In one of my previous posts, I wrote about "Where OT is calling me." The post was originally an assignment for a class which touched on new practice areas emerging in the field. At the time I was wrote about transitioning high school students with developmental disabilities to jobs. Lately however, I have been leaning more toward working with individuals with SCIs. Because OT is such a broad field, even after my first year of grad school, I am not completely sure of specific treatments we might use with these patients. However, back in November, a boy who graduated from my high school a few years behind me was in a car accident and sustained a spinal cord injury. I think of him occasionally, and check out the Mansfield News Journal website for updates. Today I came across photos of him with his OT in Mansfield. Below is the link:
http://www.mansfieldnewsjournal.com/apps/pbcs.dll/gallery?Site=B7&Date=20100420&Category=NEWS01&ArtNo=4200803&Ref=PH&Params=
As sad as I am for him, this kind of thing makes me excited to begin my career. I only have to wait a year and a half now!
Monday, May 10, 2010
Monday, April 26, 2010
Occupational Therapy Songs on Youtube!
Friday, April 16, 2010
An Ethical Dilema: Do Not Resuscitate Orders
Type of Dilemma: Do not resuscitate orders (DNRs), are orders found in patients’ medical charts, which tell health care practitioners not to perform cardiopulmonary resuscitation (CPR) (Braddock, 1998). A patient with a DNR order in his or her chart has either personally chosen not to be resuscitated, or a family member has chosen for them in the event that they are not capable of making the decision independently (NYS Department of Health, 2010). The main dilemma surrounding DNR orders lies within the issue of autonomy, or an individual’s right to make decisions for him or herself (Crabtree, 1999). More specifically, most cases may involve a conflict between professional autonomy and client autonomy; that is, the health care professional’s knowledge and thoughts on what is best for the patient may differ from those of the patient (Crabtree, 1999). For the professional, underlying principles of justice, veracity and duty may also apply depending on the specific case.
Relevant Information: Typically, when an individual goes into cardiac or respiratory arrest, health care practitioners will resuscitate him or her to restore function of the arrested system (Cleveland Clinic, 2010). Not only does this include manual CPR, but resuscitation drugs, artificial airways, respiratory assistance, cardiac monitoring, and others are considered forms of resuscitation (Cleveland Clinic, 2010). However, CPR has been minimally successful with certain diagnoses and conditions, and patients may choose to sign DNRs based on this information. See Table 1 for more information:
Table 1:
| Diagnosis or Condition | Probability of Success |
| Septic Shock | 0% |
| Acute Stroke | 0% |
| Metastatic Cancer | 0% |
| Severe Pneumonia | 0% |
| Hypotension | 2% |
| AIDS | 2% |
| Renal Failure | 3% |
| Homebound Lifestyle | 4% |
| Age Greater Than 70 | 4% (Survival to Discharge) |
(Braddock, 1998)
The problem: The problem again, lies within the concept of autonomy. With end of life care, there will always be conflicts between the autonomy of the professional, the patient, and the patient’s family, all of which can potentially have different views of how the issue should be handled. A patient may be ready to let go, or he or she may be determined to fight until the end. The family’s feelings on the issue can range across the same continuum. These views will greatly affect the patient/family’s willingness to sign a DNR order. Under the principle of autonomy, the clients should be the ultimate decision makers, choosing what is best for themselves or their loved ones. For the health care professional, a much more complicated ethical dilemma is involved with DNRs. First, the professional has a duty to disclose accurate information about the patient’s condition to him or her. This duty lies under the ethical principle of veracity, which is truth telling (Crabtree, 1999). The professional also has a duty to respect the autonomy of the patient, allowing him or her to make decisions on his or her care if possible. Yet another duty of the professional is to allocate healthcare resources effectively and efficiently, demonstrating the ethical principle of justice (fairness) (Crabtree, 1999). For example, an individual who is not likely to survive cardiac or respiratory arrest should not receive CPR as it may be a waste of precious healthcare time and dollars. DNRs are complicated ethical dilemmas; each differs greatly depending on the case. Doctors and Nurses work closest to DNRs, however, therapy professionals may be involved in DNR dilemmas as well.
Type of Setting or Practice: Because DNRs are used to prevent unnecessary and unwanted end-of-life treatment, they will most likely be seen when working with the elderly populations. Therefore, occupational therapists would most likely encounter DNRs in skilled nursing facilities and inpatient rehabilitation settings. Therapists working with these clients need to be aware of whether their patients have or have not signed DNR orders. If a therapist were to ignore a DNR order or neglect to resuscitate an individual who has not signed a DNR, a serious malpractice lawsuit might ensue.
Six Step Process for Ethical Decision Making: Purtilo’s (2005) six step process for ethical decision making provides therapists with a process for making appropriate decisions in ethical scenarios. The six steps are as follows: gather relevant information, identify the type of ethical problem, analyze the problem using ethics theories or approaches, explore the practical alternatives, act, and evaluate the process and outcome (Purtilo, 2005). This process allows therapists to slow down, think through their actions, and make the best choice for themselves and their patients.
Braddock, C. H. (1998). Do not resuscitate orders. Ethics In Medicine. Retrieved from http://depts. washington.edu/bioethx/topics/dnr.html.
Cleveland Clinic. (2010). Policy on do not resuscitate. Retrieved from http://www.clevelandclinic.org/ bioethics/policies/dnr.html
Crabtree, J. L. (1999). Ethics of culture in rehabilitation. In M. Royeen & J. Crabtree (Eds.), Culture in rehabilitation: From competency to proficiency (59-71). Upper Saddle River, NJ: Pearson.
NYS Department of Health. (2010). Deciding about CPR: A guide for patients and families. Retrieved from http://wings.buffalo.edu/bioethics/dnr-p.html
Purtilo, R. (2005). Ethical dimensions in the health professions. 4th ed. Boston: Elsevier Saunders.
Monday, April 12, 2010
Spinal Cord Injury Case Study
I was assigned a number of large projects this semester on the topic of spinal cord injuries. I am interested in working in the field, so I chose the topic hoping to learn more about it. We had to interview an individual with our specific disability and do a psychosocial case study presentation on him or her. Along with the presentation, we had to write a paper, which is the main topic of this post. The man I chose was an acquaintance of mine, who was injured in a body surfing accident 6 years ago. He had a strong pre-injury identity as an athlete, and misses that piece of his life quite a bit. The paper I wrote below shows just a small part of my presentation: one intervention that I chose to help improve this loss of identity. It's also a good way for my few readers to get an idea of what OT can do in the mental health setting.
Spinal Cord Injury Psychosocial Intervention Paper
Client Diagnosis: C4/C5 incomplete lesion spinal cord injury
Psychosocial Need: Loss of identity as an athlete after spinal cord injury
Sample Goal: Client will be able to participate in half of a wheelchair rugby game after 8 therapy sessions and extensive practice outside of therapy.
Occupational Intervention:
Therapist will provide client with practice of wheelchair rugby ball handling skills. Based on the results of range of motion and manual muscle testing, therapist will determine the client’s approximate wheelchair rugby classification and accompanying maneuvers (according to the International Wheelchair Rugby Federation, www.iwrf.com). The client being seen is most likely at level 0.5, and practice maneuvers will be as follows:
• Trapping direct passes on lap
• Batting close-range passes into lap
• One-handed under-hand “volleyball” pass
• Two-handed side “scoop” pass
(International Wheelchair Rugby Federation, 2010a)
As client masters the above skills, therapist will practice maneuvers with weighted balls of similar size. Supplies needed are as follows:
• One manual wheelchair (preferably of lighter, athletic style)
• One volleyball (beach ball if first time practicing)
• Medicine balls of light weights (2-4lbs, depending on the results of manual muscle tests)
• Ample space for physical activity
Theoretical Basis of Intervention:
The client’s previous identity as a collegiate athlete and his lifelong hobby of playing sports provide the rationale for this intervention. According to the Model of Human Occupation (MOHO), volition, habituation, and performance capacity are the three interacting components to an individual’s occupational well-being (Keilhofner, 2009). Volition is an individual’s motivation or desire to participate in a specific occupation (Keilhofner, 2009). Habituation, which consists of a person’s roles and habits, refers to the way in which an individual organizes actions (Keilhofner, 2009). The third component, performance capacity, is the individual’s actual ability to perform a task, physical or mental (Keilhofner, 2009). Due to his injury, the client at hand has extensive physical limitations, and no longer has the performance capacity necessary to play football. Before his accident, however, his role as an athlete was his main identity, and several other active sports filled his leisure time. This fact alone creates in the client a strong desire to be involved in competitive sports again, a void he wishes to fill with wheelchair rugby, a fast-paced, full contact sport for those who have impairments in all four limbs.
Objectives of Intervention:
By practicing ball-handling skills with the client, which are appropriate to the sport of wheelchair rugby, the therapist hopes to instill a new sense of self confidence in the client. The opportunity to fill the void left by football in the client’s life is motivating to the client, and once the new set of rugby skills are acquired, the client should feel empowered to get involved with the sport competitively. The therapist would like to see the client act on this confidence by becoming familiar with the sport, becoming part of a competitive team, and competing in officiated games.
Diagnostic Considerations:
The intervention itself is purely physical, using modified techniques to allow the client to catch and pass the ball. It addresses the following symptoms:
• Muscular weakness
• Muscular coordination
• Decrease/lack of muscular function
However physical, the intervention also addresses the psychological symptoms listed below, as it is a large contributor to the client’s perceived quality of life.
• Depression
• Loss of identity
• Anger
• Low self-esteem
• Loss of friends/social supports
Precautions:
Safety concerns include client’s limited ability to manage physiological responses to physical exercise, such as body temperature and respiratory functions. Client is unable to sweat below the level of injury, and may experience excessive sweating above (Atchison & Dirette, 2007). The client also may display respiratory impairments, such as shallow breathing (Atchison & Dirette, 2007). The therapist will watch for signs of overheating and provide ample water and rest breaks. Also, because of the level of injury, the client has limited to no trunk control (Atchison & Dirette, 2007). The therapist will make sure his manual chair fits appropriately and that he is properly strapped in. Also, practice of ball handling will begin with the wheelchair brakes locked and will not proceed until the client has practiced.
From a psychosocial standpoint, it will be important for the therapist to inform the client of the amount of time and effort it will take to gain the skill needed to play in a competitive rugby game. The client needs to be given the opportunity for small successes, building up his confidence over time. This will keep him from being discouraged and giving up on the sport all together.
Methods and Interpersonal Strategies:
Because this intervention and the ultimate goal are so important to the client, the therapist will employ Taylor’s (2008) collaborating mode during treatment. This will allow the client to feel as though he is a part of the therapy process, making him accountable for the results of his therapy (Taylor, 2008). It will also allow the therapist to receive feedback from the client, giving her the information she needs to keep therapy client-centered (Taylor, 2008). The therapist may also need to employ Taylor’s (2008) encouraging mode, in times when self-esteem is low and the client becomes discouraged.
Relationships:
The client would expect to experience a collaborative relationship with his therapist. He is a highly motivated individual who knows exactly what he wants to do. He is merely lacking the skills to do those things and therefore needs the assistance of the therapist. Although he would like to have control over his therapy plan, he is a respectful individual who will take the advise and expertise of the therapist seriously. Aside from personality, several other factors may affect the therapist-client relationship in this case. Among those factors are age and gender. The therapist and client are of similar age and opposite sex, which in some cases may entice inappropriate relationships to form. It will be important for the therapist to address the client as a peer, being sure to set boundaries where necessary, keeping the relationship professional.
Family and Significant Others:
The person closest to the client’s medical care is his mother. She lives in the same city and visits often. She has been involved in his medical care since the accident, however, unless the client gives permission, the therapist is legally obligated to keep all information about care confidential. If the client approves, then it will be important for the therapist to keep the client’s mother informed and collaborate with both of them on treatment options, goals, and progress.
The therapist will also need to keep in mind the client’s family history and other related issues when providing treatment. The client’s mother and father are divorced and his sister passed away from a car accident just a few months before his own accident. The family has experienced a lot of trauma and is most likely struggling to adjust, even five years later.
Cultural Factors:
The client is a Caucasian man, who values education, hard work, and leisure time. His whole life has revolved around on his athletic career, so this intervention and the possible results coincide with his values. His mother has always been supportive of his athletics, and made it a priority to make it to his games. The opportunity to compete again will provide the pair with new opportunities to bond and reminisce.
Environment:
This specific intervention requires a relatively large amount of open space, ideally with appropriate hard flooring to allow for wheelchair mobility. The client’s apartment is small, and it would be difficult for him to practice ball handling at home. The client currently lives in a community with ample resources for individuals who are interested in adapted sports. However, because he does not drive, he struggles to find transportation to facilities where he can access these resources. The therapist may be interested in researching and recommending driver rehabilitation for the client, which will be able to fit him for an adapted vehicle. In the meantime, the university he attends has an accessible recreation facility that is close enough to the client’s home for him to access without a car.
Expected Outcome:
Upon receiving this practice (ball handling), the client will experience an increase in strength and ability to perform the sport. However, this alone will not allow him to play in an actual wheelchair rugby game. The therapist will also work with him on maneuvering his manual wheelchair, and establishing a regular exercise routine which will help him improve and maintain upper body muscle strength. Along with these physical interventions, the therapist will provide other psychosocial interventions, which will help the client develop and improve the communication and interaction skills he needs to be part of a team or start up his own team. The ultimate goal of all of these interventions is to fill the void left by football in the client’s life. He will build the strength, endurance, and confidence necessary to compete as an athlete again.
Curious about wheelchair rugby? Watch the movie "Murderball." It is intense (as you can only imagine by the title). The film is a documentary featuring the USA Paralympic Quad Rugby Team. It is full of amazing input on society and disability and spills over with inspiration. I own it if you would like to borrow it. Pictured right is Mark Zupan, one of the main characters from the movie.
Spinal Cord Injury Psychosocial Intervention Paper
Client Diagnosis: C4/C5 incomplete lesion spinal cord injury
Psychosocial Need: Loss of identity as an athlete after spinal cord injury
Sample Goal: Client will be able to participate in half of a wheelchair rugby game after 8 therapy sessions and extensive practice outside of therapy.
Occupational Intervention:
Therapist will provide client with practice of wheelchair rugby ball handling skills. Based on the results of range of motion and manual muscle testing, therapist will determine the client’s approximate wheelchair rugby classification and accompanying maneuvers (according to the International Wheelchair Rugby Federation, www.iwrf.com). The client being seen is most likely at level 0.5, and practice maneuvers will be as follows:
• Trapping direct passes on lap
• Batting close-range passes into lap
• One-handed under-hand “volleyball” pass
• Two-handed side “scoop” pass
(International Wheelchair Rugby Federation, 2010a)
As client masters the above skills, therapist will practice maneuvers with weighted balls of similar size. Supplies needed are as follows:
• One manual wheelchair (preferably of lighter, athletic style)
• One volleyball (beach ball if first time practicing)
• Medicine balls of light weights (2-4lbs, depending on the results of manual muscle tests)
• Ample space for physical activity
Theoretical Basis of Intervention:
The client’s previous identity as a collegiate athlete and his lifelong hobby of playing sports provide the rationale for this intervention. According to the Model of Human Occupation (MOHO), volition, habituation, and performance capacity are the three interacting components to an individual’s occupational well-being (Keilhofner, 2009). Volition is an individual’s motivation or desire to participate in a specific occupation (Keilhofner, 2009). Habituation, which consists of a person’s roles and habits, refers to the way in which an individual organizes actions (Keilhofner, 2009). The third component, performance capacity, is the individual’s actual ability to perform a task, physical or mental (Keilhofner, 2009). Due to his injury, the client at hand has extensive physical limitations, and no longer has the performance capacity necessary to play football. Before his accident, however, his role as an athlete was his main identity, and several other active sports filled his leisure time. This fact alone creates in the client a strong desire to be involved in competitive sports again, a void he wishes to fill with wheelchair rugby, a fast-paced, full contact sport for those who have impairments in all four limbs.
Objectives of Intervention:
By practicing ball-handling skills with the client, which are appropriate to the sport of wheelchair rugby, the therapist hopes to instill a new sense of self confidence in the client. The opportunity to fill the void left by football in the client’s life is motivating to the client, and once the new set of rugby skills are acquired, the client should feel empowered to get involved with the sport competitively. The therapist would like to see the client act on this confidence by becoming familiar with the sport, becoming part of a competitive team, and competing in officiated games.
Diagnostic Considerations:
The intervention itself is purely physical, using modified techniques to allow the client to catch and pass the ball. It addresses the following symptoms:
• Muscular weakness
• Muscular coordination
• Decrease/lack of muscular function
However physical, the intervention also addresses the psychological symptoms listed below, as it is a large contributor to the client’s perceived quality of life.
• Depression
• Loss of identity
• Anger
• Low self-esteem
• Loss of friends/social supports
Precautions:
Safety concerns include client’s limited ability to manage physiological responses to physical exercise, such as body temperature and respiratory functions. Client is unable to sweat below the level of injury, and may experience excessive sweating above (Atchison & Dirette, 2007). The client also may display respiratory impairments, such as shallow breathing (Atchison & Dirette, 2007). The therapist will watch for signs of overheating and provide ample water and rest breaks. Also, because of the level of injury, the client has limited to no trunk control (Atchison & Dirette, 2007). The therapist will make sure his manual chair fits appropriately and that he is properly strapped in. Also, practice of ball handling will begin with the wheelchair brakes locked and will not proceed until the client has practiced.
From a psychosocial standpoint, it will be important for the therapist to inform the client of the amount of time and effort it will take to gain the skill needed to play in a competitive rugby game. The client needs to be given the opportunity for small successes, building up his confidence over time. This will keep him from being discouraged and giving up on the sport all together.
Methods and Interpersonal Strategies:
Because this intervention and the ultimate goal are so important to the client, the therapist will employ Taylor’s (2008) collaborating mode during treatment. This will allow the client to feel as though he is a part of the therapy process, making him accountable for the results of his therapy (Taylor, 2008). It will also allow the therapist to receive feedback from the client, giving her the information she needs to keep therapy client-centered (Taylor, 2008). The therapist may also need to employ Taylor’s (2008) encouraging mode, in times when self-esteem is low and the client becomes discouraged.
Relationships:
The client would expect to experience a collaborative relationship with his therapist. He is a highly motivated individual who knows exactly what he wants to do. He is merely lacking the skills to do those things and therefore needs the assistance of the therapist. Although he would like to have control over his therapy plan, he is a respectful individual who will take the advise and expertise of the therapist seriously. Aside from personality, several other factors may affect the therapist-client relationship in this case. Among those factors are age and gender. The therapist and client are of similar age and opposite sex, which in some cases may entice inappropriate relationships to form. It will be important for the therapist to address the client as a peer, being sure to set boundaries where necessary, keeping the relationship professional.
Family and Significant Others:
The person closest to the client’s medical care is his mother. She lives in the same city and visits often. She has been involved in his medical care since the accident, however, unless the client gives permission, the therapist is legally obligated to keep all information about care confidential. If the client approves, then it will be important for the therapist to keep the client’s mother informed and collaborate with both of them on treatment options, goals, and progress.
The therapist will also need to keep in mind the client’s family history and other related issues when providing treatment. The client’s mother and father are divorced and his sister passed away from a car accident just a few months before his own accident. The family has experienced a lot of trauma and is most likely struggling to adjust, even five years later.
Cultural Factors:
The client is a Caucasian man, who values education, hard work, and leisure time. His whole life has revolved around on his athletic career, so this intervention and the possible results coincide with his values. His mother has always been supportive of his athletics, and made it a priority to make it to his games. The opportunity to compete again will provide the pair with new opportunities to bond and reminisce.
Environment:
This specific intervention requires a relatively large amount of open space, ideally with appropriate hard flooring to allow for wheelchair mobility. The client’s apartment is small, and it would be difficult for him to practice ball handling at home. The client currently lives in a community with ample resources for individuals who are interested in adapted sports. However, because he does not drive, he struggles to find transportation to facilities where he can access these resources. The therapist may be interested in researching and recommending driver rehabilitation for the client, which will be able to fit him for an adapted vehicle. In the meantime, the university he attends has an accessible recreation facility that is close enough to the client’s home for him to access without a car.
Expected Outcome:
Upon receiving this practice (ball handling), the client will experience an increase in strength and ability to perform the sport. However, this alone will not allow him to play in an actual wheelchair rugby game. The therapist will also work with him on maneuvering his manual wheelchair, and establishing a regular exercise routine which will help him improve and maintain upper body muscle strength. Along with these physical interventions, the therapist will provide other psychosocial interventions, which will help the client develop and improve the communication and interaction skills he needs to be part of a team or start up his own team. The ultimate goal of all of these interventions is to fill the void left by football in the client’s life. He will build the strength, endurance, and confidence necessary to compete as an athlete again.
Curious about wheelchair rugby? Watch the movie "Murderball." It is intense (as you can only imagine by the title). The film is a documentary featuring the USA Paralympic Quad Rugby Team. It is full of amazing input on society and disability and spills over with inspiration. I own it if you would like to borrow it. Pictured right is Mark Zupan, one of the main characters from the movie.
Monday, March 22, 2010
I Passed the NBCOT Exam!!!
Now, I know the subject of this post sounds really exciting...but I didn't actually pass some big test. But I do have good news. Today in class, our professor handed out a copy of an email sent from a recent Shawnee State University OT graduate who passed his NBCOT (National Board for the Certification of Occupational Therapists) exam on the first try! Passing this exam is REQUIRED for therapists to practice in the state of Ohio, so this is a pretty big deal. As you can tell by my lack of updates, I've been pretty unmotivated lately...feeling pretty crappy about being in school and wondering why I chose two more years of it. This letter put me in a great mood tonight. It made me feel really good about my school work, my field of choice, and the "second-choice" institution I just happened to end up at because my Alma-mater didn't accept me.Greetings Dr. Scurlock,
I wanted to take this time to thank you and your faculty for providing me with an outstanding foundation in Occupational Therapy. I was able to take and PASS the NCBOT exam the first time on 3/15/09. Prior to taking the exam, I used a variety of material to prepare. I studied approximately 1.5hrs a day, 5 days a week, for 1 month. The books I used were as follows: National Occupational Therapy Certification Exam Review and Study by Rita P. Flemming-Castaldy, Occupational Therapy Registered Certification Examination published by NBCOT, and the Occupational Therapy Examination Review Guide 3rd Ed. by Johnson, C., Lorch, A., and DeAngelis, T.
The most relevant book that I felt was most like the examination was the Occupational Therapy Registered Certification Examination published by the NBCOT which has 150 sample questions. The font and content is as close to the exam as possible, meaning the way the questions are worded and key terms such as "MOST IMPORTANT" in bold to help the test taker really identify what is asked.
My feeling about the OT program at Shawnee State is that it really prepared me for the exam. I really felt I had a great foundation and was well prepared to take the exam. By studying for the exam, I basically reviewed everything I learned within the program. I did not learn any new material from these books that I did not already learn in class. It was just a matter of repetition.
I am currently working in the Spinal Cord Injury Unit at the VA located in Cleveland. I was competing against a Cleveland State University graduate for the same position that i believe would have had the upper hand since one of his field work assignments was at this location. Needless to say, I scored exceptionally higher in the "performance based interview" and was offered the team position in the Spinal Cord Injury Unit.
I thank you again for all that you have done to get me to this point and hope future students feel as prepared and confident as I did when I took the exam. Please feel free to contact me anytime.
Sincerely,
Brittany Wolf (I'm signing this with my name because I hope I will be able to send an email just like this 1.5 years from now)
*Sigh of relief*
P.S. Above photo is of the OT gang taking a break from homework on St. Patty's day. Work hard, play hard...right Dad?
P.P.S. I will be asking for those books for Christmas in case any of my readers would like to take note.
Tuesday, January 12, 2010
Where is OT calling me?
One of our introductory assignments this semester was a discussion post answering the following question: "Where is OT calling you?" Because OTs can wind up in a wide variety of settings, I figured that not many people really have a clue what I am hoping to do with this degree. So here is my answer...
As of yet, I am not sure exactly which direction OT is calling me. At least once a week, I learn about another area in which
OTs can be of service. I am really looking forward to my level two fieldwork assignments so that I can explore some of these areas. Ever since the beginning of my “OT journey,” I have been interested in neonatal OT. I love the idea of helping tiny babies get a good start at life. I am worried, however, that I will not be able to handle the inevitable heartaches that come with working with NICU patients. Another area that I am highly interested in is in the school system. More specifically, I would like to work with high school students with developmental disabilities, helping them to transition into adulthood, the work place, and an independent life. Summers off wouldn’t be bad either! Especially because I am interested in hippatherapy as well. This is the one area I am sure that I would like to delve into. I want to start up a small therapeutic riding center on the side – no matter what I end up doing for the big bucks! First I wanted to be a veterinarian, then a physical therapist...hippatherapy is the perfect “in-between.” I am really excited to be a part of this profession, and I cannot wait to get out there and start working!
As of yet, I am not sure exactly which direction OT is calling me. At least once a week, I learn about another area in which
OTs can be of service. I am really looking forward to my level two fieldwork assignments so that I can explore some of these areas. Ever since the beginning of my “OT journey,” I have been interested in neonatal OT. I love the idea of helping tiny babies get a good start at life. I am worried, however, that I will not be able to handle the inevitable heartaches that come with working with NICU patients. Another area that I am highly interested in is in the school system. More specifically, I would like to work with high school students with developmental disabilities, helping them to transition into adulthood, the work place, and an independent life. Summers off wouldn’t be bad either! Especially because I am interested in hippatherapy as well. This is the one area I am sure that I would like to delve into. I want to start up a small therapeutic riding center on the side – no matter what I end up doing for the big bucks! First I wanted to be a veterinarian, then a physical therapist...hippatherapy is the perfect “in-between.” I am really excited to be a part of this profession, and I cannot wait to get out there and start working!
Friday, January 8, 2010
Fresh Start
Welp, this morning topped off my first week of my second semester of OT school. I underestimated how much work I would have to do and how little time I would have to update this blog. I am hoping that I will do a better job this semester.
We have a couple exciting experiences coming up... Myself and 2 other class mates will be running a life skills education course at the local homeless shelter in Portsmouth. I am looking forward to working on that. In another class, we have been placed in teams with occupational therapy assistants (OTA) students and will be visiting a mental/behavioral health facility in Lucasville, Ohio. I have never been in either setting, so I am looking forward to learning from both experiences.
We will also be working on an aquatic therapy research project for individuals with MS. More details to follow.
I will do my best to update this thing as often as possible. I have been told that this will be our most difficult semester... Here goes nothin'!
We have a couple exciting experiences coming up... Myself and 2 other class mates will be running a life skills education course at the local homeless shelter in Portsmouth. I am looking forward to working on that. In another class, we have been placed in teams with occupational therapy assistants (OTA) students and will be visiting a mental/behavioral health facility in Lucasville, Ohio. I have never been in either setting, so I am looking forward to learning from both experiences.
We will also be working on an aquatic therapy research project for individuals with MS. More details to follow.
I will do my best to update this thing as often as possible. I have been told that this will be our most difficult semester... Here goes nothin'!
Monday, September 28, 2009
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.
Tuesday, September 22, 2009
Another OT Assignment
The Question:
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.
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