"We don't have to do it alone. We were never meant to." - Bren é Brown As Occupational Therapists, we look within and around, constantly deliberating on what and how to add purpose and meaning to anything we do - and advocate for anything that speaks to us; this is what an ideal situation of symbolic interaction looks like for our profession. Symbolic interaction is a very grounded, practical and everyday approach to social life and social understanding. According to this concept, any entity that has been created or obtained as a symbol - for example, human rights, cultures, humanities, etc. - can never follow one particular meaning for eternity. The ambiguity in which they exist and have been created needs to be contested and renewed, according to the time and population they interact with.

Co-author: MaryBeth Gallagher PhD, OTR/L BCMH 'This paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting.' Introduction Occupational disruption has been defined as a transient or temporary condition of restriction from participation in necessary or meaningful occupations. This interruption often, but not always, resolves itself as the human adapts (Whiteford, 2010). The arrival of the COVID-19 virus and the subsequent pandemic has had a tremendous impact on our daily habits and routines. It has meant that people have become socially distanced, unemployed and ‘repurposed.’ This is certainly true in the healthcare organization in which we are employed, where employee wellness has the potential to be eroded by these additional stressors. If as occupational therapists, the situation described here is something you recognize within yourself and your work environment, this paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting. This article presents the response of a small team of occupational therapists to the challenges posed to employee wellness in the face of unmitigated occupational disruption from the COVID-19 virus. The article also describes the processes and practices that were developed to support our colleagues. It concludes with recommendations to replicate and or adapt our approach to nurturing employee wellness.

This is a shortened version of the first Hanneke van Bruggen lecture, presented by the author at the 17th Annual Meeting of ENOTHE in Ghent, Belgium (2011). Introduction As an enthusiastic traveller, I observe that occupational therapy is recognisably the same profession in every country I have visited, but it also differs in the ways that it is taught and practised, reflecting diverse cultural norms and expectations. Through discussions with colleagues around the world, I have learned to appreciate just how flexible and adaptable occupational therapy can be, when we have the skills and confidence to set goals and deliver our services in ways that are culturally and socially relevant to diverse settings. What is diversity? Diversity means difference, variety and being unlike each other (Shorter Oxford English Dictionary 2002). For example, the term biological diversity , or biodiversity , means 'the variability among living organisms from all sources… and the ecological complexes of which they are part; this includes diversity within species, between species and of ecosystems’ (UN 1992). We know that biodiversity is essential to life on earth because: It is the combination of life forms and their interactions with each other and with the rest of the environment that has made Earth a uniquely habitable place for humans. Biodiversity provides a large number of goods and services that sustain our lives. (Secretariat of the Convention on Biodiversity 2000)

Occupational therapy is a very established profession in many areas of rehabilitation: Paediatric, neurological, orthopaedic, professional, to name some examples. I think that most Occupational Therapists (OTs), throughout their professional trajectory, experience many areas, until the moment when they can choose one to call their ' specialty '. It happened to me and many colleagues. I started my career attending to people with burns-related injuries, because of a great internship at my college. But, to tell the truth, there are not many places to work as a specialist in burns rehabilitation in the city I live. So I decided to go to a larger field of action and work with traumatic upper limb injuries. That's why I became a hand therapist. Nowadays, I work as an independent consultant in ergonomics and quality of life in workplaces . Of course, in this latter specialism, thinking about my quality of life was the predominant factor.

October 12th is World Arthritis Day Many may not know this, but occupational therapists play a key role in prevention, education, and intervention for this condition that affects children and adults around the world. I am an advocate for those who have any form of arthritis, as it is a condition that has affected me for the entirety of my young adulthood and will continue to affect me for the rest of my life. The purpose of today's post is to raise awareness and to encourage others to share their stories about how arthritis has affected their lives-whether it is related to yourself, a family member, or a close friend. Arthritis Facts There are so many types of arthritis & they can affect more than just your joints. Arthritis is an informal way of referring to more than 100 types of joint diseases that can affect any individual at any age, yes, even small children can have it! Some types consist of Ankylosing Spondylitis, Inflammatory Arthritis, Juvenile Arthritis, Rheumatoid Arthritis, Lupus, Osteoarthritis, Psoriatic Arthritis, and the list goes on. Arthritis is the leading cause of disability in the United States It can be difficult to understand arthritis pain and fatigue (two of the most common and troublesome symptoms of arthritis). Stigma In my experience and observations, I have noticed that arthritis symptoms can often be minimized by friends, family, and among other individuals. I have found that by sharing my story, I have been able to educate others about the real-life implications that arthritis has had on my life and the lives of millions of people around the world. Many organizations around the world, such as The Arthritis Foundation seek to end stigma surrounding arthritis by providing education and support for those diagnosed and their families. The more we talk about it and share stories, the more people will understand that it is not a condition to be taken lightly. The Reality Arthritis is no joke. I have known children who have had to take off a year or more from school to get intense treatments for conditions such as juvenile rheumatoid arthritis (JRA). I have known adult friends who have had to discontinue working or have a change in career due to the chronic pain that often comes along with a diagnosis of arthritis. In my experience, I have had people who told me that I could never become an occupational therapist. I have had to plan extra time in my day to use methods to loosen up my joints in the morning and to take naps to rest after a long day due to chronic fatigue. The reality is that arthritis is a serious condition and we need to empower ourselves, our families, and our clients to feel that they are cared about and supported. If you know someone with any form of arthritis, be there for them. Make sure that they feel validated and let them know that there are resources and support. If you have arthritis, just know that you are not alone. Many days can be a struggle, but we have to continue to educate others and advocate for health services such as occupational therapy that can increase the quality of life for those experiencing arthritis. Happy World Arthritis Day! For more information and support please visit https://www.arthritis.org. I encourage you to post a comment below, if you have a story to share about arthritis. Thank you! Sue Ram

I know what you're thinking. It's too expensive to travel for a conference, find affordable accommodation and pay for the conference registration itself, especially as a student or new grad. Although attending occupational therapy conferences can leave a hole in your wallet, you most definitely won't come back empty-handed. What I mean is that there are many benefits to attending OT conferences and here are five reasons why you should consider attending an OT conference near you (or far if you're feeling adventurous!) 1) Networking Yes, networking can seem like a daunting task, but conferences are a great way to meet both like-minded individuals and also those who can offer a perspective you hadn't thought of before. Are you interested in a pediatric specialty area? Mental health? Technology? Well, there will be many others there who share the same interests as you. It is a good idea to connect with others at a conference who are interested in the same specialty areas as yourself so that you can learn what other professionals are using in practice or are researching. Perhaps you are seeking a mentor or a supervisor, networking at a conference is a great way to do this. Networking at conferences is a great way to also meet people who you can call friends. You can make connections with people all around the globe and have a new reason to attend the next conference so that you can meet up with all of your new professional friends! 2) Endless learning opportunities Conferences are a great way to increase your knowledge on all of the up-and-coming research in our profession. From poster presentations to short courses and keynote speeches, there is something for everyone. Have you been wanting to learn about the role of occupational therapy in oncology or learning disabilities? Go to a poster presentation about a topic you didn't have the opportunity to learn about yet. Sit down at a short course and ask other attendees what they think about the topic. Conferences allow attendees to learn so much in just a few days and there is nothing more valuable than knowledge! 3) Get mOTivated and inspired Sometimes our daily routines can become a little too "routine". Attending a conference can allow you to remember why you became a part of the profession in the first place. From being around so many positive people ready to move the profession forward, you too will feel motivated and refreshed. Many conferences include a keynote speaker, sometimes this individual is someone who belongs to the profession or someone who has had personal experiences as a client who was positively impacted by occupational therapy. Hearing stories from others are a great way to get inspired and gives us an opportunity to see how much we are helping people across the lifespan with being able to function in their daily lives. It is always a good idea to step back and think about why we chose occupational therapy so that we can go back to the classroom or the clinic refreshed and ready to help those who need it most. 4) A mini vacation Conferences are a great way to get away for a little. Whether you attend a conference in your town or you fly out of the country, it provides for an awesome getaway. Conferences allow an opportunity to explore a new city with fresh faces and a chance to sleep in a cozy hotel or get to spend time at a friends home who lives in the area you are visiting. It is always refreshing to get away for a bit and attending a conference allows for that. We all need a break (hello occupational balance!) and this is a great way to learn and relax all in one trip. 5) Share ideas and research Have you been working on a research project that you want others to know about? Have you been thinking of an idea you have been wanting to try in practice, but want to know if there are others out there already trying what you want to do? A conference is a great way to showcase the hard work you have been doing throughout the year. Students and practitioners are all trying to contribute to the body of knowledge related to our profession, you can as well! You can visit a poster session related to a topic you have been thinking about researching. Ask the presenter if they have any advice for you or if they are willing to work with you on something in the future. The opportunities are endless when it comes to sharing ideas. Another perk is that for some conferences, registration fees can be lower if you are presenting! I do hope these reasons may have convinced you to consider attending a conference soon. The benefits are endless and there is nothing more refreshing and motivating than increasing your knowledge on something you are passionate about. I do recommend to at least try it out once when the opportunity arises, as conferences can be a great deal of fun. Hope to see some of you soon!

This year marks 15 years since I completed my first coach training and started to coach occupational therapists (OTs). It has been a fascinating journey. It is worth reflecting on what coaching is, what it offers OT, how OTs are using coaching in different settings, how coaching helps OTs themselves and how coaching could support OT in the future. Back in 2005, whilst I was still breastfeeding, I fell in love with coaching. It felt so natural to work this way; much less stressful than my OT work had been and more empowering for both parties. I immediately wanted to coach OTs who seemed stressed, burnt out, bullied, or wanted a change of direction. However, most of the OTs who got in touch wanted to learn to coach, rather than be coached themselves! Part of me was frustrated, but my coaching skills for OTs workshop went down so well that I let go of it and just went with the flow. Fifteen years later, that one-day workshop has been taken by hundreds of UK OTs and hundreds more worldwide, online. I don’t mind admitting that I fell out of love with OT for a couple of years . I was entranced by the coaching world, its positivity and can-do attitude and was a bit fed up with 'problem lists' and deficit thinking, which seemed to abound in OT practice (well, in the settings I had worked in). I also felt less responsible for the outcomes as a coach, rather than as an OT – it wasn’t all up to me whether something was effective, or there was a good outcome. As time went on, I started to see how coaching could really enhance OT practice, not merely be an additional tool in our already adequate toolbox. I started to see how putting coaching philosophy at the heart of my OT practice changed me as an OT. In this way, coaching was much more than just asking questions and setting goals. To date, I have used coaching in various ways: as an occupational coach in a return-to-work service; as a private coach, mostly with OTs but also corporate clients; I have set up the coaching element for a cancer vocational rehab programme; I have specialised in coaching creativity and published the first book of its kind; set up a coaching party programme with full training; taught coaching to undergraduate OTs; and many other things too! I am in the privileged position of seeing how other OTs use coaching too. Along with the leading work by Fi Graham and others in New Zealand, many OTs who work with children and families now use occupational performance coaching (OPC) in their work. Many OTs are setting up their own wellbeing businesses, combining OT and coaching; the Lifestyle Redesign Programme at USC is at the forefront of using coaching and OT; coaching is now often used within vocational rehabilitation, helping people to overcome internal and external barriers to work. In mental health OTs and many other professionals see the value of coaching in recovery but also in prevention; a coaching approach is used in many other ways, including fatigue management and conditional management programmes. I could go on, but I think you are starting to get the picture. Coaching within OT has really come a long way. To me, there are many reasons why coaching has become so popular and why so many OTs are looking to how coaching can strengthen their practice: The notion of client choice/person-centred practice is very difficult in services which are so tightly controlled. To me, coaching is a way of ensuring at least some of what we do has the person and their world at the core. Coaching helps shift the power away from the OT , into the hands of the client/patient. Not only does this grow responsibility and self-efficacy, but it should also help the OT too. In services where OT contact is limited, coaching can sow seeds , which grow long after the OT intervention has ended. Coaching helps people see how interconnected their world is, shifting away from 'I' to 'We'. An OT who coaches effectively helps people make conscious occupational choices and supports positive change. So why is all this important right now? There has been a drive, in recent years, to empower people and make them less dependent on healthcare services . Certainly, this has been seen in the UK and the Covid situation has expedited this change; access to GP services has changed and reliance on online support has increased. Covid, lockdown and the subsequent societal changes, have also shed light on how OT is such an important profession for the future. People are having their occupational lives turned upside down: staying at home more, working from home, less social contact or physical contact, with many hobbies and recreational activities stopped. Now is the time for OT to be seen in broader society and to shine. Coaching can support OTs to work in this way. Climate change, preventing further climate damage - and managing the impact that is now inevitable - all depend on changing our occupational lives. How we live, work, feed ourselves, socialise, travel, etc; all our occupations must change. Our daily 'doing' has caused climate change, so we need to change our daily doing – our occupations. Coaching helps raise awareness of the broader impact of our actions and behaviours and highlights our personal responsibilities. I am also hoping that those OTs who are interested in working in this arena will support themselves, through coaching. I know this may sound like coaching as a panacea for all the worlds ills, but if you understand what coaching can do, you will start to see its power and potential. We all need to be listened to, to have our deepest concerns and desires heard. We all need to understand our impact on our immediate and broader environment. We all need to have hope. That is why I love coaching! 😊 Jen Gash Occupational Therapist Start coaching now Click on this link and use the code 20csot for a 20% discount (to users of the Hub!) at the checkout.

Occupational therapy in Tanzania, East Africa, was first established in the year 2000, at the Kilimanjaro Christian Medical College . It is the only school in Tanzania offering occupational therapy (OT) studies. The course is offered at a diploma level. In total there are a little over 300 occupational therapists under the Tanzania Occupational Therapy Association ( TOTA ) umbrella. Only recently has the government of Tanzania acknowledged the importance of occupational therapy, which is why it has started employing occupational therapists to public hospitals. Very few occupational therapists own rehabilitation centres. Unfortunately, there are no occupational therapists working in private hospitals in Tanzania. Occupational therapy is still not well known. People find it hard to differentiate it from physiotherapy. I think it is mostly because we (OT professionals) have not taken the responsibility of making the profession as known as it should be . Another reason is the expense of using occupational therapy services, since it is not included in the health insurance fund. In view of these challenges, occupational therapists have decided to take a step in tackling these challenges. One way they do this is by using brochures that have information about occupational therapy. They spread these brochures in hospitals, schools and through WhatsApp groups . Also, they use local radio stations to talk about certain health conditions and the importance of occupational therapy for individuals. The association of occupational therapists in Tanzania (TOTA), has also been working on establishing a degree programme in the country, so as to upgrade the level of education of occupational therapists to meet the required standards. One particular center in Dar es Salaam uses a different approach. It is a group of occupational therapists from Maisha Bora Clinic/Good Life Clinic. They work with children with autism and cerebral palsy. They provide a hands-on approach at the centre and at clients' homes. Those in need of services who cannot reach the centre are approached at home. An assessment follows. This involves physical, cognitive and environment assessments . Parents/guardians who can afford to pay do so, but those who cannot pay incur costs when buying locally made adaptive tools, such as a special sitting chair, splints or a standing frame. We realise that we have a long way to go to achieve our goal of being recognised and fully utilised to our maximum potential, but we are still glad of the efforts we put in everyday. Vanessa Dallaris Occupational Therapist, Tanzania Africa Lead, The Occupational Therapy Hub

If you follow me on Twitter, you will know that I started my role-emerging virtual placement this week, which I need to do a lot of explaining about… For my role-emerging placement we decided to combine occupational therapy (OT) with my blog - Not So Terrible Palsy - and my role in the online community. So, this means that I’m on placement as I write this blog. How great is that? As I’m writing, it's day 3. I’ve barely got my foot through the doorway, but I’m already having the best time! So, what is a virtual occupational therapy placement? The truth is, I don’t really know what it is myself, as it's far too early to say; I’m writing this blog as much for my sake as I am yours. But I can give you a bit of background about the nature of this part-time placement and tell you a bit about what I have planned for the next 12 weeks. Background information To start this story off, let me introduce you to my supervisor, the lovely and creative Margaret Spencer . I was lucky to have a halfway visit from Margaret during my paediatric placement last year. I was more than lucky as, during this visit, Margaret asked me what area of OT I wanted to go into. This is when I mentioned combining occupational therapy and blogging , which is where the idea of the placement came from. The online disabled community is growing. So, why isn’t occupational therapy growing with it? This is why I started producing OT content on my blog and why I published Why I Study Occupational Therapy . This blog was to lay the foundations for this placement and, ever since then, Margaret and I have been chipping away at it so much so that I did 15 hours’ worth of placement before it even started. What my placement is going to look like It took Margaret and I a while to decide how we wanted this placement to look. Even though being online is a big part of it, it’s not the only purpose. During my last placement, I was very open about how emotionally challenging I found it (see my blog Transitioning from a Service User to a Healthcare Professional ). Therefore, another major element to my placement is this transition. I will be discussing this in my #OTalk on Twitter on 21st April, in the hope that I will find some top tips to enhance my confidence, ready for my next traditional placement. As well as my #OTalk, I have a whole bunch of things lined up, including talks at Sheffield Hallam University and Derby University, plus a podcast. I will be working closely with CP Teens UK , as Cerebral Palsy (CP) Awareness Month falls in the middle of placement - talk about perfect timing! I will also be attending the Naidex show in Birmingham and will be blogging about my thoughts before and after the show… Oh yeah, I haven’t mentioned why I took a break yet... During my placement, there will be a blog every week on my site! I mean, it is a virtual placement after all. We even have our own hashtag: #VirtualOTPlacement . I will also be running an online intervention; although the intervention is not top of my agenda yet, I’m already having a few ideas. A big aim for my placement is changing people’s attitudes about disability , so I want my target audience for intervention to be parents or carers who have just been given a new diagnosis for their child. To find out: How this diagnosis was delivered How this affects attitudes towards disability For example, a big question I want to ask is: Was the explanation of the diagnosis delivered to them in a suitable way - and was the right terminology used? That’s why I dropped another post in, Establishing Effective Terminology to Minimise Barriers . I was hesitant to include my intervention in my blog, in case this idea falls through. But then I thought, 'how will I ever get anyone to be involved in my intervention if I don’t get the word out there?' So that’s what I’m doing. I apologise in advance, as this blog is going to be shared a lot during these first few weeks! Why does a virtual occupational therapy placement work for me? A virtual placement works for me because it’s a lot more flexible . I can work whenever I want... I mean, it’s nearly 10pm as I’m writing this. This is not like me, but I am well and truly in the zone! Due to it being flexible, I can tailor it towards my needs and work at my own pace. If I’ve had a bad night and didn’t sleep then I can have a few extra hours in bed and start working later on, which works well with my fatigue levels . Another advantage is that I can sit in the chair that’s made for me every day, which works better with my posture . Anyone can do this placement - and this is why this placement means so much to me. I want to scope this out and lay the foundations - so that future students can also do a virtual occupational therapy role-emerging placement, as everyone has different ideas. So, I hope you follow me on this placement and see what I get up to, by using the hashtag #VirtualOTPlacement and checking out my blogs - because none of this will work without your support! I hope my placement now makes more sense to those who were already aware of it. Thank you for reading, Georgia Blogs: Not So Terrible Palsy Georgia on Twitter: @GeorgiaVineOT

By Sadie Charlton. Written as a 2nd year OT student (2015) So it’s the start of a new academic year for us all here at SHOUT (Sheffield Hallam Occupational Therapy Undergraduate Team). What better way to start than to be attending a two-day workshop hosted by Sue Parkinson based on her recent book release - Recovery through Activity. After a busy (and long!) summer entertaining my toddler (and not doing much reading... oops) this was exactly the opportunity I needed to jump back in to year 2 of the course. I was thrilled to be given this opportunity but also felt a bit nervous due to my lack of experience in Mental Health and also my knowledge on MOHO. So I thought the best thing to do to prepare would be to buy the book and see what it's all about. Sue Parkinson, lead author of the Model of Human Occupation Screening Tool (MOHOST) , is recognised as an influential and passionate occupational therapist who has made a huge impact within the evidence-based realm of mental health. The book which the workshop was based on, titled 'Recovery Through Activity' (2014) is a flexible, easy to digest, tool aimed towards facilitating groups and exploring the value of activities.  The first thing that jumped out at me about the book was the clear layout and straightforward text. As a second year student who, at times, has struggled with the extensive amount of reading and the effort that comes with reading and re-reading whole pages just to make sense…this text was a breath of fresh air. The book is sectioned into 12 areas of activity (eg; leisure, self-care), each with background information including evidence base. There is then suggestions to facilitate discussions about these activity areas, group exercises, ice breakers, hand-outs to photocopy and ideas to follow-up the session. The book is heavily underpinned by MOHO theory, which is great in allowing you to link in with MOHO assessments and recognising that familiar language (which as a student really helps me apply the language into something tangible). I wont say any more about the book itself as I have absolutely no experience in book reviewing (as you can probably tell) so I'm afraid that I wouldn’t do it justice. Just trust me when I say it is definitely worth owning a copy. Back to the workshop! It was based in Sleaford, so very early start commuting from Sheffield but worth it. In total there were 4 students and the rest that were OT's from a variety of mental health areas. It was interesting to spend time with these professionals and exciting to hear them speak so passionately about their careers (& picking their brains during the tea breaks!). The theme of the workshop started with a discussion about facilitating groups, and why we do this. I was surprised to find out that not many of the OT’s in attendance were currently facilitating groups, though the majority had experience in doing so. Group facilitation is not something I have experience in, but an area I am certain I will explore. Sue spoke about the basics of running groups and areas to think about when doing so such as; is the group open or closed, how often sessions are held, the target group, session topics etc. Sue also went on to explain why facilitating groups is worthwhile, as it brings it back to the OT basics – during group activity the emphasis is on the doing. Sue also used Yalom’s ‘11 curative factors of group therapy’ to explain the dynamics of engaging this way. It was certainly an eye-opening discussion for me as I hadn’t really thought about how powerful groups can be.  I particularly liked the way Sue explained so effectively where ‘Recovery through activity’ groups could fit in to the OT process and the role that they can play in exploring an individual’s interests resulting in goal collaboration. As a future Occupational Therapist I have a clear view to where I could use the recovery through activity groups in my future practice. Clients which need support in addressing areas of their volition could benefit from the exploratory opportunities of the group. This includes promoting confidence, social skills and validation of shared interests. Then, through 1:1 work this can be built upon by negotiating goals and focusing on skill development alongside roles and routines. ​ Day 1 of the workshop ended with a discussion and activity on negotiating treatment goals. This involved coming up with examples of goals which were measurable, achievable and person-centred. As a student I have sometimes struggled with writing the ‘SMART’ goals that we are taught at university, many times have I written a goal only to get the feedback ‘Make it smarter!’. The way MOHO uses levels of change and support strategies within the goal setting, I believe makes it a lot more focused and effortlessly smart. I feel confident now with my goal negotiating and I am looking forward to using it in practice. (At the end of the blog post you will find some additional reading references on goal negotiating that I hope you find useful). ​ Day 2 and getting up at 5am was even easier as I was raring to go with what I would learn at the workshop. The day was a lot more practical with emphasis on building a potential recovery through activity program. Before we did this though, Sue spoke about the Do-Live-Well Framework which is a Canadian framework for promoting occupation, health and well-being. See the YouTube clip here: I think that the easy to understand video is a great tool for explaining the areas of occupation to service users and members of the MDT. Looking at the 8 areas, described within the framework as ‘dimensions of experience’, Sue explained where the activities within the Recovery through activity programme could fit. For example; under ‘Personal Care’ could be both self-care and faith activities. This allowed for a clear view to which activity areas would be useful to include in your programme depending on which of the 8 dimensions of experience you choose to focus on. In the afternoon of day 2 we separated into groups, based on service areas, to have a go at outlining a recovery through activity programme which could be used within practice. The students were asked to separate and join in with the clinicians to bring ‘fresh ideas’. My group was made up with clinicians who were working in secure forensic settings. We brain stormed some ideas and decided on using the ‘Community’ area of activity, using resources from the recovery through activity book to support us. We decided using discussion exercises could prompt shared ideas on what community means to the individual and to reflect on their roles within their community setting. The session would end with brainstorming an activity to follow up, we suggested creating a wall mosaic that represents the community within the secure setting. This would link nicely to the next group topic which could be ‘Creative Activities’. This was just one idea of many shared that day by the group, all which centred on our main ethos of ‘doing’. This is what I loved about the workshops and the book itself, the focus is on what we trained (or are training) to do – the use of activities to recover, sustain and thrive. Overall I had a brilliant two days and feel like I have really benefited from the experience. My knowledge of facilitating groups has grown, along with the concepts of MOHO. It was such a privilege to attend and meet Sue Parkinson, who is not only a MOHO legend but a really lovely and inspiring lady. Perhaps Sue may come to Sheffield Hallam and speak at a SHOUT event in the future?... Watch this space! References Kielhofner, G. (2008) Therapeutic Reasoning: Planning, Implementing, and Evaluating the Outcomes of Therapy. In: Model of Human Occupation . 4th ed. Baltimore: Lippincott Wiliams & Wilkins.  Parkinson, S. (2014)  Recovery Through Activity . London: Speechmark Publishing. Parkinson, S.  et al. (2011) Enhancing professional reasoning through the use of evidence-based assessments, robust case formulations and measurable goals. British Journal of Occupational Therapy [online]. 74, pp.148-152.

Occupational Therapist recounts her journey from patient to professional - and the support that got her there. On Friday 15th November 2013, I was driving to work as usual. It was a day like any other , travelling the same route that I had done for months. Suddenly, my car skidded on a patch of ice – sending me off the road and through a hedge. I woke up, in the driver’s seat of my car, in a field. An overwhelming array of emergency service vehicles arrived on scene, including an air ambulance service . It was their paramedic who was immediately worried about my neck, and she travelled to the nearest hospital with me in an ambulance. I was relieved to have somebody so caring with me, but couldn’t quite believe what had happened. I was then moved to a hospital in Birmingham for specialist treatment. Here it was confirmed that I had broken my neck. I had several lacerations and a broken left arm, as well as my C1/C2 incomplete spinal cord injury . After a series of operations, I was moved from critical care to the trauma ward and then prepared to go to my parent’s home to start adjusting to this new chapter in my life . As my spinal cord injury had minimal impact on the movement of my limbs, the staff at the hospital never really discussed how it might affect my life. I was quite positive about my recovery and, at that stage, hadn’t felt the full psychological impact of the injury . It was once I’d left the hospital that things started to hit home. I discovered the discomfort of wearing a neck brace constantly, came off strong pain medication and had regular periods of fatigue. Being a passenger in a vehicle made me particularly anxious, as I had no control over the car and this constantly reminded me of my accident. It was at this point that I decided to reach out for help to overcome some of the new challenges I was facing. Back Up came up in my internet search, and I was amazed that they offered support for people with a spinal cord injury who can walk , like myself. I applied for their Next Steps course in 2016 and was thrilled to get a place. I met some inspirational people and was encouraged to see my situation in a positive way – allowing me to explore my feelings and frustration in a safe environment . They helped me to address my pain levels and fatigue, and gain the physical and emotional confidence I needed to move forwards with my life. It was a lot of fun too. I highly recommend such courses to anyone with a spinal cord injury. Since then, I’ve called the charity whenever I’ve needed to talk things through. This led to me getting a mentor and it’s been great to have such a knowledgeable support network at the end of a telephone. I’ve now realised that I am not alone in my thoughts. I’ve even become a mentor myself, and I’m enjoying passing on all the advice and support that I was so glad to receive. Before the car accident, I advised on equality and human rights, as well as working at a pub on evenings and weekends. After the accident, I had several sessions of physiotherapy and occupational therapy on my left arm. The therapists I met along the way were all amazing and made me feel positive about the future. I really wanted to give back a bit of what they’d given me . So I decided to return to university, to retrain as an occupational therapist. University was a welcome challenge . Placements varied as I was in different settings throughout the three years of study. My first placement was also the first time I had returned to full-time work since the accident. For more physically demanding days, it was important that I kept up good habits : sleeping well, staying hydrated, and taking regular tablets and vitamins. This has continued until this day, and I have learned to look after myself and be open and honest about my spinal cord injury and how it affects me. Now practising as an occupational therapist, I remind myself of the learning curve that I have been on and how I can use that experience to help the people I work with in my job. I also try to pass on some of the positivity and hope that I was given by my therapists, as I know how important this was to me during the early days after my injury. It is rewarding to know that I might be able to assist someone during their rehabilitation in the same way my occupational therapists and others supported me. That’s pretty special. If you would like to find out more about mentoring, the Next Steps course or any of Back Up's services, please visit the Support for you section of their website.

By Sarena Jones, Occupational Therapist This is actually really hard… Health professionals are often the worst at looking after themselves. Chefs rarely cook well for themselves and builders always have renovations or personal projects that never seem to go anywhere! Personally, I’ve always been a fan of thinking about myself - or sorting my own stuff out - last. I’m going to go out on a limb here and assume I’m not the only one? Boy, does this stupid trait exacerbate when you have kids! Let’s presume we all need to eat a variety of healthy food, regularly exercise and get between 6-10 hours of sleep a night - but what else is there? The quick fixes are always good - sex, chocolate, laughter, patting furry animals, etc. What about long lasting self-fulfilling happiness? Well, engaging in ‘meaningful occupations’ is what the occupational therapy profession is built on! Keeping yourself busy and active - not just with exercise, but just doing keeps your body, mind and spirit healthy. Learn new stuff, try new stuff, get out and about, do the stuff you enjoy. Don’t overload yourself with easy thoughtless entertainment - hmm, binge on Netflix, or social media stalking anyone? As I’m an OT I’m going to consider some theoretical models for just a second… Stay with me! 1) Find your motivation. What gets you going? Model of Human Occupation (MOHO) (Kielhofner, 2008) Here, volition (or motivation) and its interaction with daily routines, functional performance and the environment in which they occur is vital. What interests you, what are your values , what motivates you? Try doing more of that! Now think about that patient you feel might be stuck in a rut. What motivates them? 2) Pay attention to your body, mind and spirit Occupational Performance Model (OPM Australia) (Chapparo and Ranka, 1997) Here, the body, mind and spirit all require some love, in order to achieve meaningful occupational roles in our lives. The body often speaks louder than the other two, but how do you care for your mind or your spirit? Do you practice cognitive exercise? Do you try new things? Challenge yourself? What about mindfulness? Do you have daily ‘roles’ that are important to you? Mother? Health professional? Gardener? Carer? 3) Understand your unique purpose. Do you feel satisfied with your day-to-day? Maslow’s Hierarchy (Maslow, 1943) As you can see, ‘ self-actualisation ’ or ‘fulfilment’ is at the pointy end. Do you feel you prioritise and listen to your internal drive? Achievement of one’s potential through creativity, independence, spontaneity. Why are you here on earth do you think? No biggie - just something to think about! This is where it’s at, but of course you must make sure all your other needs are met before you get there. As in, you can’t reach your potential and great happiness if you don’t feel safe and confident, spend time with friends and family and eat your veggies! Well, that’s what I tell my kids and my husband. For me, I always appreciate the ‘keep it simple stupid’ theory: If I’m doing something that brings me joy, challenges, energy and a sense of pride and achievement, I’m probably on the right track. So, in closing - obviously I need to read and re-read this post on a regular basis… I need to prioritise quiet moments to myself to do a ‘spot audit.’ Do you? What’s important to you? What’s at your core? What gives you joy, pride, challenge and energy? There are many resources out there, but here are some good ones to start with: Beyond Blue Reach Out Mindful Life Coach Hub Don't just survive. Thrive! Many thanks - and may you find your real happiness and share it with the world… Sarena References Chapparo, C. and Ranka, J. (1997) Towards a model of occupational performance: Model development. In Chapparo, C. and Ranka, J. (Eds). Occupational Performance Model (Australia): Monograph 1 (pp. 24-45). Occupational Performance Network: Sydney. Available from: www.occupationalperformance.com/origin [Accessed 15 July 2017]. Kielhofner, G. (2008). Model of Human Occupation: Theory and Application . Fourth Edition. Philadelphia, PA: Lippincott, Williams and Wilkins. Maslow, A.H. (1943). A theory of human motivation.  Psychological Review. 50 (4), pp.370-396.  doi : 10.1037/h0054346

Conference in Germany, 2017 If I had to define my experience at the Occupational Science Europe Conference, many words come to mind: Occupation. People. Meaning. Context. Critical Thinking. Social Transformation. Multi perspectives. Exciting. Research. Knowledge. Sharing. Health. Wellbeing. Inspiration. Creativity. Evidence. Occupational Justice. Occupational Science... My experience as an assistant at the conference was wonderful. I look forward to 2019 and having the chance to attend the next Occupational Science Europe Conference. This will be in Amsterdam, in August 2019. On 7-9th of September, we learnt and shared a lot of things. We discussed about Occupation-based social transformation, and attending many different and diverse talks about occupational justice, critical occupational therapy, creativity, precarious employment, immigration, refugees, etc. The content of the discussion was very rich and it opened my mind to other beautiful points of view. Furthermore, we met people from different countries - Australia, Canada, USA, the UK, Ireland, Germany, Norway, Spain, Portugal, Brazil... I observed our cultural diversity, which was rewarding! We learnt about how occupational therapy is in other countries and we discussed about how occupational science is taking into account. Furthermore, the fact that some assistants were from other degrees was fantastic, because it let us understand how occupational science is important for many other professions. I also felt many emotions when some of the committee showed us the settings where Occupational Therapists work in Hildesheim. For instance, nursery school and services for people who are socially excluded or experience poverty. It was great to find out and appreciate which emerging OT practices are being carry out in other places around the world. In conclusion... The experience was magical and fantastic. I recommend it to everybody.  I look forward to meeting some of you in Amsterdam in 2019!

When looking for Occupational Therapy (OT) positions, there are a number of factors that require consideration, such as where you want to work, what kind of job you want to do and what will be expected of you as an autonomous practitioner . Having just finished my preceptorship year, I hope to offer some reassuring advice in this article, for those who are taking on their first jobs as newly qualified Occupational Therapists. In the summer of 2018 I graduated from the University of East Anglia (UK), with a 2:1 in Occupational Therapy. Getting my degree was a struggle, as I intercalated halfway through my second year due to illness, meaning that I took a year out and sadly did not graduate with the people I started with. Nevertheless, I formed good relationships with the cohort I went into. Due to prolonged illness during the year I had out, as well as other pre-existing health conditions, I did my placements part-time , which meant three and a half days per week, over a ten-week period, (rather than full-time over eight weeks). When I graduated I was initially nervous about applying for a full-time position, as I was worried about how I would manage this physically - which was limiting, as most OT positions are full-time. I knew from my placement experiences that I was most interested in working in mental health, as I had one community and one inpatient mental health placement, which were two of my most enjoyable. At this time, there were no OT jobs in mental health in the Norwich area, as Norfolk mental health services were in crisis . I managed to find a part-time job as a recovery worker for Mind (the mental health charity), which I enjoyed and was brilliant mental health experience. However, I realised that I was missing practising my OT skills . I decided to try working full-time and broadened my geographical area in looking for jobs. Applying for an OT job There are a number of websites which advertise for OT positions in the UK, but the one I recommend most is NHS Jobs , as this is specifically designed for National Health Service (NHS) staff. When looking at jobs, I started by looking at the whole of the UK, including the Isle of Wight. Upon reflection, if you are moving for work, I think that it is important to move somewhere which you know will suit you; somewhere you are able to pursue your own occupational interests and where you have a good social network . Having social support, especially in your first year, is important in maintaining your own mental health. Therefore, the Isle of Wight would not have been a particularly happy destination for me personally. I found two jobs in London which I was interested in; one was a permanent position in a community recovery team (CRT) , the other a mental health rotation . I heard back from the community recovery team first; they invited me for an interview and offered me the job then and there. Following this, I was invited for an interview for the rotational post, but having already accepted the other job, I turned this down. Thinking about who you want to live with can be a significant factor in deciding where you want to work. This may be influenced by obligations you already have or financial factors . I live with my partner, who is doing a PhD, so fortunately he is able to be flexible with where he works. We found a flat just round the corner from the main office, where the community recovery team is based. I had my interview just before Christmas 2018 and started the job in February 2019, so it was a quick process of moving from Norwich to London. We got the keys for the London flat on the Wednesday the week before I started, so it was quite stressful ! When looking at jobs and going for interviews, when you will be expected to start a new job is definitely something to consider. What type of OT job to do? I was fortunate in that I knew I wanted to work in mental health. However, many leave university unsure of which area they are most interested in. For people who are unsure, doing a rotation is a good idea; it enables you to try out a range of different areas for much longer than you would ever do on placement, before deciding on a particular area you are interested in working in. If you are considering doing a rotation, it is also important to consider where the different rotations may be and what your capacity for travelling to those different areas is. You may also want to explore a setting which you did not have the opportunity to work in during placement. During my preceptorship year, I met a number of people who were trying new areas; it sounded like the staff where they worked were very supportive and easing them in gently. Fortunately, OT skills are highly transferable , so if you work in one area and decide you want a change, this is always possible. What does my job involve? I am a care coordinator, in addition to being an OT , in a multi-disciplinary community mental health team (CMHT). This means that I work with clients who have a range of different mental health diagnoses, including obsessive compulsive disorder (OCD), bipolar disorder, paranoid schizophrenia, anxiety and depression. Now that I have finished my preceptorship year, I have a maximum caseload of 20 people, who I see minimum once a month, maximum once a week. I complete home visits on my own to clients and use my OT skills with them: graded exposure work, such as travel training independent living skills development , such as with finances and cooking psychological interventions , such as mindfulness and self-care activities I can refer my clients to other professions in the team (such as to psychology) and refer to a range of community-based services. I attend medical reviews with the psychiatrists and my clients. I also help in facilitating our recovery group , of eight sessions over eight weeks, which we run three times a year. I complete occupational therapy assessments via referral from other care coordinators, which could be assessing functional baseline needs, for adaptations, equipment and for social prescribing . Starting my first OT job The first two weeks of the new job were induction weeks off-site, training us in company procedure and protocol, setting us up with laptops and basically introducing us to the Trust. Following this, I shadowed other professionals in our team on visits and was gradually given my own caseload. After about six weeks in the Trust, I had 14 cases. At times this did feel a little overwhelming . Although I had already worked at Mind for six months before starting my OT role, I had only ever had a caseload of nine people maximum. On placement, whilst you may be given the sense of managing a caseload, you are never fully responsible for these clients - so it did feel like a huge amount of responsibility . I remember being shocked to discover that some of my more senior co-workers had caseloads of up to 30 people, thinking that it was utterly amazing they could care coordinate this many. However, they have had years of experience and plenty of time to develop their skills. Working with people who have this experience is really good for your own development, as you can draw on the skills and advice of others in your team. I felt that my team was very supportive and always there for me. It is really important to be kind to yourself in these earlier stages and not compare yourself to anyone else . I found this difficult when I first started to work with some of my clients; they would talk about how good their old care coordinator was, but I realised they had worked with that person for a long time and had formed a good relationship with them, so this change was also difficult for them. It is easy to think that, now you are qualified, you should know everything and to feel the urge to prove this. The reality is, nobody expects you to be the finished article straight out of university. In fact, no one is ever the finished article; everyone has their own weaknesses and areas for development and we all have our good and bad days . If you are unsure of something, you should speak to your supervisor or someone else in the team before taking action; as with placement, you should continue to have regular supervisions , which are a good place to discuss any concerns. In light of this, I attended a Band 5 development group once a month, where other newly qualified practitioners would present a case study of someone they had worked with. We were given time to talk to each other and discuss any problems we might be having at work. This was a really good opportunity to develop our skills and learn more about the different areas of OT. I also attended preceptorship training . This seemed to be very directed towards nurses; they made up the majority of the attendees and there were complaints about this. I understand that they are changing the programme, to make it more generic. I’m sure that how preceptorship programmes are run is different in other places. I would also recommend having a look at what events the Royal College of Occupational Therapists (RCOT) is running, or those of your country's professional body. These are brilliant for your CPD and learning, really well run and a good opportunity to meet other professionals. You should also have a reduced caseload in your first year , to allocate more time to your learning and development. Managing the demands of your own life Working in healthcare is demanding. During one of the preceptorship days I attended, another girl summed it up well: "Sometimes it is difficult going to see clients, when you feel like rubbish yourself." With my clients I create care plans; it is important to think about this for yourself, to avoid burnout . For example, having a list of self-care activities and taking time away from everything to look after your own needs. Think about what you would recommend for your clients and apply this to yourself ; for example: sleep hygiene diet and exercise social interaction (outside of work) occupational engagement in enjoyable activities Basically, think about the self-care/leisure/productivity model. As I mentioned earlier, I have my own health conditions; following this model of self-care is what has enabled me to successfully work full-time. Holidays I have included this as it was something that I found hard to adjust to, especially coming straight through school and university and having friends as teachers (who get the school holidays off). Going from 18 weeks off a year to five is quite a change! I know that this is something many new starters find is an adjustment , even those who have worked prior to doing their university courses; it is easy to get used to long holidays. This is also important to include, as it plays into the self-care aspect of avoiding burnout. I would recommend structuring your annual leave , so that you don’t take it all at once and you have time off every few months. Whilst you may want to go full speed into the job, I recommend thinking at the start about when you would like to take your annual leave. Final Words Overall, I feel that I have learned so much from the last year, which I will take forward on my career journey. I love being an occupational therapist. I love feeling that I am bringing meaning and purpose to the lives of others and supporting them to fulfil their potential; I wouldn’t want to do anything else.

By Laura Jones, Occupational Therapist I haven’t written an article before, but I thought it may be interesting for people to get an insight into a week of the life of an occupational therapist working with adults with learning disabilities in the community! It is a very varied role, no one day is the same and, most of all, it is incredible rewarding and enjoyable. I hope showing you a week in my working life can show you just how rewarding, interesting and varied it can be! All names have been changed for confidentiality purposes. MONDAY Independence and routine at work I attended a meeting at Ellie’s place of work today. Ellie was off work for over a year due to a period of illness and is finding it difficult to get back in to her routine at work since returning. I am working alongside psychology, Ellie’s manager and a HR representative, as well as Ellie and her mother - to gain an understanding of her needs and what the barriers to her engaging in her job role are at present. Ellie has gone back to work on a phased return and is currently doing two short days, which she has never done before. Myself and the psychologist have ascertained that this is totally out of routine as Ellie has always worked part time, and that this may be contributing to her current difficulties, which include being easily distractible and not being able to complete tasks in the allocated time. As Ellie had never done short days prior to this and has been in her job for many years, it was proving difficult for her to solidify this as her routine. Ellie’s manager showed me the job list expected of Ellie, which has also been provided to her and discussed verbally with Ellie on numerous occasions. The job list was very wordy, and not accessible for Ellie who was struggling to follow this. As a first port of call, I worked with Ellie to develop an easy read checklist that she could use at work, which is comprised of much less words, and pictures to guide her through the jobs she needed to do on a daily basis. I have talked to Ellie’s employers about the Accessible Information Standard, which aims to make sure that people who have a disability, impairment or sensory loss get information that they can access and understand (NHS England n.d). We have also discussed the legal requirements for an employer in relation to reasonable adjustments for individuals with a disability, to ensure that they have every opportunity to flourish in their role (GOV.UK 2018). Part of my job is to educate and train others, whether that be someone’s employer, mainstream healthcare services or support staff and carers, to ensure that the information they are providing to individuals with learning disabilities is accessible. Ellie’s employer has asked for some more information to be provided about Ellie’s needs in relation to reasonable adjustments. I have referred Ellie to speech and language therapy for a comprehensive assessment of her communication needs and information processing skills, as we feel this will help us to have an understanding of any reasonable adjustments needed, in more depth. Meaningful occupation and mental health Following this I had a joint visit with our OT Technician to see James. James is currently having a relapse of mental health symptoms and is having difficulty with concentration and motivation to engage in meaningful occupations. Myself and the OT Technician went with James to a specialist mental health support day service, at his request, to engage in some activities that he expressed would be of interest to him. We played several games of pool, which proved quite difficult for James in terms of concentration, due to his current symptoms. We tried some distraction and positive affirmation techniques to try and encourage James to continue and manage his symptoms more effectively. James was clearly finding it difficult to engage in any activities, however we did stay out for longer than he has done in a some time and he stated that he did enjoy the time he spent out and found it to be a positive experience. Myself, James and the OT Technician are working alongside the mental health services in order to ensure he is getting equitable healthcare and the reasonable adjustments he needs in order to access their mainstream service. Our speech and language therapy team have done a comprehensive assessment of James’s communication needs which has been provided to them, with permission from James, to ensure they have a greater understanding of how his learning disability affects his communication and information processing skills. TUESDAY Delivering training Today I delivered the Occupational Therapy section of the Dysphagia training, alongside some of my speech and language therapy colleagues. We deliver this to carers and support workers who are working with individuals with a learning disability and dysphagia. This includes explanation around the role of an occupational therapist in managing dysphagia, how we assess feeding difficulties and tools and techniques around this, including aids, adaptations and equipment and the impact of the environment. We aim to ensure several things through this training, firstly that the individuals with learning disabilities we are working with are safe when eating, whether they receive support with this or are independent. We want support staff to be aware of the signs of dysphagia and ensure that they are aware that we are available to support with this as and when needed. It is also a great opportunity for me to talk about the OT role, as it is often something people do not fully understand or are aware of! On a serious note, it is very important that staff working with individuals with learning disabilities have an understanding of dysphagia and its signs and symptoms, and often these are missed if it is a mild case. Furthermore it is generally accepted that people with a learning disability are more likely to have dysphagia than other group and is a leading cause of death in individuals with a learning disability (Public Health England n.d). WEDNESDAY Sensory Assessment Today I did an initial visit with Mike. Mike was referred to Occupational Therapy due to potential sensory seeking behaviours, such as biting his hand and hitting his face. I met with Mike, an individual with a profound and multiple learning disability, for the first time at his home. I took a long a box of sensory items, and introduced myself to Mike and put the box near where he was sitting to see if he showed any interest in the items. I explained who I was and why I had come to visit him today. I showed Mike several sensory items, such as a massage ‘snake’, bells, cotton wool, light stick and a rain maker among many other items. Mike seemed to respond well to tactile items and also took a lot of items to his mouth, which gave me some idea of his sensory preferences. I then asked Mike if it was okay to ask the support workers some questions about what he likes and doesn’t like. I then completed a sensory profile assessment with Mike and two support staff that know him well, which gave me a comprehensive overview of his sensory needs and preferences, in order for me to make any recommendations going forward to try and reduce any incidents of self harm. THURSDAY Cooking Skills and Outcome Measures Today I saw a married couple, Kate and William, that I have been working with for over a year in order to support them to develop their cooking skills, as they are both underweight and have limited diets. Our work together has involved me doing a cooking assessment and MOHOST. Both the cooking assessment and MOHOST allowed me to identify areas in which they had some difficulties. For example Kate was having difficulties with lifting heavy pans of water, so I put some simple cooking baskets in to place which allowed her to lift the pasta out of the pan without the water. Kate and William also benefitted from a kettle tipper and an electric can opener, as arthritis made these tasks difficult. The main barrier that I identified was lack of confidence in using the oven and cooker, and in particular a fear that they would hurt themselves. Through weekly work on developing their cooking skills around meals they both identified they’d like to be able to make, they began to develop the skills and confidence to cook independently and increase their weight and nutrient intake. We have developed easy read recipes for the chosen meals, and easy read guidelines around using their microwave and timer, and they are now using their microwave independently, and their cooker through the use of these guidelines. Today was the first time I was told I was not needed as they had already made their meal. The words all OT’s want to hear! I repeated the MOHOST as an outcome measure, and it has allowed me to see and document their progress over the last year, with a very positive outcome! FRIDAY Eligibility Assessment Today myself and one of the Learning Disability nurses went on a joint visit to complete an eligibility assessment. We use the Adaptive Behaviour Assessment System 3 (ABAS-3) to determine if an individual that has never received support from us is eligible for our service. To be eligible, one must have an IQ under 70, have significant impairment of social and adaptive functioning, with this having occurred prior to the age of 18. ABAS-3 is a rating scale useful for assessing skills of daily living in individuals with developmental delays, autism spectrum disorder, intellectual disability, learning disabilities, neuropsychological disorders, and sensory or physical impairments (Academic Therapy Publications 2018). We usually do this with the individual and will ask a family member of carer to also complete one, to ensure we have a well-rounded understanding of the individual and their function. We will then correlate the results to determine whether the individual is eligible for our service. On occasion, it may be difficult to determine from the ABAS-3, or results may be borderline, and we will look to do further assessments to ascertain an individuals’ level of need. References Academic Therapy Publications (2018) Adaptive Behaviour Assessment System 3 Comprehensive Kit [online]. Available from http://www.academictherapy.com/detailATP.tpl?eqskudatarq=DDD-1934 [30 July 2018]. Growing up Autism and Sensory Processing Disorder (2017) The seven senses and sensory diets [online]. Available from http://growupspd.blogspot.com/2015/05/the-seven-senses-and-sensory-diets.html [7 July 2018]. GOV.UK (2018) People with learning disabilities: making reasonable adjustments [online]. Available from https://www.gov.uk/government/publications/reasonable-adjustments-for-people-with-learning-disabilities [30 July 2018]. NHS England (n.d) Accessible Information Standard [online]. Available from https://www.england.nhs.uk/ourwork/accessibleinfo/ [30 July 2018]. Public Health England (n.d) Swallowing difficulties (dysphagia) [online]. Available from https://www.gov.uk/government/publications/reasonable-adjustments-for-people-with-learning-disabilities/swallowing-difficulties-dysphagia [20 July 2018].

Occupational Therapy (OT) is a vast and varied profession. One of its many specialisms is wheelchair services; traditionally a National Health Service (NHS) service in the UK, but more increasingly becoming a privately contracted one. Many occupational therapists (OTs) may not know much about the breadth of wheelchair provision or consider it as an area of practice. Wheelchair services have unfortunately received a negative view in the press in recent years, which I believe discredits the amazing work that goes unreported . It is a specialist clinical service, troubled by complicated commissioning, resulting in a postcode lottery of provision. When you unpick wheelchair services, you see the complex depths of wheelchair prescription is completely individual - and why wouldn’t it be? No two people are the same or have the same requirements from a wheelchair. The day usually begins with tea, because who can function without a first cup of tea in the morning?! I scan through my emails, then to my running sheet for the day. This lists my appointments and whether they are clinics or home visits . As a service, we try to see as many people as we can in clinic, because we have the facilities required for a thorough assessment. People don’t generally have a plinth in their home, or a variety of transfer equipment; plus the travel time around the county means that not as many people can be seen within the same time frame. For each of my planned appointments that day, I read through the referral forms, what the appointment is planned for and any recent previous assessments, check what equipment they currently have on issue and make a note of their diagnoses, thinking about how that may impact their function. Then it’s time for our clinical team 'daily huddle'. We sometimes refer to it as our 'daily cuddle', because this is the platform where we support each other as a team, share clinical cases, make joint decisions and discuss any pressing issues. My first appointment is a gentleman with multiple sclerosis (MS) who uses a powered wheelchair . His hand function has been deteriorating and he is now finding it more difficult to use the joystick to control the wheelchair independently. His fingers are flexed into a fist and despite using night-time splints, he is unable to open his fingers towards the end of the day. His shoulder is getting stiff and he can no longer rest his arm straight on the armrest. So we explore moving his controls, so that they are mounted on a tray across his lap, instead of on the armrest. We try out some different shaped joystick knobs, finding that a chin cup works well and he can still move this around using the outside edge of his fist. With support from our Rehabilitation Engineering Technician , parts are identified to change his controls. We agree to order them and arrange a follow-up appointment for them to be fitted. After a quick write up, the next appointment is to hand over a self-propelling wheelchair to a 5 year old girl who has always used a buggy until now . She has cerebral palsy , which mainly affects her legs. Her mother lifts her into the wheelchair and, after a few minor adjustments, she is keen to get moving. She doesn’t require much instruction on how to self-propel before she is off and squealing with delight. "Wow, I can move myself!" Her little brother is fixated with the flashing lights that shine brightly from her front castors. Her parents chose them as a 'top up' personal wheelchair budget, so they would match the flashing lights her brother has on his scooter and they can both light up on the way to school. After signing their conditions of loan, they are on their way. I write up their notes and close the referral as completed. My next appointment is a lady with a spinal cord injury, has developed a pressure ulcer on her sacrum. We discuss: her daily routine how she transfers what clothing she generally wears how long she spends sitting in her wheelchair what mattress she has on her bed whether she sits anywhere else during the day From this discussion - and by reviewing her position in the wheelchair - it appears that she is sitting with a posteriorly tilted pelvis . This means that a lot of her weight is going down through her sacrum. She is hoisted out to the plinth, to assess her posture outside of the wheelchair. She is able to sit with a neutral pelvis, so it is not a limitation of her body structure that is causing the pressure ulcer. We decide to pressure map to ensure the cushion is providing the correct support. This involves her sitting on a pad across the top of her cushion, which then projects an image of her bottom to the computer screen - a bit like a weather map - showing areas of blue/green for even pressure and orange/red for high peaks. She is hoisted back into the wheelchair. The image shows she has a high peak centrally at the back, where her sacrum is located (and at the exact point of her pressure ulcer). She is then re-hoisted, using the longest loop on the leg strap of her hoist sling. The pressure map is now fully blue/green. She is amazed that something so simple can create such a difference to her position and reports that she feels as though she is sitting more upright - and will discuss it with her carers when she gets home. Time for lunch and then I’m on duty for the afternoon. This involves answering queries and taking calls from service users and therapists. First, a gentleman whose cushion is worn out and needs replacing. I source one off the shelf, label it up in the warehouse and request delivery by our repair team. Next is a student at college with a broken harness strap, so I find a replacement in the warehouse and check who is available. One of our Rehabilitation Engineering Technicians has had a cancelled appointment, so is able to fit it for him at college, before he’s due home on transport. I take a couple of queries from OTs in hospitals, who want to discuss cases they are considering referring, to clarify eligibility criteria . Each phone call requires a write-up, so it’s a slow process. However, I feel satisfied that I have made a difference and sorted out some issues for people. I round off my day by checking in with the two therapists that I supervise . I ask how their appointments have gone and if they need any support. One of them is running an approved prescriber training course the next day for community therapists, so I help him set out some wheelchairs and accessories ready for the morning. Then it’s home time. No two days are the same. It’s such a varied and challenging role, with the added value of working autonomously, but also within a supportive team. I think a lot of OTs have a perception that working in wheelchair services would 'de-skill' them, but that couldn’t be further from the truth. The core values of our profession are about participation in activity. Providing wheelchairs and postural supports are central to enabling people to be - and remain - active and engaged in daily life . If someone is unable to hold their head up independently, or needs to prop themselves on their arms to maintain an upright sitting position, how are they going to be able to engage in any meaningful activity? Postural management is a prerequisite to occupational performance and mobility is a human right. As wheelchair therapists, we do such an important job of enabling people to both do what they want to do and get to where they want to go. I love it and am a self-confessed 'wheelchair geek'!

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.

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 .

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 If 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 during 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). 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' 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 communication 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.

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

In each setting and specialism that I have worked as an Occupational Therapist (OT), the adoption of routine has been key to the recovery, rehabilitation or general maintenance of an individual's health and/or well-being. In this article, I encourage you to consider, reflect on, or be reminded of the value of routines and rituals - for both you and those you support in practice... routine /ru: ˈti:n/ noun a sequence of actions regularly followed repeated behaviours that become second nature and require little conscious thought Personal practice experiences of utilising routine At an acute community 'rapid response' service By collaboratively adjusting medication timings, ensuring an appropriate frequency of welfare checks and structuring personal care support, older adults were kept safely in their home environment - rather than admitting them to hospital unnecessarily. By making (often minor) adjustments to how they went about their day, rates of falls and medication errors would reduce and clinical observations could be increasingly stabilised. This might also rely on the provision of adaptive equipment to carry out activities of daily living (ADLs), but it would ultimately make engaging in necessary occupations safer and easier. At an inpatient brain injury rehabilitation unit Post-stroke routine was crucial to orientation (time and place) and to restoring patient's cognitive abilities. Devised by a multidisciplinary team of therapists, a daily timetable incorporated occupation both as a means and an end*. This included set breakfast periods, when patients were encouraged to eat and drink in the dining room - providing context, orientation and social connection, within an appropriate physical environment. Early rehabilitation also involved gathering information from friends and family about the person's usual personal care routine, then accommodating for and encouraging these preferred methods and orders of task completion. In doing this, interventions exercised social and communication skills, as well as addressing cognition - including working memory and executive functioning (divided attention, planning, sequencing, problem-solving, etc). * Occupation as Means vs Occupation as Ends: ​Occupation as Means ​Using the engagement and performance of occupations as intervention. ​Occupation as Ends The outcome of the intervention or goal is the ability to perform or engage in occupation. It does not necessarily mean the use of occupation was used directly as an intervention. [Gray, 1998] For young people struggling with their mental health "Many people don’t realise just how much their routine - sleep, eating, exercise, work, how you like to do things - impacts their mental health until they’ve had their routine disrupted." - Dr Gold (Gilbert, 2023) Incorporating meaningful activity and social opportunity into daily routines provided a much-needed volition-boost, distraction from negative or unhelpful thought cycles and a chance to re-connect. The community-based mental health charity facilitated peer support, allowing teenagers to learn resilience tools and tips from others going through similar experiences. Planned meaningful activity, in a safe, after-school environment, included fortnightly art classes, evening discussion groups and weekly yoga sessions. Often linked to a reduced motivation to engage in normal daily routines, the self-care practices of those affected by mental ill health often break down. This potentially has knock-on effects to physical health, hygiene and self-esteem, among other domains. In turn, this may impact on an individual's social and/or work life. Factors are inter-connected, but routine intertwines all aspects of our lives. Adopting daily routines removes the stress of decision-making. For example, if your routine is to eat a bowl of cereal when you wake up, less valuable time is spent deciding what to have for breakfast. That frees up brain power for more important decisions as the day progresses, that deserve more of our energy and stress (Van Raalte, in Gilbert, 2023). Within a paediatric disability service I have explored elements of routine management with parents of children, including those with autism spectrum disorder (ASD), where behaviour that challenges can also impact on the wider family's daily life. Adapting showering or bathing methods, attending after-school clubs and staggering mealtimes are just a few examples of how triggering behaviours might be avoided or reduced. This often involves liaising with family members and other healthcare professionals, to establish if a child is sensory-seeking or sensory-avoidant, then making minor adjustments to the execution of ADL(s). Alongside referring to a sensory advice service - and sometimes making home adaptations - parents can be empowered to support their child's daily routine. Goals might focus on engagement in an activity with greater ease, independence and/or safety. In an outpatient neurorehabilitation centre I currently work with patients, often on intensive packages of rehabilitation, following a range of neurological conditions, including stroke, traumatic brain injury (TBI) and spinal cord injury (SCI). In neurologic rehabilitation, repetition is required to maximise levels of improvement and brain reorganisation, to facilitate an individual maintaining and making greater functional gains. Animal studies in neuroplasticity have shown that approximately 400-600 repetitions per day of a difficult functional task are needed before the brain reorganises. This means that... 'If an individual is working on a functional task such as grasping, it will take 400-600 repetitions of grasping per day to help drive neuroplasticity and cause changes in the brain' (Kimberly et al, 2010). And the link to routine? Well, whilst face-to-face occupational therapy and physiotherapy sessions might last two-to-three hours per day, how my clients engage in activity outside of the clinic will be just as key to their speed of progress and potential. Working with them on a functional home exercise programme (HEP), that fits realistically into their current routine, will help embed techniques, skills and abilities learnt in OT sessions. Away from clinical practice, I am sure you are more than aware of the power of routine (or a lack of it), as we coped with change throughout the coronavirus (COVID-19) pandemic. Regularised routines 'can buffer the adverse impact of stress exposure on mental health' (Hou et al, 2020), something that affected us all, to varying degrees. This relatively recent experience is highlighted in a piece by Megan Edgelow, who explores the influence of 'doing' on the quality of daily life - a concept that every occupational therapy professional holds close to their heart! I reference Megan, Assistant Professor at Queen's University, at the end of this article, but I would like to share her main points with you. Click the three statements below: Routines support cognitive function A daily routine and regular habits support cognition. They can even free people up to be more creative. According to research, regular work processes allow us to spend less cognitive energy on recurring tasks; in turn, this supports focus and creativity for more complex tasks. Researchers found that many influential artists have well-defined work routines, which might support their creativity, rather than constrain it. Research on the subject of memory has shown that regular habits and routines can support older adults' functioning in their home environments. For example, if taking medication at the same time and putting house keys in a particular place is part of a daily routine, less energy is used looking for lost objects and worrying about maintaining health. This frees up time in the day to do other things. Routines promote health Routines and rituals improve our sense of control over daily life, allowing us to take positive steps in managing our health. For example, making time for exercise can help meet recommended daily activity levels. The pandemic has played havoc with long-established routines and rituals; reflecting on how these might have changed might be a helpful first step to improved health. Routines can support our health in other ways, such as regular meal preparation, sleep hygiene and set bed times. These activities might sound simple but, with regular implementation, they can contribute to healthy ageing over our lifetime. Routines provide meaning Regular routines can stretch past daily task efficiency; they can 'add life to our days'. Evidence has shown that health-promoting activities, such as cycling or walking, offer chances to enjoy nature, explore new places and meaningfully connect with others. Research on the concept of flow - a state of full absorption in the present moment - shows that activities like arts, music, sports and games can be fulfilling and reinforcing (Nakamura and Csikszentmihalyi, 2009). Regularly taking part in meaningful, engaging occupations can also benefit our mental health. [Edgelow, 2022] How could you build on your own routines? Do you think you - or those you support in occupational therapy practice - could do with improved or adjusted routines? Take a look at these small steps, that might help cognitive functioning, promote better health and/or provide greater meaning in daily life: Decide on a regular time to wake in the morning and go to sleep at night; aim to keep to this most days of the week. Choose a familiar, low-stimulation 'wind-down' activity to precede going to bed (avoid screen time!) Organise your day with a timer or smart phone app; put tasks you want to do into your schedule. Start a new leisure occupation or hobby, or take up an old one. Need ideas? Consider playing an in/outdoor sport, engaging in arts and crafts, playing a musical instrument or singing in a choir. Make physical activity manageable, with local walks or bike rides a few times a week. Or consider walking or cycling your commute to work, rather than driving or getting the bus (if this is realistic for you). In summary... Routines are powerful tools! Whilst the notion can sound mundane, research shows that implementing them can support better physical and psychological health, as well as social connection and wellbeing. Occupational therapists and therapy assistants can use routine to support patients and clients in their recovery, or to maintain a level of health and/or cognitive functioning. As occupational deprivation and disruption of the coronavirus pandemic passes, we all have the chance to evaluate routines that we want to keep and the meaningful occupations we need in our daily lives, to stay happy, healthy and productive. References Edgelow, M. (2022) What you do every day matters: The power of routines. The Conversation. Available from: https://theconversation.com/what-you-do-every-day-matters-the-power-of-routines-178592 [Accessed 23 March 2022]. Gilbert, K. (2023) 3 Expert-Backed Tips for Building Mental Health Routines That Stick (online). Peloton: The Output. Available from: https://www.onepeloton.co.uk/blog/mental-health-routine/ [Accessed 8 August 2024]. Gray, J. (1998) Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy. 52(5)3, pp.354-364. Hou, W.K., Lai, F.T.T., Ben-Ezra, M. and Goodwin, R. (2020) Regularizing daily routines for mental health during and after the COVID-19 pandemic. Journal of Global Health. 2020; 10(2): 020315. doi:10.7189/jogh.10.020315. Kimberly, T.J., Samargia, S., Moore, L.G., Shakya, J.K. and Lang, C.E. (2010) Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. Journal of Rehabilitation Research and Development. 2010; 47(9): 851-62. doi: 10.1682/jrrd.2010.02.0019. Nakamura, J. and Csikszentmihalyi, M. (2009) Flow Theory and Research. The Oxford Handbook of Positive Psychology. 2 ed. July 2009. DOI: https://doi.org/10.1093/oxfordhb/9780195187243.013.0018.

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 employment 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