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A Revitalizing and Non-Traditional Level II Occupational Therapy Master’s Fieldwork Placement, for a Veteran COTA during COVID-19

Thirty-four years ago, I was a new therapist, struggling through my first fieldwork experience. I used Connect-4* with a stroke survivor, for much longer than I should have. Why? Because I had watched my supervisor use it with this patient and I had no clue what else I might do. Over the following weeks I began to better understand how the activity supported his improvement in motor control, sequencing, planning and problem solving . Years later, as an associate professor teaching occupational therapy coursework, my students would frequently ask “What should I do for someone who has a diagnosis of X?” My reply became “The diagnosis is not all that important. Ask yourself what your patient cannot do and why . Then, to get started, pick an activity - ANY activity - that promotes the return of those missing components, be they cognitive or motor.” Occupational therapists working in rehabilitation settings are challenged to assist clients in maximizing the return of motor control in the affected limb. We encourage our practitioners to use activities which are purposeful as well as meaningful to our patients. The importance of purposeful vs non-purposeful activities are supported by the AOTA (AOTA, 2020). However, I frequently find it challenging to come up with novel activities , which both serve my goal of improving upper extremity movement, as well as being appealing to my clients. Be honest with me here, how long can you continue to practice buttoning a shirt? My Interest in Kendo/Iaido Some fifty odd years ago, while on R&R in Vietnam, I encountered a Japanese martial art, Kendo (the 'way of the sword'), which I have maintained an interest in pursuing. Early Japanese swordsman developed it as a safer way to train students or maintain their own skills . Kendo practitioners use split bamboo swords, along with helmets and body armour to reduce the risk of injury (The All Japan Kendo Foundation). In January 2020, I was recovering from my own surgery and decided to enrol at a local Dojo that offered Kendo instruction as part of my recovery. I quickly came to understand why Japanese children commonly start to participate in Kendo around the age of 7. I might be a healthy 72 year old, but I am still 72 years old and it soon became apparent that I no longer had the stamina or respiratory reserves to compete! As luck would have it, my Sensei ('teacher') also includes a martial art form, Iaido , in our Kendo instruction. Whereas Kendo requires quick movements and great stamina, Iaido stresses slower, precise motion. Kendo also involves sparring against a partner, while Iaido is generally practiced solo. I found the movement sequences of Iaido challenging but somehow calming. Literature suggests as many as 700,000 Americans will experience a cerebrovascular accident (CVA) in a given year, with nearly 500,000 survivors experiencing some level of remaining disability. (Kwon et al, 2004). For many of these survivors, a loss of upper extremity control will persist (Kyung et al, 2014). This loss leads to reduced participation and/or independence in activities of daily living (ADLs and IADLs), with a concurrent reduction in quality of life and loss of self-esteem (Misook et al, 2016; Hillis, 2014). Iaido as a Therapeutic Technique Iaido is a martial art that emphasizes the ability to smoothly draw a sword from its scabbard ('Saya'). Students of this martial art use a non-sharpened metal or wooden sword ('bokken'). As I practiced my lessons and observed other students, I began to realize that Iaido required many of the motion patterns that were difficult for my patients . My Dojo kindly provided me with a lightweight bokken, to use in our occupational therapy clinic. To-date we have used this with three patients. The initial individual had good standing balance, as well as the ability to perform many upper extremity motions, both in isolation as well as in mass. She was near the end of her treatment cycle and agreed to try this activity in an effort to ' fine tune ' her abilities to perform bilateral activities . With a therapist guarding her balance, she followed movements I demonstrated for her. A second patient demonstrated good isolated motion, but had much difficulty with mass patterns. He initially was unable to perform reciprocal pronation/supination while holding the bokken. He stated he enjoyed the activity and would practice this sequence at home using a dowel or ruler prior to his next treatment session. On his follow-up session he was able to perform full pronation, with approximately 80° supination multiple times. He no longer had to grasp and release the sword with his affected hand as he supinated. He has continued to use the bokken during therapy sessions and is now working on increasing shoulder flexion while in supine. He was, with assistance, successfully able to use his affected arm to 'draw' the sheath from the sword during his last session. A third patient is working on increasing grip strength. He works with exercise putty at home, but had some knowledge of this martial art and was enthusiastic about increasing the amount of time he can hold the sword. His ultimate goal is to develop grip strength to decrease the incidence of 'drops' at home. One additional benefit of using Iaido is that the motion sequences can easily be done in sitting; neither the 2nd or 3rd patients are able to safely stand without contact guard at this time. We do not teach Iaido I should make it clear at this point that I am NOT attempting to teach my patients how to become Iaido practitioners. I am but a student myself, still struggling greatly with the required motions, balance and coordination. In introducing the activity, I mention the term Iaido briefly, but I do not attempt to teach full sequences, nor do I teach the purpose of any of the sequences (attack, defend, etc). No treatment session is devoted completely to Iaido and it is used only when an ADL/IADL deficit can be addressed by one or more of the motions required by Iaido practice. A variety of activities I firmly believe that we need to use a wide range of activities when working with clients... Often, the more novel and interesting the activity, the better chance that patients will be compliant and increase the time spent in self practice. I might work with a patient whose grip is weak, but who wants to work towards being able to hold a cup in their affected hand. We might start with an empty plastic cup, moving towards a styrofoam cup (carrying without crushing), to cups with increasing dry weight, to cups with increasing amounts of liquid - and finally a walk to the cafeteria and return to the clinic with that cup full of liquid (which they can then drink). I can increase the challenge level , by asking a client to talk to me as we walk, as this multi-tasking will engage other parts of the brain. Patients working on fine motor control are sometimes challenged to keep time to music they enjoy. We start with unilateral and bilateral wrist motions. If they are able, we progress to individual digits. If they do well with this and are interested, I might move on to teach them rudiments, drawn from my days as a drummer in a dance band. For fun, I often attempt to teach them some of the names of the patterns, such as flamadiddle, paradiddle** and ratamaque. The terms can be as challenging to pronounce as the motions are to perform; we frequently end up having a good laugh together! Other patients learn how to play Solitaire, without a computer. This is a common activity for those needing to address deficits in lateral pinch, upper extremity motions (particularly of the forearm), as well as the ability to plan, problem solve and recognize errors. Each activity is introduced by 'attaching' it to an important ADL or IADL task, that the patient finds challenging or impossible. After treatment sessions using these novel activities, we engage in discussions about whether a client feels the novel activity is helping them achieve greater independence in the targeted ADL task. Patients will, on occasion, ask that we return to task-specific behaviors and that wish will always be granted. I want my patients, however, to understand that 'living' provides an infinite number of ways they can enhance their own recovery, if they will challenge themselves to use the affected limb at home, as well as in the clinic. Unique terms ** Paradiddles are one of 26 sequences of drumbeats (called rudiments) drummers are often required to learn. The paradiddle is made up of alternating beats R L RR or L R LL. * Connect 4 is a strategy game, played by two players, with each attempting to get 4 of their tokens in a row: vertically, horizontally or diagonally. With appreciation to Karate International of Raleigh, North Carolina for the use of their logo. Sources cited American Occupational Therapy Association (in press). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (Supplement 2). Advance online publication. Hillis, A and Tippett, D (2014, November 11). Stroke Recovery: Surprising Influences and Residual Consequences . Retrieved September 30 2020 from: https://doi.org/10.1155/2014/378263. Kyung et al (2014). Correlation between the activities of daily living of stroke patients in a community setting and their quality of life . Retrieved September 30 2020 from: https: // www.ncbi.nlm.nih.gov/pmc/articles/PMC3976015/ Misook et al (2016). Effects of Self-Esteem, Optimism and Perceived Control on Depressive Symptoms in Stroke Survivor-Spouse Dyads . Retrieved September 30 2020 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526460/pdf/nihms-640858.pdf Kwon et al (2004). Disability Measures in Stroke: Relationship Among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale . Retrieved September 30 2020 from: https://www.ahajournals.org/doi/pdf/10.1161/01.STR.0000119385.56094.32 The All Japan Kendo Foundation (n.d.). Retrieved from: https://www.kendo.or.jp/en/knowledge/kendo-origin/

An eating disorder is defined by abnormal eating habits, which negatively affect a person's physical and mental health. These mainly include: Anorexia nervosa, Bulimia nervosa, binge eating disorders, Pica, Rumination disorder and Avoidant/restrictive food intake disorder (AFRID).

Author: Ryan Osal, MS, OTR/L, CEAS, CHC

As clinicians we are trained to be client-centred in our approach. Meaning the clients’ goals, values and interests are the driving force behind the interventions we provide. This obviously requires clinicians to listen and clients to open up and disclose their struggles with us. In my journey, I have met many mental health professions from all different disciplines. However, the one thing that makes me feel safe in opening up to you is whether I feel I know and trust you. As a patient we are too often expected to quickly share our life story with you, our history of abuse, past suicide attempts and self-harm. All which many of us are ashamed to disclose and to someone we have just met. If this process is done in an insensitive and matter of fact way, it can leave us feeling even more vulnerable and alone. So how can we help our clients feel safe and open up? The professionals who have had the greatest impact on me have been those I have got to know myself. Who have shared a little piece of their life with me and made me feel that I am a person and not another ‘patient’ on their list. The best memories I have of my admissions are the times when I have been able to listen to my nurse’s story and laugh together as we shared why he/she wanted to become a nurse, what their interests are, their pets, and about their culture. In sharing a small piece of your life with me, it’s like a visible connection is formed from my soul to yours and I can see that you, just like me, are a person. A person who cares to spend their time with me and not for the sake of ticking some mental checklist off in your mind. I hate seeking help from people when I am admitted to hospital. I find it really unhelpful when someone I barely know says ‘I am your nurse this afternoon, if you need anything come get me’. Those are the times I feel so alone and isolated in hospital. I have learnt that the clinicians that don't feel afraid to share with me and don't think I’m ‘dangerous’ are the one’s I will seek out for help. As patients we often feel like we are on a conveyer belt. Each day are new faces, new people we must open up to and disclose our inner most thoughts, which all starts again the next day. It wasn’t until I became a patient that I realised how strange it is for me to be in the opposite role no longer asking the questions but giving the answers to a stranger. As clinicians we should feel privileged to partner with people who are in the depths of despair. As a client I want to partner with you. But this requires trust and a mutual understanding of each other, which often starts with you. I encourage you to not be afraid of sharing a small part of yourself with your clients. In doing so, you treatment and advice is going to be more accepted, understood and appreciated. Think about what you feel comfortable talking to your patients about e.g. pets, holidays, children, culture, your studies, your mistakes in life and importantly what made your work in mental health. It will make a huge difference to your clients and perhaps your own work satisfaction. Thanks for reading! To get the latest information please see: www.facebook.com/OTforBPD

A couple of weeks ago I attended a networking meeting run by a local university. As part of the event, a few of the lecturers did a presentation on various occupational therapy models. It was an interesting feeling 'going back' to uni, and having a refresher course on things that had been hammered into me while I was there! I felt pretty confident that what was being talked about had become an automatic part of my practice. I left the presentation feeling pretty sure that what I had learnt years ago at uni was still being applied in my day to day practice. Then I met one of the lecturers and got chatting with her about the struggle to find appropriate placements for her students, as a fair few private occupational therapists are not focusing on occupation, rather they are too deficient focused and are using non evidence based therapies. After hearing all her concerns, I suddenly felt that maybe I wasn't applying occupational therapy principles as well as I thought I was. I was guilty of doing some of the things she had issue with! I know that the 'ideal' isn't always completely relevant or particularly applicable for real life. In the workplace, you come across situations that uni simply can't prepare you for. You develop your own style and repertoire of knowledge and skills. Sometimes all you have is your clinical judgement to make decisions, because everyone is an individual, and no one size fits all. But the core concepts that you are taught, that makes your profession what it is, they don't change. Sure there might be advances, new research, new ways of doing something. You might trial something that hasn't yet been validated by research or studies. But at the end of the day, teachers still teach, engineers still engineer, and occupational therapists focus on occupation. I was confronted with the challenging thought of "Am I even doing this right?" My colleague and I walked away from the meeting discussing our practice, and analysed if what we were doing was goal oriented, strengths based and  occupationally focused. We decided it was, yet I continued to go over and over everything I have ever done, said or wrote. And then I begun wondering, why was I struggling so much to understand what was 'right' in my own profession? After much reflection, I think that it's because occupational therapy has been diluted. That sounds really harsh, but as I started talking to and reading blogs from therapists, students, educators and parents I realised I wasn’t the first to come to this conclusion. Why do I think our profession has been diluted? I think in part it’s because occupational therapists can work in such different ways, and across vastly different settings. We often work in multi- or trans-disciplinary teams, so the lines between our profession and others can be blurred. If you go to a job search website, you'll see adverts for a Physiotherapist/Exercise Physiologist/Occupational Therapist as if we are interchangeable or one and the same. I have met occupational therapists who vehemently advocate for completely different therapies, often contradicting one another. There is no wonder that parents, families or individuals are confused about what constitutes occupational therapy, when as a profession we can struggle to agree. Leaving university, I felt are so sure of what occupational therapy is. We were taught to focus on occupation, to use it as a therapeutic tool, as a means to an ends. We were taught to advocate for and find meaning and purpose and to use a "top down" approach. But out in the workplace, it can be really hard to hold onto this. It can be easy to start looking at personal impairments rather than overall functioning. We get asked to help a child self regulate, or hold a pencil correctly, or to have better attention. It's our job to dig deeper, to find out the "why". Why does a child need to self regulate? What is the end goal? Self regulation itself isn't a goal, but self regulating in order to engage in a meaningful and purposeful activity is. It's easy to slip into the habit of focusing on trying to address individual differences rather than focusing on making changes to the environment and occupation. When listening to the models being presented, I thought to myself "I do that. I think that". But when I talked to someone who really did do and think those things, I realised I use a watered down version. That sometimes I did try to 'fix' the hand strength of a child in order for them to hand write, using an activity that had no meaning or relevance to the individual. That I have focused on improving an individuals attention, instead of focusing on adapting the environment and activities given to support what they can do. That I have used strategies because I had been told or shown them, and not necessarily looked into the research (which was sometimes very weak or non existent) behind it. Does this make me a terrible therapist? I don't think so. I think it makes me a therapist that might not be as good as I could be, but I don't think it makes me a "bad" one. I do set meaningful goals, I do look at the environment, I modify, grade and adapt tasks. I might slip into bottom up thinking from time to time, but I've also been told (on more than one occasion) that I always see the best in those I work with (and that maybe sometimes I should be a little more "realistic"... I refuse to accept that one!). I have to acknowledge that it is hard to be up to date on research for everything I do, and that I often need to use my clinical judgement and previous experiences to guide me. Research is limited, and a study may not have included the clientele I work with, or it may have been a small sample size. Sometimes I do have to focus on the individual, and work on their individual needs, but this should not be at the expense of meaningful and purposeful activities. An activity might be fun, but that doesn't necessarily make it meaningful. I think it comes down to having pride in our profession, and refusing to be cheapened by pseudoscience or quackery. We must hold ourselves accountable, at every moment and during every decision. I don't want ever want to be asked "why did you do that?" And have my answer be "to fix blah blah blah". Instead, my answer should be “in order for this individual to engage in an occupation that is meaningful and purposeful to them”. Last year, I had an OT colleague say to me "I think occupational therapy is just common sense". To me, this is as bad as occupational therapists spruiking advice that has no evidence behind it, or being deficient focused. We should not hold ourselves to such a low standard. If what you are doing is “just common sense”, then you're probably not doing it right. It's easy to look at a situation the same way as everyone else. As occupational therapists, we are trained to look at things differently. Sometimes simple is best, but if your answer is always "just common sense", then you aren't applying your skills effectively. It's easy to fall into bad habits, to do what others do without thought. It’s easy to be sucked in by convincing people who sound like they know what they are talking about. What's not so easy is being consistently vigilant that what you are doing is true to your profession. That what you are doing is evidence based. I think there is a reason we don’t have mountains of research in occupational therapy; we’d generally prefer to work with someone than analyse statistics. But we must hold ourselves and each other accountable. We need to be critical of therapies that put our profession at risk of a poor reputation through encouraging poor or lazy practice. We need to be able to define what sets our profession apart from others. I'm committed to making my practice better every single day. Who's with me? Originally posted on Rocket OT , as 'Standing on My Soapbox: A Paediatric OT's Ramble.

In January of 2021, I resigned my position as a staff occupational therapist, after 35 years in the field. It has been, to say the least, an incredibly rich, as well as challenging, journey. Although I looked forward to retirement, it has been hard to 'hang up my goniometer.' If truth be known, I'm still working as much on-call as when I was full time. To the best of my knowledge, I had never retired before, so retirement provided an opportunity for reflection , along with questions related to "What the heck do I do now?" I’m going to leave the future in the future for the moment. What I would like to do here is to give the reader a chance to laugh at some of my experiences, contemplate others and, hopefully, acquire a few more tools for life as an occupational therapist. The stories that follow are roughly in chronological order, from fieldwork to present. 1) Over Before it Even Started (almost!) My first patient while I was a student was a 30-something gentleman, who had crashed his ATV (all terrain vehicle) while out on a ride in the woods. Although he was in a coma there were almost no marks on his body, except for a pencil lead-sized wound just over one of his eyes. He had been tossed into a bush and a small branch had entered his brain just over that eye. I was asked to perform passive range of motion twice-daily until he 'woke up'. Sadly he never did; after his passing, a family member asked me if my therapy could have caused his death . I knew it had not, but the question was devastating. I seriously considered ending my occupational therapy career at that point. His attendant pulled me aside and said, "I know what you are thinking - and stop! You absolutely know that nothing you did caused this." Deep down I knew that, but I needed to hear it from another professional to regain my composure. Losing a patient can and will be devastating for your mental health. It will happen, but take comfort in the realization that you treat your clients with love and respect. 2) Learning from practice (Level 5 therapist?) My second Fieldwork took place at a psychiatric institution in the state of Rhode Island. One of the funnier memories from that experience was working with a young man who wanted to make something nice for his girlfriend. This site, at that time, operated under the Allen Cognitive Model . In the 80s, the model had essentially six levels; the sub levels that now exist were added at a later time. My patient scored at Level 5 in terms of his abilities. People operating at Level 5 had minimal cognitive impairments, but often did not consider the consequence of their actions . My patient decided he wanted to make a ceramic vase and I went over the instructions with him. The final instruction was that, when the timer rang, he was to pour the slip (mud) out of the mould. This was actually a Level 6 activity, but I was convinced that the evaluation was in error as he was verbally operating at such a high level. He assured me that he understood the directions and I moved on to work with a second patient. I kept him in eyesight, so I could monitor his behavior and noted that, when the timer rang, he dutifully poured the mud out… onto the floor. He had done exactly what I asked him to do, as I did not tell him to pour it back into the container. Prior to becoming an occupational therapist, I had earned a Master's degree in counseling. One of the courses we took required us to demonstrate competency in administering a number of cognitive evaluations. When I first encountered the Allen Cognitive Test I was extremely skeptical of its ability to diagnose cognitive function. From this incident, I developed a deeper respect for some of the assessment tools found in occupational therapy. The patient had significant skills in communication. What I neglected to consider was that verbal skills did not necessarily correlate with the ability to recognize potential errors in behavior. The entire experience was a lesson in humility... Perchance it was I who was operating at Level 5 that day? 3) Nurses My first physical disabilities position was at a medium sized hospital in Maine. Most days I found myself on the eleven bed rehabilitation unit. The nurses there were absolutely great and two memories about the compassion they displayed stand out. One day they brought in a survivor of a terrible automobile accident, an eleven year old boy. The family had been towing a new boat back to Maine when a strong crosswind caused the father to lose control. This child was the only survivor; he had lost his entire family in the crash. Certainly he had terrible physical injuries, but his emotional trauma was even greater. The nurses could have simply placed him in a wheelchair to move him down to the shower room each day. Instead, I think they sensed that what he needed most was emotional support, as each morning I would see one of them gather him in her arms and carry him to the showers. Another patient was a terminally ill woman with a large astrocytoma. Since the day she arrived on the unit she was deeply confused, which led to a tremendous amount of agitation. She had spat on, sworn at, scratched and just generally made her nurses lives difficult for weeks . Yet, on the day she was to be moved to the hospice, every one of the nurses she had abused stopped at her gurney to hug her, kiss her forehead and wish her well. Their compassion greatly calmed her . They also had a great sense of humor. On my last day at this unit I was talking with the charge nurse, when we heard a crash and call for help from the shower room. As she sped off she touched me on the shoulder and said, "We probably need help, come with me." We entered the shower room to see a transport chair on its side in one of the stalls. The next thing I heard was the door being slammed shut, as the curtains in each stall slid back to reveal more nurses armed with hand-held shower heads. They proceeded to use them on me, while my 'friend' the charge nurse made sure I couldn’t escape. Everybody got soaked but it was one of the funnier times I ever experienced as an occupational therapist. It was a hilarious way for them to send me off after two years on their unit. In the years that I taught, I would always tell my students that I never wanted to hear any of them complain about those who chose nursing as a profession. [Nurses] are truly the 'grunts in the trenches of a medical battlefield'. They deserve all the respect and assistance that we can possibly give them. 4) The Unholy Alliance: Physical and Occupational Therapy Patient : I've finally figured out the difference between Physical [Physiotherapy] and Occupational therapy! Us : Oh, what? Patient : Well, PT stands for physical torture and OT means occasional torture. Close enough! During my college years and early on in my occupational therapy journey, physical and occupational therapy battled constantly over 'turf'. Thankfully, I believe that those battles are pretty much a thing of history. An OT and PT team is a powerful entity . In evaluations, much of what we collect is identical; joint evaluations allow the patient to provide demographic information only once. Joint treatments can be just as effective when conducted by a team. In this situation, two sets of eyes really are preferable to one. Unfortunately, in the US, Medicare disallows payment for joint PT/OT interventions. Yet if you can work together, your patient will benefit greatly. 5) 'Common Threads' All too often we see our patients as 'the grouch in room 9', or one of a myriad of evaluations and treatments we need to do to get through the day. All this before we can even begin our documentation. I love working in hospitals, but some days we are overwhelmed by high caseloads and increasing demands. A 'common thread' is something that a therapist and patient share. It could be an experience, hobby or interest; virtually anything that allows a patient and therapist to connect 'outside' the medical setting. This point of mutuality allows both parties to begin to develop a relationship based on trust and respect; I might argue that it is the origin of the therapeutic relationship. As a veteran, very often the common thread has its origin in the shared military experience. When you first enter a patient's room, it is wise to remember that two evaluations are occurring simultaneously. Just as the therapist is evaluating the patient's cognitive and physical abilities, so the patient is evaluating the therapist. The patient is assessing whether the therapist appears competent and whether we have something to offer, in terms of their recovery. In addition, the patient is evaluating the therapist's demeanour, deciding whether they even want to work with us. Prior to starting a new evaluation on a 70+ male years ago, one of his caregivers told me, "Oh, he is the laziest man you’ll ever meet, he does nothing for himself." I introduced myself to the patient and explained what my role was in his recovery. When I asked him what he might like to do, he replied that he needed to use the bathroom. Afterward he gruffly told me he couldn’t perform his own hygiene (all of this was stated in rather more blunt terminology!) Needless to say, my initial impression of this man was not great. In the days to come he would always be too tired, uninterested or just irritable. I began to put him late on my daily schedule, knowing that he would refuse therapy. One day I entered his room to find him asleep (as usual) with a newspaper across his chest. It was opened to an article about a controversy, centered around the possible reclamation of two aircraft that had collided and crashed into a large lake in Maine, during WWII. The aircraft had been flown by Canadian student pilots and their remains were still in the wrecks. The Canadian government viewed the aircraft as gravesites and was against them being disturbed. As I looked at the article, my patient awakened and I asked him for his view of the debate. He replied, "I flew one of those during the war." My immediate thought was that he couldn’t fly his butt to the bathroom and back, so how could he have flown one of those. I said to him, "You flew an F4U?" I really didn’t believe him and thought I could test him, by referring to the official designation of this plane. His eyes widened and he replied, "You know about the Corsair?" In the days that followed, I would always begin by asking him about his experiences in that plane. After a short history lesson he would look at me and say, "What do you want me to do today Bill?" His entire demeanour and willingness to work with his therapists changed. In the end I came to know that this was a man who did fly in WWII and who turned down an offer from his commander to attend law school free of charge, at war’s end. He did attend college, earning degrees in dentistry and theology. His post-war years were spent flying bush planes into remote parts of South America, bringing dentistry and religion to those he met. A mutual love/interest in aviation was our common thread. But the experience also taught me a valuable lesson: don’t write people off just because they are difficult. I used to tell this story to my students, along with the point that this patient had called me a 'gentleman' on our last day. I tried to make it clear to my students that, if I had not kept searching for some common ground , I would never have learned his story - and he would have gone to a nursing facility, instead of his assisted living residence. 6) Ahh I’m sorry, but can you repeat your question? Standing in front of a class of students, who have chosen to major in occupational therapy, is simultaneously thrilling, terrifying, rewarding and frustrating. If you ever have a chance, even as a guest lecturer, please take advantage of it. Students are hungry for clinical anecdotes, both as a way to understand the why of what they are required to learn, as well as how the learning will be used in treatment. The fact that many instructors have left the clinic to teach is one of my pet peeves. We need to be teaching content that is relative to what the student will encounter in her/his own professional life. I frequently compare students to chrome mannequins. If there is no framework to attach new learning to, it simply slides off. As a professor, my job was not only to be professionally competent in my skills, but to have developed a method to assist my students incorporate new learning into the frameworks they already have. It is challenging, at times frustrating, but so incredibly rewarding, when you see the light of understanding in their eyes. Oh the title for this section? After years in the military, riding motorcycles and heavy use of power tools, my hearing gradually began to fail. It got to the point where any question posed by a student had to be repeated at least three times. If you approached me during a test, asking for a clarification of a question, whispering… there was NO chance I would understand. When I finally got my hearing aids, I turned to my class one morning and said, "If you talk behind my back now, I WILL hear you." We all got a big laugh out of that. 7) The Missing Switch He had survived something like six strokes. Although physically able to ambulate, dress, bathe etc., he could not. I would ask him if he wanted to get dressed, to which he would reply "Yes", but then he would sit there. The patient could even describe in detail what we were asking him to do. At one point we began to think he was just flat obstinate. One day, a nurse walked by and asked him if he was cold without his shirt. He replied yes, at which point she held one out for him. He immediately took it and put it on. We began to realize that he could perform tasks spontaneously but not to command . He just couldn’t find that 'switch'. Sadly, he was never able to go home, as the family could not understand our explanation of his behavior. I went to treat him in his nursing home one day; walking down the hall I could hear someone saying "Help me, somebody help me" in a muffled voice. I walked into his room to find him in his bathroom. He was standing at the toilet, pulling toilet paper off the roll, but couldn’t figure out how to stop. The toilet bowl had the prettiest stack of white tissue in it, resembling a giant ice cream cone. When I handed him his toothpaste, he grabbed it and exclaimed, “Oh thank you." Essentially, our strategy was to stay one step ahead of what we wanted him to do. Initially, the physical therapist involved in this case and I spent a considerable amount of time trying to understand why our patient could not follow requests . The patient was, at all times, friendly and eager to work with us, so assuming he was being obstinate did not seem likely. His behavior did not suggest either ideational or ideomotor apraxia. He understood the 'idea' of objects and tasks. He could perform 'motor' behavior spontaneously but often, as in the anecdote above, could not start or cease a behavior once initiated. These issues were not solely related to ADLs. As he and I walked to the bathroom one day, he spied the open doors of the wardrobe in his room. What do you do with an open door? Walk through it! Very shortly he had 'folded' his tall frame into the wardrobe. I got in with him and he laughed and said, "Bill we have to get out of here." I replied, "Yup, I'm working on it." My best guess was that the transient ischaemic attacks (TIAs) had damaged a portion of the brain responsible for initiating or stopping behavior. 8) “Well son, I’m 93 and no man has ever seen me naked” Another rehabilitation hospital, this one in Portland, Maine. My patient was a 93 year-old woman, never married, who had just come through bilateral hip replacements (WHY would you do them both at once!) I went to meet her the day before and explained what we would be doing the next morning. I told her that I understood that she might be uncomfortable working with a man and asked her to think it over. I would try to find one of the women therapists to work with her, but that we were short handed. The next morning I entered her room and re-introduced myself. "Have you had a chance to think about bathing and dressing?" "Yes" she replied. “I’m 93 and no man has ever seen me without my clothes. Then I got to thinking; I’m 93, what the heck do I care?" she said, with a smile and a laugh. She did have to give up wearing her traditional garters, but she did go home! 9) North Carolina days Bilateral shoulder pain in a 92 year-old female... Me : "Ma’am, is there anything you do during the day that seems to aggravate your shoulders?” She : "Well, when I’m out there chopping wood it bothers them." Me : "You still chop wood?" She : "Well, somebody's got to do it. My daughter works and the kids are all in school." Me : "Ma’am, how much wood do you chop?" She : (Looking at me incredulously) "I chops till it’s done." Me : (To daughter out in waiting room) "Does your mom still chop wood?" Daughter : "Oh yeah, we can’t keep her out of the woodpile!" The patient and I agreed that she would count the number of pieces she split each day for a week. We averaged the number and I asked her if she might just chop half that number each day. She agreed and consequently the pain went away. Discharge ensues. A Lifetime Together She had fallen and incurred a fracture to the distal radius of her left forearm. The fracture heals well and motion begins to return. But she is absolutely one of the saddest people I’ve ever met. She related that her husband had recently died; that she had spent every evening in the hospital with her husband of 50 plus years. One morning, she awoke to find he had passed away during the night. He was on his side with his face pressed against the rails of his hospital bed. She could not shake the guilt that she had slept through his final minutes and he had died in such an uncomfortable position. In her grief and guilt this lady had completely withdrawn from any contact with friends - and life in general. In the weeks that had passed since her occupational therapy treatments had started, she had spoken often on how they had met, grown up together and eventually married. They had literally spent a lifetime in each other’s company. The treatment prior to her final one I asked her to consider another possibility. Perhaps he had known that he would die that night and wanted his last memory to be that of the fifteen year old girl he had married decades ago. So he rolled onto his side, getting as close to her as was possible and gazed at her in those final minutes. She didn’t say anything, just donned her coat and left. A week later she entered the clinic one last time. "Bill, I don’t know that what you described is what happened. But I’ve decided that it might be and that I need to go on living my life . I’m going out with my girlfriends tonight and for the first time in months, I’m looking forward to it." 10) …and in the end When I arrived at this final chapter I found myself completely stumped. No anecdotes to relay to you, nothing stood out from these last seven years. I finally began to realize that maybe I’ve come to a point where I can appreciate all my patients, not just the special cases. Every patient has a story, if you will just listen . Therapy is a 'dance' between two people. Just as in a dance, sometimes you lead; but, to be effective, you need to be willing and able to step back and let your patient 'lead.' The patients, who I have been honored to work with over these decades, have enriched my life as much as I may have helped them understand how to heal their bodies and minds. In closing, I would like to leave you with the words of Michael Weisskopf, a Time Magazine Senior Editor, who was severely wounded while on assignment in Iraq. Weisskopf saw an object fly into the back of a truck in which he was riding. The object was a hand grenade and as he attempted to throw it out it exploded, taking off part of his right arm. "For me, occupational therapy was a land of potential, a place to stop grieving and learn how to compensate for my injury, with technology and ingenuity. It was my bridge to a normal life." Reference Weisskopf, M. (2006) Blood Brothers: Among the Soldiers of Ward . 57.

Occupational balance is a core concept underlying the practice of occupational therapy. Whilst occupational balance cannot be defined in a ‘blanket statement to fit all’, occupational therapists generally consider that engaging in a balance of activities, within the broad functional areas of self-care (including rest), productivity and leisure , is fundamental to well-being, happiness and health. Achieving a sense of occupational balance is a dynamic process ; it is not a state of being, or something you seek to achieve one day and that’s that. It differs for each person, depending on their roles, responsibilities, routines and habits , plus their own subjective perceptions of quality of life and well-being. All of these are of course ever-changing. My favourite definition is from Catherine Backman (2004, pg. 208), who proposes that occupational balance is: “a relative state, recognisable by a happy or pleasant integration of life activities and demands” This definition acknowledges that exploring this concept is a personal affair , requiring constant review. During these strange times, we are noticing the impact that isolation and lockdown, as a result of COVID-19, are having on people’s ability to achieve a sense of occupational balance; particularly if they are also struggling with pre-existing or new mental health symptoms, recovering from physical injury, or living with a long-term disability, where occupational balance was perhaps already compromised. Many people have needed to focus their time on changing how they work , getting to grips with video conferencing and the like, missing being with their work mates, or perhaps getting used to not being able to work at all. For key-workers on the front line , or people with relatives unwell, times are beyond tough and a whole plethora of emotions are being navigated. Others are needing to juggle their different roles and responsibilities, for example suddenly needing to home school their children, at the same time as working from home. This change in people’s usual roles, responsibilities and routines will undoubtedly limit their capacity to engage in necessary and meaningful self-care and leisure/social activities. Indeed, some leisure and social activities, that many previously enjoyed and valued, are currently not possible or accessible. Not everybody has the ability or means to use the internet and social media to stay connected with those around them - and, for most people, virtual contact does not compare to being physically around people . This is putting some at high risk of being deprived of occupations that are crucial to their mental and physical well-being. However, as a positive, we are also noticing a trend in people using this time to reflect on their balance of occupations, perhaps comparing how their life was before the crisis and how it is now, finding some things to learn from. People around me (including myself), plus people in my wider (social) network, have been voicing some positives about spending more time at home , below are a few examples: It has helped them connect more deeply with their loved ones Has enabled them to engage in meaningful activities that they perhaps did not make time for before, for example reading, playing games and creating art Has given them time to get those jobs done around the house that they have been putting off for ages Has reduced the stress of being stuck in traffic or waiting at train stations I have observed that people are using this time to think about what they would like their lives to look like when this global crisis passes i.e. ensuring that they continue making time for activities they enjoy . It also appears that people are practising gratitude a lot more at present; reflecting on what they do have and can do, plus acknowledging the contribution of those close to them and the amazing statutory/private services available to help, which can only be a good thing, right? To start exploring what occupational balance means to you, you could ask yourself some or all of the following questions: What activities are the most important to you and why? This may be your career, exercise, spending time with family/friends etc. Looking at that list, do you generally allow enough time for each of these activities in your life? Is there any type of activity that is/was dominating most of your time? Think about the categories mentioned above: self-care, productivity and leisure. What are you finding difficult about achieving a sense of occupational balance? Or in other words, what is currently stopping you from engaging in the activities you enjoy? (The answers to these questions tend to be either personal/internal e.g. motivation, habits and behaviours, fatigue, physical limitations, cognitive factors, lowness in mood, or, external, e.g. time, money, physical environment, social environment). What have recent events taught you about how you usually balance your occupational activities? And, what can you do moving forward to ensure that you achieve more occupational balance in your life? (p.s. the answer(s) to the last question may entail asking for help). Georgina West, Occupational Therapist OT|33 Occupational Therapy and Wellbeing Tel: 01908 551877 Email: info@ot33.co.uk Reference Backman, C, L. ( 2004) Occupational Balance: Exploring the Relationships Among Daily Occupations and Their Influence on Well-Being. Canadian Journal of Occupational Therapy. October 2004.

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub

By Jamie Grant - Director, The Occupational Therapy Hub. Originally written in 2016. UK stroke discharge service.

Over the last couple of supervisions I have carried out, with a wide range of occupational therapists from regional directors to students, I have had some valuable insights from them about the real added value for OTs of external supervision. Because I am independent of the organisation, we can identify the direction that you want to go, without an agenda that a manager or colleague would have. We can explore your resilience to carry out your plans or goals, again without the needs of the organisation overshadowing your personal and professional development. The reason for this is that I don't come with an agenda, I don't live in your world. I am completely neutral in exploring your world with you, from your perspective. Supervision provides a safe, confidential space to unburden yourself of all the worries and challenges of the month. It all goes on the table in front of us. You prioritise the things it would be most useful to pick up, examine, identify the value of, and work out if it's worth prioritising to talk about. You set the agenda. I am not your line manager or someone you work with everyday. We don't go outside the room and revert back to our roles and get on with the day job. Because I am not part of the organisation, your action plan doesn't have to fit in with the 'Strategic Plan'. Occupational Therapists I work with tell me that the freedom that brings is incredible, it's different from any supervision they have had before. Imagine having an hour or two that is totally dedicated to you, your priorities, your personal and professional development? Working as a health care professional these days is a high pressured demanding job. It needs some decompression time. Take a moment to think about how are you achieving that for yourself? Do you need a bit of time dedicated to enhancing your personal and professional development? Think about how you relax, how you keep your occupational balance? Could external supervision be part of that for you? Have you read my testimonials? Everyone uses the sessions differently, everyone feel in a better place after the sessions. Imagine if you had external supervision. Tell me what difference could it make to you? I would love to hear from you. Margaret Spencer margaret@ot360.co.uk

By Jimmie Wilbourn, OTS, Florida International University Why would I travel out of the country for my level 1 fieldwork when I can complete the requirement nearby? Wrong question. Why would I not travel out of the country if I had the opportunity? Better question. Now, I understand there are circumstances where traveling abroad is not feasible. Those notwithstanding, allow me to indulge you for a moment. As future occupational therapists, we must find it within ourselves to strive for cultural competence on a daily basis. This term is not some esoteric concept that only those with infinite wisdom and understanding can master but rather it is a fundamental principle that we must uphold in our practice as we engage with our clients. Interestingly, the definition of cultural competence is elusive however, according to Odawara (2005) “it is not only developing the awareness that culture is an issue in health, illness, and health care, but also learning one’s own cultural assumptions, values, and beliefs in order to interpret the therapeutic situation from multiple perspectives” (p. 326). Importantly, the AOTA Code of Ethics (2015) expresses under the principle of autonomy that when providing care we must acknowledge a person’s right to hold their own views, make choices, and make decisions based on their own values and beliefs. If that wasn’t enough for you then allow me to trek forward with more enthralling evidence. The Occupational Therapy Practice Framework: Domain and Process , 3rd edition (2014) has an entire section devoted to the cultural context, which include: customs, beliefs, activity patterns, behavioral standards, and expectations accepted by the society of which the member belongs. To further feed the cultural competence fire, the Framework states that culture plays a pivotal role in shaping our values, roles and our choice of participation in meaningful activities (AOTA, 2014). Are you a believer yet? In school, we are tested on cultural competence and the concept is sprinkled throughout the entire occupational therapy program to become implanted into our very being. Is that enough to make us competent and effective entry-level practitioners with the skill of cultural competence proudly displayed on our resume? I think not. To become good at anything we must practice. Which is why I went to the Bahamas for my level 1 fieldwork to immerse myself in a culture different than my own. There is no doubt that the beginning of my occupational therapy journey will be forever impacted by my fieldwork in the Bahamas. I was welcomed by kind and affable people who represented a culture full of self-expression and hospitality. It became apparent early on that therapy was more than just a service for these clients rather it was a time to make a connection and socialise on a fundamental human level. Even within a time of need, humour and jovial conversation filled the therapy room. During my time in the clinic I began to notice how the Bahamian culture intertwined into a therapeutic session. For instance, they showed an immense pride in their country and made sure that I was soaking in everything their island had to offer. A client would often share places to eat, sites to visit, or how to manoeuvre around the island on the local buses. The culture seemed to have an underlying tone of calmness and reassurance that time could be embraced and slowed down. Clients would sometimes miss appointments but rest assured they would come by later in the day when they were available. Additionally, due to space constraints on the island, families would often own one vehicle so it is important as a therapist to recognise the impact this may have on making it to appointments on time. Another key point is that the clients were not passive recipients of care. They were informed consumers that wanted to know why we used a certain exercise, modality, or therapeutic activity. Overall, their attentiveness helped me hone my ability to relay the evidence behind our therapeutic process. In essence, the power of occupational therapy lies within our compassion, creativity, ingenuity, knowledge, and desire to be a client-centred profession. It isn’t always about how many tools are in your OT toolbox but rather the quality and purpose of the tools inside. Commit to filling your toolbox with cultural competence and reap the benefits of helping your clients achieve their goals. If you need me, I’ll be eating conch fritters and dancing the night away at a Junkanoo festival. References American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl. 1), S1-S48. American Journal of Occupational Therapy, September 2015, Vol. 69, 6913410030p1-6913410030p8. doi:10.5014/ajot.2015.696S03 Odawara, E. (2005). Cultural competency in occupational therapy: Beyond a cross-cultural view of practice. American Journal of Occupational Therapy, 59, 325–334.

I always use the phrase "Make the most of every opportunity” - and this opportunity is one I will never forget. In April 2018, I was delighted to be one of the nine students from Coventry University to go to Lithuania on a field trip for the week. In this article I am going to share my experiences, reflect and promote the benefits of working with other students around the world. I hope you enjoy reading! We spent most of our time based at Klaipeda University to complete a Sensory Processing Disorder course and stayed on the university campus in accommodation. For three mornings in the week, we visited the children’s home using public transport. On our final day, we had the chance to visit Palanga , a beautiful town and beach in Lithuania. This trip gave us the opportunity to put on our 'sensory goggles.' Meeting the Belgium and Lithuanian students On our first day of the course, we had a welcome lecture and this was followed by a group task. Encouraged to find a partner from a different country, and discuss our sensory preferences. Including likes/dislikes using different senses. This gave us the opportunity to start communicating to the Belgium and Lithuanian students, and our task was to make a creative name badge for our partner. By the end of this task, I felt that I knew my partner and other students on the table well. It surprised me how quickly we all got to know each other, started to build friendships which developed over the week! Following day trips, evenings spent together and spending the days at the university, I think we can all agree we didn't want to leave each other at the end of the week. This highlighted that even though we are all studying Occupational Therapy in different countries, we still have equal passion for the profession! #ValueofOT Let’s H-OPP together The Hasselt Occupational Performance Profile (H-OPP) is used as a framework to explore the clients daily functioning. The main components of this model include the client’s perspective, internal/external factors and considering the environment (Ghysels et al 2016). Gathering information using H-OPP helps us to form an Occupational Performance Diagnosis. At first, I thought it would be overwhelming to learn and apply it in practice in a short time frame. However, I used knowledge of models we use in the UK e.g. MOHO and CMOP-E and identified similarities/differences. Working in groups with the Belgium and Lithuanian students, allowed us to support each other when applying the H-OPP framework before creating the child’s Occupational Passport for our final presentation. Group work During the week we participated in several group activities and presentations. Each group had a mix of Coventry, Belgium and Lithuanian students. The image to the right shows 'Envir-OT'. This is a presentation based on our ideas for a new sensory app, highlighted areas of the environment which could impact an individual's sensory needs. This showed different working styles, but also gave us the opportunity to help each other to understand the task while sharing ideas. In the children’s home, the Lithuanian students in my group did an amazing job of starting conversations with the carers. Our task was to choose a child to focus on for our final presentation. We found it useful to ask the Lithuanian students to gather information regarding the children’s Activities of Daily Living, their likes/dislikes, and health conditions. This conversation was translated to us back in English, so we could record the information. The Occupational Passport helped us to consider the child’s sensory needs, and communicate these clearly. This is a document which could be used with the child’s family or for health professionals, and can be added to as the child develops further. I think if I wrote about all my experiences from this trip, I would be writing for days! In conclusion, I am so pleased that I had the opportunity to go to Lithuania! Not only have I learnt more about cultures, students and Occupational Therapy in other countries. This field trip has allowed me to develop my own skills, especially my confidence. This will help me through the rest of my time at University, and for future practice. I would like to thank all the students and the lecturers for making this trip so enjoyable, and full of memories! The image below is from our final day of the course, receiving our certificates during our mini graduation ceremony. Celebrating the amazing time we had during the week! Any other questions about the field trip to Lithuania, I’m happy to answer these via twitter @bethjmOT or email marsha98@uni.coventry.ac.uk . I look forward to sharing and presenting our poster at the Coventry University 16th Annual OT Student Conference . Can’t attend? Why not follow the tweets by using the hashtag #CovUniOTconference2018. Reference Ghysels, R., Vanroye, E., Westhovens, M. and Spooren, A. (2016). A tool to enhance occupational therapy reasoning from ICF perspective: The Hasselt Occupational Performance Profile (H-OPP). Scandinavian Journal of Occupational Therapy, 24(2), pp.126-135.

Studying for the NBCOT Exam is stressful, exhausting and feels like a process that will never end. One of the few worse things than having to do it once, is doing twice, three times or even more. Here are ways to ensure you don’t make mistakes so you do it once, and get it over with. Learn many topics at a time Trying to master multiple topics at once can add even more stress to the process, learn one, do well on quizzes and tests and then move on, periodically doing quizzes on the topics over the course of your study period to ensure you don’t forget the information. Doing the same thing over and over, expecting the same result If something isn’t working, don’t force it. Learn from your mistakes and take a different approach, making tweaks until you get it right. Not having balance This is so, so crucial. While it's important to be focused with your eyes on the prize, spending time away from the books is imperative; go see friends, workout, spend time outside, whatever allows you to relax and take your mind off things.The time away from the books will only allow you to be more focused when you’re reading them. Being distracted when you’re working You read that right, put your phone away, turn the TV off and pay total attention to the work you have to accomplish. Not only will you be more productive, but you also won’t have to work nearly as long when you’re 100% focused. Changing your answers Unless you’re 99.9% sure, don’t change your answer. Your gut is almost always right and usually, when you want to change your answer it means you’re over analyzing a question too much. Not making a study schedule Mapping out when you’re going to study specific topics helps alleviate some of the stress that comes with preparing for the NBCOT Exam. If things don’t go to perfect plan, don’t freak out, just figure out what days you can catch up on topics and start chipping away. There you have it. Studying for the NBCOT Exam doesn’t have to be as stressful as its made out to be. By following these simple tricks, you’ll make your life easier and your study time, tremendously more effective. About Us Pass the OT offers the most effective and affordable study prep for the NBCOT® exam. Since launching in June of 2013, our web course and one-on-one personal tutoring via Skype/phone has helped over 1500 students pass the occupational therapy test (NBCOT® exam).

The article has been a sort of 'OT Updates', as you can find here on the Hub, where I’ve been writing about news in occupational therapy, from a Swedish perspective. From new laws, new findings in science and other news relating to us OTs. Jan 08, 2019 Green thumb therapy A few months have now past since Black Friday, the holidays are over and all the gifts have been opened. All the early reports I’ve seen seams to say that even this year we broke all the records for buying new things during this part of the year. By now news of how 2019 will change the future with new gadgets, new technology and new science are already filling up my retinas. Our consumerism doesn’t really seem too slow down now does it? A couple of weeks back I came across a news article about how “Green thumb therapy succeeds where other fail”. A great short piece about how occupational therapy is used to engage patients in gardening. My last post looked at a thesis about physical activity among older people in assisted living facilities. Where, unfortunately, many of our elderly don’t get enough physical activity during the day. This thesis mostly looked at the indoor environment and what it offered the elderly as a mean for being active during the days. When I read about assisted living most news are about how robots will change healthcare. How robotic assistants will keep our elderly company. Sadly I don’t read so much about how elderly get to explore the outdoors. In Sweden “green therapy” is really growing. Even though some newly built assisted living facilities have some sort of garden we mostly talk about “green therapy” as a measure for people who struggle with returning to work. Or for people with mental illness. And all I can’t think about is why we don’t use gardening more? Why we don’t spent more time outdoors with our elderly? Why most of the time we look at new technology that can help us with this or that? Im not saying us occupational therapists shouldn’t participate in the future of new gadgets and aids. On the contrary, I welcome it. Because the development for new tools and gadgets is inevitable and will absolutely help with eg. our working environment. But sometimes I think we really need to take a step back and read an article like the one linked bellow. About how simple gardening helps people be more active. How it makes them feel happier and makes them open up more. How being outside is the motivation for getting up out of bed in the morning. For us on the north side of the globe winter is upon us. But like the saying goes “There's no such thing as bad weather, only bad clothes” ________________________ https://www.columbiatribune.com/news/20181127/green-thumb-therapy-succeeds-where-others-fail #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Nov 23, 2018 Physical activity among older people in assisted living facilities This is a long awaited thesis, on my part. At work the discussion about a reablement and letting our patients be as active as one can be is always a topic. It might seem easy and should be considered as self-evident, that even though you are living in in assisted living facilities you should have the possibility to participate in different physical activities every day. But this is not always the case as this thesis shows. One should know that there are specific recommendations for people living in assisted living facilities. In the 4 different articles we can read that: Older people and staff do not always define the concept of physical activity. It is important for the staff to be aware of these different definitions. With such awareness, staff can create activities that the residents want to do and thus meet their individual needs in their daily lives. Residents are not involved in determining which activities should be available in the facilities. But if you are able to walk around on your own and the facilities have a gym/exercise room you have more opportunities. It was accepted that the residents’ individual needs cannot be met. Furthermore culture and norms might determine how the staffs acts. (Be prepared to have your OT mind blown) The environment play a big role on the possibility of physical activity in the living facilities. Among the staff and residents there was an acceptance that not all environments in the assisted living facilities were optimal. Even though the thesis mainly focus on physical activities and physiotherapists there is much interdisciplinary knowledge we can use as OT’s. I know the thesis is in Swedish but there is an English summary of 8 pages with lots of good sources. You can find the thesis in the link below. Have a great weekend! _____________________ http://www.diva-portal.org/smash/get/diva2:1247169/FULLTEXT01.pdf https://goo.gl/UeFjQv #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #arbetsterapi #arbetsterapeut #arbetsterapisverige #rehabilitering #theothub #occupationaltherapy #occupationaltherapist Nov 14, 2018 Patients’ Experiences of Accessing Their Medical Records We all are affected when it comes to writing and keeping journals of patients' care. In Sweden, we occupational therapists are, by law, required to write a journal and keep medical records. But how we do this is not as clear as one would hope. We have 21 regions (Public health care) and 290 municipalities (commune healthcare), who all choose which program to use and none of these programs seems to communicate that well with each other. We also have to give all the information necessary to the patient, to make them involved in their own care (e.g. explain different treatments and why results may vary, inform what type of wheelchairs we can provide, show what different colours the walking aids come in and let the patient choose...and so on). One way to give patients a chance to get involved is to give access to all information and medical records. In 2012, Region Uppsala gave its 300,000 citizens access to their medical records through a patient portal “ Journalen ”. Since then, more and more regions followed and now it’s a national service (although private companies and the healthcare services in the municipalities are not get connected to the service). Although I must add, this wasn’t easy. Many complaints from different caregivers and worried staff have been seen in the media this last couple of years. Despite all of this worrying, it seems patients like this service. A series of studies are being conducted by DOME - to see patients' experiences of accessing their medical records, how different patients use this service and finally a study on the contrast between the worrying health care apparatus and the patients' experiences. The study was conducted by a survey, whom 2587 patients from all over Sweden initiated. The majority of respondents reported to use the service “Journalen” about once a month. The top three reasons for using it To receive an overview of one’s own medical history and treatment To follow up on doctors' visits To become more involved in one’s own care The top three reasons why patients believe that “Journalen” is important It makes them feel more informed It improves their communication with care It results in a better understanding of one’s own health status If you want to read more, you can find the link to the full text below: https://www.jmir.org/2018/11/e278 Have a nice day! Nov 8, 2018 What to do when you retire? Have you ever thought about what you will do the day you retire? As it seems this is one key factor for good health after you retire from work. This week BJOT gives you free access to their articles. There I stumbled on the study ”The influence of work on the transition to retirement: A qualitative study” takes a look at the transitioning phase from work to retirement through the eyes of occupational therapy. It’s a small study with only 11 participants, but since we are getting older and more and more discussions arise on how people should and could work in a later age, I find this study worth reading. The authors found three themes “preparation”, “transition” and “retired” relating to the retirement stage and the volitional processes from MOHO. How does this article affect us OTs? Well we all focus on engaging our patients in meaningful activities. By assisting in adjusting to life transition (work-to-retirement) we can do just that. Either by helping people find meaningful activities outside of work, or by adapting the workplace so the environment is adjusted for the person. Well this is just the short version of the article so if you find this interesting be sure to click the link bellow. The full text article should be available at least until this Sunday. http://journals.sagepub.com/doi/full/10.1177/0308022618766244

From the moment the message was received about this trip, I knew I wanted to go! From 21st to 29th September, I was extremely excited to be one of ten students from first year occupational therapy to be going to Cape Town, SA. In this article, I will share my experience on the field trip as well as reflecting on my time, learning about occupational therapy in South Africa and the opportunity to talk to other OT students. I hope you enjoy giving this a read. The first weekend we were there we of course did some touristy things! I had never been to south Africa before so this was a new experience for me. We were staying in a hotel in Cape town and it had the most stunning views of Table Mountain and the sea. one of my favourite activities we did that weekend was definitely the big five safari and driving all the way to cape point. After the weekend of sightseeing we visited many interesting places. On the first day we visited the children’s home which was in the centre of cape town. When we were there, we were given a tour of the site and we even ended up playing a football tournament with the children. During this first visit was when I first witnessed a culture difference in South Africa. The lady who managed the home stated ‘we can’t host children who are mentally retarded because we don’t have enough staff for these children’. The word ‘retarded’ put me in an uncomfortable position as I thought for a second, she was using the wrong descriptive word at first. This is because in the United Kingdom calling a service user ‘mentally retarded’ would be against regulations. The next place we visited was the private paediatric centre called the success therapy centre. Here the group had a discussion with a paediatric OT who owned the centre. This was an interesting visit for me as on the occupational therapy course at Coventry university, unless you do a placement in paediatrics or your third-year option module in this then we don’t get taught OT in this area. We then visited HOPE which is an isolated community. One woman opened up a pre school for the children and babies in the community and she recently opened up a clinic which is a size of a cupboard. This type of place we visited they would be in need of occupational therapists but they don’t have the funds for this unfortunately. On this trip we also visited occupational therapy departments in hospitals while we were there, one being Groote Schuur hospital. One aspect of occupational therapy I found interesting in south Africa is that students must study for four years and then they must work in the community for a year until they qualify as an occupational therapist, where as most occupational therapy course in England you qualify after three years. There is so much more I could write in this post but I think it would be pages long. I am so grateful for this opportunity. This trip has taught me that you have to be aware of differences in culture as an occupational therapist. Also, the trip has greatly improved my confidence and I even made some new friends from my course which is even better. I would like to thank the lecturers and hosts in south Africa who help organise such a wonderful experience that I will never forget! Thank you for taking the time to read this post and if you have any questions don’t hesitate to contact me via twitter @Rebecca51546111 or email griff207@uni.coventry.ac.uk. This trip inspired me to apply for an international placement in my third-year. Following the field trip to South Africa, two of the places we visited are offering two placements for third year occupational therapy students at Coventry University. You never know, my next article might be about my travels and experience of an international placement…

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub

By Louise Martinez, Neurological Occupational Therapist

I'm Georgia, a student occupational therapist with Cerebral Palsy . I have been considering writing this for some time now and this is for two reasons. The first reason being that I just feel that I need to explain why I was drawn to occupational therapy - and the second reason being to discuss my future with occupational therapy. But on the other hand, these two reasons were the same reasons why I didn’t want to write this... I shouldn’t feel that I need to justify why I study what I study - and I didn’t really want to discuss my future without knowing what the future holds. Then I realised that this article would be a great post to refer back to in the future and could potentially be a learning curve, so I thought that I would share it with you. I've previously shared this on my own page Not So Terrible Palsy and I was pleased with the response, but I still feel like I needed to reach a wider audience so here I am... Here we go! Point one - and before I make this point, I am sorry if this comes across in a controversial way. But this is a question that I have been meaning to answer for quite some time. I’m not going to bore you with all the reasons why I chose occupational therapy and why the course stuck out for me. But, just for a bit of background information – occupational therapy was the right course for me, as I’ve always wanted to explore the field of healthcare. OT also entails a lot of problem-solving. Sometimes with occupational therapy the answer isn’t right in front of you so, seeing as I love maths, this felt great! Not to mention that the signature colour for occupational therapy is green, just like Cerebral Palsy - I mean, could it be more perfect!? However, the aim of this article is not to rewrite my personal statement; the aim is to answer a few questions that I have been asked around occupational therapy since starting my university journey. So, let’s get the big question out of the way… ‘Why go into the system, when you’ve just come out of it?’ I have been asked this question a few times. Sometimes it hasn’t been as direct as others, but I’m capable of reading between the lines. I find this question quite annoying - especially when it’s someone I’ve just met - because it just makes me aware that I am probably never going to stop answering this question. Apart from the fact that I might not even go into the system (which relates to point two), the thought of potentially going into the system and changing people’s lives makes me feel even more determined to complete this course. This is not because I want to change the system. A big reason why I want to go into occupational therapy is that, when I was younger, my occupational therapists were just phenomenal. They played that much of significant role in my life that they inspired me to go for this career. If I can make half the impact on an individual that they've made on my family and I, then I know it is all worthwhile. Georgia on her occupational therapists: "If I can make half the impact on an individual that they've made on my family and I, then I know it is all worthwhile" The other questions I have been asked have been around my capabilities within occupational therapy. These questions don’t annoy me as such, because yes, my disability will always be the elephant in the room; again, this is based on such little understanding. Occupational therapy is such a broad profession; you could be working in a clinic or hospital, or you could be working in a driving skills centre. So, I think eventually I’ll find an area of occupational therapy that I want to work in. I’m not saying that it won’t be harder and that my options aren’t limited, because it would be wrong of me to think that they weren’t. But I know that there is certainly a role in occupational therapy out there for me - that works with my needs. This then links on to point two… I’m only in my first year at university, so I don’t have my heart set on an area of occupational therapy just yet. But I have a better idea of which areas I do and don’t want to explore than I did a year ago. A few weeks ago, I did a presentation about my blog. I wanted to make this presentation slightly more interesting and wanted to talk about more than just blogging. For a while now I’ve said that I’ve wanted to link occupational therapy in with blogging. So I had the idea of doing research about the impact of occupational therapy online, to incorporate this into my presentation. Then, after researching, I found that there wasn’t much around this and I realised that this maybe the area suited for me. This presentation was done recently, therefore I haven’t really had the chance to investigate this any further. However, prior to this, I had a discussion with my university lectures about linking blogging in with occupational therapy - and from this, they advised me to write this piece. I’d been toying with the idea of writing this for sometime before I posted it, because I didn’t want to tell everyone about my future in occupational therapy without knowing what would happen. I asked myself a lot of questions around this, with one of the big ones being ‘Where am I going to start?’ Therefore I decided to write this piece and share it with yourselves, because this is where I am going to start. I can’t start something without a general idea of where it’s going to go, just like I’d built up my work online before starting Not So Terrible Palsy . So, this is me starting my journey within occupational therapy! You’re probably thinking why this article is named 'Why I Study Occupational Therapy' - and why I talk about this, if this is not the main reason why I wrote this. This is because the reasons for studying occupational therapy are also listed in point two, as well as in point one, even if it doesn’t seem apparent. In my first post for my page, I wrote ‘I believe that I was born with Cerebral Palsy for a reason.’ From my previous work, I’ve realised this reason could be to create a link between the online community and occupational therapy. I study occupational therapy as I can bring personal experiences as well as my professional experiences to the table - and this is how blogging links into it, even if this link isn’t visible yet. So, now that I’ve finished my first year, I can finally say that I know all the reasons I study occupational therapy and why I’m more than willing to go back into the system! As previously mentioned, I don’t quite know how and if this idea will work, but what I do know is that I am very determined to get my idea off the ground! Thank you for reading. Georgia @georgiavine4213 @georgiaannv

When The Occupational Therapy Hub asked me to share this piece with them I was more than willing to get my story out there - because, if I’d read a post about someone’s driving experience when I was 15, I would be a lot further in this journey! So here it goes, put your seat belt on (pun intended). This is quite a story! When I started to plan for college at 16, I realised that what I’d always known was about to change . My timetable wasn’t 8:30-15:00 every day, so my parents could no longer drop me off and pick me up. This meant that I would be getting a lot more taxis and, at this time, the thought of being in a taxi alone made me feel vulnerable. But then I thought I’ll start driving lessons soon - then, in the second year, I’ll be able to drive (which of course made me eager to start driving). So, 6 months before my 17th birthday I applied for my provisional licence. My 16-year-old-self thought that it would be enough time to get the ball rolling, not knowing what was ahead... The first hurdle: As a result of my Cerebral Palsy I have epilepsy , which didn’t make getting my provisional licence easy - despite not having a seizure in 12 years. But, after filling out multiple forms, 3 months later my provisional licence came. This process itself took a lot longer than anticipated and started to make me realise that this course was going to be more complex than expected. As soon as my provisional licence came, we started looking for a disabled driving instructor , knowing that I’d probably need a little extra support. So, after another few months of phone calls, I finally had my first driving lesson, 2 days after my 17th birthday. Again, we didn’t think it would take another 3 months on top of this and had hoped that I would have had a few lessons by this point. Being disabled you can start at 16 (clearly something I didn’t know). But I didn’t mind. It felt right, as I was starting around the same time as my peers and I was where I wanted to be! My first lesson was meant to be 2 hours but, after an hour, we discovered that I needed further adaptations . The next stage was to go to a centre to be assessed. My report came through from my driving lesson and a date was made to go to the assessment centre. I waited to go there for 5 months. I didn’t mind because this was over summer, so I could start over summer when I wasn’t at college, meaning that I could have more lessons and speed up the process. Over this period, I was told to start revising for my theory test, so I did. Luckily I didn’t book anything before knowing the outcome of the assessment. I thought that if I was being told to put in for my theory then it couldn’t be much of a wait. "The tests included trying different adaptations, as well as having reading and cognitive test. You name it, I had it!" The day had finally arrived. I was going to the assessment centre and I thought that I could see light at the end of the tunnel. It was a very long day; the assessment centre was quite a drive away as well, but I was prepared for a long day! The tests included trying different adaptations, as well as having reading and cognitive test. You name it, I had it! It was quite a draining day, so I slept most of the journey home. We’d concluded that I was too weak in my legs to be able to use the break and accelerator. So we explored alternative options - one of them being a lighter steering wheel, which had the break and accelerator attached to the wheel. This assessment was useful, because we discovered that I couldn’t use my legs and that I was cognitively able to drive. But we’d not found a way for me to drive. I came out of the assessment feeling deflated, as this was the first time that I’d realised that I may never be able to drive. Side note: This assessment was carried out by an occupational therapist - just thought I’d mention it! I was then referred to have another assessment with a driving instructor. The wait was only a month and during that time I was ready to go on holiday and just forget about driving! Once again, the day came - but this time I wasn’t that excited, as I didn’t want to get my hopes up for them to be demolished again . However, this assessment turned out to be the best one, as we managed to find an adaptation that I was able to use. A year later and things were finally looking up. The adaptation I found was the tiller , which works a bit like the handlebars on a bike. So, it was decided that the tiller would be the adaptation I should use! However, this meant more waiting. There were only two vans in the country fitted with this adaptation for learner drivers; if I was to have this adaptation I would have to have my own vehicle adapted first, before I learnt how to drive. This resulted in more assessments, to ensure this was the right adaptation. With a load more phone calls, emails and letters, another 6 months went by. The guy that came was lovely and he walked in and straightaway said ”You’re going to get this adaptation, our number one priority is to get you driving.” Relief - I’d not waited another 6 months to get rejected. Just an update (for those not counting): the total time I’ve been waiting, since applying for my provisional license, is 18 months... It was now time to hunt for cars. Quite exciting, although my options were limited; I needed a car big enough for a hoist for my electric wheelchair . However, a lot of the bigger cars require someone over 25 to drive them, so I had very few options. A few months went by and we’d picked a car and got the ball rolling . Little did we know that our plans were about to get knocked back again… The plan was to get the car and then send it away for it to be adapted with the tiller. This didn’t take off as quickly as expected, as the company were having trouble getting hold of the car. We had to wait until they could get hold of the car; as mentioned, all suitable cars required the driver to be over 25 . So at this point I’m thinking 'I’ll just have to wait until I turn 25 before I can drive' - thinking that was my only option. Fast forward 4 months and we finally have a car; the adaptation process begins! At this point, I was going back and forth to have fittings. Once again, the car took a lot longer to be adapted than we thought. But it had to be perfect , even if that added another 4 months on! During this time, I decided that it was time to do my theory. Good job I didn’t do it 2 years ago when I got told to! So now that my theory was done, I was just eager to start driving lessons. But there was nothing I could do apart from wait; I’d played my part at this stage. "My life is always going to be full of unexpected battles, it’s just part of Cerebral Palsy . Even though this is frustrating, it only makes the result more worthwhile." We are now up-to-date, 34 months later! I finally have my car and have started my driving lessons. This unexpected battle has taught me a lot. Even though I’ve spent the majority of these 3 years being very stressed and frustrated with the process, this has been a massive learning curve. My life is always going to be full of unexpected battles, it’s just part of Cerebral Palsy . Even though this is frustrating, it only makes the result more worthwhile. After all this waiting, I’d be lying if I said I don’t want it to all be over and to pass my test... But doesn’t everyone? Driving will be great for me, as it’ll give me much more independence . It doesn’t just allow me to go to places; it allows to go to places alone, because then I can go in my chair! So it will be worth it in the end. At least now I can wholeheartedly say that I can see the light at the end of the tunnel ! There have been so many people involved in this journey that I would like to thank! I would also like to thank my parents for literally spending days on the phone. If it wasn’t for their hard work, I wouldn’t be at this stage! I’ve previously discovered that you can apply for your provisional licence from the age of 15 and 9 months, so if you’re coming up for this age, get applying. I wish I’d have known that! Thank you for reading. Georgia @georgiavine4213 @georgiaanv Georgia's website: Not so Terrible Palsy

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub

Darren Swift lost both his legs and sustained other injuries when he was blown up by a homemade grenade, consisting of a coffee jar, Semtex and shipyard confetti (nuts, bolts, screws).

Occupational therapy (OT) is a practice that can assist older individuals with living a more comfortable and productive life. It majors in the areas that help enhance quality of life. There are a number of rehab facilities providing occupational therapy to older adults. They take in individuals with certain medical conditions and injuries, with the drive and ambition of giving comfort and professional assistance. OT teaches life skills, which helps overcome many obstacles in the latter phases of life journeys. It's more of improving the self-reliance techniques devoid of the physical challenges.

An absolutely fascinating, innovative approach, to create something from nothing...

By: Dr. Sakshi Tickoo (BOTh)

In the last two years of my professional career, working within the diverse practice area of Occupational Health (yes, not a typo) in a UK NHS Trust, I formed a special interest in two areas: Menopause and its effect on our (largely female and middle-aged) workforce - and retirement . The former I feel I have got out of my system; we devised and ran workshops which were oversubscribed and feedback suggested they had been extremely worthwhile. However, my interest in the impact of prospective retirement on individuals has not left me... At work, I was primarily in post to explore alternative strategies to counselling , with employees who were experiencing a testing time with their mental health. Two people particularly stick in my mind. One who was nearing retirement age and terrified that they may be ‘encouraged’ to go - and another who was over 60, had been transferred into a completely new service area and was struggling with alien systems and processes. She had been referred with the query of early stage dementia. Nothing could be further from the truth. Her self-esteem was at rock bottom and this made her struggle even more, risking ending her successful career as ‘a failure’. Retirement is heralded as a time to let go of responsibilities, spend time on your own interests and celebrate the end of a working life. For so many, this is not as straightforward as it sounds. On a personal note, not long after the menopause work ended, I was faced with the transfer of my job to another provider, which would have involved too much travel to be practicable. I was 59 ½ . I decided to retire. In this piece I would like to pose two questions: Are Occupational Therapists at an advantage in retirement, with strategies to fill the occupational void that it brings? Is pre/post retirement a potential clinical area for Occupational Therapists to explore? 18 months before the world was suddenly faced with a devastating change to daily life, I elected to make my leap into retirement with no plan, no party - and the next piece of work I had been intending to start, left on somebody else’s to-do list. A year to the day after retirement I wrote a reflective piece (published in February 2020's OT News), that was largely covering how I problem solved plunging into new found freedom . It was not an easy year. So much time to fill, friends and family still at work... and after 6 months finding I had more or less established a routine that looked very much like... work! However, by the end of that first year, I concluded: “I had always assumed, as my professional status was so much a part of my ego and identity, that retirement would be a traumatic event. What I have discovered is that, while I knew professionally that occupation is at the heart of physical and mental health, having a meaningful occupation is what drives and sustains me, rather than being an occupational therapist” (Tomes H, 2020) A literature search of published articles by Occupational Therapists in the UK revealed very little, with the most recent I found from 2011. This study focused on the occupational transition to retirement and its impact on health and well-being. At that time ‘It would appear that recent occupational therapy retirement research had predominantly taken place in Sweden… and Australia’ (Pettican, A. and Prior, S., 2011), that their own ‘findings suggest that providing pre-retirement and post-retirement interventions may be a future potential area of practise and research for occupational therapists’. I looked up some of their references and found that most studies used subjects in old age – rather than the younger (55yrs+) age, who now are potentially considering retirement. Could intervention at this stage prevent some of the mental and physical health problems in old age? Is the pandemic we are currently living through a catalyst for some who had not previously thought about retiring early? My experience of a jerky transition into retirement seemed to resonate with some readers, OTs retired/considering retirement, as well as some contemplating a major career change. The overriding theme seemed to be that it was not retirement itself that posed a problem - more the amount of agonising over the decision of when, why and how to retire . I asked all responders if they would like to keep in touch and do some more work on this; when the pandemic struck we were a group of seven OTs, who met regularly by Zoom. From preliminary discussions, it was decided we would devise a guide called ‘How do I make the decision to retire?’ Although concentrating on retirement as the theme, it could have an application to those now faced with other major career decisions. We would love to share the guide with the wider OT community; it is included as an additional file, at the end of this article. Is it far fetched to presume that many more working people struggle with the idea of their own retirement? Do men really suffer post-work, more than women? Do couples or single people fare better in making the switch? Does a lack of purpose adversely affect mental and physical wellbeing? Is the switch to working from home, for many, a useful portent of what retirement can hold, both positive and negative? Why do retirement and old age seem to get lumped together, when there could be a clear 20+ years between ending work and slowing down? Is this an area of practice that Occupational Therapists are already engaged in? Should they be? One thing is certain, retirement brings a change of identity . A new normal, to pinch that now familiar cliché. Mine is ‘Adventurer’. Not defined by money (adventures do not need to cost anything) but more by attitude. What is or will yours be? I am intrigued by retirement being the occupational disruption that almost all working people must face - and that it is portrayed as occupational 'liberation', even though that is not the experience of many. I wonder if retirement is easier or more difficult after a working lifetime of being an Occupational Therapist? I would love to know what you think. Helen Tomes Retired Occupational Therapist References Tomes, H. (2020) Finding a new occupation in life. OT News 28 (2), 46-47 Pettican, A. and Prior, S. (2011) ‘It’s a new way of life’: an exploration of the occupational transition of retirement. British Journal of Occupational Therapy 74 (1), 12-18 Other resources We have set up a Facebook Group: ‘ Occupational Therapists Planning and Enjoying Retirement (UK) ’. The ‘UK’ simply notes where the core members of the group are from. Overseas members would be most welcome!

A newsletter presentation by Chantelle Martin, Occupational Therapist and Social Prescriber [NB. Format best viewed on larger screens] " Social prescribing is making connections, giving people a sense of belonging... helping them find purpose... helping them stay physically and mentally well (NHS England, 2019). How was I going to do this in the middle of a pandemic?" Read Chantelle's newsletter in PDF format:

By Jamie Grant - Occupational Therapist; Director, The Occupational Therapy Hub

By Jamie Grant - Occupational Therapist ; Director, The Occupational Therapy Hub