OT Month: ABCs of OT 2016

Occupational therapy is a powerful, science-driven, and evidence-based profession. Part of an OT’s role is to help meet society’s occupational needs. However, how can we help meet these needs, if OT is not widely known much less widely understood? April 1-30 was designated “OT Month” to correspond with AOTA’s Annual Conference & Expo. I decided to participate in the #OTPhoto challenge on IG by posting a picture and description of how valuable OT is using each letter of the alphabet in order to promote #OTMonth.

the OT Alphabet…

A is for ADAPTIVE Equipment.

To enable functional outcomes sometimes our clients need a creative way to do an activity differently. We want them to maintain as much independence as possible. Adaptive equipment can come in many different forms. Here are a few examples.

• Sock aid: a client who recently had a hip replacement will have hip precautions that interfere with his dressing. We use the sock aid to help him put on his socks without bending down too far.
• Colored overlays: useful for little kiddos who have trouble attending to the reading task or has dyslexia
• Adaptive door knob: picture a client who has a SCI and cannot grasp or pronate/supinate-wrap foam tubing around a door and zip ties so that client can use his wrist to push down to turn the knob.

B is for BALANCE.

Balance can come in many forms. Here are a few examples.

• To improve one’s dynamic sitting balance, the client may be guided through an isometric core routine as a warm up before performing ADL’s on the EOB which will require client to reach and work on balance simultaneously.
• To improve one’s dynamic standing balance, the client will be asked to perform an activity such as a sorting task (laundry, meal prep, etc) while standing. OT will have a gait belt on the client for safety reasons.
• Balance is not just for clients. The OT or in my case-the OT student-always will need to work on her own occupational balance. When I prioritize my time and balance my schedule in order to fulfill OT school demands with my leisure pursuits (writing, painting), social needs (spend quality time with family and friends), and self-care/health maintenance needs, then I consider myself in occupational balance.

C is for CONTEXT.

Context can mean many different things and can be analyzed in every situation. Here are a few examples. 1) Personal Context: an individual’s internal environment that comes from his or her gender, age, values, morals, and beliefs 2) Social Context: this is the human environment that helps us define our roles and can hinder or facilitate one’s occupational function 3) Cultural Context: these are the norms or traditions that the community creates or establishes.

Context applied to my life when I went for a family boat ride… Personal Context: made the choice to wear a life vest during the part of the ride when we were in much deeper water d/t my personal beliefs to be safe rather than sorry. Social Context: my social role was “child” since I was with my parents which influenced my behavior- in contrast to if I was on a boat with a bunch of girl friends. Cultural Context: to comply with unwritten norms my dad chose to pull his boat up to the farthest spot rather than parking at the closer, more convenient spot. Each client brings their own personal, social, and cultural context which influences assessment and guides treatment planning. Before trying to understand our client’s context, we must first think about our own. Becoming familiar with the multiple context in our clients’ lives will help us to empower them.

D is for D R E A M T E A M .

And no I’m not referring to me and my ☀️, but to what this picture represents in the context of this moment. When you look at this picture you see two seemingly healthy people sharing a meal, but actually I’m pretending to be an OT helping to teach my “client” with visual impairments, dementia, and poor safety awareness how to cut and eat his meal again with the appropriate visual and tactile cues. This was for a project video that my classmate Kris and I did did on our well-mannered patient (my boyfriend) last spring.What you don’t see in this picture is my depression, anger, and anxiety from tearing my ACL literally two days beforehand in my senior recognition track meet which exemplifies how much we don’t immediately see in our patients. If you relook at the picture now you’ll see my long stabilizer brace. However, to make the video seem like a realistic OT/client simulation I tried my best to hide my emotions.

What does this picture have to do with OT month and dream team??
1) SLP: eating and feeding is an ADL but without our speech pathology friends, this fictional client would struggle even more with cognitive and swallowing tasks.
2) PT: without physical therapy this client’s ambulatory and balance ability will decline further; without my PT I would not have a normally functional knee joint again
3) OT: this fictional client wouldn’t have a choice in strengthening his functional ability to perform previously meaningful occupations. Without my OT friends/classmates, I would have forgotten that I was still meant to be in the Class of 2016 and that I could be resilient and practice what we preach to our patients in overcoming an obstacle.
All three of these disciplines are needed! SLP + PT + OT = Rehabilitation DREAMTEAM

E is for ENCOURAGER.

The art and science therapists encourage their clients on a daily basis. The art of occupational therapy requires the OT to examine different or creative strategies to create a rich intervention while displaying appropriate empathy and giving encouragement as needed to enhance the recovery or to empower a client. The science of occupational therapy requires the OT to plan Evidence-based, Science-driven interventions while adhering to AOTA’s Code of Ethics.

In this picture, my current Clinical Instructor of my fifth and final Level 1 fieldwork (in an orthopedic/hands OP setting) encouraged me last week by giving me a challenge to do by today. Because of her encouragement and guidance I am now able to (without cheating and looking at my anatomy book) draw the Brachial Plexus out, label all of the nerves, group and name the muscles, categorize common conditions and apply this knowledge. OTs encourage their clients, but OTs can also encourage their coworker or student OTs as well!!

{Brachial Plexus: C5-T1; draw it by remembering 3 Y’s, 2 E’s, 1 X and a long thoracic; helpful nemonic is Reach To Drink Cold Beer for Roots, Trunks, Divisions, Cords, Branches (I actually hate beer..) and for the nerves to remember lateral from medial Most Alcoholics Must Really Urinate for Musculotaneous, Axillary, Median, Radial, Ulnar! }

F is for FUNCTIONAL.

Occupational therapists design client-centered interventions with functional outcomes in mind! It all starts with listening to what is meaningful for that individual client and moving forward from there.

Functional assessment: OTs observe a client’s behavior in a natural context (shout out to home health) or in an environment that closely simulates the natural context to understand how environmental factors affect performance. We observe our clients performing their normal occupations to determine their strengths and what needs to be strengthened, their needed level of supervision/assistance, and address any barriers that are inhibiting their occupational readiness.
Application: A client who works at a coffee shop as a barista was recently diagnosed with MS. She relates that feels depressed and very fatigued and is worried that she won’t be able to keep up with the motor demands (both fine and gross) that it takes to be a great barista.

G is for GROWING.

Did you know that the job outlook for occupational therapy is very high in demand!! Not only has it consistently ranked high on multiple lists of top and recession-proof jobs but it is grrrroooowwinnggg! Idk about you but job security is kind of an important trait when deciding your career path.

Don’t take my word for it! Look up the following sites for yourself! List from AOTA website.
•U.S. News & World Report, Jan. 2016, “Ranking of Best Health Care Jobs”
•TIME Magazine, Jan 2016, “These 12 Jobs Will Grow 30% by 2024”
•NPR/WNYC-TV NBC 5, Jan 2016, “Following Up; Occupational Therapist Shortage”
•Career Alley, December 2015, “Hot Jobs for 2016”
•The Examiner, December 2014, “Top 5 Health Care Jobs for 2015”

H is for HOME modifications.

Home modifications are keeping our baby boomers in their homes as long as possible!
•Currently, only 1 in 6 of these baby boomers have made home modifications that will ensure that they will live safely in the comfort of their own home! •OTs can specialize in home modifications with further education in order to achieve the SCEM or CAPS credentials ~~Specialty Certification in Environmental Modification | Certified Aging in Place Specialist~~•OTs can provide an evaluation in your home to assess your family member’s safety, skills, and abilities and make recommendations and offer solutions to increase accessibility or enhance function within the home environment.

We want your home to work for your individual needs!•Interested in having an OT help you stay in your home, >>>>ask your primary care doc DO/MD<<<< for a referral! Recent medical changes may qualify you for home health services!! Your local home health agency can provide you with a creative OT who is skilled in addressing your needs for home modification. Never heard of a DO???? click here—> MD vs. DO: DO your research

I is for INDEPENDENCE & IADLs

 

Occupational therapists do everything they can can to make you as independent as possible again!! If making delicious pizzas for your family is a skill {meal prep/cleanup–> Instrumental Activity of Daily Living (IADL)} that is meaningful to you, well we can improve your ROM and endurance and remove any contextual barriers and even give you adaptive utensils if necessary to give you your independence back! IADLs are the activities you do within your home and community!! IADLs include: care of others,care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal prep and cleanup, religious activities, safety and emergency med, and shopping. OT is so necessary and I think it’s pretty cool how broad this art and science therapy truly is!! Cheers to holistic health-healthy mind and body & this pizza.

J is for JUSTIFICATION.

How I feel trying to justify my rationale for a group class assignment case study. Mr. Skellie says life would be easier if we didn’t have to back up our intervention ideas with evidence-based practice, but that’d make things too easy (and not skilled)!

Documentation is just one of those things you have to get used to doing a lot of as a healthcare professional to justify your services to insurance!

Justification gets easier with practice and a little creativity! OTs document their evaluations, interventions, daily notes, and more–all to justify why you need our services–and to document your progress.

K is for KINESTHETIC.

April 11, 2015 was not how I anticipated my USA Senior Recognition Track Meet competing in the steeplechase to have went!! Tearing your ACL can really throw off your plans! I had my reconstructive surgery during my two week “summer” break between second and third semester of OT school on May 12, 2015. This picture (my mom was cheering/taking action shots) was taken seconds before I landed and unfortunately hyperextended my left knee and tore my left ACL.I was a mixture of feelings that day, but I am rejoicing a year later.

In my physical therapy rehab to restore my mobility, I participated in a lot of kinesthetic activities. OT can also use kinesthetic approaches such as in teaching handwriting to kiddos through Handwriting Without Tears and even with an orthopedic client through kinesthetic biofeedback. Hurray for OT month and for overcoming trials!!

L is for LOW Vision.

Low vision can occur throughout the lifespan! Low vision truly hinders individual’s ability to perform meaningful occupations and/or negatively affect their occupational roles. This is where OT comes in!! OTs believe it or not can work with ophthalmologists (MD/DO)  and optometrists  (OD) on a vision team! Did you know that it wasn’t until 1990 that physicians could refer clients for occupational therapy with a sole diagnosis of low vision!!? Two certifications OTs can receive for low vision include becoming a Certified Low Vision Therapist or receiving a Specialty Certification in Low Vision (SCLV)-formal recognition for OTs for specialized knowledge and expertise with clients in this population. The SCLV is a 5 semester program that practicing OTs can go back to school for aka me after I get a few years into my practice!

M is for MANUAL Dexterity.

M is for Manual dexterity (and for my advocacy blog mOTivatedtoDO ) Manual dexterity is for typing on our computers for our 250350 group projects we have in our last semester of OT school in the classroom. It’s also for Management, Modifications, Motivation, Motor Skills, Metacognition, MultiSensory and MawMaw at the SNF.

 N is for NBCOT.

NBCOT – the National Board for Certification in Occupational Therapy// in addition to seven semesters of graduate education to get the beautiful “OTR” behind my name, I will take my boards shortly after graduating at the end of the year!! Can’t thank these two lovelies enough for all of their support through it all!

“NBCOT provides a world-class standard for certification of occupational therapy practitioners. They develop, administer, and continually review our certification process based on current and valid standards that provide reliable indicators of competence of the practice for occupational therapy.”

Mission Statement: “Setting the standard for lifelong professional growth, advancement, and practice excellence in occupational therapy.”

O is for OCCUPATIONAL beings.

My current apartment complex encourages my occupational role of graduate student by providing me with obscene amounts of coffee for freeeeee.

>>>>To be human is to be occupational!!<<

This is a founding principle of OT! We believe it is through the therapeutic modality of occupations that clients’ functions can not only be restored, but allows them to flourish!! As occupational beings, we each have our own individual needs that must be met to fulfill life’s daily demands! Occupational therapists recognize that the simple activities we do everyday are “occupations” (ADLs, IADLs, Education, Rest and Sleep, Work, Social Participation, Leisure) and our priority is to promote access, enable participation, restore functioning and more!! If you’d like to really dive into how OTs incorporate and perceive occupations a therapeutic tool then view my blog post at OT: the art and science therapy

P is for PERFORMANCE SKILLS.

Performance skills are observable elements of action that have an implicit functional purpose for life’s daily activities! OTs look at a client’s performance skills in order to understand the client’s ability to use one’s body functions and structures to engage in desired occupations. The 3 main types of Performance Skills related to occupational therapy intervention are… Motor Skills, Process Skills, Social Interaction Skills

• Motor Skills: “Occupational performance skills observed as the person interacts with and moves task objects and self around task environment” (e.g. ADL motor skills, school motor skills)
• Process Skills: ” Occupational performance skills observed as. Person (1) selects, interacts with, and uses task tools and materials; (2) carries out individual actions and steps; and (3) modifies performance when problems are encountered”
• Social Interaction Skills: “Occupational performance skills observed during the ongoing stream of a social exchange”. Source: AOTA- OT Framework 3rd ed.

Q is for QUALITY of life.

OTs care about you and hope to use our therapeutic use of self along with our client-centered interventions to help create, promote, establish, restore or maintain your quality of life! We do what we can to help you achieve your goals and participate in what’s meaningful to you!

 

 

 

R is for REGULATION strategies.

Regulating your emotions is a strategy doesn’t come natural for everyone. OTs help our kiddos (and sometimes adults) with poor frustration tolerance, ineffective coping mechanisms, poor social interaction skills etc. learn how to >>>self-Regulate<<< their emotions to encourage age-appropriate behavior.

3 emotional >Regulation< strategies: (may or may not have used one of these strategies during our sand volleyball game)

• “Take Five“: Place your left hand flat on a table. Place your right index finger on the base of your left thumb (anatomical snuff box) and trace your thumb up and breathe in. Trace your thumb down, breathe out. Repeat for the other four digits.
• Social Story: Create a visual aid through PPT that is catered to the problem areas that the child needs to work on. Make it fun and include lots of pictures and short captions that models appropriate behavior.
• Calm Down Corner: create a dim lit space with soothing music, several pillows and blankets, soft colored lava lamp, and stuffed animals for your child to go to when he/she needs a moment to calm down

S is for SPLINTING.

For my last Level 1 I was in an orthopedic/hands setting! All of these clients were affected by some type of orthopedic injury to the shoulder, elbow, wrist, or hand (rotator cuff injury, lacerated tendons, nerve damage, carpal tunnel syndrome, mallet finger etc..)They each had their own story -patient centered- and hopes to improve their functional outcomes in order to do daily activities that we often take for granted!

One of the coolest parts of this fieldwork experience was helping create >>>splints<<<< for different clients to prevent contractures, promote a functional wrist, improve position of MCP joints and more!! I also was blessed with a great CI for this rotation. The  bottom right picture is a cheapo version of a resting hand splint I made perhaps for a client who does not have insurance coverage. The idea is to decrease pain and prevent muscle contracture with the simple adaptation of a pool noodle and a strapped band.

T is for TEAM-BASED approach.

If you want to become an OT you better get used to being on teams. You need to invest in your team’s dynamics. OTs who work in schools will be on an IEP >>team<< comprised of other rebab/medical professionals and teachers. But what if you are like me and don’t want to be an OT in the schools…?? I envision my first OT job to be in a SNF or in a hospital-based setting. I will not only have to frequently co-treat with PTs or SLPs and communicate with social workers and nurses, but also with –> referring physicians. All healthcare practitioners are important to the team and all deserve to be acknowledged for their roles!

And contrary to popular belief, as an OT you should probably learn that physicians come from two backgrounds: allopathic (MD) or osteopathic (DO).

Most physicians will probably be too nice to correct you if you assume they are MDs, but DOs are a thing people and they are our referral source! In fact, DOs are taught from a much more holistic approach which is truly more in line with OT principles, whereas MDs are taught from a more symptoms based approach–but they are both awesome and are the ONLY types of doctors that can treat, prescribe medicine, and perform surgery on OUR clients.

MDs and DOs receive similar medical education and must pass several board certifications and residencies. DOs receive additional training on osteopathic manipulative treatment which is a more hands on approach to diagnosing, treating, and preventing illness.Be inspired to be team player for the sake of your clients and take some time to learn about the backgrounds of your teammates.

U is for UNDERSTANDING & UNIVERSAL Design.

Sometimes, we need to lend an extra hand to help out others. OTs understand that if a client has a certain physical disability that causes him to be W/C bound he deserves the dignity of accessibility that doesn’t require him to feel further isolated by wheeling to the back of the store to go through the wheelchair entrance.

Universal design is the correct design choice. Design environments and products usable to all people! When OT makes adaptive equipment recommendations or caregiver education, we place an emphasis on this in order to simplify life for everyone.

V is for VERSATILE.

 

This is one of my favorite OT professors and today was my MS2 class’s “going away” party for our Level 2 fieldworks hosted by the MS1’s.

<< OT is versatile because OT is needed and can be found everywhere.>>>

We can work in the “normal” places people assume such as in a hospital or at a nursing home but we can also work in prisons, medical homes, churches or hold in political positions.

 

 

W is for WHOLE-person care.

OTs are taught from a holistic approach. We believe that our clients are >>not defined<< by their disease/diagnosis/injury. We recognize that every client brings their own story, upbringing, valued, beliefs, and more to therapy. While we envision always performing evidence-based and occupation-focused interventions, quite frankly it is more than that. OTs must provide client-centered treatment that truly takes the Whole person (mind and body) into consideration. While it’s imperative to strive for and to achieve good outcomes, emphasis must be on the person’s goals and needs from therapy.

 

X is for XENIAL.

I definitely had to look up an “X” word…. anyways OTs are xenial, another word for hospitable, since we serve a highly varied client population and provide a multitude of services. Cheers to my Class of 2016 because we are almost out of the classroom!! Praiseeeee.

Y is for YOUTH.

As OTs one of the populations we serve is children and Youth. AOTA notes that children and Youth is actually one of OT’s emerging practice areas. (This picture is obviously for the adult parents, caregivers, and guardians who care for the kiddos for the 95% of time they aren’t in therapy. Also, it’s for higher caffeine consumption for approaching finals and end of the semester projects, yay.)

 

OT is really cool because we have the opportunity to mentor and serve our communities in places like prisons or in this case-juvenile detention centers-for >>>>Youths who have been incarcerated<<<due to a variety of different crimes. Shout out to my grant group because we are almost done with finalizing our grant that is advocating for (and asking for some moneyyyy🤑🤑) OT services to be provided free of charge to the Youths! We plan to provide Life Skills lessons (care of others, money management, health maintenance)to these Youths since they are experiencing a disruption from their developmental transition to teenage years or young adulthood! Cheers to the future and current pediatric OTs who serve the Youth of our communities! May your ☕️ coffee pot always be hot.

Z is for ZEALOUS

 

Zealous is a positive adjective that describes a person and is marked by active interest and enjoyment! OTs are the zealous healthcare providers that are known for their creativity in the methods they use when planning client-centered interventions!

Personally, I am a zealous fan of health, fitness, and occupational balance. In the future, I strive to always model healthy, positive behavior for the clients I will be blessed to serve!

 

 

 

Happy OT Month. Until next year.

With love,

SHANNEN M.