Sue Paul COO,OTR/L has been the Chief Operating Officer of Baker Rehab Group since 2002. Ms. Paul has held certifications in geriatrics through the American Occupational Therapy Association and served as AOTA representative for the End of Life Practice Recommendations for the National Alzheimer’s Association in Washington D.C. She is the author of the Head, Hands, Heart Dementia Assessment System, which is a healthcare provider tool for assessing and treating persons with dementia.
Well here we are at the end of OT Month 2015 and we’ve had some great insights and lessons shared by some of our colleagues. But not everybody got the chance to share. Not only was April #OTTakeover Month, it was also annual compliance month, and let’s-install-a-new-electronic-medical-record-month, and spring break month… and a month filled with a ton of work and growth and “stepping up” at BRG. Our therapists have been pushed to the max this month so we’ve decided to spread the love out over the rest of the year. So watch your inbox and the Baker Beacon for additional nuggets of OT wisdom. It’s good stuff.
But since it is still technically OT Month, allow me to share with you my own recent “a-ha” lessons. I’ve been an OT for almost 25 years, which means I pretty much know what I know, and I know what I don’t know. But it turns out, what I thought I knew is really something I used to know, or maybe I still know, but I lump in with other things I know into a fuller body of knowledge. Such are the fruits of maturity and experience. However, it seems I’ve been neglecting to put into practice some key principles that are really important in the delivery of quality occupational therapy services. Even more eye-opening is that I learned these valuable lessons from a new grad.
I have been covering patient treatments for one of our younger, newer therapists while she is on vacation. I have been pleasantly assured by all of her patients that her skills and aptitude for home health OT is top notch… they all love her. The one thing that they each have mentioned to me, and that they really appreciate, is how she has been able to break down the parts of task into smaller components. By reviewing each step of a task, they are able to hone in on each weak link and work on corrective actions. I keep hearing the same feedback over and over, “She really breaks it down for me.”
In occupational therapy lingo, this is called task analysis. We spend a lot of time in OT school breaking down functional tasks into components that consider movement patterns, cognitive processes, and environmental and psychosocial elements. It’s OT 101.
When you’ve seen the same task performed hundreds of different ways over the course of 25 years, you tend to take a more macroscopic view of issues. Or you tend to assume that the problem is obvious to everyone, because you’ve seen it so many times before. I have been reminded lately how crucial it is to explain task analysis to our patients. I had forgotten how much they appreciate understanding our reasoning behind treatment approaches, even the most obvious detail, and how important it is to show them the weak link in a sequence. I may know what the problem is and how to fix it, but may not bother to break it down into smaller steps for the sake of better compliance and participation. I tell them to trust me. When did I become such a know-it-all?
So I’d like to thank Rachel Hensberger for her stellar contribution to the OT community and for reminding me how valuable our basic guiding principles are. She has done her patients, her profession, and her “boss” a great service. I am humbled and grateful.
Katie Schroeder-Smith, MOT, OTR/L has practiced occupational therapy for over 13 years after studying psychology at UNC Chapel Hill and receiving her Masters in OT at Nova Southeastern University. Katie is certified in sensory integration (SIPT) and has received advanced training in pediatric and therapeutic yoga, handwriting, and Therapeutic Listening. She has diverse experience with all ages from infants to adults in home-based, school-based, and clinic-based settings, as well as hospital and nursing homes. Katie sees patients for Baker Rehab Group as an independent contractor, which allows her to work for a number of different providers in a variety of settings. Her contribution to the BRG OT network has been invaluable.
What do occupational therapy (OT) and yoga have in common?
First of all, to define occupational therapy, it is helpful to know that the “occupation” part actually comes from the verb: to occupy oneself, purposefully, meaningfully, and driven by ones own motivation and goals. Dysfunction, occupationally speaking, could occur in any aspect of one’s purposeful life.
There’s physical dysfunction (perhaps a person is limited by chronic back pain, arthritis, a heart condition or a broken bone) and psychological dysfunction (depression, anxiety, dementia, autism, ADHD).
Dysfunction may even occur at a deeper level, where a person has lost motivation and goal oriented activity, or has perhaps been enabled by learned helplessness or perceived inability. Dysfunction may result from a mismatch between a person and his/her environment. Think of an elderly individual with severe arthritis and osteoporosis who lives in a 3-story row home with narrow doorways, or how about a child with ADHD who lives in a disorganized house without family support who frequently loses his homework.
Dysfunction can present itself in activities of daily living—think again of the arthritic woman who can no longer dress herself or carry things up and down the stairs, or the child with ADHD who cannot sequence his morning routine. It can present in work related tasks– the woman who has poor balance in standing to cook a meal for her family, the child who struggles to sit still or write a sentence in school; or in leisure tasks- the woman who cannot perform her favorite hobbies of needlepoint and gardening, the child who has difficulty participating in organized sports.
However, as the American Association of Occupational Therapy (AOTA, www.aota.org) points out, OTs ask a client “what matters to you?” rather than “what’s the matter with you?”
When a person is not well for whatever reason, he/she often experiences a disintegration of body, mind and spirit, and what matters to that individual is not always readily apparent to even that person. The individual who suffered a stroke must now learn to function inside a body where he can only control one arm and one leg, struggling with basic skills such as rolling over in bed, using the toilet and brushing his teeth. Ask that person what matters to him now, and it’s not yet golf or returning to work; it’s simply walking, talking, and eating.
Yoga can be defined simply as “unity”. Unity of body, mind and spirit. As an OT, I can’t help but extrapolate that to unity of person and environment, unity of person and task, unity of person and person. Yoga is a discipline, traditionally based in eastern philosophy. Occupational therapy, using principles, strategies and poses from this ancient holistic perspective, merges beautifully with the foundations on which the profession of occupational therapy was built. Looking at a person holistically, the OT with a yoga perspective will consider the following 5 tenets of yoga: relaxation, exercise, breathing, eating and positive thinking.
Relaxation, noticeably important in cases of anxiety or stress, is also very significant to recovering from a physical injury. I haven’t met a person with an orthopedic injury who doesn’t tense up or compensate with other muscles. Yoga can help develop body awareness and coping strategies to relax the muscles that don’t need to work, and focus on working the ones that need it. Yoga can also help a child or adult with self-regulation, or learning how to find that calm alert state for optimal attention, focus, and social skills.
Exercise is perhaps the most obvious similarity between yoga and OT as a rehabilitation profession. What is special to yoga however is even the most basic poses require the use of core muscles, those abdominal and spinal muscles that provide stability and alignment for all of life’s activities and movements. Yoga, as a form of exercise, can also be easily adapted to all ages, from infancy to the oldest of adults, and can be graded to the individual’s needs and abilities.
Perhaps one of the most significant contributions of yoga is its focus on breathing. Learning proper breathing methods is critical to those with cardiovascular and respiratory conditions, of course, but it is also crucial for both relaxation and exercise to properly occur. Focusing on the breath allows one to be in the present moment, engaging in an occupation of choice. Breathing techniques are also one of the most effective strategies for self calming, an area that many kids on the autism spectrum or with sensory sensitivities struggle with.
Eating, as a vital activity of daily living is an area that OT traditionally focuses on with regard to independence, adaptation, meal preparation, or oral motor skills/ swallowing. Using a holistic yoga perspective, which foods a person eats and how they regulate their eating patterns also becomes important.
Lastly, positive thinking seems like a no- brainer, for any professional looking to help and heal others. Through the principle of non-judgment and use of strategies such as meditation and positive affirmations, yoga is a wonderful adjunct to OT as a client deals with frustration and patiently works towards his/her goals.
OTs use occupation as both and ends and a means. Simply stated, not only is the person working on a goal in one or more areas of his occupation (I.e. Putting a shirt on independently) but as a means of achieving that goal.
One of my favorite quotes about OT comes from a renowned OT, Mary Reilly: “Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.”
There is more to occupations than activities, purpose, and meaning. Occupations affect our health. What we choose to do, or not do, to occupy our time, profoundly influences our health. Occupations change and evolve over our lifetime, and are most definitely influenced by illnesses, traumatic events, or injuries that occur along the way.
My father was always an avid skier until he had a bad fall and broke his leg. Physically he could have returned easily to the sport after recovering, but his motivation to engage in this was severely changed by his traumatic experience. Luckily, he found other healthy occupations to replace this one.
Yoga can be a healthy, doable replacement for occupations that were unhealthy, impractical, or no longer enjoyable. Yoga can also be a therapeutic means in which to reach another occupational goal, for example improving posture to be able to sit upright to feed oneself, or to optimize focus in the classroom. Last but not least, yoga can be a lifestyle change, in which it is integrated into daily life routines to positively influence health, decrease stress, and improve performance of occupations throughout the life span.
I did not even mention all of the research pointing to the benefits of yoga for health, various medical conditions, and in school age children, to name a few. Look for another post in the near future!
Theresa Davis is an independent contractor who provides occupational therapy services for BRG clients, as well as through other providers in Maryland. Theresa has spent the majority of her career working the older client. She has such great insight into the benefit of occupational therapy in the home health setting.
After working in various settings for 20 plus years as an Occupational Therapist, the one thing I have learned is the importance of being patient, caring and loving with our elderly residents.
There is so much we can teach our patients about being stronger, improving their endurance, increasing their hand dexterity, dressing themselves with less assistance, learning to walk better to use their bathrooms, etc… However there is so much they can teach us as well.
They teach us to listen better, to be empathetic and understand all the troubles they are having. This in turn allows us to find the best ways to motivate them. The most important thing to most of them is that we care and that we are there to “listen” to them. As therapists, we sometimes undervalue our role and the importance of “touch” for this population. For many of them, they have been placed in a facility against their choosing in which their families either can’t or don’t come to see them, leaving them to feel both empty and abandoned. I have to come to realize over the last several years the vast importance of empathy, hugs, smiles, asking how their day is going, and just providing the acknowledgement that I care about them and am invested in their well being. Even the residents that are not being seen by therapy services in a senior living setting still benefit from the acknowledgement and caring attitudes we give them. We have several residents that come into our clinic just to be around us and talk.
Additionally, we need to help bridge the gap between the overworked caregivers- who may not understand the disease process of the cognitively impaired- and the residents who need so much more than basic care. This population needs additional love, touch and empathy, even when their minds and bodies are failing them. They can still understand a smile, a hug, and positive body language. So, sometimes when we feel frustrated because the physical progress may not be as aggressive as we would like, we need to remember the positive impact we are having on our residents in other ways to improve their well being.
“We just can’t make your glasses any stronger.” To many individuals with low vision, this is a frequently heard statement from eye care professionals. It is estimated than one in four people over the age of 80 are affected by low vision. As the population ages and life expectancy increases, low vision has become the third leading cause of disability in older Americans. Most of us know someone whose life has been altered by severe vision loss. But few people know that there is something that can be done about it.
Low vision is defined as a visual impairment that cannot be corrected by eye glasses, medicine, or surgery that interferes with the ability to perform everyday activities. The most common conditions are macular degeneration, diabetic retinopathy, glaucoma, and vision loss from stroke.
People with severe vision loss have difficulty performing simple daily tasks that many of us take for granted. Reading medication bottles, writing checks, or setting the dials on the stove can be nearly impossible for someone with low vision, even with the use of corrective glasses.
While many of these conditions are irreversible, this does not have to mean a loss of independence or quality of life. If you are experiencing vision loss, the first step is to contact your eye care professional. An ophthalmologist can diagnose and treat eye disease and may prescribe medications or surgery to address vision related conditions. An optometrist can diagnose eye disorders and prescribe glasses, low vision devices, or vision therapy. It is important to find an eye care professional that specializes in low vision. Your doctor may then recommend that you receive additional low vision training through a vision rehabilitation teacher or an occupational therapist.
Why Occupational Therapy?
Occupational therapists are rehabilitation professionals who are uniquely trained to help clients achieve the highest level of independence despite disability or impairment. Many occupational therapists now have specialized training in low vision. A low vision occupational therapist (OT) can evaluate the home environment, provide treatment, and teach compensatory strategies so that the client can use their available vision. Recommendations may be made for assistive devices that can enable the person to remain in the home and perform daily activities independently. Low Vision OTs can also provide information on the many services and organizations available in the community. Because occupational therapy is a skilled rehabilitation service, these services are typically covered through Medicare and other third party payers.
Most seniors have a strong desire to remain independent in their own homes, even with declining vision. With the appropriate modifications, this is a viable option for many. Increasing lighting, contrast, and improving organizational strategies are a few simple things that may enable someone to remain independent at home. Training in orientation and mobility can allow individuals to remain active in the community as well.
When standard glasses are no longer an option, optical devices can provide the needed magnification so that an individual can continue reading. High powered magnifiers and electronic readers now are able to magnify print up to 20x the original size. Additional devices such as talking glucometers, color identifiers, and large button cell phones are also available to those with low vision. If vision loss has impacted you, remember that you are not alone and there are many options available to improve your quality of life.
“Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.” - Michael Jordan
10 Simple Low Vision Tips:
Use full spectrum or natural daylight bulbs to reduce glare and imitate daylight
Remember to light up stairs, pathways, and walkways
Consider goose neck style lamps which are best for reading
Use a black felt tip pen on white paper when writing
Avoid too much pattern on placemats and tablecloths
Label buttons on appliances with bright stickers/raised dots
Label medication bottles with large bold letters on top
Color code household documents and papers
Ask you bank about large print checks
Consider audio books when reading is no longer an option
Mary Schwartz, OTR/L is a low vision occupational therapist with Baker Rehab Group in Frederick, Maryland and sees clients both in the home and within many local assisted living facilities.
Client Care Facilitator (CCF) in Montgomery County, Maryland
Friends of Baker Rehab Group, here’s a therapist you just have to meet.
Connie Mulloy is an occupational therapist and serves as a Client Care Facilitator (CCF) for Baker Rehab Group in Montgomery County, Maryland. Connie brings nearly 30 years of clinical expertise to our team, and is an invaluable resource for training, mentoring, and supervision to our newer staff members.
Connie has earned specialized expertise in the concept of aging in place, also known as CAPS (Certified Aging in Place Specialist). Her CAPS qualification ensures our clients that Connie is current on the latest home modifications and equipment available to maximize safety and independence in their homes despite age, illness, or disability. She is also a valuable resource for contractors, builders, and project managers who need input into design and function during new construction or remodeling.
Here at Baker Rehab, we frequently call on Connie’s wisdom to trouble shoot processes that could run more smoothly and to help develop new, evidenced-based practices that enhance the skills of our therapists. She is beyond generous with her time and talents, and every one of her patients would agree.
Check out Connie’s blog where she shares tips for aging in place atAging in Place Tips for Caregivers. You can also call our office if you’d like to reach Connie for consultation or regarding an educational event.
Thank you for being so awesome, Connie. We think you’re the best!
You know her… everybody does. She has been in and out of so many homes in Frederick County over the last 13 years that it is very likely that if she wasn’t in your home, she was at your neighbor’s, and she passed you on the street. And she waved. She’s like that.
Theresa Davis is our October Spotlight on Excellence therapist because, well, she’s excellent.
Theresa has been an occupational therapist for 18 years, spending her entire career working in geriatrics and the vast majority of it in home health.
“I love home care because it’s true Occupational Therapy – working in a client’s home and focusing on improving their safety, mobility, and independence. I love the elderly and making their days brighter just by talking with them and showing interest in them. Sometimes a hug and a smile will really make their day better.”
Theresa is proficient in environmental modifications and dementia care. She is a huge resource for Baker Rehab Group in providing training and management of our newer therapists. She is a staple at many area assisted living facilities, and is skilled in joining forces with their management teams to integrate rehab into each facility’s structure.
Many would describe Theresa as “sunshiny” due to her love of the beach and infectious laugh. She is a talented multitasker- juggling her busy work life with two active sons and a wonderful husband who she adores.
“I love the other therapists I work with and feel lucky to always have such a collaborative relationship to improve the lives of our patients.”
We feel exactly the same way about you, Theresa!!!
Theresa provides occupational therapy in the home to much of Southern Frederick County in Brunswick/Jefferson and Washington County, Maryland. If you’d like her to come work with you or your family member, please email us or call our office at 866.727.3422.