My geriatric fieldwork…so many highlights

Some excerpts from my OT mental health fieldwork (inpatient geriatric psych ward) journal, a decade ago:

I did a group called “Transformation” and it had to do with drawing past and present and future, and discussing things to do to help ensure the future as they depicted it.

One sharp lady drew an embryo for past, a stick lady for present, and a casket for future. She cackled about it, but when I asked her what she wanted to do before the casket, she got thoughtful and had several things she wanted to work on.

Another HILARIOUS lady said she wanted to have “quar triplets” …lots of babies.

Another lady drew a smiley face for past, sad face for present, and smiley face for future.

Another lady didn’t draw anything, but verbally stated she would get better by eating right, taking vitamins, and “coming to groups”…lol. I liked that answer.

Also: Last night I watched a friend have his debut performance at a VFW (veterans of foreign war). I think I was the youngest one there by about a thousand years, but everybody was in great costume. There was a few old ladies SHAKING IT UP on the dance floor, although really their shaking was more like quivering…barely moving. Loved that they didn’t care.

And an old man taking it down to the floor….getting back up was a little precarious, a woman next to me who knew I was in OT school whispered, “That man may need your services in a minute.” 

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One of my favorite moments of day:
Male patient with severe dementia: I don’t remember. I’m 88, you see.
Me: You don’t look a day over 87!
Patient: ::genuinely laughs:::

Also, one of my patients who was psychotic kept hearing things in his head…including calypso music! You try interpreting the word “calypso” from someone with dysarthria!!

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I also very much loved and appreciated the sentences my clients would write while taking a cognitive assessment. See here:

The Hidden Poignancy of the MMSE – When clients write a sentence.

The Life Lemonade Resume: Making those Lemons Palatable

What makes you, you? We all have our unique stories, our life of accumulated events that define us. Sometimes it’s hard to look on the bright side when life hands us lemons, especially when Life shops at Costco. I’ve kept a “life resume” for years, and many of its entries come from life-lemonade events.

For example, have you…Ruined an iron by permanently branding it with a platypus?

Saved a dying angelfish in your aquarium using only a long breadstick?
Been followed home by a former client in an airplane?
Been burned by a crystal ball?
Broken your toe on a rock while hula hoop dancing at the beach? [Just happened last week. Ow.]
Given yourself a black eye with an ice cream scoop?
Nearly strangled yourself to death with hula hoops in a parked car?
Been bruised by a gallon of green juice bouncing off your shin?

No? Because I have. Stories like this make me “me,” they give me my occupational identity. When that gallon of juice bounces off my shin, my first thought is OW, that sucked. But my second thought is haha, another entry for my life resume. Bet not many other people can say juice bounced off their shin. Another “this is the unique story of Karen” moment.

Think about yourself, think about your clients. Do you have any that can see the humor or uniqueness in their stories, especially the smaller, day-to-day ones? Do you think you could compile your own life resume? You can make one that includes all the life basics – places you’ve been, people you’ve met, special events, pets, scars, etc. Add in life lemonade – and life awesome-ade – as it comes! It can be little – if you get creative, you could probably have daily entries.

With this reflective approach, we “aid” our lemon events in becoming more palatable. We recognize that each event is a contributor to our unique occupational identity, rather than a detractor. And we can laugh about a lot of them! Laughter is the most natural sweetener there is…truly a way to make lemonade.

How to Not be a Crappy OT (Learned the Hard Way), Lesson #1

The Hidden Poignancy of the MMSE – When clients write a sentence.

The MMSE or Mini Mental State Exam is a 30-question exam that asks very basic questions and is designed to screen for cognitive impairment. I did a lot of them while I was doing a 3 month fieldwork as a Level II OT Student in a geriatric psychiatric ward in Tennessee back in 2009.

What I recall most about this exam is the poignancy of the responses when I would ask some of these clients to write me a sentence, any sentence they wanted. I wish now I had saved more of them. Some wrote things like “You are so pretty.”

Or “When will I get better?”

or “I want to leave.”

or simply writing down what I had said: “Write a sentence.”

One euphoric lady’s sentence was: “I am a very happy person and I love everyone.”

For one lady who talked/processed sooooo slowly, she reminded me of Alice in Wonderland, using circular answers such as: “That is the answer to which the answer is asked.” She could not remember the state she was in at all, or county, or town. She scored in moderate dementia range. Her written sentence was: “Please understand.” It gave me chills. 

This particular lady (image) wrote “I wish and pray to the Good Lord I go get better” I seem to recall quite a few writing to the Lord to get better. It was always the sentence they wrote that was the most revealing to me as to their inner thoughts. Sometimes it made me smile, sometimes want to cry.

http://en.wikipedia.org/wiki/Mini%E2%80%93mental_state_examination

OT stream of consciousness

It’s funny to me to see what gets re-posted or commented on versus not. I love my blog and I wish I could return to my obsession with it….mostly lately I’m obsessed with Facebook and sloths. Fun, but not exactly good for my career, lol. I had a rough night! So tired! Blegh! I wanted to write something though, and now I am blanking on what exactly it was.

I guess instead I’ll mention some random things or ask questions.

1. I really am perplexed as to how to handle emotionally disturbed kids. I don’t have many on my caseload, but I am around them becaus of time spent in learning centers, and they really perplex me. If they don’t listen to adult instructions and consequences don’t really matter to them, where do I go from there??

2. I need to write about rythym sticks ,but not the normal ones. The ones where you kind of juggle. Have to send a picture though so you know what I am talking about, first.

3. I can’t spell rythym to save my life.

4. I feel like I could do some occupational therapy with sloths. I’m aiming for Costa Rica next summer (this summer I’ll be in Scandinavia).

5. My mind is constantly, constantly trying to think of new OT things.

6. I am doing a ton of inservices to different young grade levels on fine motor center possibilities using cheap things such as styrofoam pretty soon – we are seeing more and more kids, an absolute epidemic, of kids who have no idea how to use their hands or body or eyes. But they’re awesome with things involving screen time. Ugh. So we need to bring back some fine motor centers during short breaks or free choice etc to work on those skills.

7. I have “invented” a cool game that I want to post about, it’s so straight-forward, but first I need to submit it to Abilitations ….I am pretty big on creative commons and sharing everything, but at the same time I don’t want one of my ideas taken and submitted by someone else.  Actually I have 3 inventions I want to submit. I speak with Tonya over at TherapyFunZone.com about them, it’s nice. Oh that reminds me, I need to send her some things.

8. I was thinking about imagination and playfulness and how rigid some of our kids are, especially those with anxiety and/or autism. I turn EVERYTHING into a game more or less. It’s very rare I say “Crumble up this paper and throw it into the recycle bin.” Instead I say “Okay, here is our hungry shark (referring to recycle bin which has a taped shark face on it). Feed it carefully!!! I don’t even really do it on purpose, it’s just how my mind works. But kids get really into it. Seriously. Feeding a hungry shark is way more fun than a normal recycle bin. It doesn’t have to be elaborate..most kids “get it” right away. Try turning all your instructions to do something into mini games and see how it goes. Also, I feel that sometimes lots of tiny steps help kids become more aware of flexibility and imagination. So. For example. When I pick a kid up from his classroom for a 30 minute session, I may say brightly and exaggeratedly, “Today we’re going to do nothing but really hard high school math!” or “Today we’re just going to sit and stare at a wall!” – ludicrous things. Challenging them to say something like “That’s not true” or “Really?” or “Are you kidding?” Or I’ll ask them to come up with new names for the session. “Pick a new name! You are no longer John, you are X”…and I’ll suggest some fun names. Some kids can’t even handle that much change and just want to be their own name. So I chip away at their concept of reality with a lot of absurdity, exaggeration, silliness, etc. Tiny steps. But I strongly believe tiny steps make big changes over time. 🙂

9. Still working on the Pied Piper concept. So many kids hate being singled out and taken somewhere. At my schools, for whatever reason, there doesn’t seem to be much awareness of special ed or stigma attached, but I work with pretty high functioning kids. It’s definitely impressive and makes me glad. But it’s still weird for an adult to show up and take a kid away. (Phones make me nervous, I almost never call for a kid unless the kid prefers it). But random kids come up to me all the time to comment on my hair tinsel, or eyeliner sparkles, or my Mario laptopcase, etc etc. Some of my classrooms get really into me showing up because I told them once I never smile (obviously a total lie) so when I walk in they get really excited about whether I’m smiling or not. My guys love that the entire classroom gets into it before I take them away. The same is true for being “Miss Awesomeness”….kids will ask about me and remember that in a way they won’t remember Miss Karen. (I am Miss Karen to MOST of my kids, but some do way better with miss awesomeness). Is all of this a fool-proof thing? No….but I think it helps my kids feel special to know the other kids are jealous, rather than snickering at them being singled out.

10. The other day I brought in some CVS fine motor toys that are seasonal (cheap and cool…check them out). One were those pop-up things? Where it’s a suction cup and spring bunny, you press down, and about 10 seconds later they jump into the air? Those were SUPER popular. One of my kid flinched each time they jumped, but still loved them. Plus I’d say things to the bunny while it was still down like “Be chill, man. Don’t freak out. Don’t explode. Just calm down.” and then of course it jumps up and the kids thought that was hysterical. 🙂 Then started imitating me. Hearing a 2nd grader say “Be chill, man” cracked me up. ahahahaha. Anyway, these little jumping bunnies are pretty explosive and silly, so for one of my kids, we ended up writing a police report on those bunnies! I just wrote “Police Report” on the top of lined paper, then we wrote Who: Bunnies. What: Exploding. Why: Angry. When: Date Where: Work Room. They were cool with writing a police report, lol.

11. A lot of my kids are supppperr excited to watch themselves on video. Photo Booth has all sorts of funky effects, too. I know you can’t video/tape and show others without permission, of course, but they watch themselves immediately after (like 2 minute clips) and then I erase them. We do a lot of “teaching” videos. I have a kid who is a reaaaalllyyy poor drawer and hates it and avoids it, but when he got to do a teaching video on how to draw, he drew more than any of us had ever seen before. So I’ll say something like “Do you want to make a teaching video on shoe tying, handwriting with special paper, drawing, etc”….they always say yes and never seem to think about the fact it goes no farther than that, lol. They just want to see themselves on camera as an expert. Sometimes we’ll start iwth “What not to do videos”. For example, most of my kids get so frustrated with shoe tying. So we talk about it first. I’ll say, some times my kids get so frustrated, they try tying the shoe a few times, then throw it down and stomp away. Let’s make a video showing that and how that’s NOT what you should do. So we make the video of them throwing the shoe down and being angry and how it’s not okay. Then I’ll chat with them a little about their frustration tolerance that day. “You know, John, sometimes kids get really frustrated with shoe tying. Have you had a frustrating day already? How many times do you think you can try tying the shoe without getting too frustrated? 3 times? 5 times?” They think about it…most end up saying about three times. Which is fine with me. I know that I think of frustration as being a daily budget, and sometimes I can tolerate more frustration than others….so I like to get them thinking about what they can handle that day.

I guess when I think about it, a lot of what I’m talking about is kind of the psychological aspect of OT more so than actual tasks. But getting them to do actual tasks is so much easier when the “psychology” is right…
.that they feel special and not singled out….that they realize they can temporarily change their rigidity with tiny things…that they can teach others…that they can gauge their own frustration and what they can handle at that moment….etc. The actual fine motor tasks are the easy part….getting them in the “just right” zone to attempt a task is the hard part.

12. I’m not perfect. I screw up all the time. I get tired, or say something the kid doesn’t get, or use too much verbal language. (But do remember I have relatively high functioning kids by typical OT standards). Sometimes things don’t go as planned for a variety of reasons. So all this blabber up above is just a stream of consciousness of IDEAL practices that I strive for, but um. It doesn’t always happen that way. 🙂 But I do hope that at the very least, you see some aspects of your OT in a different light, or consider incorporating some of these elements…

13. I would love, love, love, to know if any of you have thoughts/comments/suggestions on any of the above….but please remember I’m a real person with feelings, so if you disagree with anything I say, please use constructive criticism….

Have a great day everyone….I’ve got a cat on my wrist helping me type…am watching the crazy wind and white-capped waves rolling in while I lie in my bed…am super tired from a bad night…….gonna be kind to myself for a few hours while I can and just rest….then off to visit a friend and then to my dad’s house for St Patrick’s food tonight, yum. I haven’t seen my dad since his mother/my grandmother’s funeral. Will be good to see him. Hopefully I can get some more paperwork done tonight too. I FINALLY got all my toys put up, now I need to figure out my papers.

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