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In recent years, it is possible to identify a clear trend in the design and development of rehabilitation technologies. Initially, technologies were based more on a user-centred approach and now we can clearly see a paradigm shift from general user-centred approach to a more specific activity-centred approach. When we talk about rehabilitation using advanced technologies, we see a transformation of flow as real world demands meet the person or the environment. Addition of these technologies can create and cultivate an optimal experience to the person in the environment. It thus improves the quality of life of the individuals, through effective support of his/her activity and environmental interaction. Let’s speak technology and rehab! Below I have listed the top 5 types of technologies that are used in rehabilitation, dividing them according to their functional use and therapeutic benefits. 1) Technologies that aid in functional gains The first thing that comes to mind is the use of Robotics. The development of robotic devices for healthcare has generated a fresh new wind in the field of rehabilitation. Robots can simulate a variety of computerised activities and quietly switch between them. Some robotic devices have the capability to generate arbitrary patterns of assistance and resistance as required, while some can simply assess the performances in an integrated and objective fashion using sensors. Next in the list to aid in functional gain are the exo-skeleton devices. There are a lot of these devices available in the market, some though in the prototype stage. These devices are capable of providing partial to complete automation of functions. 2) Technologies used to achieve recovery of functions We as occupational therapists are the masters of adding 'fun' in 'FUNctional'. As exercises and activities become repetitive and boring, technology comes to the rescue. Rehabilitation gaming systems and virtual reality use an innovative technology consisting of computer-based environments, that represent a 3-D artificial world. Some of these gaming systems even permit human computer interactions in real time. 3) Technologies that use the body’s own signals to achieve therapeutic gain The best example of this is the biofeedback machine, using the brain computer interfaces. It directly uses brain activity signals to allow users to operate the environment with or without partial muscle activation. Another example is wearable technology. This is the most common and easily accessible one. It is available in a wide range and variety, right from smart garments with embedded sensors, to arm bands and watches, using body sensor networks. 4) Technologies that enhances impact of rehabilitation With the ease of availability to use video calling and messages as a mode of communication, tele-rehabilitation is a definite advancement in the field of rehabilitation. Although very little evidence is available for its use in occupational therapy. We can wait for what this newer method is going to serve up for us. However, I feel it is definitely worth keeping an eye on future home programs. These would widen the scope of our services and practice, giving us the ability to reach to people in remote places and environments. It is also important to understand that most of the above technologies work via physical interactions, but what when physical interactions are not ? For such situations we have something called as socially assistive robotics (SAR) for assisting through social interactions without physical interactions. Again, here there is very limited literature on it for its use in rehabilitation. 5) Mobile technologies Last but not least we have mobile technologies. Smart phones, tablets and laptops have revolutionised mobile technologies and the way we communicate today. The introduction of apps (applications) have further changed the way we look at our phones. They have transformed the assistive technology market for people with disabilities. While some apps can assist function, some others can be used as rehabilitation tools for both training and retraining purpose. Not forgetting how these computer technologies have also eased the process of documentation and data storage. Apart from mobile technologies, most of the above are expensive and not easily available to all. This makes them less accessible. To summarise, I would say that this is just the beginning and a long way to go with rehabilitation technologies. A lot of them have their pros and cons and for the successful implementation of such technologies into clinical practice, the therapist must be able to analyse and integrate them into our conceptual frameworks. Share your views below - and if you are using any such technologies in your practice, feel free to share your experiences. References Susan E. Fasoli, Chapter 22 - Rehabilitation Technologies to Promote Upper Limb Recovery after Stroke, Stroke rehabilitation (4th edition)2016, Pages 486-510. https://doi.org/10.1016/B978-0-323-17281-3.00022-8 KREBS, H. I., & VOLPE, B. T. (2013). Rehabilitation robotics. Handbook of Clinical Neurology, 110, 283–294. http://doi.org/10.1016/B978-0-444-52901-5.00023-X Imam, B., Miller, W. C., Finlayson, H. C., Eng, J. J., Payne, M. W., Jarus, T., … Mitchell, I. M. (2014). A Telehealth Intervention Using Nintendo Wii Fit Balance Boards and iPads to Improve Walking in Older Adults With Lower Limb Amputation (Wii.n.Walk): Study Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 3(4), e80. http://doi.org/10.2196/resprot.4031 Wang, M., & Reid, D. (2013). Using the Virtual Reality-Cognitive Rehabilitation Approach to Improve Contextual Processing in Children with Autism. The Scientific World Journal, 2013, 716890. http://doi.org/10.1155/2013/716890 Kroll, R. R., McKenzie, E. D., Boyd, J. G., Sheth, P., Howes, D., Wood, M., … for the Wearable Information Technology for hospital Inpatients (WEARIT-IN) study group. (2017). Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study. Journal of Intensive Care, 5, 64. http://doi.org/10.1186/s40560-017-0261-9 D. Feil-Seifer and M. J. Mataric, "Defining socially assistive robotics," 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005., Chicago, IL, 2005, pp. 465-468. doi:10.1109/ICORR.2005.1501143. Criss, M. J. (2013). School-Based Telerehabilitation in Occupational Therapy: Using Telerehabilitation Technologies to Promote Improvements in Student Performance. International Journal of Telerehabilitation, 5(1), 39–46. http://doi.org/10.5195/ijt.2013.6115 Nix, J. and Comans, T. (2017). Home Quick – Occupational Therapy Home Visits Using mHealth, to Facilitate Discharge from Acute Admission Back to the Community. International Journal of Telerehabilitation, 9(1), 47–54. http://doi.org/10.5195/ijt.2017.6218

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

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

When you think of 'sensory integration' or even 'sensory circuits' you may think about young children playing on big pieces of equipment, such as a swing. The types of diagnoses that may come to mind are autistic spectrum disorder (ASD), learning disability and maybe even attention deficit hyperactivity disorder (ADHD). But if I said that a 90-year-old woman could benefit from sensory circuits I am sure, like me, you would be pretty sceptical. Following my sensory training earlier this year, I felt inspired to introduce this into my interventions. I have seen sensory circuits done before, primarily with diagnoses such as Emotionally Unstable Personality Disorder and Autism. As I started researching sensory and the elderly, unsurprisingly there is limited evidence. Despite this, I thought it was worth a try, because of the denoted needs of this population. So we began - and below is roughly what the session entails and my personal experience and somewhat reflection of this intervention. Session outline The session is set up in a large gym area with 4 main ‘stations’ prepared. These stations encompass an organising activity, 2 alerting activities and one calming activity. So far this is feeling very similar to all of the other sensory circuits you may have seen. The difference is the grading and adaptation of the activities. For example - when using the trampet for vestibular input, patients will sit down on a comfortable chair, bounce their legs and be encouraged to rock back and forward. This may be done by using a tool to make them rock back and forth, or getting them to move in a way which encourages head movement. This still provides that vestibular input and can be calming for patients. Another example is that when we play hoopla (organising activity), patients are encouraged to utilise a step to go up and down, so they still get the vestibular input. In terms of an alerting activity, it is good to use something familiar, so we use proprioception in the form of sweeping. A good example is to bounce and catch big gym balls to encourage that proprioception and we often encourage a simple word recall activity to go alongside this. This activity is another familiar one that elderly clients appear to understand and connect with. In some activities we will also use the mirror, to encourage development of self-concept. Calming activities can be anything from giving the patient a gentle hand massage to listening to slow music and encouraging them to focus on the different instruments. In my experience, I find that having this structured sensory input has improved my patients' well-being and arousal levels. In particular, I am finding a lot of patients who suffer from dementia and appear under-alert for the majority of the day benefit from this type of activation, which makes them more alert and able to communicate which impacts on their occupational performance. Another great benefit of activation is that patients may be more able to feed themselves and adjust their posture, to be open and ready for the eating process. Conclusion This learning has enabled me to experiment with the use of sensory approaches within the client group you work. Providing interventions that attempt to integrate the sensory systems will influence their functional ability. It is an important aspect that we do not overlook, due to age or perceptions of mobility. Hopefully this may inspire you, if you are dabbling with sensory approaches and not sure how to start!

A retrospective piece, sharing an intervention idea from an occupational therapy placement I was given the chance to work with a UK mental health charity, supporting young people in a variety of role-emerging OT settings. Experiences included designing and facilitating group sessions on resilience, to a secondary school for deaf and hard-of-hearing children. I know from experience how stressful teenage life can be, but communication and engagement with the wider social environment is clearly an additional barrier for this community. Although a sign-language facilitator was present, this provided an extra layer of challenge, as I'm sure you can imagine. Frankie and I were keen to rise to this and we loved our time at the school. We brought the Five Ways to Wellbeing to pupils, via a variety of weekly classes. These were designed to be fun, engaging and mindful of the stressors faced - both by those with hearing impairments and by teenagers in general. The Kawa Model The Kawa Model of occupational therapy practice was used, to engage students in a creative activity. This model was developed in Japan by Dr. Michael Iwama. For information and the theory behind Kawa, visit the Kawa Model website. We wanted each person to consider the personal challenges they currently face and the skills and supportive structures to help overcome them. "Designed to be fun, engaging and mindful of the stressors faced - both by those with hearing impairments and by teenagers in general" We designed a basic river template and then laminated a copy for each child. This could then be written on with wipeable pen ink. We felt that the visual element could be supportive to learning! You can download a copy of the river template here: Objects to place in the river were then cut out and laminated. This formed a blank canvas for each pupil to map out their life flow. This would be a changing picture... KEY Rocks = circumstances that block life flow and cause dysfunction or disability Driftwood = skills and resources that support and enhance daily living Fish = personal qualities that help to overcome challenges faced River bed = social, physical, cultural and institutional environment (a hinderance or help) Each student could experiment by placing objects in different places within their river, to assess how one could support or hinder another aspect of their life. Check out my example river at the top of this post. Whilst the concepts could be considered abstract, most pupils engaged well with this interactive and visual learning tool! Why not utilise the Kawa Model in your work with those you support? It's a tool that works across ages and cultures. Jamie Grant Occupational Therapist, UK Director, The Occupational Therapy Hub

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

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

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

Autistic, Lesbian, Gay, Dyslexic, Transgender, Bisexual, Schizophrenic... These are a few of the many common words we may use in clinical settings (and now also social media) when we address people we work with in the field and communities. For decades now, there have been vicious arguments about person first vs. identity-first language across different types of communities across the globe. In occupational therapy education and academic publications, person first language is the preferred choice. However, when out in the field, this really boils down to what each individual or family would prefer. And as a profession that is known for its client-centred and family-centred practices, this is a question we need to ask as soon as possible so that we can get this right from the start... not after treatment #5, #10, or when the series of treatments are all finished. Yes, I am a person who is really caught in the middle of it all. On one hand, occupational therapy school has taught me about the importance of person first language. On the other hand, when I was diagnosed with autism in 2010, I began to be more aware about why many in the autism community prefers identity first language. Until I got my OTD, I truly had NO idea on what is "right". After I got my OTD, I know I have to make a stand. So, I chose the easy going neutral stance in regards to autism. On one hand, I am using identity first language to identify myself on social media. I use the word "aspie" or "autistic" to describe myself. On the other hand, I have been advocating for us to ask what the families or clients prefer first before we do our initial evaluation or treatment, with the reason being that if we are claiming to be client and family centered, then the occupational therapy profession has to start from how we address our clients and their families. After all, both sides have their arguments, but the tiebreaker on what is right should be going to who we work with, which is our patients and clients. Unfortunately, there are some occupational therapy students and practitioners who are sticklers of person-first language. When they see people use identity first language, they will often bash these people. (I was a victim of such from an occupational therapy student and she quickly blocked me on Twitter.) Usually I let stuff like this go, but since this is a near and dear subject to my heart, I decided send in a surprise LinkedIn message to one of her instructors so that the instructor could make an example of her on what NOT to do to not only disagree with an elder in the profession, but also somebody amongst the communities we serve. But back to the subject... Remember, our clients and families are the experts of what they are dealing with on a daily basis. Also, if we have peers who belong in any disability and/or LGBTQ+ communities, we should consider ourselves lucky because we don't have to go far and wide to potential experts. Moreover, if we happened to inadvertently offend our peers, usually they are more forgiving (I know I had my fair share of such blunders over the years.) than other service users online and they can teach you what might be better ways moving forward both online and clinically. Also, the consequences are not as harsh when you accidentally offend a peer vs. a complete stranger or unknown family out in the field. Next time you have a disagreement with a peer on identity first vs. person first language, please don't push the block button quickly on social media or other actions that you are trying to imply to the other person that he/she is flat out wrong. Talk it out and accept each other's differences. There is no right or wrong answer in this debate. However, a wrong response in this context will be acting rashly and believe the other person is 100% wrong. Speaking of which... I also found an oldie, but goodie YouTube video where the late Ann Neville-Jan was in the panel:

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

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

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

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

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

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

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

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

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

By Alice McGarvie - Occupational Therapist, From the Harp Occupational therapy celebrated 100 years in the USA in 2017 and 100 years in the UK in 2019. I’m from the UK and look forward to learning more about the history of occupational therapy in my country and celebrating all we’ve achieved and our vision for the future. I urge you to find out your country’s occupational therapy history and vision for the future, promote this and celebrate! Even if occupational therapy is fairly new in your country, your country will have an interesting occupational therapy history. In 2017, my blog What is occupational therapy? went viral, with nearly 40,000 views and over 20,000 Facebook shares. I found myself at the forefront of promoting occupational therapy. This is not something I had set out to do, but having been catapulted into that position I tried to circulate the post more, because occupational therapists and others around the world seemed to relate to my explanations of occupational therapy. Ours is the only profession that promotes meaningful engagement in every day activities and I believe it is vital that we retain that identity and can articulate why we are the best profession to do that. In the UK, promotion of occupational therapy largely focuses on our role within the National Health Service (NHS). Essentially, this amounts to attempting to reduce NHS costs by either keeping people out of hospital, or facilitating speedier discharges from hospital. In any case the promotion of our role appears to be mainly concerned with saving the NHS money and keeping people out of hospital. But, I believe, we have a far more profound role in preventative health and supporting people to live well. As Occupational Therapists, we know that our occupations keep us well, give us meaning in life, and motivate us to get up in the morning. Science backs this up. Further, neuroscience research now suggests that occupation has the power to distract us from pain and anxiety. But other professionals seem to be making claims about the positive effect of occupations like gardening, singing, art and crafts, etc. When these things are shared on social media there is often a comment added along the lines of ‘great, but I wish it had been an Occupational Therapist that did it’. In the media others appear to be writing and taking credit for the work that Occupational Therapists practice day-to-day. For example, Dr Tamlin Connor - a psychologist and lead study author for research, printed in the Journal of Positive Psychology, into the effect on well being after participating in arts and crafts - states: “Engaging in creative behaviour leads to increases in well-being the next day and this increased well-being is likely to facilitate creative activity on the same day. Overall, these findings support the emerging emphasis on everyday creativity as a means of cultivating positive psychological functioning.” We know this: it is our bread and butter. But we need to make sure other people know. We all know occupational therapy is hard to explain, as it is so broad and varied, but we owe our colleagues around the world - and the colleagues coming after us - to do this. Let's make it easy for ourselves - we just have to explain our role, not all the possibilities of positions and work places for occupational therapy. Let's keep it simple for us and our audience. As an occupational therapist I question: What’s the difficulty? Why is it a difficulty? How can life be made better? What can we do about it? Can you base your explanation around this? We need to start being confident explaining occupational science too. I feel it’s an historical problem for us that occupational therapy came first and then the science: occupational science came much later. We’re playing catch up. We’re only 100 years old (in the US) and we knew we were on to something before we had the science and the evidence base. Medics took over 2500 years to get their evidence base together. Occupational science was named in 1989. As an analogy, if evidence for medicine has been around for one hour, occupational science has been here for 30 seconds. For every person that doesn’t know what occupational therapy is, there are probably many more who have never heard of occupational science. It’s new and it’s exciting, so let's be loud and proud about explaining the value of occupational therapy and it’s underpinning in occupational science. We have the evidence, there is much more to us and our profession than ‘feeling good when we do a hobby'. If other professionals don’t know what we do, then our holistic and creative practice and professional integrity is at stake. The more other professionals understand what we do, the more likely we are to get more referrals, get more funding and prevent other professionals encroaching on our work. So I urge you to get confident explaining your understanding of occupational science and your role as an Occupational Therapist, so we can promote the profession and protect our uniqueness. Go and add to our history: tell somebody today what you do - and the science behind it.

By Jamie Grant - Director, The Occupational Therapy Hub. Originally written in 2016. UK stroke discharge service. I first met 'Mr. M' on a stroke ward, when I assisted another occupational therapist with the patient’s self care (wet shaving). On discharge to the stroke discharge team, I led and co-facilitated Mr. M’s upper limb assessments, with regular visits to his home. I was then able to lead a home exercise programme (HEP) and shaving intervention, both of which were meaningful to him and focused on key skill deficits following his stroke. His rehabilitation was also supported by a nurse and support workers. Background DIAGNOSIS: Ischaemic stroke in left cerebral hemisphere; right side affected DOMINANT HAND: Left hand PAST MEDICAL HISTORY: Ex smoker HOME ENVIRONMENT: 2-storey house; 1 flight of stairs; upstairs bathroom. SOCIAL ENVIRONMENT: Lives with his mother, whom he cares for. She is a heavy smoker and had a past stroke herself. He does most of the housework and cooking for them both. Upper limb assessments The following assessments were carried out with Mr. M: Neurological assessment Upper limb assessment 9-hole peg test Through this broad approach, therapists were able to establish the patient’s ability in the following domains: Range of movement (ROM) Muscle strength and tone Dexterity Proprioception Coordination Sensory awareness Initial presenting symptoms and ability level Right-sided muscle weakness; main deficit in U/L fine motor strength, dexterity and range of movement (ROM); good gross ROM; L/L largely unaffected, with minor foot drag. Mobilising independently around the flat, no balance issues Moderate sensory deficit in right U/L Proprioception and coordination impairment - reduced ability to mirror affected U/L position with eyes shut Mild receptive and expressive dysphasia Mild dysarthria Home adaptations None made, due to Mr. M’s sufficient mobility and strength. Client-centred goals Following the outlined assessments, key motor and sensory-related goals were set, through discussion, input and mutual agreement with the service user: To regain sensation in right U/L To improve right hand dexterity, coordination and proprioception To improve right shoulder flexion, increasing active ROM To improve right wrist extension, increasing active ROM Mr. M wanted to get back to meaningful occupations he participated in before his stroke. Those most important to him were: ADLs: Wet shaving; using cutlery for meals Leisure: bowling/skittles at his local club Productivity: Supportive tasks as a carer to his mother Interventions – encompassing clinical reasoning and problem solving Interventions were established with Mr. M that would improve his motor and sensory ability and enable him to continue with the meaningful occupations listed above. Highlighted below are some of these interventions: Wet shaving Mr. M stated that shaving was a key priority for him, given that he would be going out in the community again this week. He needed guidance to build up confidence with everyday tasks such as this. Initially, I planned to get him to practise brushing his Bic razors against his stubble, but with the blade guards on. This would allow him to work on the upper limb movements and pressure level required with the razor, without cutting his skin. However, given that he had right-sided weakness but his left hand is dominant, I reasoned that, with caution, he could start shaving straightaway without the blade guards. Mr. M was able to shave to a level he was satisfied with. He applied shaving foam and used the razor correctly. He was supported by sufficient strength and dexterity of his unaffected left hand, alongside improved sensation on the right side of his face. Barriers included navigating around a post-surgery scar on his neck and wearing the wrong glasses at one point. I perceived that he could have cut hairs a little shorter. However, Mr. M stated that this was the first time shaving since his return from hospital and he would try again in the coming days. Home Exercise Programme [HEP] Exercises were compiled into a HEP. The programme focused on dexterity and balance, for his ADLs and leisure interest of bowling, respectively. Impact of patient’s role: carer for mother During Mr. M’s session with myself and his occupational therapist, it became clear that the combination of his stroke recovery and the caring responsibilities for his mother were impacting on his mood. Mr. M was observed losing his temper with his mother. He later mentioned to me how she was recently impatient with him when he was making her a hot drink. He stated that she has been used to his support until now and that this currently puts a strain on him, given his own need for rehabilitation. In terms of finding a solution, I asked Mr. M if he had any friends or other family locally, who could occasionally support his mother instead. This would provide some respite for him. Additionally, I suggested that he take more time out of the house, to participate in bowling, go shopping or take a walk, given his good lower limb mobility. He was not overly forthcoming in his response to these ideas, but acknowledged they might help. Mr. M is still continuing occupational therapy rehabilitation and I will be visiting him in the coming weeks. Respite, such as that discussed above, should be reviewed before he is discharged from the stroke discharge service. Personal practice reflection I have enjoyed being part of Mr. M's rehabilitation, given his occupation-centred interventions of shaving and upcoming return to bowling. Professionally, I believe my confidence has developed when physically assessing motor function of the upper limb and during the rest of his neurological assessment. This has included examining the extent of his field of vision. I have needed to carefully problem solve, when putting together a relevant exercise programme to match his deficits. It is clear that he has been engaging with his HEP. I look to continue working on his proprioception and developing his U/L sensory ability in the coming week.

By Jamie Grant, Occupational Therapist; Director, The Occupational Therapy Hub [Setting: Stroke early supportive discharge (ESD) community team, based in the UK] Occupational therapy assessment and intervention I visited 'Pete' (name changed for confidentiality) regularly for 5 weeks, following and shaping his rehabilitative journey after a stroke. He engaged with an evidence-based constraint-induced movement therapy programme (CIMT). Multidisciplinary input included occupational therapy, physiotherapy, speech and language therapy and nursing. Background Diagnosis: Right Temporal ICH (Intra-cerebral Haemorrhage); left side affected Dominant hand: Right hand Relevant past medical history: Right ICH 3 years ago Physical environment: 2-storey house; 1 flight of stairs, 2 rails; upstairs toilet/mowbray; upstairs bathroom (shower over bath) Social environment: Lives with wife, children and grandchildren live elsewhere Meaningful occupations: Reading; shared cooking, gardening and walking with his wife Ward outcome measures: Montreal Cognitive Assessment (MoCA) = 23/30 Motor Assessment Scale (MAS) = 6/18 9-hole peg test = 29 secs (right hand); left hand unable to complete Initial visit: presenting symptoms and ability level Left-sided weakness in upper limb (U/L) and lower limb (L/L), needing assistance of 1 Significantly reduced dexterity Reduced balance Proprioception impairment Dysarthria Cognitive deficits – slowness of thought, impulsivity, poor attention (including L hand) Pete was reliant on a stick to mobilise around the house. He required supervision to scale his flight of stairs, with his left foot often dragging. Transfer into and out of the bath was a challenge and, on observation during an initial visit, the occupational therapist deemed this a health and safety risk. It was recommended he refrain from washing in the usual way until adaptations were made. He was unable to execute or complete some tasks requiring fine and gross motor skills of the hand and was not engaging with activities in his garden or out of the house. The service user’s communication with relatives and therapists was largely unaffected. However, he was conscious of some slurred speech and occasional dribbling, as a result of dysarthria. Home adaptations Bath rails (x2) were fitted around the bath, in consultation with Pete and his wife. A bath board was also provided. An additional rail had been fitted to his flight of stairs, prior to the stroke discharge team's involvement. Goal Attainment Scale (GAS) goals The following were established in collaboration with Pete and his wife, all deemed of equal importance: To be independent with personal care To be independent bathing To walk inside without a stick To walk outside To be independent making breakfast CIMT Programme Clinical reasoning Intensive practice using the affected hand for daily activities discourages reliance on the unaffected hand and aids to regain fine and gross motor strength and dexterity. To reduce functional deficits, a mitt is used as a restraint for up to 6 hours a day, for 2 weeks (Curtin et al, 2010). The biological mechanisms responsible for the benefits are unknown. However, according to Spence and Barnett (2012, p.276), CIMT treatment ‘shows promise, especially for survivors with moderate disability following stroke.’ CIMT and Pete The service user agreed to engage with a 2 week CIMT programme. This was altered to a modified programme, as 4 hours was deemed more manageable and would complement his unstructured, ad hoc approach to daily activity. The following tasks were selected to focus on, after initial brainstorming by the physiotherapy team... Lifting weighted bag, from extended arm to chair and from chair to table: Developing strength of bicep, deltoid, pectoralis major and rotator cuff muscle; encouraging movement in a straight, sagittal plane Transfer of cans from one kitchen surface to another: Developing flexion and extension of muscles that mobilise digits of the affected hand; improving balance and proprioception Tipping water from cup to cup, through supination of the hand: Rebalancing the tendency to over-pronate during reaching tasks Buttoning up shirt Tying shoe laces Turning book pages; reading is a meaningful occupation to Pete Evaluation of engagement and progress in rehabilitation Pete’s balance has improved to the point that he neither requires a stick to mobilise, nor supervision to complete the flight of stairs. He has developed increased strength in the muscles supporting and moving his upper and lower limbs. Range of movement and dexterity have improved to some degree. However, on discharge, he still had some deficit, struggling to smoothly supinate whilst picking up, turning and placing down coasters on a table. Complete control of his 4th/5th digits is yet to be recovered. Cognitively, Pete feels his previous slowness of thought has reduced and the stroke therapy team have observed improved attention during conversation and task execution. Symptoms of dysarthria have also improved; he no longer complains of being self-conscious from slurred speech. Focus on occupation… In terms of occupational performance and engagement with ADLs, Pete now bathes independently, with assistance of the fitted hand rails. This was the main self care activity he struggled with post stroke. He now also able to tie his laces and button his shirt, although this still takes longer than pre-stroke. He shares some kitchen tasks with his wife, including breakfast and clear up. In terms of productivity and leisure, he reported to be back outside mowing the lawn and has recently been on walks everyday with his wife. He enjoys reading, often referencing the dictionary. Pete has not been disciplined with the CIMT programme, admitting not to completing a full 4 hours of the modified programme or keeping to routine. This could be explained by his ad hoc and spontaneous daily routine, coupled with the fact that the affected left hand is not his dominant hand, leading to reduced motivation to improve its function. However, with the stroke discharge team's intervention, personal determination and the continued encouragement and guidance by his wife, this service user acknowledges significant improvements in motor function. In terms of ongoing support post-discharge, Pete is to be referred to a neurology outpatients ward by the physiotherapist. He will continue to practise the exercises taught to him by our multidisciplinary team. Personal practice reflection I have enjoyed being part of Pete’s rehabilitation, working closely with both service user and family to maximise his recovery potential. My confidence working with him developed on each visit, in terms of explaining clinical reasoning, suggesting variations around intervention and physically assessing motor function of the upper limb and back muscles. Pete was my first occupational therapy service user; I am pleased with how quickly I felt comfortable with assessing tone and range of movement. I was able to creatively problem solve, when guiding the service user to move in a straight sagittal plane, during functional strength training. I suggested he imagined an egg was resting on his upturned clenched hand during shoulder flexion exercises, so as to discourage pronation of the hand and abduction of the elbow. This distraction and visual imagery was well received by Pete, with performance observed to improve as a result. Pete chose his own GAS goals and any intervention introduced was always with these in mind. Although functional strength training exercises were not always meaningful in themselves, they were chosen to focus on regaining skills Pete required for his daily occupations. For example, he shares shopping tasks with his wife, so repetitions lifting a weighted bag were useful for developing strength in the muscles required for this task. I believe this is reflective of the client-centred approach I adopted whenever possible during the rehabilitative programme. References Curtin, M., Molineux, M. and Supyk-Mellson, J. (2010) Occupational Therapy and Physical Dysfunction: Enabling Occupation. 6th ed. Edinburgh: Churchill Livingstone Elsevier. Spence, D. and Barnett, H.J.M. (2012) Stroke Prevention, Treatment and Rehabilitation. New York: McGraw Hill.

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

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