Handwriting for Occupational Therapists (OTs) - development, assessment, treatment

We recently had a handwriting lecture by a occupational therapist in private practice, Jennifer. We learned about the importance of handwriting, skills used in handwriting, how handwriting develops, how to evaluate it, and how to treat problems with handwriting. The following information is essentially a partial outline of her powerpoint.

Handwriting is rarely taught as a subject anymore, and many teachers don't feel they can teach it well. However, considering how much a child has to write during a typical day, problems with handwriting can cause a LOT of different school problems, including frustration, fatigue, low test scores, and more.

Handwriting is more complicated than it seems - it requires trunk/postural control, head stability for visual tracking, strength, hand control, visual perception, cognitive skills, etc.

Even things like the thumb web space, the ability to separate the two hands in terms of motor control, and well-developed palm arches, are important to handwriting. For example, one hand has to hold the paper while the other hand writes. The hand has to curve around the writing utensil properly.

Most agree that ages 4-6 are appropriate ages to begin handwriting instruction. Typically children go through a hierarchy of grasps..starting with a pronated hand (palm in a contorted position, facing outwards) and eventually moving into a more neutral position, with better finger control. Vertical and horizontal lines need to be mastered before diagonal lines.

During evaluation, it is important to not only look at handwriting skills. It is important to look at the context - the physical layout of the room/desk, the social context (lots of distractions by fellow students?), how much time the children are given, whether or not the children have to copy from the vertical surface of the board to the horizontal surface of the desk, and more!

There are lots of different handwriting assessments that can be used (as well as informal observation), such as the ETCH - Evaluation Tool of Children's Handwriting. These assessments can help further define the problem area - ie, is the handwriting issue a fine motor problem, a visual-perceptual problem, a cognitive problem, a trunk control problem, etc?

Treatment can vary based on the problem causing handwriting issues. It may be modifying the student's chair/desk, it might involve doing weight-bearing activities to improve proprioception, practicing fine motor activities, used paper with raised lines, or color-coded paper, using special grips...the possibilities go on and on.

Jennifer also showed us a large toolbox full of helpful items, such as very tiny pencils, an odd assortment of grips, fine motor squeezing/grasping/pinching activities, and "crayon nibbles", which seemed pretty cool! She also said a kitchen store can be a great place for an occupational therapist, because typically such stores have things like strawberry hullers and tongs of different sizes, which can be used to help the child work on in-hand manipulation and strength. She even suggested getting a liquid laundry detergent cup, putting a sticker on it that clearly has an up/down (like a silly face), and then having the child manipulate the cap in circles between one hand.

It was a pretty interesting lecture and it really made me appreciate how complicated handwriting can be, for some children. So have some patience, try and get to the root of the problem,  and then get creative!

Visual-perception, LOTCA, Scorable, Minnesota Rate of Manipulation...occupational therapy labs galore

This morning we had a 3-hour lab on visual-perceptual skills. We had to use Mary Warren's hierarchical pyramid, which starts with foundational skills, then goes to visual processing skills, and then goes to the highest level, visuocognition. We did a ton of different worksheets and experimented with a ton of games to determine what visual skill or deficit was being addressed, what Occupational Therapy Practice Framework intervention approach could be used to treat it, etc. It was pretty tough. A lot harder than I would have expected. I have really incredibly poor visual-perceptual skills, especially when it comes to visual imagery, visual memory, and spatial perception, so I really struggled with almost every worksheet and game!

In the afternoon we had a lab on learning how to use the LOTCA and the Scorable assessments, both of which test some basic skills. We had to do things like sequence the order of what you would do at a laundromat, write out a check, do some basic balancing, find a certain number in a phonebook, use a map to find a location, etc.

This evening, I met my friend Sarah, and brought my OT friend Allison along last minute, to go eat Mexican outside, and to hang out a while! Then I tried to work more on my DVD-picture slideshow for new OT student orientation this weekend, and now I'm writing this. I have a thousand projects to work on but I'm probably not going to do any of it tonight. Again. This is becoming a pattern, hmm!

I found out today I got a 98 on my novel-occupational profile, and I passed the crazy-insane Frames of Reference test, so that is good news! Normally I'd be crushed with a B or C, since I'm all about the straight A's, but that Frames of Reference test was ridiculous (completely unfair in my opinion), so I'll take my C+ or low B (whatever an 88 is - that was WITH a 7 point curve), and run with it!

I'm going to go ahead and write up my handwriting post, and then do a little OT work before heading to bed. Tomorrow we have several breaks and so I think I can get quite a bit done during the day.

Future posts I'm still dying to write and I wish I had the time to do it all right this second but I'll try to get to it soon:
1. Type A+ personalities
2. Cheap OT Toolbox (via video blog)
3. AOTA Student Conclave!! In Pennsylvania in a few weeks! I'll be there! With really dorky networking business card thingies!
4. Minnesota Rate of Manipulation test (OT assessment), normal + blind-folded,  plus crazy Arkansas, California, and Tennessee versions, made up by my OT classmates! All via video.
5. Wow, I'm blanking out...guess I'll think of more later.

Brain Train, Minnesota Rate of Manipulation, and a Good Day

Today was actually a pretty good day. The first good day I've had in weeks, it seems!

We learned about Brain Train in the morning (a computer program that teaches patience, focusing, etc) - had a long break to work on projects - then had a class on the Quality of Life scales and the Minnesota Rate of Manipulation Test (or something like that). Then a class on Group, and then Allison and I went and worked out. I came home and started laundry, did errands, etc, and now I'm finishing laundry, finishing dinner, and then going to settle down and start working on homework. My goal is to finish several different OT-related projects tonight, since we have finals coming up somewhat soon! It's kind of crazy - every time I think we can give a sigh of relief, we end up with new projects! Oh well!

I also got my new camcorder (a Flip Ultra) and my graphics tablet today - it was my birthday present from my parents, which I bought on Amazon. So I spent easily an hour messing with those two things when I should have been more productive. The good news is, I plan to use both to my advantage, and use them for putting on lots more videos on my blog/Youtube, as well as add captions or silly stuff to my pictures! So both new items should enhance the blog experience.

I'm really good at rationalization.

Ok, I need to get my laundry out of the dryer now. I got stuck in rose bushes earlier, trying to get to the laundry area (across the garden in my landlord's house). For a few seconds I was literally unable to move. You can't make this stuff up.

I plan to put up some mini videos within the next few days, from today's Brain Train and Minnesota Rate of Manipulation Tests. My handwriting post will probably be the last thing I do tonight! My handwriting is horrible by the way! I blame my sinister hand!

Clients & body fluids

I've decided it is time to become more coherent! I'm going to stop with the AUGH posts for a while before I scare away incoming or prospective OT students! Just remember, OT school is amazing and so is the profession!

This weekend I've organized my house, organized my papers, organized my e-mails, done errands...well at least did some work in each of those four categories. I also got to play Four-Square today (long story!).

I was going to write about handwriting tonight, and I also am dying to do a post on cheap OT tools, but priority-wise, I've run out of blogging time for the night, and I wanted to address an acute issue! So I guess handwriting/cheap tools will be tomorrow.

Check it out here, I updated one of my old blog posts with the problem - it has to do with clients & body fluids.

http://otstudents.blogspot.com/2007/10/ultimate-irony.html

A hodgepodge of random insanity

So...this weekend I randomly decided (because it was driving me crazy which I guess makes it not so random) that it was time to tackle the re-organization of my clothes, my bookcases, my mudroom, etc...and the net result is that my clean, albeit cluttered, house, has turned into a disorganized dirty house, because I bit off more than I could chew! I have also been doing a ton of research for OT school at an assisted living facility on top of everything else, and I spent several days staying with a kid while his parents have been out of town, so things have been stacking up and/or not been my normal routine. I'm way behind on answering e-mails (sorry all, I'll try to get on top of that asap) I'm way behind on coherency, and I'm way behind on sanity. Definitely having a tough week. So...think good thoughts, I'll try and not go crazy.  Some posts I want to do soon is a post about some great low-price tools for the OT toolbox, and another about handwriting/handwriting tips, based on a recent lecture. Interesting stuff, I promise! And if it's not as interesting as I intended, I'll at least post some crazy picture. So it will be a win-win...

So anyway. I'm delirious. Today my plan is to get my disorganization back into organization, clean, grocery shop, pet-sit, go work on an assessment for OT school on the Routine Task Inventory-Expanded, with another girl in my class, and try to catch up in general with OT work. I hope to write again tonight giving a glowing report on how I've cleaned my house, prepared for the week, and done a ton of work for OT school. But who are we kidding. Tonight's post will probably consist of AUGHing. As is the recent norm. But we'll try for a good day!! Cross your phalanges!

I am not a rote-ational therapist, I AM AN OCCUPATIONAL THERAPIST!!! (student)

So....when on my fieldwork, I talked about how it seemed like we were just "upper extremity physical therapists" when working in inpatient rehab...sure, you see the occasional folding laundry, or unloading fake groceries, but mostly, you see a lot of arm bike, arm pulley, theraputty...I guess that falls under "preparatory methods" in the OTPF, but still! BORING! Tedious! I know those exercises are important for endurance and strength, but we all know it is boring!

So anyway. I was responsible for a treatment plan for a certain patient while on my fieldwork, and I racked my brain trying to think of appropriate activities that weren't just "arm bike!" Merrolee, famed New Zealand OT Extraordinaire, helped me out. She asked me about his hobbies, and I told her he liked to travel. She suggested I bring a big map and have him stand up (we were working on standing balance and endurance), while tracing where he had been on a map. I thought that was a great idea. I looked for a map in my house, but had to settle for a US map puzzle I had bought at the dollar store, years ago. I brought it in, and I had my patient sort out the states by ones he had been to, wanted to go to, or didn't care about. He stood up and started sorting. He talked about the places as he sorted, and it was clear he enjoyed it - and he stood up 3 minutes and 30 seconds, which was the longest - by almost double - he had stood up before.

It was a very good example of how occupation-based activities work a lot better than rote activities!!!!!!!!!!

I hope you all enjoyed this episode of 'Occupation Rocks, Episode 1,3001"

Sincerely,
Karen, MOTS!

I repeat: AUGHHHHHHHHHHHHHHH

Today we had neuro, pathology (joke), a long break, and then a really great lecture from a local community leader who told us how we are in a great profession and helping save souls. In a non-religious kinda sense. And then I went with Allison to go pick up the kid I'm staying with, to find out he had been picked up by his grandfather a few minutes earlier due to him being pushed into a mud puddle. So Allison and I went by his house to check in, then went to the grocery store together, and then I ran home, and in in my unheated 55 degree home I took a shower and got my stuff ready for tomorrow, all within about 20 mins, since I had said I'd be back to be with the kid by 630pm. We went out for pizza & donuts, and now he is sitting here watching Cartoon Network, and I am sitting here writing this! The last few days have been nonstop crazy it seems! And our research project is absolutely insanely time-consuming, so we are even more busy than we normally are. Which is hard to believe. Ugh.

So anyway...I'm kinda stressed out, about life in general, beyond just occupational therapy school...although that's a lot of the stress. And luckily the fires are abating in San Diego.

I did REALLY REALLY REALLY ENJOY meeting my OT little sister, Talli, yesterday. She wrote me a really nice e-mail today thanking me!

I'm gonna write one more mini-post and then work on some homework for a few hours. I feel like every day I finish one assignment and think I can breathe slightly easier, but then professors clarify something or ask something and bam, we have a new assignment. Augh!!!!!!!!!!!!!

Ok...as always...my refrain...I LOVE OT SCHOOL....I just don't LIKE it right now...AHAHHAA...get it...yeah, I'm hilarious. No, seriously, OT school is the bomb....and just like any graduate program, it has its pockets of stress!!!! So go to OT school and let your stress be fueled by glitter crafts and wheelchair wheelies and toolboxes and tons of other really fun things! If you are going to be stressed out, don't you want it to be from fun stuff instead of trying to calculate calculus vectors? If those even exist. I'm not a math person. You won't find a lot of math people in OT. We're all about touchy-feely client-centered stuff. :) Math: Two + two = four. OT: Two + two = ? You can do it! Let's figure it out together!

A long day! Not much else to say!

My fingers are so cold I can barely type! It's like severe arthritis! But I refuse to turn the heat on for a few more days...if I can stand it.

I spent 8 to 1140ish doing research assessments and did not poke anybody in the eyeball, so it was a success. Also, nobody asked what occupational therapy was. They weren't quite at the cognitive level to even be aware that would be a good question! In fact, now that I think about it, I don't think OT is mentioned anywhere in the study! Hmmm, I bet it is and I am just crazy. I will have to go look.

I spent 12-3ish working on an assessment (the Routine Task Inventory-Expanded, part of Allen's Cognitive Levels) with Kerri, and then I met my new OT little sib at 330 and we spent almost three hours together! I showed her the monstrous binders and gave her tips on anatomy and stuff. I emphasized it was tons of fun but a lot of work. Not a huge brain strain most of the time (except with anatomy and neuro!), but very time consuming. She seems to be eerily similar to me in many ways so I'm pretty sure I didn't scare her away. I know that the more information I have, the happier I am, and she is the same way. It was fun! I am going to be spending the next two nights at a friend's house, staying with their 13 year old child while they are away. So I need to go pack to head over there, I will have ten thousand books with me! And my computer better work there (wireless)!!

Tomorrow we have a neuro class, a pathology class, and umm, some stuff in the afternoon, I forget what! Our schedule changes daily so who knows!

I may think of more things I want to share later on today, but for right now my mind is as numb as my fingers.

OT is all about the duct tape...

I am stressed out! We got some bad news about a test we took a few months ago where we failed to show "competency" and it really frustrates me. Long and unfair story. Anyway, I'm also stressed because of a bunch of assignments, some class drama, and the fact that, I don't know, my family and friends are in danger of being fried up in San Diego!

I should be working on my occupational profile, case of marcus, cranial nerve presentation, and routine task inventory assessment, before working at 9pm, but instead, I'm going to procrastinate slightly and share one insight and one quote that I wrote down in my planner from today.

Insight from school therapist Jackie: A trained OT (or really anyone) can sometimes tell who could benefit from OT services just by looking at the art hung up on the halls in an elementary school! I thought that was hilarious and a good point - there is always a few pictures where you can only go "Huh?"

Quote from Jackie's lecture today on school-based occupational therapy: (I might have the words slightly off but I think I got it right): "Occupational therapists are great at making low tech assistive devices. Give us a milk jug and a roll of duct tape and we will get things done!"

Tomorrow I meet my little OT sibling and also we start doing actual research assessments on actual geriatric residents at an assisted living facility, so wish us luck! I hope I don't poke any old people in the eye!

Karen

Update: AUGH!

AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHH

AUGHHHHHHHHHHHHHHHHHHHHH

All you future occupational therapy students, cover your ears. I swear occupational therapy school is wonderful. 99% of the time. Right this moment I'm in the 1% of the time.

AUGH!!!!!!!!!!!!! AUGH!!!!!!!!!!! AUGH!!!!!!!!!!! AUGH!!!!!!!!!!!!!

AUGH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHh


That will be all. More later.

My cortical systems are failing me

Today we learned about cortico-striatial-pallido-nigral-thalamo-cortical systems. Or something similar to that... And we learned about hand skill interventions. And we worked on peripheral nerve injury worksheets ,and learned about falls in the elderly. Sometimes I think (in fact, I'm sure), people look at OTs and go, why in the world are we paying so much to have her swing our child or make him play with play-doh?" Well after days like this I have a lot of scientific sounding answers! And I plan to share these answers (on the generic "why do you have a master's/why should we pay you so much for common sense stuff) soon!

And my research group spent two hours with our professor mentor figuring stuff out.

And then I went to dinner with nine OT girls and two of their husbands/boyfriends, to celebrate my birthday! And I got some wonderful presents!

We went to a great little Mexican restaurant called La Espiga. It was fun and I really appreciated it!! That's the best part about OT school - the wonderful friends you'll make! Oh yeah, and learning how to help people...AHAHAHA just kidding - it is ALL wonderful. Although I'll admit I'm tired and feeling overwhelmed. And that my left eyeball feels like someone is pushing it into my skull. That doesn't really motivate me to study. I may work a little on research and then call it a night! Pathetic I know! Oh, and I officially submitted my Assembly of Student Delegates application! We can't campaign until November though! So I won't go off on a tangent telling y'all how wonderful I am and why I should hold a certain position! Just kidding. :)

It's good to be back in school and to see everyone! Perhaps tomorrow when my left eyeball is behaving and not messing up my cerebral cortex, I will have more to say.

Oh, and today is PATTI's birthday, everyone! She is a new MOT student and her blog is linked on my sidebar!
Oh and my OT "little sib" (incoming class) e-mailed me and she also seems very devoted! This upcoming generation of OTs are going to kick some occupational BOOTIE!

By the way, this might totally get me in trouble, and if I get outraged responses I'll end up deleting it, but I decided the slogan of outpatient occupational therapy should be "More paperwork, less poo." ...because it seems a lot of OTs and/or OT students base their decisions on where they want to work, based on how they handle body fluids!

Happy Birthday to Me! And my twin! Happy Birthday Dear Future Occupational Therapist...

A photo documentary of a budding occupational therapist....haha I'll do anything to pretend I'm staying on-topic!

Age Four

Kristina and I were eating chocolate spaghetti. And we were angels at one point too.

Our first day of school at age 4, and being siamese twins...
My sister and I in DC a few years back, she dressed me up!

Me and Haley after getting TOTA scholarships in Nashville!

I am 25 today! Insane! A QUARTER OF A CENTURY! And obviously my twin is too, she lives in San Francisco!

I am allowed to be 100% off-topic today, seeing as how it is my BIRTHDAY! Woot woot! But I did say occupational therapist like twice!, so that counts for something.

I've gotten a bunch of Facebook messages, a few e-mail cards (including a video of my friend's adorable two year old singing happy birthday karen, happy birthday snail breath...), a few little adorable glass snails, a cool laptop tray, cookies, thank you cards, pencils, Costco cash, and money to buy a graphics tablet, a mini camcorder, and a few American apparel dresses...etc. Yay!

I'm about to go work out and do some cleaning/homework, but other than that, I plan to spend a lot of the day talking to peeps abroad (my Norwegian host family, my friend Doug in England) as well as my family and hopefully some friends!

I start back with OT classes again tomorrow, the fieldwork is over, so I better try and enjoy today as the craziness is ABOUT TO BEGIN! Or rather, CONTINUE!

Someone. Is. Going. To. Die. Miss. OTPF. Is. Going. To Go. Postal.

I've been working on my occupational profile, and I've been doing the cultural, physical, social, personal, spiritual, temporal, and/or virtual contexts that either support or inhibit my patient's desired outcomes. I had gone through three of them and had easily a page done, when my Microsoft Office Word document got an hourglass and stopped responding, which has never happened before. I had to close out and I LOST MY WORK! I LOST MY WORK! I LOST MY WORK! I LOST MY WORK! I am SO mad! SO SO SO SO SO SO SO SO SO SO MAD! AND NOW PARANOID ABOUT LOSING MORE WORK! AUGH! AUGH! AUGH!

Okay. I'm done with my emo rant now. But seriously now. That sucks. A lot. Ok, let's go see if I can remember what I wrote about those first three contexts. Good thing I'm Miss OTPF 2007 or I'd be hurting even more right now...deep breath....

BTW: I held a baby today while volunteering, and the baby was in such an angry state when I walked in (he was in isolation so it took me a while to gown up) that his heart rate was showing as over 300!!!! BPM!!!!!!!!!!!!!!!!! I think my heart rate is 500 BPM right about now! Augh! Augh! Augh!

How to pack for a stay in a rehabilitation hospital

In the last two weeks I've learned a lot about what should be packed for patients who will be staying a while in a rehab facility! The information I give here may vary slightly in different rehab hospitals but not by much!


Short version of How to Pack for a Rehab Hospital Stay:
Pack simple and comfortable outfits, like a slightly baggy sweatsuit (for wheelchair comfort, ease of pulling it up, and/or room for a diaper and/or catheter)
If possible, put an outfit together for the patient and leave it sitting out each night! It makes it easier for the person helping the patient dress
Bring any special toiletries like toothpaste brands, deodorants, etc - make sure the patient won't run out.
Bring fitted diapers if needed - the elastic underwear ones
Bring some pictures, flowers, balloons, cards...anything that gives the room a personal touch and reminds the staff (and patient) this person is LOVED and REMEMBERED!

UPDATE: My friend Burt pointed out that stenciling your name into ALL items brought into the hospital is a really good idea! Things DO get lost!

Long version of How to Pack for a Rehab Hospital Stay:
WHAT TO PACK FOR A STAY IN A REHAB HOSPITAL/WHAT TO CONSIDER:
The patient will be given a basin for basic washing (and should have access to a shower at some point in the day), as well as some basic toiletries as needed, like a comb and toothbrush. The patient will have on a basic gown and may have the possibility of being double-gowned or given paper scrubs, but it is by far best to have the patient's own clothes. I recommend you have basic clothes that can be mixed/matched, and that are very comfortable to have on while in a wheelchair all day. If possible, sweat pants are good - the patient may end up with a diaper and/or catheter and could use the extra room in the pants. Plus, sweatpants are easy to put on, even with one hand. If you are visiting daily, consider putting an outfit out for the next day. Otherwise the patient and therapist or nurse have to spend time figuring out what to wear, which often involves the patient pondering a while or having to direct the therapist/nurse in finding exactly what he/she is talking about. I can't tell you how many times I had to unzip suitcases or root through dirty clothes trying to find what the patient was talking about. The patient will probably be given socks that have traction stickies on them, but will probably also be wearing compression stockings for a while. Consider bringing a pair of sneakers and some socks, just in case or for when the patient doesn't have to wear the stockings anymore (it's usually based on their diagnosis or how far they walk - it is to help prevent DVT). Also have a basic toiletry bag with any special toothpaste, special brushes, special makeup, special deodorant, special anything, since the stuff provided by the hospitals will be cheap and generic. AND - it seems most patients in rehab hospitals are in diapers. The diapers provided by hospitals are usually generic wrap-arounds like the ones used on babies. Consider buying the type of diapers that have elastic in them and can be pulled up like underwear. Patients seem to really prefer those. Buy a lot!

Consider bringing in basic candies/snacks if the patient can tolerate them/is not diabetic. Also, I cannot stress this enough - pictures of your family or the patient - as well as signs of outside presence like balloons or flowers or cards or even just writing on the bulletin boards- is really, really helpful, in an indirect way. I think it may sometimes be easy for rehab staff to forget that this patient is a loved person who was not always as low-level as he/she may currently be. While I never saw any instance of a nurse or staff member being mean or unhelpful to a patient, I think that those patients who had that extra touch, helped remind us of their "real" life. At least, that was the case with me! When I would see a patient who seemed barely able to function and was hard to understand, it was only those pictures that helped me realize this was a loved being with a family and a history that far exceeded that of which I was currently seeing.

Moving on. The patient will probably be woken up in the morning by either a therapist or nurse to do some basic washing and grooming, before being taken to breakfast. The patient will then have a combination of OT, PT, and possibly speech, along with breaks, until around 3pmish. Books or other ways to pass the time - playing cards, magazines, etc, would be appreciated. Don't forget to write a thank-you card for all the staff when the patient leaves, if you think they did a good job. Even just a simple "Thanks for all your hard work!" on a sheet of printer paper can boost morale. Overall, I felt like all the rehab staff at my hospital did a great job of being compassionate and caring!

I wrote up this list because it seemed to me that a lot of families would pack slightly differently if they knew what I mentioned above. Keep the toiletries and clothes simple, keep the clothing comfortable, keep whole outfits easily at hand, and provide personal touches like flowers, cards, balloons, messages, or taped-up pictures.

Final day of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

I had fun today. I got to treat my patient alone and wrote his note without a single correction needed. I made him make slugs and porcupines with theraputty and pegs, among other things. I assisted others as needed w/o problems. I helped out my therapist with a really low-level TBI patient with lots of wounds/fractures. I said goodbye to patients and they were all very sweet about my departure. My supervisor gave great feedback to me on my required forms and said the biggest thing was to work on assertiveness, but she also felt that would come with time as I gained more confidence in what I was doing. I had a good time with her. The afternoon went by equally quickly and nicely, with no problems at all. I feel like I've gotten proficient in basic wheelchair maneuvering/leg-attachments, how to replace oxygen from the room to the tank, where to find all your basic comfort things, how to assist a patient in ADLs in the morning, basic transfers, basic insurance knowledge, basic chart reviews, basic evaluations, etc. A lot of knowledge in just two weeks!

The Ultimate Irony - with an update

A patient with a TBI (traumatic brain injury) trying to flirt with me and telling me that I was a beautiful woman. And then me helping change his poopy diaper.
=========================

Update: I got two e-mails on this post. One was written by a person with spina bifida, and the other person was a TBI survivor. Both weren't thrilled with the tone of this post.

You know, I keep making this mistake...I write something that my friends/family might find either amusing or at least not think twice about, but then I hear from people who have the diagnosis/similar problem, who are offended by what I said. You would think I'd have learned my lesson by now, but apparently I haven't. I'll keep trying, I promise. It's not so much that I lack compassion so much as I'm still learning to remember to try and see things from the client's point of view.

Another Clarification: - "irony" is probably the wrong word to use in regards to the above situation, because it makes it sound like I'm saying it's ludicrous for an incontinent person to flirt. That is not the case at all, and it wasn't what I meant to imply. I guess I found it ironic that even a man who was extremely confused and incoherent, covered in tubes and barely able to move, functioning at a very primitive level, would still even have the presence of mind to say flirtatious things! It shows you how little it takes for testosterone to kick in!

Also, both men pointed out how humiliating it can be to have your diaper changed, which I would completely agree with. I can't imagine how it would feel if I had to experience that. So I can see why, as a TBI survivor or someone who has had to deal with this, it would be hurtful to discover that people wrote about how much they disliked it.

One of them pointed out that it can be taken as offensive that I showed strong distaste regarding dealing with body fluids. I apologized, because I could see the situation from his point of view. However, I am also a student, new to fieldwork and only just delving into the world of adult diapers or other body-fluid related things. The average adult walking around, has little to no experience dealing with such things. I think it is natural that I would find it difficult to deal with for a while. In the two weeks I was on fieldwork, it got easier and easier to handle seeing and/or changing diapers, and I know eventually it will become commonplace, and I won't think twice about it. But for right now, it IS something that affects me, and while I don't plan for it to affect me forever, I do think it's okay to bring the topic up. I just need to do so in a less offensive manner!

I appreciate that the men were willing to share their viewpoint with me. It was yet another good lesson on awareness and understanding. I originally told them I'd just delete the post, but I realize it's better to just add on this update, explaining what happened and why - as perhaps others can learn from my (repeated) mistakes.

Medicare Therapists

I got a comment on a recent post where I talked about struggling about working with a geriatric population in a rehab hospital . Aine left a comment saying "But during my years in management, I supervised many therapists who struggled with the role of therapy in that setting. We used to divide ourselves into "medicare part A" therapists and "medicare part B" therapists. In other words, some didn't feel comfortable or competent with the long-term population (med. B patients) and only felt effective with the med A patients (those in for short-term rehab before going home)."

I thought this was an interesting way of looking at it!

I'm watching Grey's Anatomy and making sure a tornado doesn't hit Memphis (it never does) while also working on my patient's occupational profile, playing online, and eating pudding. Talk about multi-tasking?

Day 9/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Day 9/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Today started out a little rocky but ended smoothly. We got several new patients to eval, and they were all low-level, so there was going to be triple-booking and times when I would ideally treat a patient alone, which isn't technically allowed. I was nervous because I do not feel confident in my ability to handle transfers or anything alone. It ended up working out. I helped one of our "regular" patients with ADLs,  and assisted with evals as needed. One of the patients was in a motorcycle crash and VERY low level, so it was exhausting for the OT, PT, and PT student to deal with that patient. During that hour I was treating my patient, with another OT in the gym keeping an eye on me. We stuck mostly to arm exercises and didn't do a lot of standing so that the potential for problems was minimized. I used an idea that Merrolee gave me, about trying to be more occupation-based, to work with my patient. He is working on standing balance and endurance, and I've been having him do tabletop fine motor activities to distract him while he stands. I knew he liked to travel, and Merrolee suggested pulling out maps and letting him trace where he has been, or something along those lines. I searched around my house but apparently didn't have a US map. I did have a US state-puzzle from the dollar store, though. I brought it with me and had him stand up, then pick up the state puzzle pieces and make a pile of states he had been to, states he wanted to go to, and states he had no interest in. It got him thinking about his past and his adventures, and he stood up longer than he ever has before. It pretty much rocked. I didn't make him do anything crazy with theraputty today, although tomorrow I plan for him to make slugs and porcupines. Slugs meaning he will make long skinny rolls of putty, then stick pegs in for eyes. Porcupines - round balls with tons of pegs. Good for hand strength and endurance and also slightly more amusing than just rolling it back and forth forever.

I also got this great idea for getting mini armadillos and stuff and throwing them around the hall, then letting him run over them with his roller, to make roadkill, just like he would in a RV. Am I amusing or what? I'm totally kidding. But the thought did cross my mind.

I ALSO had this great idea that perhaps tons of other people already know, but I thought about putting some bubble wrap (on some dysem so he won't slip) underneath his non-weight-bearing foot, for sit-to-stand transitions. The point is to NOT pop any bubbles while standing up, with that foot. Many people have a tendency to put weight on the affected foot when standing up, so this would provide some feedback. Maybe it won't work, or maybe it's been done. Whatever, I'm proud of my idea.

I've been trying really hard to make sure the patients know I respect them, I will be gentle with them, and I won't treat them like a piece of meat. I will also be respectful of their feelings and not just randomly start wheeling them backwards or something without giving them some feedback on what I'm doing/why. I also look them in the eyes and smile. I think it is paying off. Today I took an older woman back to her room, who has a ton of problems. She speaks very slowly and haltingly, with exaggerated yet imprecise mouth movements. She can be hard to understand. I put her back in her room and made sure she was ok, and she said "I...like....you." I was like awww! I like you too! That REALLY made my day.

Overall, I'm enjoying this rotation now. I don't know if I'd want a job in such a place, and in fact I'm pretty sure I wouldn't, but I am getting to appreciate my patients a lot more now.

One patient today, who we were evaluating, had no teeth and tardive dyskinesia, and she was VERY hard to understand. My OT asked her to repeat herself and she said "You...have...hearing...problems." AHAHAHHAAH

I also got to see pitting edema today! The patient had nicked herself somehow and edematous fluid was steadily dripping out, TONS of it. It was gross but cool to see!

Hmm...that's about it for today. Tomorrow is my final day of fieldwork! And Sunday is my birthday! I'll be 25! Wow! That is crrrrazzzzzzzzzzzzyyyyyyy.

Day 8/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

Day 8/10 of Adult Physical Dysfunction Level I Occupational Therapy Fieldwork!

I've been hearing some hilarious stuff lately! I had one patient (CVA) tell me she was brought to the hospital just because she was extremely constipated! I had another one tell me that me and my OT supervisor were "twins". I've also been hearing stuff broadcast over the nurse station speaker from the call button - things like "I need to go Number Two Extremely Urgently!" - or "I need help! I need EVERYTHING!" -  okay, that's not funny from a patient perspective, but it's funny to overhear it! Another patient asked my OT supervisor to "unimpact her". And it seems that, almost universally, patients call us "Nurse" or refer to themselves as being in "physical" therapy.

I would actually say I had fun today! I'm officially retracting my soul-sucking statement from last week! I was able to help with transfers, assist with multiple patients, treat my own patient with some different things, etc. I left a note on one patient's bed who was being discharged today that said "Hi Mrs. ___, we'll miss you! - The Twins, Karen and Supervisor" with a really bad picture of us playing balloon volley and the kitty puzzle with a missing piece. She appreciated it! LOL.

Today I got there a little bit early (around 6:50am) to do some brainstorming. I flipped through my ENTIRE textbook of "Occupational Therapy for Physical Dysfunction" by Trombly this morning, to try and see if I could find anything that would be helpful..nothing screamed out to me though as a treatment activity for a patient who has a hip replacement, touch down weight bearing status, bilateral shoulder arthritis causing limited range of motion, and hand arthritis.  I'm tired of therabands and arm bike and arm pulleys! It seems like such a cop-out! I know it is necessary but still! So today we did the arm rickshaw which works triceps, shoulder flexion stretches using a bolster on an inclined table, standing up four different times and doing a nut-bolt activity and a wooden colorful puzzle activity, and then doing some theraputty exercises. I made him pick little objects out of the theraputty, which is pretty typical, but then I forced him to make little balls and stick pegs in it, ie cupcakes with candles...he thought I was crazy but he was a good sport and went along with it! I just am trying hard to think outside the box! I definitely don't know what I'll do tomorrow! Guess I'll get there early and brainstorm again by staring at the shelves of random stuff!

My favorite thing in the world right now is smiling at a patient and having them smile back! Sometimes it is a sympathetic smile, sometimes it is an ironic smile, sometimes it's a genuinely happy smile...whatever the reason, I LOVE having that smiley connection! I think a lot of these patients don't get smiled at enough!

Another huge thing to me right now is learning that phys dys is NOT magic! It all is starting to make sense! Even things like changing out catheter bags doesn't seem so crazy anymore. I'm figuring out how to charge insurance, do chart reviews, do evaluations, write progress notes, etc! I'm not as scared about my Level II three-month rotation at a rehab hospital anymore! Also....here is a tip to all you current/incoming students....it might seem a little bit overwhelming when you are learning little nitpicky details about how to do manual muscle testing or goniometry on tiny areas, while in school...but it is very likely you will never do any of that in a normal rehab hospital or job! Insurance typically just wants to know, grossly, how that patient is functioning. You can typically eyeball range of motion, and just do huge muscles for manual muscle testing. It's easy! So learn it just in case you get a job in hand therapy or orthopedics, but probably you won't have to memorize nearly as much as you think! Don't be scared!

I will be glad to get back into my "normal" school routine, crazy as it is...but I plan to enjoy my last two days of fieldwork!

Days 6 and 7 of Adult Phys Dys Level I Fieldwork in Occupational Therapy

10/15- Monday

Today went smoothly. I was tired after the weekend conference though! And my patient that I was following, was suddenly discharged this weekend because his family decided to take him home! So I wrote up a week-long treatment plan for nothing! Oh well! You have to roll with the punches! So I got a new patient of my own, who had a total hip revision! I need help thinking of occupation-based, minimal resources needed, ways to work on improving his standing balance, standing endurance, general weakness, etc. It's hard! I forgot to journal this Monday so I'm writing this Tuesday, and it's honestly hard to think of things that happened yesterday! The days run into each other when you see the same patients and do roughly the same things every day.
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10/16 - Day 7/10 of Adult Phys Dys Level I Fieldwork in Occupational Therapy

Today went pretty smoothly. It started out normally. We did ADLs (activities of daily life) with patients from 7am to 9am. Most of our patients were already dressed and ready by the time we got there. That is actually somewhat of a pain, because each patient needs 1.5 hours of OT a day (6,  15 minute, units), and typically two of those units are used for ADLs. If patients don't require assistance, we have to figure out if there is a way to sneak them in later, to get in all their required therapy! However, for me personally, I like it when they are already dressed, because there is less likelihood to see nakedness and potty parts! If you know what I mean! Today I saw a woman empty her colostomy bag and it was REALLY gross looking. She was very casual about it though, and so was the OT, so I was impressed with both of them. I am good at keeping a poker face but it still grosses me out!

At 9am I got to treat the patient I am following. Denise was nearby and would help if needed, but I was in charge. I'm going to admit to y'all, I was NOT occupation-based. I know we are in school right now learning that the whole point of OT is to be occupation-centered and to not be "upper extremity physical therapists". But guess what - in an inpatient rehab gym with limited resources and limited time, and/or low functioning clients - it's all about the therapeutic exercise, which I guess counts as preporatory methods. We did stuff like the arm pulleys, pulling items out of theraputty, hip precautions education (no internal rotation, no adduction, no bending past 90 degrees, etc), and then some standing, while doing tabletop fine motor activities. It's really nerve-wracking to me, dealing with the patient and the wheelchair maneuvering, and especially taking on and off the leg rests as the patient moans in pain! I think I'm doing okay though! The patient is very patient with me! Haha I kill me. Ok, anyway.

We saw all our normal patients - I did a lot of transporting and a lot of stand-by treating. I wrote the note on my patient and I was so proud. Unfortunately a lot of the medical shorthand isn't transferable to computer, but it's basically stuff like "Patient seen in am for adls. Patient seen in am for approximately 1 hr of therapeutic exercise, standing balance tasks, and education. Patient performed approximately six minutes on the arm bike, with three to four rest breaks. Patient has fair+ endurance. Patient did this. Patient did that. Patient c/o p! 2 B shldr arthritis. (Patient complained of pain secondary to bilateral shoulder arthritis)  It's pretty cool writing notes! And seeing patients! I had slept well last night, but had a lot of bad dreams, including one where I cried constantly, so I was feeling a little bit jittery/nervous today. Luckily everything went okay. One of the patients cracks me up constantly. She literally makes me laugh out loud with the things she says. She and I were working on a 100-count kitty puzzle while working on her standing endurance/balance, and at one point she said "I hate you kitty!" while trying to figure out a certain piece. Also, we finished the puzzle and one piece was missing, and she said, "This kitty is missing a body part. It should come to therapy, that's where they get help".


Overall it was a normal day. I don't feel like my soul is being sucked out of me anymore, but I do feel regularly nervous. I'm an anxious person and it FREAKS ME OUT to not be in control or know what's happening or not know how to help someone! So I still wait eagerly for the day to end - which I didn't do in my pediatric rotation - but everyone is really nice and helpful!

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TOTA Conference 2007

I attended the Tennessee Occupational Therapy Association (TOTA) Conference in Nashville this past weekend! It started at 8am with some basic election information and scholarship announcements! Haley (a fellow student on the Chattanooga campus) and I each won a mini scholarship! It was very exciting and very much appreciated!

We then started educational sessions! You could either do the 9-5 Sensory Integration session, or do two shorter sessions - one on AgrAbility (farming) and one on spirituality! I chose to do the two shorter ones. There were also many vendors there with information and free stuff (YAY MY FIRST GAIT BELT YAY!), as well as lots of opportunities for networking, and yummy food! The next one is in Dickson, TN and y'all better go if you are in Tennessee! Or I'll hunt you down and beat you with a stick. Moving on.

The three-hour session on farming was really interesting. It talked about how farming is one of the most hazardous occupations, and that many Tennessee farmers experience injuries or illnesses each year that can affect their ability to continue farming. Seeing as how there are so few farmers left, it is in our vested interest to keep them healthy and productive!
The Tennessee AgrAbility Project is the state version of a national project, aimed at helping keep disabled farmers leading productive lives! Occupational therapists can help by helping farmers modify equipment (or at least making suggestions), figuring out ways to make the task easier, figuring out ways for others to contribute, etc. Basic problem-solving, typical of an OT, only geared at farmers! www.agrAbility.org for more information! (Quick side-note: My friends are members of Slow Foods Memphis, and this organization is all about supporting local farmers! I am suggesting the two organizations do some hooking up! Also, I'm now a famous chicken - Karen, the eponymous (?)) Dorking chicken, had her debut in Edible Memphis Magazine! With a picture and everything!)

The second, four-hour session, was in the afternoon. It was called "Spirituality in the Clinical Context" and it was run by Chaplain Patrick Whiteford, who works at the local VA here in Memphis, TN. I learned some pretty neat stuff in that session as well! We discussed the differences between spirituality and religion (my own definition: religion is spirituality with boundaries), and how as clinicians we should be willing to discuss spirituality with our clients, if we truly want to be as holistic as we say we are.

We talked about the seven core spiritual needs: dignity, power, freedom, meaning, love, rest, and celebration.

We talked about "loss of the assumed world", where everything you knew and trusted to be true, is shattered in an instant - loss of a limb in a car accident, etc. We also discussed the "ministry of presence", which is essentially how it can be therapeutic for someone if you are just sitting there, listening - being actively present.

My own tangent: Do you know how sometimes you are on a long road trip with someone close to you, and you will say things to that person while staring ahead at the road and driving, that you would not otherwise be willing to reveal? I feel like OTs are sitting in that car - you are occupying the patient and distracting him/her, and he/she is able to bounce things around in their head and reveal things to you that he/she wouldn't reveal to a family member, doctor, or even a psychologist. Probably the most important thing we OTs can do is listen - not be judgmental or offer advice, but just listen. Usually the patient will figure out their own storyline based on their own spiritual/religious beliefs.

We also discussed three spiritual assessments - F -I - C - A, HOPE, and 7 x 7. The Hope is probably the easiest/most relevant to OT. It asks questions such as "What sustains you and keeps you going?" "What are the sources of hope, strength, comfort, and peace?" Etc.

The main point was, OTs should be willing to discuss spirituality/religion with their patients, in a nonjudgmental or controversial manner. It may make a difference in that patient's treatment. Be client-centered and holistic like a good OT!


Hopefully pictures will come soon! I am waiting on friends to e-mail me some!

I half-won a TOTA scholarship!!!

Guess what!!!!!!

I half-won a TOTA scholarship! I guess I technically won a full TOTA scholarship, but two of us students got one, which I think is unusual, so we each got $550 to go towards our tuitition! So I am calling it a half one! I am really excited and happy and pleased about that!

Conference was great and I want to give you all details. Unfortunately I am sooo exhausted. I drove to Nashville Friday afternoon, got up early Saturday and had conference all day, got home 6ish, dozed from 7pm to 9pm on my friend's couch, slept 9pm to 11am...so almost 14 hours of sleep...but am still exhausted from this past week.  I fatigue ridiculously easily! I have chronic fatigue without the syndrome!

It's 9:20pm - I got back in town mid-afternoon, unpacked, met friends for dinner, came home and unpacked some more...and I haven't taken out the trash, done the dishes, prepped for tomorrow, washed my hair, put together my new laptop tray, finished unpacking at all, dealt with my ten thousand e-mails and online things to do, etc etc. And I just realized a few minutes ago that I had not done my treatment plan for my patient for the week - so I have to do that now. That makes me almost want to cry because I am so tired that I just want to sleep! I'm going to work on it until 10pm then go to bed. Ugh. So...I did have a fun time at conference, and I have enjoyed getting so many e-mails from OTs and OT students recently...and I will post more details about conference, hopefully tomorrow night. My wish for the night is that tomorrow afternoon I will have the energy to do all the things I did not do tonight! And my other wish is that I'll be a little bit more coherent tomorrow since I just reread what I wrote and I sound like I need some Ritalin!

So...YAY on the scholarship!!!!!! More tomorrow!!

Day 5 of Phys Dys Level I OT Fieldwork + TOTA

I am writing this from Nashville! I left the hospital at noon to get here at a reasonable time for tomorrow's Tennessee Occupational Therapy Association conference - avoiding Friday rush hour traffic, and no night driving, since my night vision is NOT good! I am exhausted so I hope I can go to bed really early tonight! I am staying with some good friends of mine so that helps, money-wise!

Yesterday, I said this rotation was sucking out my soul. I also got a really interesting comment on that from an OT who used to work with a geriatric population. I'd share it but I am on a guest computer which is awkward/frustrating, so I'm only doing a bare minimum the next few days! Well, today was a much better today. All our patients were in good moods, and our slowest patient was already dressed and funky when we checked on her. I walked in on my OT wiping the bottom of one of the patients and it didn't even faze me. I got to semi-treat several patients with my OT standing right there. Also, one of my favorite patients had several visitors (her son and daughter-in-law) - I got to encourage them to watch her therapy, and explain to them why we were doing what we were doing. Unfortunately we were doing therapeutic exercises like thera-band and arm bike ("upper extremity physical therapists", so I couldn't really brag about the whole occupation-based part. I really felt like the patients were okay with me and that they could see I was trying to be gentle and respectful with them. I try really hard to warn them when I'm about to wheel them backwards, because I know it is disorienting to not see how you are being moved. Not to say I don't fumble with their wheelchair leg rests or bump their foot against something a little, or say something correctly, but in GENERAL, I did not feel like my soul was being sucked out, and I felt like I could maybe actually get good at this eventually! I feel like I have already learned a TON in just a single week. It's amazing how much you can learn, so quick.

I'm learning an easy way to put compression stockings on patients with serious edema next week, and I'm going to try and continue to become more wheelchair proficient. I've gotten good at putting on/off the leg rests and stuff - simple to so many, but for me it was hard!  I know how to re-connect oxygen tanks and swap them out as needed. I know how to help patients push off from their chair and not their walker. I also can handle a basic occupational profile and/or evaluation, where you do some basic gross manual muscle testing, proprioception testing, sensation testing, etc. Well, bragging about it here, I realize it all sounds really simple and easy, but those are skills I hadn't practiced much, and I'm proud of them! I just did an OT evaluation on my friend! Because I'm a dork! Woot!

I am excited about conference tomorrow, and I am also not as scared about next week of my phys dys rotation! Like I said earlier, I'm at a friend's house on a guest computer, so it's hard to maneuver...I really want to update several posts but it will have to wait until at least Sunday! AOTPAC gave me permission to print their letter in entirety, plus I got a ton of e-mails recently from new students with various questions, so I want to deal with all that Sunday too!

Thanks to all the kind comments I've gotten recently - they really mean a lot to me and boost my spirits, and it is encouraging as well! Please don't be shy to e-mail me anytime!!! I am not always quick to respond though, depending on how projects are going at school!

I'll probably post tomorrow about how TOTA conference went and if I got a scholarship or not! Don't forget those good vibes!

Day 4/10 of Adult Phys Dys Level I Fieldwork

Well, I'm now at day four of ten. I'm trying to keep an open mind, but in all honesty, I feel a little bit like my soul is being sucked out of me! I count down the minutes until I can leave. It's not that I don't think phys dys rehab is important or that I'm not learning things- it's just that I'm "sensitive", and constantly having to tell confused geriatric patients that I can't do X, Y, or Z, really, really, really wears me out and makes me sad. Every second that passes is another opportunity for me to NOT be able to help a patient with their request! I know I'm just taking things personally and maybe with time I'll get used to it, but for now, it bothers me a lot!!! A lot a lot. A lot.

Requests:
Okay: Will you get me another blanket? Not okay: Thanks for that blanket. I'm still cold. will you get me three more blankets?
Okay:Will you get me a cup of water? Not okay: They take away my water! I'm thirsty! Am I in a prison? Give me some water! (to a person on fluid restrictions)
Okay: Will you dial my daughter's number for me? Not okay: Will you go look up my daughter's number in my medical chart,  then call her, and then let me talk to her for three seconds and then say "Here, the nurse wants to talk to you".
Okay: Will you wheel me to the dining room? Not okay: Will you take me back to my room so I can shift around and take off my security system off my wheelchair that prevents me from slipping out, and then bring me back?
Okay: Take me to therapy. Not okay: Take me to therapy, but first help me change my diaper (while I'm alone in the room).
Okay: I'm doing arm exercises, wow this is hard! Not okay: OMG OMG OMG THIS IS SO INSANE AND HARD OMG LOOK AT ME ::flails arms dramatically, then bursts into tears:::
Okay: Oh no! My water cup dropped into the sink! Can you rinse it out for me? Not okay: Go track down my nurses and get me another pink cup, this one touched my running water (when this is like the person's fifth plastic cup)

I know that these patients have valid concerns and that it is agitating and scary to be in a rehab hospital with a ton of strangers. I know it's hard for the patient to understand the difference between the job descriptions of OT, PT, SLP, LPNs, RNs, MDs, etc. I think some of these patients have a lot they can teach me. But I just can't handle the constant "no, no, no, no, no, no I'm sorry"!! I feel like the therapists/nurses willing to work in rehab hospitals are saints - I just don't have the patience or desire to work with a geriatric population! Everyone has their strengths and mine is not in geriatrics!

Today I got to see the same patients as the last few days, and we did similar exercises. There is a lot of transport from one place to another, ADL work, and therapeutic exercises. Each day I'm able to have a little bit more responsibility. Tonight - and this scares me - I need to write a problem list for a particular patient. Tomorrow I have to interview him to do a mini occupational profile. It's a little difficult to understand his answers since he has no teeth and mumbles! But also, I have to come up with treatment plans, and for my final six days, I'll be the one treating him for an hour and a half today! I mean, my OT supervisor will be standing next to me and I'm positive she'll end up doing stuff/assisting...but I'm at the very least in charge of planning his treatment. I'm trying to figure out some occupation-based stuff! Scarrrrrrrrrrry!!! Augh!!!!!!!

I need to go - I'm leaving for TOTA conference in Nashville, tomorrow,  right at noon straight from the rehab hospital, and I still need to pack, deal with some projects, etc etc. Plus I'd like to go to bed kinda early since this whole getting up at 6am stuff is not so cool! Damn the real world!!!

One last thing - to the person who left me a comment about being a fan of the blog and enjoying learning about fieldworks - thank you! Your comment really, really, really, meant a lot to me, and boosted my spirits. Don't be anonymous though -e-mail me or something so I know who you are and we can chat more!

Day 3/10 of Adult Phys Dys Level I Fieldwork

Today was a tiring day! It started at 7am with the ADL rounds...helping people get up, brush their teeth, hair, bathe, etc. I saw more private parts this morning than I think I've seen in my entire life! It seemed like many of our patients were anxious/depressed/agitated today. It really hurts my heart to not be able to help with the cause of their agitation, because typically it is not something alleviated by occupational therapy! In fact, it is often something that can't be helped, period.

Today I got to help with transporting patients, swapping out oxygen tanks, and standing by as patients did their therapeutic exercises! I also got to see a Modified Barium Swallow Test (the SLP invited me)! It was pretty cool watching food go down a throat in real-time! The SLP and I talked about how school always makes things sound like there is always a black & white answer to ethical/moral dilemnas, when really there is almost always shades of gray!! Rarely is life black and white.

I made an old lady cry today, although it wasn't really my fault. She was pretty crazy and dramatic and I did something minor that caused her to burst into tears. I rubbed her back helplessly a few seconds, but that was about all I could do!!

I went into this fieldwork thinking I'd be tested on manual muscle testing on little joints like the DIPs, spinal cord injury levels, goniometry of every joint imaginable, etc. It turns out that in the real world, insurance doesn't care about such things. Insurance just wants a general idea of how strong the patient is - some muscle testing of major muscles (don't let me push your arm down!), a little bit of sensation (where am I touching you?) and proprioception testing (am I moving your arm up or down?), a little bit of history (do you live in a one-story house? Who lives with you?), bam, there is your occupational therapy evaluation!

I don't really have a lot to share about today, that doesn't possibly violate HIPAA. I know I say to be open-minded, but for me personally, I can tell already that adult phys dys will never be a passion for me! I do enjoy following my OT and I have learned a lot from her, and I am glad I am having this experience. However I'll be glad to get back to my normal school routine, I am a creature of habit.

Friday I get off at noon so I can go to TOTA Conference. I am excited! I think it will be great! I got some "business cards" today at Kinkos, just basic ones with my name, email address, school, website etc, to have handy while networking. It's such a pain to write information down repeatedly on little scraps of paper! Yes, I'm a dork.

Overall fieldwork is fine, not too hard, not too easy!

Ok it is already 9:40 and I spent several hours enjoying dinner outside with some friends, but now it means I need to hurry up and prep for tomorrow and get to bed! Gotta be up extra early!!

Level 1 Fieldwork Adult Phys Dys Day 2!

I started out the day a little scared, after reading Merrolee's comment about how it can get really hot when observing showering and it might make you feel faint!! After my experience with a really hot room for burncare and almost fainting, I didn't want to repeat the experience!

I got there around 6:45am and I was supposed to park in this really far away and empty lot. In the dark. I parked, saw a man walking near by, and went noooooooooo, turned on my car, and parked in the normal parking lot. Around 7 we started our rounds of helping with ADLs (activities of daily life - like brushing teeth, bathing, combing hair, dressing, etc). I was a little bit nervous - I'm not really comfortable around naked people or toileting activities! Plus I couldn't imagine the patients themselves would be thrilled with an extra stranger watching. I tried to be as discrete as possible, like kind of not just staring directly at the person while they were in the middle of more intimate acts!

Then we just had typical patients, most of whom we had seen yesterday. Several of them were complaining of nausea and pain, which my OT said is not that common, actually. Some got out of therapy. Others complained, but were willing to attempt it. I got to help today with things like pushing the wheelchairs, encouraging people during upper extremity exercise group, sitting with patients while they did things like upper arm bike, sanding (pushing) exercises, etc. It was fun, a little scary.

The part that got to me most today was just helping people get dressed! It was torture to watch. It is frustrating to only be able to use one hand/one leg! (Like in the case of a stroke). There are certain tricks to making dressing easier. For example, when putting on the shirt, you put the affected hand in first. When taking off a shirt, you take the unaffected hand out first. When putting on pants, you put the affected leg in first. Etc. You can also cross your affected leg across your unaffected leg to get the pants started. It's still not easy though.

I like to understand everything that is going on, and I maybe ask too many questions. I hope I'm not completely driving my OT crazy!
Day 2 was fine, but exhausting. This 7am to 3:30 stuff with people, nonstop,  is hard to get used to. I know it's the real world, but it is both physically and mentally exhausting. Mostly mentally - dealing with new people, mostly people who don't particularly feel like doing anything, all day long, is hard on an introvert like me!! Yes that's right! I'm actually an introvert! Shocking I know!

Ok...I'm prepped for Day 3. I only need to get through until Friday afternoon...then I get to leave for TOTA Conference in Nashville! Then only one more week. I guess it will fly by, but right now it seems slow!

AOTA, AOTPAC, _OT Associations....jklmnopqrst

Caption: Julie and Anna wearing the OT hoodies they got at AOTA conference in St. Louis!

Some of you may wonder sometimes why I'm so rabid about exposing the wonders of occupational therapy to the masses. Part of it is because I really just think it's amazing and want everybody to know!! But another reason is that occupational therapy is a threatened profession! Occupational therapists could go extinct if we don't have people watching out for our interests!

This is where AOTA (American Occupational Therapy Association), the AOTPAC (American Occupational Therapy Political Action Committee), and your state OT associations, come in. They protect our investments in the career of occupational therapy. They are constantly monitoring political issues that may affect the future of occupational therapy. They also serve as advocates, and just in general serve as our mother hens of the OT world! They want their little OT babies to stay safe and happy!

AOTA, AOTPAC, and your national state associations (in my case, TOTA), need the support of the occupational therapists as well, however. It's a two-way street - they can't support us unless they get some support themselves. That is one huge reason it is important to be a member of your state OT association and national association. The benefits you get from such a membership (networking, access to invaluable resources, etc), more than make up the cost. It's especially cheap to become a member as a student!

While these associations can always use financial support, it's just as important, if not more important, that their members stay aware of the political/legal issues affecting OT. For example, it may not seem like a big deal if physical therapists ask for a little change in their scope of practice...well, it IS a big deal if it means that they can encroach into the occupational therapy's scope of practice!!

Today I received an e-mail from AOTPAC, discussing "Medicare Issues Ignored by Congress!" It includes a possible therapy cap and negative changes in the fee schedule. These two things could seriously handicap OT as a profession.

The following is a quote from the e-mail:

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Help your clients get the OT services they deserve, protect your rights to appropriate payment from Medicare, and stand up for your profession!

Contribute to AOTPAC today. It is the legal and authorized way to participate in the political process and support those who support occupational therapy. AOTPAC's Board of Directors decides how best to use your contribution to have the most impact for occupational therapy legislative issues. Be part of that process! Make your contribution now and defend occupational therapy!

Make your contribution on-line via the secure AOTA Web site at: http://www.aota.org/aotpac or mail the attached form with your check or money order payable to AOTPAC.

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They also ask that you visit the AOTA Legislative Action Center and send an e-mail to your Members of Congress about these and other important issues!

Thanks for sticking around for a "heavy" post. I am definitely not the most political person, but I think we need to remember that we owe a lot to our national and state associations and political action committee!

Update: Here is the full e-mail, I got permission to use it, with one caveat. AOTPAC by law is not allowed to solict individuals who are not AOTA members, if you are not a member, please disregard that portion of the e-mail!

Subject: Medicare Issues Ignored by Congress!
Dear Colleague:
Congress cut critical corrections to the Medicare program from legislation in September, posing a serious threat to two issues essential for occupational therapy. Medicare caps on occupational therapy will go back in effect on January 1, 2008 unless Congress acts this year. The Medicare fee schedule will be cut nearly 10 percent in 2008 if no action is taken.

Fixes for the therapy cap and fee schedule were stripped from the State Children's Health Insurance Program bill. AOTA worked hard and long to get fixes included and now we must continue to make sure Congress takes action NOW. Without your contribution to AOTPAC and your letters to Congress WE CAN’T BE SUCCESSFUL!

Without action, patient care will be restricted and your payment will be reduced significantly. AOTA is working on Capitol Hill to ensure Representatives and Senators know that the Medicare cap on occupational therapy and changes to the fee schedule must be made this year. But we can’t do it alone! Your contribution to AOTPAC increases the impact of the occupational therapy voice! It helps to support friends of occupational therapy and gives us opportunities to educate about the need for a solution to the cap and the fee schedule this year.

Help your clients get the OT services they deserve, protect your rights to appropriate payment from Medicare, and stand up for your profession!

Contribute to AOTPAC today. It is the legal and authorized way to participate in the political process and support those who support occupational therapy. AOTPAC’s Board of Directors decides how best to use your contribution to have the most impact for occupational therapy legislative issues. Be part of that process! Make your contribution now and defend occupational therapy!

Make your contribution on-line via the secure AOTA Web site at: http://www.aota.org/aotpac or mail the attached form with your check or money order payable to AOTPAC.

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Also, check out this website: http://www.aota.org/Practitioners/Advocacy/AOTPAC.aspx

HIPAAAAAAAAApotamous

I have a question. I want to be able to write client stories, especially as I am now on my 2 weeks of a Level I fieldwork in physical dysfunction at a local rehabilitation hospital. I can't stand writing vague stories, and nobody wants to read a story about a stick figure. But I'm not sure how far I need to take HIPAA. Am I writing a client story so that a normal person can't recognize the client (hypothetical Level 3), or am I writing a client story so that that client's therapists or family couldn't recognize the client (Level 2), or am I writing it so that the actual client couldn't recognize his or her self (Level I)? I have to get progressively vaguer as I go from Level 3 to Level 1, so I would love to know what level I have to write at. I'm unfortunately guessing it's Level 1. I might just have to stick with making up fictional patient stories and only keeping my reflections on the story the same. Anybody familiar enough with HIPAA to answer this question? I did take an online course on HIPAA through my school, but it doesn't exactly touch on how thoroughly it would affect blogging. Ooh the gray areas of the online world!

Thanks!!!!

Laundry lists: Yay or nay?

Too many projects!

I've recently received some feedback about this journal. The consensus is that I should stick to one topic within a post (I agree), the shorter the better (I agree but um, yeah right), pictures are always good (I agree), and I should stick to professional/personal experiences that really delve into OT, instead of just my lists of "I have so much to do for OT school, look!". I've thought about it, especially since I do want to improve my writing. My thoughts on the matter are that I enjoy writing streams of consciousness about my day or upcoming projects - it helps me figure out what I need to do and if I'm going to write it up anyway, I might as well share. Do you all agree? Should I stop posting my to do lists or "im stressed out" posts, and just focus on the professional and personal experiences? I would appreciate input. If I were writing this 100% for myself, I'd continue writing them, because it brings me sanity. But since I only do it 90% for myself, I do like hearing what others think!!

My first day of my OT Level 1 Fieldwork in Adult Phys Dys

Today was my first day of my adult physical dysfunction Level 1 Fieldwork, which is two weeks long. I was sooo nervous this morning! Adult phys dys is way outside my comfort zone. I can handle a baby with a ton of tubes, but an adult who needs their shoulder moved? AUGH! Scary! I felt a little unprepared because even though I had made like 6 pages of cheatsheets (cough), I had forgotten to focus on the most important thing, which is neuro!

I am doing this rotation with one other girl in my class, Marla. She is really quiet and really sweet. She and I were each assigned different OTs, but we are in the same little neuro gym, which is a locked unit, so you have to know a code to leave. (Only because patients can be confused, not dangerous.)

My OT is named Denise and she is really nice. She is also an UT alum. I got to see one child and a ton of geriatric patients with her! Just observing, though, obviously. Some of the patients are grumpy (because they are in pain and deconditioned!!), but most of them are so cute you want to eat them up with a spoon! Which is kind of a gruesome expression, when you think about it.

I think my hospital got confused about JCAHO, because they seemed to think Marla & I needed to go through new employee orientation, which is almost a full day and requires about five hours of video watching on stuff like how to dispose of hazardous waste. After we questioned the need for this considering we were primarily observing, never alone, and only there 10 days, the human resources people made some phone calls and it turned out we only needed to fill out a few forms and watch a few videos. I am pretty sure JCAHO is the same anywhere, requirement wise, and I know none of the other hospitals seem to require this for a two week rotation, so I don't know where the problem really lies!

Beyond that, it was a nice experience. It was good to see that adult phys dys is not magical, and that there is actually the possibility of me learning how to do it. I have two problems. One is that I lack confidence in my ability to handle "hands-on" experiences. The second problem is that I'm a softie. If a patient doesn't want to get out of bed or finish their exercises, I'm like "Oh. Ok" when really I should be like "IF YOU EVER WANT TO BE INDEPENDENT IN YOUR ACTIVITIES OF DAILY LIFE YOU BETTER GET THIS BOOTIE UP!!!!!!!!!!!" Ok not quite so strongly worded, though.

One thing that really rocked today is that I got to see a patient with no prior knowledge of her medical history, and I could tell she had a left CVA! I knew because the left side of her face and the right side of her body had hemiparesis, and she had aphasia, which is typical of a left CVA. I was really excited to be able to diagnose that.

Overall it was a nice day, not too scary. I will be there 7am to 3:30pm every day, although I have plenty of projects to work on at night unfortunately, and need to get prepared for the Tennessee Occupational Therapy Association annual conference, which will be in Nashville this Friday and Saturday! I'm trying to win a scholarship so I hope anyone who likes me will send good vibes this way. Also, y'all should hope I have the right fashion sense and wear an appropriate outfit to TOTA conference, because I'll just admit it, I'm even stressing out over what to wear! I'm ashamed. Sorry.

Tomorrow I'll experience (observing) an OT helping patients with their morning ADLs, so I'm excited! And scared! Again!

OT Superheroes take over the world!!

Occupational Therapist Student = Tree Killer

I just spent the last few hours going through, literally, about two reams worth of notes. I caught up on all my academic filing and did binder transfers as necessary. If I were to stack up the binders of papers I've accrued just since July, it would be about two feet high, easily.

Now it's 1:20 am. I'm more awake than I need to be, especially since I volunteer tomorrow morning holding babies!

Over the next two weeks  I need to:

1) Finish my ASD app
2) Sign up for the first ever National OT Student Conclave in Pittsburgh, PA, that will be held in November. Good thing I bought a smashing new coat. ;)
3) Make tipsheets/cheatsheets for my physical dysfunction Level I fieldwork starting on Monday, which lasts two weeks. Review notes on SCI (spinal cord injuries), TBI (traumatic brain injuries), and CVA (Cerebrovascular accidents, ie strokes). I'll post them here and send them to my classmates as well. Hopefully they will help others - I searched Google and didn't find any helpful quick tipsheets. If you have any, let me know!!
4) Work on a group assessment presentation with 3 other Memphis members, 2 Chattanooga members.
5) Work on my part of a group community initiative proposal with 4 other students (using a shared Google document)
6) Go through the syllabi and master schedule and search for conflicts for the remaining 6 weeks, since I somehow missed a few recent conflicts and need to double-check my accuracy!
7) Work on my part of a case study I am doing with 5 other students on a child with hemiparesis
8) Work on my treatment creation activity based on previous projects (a sensory integration (SI) board game loosely modeled like CandyLand)
9) Try to do some professional blogging instead of my typical "AUGH OMG I AM SO CRAZY BUSY AND STRESSED OMG OMG OMG MORE LATER" posts.

 I'm probably forgetting something else.

Think I should go to bed? Yeah, me too.

Sounds like...you need an OT (sings)

I'm turning into an occupational therapist. Slowly but surely. Tonight at dinner I found out one of my friends had crushed his hand in an automobile accident and had an "erector set" around it. I immediately thought of external fixation, and then asked about his range of motion and which bones specifically were damaged. Also, I have a screen door that I usually have to prop open with one leg while I work on the real door. Today I was like "I'm externally rotating my leg to do this." Or I hold a baby and end up automatically checking the baby's tone, trunk and neck control, conjugate gaze, sensory defensiveness, and reflexes.

Every time I see someone do something weird or awkward or just plain wrong, I'm thinking, "You need some OT!!"

Dear Abby & all those other advice columnists always have people write in about their woes, and I just really wish Abby would be like, "Your grandma is not doing so great living alone? Get an OT, yo. It will make your life better!"

So far, no luck.

Ok, I have to get back to my trunk extension, butt weight-bearing, leg extending, gaze-focusing,  now. In other words, sitting around relaxing for an hour before I work!

Augh!!! Augh!! Augh!!

It's 11:52pm and I have SO MUCH WORK TO DO!

I left the house at 7:30am and didn't get home until 10:30pm. From 4pm-10pm I was doing fun stuff that was not planned, so it completely messed up my schedule!!  It was therapeutic and I don't regret it because it's important to have some chill time, but now I'm freaking out because I need to do a pathology test tonight, deal with some e-mails, do some bank account issues, get some crap in order...and it all needs to be done ASAP because I have an application deadline due and some other stuff.

Augh!!!!!!!!!!!
I love being an OT student 99.99999% of the time but this is the 0.000001% (cough I can't do math cough) of the time where I wish were a drop-out!!

Occupational voyeurism and LOVE

I like reading about the lives of others. I would gladly read the autobiographies of truck drivers, pilots, waitresses, you name it. It all fascinates me. I used to think it would be SO MUCH FUN to just randomly get to spend a week with strangers, and see how they lived. Little things, like what kind of foods the family eats or how they spend their evenings, is really intriguing.

Lately, seeing as how I am in occupational therapy school and focusing on health care, I enjoy reading the blogs of mothers who have children with special needs. One mother, "Dream Mom", talks about life with her son, who has severe mental retardation, intractable seizures, no toilet training ability, no language, and no use of his limbs. She talks about the challenges she often encounters, from Hoyer Lift maneuvering to figuring out how to change a 150 pound boy's diaper in a public restroom. She makes me think about things I've never thought about, because I've never HAD to. She and I have exchanged e-mails several times over the last year, and I recently e-mailed to tell her how helpful one of her posts had been, that talked about ideas for toys for children who have little mobility. I confided to her that I was scared. Reading blogs like hers was somewhat overwhelming, because it was clear she has so much knowledge of how to handle his disability. As a future occupational therapist, I can't even imagine how I'm going to learn enough to be able to actually be able to help her. If I see a child with severe special needs an hour a week, and she lives with her child the other 23 hours of the day, it seems unlikely I'll know something she doesn't. Luckily, she wrote back and explained that that wasn't the case, and she also gave me some good tips. I'm going to paraphrase her response:

1. When you have to transfer someone from the car to a wheelchair, every second can count depending on the weather. So make the equipment for the transfer/wheelchair as easy as possible!

2. Mothers are exhausted. The therapist can bring options to the table, and sometimes the therapy given by the OT/PT/ST is all the therapy the child is going to get, because there just isn't time/energy for more. The easier the treatment is to incorporate, the more likely the mother is to actually use it.

3. Know what the family can afford! Don't present options for expensive items or permanent changes to the household, if the family can't afford it or if they live in an apartment and can't modify things. In other words, do your occupational profile!

4. Options, options, options - show available equipment/services to the family, and explain why things are important. This is especially true for parents whose child has only recently been diagnosed.

5. Be creative. Mittens not big enough and gloves not acceptable? Use socks.

6. Listen to the parents.

7. Figure out ways to make their life easier. Giving ideas for toys for Christmas/birthdays is always a plus.

8. Find a way to compliment the child's ability. Even if the child can't move or talk, there is a good chance there is SOMETHING about that child that can be complimented. Maybe the child is beautiful, or clearly has a good sense of humor, or who knows. Find that "strength". Parents know their children have special needs - it's nice to hear something positive every once in a while .

I really appreciate Dream Mom's insight. And my favorite part? She loves her son with all her heart, and it shows. Even if she only gets an hour of sleep at a time or strains her back constantly, she adores him. He is her heart.

I saw this same love and adoration from another blogger I recently discovered ("Ryn Tales"). This mom has a daughter with cerebral palsy. She openly discusses some of the trials and tribulations that her child's diagnosis causes, but just like Dream Mom, her writing radiates love. Her most recent post talked about how people sometimes view her and her daughter with pity, and don't understand the depths of joy her daughter brings her, disability or not. I'm going to copy a quote from her post because it really struck me.
"I see this beautiful little girl, with skin that is the color of my bolero blush roses, green-eyed and blondie curls who seems to soak up the sun and emanate it from within no matter what the lighting. I see her cheeky grin and find myself striving to make her laugh just to see her smile and hear her giggle which is the cutest thing I have ever heard. I see a person who opens my heart the instant I even think about her."


So, it took me about fifteen pages to share my thoughts on this matter, and I'm not sure I ever really had a specific point. Okay, well, I kinda had two. One is that you always have SOMETHING to offer the parents of a child with special needs, no matter how severe or intimidating. Two is that these children are deeply loved. And that's the most important thing.

And then I poke a goniometer in his eyeball...

I can't sleep. Today was the first day of my increased dose of Wellbutrin, and a side effect is insomnia. I'm now at the normal dose. I went up from my half-dose because I was starting to worry obsessively again! Here is a typical thought pattern while trying to fall asleep:

Ok. What if I am on fieldwork next year and I am measuring a patient's neck flexion with my goniometer and someone comes in and startles the patient and I am startled too and I poke the goniometer in his/her eye and the person gets an infection and then I get in so much trouble my name gets put on that list of people who can never have licenses and then I'll be the laughingstock of the entire OT world, the end.

Do you see why I need drugs now? ;) I'm going to post a little bit now to calm my thoughts down!

PS: I found this picture on StumbleUpon, and it reminded me of me!

Laundry list of occupational therapy student tasks

This post is basically a laundry list of my day as an OT student as well as tomorrow's list of things to do. It helps me keep track of what I'm doing! But if I'm going to write it down anyway, I might as well share, right? My goal for the next few days (after tonight) will be to write proper professional posts about recent activities! And I have a deep & burning question about HIPAA to ask y'all soon.


Soo...I'm having a good day! OT Practice has tentatively accepted my submission of the balance of occupation article! And I worked out! And I volunteered! And I got a wonderful reference letter from one of my sweet & distinguished professors! And I got stuff printed out! And I finally get to do the lumbar stability exercises that I learned 6 weeks ago for a PT research study, and didn't get to do because I was a control subject, but now I can because they did their final assessment on me! And I don't have a ton of work to do tonight! (Just the normal crushing load AHAHAHAA)

Tomorrow we have a student lecture on Conductive Education, then Meg, Emily, and I present on Biofeedback, including showing the class the $20,000 Biometrics program. Then we have a pathology class where we will receive our second test. Then I'm going to the faculty meeting, just for a minute, to share some student concerns (as one of the academic representatives), and then meeting my research group to talk about our community initiative, and then we have a class on leadership where we have a speaker coming to discuss Level 2 fieldwork. Then I'm meeting a friend who is a MOT student in the class ahead of us, Mandi, to hang out a little while. Then maybe I'll work out (cough with Allison cough please come cough) and then I'll just work on some various projects.

Tonight I need to figure out what I'm going to wear for the presentation tomorrow (gasp), practice giving the presentation, work on my community paper, try to finish up my TOTA/ASD applications, and in general get focused on stuff!