Quote of the day…

“I'm not hot, I'm just crazy.”

Gotta go get dressed to go to some alumn career networking thingie. Ugh. When I get home I have a lot of work to do!!!

Day 3/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center

Today was Day 3/10 of my geriatric Level I fieldwork at an Alzheimer’s Day Center.

Today was a little bit more intense! When I came in this morning, one of the women who had previously been quiet was having a mini melt-down and yelling at one of the PCAs. The non-stop talker was there, as was the faithful anguished wanderer, of course. I took aside the woman I had chosen to do my school project on since she is pretty high functioning, let’s call her Miss Betty. She answered questions about her life, including admitting she wants her own apartment and a “MAN” (leer), and that her daughter bosses her around too much, and she has to tell her daughter sometimes to “Step to hell”. This cracked me up TO NO END, that is the greatest expression ever. Step to hell. At one point she said “I love coming here, but I don’t need to be here. I don’t have that disease where you forget things….what is that disease called, I forget.” I was like hmmmmmm. LOL. But seriously, she is very high-functioning, sweet, and kind, and I’ve learned a lot from her on how to interact with others.
————-
We had several random sessions – most of which were dispirited and somewhat boring today – I’m realizing that a lot of their stuff is pretty repetitive and that even the residents (the ones paying attention anyway) are bored too. It’s not the fault of the person running the session or anything, it’s just that it’s difficult to entertain people all day every day, with a range of skill levels. The facility has a lot of stuff, and I’m trying hard to brainstorm new ideas or at least pump in some energy, but I’ll admit I have so many things on my plate right now that it’s not getting the attention it deserves. I think my plan for the rest of this week is to continue stepping up my assistance and meeting different people, reviewing more charts, and continuing to take aside people for one-on-one time. Then this weekend I can focus on some serious brainstorming and see what I can implement next week.

——————-

I asked to see a few specific charts today – the charts were in good order and everything, but since they are just a day center they aren’t medical model or anything, and they lacked quite a bit of detail. For example, one of the women there (FixxyLady), is now making no sense at all 99% of the time, but if you were to look at her chart, you wouldn’t realize the severity of it, because when she first started coming there, she was considerably more normal. I guess I’m used to seeing a lot of specific OT documentation instead of an occasional checklist assessment, so I was a little bummed there was not more information within the charts, that I could possibly use for “detective work”.

—————–

I felt like I was in an Oliver Sacks book today, more so than before, as I encounter more and more interesting behaviors. Like a woman who was talking about “this thing, you know, that…” and pulling on her ear. When I volunteered “Ear?” she said yes, that! I also spent some time outside with the nonstop talker and the anguished wanderer, and if you listen to the talker, he actually makes sense to some extent, although he never stops talking and there is a lot of repetition so it’s not easy. The anguished wanderer just seems to be in torment, as if in a living Hell. She’ll wail like a little girl and the PCAs or whoever is near, including me, will hold her for a few seconds until she wanders more. One of the most awesome PCAs and a team leader was out there with them and they are a handful. This PCA is really intriguing to me because she is VERY VERY VERY good at what she does and tries to make sure everybody gets some personal attention and is okay. She is great at making people feel good. She has been doing her job for like 18 years and loves it. I think she feels slightly threatened by her lack of real-world education though, based on some of her comments to me. I don’t know, but I really like her and have a lot I can learn from her.

Now for the most interesting and surreal time of day. I have been interested in a woman who walks jerkily and walks around with a sippy cup. She speaks clearly and looks intellectual, but nothing she says make any sense. This is the one I said sounds like she came out of Alice in Wonderland. I had learned yesterday that she reads things well (reading hymns out loud) and I was intrigued. I asked her if we could sit down together today and chat, and that I like to write things down so I can keep my thoughts together. While I missed a ton of things of course, here are just a few of the random things she said that I wrote down.

“That I need what I have to have”
Do something with him because he is doing very well…he’s worked on almost anything…he’s the one you must have come. He loves “up” (gestures).
And I saw him. And they are nice people because when you get this you can get it. You can look at them.
“I am a mother of it. She loves it.”

I handed her a slip of paper and a pen after a while to see what she would do with it. She said “Can I use this on this?” and clearly meant using the pen on the paper, which of course I said yes to. She has really lost her ability to name things but you could tell that what she says would make sense if that weren’t the case, lol. She didn’t ever really do anything exactly though, so I drew a picture of a flower on her paper and said “What’s this?” and she said “She’s going.” Also, previously, I had pointed out a cat walking around in the distance and said “Oh look, a kitty” and she said “Oh yes, a fixxy”. So later on I asked her what a fixxy was, to see if she would retain the same strange word, but she said “I took it”. Her chart confirmed she tends to make up words and has a lot of word-finding problems. The progress notes show a steady decline over the years in her ability to communicate properly, although she used to be very social and appropriate. It’s sad.

So anyway. I’m just finally getting to the surreal stuff. I noticed in her chart that she enjoys babies and dolls. I had seen a few dolls in a cabinet earlier so I got an idea. Occupational therapy is all about using occupations that are meaningful to the patient, and this was information I hadn’t known. I discovered a small room I hadn’t noticed, and got permission to take aside FixxyLady alone. They told me they weren’t allowed to be alone with patients but I could take one aside whenever I wanted as long as I checked in and wasn’t going to do anything crazy, lol. All the areas have windows too. Anyway, I found FixxyLady being somewhat of a pain that afternoon (the chart noted she started getting more anxious in afternoons), and I took her to this small room. I got out two small babies, one for each of us, and asked her to hold the babies with me. We sat down in the recliners in this small quiet room with them. She held her little blonde baby girl doll for a while and I held my little brown-haired baby boy doll for a while, resting him as if he was sleeping. We talked about them as if they were real – discussing how beautiful they were, how mine was sleepy and hers wasnt, etc. And she became LUCID to some degree, it was an amazing transition. It was obviously calming to her. She would say appropriate things like “Look at the little rash on his face” and I said “Where?” and she turned him around to show me and say “There”. Or she’d whisper things to the baby that made sense. Eventually she said something along the lines of “let’s salt”, but by her gestures I could tell she wanted to trade babies. So we traded, and I asked if she wanted me to get a third baby, which she did. I got that third baby and gave her all three at that point, which I arranged on her very carefully as if the dolls were real. She rocked and rocked. I realized they had a fake sleeping puppy in there (one of those ones you see at a drug store intended for lonely elderly), so I grabbed that and petted the dog while she rocked her babies. One of the PCAs came in and turned on the colorful bubble lamps, a project
ion of the sky, and this really long fiber optic green glowing horse tail thing, and then turned off the harsh overhead light and left us again. So she sat there rocking her babies, I petted my dog, and we watched the room change color and glow all around us, while the sounds of music penetrated the room. PCAs would occasionally look in on us and she even said with a slight laugh”Oh look at them looking in on us”. Sometimes I couldn’t tell if FixxyLady was grimacing normally or wanting to cry, she seemed rather sad. She said some things about no one to care for, and it broke my heart. If I asked her questions like “Do you like the girl baby or boy baby better?” she would go off on one of her unusual answers, but if it was a simple question related to the dolls, she could handle it. Like if I said “Oh look, your beautiful blonde baby is getting sleepy”, she could say “Yes, she sure is”. If you could just compare her normal talk to her talk with the babies, you’d know how AMAZING the difference was in her level of clarity.

We rocked there a long time, and I eventually started to get a little uneasy. I realized my experiment had been successful and I was glad it was calming and nice for her, but I wasn’t quite sure how to bring her back out into the big room of commotion with noise and light. We probably stayed in there easily an hour, and I sat there petting my stuffed puppy and thinking how surreal this entire experience was. I eventually let her know it was time for our snacks, but we could lie the babies down for a nap in the meantime. I carefully took each baby, watching their necks, and laid them out, one by one. So then we re-joined the commotion and it was snack time. The adorable little old lady was out there constantly asking for food and asking what she was doing there, and every time I answered (every few minutes) she smiled so kindly and said sincerely “Oh thank you so much. You are so kind. You are so wonderful. You are so beautiful. You are a true angel. I love you so much.” or something very close along those lines. The poor lady only kept about 3 minutes in her mind before re-starting the loop.

After snack time, I discovered FixxyLady wasn’t so happy anymore. At first I thought it was my fault but it appears this is common behavior for her. She was getting agitated. She came up to me and pulled at my volunteer smock, wanting to see the papers I had been writing on before. I showed her one and she read the information on it angrily. (I had written a few lines that said things like FixxyLady is cute. FixxyLady loves her son.” to see if she could respond to written things easier). She ranted a while, grabbed my hand and clearly wanted some things from me that I didn’t understand. She even threw a book down onto the counter for emphasis, and was obviously angry. I was like ummm. lol. I said, FixxyLady, I have to go now, but let me go get one of the babies that woke up. Will you hold her and rest with her?” And she smiled when I handed it to her and was fine again. And I breathed a sigh of relief. I found out that she sometimes spanks the PCAs when angry so I didn’t feel so bad, but I could totally see her spanking me and it made me laugh lol.

So this was ridiculously long yet again but this is an amazing and fascinating experience and so I don’t want to forget anything!!! I love these people and I’ll end up visiting sometimes after fieldwork ends. :)And now I need to go work on making handouts for well elderly and working on a communications proposal….boo….so uh, more tomorrow

Day 2/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center

Today was Day 2/10 of my Level I Geriatric Fieldwork at an Alzheimer’s Day Center.

Today went smoothly and was quite fun. I did a lot of bouncing around from group to group, observing personalities of both “participants” and the staff. I was overall impressed with the behavior of both groups. Today I observed and/or participated in Civil War Jingo, Bingo, Rubber Chicken Hot Potato, walking, breakfast/lunch/snack, trivia, you name it…

There were several interesting incidents today. In all cases I mean no offense to the participant – I’m merely explaining some of the things I encountered.

1)      There was a man there today who NEVER stopped mumbling. Not once. Not even for a minute. Constant mumbling that was mostly incomprehensible. If you said HI! To him, he’d say Hi! Back and maybe a “How are you?” before lapsing back into his nonstop speech. He definitely annoyed other participants. At one point I led him (with permission) into an empty room. I held his hand to take him there, and then when I got there I gestured for him to sit down, and he kept standing up and talking. Eventually I literally gently took his hand and somewhat initiated the sitting down movement for him, and then he was fine. I got out some of the big poker chips they use for Bingo, because I figured I could play with them while he talked, while also seeing what responses I could get out of him. I sorted the chips by color slowly, occasionally waving one in front of him to see what he’d do, or trying to put one in his fingers to see if he’d stack it. Occasionally he’d take it and then examine it and lay it back, but never in one of the stacks. Another time I held up a red one and he said clearly “That’s a red one” before going back into his mumbles. Another time I deliberately knocked over a stack of blue ones to see if he’d startle/respond, which he did, and even hesitantly started rebuilding the stick for a few, before lapsing back into mumbles. I tried interrupting him a few times which mostly didn’t work. At one point I said “Knock Knock” to see if he could quickly do a Who’s there? But instead his response was “Memphis State”. LOL, I thought that was awesome. J To me it felt like there were snippets of his prior self inside of him, but those snippets had almost no choice against the tornadoes destroying his brain. I wondered how his wife caregiver handled the incessant talk.

2)      The wandering woman was in full force today again. She walks with her hands drawn up and a worrisome look on her face, very rarely saying anything and always aimless. She will walk for hours and hours, so long that she will start falling because she gets so tired. Today they had to physically restrain her in a special chair to make her rest for a while so she wouldn’t hurt herself, but she was very upset about this, and she kept trying to get out, and crying. The staff was very kind to her and stayed with her. I don’t know this lady’s background, but from an OT perspective, I thought that while restrained, she would benefit from a weighted vest (deep firm pressure), as well as some duct-taped phonebooks underneath her feet so they wouldn’t dangle and she could feel better contained. My friend Suzy mentioned a stationary bike or something, which to me was an interesting idea. I would like to see her charts to see if there is any background on her previous occupations, because ideally of course, she wouldn’t need to be restrained at all.

3)      There was a nice intellectual looking woman there who walks jerkily and always carries a sippy cup. She started talking to me today and the first thing out of her mouth was something along the lines of “I have lost what I cannot find, but how can I find it if I don’t know what I lost”….I said to her (kindly), “You sound like Alice in Wonderland!” She repeatedly said things that made no sense at all. She loved to talk, so I just did a lot of nodding, smiling or frowning, and making little “listening” comments, even though there was never a time she made sense. She could clearly read well, reading and discussing (but not making sense) the lines of the songs we were supposed to be singing. Most of which I’ve never heard – like Bye Bye Blackbird and Meet me in St Louis and Wild Irish Flower or whatever.

4)      I met a thin wisp of a lady who would say to me (and others), “You’re very pretty. You’re an angel. Thank you so much. I love you.” She worried incessantly about her husband picking her up and kept asking about him every few seconds, as well as asking about eating. I would say to her, “Your husband had to go do some errands. He’ll be back soon. And we’re eating lunch soon.” So she’d say the whole “I love you” stuff, but then 15 seconds later, ask me again. And again. And again. It takes patience to repeat the same words a thousand times. J She wanted me sitting next to her and was scared I would leave her, so I spent a lot of time holding her hand. When I finally did leave, she said to me, I’ll be so lonely. I told her that  the lovely ladies next to her would be her friends and keep her company, and the woman next to her nodded and told her, “I love you”. And my sweet little lady responded “Thank you, I love you too”. LOL. Awwwww.

5)      Some of the higher functioning patients reassure the lower functioning patients in ways that teach ME how to react…I learn from them as well as the PCAs the proper ways to respond. It seems validation theory is in use here – just going with the flow.

6)      At one point I wandered over to an activity where they were cutting out brown things for some reason. I realized the lady I had just walked up to was in the process of cutting her up name badge (they all wear one around their neck). I let the PCA know, who wasn’t pleased but didn’t chastise her or anything. The lady knew she had done something wrong and she put down her scissors and put her head on her desk like a little girl crying from being in trouble. It made me feel so sad. I rubbed her back and told her it was okay, it’s easy to make mistakes like that and we’ve all done it, and she isn’t in trouble. She perked up a little after that.

7)      I got to feed a woman this morning. I’ve actually never fed anyone over the age of like, 2, before. She kept her eyes closed the entire time with her head bowed. The feel of the spoon against her lower lip would cause her to open her mouth and get the food, and she didn’t appear to care what the food actually was.

8)      Overall, today was really neat. I got to do more helping out, and tomorrow I plan to try and do even more…and then after tomorrow, start seeing about taking people aside and trying out various things with them. J Everyone there is so great.

Day 1/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center

Cold room, chatting with highest functioning Alzheimer's participant:
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!

::moves on with conversation::

Two minutes later:
::looks at me again:::
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!

::moves on with conversation::
Two minutes later:
::looks at me again::
Lady: Honey, aren't you cold??
Me: No I'm fine, thanks.
Lady: Wooiee!

—————

Helping a woman with mosaic tiling during a 30 minute session: The PCA (personal care assistant) in charge says some of them just don't do it. I like a challenge and pick a woman who has crossed arms that I know from earlier has at least basic cognition.

Her: ::sits there doing nothing::
Me: Look at all these pretty tiles. Do you like them? I like purple and green.
Her: Yeah, the colors are very nice, very subdued.
Me: Exactly! Do you want to put them in this tray? I'll start the glue part.
Her: Ok, that's fine.Sure!
Me: Ok, it's very simple. Just take the tile and put it right here, like this ::demonstrates:: Ok, now let's pick your next color.
Her: ::discusses choices for about 10 minutes, always wanting me to decide:: (finally we do)
Her: So I just put this tile here, right?
Me: Yes. Pick up the tile with your fingers, here it is for you.
Her: ::asks more questions::
Me: Yes. Here, take this tile.
Her: ::asks more questions::: (appears to be stalling each time – not that she doesn't want to do it, though)
Me: Yes. Here is that tile.
Her: ::takes tile::
Me: Ok, now place it right here. ::shows her for the tenth time::
Her: Where?
Me: :::shows her:: right here. Here, let me have your pointer finger. ::guides her finger to it:: do you see? Right on top of the last one we did.
Her: Oh ok. ::hesitates:: now what do I do? where do I put this???
Me: :::shows her again multiple ways:: Why don't you put that tile in your fingers, and I'll help guide your fingers to the right place okay? You're doing a great job.
Her: Thanks, I like doing this kind of stuff.

Now, repeat those questions on how to do it, for every single tile, and we did close to 15 tiles. I was amazed. At first, I thought maybe she had low vision and it prevented her from seeing the tiles. Then I thought maybe she was playing around for attention. Then I thought maybe she has some apraxia (still think that – she seems to have difficulty initiating the desired motion). Then I thought (rightfully, imo)maybe she had low confidence and was scared of messing up. Then I thought that something with her Alzheimer's makes it so that she clearly articulates and sees and understands the process, but as soon as she picks up the tile herself, she loses her ability to handle the situation. It was pretty interesting. It required a LOT of patience.

—————————-
Today was Day 1 of 10 of my geriatric Fieldwork, I am at an Alzheimer's Day Center, where people can drop off a person with Alzheimer's anytime between 7am and 6pm, Monday-Friday. I've never been in such a place, but I was impressed. This particular place is made up of one giant room with several small rooms attached. They had a nice sunny area with birds in a cage, a nice sunny circle area with a giant fish tank to watch, several circle areas designed for exercise or singing, tables for tablework or other games, a nice little game room for playing Bingo, Jingo, cards, etc. And a nice art room. Also, a large white trail snaked around the entire place, and there were gardens outside. All the rooms were stocked with TONS of nice stuff that any OT would love. Colorful art supplies, lots of cognitive stuff including reminiscing series with old songs and old events…very neat place and very open. I was put with one of the higher-functioning patients (let's call her Gladys) and followed her around for a few hours. She kept asking me if I was cold. As we walked around, we encountered a woman who just wandered aimlessly. Gladys whispered to me, “she has problems”. Then we came across a woman who talked about something completely off the wall to Gladys. Gladys acted like she knew what she was talking about and spoke kindly to her. Then whispered to me, “she has problems”.

The first thing we did after walking the trail, was listen to one of the many PCAs (personal care assistants or attendants or whatever) read out loud from the newspaper. This was a girl who interacts wonderfully with her patients, but clearly didn't read very well. She used her finger to follow and was hesitant with almost every word. She read the weather, horoscopes, and Billy Graham. She had a large candy or gum in her mouth, and would say things like “Yous a Scorpio.” At one point she said “you will be forgived”, and one of the higher functioning patients corrected her with “forgiven”. They were all very friendly and kind to one another. I noticed that several of the patients had trouble understanding her but they're all very patient and just sit there regardless.

When I work with patients, I always tend to think I'm boring them and I want to rush around and entertain, but the more time I spend with older patients, the more time I realize that they are usually fine with things going slowly and don't require much entertainment.

We then moved on to playing Jingo, which is apparently a popular form of Bingo where instead of numbers it has to do with answers. We played Bible Jingo, so for example a question might be, Where did Noah place all the animals, and then the answer would be a picture of the ark, on answer sheets, to cover with a chip. I noticed several things. 1) The chips were many different colors, and this really confused most people, and they wanted to know which color to use. It would probably be helpful if they used only one color chip. 2) The PCAs wandering around have a lot of people to take care of and can't take the time to really “help” so they will just point out the answers to lower-functioning people instead of trying to help with “it's in this row, do you see it?” kind of stuff. I guess I would too if I were in charge of a whole room at a time! I only mention it since I'm trying to look at everything critically so that I can try to use OT skills to figure out things that could be changed, or should be changed, or gaps to be filled, or whatever (I'm not saying like tell the boss necessarily, just for my own education).

Then it was time to watch some video of an overly enthusiastic older woman sitting on a chair with blackness behind her, talking VERY animatedly about making food and how you need an apron and blah blah. She was like Barney reincarnated. It was frankly probably insulting and condescending to ANYONE – it was the kind of thing you'd see for 3 year olds but clearly aimed at dementia patients. Yet the higher functioning patients have no need, the moderate functioning patients aren't going to sit in a random room and watch a lady talk about the basic steps of making food, and the lower functioning patients could care less.

I kinda wandered at this point – I observed exercise groups, a group playing with a parachute with balls, groups playing basic trivia, groups singing old popular songs, and more. There were plenty of PCAs to run each activity, AND plenty of PCAs to kind of wander and deal with the lowest functioning patients who required a lot of hand-holding, quite literally. These patients mostly wandered aimlessly and if they talked, it was incomprehensible/made no sense. I get uncomfortable when patients talk to me and I don't understand, but these PCAs are very good at what they do. They are loving and patient and kind of placate the person, then hold their hands and walk around some. Eventually I ended up holding
the hand and walking with a woman who kept wanting to go check to see if her husband was there yet. Most of them fretted about being picked up. It was neat to see how they had camouflaged the main doors by painting it with scenery that matched other parts, so you can't see the doors well. In fact, one woman was talking about her husband always coming from “over there” and vaguely referring to that area but not quite sure where. To get out you have to punch in a code that is actually right there, you just have to punch it in backwards, which is beyond the ability of all the patients. All the doors to offices had half doors where it prevented a wanderer from getting in but allowed everyone to see what was going on. They also had special chairs for some of the wanderers to be “restrained” in as needed.

Between all the activities I discussed and lunch + snack, it filled up 9pm to 4pm and it was a very pleasant day. I was truly impressed with how kind and patient EVERY employee was. I was also impressed that almost all of the patients were ambulatory – a few required canes or walkers, but I didn't see any in a wheelchair and most of the people were quite spry, and dressed nicely. I got to wear a giant volunteer smock, woot woot lol.

I was impressed with the place, and here are my Yays for the Day:

1) I was the least scared to start this fieldwork.
2) The place is well-equipped for OT-like work.
3) I came with an idea to have the patients paint pre-cut-out individual fish, to put on a blue cardboard and donate to a children's hospital or classroom or something.
4) I showed several women how to unwrap their peppermints by pulling on the outside ends and letting it untwist itself, because they had a devil of a time opening them due to not doing that step.
5) I got at least one woman who wouldn't normally participate, to do the mosaic…which led me to helping another woman who wouldn't normally do it…which lead to two others looking at me with curiosity and honestly probably would have done it too had I sat with them. I think when the PCAs say “They never participate”, what is more realistic is that the patients WOULD participate if they had someone with them individually every step of the way…which is obviously unrealistic. Because they don't have the ability to do it without much help, they just don't even try.
6) All employees are patient and great with the individuals and I can learn a lot about interactions by watching them.

I know this is ridiculously long but since I have to journal it, well, now I've done so, and now I've gotten my mind clear and can try and finish the last 5 group protocols for my Well Elderly project, and perhaps make 10 postcards to go along with my flyers, as well. And make my budget. Then later this week I can do research to back it all up, and then I am DONE with that gigantic project. Which is great because I need to get a communications proposal put together this week, and also really need to start to focus on just Tai Chi.

On Wednesday I am meeting a student from my undergrad college, who is considering going into OT and was given my name by the health sciences advisor. On Thursday I am also going back to my undergrad collage to attend a Networking Career session for Alumni, to talk to people about what we are doing and such. So a very heavy OT week!

I got a really long and great e-mail from someone interested in mobility and assistive devices that I may share tomorrow since I don't know all the answers! LOL.And a few other things. Ok, off to work on Well Elderly.

Projects aplenty for an OT student…

The good news is, thanks to fellow OT student Virginia, I got work done on my well elderly project, and I made all ten of my fliers (one for each session) tonight! Now I just have to um, write out the protocols, make a budget, and 3 fliers for the program as a whole, and then make final touches on my cover letter and my basic information, and then do a ton of research to back it all up.Yeah, research shoulda come first. Whoopsie doodles.

The bad – but good – news is, I took on two new voluntary projects this Saturday, because I am certifiably insane. This is obviously on top of my well elderly project, Tai Chi research project, and fieldwork projects.

1) A few pages, backed with good research, on how disability is a type of diversity that is often overlooked, especially when you look at the Centennial Vision for OT. “Cookie Gimp” pointed out that you don't see a lot of OTs with disabilities. It was a valid point. OTs of all professions should be able to adapt the situations to allow more OTs with disabilities. I still have a post to write about a blind OT that he sent me! The disability/diversity paper will be in association with Kuma, a great OT student up North, who is focusing on more cultural diversity (and doing by far the bulk of everything, my part is minimal). He is enthusiastic about the collaborative effort between students from different classes, and his passion for OT was exciting!  The hope is to eventually have a paper to submit to journals such as OT Practice.This is a project for April

2) I'm working with a member of the ASD Steering Committee on the start of a Communications proposal that looks at how the committee members as well as delegates, nationwide, can best keep in contact with one another.  That's due this Friday.

I'm house-sitting/cat-sitting, and the cat is starting to complain because I'm kinda heavy. Just kidding. The kitty is glad to have company. This morning when I woke up she had dragged her fishing pole into bed with me. Nice. Her mommy and daddy, OTS Kerri and Brent, will be home tomorrow and her trauma will be eased.Phew.

It's 12:45am and I guess it's now Easter, happy Easter everyone if you celebrate Easter and if not, happy Sunday if you celebrate Sundays.

Ok good night.
Oh I want to talk about holding babies, and a retirement chat I had with my landlord's mom, and other random stuff!! Alas it must wait…

Congratulations My! You're a real OT now!!

Congratulations to “My” (that's her name) for graduating, passing the boards, and having her official license – it just came Saturday! She was an MOT student at TWU!  Check out the blog at

http://twumotclassof2007.blogspot.com/

Books for OT students yay….

These two books have been recommended to me via blog comments – I remember Patti telling me about an awesome book having to do with like a pumpkin or something, I sooo can't remember ….anybody else have some books they really recommend an OT student read? I know Cookie Gimp has some good books for me, I need to go dig those up. On my to do list for this afternoon. 🙂

“Pride and a Daily Marathon by Jonathan Cole ” – recommended by an Annony

“”the elephant in the playroom”….i picked it up at the library and it's a pretty interesting read. little short stories/anecdotes from parents who have kids with special needs (mostly on the autism spectrum or learning/speech delays) ” – recommended to me by the awesomest person in the world 🙂

Bingo in 5th grade, Bingo in 50th grade…

It doesn't matter if you are in high school or in an assisted living facility, people can still be catty! LOL!

I was volunteering at Bingo tonight and while we were playing, one of the more notorious women there came slowly walking by. She didn't look very good and a lot of people apparently think she is bipolar. I heard several women whisper to each other, “what's wrong with HER”, in the same voice you hear high-schoolers use. I personally love this particular woman for the very reason that she IS (cough) rather different, but it amused me to hear the cattiness of women in their 80s and 90s…

It was a lot of fun being a Bingo volunteer  – everyone is (usually) so kind and grateful for the littlest things. A lot of the higher-level residents would make sure the lower-level residents were keeping up with the numbers. They also had homemade GIANT bingo boards for people with low vision, which seems clever/neat.

Time to go to bed. I better be productive tomorrow or I'll pay for it!!! And I'm back to having a bunch of e-mails to deal with, including a few things I accidentally dropped the ball on. What does that expression mean, anyway? Hmm. My goals for tomorrow include doing at least 3 hours on well elderly, working out, doing dishes (AUGHHHHHHHHHHHHHHHHHHHHHH), dealing with e-mails, making phone calls, and maybe working on other projects, including reading up on Alzheimer's in preparation for my fieldwork starting Monday…when I called the activities director (my supervisor), he seemed to have no clue what OT students are, because he mentioned us wearing volunteer smocks and giving us a run-down of Alzheimer's when we start. I wanted to be like nuh-uh, how about I GIVE YOU!!!!!!!!!!!!!!!!!!!!!!!! a lecture on Alzheimer's!!!!!!!! Neurofibrillary tangles, yo!!! Retrogenesis, validation theory, plaques, blah blah blah…lol. Just kidding. But I want to brush up on my knowledge big time so that he gets a good impression. I'm actually somewhat nervous because book learning doesn't mean I'm ready to handle it in real life…guess we'll find out. Anyway. I'm rambling. I'm gonna go read in bed, in the middle of a book about pediatric heart surgeons by Michael Ruhlmann who also wrote several awesome books on chefs! He is a Tracy Kidder! I hope I'm an author like them too one day, except in the OT arena, and as a female. ahahahaha

Get Excited…AOTA Conference Coming Up …

Check it out y'all!

My first official post as an AOTA Conference Blogger! A little premature perhaps, but did you expect anything less from me? Exactly. I tried to limit my !!!!! to only like, three at a time. I think that shows a lot of professional restraint, don't you?

http://aota2008conference.blogspot.com/

By the way – they are looking for OTs and OTAs to blog from Conference, so if you are interested, please e-mail me or comment and I'll pass on your information!

Wellness project for Little People

Jason, Ashlee, Virginia and I did this hypothetical project for our management class…just copy/pasting the entire document!

     Occupational therapy can be used with diverse populations of all age groups, to help improve occupational functioning. We would like to develop programming for “Little People”, which is a population that has not typically utilized occupational therapy. We plan to use the Person-Environment Occupation (PEO) model of practice to help us determine program development.  

     The PEO model explains how the person, environment and occupations relate to each other as a system.  The person is defined as a unique being who assumes various roles simultaneously.  The environment is defined as the context in which behavior takes place.  The environment provides cues to the person about how to behave.  Occupation is a group of self-directed, functional tasks and activities a person engages in over the lifespan.  And occupational performance, the fourth element of the model, is defined as the outcome of a dynamic and transactional relationship between the other three elements.  The PEO model is a conceptual model that can be used in all settings and with all types of populations.  It also facilitates communication with those outside of occupational therapy by interfacing with other theories and perspectives.

Assumptions made by the PEO model

·         The person is a dynamic, motivated, and ever-developing being, who is always interacting with the environment.  

·         The environment can enable or constrain occupational performance.

·         The environment is often easier to change than the person.

·         Occupations are necessary for quality of life and well-being.

·         The relationship between person, environment and occupation is interwoven and difficult to separate.  Their congruency is constantly changing.  The closer the fit, the greater the occupational performance.

The role of the occupational therapist is to identify and evaluate barriers to performance and the resources available.  The therapist, family, and client develop strategies to eliminate these barriers and provide supports to improve the quality of the PEO fit.  This leads to better occupational performance in the area of concern or deficit. 

Doing a literature review of little people helped our team identify several themes that are common issues among little people. The majority of resources were based on medical or health related topics. These issues included common characteristics, orthopedic issues, nutrition, pediatrics, and stages of development. This reveals the little people’s strong desire for answers about their physical disabilities. The second theme was based on psychosocial issues. This included topics about raising children with dwarfism, legislation, and advocacy. These issues were brought up because of the difficult life little people lead in the midst of a world designed for the average height. The final theme identified was quality of life issues. These topics included different perspectives of little people, occupational functioning and qualitative research on quality of life. Quality of life and occupational performance for a little person is diminished due to the lack of person and environment fit.

Our research led to the identification of three major gaps in little people literature. First, research was difficult because of the extremely limited amount of sources available. Second, the articles we found were often out-of-date by ten or more years. Thus, we were able to access only the abstracts from those articles. When we were able to locate an article, access to them was restricted for cost reasons. The final gap was the lack of information regarding adaptations in home, school and work environments. A limited amount of information was available concerning the variety of adaptations and modifications needed to make these environments functional on a day-to-day basis.  We then used the PEO model to outline the findings of our literature review, to help us determine program content for little people.

Population challenges

Person        

·         Physiological

o   Short stature, limbs and fingers

o   Curvature of the spine

o   Trouble with joint flexibility and early arthritis

o   Lower back pain or leg numbness

o   Breathing problems caused by small chest cavity

·         Psychological

o   Self worth

o   Stress of day to day requirements

o   Social isolation

o   Psychosocial problems related to body-image

o   Depression

o   Support systems needed

Environment

·         Adaptations

o   Adapted tools needed for ADL’s

o   Tool requirements such as requiring large hands for gripping

o   Unreachable height of environmental controls

Occupation

·         All Normal Occupational Roles Affected

o   Parent, Student, athlete, employee

o   ADL’s

§  Personal hygiene such as being able to see into a mirror for grooming, functional mobility and showering.

o   IADLs’

§  Community mobility such as difficulty driving, and raising children, meal preparation, shopping.

Program objectives:

·         Create new “Wellness” niche in occupational therapy, for the little people population.

o   Create advertising campaign to use in newspapers, e-mail, websites, listservs, and fliers, promoting occupational therapy wellness program for LP.

o   Examine LP listservs, LP websites, and LP focus groups, to collect data about daily issues the LP population can face, including psychosocial issues.

o   Show LP that OT understands the unique characteristics of LP and that their dignity is respected and valued.

Physical disabilities:

·         Determine medical issues that are common to LP (such as arthritis) and provide education on how LP can be aware of/handle these issues.

·         Compile educational resources for LPs such as websites and listservs.

Psychosocial issues:

·         Start psychosocial support groups for LPs, on a local scale as well as an online national scale.

Quality of life:

·         Determine basic home modification techniques that will be helpful for LP, such as adjustable counters and reachers.

·         Determine basic car and environmental modification techniques that will be helpful for LP, such as custom foam car seats and advice on handling check-out lines. 

·         Determine cheap and easy ways for LPs to make basic adjustments to daily life in order to improve quality of life while not compromising LP identity

Implementation

The most effective medium for implementing the planned programming is the internet.  We plan to create a website that little people will be able to use as a source of information for improving their performance.  This website will explain how occupational therapists can work with people in the community on ways to decrease environmental barriers and to help individuals on a personal level.  We could be
gin by advertising the soon to be created site at the major conference.  Attendees would take this information with them and distribute it at local levels which would decrease the costs and effort of traveling around trying to create interest.  Finding an endorser to promote the website may improve our credibility within the community. 

The goal is to create a website called littlepeopleonline.com that acts as a centralized hub for information and communication about issues affecting little people.  Chat rooms and message boards could be hosted on this site to promote communication and community among its members.  Online support groups could be conducted since many individuals may be unable to find a local group.  For those in more heavily populated areas, contact information for local support groups could be posted on the site as well as information on how to start a support group.  Regional meetings could be organized through the website to bring those in the community together in fellowship.  Web video content could be uploaded to the site.  Videos posted on the site could be instructional, provide information, or be humorous in nature.    An online gift shop that sells t-shirts that promote the site, LPO, could be used to help fund it. 

This website, LPO, is directly based on the PEO model. Little people constantly find that there is a poor fit between person and environment, due to their small stature. It is obvious that a little person cannot change their height; therefore the environment must change in order to enable better occupational performance. One item to use in education and promotion would be universal design. The website could include a form letter to be sent to congressmen regarding the importance of universal design, how it is all-inclusive, and how it actually saves money long-term. It could also include a generic organizational letter for little people to send to local areas. Universal design is heavily promoted in the PEO model since it focuses on the fit between person and environment. Improving physical access to indoor and outdoor environments will allow a little person to more fully participate in age-appropriate activities with others of more typical size.  

The website could also have a section on common adaptations and modifications. For example, many little people have difficulty driving comfortably or safely, due to the height of the seat. There are ways to make a portable custom-foam seat that can transfer to different cars, and allow the person to be more comfortable and safe. Directions on how to make this could be posted. Other modifications or adaptations that could be discussed included lever door handles, the use of assistive devices such as reachers, using easy to manipulate rolling-open drawers, informing them of smaller keyboards for easier use, using non-skid liner to help keep things steady, reorganizing their kitchen so the most commonly used items are down low, installing adjustable counters, putting another lock on doors lower down, and more. The possibilities are numerous.

     Finally, the website could focus on sharing resources and promoting support systems. Little people often feel isolated. They are unaware of support systems or resources that can help make their life easier. There are many active listservs online specifically for issues that little people, and there is a Little People Association (LPA). OTs can be on these listservs to monitor issues within the OT scope of practice.  Also, both online and local support groups could be encouraged. Currently there are almost no online resources related to little people and occupational therapy. By providing a website that provides many helpful tips, a little person will have new ways to make a better person-environment fit, thereby enhancing occupational performance.

     Little People Online (LPO) is dedicated to improving the quality of life for people with dwarfism by providing education and resources on ways to adapt their environment so they can be successful and productive members of society.  These adaptations will increase their function, mobility, and independence. LPO strives to bring people together to share their stories. These support groups will increase self-confidence and community outreach. We hope to expand this program in the future to an organization that will be able to provide more resources and support to all the little people in America.

References

Adelson, B. (2005). Person’s with dwarfism: A changing perspective. The Genetic Family History in Practice, 4, 1-8.

Bailey, J. (1970). Orthopaedic Aspects of Achondroplasia. Journal of Bone and Joint Surgery, 52, 1285-1301.

Campbell, J., Dorren, N. (2006). A Guide for raising a child with dwarfism. Little People of America, 1-33.

Hall, J., Flora, C., Scott, C., Pauli, R. & Tanaka, K. (2004). Majewski Osteodyplastic  primordial dwarfism type II (MOPD II): Natural history and clinical findings. American Journal of Medical Genetics, 130A, 55-72.

Stewart, D., Letts, L., Law, M., Cooper, B., Strong, S., &Rigby, P.  (2003).  The person-environment-occupation model.  In E. Crepeau, E. Cohn, & B.Boyt Schell (Eds.), Willard & Spackman’s Occupational Therapy (10^th ed.).  Philadelphia:  Lippincott, Williams & Wilkins.

Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., Cooper, B.  (1999).  Application of the person-environment-occupation model: A practical tool.  Canadian Journal of Occupational Therapy, 66 (3), 122-133.

Trotter, T., Hall, J. (2005). Health Supervision for Children with Achondroplasia. Pediatrics Journal, 116, 771-783.