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.