NICU-neonatal intensive care unit

Before I went out on Peds fieldwork, we had a speaker come in and talk to us about the NICU--neonatal intensive care unit. This is basically a hospital unit dedicated to caring for ill or premature newborn infants.

Apparently this is a difficult area to get into as a new grad, which is not surprising considering the amount of knowledge and experience you need to care for these infants.

One assessment used to evaluate NICU infants is the Ballard assessment. This assessment helps you determine the baby's gestational age so you can know which kind of care it needs. Basically, you look at various systems, appearance, function and so on such as skin, lanugo, genitals, eyes and ears, tone, etc and give each area a score, sum the scores and compare the final score to a chart which tells you the baby's week of gestation. It's very interesting.

OTs in NICU assess a baby's development, calming ability, orthopedic and neurological conditions, positioning and educate staff and parents. I learned that with all the hype surrounding SIDS (sudden infant death syndrome) baby's don't get the 'tummy time' that they need and they often end up with flattened heads or developmental delays. Babies need at least 2 hours of SUPERVISED tummy time per day.

Finally, an interesting calming strategy is to try to recreate an environment for the baby that is as close to the womb as possible. Remember the womb is where the baby ate regularly, was warm, comfortable and safe. You can accomplish this by the 5 S's: swaddle the baby, sway the baby, give the baby something to suck, position the baby in sidelying and 'shhh' the baby. Apparently the little boogers like these actions and it calms them. I've certainly noticed this with my niece!

Good times with the kids

(Pom Poms)

So, as you know I LOVED working with those kids. They were all so cute and so funny and so adorable and so FUN. I had a ball!

Here is a joke one student told me. He said he made it up and he was so proud of it.

Him: What is a beaver's favorite food?
Me: I don't know, what?
Him: Steak...
Me: (silent, because I just did NOT get it, haha!)
Him: You don't get it?
Me: No, sorry! (ashamed, head down) I don't get it.
Him: You know, beavers eat wood and 'stakes' are made of wood.

I nearly fell out laughing and I think you know why.....


During another instance one student made such a hilarious statement that my supervisor and I had to turn away so she wouldn't see us laughing so hard:

We were making Christmas trees and decorating them with ornaments such as yarn, cotton balls and small pom poms (if you don't know what a pom pom is see the picture at the top of this post). This can be a sensory activity as many of the kids don't like touching glue and as a result they often don't put enough glue on the paper. When this happens, the pom poms fall off.

Boy X was gluing his pom poms to his Christmas tree but did not add enough glue. But, he was so proud of his tree that he held it up for everyone to see and his ornaments started falling off. Girl Y, trying to help him, said, "Hey, Boy X, be careful. Your balls are falling off.. Hey, did you hear me??? YOUR BALLS ARE FALLING OFF!!!!"


I nearly peed in my pants.

Individual Education Plan (IEP) meetings summary

I've had the pleasure of sitting on a few IEPs (Individual Education Plan) while on my pediatric fieldwork and I really enjoyed them.

In a nutshell, various professions in education--psychologist, occupational therapist, physical therapist, speech pathologist, special education teacher, classroom teacher, nurse, case manager, paraprofessional and any other professional, and parents all meet together to discuss the needs and goals of the child's education. Everyone gets a turn to speak and report on observations, evaluations, assessments, interventions and outcomes. They also each report on how the child is progressing and if he should remain eligible for their service over the next year.

These meetings can last for HOURS. Of course, the time flew for me because I am a student and everything is new and fascinating but I can see how over time these meetings can be frustrating if people come late or unprepared. On at least 3 occasions the parents did not show up or were so late my supervisor and I had to leave to make appointments at other schools to see our regularly scheduled kids.

I also noticed how some professionals use words that may be unfamiliar to some parents, particularly to those with certain educational backgrounds. Words such as bell curve, fine motor, adaptive equipment, pincer grasp, range of motion, etc., may be unfamiliar to some parents. As professionals we must remember to speak in layman's terms so that everyone in the meeting can participate and understand what is being said. It's also important so that parents feel comfortable enough to participate in the meeting and ask questions.

As professionals we need to be aware of what is not being said during these meetings. I noticed that some parents were very passive and only spoke when a question was asked; the professionals dictated what was to be done to their child and they went along with it. Other parents were very proactive and asked lots of questions and had a very aggressive (but not in a negative way) role in the meeting. I think that when we notice parents are passive and go along with what is being said we need to ask them for their input because what they think is important.
Additionally, it's important not to speak so negatively about the child to the parent that you make the kid sound like an idiot. In some instances, I felt badly for the parents as professionals talked about the kid as if they were slow, or stupid or amazingly abnormal. This is still someone's kid and although as the professional what you say may be the truth, it's still rather crass and insensitive to speak so poorly about the child. Every child has SOME thing they do well and at some point it's beneficial to reflect on what the child does well. Parents are an integral part of these meetings and without their cooperation and support some of these kids won't progress.

On that same note, it's important for parents to consider that professionals have appointments to make and their world does not revolve around you. Be sure to confirm the time of your appointment if you plan to attend and then, actually BE THERE at that time. If you will be late CALL THE SCHOOL and inform someone that you will be late. It's frustrating for people to sit twiddling their thumbs waiting for parents to attend the meetings because everyone has paperwork to complete, other meetings to attend and kids to see. So much time could be saved if people would communicate their whereabouts and intentions.

FAQs--OT books

So, I received a question (a really long time ago, haha) asking for suggestions on good books on occupational therapy.

Shamefully, because I'm always studying textbooks I only have two suggestions on leisure reading:

1. Treebarking by Nesta Rovina. I read this book sometime ago but it is basically a compilation of an occupational therapists experiences. I found this book incredibly interesting and I highly recommend it. It was one of the first books I could find on occupational therapy so I picked it up and read it. I thought it was a great read. I couldn't put it down.
2. Look Up for Yes by Julia Tavalaro. This is another excellent read. Ms. Tavalaro suffered several strokes that left her unable to walk or move or do anything. Everyone thought her mind was mush when in fact she was very much cognitively aware of everything that was going on around her. She was treated terribly by medical staff and professionals (emphasis on TERRIBLE) until an occupational therapist, physical therapist and speech pathologist came along and helped her. I highly recommend this book.

I'm going on another one of my international trips soon (more on that as the time approaches) and I will have more time to read so I can recommend more books then. I've found very few books specifically on occupational therapy. Rather, many books are narratives on the experience of sickness, injury or some other setback. I think books of this nature are good to read because they provide insight into the medical profession and occupational therapy.

So, thank you, Sara, for asking that question and I hope others begin to read more books in this genre!

We started our Pediatric Fieldowrk!

So, I'm on my pediatric fieldwork now and I LOVE IT!

I have an incredible supervisor! She is patient and answers each and every one of my 3 million questions thoroughly. She brings me resources and samples regularly and I'm reviewing and learning from all the material.

The kids have disabilities that range from cerebral palsy, muscular dystrophy, autism, ADD/ADHD, mild Sensory Processing Disorder, handwriting and developmental delays. What's interesting is that a lot of the time is spent on paperwork, at least more than I expected. My supervisor is very gracious because during that time she takes breaks from paperwork to answer my 3 million questions per day.

My supervisor is awesome about allowing me to experiment, play with, joke with and work with them. I love working with them! One of the kids said to me, "Hi, I'm Boy X. What's your name?" I told him my name is 'Ms. Kim' to which he promptly replied, "What grade are you in?" It took everything in me to keep from laughing. Because I'm 'novel and new' the kids love working me and none of them are shy.

I had the opportunity to sit in on an IEP (Individualized Education Program) meeting and it was incredibly interesting! I had to sign the IEP paperwork, as an OTS of course, because everyone present has to be acknowledged. A variety of professionals were present--the psychologist, special education teacher, classroom teacher, case manager, occupational therapist (of course), Speech Language Pathologist-- and the parents were there. I felt that some of the language was a little too technical for the parents and I made a mental note to always remember to speak simply and clearly and explain everything when talking to people who are not occupational therapists. What is simple and common knowledge to me may be technical mumbo-jumbo to someone not in the field.

A lot of our therapy takes place in odd locations due to lack of space, including the hallway, closets, the classroom, backrooms in the library and other super small areas. Each area is distracting and exceptionally visually or aurally stimulating. I don't know how the kids can concentrate, given their occupational needs, and I'm always amazed at the kids' ability to concentrate with so much 'business' going on.

I've noticed that performing standardized assessments can be a bit challenging because the kids don't have the attention span, patience or focus to complete the assessment. So, the evaluations that I've witnessed use creative tools and simple/clever games and tasks.

So far, I love working with small children. I'm still learning how to really analyze their grips, posture, sensory needs or aversions, speech, gross and fine motor skills and a host of other things. I'm really working on being more observant to their abilities and delays.

A Man without Arms and Legs

The other thing that I did in honor of participating in something new every month was visit a talk by a man who was born without arms or legs! Yes, it's true. I went to a church with my classmate and we sat for 30 minutes and listened to Nick Vujicic tell us about Jesus Christ, the Gospel and living nearly 30 years without limbs.

He wrote a book that you can purchase from his website or from Amazon entitled Life Without Limits: Inspiration for a Ridiculously Good Life. When we go on break in December, I'm going to purchase this book. I really enjoyed listening to what Nick had to say and I'm looking forward to reading his book.

One of the most interesting things was his wheelchair. He drives it with his 'flippers,' as he calls his feet, and he was very adept at maneuvering through the aisles. Nick was born with a rare disease called Tetra-amelia. From an occupational therapy point of view, he talks as if his daily occupations and functions have not been affected. I can neither confirm nor deny this as I have not evaluated him, obviously, and I choose not to place my own limiting beliefs on him. According to him, he's done tons of things--played golf, surfing, scuba diving, tons of things. You can view pics of all these activities here. And, of course, you can always Google him. Google knows everything...

You can find more information about Nick and his book by clicking here--Lifewithoutlimbs.org.

Sculpture Tour

'Phoenix'...a really beautiful piece. It actually looks like a Phoenix.

'Bodark Arc.' Of course, while we were on the tour we didn't get this view. The staff part of the bow is a row of orange trees. The string part of the bow is a beaten down path that turns into a bridge that crosses parts of the pond. The view from one end the tree grove to the other is absolutely incredible! I REALLY wish I had my camera that day.

The 'House Divided' sculpture. This pic shows the 3 entrances, all of which lead to the same area since 1/2 of this structure is cut off by the diagonal wall. If you look closely you can see part of the wall.

'Yes! for Lady Day.' This is an interactive sculpture that moves and 'sings.'

So you know I'm committed to trying something new every month. I didn't post what I did in October so here it is! First, I went on an art tour. I don't know if I every mentioned this but my school has the largest outdoor sculpture park in the United States--Nathan Manilow Sculpture Park. Interesting, huh? Well, the last tour was in mid-October, it was free, so I went. I was the youngest person there, which was great. I invited my entire occupational therapy class but no one came :-(

Of course the tour group made all kinds of humorous comments about my youth because the tour was loooong--a little over two hours on foot and we didn't even see everything! I met a gentlemen who was 83 years old! He and I talked the entire time. He was incredibly talkative, open and friendly. I like talking to seniors because they always have something interesting to say.

Anyway, the tour gave me a new appreciation for sculpture and other art forms and I will definitely attend another tour. I wish I had taken pictures because the fall backdrop was absolutely GORGEOUS. The tour guide was excellent and gave an excellent review of each piece of art.

The most interesting part of the tour was the 'House Divided' piece which was a large white building, similar in shape to a barn. You could actually walk inside this piece. As the website describes, "When we step inside we are surprised to find the structure has, in fact, been divided in half, diagonally. Three entries to the outside create an uncomfortable space with no corners. Fully half of the structure has been rendered useless." The artist does not offer an explanation of the piece but rather leaves the interpretation to the viewer.

Our tour guide stated that someone once suggested that since the piece illustrates a complete waste of space with a diagonal wall with no doors to the other side, is titled House Divided, gives reference to Abraham Lincoln and is in Illinois, then one possible meaning could be the incredible amount of talent and skill wasted and lost by slaves who were never allowed to reach their full potential and contribute to society.

Their was an eerie silence as that statement sunk in and of course everyone turned and looked at me since I was the only brown skinned person on the tour. But walking into that piece and feeling and seeing how the space is completely useless and wasted by that diagonal wall really stuck with me.

I really enjoyed the tour. I wish more of my classmates would have experienced it with me.

Did you vote today?

DID YOU VOTE TODAY?

The answer HAD BETTER be YES! I got up nice and early this morning to vote. Well, it wasn't quite so nice since it was still DARK outside. It was waaaay before the crack of dawn, the sun was still sleeping. But I performed my American privilege and voted. For me, voting is a pretty serious matter and I do whatever is necessary to get to the polls.

No offense to any American white males out there who may be reading this but I must say this: If you are a minority or a woman and you did not vote you deserve a SPANKING and you should be sorely ASHAMED of yourself. A lot of people busted a lot of sweat and tears for this PRIVILEGE and RESPONSIBILITY and I believe it's disrespectful not to vote. So, you had better have a pretty darn good explanation for not going.

While at the polls and talking to the people checking my paperwork I got a little teary-eyed thinking about the privilege of voting. I'm serious, I was really holding back some tears. I thought about my grandparents who didn't have this privilege when they turned 18, how proud they must have felt the first time they voted and how, amazingly, 75 years ago I would have been spat upon for coming within 15 feet of a polling place.

Voting is simple yet powerful act.

It made me happy and proud to be able to say I voted today.

Random pics from the Girls' Home

I found these pics when going through my iPhoto. I forgot to post them from the summer!


A random pic of me before going to work at an occupational therapy information session.

We went to a 'carnival' with the girls. They did face and arm painting and made me a Dora balloon. Hola!

The girls did my nails...and Amy's nails...

We played a game on managing your emotions. We all sat in a circle with a tub of candy in the middle. Each person took a turn rolling a pair of dice. If you scored doubles you got to choose a candy. Once all the candy was gone we each rolled again; if you scored doubles you got to choose someone else's candy. At the end of the game we talked about how it felt to score doubles and choose candy from the tub, to choose from someone else and to have candy taken from you from someone else.

We played another game where we pretended everyone was on a cruise. We had them make and decorate hats. Before the activity we created 'keys.' During the activity each person received a key and went around asking others to exchange their key. The keys with the hearts have 'HIV.' At the end we asked who had the heart keys.

Switches & Circuits

(this is the switch using the mercury filament. See the pencil gripper in my left hand? Inside is the mercury filled chamber--we glued it in the gripper so it won't fall out. I'm holding it upside down, and as a result, the light is off).

(We joked that he was a Chilean miner. He actually is from Chile! And with the flashlight clipped to his hat, well, you know...)

(sometimes it was a little frustrating and the switch wouldn't work)

(an open circuit. When I close the circuit by connecting the two sides of the business card the flashlight will light up.)

(my completed switch! Eureka! It works!)

We made switches last week. In layman's terms, a switch is an electrical circuit that turns something on or off. Occupational therapists use switches to make adaptive equipment/assistive technology. As an example, we made two switches. The first switch was for a flashlight. We taped metal strips to a business card to conduct electricity and complete the circuit (for more info on circuits click here). This type of switch would be useful for someone who doesn't have the ability to push the knob on the flashlight to turn it on. With this switch, they would only have to close the business card, this requires less energy and finger movement.

The second switch we made used mercury to close the circuit. Instead of connecting two ends, with this switch you hold the tip upright or upside down. I don't know all the terminology but basically we had a glass chamber with mercury touching something that was like a metal filament. When held upright, the mercury touched the filament and closed the circuit; when held upside down the mercury did not touch the filament and opened the circuit.

A visit to an Alzheimer's facility

We went to an Alzheimer's facility about a week and a half ago. This facility was awesome! It was just so cute. It was built so that everything is in a circle so that the residents will never get lost. They had a library, a bistro/cafe, an outdoor sitting area, a salon, a recreation room, a complete kitchen (with all stove/burners turned off), and 'neighborhoods'. The neighborhoods had their 'homes,' which were really cute little dorm rooms. The neighborhoods were marked with distinct names, pictures and colors so that the residents will recognize in which area they are in. The outdoor area was completely fenced in with 8-foot fences, but the area was so large that you didn't feel like you were fenced in. The outdoor area was in a circle as well so that the residents would not get lost.

The residents are free to move about the facility as they pleased, including going outside whenever they want. The purpose is to give them the freedom to roam so that they feel like they are not in a 'hotel' or some other foreign place; the facility wants them to feel like they are home. To help them remember their 'home' each resident had their picture outside the door and some had pictures of family and pictures of themselves when they were younger.

I had a conversation with a woman at the Bistro. She was drinking a hot chocolate and the convo went something like this:

Me: Hi, my name is Kim. What's your name?
Her: I'd like something to go with my coffee.
Me: Ok, I'll get you something to go with your coffee in just a moment. Do you have any children.
Her: I'd like something to go with my coffee.
Me: Ok, yes I can see that you need something with your coffee. Can you tell me the names of your children?
Her: Yes, I have three children. I'd like something to go with my coffee.
Me: Three children, that's awesome! Are you married
Her: Yes, I was married. He was very good to me.
Me: That's great. How long were you married?
Her: He was very good to me. I'd like something to go with my coffee.

And you get my drift. The conversation went on and on like this.

As the marketing coordinator was talking about the horrors of Alzheimer's disease I became overwhelmed and had to fight tears. I started thinking of my grandmother and all the pain she must have gone through. I had no idea Alzheimer's was so...debilitating. I knew it was bad, but not as bad as what the marketing coordinator explained. It made me angry and sad and remorseful. I went through a bunch of 'I should've done this and that and the other thing.'

My classmates could see that I was fighting back tears. It took everything in me to keep from getting up and running to the bathroom sobbing.

Assistive technology creations

(sequencing flashcards. for more fun you can play a game with these)

(the pic above and below are of a universal cuff for scissors. Also, that nail polish is pretty darn cool! I gotta buy some!)

(This project allows someone to practice matching and placing utensils, a vocational skill).

(This project allows someone to practice signing their name on their checks. It gives visual cues that they have signed in the correct place.)

(sequencing flashcards--how to put on a shirt)

(sequencing flashcards-how to wash hands)

(this pic above and the one below are a sensory cube--notice the various textures on all sides)

(a communication/reading slant board for those with low tone/motor skills. This board holds communication books high and at a slant for communication)

(Since I'm such a high sensory seeker I loved these proprioception bags! The one on my lap was filled with rice and was nice and heavy! The one on my neck felt good too! Sorry I know I look crazy. My friend Amy had me cracking up laughing and I was trying to stifle it and my hair was all over the place!)

(a picture communication book)

(The Dynavox bag! I love this project! The cereal represents the Dynavox. Dynavox is an augmentative/alternative communication device)

(Door lever. Note that this is soooo much easier to open than the regular knob).

(Our project! You can't see it too well here but the blue cup has a wide-spaced handle so that Boy X can pick it up. We then glued it to the yellow plastic plate. The other cup is a heavy duty plastic cup with a 10-inch straw and placed into a plastic storage container with the bottom cut out)

Two weeks ago we went to an organization that provides special education for those with special needs in their school district. The students were all severely disabled with a range of disabilities, including those that are blind, have cerebral palsy, mental impairments and autism.

As part of our Assistive Technology class we had to talk with the teacher, and, if possible, some of the students and determine what low-tech (aka low cost) assistive technology they may need. Assistive technology is basically any device or tool that is adapted for use for people with disabilities. As an example, many of the things we use today were originally invented for people with disabilities. The 'lever' door handle that is so ubiquitous now used to be very expensive because it was for people with disabilities. But now we realize that senior and children find this type of door handle easier than the round knob handle. The rubber grip pads that you use to provide friction to open doors were designed for people with disabilities to make that task easier. It used to be expensive but now you can find that at any Walgreens or CVS.

So, anyway, my group chose a 21 year old male with cerebral palsy. We saw his instructor holding a cup with a straw so he could have a drink of water. We found out that every time he wants to drink she has to hold the cup for him. With further inquiry we discovered that he has the capability to grasp a cup (he's very spastic/high tone) if the handle is wide enough. We asked if he would like a cup and she emphatically said he would love a cup!

So, we glued a plastic water bottle to a plastic plate (for a wider base of support in case his motor planning is poor and he drops it instead of placing it on a table/desk). We also cut a hole in a plastic container, glued a thick plastic strip around the cut out (for grip) and place rubber on the bottom of the container (for grip). We placed a loooong straw in it. Now he has two cups that are his from which he can drink on his own.

Some of the other class projects include:

• picture sequencing books, for those who have trouble with the sequence of washing hands or brushing teeth
• picture books for activities, for those who are non-verbal but can point to activities in which they want to participate
• sensory cubes, for those who are learning to modulate tactile sensory input or who desire more tactile sensory input
• proprioception bags (filled with rice or beans) for those who need proprioceptive input
• a reading board, for those who are unable to hold a book but need a slanted board that will maintain the book's position
• a Dynavox bag holder (I thought this was VERY creative). My classmates bought a regular bag from Wal-mart, dyed it purple (the girl's favorite color), put a purple pressure strap on it, then lined it with that plastic material that school folders are made from (for structure and stiffness) and then lined that with foam (for softness). So, now the girl can carry her verbal assistive tech devices with her in a cute little bag!

So, I thought this was a very interesting and creative project and I learned that it doesn't take lot of money to provide someone with the tools they need to be successful or comfortable. That's what occupational therapy is about!

(I have pics of everything, I'll post them when I get home).

Living Sensationally!

Turns out I'm a Sensory Seeker! No surprise there, given the events of my life.

Last week we completed the Adult Sensory Profile assessment questionnaire by Winnie Dunn. This assessment asks questions on visual, auditory, touch, taste, activity level, and that's all I can think of off the top of my head. The test measures strong patterns of over- or under-responsiveness to stimuli in comparison to the population. Turns out I have a high affinity for taste and activity.

As a sensory seeker my neurological threshold for stimuli is high so I actively seek pleasurable stimuli in taste and activity. So true. I will eat any weird food (while living in Japan I ate the toxic Puffer fish and fish eyes and while in China I ate all kinds of strange things. I loved it!), I love going out to ethnic restaurants and trying to cook different foods. I also DO a lot. I love new experiences that take me out of my comfort zone and I love just trying something new, period. I just love it.

If you have the opportunity I encourage you to read Winnie Dunn's book, Living Sensationally. I'm reading it now (only a few pages a night, it's leisure reading. I'm a student for goodness sake! I have no time to read more :-). In a nutshell the book discusses that we each 'have a sensory profile that drives the way we structure our routine, choose our wardrobes, design our menus, and interact with co-workers, friends, and family members' (this description from from About.com). The four profiles examined are Sensory Avoider, Sensory Seeker (me!), Sensority Bystander and Sensory Sensor (or sensitive).

You can read the book to find out more. I think it is an EXCELLENT introduction to sensory topics.

We administered a standardized Pediatric test!

As part of my occupational therapy assessment class we've been visiting a nearby school/development center. Today we had to perform a play assessment, a standardized assessment and an interview with the teacher on the child. Yikes! We worked in groups of 5 and we did very well, actually! And it was a LOT of fun! A lot! Does this mean I'm sold on peds???? I'm not sure yet. Everything is fun when you first try it! haha.

I was terrified at first, but then I realized, I'm great with kids and all kids love me because I'm fun! It's true, I'm not being facetious, I'm lots of fun!

Anyway, we administered the Bruininks-Oseretsky Test of Motor Proficiency on a 4-year old boy (who was adorable, btw, seriously, just too cute!). We started off by playing Duck, Duck Goose, then we played catch with a large, soft nerf ball, then catch with a tennis ball, then we constructed an obstacle course (I had to model it for him, imagine my big self crawling through tunnels and laying on a scooter! haha), then we rolled him on a scooter, then rolled him on a scooter while he held a hula hoop and I pulled him (we made train noises), then we played Simon Says (you can learn a lot about cognition, proprioception, and motor skills from this game, wow!), then we sat down and drew lines, circles, X's and crosses (as I drew I made sure to make noises, like rolling my tongue, to make it more animated for him) and then we finally started the test.

The test is a lot longer than we anticipated, and because we were all new at it and had no time to prepare, it took ALL five of us to do it! LOL. We took turns with each module and we all helped set up to keep it moving so he wouldn't get bored. By the end he was definitely antsy and we tried to speed it up again. The BOT is very long and I don't know how any kid sits through it. We didn't do all the modules because our kid was technically too young (but we needed the practice) and we were short on time--we were, after all, interrupting his class time.

Afterward, we interviewed the teacher. This normally happens first but she had a class and we had to wait for her to finish. The interview went very well and we learned a lot about our kid, how he interacts and how to conduct an informative interview.

By the end, I was sweaty, dirty, and tired. But, I learned that I need this type of constant stimulation because, just like a kid, I get bored very easily. I am a Sensory Seeker (more about that at the next post) so I need constant stimulation. Working with kids may be for me. We'll see.

I think I was on MTV's Punk'd...

(Just a random pic of me. Just thought I'd share :-)

So, we went back to the community center to speak with the seniors again. My original group of ladies was not there (yes, I was very sad) so I sat with a new group. This group of three was interesting because of two people: one gentlemen, who completely dominated the conversation, even at inappropriate times, and a woman who suffered from terrible episodic memories.

The gentlemen, Mr. Doe, talked about himself incessantly. He talked about his travels to one European country while he was in the army and he talked about the jobs he held after that. He talked, and talked and talked. When I tried to incorporate Ms. Doe (they are not married, just friends from the community center) into the conversation with openers like, 'Mrs. Doe, how are you?' 'Do you have any children?' and 'Tell me more about your children' Mr. Doe would interrupt with something totally unrelated but about himself. He had an amazing narcissistic quality.

When I asked Ms. Doe if she had any children she told me that she had a certain number of children living and one that died when he was very young. She then immediately began to describe how the child died! And she went through the entire day, from how she woke up and got dressed (all the details of that), to how the child didn't want to go to school that day (all those details including how she gave him a tap on the romp), to going to work to how, when and in what manner how child died. I was stunned because I asked a simple question and she gave me a lot! It was very sad. It was also very interesting that that is what she decided to tell me (an excellent example of episodic memory). When I asked about her living children she gave me another very sad story about the problems of her children.

Intermittently Mr. Doe interrupted every single one of Ms. Doe's sad stories to tell me a story of something totally unrelated--like a war, his war travels, his jobs, etc. This was narcissism at its best. A woman is telling me how her child died and he interrupts her to tell me about country X and the women there and how they loved Americans.

At one point Ms. Doe was so tired of Mr. Doe interrupting that I saw her physically take a HUGE breath, roll her eyes and sigh. She was clearly very frustrated. When Mr. Doe was distracted with another classmate I said, 'Wow, Mr. Doe has a lot to say, huh?' And she went on and on about him (I laughed inside at this). After I listened to her stories for a little while and Mr. Doe couldn't stop interrupting, Ms. Doe just got up and left. It was being on the Twilight Zone or a bad episode of MTV's Punk'd.

What sucks about growing old...

Today we went to a senior community site to visit and talk with seniors as part of the late adulthood portion of our Human Dev course. We were supposed to observe their social, emotional, cognitive and physical abilities/disabilities and see if what we observed complemented or confirmed what we learned from our readings. IT WAS SO INTERESTING!

I happened to choose a table with the liveliest seniors EVER. The moment I sat down one of the women said to me, 'You know, Ms. Doe over here is telling us about her online dating.' Ms. Doe is 81 years old! Haha!

There were four women at my table, ranging from 58 to 81 and they had the best stories. I can't repeat what was said but some of the topics were:

• abusive husbands
• decent husbands
• raising children
• how breastfeeding makes your breasts sag
• how old breasts are like eggplants and torpedoes (no kidding, they said this)
• how breast minimizers push your breasts under your armpits
• the cup size of each woman at the table (these were some large women!)
• how one woman heard a joke about a 69 and went home to ask her sons what that meant (haha)
• the secret to a happy, long marriage
• what sucks about growing old
• my personal dating life
• how growing old can be lonely...and boring
• how growing old can be physically painful
• how when you're young everything is tight and compact
• how I don't look my age
• how online dating sucks
• why you shouldn't marry for looks unless you want a deadbeat, an abuser or a womanizer for a husband
• why a prenup is good...for a short time, and when you really trust one another it should be destroyed

and a host of other things that I can't remember right now. I had a lovely time and these women were so open, they just talked about EVERYTHING.

Systems Theory and Energy

(the instructor didn't know our names so we had to create nametags)

Last week for my Interdisciplinary class we had a guest instructor. If you remember this is the class I told you about that uses the quantum physics textbook. Anyway, this instructor basically taught us about energy and how everyone and everything, including the earth, emits a certain energy wave that other living things pick up on.

She explained how, for example, if scientists all over the world are working to crack open some super hard code in health science, and finally somone in Japan figures it out then immediately someone in America will find a similar solution. The proposal is that the Japanese scientists emitted that energy out into the universe and the American scientists were open to it and picked up on it.

I suggested that this sounds something like the premise of Malcolm Gladwell's (one of my favorite authors! You have to read his books. all non-fiction) book, Blink. In this book, Gladwell discusses how mental processes work rapidly and automatically from relatively little information. It considers both the strengths of the adaptive unconscious, for example in expert judgement and its pitfalls such as stereotypes. (source: Wikipedia) In a nutshell, why is that when we meet someone we just don't like them. We can't explain what it is about them but we know that something is not right and they are not a good person. Or, how we just know a certain situation is just not right, we can't explain it but we know something about it is not right.

Our guest instructor proposed that what Gladwell is actually talking about is the energy that people emit. Of course, Gladwell didn't use those words or even suggest such a thing but that was her interpretation.

Finally, we performed an 'energy exercise' where we wrote down something we want in the next 6 months. We then had to write down 5 things we would experience from that want; she was careful to explain that it had to be experiences not emotions. For example, I chose that I wanted to go to Chile. My experiences were something like see occupational therapy there from my classmate's old job, relax and read on the beach, see the natural sights, and some other stuff I don't remember. But I could not say because it will make me feel good because that is an emotion.

We were then instructed to sit quietly with feet flat on the floor and close our eyes. We performed some deep breathing exercises. We then had to imagine a large pink bubble coming closer to us. The bubble had a door, in which we opened and placed our want. Then we shut the door and sent the bubble off. The instructor's instructions were 'don't think about it, just let it go. It will happen. '

The class was incredibly interesting, even though I disagreed with a lot of what she said. Even still, I'm interested in hearing more about it.

I saw cancer and, yes, it was ugly

Did I ever tell you I saw cancer?

This is not a joke. Over the summer I decided to pay the incoming occupational therapy class a visit to their anatomy class. As they were poking through their cadavers someone asked me if I wanted to see what cancer looked like. Me being me, of course I said yes!

I saw pancreatic cancer. I wasn't prepared for my emotional reactions--sadness and anger. I don't know what I was expecting cancer to look like but it didn't look like what I expected. His pancreas was covered in these white blobs. The cancer had spread to to parts of his liver and colon. The gentleman who died from it was 45 years old, so young! I felt angry that he died so young and sad that he died so young.

All I could think was, "Wow, cancer is a BEAST." I can't imagine the pain that man must have been in...that cancer was everywhere. I wondered about his family and what kind of life he lived before he died.

My classmate told me that she drives by a billboard of a young girl, in her early twenties, with a caption that reads, 'CANCER, YOU'LL QUIT BEFORE I DO.'

Well stated.

Treating a patient with Breast Cancer

(this daring photo came from this blog -- Musing of a Home Engineer. I know it's racy but I think it's important for people to see images like this so they can not only know the impact of breast cancer but FEEL it. I encourage you to read the post on the blog.

I also encourage you to view my favorite, most inspiring mastectomy photo by clicking here. All I can say is "Wow.")

In Human Dev class we had a case of a woman just referred to occupational therapy from her doctor due to a radical mastectomy (complete breast removal and some muscle, skin and other tissue) as a result of breast cancer. To illustrate how we project our ideas on our clients we had to name her based on our interpretation of the situation. I named her ADORING MOTHER because in the profile she stated that she just wanted to be able to take care of her children and her home. I thought that was interesting because here she is, with breast cancer, recently from surgery, and one of her most pressing concerns is an IADL--taking care of those around her. Wow.

The conversation then went on to describe the things we'd like to know to start our first treatment session, such as

• how is she dealing with her illness
• which occupations are most important to her and why
  
• how does she see her future
• does she have hope or does she feel hopeless
• does she understand lymphedema and other possible effects of breast cancer and mastectomy
• how is her social support
• does she understand her current limitations (no lifting her children, heavy things, etc. for awhile)
• what theoretical approach and assessment tools will we as occupational therapists use to treat her and why
  
• what questions do we, as occupational therapists, have about breast cancer, mastectomies, the psychosocial effects, normal cognitive and developmental changes in a woman of her age (40s)
• where will we find the answers to our questions--what books and other resources
  
• many other things I'm too tired to write right now.

The class was really interesting and I thoroughly enjoyed the discussion.

Different perspectives contribute to the whole picture

(A few of the many sculptures on campus and one of the lakes. I recently discovered that our campus has the largest sculpture park the U.S. Interesting, isn't it? I thought so, as well, which is why I am going to take a tour of the park in October.)

So, remember the quantum physics book I told you about a few posts ago? Well, I have a class that uses that book as a textbook; we meet once per week. This past week the instructors divided us into groups and sent each group to a different area of the campus (we got to go outside, I was soooo excited!!! It was like recess!).

Each member had to write down what they could see, hear, smell and feel. Then, each member had to focus on a different sensation or emotion: some focused on only the sounds they heard, some focused on what was in their immediate vision and then what was in the distance, some focused on things that were only as small as an ant, and others focused on one particular object and how it made them feel.

When we returned to the classroom each group had to collaborate on their particular focus area. I thought each person, saw, heard, smelled and felt things that other people did not even notice. For example, two people in one particular group both noticed the same statue in their area but only noticed a lamppost in front of it and the other only noticed a description post.

The purpose of the project, of course, was to illustrate that in groups people have different perspectives. Each person's perspective is important and each contributes to the whole picture. Also, it's very important to listen. The people who were instructed to only write down what they heard, heard things that the rest of us did not even notice. So, listening is an integral part of stellar teams.

What is occupational therapy?

Occupational Therapy--Skills for the Job of Living:

You'd like to brush your hair if you could only raise your arm if you could just move the muscles so you could get out of bed so you could walk to the mirror like you used to everyday without even thinking about it before you had the stroke.

After a stroke, major surgery or other illness, it can be a long road back. Occupational therapy can make the journey shorter and help to ease the frustration most people feel when they can't do things for themselves. Occupational therapy not only shortens recovery time, it helps people to become more self-sufficient by teaching them new ways to perform job and life tasks despite their physical disabilities. Things like making breakfast, brushing their hair, driving a car and earning a living. Along the way, they gain the confidence to get on with their lives.

--AOTA

(I wish I could say these are my words but this is an AOTA framed photo in one of the classrooms in my school. I love it so much that I thought I'd share it with you)

OTCAS.ORG

The occupational therapy profession is changing the way students apply to schools. It used to be that you would choose a school and apply on the school's website. Now there is a new online system for students, otcas.org. It's basically a centralized application website for occupational therapy students. You pay a a fee the web service sends your application to your schools of choice. You still have to send in some paper requirements, such as transcripts, but the site is flexible enough where even your letters of recommendation can be submitted online.

This makes me a little sad, it's like losing something...it just seems like some of the personality of the application process is lost in this. But I think I feel this way partly because I applied through a paper system and it's familiar to me. Everything is going electronic now, right? So, I guess occupational therapy has to get on the bandwagon. I also feel a little sad about all the changes because I just found out that my school no longer has a part-time option for occupational therapy students. I think this limits a lot of people who are second career like me. Thankfully, I am able to live on my scholarships and student loans so I didn't have to go part-time but many others don't have this option. So, with every change is a benefit and a loss.

I In a few years I'll probably be happy about this...

Quantum theory, chaos and occupational therapy

I have an Interdisciplinary Team Process class that basically focuses on how to effectively work in teams. We do a lot of creative things in this class.

One of the subjects we are covering is 'chaos.' We're reading a book by Margaret Wheatley that discusses how chaos can be effective in organizations. This is also known as systems theory or chaos theory. The premise is that flow of information and the formation of relationships beyond hierarchical lines opens the door for organizations to self-organize and become productive, creative, adaptive and effective. She basically says that leaders control an organization when instead they should allow organizations to be more chaotic to accomplish their goals. Interestingly, she uses quantum physics (yes, that is not a typo) to explain this.

So, last week our instructors gave us a blank sheet of paper, representing chaos, and told us to do something with it. Some groups crumpled the paper and threw it in the trash, some groups made a bowtie, some made an airplane, a few of us made those fortune telling thingies and others left the paper blank. We then had to describe why we did what we did and if we all agreed to do it (and if not, why not) and how we came to the conclusion to do what we did.

It was interesting.

Problem Based Learning

We are now in the applied section of our occupational therapy education at my school. So, over the last week we have been experiencing 'problem-based learning' (PBL) activities. Problem based learning is basically where students collaborate to solve real world occupation therapy problems. Every class period we get a bit more information about the case, in the form of doctor's notes, social worker's notes, or psychiatrists notes, just as if we were real occupational therapists. One of the most interesting things is that students do EVERYTHING. The instructors are only facilitators. So, they don't really say much. We, the students, sit in our groups, review the 'problem,' and direct our own learning process. The instructors jump in every now and again to guide our learning but that has generally been the extent of it.

I actually like this process, although it is a little frustrating because I am still new at this and need a bit more guidance. Our case has been a gentlemen named Tom, a 28 y.o. Caucasian male who has AIDS. Tom has been admitted due to complications of pneumonia and lymphadenopathy. He also shows signs of depression, isolation and loneliness.

What's interesting is that this PBL scenario is part of our Human Development course. So, one of the challenges is to determine how this disease, and his reaction to it, is affecting normal early adulthood development. This includes normal physical, cognitive, and psychosocial development. It's very interesting.

Cultural experience - Mexican Museum of Art

An ofrenda displaying the elements of earth, fire, wind and water.

These next few pics are pieces of art depicting life or events in Mexico at various times in history. The skeletons are made of paper mache!! Impressive!

The gentleman who made this ofrenda dedicated it to both his Mexican and Chinese heritage. This is only a portion of it, as it was too large to fit in the picture, but it was beautiful.

Another ofrenda displaying the elements of earth, fire, wind and water.

This is art made of sand. Isn't it beautiful???

These days one of my goals is to really focus on occupation and culture. I'm always trying something new anyways, but now I want to take it up a notch. I'd like to put myself out of my element and get a little uncomfortable at least once a month. And being out of my element does not mean I have to be uncomfortable but it does mean that I have to learn or experience something new and different.

So, on the 11th I went to the Museum of Mexican Art with one of the organizations for which I volunteer at school. I LOVED it. The art was BEAUTIFUL. We took a tour as a group and I learned quite a bit. One of the main things I learned was all about an 'ofrenda.' The closest English equivalent to an ofrenda is what we would call an 'altar,' except ofrendas are not for worshiping. Instead, ofrendas are an offering to a deceased relative as they make their way back to Earth to visit.

Living relatives decorate (is the word decorate appropriate??) the ofrenda with the favorite food and items of the deceased person as a way to honor and please them on their visit back. Of course, the deceased does not eat the food or play with the items on the ofrenda, instead they enjoy the aroma of the food and the sight of the items they used enjoy while they were alive. I learned that an ofrenda is supposed to display elements of the earth, water, fire and wind. And finally, I learned that there a lot of Chinese in Mexico, due to the Chinese participating in the building of the railroads.

Afterward, we all sat around and ate Brazilian pizza, which was delicious! I've been to Brazil and I loved the food but I never had Brazilian pizza. Overall, I really enjoyed myself!