Posts filed under ‘OT’

OT and Online Professional & Social Networking

There has been an ever-growing presence for occupational therapy on the Internet.  Social and professional networking amongst occupational therapy practitioners has been the subject of presentations at conferences, blog posts, articles, and more.  Several months ago, OT Practice had a CEU article on social networking.

In the most recent issue of OT Practice, Karen Dobyns, a student occupational therapist finishing up her fieldwork rotations, wrote an excellent article titled ‘Enhancing Practice through Online Social Networking.’  She writes about how posting stories, questions, or insights about occupational therapy creates a permenant record that can then be seen by others.  Therefore, if someone else has a question that you might have asked, it can be easily found with a search on the Internet.  Collaborating and sharing online also helps one grow professionally and clinically.  I’d like to say thank you to Karen for including my blog in your list of blogs that you shared in OT Practice.

The AOTA has made a strong push into the online world by actively engaging others in most of the social networking medias, such as YouTube, Facebook, MySpace, Twitter, Flickr, and Plurk.  Today, the AOTA has launced their own social networking media, called OT Connections.  Similar in layout to MySpace and Facebook, it allows occupational therapists to add friends, post blogs and pictures, and truly collaborate with fellow therapists. It also allows you to have access to the listservs.  What makes it truly great is that you do not have to be an AOTA member to sign up and benefit from the website.  They have made it open to any occupational therapist (or other professional) that would like to join.  I strongly encourage you to join.  On the first day alone, they already have more than 80 members!  Once again, here is the website.

November 18, 2008 at 11:03 pm 36 comments

Would a splint be contraindicated in this case?

We all know that one of the purposes of splinting by occupational therapists is for joint protection and to preserve function and range of motion.  I have blogged before about my experience with fabricating below knee amputation (BKA) splints, used to preserve knee extension for being able to fit orthoses at a later date.

Sometimes, however, I wonder if a patient really needs the splint.  For example, I once had a 85 year old patient who had severe Alzheimer’s dementia, was completely bedbound at a nursing home at baseline and had a BKA due to gangrene.  While normally I would make a splint, I wasn’t sure that it was indicated in this case.

First, the patient was bedbound at baseline, and therefore an unlikely canditate for a prosthetic.  Second, a patient is very likely to develop skin breakdown and sores from a splint if the splint schedule isn’t adhered to, or frequently monitored.  Third, splints aren’t generally the most comfortable things.

Providing a splint would not increase or improve quality of life, and so it would seem to me that a splint would not be indicated in this case for the reasons listed above.  What are your thoughts?

November 17, 2008 at 8:09 pm 22 comments

Women defend themselves from burglary with ADL equipment

Two sisters, ages 81 and 89, used a reacher to defend themselves from a burglary.  Here’s the story:

http://wjz.com/video/?id=44549@wjz.dayport.com

September 23, 2008 at 8:33 pm 6 comments

Quote of the day

While working with a patient who had cerebral palsy:
ME: “Can you try to relax your muscles?”

Patient: “You should know better than asking a spastic CP to relax!  The only way to get me to relax is with alcohol!”

September 12, 2008 at 3:24 pm 2 comments

Can a family be too involved?

One thing that I have always observed while working in the hospital setting is that the patients who have family and friends that come to visit tend to fare better when it comes to physical rehabilitation and overall attitude towards the outcome.  They are better able to laugh through their hospital stay and they have a strong support system.  The patients who are alone during their entire hospital stay tend to be more depressed, less motivated to participate in therapy, and have a poorer affect.

As a result, I have always advocated that when possible, patients should encourage family and friends to visit.  I recently had a situation where I questioned this for the first time.  The patient was an older person who was completely independent with all her activities of daily living and participating in the community.  She suffered a fall, fracturing some bones and having aches all over.

Once stable, therapy was called in to see the patient.  On a typical patient, we would normally ask if the patient would be willing to get up, and work towards getting her out of bed and to a chair, at least for the first time in therapy.  Patients usually complain of pain, but we try to coordinate with the nursing staff so that the patients can be fully medicated and ready to go.  Usually, this is enough, and we can proceed with therapy.

However, with this patient, we saw that there would be problems from the start.  Upon arrival, the patient’s son was in the room.  Right away, he told us that she was sleeping and that he doesn’t think she should have therapy so that she could rest.  If a patient is alert and oriented, I like to at least ask the patient their opinion on participating in therapy, which is what I did.  The patient was quick to say that she would welcome sitting at the edge of the bed, so I’m happy I asked.

Then, when approaching the bed and reaching out to shake her hand and introduce myself, the son audibly gasped, worried that my touch would cause more pain.  This went on throughout the entire 40-minute long evaluation.  Any time I touched the patient in any way, the son could be seen and heard wincing and gasping, as if my touching the patient was actually hurting him!

Now as an aside, I completely empathize with the son, and I fully understand that his mom is in pain.  I could not even begin to imagine what it would be like if that were my own mother.  However, the son took this to an extreme that I had never seen before.

In moving the head of the bed upwards, the son demanded that we be “gentle” several times.  Unfortunately, there is no gentle button, just an up and down button, but I managed to get the head of the bed situated in a way that was agreeable to everyone.  Before removing the patients waffle boots (used to prevent heel sores), the son made us wait and ask the patient to make sure that it was ok to remove them, as her legs were very sore.

With literally every single movement, the son was involved, asking his mom to tell us to stop when it became too much.  To get to the edge of the bed, we have to move one leg, then the other, adjust the shoulders and hips, move both legs again, adjust the shoulders and hips, sit her forward, etc. until she can sit at the edge of bed appropriately.  Even then, we had to manage her sitting balance and control her dangling legs.  Imagine for a moment getting stopped by the family member for each and every single one of those movements!  I’m honestly quite surprised that we completed the evaluation in only 40 minutes.  We had to reassure the son over and over again that we were being as gentle as possible, explaining exactly what we were doing, and why we were doing it.

Take note that I have spent most of this post discussing the son, and not the patient.  When a family member gets so involved that we can barely pay attention to the patient, I think that there is something wrong.  When the son asks the patient repeatedly to tell therapy to stop if it becomes too painful is absolutely detrimental to the patients ability to recuperate.  Patients need to be encouraged to do more so that they can get stronger and healthier.

Once again, I empathize with the son and I think he is the greatest son a mother could have for his ability to be at her bedside throughout the day and worry about her.  But there comes a time when it can be too much.  I had actually heard rumors that when the patient was in the ICU (where they have very specific visiting hours), the patients heart rate and blood pressure was noted to be higher when family members were present!  So, while I normally advoate for patients to welcome family members and friends to visit, I also think that there is a time when they need to step back and let the patient get therapy so that they can get well and go back to being independent.

July 17, 2008 at 10:31 pm 11 comments

Fundamentals of Clinical Instruction

One of the great things about the place I work is the fact that we have a vast amount of opportunities to attend inservices and continuing education classes.  A class I recently attended that was put together by therapists at the hospitals was regarding clinical instruction, and how to be a fieldwork educator.

The class was broken up into two parts.  The first part was just with the occupational therapists, and laws and regulations related specifically to occupational therapy were discussed.  The second part went over how students learn, various learning methods, and how to handle the problem and exceptional student.

Hearing about ways of handling the problem student was especially interesting, as we got to hear stories about various students who did all sorts of things that I could never imagine doing myself as a student.  But we also got to hear about some creative ways of working with students who have a hard time with certain skill sets.

For example, if the clinical instructor (CI) sees that the student has a hard time managing the patient and the IV pole at the same time, the CI should attach a blood pressure cuff to his arm, and use the vitals machine as the IV pole.  A clean chest tube drain can be used a Foley catheter.

Overall, it was a great class, and it was nice to see that my hospital takes teaching students so seriously.  At any given time, there are always at least two students somewhere in the hospital, whether it is a phsyical therapy student, occupational therapy student, or a speech-language pathology student.  While I did already have a Level I student, I hope to soon be able to take a Level II student and use some of the principles I learned in this class.

June 19, 2008 at 11:09 pm Leave a comment

OT and Social Networking

After completely failing to complete my 31-day Comment Challenge, I have learned that as much as one can try to get a certain project done, sometimes real life takes over and the project has to take a back seat.  Unfortunately I did not complete the challenge.

However, something that did get done over the past few weeks is very exciting to me.  I played a minor role in presentation that was given at the British Association of Occupational Therapists in discussing the role of Web 2.0  (social networking specifically) and the professional development of occupational therapists.  As a result, and with the guidance of Merrolee Penman, the two of us were able to make an 11th hour sumbission to the AOTA to possible present at their conference next year in Houston, Texas.  For more info on the presentation at the BAOT conference, see Merrolee and Sarah/Angela‘s blogs.

June 19, 2008 at 10:45 pm 6 comments

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