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The word 'play' has a variety of meanings and explanations. Play is a physical or mental activity that takes place for the sole purpose of amusement. Games have a different outlook for different ages. For example, for an infant, play is a self-soothing activity that involves exploring things through their eyes; for the toddler, it's more of imitating others. Following the direction of others, for teenagers, it is learning; for adolescents, connected to their leisure activity; for adults, it is a diversion and relaxation. Play is not dependent on toys, items or external objects. Games can be an excellent medium for motivation and engagement of the individual. Play is the foundation of learning, yet many are not connected with it. Play in early childhood plays a role in child development. Play helps children learn rules and what to expect in different situations. As children get older, they learn how to act in society, through play. Nowadays, parents are so busy with their day to day activities, work and other responsibilities that they may not get a chance to explore play with their kids. For such parents and all other parents, play holds an integral role in building relationships and understanding their kids. There are children who are unable to process their emotions and convey thoughts to parents or other adults. Depression, anxiety, stress, hyperactivity and sensory issues are widespread nowadays. Therapists use play therapy as a medium for exploring trauma, abuse and bullying incidents, which are increasingly common. Play Therapy has foundations in psychoanalysis; both disciplines are similar, in that they provide access to the child's inner world. Play therapy is a therapy mainly used for children, defined as follows:- "The systematic use of a theoretical model to establish an interpersonal process, wherein trained play therapists use the therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development." Association of Play Therapy (2008) Play therapy is a form of child-led counselling, for children who experience social, emotional, or behavioural difficulties. As adults, when we are worried, we usually use words to express ourselves, but sometimes children need an external way to take out or express their emotions. Most children don't have the vocabulary to talk about their experiences, especially non-verbal kids; for them play is a mode of communication. However, they can express themselves and show how they are feeling, using the language of play. Play therapy provides a safe and confidential place for children to work through their problems. Play therapy gives children an open platform, where they reflect on their feelings and emotional regulation, without being judged by the therapist. A trained therapist/clinician carries out these sessions. The therapist uses playtime to observe the child and understand the child's problems, without labelling. Many therapists use creative art materials, musical instruments, puppets, books and costumes in their therapy. There are many other new techniques that we can incorporate during a play therapy session, like a sand tray. While playing with these children, they often unconsciously play out the experiences that are troubling them, or express and externalize in some way the things they are feeling inside. In doing so, children get to experience the enormous relief that comes with expressing stressful thoughts or worries. Play therapy gives kids a chance to see their troubles from a new perspective, to ask for help if they need it. Play therapy is the best medium of empowering kids, by making therapeutic relationships, reflective listening, tracking and following the child as a leader. Play therapy differs for every child. The therapist first conducts interviews with the child and parents. After observing the child, the therapist will set goals and some necessary limitations. A play therapist pays close attention to how a child reacts when separated from the parent, when the child is alone and when the parent returns. The play therapist uses these observations to decide what to do next. Some therapists bring parents and siblings into play therapy. Meta-analysis research, conducted in 2000, included 94 play therapy outcome studies involving children. Results revealed a large positive effect on treatment outcomes across modality, gender, clinical vs. non-clinical populations, setting and theoretical schools of thought. Additionally, positive play therapy effects were highest when a parent was fully involved in the child's treatment (Bratton, Rhine and Jones, 2000). Play therapy has shown to be beneficial in many studies, important in many aspects of life. Implementing clinical practice can be helpful and can help in achieving a breadth of goals. Reference Bratton, S., Rhine, T. and Jones, L. (2000) A Meta-Analysis of the Play Therapy Outcome Research from 1947 to present. International Journal of Play Therapy. October 2000.

Co-author: MaryBeth Gallagher PhD, OTR/L BCMH 'This paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting.' Introduction Occupational disruption has been defined as a transient or temporary condition of restriction from participation in necessary or meaningful occupations. This interruption often, but not always, resolves itself as the human adapts (Whiteford, 2010). The arrival of the COVID-19 virus and the subsequent pandemic has had a tremendous impact on our daily habits and routines. It has meant that people have become socially distanced, unemployed and ‘repurposed.’ This is certainly true in the healthcare organization in which we are employed, where employee wellness has the potential to be eroded by these additional stressors. If as occupational therapists, the situation described here is something you recognize within yourself and your work environment, this paper offers targeted strategies you can use to address the impact of occupational disruption in your own setting. This article presents the response of a small team of occupational therapists to the challenges posed to employee wellness in the face of unmitigated occupational disruption from the COVID-19 virus. The article also describes the processes and practices that were developed to support our colleagues. It concludes with recommendations to replicate and or adapt our approach to nurturing employee wellness. The Impact of Occupational Disruption The occupational disruption caused by this pandemic has meant that healthy and well people, used to accessing meaningful occupations of their choosing, have experienced a disruption to their doing that impacts on their ability to be well and stay well. The level of disruption from the COVID-19 virus to the daily routines of a country, and indeed the whole world, is generally experienced by a small minority who encounter sudden traumatic life events that impact on physical, mental and emotional intactness. When the pandemic began to alter our daily practice, we went to the literature seeking knowledge to address some of the challenges we were encountering and build an evidence base for our practice in hospital based mental health during the COVID-19 virus pandemic. Whalley Hammell’s 2020 article details issues related to engagement in living during this crisis and the worldwide occupational disruption that has resulted. It’s message and the content within presented an opportunity for us to consider how to provide occupational therapy to address the occupational disruption impacting ourselves and our colleagues. This conceptualization of occupational disruption presented us with multiple opportunities to impact positively on our health care colleagues and the system response to the pandemic. Despite facing many barriers to implementing occupation centered and occupation based practice (Fisher, 2013) within an in-patient setting, keeping an occupational perspective remains critical. Leveraging our knowledge of the role of occupation in the lives of humans enabled us to seize the opportunity to develop health promoting interventions when it arose, and we were able to engender internal team collaboration to address employee health and wellness. It enabled us to educate our colleagues broadly about occupational therapy philosophy, our occupational lens, our role in wellness and the value of our contribution to a systemic wellness program for addressing the needs of individuals. The Whalley Hammell paper (2020) mentions two key frameworks that have addressed building resilience in individuals experiencing trauma and disruption. The first is Rachel Thibeault’s 5 C framework (2011) developed from her extensive work with populations experiencing civil war and torture. The second was a program in the UK, “5 a day” that focused on ensuring a daily diet of occupations that promote mental health, similar to how nutrition and dietetics use the ‘5 a day’ of fruits and vegetables to support physical health. These concepts then formed the basis for the development of an employee health and wellness program from within occupational therapy. Our intent is to coalesce with the system level health and wellness program established almost exclusively for medics in 2018, to proffer an occupational approach. After identifying relevant theoretical concepts, we returned to the literature to explore occupational therapy’s participation in wellness programs. While there are limited examples outside of vocational rehabilitation, the faculty practice at USC Chan Division of Occupational Science and Occupational Therapy ran an ‘executive health’ program. This long-established practice employs Lifestyle Redesign (trademark) principles to support people experiencing a range of lifestyle based conditions impacting mental and physical health, including executive health. Existing wellness programs within organizations appear to be incentive driven and target particular populations, like people who smoke and those who are obese. These programs tend to assume people are ready to change or modify behaviors. Additionally, the success of these programs is generally measured by the uptake number (Boudreau and Frederick 2016). These identified limitations provide an opportunity for an occupational perspective that can foster a person’s intrinsic motivation to build a healthier lifestyle. These health promoting routines could include connecting with others, and providing restoration, purpose and satisfaction in one’s daily habits. The Occupational Therapy Process in Health and Wellness Our program focused on wellness, wellbeing, and health promotion. We defined wellness as an active process of becoming aware and making choices towards a healthy and fulfilling way of life. It is a conscious, self-directed and evolving process of achieving full potential (National Wellness Institute). These dimensions of wellness emphasize a dynamic process through which an individual makes health promoting, conscious and intentional choices about what to do and how to be. These are fundamental to establishing habits that build resilience to effectively manage mental and physical wellbeing, both in the workplace and beyond. The target audience for this wellness program is anyone across our healthcare system experiencing occupational disruption including administrative staff, environmental service staff, security, medical and rehabilitation staff. Additionally, as a teaching hospital we believe this wellness program is valuable for supporting our students with disrupted and postponed placement experiences due to the COVID-19 virus. Using an occupational therapy process, we created a wellness program based on the five tenets of resiliency building: contribution, creation, centering, contemplation and connection (Thibeault, 2011). The process begins with an occupational needs assessment. For this, we chose to use the Engagement in Meaningful Activity Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002). This survey is designed to garner the level of meaning a person experiences in their day to activities. It poses twelve questions related to the level of meaning experienced in daily activities over the last thirty days. Respondents answer with 1 (rarely), 2 (sometimes), 3 (usually) or 4 (always). The scores are then added to determine the overall level (low, moderate or high) of meaning a person is experiencing in their daily occupations. Most of the respondents are not occupational therapists and the tool is virtually accessible. Therefore, we have proposed within the survey which daily occupation relates to which of the five Cs. For example: The activities I do reflect the kind of person I am. We suggested this might address contemplation due to the internal focus on values. Respondents are then asked to identify the two lowest scoring Cs from the survey. From there, they are provided with a template of a tailored plan for building resiliency in response to identified occupational needs in the form of an included visual map. The visual map is an occupation analysis of identified actions based on meaning of engagement for individuals. For example, if a person was creating an action plan to increase how reflective of their values their activities are, one action might be; spend 5 minutes alone a day thinking about your personal values. Then, having identified an important value, choose one occupation that is symbolic or representative of that value. Audio enhanced resources expanding on each of the 5C’s can then be accessed to further develop the person’s visual map and wellness and resiliency plan. Sustaining and Promoting the Program Due to the recent launch of this wellness initiative, data is not yet available to fully determine the efficacy. However, anecdotally it has been well received with respondents reporting the resources as ‘comprehensive’, ‘impressive’ and ‘very useful’. At the time of writing, there is ongoing enthusiasm for this initiative from all levels of management and participants. It is our intention to make this wellness program integral to ongoing employee health and wellness and not just a response to the COVID-19 virus. We have identified a need for an occupational perspective in supporting employee health and wellness. This is especially important within a very large organization even when that organization has already taken steps to support employee wellness. The literature identifies high levels of burnout and compassion fatigue among healthcare workers. The nature of healthcare practice in which one is consistently working to improve the health and lives of people experiencing ill health, trauma and deprived social circumstances, has its emotional impact at a conscious and unconscious level. Often one of the first indicators of workplace stress is an emotional impact and a loss of meaning in what we do (Reith 2018). We believe as occupational therapists that this needs addressing to enhance and maintain a healthy, well and engaged workforce. If the situation described here resonates in your practice and your setting, or indeed is something you recognize within yourself, the strategies presented here may be useful for intervention in your own setting. Firstly, become cognizant of the occupational disruption present in your own personal and professional experience. Some examples of what could contribute to occupational disruption beyond the COVID-19 virus, include a lack of formal supervision, frequent and enduring use of peers as buffers of stress and emotional processing, increasing demands on your time, expertise, and participation in daily challenges inherent in healthcare. Next, identify needs that could be nurtured through an occupational perspective of workplace wellness. Recognize how your current practice already includes strategies that could be supportive and valuable to those who do not have a ‘diagnosis’, but whose occupational disruption comes from the pandemic and high workplace stress. Then using the occupational therapy process described above as a guide, use your occupational lens to assess levels of meaning, create action plans and begin to build resiliency and wellness. Conclusion In this paper, we have described the occupational therapy process to address wellness in our setting in response to the occupational disruption caused by the current the COVID-19 virus. We identified a need to address the wellness of ourselves and our colleagues. We used an assessment of meaning, as meaning is linked to positive mental health, and provided interventions to improve resiliency building in daily life through our altered sense of doing and being. This initiative has broadened the scope of mental health practice in our setting and highlighted the pivotal role that occupational therapy plays in maintaining health and wellness. References Boudreau, J. and Frederick, B. (2016) Why corporate wellness programs need a dose of occupational therapy and analytics. Accessed on 4/2/2020, at https://www.visier.com/clarity/why-corporate-wellness-programs/ Fisher, A. G. (2013) Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy. 20 (3), pp.162-173. Goldberg, B., Brintnell, E. S. and Goldberg, J. (2002) The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occupational Therapy in Mental Health. 18 (2), pp.17-44. Hettler, B. (1976) About wellness. Retrieved from National Wellness Institute. Accessed on 6/3/2020, at http://www.nationalwellness.org Reith, T. P. (2018) Burnout in United States healthcare professionals: a narrative review. Cureus, 10 (12). Thibeault, R. (2011) Occupational gifts. Spirituality and occupational therapy, pp.111-120. Whalley Hammell, K. (2020) Engagement in living during the COVID-19 pandemic and ensuing occupational disruption. OT Now. Accessed on 4/2/2020, at http://caot.ca/document/7179/Ensuring%20occupational%20disruption.pdf

"We don't have to do it alone. We were never meant to." - Brené Brown As Occupational Therapists, we look within and around, constantly deliberating on what and how to add purpose and meaning to anything we do - and advocate for anything that speaks to us; this is what an ideal situation of symbolic interaction looks like for our profession. Symbolic interaction is a very grounded, practical and everyday approach to social life and social understanding. According to this concept, any entity that has been created or obtained as a symbol - for example, human rights, cultures, humanities, etc. - can never follow one particular meaning for eternity. The ambiguity in which they exist and have been created needs to be contested and renewed, according to the time and population they interact with. Symbolic Interaction between Humans Within this concept, individuals try to survive and flourish by living in their natural environment, doing things together and trying to make meaning in their daily life activities. Finding purpose and meaning is a convoluted process for some, yet we strive to define every situation we enter into. Without purpose or meaning in life, human life is prone to be wasted and become worthless to live for. This is the essential characteristic of human nature as a symbol; we constantly attempt to find meanings in our daily lives, while interacting with our environment. It is never fixed, but emergent and contested at all points of life. Moreover, what seems meaningful to one person may not make sense to anyone else. This very quality of humans as symbols is powerful. The fact that we tend to forget and embrace this ever-developing, changing and flowing aspect of humankind is the reason why we live in a world of differences and discrepancies. Interactions in Cultures and Sexualities Human cultures are multi-layered, ever-emergent symbolic interactions. At the core of culture lies social life. Cultures are never tight, fixed or agreed upon, but are multi-layered 'mosaics of social worlds.' Cultures are 'the scraps, patches and rags of daily life', toolboxes of ideas and materials, which are constantly in flow and flux, to help us resolve daily problems of living. This social road leads us to our main tools of symbolic interaction: language and communication. These tools help us make sense of our external environment, just like our other senses. However, the only thing certain about these tools is the uncertainty that they bring. Unfortunately, what makes sense to one person is not a widely accepted standard, given the discrepancies in the interpretation of our cultures. Flowing out of this view of social life is a distinctive view of sexualities - both naturalistic and biological. So, what we need to deliberate upon is, how sexuality depends upon collective conduct and the wider cultural sense associated with it, when this very same concept of sexuality is changing and developing. To speak of 'non-ambiguity' in sexual cultures is an unrealistic idea, that we are trying to preach and change. Cultures as powerful symbols cannot speak non-ambiguity, because of their very nature. To speak of 'Indian culture', 'Western culture', 'Queer culture', or others, is like walking into a world of multiple interpretations, tensions and differences. It is extremely important to grasp this; some views of culture and human rights debates on sexualities can get very lost if they work with this naïve, dead and over-simplistic view of culture. No single culture can be thoroughly rigid and fixed, rather it shouldn't be. This way it not only loses its essence, but cannot change and develop. Cultures - and humans - are lived actions: mobile and complex. Cultures are always negotiated and deeply contested, at all times. This is their nature, their essence; the essence of muddle. Without multi-cultural inclusion and intersectionality within communities, the culture dies a quick death. Individual cultures are not separate entities, apart from each other; they are continually overlapping, emergent and internally contested. Reconsider the Narrative Stories have recently moved centre-stage in social thought: as the pathways to understanding culture; as the bases of identity; as the tropes for making sense of the past. We all hold a variety of narratives in our minds, that reflect the variety of our identities - like man, woman, parent, friend, lover, relative and professional. Some of my stories are about how I came to learn about, advocate, educate and empower humans as sexual beings - and why it can be difficult to implement in Indian culture. The stories of the past help re-live and re-write stories of the present. But amongst these differences, all cultures reflect a similar understanding of sexualities, fears, pleasure and guilt. By viewing our limited social lives as symbolic, emergent and interactive, we may deepen our understanding of our sexualities, our rights and ultimately our human capabilities. A lot more to fight for. A lot more to build upon. A lot more to struggle for. A lot more to be joyous about. About the author Dr. Sakshi Tickoo is an Occupational Therapist, Personal Counsellor and a Student Mentor, specialising in Sexuality and Mental Health - wellness and rehabilitation. Apart from working school-based and in adult home healthcare settings, she runs her platform Sex, Love and OT (sexloveandot.com). The aim of this is to educate and guide healthcare professionals in this intimate ADL and help clients integrate intimacy and sexuality in their daily occupations, irrespective of their age, gender, sexuality, race, culture and/or limitations. References Blumer, H. (1969) Symbolic Interactionism. NJ: Prentice Hall. Denzin, N. (1992) Symbolic Interactionism and Cultural Studies. Oxford: Blackwell. Plummer, K. (2010) ‘The social reality of sexual rights: A critical humanist view’, in Aggleton P. and Parker, R. (2010) The Routledge Handbook of Sexuality, Health and Rights. Plummer, K. (1995) Telling Sexual Stories: Power, Change and Social Worlds. London: Routledge. Plummer, K. (1982) ‘Symbolic Interactionism and Sexual Conduct: an emergent perspective’, in Brake, M. ed Human Sexual Relations. NY: Pantheon. Schafer, K. and Smith, S. (2004) Human Rights and Narrated Lives: The Ethics of Recognition. Palgrave. Tickoo, Dr. S. and Ellis, Dr. K. (2019) Indian Narrative of Sexuality: An Occupational Therapy Perspective. Weeks, J. (1996) Sexual Cultures: Communities, Values and Intimacy.

I was shocked to see the worldwide prevalence of COVID-19 in such a short timespan. So many have been severely affected, both mentally and physically. I quickly realised that outpatient services could not see patients face-to-face; instead, we could conduct telephone consultations, to ensure the safety of patients and their families. Everyday I used to call our patient’s families, checking on their well-being and providing strategies and advice over the phone. It worked well for a few weeks, but families were not as satisfied as they could be... Challenging behaviour and sensory difficulties were getting worse among children, likely due to being kept at home and feeling helpless. Parents were struggling to effectively motivate their kids at home, stressed out with many other responsibilities. One day I shared an idea with my husband about making videos with my son and sharing them with parents, for their reference. Considering the situation, I kept my activities simple and made sure they could be completed using materials readily available at home. This could be helpful for both parents and their kids. We made a series of videos and started sharing them with parents. Then we thought it would make sense to keep all the videos in one place, and my husband initiated a YouTube channel called 'Kioskid'. So far we are getting a good number of responses and views. The initial video responses motivated us to make more and continue sharing them, keeping in mind the goal of engaging kids at home - safely, happily and therapeutically. We have 8 senses in our bodies: Vision Hearing Taste Smell Touch Proprioception Vestibular Interoception Lifestyle changes related to coronavirus may affect these senses, leading to dysregulation within our children. This can affect them in many ways, including distractibility, meltdowns, stress, aggression, or burnout. As a result of physiological or cognitive changes, children with COVID-19 may therefore have difficulty engaging in everyday activities independently. Occupational therapists can work with people to develop strategies to facilitate continued access to their occupations. Circumstances to consider include (but are not limited to) individual, family, community, social and environmental. I aim to enhance, enable and empower young people’s participation in daily tasks. This can be assisted through the inclusion of sensory activities in their day-to-day life, helping children adapt to life's challenges. As occupational therapists, we can increase their independence, drawing on strategies, home planning, sensory diets and telehealth. I believe our role is crucial, as many children are currently struggling with anxiety. To cope, they need help to work on their routine, gross motor activity, physical activity, play, fine motor skills and sensory balance. Occupational therapy is a creative discipline. I believe its applicability and practicality has no boundaries; our scope is vast... For parents who need expertise or specialist teams to support their children, the current situation can be disabling. Therapists must therefore adapt, making arrangements as per the needs and availability of clients. It’s time to view things differently and help parents fighting through the pandemic!

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:

This paper was presented at the 2nd National Conference for Occupational Therapists working in Diverse Settings, at the University of Brighton, UK (6th September 2017). Introduction The profession of occupational therapy was founded over a hundred years ago by small groups of people concerned about the inadequacy of treatment for people with long-term conditions, such as psychiatric disorders and physical disability. The first qualified occupational therapists provided practical activities for people in asylums for the mentally ill, sanatoria for people with tuberculosis, military hospitals and curative workshops for soldiers injured in the first and second World Wars (Paterson 2010). These early practitioners were energised by their beliefs in: people’s capacity to promote and maintain their own health through occupation (Meyer 1922/1977), and in the power of occupation to engage interest and build self-esteem (Haworth and Macdonald, 1946). Occupational therapists in the UK worked in settings that were dominated by the medical profession and, as a result, the developing theory base of occupational therapy was strongly influenced by biomedical theory. For example, a British occupational therapy textbook from the middle of the century asserted that: 'the development of rehabilitation by occupation could only follow the progress of the sciences which contribute to all forms of medical treatment. Those particularly relevant to occupational therapy are anatomy, physiology, psychology and pathology; mathematics and mechanics' (Haworth and MacDonald, 1946 p.3) From the late 1940s onwards, occupational therapy practitioners embraced a biomedical approach to rehabilitation and the educational curriculum moved away from ‘teaching the application of occupations such as arts and crafts, work and self-care tasks, to the healing, rehabilitation and adaptation of persons with disabilities’ (Cole, 2010, p.78) in favour of teaching biological sciences, developmental theory, physical medicine, psychiatry, psychology and sociology (Creek 2002). In the early 21st century, patterns of employment for occupational therapists in the UK are in the process of adapting to changing economic circumstances, emerging social and health care needs and developing public expectations of what health and social care services should provide. In order to support this evolution, it is necessary for the profession to devise new approaches and develop new theories to support a more diverse practice. This paper begins with an account of the development of occupational therapy in the first half of the 20th century, showing how one of the major influences on the new profession was a concern with social justice. It then argues that our theory and practice were reshaped during the second half of the 20th century by occupational therapy’s close alliance with medicine. In the changing world of the early 21st century, occupational therapists are reconsidering our professional role and purpose, both of which are expanding and diversifying in response to emerging social and health needs. The paper identifies the personal attributes, knowledge and skills that occupational therapists draw on when working in non-traditional settings, highlighting the importance of developing a broad range of thinking skills. It concludes that practice in diverse settings is driving innovation and creativity in occupational therapy. The origins of the occupational therapy profession The generation of occupational therapists who trained in the 1960s were taught and supervised by the women who established the profession in the UK, 40 years earlier. The photograph shows Margaret Barr Fulton, the first qualified occupational therapist to practise in Britain, who began her career in 1925, at the Aberdeen Royal Asylum. She is presenting their diplomas to the first cohort of occupational therapists to graduate in Aberdeen, from the Grampian School of Occupational Therapy. In the background, you can see Jennifer Creek, the author of this paper. This direct link between the first occupational therapists and those who started work in the 1950s and 1960s meant that, although we worked in established departments within health and social services, our practice and ways of thinking were informed by the beliefs and values on which the profession was founded. Occupational therapy emerged from a number of social movements in Great Britain and the United States of America in the late nineteenth and early twentieth centuries, including the arts and crafts movement and the Settlement House movement. These social experiments sought to improve the lives of people who were marginalised in society, such as: the urban poor, immigrants, women and those with mental illness. The Settlement House movement is described here as an example, showing how it contributed to the development of occupational therapy. The Settlement House movement was started by two philanthropists, Samuel and Henrietta Barnett. In 1884, they founded Toynbee Hall to offer amenities, education and guidance to people living in impoverished urban areas (Darley 2010). The Women's University Settlement was established in 1889, to ‘promote the welfare of the poorer districts of London, more especially of the women and children, by devising and advancing schemes which tend to elevate them, and by giving them additional opportunities in education and recreation’ (Blackfriars Settlement). The movement quickly spread to the USA, where Hull House Settlement was established in Chicago in 1889, with the intention ‘to integrate new immigrants into American society’ (Paterson 2010, p. 7) and ‘… to provide a centre for the higher civic and social life, to institute and maintain educational and philanthropic enterprises and to investigate and improve the conditions in the industrial districts of Chicago’ (Davis & McCree 1931, quoted in Paterson 2010, p. 7). One of the social activists connected with Hull House, Julia Lathrop, helped to organise a series of courses for caregivers, which evolved into a social work school: the Chicago School of Civics and Philanthropy. In 1908, Lathrop contributed to setting up a six-week training course at the School: Occupations for attendants in mental institutions (Hopkins 1978). One of the social work students, Eleanor Clarke Slagle, attended this course in 1911. Four years later, she organised the first professional school for occupational therapists at Hull House, the Favell School of Occupational Therapy (Friedland 2003). Occupational therapy’s changing scope of practice The first generations of occupational therapists, therefore, were confident that they had the skills to work with anyone experiencing constraints on their ability to participate fully in society’ through engagement in a range of socially acceptable occupations. Those occupational therapists who started their training in the 1980s, or later, tend to have a narrower understanding of traditional occupational therapy practice, based on our restricted professional role in statutory health and social care services and on the dominance of biomedical theories in the curriculum. When the occupational therapist’s role is limited to promoting independence in activities of daily living, enabling safe discharge from hospital or facilitating return to work, we do not draw on the full range of skills developed over nearly a century of practice. In these roles, we are expected to follow pre-designed programmes and pathways that are approved by our managers and colleagues. The pioneers of the profession had no protocols or established procedures to follow: they were pragmatists who explored different approaches until they found what worked for individual patients in particular situations. Similarly, occupational therapists who work in emerging roles outside mainstream health and social care services are also pioneers, who cannot depend on universalist theories and models to guide their actions. As more practitioners take up work in these roles, the profession needs to develop more flexible skills and ways of thinking that will serve us across a range of settings and circumstances. In recent years, austerity economics have led to pressures on health and social care budgets, necessitating cuts in some services and rationing of others. Following the COVID-19 pandemic, these financial pressures are likely to become more acute and to impact on the number and grade of posts available for occupational therapists within statutory services. Already, it is not always possible for universities in the UK to find sufficient student placements in clinical settings, either within or outside of the NHS. Some universities now offer their final year students opportunities to undertake fieldwork placements in non-clinical settings, such as hostels for homeless people, refugee centres, prisons and shelters for abused women (Duncan and Creek 2014, Lawson-Porter 2014). This has contributed to a revived awareness of the potential for occupational therapists to expand our professional role into non-traditional settings, where needs tend to be defined as occupational rather than medical (Creek and Cook 2017). The changes outlined above are not confined to the UK. Health services around the world, even in affluent countries, struggle to cope with the rising costs of health care and of supporting increasing numbers of people with long-term, complex health conditions. In order to respond to changing patterns of disease and disability, in both developed and developing countries, it is widely accepted that the cost of health care will continue to rise, but it is necessary to ensure that funding is provided for health promotion and disease prevention as well as for acute health services (NMHCS 2009). In developed countries, governments have to balance the cost of routine interventions to promote and maintain health in the general population against demands for expensive treatments to prolong the lives of individuals with serious illness. In developing countries, where budgets for health and social care are much smaller, the focus is necessarily less on highly specialised individual interventions and more on the universal provision of basic services, such as: maternal and child health; health education, and vaccination (UNDP 2014). While there is pressure on occupational therapy posts within the NHS and local authority social services, employment opportunities are emerging in other settings, for those practitioners who can envisage themselves in roles that are more concerned with occupation and health promotion than with rehabilitation or therapy. Increasing numbers of occupational therapists are finding or creating roles for themselves in, for example, disability prevention (Byrne-Fraser 2014); accident prevention (Hawthornthwaite 2014); the promotion of physical and mental health (Howard 2017, McNulty et al 2017); occupational health (Cookson 2014), and services to keep people out of hospital (McLachlan 2017, Ward 2014). This movement towards a broader understanding of the legitimate domain of concern of occupational therapy is likely to continue to gather momentum, as more recently educated graduates move into teaching and management positions. A biomedical paradigm is inadequate to support practice in non-traditional settings, where a more open, flexible and responsive approach is needed. The expansion of occupational therapy’s practice domain is putting pressure on universities to move beyond the limited range of reductionist theories and procedural models for practice that have formed the core of educational programmes for several decades. Practice in marginal settings has to be supported by ‘occupational science, with its focus on understanding the nature of occupations and the challenges to participation in occupations’ that people may face (Lawson-Porter 2014, p.178). A study of occupational therapy on the margins In 2014, the author completed a PhD study of occupational therapy on the margins, at Sheffield University. The margins, by definition, exist at a social and/ or physical distance from the centre or mainstream and are characterised by inability to access the support and resources of the centre. The study found that occupational therapists practising on the margins share a number of attitudes, knowledge and skills that enable them to work effectively in resource-poor settings. Occupational therapists working on the margins have a vision of what they can contribute towards addressing unmet occupational needs that have an adverse effect on health and are neglected by existing services. For example, one of the practitioners in the study set up a landscape gardening business to provide paid employment for repeat offenders when they came out of prison. These occupational therapists find practical ways of translating their vision into action, with and on behalf of the people in need. Professional action is shaped by the attributes, knowledge and skills that occupational therapists bring to their practice. Personal attributes are the therapist’s individual characteristics, motivations, attitudes and interpretations; such as an ability to think outside the parameters of everyday professional reasoning and a capacity to innovate in practice. The characteristics shared by most practitioners in the study included, to a greater or lesser degree, initiative, perseverance, cognitive flexibility and self-awareness. These characteristics influence how practitioners perceive and react to situations and circumstances. Attitudes are the therapist’s habitual modes of thinking and feeling, such as having a positive attitude to life or a flexible attitude to work. Interpretations are the constructions or meanings the therapist puts on what she sees or experiences. Examples of attitudes shared by occupational therapists working in non-traditional settings include positivity and willingness to compromise. These therapists tend to frame difficulties in positive ways that leave open possibilities for action, and they see difficulties as problems or challenges rather than as barriers to action. This is shown in the example in Box 1. Box 1: A positive attitude The can-do attitude of practitioners working on the margins is exemplified by an occupational therapy lecturer, Lisa, at St Louis University in Missouri. The University has a commitment to social justice and provides an associate degree in Theology for prison staff and prisoners in the state prison. Lisa observed that the working conditions of prison staff are not good and, as a result, the staff have many health problems. She applied for, and was awarded, a grant on workplace health but the prison was not interested in hosting a project. Lisa then took the grant to the city gaol, where she did a participatory survey of warder health issues. As a follow-up to this study, she set up a healthy eating programme for the staff, who work 10-hour shifts. This gave her some leverage within the gaol, which she used to start a transitional programme for prisoners pre- and post-release. The gaol now employs a full-time occupational therapist to work with female prisoners on issues such as finding work, housing and money management. Lisa also got funding to employ a part-time occupational therapist in the community to continue working with prisoners once they are released. The occupational therapist choosing to work in a non-traditional setting needs more than a vision of what can be done and a positive, can-do attitude. Successful practice on the margins also depends on the therapist having a range of professional, personal, local and cultural knowledge. Professional knowledge is gained from preregistration education, work experience and continuing professional development. Personal knowledge comes from school education, family, friends, personal interests and other life experiences. Knowledge of local conditions and norms is often accumulated during the course of working. Local knowledge includes understanding: the legal and policy context; organizational structures and systems; the location of power; what resources are available and how to access them, and how to adapt to the local context without compromising the purpose and effectiveness of occupational therapy. The interplay of different forms of knowledge is illustrated in the example in Box 2. Box 2: Forms of knowledge Some years ago, I was asked to take over a women’s craft group in a community centre on a housing estate in the north-east of England. This was an area of deep social and economic deprivation. My remit was to help increase the women’s emotional resilience so that they would be better able to cope with the stresses of their daily lives without becoming ill. This was my first experience of a health promotion role and I did not have a blueprint in my mind of how to approach it. I drew heavily on my professional knowledge and experience of adult mental health and of working with groups. I also used my personal knowledge of crafts and creative activities, checking that the activities would be valued by the women and enhance their self-esteem. They were quite protective of me, seeing that I lacked local knowledge and street wisdom, and I was able to develop a reasonable understanding of the local culture during the years that I worked on the estate. The skills of the occupational therapist We have considered the personal attributes of occupational therapists working successfully in non-traditional settings and the breadth of knowledge required. We will now think about the range of skills that make up the occupational therapist’s toolbox. These skills are acquired through learning and experience, including both professional and life experience. Professional learning begins with pre-registration training and continues throughout the therapist’s working life, which may include practice in a number of different jobs or even different fields. Life experience includes all the learning associated with growing up and living in particular social groups, cultures, geographical locations and political and economic contexts. The skills of the occupational therapist, acquired from these sources, can be categorised as: professional skills, practical skills, interpersonal skills, entrepreneurial skills and thinking skills. Professional skills include: assessment; problem formulation; risk assessment and management; goal setting; selection and adaptation of activities to meet specific goals; record keeping; activity group planning, organisation and facilitation; environmental analysis and adaptation, and so on. Practical skills include: splint making; equipment adaptation; handicrafts; driving; cooking; sports; computer use, and so on. Interpersonal skills include: communication; negotiation; compromise; empathy; persuasion; collaboration; sharing, and so on. Entrepreneurial skills include: seeing opportunities; trying new ways of working; finding markets for goods; maximising resources; enlisting support, and so on. Thinking skills include: clinical reasoning; reflection; ethical reasoning, and other forms of professional reasoning. The occupational therapist working in a marginal or non-traditional setting will find all these categories of skills useful, but makes judgements about the relative importance of different skills to particular projects and selects the most appropriate skills for meeting particular goals. Thinking skills come to the fore when the therapist is faced with an unfamiliar situation. Clinical reasoning is the thinking process that the therapist engages in when working out the best way to engage or support a particular participant or group. Occupational therapists use different types of clinical reasoning, such as procedural or conditional reasoning, switching between them as the issue under consideration changes. Box 3 provides an example of an occupational therapy intervention in a non-traditional setting that highlights the need for cognitive flexibility. Box 3: Thinking in action Two occupational therapist in Missouri volunteered to help when Oklahoma was hit by severe storms, flooding and tornados in 2013. They drove to El Reno, four days after the area was devastated by a tornado. The American Red Cross had set up a shelter at a Community College for victims of the storm, and residents left homeless were being provided with temporary housing constructed from shipping containers. When Jeanne and Sherry arrived at the Red Cross shelter, they were not expected and had to find roles for themselves. They observed that people were waiting up to five hours to be registered, while their children whined and pestered them. The occupational therapists immediately set up a play area for children, to give their stressed parents some relief. It was also important to engage the children in trauma-informed constructive play so that they could process their terrifying experiences and avoid establishing maladaptive responses. There were some large cardboard boxes that had contained donated goods, and the children were encouraged to use these to build houses. Once the children were organised, it was possible for one of the occupational therapists to look for ways to help the adults. Another type of thinking used by practitioners is reflection on their own place in the intervention, the quality of their performance and the impact of their actions. Reflection enables the occupational therapist to identify what she is doing well, what could be improved, what further action is needed and how to modify what she is already doing. Reflection underpins all professional development. Ethical reasoning is the type of thinking the practitioner employs when deciding what the morally right course of action, as opposed to the best clinical course of action. This type of reasoning may be based on principles, such as doing no harm, or on outcomes, such as achieving the greatest satisfaction for the largest number of people. Ethical considerations do not always concur with clinical ones. Professional reasoning includes the types of thinking used when: working with clients, teaching students, establishing new services, developing existing services, negotiating with funders, managing staff and so on. An example of using professional reasoning is shown in Box 4. Box 4: Professional reasoning In 2015, three practitioners, including an occupational therapist, were commissioned to plan and deliver a training programme for staff working in child-friendly spaces in two refugee camps, in Northern Uganda. They used various forms of professional reasoning in developing a programme that would both suit participants’ individual learning needs and be appropriate to the social, cultural, political and economic context of their work. This reasoning took place both in the UK, before the programme was delivered, and during the training week in Uganda, as they observed participants’ responses to each session. This paper gave a brief account of the development of occupational therapy in the first and second halves of the 20th century, showing how that development was influenced by both social movements and pragmatic considerations. It described how occupational therapists are responding to changing social and health needs in the early 21st century, highlighting the personal attributes, knowledge and skills that we draw on to support our practice in non-traditional settings. In most of the fields where occupational therapists work today, we often find ourselves supporting people who have complex and sometimes intractable problems. Following rules or protocols does not help the therapist’s judgement when the problems that brought the client for treatment intersect with poverty, substance abuse, lack of education, homelessness and the many other factors that commonly accompany illness or disability. In order to work effectively, the occupational therapist has to develop expertise in a wide range of thinking skills and professional judgement (Nixon and Creek 2006, p.78). One of the key features of occupational therapy practice in non-traditional settings is that the practitioner is not constrained or driven by the need to demonstrate what she knows or what she can do. Rather, she makes continual judgements about what would be most useful for different aspects or stages of the project. She does not seek to impose a theoretical model or predetermined process, developed outside the particular context, but looks for ways of using her knowledge and skills to support working with what is there. This means that the therapist sometimes has to tolerate not having a clear idea of what to do, especially in the early stages, before she has collected sufficient information to formulate clear aims. The striving by mainstream occupational therapy services in developed countries to standardise assessments tools, processes and models has narrowed the scope for developing alternative modes of thinking and practice. It is in non-traditional, diverse settings that innovation and creativity have continued to thrive. References Blackfriars Settlement www.blackfriars-settlement.org.uk/history. Accessed 13/01/17. Byrne-Fraser, S. (2014) Leisure activities for improving motor skills. OT News 22 (2): 25. Cole, M. (2010) Occupational therapy theory development and organization. In: Sladyk, K., Jacobs, K. and Macrae, N. (eds) Occupational therapy essentials for clinical competence. Thorofare, NJ: Slack. 75-86. Cookson, K. (2014) Occupational therapy in occupational health - is it working? OT News 22 (4): 28-29. Creek, J. (2002) The knowledge base of occupational therapy. In: Creek, J. (ed) Occupational therapy and mental health. 3rd edition. Edinburgh: Churchill Livingstone. 29-49. Creek, J. and Cook, S. (2017) Learning from the margins: Enabling effective occupational therapy. British Journal of Occupational Therapy 80 (7). Darley, G. (2010) Octavia Hill: social reformer and founder of the National Trust. London: Francis Boutle. Duncan, E.M., Creek, J. (2014) Working on the margins: occupational therapy and social inclusion. In: Bryant, W., Fieldhouse, J., Bannigan, K. (eds) Creek’s occupational therapy and mental health. 5th edition. Edinburgh: Churchill Livingstone Elsevier. 457-473. Friedland, J. (2003) Muriel Drive Memorial Lecture: Why crafts? Influences on the development of occupational therapy in Canada from 1890 to 1930. Canadian Journal of Occupational Therapy 70 (4): 204-212. Haworth, N.A. and Macdonald, E.M. (1946) Theory of occupational therapy. 3rd edition. London: Ballière, Tindall and Cox. Hawthornthwaite, B. (2014) Falls and fractures. OT News. 22 (5): 29. Hopkins, H.L. (1978) An historical perspective on occupational therapy. In: Hopkins, H.L. and Smith, H.D. (eds) Willard and Spackman’s occupational therapy. 5th edition. Philadelphia: JB Lippincott. 3-23. Howard, J. (2017) Adding meaning to medicine. OT News 25 (6): 22-24. Lawson-Porter, A. (2014) Developing the student practitioner. In: Bryant, W., Fieldhouse, J. and Bannigan, K. (eds) Creek’s occupational therapy and mental health. 5th edition. Edinburgh: Churchill Livingstone Elsevier. 176-186. McLachlan, H. (2017) Reflections on life as a rural occupational therapist. OT News 25 (7): 32-34. McNulty, C., Laming, N., Pollard, N. and Wood, C. (2017) The Human Library. OT News 25 (5): 20-22. Meyer, A. (1922/1977) The philosophy of occupation therapy. American Journal of Occupational Therapy 31 (10): 639-642. Reprinted from: Archives of Occupational Therapy. Volume 1, pages 1-10, 1922. Nixon, J. and Creek, J. (2006) Towards a theory of practice. British Journal of Occupational Therapy. 69 (2): 77-80. Norwegian Ministry of Health and Care Services (2009) Summary in English: Report no. 47 (2008-2009) to the Storting. The coordination reform: proper treatment - at the right place and right time. Oslo: NMHCS. Paterson, C.F. (2010) Opportunities not prescriptions: the development of occupational therapy in Scotland 1900-1960. Aberdeen: Aberdeen History of Medicine Publications, no. 3. United Nations Development Programme (2014) 2014 Human Development Report: Sustaining human progress: reducing vulnerabilities and building resilience, New York: UNDP. Ward, M. (2014) Hospital at home. OT News 22 (11): 26-27.

Through a global health pandemic, COVID-19 times are definitely trying. Many occupational therapists (OTs) have transitioned to telehealth practice, with populations ranging from paediatrics to adult home health services, while academic programs have shifted to distance learning. We know that health professionals are at the forefront of this public health crisis. But what else can OTs do to contribute during this time, in addition to providing services to our clients? Discussions have taken place between OTs globally, on educating the public and our clients to be equipped to navigate the current situation. Here are some of the ways that occupational therapy can contribute... Activity Analysis Since 1917, we have been focused on breaking down tasks to the 'nitty-gritty', in order to promote successful occupational performance. One way we can contribute is to analyse various activities, such as hand-washing, disinfecting surfaces and taking the proper safety precautions. This is what we do best. If we look back a few months ago, something as simple as hand-washing was something we didn’t have to think twice about, especially as health professionals. Flash forward to the present day, there have been videos circulating of health professionals urging the public to follow safe and effective hand-washing protocols. OTs are equipped with the unique skill to observe and analyse the way someone carries out any given task. Things may not be exactly the way they were before but, as occupational therapists, we can help others adapt, as changes occur. By following reliable guidelines, we can educate the public on proper methods. Occupational therapists' unique skill of activity analysis is so important during this time, to ensure that people are staying safe and reducing the spread of the virus. Activity Idea: Have a friend, child or family member wash their hands (or send you a video), while you analyse the activity. Use this opportunity to educate and promote proper hand hygiene! Evidence-Based Practice With social media and television being some of the primary ways we get information on COIVD-19, it is important to share information that is reliable and accurate. As OTs, we are trained to search for the most compelling evidence out there. We can use that skill to share accurate information regarding the health pandemic. We can do our part by sharing information that is backed by evidence and that comes from reliable sources, such as the World Health Organization (WHO). Sharing peer-reviewed articles, on topics ranging from the benefits of telehealth services to an OT's role, can educate policy-makers and the general public about our profession. What better time than now to advocate for our profession? Mental Health and Self-Care With many regional/state-wide restrictions, travel bans and businesses closed, it can be difficult to put our mental health as a top priority. Organisations such as The National Alliance on Mental Illness (USA) have provided information on ways to get support (see below). As OTs, we are equipped with the ability to educate the public, by providing community resources and education related to self-care. Adding a little self-care into each day can make all the difference, such as trying out an online yoga video, or going for a walk outside. It is our duty to ensure that we are taking care of ourselves, whilst educating others on taking the time to check in with themselves during this time of uncertainty. On this theme, check out 'Achieving a Work-Life Balance as an Occupational Therapist' from CovalentCareers. Social and Leisure Occupations Occupational therapists are skilled in adapting activities - and we know how important social and leisure activities are! Human beings have an innate need to be close to friends and loved ones, not normally thinking twice before hugging or shaking hands with someone. Whilst OTs must educate clients on the importance of social distancing, we should also highlight the many alternative ways to be social, despite being apart. Instead of meeting someone for lunch, why not suggest video calling and preparing the same recipe together, or a virtual video streaming party with friends? Ergonomics Many individuals are now having to work from home. If you haven’t done it before, there is definitely a learning curve that comes with working from home. It is important to find an area to work in that is comfortable, with a chair that promotes alignment of the spine, to optimise posture. Although it might seem nice to work from the bed or couch, OTs should educate the public about how to prevent injuries such as back/neck pain and diagnoses such as carpal tunnel syndrome. We can provide strategies to use while many work from home or participate in distance learning. Below are a few resources: Postural Management and Good Sitting Posture (The Occupational Therapy Hub) Occupational Therapy’s Role with Ergonomics - Fact Sheet (AOTA) Health Promotion and Education The Occupational Therapy Practice Framework (AOTA, 2014) says it best; it is within our scope of practice to emphasise health promotion and well-being. During these challenging times, OTs should continue their role of promoting healthy habits and routines, thus helping the public to stay well and reduce rates of illness or disease. We must empower others to understand what is going on, keeping vulnerable populations out of harm's way. Reliable and trustworthy education - for healthcare workers, clients, neighbours and friends - is a vital part of combating this pandemic. Our profession is equipped with skills and knowledge to educate other health professionals and the general public. Communicating with Children Children face uncertainty and confusion in the current climate, with schools closed and differing routines. It can be difficult for children to understand why they aren’t having to go to school, or why they cannot see their friends. Occupational therapists (especially those working in paediatrics) understand how important it is to communicate with children and provide them with coping mechanisms. OTs are creative; we can use social stories, engaging handouts/activities and picture schedules, to educate children about what is going on. We can assist parents in ensuring children are still learning and sticking to some form of schedule. During these unprecedented times, take care of yourself, follow guidelines and draw on your professional creativity, to bring your passion for helping others to a new level. Together, we can stay healthy, whilst also advocating for occupational therapy! Sue Ram Guest Writer, The Occupational Therapy Hub Reference American Occupational Therapy Association (2014) Occupational therapy practice framework: Domain and process (3rd ed). American Journal of Occupational Therapy. 68 (Suppl. 1), S1-S48. Photos courtesy of Adobe Pixels Stock.

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

As occupational therapists, we develop a list of 'tips' to help our clients attain their desired outcomes. Over the past few years, I have become more involved in the field of positive psychology. There, these strategies are recognised as concepts that have been fully investigated, with a strong history of success when implemented in the clinical setting. I have compiled a list of strategies that can be employed by the clinician, that go a step beyond your typical approach in the clinical setting. I have chosen a few of my favourites to share with you. Each on its own is not a panacea, but can offer alternatives to meet the individual needs of the client. The bonus is that the more you engage in these practices, you as the clinician will also reap the benefits, resulting in fewer symptoms of burnout and more enjoyment in the workplace. 1) Active listening It has been shown that, when you allow the client to speak about their issue for 92 seconds, uninterrupted, they will tell you everything you need to proceed with the treatment sessions. The client perceives this as being 'seen and heard', which results in immediate trust-building, a key ingredient to adherence - and ultimately a more successful outcome. You also get described as an 'amazing listener'. Win-win! So settle in, it’s only 5% of a 30-minute treatment session. In western culture, it is acceptable to maintain eye contact at least 60% of the time and still be effective. 2) Emotional contagion The definition is 'the phenomenon of having one person’s emotions and related behaviours trigger similar emotions and behaviours in other people, either consciously or unconsciously.' In everyday language, your co-workers and your clients are picking up on your mood and attitude. Depending on your behaviour, these 'vibrations' will have a direct impact, either positive or negative. When we are in the professional setting, it is important to take a minute to shake off the negative attitude before any interactions. Since we are all human, a realistic way to manage a bad day is to take a minute before we walk in the door, to acknowledge how we feel to ourselves or a trusted co-worker. Saying out-loud what we are experiencing allows us, at least temporarily, to rid ourselves of the negative and reframe our thought patterns, to bring a more positive attitude into the clinical setting. 3) Empathy This is one of the most effective tools we have as clinicians and, when used effectively, can significantly reduce clinician burnout. Empathy is about focusing on the patient’s perspective, staying out of judgment and acknowledging the person’s emotions. In a nutshell, this keeps you 'out of the patient’s story' and allows the healing to begin. When you are being empathetic, you seek to understand the patient’s perspective - but the secret is, you don’t have to agree with their perspective. By actively listening and allowing the client to feel seen and heard, you are instantly building trust. This improves adherence, right at the first encounter, when patients are at their most vulnerable. 4) Flow The concept of flow, often referred to as 'being in the zone', was first described in the literature by Mihaly Csikszentmihályi PhD, in 1975. In order to achieve flow, three components need to be in place: Clear goals Immediate feedback An existing balance between the challenge of the activity and the person’s potential for success with that specific activity Flow can be accomplished in the clinic and within the home exercise program, when the occupational therapist introduces an activity or exercises that provide a specific and individualised purpose to the patient. The introduction of a customised activity increases the client’s intrinsic motivation; they focus better on an activity that is meaningful and purposeful to them. In turn, this also increases adherence. To create a 'flow' environment, set the long-term goal first (e.g. to return to playing an instrument). Then proceed to set many short-term goals (attain needed range of movement, coordination, etc). All of these goals can then be used to measure progress. Since flow is attained during some sort of intervention, provide tasks that are engaging without being tedious or too difficult. In a busy clinic, or when treating someone with limited access to therapy sessions, this is highly effective when made part of the home program. For example, if the client’s goal is to return to oil painting, instruct the client to begin painting in ten-minute intervals, with instruction to add five minutes to each painting session, as tolerated. 5) Post-traumatic growth Positive psychological change, resulting from adversity and other challenges, producing a higher level of functioning. Sometimes referred to as 'benefit finding', this growth occurs because of the unexpected injury; the client believes they are stronger and better, as a result of what they have experienced. Anecdotally, I will introduce this concept when I witness a client having difficulty improving as a result of a negative mindset regarding the injury or situation. First, I ask them to consider accepting the injury or event has happened and then to acknowledge that the current situation is temporary and will improve. Second, I encourage them to look for changes that, in future, may be interpreted as positive. This approach helps to reframe the client’s outlook to one of a growth mindset, as based on the work of Carol Dweck. When I am reviewing the final home program, I query the client about what changes they have experienced. It is rewarding, for both the occupational therapist and the client, to acknowledge the positive change that is a result of this negative event or injury. 6) Shared decision-making A process in which both the client and the occupational therapist contribute to the decision-making process; an essential ingredient to client-centred care. It prioritises the client’s values and goals and allows the person to feel in control of the situation. The client expresses their desired outcomes as the main focus of the rehabilitation program. Once established, the clinician contributes their expertise regarding the best way to attain the client’s goals. Only with the client’s consent can a mutually agreeable plan be declared. The discussion results in a clear outline for both the client and therapist, allowing both parties to work toward the same goal. This approach also quickly builds trust and will promote adherence to the treatment plan. An example of a way to implement shared decision making into the everyday dialogue is to explain the reasoning for the next step, and to add “and if you are in agreement, I would suggest we proceed with x, y and z”. 7) Strength-based treatment approach A widely used and highly researched approach in the field of positive psychology. It is also referred to as 'strength-spotting'. It directs the attention from the pathology/injury and focuses on the promotion of health within the context of the injury. This creates what is known as the ‘Rosenthal Effect’, after the Rosenthal-Jacobson study completed in 1968, where it was shown that higher expectations lead to an increase in performance. A strength-based approach shifts the focus to what is important to the client and helps to redirect maladaptive attitudes prone to a person who has undergone an injury or trauma. Strength spotting can be initiated during the initial evaluation, through use of the occupational profile, by asking about the client’s interests, talents and competencies. I open the dialogue on the first visit by asking “So, what do you do for fun? What brings you joy?” I don’t move onto the next question until the client gives me a concrete answer. By emphasising what matters most to the client and by acknowledging what strengths the client is utilising to attain their goals, the client’s motivation for success becomes intrinsic, allowing the person to feel they have control of their situation. This approach also leads to better adherence with the rehab program and, ultimately, a positive outcome for both the client and the clinician. References and further reading Langewitz et al. (2002). Spontaneous talking time at start of consultation in outpatient clinic: cohort study. British Medical Journal, 32, pp 682-683 Cuff et al (2016) Empathy: A review of the concept. Emotion Review Vol. 8 No. 2, 144-153 DOI: 10.1177/1754073914558466 Riess, H (2017). The science of empathy. Journal of Patient Experience. vol.4(2) 74-77 Reid, D. (2011). Mindfulness and flow in occupational engagement: presence in doing. Canadian Journal of Occupational Therapy, 78, 50-56. DOI: Csikszentmihályi, M.; Abuhamdeh, S. & Nakamura, J. (2005), "Flow", in Elliot, A. (ed.), Handbook of Competence and Motivation, New York: The Guilford Press, pp. 598–698 Jacobs, K. (1994). Flow and the occupational therapy practitioner. American Journal of Occupational Therapy. 48. 11. 989-996 Vranceanu, A, et al (2009) Integrating patient values into evidence- based practice: effective communication for shared decision- making. Hand Clinics 25, 83-96 DOI: 10.1016/j.hcl.2008.09.003 Linley et al (2010). Using signature strengths in pursuit of goals: effects on goal progress, need satisfaction, and well-being, and implications for coaching psychologists. International Coaching Psychology Review.Vol 5, No. 1, March Rashid T. (2015) Positive Psychology: A strength-based approach. The Journal of Positive Psychology Vol. 10, No. 1, 25-40 Xie, H (2013) Strengths-based approach for mental health recovery. Iran Journal of Psychiatry and Behavioral Sciences, 7 (2); 5-10, ID: 24644504 Mitchell, Terence R.; Daniels, Denise (2003). "Motivation". In Walter C. Borman; Daniel R. Ilgen; Richard J. Klimoski (eds.). Handbook of Psychology (volume 12). John Wiley & Sons, Inc. p. 229. ISBN 0-471-38408-9. Dweck, C (2006) Mindset: the new psychology of success. Ballantine Books

Sensory toys are an absolute must-have in any pediatric [UK: paediatric] therapist's toolbox. Often, it takes a series of trial and error to implement just the right tools. Before application of these toys, it is important as a therapist to understand the underlying purpose of using them. Are you using the activity to calm an over-responsive child? Or are you using it to increase input to an under-responsive or sensory-seeking child? Once I've answered those questions, that's when I pull out my toolbox of kid-favorite toys! Read on for a case study and some examples... Jay is a newly-referred 5-year-old child, diagnosed with autistic spectrum disorder (ASD) and sensory processing disorder (SPD). Before beginning our first occupational therapy session, I asked his mother: What Jay’s daily routine consisted of What his favorite toys and games were What specific goals mom and the family had, so that I could include them into sessions Mom explained that one of her main goals for Jay is to be able to tolerate a haircut. She further explained that Jay is unable to successfully sit down and receive a proper haircut, due to tactile defensiveness and fear of the loud buzzing sound of the razor near his head. He often had extreme behavioral reactions, cried loudly, and would self-talk (stim), in order to self-regulate. The first 2-3 sessions with Jay consisted of rapport building and establishing a foundation of trust between child and therapist. Once that was established, I moved onto slowly introducing the use of the vibrating toy. Initially, Jay was hesitant and fearful when I presented the toy, due to the loud buzzing sound. So I allowed him control of the toy on my own forearm and hand, to assure him that it was not harmful. Once Jay was comfortable with controlling and handling the toy, we counted 1-5 seconds of alternating turns on whose hand and forearm would get ‘tickled’ with the toy. Gradually, Jay was able to tolerate the sensation and sound from the toy on his arm - then shoulder, neck, and eventually, Jay was tolerating the vibration on his head. To promote ongoing success and future transition, I explained to Jay’s mom the importance of carry-over of techniques - from therapy input into the home environment - and demonstrated how I used the toy during sessions. Disclaimer: Neither The Occupational Therapy Hub, nor the author, have any affiliation with the sellers below. Links are for US delivery. Other stores are available. Plush toys A classic go-to plush can never go wrong! Plush toys are a great way to provide sensory calming or sensory stimulation. In addition, using plush toys are perfect to incorporate in treatment, to facilitate pretend play skills and social skills at an early age. Regulation Putty Not only a kid-favorite, but a personal favorite for de-stressing. Regulation Putty is fantastic to target fine motor skills and strengthening, but also provides sensory input from the pressure of the putty. I keep a stash with putty of different levels of resistance; this allows you to determine which level of resistance works for each child. Vibrating sensory toys/hand-held massager Vibrating sensory toys/hand massagers are an effective way to promote deep and consistent sensory stimulation for sensory cravers. Plus, they are low maintenance, easy to store and portable! Hand-held vibration massagers are also superb to use for kids who are sensory defensive and have goals of tolerating a haircut. I sometimes use this tool to simulate a hair razor and gradually work my way up, from using the massager on their hands until they can eventually tolerate the massager on their heads. Yogarilla Cards Yogarilla Cards are a fun way to engage children of all ages to participate in yoga or body awareness poses, for sensory and coordination skills. Children may not want to participate in yoga when first introduced to the activity, so I incorporate the cards into obstacle courses to keep engagement going! Modification of the poses can be easily applied to meet the child's 'just-right' challenge. Pop the Pig Last, but not least, Pop the Pig is the perfect game to target various developmental skills (e.g. fine motor skills, color recognition, turn-taking, attention skills, etc.) and gives proprioceptive input while playing the game. Kids love the deep pressure from pushing both hands onto the pig's head and they never seem to get tired of it! By Elisah Gelladuga, COTA Reference Proprioceptive - Best Practice (n.d.) Retrieved from: https://sensory-processing.middletownautism.com/sensory-strategies/strategies-according-to-sense/proprioceptive/

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

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.

The profession of occupational therapy emerged in North America and northern Europe at the beginning of the twentieth century. The first professional occupational therapy association was founded in the USA in 1917 (Paterson 2010); the Canadian Association of Occupational Therapists in 1926 (Friedland 2011) and the Scottish Association of Occupational Therapy in 1932 (Paterson 2010). A meeting to establish an international association was held in England in 1952, when the World Federation of Occupational Therapists was inaugurated. The founder members of the new international body were: Australia, Canada, Denmark, India, Israel, New Zealand, South Africa, Sweden, the United Kingdom and the United States of America. Seven of these founding countries were Anglophone. The first president of the Federation was Scottish (Paterson 2010). At the time when occupational therapy was emerging as a profession, the UK still had the remnants of an Empire that once stretched all around the world, and the USA also had influence across the globe. It was inevitable that the international language of the new profession of occupational therapy would be English. Since 1917, the influence of the English language on the development of occupational therapy has been so pervasive that most people take it for granted and cannot conceptualise alternative ways of framing the profession. Today, throughout the world, occupational therapy principles, values, theories, methods, domain of concern and professional purpose are primarily conveyed in English; through such media as textbooks, journal articles and international conference presentations. When these concepts and ideas are translated into other languages, the process involves deconstructing the meaning behind an English term, making sense of it within another geographical and sociocultural context, and reconstructing the meaning using another language. This can be a challenging process, because different languages do not delineate concepts in exactly the same ways. For example, even within European languages, which share common roots, Danish has only one word for occupation and activity, while German has three words for occupation. The difficulty is compounded by the inability of Anglophone occupational therapists to reach agreement on the meanings of key terms, such as occupation, skill and function. We do not have a standard terminology and many different definitions of our core professional concepts can be found in the literature. This paper highlights the importance of thinking critically about the language we choose and use, when thinking and communicating about our professional role and purpose. It begins with a brief explanation of what language is, and discusses the nature and functions of professional language. It goes on to describe how I myself gradually came to recognise the impact of language on what we do, on how we understand what we are doing and on how we do it. This personal journey is illustrated with examples of my work on professional language, with colleagues in the UK, the European Union, South Africa and China. How language is defined and understood What is language? It has been defined as ‘a system of human communication using words, written and spoken, and particular ways of combining them’ (Shorter Oxford English Dictionary 2002). Language can be thought of as a tool for both communicating and thinking. The words that we use are important, because they not only shape how other people see our actions but also influence how we feel about what we are doing. Words are not neutral but have an impact on how a person thinks, feels and acts. For example, if you say to yourself that reading this paper is work - a necessary part of your professional CPD, but not something that you expect to enjoy - then you will not think very hard about it. If, on the other hand, you say to yourself that you expect the paper to be stimulating and relevant, then you are likely to read actively and relate the content to your own experience. The basic building blocks of language are words, and words represent concepts. A concept is ‘an idea of a class of objects [or] a general notion’ (Shorter Oxford English Dictionary 2002). For example, the word furniture represents many of the non-human objects that we see in buildings. The word table represents a sub-set of furniture. Both these words represent concepts, or classes of objects. The term occupational therapist also represents a concept and can be found in a dictionary. If we want to know what concept or concepts a word represents, we can look in a dictionary, where we will find definitions of that word. A definition is ‘an explanation of a concept… or formal explanation of the meaning of a word or phrase’ (Shorter Oxford English Dictionary 2002). Some words have more than one definition. For example, to occupy means: ‘to take possession of [or] seize [to] enter and remain in (a building etc.) forcibly or without authority [to] be situated in or at (a place or position) [to] keep busy, to live in (a place), to make use of [and to] follow or ply as one’s business’ (Shorter Oxford English Dictionary 2002) Some definitions can be represented by more than one word. For example, the state of being active can be called action, activity, animation, doing, liveliness, motion, movement or occupation. These words have slightly different meanings but they can all be defined as a state of being active. As highlighted above, the words we use are not neutral; each word represents a particular way of seeing the world. For example, the people occupational therapists work with may be referred to as: patients, clients, service users, citizens or something else. Each of these terms has a slightly different meaning that indicates something about how we see the therapeutic relationship. When I worked as a Mental Health Act Commissioner, the people I visited were called patients. This term connotes the imbalance of power between the person who is detained in hospital against her will (the patient) and the person who determines whether or not the detention is legal and acceptable (the Commissioner). When I worked in a community centre, the people attending my women’s group were called women. This term signifies the freedom they had as citizens to choose whether or not to attend the group each week: it carries no suggestion of inequality in their relationship with me. What is professional language? Each profession and scholarly discipline uses its own, specialised words to refer to key concepts. For example, biologists use such words as: genus, phylum and species when talking about how living organisms can be classified. Particle physicists talk about electrons, bosons and fermions when referring to their field of study. In order to study any discipline or profession, it is necessary to learn the professional language of that field. Professional language is ‘the specialised vocabulary of a discipline’ (Shorter Oxford English Dictionary 2002) that is sometimes called professional terminology. Having a coherent professional terminology is important to occupational therapists, because we cannot think clearly and logically about our professional purpose and practice without a specialist vocabulary to refer to aspects of occupation. Precise language is also important for the purposes of teaching, research and sharing good practice. A third function of our professional terminology is communicating the purpose and process of occupational therapy to clients, service commissioners, managers, colleagues from other disciplines and the general public. My own journey through occupational therapy language My interest in occupational therapy language was stimulated in the 1980s, on hearing occupational therapists complaining endlessly that no-one understands what we do and seeing numerous articles in the British Journal of Occupational Therapy, with titles such as: ‘Occupational who? Never heard of them!’ (McAvoy 1992) and ‘Explaining psychiatric occupational therapy: an art in itself?’ (Madden 1984). I was inspired to embark on a research degree, investigating the difficulties that occupational therapists have with the language of occupation. The working title of my study was ‘Why can’t occupational therapists say what they do?’ In 2003, my fascination with occupational therapy language led to an invitation to join a European project group, that was attempting to produce a standard terminology for occupational therapy, in all the major European languages. In 2001, the European Network of Occupational Therapy in Higher Education (ENOTHE) had formed a working group, to select and define key occupational therapy terms and to organise the translation of the definitions into all the main European languages. The terminology working group was made up of six members from six different countries, representing six European languages: English, Flemish, French, German, Portuguese and Spanish. Working together for six years, the terminology group developed a method for producing definitions of key occupational therapy terms and a protocol for translating each definition into other languages. By the end of the project, we had selected 30 key terms and produced definitions, in English, that everyone agreed could be successfully translated into their own language (Creek 2010). To construct the definitions, the group chose to use existing definitions of key terms from the occupational therapy literature, as a basis for constructing consensus definitions. The European definitions were based on the work of occupational therapy scholars from around the world: most of them, of course, Anglophone. Each member of the working group collected definitions from the literature we were using in our own countries. A consensus definition is one that is in accordance with the meanings of the majority of the original definitions of the term and that everyone in the working group could agree on. The working language of the group was English, so definitions that had been written in other languages were translated into English for the analysis. Unsurprisingly, we found very few original definitions of terms in other languages; most of them had been translated from English. Part of the process of constructing consensus definitions was to consider how each term relates to other, similar terms, so that all the definitions would work together. For example, it was necessary to think carefully about how the concepts of setting, environment and context relate to each other, what elements are common to all and how they differ. When we began working on new terms, we had to revisit our earlier definitions and sometimes rewrite them to clarify their relationship to other terms. This process took a long time, partly because the boundaries between concepts are different in different languages and we had to produce a set of definitions that would work for the whole of Europe. It was my task to suggest definitions, containing the agreed elements, that would work in English. The other group members would then look at the definition and say ‘No, that doesn’t work in French’ or ‘You can’t say that in Spanish’ or ‘That is ambiguous in German’. We would rewrite each definition many times until we could all agree that it would work in translation. The final task of the terminology group, before we disbanded in 2009, was to identify the terms that refer to occupation from the perspective of the performer; such as autonomy, habit and task. We found 25 of these terms and organised them into a conceptual framework, that provides a descriptive theory of occupation. All the terms in the framework refer to aspects of occupation from the point of view of the person who is engaged in occupation. For example, during the performance of an activity or occupation, the performer experiences autonomy to a greater or lesser extent. One of the features of the conceptual framework is that it is organised into three worlds: the internal world of the performer the external world in which performance takes place the interface between these two worlds, in which all actions are performed (Creek, 2010) The internal world is made up of the person’s capabilities for action, such as skills and functions, and the person’s energy source for action, including motivation and engagement. The external world consists of the place where action happens, which includes setting, environment and context, and the social contract for action, which includes roles and participation. All the concepts in the internal and external worlds refer to factors that influence what people do, why they do it, how they do it, where they do it and so on. The interface between the internal and external worlds is where all action takes place. It contains all the terms that refer to action, including the boundaries, such as dependence, performance, forms of action and how action is structured in daily life. It can be useful to reflect on which of these aspects of occupation you tend to focus on when working with clients, and which ones you never think about. Do occupational therapists from different countries and cultural backgrounds all pay the same attention to the same things? The European Conceptual Framework was published as a book. Most importantly, each member of the terminology working group wrote the book in her or his own language. It was not written in English and translated into the other languages of the group. Each author was able to use the idioms of her or his own language, culturally appropriate modes of expression and relevant examples. In 2016, I was invited to the University of Cape Town, as a visiting scholar, to share my experience of developing a multilingual occupational therapy terminology. South Africa has 11 official languages; two with European roots - Afrikaans and English - and nine indigenous African languages: IsiNdebele, IsiXhosa, Sepedi, Sesotho, Setswana, Siswati, Tshivenda and Xitsonga. Like many ex-colonies, the country is attempting to decolonise its education system, along with other systems. Decolonisation has been defined as ‘a process by which colonies become independent of the colonising country’ (Encyclopaedia Britannica, 2020). However, this is not just a political process. The Sovereign Union of First Nations and Peoples in Australia (2019) states, on its website, that: '…to achieve true decolonisation, …we must learn to decolonise our minds. This essentially means that we must stop thinking like our oppressor and thereby stop trying to fit a round peg in a square hole.' Trying to understand the varied and complex occupations of different countries and cultures through the lens of a single language, English, is like trying to fit a round peg in a square hole. This is why I use the term decolonisation, to refer to the work of thinking about occupational therapy in indigenous languages. One of my activities in Cape Town, as a visiting scholar, was to facilitate a workshop for a small group of faculty and practitioners interested in developing a terminology, for use on the occupational therapy programme. The group hoped to produce a terminology in the three dominant languages of the region: IsiXhosa, English and Afrikaans. It was educational for me to realise that most of the occupational therapy faculty chose not to attend the workshop, possibly because they saw the paradoxicality of asking a member of the ex-colonising nation to assist in the process of decolonisation. Nonetheless, within the group there were native speakers of English, Afrikaans and one of the indigenous African languages: a dialect of IsiXhosa. I began by presenting the method used to produce the European conceptual framework, then asked the group to carry out a critique of both the method and the framework itself. Some of the feedback was about the impossibility of translating English concepts into IsiXhosa. It took some time for participants to feel comfortable with me and with each other but, eventually, people began to share their own feelings about language. One of the young, black men told us about how he joined the Rhodes must fall movement when it first started. He told us that the group was gradually taken over by people who had experience of activism and who spoke the language of activism, which he did not understand. For example, when they talked about ‘mobilisation’ he thought of joint movement. Eventually, he felt silenced and decided to leave the group. Participants in the Cape Town workshop also said that it is essential to explore concepts of time, space and place as they are understood in Africa, because these are different from European understandings. The two indigenous African language speakers said that additional occupational therapy concepts would need to be identified and defined in order to express an African worldview. They suggested that these new concepts could form a fourth world, complementing the three in the European Conceptual Framework, to represent the worldview of an IsiXhosa speaker. We had difficulty exploring the nature of this fourth world in English, but the IsiXhosa speakers agreed that the fourth world is transcendental, spiritual, ethereal and is conceptualised as surrounding and shaping all the others. It influences personal and social identity; it is about what will motivate you versus what will motivate others. The concepts discussed by the IsiXhosa speakers in the workshop are not found in English or Afrikaans, so they would have to be identified and defined by IsiXhosa speakers. A way must then be found to translate these definitions into English and Afrikaans. Speakers of these two languages can then select the terms they will use to name concepts from the fourth world. When we produced the European Conceptual Framework, we worked with six languages and six cultures. However, all these languages and cultures share similar roots. The workshop in Cape Town taught me that occupational therapy needs to learn from more diverse languages and cultures, in order to be fit for purpose across cultures and language groups. Shortly after my trip to Cape Town, I was introduced to a Chinese occupational therapist living in Hong Kong: Teresa Chiu. Teresa observed that occupational therapy concepts and theories are not easily translated into Chinese languages. Working independently, she began to study Chinese characters (that is, the written language of Chinese), to identify which one best represents the concept of occupation, as it is understood by occupational therapists. China has many dialects but only one written language. There is no Chinese alphabet but a set of characters, each of which represents a concept. This means that people all over China, speaking different dialects that cannot necessarily be understood by each other, can understand the written script. Teresa and I decided to submit an abstract for the WFOT congress in Cape Town in 2018 and we presented a workshop together. There was a large audience, suggesting that the occupational therapy world is beginning to wake up to the importance of language. For me, one of the highlights of the workshop was when a Scandinavian participant said that he now wants to redefine occupational therapy concepts, starting with his own language. Summary This paper began with a brief explanation of why English is the dominant language of occupational therapy around the world. It discussed the nature and functions of language and, specifically, professional terminology. My own work on occupational therapy language was described, extending back nearly 40 years and including: a 1980s study into why occupational therapists find it hard to say what we do; the European occupational therapy terminology, published in 2010, and the 2016 language workshop at the University of Cape Town. Addressing the challenge of defining occupational therapy from first principles, in every language where we practise, will not only be of inestimable benefit to the speakers of those languages, and to the recipients of occupational therapy services; it will also provide the profession as a whole with opportunities to explore new ways of thinking, that are not often found in the English-speaking occupational therapy world. The understandings that can be gleaned from non-English speaking cultures will enrich and enhance the global development of occupational therapy. References Creek, J. (2010) The core concepts of occupational therapy: a dynamic framework for practice. London: Jessica Kingsley. Encyclopaedia Britannica: https://www.britannica.com/topic/decolonization. Accessed: 22 April 2018 Friedland, J. (2011) Restoring the spirit: the beginnings of occupational therapy in Canada, 1890-1930. Montreal: McGill University Press. McAvoy, E. (1992) Occupational who? Never heard of them! An audit of patient awareness of occupational therapists. British Journal of Occupational Therapy. 55 (6): 229-232. Madden, A. (1984) Explaining psychiatric occupational therapy: an art in itself? British Journal of Occupational Therapy. 47 (1): 15-17. Paterson, C.F. (2010) Opportunities not prescriptions: the development of occupational therapy in Scotland 1900-1960. Aberdeen: Aberdeen History of Medicine Publications. Shorter Oxford English Dictionary (2002). Oxford: Oxford University Press. Sovereign Union of First Nations and Peoples in Australia: http://nationalunitygovernment.org/content/what-decolonisation-how-do-we-decolonise-1. Accessed 22 April 2018.

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

This is a topic that I have recently become inspired by and motivated to learn more about in my practice. To help cement my learning in this area, I thought I would reflect on my understanding. I will firstly explore vital concepts and understanding within the field, before considering the impact on practice. Trauma can be caused by a number of stressors that reach beyond the obvious abuse and neglect; it can be the result of a dental procedure, or a concussion that causes significant shock to the body (Van der Kolk 2015). When our body experiences chronic stress, our cortisol levels increase, in order to enable us to respond to the perceived threat (Levine, 2015). However, in a highly anxious state, only basic functions are carried out, involving the nervous system survival response (eg. fight, freeze and flight) (Selye, 1976). If stressors continue, the body remains in high stress survival mode long after the stressor is gone. This puts constant stress on the body's systems (e.g. digestive system), making it difficult to function properly (Maté, 2011). This response is seen by those who have experienced adversity in early childhood, such as abuse, misattunement, attachment and chronic neglect during infancy. Research indicates a link between adverse early childhood experiences and poor development, due to the impact of chronic stress on the body (Van der Kolk, 2015). The Adverse Childhood Experiences study found that children who grow up in dysfunctional family environments - including those negatively impacted by alcohol, abuse, domestic violence or poverty - are at a greater risk of psychological distress in later life (Felitti et al., 2019). A young child is at risk of poor formation of neural pathways that support functioning and child development. A good example can be seen through an insecure attachment bond; a baby relies wholeheartedly on the primary caregiver to meet their every physiological and emotional need (Beck, 1969). If the parent has never had their own needs responded to as a child, they may lack the knowledge and skills to respond to that of their young. There is concern that current health practices (especially those in inpatient settings) serve to reinforce these traumatic experiences, by rejecting and exerting significant control on clients (Muskett 2014). A good example in my own practice is sectioning. While based on ethical principles of maintaining the safety of those who are at high risk to self/other, they can serve to re-traumatise individuals, who are denied access to their basic human right of freedom of movement. In particular, I have always found physical restraint/injection particularly difficult to consider, given the level of control implemented on scared and often traumatised clients. Trauma-Informed Practice is grounded in an awareness and responsiveness to the impact of a trauma. This approach focuses on physical, psychological, and emotional safety, creating opportunities for empowerment, to develop a sense of control and safety (Substance Abuse and Mental Health Services Administration SAMHSA, 2014). Trauma informed services utilise a strengths-based approach, understanding maladaptive behaviour as related to trauma; facilitating changes in behaviour, through strengthening empathy, resilience and protective factors (Oral et al., 2016). Services should utilise a whole systems approach, including interventions and settings that reflect trauma informed care (SAMHSA, 2015). Mental health acute settings tend to reinforce maladaptive behaviour, since clients are only offered help (e.g. admission) when they present as high risk and engage in extreme self-harming behaviours. As a service, we need to be trauma-sensitive and reinforce feelings of empathy and safety to build trust in professionals. Sometimes admission is not appropriate, due to controls such as locked medication cabinets; these can serve to reinforce existing maladaptive behaviours on discharge. It is important that, as a team, we continue to provide regular community support, despite participation in negative coping strategies. Lastly, I would like to identify the value of trauma informed care when working in learning disabilities [US: intellectual disabilities]. Many of my clients have experienced institutional neglect and abuse, with prolonged hospital stays and high levels of covert medication use (Department of Health, 2012). As a team, we now promote person-centred care in medication treatment planning, to support inclusion and avoid re-traumatising clients. This involves advanced decision treatment planning, to include client choice - when individuals are mentally well and able to make informed decisions around their treatment plan. References Bowlby J. (1969) Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic Books. Department of Health (2012) Transforming care: A national response to Winterbourne View Hospital. Department of Health Review: Final Report. Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. and Marks, J.S. (2019). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine. 56 (6), pp. 774-786. Levine, P.A. (2015) Trauma and memory: Brain and body in a search for the living past: A practical guide for understanding and working with traumatic memory. North Atlantic Books. Maté, G. (2011) When the body says no: The cost of hidden stress. Vintage Canada. Related to physical disease Muskett, C. (2014) Trauma‐informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing. 23 (1), pp. 51-59. Selye, H., (1976) Stress without distress. In Psychopathology of human adaptation (pp. 137-146). Springer: Boston, MA. Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Van der Kolk, B.A. (2015) The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

The start of 2020 saw many masters students across the UK completing their two-year pre-registration Occupational Therapy programme. Throughout the course, students will have gained an insight into the importance of continuing professional development, including management of change within health and social care settings. With health services and the role of Occupational Therapists ever changing, there is great emphasis placed upon service development. Students at the University of East Anglia have completed their final assessment on just this topic. As a culmination of their learning - using their experiences from their final elective placements - students were tasked to come up with service development ideas for their given setting. They were then required to demonstrate comprehensive knowledge and planning of their idea and present this to their peers, as a timed and graded assessment. The students used a variety of models of change - such as the PDSA model (as outlined by NHS Change) - as well as process maps, to demonstrate their knowledge and understanding. Student OT Caroline Silby found that the process helped her to “consider team dynamics when operationalising change” and made her “more proactive within service development, whilst applying critical thinking to a clinical environment”. Students were only formally required to complete the planning phase of these projects, but some were able to begin implementing trial periods whilst on their placements - and others have reported that their plans have been taken on board by their placement colleagues, with the aim to implement them in the near future. When considering areas for development “the service improvement task helped me to understand the service I was in on placement and identify areas that had not been previously considered” - Lorna Day, who was based in a low secure unit for her placement, says. Lorna is now qualified, employed as an occupational therapist and has already found the skills developed on this task helpful; “since being employed as a qualified OT, I feel I can confidently plan improvements to this service on a small scale and larger scale if necessary. It’s a very transferable skill for the work environment and also helped in my job interview.” The students were in a wide variety of settings, from acute hospitals and mental health to role emerging; this gave opportunity for an array of ideas to be shared amongst the students and lecturers. Charmaine Chandler, University of East Anglia MSc Occupational Therapy Course Director, explains the importance of this final assessment. “One of the core aims underpinning the MSc pre-registration Occupational Therapy programme at the University of East Anglia is - ‘To develop therapists that are flexible and responsive to change, able to manage themselves and others within changing contexts of health and social care, whilst ensuring best value'. This final assessment of the programme enables this aim to be assessed; determining the students' ability to identify areas of potential service development and be responsive to the needs of the service in developing ideas for implementation. The students explore their ideas from the perspective of all stakeholders, to understand the potential value and impact and ensure that the change proposed is both feasible and sustainable. The variety of innovative evidence-base presented on the assessment day confirmed that this aim had been realised - but, most importantly - that these newly qualified Occupational Therapists have the mindset and skill to support the continued development of both effective and efficient health and social care services.” Students and lecturers alike feel that sharing the service development titles with The Occupational Therapy Hub community would be beneficial in demonstrating: the hard work and emphasis placed upon service development in the current OT course the valuable contribution students can have in implementing change in your services Some of the service development titles that students elaborated on are as follows: 'Encouraging the Practice of Relaxation Skills on a Tier 4 CAMHS Eating Disorder Unit' - Hannah Plyte 'Implementing a Resident Activity Organiser in a Low Secure Unit' - Lorna Day 'Introduction of an Executive Functioning Group in a Private Paediatric Service' - Cherrie Lai 'Implementing the Occupational Self-Assessment Short-Form (OSA-SF) in a Care Farm Setting' - Aimee Craske 'Introducing Therapy Outcome Measures (TOMs)' - Hadija Uwase-Pottier 'Activity Specific Educational Posters for Sensory Integration Climbing Groups' - Bethany Malin 'Improving Delivery of Therapy Interventions Through the Introduction of a Therapy Advocate Role' - Charlotte Austin 'Improving Administrative Efficiency for Occupational Therapists when Completing Risk Assessments' - Samantha Baker 'Vocational Rehabilitation in Secure Services Introducing a Pre-Vocational Skills Group' - Kathleen Jarvis 'To Reduce Occupational Deprivation Through a Community Meeting that Empowers Patients to Give Feedback on Day to Day Life on a Level 1 Neuro-rehab Ward' - Alexandra Hunter ‘Improving Administration Time for Occupational Therapists Within a Regional Spinal Injuries Unit’ – Menai Parry ‘Development of Language Appropriate Health and Service Documents to Ensure Accessibility to Non-English Speaking Service Users’ – Caroline Silby 'Increasing Awareness of Importance in Collaborative Working Within an Inpatient Neurological Rehabilitation Setting For Staff and Family' - Ellie Keeler 'Introducing an Activity-Based Group for Service-Users of a Perinatal Community Mental Health Team' - Tess Tebboth 'The Development of a New OT Notes Proforma for Burns ITU' - Susanna Harvey References NHS Improvement. (2018). ‘Quality, service improvement and redesign tools: Plan, do, study, act (PDSA) cycles and the model for improvement’. NHS Improvement. [Online] Available at: https://improvement.nhs.uk/resources/pdsa-cycles (Accessed 8 March 2020).

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

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

This paper is a keynote address delivered at the RCOT annual conference in 2017 Occupational therapy emerged from social movements that were flourishing in the UK and the US towards the end of the 19th and beginning of the 20th centuries, including: women’s suffrage, socialism and the settlement movement. From the beginning, occupational therapy was essentially a women’s profession, dedicated to helping people experiencing marginalisation and deprivation. In this paper, I discuss the terminology of the margins and the key features of marginal spaces and places that are of interest to occupational therapists. I write about the British Empire, which, at the time occupational therapy was founded, extended around the globe; showing how a colonial worldview influenced the new profession. Great Britain was the centre of the Empire and the colonies were the margins. I explore the two-way traffic of ideas and practices between centre and margins, applying this to both the British Empire and the occupational therapy profession. Occupational therapy, which began on the social margins in Britain and America, became integrated into the mainstream during the 20th century, losing some of its pioneering spirit in the process. I argue that we have much to learn from occupational therapy theory and practice on the margins, where creativity and innovation are thriving. I conclude that mainstream occupational therapy services can be improved by the adoption of ideas, skills and practices from the margins. The profession of occupational therapy emerged from a number of social movements in Great Britain and America in the late nineteenth and early twentieth centuries. These movements sought to improve the lives of people who were marginalised in society, such as: the urban poor, immigrants, women and those with mental illness. Finding it difficult to enter the established male professions, women started working as volunteers in the social sector and went on to build careers for themselves; for example, as nurses, social workers or masseuses. One of the social changes that allowed the emergence of women’s professions was compulsory education. At the beginning of the 19th century, a wife in the prosperous middle classes was expected to devote herself to creating a home for her husband and caring for their children (Frader 1987). From 1870 onwards, a succession of Education Acts made education mandatory for all children up to the age of 12, creating a class of educated young women with aspirations. Having an education opened the possibility for women to take ‘…their caring, and previously family oriented, talents to the ministration of others in the extended community’ (Wilcock 2002, p. 28). Opportunities for turning a caring role into a career were advanced by four wars fought by Britain between 1853 and 1918. Women like Florence Nightingale, who organised a team of nurses to tend sick and fallen soldiers in the Crimea (biography.com), and Emily Hobhouse, who worked to improve conditions for women and children in concentration camps in South Africa during the second Boer War (Wikipedia), were trail blazers who introduced other women to the potential for pursing professional careers, usually as an alternative to marriage. Octavia Hill, born in 1838, is probably best known as the founder of the National Trust but her career was as a housing manager and one of her chief ambitions was ‘to provide better homes for the poor’ (Hilton 2002, p. 392). In 1884, two of Hill’s close friends, Samuel and Henrietta Barnett, founded Toynbee Hall, the first of the Settlements, to offer amenities, education and guidance to people living in impoverished urban areas (Darley 2010). In London, the Women's University Settlement was established in 1889, to ‘promote the welfare of the poorer districts of London, more especially of the women and children, by devising and advancing schemes which tend to elevate them, and by giving them additional opportunities in education and recreation’ (Blackfriars Settlement). Women from London colleges were invited to live at the Settlement rent free in exchange for their work in the community. The movement quickly spread to the US, where Hull House Settlement was established in Chicago in 1889 with the intention ‘to integrate new immigrants into American society’ (Paterson 2010, p. 7) and ‘…to provide a centre for the higher civic and social life, to institute and maintain educational and philanthropic enterprises and to investigate and improve the conditions in the industrial districts of Chicago’ (Davis & McCree 1931, quoted in Paterson 2010, p. 7). The settlement movement continued to expand across the US, ‘…with an international reputation for social welfare programmes [and] women’s suffrage’ (Paterson 2010, pp. 7-8). One of the social activists connected with Hull House was Julia Lathrop who, in 1903, helped to organise a series of courses for caregivers, which evolved into a social work school: the Chicago School of Civics and Philanthropy. In 1908, Lathrop contributed to setting up a six-week training course in Occupations for attendants in mental institutions at the School (Hopkins 1978). One of the social work students, Eleanor Clarke Slagle, attended this course in 1911. Four years later, she organised the first professional school for occupational therapists at Hull House, the Favell School of Occupational Therapy (Friedland 2003). In Britain, the Women’s University Settlement supplied women for a wide range of social work positions, providing many workers for Octavia Hill, who employed them as rent collectors and district visitors. One of her employees was a young woman called Elizabeth Casson, who went on to study medicine. In 1919, after becoming the first woman to be awarded the degree of Doctor of Medicine at the University of Bristol, Casson decided to specialise in ‘the treatment of nervous and mental disorders’ (A.W.R. 1955, p. 85). She gained a Diploma in Psychological Medicine at the Royal Holloway Sanatorium, where she began to organise occupational therapy; ‘…employing people with particular skills and expertise as there were no specifically trained occupational therapists at the time’ (Wilcock 2002, p. 121). One of these people was Constance Tebbit, who was inspired to go to the United States and train as an occupational therapist. When Tebbit returned to the UK, in 1930, she went to work at Dorset House, the psychiatric clinic Casson had opened in Bristol, becoming the first principal of the Dorset House School of Occupational Therapy. From this brief account, we can begin to see how the occupational therapy profession, in its early days, was intimately connected with a number of organisations and movements that sought to improve conditions for people living on the margins of society. What do we mean by the terms marginalised and margins? When we talk about someone or something being marginal, we usually mean that it is situated on the edge, either physically or socially; not fully integrated into the mainstream. The Oxford English Dictionary (2002) defines a marginal position as ‘on or close to the margin below which something ceases to be possible or desirable’. For example, the living conditions in refugee camps may be very close to impossible or undesirable for the inhabitants. The Oxford Dictionary also suggests that having a marginal status means someone or something is ‘of minor importance…having little effect’. For example, people with a mental illness diagnosis in the UK have little power or opportunity to influence the type and quality of services they receive. A margin can be a physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin, there is a centre or core that represents some form or position of authority, power and privilege. (Duncan & Creek 2014, p. 460) Margins share a number of features, all of which exist in relation to a centre of power, privilege or authority (Duncan & Creek 2014). These features include: Social and/or physical distance from the centre Lack of resources and/or inability to access the resources of the centre Powerlessness relative to the centre Marginalisation is the process of moving something or someone from the centre to the periphery, to impoverish, depreciate or undervalue. For example, when an unskilled worker loses his job, he also loses his status as an earner and, if he cannot find another job quickly, is marginalised as an economic burden on society. If the loss of earnings leads to loss of his house, then he is also marginalised as a homeless person. Thus, the process of marginalisation can be progressive and cumulative. Mainstream services, such as the National Health Service, are positioned at the social centre and, usually, at the physical centre of a community; such as the major hospitals located in large towns and cities. However, the concepts of margins and mainstream are not diametrical opposites but: represent the ends of a continuum, [so] that a setting or position can be more or less mainstream or marginal. For example, in a developed country such as the UK, unemployed people are marginalised, but not to the same extent as people who are both unemployed and homeless. A particular group of people may be marginalised in some ways, but not in others, such as those who have a mental illness diagnosis but are highly successful in their chosen sphere of work. Furthermore, it is possible for a marginal social position to exist in close physical proximity to a social position of privilege and authority, such as street sleepers in the financial district of a city. Far from being an absolute state, marginality represents a family of conditions that may be experienced by different groups in different ways. (Creek 2017, p. 238) During the first decades of the twentieth century, the time when occupational therapy was emerging as a profession, Great Britain had an Empire that extended around the globe. Power, privilege and authority were concentrated in the administrative structures of the Empire, while the colonies constituted the margins. Goods, wealth, raw materials and labour flowed from the margins to the centre, in exchange for laws, knowledge, education and technology carried by traders, missionaries, administrators and their wives to the furthest reaches of the Empire. The colonisers believed that their ways of understanding and ordering the world were superior to those of the people they governed, and that everyone benefited from the civilising influence of colonial rule (New World Encyclopaedia). But their dominance went further, in that they ‘exercised power and reinforced domination by establishing the parameters of permissible thinking and by suppressing challenging ideas’ (Hammell 2011, p. 28). With this colonial heritage and context, it was inevitable that the two countries where occupational therapy was first recognised, Great Britain and its most powerful former colony, the United States of America, would see themselves as the privileged and authoritative centre of the profession. Throughout the twentieth century, occupational therapists from these two countries colonised the rest of the world with their own ways of understanding and practising occupational therapy; in a process of ‘theoretical imperialism[,] by which theorists develop and perpetuate theories that privilege their own perspectives while overlooking, ignoring or silencing the perspective of others’ (Hammell 2011, p. 28). Like the colonialists of 100 years earlier, these occupational therapists believed implicitly that their knowledge and skills were superior to those of people on the margins. The flow of knowledge and experience was unidirectional, from the centre to the margins, and English was firmly established as the dominant language of the profession. Earlier in this talk, I described margins as spaces and places far from the social mainstream. This means that people on the margins not only lack access to the resources and power of the centre, they also function at a remove from the rules and traditions that characterise the activities of the centre. In marginal spaces, where the control of the centre is weakened by distance, creativity and innovation tend to flourish. This phenomenon can be clearly seen in the social movements that gave rise to occupational therapy. The pioneers of the profession, unconstrained by long-established modes of thinking, were able to find new ways of framing social problems that offered realistic solutions. For example, Casson’s decision to become a doctor came from her observation, while visiting poor people on Hill’s housing estates, ‘…that appalling ignorance and neglect of physical weakness and disease accounted for much of the misery and poverty she found’ (Reed 1955, p. 87). Instead of seeing the chief cause of poverty as individual laziness or a persistent refusal to exert effort, a dominant social belief at the time (Darley 2010), Casson linked poverty to lack of education and ill health. This formulation gave her two potential avenues for practical action: she could train as a teacher or as a doctor. Those at the centre of society have a tendency to keep an eye on the margins and move to colonise them at the point where something useful is produced. An example of this is Banksy, the Bristol graffiti artist, whose work now commands hundreds of thousands of dollars in auction houses (Ellsworth-Jones 2013). This tendency means that the margins are always changing, as formerly marginalised people and ideas are incorporated into the mainstream, while new margins spring up in the spaces that are passed over or missed by the centre. When innovations from the margins are absorbed into mainstream thinking and practice, they gradually become codified into rubrics and procedures, until no-one remembers that they started out as contingent, mutable and provisional ways of working. This process of calcification has occurred in occupational therapy theory and practice, which were originally tailored responses to the observed needs of people whose access to occupation was blocked by disease, disability or disadvantage. As the profession came under the control of the centre, effectively through the regulating influence of medicine, theory and practice became systematised into precepts and routines, to be applied uniformly. While mainstream occupational therapy services in developed countries have been striving for standardisation of assessments tools, processes and models, thus narrowing the scope for developing alternative modes of thinking and practice, innovation and creativity have continued to thrive on the margins, in ex-colonies where national identities are being explored. An example of this is the work of Minnie Lagria in the Philippines, who is helping to resettle villagers displaced by Typhoon Yolanda. Lagria co-ordinates a wide range of activities designed to: facilitate the transition from islet to village living; promote the acquisition of new skills for diversified livelihoods; assist villagers to adapt to new routines and habits, and promote better health. My realisation that there were radically new theoretical and practical developments taking place in the profession came in 1999, during a visit to South Africa. I was amazed and delighted to find that occupational therapists there were finding ways to address some of the major issues facing their country: the HIV/AIDS epidemic, structural poverty, the legacy of apartheid and the consequences of gender inequality. For example, Theresa Lorenzo used the United Nations 22 Standard Rules on the Equalization of Opportunities for Disabled People (UNDP 1994) to guide her work with disabled women in townships around Cape Town (Lorenzo 2004). The 22 Rules cover: the preconditions for equal participation; target areas, and implementation strategies (UNDP 1994). Lorenzo was the first occupational therapist I encountered who had the ambition and courage to measure her interventions against international standards, rather than limiting herself to the application of profession-specific approaches and assessment tools. Innovative thinking and action on the margins are driven by a combination of extreme need and lack of resources, but they are enabled by distance from the power and control of the centre that leaves people free to devise their own solutions. My observations of occupational therapy in South Africa, and other developing countries, led me to speculate that mainstream practice could learn from practice on the margins. To test this idea, I undertook a PhD study of occupational therapists working on the margins of society: the study was completed in 2014. For the study, I interviewed practitioners working with people who are unable to access the services or resources of the mainstream and who experience powerlessness in relation to the privileged centre. These marginalised groups included: young men who migrated from the African countryside to the city, where they were unable to find work; people left disabled by war in northern Uganda; repeat offenders in Scotland; homeless people in a UK city, and people in UK towns and cities living with a mental illness diagnosis. The main findings of my study were that: the process of occupational therapy on the margins is different from the process described in textbooks; practice on the margins is qualitatively different from mainstream practice, and practitioners on the margins share a particular set of characteristics that enable them to work effectively in resource-poor settings. I will briefly describe these three findings. The starting point of the occupational therapy process in marginal settings is the therapist’s perception of an unmet occupational need and recognition of how that need might be met. For example, one occupational therapist in my study observed that many of the people she visited in prison, as a volunteer, were repeat offenders. She felt that paid employment was an important factor in reducing the reoffending rate so she set up a landscape gardening company to employ men when they came out of prison. A key aspect of perceiving need is the awareness that something can be done to improve the situation and that the therapist has the skills and knowledge to bring about positive change. Perception of need leads to action by the therapist: action with and on behalf of the people in need. Crucially, the therapist’s actions are not directed by pre-selected theories, models or approaches but are shaped by interaction between the therapist’s own knowledge, skills, experience and attributes and the external resources available. The South African occupational therapist, Kathleen Brodrick, demonstrated this process when she set up the organisation, Grandmothers Against Poverty and AIDS (GAPA). A longitudinal study by the Institute of Ageing in Africa had found that when one or more parents dies from AIDS the grandmother may become the sole provider and supporter of the grandchildren (Brodrick 2004). Brodrick framed this issue as occupational: the grandmothers needed help ‘to deal with the impact of the AIDS pandemic on their lives, and especially with the devastating financial impact’ (op cit., p. 235). Her response to this perceived need was to organise a series of workshops at which grandmothers could receive useful information, about such matters as HIV/AIDS, nutrition, bereavement and business skills, and share the issues they faced. In 2004, Brodrick wrote: It was clear from the workshops that there was considerable distress amongst the grandmothers, as well as an urgent need for help with productive occupation[s]. There was only one occupational therapist, and she was not fluent in isiXhosa. Clearly, an individual counselling method would be inappropriate. (Brodrick 2004, p. 236) The second finding of my study was that practice on the margins differs from mainstream practice along several continua. Occupational therapy practice can be: Driven by particular ways of doing things, including models and procedures Focussed on the individual, who is seen as the locus of the issue Controlled by external forces, such as managers, employers and contracts Based in an institution, such as a hospital or prison I suggest that these qualities are more characteristic of practice in the mainstream than on the margins. Practice on the margins is more likely to be: Responsive to local conditions and needs Focussed on the collective, that is, on the community, family or work group Delivered by a professional who is able to make autonomous decisions about what to do and how to do it Based in the communities where people live and work. One of the occupational therapists in my study went into hostels for homeless men, to carry out an art project with them. Her approach demonstrates several of these qualities. One of the key groups that I’ve really… found incredibly difficult to work with were the very… young men... we’re talking 14 to 16 to 18, that sort of grouping there. Particularly kind of chaotic; particularly kind of aggressive; very defensive about things; very, very vulnerable. …in normal circumstances, I wouldn’t have chosen to work with that group… It’s been good having to, actually, because it’s presented me with a lot of reflection about my own discriminatory ideas… the group was about people choosing to be in it, so I didn’t have any control about who came into that group. It was about people saying, ‘I want to be in that’. And sometimes you just wonder… why do you want to be in it? Because you’re so disruptive, you’re so breaking up things, why do you want to be here? But again, you know, also being powerless within the group, I couldn’t say to people, ‘You can’t do that’. I had no official… status so, again, that meant that I had to recalibrate my kind of therapist self, that I would fall back into as a kind of protective process to manage the sort of thing. The third finding of my study was that occupational therapists working on the margins share a number of characteristics that enable them to work effectively in settings that lack the structure and resources of mainstream services: I call them the five enabling characteristics: Agency is the capacity to take action towards an end Openness involves taking an anthropological perspective; trying to understand what is there on its own terms Responsiveness means being willing to let go of habitual ways of doing things and react in ways appropriate to the circumstances Commitment is the stamina to persist with a project over a long period of time, despite challenges and setbacks Resourcefulness is imagination and creativity in finding and making use of the human and non- human resources available in the environment. All these characteristics are embodied in the occupational therapists I have met who work in townships in South Africa. A few years ago, Madie Duncan, a lecturer at the University of Cape Town, took me to visit a settlement in the Western Cape where she has been taking groups of students for over a decade. We were there to deliver the report of a study carried out by the latest student group into the mental health needs of the community. This was the fourth piece of research undertaken by the students, and the ANC counsellor we met said that he is able to use their findings to support grant applications for improving the lives of residents. This paper began with an account of how the occupational therapy profession originated from the margins of society, and ended with some of the findings of my PhD study into occupational therapy practice on the margins today. I would like to finish by arguing that the features and characteristics of practice on the margins make it more effective than institutionalised occupational therapy practice for people living with long-term, complex conditions. I suggest that, as our present health and social care services struggle to deal with increasing numbers of such people, it is time for us to let go of established ways of thinking and practising, and allow ourselves to learn new and more successful approaches from practitioners on the margins. References A.W.R. 1955 Profile: Elizabeth Casson, MD, DPM. In: The Dorset House School of Occupational Therapy 1930-1986. Reprinted in: Occupational Therapy 18(3): 85-86. Biography. com http://www.biography.com/people/florence-nightingale-9423539#crimean-war (Accessed 02/02/17). Blackfriars Settlement www.blackfriars-settlement.org.uk/history. (Accessed 13/01/17) Brodrick K 2004 Grandmothers affected by HIV/AIDS: new roles and occupations. In: R Watson, L Swartz (eds) Transformation through occupation. London: Whurr. 233-253. Creek J 2017 Enabling occupational therapy practice in marginal settings. In: D Sakellariou, N Pollard (eds) Occupational therapies without borders: integrating justice with practice, 2nd edition. Edinburgh: Elsevier. 237-244. Darley G 2010 Octavia Hill: social reformer and founder of the National Trust. London: Francis Boutle. Duncan M, Creek J 2014 Working on the margins: occupational therapy and social inclusion. In: Bryant W, Fieldhouse J, Bannigan K (eds) Creek’s occupational therapy and mental health, 5th edition. Edinburgh: Churchill Livingstone Elsevier. 457-473. Ellsworth-Jones W 2013 The story behind Banksy. Smithsonian Magazine. www.smithsonianmag.com/arts-culture/ (Accessed 05/03/17). Frader LL 1987 Women in the industrial capitalist economy. In: R Bridenthal, C Koonz, S Stuard (eds) Becoming visible: women in history, 2nd ed. Boston: Houghton Mifflin. Friedland J 2003 Muriel Drive Memorial Lecture: Why crafts? Influences on the development of occupational therapy in Canada from 1890 to 1930. Canadian Journal of Occupational Therapy 70(4): 204-212. Hammell KW 2011 Resisting theoretical imperialism in the disciplines of occupational science and occupational therapy. British Journal of Occupational Therapy 74(1): 27-33. Hilton T 2002 John Ruskin. New Haven: Yale University Press. Hopkins HL 1978 An historical perspective on occupational therapy. In: HL Hopkins, HD Smith (eds) Willard and Spackman’s occupational therapy, 5th ed. Philadelphia: JB Lippincott. 3-23. Lorenzo T 2004 Equalizing opportunities for occupational engagement. In: R Watson, L Swartz (eds) Transformation through occupation. London: Whurr. 85-102. New World Encyclopedia http://www.newworldencyclopedia.org/entry/Colonialism#Justification_for_Colonialism_argued_by_Colonial_Powers (Accessed 17/02/17) Nixon J, Creek J 2006 Towards a theory of practice. British Journal of Occupational Therapy 69(2): 77-80. Paterson CF 2010 Opportunities not prescriptions: the development of occupational therapy in Scotland 1900-1960. Aberdeen: Aberdeen History of Medicine Publications, no. 3. Reed E 1955 Dr. Casson’s early life. Occupational Therapy 18(3): 87-89. UNDP 1994 United Nations 22 Standard Rules on the Equalization of Opportunities for Disabled People. Vienna: United Nations Development Programme. Wikipedia https://en.wikipedia.org/wiki/Emily_Hobhouse (Accessed 02/02/17) Wilcock AA 2002 Occupation for health, volume 2: A journey from prescription to self health. London: British Association and College of Occupational Therapists.

By: Dr. Sakshi Tickoo (BOTh) Like all forms of human development, sexual development too begins at birth. Sexual development includes the physical changes that occur as children grow, the sexual knowledge and beliefs they come to learn and behaviours they show. Parents often become concerned when a child demonstrates sexual behaviours, such as touching self or another child’s private parts. Such behaviours are not uncommon in developing children; most sexual play is an expression of child’s natural curiosity and should not be a cause for concern or alarm. In general, 'typical' childhood sexual play and exploration: Occurs between children who play together regularly and know each other well Occurs between children of the same general age Is spontaneous and unplanned Is voluntary (the children agreed to the behaviour, none of the involved children seem uncomfortable or upset) Can be easily diverted when asked to stop Natural and healthy sexual exploration during childhood is an information gathering process. At a very young age, children begin to explore their bodies by touching, poking, pulling, and rubbing all their body parts, including their genitals. Hence, it becomes essential for children to learn about sexuality throughout the course of their life. The more information that parents have about psycho-sexual development, the better will they be able to respond to their child's behaviours. Moreover, the child receives this information beforehand, unlike what they would have from wrong or unreliable sources. Table 1 provides parents with a guide on what behaviours they can expect to see - and how to introduce topics of sex education appropriate to the situation [2]. Note: The parent should keep in mind not to bombard children with information all at once. Let the situation - and the child’s questions - guide the lessons they share. Unfortunately, not all parents feel comfortable discussing sexuality and/or may respond to behaviours by over-reacting, shaming, blaming and/or punishing the child [3]. This is exactly where Occupational Therapists try to bridge the knowledge and communication gaps. Like every other activity of daily living (ADL), Occupational Therapists (especially, paediatric and school-based OTs) advocate for and bring these topics into discussion, to promote a healthy dialogue between the therapist, parent and the child. The most frequent statements I have heard in practice by parents are: “Addressing topics of sexuality with children would mean talking about sexual activity.” “Talking about sex with children will just encourage them to become sexually active.” Much to their amusement, these statements are mere myths! Fact No. 1: Sexuality includes a lot more than just the activity of sex. Teach what the child needs to know in the situation. Provide them information appropriate to their needs and developmental level/age [2]. When you talk honestly with your children about sexuality and sexual health, you can give them the knowledge and skills they need to keep safe and to make good decisions about expressing and conducting themselves. Fact No. 2: In a survey conducted in 2009 (CHSS, Kent; Sept 2009), 8 out of 10 teens said it would be easier to delay sexual activity and prevent unwanted pregnancy if they were able to have “more open, honest conversations” with their parents on these topics. In fact, bringing up topics of sexuality and sexual health opens children to feelings of compassion and respect for all genders from a very tender age [1]. How to respond to these behaviours? Children's understanding of genital exploration is that "it feels good", not that "I am doing something sexual". When children begin to explore, ask questions and/or experiment with their own bodies or with others, this is a sign to parents that they are curious and have questions [2]. Children will touch their genitals to explore their anatomy and sensations. Such touching may lead to “masturbation”. This normal childhood development via masturbation often serves to relieve tension, promote relaxation and comfort for children. As children begin to explore their bodies and experiment with their peers, parents may feel uncomfortable, embarrassed, or unsure discussing sexuality may seek professional help from Occupational Therapists to guide them through this process of development. When responding to sexualised play between children: Do not over-react: By staying calm and handling the situation without over-reacting, children will develop a positive sense of self and sexuality. Ask questions: When talking to children about sexual behaviours, it’s important to maintain even tone of voice and ask open-ended questions as much as possible, so the children can tell what happened in their own words, rather than just answering yes or no. For example [3]: What were you doing? / Why were you doing it? / How did you learn about this? / When do you feel like doing it? / How did you feel about doing it? The important thing is to let children know that you are ready to listen and to answer whatever questions they may have. Parents should also ask the children if they have any questions and be available to answer any that they ask. Stop the behaviour: If children are masturbating in public or in front of others, explain them that it is inappropriate to touch their private parts in public and that if they feel they need to touch their private parts, they need to do it in private, hence "private parts". Children should not be told that it is "bad", "dirty", or "nasty", when found masturbating. When children are exploring their sexuality with other children, parents should explain them that when they are playing with their friends, they need to leave their clothes on and it is not okay to touch or show private parts [3]. Don't punish: Punishing sexual behaviours can lead to sexual inhibitions later on and hinder a child's sexual development. Tell children that their behaviour is not appropriate by being clear and direct without making them feel guilty. Importance of Sensory Processing Just because a behaviour is typical, it doesn’t mean the behaviour should be ignored. The scope of Occupational Therapy practice is not only limited to children showing normal developmental patterns. Occupational Therapists are equipped in helping children with behaviour problems, intellectual or physical disabilities grow with a sense of 'sexual being-ness' too. Quite often, children with social, communication and sensory difficulties can show obsessions, repetitive behaviours and routines via sexual behaviours [4]. In such scenarios, Occupational Therapists can help children with appropriate integration and modulation of sensations and adequate channeling of emotions, to avoid inappropriate genital stimming and/or proprioceptive seeking behaviours. Along with the parent, therapists can explore and identify the reasons and function of the behaviour, to gain an insight towards precursors... Set boundaries: Set clear, consistent limits. Decide together a realistic target and put together a plan to reach that target, over a period of time. Consider what needs to be changed (the frequency or the duration of repetitive behaviour). If it is a mixture of both, focus on one aspect to change at first, to increase the chance of success and reduce anxiety. For example [4]: Week 1: Decide on the plan and target, creating a visual support explaining the change. Week 2: Child is allowed to explore via touching for 10 mins, every hour. Week 3: Child is allowed to explore via touching for 5 mins, every hour and so on. The frequency can be later changed depending on the progress of the child. Provide alternatives: Alternative activities direct the child behaviours into a more acceptable play activity. A balanced sensory diet is that which an occupational therapist develops specifically to meet the needs of the child's own nervous system. Its purpose is for the children to become more focused and meet their sensory needs. A sensory diet includes a combination of alerting, organising and calming sensorimotor activities, depending on the child’s needs. Alerting activities benefit the under-sensitive children, who need a boost to become effectively aroused. Some examples are: Crunching dry cereal, popcorn, chips, crackers, nuts, pretzels, carrots, celery, apples or ice cubes Taking a shower Bouncing on a therapy ball Jumping up and down on a trampoline Organising activities help regulate the child's responses. They include: Chewing granola bars, fruit bars, dried apricots, cheese, gum, bagels or bread crusts Hanging by the hands from a chinning bar Pushing or pulling heavy loads Getting into an upside-down position Calming activities help the oversensitive child decrease hyper-responsiveness to sensory stimulation. They include: Sucking a hard candy, frozen fruit, or spoonful of peanut butter Pushing against walls with the hands, shoulders, back, buttocks and head Rocking, swaying, or swinging slowly back and forth Deep pressure massage Support skills development. Self-regulation skills are any activities that will the help the child to manage their own behaviour and emotions. For example: Use a traffic light system, or a scale of 1-5, to present emotions as colours or numbers (a green traffic light or a number 1 can mean 'I am calm'; a red traffic light or a number 5 can mean 'I am angry’ [4] Mirroring activities Use social stories to enhance comprehension of do’s and don’ts [5] “Simon Says” to facilitate self-motor control “What if” games and role plays A combined effort by therapists and parents, focusing on children accessing accurate and complete information and support for healthy decision-making, is key for all kids and teens who will transition to adulthood [1]. Dr. Tickoo is an Occupational Therapist (BOTh) and Certified Personal Counsellor from Mumbai (India), currently working at a special school. She recently started a personal blog on Instagram- “Sex, Love and OT” (@sex.love.andot), to advocate, promote and share a positive word and information about scope of Occupational Therapy practice in sexual and mental health. She aspires to extend her research and education in the above said fields. References [1] A Survey of Teenagers’ Views of Sex and Relationships Education and Sexual Health Services in Kent: https://pdfs.semanticscholar.org/7632/6e0accc7f093095d8921aaf56340aafc10e6.pdf [2] The National Traumatic Stress Network: https://www.nctsn.org/ [3] The Children’s Assessment Center, Grand Rapids, Michigan: Children’s Sexual Behaviour and Body Safety - A guide for parents [4] Obsessions, Repetitive behaviours and routines: https://www.autism.org.uk/living-with-autism/understanding-behaviour/obsessions-repetitive-behaviours-and-routines.aspx [5] Social Story-Masturbation: http://www.livingwellwithautism.com/yahoo_site_admin/assets/docs/masturbation_social_story.184124213.pdf [6] Case studies: https://www.netmums.com/coffeehouse/special-needs-and-disabilities/other-special-needs-chat-502/1056082-inappropriate-stimming-public.html [7] Promoting Healthy Sexual Development and Sexuality: https://brightfutures.aap.org> BF4_HealthySexuality Further Reading Resources for parents & therapists: Haffner, Debra W. (2008). From diapers to dating: A parent’s guide to raising sexually healthy children - from infancy to middle school, 2nd edition. New York: Newmarket Press. Includes techniques to identify and examine your own sexual values so that you can share these messages with children. Hickling, Meg. (2005). The new speaking of sex: What your children need to know and when they need to know it. Kelowna, BC, Canada: Wood Lake Publishing, Inc. Author dispels misconceptions and unhealthy beliefs about sex, provides guidelines on how to talk with children at various stages of their development, and offers examples of how to answer tough questions. Other books to consider: In case you’re curious (Alison Macklin), What’s happening to me? (Peter Mayle), It’s perfectly normal (Robie Harris & Emberley). A ton of other Online Resources are available for parents & therapists including Committee for Children, Sexuality Information and Education Council, Planned Parenthood, and Sex Positive Families to name few. Amaze.org is an animated video series that give provide parents and children with all the answers they want to know about sex, sexuality, body and relationships. Books for Children: Brown, Laurie Krasny. (2000). What’s the big secret? Talking about sex with girls and boys. New York: Little, Brown Books for Young Readers. For ages 4–8. This colourful book uses illustrations, cartoons, and very accessible text to explain the basics of anatomy, reproduction, pregnancy, and birth along with topics of feelings, touching, and privacy. Hansen, Diane. (2007). Those are MY private parts. Redondo Beach, CA: Empowerment Productions. For ages 4–8. This short, easy-to-read book uses colourful illustrations and catchy rhymes to teach children that no one - relative, friend or neighbour - has a right to touch them in a way that makes them feel uncomfortable.

An absolutely fascinating, innovative approach, to create something from nothing... Established in 2010 in central Kenya, there is an innovative workshop that has been making chairs and standing frames and other pieces of adaptive positioning equipment - made simply from recycled cardboard boxes. This means they are ultra low-cost and affordable to all. Currently over 2,000 items have now been custom designed and fabricated on site, at the Metropolitan Sanctuary for Children with Disability. It is a charitable Christian rehabilitation centre, in the heart of central Kenya. The equipment is individually designed by the occupational therapy team at the Sanctuary, to meet the individual needs of each recipient. They are designed to keep the child in a good position and alignment, either in lying, sitting or standing. Adaptive seating provides a stable base of support to enhance function, reduce fatigue and offer some much needed comfort to each beneficiary. It helps to position the person well, which in turn, prevents development of contractures and deformity. It enhances feeding, swallowing, digestion, and having a stable base of supports promotes use of hands and supports trunk and head function. Good positioning also enhances cardiovascular and respiratory function and manages pressure distribution well. Most importantly, keeping a person upright and at eye level with others enhances the social interaction and engagement in community life. Standing frames are used to enhance strength of the trunk and lower limbs, offer opportunity for being upright and facilitate bone density. ''Creativity is intelligence having fun'' - Albert Einstein If you would like to hear more contact Jolene Allen, Occupational Therapist at the Metropolitan Sanctuary for Children with Disability, Nyeri Kenya. Email: joleneallen7@aol.com.

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. The following are key benefits of occupational therapy: Life transitions Occupational therapy can help reduce the frustration involved in the transitional phases of an older adult. Difficult changes, such as the loss of a spouse or partner, relocation, or even retirement are changes that OT can assist with. Unlike the more physical side of OT, the goal of therapy in the instance of dealing with life transitions is to give the individuals problem solving methods, to help them adjust to a 'new normal'. An Australian study looked at older individuals who were moving into retirement homes and the positive impact that OT had as the individuals adjusted to their new homes. Unfortunately, there is a greater need for more thorough research on OT and life transitions, but there are definitely indicators that OT aids older individuals as they navigate life changes. Falls prevention According to Jane Byrne, coordinator for a nursing home in Bray, “Older adults are prone to slip and fall accidents due to a variety of health conditions, such as poor reflexes, instability or bone fragility. These accidents may cause severe injuries, rendering them incapable of performing daily tasks.” Occupational therapy shares knowledge on how to preserve energy whilst staying active, as well as techniques to aim to reduce slip and fall accidents. Because reducing falls can help prevent further healthcare costs, the need is great for this aspect of OT. Overcoming everyday challenges Therapists can help impact living standards for older adults, by utilising modern exercise and educational techniques to make life easier. Occupational therapy can assist a variety of activities such as dressing, bathing, feeding and toileting, which gives adults the independence they previously had. In an American study done in 2006, OT for stroke patients was studied. It determined that the profession helped maintain partial independence. The exact form of this therapy has yet to be defined, which means it hasn’t been fully implemented in healthcare settings. Knowing that it exists and helps patients' mental and physical lives improve is an important step towards improving and fine-tuning OT for each patient. Helping to keep arthritis at bay Arthritis is associated with joint inflammation, which can lead to immobility and inactivity. Occupational therapy takes charge of the matter; it conducts relevant examinations to determine the type of arthritis and helps individuals come up with an ideal course of action. The Arthritis Foundation recommends that, on diagnosis of arthritis, individuals should seek an occupational therapist, to assist in identifying which daily activities are difficult and which self-management skills are needed, in order to maintain control of daily living. Providing support for memory loss This form of therapy is most helpful in the earlier phases of memory loss, but is useful throughout all stages. As long term memory loss has no cure, the OT’s goal is to create a safe and supportive environment that helps older people maintain their activities of daily living, whilst aiming to prolong their independence. Additionally, the OT will work with family memories and concerned friends, to help maintain function as the disease progresses. The therapist also comes up with ways to help them recollect and remember useful details, including via to-do lists. The overarching goals of OT for their patients suffering from memory loss are support and education, to help them continue to live their lives to the fullest. Helping to cope with chronic pain Chronic pain can emanate from various parts of the body, leaving many older adults unstable or inactive. Some have adverse effects that may lower ability and control over daily activities. OT helps older people adapt and use managed and modified approaches to perform their daily activities. “Occupational therapy practitioners have a much broader view of the person [than other disciplines]. They understand the sensory, cognitive and emotional dimensions of multi-factorial pain," McGeary says. "Sometimes there’s a climate of distrust - the idea that people are malingering. But occupational therapy practitioners are much more willing to accept that attitudes and belief systems have a strong, powerful impact on how people see themselves and their ability to cope.” The benefits of OT with chronic pain are helping older adults redirect and thereby cope with their pain, whilst managing daily activities.

This is a question that I come across a lot in work. As Occupational Therapists (OTs) have expanded their role across different settings, there is still misunderstanding of the benefit of OTs in a generic mental health role. Subquently, I have taken some time to reflect on my role within the team. As a mental health practitioner working in the mental health nursing team I am well placed to bring a variety of different skills and viewpoints to the role. As an OT, I draw on the social model to inform my practice. While the traditional medical model may prioritise diagnosis and medication treatment plan, I am to take a holistic view and explore other options for recovery. OTs explore the impact of the person, the environment and their valued occupations on health and well-being. The research supports the role of developing positive occupations and coping strategies through enhancing life skills, meaningful roles and valued relationships. As an example, I have supported a client to explore the benefits of relaxation, through using sensory oils, hand massage and everyday self-care (bath, shower), in order to promote mental well-being. As an OT, I have expertise and knowledge in promoting skills development and supporting people to engage in meaningful occupations, through adaptation and equipment. For example, by tailoring a cooking task to meet the client’s needs, such as using a recipe plan, visual imagery and sequencing. I also actively promote the use of self-management of mental health symptoms, by managing anxiety through mindfulness apps, meaningful activity or journaling. In addition, I am aware that equipment can also be used to help people manage basic activities of daily living and retain some level of functioning. During cooking, a perching stool can support those with reduced standing tolerance; with personal care an electronic stand aid can promote independence and reduce loss of skills (e.g. core strength and stability). The reason that I see this as important is to promote independence and choice in everyday living, thus supporting health and mental well-being. Through reflective practice, I have engaged in healthy discussion with fellow colleague Rebecca, to explore the value of meaningful occupations for health and well-being. My professional experience enabled me to see a different perspective, promoting choices and responsibilities around our human right to engage in valued occupation. Occupational injustice can occur when a person is denied, excluded from or deprived of opportunity to pursue meaningful occupations; thus limiting independence and life satisfaction. These occupational concepts are aligned closely with social justice and the Human Rights legislation. Occupational beings have the basic human right and need to participate in meaningful occupations for health benefits. As a service, we can often feel the need to protect people with a learning disability, to the extent that they avoid consequences such as prison. However, in order to avoid discrimination, we must recognise the responsibilities that come with individual rights and choices. We concluded that, as health professionals, we do not have the right or legal framework to deny someone opportunity to engage in sexual activity, despite the risks associated with the client's understanding around sex. This learning opportunity has helped me to redefine my contribution and role within the scope of my professional practice. My service users will benefit from my knowledge and expertise in promoting occupational rights, in the context of health and well-being management. I would encourage anyone to take on a generic mental health role, to embrace the challenge and promote the value of OT in a variety of different settings and roles.

Author: Ryan Osal, MS, OTR/L, CEAS, CHC I have been an Occupational Therapist (OT) for 10 years and I am currently working in a subacute adult and geriatric setting in the US. Most of my clients have a co-morbid condition of diabetes mellitus (DM). When I started working as an OT in the adult population, I focused on interventions for the sensory and motor deficits as complications from uncontrolled DM. Most of the clients were able to achieve their optimal functional skills at home and in the community, but they were still re-admitted to the hospital and rehabilitation centers, due to poor self-management of their chronic medical conditions. The cycle of admission and discharge to and from home and healthcare facility goes on and on. I started to pursue training in health and wellness coaching because of my interest in food and nutrition. That opened up my idea of the preventive part of OT and our important role in diabetes and lifestyle modification. According to the World Health Organization (WHO), the number of people diagnosed with DM has risen to 422 million in 2014, from 108 million in 1980. Diabetes is a major cause of lower limb amputation, blindness, stroke, kidney failure and heart attacks. The WHO recommended lifestyle measures to prevent or delay the onset of diabetes (Diabetes, 2019). Diabetes self-management (DSM) is an important part of this medical condition and the expertise of OT practitioners in health-promoting activities is a promising resource. Unfortunately, DSM in OT literature is not widely published (Pyatak, 2011). Self-help tasks, such as healthy eating, taking prescribed medications, exercises, coping strategies, risk reduction and problem-solving are components of lifestyle management, for individuals with DM to better their health and improve quality of life (Chen, et al, 2011). There are training programs for OT clinicians geared toward the management of diabetes and related medical conditions. One is the Lifestyle Redesign course from the University of Southern California. Another one is the list of approved programs from the National Board for Health and Wellness Coaching. The International Board of Lifestyle Medicine has affiliate organizations to be certified in lifestyle medicine. Inter-professional collaboration in diabetes care is critical to yield better patient health outcomes. It is recommended to clarify roles, have frequent communication and negotiate space and place to practice among healthcare professionals. This way of integrating health services in diabetes management is vital to the success of the program (Gucciardi, et al, 2016). Author Ryan Osal is currently a graduate student in the Post-Professional Doctor in Occupational Therapy, Boston University, College of Health & Rehabilitation Sciences: Sargent College; Boston, MA, USA. References Chen, Mei‐Yen, Huang, Wei‐Chao, Peng, Yun‐Shing, Guo, Jing‐Song, Chen, Chia‐Pei, Jong, Ming‐Chung, & Lin, Hui‐Chuan. (2011). Effectiveness of a health promotion programme for farmers and fishermen with type‐2 diabetes in Taiwan. Journal of Advanced Nursing, 67(9), 2060-2067. Diabetes (2019). Retrieved from: https://www.who.int/news-room/fact-sheets/detail/diabetes. Gucciardi, E., Espin, S., Morganti, A., & Dorado, L. (2016). Exploring interprofessional collaboration during the integration of diabetes teams into primary care. BMC Family Practice, 17(11), 12. Pyatak, E. (2011). The role of occupational therapy in diabetes self-management interventions. OTJR : Occupation, Participation and Health., 31(2), 89-96. Photo credit: https://www.foodservicedirector.com/menu/whats-healthy-now

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). Darren - also known as Swifty to his friends - spent the next 18 months going through rehabilitation trying to come to terms with his new way of life; the life he had nearly lost. Darren explains: "When I was in hospital and all bandaged up, I was assigned a PT, Alison. She was my PT and sort of stuck to me like glue, really. Every morning I was in the gym or the hydro pool doing some sort of exercise with her. It was good because it was that which kept me moving, both physically and mentally. It’s good to have a focus and keep your brain occupied when you’re trying to cope and come to terms with what has happened.” Darren continues... "Alison’s work method was patient-led. She’d explain to me what activities and exercises we should be doing at the point in the rehabilitation, followed by the question of how much of it I’d thought I could do - and then we’d have a go at it. For example, I remember I couldn’t swim; it really messed with my head, especially as I was a good swimmer when I was able-bodied. I remember when I first jumped in the pool to do some exercises with Alison, I sank to the bottom and I just about made it to the side. I was beside myself. I couldn’t believe I’d lost my ability to swim. I mean, I really couldn’t swim. There was nothing I could do to make myself stay on the surface and no matter how much I waved my arms around I could not swim. This lasted for around four months." Darren’s sense of humour comes across when he talks... “I would call myself the Michelin man because, before I got in the pool, I’d have rubber rings and buoyancy aids strapped to every part of my body and I basically just bobbed about in the pool.” I looked ridiculous I really did. It looked very comical; I wished we had taken a couple of photos back then, but this was before the days of cell phones.” Darren’s determination and resilience pushed him to continue to try and learn to swim again... “Anyway, we persevered - or she persevered with me. I was getting more and more frustrated because I knew I could swim but I’d just forgotten how and I couldn’t do it. You get absolutely no propulsion at all when you just have stumps, no propulsion at all. No matter what you do with them you’re not going to drive yourself forwards or backwards or anywhere; so it’s all about your arms. One day I’d had a bad night’s sleep and I wasn’t feeling brilliant. As I got to the pool Alison said ‘Come on, let's get all these rubber rings on you - and I said 'no, not today.' I sat down on the side of the pool. I took a deep breath and sort of launched myself into the pool and I came up swimming! I just bobbed to the surface and started swimming; it was just bizarre. It just came back to me, I just started swimming.” Darren went through rehabilitation for 18 months in which he had encounters with PTs and Occupational Therapists and has many more positive stories regarding his experiences with them. “OTs helped me learn how to be independent again. I’d have cooking lessons and be taught how to use computers and see how well the dexterity was in my hands, after losing some of my fingers.” Darren continues to be independent to this day. He travels around the world snowboarding, parachuting and giving back to the community that had helped him through charity work; something which he is very passionate about!

By Dr. Sakshi Tickoo (BOTh) and Dr. Kathryn Ellis (OTD) Stories have recently moved centre-stage in social thought: as the pathways to understanding culture; as the bases of identity; as the tropes for making sense of the past. We all hold a variety of narratives in our minds that reflect the variety of our identities - like man, woman, parent, friend, lover, relative, and professional. Some of my story is about how I came to study and advocate for humans as sexual beings and learned why this is difficult to implement in India... Sexuality narrative and healthcare practices in India The stories and narratives around sexuality from an Indian perspective remain problematic, because of India’s predicament between tradition and modernity, coupled with religious tension. Indian Nationalists tend to be anxious and shameful about the western description of India, being the ‘land of the Kamasutra and Tantra’. These anxieties date back to systemic colonial disapproval and instatement of colonial “obscenity” laws, which have led to construction of societal frameworks of “right and wrong” sexual behaviours. On the contrary, architecture, sculptures and paintings to the old texts of Kamasutra (and other ancient literary material references) evidence that ancient India accommodated a whole range of sexual behaviours. This largely contradicts the modern belief that monogamous heterosexual marriage is the only form of permissible sex and all other forms of sexual orientation or gender expression are unacceptable. This hetero-patriarchal, hegemonic ideology has erased spaces and created new subjectivities for expression of sexuality. In turn, this negates the grand narrative of Indian nationalism in terms of sexuality and gender expression. It seems as though dialogue is loosening and widening, to attempt to redefine the dynamic nature of sexual behaviours, re-administer new tolerance and trust amongst the community - and change policy and laws. This shift in dialogue in turn sheds light on the category of regions, their perceptions and evaluations on the complexities of the evolving biases of sexualities and identities in contemporary India. So, while progressive households or regions endeavour to abridge the communication gap, others remain silent and unconducive to these matters. Hence, significant and serious gaps still remain in sexual knowledge amongst teens and adults, leading to engaging in risky sexual behaviour - including rape, violence and abuse, unplanned pregnancies, and STIs, which are relatively common among the population now. Now, the real question that arises is... Are occupational therapists, representing this diverse community, prepared to take the onus on initiating and discussing concerns of clients in this domain of intimate ADL? Not surprisingly, the tensions evident in public addressal relating to sexuality are reflected in the healthcare setting. However, given that occupational therapists frequently work with clients whose illness or disability impacts upon their ability to express their sexuality, it is important that therapists are prepared to respond appropriately. While no studies were identified specifically focusing on how occupational therapists in India address sexuality, an informal survey among 91 occupational therapists in Mumbai was carried out by the first author of this article. The responses indicated an uneasy balance between traditional conservative teachings and liberal experiences - not to mention a serious dismissal by a few towards sexuality as a substantial part of activities of daily living. How can a sexual narrative be therapeutic? We are heavily influenced by how we construct our own stories. This is particularly true for sex, as owning and sharing our narratives as they relate to sex can either liberate us or continue to repress us. By recreating associations to sexual identity through narratives, one tends to... evaluate emotions gain insights to pleasant or unpleasant feelings (anxiety, confusion related with the activity or any particular encounter(s)) boost body awareness In a therapeutic setting, this not only creates a safe space to communicate these feelings but also benefits both the client and the therapist, to reach a mutual decision and set up a plan for therapy. It is essential in some circumstances to recondition both the mind and body to think of desires differently and reinforce them as sexual beings again. Desensitising negative memories or experiences that were uncomfortable and triggering - replacing them with new sensory associations, to enhance body awareness and exposure to safe sexual experiences - is helpful in creating possibilities for a sexual future. As therapy progresses, clients can change, modify or evolve his/her/their sexual narrative. Client-therapist collaboration, coupled with the foundation of this therapeutic setting, allows for resetting of intentions at every stage of therapy. What is needed to improve current occupational therapy practice in this area? In the informal survey I conducted, participants were asked about their views on: sexuality sexual health barriers experienced during everyday practice, towards clients’ sexual health concerns The primary aim of this survey was to consider occupational therapists’ views toward addressing sexuality in an Indian context. A large majority of participants acknowledged the need for Occupational Therapists to adopt more open attitudes towards sexuality and its inclusivity as a vital goal of rehabilitation. The need for avoiding superimposition of self-values and beliefs (due to socio-cultural influence) was highlighted as another factor potentially hampering a holistic client-care approach. Suggestions offered by survey respondents to achieve a change in practice included: clear demarcation and description of roles for each profession and when referrals should be made to them (Occupational Therapists) the inclusion of questionnaires relating to sexuality as part of a standard initial evaluation process educating and informing clients on the scope of occupational therapy practice in this domain improved training for occupational therapists, to equip them with relevant skills When occupational therapists do not address the sexual needs of individuals with disabilities it can perpetuate the social construct that they are not sexual beings. Such views align to a narrow understanding of sexuality - emphasising only its reproductive function and excluding clients’ wishes to express their sexuality in other ways, beyond the act of penetrative intercourse. Additionally, occupational therapy professionals and clients need to be assured that raising or discussing concerns relating to sexuality, in the context of healthcare interactions with mutual consent, is appropriate. Implementation of these suggestions can reflect a commitment by occupational therapy professionals to prioritise sexuality and sexual health. Occupational therapy professionals in India can reflect in their practice the progressive movements to acknowledge humans as sexual beings in all forms of sexuality and gender expression, in order to serve the needs of the populations they serve. Dr. Tickoo is an Occupational Therapist (BOTh) and Certified Personal Counselor from Mumbai (India), currently working at a special school. She aspires to not only extend her research in the fields of psychosexual rehabilitation in the context of occupational therapy, but also continue her further education in Sexology and Mental Health Rehabilitation. Dr. Ellis is the owner and founder of The Institute for Sex, Intimacy, and Occupational Therapy, which offers online education courses to help occupational therapy professionals build their skills addressing the sexuality and intimacy concern of their clients, to help their clients thrive in these meaningful occupations. Visit her website to take a course and hone your skills! Resources and References: Informal survey conducted by Sakshi Tickoo (first author) and Dr Kathryn Ellis (co-author): Pilot survey conducted in Mumbai, India on exploring views of Occupational Therapists towards addressing sexual health and potential barriers (unpublished data; contact first author with questions) Sexual health as per National Health Portal, India: www.nhp.gov.in/sexual-health_pg Sexual assault statistics in India: https://en.wikipedia.org/wiki/Rape_in_India Sexually Transmitted Diseases (STDs) statistics in India: www.nhp.gov.in/disease/reproductive-system/sexually-transmitted-infections-stis Sexual health policy discourse in India: https://yourstory.com/socialstory/2019/06/sexual-health-reproductive-health-policy-discourse Further Reading I have relied on the works of the following people to further learn and explore the current works being done in the field. Below are links to few of them: The Institute for Sex, Intimacy and Occupational Therapy: www.sexintimacyot.com In Plainspeak by TARSHI: A digital magazine on sexuality in the Global South www.tarshi.net/inplainspeak OT after Dark - a podcast run by two Occupational Therapists, for adults only: https://otafterdark.com

Trigger warning: Self-harm and abuse A Mental Health Act tribunal is where people who are detained in hospital against their wishes get the chance to appeal their detention. They get legal representation and while staff argue why they need to remain detained, the solicitor picks apart their statements to show that the detention is unjust. Watching this are a panel of three people: a psychiatrist, a judge and a lay person - and at the end of the merry process they get to decide whether the detention is required. In the UK, this is how we make sure people aren’t deprived of their liberty without good reason. This bit was a bit dull, but it gets more interesting from now on… I was at a mental health tribunal once where I was asked this question: "If self harm is what keeps them in hospital and they really want to get out, why don’t they just stop doing it?" I relished answering this but my heart sank a bit as well. This was the medical expert on the panel and it is so frustrating that people in such a position of power hold the view that self harm can simply be 'turned off'. I’m not a fan of diagnosis but, using a medical model, self harm is one of the symptoms of borderline personality disorder. In what other area would we suggest people just stop the symptoms of their illness? "Why don’t they just stop hearing voices?" Or even "Why don’t the manic people just calm down?" Obviously, any action that someone takes has an element of choice involved, but in mental health we work with many things that people do that cause them harm. I’m going to suggest that, if the attitude we take into our work is that people should just stop doing what they are doing, it is going to be absolutely impossible for us to help them. It also conveys the idea that people who could just stop are unworthy of help. If you feel that alcoholics should just stop drinking, agoraphobics should just go out more or anorexics should just have a McDonalds, this probably isn’t the article for you. If you’re interested, I’m going to try and explain how to make sense of why people do things that aren’t obviously in their best interests. I’ll probably focus on self harm, but you can use this process for understanding most things. I’ll give it to you in a couple of steps, but the order doesn’t really matter... The things people do make sense Nobody self harms for the sake of it. Nobody self harms because of their diagnosis. The only reason someone self harms is because, in that moment, it’s better than not doing it. You’re not that important There’s a good chance that the reason someone self harms is nothing to do with you. Yes, its painful to see someone you’re supposed to care for hurting themselves. Yes, it’s frightening to think you’ll be blamed for what they do... and yes, it can feel personal. Despite your initial reaction, you will be much more useful if you can start in a non-judgemental and curious manner. If you have to make an assumption, work hard to make sure it is the most empathic one you can think of. Be curious The best source of information about why someone does something is the person themselves. I once read 'She spent time in her bedroom and self harmed due to her diagnosis', which I thought was one of the worst things ever written in somebody’s notes - and the winner of my 'Utter Lack of Interest' award. We need to ask questions: "Can you help me understand why you do that? I want to understand how it’s useful to you." "How does it help?" These are all things we can say to help people talk about why they do things; as a bonus, it gives them a sense that we are interested in them. It does something for them Everyone’s reason for self harming will be different, but it's likely that they get something positive out of it. It might allow them to feel something (because feeling nothing is terrifying). It might ground them and help them focus. It might validate their sense that they need to be punished. It might... well, anything really. Whether it affects their physiology, thoughts or feelings, there is likely to be some result that is worthwhile. It does something to other people It’s very easy for us to start thinking of ‘attention seeking’ at this point. Let's throw that term out of the window and just think about what happens in the environment once someone has hurt themselves. It might mean that people spend time with you. It might mean that people don’t abandon you. It might mean that people keep you away from something that terrifies you. It might mean that people care for you in ways that they wouldn’t otherwise. I remember one person who had always been neglected by his parents. They only showed they cared when he was physically unwell. Later in life, the only time he could accept people being nice to him without a crushing sense that he didn’t deserve it was after he had poisoned himself. If we ask, we can find out why it makes sense. But they could just ask us! But you won’t ask for things you don’t think you deserve. Many people have lived lives where they were never given what they asked for. Even if they did ask, let’s have a think about who is given the clearest message that people care about them. Is it the person who asks politely for support, or is it the person in their room turning blue, with a team ensuring they stay alive in that moment then watching them for the night? In mental health services we are very good at conveying the message that the amount of care you receive is related to how dangerous you are. It’s weird that we then get annoyed when people respond to that. We can’t see the choice they’re making If we don’t ask, we are in danger of thinking people self harm for the sake of it. It’s very hard to sympathise with that. If we can see a choice, between cutting and another night of staying awake replaying the most traumatic experiences in 3D IMAX in their brain, it makes a lot more sense. If we can see a choice, between overdosing and feeling that your head is going to explode, it makes a lot more sense. If we can see a choice - between head banging and listening to the voice of the person who hurt you telling you how awful you are and that you deserved it and that no one likes you and it will never get any better, ever – again, it makes perfect sense. We won’t know what is going on for someone until we ask them. We need to make sure we do that. So all of the above are just some ideas. To make it a bit more MOHO, people only do things because they want or need to do them. Other ideas are available, so feel free to dismiss this. I’m going to suggest that if you can do the above you’ll be much more effective at helping people. It might even mean that you work on the problems that lead to people hurting themselves, rather than just trying to stop the self harm itself. Don’t be the person with a deciding vote in someone’s liberty thinking that they should just pack it in. Be curious, be empathic... and honestly, if stopping was easy, people would do it. It is the height of arrogance for me to be writing about this. People who actually experience these difficulties do it much better. I highly recommend reading this by @hoppypelican. There are a lot more articles like this written here Follow Keir on Facebook: Keir Harding OT; Instagram: Keirhardingot; Twitter (where he is busiest): @keirwales Keir is a Lead Therapist in an NHS Specialist Service and provides training, consultation, supervision and therapy around complex mental health problems through Beam Consultancy.

Adapting a living space to overcome architectural barriers such as steps and staircases can be achieved with the installation of a platform lift. To help Occupational Therapists understand the different types of lift products available and the ease of installation, we have provided this useful guide. Reaching short distances (up to 1.25 metres) Most Occupational Therapists will have experienced the issue of creating accessibility within a small living space. In situations where a ramp will not fit or takes up too much living space, you could consider an open residential platform lift solution. These types of lifts can overcome a change in floor level without having to make any structural alterations to a home. The other benefit of this type of product is that you enter one side, then exit the other side which means the person in the wheelchair is always facing the right direction without having to turn it around. The open residential platform lift is fixed to a level floor and requires a power supply for the control unit. The platform lift is typically battery motorised and operated by a remote control, push buttons or a control panel. Another popular solution is the FlexStep space-saving 2-in-1 platform lift solution. It provides both stairs and a stairlift even in the tightest of spaces. At a touch of a button, the FlexStep transforms from a flight of stairs to a platform lift. The Flexstep attracted a big crowd at a recent OTAC exhibition; Occupational Therapists liked the versatility of the product and that it is cost-effective. Both types of lifts can be installed internally or externally, and customers can choose from a variety of materials and finishes to complement their interior design or architecture. Travelling to a different floor If there is a difference in levels of more than 2 metres, then a residential platform lift with a shaft or a contained cabin is required. Through the floor lifts can be positioned virtually anywhere within a home as they have a self-supporting structure. They offer ease of installation as no major structural alterations are required. They can only travel to the next floor – for example, the living room to the room above. The Platform Lift Company specialises in residential platform lifts, which can be installed either internally or externally. Again, this type of lift doesn’t require major structural alterations as it comes with its own shaft which can even be steel in any RAL colour, stainless steel or glazed to create a feeling of space within a room. Installation is as simple as creating an aperture in a floor, building the lift shaft and creating a shallow pit (as little as 50mm). Alternatively, a ramp can be fitted to the front of the shaft on the ground floor level instead of creating a pit. Residential platform lifts can travel up to 12 metres. If budget isn’t an issue then a cabin style residential platform lift is the ultimate choice and offers a similar experience to a passenger lift. The design possibilities are endless as a customer can choose their desired material and colour for the shaft and cabin. This is truly a high-end luxury product. Screw and nut or hydraulic Another consideration for Occupational Therapists to be aware of is that there are two main types of lifting mechanisms for cabin style platform lifts; hydraulic or a screw and nut system. Both types of platform lifts travel at 0.15 m/s. Hydraulic platform lifts are quieter and occupy less space within a property for the lift shaft; this is because the pump box or machine room is housed separately outside. A screw and nut platform lift is motor driven. The shaft does require slightly more space because the lifting mechanism sits adjacent to the first level door, but remember there is no need for an additional machine room. The other huge advantage is that this type of lift only requires a 50mm pit, therefore minimal building work. A screw and nut platform lift can be installed within a two-day period in some cases. The installation of platform lift could help a person stay within their own home as they can access different rooms without having to drastically change their environment. This kind of adaptation also maximises living space and gives patients more flexibility to join friends and family without the barrier of steps or stairs. One last piece of advice when it comes to maintenance is to make sure your platform lift benefits from servicing at least twice a year. For more information visit https://platformliftco.co.uk

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub Service type/setting: Acute care rapid response service; community home visit. Assessment type: Initial, completed by an Occupational Therapist and Nurse. History 'Claire' (name changed for confidentiality) was referred by paramedics and district nurses (DN), due to a non-injury fall, with a long lie of approximately 12 hours. DN was visiting for routine wound care - dressing of right lower limb stump (Claire is an amputee) Referred for clinical monitoring, venepuncture (blood sampling), falls assessment, mobility and transfers assessment, safety and welfare check Past medical history (PMH): Below knee amputee (right leg); fracture of thoracic vertebrae; chronic osteomyelitis; previous cellulitis; hypothyroidism, chronic kidney disease (CKD) stage 3; past right frozen shoulder Medications: Levothyroxine, paracetamol, tramadol, alendronic acid Falls assessment: Required Cognitive screening: Required Has mental capacity to give consent for assessment and intervention Social and Environmental Background Claire lives alone in a two-storey house. She has no package of care or piper alarm. A local friend comes in to support her with house tasks, on an ad-hoc basis. Claire has a prosthesis for her lower right limb. She normally uses a collapsible zimmer frame to mobilise around the ground floor and there is a two-wheeled walking frame (2WW) upstairs. Stair lift and key safe in situ. There is no bathroom downstairs. No central heating in property. Other equipment/aids in place: Walking stick, outdoor four-wheeled walker (4WW), outdoor scooter, 1/2 step into kitchen, helping hand aid, bathroom perching stool, female urinal bottles upstairs, chair raisers on sofa, grab rail by stepped entrance to kitchen and by toilet. Initial Acute Examination Access to property via keysafe. On arrival, Claire was sat on her sofa. She was alert, but appearing muddled; unsure if she went to bed last night. Her medication was reconciled against the GP summary. She stated she only takes paracetamol. She has not been taking tramadol, as this makes her sleepy; feels she does not need to take levothyroxine. Cardiac Sitting blood pressure reading: 102/80 Pulse rate: 83 beats/min (regular) Capillary refill time: 2 seconds No chest pain, no heart palpitations, no dizziness Mild oedema up to knee, not pitting; prosthesis on right leg Respiratory Rate of respiration: 20/minute Peripheral blood oxygen saturation (on room air, at rest): 96 % No breathlessness, no cyanosis Dry cough Abdominal Acute Kidney Injury (AKI) risk score: 3 - medium Prompted 200mls of water and 100mls of tea. To increase frequency of visits to three times daily (TDS), for fluid and food prompt, plus welfare check. No abdominal pain, no nausea, no vomiting, no diarrhoea, not constipated No genitourinary pain Bowels last open: This morning, during visit Continence: Bladder and bowels fully continent Dietary and fluid intake: Claire had not eaten today, due to inability to rise from chair. She was encouraged to have cup of tea, 200mls of water and and two biscuits during visit. Bi-weekly cleaner entered property as rapid response team left, providing porridge, toast and tea. Neurological Consciousness level: Alert Known confusion; unsure of the year, next of kin (NOK) states this isn't a new problem for her No FAST symptoms (stroke: Face, Arms, Speech, Time) Neurological pain: Long-term chronic pain over right stump; taking paracetamol for this No obvious head injury from fall; no numbness or obvious weakness Pupils equal and responsive to light (PEARL) Memory concerns identified on this visit; will require a cognitive screen Loss of confidence? With mobility and transfers; worried about falling and about prospect of potential hospital admission Declining hospital admission; anxious about hospital Exposure Tympanic temperature: 36.8 degrees Celsius Blood glucose level: 5.6 mmol/L Evidence of injury/wounds: Right leg stump wound; known to DNs National Early Warning Score (Royal College of Physicians): 1 Musculo-skeletal Musculoskeletal pain score: No pain on sitting, but raised to 4/10 on weight-bearing and walking with zimmer frame Current falls history: Has had a fall within the last week; family had to pick her up from the floor. Also fell on floor yesterday, with a long lie of 12 hours Falls in last year: 2 - Multi Factorial Risk Assessment (MFRA) required Pain comments: Complaining of pain, predominantly in right lower limb, in contact with prosthesis. Claire also reports pain in right shoulder, from an historical fall Skin and Waterlow pressure scale Waterlow pressure sore risk score: 14 Examination of skin: No pressure injuries identified Positioning: Claire needs assistance to move (details below). She sits out during the day and repositions every four hours. Rapid response team unsure if Claire has been to bed in the last few days. Incontinence: No issues identified Nutrition: No concerns Malnutrition universal screening tool (MUST) score: 0/6; repeat in 4-6 months Mobility / Functional Mobility / Transfers Mobility Assessment Claire was mobile with aid of a collapsible walking zimmer frame (WZF). She walked slowly, using her prosthesis. Very slow pace and shuffling gait. Trailing left leg as she was unable to put full weight on right (prosthetic) leg with ease. Nonetheless, steady and able to navigate around doorways, from living room to stair lift and top of stair lift to toilet. Claire returned very slowly along first floor landing, with increased speed on return to her living room. Transfer Assessment On initial assessment of standing and mobility, it was difficult for Claire to transfer from her sofa. Multiple attempts, requiring much time. Reassurance given, verbal and light physical support of one to stand. Sofa has only one arm support that does not extend to front of sofa; ease of weight bearing in right arm compromised. Sit-to-stand transfer from top of stair lift was completed with greater ease and in reduced time, compared to sofa transfer; arm rests helping here. Final transfer assessment in armchair; multiple attempts and physical assistance of one to stand. Stairs Assessment Claire has a stair lift in her two-storey house. It doesn't swing round when downstairs, staying sideways, meaning she has to step onto stairs to sit down. Staircase has a banister on right hand side; Claire uses this to help get onto her stair lift. Personal Care Assessment Claire stated that she normally has a strip wash at the sink in her kitchen, sat on an existing low stool. She has a perching stool with back support; this could be brought downstairs for washing. She was able to sit down on first floor toilet; opened her bowels and passed urine. Claire initially needed to readjust her buttocks, due to high toilet seat. She may benefit from a toilet frame. Use of existing right-sided grab rail was used to stand, but she relied on pushing off her seat and the nearby sink. Kitchen Assessment Claire has a friend who does her food shopping for her. There were microwave meals in situ during this visit. She stated she can make her own meals. She may benefit from a kitchen assessment on the next home visit. Falls Assessment Claire has refused hospital admission. CURB: She can communicate, understand, retain and balance information about this decision. No continence issues, no frail skin/pressure area issues, no weight loss or appetite issues History of falls/recent fall: 2 falls in last year Mobility issues: Struggling with ADLs due to pain and reduced mobility Medication issues: Taking more than 4 medications (increased falls risk) Cognitive concerns: Gradual reduced cognition/memory Environmental/social concerns: Isolation/lack of social support; temperature (cold house) Risk Factors: Cognitive concerns; pain that affects function Management Plan: Advise adequate and regular paracetamol; gain consent to a cognitive/memory screening Clinical frailty scale (Canadian Study of Health and Aging): 7 Shared decision making The rapid response team's Occupational Therapist and Nurse have raised concerns about Claire being at home alone. This is due to her inability to complete safe transfers without support - and therefore current inability to access food and fluids with ease. The team discussed options of hospital admission (to provide short-term support, therapy and clinical review) and getting more social support at home. The risks of not going into hospital were clearly explained to Claire. She was able to talk these back with the team and has mental capacity to refuse hospital. Claire declined hospital admission, despite the Nurse's recommendation to be admitted. Therefore a decision was made to take bloods (as below), bring out a commode for downstairs and return for a clinical and mobility review. Venepuncture Blood taken by registered nurse, on visit with the Occupational Therapist. Bloods taken from Right Antecubital fossa; two attempts required to take blood; hand hygiene guidelines followed when undertaking this procedure Blood tests requested: Full Blood Count, Serum C reactive protein level, Calcium Group, Liver Function Tests, Serum folate, Urea and electrolytes, Vitamin B12, Thyroid Function Test Results: eGFR = 23 (previously 60, 2 months ago); White Cell Count = no abnormality discovered; Urea = 13.2 (previously 9.0); Creatinine = 169 (previously 77, 2 months ago) Flagged as AKI stage 1 Blood results discussed with senior nurse and physiotherapist (PT), who is due to see Claire next at teatime. Due to having a stage 1 AKI, the PT will take a fluid chart out and prompt further fluid intake. Rapid response team to continue oral fluid protocol with four-times-daily (QDS) visits to support this. Initial Assessment Actions (Summary) Clinical observations and blood glucose monitoring Medication reconciliation Mobility and transfer assessments Skin pressure areas checked Assistance with toileting on first floor Discussion of commode provision; Clair not keen, but consented Discussion of potential hospital admission; Claire refused and could repeat back the consequences of not going in Discussion of requiring further support; she would accept more support Food and fluids provided - pushed 200ml of water and 150ml of tea; porridge and toast prepared Discussion with NOK (sister): Claire's sister was concerned about her home status, but unable to provide support or stay with her, due to her own Parkinson's-related challenges Analysis Claire has poor physical ability to complete functional transfers. This prevents independent engagement in her ADLs - particularly toileting, food preparation and washing. Barriers to her engagement in safe mobility and transfers:- Prosthetic lower limb; long lie following fall; weakness in right upper limb; lack of food or fluids; gradual but raised acute cognitive confusion; no local and reliable local support. Claire is not able to get out of her armchair independently and declines Nurse's request for hospital admission. She has mental capacity to make this decision. The Occupational Therapist feels that - with repeat visits in the short-term - Claire may be able to resume engagement in her ADLs and other occupations at home. She will require QDS visits by the rapid response service, until her mobility and transfers improve and ongoing care arrangements are organised. Recommendations QDS double-up visits: For welfare checks, personal care support, skin checks, food and fluid provision and medication administration support - until mobility and transfers improve Repeat visit today: For provision of (and assessment transferring onto) a commode, plus to repeat clinical review Provision of medium 2-wheeled walking frame, for downstairs mobility Provision of and assessment using toilet frame in upstairs bathroom Lying to standing blood pressure monitoring, to complete falls assessment Advise regular paracetamol, to help with pain when mobilising Monitor and encourage fluids, due to long lie and medium AKI risk; provide food and fluids on visit, if Claire is unable to these herself Assist with personal care as required Mini cognitive screening Kitchen assessment Initiate a social care referral for reablement team or package of care support

By Jamie Grant - Occupational Therapist; Director, The Occupational Therapy Hub 'Terry' had a stroke originating in his left cerebral hemisphere. At the age of 40, he became a relatively young service user on our caseload. He experienced very little motor and cognitive deficit, but was significantly affected by dysarthria - difficulty speaking caused by brain damage (NHS 2019). His quality of life was also impacted by fatigue and hemianopia - partial blindness or a loss of sight in half of your visual field (Healthline, 2019). Prior to hospital admission, Terry had been working, enjoyed family time and played golf to a high standard. I visited him and his wife at their home, where I observed the extent of his symptoms. His frustration with slurred speech and impaired sight (loss of right visual field) was clear to see, made worse by the uncertainty of his prognosis and the lack of structure to his week, due to being off work. 'It can be argued that vision is the major sensory input into the human brain, by virtue of the fact that about half of all afferent fibres projecting to the brain are from the eye and by the sophistication of the neural systems controlling visual processing. Brain damage disrupts these complicated processes, resulting in severe visual impairments including hemianopia. Patients with hemianopia complain mainly of difficulties with reading and scanning scenes fast enough to make sense of things as a whole.' (Pambakian and Kennard, 1997) Terry was referred to the speech and language therapist, to work on his dysarthria. I explored elements of grading and pacing that he could adopt, in order to address the fatigue he was currently experiencing. This included pacing mobility around his large two-storey house and simple adaptive approaches, such as placing chairs at suitable points, to rest. As part of my intervention, I researched and introduced University College London (UCL’s) Read-Right to Terry. This is an online programme to work on reading speed; he found the visual field loss affected this occupation. My team also suggested Terry purchase a white stick, to act as a prompt to the public. He had discussed a stressful experience at a train station, when people passed him at very close range and he was only able realise their presence at short notice. Post-discharge from the stroke team's support, I called Terry to discuss his recovery and recent ophthalmology appointment. Due to the dysarthria, his wife currently answers his phone. She informed me that consultants had confirmed his hemianopia diagnosis, that he is now certified as ‘sight impaired’ and that he is unlikely to be able to drive again. He has been recommended to contact a charity for the blind, to discuss benefit entitlement - and to contact his workplace occupational health department, to discuss what he is still able to do professionally. He now uses golf as rehabilitation, to improve his balance and stamina. The experience of working with Terry was emotive. He was young to have had a stroke and previously active in many occupations. I also gained clear insight into how it was affecting his wife and their relationship. It was difficult to see Terry come to terms with the long-term impact of hemianopia on his quality of life. I understood that, with regards to occupational therapy in this service, there was limited rehab potential for his loss of vision. Longer-term, he could adapt his routines, but his occupational potential had been reduced and he would not be able to drive again. On the other hand, I believe my Read-Right intervention was of use to Terry. It provided him a focus and offers long-term improvement to his reading processing speed. He also values the use of the white stick, putting aside the stigma attached to it. Terry's wife was appreciative of the follow-up call, including my agreement to contact the physiotherapist in our team, to provide advice regarding continuing neck pain. Multidisciplinary working has been demonstrated well throughout our intervention with Terry. However, due to only a few scheduled visits, I was unable to provide more signposting input, or further assessment of his reading speed. I would also have liked to join him on a visit to his golf club, to provide support for this meaningful occupation of his. Despite the inability to restore Terry’s visual field, a condition of this nature presents opportunities to work broadly - from leisure activity and vocational support, to dealing with the emotional impact and signposting to charities and other specialist supportive organisations. I have taken from this experience the realisation that, unlike with most service users I have supported to-date, there can exist a ceiling to occupational therapy rehabilitation. The fight in timetabling a large caseload also conflicted with intervention potential for Terry - although the time allocated to him was used efficiently and effectively. In future, if session allocation was flexible, I would commit greater therapy input to a service user affected by stroke in this way. Originally written in 2016. Setting: A community stroke discharge service in the UK. For more information on UCL's Read-Right programme, visit their website. References Healthline (2019) Hemianopia. Available from: https://www.healthline.com/health/hemianopia [Accessed 26 July 2019]. NHS (2019) Dysarthria (difficulty speaking). Available from: https://www.nhs.uk/conditions/dysarthria/ [Accessed 26 July 2019]. Pambakian, A.L.M. and Kennard, C. (1997) Can visual function be restored in patients with homonymous hemianopia? British Journal of Ophthalmology [online]. 81 (4), pp. 324-328. [Accessed 26 July 2019].

By Jamie Grant - Occupational Therapist; Director, The Occupational Therapy Hub Miss B was referred to the rapid response team following acute back, hip and groin pain, akin to symptoms experienced after past fall. I was able to support the patient on four visits, despite the short-term nature of the rapid response service. This was due to her reported increased pain levels, requiring longer input. Assessment and interventions were carried out by occupational therapists, a physiotherapist and a support worker. Initial assessment History of presenting condition Referral to our team, following acute pain in hip, left groin and lower back, which began a fortnight ago. Decreased mobility as a result. Prior to pain onset, Miss B stated she was very independent and would regularly walk her dog. A recent X-ray ruled out a fracture, indicating an osteophyte* and a sub-chondral cyst** on her acetabulum. *osteophyte (bone spur) = small bone prominence, developing in joints damaged by arthritis **sub-chondral cyst = sac filled with fluid, protruding from joints, that causes pain Past medical history + current medication Fell 4 years ago, resulting in pain from thigh to pelvis Arthritis in hand Macular degeneration Labyrinthitis On morphine, tramadol, paracetamol, omeprazole General observations Flushed skin; reduced appetite, with little fluid or food eaten today Pain score = 10/10. On tramadol, as prescribed Blood glucose level = 6.3 mmol/l Clinical Frailty Scale (Canadian Study on Health and Ageing, 2008) = 6/9 Falls assessment: Not required (no falls in the last 12 months) Mobility and transfers Use of walking stick for mobility from bed to toilet and with stairs. Furniture walking observed downstairs, from stairs to kitchen. National Early Warning Score (NEWS) Cardiac BP = 150/70 (left arm, sitting), 142/90 (left arm, standing); no postural drop HR = 84 regular Not symptomatic – no chest pains, palpitations or dizziness reported Respiratory Respiratory rate = 18/min Oxygen saturation = 97% (at rest, on air) No shortness of breath or cough observed Abdominal Some wind with abdominal pain Patient vomited yesterday Bowels last opened 1 hour prior to visit, previously 4 days ago Continence: Not previously incontinent; recent urges to urinate; no other symptoms Neurological Patient alert and oriented to time, place and rapid response staff visiting No FAST symptoms observed Patient reported reduced muscle strength; no sensory alteration Mood: Settled, patient reported to feeling OK in herself FAIRI (cognitive) assessment: Not required, no signs of dementia observed during visit Exposure No injuries, cuts, wounds or bruising observed SSKIN assessment: Heels, elbows and buttock skin all healthy Waterlow Pressure Ulcer Risk Assessment and Intervention Tool: Score = 19 (Amber) Temperature = 37.4 degrees Celsius NEWS SCORE = 0 Occupational therapy initial assessment PERSON Physical Slight in stature; able to mobilise using stick, although frequently furniture walks; patient has macular degeneration, although this is not currently severe enough to limit daily activities; arthritis in hand. Cognitive No cognitive deficit observed. Affective Stable mood. However, frustration displayed, due to reduced occupational performance and unclear cause of current pain. Spiritual/Cultural Western societal upbringing, values independence. Communication Patient condition not impacting on her ability to communicate verbally/physically. ENVIRONMENT Physical 2-storey house; 1 step up to property; 1 flight of stairs, rail on right side (ascending); upstairs bath, no shower fixings; upstairs toilet only; kitchen with dining table; double bed; adequate lighting and ventilation. Social Lives alone. No current family support or package of care. Previously independent with ADLs/IADLs/mobility. Currently supported in meal preparation by two neighbours. Appears to have a close relationship with them, who look out for her. Owns a dog. Institutional Patient has private health insurance, which may allow for more rapid access to hip replacement treatment. However, this would not include occupational therapy provision. OCCUPATION Self-care Currently independent in eating, dressing, strip washing and accessing the toilet. However, pain is limiting patient speed and ease with ADL occupations. Meal provision is supported by neighbours. Previously independent with all self-care and IADLs. Productivity Retired. Currently reliant on neighbours to assist with house chores. Usually does her own clothes washing, house cleaning. Leisure Currently limited, as restricted to her house and bed. Usually enjoys an active and independent lifestyle, including walking her pet dog. Kitchen assessment Mobility and transfers preparing breakfast - coffee and yoghurt/chopped fruit Motor aspects Independent with: Set up of environment; Reaching (all meal preparation items within easy reach); Bending; Side stepping; Transporting (released grip from WZF, to place fruit in pockets); Coordination; Manipulation. Verbal prompts with: Standing (reminder to use WZF provided for stability, instead of furniture); Mobilising (reminder to return to WZF after accessing fridge). Assistance with: Lifting. I was asked to lift a bag blocking her fridge, due to load/bending effort required. Cognitive aspects Independent with: Planning; Initiation; Sequencing; Concentration; Noticing/responding (engaged well in conversation with RRT staff during meal prep); Orientation; Memory; Using items appropriately. Verbal prompts with: Safety awareness (reminded of importance of using WZF during recovery, as deemed potentially unstable at times, using stick; suggestion to have rug removed, as WZF caught when mobilising to kitchen). In summary, Miss B was deemed competent and safe whilst preparing a hot drink and cold breakfast. Her gross and fine motor strength and dexterity met the demands of the task. She displayed sufficient strength and stability in both upper and lower limbs, to complete the activity. Miss B is adjusting to using her new downstairs WZF and caddy; she sometimes chooses to furniture walk instead, transferring her weight onto nearby kitchen surfaces and door handle. This could put her at risk if her frailty/stability increase. Further intervention Personal Care Plan - goals The following were established in collaboration with Miss B: To return to her normal routines To improve confidence and ability in stair mobility To return to walking outdoors The rapid response service remit is short-term input for acute conditions, to maintain independence at home and prevent hospital admission. Therefore, short-term personal goals are set with patients, that may be followed up after referral to ongoing service provision. In this way, goals often focus on ADLs, rather than leisure occupations. Whilst it could be argued that this potentially overlooks more meaningful activity, the aim is to address high priority needs. Maslow’s hierarchy of needs comes to mind here! Once these have been achieved, the patient is likely to participate more actively in wider occupation. Assistive technology and equipment provision Walking Zimmer Frames (x2, ground and first floor), for increased stability and confidence. Patient showed safe mobility using stick on stairs, but unsteady walking and furniture walks. Caddy for ground floor WZF, to allow safer transportation of food and drink during meal preparation. Bath board, for washing with greater safety and ease. Patient has found rising from her bath difficult and has no shower fitting to stand and wash in her bath. This was fitted at the opposite end to the bath taps, in consultation with Miss B. Patient was observed getting on and off the board with ease and safety. She said she was happy with how much easier this transfer was than she had expected. A second stair rail fitting was suggested on one visit, due to initial concern regarding Miss B's safety and mobility speed. I recommended a physiotherapy visit, to assess fluctuating ability and confidence with stair mobility. Repeat visits demonstrated safe and competent mobility, using her stick and the one existing stair rail. Patient stated that she would continue to manage in this way. Complications preventing earlier discharge Discharge of Miss B from the team's caseload was planned for the last visit I made to the patient. However, on arrival, Miss B complained of an arthritic flare-up, with increased "stabbing pain" in her lower back and down her legs. She continued to rate her pain at 10/10 severity. The multidisciplinary rapid response team felt that Miss B's repeated maximum pain rating did not always match her occupational performance. This included her safe stair mobility and competent ADLs, such as washing her top half in the bathroom. However, on evaluation, Miss B could not be discharged on the originally planned date. Whilst she was medically stable and could safely engage in toileting, she now lacked confidence and perceived she was unable to descend her stairs. This meant she could not safely access food or fluids, given that she lives alone, with no package of care in place. Miss B was keen to either be visited by her GP or to be admitted to hospital for tests. An Occupational Therapist telephoned her GP, who visited the patient's home. Morphine was raised to a 15mg dose, including use of a butrans patch. Ongoing support, following home visits The patient had contacted a charity for a package of care and was asked to get in touch with other agencies. She stated that she would like assistance with shopping and laundry. She was reported to have eaten twice, having safely mobilised the stairs with her stick and made her own soup. She had a good range of movement in her hip and back, as she was observed to pick up items off her floor. Therefore, Miss B was not deemed to have acute enough needs to require further rapid response input. She was considered for a community rehabilitation team referral. However, the patient was discharged from rapid response, due to a GP visit that resulted in hospital admission. Her bloods indicated a possible acute kidney injury (AKI), a complication not previously evident to our team or her GP. Reflection and evaluation of practice In terms of social and cultural influences on occupational therapy practice, Miss B’s social environment was most influential. Whilst no strong cultural factors were evident, it could be argued her neighbours were both supportive and a hindrance. On one hand, they were a vital lifeline for meal provision and were able to provide a second viewpoint in understanding the patient’s baseline. On the other hand, the team found them to verge on interfering at times. Concern was well-placed, although they could be distracting. Whilst carrying out a lengthy initial assessment, the presence of 3 staff and 2 neighbours was deemed too much for Miss B. Furthermore, the lack of a package of care or family support meant that discharge took longer than it could have. Had there been more reliable and regular help accessing food and fluids, the rapid response team may have not felt the need to retain Miss B on the caseload for so long. I also came to understand the importance of the patient taking control of their health in this acute setting. A fine line exists between being wholly supportive with critical care and encouraging the patient to remain motivated and empowered to help themselves. As therapists, we sometimes went beyond our remit, including making Miss B breakfast and contacting her GP, at a stage where she could have done this herself. On reflection – in terms of personal goals – Miss B was unable to return to walking outdoors during our brief time with her. She was able to continue routines related to ADLs, although these were sometimes restricted to her upstairs. I believe the patient achieved her goal of improving confidence and ability in stair mobility, as best as possible. The nature of an acute and changing condition was often a barrier to this. Additionally, her wavering confidence and tendency to rate maximum pain levels proved challenging. I am pleased with the interventions myself and the rapid response team recommended and provided for Miss B. I gained greater confidence as visits progressed. Having developed an understanding of her situation and built rapport, I was able to articulate progress to members of the MDT going on subsequent visits. I had reached a stage on my placement that I felt confident in my clinical reasoning behind provision of assistive technology, walking and bath aids. I identified a potential need for the fitting of a stair rail, although this was later deemed unnecessary, given Miss B’s safe demonstration of stair mobility. Originally written in 2017. References Townsend, E.A. and Polatajko, H.J. (2007) Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa: CAOT Publications. Turpin, M. and Iwama, M.K. (2011) Using Occupational Therapy Models in Practice: A Field Guide. Edinburgh: Churchill Livingstone Elsevier.

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

Anastasia Barnes, senior occupational therapist at the Emerald Centre in Colchester (UK), was the proud winner of the 'Cosyfeet OT Award.' This helped to fund the creation of a sensory garden, where dementia clients and their families spend quality time, gardening and relaxing together. Here she reports on the project. We recently celebrated the official opening of a very special garden at the Emerald Centre. Clients and their families, supported by staff, worked very hard to create the sensory garden, which was officially opened by the Mayor of Colchester. The Emerald Centre is part of the Essex Partnership University Trust. The centre houses services for people with a diagnosis of dementia. These services include initial memory assessments, consultant reviews, medication monitoring, crisis intervention assessments, home treatment, occupational therapy, psychological assessment and treatments and a 24-hour helpline. The centre also houses group therapies and activities, including cognitive stimulation therapy and a vascular wellbeing group. An individual suffering from dementia, whether the cause be from Alzheimer’s disease, vascular problems or any other brain injury, have in common a group of symptoms associated with an ongoing decline of the brain and its abilities. These include cognition, memory, language, understanding and judgement. Although the most common is Alzheimer’s disease and is generally diagnosed in people over 70, there are individuals who have a diagnosis before the age of 65. This is referred to as early-onset dementia and can have a profound effect on the individual, their family and friends. It is important that, whatever age a person is diagnosed with any form of dementia, they continue to feel worthwhile, useful and understood. With this in mind, when the opportunity arose, we decided to create a garden where people could enjoy being together in a creative way, using and maintaining the skills and creativity they might have, giving them a sense of purpose and pride. The Garden At the Emerald Centre there is an enclosed garden area that was little used and only maintained by Trust gardeners to prevent overgrowth. The project was started when a volunteer offered to decorate the four very large clay pots in the garden with mosaic tiles to add some colour. We decided to expand on this and invited our clients and carers to become involved in creating a sensory garden which would be a therapeutic space they could enjoy. The garden project for our client group was designed to encourage and promote the following: A sense of achievement / building confidence / self esteem To boost energy levels and help with sleep difficulties Working with others to promote social interaction / reduce isolation To create a sense of purpose / meaningful activity Exercise, to promote physical health and wellbeing / help to maintain mobility and flexibility To help maintain skills / encourage memories Enjoyment / pleasure / reminiscence A place to share experiences and create new memories with family or friends It is well documented that gardening is beneficial for mental health and wellbeing. Studies have found that the mental health benefits of gardening are extensive, reducing problems such as anxiety and depression. It can also reduce stress, help combat high blood pressure and help improve overall physical fitness. According to Ulrich (1999), being involved in garden activities can help improve memory and assist with maintaining rational thinking and cognitive function. The activities in the garden help to arouse the five senses of sight, sound, touch, smell and taste. Garden activities can also promote a feeling of calmness and reduce problems associated with dementia such as boredom, depression, aggression, agitation and increased stress. It was a huge undertaking and hard work to begin with. We were fortunate to have the help of a group of volunteers from the university and an enthusiastic group of Girl Guides, to clear the space and ready the garden for our clients to begin their project. Fliers were sent out to our clients and their families or carers, informing of a start date for the group and requesting donations of old unused garden equipment or any spare plants. We applied to the Trust for funding to enable us to purchase gardening tools and entered the award programme. We were overjoyed to win and the £1000 award enabled us to purchase, paint, plants, arbours and seating. The client group was divided into two, with the clients who wanted to work outside in the garden busy designing areas, painting benches, planting, weeding and generally creating the garden. The ‘inside’ group were busy creating artwork for the garden that included making bird boxes, painting pots and using household items to create various sculptures. The project has grown since the opening and we now have a very well attended group who are enthusiastic, creative and motivated to continue developing ‘their’ space. The project has proved to be an enormous success. We have observed the benefits first-hand, with our clients forming relationships, talking, laughing, being physically more active and best of all inviting their families and friends to enjoy the garden with them. Case Study A: Maria Aged 63, Maria was diagnosed with vascular dementia six years ago. She also has diagnoses of depression and arthritis, which cause Maria chronic pain. Maria lives with her husband Norman, who is supportive, but Maria likes to remain as independent as possible and continues to cook and bake. When the garden project started, Maria joined and it quickly became apparent that Maria’s skills in art and craft would be a huge benefit to the group, as this is an area that Maria excels in. In the past, Maria has found it difficult to be in groups, but now she reports she enjoys the interaction in the group. “For me, it’s a source of social interaction and an outlet for my creativity. I also paint and do art and crafts at home, but I love seeing my work on display in the garden. It makes me feel proud”, says Maria. “The garden group has enriched my life and the people I have met have made a huge difference to my life.” Case Study B: Wendy and Ivan Wendy (aged 63) and her husband Ivan (aged 62) are founder members of the group. Wendy was diagnosed with vascular dementia in 2017, but has a long history of bipolar disorder. She also experiences panic and anxiety episodes, making it difficult for her to cope in large groups. Wendy has osteoarthritis and this affects her mobility, requiring her to use a frame to walk. Initially, she was reluctant to attend the group without her husband. Although Wendy would be happy to attend alone now, Ivan also enjoys the group, so he continues to attend. His expertise in the garden has been invaluable to the project. “The garden group is everything to me. It helps with my mood and my memory” says Wendy. “Working in the fresh air and mixing with others helps keep me mobile and lifts my spirits; I look forward to attending each week.” “I enjoy attending with Wendy every week" says Ivan. "When I’ve felt stressed with my role as a carer it’s been good to be with others. The physical activity has helped me keep fit and I’ve enjoyed being part of creating the garden and watching it develop.” Reference Ulrich, R.S. (1999) Effects of gardens on health outcomes: theory and research. Chapter in CC Marcus & M. Barnes (Eds.), Meds. Healing Gardens: Therapeutic Benefits and Design Recommendations. New York: John Wiley and sons, 27-86.

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

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

By Pam Clarke, Expert Hand & Rehabilitation Therapist, The OT Practice Introduction Fatigue is a common feature of a client’s journey, whether that be one of rehabilitation and recovery, or restoration and maintenance. Despite its prevalence, however, fatigue remains poorly understood. There is little consensus as to which part of the brain is responsible for generating fatigue, while its impact upon function and quality of life continues to be either underestimated, or overlooked. Fatigue can be broadly categorised into two groups: non-pathological (or ‘normal’) and pathological (or chronic) fatigue. Normal fatigue is a signal from the body that a rest is required, usually triggered by an episode of physical or mental exertion. This type of fatigue is time-limited and alleviated by an appropriate period of rest and recovery, with little in the way of impact on functional ability. Conversely, pathological fatigue is commonly associated with a pervasive sense of lassitude or lethargy, disproportionate to the prior activity, unresponsive to rest and can prevent engagement in usual and required daily activities. That said, it is also important to remember that fatigue in itself is not a disease; rather an underlying symptom triggered by another illness or condition, such as: Brain or spinal injury Neurological conditions - such as Multiple Sclerosis, Parkinson’s Disease, Motor Neurone Disease, Stroke and Dementia Rheumatoid Arthritis Mental health conditions Visual impairments Amputation Viral illnesses Cancer Older age Endocrine and metabolic disorders Complex disability There are, however, occasions where the trigger or cause may remain unidentified - with fatigue being present, despite the lack of obvious illness or disability. Signs and Symptoms Fatigue is a subjective and uniquely personal experience that can make it difficult for the individual to both articulate and quantify their symptoms. However, in my experience, the following are commonly used words and phrases by individuals when attempting to describe how they feel: Exhausted Weak Lacking in energy and motivation Irritable Forgetful Dizzy Brain-fog Walking through glue Withdrawn Feelings of uselessness and hopelessness Frustrated Word finding difficulties, or slurred speech The role of the OT Once fatigue has been identified as a barrier or challenge to the rehabilitation / maintenance journey, there are techniques and strategies that can be taught and implemented to support the client with managing or over coming this. As part of the assessment process, the occupational therapist (OT) will work collaboratively with the client to determine the type and severity of the fatigue. While there is no specific test or objective assessment to do so, the OT will work with the individual, their family and others involved in their care to obtain as clear a picture as possible of the nature of their client’s problems. They will consider how they experience their fatigue on a day-to-day basis, its impact upon their illness or condition, their overall functional ability and the impact upon their quality of life. Having established the type and severity of the fatigue, the OT will then work with the individual and their family/carers to develop a fatigue management programme. This may involve building a programme of graded achievable activities which seek to restore function, whilst managing the need for rest and recuperation and ensuring that the individual is supported and encouraged to stretch their capabilities. Throughout this process, it is critical that ‘normal’ activity is encouraged. For example, the individual should be discouraged from either resting or sleeping for lengthy periods of time throughout the day. Equally, they should not be attempting to engage in vigorous activity or immediately resuming previous daily patterns, as this can exacerbate their symptoms. The OT will also work with their client, assisting them to both prioritise and adopt pacing and energy conservation techniques, when completing activities of daily living. Breaking down tasks or activities, to ensure that they are completed in an efficient manner, which may include learning alternative techniques or strategies, in addition to considering the use of adaptations and equipment. The overall effect of which should be to minimise an individual’s overall level of fatigue, whilst enabling them to move forward toward their goals. Identifying Triggers and Managing Set Backs The process of rehabilitation is rarely straightforward and inevitably an individual will encounter setbacks, the severity of which can be difficult to both foresee and to manage. To obviate this as far as possible, the OT will work closely with their client to identify likely triggers, which may be physical, psychological or environmental. The OT will also work to develop strategies and techniques to manage these, whilst supporting the individual to work through the difficulties they are experiencing. All this must be done with a view to providing their client with the necessary skills to navigate future problems and minimising the impact of further setbacks upon their functional ability. Why is fatigue management important? Fatigue can pose a significant barrier to function, its effect can pervade all areas of an individual’s existence and can often have a devastating impact upon their life and that of their family and friends - which can be difficult to overcome. While there is little research to objectively demonstrate that fatigue management is effective, in my practice, successful management of fatigue has, without exception, had an enormous impact upon my client’s ability to engage in their activities of daily living - and has had an objective positive impact upon their quality of life. Conclusion Fatigue is experienced by everybody at one point or another and is frequently discussed within day-to-day life, often in a competitive way. It is therefore important to remember that pathological fatigue, which has many similar descriptors to non-pathological fatigue, is by nature - and the way that it is experienced - entirely different. As such, the individual experiencing it frequently feels misunderstood, frustrated, a burden to their family and friends and distressed at the often utterly disproportionate level of fatigue that they feel, often many months or years after their injury or illness. This must be acknowledged and respected by the therapist and not compared to other clients, whose injury or illness may objectively appear more or less severe. Instead, the therapist must work in collaboration with their client and their family to promote understanding of the condition and to develop the tools with which to overcome it, in order to restore functionality. While working collaboratively, the therapist must also ensure that underpinning any intervention is the notion that fatigue management will for many be a life long approach, which must be adopted in all aspects of their day-to-day life. It will not be overcome by the miracle of hands-on treatment; instead it will in all likelihood require a progressive approach. This will, over time, work with the individual to not only achieve their aims, but also to moderate and mediate the effects of set-backs and failures. The key to fatigue management from an OT perspective revolves around providing your client with the resilience to persevere with the programme and thereby promoting confidence and independence in their daily life. Interested in Private Practice? The OT Practice: Expert Blog Case Managers Newsletter

Occupational deprivation is often believed to only affect those experiencing extreme situations, whose opportunity to complete desired occupations is restricted and limited. These extreme situations allude to those who are refugees, those currently experiencing imprisonment or even those experiencing domestic abuse, for example. So what is 'occupational deprivation' and why should we all be aware of it? What is occupational deprivation? The definition of occupational deprivation is 'prolonged restriction from participation in necessary or meaningful activities due to circumstances outside the individual’s control.' This means that hobbies and activities that people choose to do for their own well-being or as part of cultural norms are being limited. Consequently, rather than occupational deprivation affecting only those in 'extreme situations', it can affect those who are disabled, have mental illness, are homeless, have been hospitalised for prolonged periods, those experiencing racial discrimination, plus many more. Considering this, occupational deprivation is experienced by much more of the population than most people believe. The table below shows the number of some of those potentially experiencing occupational deprivation due to their current circumstances: As these figures show a year-on-year increase, it is likely then that occupational deprivation is also on the rise. Why is occupational deprivation so important? As stated in an earlier article “What is occupational therapy?” the word 'occupation' refers to things that occupy your time and bring meaning to your life. The World Federation of Occupational Therapy (WFOT) states that engagement in occupations are not only a right, but also a need. Consequently, occupational deprivation results in having a lack of meaning or purpose in your life and creates or prolongs mental and physical illnesses. This is due to prolonged occupational deprivation leading to despair, erosion of skills, poverty, poor health and social isolation. Whiteford (2011) suggests occupational deprivation is in part due to social exclusion, with political dossiers playing a key role. This is due to these dossiers potentially influencing social opinion, often resulting in negative media portrayal, which continues the cycle. Social division is then ensued, potentially leading to social unrest. How can we prevent occupational deprivation? Occupational Therapy Australia position paper states that occupational therapists play a key role in raising awareness and bringing communities together, with the aim of reducing occupational deprivation (or occupational injustice). The paper also suggests occupational therapists should remove environmental barriers to facilitate occupation, whilst designing programmes that enable engagement. Providing information to policy makers is another way to prevent possible unintended occupational deprivation and increase social cohesion and inclusion. Additionally, Hocking (2017), suggests that continued research to increase understanding of occupational injustice is required. However, to adjust social thinking around those who experience occupational deprivation or injustice, acknowledgement of difference, with a focus on ability rather than what they may be receiving is required. Summary Occupational deprivation is a far-reaching challenge affecting mental and physical well-being. Social cohesion is also affected by occupational balance, which is all influenced by political dossiers presented at that time. Consequently, in order to ensure a cohesive, social and skilled society, a focus on ability in all is required, as is further research and increased awareness. Occupational Therapists play a key role in this through the services offered, information provided and training in environmental adaptations. To read similar content, visit Therapy Buzz.

By Anthony Yuill - specialist rehabilitation Occupational Therapist Introduction As health professionals our role is to assess and treat people holistically. Yet, there is still the debate in healthcare as to what to treat first: physical disability or mental health? As Occupational Therapists we recognise that any assessment is not only the physical presentation that we see but one that also encompasses the mental and emotional health and wellbeing of our clients. With the holistic approach at the forefront of many health professions, the question should be 'Why not simultaneously treat them both?' In 2016, the Mental Health Foundation published a document that stated more than 15 million people (30% of the UK population) have long term physical disabilities with more than 4 million of these people also developing mental health problems. There is numerous research and publications, inclusive of the Mental Health Foundation document (2016) that suggest those with physical health problems are at an increased risk of also developing mental health problems. Thus suggesting a direct link between physical disability and mental health. However, it is helpful to explore this link and understand why physical disability and mental health go hand-in-hand. Physical Trauma: The impact on Mental Health Whether a physical disability has a gradual onset or is a result of acute and catastrophic injury, an individual is likely to experience life altering physical changes. These physical changes will undoubtedly impact on their lifestyle, roles and relationships and indeed their entire lives. This impact can be profound and often traumatic. So much so, the World Health Organisation (WHO) developed guidelines in 2013 for addressing the mental health consequences of trauma and loss. These guidelines were compiled to assist primary care providers to offer immediate psychological support for individuals following a traumatic event. Traumatic events can be defined as experiences that put either a person or someone close to them at risk of serious harm or death. They are more commonly experienced following road traffic accidents, worksite accidents, after violence or prolonged abuse and even following the onset of serious illnesses. It is natural for the body to create a stress-like response following trauma. This can make people feel a variety of physical symptoms, for example raised blood pressure, increased heart rate/sweating and reduced stomach activity (loss of appetite). It can also make individuals behave differently and have more intense emotions, for example being 'on-edge', increased anger/frustration, reduced tolerance levels and altered mood. This response is often referred to as the 'fight or flight' response. This is natural in some situations. However, if these feelings persist - as often the case with physical trauma - they can lead to more serious mental health problems, including post traumatic stress disorder (PTSD), depression and anxiety. Chronic Pain: The impact on Mental Health and the Rehabilitation Journey Pain is subjective and is difficult to define. However, following traumatic injuries most individuals will develop the onset of chronic pain to varying degrees. Unlike acute pain, chronic pain continues beyond the expected healing time of the injury and is often difficult to treat. Chronic pain affects all aspects of a individual's life, including their relationship with others, their employment roles and their ability to participate in their normal activities. Often people with chronic pain will develop negative emotions and have increased feelings of guilt and shame (Turner et al, 2015). This could then lead to the development of depression and/or anxiety. As healthcare professionals we need to look at the psychological and cognitive impact of pain within the rehabilitation journey. If we fail to do this, how can we say that rehabilitation has been holistic, client-centred and fully effective? It is common that individuals may perceive their pain to be at a level in which they truly believe they can't perform certain activities. Albeit the physical response to pain may not be to such a degree, the level of perceived pain will undoubtedly affect an individual's sleep pattern. This can lead to greater isolation and feelings of depression. It is likely that these individuals would display avoidance behaviours. Thus impeding their rehabilitation (Moyle 2016). Through exploring the psychological and cognitive impact we can implement treatments, such as cognitive behavioural therapy, to change individual thought patterns and, in turn, their behaviours. Thus prompting rehabilitation, through the reduction of avoidance patterns. Mental Health: Prevalence, Challenges and the Rehabilitation Plan Individuals who sustain physical injuries can experience a range of mental health problems related to their injury and changes in physical health and function. We have explored the links between traumatic events and the onset of conditions such as post traumatic stress disorder, depression and anxiety - the most prevalent following injury. However, the individual may also experience changes to their behaviours - in that they may have reduced tolerance levels, increased frustration, irritability and also some may experience increased anger or be emotionally labile. The individual may also experience changes to their sleeping patterns. These conditions and changes can be further complicated and exacerbated when injuries result in an individual being unable to participate in everyday activities, such as personal care, work and/or socialising with peers. This should be considered within the rehabilitation plan. Common symptoms individuals may experience following the onset of physical disability and mental health problems include the re-experiencing of the event in nightmares or flashbacks, avoiding activities and/or developing avoidance behaviours. In addition, people may also experience poor concentration, sleep disturbance, panic attacks and develop feelings of intense emotions, hopelessness and helplessness. Through the onset of physical injuries - whether as a result of acute or gradual onset - the individual will undoubtedly experience a loss or significant change to their roles and relationships. Prior to their physical disability, many individual's will have roles such as partner, spouse, employee and/or driver. Following the onset of their physical disability, these individuals may have developed into the role of patient - dependant and requiring care or assistance to complete their basic activities of daily living. The changes to roles will undoubtedly lead to a change in their relationships. The individual may now class their partner/spouse as their carer, with the potential for a change in the relationship dynamic. The loss or change in roles and relationships play a key component within an individual's recovery and rehabilitation. A loss of role or change in relationship can lead to greater feelings of helplessness, hopelessness and feelings of guilt and being a burden. Alongside the physical pain and trauma of injuries, this has the potential to develop progressive negative feelings, leading to the onset of common mental health conditions associated with trauma. The development of these conditions will impede an individual's recovery and rehabilitation. As every person is unique, so are their coping mechanisms. Although one person may be mentally capable of managing changes to their physical health and/or function, another person may not. There is no predictable sequence or pattern when exploring the psychological impact of injuries. However, a study by Taneal et al (2015) found that early identification of depression, anxiety and stress following injury - and subsequent preventative intervention - may reduced the long-term symptoms and negative impacts. Due to the impact and common link, it is not surprising that the mental health implications associated with physical injury and disability are important areas that need to be considered when developing any rehabilitation plan. Through the development of a holistic plan, encompassing all areas and difficulties an individual may experience, the outcome for that individual will be maximised. Further to this, the same study by Taneal et al (2015) noted that, in the three months following injury, 40% of their participants developed symptoms of depression, 34% developed symptoms of anxiety and 37% developed symptoms of stress. From this, is it clear that any rehabilitation plan needs to be reviewed and altered as necessary, in response to the individual needs of our clients. Conclusion As occupational therapists, we aim to improve health and well being through enabling participation in occupation. The link between physical injury/disability and the onset of mental health problems is clear. As a profession we can recognise that, not only does engagement in meaningful occupation promote good mental health, it can also assist recovery and help individuals to achieve their personalised outcomes. From full exploration of the individual within a holistic approach, we can investigate the impact of their physical disability in all areas, including the impact on their mental health. This will enable the development of holistic rehabilitation plans, that address all difficulties that an individual may experience. Through this holistic approach, the outcome of personalised goals will be maximised. References Moyal Sally, (2016) The emotional and psychological impacts of chronic pain (online article): www.ausmed.com/articles/chronic-pain-emotional-psychological-impacts Mental Health Foundation (2016) Fundamental Facts about Mental Health (online document). Available from: www.mentalhealth.org.uk/file/2518 Taneal A, et al (2015) Incidence of depression, anxiety and stress following traumatic injury: A longitudinal study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. Available from: https://sjtrem.biomedcentral.com/articles/10.1186/s13049-015-0109-z Turner-Cobb, J. M., Michalaki, M. and Osborn, M. (2015). Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report. Psychology & Health, 30, 495-501. World Health Organisation (2013) Protocols for Mental Health Care following Trauma (online document). Available from: www.who.int/mediacentre/news/releases/2013/trauma_mental_health_20130806/en/ Further Reading Lloyd, C (2010) Vocational Rehabilitation and Mental Health, Wiley Blackwell Creek, J (2014) Occupational Therapy and Mental Health, Churchill Livingstone Duncan, E (2011) Foundations for Practice in Occupational Therapy, Churchill Livingstone Useful Links RCOT Hot Topic: Check with RCOT Library or website for most recent publications Healthy Working Lives Mental Health Foundation Interested in Private Practice? The OT Practice: Expert Blog

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

By Catherine Hayden, The OT Practice Functional Rehabilitation team, MA in Design for Disability. Virtual personal assistants such as Amazon’s ‘Alexa’ are changing the way people live and as Occupational Therapists (OT) this type of assistive technology provides an exciting opportunity to enhance our practice. Rapid developments in this type of technology coupled with OT expertise in function and our problem-solving approach could open up a whole new level of independence for our clients. Who or what is Alexa? Alexa is a virtual personal assistant which is housed in a smart speaker and follows voice commands to carry out tasks for its owner. It is just one type of virtual assistant, with Google, Apple and others having developed their own versions. One in twenty Britons (5%) owned a smart speaker in quarter 3 of 2017 with this increasing to 10% by quarter 1 of 2018 (1) . The Amazon Echo with Alexa virtual assistant is the original smart speaker and has dominated the sales market. Amazon sold 2.8 million devices in 2017, compared to the 1.14 million sold by the other market leader, Google Home(2). YouGov research shows that so far, the most common uses of such devices are to play music, answer general questions, set alarms and reminders, make lists and use calendars(1). However, use of such technology is developing rapidly with Alexa being used in health care in the US(3) and the UK government recently announcing plans to work with Amazon to provide health advice to Alexa owners(4). The smart speaker is modern and commonplace in many homes, it has the ability to link with other speakers and equipment. They are affordable. The cheapest smart speakers cost around £50 and once set up, the speaker is activated simply by talking into the air. There is no need to be able to use your hands, leave the bed or chair or see to activate it as long so as the individual is able to hear, understand and remember how to use the product. How can OTs use Alexa? Assistive technology is not a new concept for OTs, with technology such as telecare and communication devices being utilised to enable client safety and maximise independence for many years. But there has been a step change in regard to the use and acceptance of such technology in the home and many healthcare professionals are now keen to use this as an opportunity to enhance and develop their practice. What virtual assistants actually do and how they may benefit OT clients varies between products as do their strengths and weaknesses, with new features being developed and improved all the time. The table below summarises some of the main attributes, possible OT use and the potential benefits for clients and carers. The potential clinical use for key virtual assistant product functions These features add convenience and aid everyday life for all product users but have the potential to be life changing for those with disabilities. The addition of downloadable apps, known as ‘skills’ on Alexa, allow additional functions to be activated, expanding the rehabilitation potential as the technology evolves. For example, some of the additional Alexa skills could be used to address the developmental needs of children and assist with their rehabilitation for executive functioning and sensory processing goals(5). The OT may wish to add apps specific to their clients’ rehabilitation needs in order to assist therapy goals. Who may benefit? Any individual who requires assistance using technology or physically controlling their environment may benefit from the use of a virtual assistant. For example, for people with visual impairments use of touch screens is problematic, but smart speakers allow easier access to audio content on the web, choice of radio or TV station to listen to and the development of the Amazon ‘Echo Look’ may assist with choice of clothing in the longer term(6). The potential use of virtual assistants for those with movement difficulties (for example spinal cord injuries or neurological diseases) are vast, allowing individuals increased independence with many tasks. Smart speakers can also be used with voice activated software increasing usability for people who may be unable to speak to the device. Those with mild cognitive disorders such as head injury, stroke, learning disability or early dementia may find the virtual assistant provides the prompts required to manage their daily activities with a higher level of independence, although they would need to be able to remember how to use the product which may limit accessibility. The OT role may include teaching clients to use the technology to aid their independence, provision of apps to meet the individual’s rehabilitation needs and virtual monitoring of progress between therapy sessions. As well as aiding rehabilitation and increasing independence, use of a virtual assistant may cover the tasks previously aided by several technological solutions, therefore simplifying the process, reducing the amount of equipment in a client’s house and possibly reducing the costs of running more than one system. The increase in independence is likely to have a positive impact on quality of life for both the client and their family. On a larger scale, there is potential to reduce the number of healthcare visits a client requires for prompting with daily activities, health monitoring and rehabilitation. Hampshire County Council claim that distributing Amazon Alexa’s to elderly and disabled residents has reduced costs by £43 million over a two-year period(8). Use for banking is being developed(9) which should increase independence for those unable to use a keyboard. KidsMD has been developed by Boston Children’s Hospital, US to ask child health related questions(9) and a similar service between Amazon and NHS Choices website is being developed for adults and children in the UK(5). Which to buy? This seems to be down to individual preference although my research has led me to believe that the Google Home call function may have more flexibility and the search engine from google is a more reliable source of information than Amazon’s use of Bing. However, if you are already an Amazon Prime subscriber or your family and friends all have the Echo then this may be the one to go for. A word of caution Clearly the potential for Alexa and other smart speakers is almost limitless. Especially when considered with the potential of linking these devices to other appliances in the home in the much hyped ‘Internet of things’ but what are downsides to such devices? Alexa only calls Alexa, so the whole family must buy-in to allow it to be used fully. To be able to use the smart speaker individuals must be able to understand and remember how to use it. There are language limitations and of course the individual needs to be able to hear sufficiently to use the product. While virtual assistants reduce the need to use technology, to operate the product the client must be comfortable talking to it and accept a way of functioning which may be completely alien to them. Confidentiality could be an issue. This is an important consideration especially when data protection is taken into account, the potential to hack these devices to collect data for criminal use is a major concern. If used as a healthcare reminder for medications, exercises etc what are the ramifications for the clinician if the device does not perform this function? Finally, what if the device fails to recognise the patient’s request and inaccurate advice is given, should and can human contact be replaced by use of a device? All of the above problems are not limited to the clinical use of such devices. However, as they become increasingly common in our homes their abilities will increase and will address many if not all of the issues above. Should I use Alexa in my clinical practice? The use of virtual assistants has huge potential to change the way we interact and treat patients now and in the future. There are simple tasks and functions that the device is already assisting hundreds of thousands of people with. This list will expand as the legal, ethical and technological barriers are broken down. OTs should continue to be involved in the development and use of such practice as the potential to assist with OT rehabilitation and enable client independence is huge. References https://yougov.co.uk/news/2018/04/19/smart-speaker-ownership-doubles-six-months/ https://voicebot.ai/2018/02/28/amazon-echo-google-home-european-smart-speaker-sales-approach-6-5-million-units-2017/ https://mhealthintelligence.com/news/how-one-home-health-provider-turned-alexa-into-an-mhealth-assistant. http://www.pulsetoday.co.uk/new/gp-topics/it/government-to-partner-with-amazon-alexa-to-offer-nhs-advice/20037111.article https://www.theottoolbox.com/2017/04/alexa-skills-for-therapy.htmlhttp://uk.businessinsider.com/amazon-echo-features-2016-10/#this-only-scratches-the-surface-20 http://www.accessandmobilityprofessional.com/cash-strapped-council-saves-43m-turning-amazon-independent-living-solutions/ https://uk.pcmag.com/amazon-echo-2017/92743/news/why-amazons-alexa-is-life-changing-for-the-blind Interested in Private Practice? The OT Practice: Expert Blog Case Managers Newsletter

By Louise Martinez, Neurological Occupational Therapist Feeling cut off from the world: social isolation is common after experiencing sensory impairment. Introduction This guide has been produced to explore the role of the occupational therapist in treating clients with sensory impairments. Two case studies have been provided, to give the reader some practical insights and transferable ideas within clinical practice. Sensory impairments are often overlooked and an invisible health condition in the world of healthcare, where much of the focus remains on diagnosing the clinical priority areas outlined in the Five Year Forward View (UK), with cancer, mental health and dementia as the top three in 2017. And yet the services of occupational therapists, with skills in sensory impairment, are increasingly being requested. There is a higher prevalence of sensory impairment amongst the increasing older population and with more people living longer and healthier lives, sensory impairments are a more common feature of growing older. Occupational therapists, with their analytical, yet holistic approach - and wide knowledge base - have a thorough understanding of the effects of disability on quality of life. They are uniquely placed to provide the most effective interventions for those with sensory impairments, as their skills lie in understanding the relationship between the person, the environment and the occupation. The Definition of Sensory Impairment Most of us are aware of the five senses; sight, hearing, touch, smell and taste. We rely on these every day without much thought. They rely on the collection of external information from outside the body. We also rely on our vestibular systems (balance and movement) and proprioception, which is our sense of where our body parts are in relation to the environment. These rely on information from within our bodies. A loud noise might alert us to a potential danger approaching (e.g. a bus coming around the corner). We rely on our sense of touch to tell us whether a shower or bath water is too hot, too cold, or ‘just right’. Our senses are a vital defence in protecting us from coming to harm, in addition to bringing us pleasure and enjoyment in life. Our senses work together in balance, with no one particular sense overriding or standing out. This is known as modulation, which is the ability to rely on our senses to react accordingly to each stimuli, gathering just the right amount of information to communicate back to our brains, eliciting the appropriate reaction. But what happens when one or more of our senses becomes impaired? Sensory impairment occurs when one or more of our senses are no longer functioning as expected. For example, if you wear glasses you have a sight impairment, if you find it hard to hear or have a hearing aid then you have a hearing impairment. There are obviously different levels of sensory impairments, and it is possible to live quite independently with some degree of sensory impairment with the right skills, aids and or compensatory approach. Certain groups are more at risk of developing sensory impairment. For example 81% of people who are blind or have sight impairment are aged 50 or above (WHO, 2017). People with a learning disability are 10 times more likely to have serious sight and or hearing problems and other sensory impairments. Some individuals will have more than one impairment, such as dual sensory impairment (combined sight and hearing loss, or ‘Deaf Blindness’). Life choices can become more complicated when sensory impairment occurs on a background of other co-morbidities. As outlined in the case study below, had Norman not been diagnosed with Dementia, he and his wife may have moved to a fully adapted bungalow. However, Norman’s need for familiarity and orientation became more of a priority, so they remained in their home. The Functional Impact of Sensory Impairments. Cognition and Mental Health - ‘The Invisible Person’ Imagine losing your sight suddenly due to illness or injury. The loss of one of our senses can be devastating. But imagine losing your hearing too. The effect of losing one or more of our senses can result in an individual’s inability to interact with the environment. Even those living with loving and supportive family or carers can experience feeling completely ‘cut off’ from the world. Helen Keller (a deaf blind 20th century female activist) noted “blindness cuts us off from things, deafness cuts us off from people”. Coping with dual sensory impairment can be very difficult. Signs of sight loss may be apparent to others, with visual cues such as a walking aid, a guide dog. However, hearing loss, or taste, touch or smell impairments are invisible disabilities, and the needs of such a person will rarely be apparent to the wider community. The stress of living with sensory impairment can put people at risk of depression, adjustment disorder, distrust, anxiety, anger, poor self-image, lack of confidence and self-esteem and feelings of isolation and marginalisation. Christina Hartman (a writer) has dual sensory impairment. She gives a detailed insight into her experiences in her blog. “I’ve started to rely more on memory, organisation, and rote, which is hard because I am naturally disorganised and forgetful. I memorise routes that I take through stores, locations of the things that I like to buy, where I put my cell phone. I clean the kitchen methodologically rather than just cleaning what’s dirty. It’s tiring sometimes, keeping so many things in your mind. Earlier this year, I’d have to sleep for nine to ten hours a day just to feel somewhat rested because I wasn’t used to the visual and mental strains. Now, I’m better and getting used to it. I also find myself turning on my cochlear implant more often to feel acquainted with my surroundings. I used to prefer absolute silence, and at some level, I still do. But I no longer feel safe. It’s sometimes a bit terrifying to even go outside. I feel like since people will assume I can hear, accidents may happen. But I don’t want to become a dependent hermit, so I force myself to go out.” > More about Christina’s experience Approaches used within Sensory Impairment by Occupational Therapists Sensory impairments such as sight loss or hearing loss are usually permanent and irreversible. Thus, the approach is most likely to be a compensatory one, rather than a restorative one. A compensatory approach aims to manage, not change, the needs of the person, working within their new limitations to maximise independence. The impact of sensory impairment differs from person to person. A person’s sensory impairment must be considered in the context of their occupational engagement and ability to function in their own environment. The skill of the occupational therapist is in identifying those activities meaningful to the individual which are adversely affected by their sensory impairment. Therefore the OT would focus on examining roles, relationships, activities of daily living, or accessing the community. The assessment will consider a demand analysis of the following sensory and perceptual skills: Vision – does the activity require vision? (short/long/colour recognition/depth perception) Auditory – is hearing necessary? (sounds/tones/volume) Gustatory – does the activity require taste discrimination? Olfactory – does the activity require distinguishing between different smells? Touch – does the activity require fine or gross motor skills / is the ability to recognise different shapes / textures or changes in temperature necessary? Are stereognosis / proprioceptive or vestibular skills required? The management of sensory impairment can be through a range of compensatory approaches. From reorganising the environment, to adapting the task itself or teaching new strategies to enable the client to self-manage their needs. The latter is dependent on cognitive functioning and insight and may not be the optimal approach for someone with cognitive impairment). An OT might, for example, suggest the following approaches to the sensory environment in order to accommodate a client’s specific needs. For example, adjustments to lighting, temperature, noise level, removal of clutter (BAOT, 2015). It is important to include family members in the entire process of assessment and treatment, as carers will be essential in helping to establish new routines and ensuring successful outcomes in the day to day execution of goals. Someone living with sudden and irreversible sight loss in later life may experience rapid deterioration in mobility and independence. It is not possible to treat the sight loss, but it may be possible to adapt the task itself. Providing access to a befriending service / volunteer to assist the individual to access the community, can help reduce client social isolation. Individuals are then more able to engage in the activities they enjoyed pre-sight loss. Other strategies include the Alert Programme (Williams and Shellenberger, 1996) - a programme for children, parents and teachers to be able to assist the child with sensory processing difficulties to recognise how alert they feel. This is a specialist area, requiring an experienced Paediatric occupational therapist. Assessment of individuals with sensory impairment requires occupational analysis of the whole person, their previous capabilities, occupational roles, interests, choices, belief systems, as well as their current occupational performance. It is important to consider the realities of possible function according to the stage of any co-existing co-morbidities on the sensory impairment (as seen in the case study of Norman). In the table below, some further examples are given of sensory impairments along with possible causes, impact on function and compensatory strategies which may be used by an OT. It is useful to note that there are some common themes occurring in the impact on client’s lives and function, despite differing causes. This list is not exhaustive, but aims to provide the reader with an overview. * www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment Case Studies The case studies below explore the role of an occupational therapist with an adult with sensory impairment (Norman) and the role of a Paediatric OT explored by way of contrast in Sally’s case study. Norman (Adult Case Study) Norman, aged 67, has age-related macular degeneration, worse in his left eye. He has been hard of hearing for some time but this did not affect him until he lost his sight. He experienced total and irreversible sight loss in his right eye after developing temporal arteritis. He became wholly reliant on the residual vision in his left eye, which was sufficient for global navigation, but not much else. As a consequence of the visual loss and hearing loss, Norman’s ability to interact with his environment is now severely limited, and he spends most of his day sitting on the sofa. Previously he was a very active individual for his age, he enjoyed reading and spending time with his grandchildren. His wife became his main carer. Not long after his sight loss, Norman was also diagnosed with Dementia, following short term memory difficulties. His care needs increased as a result. After the shock of the multiple diagnoses and finding that Norman now needed 24 hour supervision and assistance for most tasks, Norman’s wife decided it was time to move to a bungalow from their much loved family home, which was a two storey property with stairs. Following a full OT assessment, it was clear that the impact of his sight loss on Norman’s mobility was significant; he began to experience regular falls at home. His wife now needed to supervise him 24 hours a day. However, it was identified that Norman remained independent in some areas, such as being able to take himself to the toilet and washing his upper half. He was able to use his long term memory of the layout of his home, (where he has lived for over 30 years) to carefully navigate his way from room to room. As long term memory is often retained the longest in Dementia conditions, and Norman became disorientated and distressed in new environments, the OT assessment helped his wife to realise that staying in their own home was the better option for Norman. This strategy would help to increase his sense of belonging and maintain his orientation for as long as possible. Whilst his sight loss combined with hearing loss and short term memory loss was causing him to disengage and be socially isolated, OT focused on provision of equipment which would maximise engagement in activities he enjoyed and minimise isolation. Occupational therapy input included adapting the home environment, with a focus on compensating for Norman’s sight and hearing loss, but factoring in the short term memory loss. Norman’s wife was no longer able to assist him in and out of the bath. The bathroom was therefore fully adapted into a wet room, with a padded wall mounted shower seat in contrasting colours to utilise the limited remaining visual acuity in Norman’s left eye, to help guide him to the seat. Further sensory support systems were also provided, such as, a shower unit with raised tactile symbols, audible adjustment indicators and illuminated LED indicators. The occupational therapist sourced a local builder; plans were made to convert a room downstairs into a bedroom, for Norman for when he is no longer able to manage the stairs. Aids and equipment are provided to enable Norman to regain independence in meaningful activities, such as a DAISY, to enable him to listen to audio books. Advice and guidance was also provided on boot hoists for their vehicle, to enable Norman’s wife to more easily lift the wheelchair in and out of the boot. The OT helped to set up weekly respite for Norman’s wife, allowing her some much needed time for herself, whilst Norman visited a local day centre. Following OT input, Norman and his wife both said they felt relieved they were able to remain in their own home, and manage their day to day life with Norman’s sensory impairments. Sally (Paediatric Case Study) Sally, aged 5, was born with total sight loss. She rocks continuously when sitting. She also steps from one foot to the other when standing and walking. People with full sight are able to receive all of the vestibular stimulation they need during brisk walking movement (which is forward and rhythmic). A blind child may seek vestibular stimulation, but cannot walk with the same confidence and rhythm. Rocking herself gently gives Sally the same vestibular effect, but in a comforting and safe way. A Paediatric OT would work closely with Sally, her family and her teachers to provide safe ways of enabling Sally to compensate for her sight loss and to regulate her emotions, feel safe and secure at home and in schools. This may involve use of the Alert programme, sensory integration and other strategies such as deep pressure touch input (through massage, weighted clothing, hugging) which stimulates receptors in the skin. This has a calming effect on the brain stem. OT input will ensure that Sally has opportunities to integrate these activities into her daily routine. A large part of the OT role is to ensure that teachers, family and peers are also educated in sensory impairments, to maximise social inclusion. Conclusion It is hoped this guide has provided an overview of the breadth and scope of the role of the occupational therapist in maximising independence with individuals with sensory impairments. Further information and reading is provided in the references list below. References Communication Passports: www.communicationpassports.org.uk/about Five Year Forward View, NHS England (2017) www.england.nhs.uk/five-year-forward-view Loss of Smell experience: www.bbc.com/future/story/20150811-how-it-feels-to-live-with-no-smell Practice Briefing, The Role of sensory integration in occupational therapy, April 2015, www.rcot.co.uk/practice-resources/occupational-therapy-topics/childhood-adulthood Royal College of Occupational Therapists, Professional Standards for Occupational Therapy Practice, 2017 – available via RCOT website: www.rcot.co.uk Royal College of Occupational Therapists (2015a) Code of Ethics and Professional Conduct. London: COT. Available via RCOT website: www.rcot.co.uk Royal National Institute for the Blind (RNIB): www.rnib.org.uk/who-we-are Synapse, Reconnecting Lives, Proprioception Factsheet: http://synapse.org.au/information-services/proprioception-fact-sheet.aspx World Health Organisation (WHO), Blindness and Deafness: www.who.int/pbd/en Further Information To discuss how The OT Practice might assist your clients with a sensory impairment, please contact one of our dedicated Client Managers, who will be able to discuss in detail how we can support you in delivering the best possible service to your clients. For those interested in Private Practice The OT Practice - Expert Blog Case Managers Newsletter

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub [Written following intervention in 2019] 'Dorothy' Follow-up home visit, by Occupational Therapist, Urgent Care Team. For ongoing clinical and functional assessment, focusing on general mobility and transfers, toileting and personal care. OVERVIEW Dorothy (not her real name) is a retired midwife, with a past degree in philosophy. She lives with a live-in carer, in a two storey semi-detached house, on the city outskirts. Dorothy was referred by a hospital emergency department discharge team, following a fall and sustained right fractured scapula. Conservative management in broad sling. A recent fracture clinic appointment also identified an old fractured clavicle. She is taking analgesia for pain. Her GP has held some medications for one week, due to low blood pressure and her falls risk. Bloods taken showed reduced EGFR, ferritin and folate levels. GP has referred to the district nurses, for repeat bloods. A falls assessment has been completed. Cognitive assessment is not indicated. Equipment in situ Quad stick, perching stool, bed lever, static commode, cantilever table, slide-sheets, two-wheeled walking frame (out of use, due to non-functioning right arm). Factors affecting engagement and participation Dorothy has had high levels of acute anxiety regarding falling, with subsequently reduced functional mobility and difficulty with her daily transfers. Since referral to the urgent care team, she has required close supervision of two, by her OT and live-in carer. Alongside historic and new fractures and anxiety, Dorothy has significant kyphosis of the spine. Dorothy has mental capacity to give consent. Given today for assistance with toileting transfers, mobility and personal care assessment. Access to property gained via live-in carer. On arrival, Dorothy was sat up in bed. In a settled mood and in company of her carer. ASSESSMENTS CLINICAL OBSERVATIONS [Heart rate, blood pressure, respiration rate, oxygen saturation, temperature] Not indicated today; clinically stable on recent visits. CARDIAC Patient has no chest pain Patient has no oedema Dizziness not present Waterlow pressure sore risk: 16 RESPIRATORY Breathless on mild exertion; likely due to anxiety before and during completing mobility and transfers No cyanosis No cough ABDOMINAL No abdominal pain No nausea or vomiting Diarrhoea not present Not constipated Bowels last open: Yesterday No genitourinary pain New urine incontinence: Raised during intervention. Message left with GP for callback, regarding medication changes related to this Incontinent of faeces severity: Mild. Perceived cause is inability to easily and independently reach commode NEUROLOGICAL Alert, no confusion No FAST symptoms No memory concerns identified on this visit Anxiety: Longstanding generalised anxiety, with recent acute anxiety, related to falls risk and lack of confidence with functional mobility and transfers Loss of confidence EXPOSURE Amber Protocol: No current pressure damage, but largely bed-bound until now Implement full skin inspection weekly Increasingly mobile and finding transfers less anxiety-provoking Sitting for short periods in chair during the day Live-in carer monitoring skin. No pressure areas identified, other than mild redness of skin at ankles; feet elevated in bed MUSCULOSKELETAL Pain: Continues to complain of pain in right humerus and scapula areas. Increases on mobility and during transfers, plus during personal care and when assisted with dressing Number of falls in last year: 3 Falls risk assessment: Completed Canadian Study of Health and Ageing clinical frailty scale: 7 Mobility Assessment Mobile with quad stick. Once transfer from commode was complete, Dorothy's mobility was largely independent. She required regular reassurance and light-touch support at waist, assisted by OT. Using quad stick, Dorothy was able to mobilise from the commode at bedside to the perching stool in her bathroom. Suggested by OT, her live-in carer followed behind with the static commode, should patient want to sit to rest mid journey. However, this was not required. Normal gait, adequate power and balance. On completion of her personal care (as below), Dorothy was able to return to her bedroom via the same method, unaided beyond close supervision. Dorothy has a significant lack of confidence with stepping/walking backwards. On return to her bedroom, she needed to step backwards to sit on the chair at the end of her bed. She was unable to complete this and required the commode to be placed right behind her. She fell back heavily onto the commode, before completing a transfer from the commode to a chair, where she would be given lunch by her carer. Transfer Assessment In contrast to recent visits this week, Dorothy was very able with her transfers out of bed, onto the left side, via use of bed lever. She remains very nervous, but was vocally less anxious than on the last visit. Close supervision of OT was required for her turn clockwise on the spot, to stand in front of the commode. She was not confident with stand-to-sit transfers, with a (controlled) fall back onto the commode seat. On arriving in her bathroom later, she safely and independently completed transfers on and off her perching stool. Personal Care Assessment Dorothy was able to reach her bathroom, having requested support to brush her teeth. Sat on the perching stool, she explained her routine prior to her fall and fracture. At baseline, she perches her toothbrush head on the plug hole, to allow her to apply toothpaste. Dorothy completed brushing independently. She required support to hold a towel under her chin, to prevent paste dripping. A towel was brought to her mouth for drying. Dorothy was able to flannel wash and dry some areas of her upper body, using her left (unaffected) arm. She required assistance from her carer to complete a strip wash at the sink, covering areas not reachable to her (including her back). Kyphosis and pain from her scapula fracture acted as barriers to her engaging fully in independent self-care. ACTIONS Support, with live-in carer, to mobilise and transfer to commode for toileting Close supervision and regular reassurance to complete mobility to bathroom Assessment of and assistance with personal care: upper body and brushing teeth Reablement referral passed onto urgent care admin for processing Discussion with manager of care provider, who was visiting to reassess support needs. Informed and demonstrated current level of function Call to GP surgery; to request a discussion regarding potential return to ceased medications; for review of incontinence Out-of-hours team referral complete, for night-time routine and assistance with toileting Referral made to reablement and community rehabilitation teams, for support following discharge from urgent care team ANALYSIS Dorothy continues to be highly anxious before, during and after engaging in all mobility and transfers. This was highlighted during commode access and whilst engaging in her personal care. Dorothy has long-standing generalised anxiety and reports that she "worries if there is nothing to worry about." A lack of confidence and trust in her own abilities is not supported by having a temporary live-in carer. Her regular, familiar carer is on a two-week holiday. New urinary incontinence has been identified. This is likely due to her inability to easily reach her commode independently and in haste, rather than other physiological causes. Her GP has held some medication for one week, ending tomorrow, which will need a review. A huge improvement in functional ability has been observed in recent days, with Dorothy able to walk independently to the bathroom and back, using her quad stick and with close supervision of one. Notably, ongoing encouragement and patience - from the urgent care team staff - has contributed to her now being able to complete some personal care tasks in her bathroom. This progress and goal achievement has been aided by the occupational therapist's therapeutic use of self and by building rapport, via discussions around her past vocation. RECOMMENDATIONS Teatime visit today, to continue to assist live-in carer with toileting Out-of-hours team referral for night-time routine and toileting Follow up GP call requested, regarding medication changes Telephone care agency on Monday, for outcome of future care provision Await start date of reablement (support workers) and community rehabilitation team (occupational therapists and physiotherapists). To continue progress engaging in personal/instrumental activities of daily living and to develop self confidence around independent living, thus reducing falls risk

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

Sexual activity and intimate social participation are often considered meaningful occupations. Healthy intimate relationships and satisfaction with one’s self as a sexual being have the potential to contribute to quality of life and wellness. While sexuality and intimacy can play a very positive role in individuals lives, there is also the potential for sexuality to have grave consequences and be used as a vessel of power. Considering the powerful impact of sexuality on individuals' lived experiences, occupational therapy professionals should be prepared to address sexuality and intimate occupations with their clients. Occupational therapy professionals are perfectly situated to address sexuality and intimacy occupations, due to our training in activity analysis, therapeutic use of self, cultural competency and trauma informed care. What is sexuality? Sexuality encompasses concepts beyond heteronormative penetrative sex. Sexuality can be understood as sexual expression, sexual activity, sexual decisions for example abstinence, sexual communication skills, and understanding one’s sexual self-concept. When considering sexuality in this manor, one can understand how sexuality is one of the few occupations which is relevant throughout lifespan. We have evidence of infants masturbating in utero, know it is important for adolescents to learn sexual limit setting, and know it is common for individuals at end of life to want to share physical touch with their loved ones. What is intimacy? Intimacy is understanding it is not a euphemism for sexual activity. Intimacy is separate from sexuality. Managing intimate relationships involves executive functioning skills, such as planning and organising skills, communication skills, emotional regulation, sensory regulation, self-awareness and positive self-concept. Often a strong, intimate relationship is a precursor to a healthy and satisfying sexual relationship, particularly for couples who have been together long term. Intimacy can be enhanced through prioritising pleasant shared time together, maintaining respectful communication, affirmation and advocating for one’s relationship needs and giving effort towards meeting the relationships needs of their partners. "Occupational therapy professionals are perfectly situated to address sexuality and intimacy occupations due to our training in activity analysis, therapeutic use of self, cultural competency, and trauma informed care." Who might have concerns related to sexuality and intimacy? Everyone! Regardless of diagnosis, gender, sexual orientation, gender identity, age, religion, race, many individuals will find meaning in how they desire, choose, and are empowered to be sexual and intimate. Occupational therapists can work with individuals with a range of diagnosis and many of these individuals will report a desire to improve their performance and satisfaction with sexual activity and intimacy social participation. Examples include, but are not limited to poly-traumatic injuries, post-traumatic stress symptoms, anxiety, cancer, erectile dysfunction, or sexual trauma. Occupational therapists can help clients explore their physical, cognitive, and emotional barriers to engaging in sexual activity or intimate occupations. After establishing awareness of the contributing factors, they can make recommendations to assist with mitigation of those barriers and providing suggestions for affirming and enjoyable sexual and intimate activity. Interested in learning more about how to address sexuality and intimacy in your occupational therapy practice? Here are a few tips and recommendations: If you don’t feel competent, generate an open discussion with your clients and hear from them how their sexuality and intimacy is impacted by their illness or experiences. Our clients are our most important stakeholder, they can guide us in the right direction. If you don’t feel comfortable, generate an open discussion with your colleagues, classmates, professors, loved ones, or children. Give yourself practice having professional and productive conversations around the topics of sexuality. Practice makes perfect and gives us confidence. Visit author Kathryn's website, www.sexintimacyot.com, to sign up for the mailing list and be kept up-to-date with learning events and advocacy efforts. Check out the Social Responsibility page, for free resources and content. Take a look at two books Kathryn has written/edited: Sexuality and Intimacy: An Occupational Therapy Perspective and Sex and Intimacy for Wounded Veterans: A Guide to Embracing Change. Image credits: Institute for Sex, Intimacy & Occupational Therapy For access to images, contact kathrynellis@sexintimacyot.com.

"This shirt tag is really itchy. Do you mind helping me handle it?" Yeah, right. That's never how our kids with tactile defensiveness handle sensory issues. Instead, we're running around trying to figure out if it's the funny tasting breakfast cereal, the annoying radio station, or the gloomy weather that's setting out kid off. Tactile issues can set our kids into overdrive really quickly. What are some great ways to help a child who struggles with tactile defensiveness? 1) Deep Touch Pressure Deep touch pressure helps the body re-regulate itself and leave 'fight or flight' mode. This is why tight hugs can be so calming during a temper tantrum. Not only is deep touch pressure great when a child is feeling overwhelmed, it's a great primer too. By adding deep touch pressure into the child's daily routine, you can gradually decrease tactile defensiveness overtime and better prep the child's body for tactile sensations they'll face. 2) The Wilbarger Brushing Protocol Be sure to receive proper training before implementing this with a child. 3) Have Fun with Sensory Play The more that the child can have fun with different textures and experiences, the more they'll associate positively with tactile sensations. While tactile defensiveness is never easy to manage, there can be a lot of benefits to exploring each individual child's triggers to find the best sensory solutions to try. Diana is an occupational therapist and the founder of The Sensory Toolbox, a place for education and resources on all things sensory. Read more about her take on tactile defensiveness in this post.

Single-handed care seems to be a hot topic at the minute, and it will probably only get hotter and hotter until something is done about the healthcare sector. Budget cuts and the increasing aged population have put an incomprehensible amount of stress on care workers as it is; people are putting forward single-handed care not as a solution, but as something to alleviate this stress. But the idea of single-handed care divides opinions throughout the sector. Can you really get the same quality and level of care from one person? The State of Play The current strain on the NHS and social services is almost unquantifiable. People are living longer and requiring more care, yet less funding is going into social care, and fewer people are choosing to become carers. A study carried out by The King’s Fund found that social care is facing a funding gap of £2.5 billion by 2019/2020. On top of this, the community nursing workforce has declined by 2.3% over the past two years. With the government estimating that the 85+ demographic will double by 2020, it seems there is no way that social care can maintain its workload without more funding and some key changes. What is single-handed care? Single-handed care is exactly as it sounds. It is the review and reduction of care packages to require fewer carers per person, without putting that person’s health and well-being in harm’s way. In turn, staff can cover more care packages with no detrimental effect on the quality of care they provide. But naturally, people are quite sceptical of this idea. The shortfalls of care have been broadcast from pillar to post; carers turning up late, not staying long enough, and cancelling visits last minute can be incredibly distressing for someone who relies on care staff to provide them with support every single day. How can we maintain high-quality single-handed care? If a plan is to be put in place to incorporate single-handed care, then it should be rolled out with due attention. Care packages should be reviewed on a case-by-case basis and the principles of single-handed care should only be introduced if it’s entirely safe and appropriate. Evidence shows that if single-handed care is carried out in the right manner, it can be applied to about 40% of cases. Of course, there’s the physicality of single-handed care to think about as well. What happens when a carer goes to someone’s home, but cannot carry out proper moving and handling manoeuvres because it usually requires two people? Having the right equipment is a great solution for this. Investing in the right tools for the job can be incredibly cost-effective in the long-run, and it can help to make care easier and quicker overall. Tackling falls with single-handed care Falls are a big problem for those who need care as well as their carers. Age UK reported that every year in the UK, just over one in three people over the age of 65 suffer a fall that may lead to serious injury or death. Trying to lift someone by yourself without any equipment can cause more harm than good. Fortunately, there have been lots of developments made over recent years – particularly with falls lifting devices that can be use by a single carer. For instance, the Raizer lifting chair has been adopted by moving and handling teams, independent OTs, and emergency services across the country. It is operated by one single carer, and can lift a fallen person from the floor to standing in just minutes. The Raizer allows the operator to maintain eye contact and conversation with the fallen person, therefore helping to deliver a person-centred approach to care. Are there any results so far? The evidence is always growing when it comes to single-handed care and its benefits, and one company that are dedicated to this have shared some incredible figures. A1 Risk Solutions found that Cambridgeshire County Council had trialled a review system for single-handed care during 2016/2017, and had a 44% reduction in care packages and plans. From this, they worked out that they would be spending around £10,000 a month on equipment, but saving over £800,000 a year. Conclusion The evidence that support single-handed care is growing, and it presents a stronger case for it with each and every study. Even equipment designers and developers have noticed the change in trend, and are now focusing on creating items that can be operated easily by one person. The financial stress and strain on the NHS and our social care services won’t be ending any time soon, so single-handed care may be the solution we were looking for to help bridge the gap and alleviate the pressure.

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…

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

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