THANK YOU! for supporting my blog

You guys (dear readers) are so awesome. I really appreciate all the emails and comments and encouraging words. I know I'm terrible with getting back to you in a timely manner and I AM SO SORRY. I try to work on that, I really do, but so far, I fail every time. lol. But thank you for supporting my blog and continuing to check in, ask questions and encourage me. I really appreciate it.

Hugs and kisses!

Glioblastoma Multiforme

GBM in the right hemisphere (the left side of this picture)
source of photo

Otherwise known as GBM, is a tumor I've been seeing quite a bit lately. The sad part about this tumor is that the prognosis is very poor. People diagnosed with this tumor usually have from 3 months to 2 years to live. What bothers me about this is that when we see patients and discharge them, we're basically sending them home to die. Many of them need acute rehab care but some of them refuse, stating that they'd rather spend their remaining time with their family. I don't blame them, really. But seeing this diagnosis really bothers me because these patients know they are going to die and their families know this as well. I just can't imagine.

GBM is treated the same as most other tumors--surgery (which is popular where I am), radiation, chemotherapy, steroids, etc. But let me back up and bit and give you a bit of info on this tumor. GBM is a very aggressive brain tumor of the glial cells. Glial cells are cells that support neurons by protecting neurons from foreign invaders, providing nourishment to neurons and destroying old neurons. Glial cells also hold neurons in place, assist with neuroplasticity and help repair neurons when they are injured. What I find interesting is that glial cells are not neurons themselves, they only serve as bodyguards.

As you can probably infer, glial cells are very important to the nervous system. GBM is more common in males, particularly white and Asian men over 50. Unfortunately, the tumor can grow without symptoms until it has become a dangerous mass. As an occupational therapist (student :-) in an acute hospital setting, we work on a variety of functional activities, such as orientation (making sure the patient knows who they are, where they are and the date), upper extremity active range of motion, functional mobility that is comparable to walking a distance within the home, putting on shirts, pants and socks, sitting balance, walking balance, vision and perception and fine motor coordination. We work on other things depending on the needs of the client but these are the most common.

Here's a website that has contacted me twice. They have occupational therapy jobs and other resources, including other occupational therapy blogs! (click on the Resources link)

I've checked it out and it looks interesting, to say the least. I am not endorsing or attesting to the validity of their service or ANYTHING of that nature. I think this is an interesting site and they asked me to put the link on my site and I agreed to do so, so here it is:

http://www.GetOccupationalTherapyJobs.com

View at your discretion... :-)

Week Four!

This picture gives you a a general idea of what the ICU is like. Now imagine a patient in the bed with lines coming out of their head, nose, neck, chest, arms, wrist, hand, genitals and legs. Yes, seriously, that many lines. The entire visual is very...busy. I'll write a post about it later to give you an idea of what to expect if you ever have the opportunity to work in the ICU. As usual, this is not my ICU, just a random pic :-)

Wow! One third of the way through my first Level I Fieldwork. Again, Wow!

It dawned on me that I didn't actually explain what I'm doing. At least, I don't remember explaining...anyway, I'm a student in Neurology-Acute Inpatient. I don't know if that is the official name, but that's what I'm doing. I only see patients that have neurological diseases or medical concerns, such as brain tumors, multiple sclerosis, strokes and a host of other diseases that are rare neurological disorders. Many of the patients are in the ICU, and that is exciting and scary for me because the ICU is BUSY. There are so many lines, monitors and noises, you have to be focused on 10 things at once. At another time I'll write a post just on that. It's sooo interesting.

This hospital treats A LOT of diseases that are far and few between; outside hospitals send their patients here when they are unable to provide further care or determine the exact problem. As a result, I see a host of interesting disorders that are very uncommon. Sometimes, I also see burn patients or 'general medicine' patients.

Please note that hospital inpatient acute is different from rehabilitation (inpatient) acute care. It's confusing I know...I've noticed that clinicians often use them interchangeably, depending on with whom you are speaking. However, they are different.

As a hospital inpatient acute therapist, I work with people who have come to the hospital with an illness or problem, the doctors have diagnosed the problem or are medically managing it and the doctors require the occupational therapist to see the patient to determine if the patient is safe and stable enough to go home or participate in other forms of care, such as outpatient, acute, day rehab, etc. The patients are only in the hospital for 7 days or less, rarely longer, hence the term 'acute' for this setting. These patients are acutely sick.

A rehab acute therapist works with people who require a long-term hospital stay, 24-hour nursing care and daily medical supervision AND they must need (and be able to tolerate) at least 2 hours of therapy a day of AT LEAST 2 skilled services--occupational, speech and/or physical therapy. This is the key to acute care-- inpatient stay, 2 or more services, 3 hours a day. Please note that rehab acute care is not offered at all hospitals. As a result, it may take place in a hospital or another facility, but the premise is the same, regardless of the location.

Hope this clears things up, even if just a little; I hope I explained it well. So, back to me. As an inpatient neuro acute student therapist, I assess the patient's current function and abilities, perform a verbal investigation of their functional history before they were injured and determine how what they can do now compares to what they were previously able to do.

I make a discharge recommendation, stating if they are able to go home (safely, of course) or if they need additional care, such as further acute care, outpatient care, day rehab, home health, 24-hour supervision, etc. The purpose is to determine how functionally independent AND safe the patient would be if they were to walk out of the hospital at that exact moment and return to their normal living conditions.

As you can imagine, most of the patients I see are not safe and require additional care. In the meantime, while they are still inpatient patients at the hospital I continue to see and work with them. We work VERY closely with the PTs, we work in teams. We work together to evaluate and treat patients. Because patients are so acutely sick, 99% of the time they are laying in bed 24 hours a day. As you know, this is a recipe for pressure/bed sores.

So, we work on sitting them up in bed, balance while sitting on the edge of the bed, standing and walking. We also work on other functional activities, such as dressing, eating, cognition (do they know where they are, the date and the president? You'd be surprised how many people who have not been medicated are clueless), following - multi-step commands, safety awareness, sensation, vision, L/R discrimination, toileting, transfers, attention, and memory, to name a few. Our goal is to get them healthy enough to leave the hospital and return home or to the next level of care.

I hope this has clarified some things a bit...Some people expressed some confusion.

Week Three!

I'm always amazed at how one day I look up and BAM! It's been weeks since I've posted. Time is flying and it's a little scary.

Week three of my first Level I Fieldwork is coming along well, I think. I'm always amazed at how little I actually know. Just when you think school has stuffed you chock full of info you go on Fieldwork and realize it wasn't enough. I'm learning diagnosis I didn't even know existed and sometimes there are 2 and 3 variations of one diagnosis.

I'm also learning that every OT and every facility has their own way of writing notes and writing goals. So, just when you get used to doing it one way, you go to another facility and their protocol is slightly different.

Please know that to date I've had 2 clients kind of tick me off by saying inappropriate things to me, however, I smiled each time and kept my cool. I can take a client being rude because they are tired or mentally impaired or don't want to do therapy, that just comes with the territory and doesn't bother me much. But when people make personal assaults, well, that ticks me off. I am a professional AND I am a student, so that puts in the position where unless they call me something really outrageous or do something to threaten my safety then I just nod my head and move on. But you future occupational therapists need to be prepared for the fact that patients say crazy things, even though they themselves are not crazy. They may catch you off guard and, as a student and future employee, it's not in your best interest to give them a piece of your mind. Sometimes you have to just smile and let the patient think they are right or let them think they know more than you. The way I see it, they are not an integral or fixed part of my life; I'll only be working with them for a short time and then it's over.

First day of Fieldwork - 10 tips

Before I go to bed, I want to share some brief tips with you on making your first day go along as smooth as possible:

1. Call your clinical instructor AT LEAST 2 weeks before your start date to introduce yourself.

2. Ask about appropriate attire and BE SPECIFIC. At one hospital and another pediatric site, I wore corduroy pants and both sites said it was fine. At a different hospital, the administrator had a HUGE problem with it and said corduroy's are actually jeans and are inappropriate. At some place, khaki's are okay and others they are not okay. So, ask specific questions.

3. Find out if your site requires a background check. They may ask you to pay for it and these things can be expensive so save your money and be prepared.

4. Your site may require vaccinations or titers. FIND OUT! Once you find out, DO IT immediately, assuming you don't object or have personal convictions against being vaccinated. Be sure you read the paperwork carefully. My current site requires tither/vaccinations against Rubella AND Rubeola, and YES, THEY ARE TWO DIFFERENT FORMS OF MEASLES. Only after triple-checking and calling the site did I clarify they needed both. It would have been tragic to show up and be unprepared for this. These injections and titers can get expensive so if you feel comfortable, go to a clinic, it's generally cheaper. Or, if you're at a hospital, they can do it for you--this option may be more expensive but at least you'll know you'll have everything you need and it will be done correctly.

5. Your site may require a urine/drug test. Find out how many 'panels' they require. If they require a 9-10 panel test this is more expensive so be prepared.

6. Ask your CI if there is anything you can study to prepare for the upcoming weeks. Express how eager you are to start and how much you appreciate them taking you on.

7. Review the FIM and your Manual Muscle Testing grades! Many sites use these and it comes in handy to know it!

8. If you can, submit your paperwork, titer/vaccination paperwork early so you don't have to take care of all that on the first day. If you need an ID, see if you can come in early and complete that process.

9. Do a trial run to your site! Drive, walk, bike, take the bus, whatever your mode of transportation will be during your fieldwork, take the time to do it and time yourself. It will prevent you from being late, finding/paying for parking on the first day, or getting lost. Trust me, I do this and IT IS SO HELPFUL. I even go INSIDE the site and find the occupational therapy room. This way I know EXACTLY where I am going on the first day.

10. Go to bed early the night before and get up early enough to take your time and eat a good breakfast. Many sites have set times for lunch, which can easily be 4 hours from your arrival. You may not have time for snacks because you're so busy. If you ate a skimpy breakfast you will starve and this may affect your concentration and performance. I wake up 1.5 hours before I need to leave so I can do my hair, cook and eat a huge breakfast and take my time to get ready. I don't like feeling rushed before leaving out the door for fieldwork. Also, be sure to pack your bag with everything you need so that you can just zip the bag and go!

BONUS--When it's all over-- Send a thank-you card or buy a small, but useful, gift when your fieldwork is done. Remember, taking a student is a both a burden and a blessing. Be respectful of CIs and sites that agree to take you. I ALWAYS send thank-you cards. At one site, they needed clothing for their girls so my classmates and I got together and send clothes for about a month. One girl got her Old Navy co-workers to chip in and buy LOTS of Old Navy clothes. At another site, I noticed my CI was carrying everything in plastic bags so I bought her a sturdy plastic carrying case to make things easier (only $5) and I wrote a thank-you note for good measure. At another site, I wrote about 10 thank -you cards, one for EACH PERSON that took me under their wing, even if it was only for an hour. The point is, show your appreciation in a form that is NOT email. People will remember that and they will remember you.

Good luck!

Level II Fieldwork - Day 2

So, today was my first REAL day of Level II Fieldwork. Yesterday, I took care of all the 'new person' logistic things, like meeting my CI, getting to know the building, taking a HIPAA course (which was about 2 hours!), getting keys and access to the electronic system, getting a locker, signing papers, going over expectations, meeting the other clinicians and taking a 3-hour course on using the electronic documentation system. By the time I did all of this it was about 4pm and so they sent me home.

Well, today, that was not the case! Haha! I had a FULL day. I did some ICU (Intensive Care Unit) treatments, evaluations and inpatient treatment. I did not actually DO the treatment, that comes in the next 3-4 weeks. Rather, I observed and assisted and asked a gazillion questions. I probably won't be posting much detail, due to privacy and discretion and all that good stuff, but I'll try to post the most interesting things that I see or experience so that all of you can share this wonderful Level II experience with me.

One thing I must say is that this particular fieldwork is INTENSE. At my last fieldwork, I would hear a diagnosis and it would be familiar. At this location, however, there are diagnosis that are so rare or uncommon that many times the only way to know is to ask the doctor, use the online medical database or Google it. I can definitely say I will be trained very well by the end of this fieldwork because I am learning diagnoses that I didn't even know existed. My CI confirmed that they tend to get a lot of special cases...which is good for me.

Another thing I must say is that I have been blessed with some AWESOME CIs, at this location and all my fieldwork locations prior to this one. God is really looking out for me because I have not had some of the horror or boring experiences that others have shared with me. Taking on a student is a HUGE responsibility, and in a way, a big pain in the buttocks. Taking on a student definitely slows the therapist down due to all the questions, having someone follow you EVERYWHERE you go like a shadow, explaining all the steps in the treatment process when you would normally zip right through it and then the biggee--documentation. Showing a new student how to use the system and then how to write in OT language is a huge challenge and not everyone can teach this well. My CI stayed behind an hour today just to show me how to document, to assess my clinical reasoning and to ensure that I understood what we saw, how we treated the patient and how to translate that information in a way that OTs and other medical professionals can use it for further treatment and discharge.

At the site prior to this one, my CIs were the same way. They were soooo patient and were very good and pushing me to jump right in and do it. I learned so much from them and they gave me an excellent baseline for this fieldwork.

I probably won't get to go out with my friends as often because I'm realizing all that I don't know. I'll be one Googling sister. Seriously. There's not much time for me to Google while I'm on site but when I come home I have to make the most of my time, and there's not much time in the day. I'll probably be in the bed by 9 tonight. Right now, it's 8.30 and I'm exhausted--and it's just the first day! Lol. After work, I had to run some errands, eat dinner, prepare everything for tomorrow and update this blog.

I also have all these blog notes I wrote from the last fieldwork, notes on things I observed or participated in and wanted to share with you on this blog. However, I rarely had time to log on, as you can see from my limited activity last month. Additionally, I have notes from things I learned months ago while in class, along with a ton of pictures I took of adaptive aids and devices and other interesting occupational therapy items. As you can see, none of that has been posted yet! I'm so busy. But I promise I will get it posted, slowly but surely. It's really important to me that this blog is a resource for those pursuing occupational therapy or interested in more information about occupational therapy.

I'm so sleepy and there are probably all kinds of typos and grammar errors and words missing in this post. If so, I truly apologize!

First Level II

I started my first Level II today! Whooooooo...scaaaaaary. But, so far, l'm loving it! It's only been one day, but still...

All day, I kept thing that this is it. This is LEVEL II. I finish this fieldwork in August and then I start the second Level II and then...graduation...and then real life. I'm a second career occupational therapist, I don't know why I treat this as if it's my first job.

More importantly, this is Level II and this is the real thing. My last three Level I's were more like practice. I observed and I asked questions. I performed some evaluations, planning and interventions but not every day and not with every patient. This time, however, it's a bit different. The first 2-3 week will be observing, asking questions and working with a few patients. But, by week 6, both my school and my CI (clinical instructor) will expect me to have a caseload, as in a minimum of 8 patients that are my own. My CI reviews everything I do, of course, but for the most part there will be many, many, many times when I am alone with the patient and need to use my professionalism, knowledge and clinical reasoning/judgment.

Thankfully, this will be an interesting and fun experience. I can't wait to get into the groove of things. I'm really looking forward to it.

Don't ASSume relationships!

Although I'm pretty good at making conversation sometimes I have to watch the questions I ask, especially when I'm distracted. Normally, when someone comes to therapy with another person I ask, "So, are you related?" because you never know if someone is a son, daughter, caregiver, girlfriend, boyfriend, wife, husband, etc. I don't like to assume those things with strangers because I don't want to offend anyone. If someone wants to expand on their relationship then they will, if they answer and get quiet then I know not to press the issue. I usually just have to feel the person/family out and see how open they are to sharing and conversation.

Last week I asked a client this question and she replied that she was the caregiver. I was sooo glad that I did not assume anything. However, there was another client who had someone with him who, to me, looked really young. I asked, "Is that your son?" He gave me a look and then started laughing and said, "No, that is my younger brother" I was just like, "Oh" as I listened to all the crickets amplifying the silence that followed my mistake. haha.

He was pretty good about it, thankfully, but this is an excellent example of BEING CONSISTENT and NOT assuming familial or any other relationship. The client's brother was young, but not THAT young, he only looked significantly younger. I have not experienced the situation where you ask if one is the wife but she is actually the girlfriend and then the wife comes by later. That has happened to others I know, but thankfully not me!

So, the point of this story is to be mindful of assumptive questions. It's best to ask vague questions than direct, yes or no questions. Save yourself, and the client, the embarrassment.

Work Hardening/Conditioning

I visited a work hardening/conditioning site today and it was so interesting. In a nutshell, work hardening is occupational therapy that focuses on returning a person to work. Treatment focuses on mimicking, as much as possible, a client's job duties and work environment.

This facility was wonderful. Some things I noticed are

• streetlights (yes, a real streetlight, truncated of course)
• tall and short ladders
• nuts and bolts for screwing on and off on a high or low board
• bags of true-weight cement
• garbage cans
• buckets to simulate the weight of paint buckets
• vacuum cleaners
• shovels
• inclines and declines
• gravel
• carts for pushing and pulling
• carpet for friction
• a dummy in a wheelchair
• a plumbing setup
• scaffolding
• all sorts of boxes of various weights
• stairs
• and even a simulated bus/truck driver unit. I got in this unit and it moves and feels just like a truck/bus. It has a clutch, gears, and a TV to simulate driving on the road.

They also have a machine called the BTE or Baltimore Therapy Equipment which is basically a machine that simulates all kinds of real world movements for job function or personal interest. You can set the machine for appropriate resistance and to mimic the motion. For example, I was told the story of a woman who said she'd love to be able to ride her Harley motorbike again. They showed me a piece that looks kind of like a wrench. It was attached to the simulator and when I gripped and squeezed it, it had the weight, feel and resistance of a motorbike clutch! The machine requires that you continue to grip it and maintain the same force with each grip. It records your grip strength performance over time so the therapist can determine your rehabilitation progress.

The machine can do hundreds of simulations but some that I noted were:

• shoveling
• operating a drill press
• turning a knob
  
• using a screwdriver
• turning a key
• climbing a ladder (amazing!)
• sweeping the floor
• shoveling snow
• sanding
• painting
• steering a whel
• gripping
• vacuuming

The work hardening environment is good for all the movements needed in a job that people don't think about--kneeling, stooping, crawling, reaching, climbing, balancing, lifting, pushing, pulling, carrying, scooting, etc. Finally, work hardening is therapy that mimics a workday where one participates for 6 or more hours and work conditioning is a half day, where one works for 3-4 hours.

Very interesting!

Yo PUEDO hablar espanol!

So, all my traveling and (inconsistent) studying of the Spanish language has paid off! Today, my CI had to do an evaluation and commented that she believes the gentlemen, with a Spanish/Latino surname, only speaks Spanish, based on some information from his chart. I told her that I speak Spanish, although not fluent, I can certainly communicate. She said 'Ok, let's try it."

We walked into the room and she asked in Spanish, "habla ingles?" To which he replied no. And then she said, "Ok, Kim, you're up."

AND I DID IT.

I explained that I only speak a little Spanish and that I am the student and she is the occupational therapist. I explained occupational therapy to him (although I need to work on that part a little bit) and he said he understood. We asked about his home life, his pain level, location of pain, the type of equipment he currently has at home or used before his injury and so on. His pain level was really high so we called in a nurse and I had to translate that exchange, explaining when his doctor would be in to prescribe more medication.

I tried to explain some adaptive equipment to him but he was in so much pain he didn't want to be bothered. Also, some Spanish words I couldn't understand because I didn't know them and other words I couldn't understand because he was mumbling and slurring words together.

I'm not sure if he understood that we were OCCUPATIONAL therapists and not physical therapists because he kept saying the therapists already came and made him walk around. I explained again that we are different so I hope he gets it. We have to see him again tomorrow so I'm going to write down some common phrases for his condition and write another, clearer explanation of occupational therapy. Perhaps he was drugged because he did seem a little out of it, or perhaps the pain was so great that he couldn't think straight.

Either way, it doesn't matter because I SPOKE SPANISH. Ha!

Afterward, my CI said, 'Well, Kim, you did very well. I am very impressed."

I've been doubting my Spanish skills all this time because my listening is not strong and I mix up words all the time and I get nervous. But now I realize I get nervous when someone is correcting or judging my grammar or word choice. In this situation no one was there to correct or judge my level. I only needed to communicate. It wasn't as important that I had subject-verb agreement. When foreigners speak English their subject-verb agreement is not always correct but as Americans we're used to it and let it slide because they COMMUNICATE well. My Chilean classmate told me this about a 1.5 months ago. He told me that he knows his English is not perfect but it doesn't matter. All that matters is that he is understood and he can communicate. He told me I should feel the same way about my Spanish. I would LIKE to feel this way about my Spanish but I get nervous and I want it to be perfect because I don't want Spanish speakers to think poorly of me.

I'll still probably have that thought in the back of my head but now I have more confidence in my ability to express myself and be understood. Now I'm going to REALLY have to pump up my Spanish studies.

This was the highlight of my week!

Therapeutic Use of Self

The Great Wall of China. I visited this AMAZING structure about 10 years ago while on vacation in China. If you ever have the opportunity, please go. It's breathtaking. The Chinese culture is incredible. And no, you cannot see it from space. :-)

The OT community often talks about using therapeutic use of self. We talk about it a lot in school and I understood it but now I REALLY understand it because I'm using it so much everyday. I'm not going to quote anyone for this one but tell you my own definition: using your personal, unique skill set to meet the client where they are in such a way that YOU become a valuable tool in the OT process.

A quick example before I go to bed:
At my site we have clients of all cultures. One particular group of Chines ladies comes in, does therapy and leaves, one lady serves as an off-the-cuff interpreter for the other who speaks no English. One day I commented to my clinical instructor (CI) that their Chinese accent was very interesting and I wondered if they spoke Mandarin, Cantonese, some other dialect or maybe my ear for Chinese was just off. She was curious as well so we asked at their next appointment. One question led to another and me, being my talkative self, starting asking a gazillion questions about where she was from, how long she's been here in the U.S., her job, etc.

She was excited to know that I had been to China and had a wonderful experience there. Suddenly, she wanted to share EVERYTHING with me, all kinds of stories. I asked her to teach me some basic Chinese and she was so HAPPY. She shared with me that there are three words I absolutely must learn to get by: Hello, Good-bye and Thank you. I kept practicing the words over and over and she taught me more words and kept corrected me, haha. The more we talked, the more engaged she became. Now, I know I'm still new and all but up to this point I'd seen this lady a few times and I didn't know she could talk this much! And it was so interesting!

Later that day I asked my CI for feedback and she told me that I have great rapport with the clients. I'm really good and starting and continuing conversation, making the clients feel welcome and engaging them in therapy and the intervention process. The previous week another OT clinician had told me the same thing. They both commented that I should never lose that quality.

Naturally, those encouraging words made me feel really, really good. It also hit home how just being yourself and using your natural strengths (in my case, the gift of gab and of genuinely being interested in people's cultures, family life and life experiences) can encourage the client and make therapy enjoyable.

And in case you were wondering, here's the Chinese I learned. I can't guarantee it's correct, HAHA! Either my pronunciation is off, or hers...probably the former more than the latter. :-) (smile)
Hello - Ne-how-ma
Goodbye - Chai Chen (the first sound is more like a 'j' sound)
Thank you - She-e She-e

The Framework vs. The Real World

Today we had a guest speaker come and lead a meeting about the Framework. I thought this was interesting since as a student that's ALL we do is talk about the Framework--we eat, breathe, sleep and poop the Framework. But what I hadn't considered is that the Framework hasn't been around forever, haha. There are OTs for whom the Framework is a new document and learning all the pieces of the Framework is a new process.

Today's speaker discussed how students come into fieldwork with Framework terminology swimming in their heads and, because of this, it's important for clinicians to regurgitate these terms as often as possible so that the Framework makes sense and so that students can relate what they've learned to what their actually doing in the clinic. I thought this meeting was very interesting because I'm certainly seeing the difference between how academia sees implementing OT interventions and how it's actually done.

To be clear, there are no significant differences, however, I've found the emphasis to be different. In school, the emphasis is often on occupation-based intervention, but sometimes this is just not possible in every session. Many times clients need skill-based exercises to build their strength; they need a clinician to guide, pace and review the exercises with them. Also, if the clinic environment is not built for a true occupation based intervention due to a lack of tools or time then sometimes performing 'rote' exercises (known as preparatory exercises in the Framework) is the best way to accomplish your goals.

I've found that many OT instructors I've run across (to clarify--this is not just at my school but at other institutions as well) discourage 'exercise' per se and place extreme emphasis on occupation based intervention. For the purposes of this discussion exercises are not just lifting weights but are also activities such as working with putty, thermal modalities, ROM, using thera bands, etc. There are clinicians and educators out there who frown on using these forms in treatment, especially for extended periods of time.

Thankfully, I'm in an awesome place that has WONDERFUL facilities but in speaking with others some clinics are not as well-prepared. As a result, some tasks, such as performing a kitchen task, are just not feasible. You may not be able to see how your client cooks in real time, or if they remember to turn the stove off, or if they note that the recipe calls for leaving the cake in the oven for only 10 minutes, or WHATEVER the case may be. This where that good ol' OT creativity comes in and you have create/simulate the environment as best you can.

So, please no one take this post OUT OF CONTEXT and get all argumentative on me, because I can certainly see someone doing that; please try to see the point. I hope I've been pretty clear in expressing that OT interventions encompass a good mix of preparatory (warm-up), purposeful (activity simulation) and occupation based intervention (real time intervention). Exclusively using one over the other only disservices your clients.

Also, in regard to that last post--after cooking the food, we placed a tablecloth on the table, set the table with plastic silverware and glass bowls and plates and we ate the spaghetti and garlic bread and it was delicious!

We made spaghetti!

Ok! It's getting hot in here! Things are really heating up. I'm on my third and final Level I fieldwork! For obvious reasons I can't tell you where I am or give you much detail. But I can tell you some things, though very little.

Last week I did a cooking task with two people who suffered a stroke/CVA. It was my first 'real' task. It was awesome! They made spaghetti and garlic bread. We watched them from start to finish and they did everything. Turning on the stove was interesting as one person knew how to turn it on and the other didn't. I think Pt2 had a stove with electric buttons because she kept pushing all the pictures instead of turning the knobs. I thought it was cute. Pt1 had to cut and butter French bread, which was interesting because Pt1 doesn't cook.

Pt2 swore up and down that she wouldn't be able to open the spaghetti jar. She tried to open it with her stronger side but I kept encouraging her to try it with her hemiparetic side. We looked for some Dycem (a non-slip material to help you grip items, it's like the Superman rubber material) and didn't have any so we just used a regular rubber liner. And Voila! She opened the jar with ease and she was soooo happy! She then exclaimed how now she can make spaghetti more frequently!

I really enjoyed the task and it forced me to multi-task--I had to watch and make sure the clients don't hurt themselves, we were cooking with fire after all; I also had to ensure that they successfully completed all the steps; and I had to observe their motor control, bilateral coordination, strength & endurance and make sure they were using their hemiparetic side as often as possible.

I've noticed that stroke patients often use their stronger side over their hemiparetic side. In doing so, they force non-use of their hemiparetic side. This can lead to overuse problems of the stronger side and muscle atrophy and degeneration of the hemiparetic side.

I'm still here!

Ok, I have been quite the busy bee! I know I've been away for awhile but I've had physical issues and SO MUCH SCHOOLWORK. This is my final semester on campus before my Level II fieldwork and we had a lot of loose ends to tie. I am currently on fieldwork in a hospital and I LOVE IT. I have so much to write but I can't do it now. I'm exhausted. I haven't had a rest from school. I still have 2 online exams to take and some posts to upload. Hopefully, I can write more over the weekend. Plus, on top of all that I took notes from all the weeks I missed writing on this wonderful blog so I have to catchup on all that stuff.

Please forgive my silence. I always think about my blog and content but lately I've been too exhausted to log on and type all the stories I have. I will post this weekend.

24 year-olds in nursing homes

I received an excellent submission form a reader on an article that was new information to me and very interesting. This article discusses how a growing number of nursing home residents are actually under the age of 65. Apparently, this groups suffers traumatic injuries and their families cannot afford to take care of them, either financially or because of time. As a result, they are put in nursing homes where they can get the care they need. Some people are in nursing homes because its cheaper than a hospital.

The problem is that they are still young (some are in the 20s) and want to play their music loud, get up late, eat late and hang out. This can be a problem when the people with whom you live get up at 7 am and go to bed at 9pm. They also mentioned how people are dying and that makes them very sad.

I think it is a very interesting article for occupational therapists and the health profession to review and consider. I hope you take the time to read it!

http://www.huffingtonpost.com/2011/01/07/assisted-living-more-young-people_n_805772.html

Change is good

As you know, I take voting VERY seriously. We had a mayoral election here in Chicago today, and, of course I voted! Mr. Rahm Emanuel is our new mayor, which is interesting because Mayor Richard Daley has been mayor since I was maybe 7 or 8 or something like that. He's the only mayor I really know and I'm almost 32 years old! The only other mayor I remember is Mayor Harold Washington, the first and only black mayor. I remember going to a restaurant as a kid and my dad being so excited to meet him. Mayor Washington was so gracious, I remember him picking me up...I think there's a picture of that somewhere around here.

Well, anyway, what struck me about this mayoral race is that all the candidates were minority or 'other.' At least 3 candidates were African-American, 2 were Latino/Mexican and one was Jewish. It was very culturally diverse. For Chicago, this is significant because Chicago is well-known for being a major city that is very racially segregated.

And this is quite true.

To this day there are some neighborhoods that make me nervous after a certain hour because of previous unpleasant racial experiences. Chicago is also a city with a very large black population that has historically voted for black candidates. This is mostly due to the fact that until recently the only option was white candidates and we were excited to have other options, but that's a topic for another day. This is interesting to note because Mr. Emanuel won a HUGE percentage of the black vote, he won the majority of the black vote in every ward in Chicago.

I won't tell you who I voted for in this election because I don't want my beliefs plastered all over the Internet. haha. But I will tell you that I don't vote along racial or party lines. I vote for whom I believe will best serve my interests. I did not vote 'black' in this election. I know this has nothing to do with occupational therapy but this is very important to me. I believe very strongly in voting. I hope these rants encourage people to make more of an effort to vote in future elections. I'm always very disappointed and agitated with people who give crappy reasons for not going to the polls. Anyway...

I am very happy to have a new mayor.

Change is good.

FAQs-How I found Costa Rica & Dominican Republic

I received a question asking how I found the families I stayed with in DR and CR. I performed an EXTENSIVE Google search for Spanish immersion programs. For weeks, I looked at websites and compared amenities and prices. I asked around my network to get more information on the experience and how things work.

Finally, I settled on this company--Spanish Abroad. They have a very comprehensive site and I learned a lot about the different countries just from perusing their site. I had no idea if they would take my money and run but I just went with it and it worked out very well! I chose the countries based on how much money I wanted to spend and CR & DR were two of the cheapest. Ecuador and Guatemala are pretty cheap as well but I was concerned for my safety. In hindsight I wish I had gone to Guatemala as well.

Anyway, they enroll you in the school and book your time with the family. You are responsible for your flight, although they give you arrival and departure parameters. Your school books and two of your meals are included in the price. You can choose to stay in an apartment if you don't want to live with a family. Don't think that just because you live with a family you will practice Spanish. I lived with one family that was too busy to talk to me and another family that spoke English very well so they always spoke English to me first, which was annoying as H-E-double hockey sticks. But, overall, they were both amazing experiences.

So, I have learned that the total experience is very dependent upon that country's Spanish school, the family you stay with and the country itself. I had some experiences that weren't so great. Unfortunately, I won't share them here on the Internet for the world to see because some people may get offended and it just makes me look bad.

But, buyer beware. I have not had a bad experience with Spanish Abroad, however, they are just a broker. They only set-up the experience; the family, the school and the country you choose MAKE the experience. Plus, your attitude and expectations makes a big difference, too. Go with low expectations because our living standards here in the US are very, very different than many countries Spanish Abroad offers. I knew that going in so I wasn't too surprised at what I saw and experienced.

If you use them, please tell them I referred you. I think my Spanish immersion trips are over because I can't squeeze any more money from my family and friends, haha, plus a lot of my savings is slowly dwindling away, however, you never know what the future holds. I'd like for Spanish Abroad to know that I speak highly of them.

Good luck!

(As a side note, to the young lady that left the question, I could not send you a direct email because I didn't have an email address. I think you responded directly to the blog instead of entering your email address. Anyway, I hope this answers your question. If not, email me back, I'd love to hear from you again! Thanks!)

School, Toilets and Friendship

Two things to make you smile today:

1. My classmates and I were complaining about how tired we always are and how there is always so much to do that we never get to do things we really like, such as spend time with our families, read interesting books, hang out with our friends til the wee hours, and sleep.

The 6 year-old son of one of my classmates asked her to play with him and she said, "Ok, I have some homework to do first and then I can play with you."

To which he quickly replied, "You never spend any time with us anymore. I hate school; I'm never going to school, not even after college!"

For some reason, that cracked me up!

2. Another classmate left her bag and coat in class but was nowhere to be found and the professor had started teaching. I asked another classmate where she was and found out she wasn't feeling well and went to the bathroom.

When she returned and found out that I inquired and was interested in her whereabouts she said, "Wow, you asked about me? That's awesome, thank you for thinking of me! I was in the bathroom on the toilet and I thought about you, too!"

I just shook my head and turned away. Not the image I needed at that moment.

More thoughts on (air quotes) free money

So, in regard to that last post on (insert air quotes here) free money (insert sarcastic face here), my classmate made a great point that somehow alluded me. She reminded me that paying a couple of thousand in taxes for (insert air quotes here) free money (insert sarcastic face here) is MUCH better than paying $50k+ in student loans.

Ok, dear Classmate.

Touche.

You are right and I stand corrected.

And I'm going to shut-up about it now.

Why *FREE* money is not really free

Ok, um, apparently, I didn't get the memo!

Why didn't anyone tell me that if you get scholarship money for school the U.S. government considers that income and taxes it up the yee-yang?!

Apparently when you think that income literally means going to work and making money you are sadly mistaken.

Income means ALL money that comes your way. Even free money. Period.

What gets me is that you are supposed to use your student loan and scholarship money for school and living expenses. If I have to pay taxes on this *free* money, where does the money to pay the taxes by April 18th come from? Isn't a misuse of funds to use the *free* money to pay the government?

Are the words *free* and *scholarship* misnomers?

Just curious.

Hand puppets & Pin the Tail on the Turkey

After making puppets, two of the kids spontaneously performed a puppet show for me! It was lovely!

These puppets were supposed to be Pilgrims and Indians (Native Americans).

The Pilgrims had hats and the Indians (Native Americans) had feathers. I am personally opposed to the 'Pilgrim' and 'Indian' image as I have very strong views about the way their relationship is portrayed to school children. I won't get into my personal views here because the point is that the activity was excellent.

The children were allowed to decorate them as they pleased using yarn for hair and the mouth, crayons, markers, bubble eyes and pom-pons for the nose. We had to guide some of the children with the decorations but most did well using their imaginations.

We played a Pin the Hat on the Turkey game. This game was great for social interaction, communication, following directions, knowing body parts in space (while the eyes are closed), vestibular regulation (because we would spin them around), taking turns (some of the kids struggled with this) and a host of other performance skills. This is an excellent activity.

Just a picture to illustrate how small the kids' chairs are. This picture does no justice, really. Those chairs are either really, really tiny or I am really, really big. It may be a bit of both. lol. But, I thought it was so cute that their chairs were so small. The blue chair, although it looks larger, is still small in comparison to an adult chair because it is a chair made for a larger child. I had to sit in the red chair sometimes so that I could be eye-level with the kids. It was uncomfortable because I could not scoot under the table like the kids because I am too big!

Pediatric projects--turkey and cornucopias

The kids made turkeys by tracing their hands, cutting out the shape and gluing feathers onto the paper.

The kids also made cornucopias by cutting out their favorite foods from magazines and food ads and gluing them onto the cornucopia.

(Apparently, this kid likes sugar)

Another turkey on the bulletin board.

I like these activities because they help you determine if the kids are sensitive or sensory averse to glue, construction paper or feathers. You can determine bilateral integration by looking at how and if they cut. You can assess fine motor skills by looking at how they hold the pencil when they trace their fingers for the turkey. You can determine their problem solving skills by how they cut corners and around weird areas when cutting out the pictures from the magazine. You can look at their posture while cutting and writing and you also assess their attention span and ability to concentrate on activities and follow directions. You can also assess communication and social interaction by how and if they share. Asking them what types of foods they eat for Thanksgiving also assess communication and social interaction skills and you can learn about their immediate familial cultural. (As a side note, I was disappointed to see one teacher correct a student when he said he does not eat pumpkin pie or stuffing for Thanksgiving. Thanksgiving and stuffing is a personal experience. In my family we don't eat either. Instead, we eat sweet potato pie and dressing, a typical Southern Thanksgiving meal. So, please be mindful when talking to students that we are respectful of culture and differences).

These are just a few examples of what you can assess by these activities. The kids are having fun, you're having fun and you're also learning about their performance skills. These are awesome school-based occupational therapy activities.

Pediatric Bulletin Boards

A bulletin board of turkeys and cornucopias of the kids' favorite foods.

A bulletin board at another school of turkeys and handwriting samples.

Towards the end of my fieldwork we made Christmas trees and candy canes! If you look closely you can see the pom-pons or 'balls' as one of the kids called it in my last post. :-)

HIppotherapy

The riders taking riding lessons would sometimes mount here. Those receiving hippotherapy did not mount from here because it requires an extreme amount of balance and core coordination and strength.

One of the horses used for hippotherapy or riding.

Isn't this horse beautiful?

This is one of the 'stations' where we asked the kids to pick up toys that were strategically placed or place toys on the ledge.

A saddle used by one of the riders. None of the occupational therapists or other therapists use this saddle.

Instead they used a 'saddle' like this, it's more pliable and wider than a regular saddle. This is a smaller horse that can sometimes be a bit moody, haha. We used this horse and then had to switch to another horse as the rain torment increased.

The horse being led into the loading area. I can't remember the exact name of the area.

This is a smaller horse that can sometimes be a bit moody, haha. We used this horse and then had to switch to another horse as the rain torment increased.

Mounting a child on the horse. It often took 2-3 people to mount one child. The larger the child, the more effort to mount the child.

(For obvious reasons I can't show the faces of the children although I do have permission to post these pictures. I hope you can get an idea of what hippotherapy is like although the pictures aren't as clear as I'd like).

During my pediatric fieldwork, I had the opportunity to observe a hippotherapy session. In case you are unaware, hippotherapy is therapy (in this case performed by an occupational therapist although it can be performed by other professionals as well) that utilizes the movements from the horse. From what I saw, the children LOVED it and really respond well to it.

After mounting the child on the horse we each stood on the side of the horse to hold and balance the child. Up to 4 people helped and we never stood behind the horse. I learned that standing behind the horse causes them a great deal of fear and in response they will kick back. Horses have strong legs and kicking back is never good when a human is behind them, obviously.

We then walked around the stable for 30 minutes. Sometimes we would position the child backwards to work different muscles, or hold toys out in front of them or to the sides asking them to reach for the toys or point to the toys to assess and evaluate their balance, coordination or other performance skills. Sometimes we would stop at a station and ask them to reach and pick up a toy or place it in a bucket or place it down on the ledge.

At one point it started to rain, HARD, with thunder and lightening and the horses freaked out. I was terrified. I know nothing about horses and to see them whining and walking frantically and the stable owners trying to calm them was frightening for me. It was mostly frightening because they are HUGE animals and you don't want to be on the side of one while it's scared. There was a lot of calming action and 'shhh' noises by the occupational therapists and stable owners to calm the horses.

I think hippotherapy is an interesting form of therapy and I highly recommend an observation if you have the opportunity.

How are you feeling today?

See my name? Apparently, I was very tired that day...

If you look closely, you'll see that my classmate drew a picture of me! Lol. That was when I had that funky ponytail with a headband matching my outfit. I think she did a pretty good job.

Last semester when we were discussing sensory integration and sensory processing our teacher started the class by posting paper on the door and asking us to both write and draw how we were feeling that day. We all had a ball with that one. It was interesting to see what everyone wrote and how they drew/described how they were feeling.

Disappearing Clock

A clock indicating that he has time to complete the activity.

As time goes on, the instructors can fold over the flaps to indicate how much time is remaining --15, 10, 5 or 0 minutes remain.

The flaps make the clock disappear, creating a visual reinforcement.

The clock is gone! Time is up!

For my Assistive Technology class last semester we had to come up with an idea for an assistive tech device for a student. I chose to create a prototype for a student with Pervasive Development Disorder (PDD). Autism and Asperger's Syndrome are two of the most well-known forms of PDD.

This particular student does not respond well to transitions. To my knowledge, his team of instructors at school do not give multiple notifications of the upcoming activity. I suggested that we use a clock that counts down the time of the current activity. If he can 'see' that time is decreasing on his current activity while at the same time someone is verbalizing the countdown AND providing deep pressure on his shoulder or arm to get his attention, he may be more receptive to ending that activity and starting a new one.

In the real world this would probably be laminated or created using a computer or something but you get my drift. Some of my classmates actually created their assistive technology and gave it to the students, who were elated, of course.

Graduation is around the corner

I'm a member of the Board of our school's Master of Occupational Therapy Club. We decided to welcome the incoming occupational therapy students with treats and snacks. I thought it was very thoughtful of us.

In April, we have our third, and final, Level I Fieldwork. This fieldwork is Adult Physical Dysfunction, such as Traumatic Brain Injury, Spinal Cord Injury, Cerebrovascular Accidents (Stroke), etc. After that it's Level II Fieldwork...whoo hoo, SCARY! And then after that, it's GRADUATION. I don't think you understand how excited, and nervous, I am to graduate.

Excited, because, well, it'll be the end of my life as a Master's student and I'm completely ready for that. School is physically, emotionally, and mentally taxing and I'm just downright...tired. I need a break.

I'm nervous because it'll be the end of my life as a Master's student (haha, same reason) and the beginning as an Occupational Therapist professional. Everything that I've been studying and waiting and hoping and praying for will come to be around this time next year. That's amazing.

I'll have to study for the Board and start preparing to life my life as a professional. This is my second career and it's pretty exciting...and scary.

Wow.

More Domincan Republic pics

Another interesting picture from the Dominican Republic. I was curious as to why bars would be placed on the upper levels of an apartment building. I was told it's because people climb the building to rob homes.

The crime in Chicago is sky high and people do outrageous things here so I am totally not judging. But, I thought it was interesting enough to share.

Splinting 101

Hands are so important...and so complex.

A more complex hand splint than the one I had for my finger last year (it's been a year! Can you believe it? Wow. My finger is still doing quite well.)

Two of my classmates are practicing on each other. Here they're making the outline to use as a template.

Here my classmate is creating a template for my hand/forearm.

A template I created for myself for my hand.

Here I am creating the template myself for my hand/forearm...

The finished template.

We have a class on creating hand splints. As of now, I'm fairly certain I am not interested in anything having to do with hands, including splinting. Learning about forces and vectors is interesting though and the process is pretty fun.

In case you're unaware a splint is basically just a tool or device used to immobilize parts of the body to prevent further injury so that the surrounding tissues can heal. It's kind of like a cast. Remember when I lacerated my extensor tendon and I had that strange white thing on it? That was a splint for the finger. That should give you a general idea of what splints do. The splints we will create in class will be much more elaborate than the one I had but you get the idea.

Finally, a bit on Certified Hand Therapists. So, CHT's are occupational therapists (and to my knowledge they are also physical therapists) with 5 years of practice in hand therapy, including passing a national certification exam. CHT's focus on injuries of the hand (surprise!), the wrist, the elbow and the shoulder. They assess, plan interventions and evaluate outcomes of hand therapy services. CHT's have to meet very rigorous standards.

So, there you have it! Splinting 101!