New Occupational Therapy Song/Video

As part of occupational therapy month, here’s a new occupational therapy video I found on YouTube that really shows what it is we do with real life examples:

Celebrating Occupational Therapy month

This year, I joined the OT Month Committee at my hospital to see what kind of ideas we could come up with to spread the word about OT. In past years, we had a booth set up near the cafeteria, but few people stopped to look at what was being presented at the booth. Since we wanted to reach out to a larger group of people, we decided to send out an all-user email.

In the email, we talked about how April is occupational therapy month and we had a link to an online quiz inviting people to test their knowledge about occupational therapy. Additionally, we offered a $20 giftcard as an incentive for people to take the quiz.

I was pleasantly surprised to see that a total of 67 people had successfully completed the quiz! There were plenty of wrong answers, but the fact that people took the time to try the quiz shows that we helped spread the word. As an added fun tidbit, one of the questions we asked was for people to name an occupational therapist that they knew. Many people left that last question blank, but it was interesting to see which therapists got mentioned.

Here are the questions from the quiz:

Getting my First Student

In a few weeks, I’ll be getting my first student, guiding her through her Level I fieldwork.  I like to help others (isn’t that why I became an OT?), and I think that assisting other students going through school is a great way of helping them.  I’m looking forward to the experience and was also looking for guidance.

If you have had students or you are a student yourself, what kind of things are you looking for in your Level I experience?  What worked for you and what didn’t work for you?  What kind of supervision did you enjoy?  Let me know!

Spinal Precautions

I have previously blogged specifically about sternal and hip precautions but only briefly mentioned spinal precautions.  Every day, I get visitors to this blog looking for information regarding spinal precautions, so here they are:

• No Bending
• No Lifting
• No Twisting

The precautions, also known as BLT’s (for Bending, Lifting, Twisting) are usually in effect from anywhere between two and three months.

The bending will depend on where in the spine the surgery took place.  If it was in the cervical spine, don’t bend your neck.  If it was in your back, don’t bend your back.

One should not lift anything more than 5-10 lbs. after a spinal surgery.  A gallon of milk is about 8 pounds (or 8.35 according to a patient of mine who was a firefighter), and is usually a good reference point as to the maximum you can lift.

Twisting is pretty straightforward.  Don’t twist your back (or neck).  The two areas people have trouble with this is when sitting down, one tends to twist and look to see where they are about to sit; and when wiping themselves after a bowel movement.  Be careful!

These precautions apply to most spinal procedures, whether it is just a spinal cord stimulator placement, a laminectomy, ACDF, ALIF, etc.

Ethical Dilemma with Treating Unethical Patients

I have been struggling with an ethical dilemma ever since my Level I fieldwork assignment, where I was doing my clinical at an outpatient facility within a hospital located near one of the local jails.

Since this hospital was affiliated with the city, we often got the prisoners that needed occupational therapy at this facility.  If a prisoner is scheduled to come in for an appointment, they are accompanied by two police officers and their hands and feet are both shackled.

As part of our assessments, we typically ask our patients what their own goals are for therapy.   Unfortunately, I had one patient (who had had an ulnar nerve and tendon injury from a knife fight) tell me that his goal for therapy was “to be able to close my hand into a fist so that I can fight again.”

When I hear something like that, I think to myself, “Why do I want to treat this person?  Why do I want to help this person meet his goals?”

This question bothered my enough that I knew right away that I would never want to work with forensic patients.  As an occupational therapist, I know that we have to work with patients to meet their goals and increase their occupational well-being.  But if that involves beating up other people and doing illegal things, how can I, in good faith, treat this type of patient?

Splints I have Fabricated

Here’s a list of some of the splints I have either fabricated myself or got assistance in fabricating:

• Several below knee amputation splints
• Resting hand splints (actually, these are pre-fabricated)
• Humeral fracture brace (two pieces; protects the humerus from getting bumped by others; limits some shoulder range of motion if the doctor chooses)
• Several posterior gutter splints (usually for protection of an elbow status post ORIF; often, the splint starts along the forearm and extends down to the carpals)
• Yesterday, I helped with two splints (both on the same person, one for each hand): Ulnar gutter splint that involved providing slight MCP flexion for the 4th and 5th digits; and a resting hand splint that only provided ‘rest’ for the index finger through the MCP, but allowed for free range of motion of the PIP and DIP, and the rest of the fingers.

Sometimes the orders can be very complicated and specific, such as the ones highlighted in the last bullet above.  But I really enjoy making the splints, and am more and more strongly considering to specialize in splinting.

Studying Abroad

One of my former professors recently had an article featured in OT Practice.  The article is called “Learn To Communicate
With Your Spanish-Speaking Clients; Study Abroad!” by Sonia Lawson.

If you are an AOTA member, you can access the article here, on page nine.

Educating Patients with Amputations

Aside from educating an amputee about phantom limb pain, what else do occupational therapists have to teach patients?  The things I can think of are: skin checks, wound care, ace wrapping, and splint education.  Anything else?

(My question refers to on top of the usual ADL training that we would do)

Acute Care is Intense

I started working in acute care as a student on my Level II fieldwork, so I never realized just how intensive it can be. I recently had a friend of mine who is an OT express interest in working in acute care. She wanted to follow me for a few hours to see how my day was.

Here is how I do a typical chart review before seeing a patient for the first time:

• Go on the computer
  • Check out the therapy orders, as well as their activity orders (out of bed, ambulate with assistive device, etc.) I also check what other services have been consulted. Is physical therapy on board? Social work? Rehabilitation? etc.
  • See what diagnostic tests have been ordered. A CT scan of the thorax may be ordered to rule out pulmonary emboli, ultrasound may be ordered to rule out DVT, x-ray to rule out fracture, etc.
  • Check on specific patient care orders – do they need a brace when out of bed? how many liters of oxygen should they be on?
  • Patient alerts – What kind of precautions are they on? Contact isolation? Are they on aspiration, neutropenic, or seizure precautions?
  • Diet – Are they NPO?  Stage I, II, III, or IV diet?  Knowing a patient’s diet can help with the education part of what they can and cannot do in the hospital
  • Code status – Are they DNR? Some patients have specific instructions as to whether or not they can be intubated
  • Lab values – The most common things I look for are hematocrit, hemoglobin, potassium, sodium, creatinine, PT/INR. Are the lab values high? low? Which way are they trending? All these are factors into whether or not a patient should be on hold. For example, if a patient has a hemoglobin of 7.5 and a hematocrit of 22.6, I would probably not see the patient, since they are below critical and are probably going to be too weak to see me anyway.
  • Vital signs – Check the latest blood pressure readings, heart rate, temperature, and sometimes the respiratory rate.
• Next, I check the physical chart:
  • I first go through the History of Present Illness section to see what led up to the hospitalization. Often times, I’ll find most of the patient’s past medical history.
  • Then, I check the consultation section to see what medical services have looked at the patient. This can include Medicine, Neurology, Orthopedics, Nephrology, Infectious Disease, Oncology, Cardiology, Pulmonary, and more. This section helps give a nice, complete picture of what is going on with the patient.
  • Next, I look throughout all the notes that everyone wrote. This includes mostly nursing notes, but also notes from doctors and from any of the above mentioned services giving updates. You see a progression of status as you read the notes.

I am only comfortable going into a patients room when I’m done looking up everything mentioned above. And now that I typed it all up, I can see why my friend who was shadowing for a few hours was so overwhelmed when she left! Working in acute care is intense; there is no question about it. But since I was brought in as a student and learned things slowly at a pace that a student would learn, I have no problem doing it today.

One of the great things with acute care (which others may specifically not like) is the fast pace. Going in to work, you never know who your new patients will be, making each and every day very unique. Often times, there are lots of new evaluations that need to be completed, so just the rush of trying to get everyone done makes the day go by very fast.

Acute care is definitely not for everyone, but if you can handle some of the minor stresses and be willing to learn a LOT about anything medical related, then it is for you!

Continuing Education links

I found a great post by OT in Egypt that has a huge number of links for continuing education credits, for those in need.

Here’s the link:

http://otegypt.blogspot.com/2008/01/occupational-therapy-continuing.html