Get the referrals and practice you really want

Catherine, a TodayinOT.com reader, recently commented: “I know this question has nothing to do with this article, but here goes. I currently work at an acute care hospital and the hospital primarily treats elderly; gastric bypass; hip and knees; and geri psychology. We are having limited success in getting referrals for OT from the doctors. Suggestions?”

What a great puzzle to solve — and an opportunity to actively shape your practice. I really hope we’ll hear from other readers who have ideas. In the meantime, here are some of my thoughts:

I have never left a professional position the way I found it. By actively shaping my roles, I have met a wider range of clinical goals and my own need to experiment with new ideas. We are experts at modifying and personalizing things; why not do so with our roles and practices to benefit our clients and ourselves?

For example, in my first job, prior OTs had focused on sensory integration. I continued doing SI, but I added cooking and crafts groups because I saw our kids had a need for more social skills with peers, and they were super-motivated by making things that they could eat or take home. In a youth residential treatment program, I provided the traditional school-based sessions, then added a lunchtime club to teach and practice good manners and nutrition. As an educator, I initiated problem-based learning courses.

With some imagination and planning you can expand your role to best utilize your full capabilities and interests. Start by adding some new twists to therapy sessions. Soup them up by enriching and personalizing the environment and tasks. It could mean having your session in the kitchen, preparing a snack rather than staying in […]

By |February 8th, 2016|Categories: From the Editor|Tags: |0 Comments

Research eyes role African-American race plays in stroke risk

Even though young African-Americans are at three times greater risk of a first stroke than their white counterparts, they might not be at a higher risk for a second stroke, according to a new study.

Findings were published in the Jan. 20 online issue of Neurology, the medical journal of the American Academy of Neurology. According to a news release, the study is one of the first of its kind to look at race and second stroke risk.

“The interaction between black race and age appears to be remarkably different for the risk of first versus second stroke,” study author George Howard, DrPH, with the University of Alabama at Birmingham, said in the release. “There was very little difference in race for the risk of a second stroke.”

The study involved 29,682 people from the Reasons for Geographic and Racial Differences in Stroke, also called the REGARDS study. Of those, 2,993 people had a history of stroke at the start of the study. During the seven years of the study, 301 of them had a second stroke, researchers found. Of the 26,689 people who had never had a stroke when the study began, 818 people experienced a first stroke during the study, results showed.

The researchers found among study participants without a stroke at the start of the study, African-Americans were 2.7 times more likely to have a stroke than the white participants at age 45; however, there was no difference at age 85. Race did not appear to increase second stroke risk for African-American participants at any age.

“Almost all of the ‘traditional’ risk factors for a first stroke proved to also be a risk factor for a second stroke, suggesting that controlling these risk factors may help […]

By |February 5th, 2016|Categories: News|Tags: |0 Comments

Study on ‘social life’ of paper health records receives award

An article detailing two researchers’ findings on the social life of paper health records in Social Science & Medicine received the 2015 Diana Forsythe Award from the American Medical Informatics Association in December, according to a recent news story.

Despite the ongoing transition to electronic health records nationwide, two researchers at the University of Southern California in Los Angeles have been digging into any remaining value of the traditional hard-copy records. Their article was selected as a co-recipient from a group of more than 30 other nominations, according to the story. The award is named in memory of Forsythe, who was a pioneer in the field of medical informatics.

For their research, occupational science doctorate candidate Amber Angell, MOT, OTR/L, and her mentor, Olga Solomon, PhD, MA, assistant professor in the USC Chan Division of Occupational Science and Occupational Therapy, looked at data from Solomon’s multidisciplinary urban ethnographic study, “Autism in Urban Context,” according to the USC News story by Mike McNulty. The study was funded by the National Institute for Mental Health.

To collect data for the study, the researchers followed 23 African-American families that included children diagnosed with autism spectrum disorder who lived in Los Angeles County. For about three years, investigators interviewed, observed and video-recorded the families in their homes, in physician’s offices, in their children’s schools and in the community. Many of the families faced persistent disparities in ASD diagnosis and interventions, according to the article.

The families were asked questions about how they used their child’s health records when seeking and obtaining ASD services, how the health records changed their interactions with healthcare professionals and how the records affected the families’ experiences, according to the story.
Records throughout the community
Angell and Solomon discovered records […]

By |February 2nd, 2016|Categories: News|Tags: |0 Comments

Study: Chemotherapy-induced peripheral neuropathy lingers for years

Years after completing cancer treatment, 45% of women cancer survivors still have chemotherapy-induced peripheral neuropathy symptoms, according to new research.

In the study, CIPN was associated with worse physical functioning, poorer mobility and a nearly two-fold higher risk of falls. While more research is needed, the investigators said these findings might inform rehabilitation and fall prevention interventions tailored to people with CIPN.

Findings were presented at the 2016 Cancer Survivorship Symposium, which took place Jan. 15-16 in San Francisco.

“We can’t dismiss neuropathy as a treatment side effect that goes away, because symptoms persist for years in nearly half of women,” lead author Kerri M. Winters-Stone, PhD, a research professor at Oregon Health and Science University in Portland, said in a news release. “While there are no effective treatments for this side effect, rehabilitative exercise programs may preserve physical functioning and mobility in the presence of neuropathy to help prevent falls and resulting injuries.”

Depending of the type of chemotherapy they received, an estimated 57% to 83% of patients will have signs of CIPN at some point during or after their care. It is not possible to predict which patient will develop CIPN or how long the symptoms will last, according to the release. And because there are no reliable tools for early detection of CIPN in routine cancer care, it often is not found until the symptoms become severe.

According to the authors, this is one of the first studies to explore the relationship between CIPN and physical functioning, including risk of falls. The researchers assessed data from 462 women enrolled in exercise intervention trials designed to address fractures and falls in women cancer survivors. The majority (71%) of the women had breast cancer, and others had lung, […]

By |February 1st, 2016|Categories: News|Tags: |0 Comments

Poor sleep in seniors linked to hardened brain arteries

Poor sleep quality in elderly people is associated with more severe arteriosclerosis in the brain and a greater burden of oxygen-starved tissue or infarcts in the brain — both of which can contribute to the risk of stroke and cognitive impairment, according to a new study.

Findings were reported Jan. 14 in the American Heart Association’s journal Stroke.

The relationship between cardiovascular disease and so-called fragmented sleep has been studied in the past, but this is the first study to look specifically for an association between sleep fragmentation and detailed microscopic measures of blood vessel damage and infarcts in autopsied brain tissue from the same individuals, according to a news release.

Fragmented sleep occurs when sleep is interrupted by repeated awakenings or arousals. In this study, sleep was disrupted on average almost seven times each hour.

Researchers examined autopsied brains of 315 people (average age 90, 70% women) who had undergone at least one full week of around-the-clock monitoring for rest or activity, from which sleep quality and circadian rhythms were quantified. In all, results showed 29% of the patients had suffered a stroke, while 61% had signs of moderate to severe damage to blood vessels in the brain.

Researchers found greater sleep fragmentation was associated with 27% higher odds of having severe arteriosclerosis. Also, for each additional two arousals during one hour of sleep, researchers reported a 30% increase in the odds that subjects had visible signs of oxygen deprivation in their brains.

These findings were independent of other cardiovascular risk factors, such as body mass, smoking history, diabetes, and hypertension, or other medical conditions such as Alzheimer’s disease, pain, depression or heart failure, researchers said.

“The forms of brain injury that we observed are important because they may not […]

By |January 29th, 2016|Categories: News|Tags: |0 Comments

Study eyes influence of toy types on infants’ language

Electronic toys for infants that emit lights, words and songs were associated with decreased quantity and quality of language compared with playing with books or traditional toys such as a wooden puzzle, a shape-sorter and a set of rubber blocks, a recent study found.

Findings were published Dec. 23 on the website of JAMA Pediatrics.

The reality for many families of young children is opportunities for direct parent-child play time is limited because of financial, work and other familial factors, according to a news release. For that reason, optimizing the quality of limited parent-child play time is important.

Anna V. Sosa, PhD, of Northern Arizona University, Flagstaff, and colleagues conducted a controlled experiment involving 26 parent-infant pairs with children who were 10 to 16 months old. Researchers did not directly observe parent-infant play time because it was conducted in participants’ homes. Audio recording equipment was used to pick up sound during the 15-minute play sessions. The parent and infant pairs were given three sets of toys: electronic toys (a baby laptop, a talking farm and a baby cell phone); traditional toys (chunky wooden puzzle, shape-sorter and rubber blocks with pictures); and five board books with farm animal, shape or color themes.

While playing with electronic toys there were fewer adult words used, fewer conversational turns with verbal back-and-forth, fewer parental responses and less production of content-specific words than when playing with traditional toys or books, researchers found. Children also vocalized less while playing with electronic toys than with books, according to the results.

Results also indicate parents produced fewer words during play with traditional toys than while playing with books with infants. Parents also used less content-specific words when playing with traditional toys with their infants than when playing […]

By |January 26th, 2016|Categories: News|Tags: |0 Comments

EsoGlove detects muscle signals, guides the hand for rehab exercises

Patients who have lost hand function because of injuries or nerve-related conditions such as stroke and muscular dystrophy could be able to restore movements using a new lightweight rehabilitation device called EsoGlove.

The device, developed by a research team from the National University of Singapore, is made of soft materials and builds on conventional robotic hand rehab devices, according to a news release. The EsoGlove has sensors to detect muscle signals and conforms to the natural movements of the human hand, reducing discomfort and risk of injury. It also is compact and portable, so patients who are recovering at home or are bedridden could complete rehab exercises with greater ease and comfort.

“For patients to restore their hand functions, they need to go through rehabilitation programs that involve repetitive tasks such as gripping and releasing objects,” Raye Yeow, PhD, assistant professor in the NUS Department of Biomedical Engineering, who specializes in soft wearable robotics, said in the release. “These exercises are often labor intensive and are confined to clinical settings. EsoGlove is designed to enable patients to carry out rehabilitation exercises in various settings – in the hospital wards, rehabilitation centers and even at home. Equipped with technology that can detect and interpret muscle signals, EsoGlove can also assist patients in daily activities, for instance by guiding the fingers to perform tasks such as holding a cup.”

The NUS team includes Yeow, his clinical collaborator Lim Jeong Hoon, MD, PhD, from the NUS Department of Medicine, and PhD candidate Yap Hong Kai and undergraduate student Benjamin Ang Wee Keong, both from the NUS Biomedical Engineering department.
Greater comfort and convenience
Conventional robotic devices for hand rehabilitation consist of rigid electromechanical components, which can be heavy and uncomfortable for patients.

“EsoGlove […]

By |January 25th, 2016|Categories: News|Tags: |2 Comments

Trial links higher monthly doses of vitamin D with increased risk of falls

Higher monthly doses of vitamin D were associated with no benefit on lower extremity function and with an increased risk of falls in patients ages 70 or older, according to a randomized clinical trial.

Findings appear in an article published Jan. 4 on the website of JAMA Internal Medicine.

Lower extremity function that is impaired is a major risk factor for falls, injuries and a loss of autonomy. Vitamin D supplementation has been proposed as a possible preventive strategy to delay functional decline. However, according to a news release, definitive data are lacking.

To gather more data, Heike A. Bischoff-Ferrari, MD, DrPH, of the University Hospital Zurich, Switzerland, and co-authors conducted a one-year, randomized clinical trial. Their study included 200 men and women ages 70 or older who had fallen in the past.

Participants were divided into three study groups: 67 people in a low-dose control group who received 24,000 IU of vitamin D3 per month; 67 people who received 60,000 IU of vitamin D3 per month; and 66 people who received 24,000 IU of vitamin D3 plus calcifediol per month. The study measured improvement in lower extremity function, achieving 25-hydroxyvitamin D levels of at least 30 ng/mL at six and 12 months, and reported falls.

The authors found:

Of the 200 participants, 58% were vitamin D deficient at baseline.
Doses of 60,000 IU and 24,000 IU plus calcifediol were more likely to result in 25-hydroxyvitamin D levels of at least 30 ng/mL but they were associated with no benefit on lower extremity function.
Of the 200 participants, 60.5% (121 of 200) fell during the 12-month treatment period.
The 60,000 IU and 24,000 IU plus calcifediol groups had higher percentages of participants who fell (66.9% and 66.1%, respectively) compared with the 24,000 IU […]

By |January 22nd, 2016|Categories: News|Tags: |1 Comment

New research shows four patterns of symptoms after military brain injury

Four distinct patterns of symptoms occur after mild traumatic brain injury in military service members, according to new research that also validates a new tool for assessing the quality-of-life impact of TBI.

The research results appear in the January-February issue of The Journal of Head Trauma Rehabilitation, an annual special issue devoted to TBI in the military. JHTR is the official journal of the Brain Injury Association of America and is published by Wolters Kluwer.

In print and online, the special issue includes 13 original research studies on TBI in the military, including a special focus on how TBI affects quality of life. TBI is a major concern in military personnel, both deployed and nondeployed, according to a news release. More than 294,000 service members suffered TBI between 2000 and 2013, according to a news release. More than 80% of these injuries were mild TBI, also known as concussion.
Four subtypes of symptoms after military TBI
Jason M. Bailie, PhD, of the Defense and Veterans Brain Injury Center and colleagues analyzed patterns of neurobehavioral and psychiatric symptoms in more than 1,300 veterans who had suffered combat-related mild TBI within the past two years. The goal was to develop a classification, or taxonomy, of symptoms after mild TBI in military personnel.

The analysis identified four clusters, or subtypes, of symptoms. The largest group of veterans — about 38% — had good recovery, with relatively low rates of behavioral and mental health symptoms, findings showed.

About 22% of veterans had primarily psychiatric symptoms, according to the analysis. This included mood symptoms associated with post-traumatic stress disorder, such as hyperarousal and dissociation or depression. But findings showed veterans in this group were less likely to have cognitive difficulties or headaches.

Another 22% had primarily […]

By |January 19th, 2016|Categories: News|Tags: |0 Comments

Occupational balance in the digital age

I recently listened to a Diane Rehm Show broadcast on NPR, during which experts in child development and digital media discussed the latest research on how digital technology affects children’s lives. They described large studies showing the use patterns of children in the U.S. ages 8 to 18. Researchers found teens engage with electronic devices on average for nine hours each day outside of school and homework. One expert observed that today’s children spend more time interacting with screens than they do in any other activity, including attending school and sleeping.

None of this will come as a surprise unless you have been off the grid for the last couple of decades, but here’s what may give you a moment’s pause: At least one of these experts said it was inappropriate or impossible to limit anyone’s screen time, given the pervasiveness of digital devices and their everyday usefulness. I have encountered this sense of passivity or powerlessness in some of my clients and even professional colleagues, and I hope you will join me in refuting this misconception.

Here’s an example from my practice. I work with young adults who have failed to launch because of combinations of mental health, developmental, learning and social constraints. One such young man, “Jason,” typically looked exhausted and entirely disengaged when I arrived at his home in the mid-afternoons. He rejected 99% of my ideas for activities, yet always wanted me to return the next week. His sleeping/waking pattern was flipped, and he stayed up until 4-6 a.m. playing video games. Our 2 p.m. session was in the midst of his sleep cycle. He also showed signs of depression and anxiety, for which he was seeing a doctor. Jason said he […]

By |January 18th, 2016|Categories: From the Editor|Tags: |0 Comments