

"Dignity is a birth right. There are no questions about children’s value and worth. Dignity is our sense of worth, our feelings and values. We are born with this. We are priceless. We are unique." (Hicks, 2011) What do you think dignity is - and what do you think it feels like?  If you type 'definition of dignity' into a Google search, you will be rewarded with 169,000,000 results. After reading over a hundred of those definitions, I still feel very strongly that Dr Dona Hicks’ definition encapsulates more coherently what dignity means to me. What I am very sure of however, is that although many people may struggle to define what dignity actually is, we are all immediately aware if we have NOT been treated with dignity. What are the differences between dignity and respect?  Most of us talk about dignity and respect as if they are both the same, but dignity is very different from respect . Please watch this video of Susanne Boyle: Then ask yourself, did the audience and the judges treated her as a valued and worthy person? Did you notice the expressions on the faces of the people in the audience and judges, their gesticulations, how they talked to her? You can see that they were openly laughing at her. Can you think of a compatible situation when you felt that your dignity was violated? Respect is an attitude and determines how this manifests in our behaviour towards others and ourselves. We cannot demand respect. Respect has to be earned. Susanne earned the respect of the audience and judges just a few seconds after she started singing.  As health professionals, we must ensure dignity in our interventions, by promoting a client-centred approach, engaging in effective communication and supporting the safety (physical and emotional) of each individual, regardless of any differences (e.g. physical, cognitive, language, culture, sexuality or religion). This will promote better engagement leading to corresponding improvements in recovery and wellbeing. Client centre approach This is an approach which recognises the person as a partner in their own health care . It acknowledges that each individual has a unique perception and experience of his or her own world which shapes the person that they are. Client-centred practice is about ensuring that the service user remains the primary focus at the centre of any decisions related to their life and treatment.  We must involve our service users by listening to them, thinking together, training them and sharing ideas. We should aspire to treat each person as an individual, offering a personalised service and working together in partnership. We aim to involve and inform our patients, their caregivers and family so that they acquire an active role in the treatment of their illness and adopt adequate means of recovery. This empowerment will give strength and confidence to our service users, especially with regard to controlling their lives and claiming their rights whilst attaining the optimal level of autonomy, choice and control. Safety (physical and emotional) Physical : The person needs to feel safe from bodily harm, e.g. when we use a hoist to transfer the person, or to assist them to mobilise.  Emotional : The person needs to feel safe from humiliation, e.g. some people feel very embarrassed to be naked. We should be sensitive to this, allowing them to remain covered as much as possible when assisting with self-care and eliminating the risk of other people being present. To achieve all of the above, we need to communicate with the person. However, despite the fact that we are constantly communicating, we need to develop an awareness of the role our emotions, body language, tone and choice of words play . Some of our service users may not be able to communicate verbally with words. We can use verbal prompts, but it is often the case that service users react differently with different people. As Javier Cebreiros stated in his book “ We are the emotions that we communicate" (Cebreiros, 2015).  Therefore, it is imperative to ensure that the service user feels empowered and respected when adopting a person-centred approach and that they feel that their inherent value and worth is recognised. Good communication is vital to the promotion of dignity . Giving people the information they need to make their own plans and decisions is central to the UK's Care Act 2014, Mental Capacity Act 2005 and to the person-centred care agenda. It is a basic requirement for promoting dignity in care. Each individual that we work with is potentially vulnerable , as they are likely to have some form of physical and/or mentally disability. Therefore, their dignity may also be vulnerable. Some of the negative consequences of exercising a lack of dignity and respect in our interventions are that the person may not engage in treatment, leading to poor rehabilitation outcomes, depression, stress and anxiety. The fact is that all of us want to be treated with dignity and respect, but in reality, we do not always treat everyone with the dignity and respect we expect. On the other hand, as health professionals, we are likely to have suffered the violation of our dignity in the past, whilst trying to support and help a service user. It is important that we are able to perceive the related emotions, so that we are able to maintain a professional approach and continue supporting the person. Conversely, if we fail to acknowledge our dignity or exercise adequate self-care, we risk becoming numb to our feelings , leading to apathy in the workplace and increasing the risk of depression. According to the Health and Safety Executive, in 2018/19 stress, depression or anxiety accounted for 44% of all work-related ill health and 54% of all working days lost due to ill health. English is my second language. Having a strong European accent, I frequently experience situations where service users or family members assert that 'my accent' undermines me. In my experience, these situations appear to coincide with a challenge where, for example, my recommendations have failed to reflect the service user or family’s preferences. I recall a service user’s daughter who corrected my OT report and made 15 amendments of my grammar and punctuation which my colleagues failed to recognise as incorrect. I feel that her behaviour was due, in no small part, to the fact that the recommendations contained in the report were not to her liking.  Practising mindfulness , I am able to carry on treating every person with dignity, even if they violate my dignity. I have learned how to respond and to not react (well, in almost every situation!) Tips that help me on daily basis: Start by having 30 seconds' mindful meditation before my intervention, where I just observe my breathing (breathing in and breathing out). “Mindfulness means paying attention in a particular way: on purpose, in the present moment and non-judgementally” (Kabatt Zinn, 2013). At the end of the day, I observe how many times I have done my 30 seconds meditation. More importantly, I consider the benefits of my meditation each evening, before sleeping. I list 3 things every day that I have to be grateful for I try to perform regular random acts of kindness  We do have the power to make people feel good, by recognising their value and worth, by honouring their dignity. Please watch this documentary about validation : I invite you to do your part, in making dignity the priority of any intervention and relationship in your life. References Health and safety legislation laws in the workplace. Retrieved from: http://www.hse.gov.uk Hicks, D. (2011) Dignity . Yale University Press; reprint Edition (5 Mar 2013).  Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (rev. ed), New York, NY: Bantam Dell. Care Act (2014) Mental Capacity Act (2005) https://www.scie.org.uk/dignity/care/communication    https://www.google.com/search?q=dignity+definition&oq=DIGNITY&aqs=chrome.5.0l7j69i60.7565j0j7&sourceid=chrome&ie=UTF-8   Health and Safety Executive (HSE) (2022) Work-related stress, anxiety or depression statistics in Great Britain, 2022 (online). Available from: https://templatelab.com/stress-statistics/ . Access below: About me  María N Gómez Lacalle has been a committed Occupational Therapist for 15 years, with a particular focus upon the dignity, empowerment and safety of people among the ageing population and anyone in need of support. 'I stand for the dignity, empowerment and safety (physical and emotional) of all people who rely upon the support of others. I am the founder and CEO of Healthy and Independent, providing life-changing projects for organisations and individuals, through training, practical advice and recommendations. I am the author of A Dignified Approach to Moving and Handling People: as a Pathway to Empowerment and Tecnicas para movilizar y transferir con dignidad a las personas el camino hacia el empoderamiento . The aim of my book is to awaken the potential to increase the dignity, empowerment, and safety of people who are reliant on the support of others for manual handling, whilst reducing the risk of injury to either party. We can start to achieve this objective by recognising the dignity of others, regardless of our differences.'

This piece is dedicated to a remarkable individual I had the privilege of treating for approximately two weeks. 'S' - a young man in his early twenties, from a small village in Assam, India - arrived at our department in a wheelchair, due to the sequelae of a non-traumatic spinal cord injury (SCI) . Despite his physical challenges, S displayed an exceptional level of positivity and resilience ... S was an aspiring fashion designer, who moved to Delhi to follow his passion . The lack of funds for his higher education forced him to look for a part-time occupation, which led him to take a keen interest in the make-up and beauty industry. Soon, S realised that he had a talent for using knowledge of colour theory in applying make-up and started gathering a small clientele for himself. Tragedy struck with the advent of COVID-19 and, along with many others, S was also a victim of its atrocities. Within time, he was rendered paraplegic , requiring full use of a wheelchair and with 'no possibility of going back to work again'. Clinically, S presented with impairments in: trunk control upper limb strength functional skills wheelchair mobility Recognising his aspirations and potential for rehabilitation, I immediately initiated a comprehensive treatment plan, tailored to address these areas of concern. Our first target was to establish good trunk control and dynamic sitting balance , by engaging him in activities that challenged him in these areas. For example, overhead ball throwing and graded stooping in a high-seated position. Once that was established, we worked on improving upper limb strength and endurance , as it was essential for wheelchair mobility and transfers. Push-ups were a great option and his performance was evaluated based on clearance, endurance and level of assistance provided. Perfecting a static push-up was essential for relieving pressure during long sitting hours, to prevent pressure ulcers. Dynamic push-ups were necessary for independent transfers, from bed to wheelchair and vice-versa. During our therapy sessions, one of the main issues to address was how his current functional status affected his work, to a point of resigning as a make-up artist (MUA).  He educated me on all the postural and technical difficulties a male MUA faced, while doing his job in a wheelchair. His biggest challenge was the lack of trunk stability. The other issue he faced was positioning the client to accommodate his wheelchair . He wasn’t comfortable with the idea of leaning over the client’s face with the risk of falling over them while he worked. Another problem he faced was engaging in bilateral activities like hair washing and setting, since it involved him moving all around the client while working. He wouldn’t be able to manoeuvre the wheelchair if his hands were coated in any hair-care products... In order to better understand these hurdles, we conducted a simulation with some modifications, to better suit his functional status. Two of my colleagues assisted as volunteers; we gathered all the basic tools and equipment needed for him to apply basic make-up over a client.  We were immediately able to identify some factors that affected his activity performance : The quality of wheelchair used significantly affected his performance. The size, material, state of repair, presence of chest strap, quality of brakes and removable armrests were important aspects to take into account. Environmental factors , like accessibility and open space, were necessary to take into account. Using more handheld tools and gloves helped with prevention of cross-contamination. Having the client, in this case, the volunteer, seated at an inclination instead of lying supine also made a positive difference. A detachable lapboard to place all his tools on was also a better option than the trolley that was usually used by them. Throughout our sessions, S's determination and creativity shone brightly . Despite facing financial constraints and the devastating impact of COVID-19, he remained unwavering in his pursuit of regaining independence and pursuing his passions. With the support of his mother and close friends, S embarked on a journey of self-discovery and adaptation.   Incorporating occupational therapy , vocational rehabilitation and physical therapy , our sessions focused on enhancing S's functional abilities, while exploring opportunities for him to re-engage in his interests. Despite initial scepticism, S embraced the idea of utilising his talents in the makeup and beauty industry - leveraging his knowledge of colour theory and artistic skills. Our therapy sessions evolved into a collaborative exploration , of adaptive techniques and strategies tailored to S's unique needs. From mastering wheelchair positioning for optimal makeup application, to implementing pressure relieving techniques du ring prolonged sessions, each session served as a learning opportunity for both S and myself .   As our time together drew to a close, S's remarkable progress and unwavering optimism left a lasting impression on me . His resilience in the face of adversity serves as a testament to the human spirit's capacity for adaptation and growth. S's journey continues, as he undergoes long-term rehabilitation at another branch of our institute. While I may no longer be directly involved in his care, I remain inspired by his tenacity and consistent determination to overcome challenges and pursue his dreams. In conclusion... S's story exemplifies the transformative impact of rehabilitation and the strength of the human spirit. As healthcare professionals, it is both our privilege and responsibility to empower individuals like S, to reclaim their independence and pursue their passions - irrespective of the challenges they may face. Further reading and learning World Health Organization (WHO) (2013) Spinal cord injury  (online). Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury . Accessed 13 April 2024. OT CPD Courses: Fundamentals of Posture, Pressure and Ergonomics (2022, The Occupational Therapy Hub). Plus+ Member access to participate and receive a certificate.

Pediatric occupational therapists (OTs) are widely known to help children with their fine motor skills. We are experts with kids needing sensory regulation interventions or self-help skills. But where do we fit in on a team when a child has a learning difference , such as Dyslexia or Dysgraphia? What is our role with this population? And how do we serve these children and support them academically and in their occupational role of literacy? Let’s find out! Let's start by quickly defining Dyslexia and Dysgraphia... According to the DSM 5TR, specific learning disabilities (SLD) is the umbrella diagnosis under which impairment in reading, writing, or math is delineated.

This is a topic that I have recently become inspired by and motivated to learn more about in my practice. To help cement my learning in this area, I thought I would reflect on my understanding. I will firstly explore vital concepts and understanding within the field, before considering the impact on practice. Trauma can be caused by a number of stressors that reach beyond the obvious abuse and neglect; it can be the result of a dental procedure, or a concussion that causes significant shock to the body (Van der Kolk 2015). When our body experiences chronic stress, our cortisol levels increase, in order to enable us to respond to the perceived threat (Levine, 2015). However, in a highly anxious state, only basic functions are carried out, involving the nervous system survival response (eg. fight, freeze and flight) (Selye, 1976). If stressors continue, the body remains in high stress survival mode long after the stressor is gone. This puts constant stress on the body's systems (e.g. digestive system), making it difficult to function properly (Maté, 2011). This response is seen by those who have experienced adversity in early childhood , such as abuse, misattunement, attachment and chronic neglect during infancy.

How often have we heard: "Sign up for an activity!" "You should get out more." "Don't you think you spend a lot of time doing nothing? Go for a walk" "You need to start a new routine." or "I'm worried about you." These are expressions commonly used to attempt to 'motivate' someone to do something. However, a number of questions come to my mind: What am I signing up for? When? Where? How? With whom? And why?... What we do is part of who we are I am writing this as an occupational therapist (OT). I wonder why people know so much about the properties of aspirin, for example, but not about the make-up and importance of occupation, sleep, habits, roles and routines ; certainly not about the properties of everyday life activities. Four years ago, I started a journey through a 'strange' world. I am an occupational therapist, specialising in mental health. My PhD in Psychology focused on researching the daily lives of people diagnosed with a rare disease: Variant Transthyretin Amyloidosis . I started by studying the condition, although after some time I became immersed in others, such as other Amyloidoses, Tuberous Sclerosis, Familial Spastic Paraparesis and Epidermolysis Bullosa ( known as 'Butterfly Skin'). How lucky I was! Daily life Variant Transthyretin Amyloidosis is a rare genetic disease , complex to understand and with a variable prognosis. It was first described in 1952 by the Portuguese neurologist Corino Andrade as a peculiar form of peripheral neuropathy. In Europe, the incidence of Variant Transthyretin Amyloidosis varies widely. In Portugal, Sweden, Majorca and Cyprus, Variant Transthyretin Amyloidosis with Polyneuropathy is endemic and one particular mutation predominates - Val30Met. Low prevalence, little research and therefore little understanding. That is the reality. First symptoms of the disease usually appear in the third decade of life. Patients usually experience severe physical limitations due to the genetic mutation - but psychological, social and occupational effects have also been described (Luigetti et al., 2020). Existing research suggests that being diagnosed affects activities of daily living (Buades-Reinés et al., 2016). However, in addition to the clinical approach, no type of intervention has been described that focuses on the maintenance, improvement and adaptation of the daily life of patients and their carers after the diagnosis - a competence that sits within the discipline of occupational therapy. Specifically, my PhD project aims to analyse the effectiveness of an occupational intervention in patients with Variant Transthyretin Amyloidosis. The objectives were to have concrete understanding of: what the benefits of this intervention would be in which parameters of the daily life of patients these benefits would be realised what the magnitude of their impact would be I wanted to illustrate the impact of this disease on the occupational dimension and on daily life - to open up avenues for future research, to stimulate reflection on possible lines of intervention and to highlight the importance of a differentiated multidisciplinary team - complemented by professionals in the psychosocial field, such as occupational therapists. It is the journey that is important, not the destination   During these four years I have worked with people in group and individual sessions, to work on daily living and understand how the body works as a whole. Studying, adapting, changing or starting new occupations have been my goals during my time specialising in rare diseases. I discovered that the occupational therapist is the key to motivation, planning and understanding the basic and not-so-basic aspects of daily life. And that it is not about people doing things; it is about having a meaningful life, without being conditioned by a diagnosis. I understood that occupation is not a luxury for a few; it is a right for all. Asociación Balear de la enfermedad de Andrade (ABEA) To make contact regarding this research: Aina Gayá Barroso ainabarroso@gmail.com Instagram: gaya_terapiaocupacional References   Ando, Y., Coelho, T., Berk, J.L., Cruz, M.W., Ericzon, B-G., Ikeda, S-I., Lewis, W.D., Obici, L., Planté-Bordeneuve, V., Rapezzi, C. et al. Guideline of transthyretin-related hereditary amyloidosis for clinicians.  Orphanet Journal of Rare Diseases . 2013, 8, 31-38. [Google Scholar] [CrossRef] [PubMed] Asociación Balear de la enfermedad de Andrade (ABEA). Available online: https://andradebalear.es/ Connors, L.H., Lim, A., Prokaeva, T., Roskens, V.A. and Costello, C.E. Tabulation of human transthyretin (TTR) variants. Amyloid. 2003, 10, 160-184. [Google Scholar] [CrossRef] Damy, T., Adams, D., Bridoux, F., Grateau, G., Planté-Bordeneuve, V., Ghiron, Y., Farrugia, A., Pelcot, F., Taieb, C., Labeyrie, C. et al. Amyloidosis from the patient perspective: The French daily impact of amyloidosis study. Amyloid.  2022, 29, 165-174. [Google Scholar] [CrossRef] [PubMed] Estébanez, C.T., Soriano, C.S., Escrich, A.G. and Segura, S.R. Late-onset familial amyloid polyneuropathy in the Safor (Valencia) area: Four case reports. Rev. Clín. Esp . 2007, 207, 75-76. [Google Scholar] [CrossRef] Gayà-Barroso, A., González-Moreno, J., Rodríguez, A., Ripoll-Vera, T., Losada-López, I., Gili, M. and Cisneros-Barroso, E. Accessibility to Occupational Therapy Services for Hereditary Transthyretin Amyloidosis. Int. J. Environ. Res. Public Health . 2022, 19, 4464. [Google Scholar] [CrossRef] [PubMed] González-Moreno, J., Gayà-Barroso, A., Losada-López, I., Rodríguez, A., Bosch-Rovira, T., Ripoll- Vera, T., Usón, M., Figuerola, A., Descals, C., Montalà, C. et al. Val50Met hereditary transthyretin amyloidosis: Not just a medical problem, but a psychosocial burden. Orphanet Journal of Rare Diseases . 2021, 16, 266. [Google Scholar] [CrossRef] Kraaimaat, F.W., Brons, M.R., Geenen, R. and Bijlsma, J.W. The effect of cognitive behavior therapy in patients with rheumatoid arthritis. Behav. Res. Ther . 1995, 33, 487-495. [Google Scholar] [CrossRef] Legg, L.A., Lewis, S.R., Schofield-Robinson, O.J., Drummond, A. and Langhorne, P. Occupational therapy for adults with problems in activities of daily living after stroke. In Cochrane Database of Systematic Reviews . John Wiley & Sons, Ltd.: Hoboken, NJ, USA, 2017. [Google Scholar] [CrossRef] Martín, M. Clinical and analytical variability in cases of familial amyloidotic 331 polyneuropathy (PAF-TTR): Comparison between healthy carriers and symptomatic 332 patients. Med. Balear . 2015, 30, 31-36. [Google Scholar] Matyjasik-Liggett, M. and Wittman, P. The Utilization of Occupational Therapy Services for Persons with Charcot-Marie-Tooth Disease. Occup. Ther. Health Care . 2013, 27, 228-237. [Google Scholar] [CrossRef] Munar-Qués, M., Saraiva, M.J., Viader-Farré, C., Zabay-Becerril, J.M. and Mulet-Ferrer, J. Genetic epidemiology of familial amyloid polyneuropathy in the Balearic Islands (Spain). Amyloid. 2005, 12, 54-56. [Google Scholar] [CrossRef] [PubMed] Raya-Cruz, M., Buades-Reines, J. and Gállego-Lezaun, C. Variabilidad clínica y analítica en casos de polineuropatía amiloidótica familiar (PAF-TTR): Comparación entre portadores sanos y pacientes sintomáticos. Med. Balear . 2015, 30-33, 31-36. [Google Scholar] [CrossRef] Reinés, J.B., Vera, T.R., Martín, M.U., Serra, H.A., Campins, M.M.C., Millán, J.M.D., Lezaun, C.G. and Cruz, M.R. Epidemiology of transthyretin-associated familial amyloid polyneuropathy in the Majorcan area: Son Llàtzer Hospital descriptive study. Orphanet Journal of Rare Diseases . 2014, 9, 29. [Google Scholar] [CrossRef] Said, G. Diagnostic pitfalls in sporadic transthyretin familial amyloid 346 polyneuropathy (TTR- FAP). Neurology.  2007, 69, 693-698. [Google Scholar] [CrossRef] Sakellariou, D. and Pollard, N. Occupational Therapies without Borders: Integrating Justice with Practice . 2nd ed., Elsevier: Amsterdam, The Netherlands, 2017, pp. 102-108. [Google Scholar] Van Deusen, J. and Harlowe, D. The efficacy of the ROM Dance Program for adults with rheumatoid arthritis.  Am. J. Occup. Ther . 1987, 41, 90-95. [Google Scholar] [CrossRef] [PubMed] Voortman, M., Fritz, D., Vogels, O.J.M., Eftimov, F., van de Beek, D., Brouwer, M.C. and Drent, M. Small fiber neuropathy: A disabling and underrecognized syndrome. Curr. Opin. Pulm. Med . 2017, 23, 447–457. [Google Scholar] [CrossRef]

The 'therapeutic use of self' is a term that is often used in occupational therapy and other therapies. However, many clinicians do not know what the therapeutic use of self is , or why it is so important. Read on to find out more... Therapeutic use of self 'The thoughtful and deliberate use of one’s personality, opinions and judgments as a component of the therapeutic process' ( Mosby’s Medical Dictionary , 2009) The term originates from philosophy and the theories of self . This demonstrates that researchers and practitioners acknowledge that, if you are asking a research question, completing research, running a business, or delivering care or a service, you will be influencing the outcome . What does this really mean though - and can therapy be delivered without considering the therapeutic use of self? Why is therapeutic use of self important? Asayand Lambert (1999) investigated what influenced change in psychotherapy clients, separating the possible influences for change into: therapeutic relationship, extra-therapeutic change (e.g. support, personality or 'ego strength'), placebo and technique. The results from their meta-analysis are as follows: This indicates that therapy cannot be delivered without considering how the therapist is influencing the outcome , through their therapeutic use of self. If the therapeutic use of self is so important, more so than technique, shouldn’t there be a general consensus about how therapists are going to influence change? Techniques to consider when using therapeutic use of self Carl Beuhner is quoted as saying 'they may forget what you said - but they will never forget how you made them feel.' Consequently, therapists and care providers need to consider how they are making their clients feel. Ask yourself: are you rushing around and not giving clients the time they need when you are delivering care or treatment? We all do this at times because everyone is stretched, but if that feeling influences outcomes by 30%, then haven’t you just ruined the opportunity for change, by letting the client know you don’t have time for them? 'They may forget what you said - but they will never forget how you made them feel' - Carl Beuhner The first technique then is attunement . Attunement is the ability to be completely present with the client, developing a feeling of connectedness with them. The majority of the work around this is from psychotherapies however, as an occupational therapist , don’t you pride yourself as having origins in arts and crafts, psychology, architecture, nursing, social work, philosophy, teaching and psychiatry? Therefore, you should be considering all of these aspects within your work, both in everything you do and in what you recommend. Within attunement you should be considering what your body language is saying, how your tone of voice is delivering the message, if your facial expressions and body language (including eye contact) match what you are saying and if you need to mirror the client in order for them to recognise that they have your full attention. The second technique is providing the client with unconditional positive regard . Unconditional positive regard is the ability to accept that the client is trying their best and accepting where they are at that time. This does not mean you have to agree with their choices or even like them as a person. However, it does mean that you are providing client-centred care and treatment - whilst allowing the client to make mistakes, through their ability to make their own self-determined choices. Self-disclosure is the third technique. There are two types of self-disclosure; intra-session disclosure and extra-session disclosure . Intra-session refers to reflecting how something they have done or has happened during the session has made you feel. Extra-session disclosure is disclosing information about yourself, whether that be previous qualifications, family life or interests and events. Self-disclosure can be a positive experience for the client, building rapport with them and developing a therapeutic alliance. However, Leanne Hall states there are five golden rules to self-disclosure: Waiting Being brief Being clear that this is your opinion Considering the client’s values Considering the impact self-disclosure is going to have Waiting refers to the therapist considering why they are self-disclosing, whilst being brief is to ensure the client does not feel the therapist is hijacking their session. Therapists also need to ensure that when they are self-disclosing the client knows this is their opinion and is not part of their clinical expertise or experience, as the statement could be contrary to the client’s own beliefs and values. Additionally, if the statement is contrary to the client’s own beliefs and values, consider if this self-disclosure is going to jeopardise the therapeutic relationship and alienate the client? This then leads to the final factor of considering the impact that self-disclosure can have, as clients may be left feeling burdened by the self-disclosure rather than aligned with the therapist. Whilst these 'golden rules' ensure self-disclosure is used appropriately, it is important to remember that it can assist the client with humanising the therapist. The final technique is the ability to balance the power differential . Clients often believe that the therapist or professional has greater power than them. However, this belief can lead to self-helplessness , whereas a therapist should be promoting self-empowerment and self-help . Therefore, it is essential to understand the client’s background and culture , whilst presenting yourself in an honest and congruent way. That means the power imbalance should be addressed during therapy or care. The acknowledgement that you may know more about a particular solution to their problem based on your training and experience should be made, whist acknowledging that they are the expert about themselves, their culture, their expectations and their own lives. The client and the therapist should then be working together to problem solve how the “solution” that the therapist suggests can be integrated into the client’s life, based on the information the client has about themselves. Summary In summary, based on my research and training, the therapeutic use of self encompasses four techniques: Attunement Unconditional positive regard Self-disclosure Balancing the power differential If therapists and care providers incorporate these techniques in a positive and helpful way for the client, without hijacking the client’s treatment or care, then better outcomes should be gained. To read similar articles, visit Therapy Buzz

' Heart disease is the leading cause of death in the United States . Each year, approximately 790,000 adults have a myocardial infarction (heart attack), including 210,000 that are recurrent heart attacks' (Fang et al, 2017). Outpatient rehabilitation helps reduce the likelihood of recurrences and improves the outcome for patients who have had a cardiac episode. Despite this, the Centers for Disease Control and Prevention (CDC) in the US reports that the current use of cardiac rehabilitation is suboptimal . That is, only around one-third of heart attack survivors rely on cardiac rehabilitation, with factors such as out-of-pocket payments, low awareness, and lack of access to rehabilitation all playing a role in this dilemma. The CDC recommends that out-of-pocket expenses be reduced, referrals standardised, and awareness campaigns launched, especially among underserved populations. Occupational therapists play a key role in the provision of rehabilitation services for such patients. To discover some of the interventions they carry out, read on...

By Charmi Shah - Occupational Therapist, India The word Diwali is coined from the Sanskrit word Deepavali , which means row of lamps. Also known as the festival of lights, Diwali is the most popular Hindu festival, that spiritually signifies ‘ victory of light over darkness ’! This cultural and spiritual festival is celebrated in India and by Indian origin people around the world. As occupational therapists, we talk about our holistic approach to treatments, but we usually forget our fourth dimension - spirituality . Spirituality is more than just believing in a god or goddess; it’s more than religion and faith; it is about hope, about being ourselves and reflecting on it. It is a path towards finding our inner light and reaching the stage of self-actualisation (remember Maslow’s Hierarchy of Human Needs). Even if we cringe over this, let us accept the fact that humans are spiritual beings! Besides being spiritual in nature, festivals like Diwali also add a sense of participation and belonging to a community. They strengthen family bonds and relationships, while adding a sense of happiness and value. Incorporating spirituality and activities related to festivities in our treatments can make us holistic in a true sense . This is what occupational therapy is all about: Adding meaning to life. “Like Diwali, occupational therapy is the hope that glimmers in the darkest hour" This festive season, keep enlightening and enriching lives. Greetings from India. Wishing you all a Happy Diwali! Charmi Occupational Therapist, India

It's early in the morning of August 7th 2002 and the ringing of the phone drags me out of my sleep. On the other end is a caregiver at mom's facility. "Your mom is mottling and you need to get here soon if you want to be with her." Thirty minutes later, my wife Ellen and I arrive in mom's room, to find many of her caregivers gathered around her. They had taken turns sitting with her all night. A round of hugs and it's now our time to sit beside her, as her breathing slows, becomes increasingly erratic and finally stops. Her passing that morning brings to a close the eight-year journey she, we and her increasing dementia shared. In this article, I would like to detail strategies used to help mom maintain her independence, for as long a possible... Her story Born in Northwestern Ohio in the US, in March of 1922, Grace Louise Keeler never seemed to have the wanderlust that took her three children to different parts of the country. She met and married our father, Roy Croninger and seemed to find satisfaction as a wife and mother . In the 1960s she took a job as a cashier in a large grocery store, working there for over twenty years. Not one to settle down after retirement , she continued to be active in her church, social organizations and as a driver for elder residents in our home town. Lessons learned [For each section, I'll talk briefly about challenges we both anticipated and didn't - and how occupational therapy was a powerful tool that helped both Grace and the family in keeping her independent for as long as possible]. Grace often expressed anxiety at the possibility of "losing my mind", as she felt women in her family often had as they aged. Years before we saw symptoms of memory loss , she set out to catalogue many of the items in our house. She wrote a letter detailing the history of each object and shared where she wanted it to 'go' following her death. In a second letter, she expressed her wishes for her own funeral, selecting and paying for internment and the services. Although we often felt she was 'rushing things', her forethought made the process of dealing with her loss much less traumatic for all of us. Dementia The changes came on slowly at first . My sister remembers that letters from mom would arrive with lots of tape on the back. Mom would have opened them a number of times, not being able to remember whether she signed them or put something in she had wanted to. Her handwriting, which was never good, was becoming less legible . Later, birthday cards arrived, addressed to the wrong niece or nephew. Dad had passed away in 1994 and we became much more acutely aware of problems, as well as how they had worked together as a 'team' to hide them from us . We developed a routine where one of us or a friend would visit her periodically. On trips home, we began to notice spoiled food in the refrigerator with the date that the previous visitor had placed on the wrapper. The freezer had become a study in 'freezer burn', as we became aware that nothing had moved out of it since his death. The house was gradually becoming increasingly cluttered and the garden and bushes she had been so proud of were no long being taken care of. Mom was also beginning to lose things more often . Friends now occasionally called, concerned of the changes they felt they were seeing. Lessons learned Three critical points here. We took mom for an evaluation at a nearby teaching hospital. She had a full neuropsychological exam , which confirmed a diagnosis of dementia. Although having the diagnosis does not change anything, it made mom and us aware of the problem. She felt better that she now knew she was "not going crazy". It also allows us to research and share what we would likely see in the future . The three of us set to planning for that future. The second point - possibly the most important I would make - is that we began to develop this plan before things reached a crisis point. I utilized Allens Routine Task Inventory (RTI) , to help us get a picture of her abilities and the care she required. At that time, mom was 100% able to participate in discussions. We were able to ask her what her wishes were and to jointly agree on what behavior on her part would require a decision on ours . We were fully aware that there would come a time when none of what we discussed would be remembered. Still, it allowed her to be in charge of decision points and for us to understand her needs and fears . The discussions were frequently painful for her and us. The plan, however, served us well in the days and years that followed. Finally, mom and dad had previously granted us a power of attorney , which allowed us to act on her behalf when conditions necessitated. The point in all this is that, by knowing what your loved one or clients are up against and having the legal authority to act, they will not be operating in a crisis mode. Think of it as a tripod with all legs: Knowledge, a plan and a legal right to act - equally important. "I want to stay here!" Her strongest desire was to remain in the house as long as possible . The decision to leave would be based on her suggestion, "when I can no longer take care of myself". We 'operationalized' this to mean that we would watch her personal hygiene , safety in the house and ability to find her way to and from sites on foot. I'll deal with driving as a separate issue later. We identified two areas that were affecting her ability to function independently: clutter and organization . On each subsequent visit we worked to decrease the volume of items in her environment. Mom was involved initially in helping us identify papers, keepsakes, clothing and furniture that she wanted to keep (although we had to watch her, because she would often go behind us and takes things out of the 'throw' or store boxes (sneaky devil that she was!) It was very slow work, as we made a point of encouraging her to talk about the history of objects and pictures , particularly if it was to be stored or discarded. lt turned a potentially traumatic process into a decidedly therapeutic experience for all of us. Once we reduced the volume of material in the house, we set to developing 'work stations' for common tasks. Dad's clothing had been moved out of the bedroom and she allowed us to remove furniture that she no longer needed or wanted. They had a drop-front desk in a spare bedroom, in which all bills and records had historically been stored. We removed and stored all records that she would not need. We then labelled storage spaces in the desk for each of her bills. She was able to remember to put bills in these temporary containers for quite some time. The final workstation was near the phone. As the illness progressed, mom would frequently make repeated frantic phone calls to one of us or a friend about some "problem". We placed a large calendar, clock with date and an erasable white board beside the phone. For quite some time we could stop the calls, by having her write a note to herself on the board and/or calendar. Lessons learned The statement "when I can no longer take care of myself" required clarification , so we could monitor her status. When you are working with something like this, ask yourself "How will I measure this?" If you cannot come up with a way to measure it, you likely have a concept that is too broad or abstract. Step back and see if you can break it down further. Prior to his death, dad had asked a family friend 'Betty' to look after mom's finances . Because mom loved to visit people and desired to "pay her own bills", we used a strategy that continued to have bills delivered to the house. Mom placed them into the appropriate cubbies of the desk and Betty picked them up on designated days and wrote cheques for her. Mom would then visit the appropriate place to pay them. Betty paid some bills by mail, usually because the distance was too great for mom to walk. She also provided mom with an agreed-upon stipend each week. Initially this strategy worked well; mom got plenty of exercise as well as "chat time", which she relished. However, it eventually became obvious we needed an additional tier of assistance . All three of us lived at least two days' driving time from our home town. We had no effective means of routinely monitoring hygiene and safety. Although we each researched the availability of agencies in town which could help us, we found none. The US health care system is not always set up to address diagnoses which are mental-health only . Had she been physically disabled, an entity would have stepped forward, but being physically healthy was a major impediment for us. As occupational therapists (OTs), we are uniquely qualified to evaluate and intervene in situations like this. Unfortunately, there were no OTs in or within a reasonable distance of our home town at that point. We looked into the possibility of hiring a visiting therapist, but did not feel we could afford the frequency of visits we desired. Our solution was to find a new graduate, 'Denise', who had completed her studies and fieldwork placements but not yet set for the National Exam. She was interested in working with clients in our area and in the possibility of gaining experience in a real-world environment. She was also quite happy to receive the stipend we offered. We arranged for her to work with mom twice a week, using treatment goals that she and I had devised. She provided weekly reports and called one of us anytime she had questions. Her OT training, as well as the skills she acquired in environmental modification and task adaptation, were vital - and greatly increased the time that Grace was able to remain in her home. "Where's my car?" Grace loved to drive and took every opportunity to get behind the wheel. All of us remember dad growling that she was "putting too many miles on the car", or just driving too much. Although it was obvious that she missed him deeply after 50+ years of marriage, it did allow her to be the 'captain of her own ship' and she loved her jaunts. We dreaded the prospect of eventually having to take that car. She was still a safe driver, but was becoming a very slow driver. Yet there came a time when we began to hear from family friends that she may no longer be safe driving. This was particularly concerning, as she was also still driving other elders to medical or social appointments . Some of these elders were putting increasing pressure on her for time or distance she drove them. Mom's first concession was to agree to drop her 'taxi' service. She would still grocery shop or run errands for them, but no longer transported individuals in her car. We were also beginning to notice an increase in the dents and dings on that car. Anticipating that there would come a day when she should no longer be driving, we had spoken with the chief of police in the town. One day, she called our sister early in the morning, upset because the car was not in the driveway. She wondered if we had taken it or it had been stolen . What we later learned is that she had driven to a nearby restaurant that she and dad had frequented, parked behind the building and entered through the kitchen. This had been common practice for them. Finishing her breakfast, she then walked out the front door, did not see the car and decided she must have walked to breakfast. Lessons learned Again, having a plan with decision points was critical, to being able to deal with her driving in a manner that limited the trauma for her . We had established for ourselves that a moving violation, accident or observation of unsafe driving would be our trip wire. We had also agreed that the observation would need to come from a small group of friends who frequently encouraged her and who we trusted. The power of attorney had allowed us to contact the town's police chief some months earlier. He agreed to notify us, should an event occur which involved her license plate. When mom 'lost' the car, she called the police and they notified us. We had the car picked up by a friend. We then called her to notify her that her car was safe and that we would all be coming home to talk this over. She had previously signed an agreement that allowed us to do this, but we all suspected (and were correct) that she would not remember it and would be upset. Our initial plan had included securing transportation before this happened. We knew how she normally used the car and had contacted friends who had agreed to be her drivers for church, shopping and the beauty parlor. This event was probably more difficult for all of us than the eventual move from her house. It represented a significant loss of independence for mom and was a sign of losses yet to come. Because of the safety issues involved, you must be clear in your own mind what constitutes behavior which poses a risk to life and limb - both of your loved one, as well as the general public. "Till I don't know who I am" The various strategies and caregivers we have detailed worked well for a period of approximately two years. In that period, the memory loss and confusion was also progressing. Mom had always been anxious, now even with medication the anxiety was seriously impacting her ability to function independently . Our workstation strategy, one that had served well for so many months, was beginning to fail. Once again, she was beginning to call individuals multiple times over the same question, often mere minutes apart. Even more troubling is that her sense of time seemed to be failing , as some of the calls were made early in the morning and to individuals who barely knew her. Along with Denise, we were also beginning to see the first decreases in personal hygiene. Denise reported she was wearing the same clothing day-after-day. The bill paying and allowance strategies were now failing ; she would sometimes call Betty to complain that she had not received her allowance, when she had. Now we began to hear that she was occasionally becoming lost on foot, no more than a block from her house she had lived in for over 50 years. Watching her abilities deteriorate made me think of an OT term, topographical orientation. She was increasingly no longer sure of where she was, or how to get to someplace else. It was like watching a purse string being pulled tighter and tighter, diminishing the area in which she could safely operate, even on foot. We had crossed yet another line. It was time for her to leave the house she had called home for so many years. Lessons learned In many ways, the leave-taking likely bothered my brother, sister and I more than mom. Dementia had taken so many of her memories by now that she did not seem at all upset at leaving the little house at the point of Clinton and Schultz Streets. We had previously been able to find an attractive facility in our home town. Mom had earlier expressed a desire to stay in-town until she did not know any of her friends. At that time, a number of the facility residents were friends or close acquaintances and she took to her new 'home' immediately. She did ask a number of times when she would return to "her home" - but once she saw her room with her furniture and pictures, she seemed to settle in without further questions. We learned a valuable lesson in the year she spent there. A facility that looks good and does a good job of 'selling' to you is not necessarily a great place. It is important to talk to the caregivers who will interact with your loved one - particularly important if, like us, the family members live distantly. She was always well taken care of, but we gradually began to understand that her caregivers at this facility were too overworked to be able to spend much quality time with her . The year passed quickly and it became obvious that mom had crossed one more line. She seemed no longer able to recognize any of her friends. To Maine Our brother and his wife brought mom to Maine in the Northern part of the US in March of 2002. We had been lucky to find a great facility in a town where my wife and I worked, that proved to be everything the one in her home town had not been. Once again, we were able to get a few pieces of her old furniture and pictures moved to the room prior to her arrival. The story of her time in Maine was pretty much one of excellent care, by a facility that was staffed with individuals who enjoyed interacting with the residents . She maintained her sense of humor and nearly always seemed to be in fine spirits during my once-a-week lunch visits and Sunday outings. The memory loss continued, as did the decrease in her ability to care for her hygiene. One Sunday, we entered her room to find her prepared for a day's lunch, but staring intently at the 50th Wedding Anniversary picture of her and our father. She still knew me and asked "Who is that man standing beside me in that picture?" I replied that this was dad, to which she replied, looking back at his image, "Well he wasn't a very handsome man, was he!" My wife, daughter and I were barely able to maintain a straight face. Curiously, along with the losses seemed to come peace, more smiles and laughter. The anxiety that had plagued her during all of her adult life faded. The diverticulitis that often made her miserable or led to a hospitalization also departed - and she was able to eat food that traditionally had produced a painful flareup. She is back in Ohio now, sleeping besides our father. The whiteboard (left) hangs in my woodshed, with all the beautiful goodbyes her caregivers had left on it, on the day of her passing. Two decades later, I have never had the desire to erase those kind words that they left for her. Lessons learned Again, I cannot stress enough the importance of picking settings before you need them! We had looked at many options prior to the move to Maine. Each of us considered moving mom in with us, or possibly having an extension built for her. The increasing confusion made this unsafe; I awoke during one trip to find her trying to get out of the hotel room, so she could "go home." It would have been wonderful to have her in our homes, but none of the families could forfeit a second job to allow one spouse to stay home. The facility in Maine seemed never to have heard the phrase "Oh, that's not my job", as staff and administrators were always willing to help. In those last days, we met hospice nurses from a local agency, that were incredible in the level of care provided. I had mentioned one day that she and dad had enjoyed the "Big Band" sounds of their generation. The next day there was a CD player with a collection of music from that era in her room. We had mentioned the white board to the faculty and hospice nurses and were invited to bring it in. The board was hung on the wall in her room and all parties used it as a very effective means to communicate her needs and status. Two days before her passing, we recorded 'goodbyes' from the entire family and played it beside her bed. I'm not sure she 'heard' them, but I choose to believe she did. Final thoughts In the 37 years I have been an occupational therapist, I was never known to be a 'cheerleader' for our profession, but this one time I will recommend us without reservation. I do feel that the occupational therapist is uniquely qualified to assist families in this situation. Many professions have the training and experiences to help families and clients living with dementia or Alzheimer's. But the profession of occupational therapy is a truly 'one-stop shop' in my (admittedly) biased opinion. Allen's RTI (or Routine Task Inventory) was my most valuable tool in helping my siblings deal with our challenges . It is also a tool that my brother and sister quickly became comfortable and competent at administering... Further reading Allen Cognitive Network (2023) Routine Task Inventory-Expanded (RTI-E) (online). Available from: https://www.allen-cognitive-network.org/index.php/allen-cognitive-model/routine-task-inventory-expanded-rti-e . Accessed 13 September 2023.

By Pam Clarke, Expert Hand & Rehabilitation Therapist, The OT Practice

Over the last few decades, there have been incredible advancements in healthcare. While these advancements have resulted in people living longer and, presumably, staying in better physical health, our brains - the complex organ that effectively governs our quality of life - just aren't keeping up. Deficits in cognition can arise from many physical and mental health challenges, as well as ageing and lifestyle factors. Despite this, cognition is not frequently measured as part of routine healthcare , or in acute treatment programs. When it is, occupational therapists (OTs) typically rely on rudimentary cognitive screening tools - for example, the Montreal Cognitive Assessment ( MoCA) and mini mental state examination (MMSE) - or else infrequent (and often delayed) specialised reports from MRIs, or comprehensive neuropsychological examinations.

The arts are often forgotten when considering therapy options for children with learning and developmental disabilities. Painting, drawing, music, dance and theatre can provide a range of benefits for them (and those facilitating such activities). In 5 Fun and Educational Activities with Children , Katie Pierce and The Occupational Therapy Hub explore some of these in more detail (why not take a read after this article?) Find the right medium There are a breadth of arts in which you can encourage your child, or those you support in clinical practice, to participate and thrive within. Let them experiment and see which one brings out their inner artist. Painting and Drawing One of the benefits of painting, drawing, and even crafting for children with learning disabilities (US: intellectual disabilities) is that it can help them to improve their fine motor skills (Pierce, 2022), encourage creativity , and reduce stress . Additionally, painting and drawing can also help children with sensory needs or developmental disabilities express themselves in a non-verbal way (Pandey, 2022). For children who struggle to express themselves verbally, painting and drawing can be helpful outlets. Music Learning to play music can also be beneficial for children with learning disabilities; music can help to improve memory, attention span and coordination (Palmer, 2022). Alongside these cognitive benefits, music has also been shown to reduce stress levels and anxiety. For children with learning disabilities who experience anxiety or stress, taking music lessons can be a great way to help them cope. Theatre Theatre provides an opportunity for children to develop confidence and public speaking abilities. Additionally, participation can also help children to improve problem-solving skills, as they learn to work together as part of a team; for children who struggle socially, theatre could provide a much-needed outlet (All About Therapy, 2023). Dance Like music, dance can also help to improve coordination and memory (Studio Director, 2021). Of course, dance is also a great way to get some exercise. In turn, this has a host of benefits, including reducing stress levels, improving sleep quality and supporting overall mental health . For children with learning disabilities who have trouble getting regular exercise, taking a dance class could be a great solution. Offer space to build on their artistry If you are looking for a way to update your home and to give your child a space to express their creativity, consider updating a multi-purpose room into a studio. Whilst providing that space to create or develop artistic passion, this can also be a great way to improve your home's value (Redfin, 2023). If the physical environment does not allow for converting an entire room into a studio, you could also create a mini version, by setting up a workstation in another room of the house or flat. If you work from home , try to design this creative space with that in mind. It can be difficult to juggle parenting and work - especially in the same location - but setting up a space where you can keep an eye on your little artist while you get some work done can be a great compromise. But remember the importance of taking breaks, to make time to spend with your child (Zen Business, 2021). There is arguably nothing better than doing something together that your child loves. It does not matter if you cannot draw or have no rhythm, the point is that you do something meaningful together. A bonus: New business for you? If you find joy in teaching your kids how to engage in artistic expression, it could be worth considering starting a business in this field. This can be a great way to make some extra money, whilst also doing something you love . There are a variety of ways to start an art-based business; you could start by teaching classes out of your home, or by renting space at a community centre. Additionally, you could start selling your artwork online, or through local art galleries. The take-away: Let your kids be artists As you can see, there are many benefits to engaging your child (or those you support in practice) in creative-based occupations . Not only will they likely have fun, the arts can help to improve fine motor skills, memory, attention span, coordination, confidence and public speaking. If you are looking for leisure activities that can help children in multiple areas of their lives, the arts may be the perfect fit! References All About Therapy (2023) 7 Surprising Benefits of Theatre Involvement for Kids with Intellectual Disabilities. All About Therapy (online). Available from: https://allabouttherapyforkids.com/7-surprising-benefits-theatre-involvement-kids-intellectual-disabilities/ . Accessed 18 March 2023. Palmer, J. (2022) The Powerful Impacts Of Music For Those With Learning Difficulties. New Directions (online). Available from: https://newdirectionsrugby.org.uk/the-powerful-impacts-of-music-for-those-with-learning-difficulties/ . Accessed 18 March 2023. Pandey, A. (2022) 5 Simple Art Projects For a Child with Special Needs. Autism Parenting Magazine (online). Available from: https://www.autismparentingmagazine.com/art-projects-for-special-needs/ . Accessed 18 March 2023. Pierce, K. (2022) 5 Fun and Educational Activities with Children. The Occupational Therapy Hub > Therapy Articles (online). Available from: https://www.theothub.com/article/5-fun-and-educational-activities-with-children . Accessed 18 March 2023. Redfin (2023) How to Increase Your Home Appraisal Value. Redfin (online). Available from: https://www.redfin.com/guides/how-to-increase-your-home-appraisal-value-now . Accessed 18 March 2023. Studio Director (2021) The Benefits Of Dance Classes For Special Needs Students. Studio Director (online). Available from: https://www.thestudiodirector.com/blog/the-benefits-of-dance-classes-for-individuals-with-special-needs/ . Accessed 18 March 2023. Zen Business (2021). Working Moms: How to Prioritize Kids During Busy Seasons. Zen Business (online). Available from: https://www.zenbusiness.com/blog/working-moms-how-prioritize-kids-during-busy-seasons/ . Accessed 18 March 2023.

What is health literacy? The Centers for Disease Control and Prevention (CDC) (2020) and American Occupational Therapy Association (AOTA) (2011) agree: health literacy is the degree to which individuals can find , understand and use information/services, to make well-informed health-related decisions and actions, in a manner that promotes health participation, autonomy and informed decision making. Truly conceptualizing the activities associated with maintaining and improving health can support safe, informed choices, personal efficacy and being in control over personal health . Is health literacy a national priority? Yes! On August 18th 2020, the US Department of Health and Human Services (2020) released the nation’s 10-year Healthy People 2030 initiative, which envisions 'a society in which all people can achieve their full potential for health and well-being across the lifespan' (para. 2). One of the five major goals identified by this initiative is to ' eliminate health disparities , achieve health equity and attain health literacy …' (para. 5). In the US, there are currently well over two million Augmentative and Alternative Communication (AAC) users, who have limited access to appropriate health documents. ' Augmentative means to add to someone’s speech. Alternative means to be used instead of speech ', including the use of symbols instead of letters (ASHA, 2022). When health documents are not language appropriate, the ability to make informed healthcare decisions is greatly reduced. Barriers to client-provider communication All people have the right to explore and make supported, informed decisions about their health. However, many marginalized groups, including AAC users, are rarely given opportunities to appraise and apply their own knowledge to health information (DREDF, 2020; Joint Commission, 2010). This can be attributed to perceived cognitive abilities, differences in communication and level/type of literacy skills. Studies have found that health care providers, including occupational therapy (OT) practitioners, felt ill-prepared to treat, communicate and interact with clients who communicate with symbols , due to limited knowledge and communication strategies (Sharby et al., 2015; Weil et al., 2011; Williamson et al., 2017). As such, clients reported little or no participatory involvement, due to communication barriers, difficulty understanding medical information and lack of accessible education materials - resulting in difficulty trusting providers and feeling powerless (Sharby et al., 2015; Williamson et al., 2017). Healthcare providers should be trained and have the resources to facilitate productive communication that will improve the client’s long-term health outcomes, participation, and quality of life. Current format Patient Decision Aids (PDAs) are a health literacy tool used to help educate clients about conditions, procedures and treatment options (Appendix A). Research shows that PDAs lead to: increased knowledge more accurate understanding of risks versus benefits improved client-provider communication clients feeling more comfortable with the decisions they make and the care they receive (Pope, 2017) However, PDAs are currently only available using letters, which excludes people who communicate with symbols. Health literacy tools need to be accessible to people who use symbols to communicate - and healthcare providers should be trained to utilize them. A new symbol-based format To address this barrier, an initial symbol-based PDA on Carpal Tunnel Syndrome (CTS) and treatment options was created. This was accomplished through a collaborative process, with self-advocates, content experts, the Institute on Development and Disability, Community Vision AT Lab and a WITH Foundation grant. CTS was chosen by AAC users, as this is a common condition they experience. Two options were created: AAC based and Universal Design (Appendix A). Symbol-based PDAs would be used similarly to how traditional PDAs are currently used between patients and providers - as a supplement . When utilizing symbol-based PDAs, it is also important to include the patient’s system of support , as they deem necessary. For example: family, friend, partner, interpreter and/or Speech Pathologist. This improves the translation/understanding of health information and increases informed decision making. Our process Create an advisory group , consisting of a target population Identify a pertinent/specific health topic Gather accurate information related to the chosen health topic Select the type/style of symbols; if needed, collaborate with a graphic designer who understands the needs of the populations and how to make language-based symbols Gather feedback from an advisory group, consisting of your target population Consult with content experts on accuracy, thoroughness and value Repeat the feedback process The Carpal Tunnel symbol-based PDA was anonymously reviewed by 45 content experts, from 17 US states and Toronto. They provided feedback on accuracy and value of the document. 39% included OTs, physiotherapists (PTs), Certified Hand Therapists, MDs and various nursing providers; 36% worked in patient education. Content experts and AAC users identified the following as important things to consider when creating symbol-based PDAs: Size, type and quantity of symbols used Thoroughly user-tested PDA, with diverse audiences prior to dissemination Keeping the PDA concise and pertinent Having a plan for how to use - and what other resources to pair with it AAC user perspective Prior to the development of this symbol-based PDA, a member of the advisory group felt she could not fully conceptualize nor express her preferences , due in part to lack of accessible healthcare documents. She feared Carpal Tunnel surgery, because she was unsure what it entailed, what her options were, or if it would elevate her pain. She said: "I am a person who uses AAC and I had surgery for Carpal Tunnel Syndrome, because of overuse of my hand on my communication device. Unfortunately for me, my Carpal Tunnel Release was performed a few years before this PDA was made. Looking back on the time before surgery, I was beside myself with a worry I couldn't fully express , because I didn't know what I would be experiencing after the surgery. If I had this symbol-based PDA before my procedure, I would have had talking points and information all laid out for me. This would have helped me by pinpointing my fears. I would have liked to have known what my options were. For example, I didn't know that there were shots that would reduce pain. I also didn't realize there were two types of Carpal Tunnel Releases. I, for sure, would have picked the Endoscopic operation. Maybe my insurance only covered the Open surgery and that is why I never got a choice. I am thrilled that I worked on this grant, so that other people like me will be better prepared than I was." Following the development of this symbol-based PDA, she expressed that it clearly outlines talking points and treatment options about the condition and helps to pinpoint concerns . With this symbol-based PDA, she would have been better able to understand her options and identify preferences - in order to make an informed choice that impacts her health, now and in the future. Photo by Evidently Cochrane Occupational therapy's role The 2020 AOTA statement on Occupational Therapy in the Promotion of Health and Well-Being recognizes the ethical responsibility OT practitioners have to evolve our knowledge base, including 'being cognizant of and ready to address health literacy' (Reitz and Scaffa; 2020, p. 7). Participation in healthcare is an essential occupation, that impacts other daily activities; clients should have a method for understanding health information and making informed health decisions. The Health Literacy Skills Framework (HLS) and the Supported Decision-Making Model (SDM) are approaches OT practitioners can utilize, to analyze communication/literacy skills, preferences, external factors and demands of the health task; all of these elements influence health literacy and informed decision making. To facilitate this process, we must engage in client-provider collaborations , through all phases of decision‐making, treatment preferences and agreement on plan of care. With a guiding framework, OT practitioners can identify c ommunication needs and appropriate/accessible tools that meet client needs. As members of the healthcare team, OT practitioners must ensure clients are provided with tools to participate in their healthcare, including making informed decisions about procedures and treatments. OT practitioners can assist with selecting appropriate AAC, identifying barriers to integrating AAC and creating/utilizing new communication tools, such as these symbol-based PDAs. Health literacy-focused interventions are needed to promote effective client-provider communication and empower clients to communicate preferences and make informed choices that impact quality of life. Appendix A For the entire symbol-based document, templates and process visit University Center for Excellence in Developmental Disabilities . Symbol-based PDA (page 1) vs Text-based PDA (page 1) Our vision We visualize a health care system that is communication accessible to all. Healthcare providers have tools for universal use that are easily accessible. Knowledge is shared to empower AAC users, those who communicate with symbols and disability communities. We want all people to feel heard, understood and supported, to make safe informed decision about their health and well-being. Collaborative project OHSU Institute on Development and Disability Melanie Fried-Oken (PI), PhD, CCC-SLP Kim Solondz, MS, OTR/L Rhonda Eppelsheimer, MSW Jan Staehely, Communications Assistant Community Vision AT Lab Kim Elliott, MS, CCC-SLP, ATP Carrie Luse, MSR, OT/L, ATP Project funded by a grant from the WITH Foundation. References American Occupational Therapy Association [AOTA] (2011). AOTA’s societal statement on health literacy. American Journal of Occupational Therapy, 65, S78-S79. Available from: https://doi.org/10.5014/ajot.2011.65S78 . American Speech-Language-Hearing Association [ASHA] (2022). Augmentative and Alternative Communication (AAC). Available from: https://www.asha.org/public/speech/disorders/aac . Center for Disease Protection and Control [CDC] (2020). What is health literacy? Available from: https://www.cdc.gov/healthliteracy/learn/index.html . Disability Rights Education and Defense Funds [DREDF] (2022 ). DREDF Comments on the 2022 Section 1557 Proposed Rule on Nondiscrimination in Health Programs and Activities. Available from: https://dredf.org/2022/10/04/dredf-comments-on-the-2022-section-1557-proposed-rule-on-nondiscrimination-in-health-programs-and-activities/ . Joint Commission (2010). Advancing Effective Communication, Cultural Competence and Patient- and Family-Centered Care: A Roadmap for Hospitals . Oakbrook Terrace, IL. Pope, T.M. (2017). Certified client decision aids: Solving persistent problems with informed consent law. Journal of Law, Medicine and Ethics, 45(1), 12-40. Available from: http://doi.org/10.1177/1073110517703097 . PMID: 28661276. Reitz, S. M. and Scaffa, M. E. (2020). Occupational therapy in the promotion of health and well-being. American Journal of Occupational Therapy , 74, 7403420010 . Available from: https://doi.org/10.5014/ajot.2020.743003 . Sharby, N., Martire, K. and Iversen, M. D. (2015). Decreasing health disparities for people with disabilities through improved communication strategies and awareness. International Journal of Environmental Research and Public Health, 12, 3301-3316. Available from: http://doi.org/10.3390/ijerph120303301 . United States Department of Health and Human Services (2020). Healthy people 2030 framework. Available from: https://health.gov/healthypeople/about/healthy-people-2030-framework . Weil, T. N., Bagramian, R. A. and Inglehart, M. R. (2011). Treating clients with autism spectrum disorder - SCDA members’ attitudes and behavior. Special Care in Dentistry, 31, 8-17. Available from: https://doi.org/10.1111/j.1754-4505.2010.00173.x . Williamson, H. J., Contreras, G. M., Rodriguez, E. S., Smith, J. M. and Perkins, E. A. (2017). Health care access for adults with intellectual and developmental disabilities: A scoping review. Occupational Therapy Journal of Research, 37(4), 227-236. Available from: http://doi.org/10.1177/1539449217714148 .

Adapting a living space to overcome architectural barriers such as steps and staircases can be achieved with the installation of a platform lift. To help Occupational Therapists understand the different types of lift products available and the ease of installation, we have provided this useful guide.

Trigger warning Themes of bereavement and death In the early days of the occupational therapy program at the University of New England (Maine, USA), the college of Osteopathic Medicine required all programs using the lab to provide faculty who would be trained to perform dissections on the bodies their students would eventually use. We tried to stay a week or two ahead of our students, in terms of preparation. In all honesty, this did not work well, as we were slow and just as likely to destroy a structure as we were to reveal it. The programs eventually funded a 'real anatomist', but initially it was our job. We tend to react to the presence of death in many different, often idiosyncratic ways. Our program required all occupational therapy candidates to complete a course in Gross Anatomy, spending hours each week conducting prosection [dissection of a cadaver to demonstrate anatomic structure] on the forty cadavers in the lab. Occasionally a student could not bring themselves to touch the remains, preferring to stand behind their peers and watch. It is a strategy that I never saw work effectively and prevented some students from moving on in their studies. In one class, I watched as one student seemed to have a particularly difficult time, never being able to touch a body or remain in the lab for the full session. I requested that she meet with me in the lab with no other students present. The professional anatomists were present, but had agreed to remain in one of the other rooms. When I asked her what she felt was troubling her, she remained silent for some time. Finally, she took a deep breath and related how her grandmother had recently passed and that she had yet to come to terms with her death . She could not bring herself to touch any of the remains, or even to open a body bag. I related that, in a previous semester, the body of one of the women had closely resembled my own mother and that I had great difficulty working with these remains. We talked of her memories of her grandmother for a number of days. Finally one day, she stood, sighed again and opened the 'body bag' in front of her. Watching her over the following weeks, she gradually grew more comfortable and caught up on the material with which she had been so far behind. One of my initial 'clients' was a woman in her late fifties. To my surprise, the work was not only physically demanding but often very challenging emotionally. My initial strategy was to concentrate on the specific area I was dissecting, seldom stepping back to view the person as a whole. The schedule called for our students to 'appreciate the anatomy of the forearm ' initially. To my surprise, the anterior of her forearm was 'not right.' Where the long tendon of the palmaris longus should have been, I saw a large muscle belly. Everything else looked fine, but I began to question my own memory of my gross anatomy class. I called our anatomist over and asked him what I was missing. 'Dr Tom' looked, stepped closer and looked again. Then he began to laugh. "Bill," he said, "the good Lord put her together on a Friday night or a Monday morning, because that palmaris longus is in backwards!" Sure enough, looking proximally I saw the tendon, now quite obvious, but not to my confused eyes earlier. He assured me that she likely never knew of her uniqueness, or experienced any issues with hand function . But it was this woman’s hands that caused me the most difficulty emotionally. As I began to separate - called 'teasing out' - the structures of her hands, I could not help but stop and think of what those hands had experienced over her life span. One might argue that our mouths and lips are the first major input of sensory information. I would agree, but feel that, very quickly, our hands lead us to a greater exploration of our life space and world. Individuals who donate their remains to gross anatomy classrooms retain almost complete privacy. We knew only their age and cause of death; nothing about their lives or experiences. This is as it should be, but often you could not help but wonder about the stories those hands could tell. Physically, hands are also difficult to dissect , as many of the components are supremely well attached to underlying structure, particularly when one moves distally along the fingers themselves. I frequently stopped, as much out of frustration as to rest from the concentration. At those times, I tried to imagine what memories those hands had given her. Where was she from? How had she passed her days as a young girl? What came easily to these hands and what required more effort? What was she never quite able to do to her own satisfaction? What did her hands tell her about her mother or father? How did she feel when her mother held her small hands in her own. What was her father’s beard like? At some point she found her first boyfriend or girlfriend. The first time she 'held hands' with another, did she even notice that both their hands were likely cold and clammy? More likely she was only aware of her own racing heart. Those hands later touched her lover and held her own babies. Did she marvel at how the tiny hands of her infant were already perfect in form and in their ability to learn from the environment? Emotionally , her hands became the most difficult part of the body to dissect, as I sometimes felt I was violating the most intimate place of who this woman had been. My students often had difficulty with a cadaver’s genitalia. For me, however, it was the dissection of the hand that proved most difficult, on a number of levels. I would, at times, find myself silently talking to her. Where had she been, what had she done in her life? Had she, per chance, walked with Dr King in the 60s? As a soldier in Vietnam in the late 60s, I had grown so angry with the senseless slaughter, that I walked out of a church service one afternoon. Essentially, I never returned to the church, but this woman’s hands made me wonder again at how we all came to be. In the thirty-six years I have practiced in occupational therapy, I often found myself studying the hands of my patients, regardless of the diagnosis that brought them into my clinic. Now, I watch as my own hands age. The scar left by an angry squirrel, when I foolishly tried to rescue him after he was hit by an automobile. The slight bit of distal interphalangeal joint (DIP) flexion in one 4th digit, a reminder of a mallet finger injury years ago. The bases and carpometacarpal (CMC) joints of my own thumbs are now frequently painful during tasks that require forceful grip. No doubt the result of years of aggressive scar massage with my surgical hand patients. But the discomfort frequently reminds me of their stories and of my own. Most of the publishing I accomplished during my quest for tenure was written in collaboration with a fellow professor, who had a sharp intellect, incredible attention to detail - and just happened to be an extremely attractive young woman. Male conversation frequently stopped when Sara (not her real name) and I would walk into a room, to present on some topic we were researching. One day she looked at me and laughed... "Bill, you are the only male friend I have who spends so much time looking at my hands." I smiled back, "Well it’s kind of a long story actually." Image credits 'Octavias' - first son of artist Kenney Dao, in collaboration with Thao Nguyen. Photographs of soldier and parents by author William Croninger. Palpable Anatomy: The Palmaris longus tendon - Bone Broke Other images from stock library.

I am a South African rural occupational therapist (OT). This is an identity that I am still trying to make sense of. The rural OT is often synonymous with a ‘jack-of-all-trades’. In poorly-resourced contexts - where our skills are not easily distinguishable from our colleagues’ and patients* struggle to understand our services - it is challenging to cement a unique, convincing identity as an occupational therapist. * I use the term ‘patients’ because this is how we typically refer to service users in the context of our acute general hospital. In South Africa, all graduate Occupational Therapists are required to complete one year of community service : paid clinical work at a government-run facility anywhere in the country, most often in rural and under-serviced areas. The interesting thing about this requirement is that it is a bit of a gamble – you never know where you’ll end up. I was posted to a region far from my coastal upbringing. I packed my things and drove 1,200 km north to the semi-arid Kalahari, to start my contract at a rural hospital in the Northern Cape - the country’s largest and least densely populated province. It stretches from the borders of Namibia and Botswana to the south, where it merges into the Great Karoo, a vast and ancient desert territory. The Northern Cape is the heartland of South Africa’s iron ore and diamond mining industries - and in September, the home of Namaqualand’s famous flowers. Excepting a few familiar landmarks, like Kimberley’s Big Hole, it is an endless expanse of sameness ; of scrub and bush that grows no higher than five feet; electricity wires that converge into the horizon; and small hills, or koppies - some of which are, in fact, mine dumps. I came here to find languages that are not my own, historically divided social groups now melded, if reluctantly, in co-survival - and an economy reliant on mining and agriculture, neither of which feature in my own occupational narrative. Local pastimes include trophy hunting, taxidermy, farming, drinking, raising children, braai -ing (a unique kind of barbecue) and long-distance driving. Rural health care in South Africa presents a series of daily challenges. The country’s health system is under major strain, plagued by critical shortages of doctors, nurses and other health professionals (like OTs), intermittent shortages of medicine, equipment in urgent need of repair, long waiting times for treatment - and in some cases - gross negligence at tragic human cost . As an OT working in this setting, my practice comprises endless problem-solving , as I navigate a system which – quite frankly – is not in working order. A quick disclaimer This article is not to vent, nor to vilify the shortcomings of South Africa’s healthcare system. However, these shortcomings are deeply familiar to us , the health providers, the patients and the community at-large. I would like to illustrate, though, what OT looks like in this setting, since the form it takes here might differ to how other OTs on the Hub experience their practice. There are many days when occupational therapy, for me, seems formless, even arbitrary . It’s splinting with cardboard and bandaging, scrounging for extra pillows at the laundry (to use for bed positioning) and persuading teenage mothers that tactile contact with their premature infants is beneficial for development. Often, I treat my clients through a translator. The language of the region is Setswana, of which I know almost none. As an alternative, some clients use Afrikaans, another of South Africa’s official languages - although, as with me, it is not their mother tongue. The language difficulties I encounter tend to dilute an important principle in occupational therapy theory : To partner authentically with patients and develop a shared understanding of occupation with them. But it is not only language that shapes the form OT practice takes in rural South Africa. Culture is embedded in language. When I ask the cardinal OT questions - 'What do you want to do?' 'What do you need to do?' 'How do you spend your time?' - patients seem confused. Even during interactions where language barriers are less obstructive, these questions seem inappropriate, ill-placed, even contrived. Eliciting what I consider a rich occupational narrative from my patients is virtually impossible . Then again, the narrative form I seek is, I acknowledge, embedded in the privileged expectation of a varied occupational life, filled with activities that fit snugly into all performance areas of productivity, leisure, social participation and self-care. (This is a bias I’ll discuss more deeply in a future article, perhaps). The truth is, OT does not translate well in the minds of many South Africans. In fact, in the African languages that I have very briefly studied, there is no word for ‘occupational therapist’. There is one for ‘doctor’ - the broad linguistic category for someone who fixes ailments of the body. A slightly more vivid term, ‘doctor of the bones’ may also be used to describe all rehabilitation types. But this, too, does not sufficiently capture what we do. It’s a well-cited fact that rural settings have fewer resources than their urban counterparts. Yet the challenges of OT practice in my setting transcend material deficiencies – philosophically, there is a mismatch. In a context defined by social and economic inequality , forming genuine partnerships with my clients is difficult. Our healthcare system inherits the inequities of the apartheid system , which, for decades, denied much of the population decent, dignified care. The hospital I work at is a strange monument to this; standing almost exactly as it did in the eighties - only now facing a quadruple burden of disease, one or more of which is part of almost every patient’s story: HIV and tuberculosis, maternal, new-born and child health, non-communicable diseases (hypertension, diabetes) and injuries caused by violence. Working at an acute general hospital means that patient care is (in my view, erroneously) dominated by the medical model , whereby my medical colleagues are concerned primarily with addressing the leading causes of death. With a standard clinical diagnosis always my starting point, I set out to gather the stories behind the bronchopneumonias, epilepsies, fractures and burns. Often, the occupational narratives that emerge are not what I expect – not, at least, in the way they’re defined by the West-authored textbooks I used at university. Patients do not speak of meaning or purpose or participation; they do not list hobbies or passions; they describe desire, fate, necessity, esotericism, survival, hope and fear. Their lives below the poverty line give rise to occupations that are, for the most part, centred on survival: acquiring food, shelter, basic resources. A mother recently approached me to say she suspected her five-year-old child had been given a malevolent kind of muthi - traditional medicine - by his father. More distressingly, this malicious intent apparently began even before the child’s birth, when his father gave his mother illicit abortion pills, which she didn’t take. The stories behind the acute medical conditions I see can be overwhelmingly complex and virtually untranslatable when inscribed into my own framework . Occupational therapy is concerned, optimistically and transgressively, with the leading causes of life. Yet, I find my practice wrestling with the powerful forces of the curative approach, of needing to fix what is broken, instead of building health as a resource . Of conserving the little that is left. In addition to operating in damage-control mode, the South African health care system is a perpetual game of pass-the-parcel. The patient is the parcel and I’m part of the ring - and we simply pass them between each other, hoping one of us will have an answer. Referral is code for ‘pass them on’. While referral is an essential part of health care provision, I’ve seen it fail dismally. The truth is, the referral system makes patients poorer and sicker. Vast distances lie between district-level generalists and the specialists at faraway tertiary hospitals. The same distances lie between patients - who live in remote villages - and hospitals. Phone lines are routinely down and the electricity supply is cut off intermittently. Because most patients do not have money to pay for private transit, a state ambulance is their only option. When these are not available - as is often the case - patients cannot access essential health care and are left to grin and bear their ailments, until another appointment can be made. When some do manage to make the three-hour journey by taxi to see a doctor at our hospital’s outpatient department, the risk of there not being one on duty is high. I’ve seen this happen; there simply aren’t enough doctors to cover each other when one is called to an emergency. It is a circular, incoherent dance, that ultimately disservices the patient who, too often, remains unaware of this disservice to him. In a country with one of the largest gaps between rich and poor on earth - where stark inequality continues to deny the majority access to basic services - I am an occupational therapist and I’ll admit that I struggle to understand my patients. This is not a matter of language alone; it is a matter of meaning, of being an outsider to a value system that remains opaque to me. As I interface with patients, so many dichotomies appear - urbanity and rurality, blackness and whiteness, my Englishness and their Setswana tongue, my occupational choice and their occupational deprivation . In addition to clinical work, much of my role involves helping patients navigate the convoluted health system, bridging distances (both geographical and symbolic), to help them access care . Without access in the first place, there can be no continuity, no recovery. Inadvertently, this has become a large part of what I do as a rural occupational therapist in South Africa. In a way, the OT is an interloper here, a carrier of Western values, that can’t be easily detached from the profession’s Northern roots. Philosophically, I grapple with the pressure to comply with the biomedical model that dominates my workplace - while, at the same time, trying to forge an OT practice that meets the unique needs of the context, but also remains true to its fundaments . Managing these tensions, both personal and professional, is part of my daily work, as I attempt to shape a cohesive professional identity, that satisfies me as well as the patients - the people, whose health resources are in the greatest need of development. References Abson, D. (2019) Occupational Deprivation. The Occupational Therapy Hub (online). Available from: https://www.theothub.com/article/occupational-deprivation . Baker, A (2019) What South Africa Can Teach Us as Worldwide Inequality Grows. Time (online). Available from: http://time.com/longform/south-africa-unequal-country/ . Child, K (2017) The Life Esidimeni tragedy in numbers. Times Live (online). Available from: https://www.timeslive.co.za/news/south-africa/2017-10-17-the-life-esidimeni-tragedy-in-numbers/ . PSI (2019) 25 Years After Apartheid: Health Inequities Persist in South Africa. Public Services International (online). Available from: http://www.world-psi.org/en/25-years-after-apartheid-health-inequities-persist-south-africa . WHO (2022) Health Promotion. World Health Organization (online). Available from: https://www.who.int/healthpromotion/conferences/previous/ottawa/en/ . Wikipedia (2022) Occupational Injustice. Wikipedia (online). Available from: https://en.wikipedia.org/wiki/Occupational_injustice .

As a parent, giving your children an excellent sensory learning experience (Gelladuga, 2020) is a fantastic way for them to spend their time. Even if you can get outdoors, they will need something to help occupy their time while they are home. Whilst you can teach them yourself, what can you do that will help facilitate better learning? You can improve your kids’ knowledge - and grow their social skills - through a variety of fun and educational activities. Check out these ideas, that your kids may enjoy and benefit from: 1) Learn about a new culture One of the main drivers for a child's curious nature is their interest and desire to know what the world has to offer them. It is partly why children are so eager to learn and understand things. One way to encourage this habit is by teaching them about a new culture. You might take them to another country, like Thailand for example, to experience a very different way of life . Immersing a child (or adult!) in that alternative cultural environment can enhance their learning experience and understanding of diversity (Creek, 2020). If travelling is not currently an option for you, your children could first learn about the native people of your own country. Alternatively, you could read with them about cultures and destinations that you would like them to see in the future. Visiting museums, festivals and other cultural events in your city or locality can reinforce their learning at home. 2) Teach them how to cook Beyond simply preparing food to eat, cooking together can be about teaching kids the importance of healthy eating . As they grow, allowing them to play a greater role in meal preparation will also foster independence , via a sense of ownership and increased responsibility. They will also learn to appreciate the wider value of a well-prepared meal! As they get older, you can grade up the complexity or breadth of tasks, such as by completing a grocery list or adding the task of setting the table. 'As an OT, I have expertise and knowledge in promoting skills development and supporting people to engage in meaningful occupations, through adaptation and equipment. For example, by tailoring a cooking task to meet the client’s needs , such as using a recipe plan, visual imagery and sequencing.' (Matthews, 2019) For some of these activities, greater support or assistance may be necessary. From a safety perspective, you might invite them to help with less dangerous elements of the meal preparation process. For example, washing vegetables and cleaning up peels... This would also be an ideal opportunity to teach them about food hygiene ; the importance of washing hands before food handling can be instilled. 3) Learn art at home Alongside producing an end product and learning new skills, arts and crafts have mental and psychological benefits - for children and adults alike. For example, they can: stimulate the senses promote relaxation and stress reduction encourage creativity and self-expression help to see the world in a different light enable the participant to reach a state of 'flow' (Csikszentmihályi, 1975; in Festa, 2020) - often referred to as 'being in the zone' Art and craft activities can be done together - boosting social interaction - or your child may benefit from the improved focus of doing them on their own. If appropriate, you could invite them to paint their bedroom walls, or up-cycle some furniture with you. A smaller-scale project could be to make a collage out of their old magazines. Aside from drawing or colouring in, artistic endeavours might include enrolling a child in a painting, music or dance class. It can make them appreciate their creative hobby in a different way, developing skills and building confidence . If you are a parent who values art, why not let your children explore it? 4) Spend more time reading Primarily of course, reading is an excellent tool for language learning, exposing a child to countless words and phrases. This not only teaches pronunciation, but also develops comprehension, attention and focus . If you want a child to read, it should be as convenient as possible and set at the right level for their age and abilities. Provide them with the right material and then watch them read, explore, discover and learn new things! But language aside - for lovers of fiction or non-fiction - there’s no better way to pass leisure time than by reading a good book! Whether you have children yourself, or care for/support them in your work role, you can help them discover new worlds and adventures through reading. Beyond the entertainment factor, it can offer new perspectives on life, broaden understanding of the world around them and potentially foster empathy towards others. 5) Teach topics through photos Nowadays, access to photographs is easier than ever. They can be found on social media, phones, computers, books and in other forms of print. You can show children photos of your family, friends and places you have visited (or would like them to visit in future!) Photos might be the main way a child learns about family members or friends that they are unable to see face-to-face. Aside from introducing important people, photos can be a tool to introduce a range of topics. This is especially helpful for visual learners, or those with learning difficulties. Sharing images can be a way to introduce new hobbies, such as playing a musical instrument. For example, a photo of a guitar might pique a child's interest and make them want to learn more about it. Activities for children with learning disabilities or sensory needs A child's disability need not preclude them from a breadth of activities and experiences that they want to engage in. With the right level of help or guidance, they can do anything if they put their mind to it! There are adapted toys and tools designed to help kids with a range of disabilities. For example, for someone with dyslexia, they aid the ability to process words and sounds . Audio-visual systems are also great tools for parents and educators. Engaging a child in activities such as art, dancing or soft play, allows them to access and process a range of multi-sensory inputs ... N.B. If you are interested in sensory-based activity and intervention, why not listen to the All Things Sensory' podcast - right here in the Hub's Podcast Portal ? 'Rachel Harrington and Jessica Hill are two passionate Certified Occupational Therapy Assistants, who answer your questions related to all things sensory, occupational therapy, parenting, self-care, nutrition, and health, from a therapist’s perspective. Great for those who work with children with sensory processing disorder, special needs, autism and ADHD' (Harrington and Hill, 2022). The bottom line Parents want nothing but what’s best for their children. As they grow, their needs also change - including the methods that they learn best. To cater to this, a parent, educator or therapist must constantly explore how to keep their thirst for knowledge and new experiences alive. The ideas above are just a few ways to spend quality time with little ones. These activities can be simple enough for them to do independently, or enjoy socially. Whilst they encourage and develop new skills, they are also a lot of fun! References and further reading Creek, J. (2020) In Praise of Diversity. The Occupational Therapy Hub: Therapy Articles . Available from: https://www.theothub.com/article/in-praise-of-diversity . Accessed 30 July 2022. Csikszentmihályi, M. (1975), in Festa, L. (2020) Innovative and evidence-based wellness articles, to improve client outcomes. The Occupational Therapy Hub: Therapy Articles . Available from: https://www.theothub.com/article/innovative-and-evidence-based-wellness-articles-to-improve-client-outcomes . Accessed 30 July 2022. Gelladuga, E. (2020) Must-have Sensory Toys for the Pediatric Therapist. The Occupational Therapy Hub: Therapy Articles . Available from: https://www.theothub.com/article/must-have-sensory-toys-for-the-pediatric-therapist . Accessed 30 July 2022. Harrington, R. and Hill, J. (2022) All Things Sensory by Harkla. The Occupational Therapy Hub: Podcast Portal . Available from: https://www.theothub.com/podcasts-all-things-sensory . Accessed 30 July 2022. Matthews, A. (2019) What is a Mental Health Practitioner? The Occupational Therapy Hub: Therapy Articles . Available from: https://www.theothub.com/article/what-is-a-mental-health-practitioner . Accessed 30 July 2022.

This week has got me thinking about all the parents, educators, and healthcare professionals I've worked with across the years. One thing that has stood out to me time and time again, is how much love, time, dedication and passion these individuals will put into supporting another person. Often putting themselves 2nd, 3rd, or 50th in the process. Which can be fine. Really. It's ok to put others needs and wants ahead of your own, sometimes you have to. But the key word is sometimes, not always. "Oh Simone, you optimistic, clueless woman, you have no idea what my life is like", I hear some of you sigh and shake your heads in disbelief. Yes, I may be optimistic. And definitely somewhat clueless to raising a family. But I will stand by this statement always : You can't help anyone if you yourself are drowning. Drowning is a pretty strong metaphor to use, but I chose it because people can't always tell if they're drowning from the get go, much like you might not realise now neglecting yourself is affecting you. And drowning is what it can feel like when you're overwhelmed with things to do, and you can't seem to catch your breath. I probably also chose it because I'm sitting on a beach as I write this (humble brag not intended). As I relax in warm weather listening to the waves crash in front of me, I can't help but think of those who never give themselves a break. I've worked with parents who put aside their own health or mental challenges to support their child. Educators who sacrifice their own leisure and downtime to do something for a student or class. Therapists who work long into the night researching, planning, and organising, giving up sleep for their clients progress. I get it, I've been one of those therapists who burn themselves out fighting for and supporting those around me. But that's the thing, I burnt myself out doing it. I put so much mental, emotional and physical energy into my work, that I left little to none for me. And that leaves you in a state where you aren't doing the best you can, where you are only giving 50% because that's all you have in your tank.  Parents tell me that they have no other choice. That they have to put their child first all day every day, because they are the only ones who will. Teachers and healthcare professionals tell me there's no other time to do it, and these things need to get done. But as a child of a single mother who did everything she could for her two children, I learnt this. It's ok to take the easier option to give yourself a breather, rather than taking the 'best' option all the time. It's ok to let less important things go for a bit, to do something you want to. Because then you are happier, calmer, and more energised in the long run. It's crucial you look after your own health and well-being, because you're little use to anyone if you don't. As occupational therapists we speak about occupational participation , occupational health and occupational well-being . Essentially, this means we really, really care about if people are doing the things they want to do (or need to do) that give them meaning and purpose. Why do we care so much? Because all the research in the area points to the same conclusion. It's really damn important! It impacts how well you perform in all areas of your life, how you feel and how your health and (physical and mental) well-being is.  So while yes, sometimes we need to make sacrifices for others, we can't let it become so habitual we forget how to put ourselves first. And no, we shouldn't always take the 'easy' option (because again, habits are hard to break!). But sometimes we have to, because it is actually the best option in the long run. And lastly, those things we find important - no matter how 'small' or 'insignificant' your family, friends or society thinks it is - need to be prioritised. And engaged in, not shoved aside for another task, time and time again.  If you are struggling to give yourself 'permission' to do this, I'm doing it for you now. You have permission to: go for the run have the bath pee with the door closed read a book have a cup of tea make 2-minute noodles for dinner give your child that thing that will occupy them have a decent night's sleep leave the cleaning, washing, notes, planning, scheduling, shopping and ironing for tomorrow leave your laptop at work knock off early - or do absolutely nothing Or insert whatever preferred activity you have been putting aside. You have permission for that too. But you don't need it. Last, but definitely not least: You never, ever, ever need permission to look after yourself and your desired occupations. That's your right, just as it is your child's, student's, client's and patient's. Lead by example. Give yourself a break.  Reposted by author from Rocket OT

Many friends and family still have no idea what occupational therapy (OT) is. Some still think we "help people get jobs". The purpose of this post is to break down the concept of occupational therapy, in hopes to educate the public about what we really do! If you are an OT professional, you know that we do a lot, in many different settings. In order to first begin understanding what OT is, we need to first understand what exactly ' occupation ' is. I like the simple definition by Merriam-Webster: OCCUPATION 1. An activity in which one engages noun oc·cu·pa·tion \ ˌä-kyə-ˈpā-shən \ Now, I know what you're thinking. There are so many activities one can engage in. Well, you're not wrong! Each activity that we engage in is going to be completely different for every individual and we like to place an emphasis on that during practice. Luckily, in the world of OT, we have our occupations conveniently sorted under 8 core areas (commonly referred to areas of occupation): Areas of Occupation Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) Rest/Sleep (my personal favourite) Education Work Play Leisure Social Participation Now that you know the 8 areas of occupation, I am going to further break down what makes up each area. Pay attention; many of the following may be things that you engage in every day... Activities of Daily Living (ADL) ADLs are activities that are oriented toward taking care of your body , such as bathing, showering, toileting, dressing, eating/swallowing, functional mobility, sexuality, personal hygiene and grooming. Instrumental Activities of Daily Living (IADL) IADLs are activities that support daily life within the home and community , such as caring for others and pets, driving and community mobility, managing finances, maintaining the home, preparing meals, managing health and shopping. Rest/Sleep My personal favourite! Rest and sleep occupations are activities that are related to obtaining rest and sleep to support healthy, active engagement in other occupations . Sometimes this area can be overlooked when thinking about occupation, but it is really important to get the rest we need, in order to be able to participate in other areas of occupation. This area of occupation consists of engaging in rest, preparing for sleep and participating in sleep. Education This area of occupation is related to participating in activities related to learning and participating in the educational environment, such as formal educational participation, informal personal education needs, interests exploration and informal personal education participation. Work The work area of occupation is related to committed occupations, that can be performed with or without financial reward . For example, engaging in activities related to e mployment interests, employment seeking and acquisition, job performance, retirement preparation and volunteer exploration/participation. As opposed to popular believe, we do not help people get jobs, but we can help to ensure that you have the skills necessary to perform tasks related to work. Play This area of occupation is related to any activity that provides enjoyment, entertainment and amusement. Fun, right? This area typically consists of activities related to play exploration and play participation, often geared towards the kiddos! Leisure The leisure area of occupation consists of activities that are intrinsically motivated . Basically, more fun stuff. We all like different leisure activities, whether it is playing a game of cards or going out to play a round of golf! This area of occupation focuses on leisure exploration and leisure participation. Social Participation Another fun area of occupation. Social participation consists of the interweaving of occupations to support desired engagement in community and family activities . OT likes to focus on the areas under social participation such as engaging in the community, with family, friends and peers. Now that you have a better understanding of what an occupation is, it is QUIZ TIME! Just kidding, don't leave yet! So far, we have gone over the occupation part of OT. Now, we will focus on the therapy part... Occupational therapy is unique, because we are able to work with all types of clients, from birth to 100 and we can work in very diverse settings (not just a hospital or a clinic). You can find OTs in mental health clinics, school systems, outpatient clinics, inpatient hospital units, jails, homeless shelters, home health, skilled nursing facilities and many, many more. Depending on your diagnosis, we will focus on which areas of occupation are not being completed at an optimal functioning level . Depending on specific client needs, we collaborate with the client to determine suitable interventions, to get them back to what they need and want to do - whether that is helping a child gain the social skills needed for participating in school occupations, or helping an amputee become mobile in the community again. The opportunities are endless! Our hope here at The Occupational Therapy Hub is that everyone knows the true value of OT. If you are a student or practitioner, please share this article with anyone you know who still isn't completely sure about what you are doing. We want to make sure that everyone knows how truly special our profession is! Thanks again for choosing us for your OT needs and resources. Please continue to share positive stories of OT in action on social media, to continue to raise awareness of what we can do. Reference American Occupational Therapy Association (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl. 1), S1-S48.

This case study provides a good example of a successful Occupational Therapy (OT) intervention, to help clinicians better refer for OT-specific input.

A weird thing happened the other week. I’d just been to an Occupational Therapy conference and, because I had saturated Twitter with posts about what had been going on, I ended up in a conversation around how Occupational Therapy had really benefited people . I encouraged them to write down what had been helpful to them. I thought very little of this until lo and behold this turned up in my inbox. Most OTs will find this a fairly interesting read. Just to introduce Ellie: she is someone I met at the British and Irish Group for the Study of Personality Disorder annual conference, in Cardiff last year. She ended up being highly commended for her poster 'The Impact of Activity and Occupation on Borderline Personality Disorder'. She’s a big advocate for OT and at some point I hope she becomes one. Enjoy her tale… Trigger warning: Self-harm Three years ago I was a very lost young woman . I was sectioned in an acute psychiatric ward for the fifth time, after years of borderline personality disorder (BPD) and an eating disorder slowly dragging my life away from me. My daily routine consisted of spending the nights in accident and emergency (A&E), getting stitched up after self-harm, coming back home in the early hours, sleeping in the day, self harming again in the evening, back to A&E - and so the cycle continued…Sometimes with the occasional break of an overdose or suicide attempt and sometimes with the addition of multiple trips to A&E in a day. I was admitted to A&E over 200 times in less than a year. But something about this admission was different to the last. As someone who is pretty damn intelligent (if I do say so myself), acute wards are pretty dangerous for me, as I get very bored and spend my hours conjuring up inventive ways to hurt myself. So generally, acute admissions had brought no benefit apart from new self-harm methods. However, the big difference with this admission is that the ward that I was on had double doors at one end, that led straight through to the occupational therapy (OT) department. And this is where the first glimpses of healing began . Here there were things to do , things to keep my mind and my hands occupied; I could make my own meals (which helped with my eating disorder). The staff had more time to chat to me and help me process my situation than the staff on the ward, that were rushed off their feet with medications and observations. I was also more willing to talk. It's easier to chat to someone whilst you’re doing another task - rather than artificially sitting opposite someone in a chair, in a box room with no windows. Entries in the notes from around that time show that I was considered 'complex', 'a disruptive influence on the ward' and someone who would be in the system a long time. However, when I speak to the staff in that OT department from that time, they don’t recall that side of me. I was like a totally different person once I went through those double doors . Here I was celebrated for who I am . Staff encouraged me to teach other people to hoop (my favourite hobby), to write poems and explore art, to have a go at yoga and spend time outside. This also coincided with me coming off all my medication which, after years on antipsychotics, meant that I suddenly had a clearer head and could actually engage with these things, rather than just going through the motions. I was starting to FEEL again. One day, the lead OT asked me if I would like to come and sit on the Therapeutic Activities Development Group, as a service user representative. He felt that I had a lot to contribute to ideas for activities, in the inpatient areas of the mental health trust. The first meeting was a fortnight after I was discharged from hospital. I hadn’t got out of bed or washed in over a week; I vividly remember turning up still with pyjama bottoms on and steristrips on my face. I didn’t want to go; I was anxious about being the only service user in the room and having nothing to contribute. But, to my surprise, I had a really positive reception and professionals were turning round to me and asking my opinion and valuing my input. I walked out of that meeting and went home. I had a shower, changed my clothes and felt a glimmer of hope that maybe there was something I could do in the world. I was admitted to a specialist unit in a different city for a year after that, which changed my life. All through it I worked remotely on tasks for the group and returned to Sheffield for monthly meetings, if I was able. Part-way through the year I was asked if I would like to start volunteering in the OT department on the ward; gathering service-user feedback about activity provision and just generally helping out. It meant that I had something to work towards and keep well for on my return to Sheffield - a city where I had been living a dysfunctional life for so long previously. Fast-forward a further two years and I can’t believe how far I’ve come since attending a once-monthly meeting in my pyjamas! I spent a year volunteering in OT on the ward . During that time I learnt so much; I got opportunities to present what I was doing to the rest of the Trust and this lead to further people being interested in getting me involved. I started to deliver training on mental health to police officers and A&E staff, telling my story to people on induction to our Trust, running workshops and attending conferences. My life is full of hobbies and activity (I roller skate in skate parks and take part in other circus activities). From one person believing in me - and the power of occupation on someone’s recovery (even though they are very unwell), I am now employed by the Trust. I use my lived experience in my role as patient ambassador in medical education and research. I still volunteer and I still speak about my experiences and advocate for the impact of occupation and activity on recovery. I even wrote a poster presentation on the topic, which came highly commended at BIGSPD 2018, which was a huge boost to my confidence and also helped me get to where I am today. My two years since returning to Sheffield have not been great in my personal life. I have battled with homelessness and been fighting for care ; there have been a lot of issues with services (some of which have been quite frankly traumatic), which did not resolve certain unmet needs, that are still impacting on my life significantly. It has been incredibly hard to keep going. But one of the reasons I have been able to soldier on is that now I have a purpose and a value in my existence. I’m appreciated for what I bring to the table in mental health in the city and for speaking out about my experiences. I have a future ahead of me and a whole new potential career path I would never have envisaged. And if that doesn’t end up working out then I’d actually love to become an occupational therapist . I’ve learnt to put the bad stuff that has happened to me to good use and, for the first time, I am excited about the future. And I honestly don’t think it would have been possible if it wasn’t for that OT department believing in me and encouraging me when I was in my darkest times. Occupation and activity is my medicine and it is what keeps me alive every day . You can hear more from Ellie here on this podcast Ellie talks lots of sense on Twitter: @elliewildbore Keir Harding provides clinical supervision, therapy, consultation and training via Beam Consultancy

COVID-19 has changed the way we live since it first came into our lives at the end of 2019, with widespread occupational injustice (Stadnyk et al, 2010). With daily terms such as 'new cases', 'social distancing' and 'restrictions' now common everywhere we look – from social media and the news to conversations with friends – even our everyday vocabulary has been forced to change. But what are the real impacts this global pandemic is having on our lives, from an occupational therapy perspective? Occupational deprivation is a 'state in which people are precluded from opportunities to engage in [activities] of meaning due to factors outside their control' (Whiteford 2000, p.200) The novel Corona Virus has caused widespread occupational deprivation , as we have been forced to stop or change many meaningful daily activities, that provide us not only with a sense of routine in our daily lives, but also a sense of role and belonging in our societies and relationships. A major change that many can relate to is the new work-from-home movement , that has occurred across our society. The healthy routines we had developed have been cast aside. Although we may not have realised it at the time, those routines of getting up, going for a run, having a shower, eating breakfast and rushing out the door were crucial in developing our overall sense of purpose and created a very necessary and comforting sense of habit in our lives. The days of leaving the house at 8am and returning at 6pm are gone for many of us. Our new work office is the kitchen table, our new work colleagues are our pets and our new lunch hour breaks are spent silently scrolling on our phones. This massive shift in our everyday habits and routines is likely to have caused everybody a certain degree of anxiety and a feeling of unease. We are creatures of habit after all. The uncertainty that goes hand-in-hand with this virus has tossed all the habits and rituals - that we spent many decades developing - out the window. The knock-on effect of all this upheaval is that we may now start to question our roles entirely . It is hard to feel like a member of a work team when the only interaction with the team is via a Zoom call! [Other video platforms are available]. Similarly, it is hard to feel like a manager when you cannot see your work colleagues face-to-face, for that crucial 5 minutes catch-up in the morning over coffee. In our personal lives, the virus has also caused massive social barriers . Since the first lockdown in March 2020, we have all experienced isolation to a certain extent. We longed for the simple, everyday occupations that we used to take for granted – going for a coffee with a friend, going out for a drink on a Friday night with a work group, going to a gym class on a Saturday. Zoom quizzes, voice messages and social media platforms became the foundation of all friendships and relationships and certainly caused strain and loneliness for many. Grandchildren went months without being able to hug their grandparents, as did many partners of those working on the frontline and in our health services. These sacrifices, although crucial to 'flatten the curve', had significant impact on our minds and well-being. In the words of Ann Wilcock - the founder of so many occupational therapy concepts - it is through ' doing ' and 'being' that we 'become' and 'belong'. We have adapted in so many ways, because of our integral need to engage in meaningful occupations and socialise with those around us. We have found new ways to do what makes us happy – from socially distanced gym classes to drive-in cinemas. We have overcome many social barriers, through the use of technology. But we must continue to use our innovation to overcome these obstacles, to ensure we do not lose our sense of role and belonging in today’s crazy world. References Stadnyk, R., Townsend, E., & Wilcock, A. (2010). Occupational justice. In C. H. Christiansen & E. A. Townsend (Eds.), Introduction to occupation: The art and science of living (2nd ed., pp. 329–358). Upper Saddle River, NJ: Pearson Education.  Whiteford, G. (2000). Occupational Deprivation: Global Challenge in the New Millennium. British Journal Of Occupational Therapy, 63(5), 200-204. doi: 10.1177/030802260006300503

As a busy occupational therapy student facing down deadlines you would think social media would be a distraction I’d be looking to avoid; instead you’ll find me deliberately sitting down once a week to spend at least an hour scrolling through Twitter. Even more surprising is the fact that some days, the Tweets I’m reading feel even more educational than the assignments I’m working on (don’t tell my lecturers!) What’s keeping me in front of my laptop screen every Tuesday at 8pm (UK time) is the #OTalk Twitter chat. Every week a different person studying or working in occupational therapy hosts a conversation on a topic relevant to current OT practice, education and/or research , raising key questions that get the Twitter OT community talking. Over the years that the #OTalk team has been running these chats, topics have ranged from things you might expect an OT blog to cover (like the Kawa model ) to ones you might not (like the therapeutic use of humour ) and all kinds of weird and wonderful places in between. The upsides and downsides of social media use are unlikely to ever stop being a contentious topic, but there’s an increasing awareness of how students and practitioners can benefit from using the Internet as a tool for learning, networking and continuing professional development. One of the best assets of the occupational therapy community is the diverse settings we work in and the rich variety of experiences we have as a result. Twitter provides an open and accessible forum for that knowledge to be shared - in contrast with how, in the past, meeting and sharing ideas with so many other therapists from all over the world probably would have been a much more complicated and expensive endeavour. For me as a student, taking part in #OTalk chats has given me an insight into how various issues are dealt with in the 'real world' of occupational therapy practice , as well as getting advice on how to thrive at university and on placement, from people who’ve been through it before. Using Twitter as the venue for these discussions also provides an opportunity for everyone involved to become familiar with the do’s and don’ts of social media: protecting the privacy of people we work with, respecting each other and - as we thoroughly discussed in a recent #OTalk on professional boundaries - never posting anything that you wouldn’t be happy to say in any other public place! If you are interested in #OTalk, there are a lot of ways you can join in; whether you would prefer to just 'lurk' and quietly observe what others are saying, or you are ready to add your voice to the conversation... And don’t worry if 8pm (UK time) doesn’t work for you, since transcripts of all our chats go up on the OTalk blog for you to read in your own time. If you want to take things a little further, try hosting a chat on something you are passionate about. I promise you won’t be bored on a Tuesday evening again!

Written by Abigail Matthews, Occupational Therapist (UK)

June 14, 2019 Hjälpmedel förskrivs inte jämställt Hjälpmedel förskrivs olika till kvinnor & män, men det är svårt att fastslå huruvida skillnaderna är omotiverade eller inte. Det framkommer i Socialstyrelsens rapport om ”Systematiskt jämställdhetsarbete inom hjälpmedelsområdet”. Rapporten syftar till att lyfta arbetet kring jämställhetsarbetet då vi har mycket kvar att jobbat med i detta område. Lite bakgrundsfakta: under 2014 förskrevs det totalt 1,596,000 st hjälpmedel i Sverige (676,000 individmärkta, 920,000 ej märkta). Ca 1 miljon använder något hjälpmedel varav 70% av dessa är 65+ & ca 50% av alla personer med insatser enligt SoL & LSS är hjälpmedelsanvändare. Rapporten visar att 2/3 av landets Hjälpmedelsverksamheter har styr- eller policydokument som innefattar jämställd-het. Men bara 35% av verksamheterna har t.ex. könsuppdelat statistik över sina hjälpmedel. T.ex det vanligare förskrivs hus-hållsnära hjälpmedel till kvinnor. Samtidigt som män oftare har eldrivna rullstolar förskrivna. Socialstyrelsen ger några goda exempel på verksamheter som bedriver arbete för jämställdhet. Utöver detta avser Socialstyrelsen att komplettera hjälpmedelsutbildningen med en modul om just jämställdhet. Fakta från källor i rapporten: Gällande förflyttningshjälpmedel är fördelningen av hjälpmedelsanvändare ålder 75+ - Män 20%, kvinnor 40%. Vid ålder 85+ är siffran – män 55%, kvinnor 70%. Vad gäller unga är sifforna tvärt om, fler pojkar har hjälpmedel än tjejer. Barn 0-17 – pojkar 61%, flickor 39%. Vi som arbetsterapeuter behöver ställa oss frågan kring våra normer & arbete kring jämställdhet. Även om faktorer som patienter & deras närstående påverkar vilka hjälpmedel som kan tänkas önskas så är det i slutändan som har makten att förskriva hjälpmedel. Sist vill jag säga att det är Socialstyrelsen som bara tittat på fördelning av kön. Andra faktorer kring diskriminering är inte med. Jag hade själv önskat att kunna se flera urval till denna statistik för att verkligen se hur jämställt vi jobbar. ________________________ https://bit.ly/2MM9hgU https://bit.ly/31vgeWU https://bit.ly/2wSe7yi #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist June 11, 2019 Ny forskning från WFOT och BJOT Här i dagarna kom WFOT ut med sin nya Bulletin (WFOTs egna tidning som kommer ut 2 ggr per år) med temat Practicing across cultures. Dessutom släppte BJOT fyra nya artiklar på sin sida Editors Choice, vilket innebär att dom under en period är gratis fulltext. För oss dödliga som inte har möjlighet till olika databaser är detta två bra källor till forskning och artiklar, som dessutom kommer från två bra instanser. Artiklarna på BJOT kommer du enkelt åt direkt via länken nedan, eller gå in på BJOTs hemsida och scrolla ner en bit till Editors Choice 2019. För att komma åt WFOTs Bulletin behöver du skapa ett konto på WFOTs hemsida. Det är gratis och du får tillgång till mer än bara deras Bulletin. På WFOTs hemsida kan du även komma åt Occupational Therapy International Online Network (OTION), WFOTs nyhetsbrevet WFOT E-news samt olika former av material till t.ex. arbetsterapins dag. Temat på senaste numret är som sagt Practicing across cultures. I skrivande stund är den mest lästa artikeln Use of mobile ‘apps’ in occupational therapy: Therapist, client and app considerations to guide decision-making . Men det finns en massa mer att läsa. Dessutom har du tillgång till alla tidigare tidningar. Som sagt kommer det ut 2 st per år och senaste upplaga är nummer 75:1 i turordningen. Hoppas ni hittar något intressant att läsa och diskutera på era arbetsplatser. Ha en fortsatt bra vecka! ________________________ https://www.wfot.org/news/2019/wfot-bulletin-751-practicing-across-cultures-is-now-available https://journals.sagepub.com/topic/collections-bjo/bjo-8/bjo #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist June 07, 2019 ADL aktiviteter i digitala livet Här om dagen var det #wmty2019 dagen. Många som engagerade sig för denna dag skrev om jämlikhet. Att alla ska ha lika villkor i vårt välfärdssamhälle. Som arbetsterapeuter är vi lite av experter på tillgänglighet. När detta ordet dyker upp tänker nog dom flesta på en fysisk tillgänglighet. Allt från bostadsanpassningar, offentliga miljöer och hjälpmedel är nog det vi oftast pratar om när det är tillgänglighet som står på agendan. Men som jag lyft tidigare blir det allt vanligare att diskussionen även gäller en digital tillgänglighet. Folkhälsoinstitutet lyfter fyra hörnpelare för en god hälsa är: social gemenskap och stöd, meningsfullhet, fysisk aktivitet och goda matvanor. Där social gemenskap och stöd samt meningsfullhet får en allt störa betydelse i våra digitala aktiviteter. Varav vi som arbetsterapeuter behöver vara medvetna om hur vi kan stötta dessa hörnpelare för våra patienter. Detta då ca 1,1 miljoner svenskar lever i ett digitalt utanförskap, vilket kan skapa ett socialt utanförskap. SVTs inslag som ni ser i länkarna nedan skriver utifrån äldres perspektiv. Men samma gäller även för personer med olika former av funktionsvariationer som kan ha svårt att använda digital teknik. Vi går mot en värld där alla förväntas ha tillräckligt bra digitala förutsättningar för att kunna leva, arbeta, leva och aktivt delta i samhället. Din journal är digital, dina biljetter skickas digitalt, du förväntas betala med Swish, bokning av tåg & flyg är digitalt, tidtabeller är digitala och önskar du att nyttja någon av nämnda exempel i fysisk form får du betala extra för denna service. I och med denna förskjutning till allt mer digitala liv förändras även våra aktivitetsmönster. Varav vi allt mer behöver ställa oss frågan Hur fungerar dina aktiviteter i digitala livet? ________________________ https://www.svt.se/nyheter/inrikes/1-1-miljoner-i-digitalt-utanforskap https://www.svt.se/nyheter/lokalt/smaland/ny-forskning-visar-att-allt-fler-aldre-hamnar-utanfor-det-digitala-samhallet https://ec.europa.eu/digital-single-market/en/policies/digital-skills #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist June 04, 2019 What matters to you? #WMTY2019 Idag är det What matters to you day #wmty19. Internationellt infaller denna dag 6/6. Men då nationaldagen infaller samma dag som #wmty19 kör vi på den 4 juni. Syftet med dagen är att lyfta meningsfulla samtal mellan patienter & oss arbetsterapeuter (rättare sagt alla inom vården men vill ju såklart nämna oss lite extra). Att behöva lyssna in vad individer vill & tycker är viktigt är något vi som arbetsterapeuter kommer i kontakt med dagligen. Det är ett väsentligt steg i en god vård & rehabilitering. Här om veckan skrev jag om personcentrering, något som går hand i hand med denna dag. Så kolla även in det inlägget & läs mer om personcentrering på GPCC’s hemsida. Imorgon kommer dessutom det tredje delbetänkandet från Anna Nergårdhs utredning God & Nära vård. Oavsett om det är öppen-, sluten-, primär- eller kommunal vård så är all vård densamma för patienten. Där grunden för all vård (& andra insatser av arbetsterapeuter) alltid ska vara patientens egna mål & förutsättningar. Det ska inte spela någon roll om personen omfattas av tröskelprincipen eller ej. Om personen har insatser från habilitering eller inte. Om personen är av en viss ålder eller inte. Om personen bor av landets 290 kommuner & 21 landsting eller vistas här utan svenskt personnummer. Vården ska till grunden vara densamma oavsett vilken kontext du för tillfället befinner dig i. För mig är det viktigt med vård eller andra insatser av arbetsterapeuter på lika villkor, vilket är en av anledningarna till att jag bedriver detta konto. Information som kan bidra till en lika vård ska finnas tillgängligt för alla Vad är viktigt för dig? Skriv gärna en kommentar nedan eller använd # wmty19 Ps. Så fort som möjligt skriver jag några rader om utredningens delbetänkande. Så håll utkik framöver om Sveriges eventuella framtida sjukvårds ”revolution”. Samt glöm inte SKLs webbkonferens idag där Ida Kåhlin talar ________________________ https://www.whatmatterstoyou.scot/ https://www.arbetsterapeuterna.se/nyhetsarkiv/nyheter-2019/vi-staeller-fraagan-vad-aer-viktigt-foer-dig/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist June 01, 2019 Vilka instrument använder arbetsterapeuter vid bedömning? För några veckor sedan hörde jag Magnus Zingmark föreläsa om sin senaste forskning. Ett resultat var att ca 60 % av tillfrågade arbetsterapeuter inte använder något bedömningsinstrument i samband med sina hembesök. Sammanlagt tillfrågades 1395 arbetsterapeuter, varav resultatet ger en rätt bra inblick i hur arbetsterapeuter arbetar. Tyvärr är inte denna studie publicerad ännu varav jag inte kan dela mer med er ännu. Återkommer så fort den finns i tryck Att så många arbetsterapeuter inte använder något instrument är rätt alarmerande. Anledningen kan inte vara att vi saknar instrument då bland annat följande finns att beställa på Sveriges Arbetsterapeuters hemsida: ADL-Taxonomin, ATMS-S, AusTOMs, COSA-S, BAS, OCAIRS-S, ACIS-S, VQ-S, COPM, CBS-S, DOA, GAP, LGO-S, OQ-S, REIS-S, OSA-S, RC VS: QP-S, MOHOST-S, WCPA-SE. En av anledningarna till att jag finner resultatet alarmerande är att i samband med att vår kompetens allt mer efterfrågas (t.ex. nya vårdgarantin där inte det bara är läkarens bedömning som gäller) ställs ett högre krav på oss som yrke. Utöver detta blir det allt vanligare att intyg granskas av en tredje part. T.ex. du som arbetsterapeut kan bli kallad till rättegång i samband med ett bidragsfusk om ditt intyg använts av den åtalade. Då ska du vittna för hur du kommit fram till din bedömning. Om du använt dig av ett instrument i din bedömning kan inte ditt intyg ifrågasättas på samma sätt som om du gjort en ostrukturerad bedömning. Vidare kan det uppstå problem om någon är missnöjd med din bedömning & lämnar ett klagomål. Patienten anser sig ha blivit felaktigt bedömd. Om du inte har använt dig av ett instrument, hur kan du garantera att din kollega skulle gjort samma bedömning? Detta är bara 3 korta exempel. Vi måste hjälpas åt för att använda den evidens som faktiskt finns. Ett sätt att ta tag i denna fråga på sin arbetsplats är att ta fram en verktygslåda av instrument som alltid ska användas vid olika moment. Lycka till, för detta är ett förbättringsarbete många av oss måste göra. ________________________ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 26, 2019 Bättre statistik om personer med funktionsnedsättning Här om veckan gav regeringen Statistiska centralbyrån (SCB) i uppdrag att ta fram och redovisa statistik om levnadsförhållanden för personer med funktionsnedsättning. Något som SCB hade uppdrag att göra mellan 2011-2016. Tyvärr upphörde detta uppdrag när den funktionshinderspolitiska strategin slutade att gälla. I korta drag innebär det att vi idag har det svårt att ta fram korrekta siffor för denna målgrupps levnadsvanor. För att citera vår socialminister Lena Hallengren: ”människors olika behov och förutsättningar ska inte avgöra möjligheten till delaktighet och trygghet i samhället. För att skapa ett mer tillgängligt och jämlikt Sverige krävs bättre statistik om levnadsförhållanden för personer med funktionsnedsättning”. Uppdraget SCB får består av att redovisa uppgifter i befintlig statistik om levnadsförhållanden för personer med funktionsnedsättning. Samt att kartlägga och analysera framtagen statistik för att ge förslag på hur statistiken kan utvecklas och förbättras. En annan del i uppdraget består av att göra en genomlysning och ta fram förslag på en definition av funktionsnedsättning. Idag finns inga officiella kriterier för att fastställa vem som ingår i gruppen personer med funktionsnedsättning. Detta har lett till att olika myndigheter använder olika kriterier, vilket har försvårat samverkan. SCB ska därför ta fram indikatorer som kan ligga till grund för en definition av funktionsnedsättning. En sådan definition behöver omfatta de indikatorer och frågor som används på EU-nivå. Uppdraget ska delredovisas i feb 2020 och slutrapporten kommer feb 2021. Vill du läsa mer om uppdraget kan du följa länken nedan eller gå in på Funktionshinderpolitikens hemsida där dom förklarar uppdraget. Ha en fortsatt bra dag! ________________________ https://bit.ly/2YPgUEw #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 23, 2019 Långtidseffekt av ReDO Det har varit mycket debatt kring ReDO metoden de senaste åren. Där utbildningarna som förbundet anordnar snabbt blir fyllda och efterfrågan i olika verksamheter kring ReDO samtidigt ökar. Därför är det ju kul att det samtidigt har forskats på långtidseffekten av Re-Do interventioner på kvinnors arbetsförmåga. Faktum är att artiklen bara för någon dag sedan blev publicerad på Scandinavian Journal of Occupational Therapy (SJOT) hemsida. För er som är medlemmar i Sveriges arbetsterapeuter så har ni åtkomst till alla artiklar som är publicerade på SJOT. Men till artikeln. Målet med studien var att undersöka om den arbetsterapeutiska interventionen ReDO kan förutsäga arbetsförmåga för kvinnor som befinner sig i riskzonen för sjukskrivning eller som är sjukskrivna. Samt se till vilka långtidseffekten av Re-Do metoden för målgruppen gällande bla hälsa, arbetsförmåga och aktivitetsbalans. 86 deltagare fullföljde studien (av 152) i studien som med stöd av en enkät fick svara på frågor om bla sin hälsa, aktivitetsbalans och arbetsförmåga. Enkäten genomfördes innan intervention, efter interventionen och som uppföljning 12 mån efter avslutad intervention. Resultatet visar en signifikant skillnad efter intervention, men även vid uppföljningen efter 12 månader jämfört med vad deltagarna skattade i enkäten innan intervention. Förbättring kunde ses inom bla självskattad hälsa, arbetsförmåga och aktivitetsbalans. Huruvida en kan med stöd av ReDO förutsäga arbetsförmåga visade inte samma evidens. Vill du läsa mer om studien så hittar du länken nedan. Är du inte medlem i Sveriges arbetsterapeuter eller inte kommer åt SJOT via arbetet så kan en alltid direkt kontakta författarna för att få komma åt studien i fulltext. Ha en fortsatt bra vecka! ________________________ https://www.tandfonline.com/toc/iocc20/current #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 18, 2019 2 st studier om arbetsterapeutiska interventioner Hur kan arbetsterapeuter hjälpa undomar med sämre socioekonomiska förutsättningar med sin diabetes? Samt vilken evidens finns för arbetsterapeutiska interventioner vid MS och fatigue? Detta besvaras av de två studier som jag tänkte tipsa om idag. Först ut är studien om den arbetsterapeutiska interventionen REAL (Resilient, Empowered, Active Living with Diabetes). Syftet med interventionen är att förbättra hur ungdomar med sämre socioekonomiska förutsättningar hanterar sin diabetes och således förbättrar sitt välmående. Studien är en RCT där resultatet visar att den arbetsterapeutiska interventionen ger resultat för interventionsgruppen jämfört med kontrollgruppen. Studien genomfördes 2014-2015 och mycket har hänt inom egenvården för personer med diabetes. Men studien är ett gott tecken på hur vi kan jobba med mer utsatta grupper kring att sköta sin kroniska sjukdom. Den andra studien som ser till hur arbetsterapeuter kan hjälpa personer med MS att hantera sin fatigue är en litteraturöversikt på 10 olika studier. Fatigue är ett vanligt symtom för personer med MS, där tröttheten ses orimlig i relation till ansträngningen och kan ge en känsla av total utmattning. Läs gärna med om fatigue på www.ms-guiden.se där en stor broschyr finns på ämnet. Tyvärr saknas stark evidens för ”arbetsterapeutiska” interventioner av fatigue. Men det finns evidens för interventioner som rent allmänt kan utföras av oss arbetsterapeuter så som energibesparande strategier och ADL träning. Dock rekommenderar jag denna artikel för er som vill läsa mer då många bra referenser finns i artikeln. Bägge artiklar finns i fulltext på länkarna nedan. Klickbara länkar finner ni via bloggen (se bio). Ha en fortsatt bra helg och kommentera gärna om det är något specifikt ämne ni önskar mer information om. ________________________ http://care.diabetesjournals.org/content/41/4/696.abstract https://www.hindawi.com/journals/msi/2019/2027947/abs/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 15, 2019 Transporträttvisa Som arbetsterapeuter pratar vi om Occupational justice. Att vi ska ha rätten till delaktighet genom olika möjligheter och resurser för att kunna delta i olika aktiviteter. Där framförallt samhället har ett ansvar för att människor inte ska utestängas och bli berövade delaktighet. Detta kan se ut på olika vis där samhället ska ta ansvar för att alla människor ska ha tillgång till allmänna platser och byggnader, kunna få väsentlig information i ett anpassat format inför ett val, kunna boka tid till primärvården eller hinna ta mig över ett övergångsställe innan det slår över till rött. Eller att enkelt kunna resa med kollektivtrafik eller cykla. Jean Ryan har i sin avhandling “Towards a capability approach to mobility: An analysis of disparities in mobility opportunities among older people” tittat på vilka resmöjligheter som yngre-äldre inom våra 3 storstäder, vilket stöd kollektivssystemet ger. Alltså ”Transporträttvisa”. Något som Jean Ryan beskriver ”Transporträttvisa handlar om en rättvis fördelning av tillgänglighet till aktiviteter av värd”. Ett begrepp som tvärvetenskapligt passar bra in till arbetsterapi (enligt mig själv). Tyvärr har äldre en vana av inskränkta möjligheter. Varav endast 8% svarade att de har svårt att ta sig till olika aktiviteter. Endast 1/4 uppgav att det berodde på svårigheter med själva transportsystemet. Men utan körkort eller fungerande kollektivtrafik är det svårt att dela i aktiviteter. I avhandlingen kan vi även se att kvinnor oftare reser med kollektivtrafik än män i denna målgrupp. Det finns skillnader i potentiella resenärer som vill resa för att vara delaktiga i samhället och vilka möjligheter samhället ger för att underlätta resandet. I samband med att resandet minskar ökar risken för en försämrad livskvalitet. Ofta tittar trafikplanerare på de faktiska resorna istället för resenärers hela kontext. För att lösa detta behöver alla få vara med och utforma sin miljö för att kunna delta i meningsfulla aktiviteter. Läs mer i avhandlingen som ni hittar nedan. ________________________ https://bit.ly/2W2Jnsr #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 10, 2019 MAS MAR kompetensutvecklingsdagar 2019 Då var MAS MAR kompetensutvecklingsdagar över för i år. Som medicinskt ansvarig har en ett ansvar att den hälso- & sjukvård som bedrivs inom kommuner är patientsäker & håller god kvalité (den väldigt korta versionen. Vad som styr detta ser ni i sista bilden). Besök på kompetensdagarna stod bland annat IVO, Socialstyrelsen, Regeringskansliet & SKL för. Där mycket av diskussionerna rörde hur vi kan säkra en god vård för våra patienter inom en kommunal kontext i framtiden. Även om mycket rör oss arbetsterapeuter i andra verksamheter än bara kommunal. En del av de frågor jag tar med mig från dessa dagar är: Varför anger AT i olika studier att vi inte tar stöd av olika instrument/metoder i samband med bedömning & intervention? Ca 56% av alla personer med hemtjänst får stöd/hjälp med sin P-ADL. Varför jobbar inte fler arbetsterapeuter med att träning i aktivitet hos dessa personer? Rehabilitering leder till ökad självständighet = minskade insatser ifrån hemtjänst -> minskade kostnader för samhället. Vi behöver vi bättre på att se patienters egna mål i alla delar kring arbetsterapiprocessen. Om vi förskriver ett hjälpmedel måste vi dokumentera målet för patienten, samt träna patienten i aktivitet för att uppnå det målet. Fler kvinnor än män från hemsjukvård. Viktigt att se denna fördelning & identifiera även sköra män (se inlägget om skörhet). Hur mycket pratar arbetsterapeuter om vårdhygien & rena händer? Gör ni undersökningar på era arbetsplatser för att se hur vi följer de nationella rekommendationerna kring vårdhygien? För att öka tillgängligheten av vård för alla patienter behöver vi AT se över hur våra patienter kan söka vård. Är det bara via telefon under vissa klockslag? Kan en maila? Komma på obokat besök? Samt många många fler frågor som berör hälso- & sjukvården överlag. Har ni några kommentarer kring frågorna ovan är det bara att ni hör av er. Till sist vill jag tacka MAS MAR Föreningen för två väldigt bra genomförda dagar. ________________________ https://www.swenurse.se/Sektioner-&-Natverk/RiksforeningenforMedicinsktAnsvarigaSjukskoterskor/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 05, 2019 Hur främjar du seniorers personers digitala miljö? Surfandet på internet ökar inte bara allt mer bland yngre utan ökar även bland våra äldre i samhället. Varje år ser vi en ökning kring dagligt surfande bland våra ”äldre äldre”. Som jag skrev i mitt senaste inlägg riskerar vi med åldern att bli allt mer sköra. För att bibehålla en god hälsa finns fyra områden som är speciellt viktiga för att äldre personer ska må bra: Social gemenskap, delaktighet & meningsfullhet, att känna sig behövd, fysisk aktivitet samt bra matvanor. Om en person, oavsett ålder, blir isolerad & inte får någon social samvaro kan detta leda till psykisk ohälsa. Psykisk ohälsa ökar dessutom just nu bland våra äldre, vilket gör detta till en av de grupper i samhället vi behöver prioritera. Som ett steg i att motverka äldre personers isolering vill Mälardalens högskola se huruvida webbaserade sociala aktiviteter har potential att förbättra äldre personers sociala nätverk & öka deltagande i aktiviteter, vilket kan minska deras upplevelse av ensamhet. Något som inte verkar vara en omöjlighet att undersöka då svenska seniorers (65+) surfande har bara i år ökat med 58% under Q1 jämfört med 2018. Oavsett vad du själv anser om en digital samvaro är detta ett fält som kommer bli allt vanligare i & med teknikens utveckling. Varav frågan vi arbetsterapeuter, lite beroende på vilket fält vi jobbar inom, behöver ställa oss är hur kan vi främja äldre personers digitala miljö? Vår bild av att äldre personer inte kan hantera en mobil behöver bytas ut mot att äldre allt mer vill kunna använda en mobil för att få en social samvaro. I en undersökning av Telenor uppgav hela 7 av 10 seniorer att deras skärmtid & surfande påverkat deras sociala liv positivt. Så varför skulle detta inte vara ett område för oss att jobba med för att främja delaktighet, vilket i sin tur kan leda till en bättre psykisk hälsa bland våra äldre? Om du vill läsa mer är det bara att du följer länkarna nedan. Ha en fortsatt bra dag! ________________________ https://bit.ly/2DMU5Jk https://bit.ly/2ZVqua5 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist May 02, 2019 Upptäcka och motverka skörhet Under livet slutar vi utföra vissa aktiviteter. En del sker frivilligt & andra på grund av omständigheter vi kanske inte styr över. T.ex. när gjorde du en kullerbytta eller stod på händer senast? Om vi dock jobbar med äldre personer som blivit så pass dåliga i deras förmågor att dom börjar kompensera i många av deras aktiviteter eller slutar utföra dessa helt & hållet kan vi behöva sätta in insatser för att motverka detta tillstånd. Dessa äldre patienter kan anses ”sköra”. En anses skör om man uppfyller tre av följande indikatorer: allmän svaghet, trötthet, nedsatt, uthållighet, viktminskning/aptitlöshet, låg fysisk aktivitet, dålig balans & nedsatt kognition. Något som i sin tur kan leda till ett ökat beroende i ADL, fall, höftfrakturer, sjukhusvård, institutionsboende & för tidig död. Vi som arbetsterapeuter kan jobba mycket med dessa patienter. I den forskning som bedrivs kring sköra patienter ses ofta ADL som ett viktigt område för patienter att vara självständiga inom för att undvika försämring i sitt allmäntillstånd. De sköra patienter som tidigt får insatser behåller sitt självbestämmande i längre utsträckning & skattar bättre hälsa. Genom våra insatser använder sköra patienter hjälpmedel i mindre utsträckning & får en starkare tro på sig själva. De uppger även en mindre rädsla för att falla. Den bättre skattade hälsan & ökade aktiviteten leder i vissa studier dessutom till en högre överlevnad hos dessa patienter. Till stöd att bedöma om en person är skör kan vi använda oss av Screeningverktyget ”FRESH” . Om en person svarar ja på fler än 2 frågor lider personen av skörhet & vi behöver sätta in våra insatser. Om en patients skattas som skör är det viktigt att vi jobbar med att patienten ska känna trygghet. Detta genom att träna i aktivitet för att få bättre fysiska förutsättningar. Men även viktigt att se till vissa anpassningar i form av anpassad fysisk miljö & hjälpmedel. Bäst resultat ser vi självklart om vi gör våra insatser i våra team. ________________________ https://bit.ly/2ZR6s0n https://bit.ly/2GXmrCG #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Apr 26, 2019 Att utfärda intyg som arbetsterapeut Då var vi tillbaka efter lite påskledigt. Hoppas alla haft en bra vecka hitintills! Detta inlägg kommer att handla om intyg. Om du som arbetsterapeuter jobbar inom hälso- & sjukvård & för journal kommer du att kommer utförda intyg någon gång. För någon vecka sedan tipsade jag om den nya utgåvan av Juridik För Arbetsterapeuter från förbundet. Vill börja med ett citat från boken ”Det är inte din uppgift att ta ansvar för konsekvenser av ditt intyg”. Även om det är svårt att tänka helt i dessa banor alla gånger då vill patienternas bästa. Varför måste vi skriva intyg då? T.ex. Patientlagen 3 § ”Den som är skyldig att föra patientjournal ska på begäran av patienten utfärda intyg om vården”. Vi fick även i mars den nya författningen HSLF-FS 2018:54 som beskriver kraven som ska uppfyllas vid utfärdande av intyg. Enligt HSLF-FS 2018:54 ska du som arbetsterapeut ha den kompetens som krävs för att utfärda intyg. Varav din arbetsgivare har som skyldighet att säkerställa att du har möjlighet att få den kompetens som behövs. Intyget får inte heller anpassas efter patientens önskemål. Utan behöver grunda sig i din kompetens & observation. Om du får frågan om ett intyg från någon annan än patienten direkt måste du alltid be om patientens samtycke till undersökningen. Glöm då inte att patienten alltid har rätt till att underrättas om dina fynd. Glöm inte att det som du skriver i intyget ska gå att finna i journal. Observationen behöver finnas dokumenterad i journal & inte bara i intyget. Exakt hur utförligt går inte att säga. Sist vill jag även påminna om er rätt att vara två personer vid en undersökning. Detta ger ett trovärdigare intyg samt skyddar dig om det skulle bli ord mot ord mellan dig & din patient. Det blir allt vanliga med olika rättstvister kring intyg, varav det är viktigt att ni vet om era rättigheter & skyldigheter i samband med hur ni utför era intyg. Läs mer om t.ex. vad ett intyg ska innehålla på länkarna nedan. Samt i boken Juridik För Arbetsterapeuter. ________________________ http://rkrattsbaser.gov.se/sfst?bet=2014:821 https://bit.ly/2DBiBgm #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Apr 18, 2019 Teamsamverkan skapar bättre hälsa Visst är det härligt när allt flyter på i våra team. Kollegorna kommer ihåg vad som bestämdes på senaste mötet & uppgifterna är utförda inför kommande möte. Medarbetare kommer med adekvata frågor utifrån vår profession & kompetens. Uppföljningar av ärenden sker på rutin. Alla i teamet värderas lika & är med & planerar fortsatta insatser (självklart är patienten lika delaktig). Samt teamets funktion & arbetsbeskrivning är klar & tydlig. Där alla jobbar mot samma mål även om någon person i teamet försvinner & ersätts av någon ny kollega. Hoppas detta är verkligheten för många av er. Detta då välfungerande team & teamsamverkan är bra för vår hälsa & leder till mindre stress, mindre psykisk utmattning & lägre korttidsfrånvaro. Att jobba effektivt i team har gång på gång bevisats vara det mest effektiva sättet att nå våra mål. Där patienten ska vara en självklar del i teamet. Ett tydligt exempel på detta är att i alla våra uppdaterade nationella riktlinjer belyser vikten av interprofessionella team för att ge bästa möjliga vård. Samverkan med andra yrkesgrupper, samt patient & anhörig, är även något som för oss arbetsterapeuter beskrivs i vår etiska kod samt kompetensbeskrivning Men varför ska teamsamverkan vara så svårt? I artikeln beskriver författarna till boken Teamutveckling i teori & praktik, Christian Jacobsson & Maria Åkerlund, några punkter som kan försvåra teamsamverkan. Storleken på teamet. Grupper större än 8 personer har svårare att samarbeta. Tydlighet & mål. Om gruppen inte jobbar i samma riktning uppstår lätt en försämrad samverkan. Förståelse för varandra. Alla behöver veta varandras roll i gruppen. Så även vilken kompetens alla har. Anpassat ledarskap. Helst ska ledaren/chefen inte lägga sig i för mycket. Finns tydliga mål ska chefen vara trygg i att gruppen uppnår detta & ska bara hjälpa till om gruppen är på väg ur kurs. Länk till artikeln på Prevent.se samt författarnas bok hittar ni nedan. Ha en fortsatt bra dag! ________________________ https://www.prevent.se/arbetsliv/forskning/2019/effektiva-team-ar-bra-for-halsan/ https://www.nok.se/titlar/akademisk-psykologi/teamutveckling-i-teori-&-praktik/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Apr 13, 2019 Vardag i balans Att ha balans i vardagen och ha möjlighet till meningsfulla aktiviteter pratar vi allt som oftast om. Nu har Kristine Lund studerat den, relativt nya, arbetsterapeutiska metoden Vardag i balans (VIB) för att just se hur vi kan arbeta för att förbättra vardagsbalansen och meningsfulla aktiviteter (metoden lanserades för ca 7 år sedan). Metoden VIB är gruppbaserad livstilsintervention för personer med psykisk ohälsa (mer om metoden finner ni på länk 2 nedan). VIB fokuserar på att patienter ska få en god livskvalitet med balans i vardagsaktiviteterna och hjälpa målgruppen till meningsfulla vardagsaktiviteter där vardagen som helhet blir hanterbar och i balans. De enskilda personernas behov är i centrum och den personliga återhämtningen en viktig ingrediens. Avhandlingen ”Balancing Everyday Life. Exploring change following an activity-based lifestyle intervention for mental health service users” har studerat metoden utifrån deltagares och arbetsterapeuters perspektiv. Viktig forskning för att se hur vi som jobbar med metoden faktiskt upplever det kliniska arbetet. Samt självklart hur patienten upplever samt vilka resultat patienten får av metoden. Om någon av er själva har erfarenhet av VIB får ni gärna höra av er. Resultat från studierna visar att deltagarna som genomgick behandling enligt VIB hade betydligt mer engagemang i meningsfulla aktiviteter, de skattade bättre balans i vardagen och visade sig också ha mindre symtom och bättre psykosocial funktion än personer som inte fick interventioner genom metoden. Dessa positiva resultat kunde även mätas 6 månader efter avslutad behandling där deltagarna även hade en förbättrad livskvalitet. Läs avhandlingen på länken nedan eller läs mer om VIB på länk 2. Som vanligt finner ni en massa bra studier och material i källorna. Ha en fortsatt bra helg! ________________________ https://portal.research.lu.se/portal/files/60664990/e_nailing_ex_K_Lund.pdf https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1524-7 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Apr 7, 2019 Juridik för legitimerade arbetsterapeuter Förra veckan var minst sagt händelserik för oss arbetsterapeuter. En nyhet jag inte hann skriva om var den uppdaterade boken Juridik för legitimerade arbetsterapeuter. Du som legitimerad arbetsterapeut behöver hålla dig ajour med vilka krav som ställs på dig och din legitimation. Varav jag rekommenderar att denna bok finns på alla arbetsplatser. Boken varav teori med exempel varav den är en god grund för diskussion på våra arbetsplatser. Som det alltid är med juridik så förändras våra lagar, författningar och riktlinjer med jämna mellanrum, varav även denna bok behöver uppdateras. Den nya upplagan har framförallt fått mer information om intygsskrivande. Ett område som berör fler och fler av oss och något som varit ett hett ämne för debatt de senaste åren. Andra ämnen som berörs i boken är: Vad innebär det att arbeta som legitimerad arbetsterapeut? Vad innebär det personliga yrkesansvaret? Måste en arbetsterapeut dokumentera i patientjournal oavsett var hen arbetar? Vad ska en journal innehålla? När måste en arbetsterapeut skriva intyg och vad gäller då? Hur långt sträcker sig ansvaret vid förskrivning av hjälpmedel? Den nya upplagan kom den 1 april och går nu att beställa på länken nedan. Ha en bra vecka! ________________________ https://www.arbetsterapeuterna.se/foerbundet/webbutik/juridik-foer-legitimerade-arbetsterapeuter/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 31, 2019 Vikten av en tillgänglig bostad För två veckor sedan skrev jag ett inlägg om bostadsanpassning och hemsidan Bostadscenter. Idag återgår vi till bostaden och vikten av tillgänglighet. En bostad som inte är tillgänlig påverkar direkt våra patienter och deras delaktighet i aktiveter. Något som arbetsterapeuten Lizette Norin belyser I sin hennes avhandling ”Housing accessibility and participation among older adults with long-standing spinal cord injury” som hon disputerade med tidigare I år. Vid bedömning av bostad kan vi använda oss av screeningverktyget Housing Enabler (HE). Ett verktyg med en omfattande checklista på närmare 200 punkter som ser till 60 viktigaste och vanligaste tillgänglighetsproblemen i bostaden. Verktyget togs egentligen inte fram för oss arbetsterapeuter utan för fackmän inom byggnadsbranschen. Men instrumentet används mer och mer inom andra verksamheter, bland annat hos oss arbetsterapeuter. Något vi kan läsa i avhandlingen är att instrumentet egentligen behöver anpassas för att ge korrekta mätvärden, i detta fallet för personer med ryggmärgsskador som använder avancerade rullstolar och bor i bostäder med omfattande bostadsanpassningar. Om du jobbar eller kommer i kontakt med bostadsanpassningar rekommenderar jag att ta del av denna avhandling. Den belyser verkligen vikten av hela processen kring bostadsanpassningar och komplikationerna som finns kring denna del av vårt arbete. Allt från att skriva ett korrekt intyg efter en bedömning, att genomföra en bra anpassning samt vikten av kontinuerliga uppföljningar för att se att bostaden är och förblir tillgänglig för patienten.. Avhandlingen är en del av projektet Swedish Aging with Spinal Cord Injury Study (SASCIS) som syftar till att öka kunskapen om äldre personer som levt länge med en ryggmärgsskada. Länkar till avhandlingen samt projektet om ryggmärgsskador hittar du nedan. ________________________ https://bit.ly/2EUWZvz https://ryggmärgsskada.se #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 26, 2019 Spara dina intyg Här kommer en kort men rätt så viktig nyhet. Här om veckan tipsade jag om utbildningen för förskrivare av hjälpmedel i samband med ett inlägg. För er som gått denna utbildning eller gått en annan utbildning på Socialstyrelsens webbportal kommer här viktig information. I månadsskiftet maj/juni kommer Socialstyrelsen att byta system för utbildningsportalen. Den tidigare data som finns i denna portal kommer inte att följa med till den nya. Detta innebär att du själv behöver spara ner dina intyg och kursbevis från utbildningsportalen innan skiftet maj/juni. Annars kommer all din data att försvinna. En del arbetsgivare har börjat kräva ett kursbevis/intyg från förskrivningsutbildningen. Så passa på att spara ner ditt kursbevis/intyg. Om du inte vill göra om utbildningen i den nya portalen inför ditt nästa byte av tjänst. Hjälp gärna till och sprid denna information till era kollegor och vänner. Ha en fortsatt bra vecka! ________________________ https://utbildning.socialstyrelsen.se #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 23, 2019 Förskrivarguiden HMC Sverige Många av er har säkert kommit i kontakt med Socialstyrelsen utbildning kring förskrivning av hjälpmedel. Om inte så är det ett bra tips för alla som förskriver hjälpmedel att gå utbildningen, som är gratis. Men idag vill jag nämna Hjälpmedelscenter Sveriges tjänst ”Förskrivarhjälpen”. Sidan är under uppbyggnad men har redan idag en betaversion av Kombinationsguiden. Här kan du som förskriva se vilka kombinationer av lyftar, lyftbyglar och selar som du kan använda dig av. I slutändan är det du som förskrivare som har ett ansvar kring valet av hjälpmedel som används och kombinationen av dessa. Mer om detta kan du läsa i Socialstyrelsens föreskrift SOSFS 2008:1, eller gå utbildningen ovan. Kombinationsguiden ersätter tjänsten ”kombinationsdatabasen” som även HMC hade tidigare. I kombinationsguiden har möts du av fyra val beroende på vilket lyfttillbehör du är ute efter. I nästa val har du olika modeller att välja mellan. När du valt modell visas olika tillverkare och deras produkter för denna modell. När du sedan valt en produkt kan du se vilka andra produkter du kan kombinera denna med. Under varje val har du även olika filterfunktioner. T.ex. om ni bara har en tillverkare upphandlad i er verksamhet. Enkelt va? Utöver kombinationsguiden så håller som sagt HMC på att utveckla tjänsterna Utprovningsguiden och Kunskapscenter. Mer om dessa hittar ni på länken nedan. Sist vill jag säga att oavsett om HMC jobbar för att alltid ha aktuell information på sin hemsida så är det alltid du som förskriva som har det slutgiltiga ansvaret. Det kan alltid finnas lokala riktlinjer, direktiv eller andra styrande dokument som du behöver förhålla dig till. Ha en fortsatt bra helg! ________________________ https://www.hmcsverige.se/tjanster/forskrivarhjalpen/ http://www.kunskapsguiden.se/funktionshinder/webb-utbildningar/Sidor/Forskrivning-av-hjalpmedel.aspx #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 21, 2019 Forskning om funktionshinder pågår Idag tänkte jag lite kort tipsa om tidskriften Forskning om funktionshinder pågår. Utgiven av Centrum för forskning om funktionshinder, Uppsala universitet. Centrum för forskning om funktionshinder är samarbetsorganisation vid Uppsalas universitets fakulteter för forskare inom funktionshinder och funktionsnedsättningsområdet. Ett av centrumets ansvar är att sprida information inom forskningsområdet för att stimulera en långsiktig kunskapsuppbyggnad, inom och utanför universitetet. Ett steg i detta är tidskriften ” Forskning om funktionshinder pågår”. Förhoppningsvis är det bara jag som är sen på bollen gällande denna tidskrift. Detta då den grundades redan 1992. Även om den fram till 2007 hette ”Handikappforskning pågår”. På länken nedan kommer ni åt alla tidskrifter som getts ut sedan 1992. Detta blir en del då vi får tidskriften 4 ggr per år. Fortsättnings vis kommer jag att sprida tidskriften bland mina verksamheter då den på ett enkelt sammanfattar pågående forskning. Så även avhandlingar. Några exempel på ämnen som skrivits om i de senaste tidskrifterna är: intellektuell funktionsnedsättning och rätt till delaktighet Meningsfulla aktiviteter viktiga för återhämtningen Stöd till beteendeförändring för personer med långvarig smärta Föräldraskap när barnet har en funktionsnedsättning Viktigt vad strokepatienter själv vill Ögonstyrning för barn med rörelsehinder Rätt till stöd för barn med psykiskt sjuka föräldrar Detta är som sagt bara några exempel på artiklar. Så passa på att surfa in på länken nedan. Eller googla bara på ”forskning om funktionshinder pågår” så kommer ni rätt. Tidningen kommer ni åt gratis i Pdf. Nästa nummer kommer v.22 Ha en fortsatt bra vecka! ________________________ http://www.cff.uu.se/Tidskrift_/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 17, 2019 Bedömning av körkortslämplighet En tid tillbaka var det väldigt mycket debatt om arbetsterapeutiska bedömningar av körkortslämplighet. Nu har SBU gjort en mindre sammanställning kring evidens som svarar på frågan: Vilka evidensbaserade metoder eller instrument (kognitiva test) finns för bedömning av körkortslämplighet hos personer med demens eller andra kognitiva funktionsnedsättningar? Att köra bil är som SBU själva skriver en känslig fråga då bilen är det som ger människor möjligheten att delta olika aktiviteter. Självständighet är som vi arbetsterapeuter vet en stor faktor för att vi ska uppleva ett välmående. Att inte kunna ta sig till olika aktiviteter leder ibland till att människor blir isolerade och sakta men säkert slutar delta i olika aktiviteter som tidigare var viktiga, varav hälsan succesivt försämras till följd av isoleringen. Viktigt att veta att evidensen i artiklarna är författarna själva som kommit fram till. SBU tar inte något ställningstagande. Passa på att ta del av SBU:s litteratursökning som genererade totalt 205 artikelsammanfattningar. Som vanligt är dessa rapporter en väldig god grund till att hitta fler artiklar om ni är intresserade av ämnet. Rapporten kan du ladda ner gratis på länken nedan. ________________________ https://www.sbu.se/sv/publikationer/sbus-upplysningstjanst/test-av-kognitiva-funktioner-vid-bedomning-av-korkortslamplighet/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 12, 2019 Digitala hembesök Tänk om du kunde göra hembesök, utan att behöva åka hem till patienten. Hade du sett det som en för eller nackdel? I en artikel publicerad i BJOT har författarna tittat på möjligheten att kunna identifiera risker i hemmiljön och på så vis kunna undvika fall. Detta genom att göra digitala hembesök. Resultat kommer ifrån 14 artiklar som tittat på hur denna typ av teknik har använts av arbetsterapeuter. Evidensen från denna artikel kanske inte är den bästa. Men jag finner den intressant att diskutera, då detta rent tekniskt skulle kunna gå att genomföra hos dom flesta patienter redan i dagsläget (då räknar jag in alla patienter från spädbarn till äldre äldre). För er som känner att detta är en dum idé så oroa er inte. Resultatet från studien fann att i dagsläget överväger inte tekniken fysiska hembesök av en arbetsterapeut. Dock är det värt att veta att i t.ex. Norge används rehabilitering via videosamtal som intervention som visat god resultat bland patienter som har svårt att ta sig till en mottagning. Vidare kan det ju även finnas fördelar att kunna se patientens hem för att kunna planera eventuella åtgärder. Oavsett om du som arbetsterapeut jobbar inom slutenvård och planerar en hemgång. Jobbar inom hemsjukvård och behöver planera för interventioner i aktivitet. Eller om du jobbar inom arbetslivsinriktad rehabilitering och skulle behöva få en överblick av arbetsplatsen. I studien ser vi exempel på allt ifrån att se bilder, videosamtal eller appar för planering över patientens hemmiljö. Dom flesta av oss har nog hört en patient nämna något om sitt hem och vid besöket inser vi att vår uppfattning över miljön kanske inte alltid stämmer överens med patienten. Varav digitala hembesök skulle kunna vara en lösning. Vad tror du? Kan du se dig själv flyga en drönare över till en patients hus från ditt kontor för ett hembesök? Artikeln i sin helhet kommer ni åt gratis via länken nedan ________________________ https://journals.sagepub.com/doi/full/10.1177/0308022618786928 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 09, 2019 Bostadsanpassning och intygsskrivande Förra året fick vi ju en ny lag kring bostadsanpassning. I samband med ändringarna har en del förändringar skett. Varav ni på Boverket, som dom flesta av er vet, hittar det mesta som behovs utifrån själva lagen om bostadsanpassning. Idag vill jag istället tipsa om hemsidan Bostadscenter som drivs av HMC. Hemsidan är ett resultat från projektet ”Nationellt kunskapscenter för bostadsanpassning” som har sitt stöd från bla Arvsfonden. Om några av er var på mässan Hjultorget visades denna sida redan då. Målet med projektet är att ”höja kunskapsnivån hos dem som är i behov av bostadsanpassning, handläggare av bostadsanpassningsärenden och rehabiliteringspersonal. Varje person som har behov av bostadsanpassning ska kunna få den optimalt gjord.” På hemsidan hittar du allt från information till sökande, intygsskrivare och handläggare. Hur Boverkets process ser ut. Vad ett intyg ska innehålla, vilka skyldigheter du har som intygsskrivare, vilka krav det finns på utredning, bedömning och utformning. HMC erbjuder även utbildningar kring intyg för er som kan vara intresserade. Men även information så som Behovsguiden. En sida där du interaktivt kan klicka dig vidare i 5 olika steg utefter vilka behov patienten har och vilket resultat en anpassning ska ge. Här får du tips och idéer kring olika anpassning efter vad som behovs i boendet. 1. Vad är det jag vill kunna göra? (se bilden med pusselbitarna) 2. Vad är problemet? 3. Vad i miljön hindrar mig? 4. Vilken lösning skulle kunna passa mig? 5. Använd förslaget enligt behovsguiden. Vid behov börja om från steg 1 för nästa område Behovscenter är absolut värt ett besök om du jobbar mot bostadsanpassningar. Självklart kan du även klicka dig vidare till HMCs utbildning kring intygsskrivande. Lycka till med anpassningarna och intygen. Ha en fortsatt trevlig helg! ________________________ https://www.bostadscenter.se/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 06, 2019 Höftfraktur och rehabilitering Varje år drabbas i Sverige ca 18000 personer av en höftfraktur. Denna typ av fraktur leder tyvärr ofta till försämrad aktivitetsförmåga & därmed försämrad livskvalité. En avhandling som föll bort i början av sommaren men som jag finner är viktig för oss att ta del av är sjuksköterskan Berit Gesars avhandling ”The recovery process after a hip fracture of healthy patients, 65 years and older – perceptions, abilities, and strategies”. Hon har i sin avhandling tittat på tidigare friska personer som är 65 år & äldre som råkat ut för en höftfraktur & hur väl rehabiliteringen gått (för oss väldigt tvärvetenskapligt & bra). Det hon fann var att de patienter som hade tydliga mål, där delaktighet samt nära & kära var involverade var dom som återhämtade sig bäst. Även ens vilja & kämpaglöd var viktiga faktorer för en god rehabilitering. I & med den fysiska nedsättningen upplevde många patienter en psykisk påfrestning. Efter frakturen hade patienterna fått en minskad delaktighet, deltog i färre aktiviteter, umgicks inte med vänner & blev succesivt mer isolerade. Därför belyser Berit vikten av psykologiskt stöd & uppmuntran efter frakturen. Där vi behöver bli bättre på att sätta tydliga mål som involverar delaktighet. Efter att ha läst avhandlingen reflekterade jag över de patienter som jag träffat vid hembesök i samband med hemgång från sjukhuset. I många fall var det den klassiska toalettförhöjningen, strumppådragare & eventuell kildyna (beroende på kommun & län) som förskrevs. Detta samtidigt som en gick igenom olika moment som kunde förenkla olika ADL situationer. Men det psykologiska stödet, samt mål var något jag ofta missade. Ta er gärna tiden & läs avhandlingen & reflektera kring hur ni jobbar med höftfrakturer, eller andra frakturer som kan ge stora nedsättningar. Länk till avhandlingen hittar ni som vanligt nedan. Ha en bra dag! ________________________ https://bit.ly/2NLqYKi #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Mar 01, 2019 Att skriva journal Ett av de lagkrav som vi påverkas av är att skriva journal (SFS 2018:355, SOSFS 2005:27, HSLF 2017:23, HSLF-FS2016:40 & 2014:821). Som vanligt med lagar finns det alltid undantag, varav en del av oss inte för journal. Journalföring är ofta ett ämne för debatt. Varav lite diskussion kring vad som egentligen hör hemma i en journal eller inte känns lägligt här. Jag kommer inte gå in på själva syftet med journalen i sin helhet. Utan lyfta en del punkter som jag ofta diskuterar med medarbetare & andra kollegor. Observera att era medicinskt ansvariga & andra ledande funktioner kan ha andra åsikter än jag kring detta. Se detta som en diskussion. Undvik alltid namn i allra största mån. Planering. Vad är nästa steg i behandlingen? Det räcker med att beskriva grunden i din planerade åtgärd. Du behöver inte beskriva åtgärden i detalj eller vad som händer om åtgärd A eller B inte fungerar. Du ska inte skriva när nästa besök planeras in löpande text. Mål/måluppfyllelse. Beskriv vad patienten har för egna mål. Glöm inte att skriva om måluppfyllelse. Framförallt när ni avslutar en patient i samband med slutanteckningen. Ska du beställa ett hjälpmedel? Räcker med att beskriva vad för typ. Du behöver inte beskriva specifik information t.ex. alla tillbehör. Info om hjälpmedlet ska egentligen finnas i ett separat system. Men i samband med utprovning kan det vara bra att skriva om specifik inställning när det är viktigt. Viktigaste är att hjälpmedlet ska kunna spåras. Ärr patienten delaktig? Har hen fått muntlig & skriftlig information? Har hen fått några valmöjligheter? Vet patienten nästa steg i behandlingen? Vet patienten vem hens fasta vårdkontakt är? Om en patient av/ombokar ska detta inte stå i journal. Det bör finnas ett separat ställe där ni sköter er planering. Om dock viktig information för behandlingen inkommer i samband med samtalet ska detta in i journalen. Undvik dubbeldokumentation. Detta gäller även vid överrapporteringar. Kan du hänvisa till NPÖ eller på annat sätt undvika att två huvudmän skriver samma information? ________________________ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 24, 2019 Arbetsterapeutisk första hjälpare Idag kommer ett tips om ett område som jag inte läst speciellt mycket om den senaste tiden. Nämligen att jobba som arbetsterapeut i katastrofdrabbade områden. Igår, lördag, släppte WFOT sina nya guide för arbetsterapeutiska första hjälpare vid katastrof och trauma. Guiden är till för att inte bara stärka rollen som arbetsterapeuter och första hjälpare, men även hjälpa arbetsterapeuter att förbereda sig för fältarbetet och de upplevelser som en annars kan ta med sig hem. Att jobba i katastrofdrabbade områden kan vara påfrestande varav du i denna guide får många tips för hur du ska handskas med de olika situationer du kan komma att hamna i. Allt från hur du ska handskas med negativa tankar, kontrollera din andning och andra autonoma delar av nervsystemet vid påfrestande situationer eller hur du ska hantera olika psykologiska och mentala påfrestningar. Även om det inte är ett område som det talas mycket om behövs vi arbetsterapeuter i områden av kris. Oavsett om att det handlar om att se till att personer får rätt bedömning och rehabilitering vid nya skador, eller om det är att hjälpa personer med tidigare funktionsvariationer. Materialet går att ladda ner gratis på länken nedan. Jag länkar även en litteraturstudie som tittat på arbetsterapeuters roll i katastrofdrabbade områden om ni vill läsa mer om detta ämne. Detta då guiden från WFOT inte beskriver arbetsterapeutiska interventioner. Även denna artikel är fri att ladda ner. Ha en fortsatt bra dag! ________________________ https://www.wfot.org/resources/wfot-guide-for-occupational-therapy-first-responders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5612682/pdf/OTI2017-6474761.pdf #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 20, 2019 Ny hemsida: www.arbetsterapeuterna.se Som ni såg tidigare i veckan under Händelser har WFOT fått en ny hemsida. Men inte nog med detta. Idag har även Sveriges Arbetsterapeuter fått en ny hemsida. Efter att ha fått möjligheten att testa den nya hemsidan innan den blev publik måste jag säga att den nya är betydligt bättre den gamla. Hemsidan är responsiv vilket innebär att den nu fungerar lika bra oavsett om du sitter på en mobil, padda eller dator. Men för er som har en androidtelefon så får man ibland vara försiktig med ”tillbakaknappen” på mobilen och använda ”tillbaka” på hemsidan istället. Den nya hemsidan är dessutom lyfter även fram er som är medlemmar i Sveriges Arbetsterapeuter genom olika förmåner. Dessutom har nu alla kretsar en egen sida, som alla ser likadana ut. Även om mängden innehåll styrs av varje enskild krets. Allt detta som ett steg i att uppmana fler till att gå med i facket och lättare kunna kontakta ens krets vid behov. En till nyhet är att tidningen Arbetsterapeuten lyfts fram mer. Utvalda artiklar kommer bli mer sökbara. Så det blir enklare att hitta artiklar i gamla som nya utgåvor. För er som vill sprida tidningen underlättar även den nya sidan detta. Detta oavsett om du är medlem eller ej. Så passa på att gå in och kolla igenom den nya sidan. Som vanligt är adressen: www.arbetsterapeterna.se Ps. För er nyfikna kan jag även säga att senare i år (förhoppningsvis innan vår blir till sommar) kommer vi medlemmar att kunna logga in med mobil BankID. Varav det snart är slut på att hålla koll på fler koder och medlemsnummer :) ________________________ https://www.arbetsterapeuterna.se/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 17, 2019 Vad läser du? Den senaste tiden har jag på händelser lagt upp nyheter där arbetsterapeuter/arbetsterapi nämns i media. Detta som ett steg att sprida nyheterna utan att behöva göra större inlägg. Så fortsätt håll utkik på händelser för att se fler nyheter under veckorna. I veckan kom det senaste numret av Arbetsterapeuten. Varav jag började fundera på vilka fler tidskrifter som kan vara bra för oss arbetsterapeuter att hålla ett öga på. Alla tidskrifter är gratis, men kan ibland behöva att du registrerar ett konto för att komma åt allt material. För er som läser detta på bloggen får jag hänvisa er till Instagram där du kan se alla omslag på tidskrifterna (har du inte Instagram kan du följa länken nedan för att läsa alla inlägg direkt i din webbläsare utan konto). Tycker du att någon tidskrift saknas? Kommentera inlägget eller skicka ett meddelande så kan jag tipsa om fler tidskrifter under händelser. 1. Bulletin (WFOT) Släpps två gånger om året där du får en massa information om arbetsterapi & vad WFOT pysslar med. 2. Medtech Magazine. Kommer 4 nummer per år. Du får nyheter om medicintekniska produkter, mässor, utbildningar & intervjuer med olika leverantörer. 3. Arbetsterapeuten. Sveriges arbetsterapeuters egna tidskrift som kommer i 7 utgåvor per år. Här får du allt från information till medlemmar, omvärldsbevakning & historier om olika människor (inte bara arbetsterapeuter). 4. Vetenskap & Praxis. SBUs tidskrift där du får olika resultat från olika rapporter, information om olika projekt samt olika granskningar av hälso- & sjukvården samt socialtjänsten. 5. Omtanke - Tidningen för vård & omsorg. Här kan du läsa om nya lagar & regler, relevant vidareutbildning, ny yrkesutrustning som är inriktat mot socialtjänst men även hälso- & sjukvård. 6. Funkisliv. En tidning som lyfter funkisfrågor & människor som inte alltid får det utrymme de förtjänar i traditionell media. ________________________ https://www.instagram.com/arbetsterapisverige/ https://www.wfot.org/bulletin https://www.medtechmagazine.se/epages/archive.html https://www.arbetsterapeuterna.se/Tidskriften/ https://www.sbu.se/sv/publikationer/vetenskap-&-praxis/ https://www.ssil.se/tidningen https://issuu.com/search?q=funkisliv #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 11, 2019 Nationella riktlinjer för vård vid epilepsi Så här dagen till ära, Nationella epilepsidagen, släpper Socialstyrelsen slutversionen av nationella riktlinjer för vård vid epilepsi. En efterlängtad riktlinje då tidigare undersökningar sett att vården för personer med epilepsi har varit bristfällig och ojämlik. Detta trots att det är en av de vanligaste kroniska neurologiska sjukdomarna i Sverige, där ca 81 0000 personer är diagnostiserade med epilepsi. Riktlinjerna består av 47 rekommendationer som berör alla inom sjukvården från utredningar till återkommande uppföljningar. En av rekommendationerna är även att många personer med epilepsi ska ha tillgång till ett epilepsiteam där bland annat arbetsterapeuter ska ingå. Som vanligt kommer ni åt riktlinjerna på Socialstyrelsens hemsida där dom är gratis att ladda ner. Ha en fortsatt bra vecka! ________________________ https://www.socialstyrelsen.se/publikationer2019/2019-2-8/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 10, 2019 SKL: Lagar hämmar vårdens utveckling Oavsett var du som arbetsterapeut jobbar så styrs vi av olika lagar och förordningar. En del övergripande lagar så som HSL, SOL, LSS som lägger grunden för vård och omsorg. I nästa steg kommer mer specifika lagar t.ex. patientdatalagen & vårdgarantin som styr delar av hur vård & omsorg ska utföras. Sist kommer andra styrande dokument så som föreskrifter eller lokala riktlinjer på ens specifika område/arbetsplats (en väldigt förenklad beskrivning). I samband med digitaliseringen har ibland våra lagar ibland svårt att hänga med. Något som kan begränsa utvecklingen inom vården. När väl nya lagar kommer kan sedan debatterna bli oändliga, se bara på GDPR… I veckan hade Ekot ett inslag där SKL pratar om problematiken med rådande lagstiftning & den våg av digitalisering som pågår, i samband med att Sverige har som mål att vara bäst i världen på e-hälsa år 2025. Många regioner (& kommuner som inte nämns i inslaget) ser nu över sina journalsystem & vill kunna dela mer data mellan vårdgivare. Något som rådande lagstiftningen kan sätta käppar i hjulet för. Det är underbart svårt att i dagsläget få dela data mellan vårdgivare. För att inte tala om hur svårt det är när olika lagrum är involverade (SOU 2014:23). T.ex. att hemtjänsten egentligen inte får ta del av hemsjukvårdens anteckningar & vice versa. På vår arbetsplats ser jag nästan dagligen hur svårt det är att se till att all den information vi har om våra patienter & brukare (i avsaknaden på bättre ord från Socialstyrelsen) kommer till nytta för den enskilde i alla lägen. Självklart när samtycke finns för detta Det ska bli intressant att se SKLs fortsatta arbete i dessa frågor. För ska vi nå målet 2025 är det hög tid att sätta igång arbetet för en lagstiftning som ser till nyttan av digitalisering samtidigt som informationen hanteras på ett säkert viss där rätt personal bara har tillgång till den information hen behöver. ________________________ https://sverigesradio.se/sida/artikel.aspx?programid=83&artikel=7147024 https://bit.ly/2E1ralh #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 06, 2019 Återhämtningsguiden - för dig som mår dåligt Då var det dags för ett nytt segment här på kontot. Framöver kommer jag att successivt ge lite tips om olika produkter och tjänster. Varav om har ni önskemål eller tips kring vad du vill läsa om är det bara att höra av sig. Först ut är den sprillans nya appen ”Återhämtningsguiden - för dig som mår dåligt” (den släpptes 190205). Målgruppen till appen är vem som helst som har det jobbigt av olika anledningar. Det kan t.ex. handla om psykiska sjukdomar och ohälsa, men också personer som går igenom en kris så som en skilsmässa. Sedan 2016 har NSPH Skåne som är ett arvsfondsprojekt arbetat fram två Återhämtningsguider; Återhämtningsguiden - för dig inom heldygnsvård och Återhämtningsguiden - för dig som mår dåligt. Återhämtningsguiden är skriftliga material (och nu även som app) som kan fungera som verktyg för den som mår psykiskt dåligt och är i behov av återhämtning. Den som i sin yrkesroll möter målgruppen kan använda materialen som ett stöd i arbetet. Återhämtningsguiden – för dig inom heldygnsvård är ett verktyg för den som är inlagd på en heldygnsvårdsavdelning och syftar till att skapa en förståelse för nuläget och en plan för såväl återhämtning, som tiden efter utskrivning. Det är Återhämtningsguiden - för dig som mår dåligt som nu lanseras som app, för att kunna nå en bredare målgrupp, och även göra det lätt för individer att ha med sig den. Materialet är till för den som har behov av återhämtning och kan används i flertalet verksamheter, så som öppenvård, primärvård, socialpsykiatri och företagshälsovården. Fördelen med appen är att informationen och materialet, som innehåller flertalet skrivövningar där personen själv får reflektera och skriva ner viktiga saker kring sitt mående och svåra situationer, blir mer lättillgänglig. Appen är helt kostnadsfri och går att ladda ner på App Store och Google Play. Självklart finns material kostnadsfritt på länkarna nedan. Se även NSPH Skånes Facebook för aktuell information. ________________________ https://www.facebook.com/nsphskane.se http://www.aterhamtningsguiden.se/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Feb 01, 2019 Rörelsehinder och övervikt - en ond cirkel Dags för ännu en avhandling. Denna gång för oss arbetsterapeuter 4 st tvärvetenskapliga studier som tydligt visar på att vi måste bli bättre på att prata om eventuella problem övervikt och fetma kan ge för personer med rörelsehinder. Avhandlingen står Marianne Holmgren för, som disputerade inom vårdvetenskap med inriktning handikappvetenskap. Den 20 november gick hon upp med avhandlingen:” It's time to talk about mobility disability and overweight. Quality of life and need of preventive measures from the perspective of people with mobility disability and public health nurses.” Som jag skrev innan är avhandlingen för oss tvärvetenskaplig men berör många områden som även vi borde hålla ett öga på. I sina studier har Marianne undersökt om övervikt hos personer med rörelsehinder påverkar dessa personers livskvalité och delaktighet. Avhandlingen beskriver att personer med rörelsehinder ofta hamnar i en ond cirkel. På grund av deras funktionsvariationer uppstår svårigheter inte bara på grund av mindre fysisk aktivitet utan även sämre ekonomiska förutsättningar. Svårigheterna leder till sämre upplevd hälsa, smärta, psykisk ohälsa, sömnsvårigheter, minskad delaktighet och tillgänglighet för att nämna några exempel ur studierna. Deltagarna berättade även att personal på vårdcentraler sällan pratar om problem med övervikt och fetma. Om samtalet lyftes under ett besök upplevde deltagarna att det inte blev förstådda eller att personalen på vårdcentralen saknade kompetens om deltagarnas rörelsehinder. Som vanligt består avhandlingen av 4 olika studier med kvantitativ eller kvalitativ metod. Ta gärna en titt på avhandlingen i länken nedan. Som vanligt finns en massa bra artiklar och referenser som ni kan använda. Ha en fortsatt bra dag! ________________________ http://portal.research.lu.se/portal/files/53596354/Marianne_H_KAPPAN_inkl._omslag.pdf #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 29, 2019 Lär dig syntolka Här kommer ett litet tips på kompetensutveckling till dig som vill lära sig mer om syntolkning. Utbildningen ger dig grundläggande kunskaper och råd för att höja livskvalitén för personer med synnedsättning. Det är Göteborgs Stad i samarbete med Synskadades Riksförbund som tagit fram denna webbutbildning som riktar sig till handledare, ledsagare, anhöriga, vänner och bekanta till personer med synnedsättning. Oavsett om du möter personer med lite nedsatt syn eller personer som bara kan se konturer ger dig utbildningen en bra grund att förstå hur du kan förklara och beskriva din omgivning. Du får enkla tips på hur du ska syntolka. I vilken ordning du ska beskriva det du ser och hur du kan undvika att lägga in dina värderingar i syntolkningen. Utbildningen tar ca 20 minuter att genomföra och består av 8 st filmer. Efter utbildningen får du svara på några frågor. Klarar du provet får du självklart ett diplom. Kapitel 1 handlar om praktisk syntolkning med 6 st olika teman om t.ex. att syntolka på teater och bio, toaletten och restaurangen. Kapitel 2 har 2st teman och handlar om vad som är viktigt vid ledsagning. Så klart är utbildningen gratis. Allt du behöver göra är att surfa in på länken nedan och börja din utbildning. Filmerna finns även tillgängliga på Youtube via Göteborgs Stad, om du vill använda dom i separat syfte. I skrivande stund har 75 personer klarat provet. Blir du nästa? ________________________ https://lardigsyntolka.goteborg.se/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 27, 2019 Lets stay in touch - Fjärrkommunikation för personer med kommunikativa och kognitiva svårigheter Dags för ännu en avhandling. Denna gång var det Margret Buchholz, specialistarbetsterapeut som i förra veckan disputerade. Hennes avhandling handlar om fjärrkommunikation för personer med kommunikativa och kognitiva svårigheter och heter: Let’s stay in touch! Remote communication for people with communicative and cognitive disabilities. Vad är då fjärrkommunikation? All kommunikation som du gör via mobil, platta eller dator i form av sms, e-post, videosamtal, sociala medier och andra typer av meddelandetjänster är fjärrkommunikation. Något som är en förutsättning för delaktighet i dagens samhälle. Det används för social gemenskap och för att boka in olika slags av aktiviteter. Vi förväntas ha tillgång till internet och telefon, surfplatta eller dator för att kunna utföra viktiga aktiviteter som att kontakta hyresvärden, hälso- & sjukvården, försäkringskassa eller kontakta support för olika tjänster. Personer med kommunikativa och kognitiva svårigheter som har svårt att uttrycka sig i tal och skrift kan ha stora begränsningar i tillgången till fjärrkommunikation. Margrets avhandling har som syfte att utforska och beskriva fjärrkommunikation för personer med kommunikativa och kognitiva svårigheter. Avhandlingen fokuserar på fjärrkommunikation i relation till självbestämmande och delaktighet samt undersöker personernas egna erfarenheter, förskrivares och stödpersoners erfarenheter. Avhandlingen beskriver hur tillgång till fungerande fjärrkommunikation är viktigt för att ha kontroll över sitt eget liv, självbestämmande och delaktighet. Den beskriver också hur det behövs ökad tillgång till fungerande teknik, kunskap och stöd för att personer med kommunikativa och kognitiva svårigheter ska kunna fjärrkommunicera som de själva önskar. Margrets avhandling är väldigt aktuell och belyser vikten av tillgänglighet och delaktighet i vår allt mer digitala värld. Så tar er gärna tiden och läs den eller diskutera den på kontoret. Länken till avhandlingen hittar du självklart nedan. Ha en fortsatt bra dag! ________________________ https://gupea.ub.gu.se/handle/2077/57718 http://hdl.handle.net/2077/57718 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 22, 2019 Vardagslivspodden - Nytt år, nya möjligheter Som en del av er känner igen delade undertecknad utmärkelsen Sveriges Arbetsterapeuters Inspiratörsutmärkelse tillsammans med @Vardagslivspodden med Jossan och Tessan under Fullmäktige i november 2018. Förhoppningsvis läste ni även om utmärkelsen i Tidskriften Arbetsterapeuten (och självklart om fullmäktige) där Vardagslivspodden och jag blev intervjuade. En av frågorna i intervjun var om jag skulle få va med i ett poddavsnitt framöver. Ja, som ni kanske förstår så är den dagen kommen. Idag släppte Vardagslivspodden sitt senaste avsnitt där jag blir intervjuad. Jag tycker att ni borde surfa in på länken nedan eller gå till ---> @vardagslivspodden där en klickbar länk ligger i deras bio och lyssna på avsnittet. På deras Insta hittar ni även länk till deras intervju i P4 från här om veckan som ni också borde kolla närmare på. Så här beskriver Jossan och Tessan sin podd: ”De två arbetsterapeuterna Jossan och Tessan lyfter de allt för sällan omtalade ämnet arbetsterapi ur ett vardagsperspektiv. Veckans hjälpmedel, vardagstips och veckans fråga är bland annat återkommande segment i denna unika podd. Här diskuteras vardagen ur ett arbetsterapeutisk perspektiv där allvar blandas med humor.” Ha en fortsatt bra dag! ________________________ www.vardagsliv.podbean.com #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist #vardagslivspodden #vardagslivsmedjossanochtessan Jan 20, 2019 Arbetsterapeutiska interventioner vid Parkinsons sjukdom I Sverige lever ca 20 000 personer med sjukdomen Parkinsons. En kronisk neurodegenerativ sjukdom innebär att nervceller som tillverkar signalsubstansen dopamin långsamt förtvinar & leder till ökade funktionshinder. Parkinsons delas ofta upp i tre faser: tidiga fasen, fluktuationsfasen & komplikationsfasen. De olika faserna innebär olika behandlingsformer & interventioner för att behandla symtomen. Vanliga symtom är: rörelsehämning, muskelstelhet, skakningar, nedsatt balans, smärta, domningar, nedsatta exekutiva funktioner. Men sjukdomen innebär också en del psykiska symtom så som: koncentrationssvårigheter, språkfattigdom, ökad stresskänslighet & känslomässig avtrubbning. Arbetsterapeuter har en roll vid utredningen för diagnossättningen. Det är även viktigt med en arbetsterapeutisk utredning efter diagnos. Beroende på vilken sjukdomsfas patienten befinner sig har vi arbetsterapeuter olika interventioner. Viktigt är att vi arbetsterapeuter kommer in tidigt i sjukdomsförloppet för att patienter ska kunna bibehålla sin livskvalité, självständighet & fortsätta känna en delaktighet i det dagliga livet. Vanliga arbetsterapeutiska interventioner kan vara: fallpreventiva åtgärder, stödja egenvård, träning av handfunktion, förflyttning-, gång- & koordinationsträning, träning i aktivitet, stresshantering, utprovning av olika hjälpmedel, intyg för eller anpassning av hem- eller arbetsmiljö, trycksårsprevention, information till patient eller närstående m.m. Nedan finner ni länkar till en systematisk översikt kring arbetsterapeutiska interventioner samt två PDF filer med olika riktlinjer för arbetsterapeutisk rehabilitering vid Parkinsons. ________________________ https://plus.rjl.se/infopage.jsf?nodeId=31387&childId=19714 https://www.parkinsons.org.uk/sites/default/files/2017-12/otparkinsons_bestpractiseguidelines.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413458/pdf/39.pdf http://www.parkinsonnet.info/media/14820461/ot_guidelines_final-npf__3_.pdf #arbetsterapi #arbetsterapeut #arbetsterapisverige #vadgörenarbetsterapeut #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 17, 2019 Rehabilitering vid MS Cochrane släppte i måndags en översikt som handlar om rehabilitering för personer med MS, Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Helt enkelt en översikt av tidigare systematiska översikter från Cochrane översikter (sammanlagt 15 Cochrane översikter, vilket innebär totalt 168 studier). Frågan som denna översikt ställer sig är om personer med MS som deltar i olika rehabilitering program ser förbättringar inom bland annat eventuella funktionshinder, förbättring av fysisk aktivitet och livskvalité? Som vanligt jämförs denna grupp med personer som får andra typer av interventioner eller placebo. Man tittade även på insatser från specifika yrkesroller samt interprofessionell rehabilitering. En del av åtgärderna som är inkluderade i översikten är: fysisk aktivitet, arbetsterapeutiska och arbetslivsinriktade interventioner, kognitiva interventioner, kost och diet, behandling för spasticitet samt information med mera. Tyvärr fick arbetsterapi låga poäng för sina behandlingar i dom inkluderade studierna. Men detta förklaras mycket till felaktigheter i respektive studies metoder, vilket direkt drar ner betyget för hela studien. Således får interventionerna en sämre trovärdighet. Som vanligt är dessa översikter väldigt stora. Men ofta en väldigt bra källa till artiklar och referenser. För er som vill läsa mer. Nedan finner ni två länkar varav den första är hela översikten i PDF. Den är egentligen inte gratis. Men länken är till Cochrane så passa på att ladda ner översikten så länge länken fungerar. Ha en bra dag! ________________________ https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012732/media/CDSR/CD012732/CD012732.pdf https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012732.pub2/full #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 13, 2019 LSS utredningen. Sammanfattning av slutbetänkandet Det har varit svårt att missa att slutbetänkandet för LSS utredningen (Översyn av insatser enligt LSS och assistansersättningen (SOU 2018:88)) nu är inlämnad. Hej Olika har gjort en sammanfattning av vad utredningen innebär. En del av sammanfattningen ser ni i bilderna ovan. Självklart hittar ni hela sammanfattningen på länken nedan. Vad är nästa steg för utredningen nu då? Jo bland annat ska de förslag som tagits fram i utredningen gå ut på remiss till berörda myndigheter, organisationer och kommuner. Självklart kan även du som privatperson lämna åsikter på remissen. Beroende på svaren kan förslagen från utredningen läggas ner eller leda till olika propositioner. Utredningen ger själva förslag att lagändringarna ska träda i kraft den 1 januari 2022. Mitt tips här är att följa bland annat vårt fackförbund samt SACO och funktionhinderrörelsens olika debattartiklar och remissvar framöver för att hålla dig ajour i frågan. Ha en bra dag! ________________________ https://hejaolika.se/artikel/detta-vill-lss-utredningen/ https://www.regeringen.se/rattsliga-dokument/statens-offentliga-utredningar/2019/01/sou-201888/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 11, 2019 Vårdgaranti ny lag 2019 Då kör vi en uppföljning på inlägget från 16/10. Från & med årsskiftet har revideringen av lagen om vårdgaranti börjat gälla. Lagen gäller verksamheter på primärvårdsnivå & betyder i sin korthet att den som söker vård för ett nytt, oväntat eller försämrat/förändrat tidigare känt hälsoproblem har rätt till en medicinsk bedömning inom 3 dagar av legitimerad personal (läkare, sjuksköterska, sjukgymnast/fysioterapeut, arbetsterapeut eller psykolog, samt även kurator). Den tidigare lagtexten garanterade bara läkarkontakt. Detta som ett steg för att förbättra vården i de ca 42 miljoner årliga besök som sker till primärvården vård. Genom förändringen ska bedömningen & vården effektivare kunna ges efter patientens behov. Av de drygt 27 miljoner årliga primärvårdsbesök som har varit till andra professionsgrupper än läkare har arbetsterapeuter & fysioterapeuter stått för ca en tredjedel av besöken I Propositionen till lagändringen (2017/18:83) står det: ”Den enskilde ska få en medicinsk bedömning av läkare eller annan legitimerad hälso- & sjukvårdspersonal inom primärvården. Den görs av någon med tillräcklig kompetens för att bedöma patientens tillstånd & behov av hälso- & sjukvård. Det medicinska yrkesansvaret innebär att var & en som arbetar inom vården har ett ansvar för sina egna bedömningar, beslut & åtgärder inom yrkesutövningen. Avgörandet om vem som bör utföra den medicinska bedömningen bör i första hand bero på patientens aktuella behov. Detta gäller även på vilket sätt bedömningen ska göras & kommuniceras”. I sin helhet är den nationella vårdgarantin uppbyggd i 4 delar. 1. Första kontakten med vården. 2 första läkarbesöket. 3 specialistbesök. 4 behandling initierad av specialist. På Instagram hittar ni fler bilder med bland annat materialet ifrån SKL. Länk till materialet & en del artiklar hittar ni som vanligt här nedanför. Hur har ni märkt av några förändringar i era verksamheter? Kommentera gärna nedan. Ha en fortsatt bra dag! ________________________ https://bit.ly/2SOEjDt https://bit.ly/2M3013O https://bit.ly/2H6OmlU https://bit.ly/2VKPkYc #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Jan 06, 2019 Bättre arbetsmiljö för arbetsterapeuter Hej och välkomna till första inlägget 2019! Under sista delen av 2018 skrevs några debattartiklar om arbetsterapeuters arbetsmiljö. Artiklarna bygger på en studie av Lunds universitet & Sveriges Arbetsterapeuter. Medlemmar i facket har tidigare fått mail kring denna undersökning, där resultatet ligger under ”min sida” på Sveriges Arbetsterapeuter hemsida. Där kan ni även se resultaten utifrån er krets. Mycket kan ni själva läsa vidare i de länkade artiklarna. Första länken är även en länk till P4 Västerbotten som tidigare i veckan diskuterade vår arbetsmiljö tillsammans med Brita Winsa, hälso- & sjukvårdsdirektör i region Västerbotten & Kristina Hultman, Förste vice ordförande Sveriges Arbetsterapeuter. Intervjun börjar runt 33.50 in i programmet. Men här kommer även några siffror studien som gäller över hela riket (per krets hittar ni som sagt under ”min sida”): Visar tecken på lättare stressymptom: 40,1% Visar tecken på måttligt stressymptom 17,5% Upplever att man inte & knappt hinner med arbetsuppgifter 62,2% Uttalat Utmattningssyndromenligt socialstyrelsens kriterier 21% Har övervägt att söka ny tjänst det senaste året 58% Hur kan vi förbättra dessa siffror? En del förslag från debattartiklarna lyder: Arbetsgivare ska erbjuda en rimlig arbetsbelastning & möjlighet till reflektion & återhämtning på arbetstid. Tid & resurser avsätts för kompetensutveckling samt att planer tas fram för hur karriärvägar ska utvecklas. Lönespridningen ökar samt att arbetsgivare tar fram konkreta långsiktiga planer för hur kvinnodominerade akademiska grupper i hälso- & sjukvården ska få kraftigt höjda generella lönenivåer. Chefer har ett rimligt antal underställda samt mandat & förutsättningar att skapa en god organisatorisk & social arbetsmiljö. ________________________ https://t.sr.se/2SGlWk2 https://bit.ly/2CRPNAe https://bit.ly/2Tw6Qh3 https://bit.ly/2SANuHt https://bit.ly/2F9g3sv Dec 20, 2018 Fri utbildning i digital kompetens Då var jag tillbaka efter ett litet kort uppehåll. Det har hänt en hel del saker sedan förra veckans inlägg. Så jag kommer lägga upp några nya inlägg här under jul & nyår. Håll utkik vettja. Under detta år har jag haft några inlägg om hur vi arbetsterapeuter behöver hålla oss ajour kring digitalisering & digital kompetens. Senast var om digitala hjälpmedel & innan det ett inlägg kring forskning om tillgång till internet & hur det används bland ungdomar & unga vuxna med lindrig & måttlig intellektuell funktionsnedsättning. En del av oss kommer i kontakt med människor som har svårigheter att ta del av den digitala utvecklingen och vår digitala vardag. Oavsett om det handlar om att betala räkningar via nätet, använda mobilt bank id vid signering eller att anpassa sin mobil/platta efter behov. Därför kommer här ett tips om hemsidan Digitala Jag. Hemsidan är framtagen av Google akademin & arbetsförmedlingen. Syftet med ”digitalajag.se” är att alla ska känna sig trygga i den digitala vardagen. Google & AF hoppas kunna sänka trösklarna genom att erbjuda en gratis utbildningsplattform med korta innehållsdelar som berör våra vanligaste digitala tjänster inom ämnena Säkerhet & Integritet, Kommunicera online & Söka jobb. Varje ämne har olika teman, som ni kan se i bilderna ovan (exemplet är från temat Digitala hjälpmedel), & varje tema har olika innehållsdelar. Efter varje avslutad utbildning får man ett intyg. Jag kommer själv att sprida denna hemsida i våra organisationer som ett frivilligt sätt att möjliggöra ökad kompetensen bland våra medarbetare kring digitaliseringen. Har ni tips på liknande sidor? Eller har du exempel på vart vi som arbetsterapeuter skulle kunna använda denna sida? Kommentera gärna nedan. Ha en fin dag! ________________________ www.digitalajag.se #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Dec 6, 2018 Tips på konton att följa Hej alla! Ni har blivit en rätt så stor skara som följer detta konto, varav jag märker att intresse verkligen finns hos er. Fler och fler delar inlägg, kommenterar och gillar det som läggs upp. Då intresset för kunskap om arbetsterapi verkligen växer så vill jag således tipsa om andra konton som också berör arbetsterapi på ett eller annat vis. Har försökt tipsa om konton som berör lite olika områden. Både på svenska och engelska. Har ni fler tips på bra konton är det bara att ni hör av er så försöker jag framöver att länka även dessa. Glöm inte heller att bli medlem på här på @theothub som är ett internationellt community för oss arbetsterapeuter. Där hittar ni allt från nyheter, bloggar, poddar, forskning samt forum som bara berör arbetsterapi. Självklart är medlemskapet gratis! Ni har ju hittat hit om du läser detta. Så bli medlem som sagt :) Kontona är taggade i bilderna ovan så ni enkelt kan ta er vidare. För er som läser detta på nätet så finner ni länkarna nedan till dessa konton. Ha en fortsatt bra vecka! ________________________ https://www.instagram.com/amoccupationaltherapy/ https://www.instagram.com/theothub/ https://www.instagram.com/vardagslivpodden/ https://www.instagram.com/arbetsterapeuterna/ https://www.instagram.com/readysetot/ https://www.instagram.com/allietheot/ https://www.instagram.com/arbetsterapeuter/ https://www.instagram.com/anpassaskolan/ #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Dec 2, 2018 Digitala hjälpmedel - för unga och äldre Till er som firar advent så vill jag önska er en trevlig sådan. Men annars hoppar vi direkt på tåget kring digitala hjälpmedel. Idag tänkte jag tipsa om två olika nyheter. En kring hur digitala hjälpmedel kan stärka läsutvecklingen, samt en nyhet kring digitala terapidjur. Först ut kan vi läsa om Thomas Nordströms avhandling som belyser möjligheten att stärka alla elevers läsutveckling. Detta genom ”systematiska bedömningar eller kartläggningar av läsfärdigheter och på betydelsen av att använda ny digital teknik för att främja alla elevers rätt till lärande utifrån ett inkluderande förhållningssätt”. Genom resultaten kan man bättre individanpassa undervisningen. Nyhet nummer 2 handlar om interaktiva terapidjur som företaget Caminio Care har tagit in i sitt sortiment. Enligt tillverkarna kan digitala terapidjur användas för att ”bidra till att motverka oönskade symptom av demenssjukdom så som oro, apati, sömnsvårigheter och ångest. Samtidigt kan djuren öka ett personligt engagemang och ge positiv stimulans”. Samtidigt som det inte krävs lika mycket skötsel och kostnad som med ”riktiga” husdjur. Likande produkter har funnits på den svenska marknaden i flera år redan i form av Musikdockan som kan användas på demensboenden. Vad säger ni. Skulle ni vilja ha ”riktiga” eller digitala terapidjur i era verksamheter? Ha en fortsatt bra helg! ________________________ https://www.forskning.se/2018/11/29/digitala-hjalpmedel-starker-lasutvecklingen/ https://www.medtechmagazine.se/article/view/634369/digitala_terapidjur_till_demensvarden #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Nov 27, 2018 Arbetsterapi i media Här kommer ett lite kortare inlägg en tisdag som denna. Vill lite snabbt tipsa om fyra nyheter som dykt upp den senaste tiden. En insändare, en prisutdelning och två avhandlingar. Alla nyheter handlar om oss arbetsterapeuter. Det är bara att ni klickar er vidare på länkarna nedan för att komma till nyheterna. Ha en fortsatt bra vecka! ________________________ Nyhet 1: http://www.ostrasmaland.se/article/arbetsterapeuter-far-vardagen-att-funka/?fbclid=IwAR0E0wCC4CDvkkDa-4Cp2JljsFckO3LRD1_CYEfA8dhfE5hN8Wml75KWOds Nyhet 2: https://www.skolporten.se/forskning/intervju/manga-faktorer-styr-elevers-kansla-av-delaktighet/ Nyhet 3: http://news.cision.com/se/sodra-alvsborgs-sjukhus/r/angela-bangsbo-disputerar-med-forskning-om-integrerad-vard-for-skora-aldre,c2681632 Nyhet 4: https://www.med.lu.se/intramed/styrning_organisation/nyhetsbrev_fraan_fakulteten_institutionerna/nyhetsbrev_ihv/haelsovetenskaper_interna_nyheter_info/nydanande_och_innovativ_forskning_faar_pris #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Nov 25, 2018 Article: Access to and use of the Internet among adolescents and young adults with intellectual disabilities Vi avslutar denna vecka med lite mer forskning från LiU. Denna gång skriven av en arbetsterapeut som en första artikel ur ett doktorandsprojekt. Artikeln i fråga är “Access to and use of the Internet among adolescents and young adults with intellectual disabilities in everyday settings”. Studien bygger på en kvalitativ metod där 15 ungdomar & unga vuxna med intellektuell funktionsnedsättning observerades i vardagliga miljöer för att sedan delta i uppföljande intervjuer med foton. Syftet med studien var att utforska & beskriva tillgång till internet & hur det används bland ungdomar & unga vuxna med lindrig & måttlig intellektuell funktionsnedsättning. För att ge studien lite perspektiv så har 98% av svenska hushåll tillgång till internet varav 9 av 10 minst en smarttelefon hemma. Trots detta har vi ca 500.000 svenskar som inte använder internet dagligen (Källa: Svenskarna & Internet). Vi har ett digitalt utanförskap i Sverige där vi arbetsterapeuter framöver kommer allt mer behöver titta även på delaktigheten i digitala miljöer. Tillbaka till studien. Resultatet visar att tillgång till enheter för att koppla upp sig mot internet fanns, t.o.m. till flera enheter än deltagarna använde sig av. Studien visar att det fanns utmaningar i att använda internet, men deltagarna använde sig av ett flertal strategier såsom att reducera antalet enheter & använda sig av färre, personliga enheter för att delta i internet-aktiviteter. Väldigt få deltagare hade anpassade enheter eller särskilt anpassade program installerade på sina enheter, varav närstående ibland fick hjälpa till för att skapa möjligheter till användande. Övriga strategier som användes för att hantera en digital miljö & ta del i internet-aktiviteter var huvudsakligen att ta stöd av andra, använda bilder & textbaserat stöd t.ex. förskrivna lappar, men också ljud & röst-styrda system. Vill ni läsa mer? Följ då länken nedan så kommer ni åt den I fulltext. Ha en bra söndag! ________________________ https://www.tandfonline.com/doi/full/10.3109/13668250.2018.1518898 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Nov 12, 2018 Autism & ADHD vid Downs syndrom Välkommen till en ny vecka! Idag vill jag tipsa om broschyren ”Autism och ADHD vid Downs syndrom” som är framtagen av Svenska downsföreningen tillsammans med Arvsfonden. Broschyren bygger på en forskningsstudie vid Akademiska barnsjukhuset och Habiliteringen i Uppsala. Tyvärr har neuropsykiatrisk funktionsnedsättningar tidigare inte alltid uppmärksammats hos barn med Downs syndrom. Ofta har symtomen tolkats som en följd av barnets intellektuella funktionsnedsättning, varav symtomen (den neuropsykiatrisk funktionsnedsättningen) inte behandlats. I broschyren kan vi bland annat läsa att det rekommenderas att insatser och stöd sätts in redan vid misstanke av autism eller ADHD. Detta för att lägga en bra grund för ett fortsatt lärande och för att kunna minska problemskapande och självdestruktiva beteenden. Som stöd för detta kommer habiliteringen att kunna ge råd, stöd och behandling till patienten och dess närstående (in träder arbetsterapeuten). Vi kan bidra med allt från AKK, anpassning av förskola, skola eller fritids, öka delaktigheten och därmed bryta eventuell isolering. Broschyren är informativ och finns även som lättläst. Så passa på att läs mer i broschyren. Tyvärr är denna problematik återkommande. Personer med intellektuella funktionsnedsättningar har en sämre hälsa och har en lägre förväntad medellivslängd. Det är upp till oss att fortsätta sprida kunskap och bidra till en bättre hälsa för alla i vårt samhälle. Ha en fortsatt bra vecka! ________________________ http://www.mynewsdesk.com/se/svenska_downforeningen/news/ny-broschyr-om-autism-och-adhd-vid-downs-syndrom-330842 #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltheraphist #funkis #downssyndrom #adhd #autism

By Dr. Sakshi Tickoo (BOTh) and Dr. Kathryn Ellis (OTD)

Falls and Frailty response service - An Advanced Specialist Occupational Therapist from Royal Berkshire Hospital (UK), working with a Specialist Practitioner from South Central Ambulance Service, combining their skills. The criteria We see patients who have fallen in their own homes , who are over 65 and are frail. The service aims to avoid admissions for patients who would usually be admitted to the Royal Berkshire Hospital. The service is currently available 7am - 7pm, on Saturday, Sunday and Monday. We would be dispatched from either 111 calls or 999 calls, to patients fitting the above criteria. The assessment The specialist practitioner will review the patient from a medical perspective and perhaps liaise with the patient's GP, if required. On the van, we have specialist equipment to assist with moving and handling and to lift the patient from the floor. The occupational therapist will then gather information and complete an initial assessment . They will complete further functional assessments within the patient’s home. In addition to this, the occupational therapist can prescribe equipment, either from the van or order it to the patient’s property. The team will also carry out a falls risk assessment , to reduce risk of further falls. This assessment involves: taking lying and standing blood pressure reviewing existing medical conditions and medications (sometimes discussing with GP) reviewing trip hazards in the environment a mobility review looking at footwear The team has access to a variety of different services within Berkshire, specifically looking at admission avoidance . This consists of community hospital admission avoidance beds, rapid response services and other support services. If the patient does need to be admitted, completed assessments will be handed over to the Frailty Practitioner or Occupational Therapist in Royal Berkshire Hospital Emergency Department, to reduce the patient’s length of stay. Case Study (No actual names or personal details used). 'Christine' pressed her pendent alarm , which alerted the emergency services that she had fallen within the last hour. She had attempted to stand up several times, but was unsuccessful. She therefore pressed this alarm, which was used to contact the emergency services. Christine was identified as a patient who would benefit from Falls and Frailty response team input. Her daughter arrived at the scene - as the pendent alarm service contacted her as next of kin. However, she was unsuccessful in assisting Christine off the floor. Christine had fallen on her way to the bathroom, from the lounge. The Specialist Practitioner did a medical review , to establish if Christine had an injury or was unwell. Christine stated she was not in pain and reported that she had slipped in her bathroom, as she was rushing to the toilet. A lifting cushion (Mangar Elk) was used to lift the patient off the floor. Christine and her daughter were able to give further information on how she usually functions . Christine usually mobilises with her stick and has no further support at home, other than friends and family that come to see her. Further functional assessments of Christine’s mobility and transfers were completed, alongside further assessment from the specialist practitioner. Christine was then given falls advice (such a removing the rug that she slipped on) and given written falls guidance. During the assessment, Christine and her daughter reported that she had been struggling with her washing and dressing recently, as she was being treated for a chest infection. A referral was completed to the rapid response team , who were able to come out and assess that day. Christine’s daughter stated that she will also try and visit daily, to support with Christine’s evening meal. Christine was able to remain at home , without having to be admitted to hospital. The Specialist Practitioner’s paperwork was then sent to Christine’s GP, to alert them of today’s events and interventions.

By Bai-Ou He, Occupational Therapist P ractising in London, UK (Band 6) Occupational therapists (OTs) have a key role on neurosurgery wards. Neurosurgery covers operations on the central nervous system (brain and spinal cord) and the peripheral nervous system, which can involve any area of the body. More specifically, OTs support with neurological assessments, rehabilitation and hospital discharges . The wards are fast-paced and there is a lot of multidisciplinary team (MDT) working involved. Working on a neurosurgery ward has particularly increased my knowledge of anatomy, medications and cognitive assessment skills... My typical morning includes around 10 ‘snoozes’ and some frantically put together porridge! I leave early to attend the 8am morning meeting with the MDT. The meeting includes: doctors, nurses, bed managers and therapists. We go through each patient on the ward and update on their medical status. New patients awaiting surgery will also be discussed and brain scans shown. The main role for therapists at this meeting is to identify if patients are safe for therapy intervention or if they are on certain restrictions . For example, some patients will be placed on bed rest to reduce chances of vasospasms and further bleeding in the brain, or they may have specific spinal precautions post-spinal surgery. In addition, I update the team on which patients are safe for discharge home from a functional perspective and those who are likely to need further rehabilitation. At 9am, the ward therapy team meet for a handover and allocation of patients. We sit and prioritise patients and arrange joint sessions with the physiotherapists (US: physical therapists). Those who are likely to be discharged sooner are prioritised, as the ward needs beds for the many patients waiting for their surgery. First, I see a young man in his thirties. He has had neurosurgery to debulk a brain tumour . It is day 1 post-operation, so I am keen to review his function. I complete a full neuro assessment . I start with seeing how he is feeling and some orientation questions, in order to get a sense of his mood and cognition. I then assess his range, strength and balance . I want to ensure that, since surgery, he doesn’t have any new onset of limb weakness and that he is still able to coordinate movement smoothly. I also review his sensation , identifying any new changes to touch, any onset of pain and if his vision is the same. I observe his function whilst he gets out of bed and walks to bathroom to use the toilet. He presents with no physical or cognitive deficits since surgery. However, through our discussion, he appears more anxious about the next stages of treatment and his employment. He and his family are aware of his tumour and are keen to find more support services. I provide him with an information pack, which signposts the local and national charity support they are entitled to. I also inform the medical team regarding his concerns about treatment. Next, I meet with the physiotherapist and we review a woman in her sixties, who has had a large subarachnoid haemorrhage . Since her brain bleed she has presented with low awareness and arousal . From yesterday’s assessment, the rehabilitation assistant has brought us the appropriate tilt-in-space chair. We hoist her into the chair to review her seating; it is hoped that the seated position will also increase her alertness and reduce her muscles from deconditioning from lying in bed. I then complete a standardised low-level cognitive assessment , which can help track any functional changes. This will be done over a period of days, as per guidelines. We ensure her mobility chart is updated to ‘full hoist’ and nurses are aware of her positioning needs. Subsequently, we ask the rehabilitation assistant to complete some passive range on her limbs to reduce contractures. It is agreed that we should arrange a family session for the coming week to optimise therapy . Patients tend to respond better with familiar voices, objects and smells. It would also be good to arrange a joint session with her speech and language therapist (US: speech - language pathologist), to identify if there are any ways we can support her communication. I telephone her family to arrange the joint session and provide an update of her current function. The family have lots of questions, so we decide a meeting with the wider team would also be useful. We want to ensure the family’s well-being is addressed ; it will be a challenging time and we want them to be included in decision making. At 12:15pm there is a ward 'huddle.' Since things can change quickly, we update the nurse in charge on who we have assessed safe for discharge and any concerns we have. I then document the patients I’ve seen from the morning and make any appropriate referrals. Lunch is at 1pm and we all head to the therapy staff room for some time away from the ward. After lunch I check in with my Band 5 OT (UK - qualifying grade), to see how they are managing with their caseload. I ask if there is anyone she would like me to see with her. The therapy team encourage us to support one another and are big advocates of joint sessions . I find it's a great way to bounce ideas off each other and share knowledge. I also have a quick check of emails and any continued professional development (CPD) tasks that need to be done. I will then see a few more patients in the afternoon, including a fifty-year-old man, who had a fall leading to a subdural haematoma. The neurosurgeons completed a craniotomy to remove the blood. He has been presenting on the ward with confusion and reduced short term memory . I take him to the kitchen and ask him complete a hot drink task to assess his cognition. He struggles to recall where the coffee is and what the order was. He then leaves the tap running. Once the coffee is made, he is unable to orientate back to his bedside independently. More worryingly, he is unaware of any deficits . I noted that he lives alone and has limited social support. With all factors considered, it is assessed that he would benefit from in-patient rehabilitation, with focus on complex cognitive rehabilitation . He is recommended for further OT interventions, to help him identify strategies to build and manage his short term memory deficits and to gain more insight into his current function. I spend some time calling his local rehabilitation units to check he is a suitable candidate. Once this is confirmed, I complete the appropriate referral form. It is useful to note that this OT role includes a lot of interaction with external services, such as community neuro therapy teams and social services, in order to identify the best pathway for a person. Before I finish the session, I update the ward on his risk factors , due to his reduced cognition. I inform the nurses that he benefits from supervision and verbal prompts for his daily activity tasks, such as showering and going to the toilet. Today I finish at 4pm. So in the last hour I spend time making plans for the next day, replying to emails (that I probably should have done earlier) and ensuring all my documentation has been completed. It has been a busy day, but it is always interesting and manageable, thanks to my hardworking and superb NHS colleagues!

This paper was presented at the 2nd National Conference for Occupational Therapists working in Diverse Settings, at the University of Brighton, UK (6th September 2017).

Research by Charity Bass, Lydia Hensel, Mark McMullan and Chia-Wei Fan AdventHealth University Master’s Program of Occupational Therapy