Megan Berg 0:03
All right, welcome, everybody to the very first episode of the OT edition of the resource roadmap show. This is something brand new we’re doing it therapy insights. And I think we’re all feeling excited about it, maybe a little bit nervous about it, because it’s something we’ve never done before. And, there’s not really a model for anyone else doing it. So it’s kind of uncharted territory for us or for figuring it out as we go. But this is a response to many years of feedback from members wanting a little bit more context and instruction on how to use our resources. So every month we’re gonna drop a new episode and talk about the new releases that we’ve added to the library. And you can access this via YouTube or on your favorite podcast platform, whether that’s Apple podcasts, or Spotify, or Google podcasts. And if you are subscribed to the Access Pass, and you have the printables feature included, you’ll have instant access to all of the resources that we’re talking about today, as well as everything in our library. And if you’re not subscribed, you can head over to therapyinsights.com and sign up today.
Megan Berg 1:14
We’re also offering CEU credit whether you watch this as a video or listen to it as a podcast, you just have to have the CEU feature included in your access pass membership, and then you can go on our website, go to see us find this episode. So it’ll be ot episode number one, and then you’ll just answer a couple questions and get a certificate of completion for AOTA CEUs.
Megan Berg 1:41
Um, I am your host. But just for today, I’m just here to get the ball rolling. And then I’ll pass it off to Karissa who I’ll introduce you to shortly. But my name is Megan Berg. I’m the founder of Therapy Insights. I’m a speech pathologist located in western Montana. And I spend most of my time running Therapy Insights. But I also do PRN at a hospital and right now, that’s a couple of days a week. So I’ll introduce Karissa Simon, who’s going to be your host going forward. And Karissa, I think your heart is in New Jersey, right? You’re going to be going back to New Jersey, but right now you’re in New York, and you’re kind of in limbo in life, you’re supporting your partner as he pursues a career in medicine.
Megan Berg 2:27
And I know you’ve got two little kids and just tell us kind of what you specialize in with OT and all of that outside of your life of moving around and taking care of kids.
Karissa Simon 2:38
So I’ve been an occupational therapist for 10 years now. And I started in acute care and has specialized in neurology and kind of have remained specialized neurology, since after acute care, I got a chance to work at a rehab that we really focused on Parkinson’s, and I’m LSVT big certified, and really have a great passion for treating that population. But really love occupational therapy, and now I’m working PRN, and a hospital up here and get to see kind of a wide range of everything, which has been really great. I’ve learned a lot about burns because my hospital has a burn unit. So that’s been really, really fun. But mostly specialized in neuro but a little bit of everything.
Megan Berg 3:21
Awesome, thank you.
Megan Berg 3:23
And then we also have Johnny Ryder with us. And Johnny is based in Nevada. We he just said that he changed out of a T shirt in which I’m very jealous though because it is five degrees here. He’s an American Sign Language interpreter. He recently completed the PhD.
Johnny Rider 3:40
Correct. I graduated a couple years ago now.
Megan Berg 3:44
Awesome. And has five kids. We were just talking about AOTA somehow he’s presenting four or five different papers or courses. So very busy guy, but tell us a little bit more about yourself, Johnny.
Johnny Rider 3:58
Yeah, thank you, Megan. Been an occupational therapist for a little while and I still practice but I do teach full time at Toro University in Nevada. Right now I teach anatomy neuroscience in the mental health courses, but I’ve taught a lot of clinical courses and I’ve worked from peds to adults. Currently, I work in an outpatient, neurological, basically, clinic but I see a lot of the complex rehab technology and then I also work for community based company where I see a lot of chronic conditions, mostly neuro and chronic pain, but I love all all aspects of OT haven’t really figured out what I want to do. That’s why I like ot I just jump around every couple of years and enjoy being a part of therapy insights.
Megan Berg 4:43
Excellent, thank you. Thanks for being here. And we have Megan Wilkinson. Your heart in Texas, would you say that?
Megan Wilkinson 4:53
Not so much for me. I’m very open to just wherever the journey takes me I’d you know your journey.
Megan Berg 4:59
And that journey has brought you to Ohio. You’re also supporting a spouse pursuing a career in medicine, which, apparently like you have no control over your life when that happened.
Megan Berg 5:10
Go.
Megan Wilkinson 5:12
Pretty good.
Megan Wilkinson 5:14
No.
Megan Berg 5:15
Tell us more about yourself.
Megan Wilkinson 5:17
Yeah, so, like you said kind of similar paths a Karissa just recently moved to Ohio. But most of my work has been in neuro as well. And that’s really where my heart is. I have done most of my work in post acute neuro so very specialized working with spinal cord injury and traumatic brain injury in inpatient, outpatient, respite, all different types of settings. But again, I love all of it, the flexibility, the creativity, I have a really big heart for community engagement and leisure and mental health, just kind of some of those areas that are really important, but we maybe don’t always get to practice in some of those settings. So that’s a big, big part of my passion with OT. But I’ve also worked in assisted living, inpatient, lots of different settings.
Megan Berg 6:14
Excellent. All right. So this is our OT team, fabulous people, fantastic clinicians. For those of you watching or listening, we welcome any questions that you have, if you have a question that’s like, I’m working with a patient with XYZ, what resources from the library do you recommend or what clinical perspective you have on this case? Those are questions that we would like to discuss on this show. And so you can reach out anytime at support at therapy insights with those questions. And because we’re offering this for CEUs, we do want to verbalize or disclosures. So everybody here is being paid by Therapy Insights to present this show. And we are also talking about Therapy Insights products.
Megan Berg 7:00
So with that we’re gonna dive in! We have a great lineup of resources from emergency preparedness to utilizing the growth mindset to gate control theory for pain. And so what I’m gonna do is share my screen. And so for those of you watching the video, you’ll be able to see the resources as we’re talking about them. If you’re listening on the podcast, we’ll do our best to describe the resource as needed. But you can always find the video on YouTube or find our resources online at therapyinsights.com.
Megan Berg 7:39
The first resource is called fine motor skills. And this is a push pin activity. So Megan, take it away until about this resource.
Megan Wilkinson 7:59
Yeah, so I love this material, because it just has so much. So many different ways that you can use it. The kind of primary way to use it, of course, is using a push pin to really work on that tripod grasp and focusing those really targeted skills in order to hit those dots. But we kind of created it so that there’s some simplistic shapes to follow up to moderate and then more complex. And there’s all these different ways that you can use these with your clients. So the traditional way, I’m going to kind of pull one up, I have a cork board. So I talked about on the the worksheet or the activity that having something to protect the table there sort of surrender is probably ideal if you’re using something sharp, so just a cork board and then I have a push pin and then you’re just having them follow the dots and push it in all the way across. What’s really nice about the moderate to more difficult ones is you can really add in, if you’re looking on the screen on like the chameleon one it has this cute little chameleon on a branch and so you can add in some challenges for cognition and say okay, first I want you to complete the leaves and then you need to do the branch and then the tail of the chameleon. So you’re working on kind of attention, memory sequencing, those types of things, you can add in different colors. And then push pins I think, can be maybe a little bit intimidating with some of our clientele that we might be using this with just worried about safety. So on this handout, we also have some alternatives to that you can use a highlighter to mark the dots or you can use a pen to push through.
Megan Wilkinson 9:49
You can use a Q tip with paint on it something you know that’s accessible to the patient. There’s a lot of modifications that you can do to to work on those fine motor skills.
Megan Wilkinson 10:01
It also goes into detail about ways that you can make it more challenging. So if you’re on this simple shapes on the the easier one, maybe you say, you know, do three dots on the star, then go to the triangle and do three dots and then go back. So they’re having to kind of remember where they’re at and refine their location again, or you could have been doing two different sheets.
Megan Wilkinson 10:23
You can incorporate exercise, there’s so many different ways to use this, which is awesome. And then on this material, we have some documentation tips, as well, some goal writing examples, ways that you can really, very easily set up this material, you know, grab it real quick and just kind of sit down with your your clients. So I’m looking at again, on the more complex ones is the reason they missed it because of coordination because of strength, or do they have visual perceptual issues is an attention problem, what’s going on there. So just kind of really thinking through what they’re missing, and why and being able to kind of get more understanding of where your clients at with that.
Megan Wilkinson 11:06
And then again, with a goal writing, we have like a nice little example at the bottom. Specifically, you can use the dots, count them, and pretty quickly say, you know, they got 50% of the of the dots. So it’s a pretty easy task to be able to just grab from your desk and use with a lot of different types of clients.
Megan Berg 11:30
Yeah, and I love the documentation tips, because like, when it’s five o’clock, and you’re writing your documentation, it’s nice to have some words handy. And just some guidance on like, thinking through how you can document that effectively. So I think to being able to read that first and go into the activity, thinking about, I’m not just looking at fine motor, I might be noticing some of these other things, it’s that weight off your shoulders a little bit. Yeah, even as we were talking about it, I was thinking about how I could adapt it for people like, especially with a cork board, you could just put it up on the wall and really challenged someone’s like balance and their like visual ability to see it like when it’s on a wall. So there’s so many different things you can do with this, which is such a great resource to have.
Megan Wilkinson 12:20
Yeah.
Megan Berg 12:23
Great. Thank you, Megan. And we’ll move on to the second resource. This is called emergency preparedness with a disability. And for those listening, it’s a three page resource. And it talks about emergencies at home in the community and natural disasters and I’ll let Megan fill in more information.
Megan Wilkinson 12:42
Yeah, so especially with my background, primarily being a neuro that we had a lot of discussions about these life changing conditions, you know, spinal cord injury, I really don’t stroke and you go home. And what does happen if there’s an emergency, I mean, many times in this situation, they have these ATA modifications made. But then there’s only one way to enter or exit in a power wheelchair, what happens if that’s blocked because of a fire or an earthquake, or just being able to think through those things.
Megan Wilkinson 13:16
And I really, again, like the kind of versatility of this resource, it can be the first two pages really just kind of can get you thinking, and starting out with making a plan. And you can use that as a handout for a caregiver or the client. And then kind of leave the third page out if you want, or you can have a more in depth conversation. And the third page really dives into some very specific questions about their condition, what would you do if you use a device that’s powered by electricity, and you’ve been out of power for days on end because of an emergency. So it starts out by kind of detailing the different types of emergencies. So emergencies at home, which might be a fire in the kitchen, or a power outage, like I said, or emergencies in the community, which might be you get into a car accident, and you have a very specifically modified car to drive your car because you have a spinal cord injury, then what like who comes and picks you up where, you know, how do you move if you need a specific type of vehicle, and then natural disasters and there’s part of why we have this list is depending on where you live in the country, you know, moving from Texas to Ohio, the kinds of natural disasters that happen here are very different from in Texas.
Megan Wilkinson 14:35
So really just thinking about that. And then on the second page, it really kind of divides it into like having a backup plan and what does that look like? I talk a lot in this this piece about a go bag. So if there’s an emergency, you just kind of have everything tucked in a specific place and you know, like you’re gonna have the kind of basic essentials, if you need to get out quickly, which is a really important thing to think about. And then, specifically, when we’re looking at some of these clients who have had these major life changes, they’re using a lot of assistance, assistive devices in order to be independent, and making sure they either have those with them and their go back. Or if it’s something that can’t come with them, what are you going to do in the meantime? And then dividing it into like a mobility related disability, if you’re in a wheelchair power chair, what do you kind of look for in emergency situations, and then also cognitive as well. So in the cognitive area, we talk a lot about like, if you use an augmentative device, and that gets damaged or lost? And how are you going to communicate in an emergency situation? How are you going to tell somebody like I, you know, have this disability, and these are my needs, if you can’t communicate, so just really thinking through all the different details there.
Megan Wilkinson 16:02
And I like this too, because it’s really just an a gate way for so many conversations that can continue on from this session. And how do you you set that up, there are resources like you can be in contact with in a lot of places the like electricity or the water, if you let them know that you have a disability, they actually will work in a lot of places to turn your power back on sooner knowing that you have a disability, and it will be harder for you to essentially live without that. So just really getting engaged in your community and using those resources. And I think what’s really important to know, as a clinician is that knowing your very local area, and like what you have as access in those types of situations, and who you can connect them with upon discharge related to those things.
Karissa Simon 16:56
Awesome. I love the idea of having a resource like this just because as as occupational therapists, especially, I mean, in acute care or rehab, I feel like there’s such a focus on discharge planning and like getting them back in their house. But there’s not really this focus on what you do in case of an emergency. Like I don’t remember ever like talking to my patients about what they do if the power goes out, and they’re in a power wheelchair. I think it’s really important as therapists that we do talk about this and kind of bring light to the situation. I love that this makes it easy and gives clinicians I like step by step plan to follow to or to give the patient so that they can make the plan on their own.
Johnny Rider 17:41
I’ve even found to add on what Megan said about utility companies, I live in a rural area where we don’t have a lot of services. And we found that if you notify the fire department about someone that’s living with a disability, we recently had three days without power. And they were able to reach out to all the individuals who were on supplemental oxygen because they weren’t able to use their oxygen concentrators. And I actually had a client that I worked with who we had gone through this process and use this handout and they were ready for that the fire department knew that they were on oxygen and was able to reach out to them and actually show up at their house during that power outage to ensure that they got something that they needed to survive. So this is a great resource and a good topic that we’re talking about.
Megan Wilkinson 18:27
That’s amazing.
Karissa Simon 18:30
I think too, there can be so much anxiety surrounding going home after this and knowing you know, all of these changes have happened, you don’t you want to help them feel confident in being able to handle any sort of situation that that pops up. And so I think in a lot of ways, having that backup plan, knowing you have a long list of people to contact in these types of situations, the fire department, you know, Sue from down the street or whoever to be able to come in and help you add so much security for them. So very important.
Megan Berg 19:07
And Johnny, this ties into the article snapshot that you wrote.
Johnny Rider 19:12
Yeah, it’s like we try to make sure that this content is all evidence based therapy insights. But we really do a lot of the things we share very creative from our clinical background. But we work hard as a as a team to make sure that we’re also providing evidence based information. And so very briefly, we have a scoping review for those of you listening, and it’s called advancing emergency preparedness for people with disabilities and chronic health conditions in the community. And so, the fun thing is that this is a topic that’s being talked about more and more. And the big picture from this is that the research says we as community based practitioners, including all of us in this allied health professions, but specifically occupational therapists, we can do this but what you’ll find interesting is that the research says we need more resources, which is what we’re providing today, which is perfect. But in the scoping review, they actually found 24 publications, looking at this emerging role. So there is literature out there to support our role in this. And the literature talks about the knowledge and skills and the attitudes that are necessary, which we possess as occupational therapists, and kind of the training that’s available and what we might need in the future. And so even if maybe your occupational therapy program didn’t talk about this, specifically, we want to highlight that you have the skills that are that are necessary to support your clients to enable them to be prepared for emergencies, you just may need some some resources and some time to work through this.
Johnny Rider 20:41
Some of the key things that we wanted to share. One was, hopefully everyone agrees with this. But people with disabilities and chronic health conditions have the right to be included, and to be active participants in emergency preparedness. So those of you listening or watching that maybe you haven’t addressed this, hopefully that now you’re going to start to think about this and try to utilize this resource. And if at the very least discuss this with them, do they already have a plan in place, we know that there needs to be more research to understand kind of how to optimize these interventions, and utilize what we cut what we bring from each of our own professions. And this is actually a topic that’s been talked about in I’ve seen presentations at the AOA annual conference in our state conference. So this is getting more traction, we have a responsibility as occupational therapists to increase client’s self sufficiency to prepare them to respond to these emergencies. Okay. What this review also found is that we need to be focused more on the strengths that our clients already have. And they, they suggested that we need more tools to basically highlight those strengths and prepare them rather than just focusing on what they can’t do, what can they do, what resources are in their community? What access do they have, so that they can prepare for and respond to those? And we need to think about how do we make these resources accessible for all individuals. And so when you, when you think about this, and Megan mentioned, I’m a sign language interpreter, you’ve probably seen a lot. But now when there is an emergency and announcement from FEMA or the CDC, they’re providing them in sign language as well. And if you take our resource from therapy insights, and you also want to, to add to this and kind of have have your own list, one of my favorites is ready.gov. And if you go there, they have resources to build on what we’ve provided. And even talk about kind of low cost or no cost kits, give you more ideas, once you’ve initiated that discussion with your client. But pretty much any government site, the CDC, FEMA, the US Department of Health and Human Services, and Red Cross, they all have resources and links there. And some of those are the ones that I talked about where an individual who uses sign language can actually hop on and see in their own language, what’s happening around the country, right then as far as natural disasters, how they’re supposed to, you know, where they’re supposed to go for point of contacts, things like that. So this is a scoping review, meaning they didn’t really appraise the level of evidence or anything, they just said, this is what we know, this is all the evidence. And big takeaway, again, is that we have the skills we’ve learned them, even though we haven’t really thought about that. And utilizing this resource, you can start to kind of put those skills to better use, and hopefully start to talk to clients about how are they prepared, and then enable them to be prepared and respond to various disasters or emergencies.
Megan Berg 23:35
Thank you, Johnny. Okay, moving on to piece number three, written by Megan, this is called Vision deficits in the geriatric population.
Megan Wilkinson 23:49
Yeah, so I think I just have a passion for vision, again, working in neuro. That’s something I see a lot, it’s can just be so complicated. And I think that passion comes from, there’s just kind of this immense feeling of loss that happens when vision all of a sudden goes away, or you’re missing something. And so it’s a very emotional process, I think, for a lot of our clients. And so this one, specifically looking more at the geriatric population, which as we know, the it’s more common for vision deficits to kind of just crop up due to aging. It’s just a very common thing that happens as we get older. And so this details the four kind of most common dilemmas or sorry, yeah, deficits that that come with the geriatric population, which is cataracts, glaucoma, age related macular degeneration and diabetic retinopathy. The first page just kind of gives some details on what each diagnosis is what it might kind of look like some of those differences, how we can treat it, some of them are treatable, some of them not so much.
Megan Wilkinson 25:01
And then the rest of it is really looking at function again, like as OTs, that’s our, that’s our bread and butter, and looking at what is the functional impact? What are some areas that we might see them not being able to engage in anymore? And then lots of different sections on intervention. And so always, always, always starting with education, I just so much power in education and being able to educate families and clients and what does that it? What is this going to look like? Is this progressive? Are things going to get worse? How do we treat this? Is it treatable? Do you know? Are we looking more at modifications? What, you know, how are we gonna go about approaching this. And one of the resources that I found for helping support education is there is a application that you can download on your phone, called the NEI VR application for the National Eye Institute. And they developed a very simple app that outlines these four diagnoses.
Megan Wilkinson 26:05
And if you are listening, right now, Megan is pulling them up on the screen or the app on the screen for us. So very simple. Graphics here, kind of showing what it looks like. And you can open like, for example, Megan, if you want to click on cataracts, you can open up cataracts. And then you can choose a real life scene. So let’s say someone with cataracts in a grocery store, so then you can click on grocery store.
Megan Wilkinson 26:34
And it has a view of what normal vision looks like in a grocery store. And then you can slide the picture to see what someone with cataracts might be seeing on that same image in the grocery store. And so this is such a powerful tool for family education, I feel like being or caregiver education, being able to really put into view like this is what your loved one is going through right now. And what those changes really look like, and why that might be challenging. And I think that’s, again, maybe some of my passion and vision is it’s so interesting, because it’s like, you can’t see what they they see as a clinician, like they’re telling you, well, I see spots over here, or it’s blurry. And it’s like, you have to just kind of formulate that in your brain a little bit and work with the knowledge that you have. And so this is a really powerful tool to kind of give family and caregivers like this is this is what this looks like. And so then I think being able to picture that they can go Oh, like okay, and they’re able to maybe offer more empathetic support in those situations. And so and it’s really simple to use. Megan, would you agree, I mean, it’s just really basic, very simple. But really, really powerful tool, it’s free, super easy.
Megan Wilkinson 27:58
Love that just a great visual to kind of give a, your loved one has glaucoma. And this is what this looks like.
Megan Wilkinson 28:06
So and they have little quizzes on there, too, that you can kind of take so you can learn about a couple of facts related to each diagnosis. And then it’ll just quiz you on some questions, just say like, Are you paying attention kind of thing. So awesome resource. So there is a QR code in this resource that you can just scan it, pop it up on your phone, download it, which is awesome. And then diving into some other interventions, looking at medication and health management. And just giving lots of I would say like suggestions ways to modify resources to use because there’s there are so many more than what is even in this resource. But it’s it’s really looking at kind of the main areas that we might see deficits envision. So if you imagine being able to manage your medications, but you can’t read the pill bottle or some of that really valuable information. And what are you going to do in order to manage that, the next section really looks at lighting and lighting is huge for all four of these conditions and how we can modify the environment in order to work on a task at a tabletop versus working or just, you know, watching TV or looking at your phone. And then that kind of moves into the next section, which is reading writing and screens. And that’s like, you think about that, that’s a very prime primary way that we use our eyes. And so how do we, we look at that. And again, the thing with a lot of these conditions is there the severity level to is understanding what severity level the client is that and how do we modify some of those.
Megan Wilkinson 29:53
And I love to like tasks and simplification. There’s a couple pointers in there about that. That is just like one of the best ways to just take some of the stress off of our clients and being like, so for being able to buy pre chopped vegetables or meat, so you’re not worrying about chopping with a knife and like whether you’re going to hurt yourself, and that just relieving some of that stress and pressure, it’s so easy to just say I’m just gonna buy pre chopped vegetables, and I don’t even have to worry about using using the knife or modifying this.
Megan Wilkinson 30:23
Or using one tip I really like, it’s like, we don’t have to put to paste directly on to the toothbrush. If we’re trying to get this tiny little.of the toothpaste onto the toothbrush, like it is totally acceptable to squeeze a little bit of toothpaste right into the mouth. And we can use our touch, we can use other senses in order to make that that work. And I just think that’s one that people are like, Oh, I never even thought that that would be an option there. So I’ve used that one several times. I’m using organization again, offloading some of the stress making sure like I can find the things that I use frequently, easily, I’m not rummaging around through clutter where you know, with these diagnoses, you might be looking at it and going, oh my gosh, that’s so much I can’t even, like it stresses me out, even just looking at it because I can’t even process through all of these things. And it might be like, let’s get down to just two spoons, cooking spoons that we use in the in the kitchen instead of the whole drawer of cooking spoons that we use, right so that we can kind of just ease some of that stress off of them. And then lots of different environmental modifications increasing contrast is huge. I’m a big coffee drinker. And so the the picture in this one is, is perfect for me being able to see that that dark coffee in the white coffee mug, that’s how my husband drinks his coffee, right. But I like mine with a little bit of cream. And so a white mug, the cream in there would not add contrast. And so we want to be thinking about just changing contrast and colors and so that it stands out to them.
Megan Wilkinson 32:03
And then adding color as well, if they use the microwave all the time, but they pretty much only use that one specific button for like popcorn or whatever some of those auto settings are, we can add brightly colored tape, there’s kind of those bump, the bump. Or with stickers that you can add on to it to add a little bit of extra texture to it.Or Velcro, there’s just so many different options that we can kind of again, take away the stress from our vision and add it to other senses. Because as we know, the brain will just re route to those things, we will start to look for more inputwith the tech like tactile or hearing or like with the toothpaste like feeling it in your mouth. Instead of relying so heavily on our vision practice makes perfect type of thing. Rerouting those wires in the brain. So lots of really good tips in this one.
Megan Berg 33:04
Yeah, and me, am I remembering correctly that you was it last month that you did a pretty comprehensive vision evaluation piece?
Unknown Speaker 33:12
So that
Megan Wilkinson 33:13
Yeah, absolutely. I think that was one thing I have found in my practice is that kind of similar to what Johnny was talking about with emergency preparedness, I think some programs don’t put a lot of emphasis on vision. But it’s so huge, especially if you end up working in neuro or in the geriatric population. It’s a big part of OT. And yet we don’t necessarily have maybe the education or the resources on that. And so having something simplified to be able to kind of run through the different types of vision deficits that we might be seeing. And it also points to to if these are the types of scores, they’re getting that they need a referral to go see a physician and be assessed, and then that can help you move forward with intervention. And so having something all in one place to kind of just do some quick, quick assessments was something that I’ve felt has been needed in a lot of OT settings. Yeah.
Johnny Rider 34:15
I was just gonna mention real quick. One reason why I like this is we can use this handout for us as clinicians as a quick review, or as talking points, we can share this with family members with clients. But one thing that’s great about our profession whenever we walk into the home, or we meet with a client, and they’re coming to us, especially when they have a vision deficit, and as Megan mentioned, not something that’s always correctable and may or may actually get worse over time. This handout in this discussion brings hope because what we’re really sharing with them is that hey, we have all these different tips and tricks. Let’s problem solve together and find a way that you can live well with this vision loss or this low vision. And that’s ultimately what this handout supports.
Megan Berg 35:05
Absolutely. And this segues nicely into the next articles snapshot.
Megan Berg 35:09
So he ended up to Johnny.
Johnny Rider 35:11
Okay.
Johnny Rider 35:12
And again, everything that Megan said is built upon in this systematic review that I’m gonna share, it highlights the first thing Megan said was about education, how important that is. And the systematic review highlights that as well. But it’s occupational therapy interventions to improve performance of daily activities at home for older adults with low vision for those of you that want to look it up.
Johnny Rider 35:34
Real quick, I want to mention it is from 2013. And being a researcher, myself, and Professor, I’m obviously biased about some of this stuff. But it’s hard for me when I hear people say, Oh, that’s old research, you know, we shouldn’t listen to that. If research is done, good. It doesn’t matter when it was done. And we don’t have a new systematic review. There’s definitely been research since 2013, that we want to add to our understanding, but we the themes that come from the systematic review still hold today. And so I just want us to remember that, but still look at what else has been published. But this gives us the most information we could share as a team, it actually included 17 studies with very high levels of evidence. Okay. And first of all, we know that age related vision loss is a progressive condition, and that there’s a lot of older adults living with this. impairment. There’s even a specialty certification that our profession offers. But it’s more than just going into their home or seeing them in the clinic and just offering them some devices. as Megan said, education is so important. And what they actually found here, jumping down to some other bullet points real quick was that education should start with knowledge of the actual condition. And so we have an app, we have a handout that can help us with this. But we need to help them understand what does this mean for me, then we can provide them with information, education, training on various devices, or compensatory strategies. It doesn’t stop there, though, this systematic review found that we need to train them in problem solving skills. So not just how do I use this for this one task? How do I use it for tasks X, Y, and Z. And then they found that multiple sessions were needed. So we needed to teach them this, give them an opportunity to practice it in their own environment, and then seeing them again to return to that problem solving. Something interesting that came up was they found that a lot of these multicomponent intervention programs which were the best, included some relaxation skills, and kind of processing, living with this low vision and relaxing a little bit because we know anxiety, distress, fear, some depression is commonly associated with this. And then providing them with as many resources as we could in a way that was accessible, understandable and usable to them. They found that there was multicomponent intervention, single component interventions and multidisciplinary interventions. And of course, when we had multiple components, that was the best, but we needed to provide them in over time, not just all in one day, throw them all these resources, you can imagine how overwhelming that would be.
Johnny Rider 38:17
And so, it this may seem a little weird, but if you give me a second, explain it, if you’re working with low vision, patients a lot such as you know, Megan, and Karissa and myself and you’re working in this neural population, maybe you’re working in home health, skilled nursing, you’re going to see them, you can actually cite research in your documentation. And you don’t need to know the entire name of that study. You don’t have to know everything. But I commonly cite key studies that support justification for working with these patients. And so one big finding that this systematic review came to the conclusion of was that we needed to have multiple sessions with someone with low vision. And so if we’re justifying why we need a follow up session, why we need multiple sessions, citing something like this one shows that we know our evidence to the payer sources to the to those reading it, but it also shows that we’re evidence based in our profession and as practitioners, but they need time to adopt these they need time to incorporate the new knowledge to try these different resources, these different low vision devices, and then problem solve what’s going to work for them in their daily life.
Karissa Simon 39:24
Johnny, that’s such a great suggestion, because as occupational therapists, I’m sure we’ve all faced the insurance kind of dictating how many sessions we get and what a patient needs or doesn’t need. And the idea of putting, like a citation in our documentation is such a good idea. Because most of the people who are reviewing this and making these decisions don’t have any real knowledge of what occupational therapists do or what the evidence says. So it makes it easy for them to see that what we are doing is appropriate. We don’t have to know every study out there but we do tend to work in one area. And so knowing a few key studies is really nice to support what we’re doing. But I found that some of these specialized institutions, when I was working with the Cleveland Clinic, they have therapists cite actual research in there. And that’s where I learned I learned about this and saw it as an example earlier in my career, and I’ve kind of adopted it. And I think it’s helped me, but it’s definitely made me more aware of what I’m doing and why I’m doing it. Yeah, for sure. And for anyone listening or watching this.
Megan Berg 40:31
The great thing about these articles snapshots is there’s kind of a summary of the research. And then there’s these clinical takeaways at the bottom of each one. So if you haven’t checked those out, be sure to check a few out and read them. And that’ll help guide your documentation if you want to be citing research in what you’re documenting.
Megan Berg 40:51
All right, let’s move on to resource number four. This is called growth mindset. And for those of you listening, it’s a one page handout comparing fixed mindset to growth mindset and has a picture of like a mountain path. Tell us more about it, Megan.
Megan Wilkinson 41:12
Yes, I loved the image that our designer came up with for this handout, I was like, This is so perfect. So growth mindset. Again, like I mentioned earlier, in my introduction, mental health is something I’m really really passionate about. Because we you cannot treat the whole person without considering mental health, no matter what setting you are in if you are not considering mental health and the things that the client that you’re treating, and whatever they’re going through, whether it’s it’s ortho sniff, you know, whatever setting you’re in whoever you’re, you’re treating mental health is part of that. And I find that well, one, I think we all can benefit from growth mindset, every single person on this planet clinicians to you know, I mean, I think we’ve had a lot of challenges in the rehab world in general in the past couple of years, and some of those negative internal that that voice in your head that just kind of pokes at you, and it’s like, I just can’t do this, this is way too hard. Some of those, those negative phrases that loops through our head, being able to kind of fight that with growth mindset is really valuable, too. So as a clinician, this is beneficial to you know, hang it up in your, your rehab room where everyone documents, right. But for our clients, I think this is a beneficial way to kind of approach those, those clients that are limiting themselves a little bit, they’re there, these phrases are running through them, they’re just like, I just can’t this is this is too hard. I’ve, you know, again, in neuro I’ve had a spinal cord injury, my whole life has been uprooted, I cannot do this, you know, I’m never going to be able to do do these things. Again, I’m never going to live a full life, I’m never going to be happy. Some of those phrases.
Megan Wilkinson 43:07
Using this skill, this being able to practice growth mindset can really help push them to that kind of next level. And just having those open conversations too. I think that these are the ways that as clinicians, because we develop these really in depth relationships with our patients, we can have some of these hard conversations about, you know, I know, this is hard i can i can validate how challenging this is for you. That, you know, this is a you know, you’re at the bottom of this mountain, you’re looking at the picture, right, you’re at the bottom of this mountain right now, and you’re trying to get up to that flag. And it’s not a straight line up. And sometimes in reality, you’re probably going to go back down a couple of times, but being able to have some of those real conversations about like, how do we face this challenge together, and being able to practice some of those, those growth mindset terms. So this is kind of if you look at the bullets next to each other. So the first bullet I can’t do this is a fixed mindset that’s very concrete, you don’t, you see that? You cannot change what your situation is. And that’s the end. That’s what someone who has a fixed mindset has. It’s like, this is my situation, the end, I can’t do anything about it. And someone who has a growth mindset is like this failure is an opportunity for me to be better. This is a way that I learn, which again, we’re that’s something we’re doing in therapy all the time. The first time you present them with a task, they probably get 20% accuracy or whatever it is and then you can bring that back to them a few weeks later, and it’s like, Look, you got 50% accuracy, right? Failing is how we learn and being able to kind of readjust some of those I’m so just kind of having to being able to model this. So if Megan, I might roleplay with you for a second.
Megan Wilkinson 45:12
If you are a client that I have been working with for a while, and you know, we’re really working on that sit to stand, and you just every time we get up to stand you, I can’t I can’t do this. It’s too hard. I’m going to fall. You know, I’m too weak, those types of phrases. That’s what I’ve been hearing over and over again, then I might actually have you repeat these things back to me. So Megan, can you read the first line under fixed mindset for me?
Megan Berg 45:43
I can’t do this.
Megan Wilkinson 45:45
So how does that make you feel when you say that?
Megan Berg 45:49
I feel pretty limited. Like I’m in a small box. Like that’s, that’s it? There’s nothing here to work on.
Megan Wilkinson 45:57
Okay, now, I want you to read the first line under growth mindset.
Megan Berg 46:01
I’m still learning I will keep trying.
Megan Wilkinson 46:04
And how does that one make you feel?
Megan Berg 46:07
It makes me feel like it’s okay to make mistakes, and that you’re not here to judge me or like, I’m not wasting your time by making those mistakes, and that it is a learning process.
Megan Wilkinson 46:22
Yeah, so let’s do another one. So what’s the second line under fixed mindset?
Megan Berg 46:26
It’s too hard.
Megan Wilkinson 46:29
And you How do you feel after that?
Megan Berg 46:32
Um, I think I feel like I want someone to acknowledge that it’s really hard. And but it also feels like hopeless.
Megan Berg 46:44
Yeah,
Megan Wilkinson 46:44
I think, you know, that’s, that’s fair. And having those feelings are totally valid. But let’s try the the second bullet point under growth mindset.
Megan Berg 46:54
This is going to take time and effort.
Megan Wilkinson 46:57
And how do you feel about that? When you say that?
Megan Berg 47:01
I feel like it takes the pressure off of like, it doesn’t have to be fixed today. And everybody’s acknowledging that we’re in for the long haul.
Megan Wilkinson 47:12
Absolutely. And our whole team feels that way, when we’re, we’re doing therapy with you, we understand that it takes time and effort. And we understand that it’s a process, we also understand that it’s challenging, and that it’s hard. But if What if instead, this time, when we work on our sit to stands, you use one of the phrases like I accept this challenge, or I haven’t figured it out yet, after we we try to do the sit to stand and see how we feel?
Megan Berg 47:41
I can try it.
Megan Wilkinson 47:42
All right, I love it. So being able to, you could have this at the mat with you in the gym, you’re kind of have it at the side, if you really need to be able to give them motivation. Or if you need to first have that really that like kind of sit down heart to heart, talk with them about what this means.
Megan Wilkinson 47:59
I think having those phrases is a really good way to be able to practices again, as a clinician, it makes it easy, it’s right there in front of you. And two, as a handout, this can be something that, you know, they keep with them, they keep it in their room, or if it’s a facility that they have a binder or a way that they keep their stuff together, they keep it with them. And the more that we’re repeating those positive feedback loops, those positive self talk, the more we believe it to be true. And so being able to practice that in those moments, you know, again, if there’s a specific thing sit to sands are really challenging or being able to use the the reacher to put on your clothes or whatever it is something that’s really, really challenging. Having that right there with with them and being like, let’s try this, like let’s say these words and see how we feel about it.
Karissa Simon 48:53
I think is great. I also love this for a group therapy activity. If you’re able to kind of get everyone together, there’s some there’s power in the group mentality, and everyone’s going around and repeating these positive phrases and bringing each other up. And then also having that active discussion.
Megan Wilkinson 49:12
You know, if there’s multiple people in the group who are struggling with that fixed mindset, being able to one kind of get that sympathy, like when Megan was roleplaying, saying like, I feel like I want someone to acknowledge that it’s hard, being able to connect with other people on how challenging it is, but then also working towards trying to use this growth mindset together as a group. I think there’s a lot of utility in this very simple one page handout.
Megan Berg 49:36
Absolutely.
Johnny Rider 49:38
It’s interesting because when you think about growth mindset, probably everyone listening has heard that come up in the media recently. But when they were studying, how do we help people build growth mindset? They took a little bit from the you know, therapy world’s playbook and they explain students the idea of neuroplasticity, which I bet every occupational therapist that’s worked with As someone with a stroke or brain injury has kind of explained to them in lay terms what neuroplasticity is. And then they found that these students understanding that the brain was malleable and could change and can grow new connections and things like that. They developed a better growth mindset and work harder in school. And so building off of what Megan just said, we’re probably already talking a little bit about that idea of recovery and what’s possible in neuroplasticity. And so we can kind of use that as a segue into growth mindset, but they build off of each other, they support each other. And we might get some better outcomes, will we actually talk about this term, and use this in conjunction when we kind of share a little feel about neuroplasticity?
Karissa Simon 50:44
And what a great tool for clinicians to have, I mean, we’ve all had those patients where you just can’t get them to engage like you can’t get them to buy in. And this is a sin excu explains it in a way that I think a lot of clinicians can use successfully, to try to get their clients to buy in.
Megan Wilkinson 51:05
Yeah, and at the bottom, there’s, there’s a list that talks about different ways that you can foster a growth mindset, one of the ones that I find the most powerful is to replace the word failure with learning. Every time you’re like, Well, I didn’t do that well, or I failed at that, or whatever. If you’re just like, that was a way for me to learn, right? I mean, if you change that, then that’s your whole perspective on the way you approach things is huge. And so there’s several little bullet bullet points down there, too, that can kind of help you work towards not just the phrases, but different ways, different mentalities to work towards using growth mindset.
Megan Berg 51:44
Excellent, thank you. And we’ll move on to our final piece, which is called gate control theory of pain in practice.
Megan Wilkinson 51:54
So this one is more meant as a handout for our, our clients, or maybe a caregiver of a family member who is very involved and wants to kind of understand some of these processes. So it’s very, kind of a simplified version, it’s a one page handout, and just talking about what the gate control theory of pain is, again, in a simplified version, so talking about the gate that either blocks those pain signals, or allows them through to the brain.
Megan Wilkinson 52:27
And essentially, it gives some good examples that every person has, has had. So like when you get a bug bite, how you might rub the bug bite to try to make the itch go away and how that works. And so it’s kind of the same process with gate control theory of pain. So again, a way that a client would very easily be able to relate to that I think everyone has had a bug bite before. And it talks about, briefly about how some studies have recently found that the mechanisms that were initially proposed aren’t entirely accurate, but that the therapies that have been developed, based on the gate control theory of pain are effective. And so that’s linked to the bottom with our little resource there. And then the main way that we implement this in therapy is using modalities. So again, I think, helping to understand for the client, why is my therapist starting my session using a 10s unit or using moist heat at the beginning of a session, just kind of having an explanation for… Oh, like this is because I’m really limited by my pain. And I feel better when I start my therapy session with heat or with the 10s unit and some other modalities listed on their arm massage and the use of analgesic creams. So those are kind of the the main ones that that function under that gay control theory of pains, you know, starting the session with those modalities and then jumping into strengthening or stretching or working on mobility. So very simple handout, just going back to what we’ve said a few times in this this talk is education is key, I find that my clients always do better if they understand why I am doing what I’m doing and having an excellent an explanation. And a nice little handout so that they can keep refer back to is a great tool to have.
Megan Berg 54:29
Excellent, thank you.
Megan Berg 54:33
And we’re going to wrap up with our case study. So like I said, every month we’ll have a new case study and this is a chance for us to talk about resources in the library that already exist, and also talk about different opinions and perspectives about clinical approaches. So this month we’re talking about Mrs. Tanner, who is an 81 year old right handed woman with osteoarthritis in her hands, knees and hips. She was recently widowed and moved into an assisted living facility. Her family has noticed some changes in her cognition which promoted the move to assisted living. Prior to moving to an elf, Mrs. Tanner enjoyed playing bridge knitting and creating scrapbooks in her free time. Since moving, she has demonstrated limited engagement and community activities, and is exhibiting signs of depression. And so what we’ll do the three resources that everybody’s picked out, and then after that will chime in with any thoughts about addressing this case.
Megan Berg 55:35
So Karissa, you’ve selected a resource called Origami for fine motor in cognition you and just tell us about this resource and why you selected it.
Karissa Simon 55:44
So I picked this because she had leisure tasks that were kind of similar to this, the scrapbooking, that she liked playing bridge things that involve her hands. And so I thought that origami would be meaningful to her, it would be something that would engage her and keep her interest, and she would want to do, and then also, because the family had noticed some changes in her cognition, we thought this would be a good way to assess what kind of issues that she’s really having, whether it’s a tension or sequencing, if she’s able to follow directions, maybe it’s more visual, and it’s not really cognition, and the family was just attributing it to that. So I thought this was a really great activity, you could just pull out and engage her. And hopefully this would be meaningful to her and give her like an activity that she could maybe do in her free time in her room.
Megan Berg 56:41
Great. And Megan, you selected the yarn wheel activity? Tell us about this.
Megan Wilkinson 56:49
Yeah, so I had kind of a similar thought pattern to Karissa. So she really enjoyed knitting. And so this is using yarn, and you’re kind of getting some of that tactile input. Similarly, with knitting, but again, has cognitive aspects has fine motor aspects of using that. And then also, I kind of I have used this tool in group therapy. And I was thinking that it might be because it would be meaningful to her being able to maybe do it in a group with other clients might kind of increase some of that social engagement and reduce some of the Depression.
Megan Berg 57:27
Great. And Johnny, you selected the resource called workbook impact of mental health on daily routines. Why did you pick this one?
Johnny Rider 57:36
Yeah, for our listeners, this is kind of, it’s got a lot of questions that kind of the therapists can use to dive a little bit deeper into health conditions the client may have how mood affects them, you know, how often they feel lonely, what their expectations are of themselves, what activities they enjoy, if anything, part of their routine feels like a burden. And on the back, it’s even got kind of an opportunity for them to rank those needs, and their wants and kind of identify their support network, talk about things like technology for communication, getting outside more, all those things that we know are important for mental health. And so I wanted to kind of go a little different direction and think about how I could as an OT, use this resource to really kind of prompt some discussion on you know, that onset of depression that they’re feeling, prioritize some of the client’s wants needs in this new environment with changes to their daily routines. And then with the clients permission, I think that we could share this with maybe the staff at the assisted living facility, those that would be helping or assisting or maybe with the family, and brainstorm problem, solve ideas to address that depression, to improve well being. Because in my experience, and I think this has been mentioned more than once tonight, these things aren’t always discussed openly. We may mention that we do this or it’s kind of a quick conversation. But I think getting a little bit deeper into what’s important to this individual, finding ways to bring meaning into their their new routine. And there’s just power in writing these things down having this conversation, maybe even consider posting this on the wall in their rooms. So people coming in know, what do they want? What do they need? Who is in their social network when they are having a tough day? Who can we reach out to to provide that support that they need, and maybe even help carry over some of the goals that occupational therapy has or other disciplines related to their mental health and their daily routines?
Unknown Speaker 59:37
Great, thank you.
Megan Berg 59:39
And any thoughts about this case study as far as how you would approach it from a clinical perspective, whether that’s talking with the patient or family or any thoughts you have.
Megan Wilkinson 59:54
I think Johnny’s point would be a great place to start, right. I mean, it’s again, like where we have kind of had this conversation lead in multiple times like you, their mental health is incredibly impactful. And yes, we can get them doing their maybe some more leisure activities working on some of those fine motor and cognitive skills. But being able to, to kind of get them engaged and having that positive social interaction, I think is is huge.
Megan Wilkinson 1:00:35
So to me starting, there would be probably my prime, my primary focus would be how do I get basically like, get them lifted? Like how do I get them more engaged? How do I support this person? Because again, if we are working with someone who’s got pretty significant depression, how engaged are they going to be and working towards some of the pain they’re having with their osteoarthritis? Are they going to want to be doing exercises and some of those types of things if they’re depressed? And so I think that’s an excellent point that you made Johnny. Yeah, I agree. And that the handout even has like, feel like you could pull your goals from their answers out, which is so awesome. And I mean, just knowing this population, and a lot of times moving to assisted living, it’s like very difficult for people, and they kind of just see it as the end. So giving them really trying to help her create her new routine, like find new roles, find new meaning in life, because you do really lose a lot of those when you move to assisted living. Yo
Karissa Simon 1:01:50
I know a lot of my clients have said, they just feel like purposeless, like, nobody needs them anymore. Anything, they’re just a burden. So trying to help her find roles that will engage her and give her some meaning back in her life, to give her that purpose and motivation to then address the medical issues that are going on. I think we have to always remember, and this is not unique to this case study. But maybe it’s very real here that we’re not going to be working with Ms. Tanner forever. And so the big picture here is how do we ensure this transition, which Chris has talked about, and the mental health, which we’ve talked about, is going to continue to be positive after we are maybe removed from the situation. So once discharged from the services, and I think that’s a huge role of us as occupational therapist is to involve that facility, involved family, build those connections, and we can facilitate some of that. So that hopefully, as we see that progression, and things are going great in our sessions, when we’re ready to discharge them. We don’t wonder is this going to continue? Do we have you know, we talked about an emergency plan for emergency preparedness, but do we have a plan in place for them when they do have a setback? And does that plan involved the facility? Does it involve their support system? Well, if we have that handout completed, that’s, that’s great, because it’s all there. And everybody’s aware of how to help Miss Tanner in the way that Miss Tanner wants to be helped?
Megan Wilkinson 1:03:19
Yeah, absolutely. I think engaging the, the team at the assisted living is huge to a lot of those facilities can have rotating group activities, right, like social activities. And so using some of this information, of what her leisure activities are maybe being able to bring her into one getting her engaged in that. And then you’re thinking, Oh, she’s now showing up on her own, or, you know, she’s made a friend, someone that she’s connecting with, and then that helps support. What Johnny was saying is like, well, they’ve discharged and now I know they’re attending that class every Tuesday, Thursday, they’re getting social support. They’re getting that engagement in some of their leisure activities, which includes fine motor skills, which includes cognition, some of those things that we’re, we can feel comfortable when discharge approaches.
Megan Berg 1:04:14
It’s interesting, there’s been a lot of conversation lately about this whole idea of giving minutes with patients, which has improved significantly with PDPM. Although in PGPM, there’s more issues now, but now that we don’t have that pressure within skilled nursing facilities to get the minutes, but we still have that pressure in inpatient rehab facilities, and some other settings. But all of that to say that, I think, more and more we need to advocate for therapists to be more consultants like interdisciplinary consultants, like it’s not just about the minutes that we spend with the person like we could go in and work with Ms. Ms. Tanner, and like do a lot of activities. And so every therapy session with her, she’s engaged. But then if we’re not consulting outside of that, there is no carryover of just what you guys are all talking about. And so it’s just something I’ve been thinking a lot about lately is like somehow we, we’ve been cornered into like, it’s the amount of time we spend with people.
Karissa Simon 1:05:21
And I think it’s not only that, it’s how we engage with interdisciplinary colleagues and make sure that, like what Johnny’s doing even when we’re not there, she’s still able to engage in life and meaningful activities, a lot of education, providing education to the social worker, the activities director, like in an assisted living the nurse, like what the role of OTs- what our value is. And sometimes if it’s, if it’s a new facility, to like, your new therapist to that facility, it just takes a while to develop those relationships. And then once you have it, they buy into what you’re doing, but does take a lot of education. Talking to the different stakeholders.
Megan Wilkinson 1:06:07
Yeah, I’ve worked at a couple of different assisted livings and skilled nursing facilities. And the difference in having a team that is engaged, they’re monitoring, they’re paying attention to those types of things versus a team that maybe is like, why is this ot coming to talk to me about this for the third time. And it’s like, well, because you’re, you’re not implementing what I told you to do. But the value in that there is, in those facilities where that carrier over wasn’t there, where we’re not thinking about long term, we’re not looking at what’s happening after discharge, those are the ones that come back on caseload and a month, because they’re not participating in things that support their mental health support, their cognitive health, their physical health, they’re not being supported, they’re staying in their room, or whatever it is, and then all that progress they made in therapy declines. And so that’s Megan, what you were talking about, it’s not about the minutes, it’s about long term care, it’s about the person, right? It’s its growth of the person and the individual. And when it’s just spent on minutes, then that’s when you end up with repeat admissions.
Megan Berg 1:07:20
Absolutely. Okay, I’m gonna move us forward. And we’ll wrap things up because they know we’re running over a little bit. But at the end of each episode, we’re going to just briefly mention resources that have been created by other interdisciplinary teams that there’ll be insights. So just so everybody knows the physical therapy team, just released a resource called scarf massage as a home program. And then they also wrote a resource called what is Frontotemporal dementia. So those are now available in the library. And the speech pathology team wrote a resource you all might be interested in called spaced retrieval, and it’s just how to use the spaced retrieval technique to address memory impairments.
Megan Berg 1:08:04
Oh, and then they also recently came out with a storage area deductive reasoning puzzle, and we had a great conversation on the speech therapy podcast just all about making sure that we’re not just pulling out a worksheet when we have 30 seconds to prepare for a client that this is something that we specifically choose because they are working on very specific work related skills that we can’t recreate in the clinical setting.
Megan Berg 1:08:30
So yeah, you can check all of those out. Thank you guys for joining us for this first episode. Like I said, you can get instant access to all of these resources and hundreds more at therapyinsights.com. All of the links are available in the show notes, whether that’s on YouTube, or in the podcast show notes. If you have a question for us at any time, you can reach us at support@therapyinsights.com. If you’re an Access Pass member, be sure to vote on what we create next, and we’ll have a new episode dropping on April 1. So we will see you then. Thanks everybody!
Megan Berg 1:09:04
Bye