Permission to speak freely

Occupational therapists and assistants are more than my colleagues. They are my former students from the classroom, fieldwork and internships. They are passionate about our profession. They are my co-learners at professional conferences. Today they are my readers, and people whose words I may read one day. They are my pals and partners in crime, as we’ve invented the just-right challenge therapy group or a lab activity. They are the people I can call on at a moment’s notice and who have always responded with hands-on help, words of encouragement and ideas for how to get things done. They are my role models — the people I never want to disappoint or let down. I see them as compassionate, smart, hardworking and generous to the point of giving until it hurts. I love them all.

I really want to write blogs that inspire and energize OT and OTAs. The rub is that I know how very difficult practicing real occupational therapy can be right now.

For years, I have been hearing from therapists all over the country and in many different practice settings (SNFs, acute care hospitals, rehabilitation centers, public schools and non-profit agencies, to name a few). They have been warned against providing any services short of or beyond what has been predetermined as billable. Many are threatened with sanctions or termination if they are caught documenting after-work hours, although there are not enough minutes allotted in the day for this. The very notion of providing client-centered, occupationally-focused and holistic care is frustrating and foolish, in these workers’ worlds.

I have witnessed the acculturation of my students to this reality, when they would come to my classrooms after their Level I fieldwork experiences looking confused and […]

By |September 22nd, 2016|Categories: From the Editor, Uncategorized|Tags: |0 Comments

Come to the table: Key reasons to join in decision-making

Recently, I read a compelling Facebook post by Brent Braveman, PhD, OTR/L, in which he wrote: “In another thread on a state association’s Facebook page I suggested that in order to be successful in responding to bundled payments by CMS, we need to have a seat at the table and understand the conversation. A colleague responded by describing my words as ‘trite and overused.’ So I provided 10 examples of ways my staff and I have found a seat at the table to promote the distinct value of OT.”

Braveman proceeded to list 10 excellent examples of ways that he and his staff have used or created opportunities to be included in decision-making groups within their hospital system. These committees included falls prevention, procuring DME and hospital safety. They make decisions that hugely affect patient care and therapists’ everyday work lives. I applaud Braveman’s active participation, encouragement of his team’s involvement, and willingness to take time to endorse and explain why taking a seat at the table is necessary and good.

No matter where you work, whether in a large and complex system or a solo practice, there are small groups of people making big decisions that will affect your everyday work performance and quality of life. Whether informed or uninformed, these people open and close the doors to your ability to practice occupational therapy fully and your quality of life on the job. If they do not have an assertive occupational therapist in the group, your perspective will be absent. Let’s be real. Who else on the team thinks as you do? Can you count on other professionals to look at patients’ needs with the breadth and depth that you have, or to look out […]

By |August 30th, 2016|Categories: From the Editor|Tags: |1 Comment

Good things come in small packages: Starting a private practice

Judging by comments from our readers, many of you have great, innovative ideas that you cannot always use in traditional workplaces. There are three ways to gain increased control of your practice:

1) Locate and get hired by a facility that honors your expertise and supports the kind of OT you want to provide. Fabulous, when it works!

2) Overcome resistance and gradually infuse great OT practices into settings that did not previously have them.

3) Start your own independent practice and control the quality and nature of your services.

Before you get the vapors and generate 500 reasons why you cannot start a private practice, let me just say that it’s OK to start very small and to take your time. Actually, that’s best. Also, it does not have to be all or nothing. In fact, giving up your day job one day to jump into a small business the next is not generally ideal.

Small is wonderful. Slow is fine. Part time is beautiful, too.

Not pursuing the career that you truly want and love is neither wonderful nor fine. Not fully developing your unique translation of authentic occupational therapy is a tragic loss for yourself and the many people who would have benefitted from your service.

Occupational therapists and occupational therapy assistants are well-positioned to be successful entrepreneurs. We offer services that are unique and valuable. We can craft novel and effective solutions to real-life problems. We are passionate about our work and emotionally connected to those we serve. Our clientele can access our services directly, without needing a physician’s referral.

If you’re intrigued by the idea of working with a few private clients, here are some initial baby steps to get you started:

• Read about OT practitioners who […]

By |July 28th, 2016|Categories: From the Editor|Tags: |3 Comments

A little bit of effort can have a huge impact

For several years I was the occupational therapist at a residential treatment facility for children with severe mental health problems. Initially I was hired to provide school OT services for students with fine motor/handwriting goals. Clearly, these children had problems beyond poor handwriting. In fact, they were referred to as the “sickest kids in the state” by some of the staff and administrators. I eventually initiated a number of OT programs at the center, but the after-school OT activity program was my favorite due to its simplicity and amazing impact.

I was the school OT for at least a year when I started asking to expand into the residential units. Initially I hit strong resistance because there was no budget even though I offered to staff it with OT and OTA fieldwork students. We also were told it wouldn’t be safe, even though we all passed  crisis prevention and intervention classes. In addition, we were told the child-care staff would feel intruded upon, even though it turned out they wanted us. After months of persistent effort we were allowed to observe in the units and offer ideas. What we saw was very sad.

Although the center’s newly built living spaces were clean and bright, life in the units was occupationally sparse and monotonous. The children spent a lot of their after-school and evening hours waiting — waiting for dinner, waiting to take a shower, waiting for a turn at the video games. Time was largely spent quietly in their rooms or in front of the TV, with bursts of excitement when behavior escalated into arguments, tantrums or fights. No wonder they had incidents of misbehavior and aggression. Boredom is painful, especially when there’s no end in […]

By |July 1st, 2016|Categories: From the Editor|Tags: |3 Comments

Your OT DNA: Theoretical frames of reference revisited

What makes one an occupational therapist, beyond the earned credentials, certification and licensure?

What are the shared features and beliefs that bind us together as a tribe?

One component of OT DNA is our philosophy, as reflected by our founders’ and leaders’ inspiring essays and lectures. Another is the OT Practice Framework: Domain and Process, which gives us a common language and structure regarding what, how and why we perform our trade.

Yet another aspect of our genetic code is our complex theoretical heritage.

During the years I taught OT theory, I saw the emergence of wonderful OT meta-theories that provided a scaffolding and large pattern for OT practitioners’ clinical reasoning, such as the Model of Human Occupation and the Canadian Occupational Performance Model.

Using a meta-theory can structure and guide clinical reasoning to ensure a thorough approach to OT evaluation and intervention. It gives us language that clearly reflects OTs’ domain and process, and encourages us to be logical and consistent in our actions.

In some regards, we could look at the OT meta-theories as large toolboxes.

Both the MOHO and Canadian Model offer assessment tools, most of which focus on determining the client’s perspectives and goals related to their occupational needs and priorities. The MOHO also offers standardized tools for assessing environments. These are essential pieces of an OT evaluation. Usually, we also need to obtain objective assessment of clients’ task skills, physical and cognitive abilities, environmental supports and obstacles, activity demands and information about habits and routines. With so many variables that may be relevant to occupational performance and an intervention plan, it’s no wonder that we need to have access to a number of approaches.

For example, a child may be disruptive in school because of sensory processing […]

By |May 23rd, 2016|Categories: From the Editor|Tags: |3 Comments

Stand up for what’s right

There are so many things to love and respect about our profession. We serve people in need with our knowledge, skills and hearts. I want to celebrate these beautiful qualities — we are, after all, celebrating OT Month! However, the state of things in some of our workplaces requires us to add some additional virtues and behaviors, such as courage and toughness.

Occupational therapists are known for optimism and a can-do attitude. It’s part of what makes us popular with our care teams and clients. We can bring this positive attitude to advocacy to our clients and to those we supervise, and we can adopt this positive attitude ourselves. We love our profession because it is occupationally focused, client-centered and holistic. We want to practice to the fullest extent of our capabilities and to encompass these values. OTs value harmony, and that’s what makes us good team members and co-workers. Our easy-going and flexible styles also help us to create success with many difficult clients.

Of course, there’s another side to being so agreeable. Unlike groups that are trained to expect adversity and conflict in their daily work (think attorneys and police officers), the clinical OTs I know are often unsettled and upset when they have to generate or deal with disagreement or unhappiness. When I researched what we teach our students in university OT programs about sharing bad news, some educators were offended that I would even suggest such a topic. Not doing so may ensure our popularity, but there are times when being nice and popular is not in the best interest of those we serve or ourselves.

It’s no secret that occupational therapists and other professionals can be pressured to maintain impossible levels of […]

By |April 13th, 2016|Categories: From the Editor|Tags: |2 Comments

Mind-controlled prosthetic arm moves individual fingers

Physicians and biomedical engineers from Johns Hopkins University School of Medicine, Baltimore, report what they believe is the first successful effort to wiggle fingers individually and independently of each other using a mind-controlled artificial arm to control the movement.

The proof-of-concept, described online Feb. 15 in the Journal of Neural Engineering, represents a potential advance in technologies to restore refined hand function to those who have lost arms to injury or disease, researchers said in a news release. The young man on whom the experiment was performed was not missing an arm or hand, but he was outfitted with a device that essentially took advantage of a brain-mapping procedure to bypass control of his own arm and hand.

“We believe this is the first time a person using a mind-controlled prosthesis has immediately performed individual digit movements without extensive training,” senior author Nathan Crone, MD, professor of neurology at Johns Hopkins, said in the release. “This technology goes beyond available prostheses, in which the artificial digits, or fingers, moved as a single unit to make a grabbing motion, like one used to grip a tennis ball.”

For the experiment, the research team recruited a young man with epilepsy who already was scheduled to undergo brain mapping at Johns Hopkins Hospital’s epilepsy monitoring unit to pinpoint the origin of his seizures. While the brain recordings were made using electrodes surgically implanted for clinical reasons, researchers could then use the signals to control a modular prosthetic limb developed by the Johns Hopkins University Applied Physics Laboratory.

First, the patient’s neurosurgeon placed an array of 128 electrode sensors — all on a single rectangular sheet of film the size of a credit card — on the part of the man’s brain […]

By |March 18th, 2016|Categories: News|Tags: |0 Comments

Longer, intense rehab boosts recovery after brain injury in rat study

For cognitive and functional recovery after a stroke or traumatic brain injury, a longer, even more intense period of rehabilitation might improve the brain’s ability to repair and restructure itself, according to a new animal study that also confirmed the importance of intensive rehab.

Researchers at the University of California, San Diego School of Medicine found rats with cortical injury that did not receive intensive rehab did not rebuild brain structure or recover function — while also learning a longer, even more intense period of rehabilitation might amplify the benefits.

“This has implications for medical practice and medical insurance,” senior study author Mark Tuszynski, MD, PhD, said in a news release. Tuszynski is a professor in the neurosciences department and director of the Center for Neural Repair at UC San Diego School of Medicine and a neurologist with the VA San Diego Healthcare System.

“Typically, insurance supports brief periods of rehab to teach people to get good enough to go home,” he said in the release. “These findings suggest that if insurance would pay for longer and more intensive rehab, patients might actually recover more function.”

Findings were published in the Feb. 22 online early edition of Proceedings of the National Academy of Sciences. In recent years, past studies have documented the surprising plasticity or ability of the adult central nervous system to recover from injury. Researchers continue to explore how to best encourage the repair and regrowth of damaged nerve cells and connections.

To better understand what happens at the molecular and cellular levels and how rehabilitation might be made more effective after brain injury, the team studied rats relearning skills and physical abilities. They found rats that received intensive therapy for an extended period of time showed […]

By |March 15th, 2016|Categories: News|Tags: |0 Comments

Study: One-on-one session before joint surgery aids patients

Patients benefit from a one-on-one education session provided by a PT and access to a custom web portal before knee or hip replacement surgery, according to a new study at the Hospital for Special Surgery in New York City.

On questionnaires, patients indicated they were more satisfied with their presurgery education and felt better prepared to leave the hospital after joint replacement, compared with those who did not participate in the session or have access to the website.

The research was presented Feb. 20 at the meeting of the American Physical Therapy Association in Anaheim, Calif.

“Controversy exists regarding the most effective means of delivering preoperative physical therapy education prior to total joint replacement,” lead investigator Rupali Joshi, PhD, PT, said in a news release. “Our study sought to evaluate the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.”

The goal of the half-hour sessions, which generally took place on the patients’ presurgical screening day, was to educate them on what to expect when undergoing joint replacement.

“It has been shown that preoperative education is most beneficial when provided one-on-one,” Joshi said in the release. “The sessions are customized to address a patient’s specific needs regarding preoperative preparation and what to expect in the hospital and during rehab and recovery. We also assist patients with setting realistic goals regarding outcomes, and they are able to ask any questions they may have in a private setting.”

“After surgery, patients may be dealing with issues such as fatigue, discomfort or anxiety, and it is not the most opportune time to give them information about the road ahead,” study author Amar Ranawat, MD, an orthopedic surgeon at HSS, said in the release. “With the face-to-face […]

By |March 14th, 2016|Categories: News|Tags: |0 Comments

When routine becomes a rut

“Habit is necessary; it is the habit of having habits, of turning a trail into a rut, that must be incessantly fought against if one is to remain alive.” — Edith Wharton

In my practice I work with young adults who have “failed to launch” because of some combination of developmental, mental health and social factors. Each of my clients is unique, but many share key features. Here is a (fictionalized) example:

Rob is a young man who is very bright, though often socially awkward. At age 18 he went to college, but stopped after two semesters because of low class attendance and failing grades. His parents brought him home and took him to numerous psychiatrists and therapists. Rob was diagnosed with Asperger’s syndrome, depression and anxiety. He disagreed with all of these diagnoses, and refused to take medication. Rob felt he just needed to rest up and that he would return to college next year. That was six years ago.

When I initially met with Rob, I saw an overweight, poorly groomed young man who rarely looked at me, rubbed his hands together continuously and perspired a lot. His mother said they had to bribe Rob with dinner at a favorite restaurant in order to convince him to meet with me. During our first session, I asked Rob about his daily routine of activities, which he described as:

Wake up and start the day: Sometime between 10 a.m. and 2 p.m.
Eat breakfast
Play video games
Watch TV
Dinner w/ parents: 6:30-7 p.m.
Video games
Sleep: Sometime between 11 p.m. and 4 a.m.

Weekdays and weekends are undifferentiated. When I asked how Rob felt about his activities, he stated, “I’m bored and embarrassed.”

“Well, thank goodness!” I think. Signs of health and readiness for change.

I’ve […]

By |March 11th, 2016|Categories: From the Editor|Tags: |0 Comments