Case Study

Case A-10 Mr. McMasters

Since the removal of his tumor, Mr. McMasters has been going through quite a few developmental changes. He has experienced a loss of short term memory and attention span, as well as difficulty with multi-step commands and sequencing. He has also been having trouble telling his left from his right, and is also seeing a significant decrease in strength, sensation, and range of motion of his right upper extremity.

Mr. McMasters is a retired social-studies teacher, who enjoys several activities including hunting, fishing, gardening, playing cards, and more. These few tasks in particular, will require the use of his right arm, and it will be essential to restore as much function as possible to this extremity. At the age of 58, it will be very unlikely that Mr. McMasters will be able to restore much function because of the lack of plasticity in his brain. Where function can not be regained, it will be important for Mr. McMasters to be able to adapt to using his right arm within limitations, or in some cases using his left arm more predominately. For his occupation of hunting, Mr. McMasters will be required to load a gun, hold it steady, and pull the trigger. He will most likely need to be able to field dress his kill as well, which involves the use of a knife to skin and eviscerate the animal.

Because Mr. McMasters has full passive range of motion and good finger flexion, I would suggest that he remain shooting right-handed. He should practice target shooting using a table or bench to assist him in holding his arm up and stabilizing the gun. We would be able to use a toy gun in the clinic to practice adaptive positioning, gradually adding weight to the gun and eventually simulating a “kick” by jolting the gun while he was holding it.

I would also have him working on strengthening and steadying his grip and pulling a “trigger” using a “Digi-flex” isolated finger exerciser, gradually increasing the difficulty as Mr. McMaste

rs strength improves. We would work on stimulating his trigger finger in attempt to improve the sensation necessary for pulling the trigger on time and steadily.

If possible, and after improvements have been made in the clinic, I would take Mr. McMasters to a shooting range to practice the necessary adaptations that shooting would require with a working gun. This is where we would be able to work with professionals on the dynamics of loading a gun, and extra safety precautions we may need to take into account.

I would be sure to suggest to Mr. McMasters that he bring along a friend or relative when he goes hunting, someone who would be able to keep his attention focused on the task at hand and help him safely dress his kills. Another option would be to take the animals to a meat processor or a taxidermist to perform the task for him. Although Mr. McMasters has seen a significant loss in the function of his dominant hand and arm, I believe that with some assistance and adaptive equipment, he will be able to continue his occupation of hunting.

More School Work

***It has been a busy couple of weeks, so I have been forced to use my writing assignments as updates. Hopefully I will be able to present some more interesting material soon.***

The Question: What can history teach us in dealing with the challenging, changing, and competitive healthcare market place of today?

My Answer: The healthcare system is an ever-changing entity. Costs are always rising; services are always changing, and so is the availability of those services to the public. Especially with the recent election of a new democratic president, we are sure to see some major changes in the near future of healthcare. From an economic standpoint, the healthcare field is in need of professionals that will be able to create and maintain useful members of society. Those individuals who cannot make their own living have contributed in part to the escalating cost of healthcare. They can’t get insurance because they are not employed, they can’t buy their own insurance because they don’t have an income; we can’t refuse to give them care and have to make up for costs they incurred when paying customers come in for services. While we cannot promise to restore all individuals to economic productivity, as a profession, we need to focus on proving that occupational therapy can provide services with this potential.

In the past, occupational therapy has been a part of this restorative process (Ambrozi & Schwartz 1995). In fact, the profession practically rooted itself in this concept. Injured veterans in particular were originally discarded and thought to never be able to become productive members of society again (Ambrozi & Schwartz 1995). The media pressed the issue of restoring these people to functional economic status, and recognized occupational therapy as being vital to this process. However, at the time, occupational therapy was focused on “internal concerns [and] may have missed an opportunity to promote occupational therapy to the general public by aligning itself with a theme that the media valued” (Ambrozi & Schwartz 1995).

In the future, the profession of occupational therapy needs to be aware of the public’s focus. We need to advocate for ourselves and advertise our services based on what the public is interested in, while maintaining integrity in our profession. We need to keep up with changes in politics and continue to prove to the general public, politicians, and other healthcare professionals that our services are a vital part of rehabilitation and could be a large contributor to our country's economy.

References:

Ambrosi, E., & Schwartz, K. (1995). The Profession's Image, 1917-1925, Part II:

Occupational Therapy as Represented by the Profession. American Journal of

Occupational Therapy, 49: 8, 828-831.

Another OT Assignment

The Question:

How can we present OT to the public so that we can gain greater public recognition of our services?

My Response:

In order for OT to accurately represent itself to the public as a profession we first need to be able to define who we are and what we do within our profession. We provide a very diverse group of services, and the public can not translate that back to our professional roots, which are based on holism and occupation. The problem here does not lie in the hands of the public understanding, it lies internally – within our own understanding.

One of the major problems leading to a lack of public recognition is that there is a huge disparity between the definitions taught to occupational therapy students and what is seen in clinics across the country. As students, we are being taught that occupational therapy is a unique and creative profession; it is client centered and based on those occupations that are most meaningful to the client. However, in clinics, we see something totally different. We see almost no difference between occupational and physical therapy. We see the same, monotonous techniques used day in and day out, and very little patient interaction in goal setting and therapy choices. Most importantly, we rarely see meaningful occupations being used as therapy. This is supposedly the whole backbone of occupational therapy, yet most of our currently practicing therapists do not reflect it. A change needs to be made in therapy so that, during practice, we actually show people what it is that makes us unique and the creativity we are really capable of. Once we can get on the same page as therapists, once we can truly define ourselves as one profession, public recognition will come naturally. People will finally be able to understand what we can do for them, and why it is different from and more meaningful than the services available from physical therapists.

Another major factor preventing us from gaining deserved public recognition is that we are unable to back up many of our treatments with research. We have this attitude that our treatments work, but we do have no idea why, and we lack proof. It is important that we, as a profession, really begin to criticize and revise our own theories and studies. We need to make sure that our treatments are effective before we actually put them to use clinically. Especially with the current availability of information (true or false) on the internet, not many people just believe what they are told. If we are not careful, if we do not prove our services, we could fall right out of the circle of western medicine and become an alternative treatment, such as aroma therapy or acupuncture, which most people only use if they believe it works, or as a last result. When we can back up our profession with scientific research and evidence, the general public, as well as other medical professions will be more likely to recognize our services.

The future of occupational therapy depends completely on what other people – the general public, other health care professionals, politicians – perceive it to be. If they begin to doubt us and continue to misunderstand our profession, occupational therapy is in trouble. I am a firm believer that if we fix these two major internal problems, recognition will come naturally. It is then that we will be able to truly advocate for ourselves and advertise our services.

The Final Product

Class of 2011 T-Shirts

As a part of our study of the "design process," one of our professors, Dr. Chris Raber had us create a class t-shirt. We got the assignment on the first week of class and we are to wear the shirts to class on Tuesday, September 15th. The design process consists of eight steps: motivation, investigation, definition, ideation, idea selection, implementation, and evaluation. After we go through all the steps, we will "evaluate" the final product, which will be a screen printed tye-dye t-shirt. The shirt will say SSU Occupational Therapy on the front, and the saying "OT makes every day independence day!" on the back.

The posted pictures are from class today, when we dyed the shirts. Tomorrow they will be printed, and we will wear them to class on Tuesday.

OT Quote of the Day

"Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health."

Biomechanical Theory Journal

The Assignment: Use this area to Journal your thoughts concerning your life stages through discovery and understanding of the OT theories.

Background: The Biomedical frame of reference, as it relates to occupational therapy, is focused mainly on the physical deficits of the injured or disabled client. It is based on muscle, bone, and joint integrity, range of motion, strength, and endurance.

My Entry: Since I have never been injured any more seriously than a scrape on the knee, I initially had a hard time relating my life to the biomedical model. I wanted to think about it in terms of therapy. People go to get therapy when a bone, muscle, joint, or any combination therein is limited in motion in one way or another. Then I came across a statement made in Aaron and Tiffany’s power point presentation which noted that prevention is done by making the client aware of motions that could jeopardize the structure, strength, and/or endurance of the body segment in question. This is when it clicked: maybe I’ve never really been injured because I have avoided those types of motions that could cause damage to my joints all along.

In my life, I can see the prevention aspect of the biomedical model. I have been a swimmer since 5th grade. The low impact nature of the sport did not cause any wear and tear on my hips, knees, shins, and ankles that a sport like running would. It is also an individual sport where, as opposed to football, there is little to no physical contact that could cause breaks, tears, strains, cracks, and who knows what else? Swimmers, however, typically develop shoulder problems very quickly in their careers. Our coaches provided us with stretching and strengthening exercises, specifically for the shoulder, that would help to prevent injury and pain in the future. I also remember very vividly them telling us that we needed to take our breaths from both sides, as to prevent one shoulder from providing all of the extra strength needed to pull our bodies out of the water. I took this very seriously, and immediately formed the habit of breathing on both sides, something I still do today when I swim.

Another aspect of the biomechanical model that I can relate to is that working on endurance, strength, and range of motion can not only maintain a person’s performance in those areas, but continuous working of them can actually increase performance. When I started swimming in 5th grade I was TERRIBLE! I had no natural ability whatsoever. I couldn’t even finish my first 50 yard race; I got out half way through red-faced and sobbing. My parents have even told me before that it was “tough to watch” me swim. Over the years, I slowly gained coordination, endurance, and strength, from practicing hard and learning the technique. By the end of my high school career, I qualified for districts in the 500 and 200 yard races. On the other hand, “if you don’t use it, you lose it.” I found that out really quickly when college came along and I was no longer swimming. Today I swam for the first time in months, and I got out of the pool after an easy 30 minute work out. Needless to say, that is quite a short time compared to when I peaked in high school.

As much as I would love to get back into swimming, it is really difficult for me to get in the water and find out how out of shape I am. I want to be swimming 500’s in 5 minutes and 45 seconds like I used to. I can see how someone who has been injured would struggle with a loss and the therapy following. Even though the medical model takes the reductionistic standpoint that fixing the musculoskeletal issue will fix the functional deficit, complete restoration is not always possible. At least I know that I did this to myself, and that the structure and capabilities are still there. I just need to work for them!

Self-Discovery Tapestry

In our "occupations across the lifespan" course, we had to evaluate our lives based on a self discovery tapestry. On the grid, you plot major events in your life across different situations in your life, such as who you live with, what your hobbies are, and whether or not you were happy at the time. Every time something in your life changes, you are supposed to use a new color, signifying how "colorful" your life was. After we finished the tapestry, we were asked to reflect on what we learned.


The Assignment: Discuss what you learned about yourself, your own occupational profile, and the process of creating an occupational profile, by completing the personal shield, Life Tapestry, and other self-assessment activities. Compared to this action and reflection approach, what differences do you anticipate in using interview and observation skills to complete your other occupational profile?

My Response: Upon completing all of the self-assessments, including the life tapestry, I have discovered how much an individual’s life situation (such as location and finances) can have an impact on his or her occupations. The interest checklists made me realize how many of the activities that I am interested in I am actually not currently participating in. Then my life tapestry showed me exactly why this is the case. I can best explain this with an example:

I love doing outdoor activities such as hiking, camping, fishing, boating, skiing, horseback riding etc. When I used to participate in these things the most was when I lived with my parents in Mansfield, Ohio. At the time, my parents paid for many of my needs, such as food, clothing, and shelter, leaving my own money for leisure activities and hobbies. We were also in a prime location for outdoor activities. There are two ski resorts within a fifteen minute drive of their home, as well as Mohican State Park, which is within a half hour. My grandpa, who lives about twenty minutes away from my parents, has a pond on his property where I was able to fish and canoe whenever I wanted to.

When I graduated from high school, I moved to Columbus, Ohio to attend college at The Ohio State University (a major event on my life tapestry). This took away my accessibility to these hobbies, as well as all the money needed to participate in them, as I was on my own financially for the first time. Now, at Shawnee State, my busy schedule and the expenses associated with graduate school, will most likely keep me from enjoying the outdoors for the next two years as well. While my interest in these activities still remains quite strong, I am unable to participate because I can not afford to travel, purchase equipment, or give up my time to continue my hobbies on a regular basis.

In Meltzer’s (2001) article on the self-discovery tapestry, she notes that people are always adapting their occupations, especially when their current occupation is interrupted by a major life event. This is definitely true in my case. When I started out on my own in Columbus, my occupational role as a fun-loving daughter adapted obligingly to my new situation, and I became a college student living “paycheck to paycheck.” Since I was unable to spend my free time outdoors, I found other hobbies that were less expensive and easier to access in the big city.

When I was doing these assessments on myself, it was easy for me to notice major changes in my own life and the way they affected me because I know everything there is to know about my own life. When I do the occupational profile assignment on another individual through observation and interviews, it is very likely that I could miss something. Embarrassment, denial, or forgetfulness could also keep that individual from giving me information that would be necessary to do a complete occupational profile. Hopefully, by being prepared with specific questions and examples from my own experience, I will be able to extract the appropriate information.

Meltzer, P. J. (2001). Using the self-discovery tapestry to explore occupational careers. Journal of Occupational Science, 8(2), 16-24.

First Day of School

Today was our first day of class! It was a pretty simple day, we really just did introductions, and went over our syllabus for each class.

Our first class, Theories in Occupation, taught by the program director, Debora Scurlock, will discuss all of the theory behind what we do as occupational therapists. We learned that an "occupation" is defined as anything that a person incorporates into their every day living, and that occupations differ from person to person. Occupation is also different from "activity," which is something that anyone can do, but may choose not to. As our professor described it: "My daughter wakes up every morning at 4:30AM to run. To her that is an occupation. That is an activity, I will stay far away from."

Our second class is our clinical practicum. We are volunteering at Hempstead Manor, which is a nursing home located in Portsmouth. Pictured below are several of the girls in the program, including myself, dressed in uniform before we left for clinicals. Once we got to Hempstead, We were each assigned a different resident to work one-on-one with. For confidentiality reasons, I will refer to my resident as "E." Today we just spent some time getting to know each other over some chips and dip, but I'm sure I will have much more to talk about as I get to know her more. The main part of the class is focused on planning activities for large groups. We were split into teams and we will have to plan 3 different events for the residents at Hempstead. I'm really excited that we are already working in the field!

After seeing all of our assignments written out on paper, I have come to realize that it may be difficult for me to keep up with this blog. I am going to try my best, but I will definitely post some of my assignments up for everyone to read as well!

Emily Carson

Yesterday I spent 10 hours shadowing Emily Carson, OTR at two Southern Ohio Medical Center locations in Lucasville and Wheelersburg. Emily received her bachelor's degree from The Ohio State University and began practicing as an occupational therapist in 1997. This was waaaaaay back when you only needed a bachelor's to practice as an OT. I don't mean to degrade her in anyway, Emily was very intelligent and talented, I just may be slightly bitter that I have to get my masters.

I got to experience a wide variety of patients in the outpatient rehab setting. The only place I have ever shaddowed before was in a pediatric develpment facility. There, the OTs worked with children with developmental disabilities, helping them to gain functional abilities that they may gain naturally as typically developing children do. Emily's patients were adults who have been injured or had surgery or both, and need to regain strength and/or range of motion, mostly of the joints. Some of the cases I saw yesterday include: tennis elbow (tendonitis), carpel tunnel, torn biceps, shoulder and knee replacements, and back injuries.

One of the treatments that I was able to watch Emily give to several of her patients is called ASTYM. Pronounced "a-stim," the treatment is designed to break up fibrotic tissue the body forms after injury. Normal muscle fibers run parallel, along the length of the muscle. After an injury, the new fibers and scar tissue regrow "every-which-way" and can cause stiffness and immobility. During treatment, the provider runs the edges of different acrylic tools (pictured left) along the injured muscle. Where normal muscle tissue is, the instruments run smoothly, and where fibrotic tissue is, both the patient and provider can feel what Emily described as a "washboard effect." The edges of each instrument are designed to break up that "washboard" as they are run over of the damaged tissue. Emily, as well as some of the patients, told me that the treatment can be quite painful, and can cause bruising. However, many patients have seen results including decreased pain and increased range of motion.

The most pressing issue I discovered yesterday is that I really need to brush up on my Anatomy. Emily used the specific terminology when talking with patients about their injuries. It all sounds familiar, but I wouldn't have remembered all that on my own. Looks like I'm going to have a lot of studying ahead of me!

Shawnee State University

I have recently found that a few of my newly graduated friends have been blogging about their work and internship experience. Last night I was having trouble sleeping, and decided to come up with one of my own. I'm hoping that it will become some kind of electronic portfolio of my experiences in grad school and out in the clinic. Not only will it be a fun break from my studies, but it may also work as just the opposite: a tool for me to recap what I have learned and freshen my memory later on down the road.

So for those of you who don't know, here's a little bit about me. I am a 22 year old alumnus of The Ohio State University. I received my bachelors degree in allied medical professions, with a major in Health Management in March of this year. I have learned a lot about the health field in the past 4 years, and, on a side note, I'm very interested in seeing what our newly elected president is going to do to remedy the health care situation. I think everyone agrees that something has to change, but nobody knows just how to go about it, or how we will ever afford it.

Anyway...last month I moved from the bustling city of Columbus to the teeny tiny little town of Portsmouth (or as i like to call it Practicallykentucky), Ohio, just two hours south. Here, at Shawnee State University, is where I will be studying toward my Master of Occupational Therapy. Now, let me tell you a little something about these two universities. OSU is one of the biggest universities in the US, home to over 50,000 students. The football stadium holds over 100,000 people and it's players are celebrities. Depending on your walking speed, crossing campus can take over 20 minutes, and a parking pass for the year cost over $200. SSU on the other hand, at any given time educates less than half the number of students that OSU graduated this June. It does not have a footbal team, and all the other sports are open to anyone who wants to play. I can easily walk across campus in approximately 4 minutes, and my parking pass was free.

Needless to say, I am in for a big change. I am extremely excited. While I LOVED being in Columbus, and I LOVE the buckeyes, I am a small town girl at heart, and I think I will benefit greatly from the smaller, community oriented atmosphere. My parents bought a house about a mile from the university, and I will be living with 3 other girls who will be in the MOT program with me. All of us will be moved in tomorrow, orientation is Friday, and we start classes one week from today on August 19th.

Here comes the next 2.5 years of my life!