Assistive Technology Class

Another class I had was Assistive Technology. We had some really cool projects. The first was we had to design an assistive technology for someone. It could be high tech or low tech. I came up with a hamper with straps (a twin top sheet cut in half) to carry laundry up the stairs. It can be worn three different ways. This was designed for someone with osteoarthritis, but could be used for a variety of diagnoses, such as ALS or Parkinson's. One of my teachers wanted to make it for her sons on crutches. Success!

We also help a family design their home, so that their son with muscular dystrophy could live independently. I was on the team that designed the son's bedroom. It was very rewarding to see a real family react to your ideas. The ideas they were most excited by from us were not even really adaptive. One was a TV coming out of a cabinet to increase floor space, while the other was the idea of getting a mural done by local art students so that it would be cheaper.

We talked about the ADA and insurance in this class. Both are suppose to be helpful, but sometimes they can be really frustrating. For example, insurance will not cover anything that would be helpful to a typical person. So while there are excellent communication devices on the iPad that are cheaper than a stand alone communication device; however, insurance won't cover it because iPads are helpful to typical people. Even though it is cheaper, usually by $1,000.

What we are finishing up the semester with is learning about wheelchairs. We had a salesperson come in and start to explain the different features. What he said though is we don't have to know what we want for our client, but we need to know what it should do. If we knew what we wanted we would be doing his job. That was freeing.

I almost forgot we did adaptive dressing. We learned a few techniques, but what it really boiled down to is just play around with your patient to figure it out. Since each client has unique abilities and limitations everybody is going to be different. We had someone with a spinal cord injury demonstrate dressing, transfers, and talk in general. What I took away from that was equipment is not always the answer, while it may make the task easier it does not help if you do not bring the equipment everywhere, which is a huge hassle. Overall, it has been an enlighten semester.  

Mental Health

Yikes! Happy OT Month! I have been a very bad blogger, but in honor of OT month I am going to jump back into the game. School has been crazy. This past week we had to get all our group projects done which means there is a lot to tell ya'll. I think the easiest way to this is class by class. I guess we will start with Mental Health since it is the first class of week. We had a book report due. I had to read "The Unquiet Mind", which is about a woman with bipolar. I thought it was very well written and enlightening. However, when I read reviews of the book on GoodReads some people were really mad that it did not give an accurate picture. The woman in book is a psychologist and researches mental health disorders, so she understands the medical system and had medical professional as friends to help her as well as a good bit of money. Overall, it is worth reading, especially if you are intrigued by mental health. My classmates read different books, but I can't remember which ones to recommend.

The big project we were working on this past week is a case study. We had a 36 year old Latino woman who has paranoid schizophrenia. She has been living in an inpatient facility for the past 8 years, but is being forced to leave because of funding concerns. She is currently unable to successfully complete her ADLs and IADLs by herself. We had to find a community program to help her as well as determine what assessments to use and some OT interventions. I am enjoying this project. I am in one of the best groups I have ever been in. I really enjoyed finding a community program to augment her OT sessions. I realize that is more social work than OT, but I still enjoy it. We can always help our clients find the best fit.

Overall, I have enjoyed learning about the mental health field even if the class has been frustrating at times (in the middle of writing by course reviews). I don't see myself working in the mental health field for a variety of reasons (I'll get into that more when I cover fieldwork), but most of our clients will have some mental issues whether anxiety, depression, or something else; therefore, it was definitely valuable.  

Protocols

On Friday, I implemented my protocol for my mental health class. A protocol is roughly a lesson plan for a group session. My partner and I had to implement a session about time management for a group of OT grad students. Some of the grad students were given dysfunctions, such as being hung-over, fatigued, or having a song stuck in their head that we had to deal with. Our session went pretty well. We have had the most complicated activity compared to any of the other groups, but I think it was good because it actually challenged the clients. We had a few issues. One was I forgot to restate the goal of the activity right before I gave the directions. It was stated at the intro and the conclusion, but it should also be stated right before the activity. We could have also used other clients to help the clients that were having issues instead of just using ourselves. Our discussion at the end was very stilted because we just went around in a circle, which means people knew when it was their turn and tuned out otherwise. Many things went well though. We successfully integrated the previous sessions into our session, and our opening activity was a big hit. We had a blow-up chicken with get to know you questions on it that was passed around. I would say overall it was a success.

Problem Based Learning

This week I read "Why Good Classes Fail" on mediatedcultures.com. It made the point that classes can use all the proper techniques and still fail due to a lack of enthusiasm and genuineness from the professor. We have a couple of professors who are really big into problem based learning. They love to tell us that it is the best way to learn. They are even passionate about the subject material, but no one in the class is connecting. Other teachers use project based learning (but don’t shove it in our face that they are doing it), and it works. I personally believe the problem is in relevance and connecting with the students. Both of the classes that these teachers have taught are in areas that very few, if any, of the students think they will work in. I still think both of the classes are valuable to the curriculum; however, I think the focus needs to shift. Sorry, I know that is very vague and confusing, but I don't want to call out the class more than I have. Basically, I think the focus needs to shift to more current day practicability.  The other issue appears to be that the professors have failed to connect with the students, and the professors almost always step back so that we can solve our own problems. It is definitely valuable and necessary for students to facilitate their own learning. If we were given all the answers that would an issue too. However, when we get stuck and are unable to preserve they are still unable to help us. Occasionally, they will finally explain a few classes later, but at that point we  have stopped caring because we can no longer deal with the frustration.

This was left in the comments of the article:

When a Teach for America researcher “called up teachers who were making remarkable gains and asked to visit their classrooms, he noticed he’d get a similar response from all of them: ‘They’d say, “You’re welcome to come, but I have to warn you—I am in the middle of just blowing up my classroom structure and changing my reading workshop because I think it’s not working as well as it could.” When you hear that over and over, and you don’t hear that from other teachers, you start to form a hypothesis.’ Great teachers, he concluded, constantly reevaluate what they are doing.” (A. Ripley, 2010, The Atlantic)

 I think this summarizes the biggest problem I am having with my class. According to previous students, they have been teaching like this for a while, and it never works. Reflective teaching is always important. Just because theoretically it should work does not mean realistically it will. I also think this is an important thought to keep in mind as an OT, especially as a new one or veteran. Sometimes, we get so caught up in the idea that theoretically something should work or it has always worked in the past that we forget things can be changed and they probably should be. Reflection and constant experimentation are some of the best ways to create a successful practice in my opinion.  (Sidenote: one of my undergraduate professors also left a comment. It's a small world.)

Pintrest Roundup

Another Pintrest round-up. As the site gets more popular, it is getting easier and easier to find items that apply to more than pediatrics.

The first one is a simple modification for glasses. Just stick rubber bands around a cup to enhance grip. This could be used for small hands or hands that lack of sensory input. As I am typing it up, I see it is from Real Simple magazine, which provided an idea in one of my last roundup. Mainstream OT!

http://www.realsimple.com/home-organizing/new-uses-for-old-things/favorite-new-uses-00000000019718/page34.html

This is a homemade felt board. Take a picture frame and insert felt. So simple. This could be good for car trips or waiting at doctor's offices. It is quiet and relatively small and entertaining.

http://izziemacandme.blogspot.com/2009_10_01_archive.html

Here is a low-vision idea. Place a brightly colored picture frame around the light switches. This draws the eye to it, and creates texture to denote light switches. Low vision really intrigues me. We have not talked about it much in school, but at the Active Duty Rehabilitation at the Veteran's Affairs they have a low vision lab, so many of the guys I talk to tell us about their experiences. I have to be honest though, I don't know if OTs are apart of it. This is from a home decorating blog, so again yay mainstream OT!

 http://salttree.blogspot.com/2011/09/sometimes-its-simplest-things.html

One final idea, that even I could use from time to time, a homemade ice pack. This suggest putting in dishwashing liquid to create a gel like ice pack, instead of just plain ice. Now if you are going to ice everyday, I would still suggest buying an ice pack, but if you are on vacation or in a pinch this could be a wonderful solution.

http://www.funcheaporfree.com/2011/04/youre-welcome-wednesday-diy-ice-packs.html

Gait

This week we had a physical therapist come guest lecture on gait. It was intriguing and a worthwhile  lecture. We focused on gait patterns more common in geriatric populations, since that was where her expertise was. We focus on the gaits of a person with Parkinson's or a CVA (stroke). Then we learned to walk with a variety of canes, walkers, and crutches. They are much harder to coordinate than I would have imagined. I also always thought it was the people with walkers that were slow, but it is really the walker itself. The walker forces one to take smaller steps, and it prevents one from gaining momentum. Canes should be used for balance, and almost never for weight bearing because it is likely to cause hand issues because the hands are not meant to weight bear. I also learned that I am horrible with crutches, so let's hope I never need them.

Here is a video of the gait of a man with Parkinson's before and after medication. It is amazing.  

Sometimes it was hard for the class to pay attention to details because realistically we will not be teaching anyone walk properly. We just need to know to refer to a physical therapist. However, we do need to know how the assistive devices work because often we "trick" them out to make them more functional. It is important to learn about gait though because many of the activities we do with patients will require them to be slightly mobile, even if it is a short trip to the bathroom, and we need to know how they are likely to fall, so that we can prevent it.

Lab Practicals

Occupational therapy is a hands on profession; however, many of the skills one needs are hard to test on paper. My school has chosen to test these skills through lab practicals. Typically, students are paired up and told to perform different skills on each other. Ideally clients would be brought in, but that is rarely practical and sometimes unethical.

There are many benefits to lab practicals (especially compared to paper testing), but there are drawbacks. One is they are time consuming to perform. Often it leaves students hanging around the building, sometimes for hours. Another issue is the student being the client knows what the student practitioner is looking for and typically makes it easy. In one of my practicals my "client" always knew what position to get into, and sometimes naturally got into that position without me asking. That is not going to happen in real life. Finally, these situations are very controlled. Even when the "client" is instructed to act up they are still usually on the practitioner's side. Even if in the clinic, one is lucky enough to have the perfect client there are still the issue of distractions from other staff and clients as well as missing materials. Don't get me wrong I appreciate my school giving me the time and encouragement, but I wish there was a more realistic way to test. I guess we are slowly building our way to fieldwork. It would probably be too overwhelming otherwise. 

All Hands on Deck

This semester we have started to learn manual muscle testing (MMT) and how to take range of motion (ROM) with a tape measure and a goniometer. It is really exciting to start to get hands on. So far we have only done the neck for range of motion, but we have done the trunk and neck for MMT. It is amazing how important practice is. I was practicing with friends after class today, and it was amazing how many different times we had to rearrange our bodies to be able to take the measurements. An experienced practitioner would know exactly how to position themselves, and the right order to do all the testing, so that the impact on the client was minimal. Book learning is only going to get you so far on these skills.

Today in mental health we formed four different groups for different projects. Group work is a big part of occupational therapy school. Group selection is a little different in the second semester. People have friends that they like to work with, other people want to work with people they do not hang out with, and sometimes people who like to get work done early seek the others who like to get work done early. Let's hope all these projects run smoothly.

The other big happening this week is we got to meet the family that is building the house that we are help designing. I am assigned to work on the bedroom for a 15 year old boy with Duchene Muscular Dystrophy (DMD). I was a little disappointed because he spends most of his time in the common areas currently, but I know we are going to make his room so awesome that he is going to spend all his time there. I have a to-do list that is a mile long, so I should get a start on that. 

Darius Goes West

We watched this documentary in one of my classes. I thought it was amazing. You should definitely check it out. It is the story of a boy with muscular dystrophy that wants to get his wheelchair pimped by MTV's show "Pimp My Ride". With the help of some friends a three week cross country trip in a RV from Athens, GA to Los Angeles, CA and back was planned to try to convince MTV to trick out the wheelchair. They also filmed a documentary to bring awareness to muscular dystrophy and wheelchair accessibility. It is an eye-opening and heart touching film.

The story that struck me most from the film was Darius, the boy with muscular dystrophy, was dared by some of the crew (comprised of his friends) to eat a spoonful of wasabi. Darius was not one to back down from a bet. However, someone else in the restaurant yelled at the crew for picking on Darius. Darius in no way felt picked on and felt like he was just hanging out with his friends. It was just a strong reminder that people in wheelchairs do not want to be coddled or pitied, but be part of the gang.

The film brings up wonderful perspectives on wheelchair accessibility, living with muscular dystrophy, and living your life the fullest. If you want to check it out you can go to http://www.dariusgoeswest.org/the-film/ to purchase the film and learn more.   

Here is a preview:

Spring Lineup

First week of spring classes are happening this week, and it kind of feels like spring here in Georgia. This semester we take five classes, plus a one week fieldwork in the realm of mental health. Previous students and professors warn that this semester is a lot of work. It is also said that a lot of practical knowledge is learned now, and it is a lot of fun.

The first class I have is mental health programming. This class is going to focus on assessments and interventions used in mental health. It appears that the big project in this class is to lead a group session. The group will consist of other classmates pretending to have different dysfunction. I am worried about this class because I feel like mental health is very emotional and that is not one of my strong suits. I feel like I am going to be challenged often.

Next we have Assistive Technology and Therapeutic Adaptations. I am really excited about this class. We have to do a home and community assessment on wheelchair accessibility. We perform this by actually taking a wheelchair out to one of our homes and somewhere in the community. We also have a family we are working with that is building a new home for their son with muscular dystrophy. We are helping design the home. The class is broken up into different groups to design different rooms. We still have to work together to make it cohesive. I am working on the son's bedroom. I am so excited. We get to do something with a real client. The families they have done in the past have implemented most of the changes that the students suggested. We also have to develop an assistive device for a real person of our choosing. There is a fair where patent lawyers will examine our devices as well as the professors. The have had seven ideas patented from past years due to this project. This project still scares me because I have no idea what I am going to do yet.

I am also taking movement analysis. The professor is making the class a lot of fun, but it is mostly a lecture and exam class. Did you know swinging your arms allows you to walk faster than if your arms were crossed in front of you or in your pockets? Also walking develops more core and leg muscle strength than running. Who would of known?

Kinesiology is my next course. The big project in this course is to make a movie analyzing a ten second movement. You never think of all the coordination that goes into a seeming simple task, such as brushing your hair. There are also a lot of labs involved in this course. I am ready to try some hands on stuff.

The last class is neuroscience. We are focusing on the anatomy of the brain first, but then we move into how it works. That is the stuff I like. This is the only time we will have a professor that is not an OT other than anatomy. It is going to offer some different perspectives.

It's a strong line up of courses. Here's to hoping I can handle it all!

Handwriting

Handwriting is a huge topic currently in occupational therapy and the education field in general. Cursive handwriting was eliminated from the Common Core State Standards, which 40 states follow. Most states still teach cursive, but are considering dropping it since there is no longer a standard. Schools are instead encouraging typing as technology evolves. Handwriting (cursive and print) is also being put on the back burner because teachers have so many other standards they must meet. To many Americans the loss of handwriting is not a concern and instead is seen as the education system adapting to the changing environment, but to an occupational therapist this trend is leading to a variety of problems and raising concerns.

If handwriting is decreased or eliminated in schools, then fine motor skills are going to deteriorate according to many. This connection has not been proven since typing requires fine motor skills too, but some have found that handwriting offers benefits to cognition and memory that typing does not. This is likely because the brain has to be more engaged to produce a shape versus hitting the correct key. A few also point out that handwriting offers a way of personal expression that typing does not. Not only does handwriting have more variety than typing, but children write more and faster.

Handwriting has causing another set of concerns for another population. More people are learning about occupational therapy everyday, but many just know us as handwriting experts. Many students in school are being referred to occupational therapy for handwriting, but not because of underlying issues, but instead because not enough time is being spent on handwriting in the classroom. As much as I would love to help every person function better, is helping children who just need a little more instruction on handwriting the best use of our time? Occupational therapists need to make sure their expertise is being used properly, especially when it comes to handwriting, and they are not just another set of hands.   

Links:

NY Times article onhandwriting and OT

Discussion board oncursive versus touch typing

Fieldwork

Sorry this is several weeks late. Thanksgiving and finals took over.

My fieldwork was spectacular. I learned a ton, my mentor enjoyed teaching, and I got to explore a side of occupational therapy I have never seen. I was part of a substance abuse rehabilitation center that had a very specific population. This was an area I had never heard of occupational therapists being in, but after a week of being there I think occupational therapists should be a part of the recovery program. The main role the occupational therapist had was to lead life skills groups. I was really excited because my research group is implementing life skills groups, and my mentor gave me a lot of tips on life skills groups.

I also got to see documentation for the first time. He let me write several of the notes, and I got to see a few evaluations. Now my experience with real note writing is limited, but from talking to other people note writing in reality is very different than note writing for school. Both convey a breadth of relevant information, but just in different ways. It also seems to vary between settings too.

I wish I could tell you more about my experiences, but I cannot without risking breaking HIPPA. 

COPM and Interviews

Fieldwork starts on Monday. I am so excited, but I am also nervous. I am nervous that I won't know anything. I am also worried that I won't get there at time. I have to be there by 7 am, and that includes going through security. The earliest class we have this semester is at 9 am, and that is only on Fridays. I'm sure it will be fine. This must be what it is like to be an adult. There are two other girls from my class going to the same site, so at least some friendly faces will be around.

We also have to assess a patient by using the COPM (Canadian Occupational Performance Measure). We practiced in class on a classmate, and watched a video, but giving it to a patient is going to be a whole different experience. The OT interviews the client to learn about their strengths and weaknesses. The client then rates all the activities discussed on their importance on a scale from 1 to 10. The client then chooses 3-5 activities that they would like to improve. The client then rates these activities on a scale from 1-10 on performance and satisfaction. The later in intervention the ratings should be taken again to see if there is improvement. There is no norm for this assessment, but it does measure if a person is more satisfied with their performance. I think this would be a great first assessment because you get to learn about the client and what is important to them.

Last week also started the first week of interviews at my school. Is it weird that I was nervous when I saw the signs? It is really strange to see people in suits all over our floor. This year they started putting current students in the individual interviews. I can't commit to being there for every interview, but the students who are involved seem to be enjoying it.  I'm sure we will have a great crop for next year. Seeing the interviewees reminded me why I chose my school. I wasn't going to go here originally, but I was so impressed with the staff and facilities I changed my mind. That is not an easy thing to do. That is why you should always tour the facility before you chose!

Eating Alone

This year my school is integrating current students in the interview process for new students. I think this is a great idea. Unfortunately, I can't participate because I can't be there for all the interviews. However, it was shared that a student suggested asking potential students when was the last time they ate alone. This question would help evaluate  how confident a person is as well as how concerned they are by what others think of them. They have chosen not to use the question for a variety of reasons, but there is some food for thought. Would you eat by yourself?

AMPS

Today in class we learned about the AMPS. This is an assessment that is completely occupation based. It looked really cool, and reminded me what occupational therapy is all about. It does seem hard to grade. My point is proven by the fact that you have to go to a week long training course to give the test. However, once you do that and give the test few times you send in the scores. Then they will send you back a personal calibration code. You send in basic scores, but then they do some analysis and return scores that say if the client can live independently and break it down into motor and process issues. Tomorrow we learn the COPM. We will see if I like that also. I hear good things though.

Ordinary Miracles

Ordinary Miracles is one of our textbooks. It is a compilation of short stories from OTs and OTAs. They are uplifting and remind you of the importance of occupational therapy. It is not very technical and has stories from a variety of practice areas. I would recommend it to anyone who wanted to get a better idea of the different things OTs do. It is not going to tell you all the things OTs do like write notes, and plan sessions, but it will show you some of what they can do.  

Review of Classes

It is hard to believe  I have been in OT school for almost two months. I have learned a lot in these two months and met some great people. I remember a few months ago wondering what my classes would be about. Well now I think I can give you a good picture.

Models of Reasoning

We started off learning AOTA's Practice Framework. We discussed the process OTs use to help clients and what they should consider. Lately, we have been discussing different assessments we can use to evaluate clients and how to interrupt the results. This class started off very abstract, but not it seems very applicable. Our fieldwork is also integrated with this course.   

Evidence Based Practice

This is the class that the majority of the class is struggling with. It is our research course. I enjoy the material, but our teachers don’t have the best execution in teaching the course. This semester we are focusing on how to locate information and evaluate it.

Wellness and Illness

This class is hard because it is our only class on Friday and it is three hours long. The information is very practical though. We first focused on what healthy is because to define dysfunction you have to know what functioning is. We talk about specific diseases and what interventions are used to treat them.

Foundations

I thought this class would be application based, but it is more theoretical. We talked about AOTA's practice framework for a while in this class. Lately, we have been discussing the different theories and frames of reference one can use. We have also done presentations on OT internationally and some of the different specific fields.

Lifespan

This class is about occupations throughout the lifespan. We perform evaluations on different lifespan groups. I like this class because we have mini-fieldwork. We currently at the child stage. It is much like my college lifespan course with OT evaluations sprinkled in. The rest of my classes have been very different than undergrad.

Note Writing

Lately, we have started writing notes for class. It is hard to write notes because right now we are evaluating typical people. You have to know what is typical before you can detect what is atypical. Setting goals and creating interventions for typical people is challenging. I like it though because it makes you think outside of the box. It also challenges my theory that everybody could benefit from having an OT. The other hard part is the notes we are writing are much longer than they will ever be in the clinic. This is because the professors what to know our entire thought process and observations, and they can only know that if we put it in the note. It's hard for me because I am more of a big-picture girl than a detail girl.

Tomorrow, I am going to a childcare center to evaluate a child using the Peabody. We have learned several assessments over the past couple of weeks. It makes this OT thing seem real. In the past, there have been a few kids get a real evaluation because of our results. I hope my kid is ready to be tested and do what I want. We are doing in pairs, so we have a little help in implementing. 

Interviewing

The two big ways that occupational therapists gain information about their clients is through observation and interviews. Our professors have us interviewing so many different people this semester. It is really awkward. Part of the reason is normally we already know the people we are interviewing, even if just a tiny bit. That makes the introduction weird. It also makes it hard to ask the difficult questions, such as what was the hardest time in your life. I feel like that section would be difficult either way though. Most of these interviews are somewhat conversational, but not so much so that I can have a conversation like I normally would with the people I am interviewing. I am glad that our professors force us go out and perform interviews, even if it is on people we know. It is so much harder than it seems. It is also super rewarding because I am learning things about these people that I would not have otherwise. It is also surprising to learn how many different kinds of interview there are. Who would have imagined?

Fieldwork and Burnout

Yesterday we got to chose where we are going for fieldwork. They had roughly fifty locations for the forty students to choose from. The first fieldwork is only a week long, which means I was willing to try anything. Going in I really did not want to stay local and I wanted to work with adults because that is an experience I have not had. I ended up staying near school (there was nothing worth paying for a hotel or near family) and I am working with adults. There will also be two other students with me. Overall, I am super excited even though it is well over a month away. My facility also has a psych ward, but I was told we probably would not see that this fieldwork. It was a nerve-racking process, as our names were getting pulled out. However, even though I was 35/38 I am happy with my selection. It was one of my top three, so that goes to show you that everybody wants something different.

Some burnout has started to settle in. I think everybody is ready for a break. Most of the schools we went to for undergrad have fall break around this time, but not this year. This week doesn't have a lot going on, so tonight is my somewhat chill night. Some of the burnout is my fault. I thought the first month would be how it would be all semester, so I took on more volunteering than I probably should have this semester. Just doing two out of three would be plenty. I also need to say no to social things occasionally. It is hard to say no because you know people will be talking about it the next day at class, and I want to get to know everybody, but there is plenty of time. I just need to readjust my balance. School is wonderful though, and I am learning tons.

We did have our first practical this week. We had to rank part of the FIMs, but the video did not work, so we will do it on Monday. We also had to administer part of the KELs to another classmate. It was easy because no classmate wanted throw off another classmate. The hardest part was introducing myself to the "client". The other hard part was the professor asked our "client" to ask what was occupational therapy was. I can explain it in general, but it is different in a clinical situation.