Occupational Therapy Notes

I recently received an email from an OT that I had worked with many moons ago, Allysin Bridges. Allysin is one of those superb people that has positive energy and is just wonderful to have around, a great representative of OT daily and even with the state legislature. And in an example of good things happening to good people, Allysin was selected from a lottery to participate in one of the greatest races in the world- the Ironman Triathlon Championship in Kona, Hawaii. If you're not familiar with triathlon, it is a three part race requiring the athlete to swim, bike, and run. The Ironman takes this to a level that only an accomplished athlete can finish: 2.4 miles of open-water swimming, 112 miles biking, and a 26.2 marathon run! I think that participating in an Ironman is reason enough for joy, but Allysin is taking it to another level of awesome by racing to benefit the Blazeman Warrior Foundation for ALS! Read on to learn more about Allysin's story and her challenge which is much bigger than a bucket of ice water!

- Where are you working now?

I am working for JHU School of Nursing on the CAPABLE study with Dr. Sarah Szanton. It is a grant funded program to help low income, Baltimore City older adults age in place safely using a three discipline approach - an OT, RN and a handyman (we are working with CivicWorks). I love it!

- How did you get interested in triathlon? Have you completed an Ironman before?

I had returned back to MD in 2002 after finishing grad school at NYU and had picked up a few (ahem) pounds. I was bored with the gym and was looking for another outlet. A neighbor told my mom about triathlons (she had been doing them for years) and that was her outlet. So I looked into it and I had been a mountain biker since I was 18 and loved the water so I figured it would be a good fit. So I did my first experience was Dewey Beach Sprint. I was pretty green going into it not really knowing the logistics of it (like transitions!) but I finished with a huge smile on my face and knew I had been bitten by the tri-bug. I then went into longer tri's (1/2 Ironmans) with Team In Training and I really loved the spirit and comraderie of the tri community. I trained a year for FL IM 2006 with 10 of my TNT friends and we all but 1 finished (she went back the following year and crushed it!). I took a hiatus after that to have babies and went back to it in 2011 and don't plan to stop until my body tells me so (but I don't listen well).

- How many hours are you training now each week? How do you find a balance between work, family, and training?

Training for an Ironman is a different animal. And knowing it's the World Championship, even more so. My big training days are on the weekends. And those usually add up to be 5-7 hours each day at this point since I am only 8 weeks out from the big day! A week, I average 15-23. It's basically a part time job. The balance of life while training for this type of endurance event is difficult. I rely on my mom, Jason (my sons' dad) and Dennis (my partner). Many people joke and call themselves "Ironman Widows." It is definitely a lot of time dedicated to this one thing, but in the end, this is a once in a lifetime experience and fortunately, my loved ones understand that and back me up.

- Have you found support from your colleagues in your athletic pursuits?

Aside from them thinking that I am clinically certifiably nuts, they are very excited for me. My boss knew that I was getting close to crunch time and offered a different schedule that will work out great for the next couple months. I'm very lucky. I can't get any of them to train with me though!

- You are racing for the Blazeman Warrior Foundation for ALS because you have a personal connection with this disease. Can you tell us more about that?

They are personally invested in finding a cure and raising awareness as they lost their son, Jon, in 2007 to the disease. Jon did the Kona IM in 2005 after being diagnosed and finished! ALS hits me hard. My dad died of it in 1997 after being diagnosed 2 yrs prior. It was devastating to watch an incredibly healthy and vibrant man turn into a shell with no movement, speech but had all his mental capacities. I think that's the worst part of it; being completely aware that your body has betrayed you. Imagine how annoying it is when you can't reach that itch on your foot when your shoes are on. It's like that but he couldn't scratch it and eventually couldn't even tell us he had an itch. I also feel that the caregivers go so unnoticed and they are in need of so much support.



When I became an OT, I knew that I was not capable of treating patients with ALS. I would break down as soon as I saw the diagnosis. I tried again in 2012 in an outpatient, multidisciplinary setting. They appreciated my personal connection to it but not so much what I had to say. There isn't anything positive I can tell people because it ends the same - the diaphragm shuts down and that's it. I tried comforting the patients and caregivers especially but I just didn't feel I was doing them any good as an OT. I was too close. To this day, I am haunted by the death of my dad. That's why I am passionate about finding a cure. It has to stop.

- Do you have any tips for families dealing with ALS or therapists who many not be used to the disease?

Advice: give the caregivers TLC because they are going to need it during and after. Keep researching and keep up with the newest technology for communication. Coping strategies are going to be important for all involved. It's hard for us, I think, as OTs to separate sometimes from our patients, especially when there is a personal involvement. But for those who are good with ALS patients, I thank you, applaud you, and owe you! They need you!

- Have you found any part of your OT training to be helpful in triathlon training?

Great question and I had to think on this a little. A lot of the sport is mental, whether it's during training or the race itself. It's funny how your brain can get in your way. So I have to refer back to skills I've taught my patients (a lot of psych stuff). Planning out tasks, setting goals (that's a big one), asking for help (this is a work in progress). Anatomy and physiology really helps when I have to describe and locate my pain! Actually, A&P and kinesiology help a lot during strength training, stretching and simple modalities.

- Do you have any advice for finding balance between work, family, and leisure pursuits?

Let them all mingle and be involved whenever possible. On the same coin, be sure to set aside time for just those roles/aspects - they deserve it.

- Any other info you want to share is welcome!

After I finished FL IM, I told myself that I'd do one more, and if at all possible, it was going to be Kona. I knew I wouldn't qualify so when I thought the timing was right, I put my name in for the Lottery. April 15th, Mike Reilly made that dream come true when he called me and told I was going to Kona, baby! He actually has the phone call on his website :)


Way to go Allysin! Completing such an awesome athletic pursuit is great, but to do it to fundraise for others is absolutely terrific! If you can, please consider making a donation through Allysin to the Blazeman Warrior Foundation. The Ironman championship takes place October 11 and is televised (in an abbreviated format) in the US.

People who know me (and particularly those who have known me from 2009 or longer) could attest to the fact that I am rather a picky eater. There were several months in 2002 when the bulk of my diet was composed of mashed potatoes, cereal, and pasta. My daily lunch when I started college was almost always a turkey or grilled cheese sandwich. And for the first 4 years or so of my working life, I would have the same lunch (kashi bar, pudding, applesauce) 95% of the time.
These were my natural preferences and tendencies. It got better in college, even better when I met my husband (who aspires to a mid-life crisis as a professional chef), and even better when we moved to big city Baltimore and got exposed to more flavors of the world. In the past 5 years, I have added in Chinese, Japanese, Greek, Mexican, and occasionally Thai foods into my repertoire. (this may not sound like much to you, but coming from a beige diet of American and Americanized Italian foods, it is kind of a big deal)

Recently, I have found that I have had more "accidentally vegetarian" days. This never could have happened before because I just didn’t have the variety in my diet to accomplish it. I’ve always been lazy about cooking, and now when I'm in a scavenging mood, the vegetarian options are often easier to make. I also have been better about finding vegetarian foods with protein, which makes it a "real meal" in my opinion. While I don't anticipate that I will ever cut out meat completely, I do think that this effort helps me consciously eat a little healthier every day.

The combination of my new vegetarian leanings, a penchant for easy foods, and dental work requiring a mechanical soft diet led me to a new front in my battle to conquer cuisines: yogurt. I have always loved frozen yogurt but since initially trying actual yogurt in the cup I have loathed it. Even though I like soft foods, it’s too gloppy. Yogurt with fruit in it involves mixed textures, of which I am not a fan. And every kind of yogurt I have ever tasted has the distinct and awful aftertaste which quite frankly makes me want to vomit. So why bother to try to eat it? Greek yogurt is a great source of calcium and protein without fat or cholesterol. It looks like a great breakfast or post-workout snack. Normal people can eat it. (Spoiler alert- now I can too!)

Over the space of a couple months, I decided to beat Greek yogurt. I have not taken a formal feeding course, but using my OT brain combined with what I know regarding various approaches (SOS and Food Chaining primarily) I felt like it was doable. I started very slow. I got prepackaged frozen smoothies which had fruit and frozen Greek yogurt bites in them. With each sip, I could taste that 'tang' of yogurt, but it wasn't overpowering. This definitely was more filling than a fruit only smoothie, so it did prompt me to keep going.

I could have taken a step 2, and made smoothies on my own with a larger serving of yogurt. But I’m a busy person, not inclined to a lot of extra kitchen effort. So I skipped ahead to buying the little cups of yogurt. I got a couple of flavors and decided to give it a go. With my first attempt, I took a spoonful and made the scrunched up face of awful that I had long associated with yogurt. I thought that I might gag right there on the couch. I was able to eat half a cup by liberally using graham crackers to dip in it, and made a deal with myself that any effort was acceptable. Mentally, I think knowing that you don't HAVE to eat the whole portion is very freeing. I also ate this portion at home, my safe place for trying new foods.

With new cups, I moved forward into trying to use fewer crackers and having more unassisted spoonfuls of yogurt. I took cups to work with me for breakfast (with backup breakfast and Tupperware in tow just in case). It did improve. I was able to eat a new flavor with spoon only and no crackers. Then ultimate victory was reached as such: I was visiting in another town and home alone. I decided to go for a run but needed breakfast, a soft breakfast since my teeth still hurt. I was able to go into the grocery store and get a yogurt and a spoon and eat it in a totally new place, in a hurry, with no problems.

So that is a story of successful OT self-intervention for expanding a food repertoire. Not every new food that I try has to go down this path, thankfully. But I do want this to be an encouragement to people trying to work on feeding interventions with their family. If you are struggling with a child who is an overly picky eater, I would encourage you to reach out to the early intervention service in your state and see if you can have an Occupational Therapy or Speech Therapy assessment performed by someone skilled in feeding intervention. And if you can be as excited as I am by the mundane successes in assisting others on their paths to increased independence, perhaps you should consider a career in Occupational Therapy.

Disclaimers: please work with a qualified professional when addressing feeding with any child or adult. This article is not meant to replace any evaluation or recommendation from a professional regarding feeding skills or development. The SOS and Food Chaining approaches are both under copyright and require additional training to use and this therapist does not purport to be trained as such.

OK, clearly I couldn't keep the challenge going for the full month. But this was one of the best ideas not yet written, and so I definitely want to include it.

We have a lot to be thankful for in life, and OT life is no different. Who first inspired you to be an OT? What teacher guided you from student to practitioner? Which coworker challenged you to become a better therapist? Many of us can think of a few people who have filled those roles for us.

I apologize that I did not write down my citation here, but hopefully the thought will count. Some time ago, I read a post by another blogger (maybe you?) who I believe had attended the Autism West conference. The author was talking about a presentation by Winnie Dunn where she had said to "Change one thing with one person." What a concept.

I feel like when I go to a conference, I come back bursting with new ideas and things to try and whole new schools of thought to try to enact. Sometimes, by being weighed down by the enormity of the things that could be changed, it's hard to take any action at all. If we do that (i.e. nothing) then what was the point of spending hundreds of dollars on the new course or the time spent reading that article? And then starts the sneaky guilt spiral... which gets me nowhere.

Today is a day for reflection in general, but if you have a moment to spare for OT, do it in this manner.

Today's challenge is not much of a challenge for most bloggers, since they are probably doing this anyway. And the intent of this is not to make everyone start a blog or in-depth diary of their practice. But everyone has down days where they wonder why they do the things they do... and that is why you should take time to record an "up" moment to remind yourself.

There have been several good links on twitter or my RSS feed lately and I wanted to make sure to save a copy for myself and get them out to those who aren't on twitter (or like me and might skip several days at a time)

October 27 is World OT Day! Sponsored by WFOT (now on Facebook), it's a great day to proudly raise awareness about the profession. I would rock my Super OT shirt, but I have formal meetings, so I'll wear inner-OT-awesomeness instead. :)

When I saw this link listing the schedule of online speakers for World OT Day (10/27/10) I started to get really excited!
There are some very famous OTs on this lineup, including Karen Jacobs, Kit Sinclair, Erik Johnson, Michael Iwama, and the current president of the World Federation of Occupational Therapists, Sharon Britnell. Props to Merrolee Penman, who appears to be behind the effort.

I am always seeking to learn more about occupational therapy and think that seeing the world perspective will be very interesting. I'm not sure if these sessions can be accessed at a later time- I will be working and sleeping through most of them. However, here's what I plan to catch (times EST):

2pm: Erik Johnson "Occupational therapy within a military setting" I got to see a short video from Erik during the 2010 AOTA Conference and follow his blog, so I think this will be a pretty interesting and worthwhile session. I'm going to see if we can get a group together to watch at work, and if that doesn't fly, I'm going to take a late lunch and break out the headphones.

5pm: Michael Iwama "The Kawa model: Heralding a new paradigm in occupational therapy" I don't know a lot about the River Model and think this will be a good introduction.

The following presentation 6pm "Re-Connecting: Using Facebook for Social Networking after an Acquired Brain Injury" looks interesting, but I have to get on the bus and get home sometime, so I'll probably have to miss it. (Same goes for 2, 3, 4, 7, 8, 9 which all occur during sleepytime)

7pm: Lindsay Eales & Roxanne Ulanicki "iDance: Transformative Occupations" Looks very unique and awesome, I expect to see many more OTs involved in dance, gymnastics, and other wellness outlets in the future.

8pm: Annette Rivard "The power of professional commitment" self explanatory

9pm: Sharon Brintnell "Images of now and visions for the future" also self explanatory. If you've ever been to an AOTA conference and felt the energizing rush following the president's speech, you know how instrumental that can be for taking momentum home with you and putting new learning into practice. I expect nothing less from our WFOT leader.

It seems that watching these sessions would count towards renewal through NBCOT under "attending workshops/courses/independent learning" (refer to renewal PDF) and depending on your state may count for license renewal as well.

Don't forget that week is also the time for OT Wikiflash, a time for mass editing of Wikipedia to better reflect Occupational Therapy. If you're new to wiki editing, get registered and play in the sandbox now so you can be ready. This is a great way to achieve our Centennial Vision goal of being "widely recognized." I've previously lauded a pediatric blogger for her prolific work on Ehow; Claire Hayward, Anita Hamilton and Will Wade have been active in promoting this event.

A very quick note...
I have been bothered lately by the number of times that I get asked the really tough questions, which can really bog and depress you in acute care. I have also had some of these moments with my outpatients, when I spot a cognitive deficit that is going to cause difficulty for the kids as they progress through school (e.g.- 1st grader unable to phonetically read 3 letter words; 3rd grader unable to add and subtract). I was mentioning one of these misgivings to a parent, asking about possible summer schooling and mom mentioned that "B" would be attending art camp this summer. She said she would still do some worksheets at home, but wasn't going to let him be burned out and unhappy when he had other interests. Obviously, everyone parents and advises differently, but I was definitely happy to say, "One of the great things about 'B' is his imagination and creativity. I bet he'll really enjoy that." In this fast paced, high scheduled, high achievement world, enjoyment of childhood should count too.

A few reflections from the past week, which has been very hard.
First off, I would just like to say that the AOTA conference was great, but I was very foolish to stay for the entire time and then head right back to work the next day. Because as fun as it is, it is also exhausting, and I didn't get any time to process the new information before heading right back into my crazy daily life. I was looking forward to today, my day off, to do some of that. However, I neglected to remember that we're traveling AGAIN this weekend. So that has added to the stress, and I won't really get a "me day" to process stuff until next Saturday. Very difficult on a personal level, and also because I would like to do some recaps about the cool sessions I attended and to give a glimpse of conference awesomeness to the holdouts who didn't make it this year.
In my stress, I decided to let go of thinking about presenting at a state conference this year, since all the deadlines were very close. However, I will be applying to present at next year's AOTA conference in Philadelphia. I will be trying to do a Tech Day session on hands-on optimization of OT Connections and the web in general using tools such as RSS readers, email filters, and aggregators. Basically an in-depth and hands-on version of my presentation to WVOTA last year. I feel like many people shy away from using online OT tools because they don't know the ways to make it less time-consuming. Any thoughts, or people who want to join in?
This week, work has over-dominated my life, preventing a normal occupational balance. Carved out some time for friends, but it went poorly too. So I'm trying to focus on some of the more positive or interesting things of the week.

- With the brainstorming help of some PT buds, I made a really cool splint. Our plastic surgery dept has been writing some crazy orders of late, and this time they got a crazy splint as a result, but they liked it. A woman had a skin graft on the anterior and posterior sides of her calf, and they wanted all pressure off of this to heal. However, she only had about an inch from the sole of her foot before the graft started, and then it was almost to her knee. So if you think about supporting an entire leg from those 2 points, and you've had basic physics, you know that's just not an awesome idea considering the stress and strain that would be present. And thinking about orthoplastic splint construction, I was really at a loss of how to create a solid object to accomplish this. Then the idea of using an abduction pillow came up, cutting a large piece out of the blue foam and reorganizing the straps so that no part of the graft would touch, but greater support would be available to the leg. Not having a knife, or razor blade, (either of which would have been better, more appropriate tools) I set out with scissors and my BARE HANDS to rip the foam as needed, providing a much-needed laugh to my pt. And it worked! Props to combined creativity!

- I spent a fair amount of time explaining standard developmental tasks for 3 year olds this week. They just aren't made to be perfect yet at that point.

- Happened to have the AE cabinet open, which sparked some ideas during an outpatient session. Gave a teenager a rocker knife, which she absolutely loved. Steak is a favorite food. We spent several minutes chopping up theraputty with me hovering nearby to save the other hand. Obviously, she'll have to use it with supervision, but I think that it was truly helpful for her to have a tangible skill at the end of the therapy session. (This is part of a much larger thought process right now, but that will be a very long blog post at another time)

- Spent time crying the other night over one of my pts who went home instead of to rehab because his wife is dying. Lately our sessions have just been getting him to a wheelchair so he could go visit her in another part of the hospital. Very sad situation, but luckily they have family support to make the end of life time better.

- I think the newborn nursery can sense when I'm overstressed AND happen to be the only one to cover the area. Got 2 referrals yesterday, but got my second really conscientious and involved family in 3 weeks, which is really nice. It makes up for the stress of getting everything else covered when the parents really want to get your opinion.

And that's about it. I'm behind on my online readings, but am just simplifying things by deleting several that are either too frequently posted or not compelling enough. I went from 300 unread to 74 through that method. I'm behind on my library books... really can't get into the current book and am more excited about the other one I checked out, which is about Asperger's Syndrome. I'm behind on my professional reading- I ordered a book about developmental coordination disorder and am now afraid that the child I'm treating will be out of visits before I even get it open, and I borrowed a NICU book from a colleague several weeks ago that has not even been flipped through yet. And now I have piles of notes from conference to compile, and also have to print out my handouts before they expire off the site. I also promised to add new acute people on OT Connections and work on making some awesome acute-related posts but I haven't been able to start yet. Can anyone spare some extra eyeballs and brains to help me with all that? lol. I did read a very good post by "the OT Nerd" about the worth of conference for re-energizing, and I hope that I haven't wasted that feeling by rushing back to work.

Time to jet off on another trip... I will get to everything eventually!

Still to come- video compilation from opening ceremony dancing, video from Penny Moyers Cleveland's farewell address, photos and videos from expo, photos from conference classes and events. Full uploading to be done at OT Connections.

Welcome to the First-Ever OTNotes podcast!


Featuring Kelly Casey, Occupational Therapist from The Johns Hopkins Hospital in Baltimore, who is presenting multiple topics at the AOTA Conference. (Get it? That's why we're using the special "speakers-only" badge for this entry) The audio is 22 minutes, please forgive the technical quality and instead focus on the awesome discussion points offered.



Here are some links to helpful information in case you're not taking notes:

Kelly's Topics:

Thu, Apr 29, 9:00 - 10:30 AM Short Course 105

Culture Change In Acute Care: An Interdisciplinary Approach to Creating Respect For Therapies

Thu, Apr 29, 1:00 - 3:00 PM Poster 207

Movement Towards The Centennial Vision: Steps Of Post-professional And Entry Level OTDs

Fri, Apr 30, 2:00 - 3:30 PM Short Course 223

Assessing Cognitive Disorders: Integrating Standardized Assessments In Acute Care

Cognitive assessments discussed:
- Cognitive Assessment of Minnesota
- Executive Function Performance Test
- JFK Coma Recovery Scale


Centennial Vision Statement

We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs.

At the suggestion of my dad, I read Malcolm Gladwell's books over the summer, and have some OT-related thoughts from them.

As a disclaimer, before someone jumps in to attack my lack of critical reading skills, I am well aware that none of the concepts in Gladwell's books are his own research, but there is a limit to how many individual research articles any one person is going to read in a given lifetime. So these are distilled stories with ready-made inferences, but interesting and thought provoking nonetheless. Here are some OT-related thoughts from the books The Tipping Point (TP), Blink (B), and Outliers (O).

Reading the Face (B 197) The final chapter of Blink discusses the work of Paul Ekman and ability to read emotions through expressions and micro-expressions. While I think it would be interesting to see when people are lying, frustrated, or scared, I think I would have better use to just be more aware of my own expressions and the message that I am subconsciously sending.

Fusiform vs Temporal gyrus (B 219)- After discussing visual tracking during a movie between persons w/ and w/o autism, he touches on a study indicating that most people picture and view faces using the fusiform gyrus. However, an autistic individual uses the inferior temporal gyrus to view faces, which is the same location that most people use only for objects. I wasn't really aware of that specific neurological difference but think that it would make an interesting principle to guide treatment.

10,000 hour rule (O 35)- This concept is presented as one of the precursors to mis-named overnight success. Several examples were given of people who started working in an unpopular field and had logged 10,000 hours of practice by the time that the field was ready for rapid growth. This number is referred to as the number of hours of practice needed to become an expert in the field. This would be a little over 5 years of full time work. How many OTs work their first 5 years uninterrupted, let alone in the same practice area? Just a thought. Also makes the hours needed for board and specialty certification seem almost doable.

Culture of Honor (O 161)- There was a mention of how a cultural importance of honor in highland areas has continued into the Appalachian region, giving some reasoning behind the number of feuds in the past century. This concept is also of high importance to many urban residents, especially in places where gang culture is rampant. I just thought it was an important tip to promote developing rapport with your clients and deferring to be more formal and respectful until you have a well developed relationship with your client and can be more informal.

Parenting styles (O 104)- A study is referenced that talks about 2 parenting styles: "concerted cultivation" vs "accomplishment of natural growth." I don't have full definitions for these, but they are associated with high and low SES families, respectively. The former is where the parent would encourage social skills and talent development through modeling and empowering the child. This was associated with higher confidence and better interactions with adults. The latter is a style that is more passive, leaving some of the development left up to teachers, coaches, therapists, etc. I definitely saw both types of parents when I was working with peds. In my experience, the latter style makes it hard to have home program carryover.

Levels of mitigation in speech (O 194)- The levels are restated here, and were discussed in the book in relation to studies about plane crashes. The author of that link also references an article from a person in a different power-index culture, which was interesting. I would be very interested to see a study on what terminology was used in ERs for trauma or in ICUs in critical moments between the various staff members. I may write up my observations on the language that is used at the interdisciplinary care meetings. But as far as client-therapist interactions, I think you have to balance your styles based on the client and family cultural and learning preferences. As an OT I want to give options, not take them away, however as safety concerns become larger, I do get more commanding.

Transactive Memory (TP 187) I scoured my in-depth books on cognition and found no mention of this concept, however, there is some research on this concept in the fields of relationship studies and also in computer science. This is where a couple or a group have certain tacitly designated tasks or things to remember. I never know where the various charger cords or electronic devices are, but/because my husband always does. This can happen sometimes in workplaces as well, where you have specialists and go-to guys/gals for specific tasks or theories. I think this also accounts for some of the memory impairment that I see in hospital patients as well. If you're used to sharing memory tasks it's not the same when you're out of your environment and out of touch with those you are close to.

The Tipping Point (TP 9)- Obviously this is the main idea of the first book, the idea that at some point change becomes unstoppable due to the momentous force behind it. My question here is- when is OT going to reach a tipping point? When are we going to be highly demanded in multiple fields? When are we going to be the go-to professionals for daily living, low vision, home mods, driving rehab, etc etc ad nauseum? When are we going to be respected by legislation, hospital policies, and other professions? I AM READY TO TIP! I know this is implicit in the Centennial Vision, and I would love for us as a profession to tip by that time. So I guess I'm still at the phase of tipping that I am becoming the best OT I can be so that when consumers have my services they come away with a great message about the purpose and power of OT. Just important to try your best every day since you don't know who you encounter that will be talking about you later.

Hope that's enough inspiration to help me get through the week! Anyone else have Gladwell-related thoughts?

It's hard to remember the stories from my job now since I pass in and out of peoples' lives much quicker and can zombie zone-out trying to make it through a ridiculously scheduled day. Like yesterday morning, when I found myself staring at 11 potential evals with no one to share. In the zone. Anyhow, here are some memorable moments...

3 Primary Runners for "Patient of the Day!!"

- Mr. X is 1 month s/p CVA that was not treated well at his hospital and received no rehab, now presents w/ visual deficits. He talks about his eyes dilating in and out, changes in light and dark, and not being able to see well. Finally he says, "I can only see half your face." Trying to figure out if this is a hemianopsia or other field cut, I ask which side. And his reply is, "the one with the big pimple."

- Mrs. Y is s/p fall and starting to have some memory problems, but is well tended to by her family. She says, "my daughter diagnoses me very accurately. She knew I had kidney failure while my doctor was still running blood tests." The PT asks, "is your daughter a doctor?" and she replies, "no, she uses the internet."

- Mr. Z is admitted for COPD, but apparently has no functional deficits and the shortness of breath isn't kicking in very quickly during activity. Unable to evaluate him during the morning as he had eloped out of the hospital, off the campus, and down to the gas station for a coffee and a newspaper. (independent community mobility- check!)

I just don't think you can write fiction to accurately display the craziness of the real world.

I was happy about Mr. X though because I happened to be sitting in on rounds and the PA was saying what a good vision workup OT had done with him, which made me feel good as vision is not my specialty. (Thank you Gutman and Schonfeld, I never would have remembered it without you). Later in the week, I was attending a different set of rounds and they were discussing a pt. w/ eyesight that had deteriorated due to cancer and suggested a low vision consult, and it was a good opportunity to educate the case manager, social worker, and doctor, as none of them had any idea that OT could do so much in the field. So, a few vision victories there.

Touching on the original point again, it is hard to blog after work now. The acute care life can be quite stressful and there's such pt turnover that I do mind-dump a lot. That and the use of the laptop all day makes it difficult to work on it in the evening as well. Really trying to avoid repetitive strain injuries, and it is becoming quite difficult. I do have a lot of good jotted down ideas that will get typed up eventually, but I've been restricting my blog access until I get a (for now) secret project accomplished. I am also in the midst of 7 straight weeks of full weekends- either I travel or someone traveling to me- and that leaves less time for other stuff too. Like my exercise goal, which is now back somewhere in the precontemplation phase... GIANT sigh.

Until next time- enjoy the crazy things life brings you today!

This little entry was gathering dust in my drafts queue, and though it's past OT month and likely past many graduations, here are some randomly collected semi-inspirational quotes. Feel free to share additional gems in the comments.


"Great leaders are almost always great simplifiers" -Colin Powell

"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm

"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium

"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf

"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb

"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning

"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips

"Everyone has a moment in history which belongs particularly to him." -A Separate Peace

"It's what you learn after you know it all that counts the most." -Phil Jackson

"The time to hesitate is through." -The Doors

"In valor, there is hope." -Police Officers Memorial

"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy

"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf

"The journey is the reward" -Greg Norman

"Stone walls do not a prison make, nor iron bars a cage." -Lovelace

"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks

"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach

"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King

"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher

(if this collection does not deserve the adjective "random," then I don't know what would)

I am seeing a 3 y.o. girl with PDD who is wonderfully high functioning and has very involved parents. She has some sensory issues and particularly HATES having her hair brushed. During our session, even though she was hyped up on sugar following speech therapy, after some deep pressure through shoulders and head (GENTLY, GENTLY, GENTLY! HAVE AN OT SHOW YOU FIRST!) she sat there and let me brush and do her hair. Then we took it out and had mom repeat the process w/o difficulty, and mom was really happy to have learned something she could directly apply at home. If kid and parent leave feeling happy and more knowledgable, then I feel like I did my job well that day.

Therapists, parents, teachers- Have some pediatric success stories? Your Therapy Source Inc is soliciting these for inclusion on their website and possibly elsewhere. Feel free to share here.

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I consider myself to be socially conscious and try to donate time/money/items to various program that assist those in need. But a recent event over my break challenged some of those concepts in my mind.
So owing to a 1-time forgetting to lock the car doors, someone decided to hop in our car and smoke a cigarette and take a few items. There was obvious rummaging through the glovebox and some in the rest of the car, wiped dog poop on some not-so-important papers. It is significant to note that since we are so fortunate and do have many things that it took us awhile to figure out exactly what had gone missing.

The final tally appears to be:
-Some food (crasins, miniature candy bars, lifesavers; the cookies from subway remained)
-Shelter (a sleeping bag)
-Some really random stuff (Led Zepellin CD, headphones, sunglasses and holder, and my husband's rx glasses)

Fortunately, we didn't have any money taken, wallets were in the house and even the spare change remained in the ashtray. And the only Christmas gifts that were taken were the CD and the candy bars. Nothing was of sentimental value and the most expensive pieces (glasses and sleeping bag) will not be an undo hardship to replace. However, there is the feeling of having your security violated. I had already been a little on edge since I had narrowly avoided a pickpocketing/purse snatching before we left on the trip. I don't consider the towns that I live in to be dangerous (or at least THAT dangerous) and it's a rude awakening when an unfortunate event that so often happens to others hits close to home. I was also struck by the random items that were taken, and I question how they can be potentially useful to someone. The lack of logic just confuses me, I expect rational behavior from others.

I was hurt by the fact that this did happen at Christmastime... also because I do routinely reach out and try to help those who are less fortunate. My husband and I participate in charity for our church, the salvation army, goodwill, coats for kids, planet aid. I used to be part of a school of medicine outreach to the homeless. I guess I felt like I deserved not to be affected by this kind of crime due to the charitable actions we take. But I was thinking about this today, and I guess that if there is one person in the community, country, or world that has to resort to theft to meet their most basic needs, then there's obviously more that we all should be doing. And this is relevant to OT as every OT (really every person at all, but everyone in the profession founded on helping others maximize their lives) should champion social justice causes. There are very few among us who cannot do more, and likely very many that just need to do something. Plenary sessions at previous AOTA Conferences have focused on OT and community involvement, and it is something that I believe our profession could easily reach into. But until then, we'll just have to do what we each can to try to help.

My posts that can be labeled under 'inspiration' have been pretty lacking, which is probably an outlook thing. But here are 3 great small successes from pediatric land this week, plus a small SNF story thrown in. And though they are small victories, it's more than we often get.

Little Miss X is someone I've known for awhile. She is about 8, has autism, and has recently started ABA therapy at home, also on a new special diet, and they're making some great changes at school. I cotreat w/ PT and we have recently had some success with using patterns for different actions. This has really helped her with doff/donning shoes, she really loved the "monster under the bed" toy and really understood how to retrieve the object and then reinsert it under the pillow. We have worked on throw & catch for months upon months, and yet miss S would become distracted, just flip the ball out of her hands instead of throwing it accurately. I don't know what it was about Tuesday, because we have used the "ready, set, go (throw whether ready or not)" method with her before, but this time it really worked. Even when she wouldn't put out 'catching hands' ahead of time, she would bring her hands together in time to catch the ball. We worked up to 10 rapid catch/throws with no drops and accurate throws.

Little Miss Y has also been a long term client. She is 10, has CP, and has just restarted therapy recently due to an orthopedic surgery. Her mom has more focused goals now relating to her ADL performance and overall function. Her RUE is often held in elbow extension, extreme pronation, wrist flexion, and finger flexion. This has been a challenge for me in the past when trying to help her stretch or get in a more normalized position for an activity. But at this point, I just want her to use the RUE in a semi-functional assistive fashion. So we have worked on pushing objects across a table or holding them using the dorsal side of hand & wrist. We have also started a very very modified CIMT program where a thick sock is applied to the LUE, which she hasn't actually started to hate yet. At any rate, this week, when she was pushing these oversized jacks, I noticed that her thumb was more separated from the rest of her fingers for a change. So with a lot of coaching, she was able to basically drive her hand over the jack and manage to get one stick beside her thumb, and then get enough thumb adduction to actually pick up the jack independently! Previously, the only way I could get her to hold an object w/ RUE only was after placement, but she picked up 6 jacks and transported them across midline. Only assist was for wrist flexion to stimulate release.

Little Mr. Z is the third of the long-time peds clients. We are working on developmental skill progression. We have tried a lot of BUE activity, grasp & release, purposeful use of UEs. He's nonverbal, so we anytime we can get a smile basically makes a great day. This Monday, we were working on BUE coordinated use of toys using this accordion that I found in our closet. With PT on one arm and me on the other, we pushed and pulled and made the accordion make funny little sounds and Z just laughed and laughed.

I love the little smile moments, I love having something to tell the parent how wonderful their child did. Sometimes it's hard to feel that progress is happening, especially when therapy has been continually ongoing. Heck, my BKA pt. on the SNF floor couldn't even see her own progress over the past 2 weeks when she used to be a DEP Ax3 for supine to sit and now is SBA. She was also able to don pants in bed using semi-SCI method, and transferred to a chair for the first time using a sliding board and 2-3 person assist. At any rate, we all need to feel and share the successes when we can, since the lack of progress can be so disappointing. Parents, therapists, patients... we all need an uplifting moment to get through the day.

A glimpse at some of the awful things pts have said lately that we have laughed over.

A mother was observing me in my second session with her child. She said, "Do you have to have any special training to do this?" I replied, a little icily, "Yes, I have a masters degree." Then her motive became clear when she said, "Oh... do you need an assistant?"

Our COTA gave the Mini-Mental to a man who is in early dementia but responds well when given extra time. His sentence: "I don't trust you."

We were getting ready to evaluate an elderly lady with compression fractures and she is making some pained faces as she gets out of bed. Then she says, "Don't mind me, I just bitch a lot."

I was going over the home safety cards w/ a pt. with considerable problem solving deficits. I showed him a card of a man having a grease fire on his stove, and said "This guy has a problem." He responds, "Yeah, he does. He's black."

Female PT and aide walk into a man's room and try to get him to take a walk. Man looks at the PT and says, "I'm not going anywhere with you, fatso." Aide goes, "who are you calling fatso?!" and man says "Her! [the PT]" As some background, this PT is probably the most 'in shape' person on the staff. Aide couldn't stop laughing for ten minutes!

Same PT is starting a fitness consulting business and wearing buttons with catchy slogans to advertise. I did a double take when I read her button... I thought it said "Decide, Commit Suicide." It actually says "Decide, Commit, Succeed" but my terrified expression became the laughing point of the day.

A man I am working with is struggling to get out of bed. He looks at my nametag and says, "occupational therapist... is that another term for sadist?"