Peds lab: creating a trust in therapy

In class we were divided into two groups and were not told what was going to happen. Our professor set up the room, and had the other half of our class wait in the hallway with the doors closed. She then grabbed each participant one by one, blindfolded them, brought them into the room, and had a student in the classroom guide the blindfolded student through an obstacle course around tables, 'figure 8's', standing on a step up stool, crawling under a table and ending up on a chair. The blindfolded student (the patient), was only guided by touch cues and was not given any verbal cues on what we (the therapist) were doing or why were doing it.

The learning example helped both sides talk about how easy or difficult the process was. We talked about how information was given and interpreted. Also, with no verbal language and a lack of vision, the patient had to trust the therapist to guide them correctly, make sure that the 'cues' the therapist gave were not too little or too much. It made us think about how much we, as therapists, need to guide patients through a process and have them trust us and how much we need to slow down and collaborate with them to help them problem solve along the way. Either way, I thought it was thought provoking and made me think about how I will interact with patients in the future. Also, it helped me see with a language barrier how a patient feels that may transcend into a different verbal language, or a receptive/expressive aphasia that limits their ability to dialogue with me.

OTS thoughts: It is amazing how one touch or one bit of pressure is interpreted by the therapist and received by the patient. Too much, too little, wrong spot, wrong interpretation, lack of trust, too much trust, other senses to help problem solve or lack of senses to do so- all play a vital role in the patient/therapist success. These are all things that we understand and have faced through our course load, but it keeps me focused on making every cue and every intervention count- and hope that I do not face too many miscues that might send my patient down a different track that can lead to frustration, lack of trust, or getting hurt. thanks for reading.

They did it...

So as hard as it is for me to do this... we have a 2011 World Series Champ... As the playoffs were narrowing down the field and as games began for the World Series, the Cardinals fans came out in full force. (Below is a picture of McGee Hall as you walk onto campus from the parking lot.- 'Lets Go Cards'.)

My wife's parents got tickets to the CRAZY game 6, and gave us a call that Friday morning they could get tickets for game 7. Since my Cubbies have been waiting for 108 years, and the Royals haven't been playoff ready for a few years now, I figured this might be one of the only times in my life that I could get up and go to the game. So we packed up the car and headed out to see our family friend, Ryan Theriot...and the World Series.

The game 7 wasn't as exciting as the game 6, but Freese did come through again to give the Cards an early momentum shift that carried them to the 'W'. Theriot played most of the game, which we enjoyed and St. Louis was CRAZY after the win. So in all good sportsmanship- congrats Cards, the celebration looked fun and if it was my Cubbies I would be freaking out as well. I have never been to a playoff game- let alone a World Series- and due to the craziness of cubs fans and my lack of funds, I don't exactly see myself being able to make it up for a Playoff or World Series game in Chicago. The atmosphere was fun, the fans were crazy, and I wore my halloween costume (a STL cards hat). Well played St. Louis, well played. (The pics below are of my game 7 ticket and a picture from our seats.)

First Frost- veggies

         Since it was the first frost of the season I had to dig up all of my garden and get ready for ...winter. (boo, not a huge fan of the season).  There were 2 days of solid frost, before it warmed back up to 60s, 70s, and today 80. 
          I don't know much about gardening, but with raised beds in my backyard I decided to expand my occupations/hobbies and plant some veggies.  This year I tried out tomatoes, potatoes, asparagus (which apparently takes ~6 years to take a good hold), jalapenos, lettuce, and perennial strawberries. 
        The tomatoes are pretty easy to get going, jalapenos always come up less than optimal for me (but I had a couple grow in as opposed to years past), potatoes tasted alright so that was somewhat successful, the lettuce sprouted like a plant (with flowers/seeds) before I could pick it to eat, and the strawberries were a little small.  I was mildly impressed to actually get potatoes and carrots out of my garden this year since it was my first year trying, and my asparagus actually took hold.
        Now that you are probably thoroughly bored, I am writing about this because of the cold weather that is coming and because it is pretty amazing to see things actually growing from planting things. I didn't water regularly, I didn't spread the seeds out as prescribed, and my soil is probably less than optimal, but I still got some veggies. So as you see to the left are my yield of carrots and potatoes.  I peeled both bowls full and will make a meal/soup with them.  I also picked around 2 pounds of green tomatoes- which are not pictured here (and I am not sure what to do with them- fry them?), but I had to pick them due to the frost.

Anyways, this school week is a slower week before we pick back up with more quizzes, finalizing capstone projects, and pumping through more tests and assignments.  Last week was a little rough, with quizzes, practical and assignments.  I have to keep reminding myself that the end is in sight andit will come faster than I know it.

OT thoughts:  Gardening is hard.  Maybe balancing everything as well as gardening is hard.  I did not water regularly, did not evenly space, and did not weed the garden properly and so I probably got low yields of veggies. I have talked to some people that say gardening and yard work is how they 'burn off energy' or that is their 'hobby'.  I am not sure that I would go as far as saying it is my 'hobby', but it is something I do that is not necessary to do, but I still choose to participate in it.   So kudos to you that garden regularly and are good at it (or at least better than you used to be.  Any thoughts on how to help me with gardening- tips etc...simple or complex please note them below (I need the guidance, believe me.) Thanks for reading.

The little things

THIS WEEK- Well hello followers in the blogosphere.  I have been busy this week with a musculo lab practical on Monday (Carpal Tunnel patient), an orthotics/splinting assignment due today, a capstone meeting tomorrow, a quiz today, and then 2 more quizzes tomorrow. I have worked 4 hours and will be working 14 by the week's end.  The sad part is that is how this semester has been going.  My stress levels have been high, my tiredness has been high, and the fact of being wore out from class is also running high.  However, get me to January 9 and I will be to the next step of this program- Level II fieldwork.

NEW INSIGHTS- As I was thinking about what to blog about, I realized that my life isn't all that interesting.  Sure I can offer insights into being a nontraditional student in a Master's of Occupational Therapy program at RU, or about being newly married and balancing grad school, but overall I feel as though there are more insightful people, smarter, more creative, than myself. This is not a discredit to me, but a credit to those creative, genius minds that are at work 24/7. With that being said, it made me think today about focusing on the little things.  My life is very busy and my focus is very much in this program and getting through it, while doing the best I can to balance all areas of my life.  My hope for this blog is to begin blogging more frequently and that you, the reader will gain some insights into my life, as well as think about your own.

STOP AND SMELL THE ROSES...They say to stop and smell the flowers, which means that we all need to stop in our busy days and have a look at life and see the little things that we pass up on by not slowing down more often and see these GOOD things in our life.  This program at times makes it hard to do that, but it is a goal and there is a reason it is called a Master's degree.

DAILY MOMENT- So my moment today was- COFFEE.  I have had a cup of homemade Starbucks the past couple of days and drank it on my drive into class, with the brisk air of fall coming in quickly I enjoyed the moment of having a cup this morning.  I thought about the good things in life, and today's good thing was the gift of coffee.  I thought about the hard work that goes into harvesting it, the warmth it provides on a cold day, and the caffeine that helps me get through the day's work.  So today, if you have/had coffee- enjoy the moment.  I thank God for the good in my life and for letting me take a moment to enjoy one of the many gifts I have in life. 

OTS thoughts: long week, I survived- bring on the quizzes and next week.

thanks for reading.

-John

Making some splints: lab

Quick quiz- What is one major skill that sets OT's apart from other disciplines?    ...SPLINTING

Over the past few weeks we have been getting into more peripheral nerve injuries (ie Carpal Tunnel, Cubital Tunnel) as well as other hand injuries (ie DeQuervain's Tensosynovitis, Dupuytren's Contracture). Our first test was this week, and I will let you know how the practical goes (as it is after break).  These pics were taken in lab the other day.  My partner and myself fit these splints using some pre-fabricated splinting material that was heated in a simmering pan.  They are some of our first attempts at a wrist cock up splint.  We learned about how well the material molds, how to roll some of the edges so that it does not cause skin breakdown or irritation, and we made sure that it fit the right dimensions of our arm.  We also made a resting hand splint, which looks like the picture below.  We have been learning about the protocols behind making splints like what injuries to wear them for, the wear schedule, and what type of anatomical position the splint should be made in. These splints are not finished with the velcro straps to make sure that keep the splint in place.

The wrist cock up splint helps keep pressure off the Median Nerve, who is the main culprit in Carpal Tunnel Syndrome.  The splint helps keep the wrist from bending backwards (extension) or forward (flexion) too much.  This gives the wrist a nice neutral position to rest the 'Carpal Tunnel' which is comprised of nine tendons and the Median Nerve- kind of a tight squeeze already.  You hear of this injury in occupations that do a lot of typing, writing with bad hand position, chefs, doctors, housewives, musicians, cyclists etc. Anything to put a continuous stress on the tunnel squeezing the median nerve and tendons that run through the tunnel. 

OTS thoughts: The musculo class and lab has reinvigorated my love for occupational therapy.  We have learned about splinting and an overview of modalities that we will encounter in the clinic.  I enjoy building and making things, and it will be even more rewarding to know that it will have a functional purpose that will help someone get back to living their life. Hand therapy is a long road to get certified and is hard to get into, but as I focus more on my area of practice I hope to still be making splints in some area. 

fantasy football anyone?

FANTASY FOOTBALL (FF for this blog)

As I mentioned in last week's edition of the blog, football tends to consumer my fall semester and tends to make it hard for me to balance class and doing any homework on Sundays, Mondays and Thursday nights.  I have been doing FF with my in-laws for the past 3 seasons (and now this season).  I was the league champ last year, pretty much by luck and a certain DeSean Jackson returning a punt return against the Giants to seal the deal for me to win.

WHAT IS FF?
If you have never played fantasy football (FF), it brings in a new element to just having a favorite NFL team.  The gist of it, is that you 'draft' players at the beginning of the season, you are allowed to play a QB, Running backs, wide receivers, a tight end, a kicker, and special teams/defense and they each score points based on how well or not so well they play (my starting line up from last week is posted- left).

 Each league can set different rules for how to score points and how many players each team can have.  The nice part about FF is that it makes you tune in to many of the NFL teams across the league and the individual performances of selected players that add points based on the productivity for the day.  Even if my Bears go 0-16, I could still win the league in FF by drafting the best team and having FF team play well. 

 

LEISURE ACTIVITY

                 The Occupational Therapy Practice Framework (OTPF) defines leisure as "a                 

                 nonobligatory activity that is intrinsically motivated and engaged in during discretionary

                 time, that is, time not committed to obligatory occupations such as work, self-care, or 

                 sleep." 

 

Watching football and playing FF is an occupation that I enjoy because it is part of what OT's call 'leisure activities' (or a hobby).  When I used to watch football it was a good social event but we did not get into the logistics of who is doing what on the team as long as your favorite team won.  Now with the added dimension of being able to compete with other people and having to think of each individual match-up, there is more to think about in 'competing' week in and week out.  It is my 'break' from school work and the much needed element of competition in my life.

SO JOHN, WHAT'S YOUR POINT?... (OTS Thoughts)

My point is... I love fantasy football and my brain tends to look at every activity how an OT might view the activity.  An OT takes every situation and thinks of how it can be adapted, made relative, and be functional for our clients to keep them engaged in daily activities.  I think that FF is such a great idea for competition that puts people with all different abilities on the same playing field.  FF adds a level of competition as it has been doing for several years now and could be a functional yet fun activity to possibly work into therapy one day down the road.  

There is many executive functions (ie planning, working memory, attention, problem solving, verbal reasoning, inhibition, mental flexibility, multi-tasking, initiation and monitoring of actions) as well as social factors (sportsmanship, competition, dealing with stressful situations) at work here .  As an OT we must think of 'functional activities' to elicit the therapy that patients are in need of and helps meet our goals.  FF might not be that therapy for everyone, but I feel that it is thinking in the right direction to meet the client in the goal planning. As of now, it is just my leisure activity.

Good luck this season (if you have a team), and make sure to not let FF or football overrun the focus on the semester. Thanks again for reading. 

Assistive technology: OT

So to cover the ACOTE requisites we have to have a module on learning about 'assistive technology' as used in an OT setting.   We participated in a 2 day lab last weekend which was interesting, but tough because we gave up our precious Saturday.  I had pictures to post, but my phone has blown up (figuratively speaking) and now there are in some digital limbo.  So what is assistive technology?  It is hardware, software, and peripherals that assist people with disabilities in accessing computers or other information technologies.



Items Covered in lab: Ipad, headmouse, track ball, software, keyguards, specialized keyboards, ergonomic devices, short cuts and how to use them (ie on Microsoft Word or shortcut commands for your pc), and dynavox (or similar related communication devices).
Cost: $30 up to several thousand dollars.  (This includes any software, peripheral devices, or other specialized equipment used.)

It was interesting that after having this lab, and typing up this blog the AOTA 1-minute update came into my inbox.  (Again, if you aren't signed up to receive it, its worth the minute(s) of your life.)

Its headlining story was about how Ipads are making it easier for patients with disabilities, (ie spinal cord injury, cerebral palsy (etc)) to participate in reading books easier, changing the channels on the tv, and communicating with simple commands than had been previously used.  There are pros and cons to any situation as well as the legalities behind creating new apps, but as a future therapist the Ipad and technology are making huge strides in the therapy and rehabilitation field.  I posted a 2 minute video (below) from CBS Miami news.  If you are interested in reading the story- (click onthe CBS Miami news hyperlink).  Very cool stuff.

In the lab we were shown how to use the software, hardware, and peripherals and we had to think about how they could be applied in the lab and to patients with different diagnoses'.  It was fun and interesting to learn the technologies and wrap our brain's around how they could be used.

**NOTE: I do not endorse any of the titles or brands above.  I highly encourage to research each of them and learn more about them and how they can be used in a therapy setting.  This is a point of reference blog of what we covered in our lab.

OTS Thoughts:  Technology is booming.  As if we haven't learned that fact.  In our lifetime we have had from the birth of the internet (for some of the readership) to the birth of the ipod/ipad.   In the economic situation that we are in, the use of technology is a huge step for us in the therapy field and rehabilitating patients to their prior level of function or to get them back to doing the things they love.  I am excited to be coming into the field and the possibilities of the newer technology helping out our patients.

YOUR INPUT: Let me know what you think of the Ipad and the apps, will it delete the need for other devices or drive competitors to decrease prices dramatically? Will the field work the apps into evidence based practice?  Will it drive companies like dynavox or other specialized companies out of the therapy realm? Post your thoughts/questions/discussion and see ya next week. Thanks for reading!