Karissa Simon 0:01
Welcome everybody to our second episode of the OT edition of the resource roadmap show. You can access our show on YouTube or your favorite podcast platform. And in the show, we’re aiming to provide you some context for the resources that we release each month, how you can use them with your clients, what they’re for, like different ways that you can use them. And we’re also going to be discussing a case study today and how you could use some of our archived resources to address this case. So if you’re subscribed, and you’re an Access Pass member, with printable features, you’ll have instant access to all of the resources we’re discussing today. Along with hundreds more in our library. If you’re not an Access Pass member, you can just go to therapyinsights.com and sign up for instant access. We are offering the show as an AOTA approved CEU credit course, for watching. So to get credit for that course, you just need to have your CEU feature. And then you would go to our website, select CEU, this find our episode. This is OT version, Resource Roadmap Show episode number two, and you’ll answer a few questions and then you’ll get a certificate. So I’m your host, Karissa Simon. I’m an OT with 10 years of experience in acute care, outpatient, home health and short term rehab, and I specifically specialize with Parkinson’s disease, and I’m LSVT big certified. And this is our OT team of writers, Johnny Ryder and Megan Wilkinson. Johnny, can you tell us a little more about your OT experience?
Johnny Rider 1:41
Yeah, I do practice as a clinician, still I work in outpatient and community based with a lot of chronic neurological and pain conditions. But I’m also an educator and a researcher and work at Touro University in Nevada as an associate professor.
Karissa Simon 1:56
And Megan, can you tell us a little more about your experience?
Megan Wilkinson 2:00
Yeah, so most of my experience is in neuro. I spent most of my time in a post acute neuro facility working with traumatic brain injury, spinal cord injury. And I’ve worked across many different areas. But my heart’s definitely in neuro.
Karissa Simon 2:16
Thank you guys. So for those watching, or listening, we welcome any questions that you have. And we would love to discuss your questions on our show, please just reach out with those questions to support@therapyinsights.com. And at this time, because we are offering the show for CEU credits, we want to verbalize our disclosures. All of our participants here are being paid by Therapy Insights to participate in the show, and we are going to be discussing resources available on therapyinsights.com. So before we get started discussing all of the resources released this month, we just wanted to say happy OT month to all the OTs out there. We have a great poster that’s going to be coming out from Therapy Insights that you can download and post in your workplace to kind of help remind your co workers that it’s OT month, give them a little nudge. And we also really encourage advocacy and reaching out to the community and really to everyone and explaining what OT is. We all know that we sometimes get confused with the other therapies. So anything we can do to get our message out there, what we do, why we are valuable as a profession is so important. And Megan, can you tell us a little bit about some other resources Therapy Insights has for this?
Megan Wilkinson 3:34
Yeah, so this coming month releasing start of April, we are working on some great fun ways to kind of get patients and even staff members involved in OT month working on a an OT Jeopardy OT bingo, there’s going to be some cards that you can kind of quiz people as they go by maybe give them a little reward. So lots of questions like you know, kind of what is OT what’s an ADL what’s IADLs kind of quizzing some areas that we can practice in. So I know there’s one in there talking about does only PT do mobility, no OT, absolutely does mobility so but also have some exercises in there. So you get the moving, some cognitive kind of tests for them in there. So really showing them our our broad scope that we have while also testing their knowledge on what we do as OTs in a fun way.
Karissa Simon 4:24
So look for all those resources they will be dropping in April for you to use in your own practice. So now we’re gonna dive right in. We have a great lineup of resources today, from how to garden with OT to addressing child rearing, to performing ADLs with abdominal precautions. So the resources are going to be shared on the screen for those watching. If you are just listening, you can always find the video on YouTube or all of these resources are available at therapyinsights.com. So our first resource is Child Rearing. It’s a two page document. It has some pictures on it, and it talks about the different areas of child rearing you need to consider. And, Megan, I’m going to send it over to you to explain this resource little more.
Megan Wilkinson 5:17
Yeah, so this month, I love we have two IADLs that are really special to my heart, child rearing and gardening. Child rearing, especially, I am a mom. And so this is a special one for me. But I think child rearing can feel really intimidating, because you think about what parenting I mean, you guys are our parents, too. It’s, it’s hard. Even, you know, if you don’t have some of these limitations that our clients have. And I think one of the reasons that is most challenging is, it’s really important to consider the age of the children that you’re working with, what you’re going to be working on with that child, even in the same kind of category, like the first section in our in this handout is food, like making sure that they have proper nutrition. But that looks very different for an infant versus an 11 year old versus an 18 year old, right? As a parent, how are we thinking about our clients who are needing to feed their infant versus, you know, their, their teenager who maybe knows how to do some simple meal preparation on their own, at least microwave, you know, a few things. So, what I really like about this handout is it kind of gets it separated into three main categories, which is nutrition, health and hygiene, love and affection. And again, it’s so complex, there’s so many different things that we can be talking about here.
Megan Wilkinson 6:45
But then just thinking about different kind of almost like little mini case studies that has so under the nutrition one, considering educating a father who has had a spinal cord injury on simple meal prep techniques, and how to maybe switch to grocery delivery in order to continue to cook for his 12 year old son. And then it goes on to compare practicing opening packages using adaptive equipment with a mother who has rheumatoid arthritis. So she can give her three year olds her favorite snacks, those are two very different situations, very different conditions. The needs of the age are the child’s age are very different, but still considered child rearing, and very specifically providing nutrition and child rearing.
Megan Wilkinson 7:30
So really kind of starting to open up how we’re thinking about this. This area of practice, I have one client that I think about so often with this, that she had a brain injury. And subsequently when they were doing all the scans, she then found out that she was pregnant, and she was a very young mother. And so really the anxiety that she had of like, I’m going to be a new mom and then on top of that she had a brain injury and was cognizant of having some of the cognitive deficits that she had, she also had a lot of physical deficits. And so we were practicing, like, how do you bend over into a crib to pick up your child when one of your arms doesn’t have that strength? She also had a lot of vision deficits. So really, really working through what are all the needs going to be of that age, and then also with these patients, considering the changes that might happen? As their child gets older, I know that’s something I face all the time as a mother is like, Oh man, I am a new phase here. Here we are facing new things that we’re working on. And so when our clients are facing that, and they’re dealing with things like hemiplegia or a cognitive disorder, how do they work through and problem solve as they move into those new phases? So this is a really great handout, just really sparking some of that conversation about child rearing.
Karissa Simon 8:57
Thank you so much, Megan. Yeah, I love how it breaks down each kind of category to get clinicians thinking, oh, does my client has an issue in this category, like how or is their deficit gonna be affected. So I do think it’s a really easy way to break it down for people.
Johnny Rider 9:12
I think this is such a great resource for OT month as well. Because my favorite things as an OT is when I get to explain to someone something that I do, and they kind of look at me like, that’s, that’s a part of occupational therapy. And so as you already mentioned, Megan, I had this handout last month, because I saw a client was a brand new mother, who unfortunately was going to now need power mobility for the rest of the life. And she kind of thought all I was going to do was help her with that wheelchair evaluation and train her how to use the wheelchair. And so I started talking about how she might be able to care for her child in this wheelchair. And she gave me that look. And I actually said, you know, I actually learned about this in school. That’s one of the parts of occupational therapy. We’re addressing all of these things that would have been nice to give a hand out like this to help or consider some of these things as we had that discussion and when wasn’t there so we could even continue that discussion and set some goals for her. So what a great resource.
Karissa Simon 10:08
Thank you guys, so for our next resource we have Gardening with OT. And this is incorporating gardening into functional therapy and the benefits. So this is a three page handout, it has some tables, some different pictures on it, and tips. And Megan, can you tell us a little more about this?
Megan Wilkinson 10:31
Yeah, I feel like I could talk about the benefits of gardening and OT for hours on end, guys, it’s so good. I have been really lucky to work at pretty much most of the facilities I’ve worked at have had some sort of gardening as part of their their therapy. And a lot of them have had pretty major setups, to be able to work on really those long term gardening goals. And I’ll go into that in just a minute. But I love that the beginning part of this, this handout, very beautifully designed by our designer, just talks about the breaks down kind of the skills very basically of what gardening can work on gross motor skills, fine motor skills, sensory processing, cognition, balance, strength, mental health, all sorts of stuff. And so that can be just a nice, like, if you just want the first handout to hand to your client, like, hey, this is why we’re working on this, this is why this is beneficial to to you. So love that versatility in this handout, and then kind of going into breaking down. Not every facility is set up in the same way that I have been lucky to. And so the first section talks about how you can do a single session and gardening and give some examples like if you you are the one bringing in all the resources to be able to do this because unfortunately, gardening takes time, and it takes money. And so if you aren’t able to really dive into it and that way, but you want to have a one on one session with your clients, it has some good bullet points on examples that you can do in a one session with your patients, and then there’s a longer list of then long term gardening sessions. And these are meant for places that have gardening beds or planters or if they let you have pots of plants and stuff on the patio or even around the office to kind of work on long term goals. And to me, this is like the crux of of OT right is a lot of these IADLs that we’re doing are long term things. It’s not like a one off thing. It’s something that you’re maintaining over time. And so you can really look at some of those skills in that long term manner if you’re able to do that.
Megan Wilkinson 12:44
So I’m really looking at like, I love the idea of at my old job, we would give jobs to patients. And so one of their jobs might be watering the plants. So making sure like do you remember that it is your job to water the plants and that you should be going out there this many days a week to take care of them? And do you remember the things that we educated you on like, you know, keeping a journal and keeping track of like, oh, this plant isn’t doing so well? Like maybe what should we be doing? You’re working on those problem solving skills like this, this one over in the sunlight is doing pretty well. But this one the shade not so much? And how do we work through some of those and the way that that not only works in a very specific IADL of gardening but translates over to other ADLs and IADL skills of how do I problem solve through this or being able to recall like this is a responsibility of mine.
Megan Wilkinson 13:35
And it really has so many good bullet points going into the sensory aspect of it, the health aspect of it. Again, one of my favorite ones I incorporated into this is planning like a themed garden. So like a salsa garden, things you could use to make salsa when you harvested. A tea garden things you could harvest to make tea, a sensory gardens of things that have really good smells, and just really the really diverse dynamic aspect of that and also being able to if you’re able to go out into the community with your your client, this is a great thing to saying like here’s a budget, we’re going to buy plants for our garden, you know, what’s what can we get bang for our buck, and then you have come in community mobility, you’re working on socializing or working on money management. I mean, there’s so many ways to make this a grand, amazing part of your your therapy.
Megan Wilkinson 14:28
And then the third page really dives into different adaptive equipment and modifications that you can make of gardening is something that’s really important to your client. Getting a lot of those like joint protection tools that you know make it so that the angle is a lot easier on them. They’ve got that bigger grip on them. And then it has other strategies like why don’t we lay drip irrigation? We don’t need to be going out there watering every single day that makes it so much easier. It talks about planting a in the tip section planting choices of what’s native, because that’s going to grow a lot easier, you’re not fighting the plant, when it’s native to your area, it’s going to be a lot easier to maintain. So just lots of different ways to use this handout, you’ve got someone who’s an avid gardener gardener, let’s give them some modifications, some adaptive equipment, maybe simplify some of the things they’re doing. Or if you’re in inpatient settings, working on some of these skills to really work towards other skills, fine motor skills, gross motor, memory, cognition. So just a really detailed, I feel like resource that you can use in so many different ways.
Karissa Simon 15:39
I really liked that, that first page you mentioned, like handing it to a client, you could also hand it to the like executive director of your facility to if they’re not on board to really show how beneficial gardening is not just in terms of an OT session, but for people’s quality of life. It’s such an important, like ADL for many people. And this also is very timely, because there are like several holidays coming up where especially female clients tend to get a lot of like potted plants in their rooms. And it’s always so sad when you come in and you’re like, oh, they have not been taken care of that. So I feel like it gives you some great ideas of how to use that gift that a lot of our female residents are going to get anyway and incorporate it as part of your OT session, which I’ve done many times over the years.
Johnny Rider 16:29
I think I agree with everything you both that both of you have said, but this is great for someone that have used gardening as an OT, but it’s also great for those of us that may have used in the past, we can use it to advocate it’s always hard to explain to outsiders, why we’re doing what we’re doing. And other people may look at these interventions and think we’re just out playing in the garden. But the first page tells us why we’re doing and helps educate, whether it be a caregiver or a patient or as Karissa said a director. But we know that there’s evidence behind this, and we’re going to talk about it today. And so this is just the essence of what we do. And so many of my patients throughout my career have enjoyed this from all different backgrounds, I found a lot a lot of engagement when it comes to gardening.
Megan Wilkinson 17:15
Yeah, I love seeing patients talking, did you see that that plant is fruiting out there. I mean, they’re the excitement that happens in gardening. And it’s that mental health and that social aspect to is just huge.
Karissa Simon 17:28
Yeah, we even I worked at a facility where they would like harvest the vegetables, and then they would take the vegetables to the kitchen and the kitchen would like use it in their meals. And they were so excited, like, oh, those are the tomatoes, we grew, we grew those. There we got so excited about it. And off what Johnny said you could even use some of those terms to help you document like more for why you’re doing this, like give you a justification for why you need to be gardening with them. Not just that you’re playing around in the dirt or having fun, but what you’re actually doing.
Karissa Simon 18:06
Yeah, I hope practitioners that maybe don’t have a garden in their facility. After listening to this or looking at the handout or reading some of the research consider how they can develop this program. I think it’s a great role for the occupational therapy practitioner and take on to do some program development, show those benefits. And I think it makes our job a little more enjoyable. And we may see this program continue and feel some pride in that. Because this is the type of program that can be very sustainable.
Karissa Simon 18:33
Yeah, definitely. It doesn’t have to be a huge raise that in first like it could just be a couple potted plants. And this is a perfect segue into one of our article snapshots, the “Putting the Occupation Back in Occupational Therapy:” A Survey of Occupational Therapy Practitioners’ Use of Gardening as an Intervention.” Johnny, can you tell us a little more about this article?
Johnny Rider 18:57
Yeah, thank you, Karissa. I’m excited to talk about the evidence behind gardening because we just looked at such an amazing resource. Interestingly, I was up for our podcast night and our video, but gardening or just this idea of the benefits of interacting with plants has been acknowledged in OT literature. And he guesses on when that first pops up.
Megan Wilkinson 19:18
The start of OT.
Johnny Rider 19:26
in 1932, all the way back then we’ve seen this in our literature. I believe you’re both right that we were doing it from day one, but it wasn’t in the literature until 1932. And so there’s this idea that some of you may want to look up called biophilia, which actually hypothesizes or posits that humans are drawn to the natural world, and that includes plants and animals and water. And so a lot of the research suggests that the well being and positive health benefits of gardening for example, is partly attributable to that sense of belonging, that being out with those plants provide to us.
Johnny Rider 20:04
And so in the evidence, we see all kinds of benefits. And we could talk about that. And we already have a little bit but we could go through these articles that we’re sharing have highlighted all kinds of benefits in the realm of biopsychosocial. So whatever we feel we need to work on with the client, I would suggest that we can probably find some article that shows some benefits from gardening for them, and across diagnoses as well. But this study specifically they were trying to understand, well, how and why do occupational therapy practitioners across different areas and practice settings, use gardening as an intervention. And they also kind of asked a few questions about the facility garden, and whether or not the OT practitioner contributed to the design. And they kept it pretty simple because they wanted to get a lot of feedback or a lot of responses. So they only had 15 questions. That went out to a lot of practitioners. In the end 60 of those that responded were using gardens in their practice, and kind of answered all the questions. The biggest thing that they found, which we like is that it was client-centered. So when occupational therapy practitioners chose to use gardening, it was because it meaningful, it was purposeful to clients, right? Not just to the occupational therapy practitioner, which it probably was for them well, but they found it to be very motivating, and very fun. So we know how it is to be client- centered. They also found that the frequency of using this as a therapeutic intervention, and the occupational therapy practitioner involvement in designing that garden was significant. And so basically, what that suggests was that for the practitioners, if they were involved in designing the garden, we talked about this recently, they tended to use it more. And so that environmental context supports engagement. And it really heightens the meaningfulness, the purposefulness and the usefulness of that garden. So just another reason why we should use that handout and get a gardening program going at our facilities, or wherever we’re working. And so this is an interesting study to look at we do know that we need a little bit more research out there kind of looking at what we can do with this and kind of defining how we do it. I think this also brings this idea of how can we examine our role as a profession and as practitioners in designing these gardens and making sure that they are therapeutic? And we can use some of those ideas that came from the resource that Megan just shared, to kind of think about what other aspects do we bring to the table, the utensils, raised gardens, the inclusiveness making sure it is accessible for everyone. And so I think that’s still out there. We we know we do it, but we need a little bit more in the literature. This is a great study showing us that, hey, it’s client-centered, it’s meaningful, it’s fun, and reminds us that we should get involved and advocate to help design the facility.
Karissa Simon 23:07
Thank you so much, Johnny, then we can move to the next one. So our next article snapshot is “A Systematic Review of the Effects of Horticultural Therapy on Persons with Mental Health Conditions.” And Johnny, can you tell us a little more about this one?
Johnny Rider 23:27
Yeah, we wanted to stick with looking gardening that in this session, or sorry, in this in this presentation to make sure we have that evidence there. And so this was a review published in it included interdisciplinary work. So not every study was directly from occupational therapy practitioners. However, they highlighted that all the interventions that were looked at were within our scope of practice, and a lot of them were done by practitioners. But I wanted to point that out. They’re using the term horticultural therapy, which they defined in the study as the use of plants as a therapeutic medium by a trained professional, such as an occupational therapy practitioner, to achieve a clinically defined goal. So basically, some aspect of that resource that we showed you any any engagement with plants with a therapeutic or clinical goal in mind. So it was purposeful. And they had this they had a review question they want to know do individuals with a mental health condition who received this type of therapy horticultural therapy, significantly improve their occupational performance and things like areas of occupation, client factors, performance skills, satisfaction and quality of life compared to those that don’t receive this intervention? And so they searched all the children. In the end, they had 14 studies that met their criteria, and they were across practice settings where ever your working as you’re listening to this. Your setting was in this study. They had outpatient studies, they had long term facilities, residential facilities, rehab facilities and intermediate care facilities, substance abuse treatment programs and even sheltered workshops. So they really found that this is being used and studied across all settings when it came to diagnoses, dementia, Alzheimer’s, schizophrenia, bipolar disease, major depressive disorder, alcohol, cannabis, opioid, amphetamine, substance dependence, all these different diagnoses were found in the literature as well, then they can look at outcomes or in variables were found. So for us thinking about this clinically, these are the outcomes that we know can happen from horticultural therapy. And we can consider well is this something I want to address with my client and wherever I’m working, and they found positive benefits for a lot of things aspect, agitation, behavioral, or behavior and engagement and multiple things, cognitive functioning, as we mentioned, interpersonal relationships, physical well being psychiatric symptoms, mental well being quality of life, self esteem, which is one to consider. Sleep, improved social behavior, stress and coping mechanisms, volition or that motivation to do more to engage in occupations and even behavior. So what are those things I’m sure it’s something that you’re working on with a client, turning your practice. But these are all things that horticultural therapy can assist us achieve with our clients or improve those outcomes. And so basically, the other findings that they found that I think are important to mention is that this type of therapy is viable. It’s right, we can use with clients experiencing a wide range of emotions, right? We’ve talked about indoor, outdoor, right, it can be portable, we can modify and adapt it all. All these things can be done to ensure that this is an accessible and inclusive intervention, they did find that it was mostly delivered in a group format. And these studies, however, some are individual. So again, most are working in settings where they’re kind of encouraging us to do more group interventions, this might be something that we can do, but it does. That doesn’t mean we can’t do it individually as well for working in a home health setting or an outpatient scene. But when they look at all the evidence together, they kind of look at the levels of evidence. And they say, well, we really state about the evidence. And the authors concluded that overall, this systematic review with these 14 studies, we can say that there is moderate evidence that horticultural therapy can improve client factors and performance skills. The biggest limitation this study found was that we don’t always give extremely detailed explanations of our intervention. So a lot of them were not really could be when it comes to replication. And so that’s why these conversations, learning from other OTs. Even Karissa talking about how they’ve used gardening in there, just getting us all have some ideas. And hopefully in the future as we document our gardening in the literature, we’re more specific so that we can replicate that in more research, but also in clinical practice.
Karissa Simon 28:15
And, I think Johnny, like you were saying or last episode, it’s great that we have these two articles that we can actually reference in our documentation, just show the proof as to why this is an important intervention. We’ve all been there when the insurance comes back that no what you’re really doing is not what we’re not going to cover that. And this really pushes people to say no, this is in our scope. This is important. This improves the client deficits, it’s beneficial. And here’s the study that shows that.
Johnny Rider 28:47
Yeah, and we were talking about using the resource that Megan develop, and you talk to Executive Director or director of rehab to kind of say, hey, we want to do this. Here’s your support right here. This is an evidence informed intervention that we can utilize, and it is skilled, and it’s fun, which we all want.
Megan Wilkinson 29:08
Yeah, I think it just really shows evidence for like, the bread and butter of what OT is, which is finding like our ability to pinpoint, purposeful, meaningful, engaging activities. And that because our clients are more engaged, they’re gonna make better progress, like they’re gonna make leaps and bounds because it matters to them. And so I just, I love this study so much.
Karissa Simon 29:33
Thank you guys so much. So we’re gonna move on to our next resource, which is called performing ADLs. With abdominal precautions. It’s a three page handout. It has some pictures on there of bed mobility exercises and things not to do. And Megan, can you tell us a little more about this resource?
Megan Wilkinson 29:53
Yeah, so we actually have two resources kind of in conjunction with each other too that can be used in very different ways. So this one is more detailed in looking at performing the ADLs. And the next one is just specifically talking about the precautions and so different ways that you can use those two handouts. And I, this was actually a subscriber request. And if you’re listening and you’re a subscriber and please request, I love the requests, because then I know what is needed and what you guys are, are using in your specific settings. And I can kind of get more creative and develop those for you guys. So thank you for whoever requested this.
Megan Wilkinson 30:34
So this one is really looking at, you know, those abdominal precautions that details what they are, which is no lifting, pushing or pulling. And then we don’t want to strain those abdominal muscles. And there’s some great images on this to kind of show some strategies that we’re using. So definitely using that log log roll in bed, and there’s some great pictures, showing that here, and using the bridge in bed and just detailing functional mobility and how we need to be protecting those abdominal muscles right after you’ve had a surgery and protecting that incision area. And then on the next page, we’re looking at dressing so wearing loose fitting clothing, you know, you don’t want to be wearing jeans with that button right over the incision. And then there’s lots of adaptive equipment, as we know for OTs, that can be beneficial using a reacher sock aid, long handled shoehorn all of those good things. And then showering is a pretty big one for abdominal muscles, excuse me abdominal precautions, because you don’t want to rub too hard and open up that incision. Getting in and out of a tub shower, there’s also details how you can get in without breaking those precautions, using a shower bench, how you want to wash it, you shouldn’t be submerging it typically. So lots of considerations there. And then it has a nice detailed list of once you have discharged home from the hospital, a lot of times you still have those precautions once you’ve gone home. And so things that you should probably not be doing once you go home when you are still within that kind of window with the abdominal precautions. So carrying small children, or large grocery bags, not exerting yourself with a lot of those like heavy duty cleaning activities like vacuuming or mopping, mowing the lawn, you’re not going to be going out there shoveling your sidewalk from snow, some of those types of things and then talking about when you should stop. So if you have pain and burning in the incision, and then being able to talk to your physician about being cleared.
Megan Wilkinson 32:50
So I feel like, you know, when we’re in the hospital, we’re teaching these or inpatient settings, we’re teaching these strategies to them. But this is so nice as a reference too especially if you have a spouse or a caregiver with you, for them to kind of be that that person that’s like, hey, like remember, we shouldn’t be doing that. So just detailing some of those everyday activities, and then also carrying that into after discharge, how we should be maintaining these abdominal precautions.
Karissa Simon 33:23
I love how it’s like a very concise thing that we could hand out to patients in the hospital because they feel like a lot of times they’re getting hit with so much information that they don’t necessarily remember everything. And then usually it will be in their discharge summary. But they hand them like 30 pages of this, like black and white, like very boring, like you have to read through all this stuff medication to get to what your precautions are. So this is nice, because it has pictures, it’s like engaging. And I think it makes it very clear like what you’re supposed to do and what you’re not supposed to do. And it’s an easy reference for them.
Johnny Rider 33:59
I think it’s good for therapists, because if I think back to when I was a new therapist, or maybe when you switch settings, one of the scary things is always like precautions and contraindications. And so I think this is awesome, because yes, as you’ve mentioned, it’s good to give to the patient. But if you’re if you don’t see someone with an abdominal surgery every day, and you’re a little nervous about kind of broaching this topic, this is kind of like a guide for you can walk through it with the client, and helps you remember everything that you should be talking about and ensures that you address everything and also gives you points for documentation. Like these are all the things that we covered in our session. So I like this in all aspects, but I’m sure lots of people who get a little nervous with precautions and contraindications will really find this a benefit.
Karissa Simon 34:46
So true, and then we have the second part of the document that Megan mentioned, this is Abdominal Precautions. It’s one page. It has again some pictures of log rolling on under specific precautions, and Megan, if you can tell us a little more about this one.
Megan Wilkinson 35:03
Yeah. So if you’re watching on YouTube, then you can see that this looks very similar to the first page. What this is meant to be is a simplified version, this is the one that you hang in their room. So they have a reference a way to remember, oh, like, those are my precautions, this is the way that I get in and out of bed. Makes it like you were saying, Karissa, it’s not part of the black and white information that’s just thrown at them all the time that it’s, you know, a nice color, it’s something they can easily see from bed, they can reference. So this is that more maybe introductory handout, like if you want to use them in conjunction, this would be a good one to just like, get the ball rolling of like, oh, these are my precautions that I need to be maintaining, you know, this is how I do a log roll. And then it actually has a really nice lead in paragraph at the bottom talking about how many of your daily activities like putting on your socks can strain your incision. And so then once you feel like they’re comfortable, this is posted on their wall, they are adhering to those precautions pretty well, then you can kind of maybe bring in that other handout and say, okay, like, let’s talk about these daily activities. These are some great examples. And this is a reference for you. So they go really well hand in hand. But also, if you want to just use this one, maybe for someone who maybe cognitively is not really ready for the next one. And this has really nice pictures, it’s very simple. It’s like combing colors. This is just a simpler handout keeping it, you know, less words, there’s less for them to digest. So two really good options, either in conjunction or separate.
Karissa Simon 36:48
Thanks so much Megan. Okay, and our final resource for this month is called Wants versus Needs. It’s a financial management handout. It’s two pages and has some areas where you can write some different tables and lists and Megan, can you tell us more about this one?
Megan Wilkinson 37:06
Yeah, so again, working in neuro money management was a big, big thing for us to be working on. And really what you you see in a lot of brain injury stroke is, is that impulsivity can be a big thing and not being able to reason as well that those reasoning skills are maybe not so great. And so this is, this is like starting at basics when it comes to budgeting more so is the kind of path you’re going on? Is is this something that is necessary? Should you be spending your money on on this, you know, I actually, many times had families coming in and being like, help my spouse is like getting on the phone, and they’re buying a PS5 and like, these really, really expensive things. And so having these conversations of like, is this a necessity right now like your medical bills, and you know, things like that. And so this is a really good introduction to that conversation to one that you can check and kind of see where they’re at. If you’re feeling like, Ooh, this is maybe something we need to be addressing. It gives you a clearer picture as a clinician, I feel like, and then it also allows you to really start having that conversation with them, if you’re seeing some of those behaviors.
Megan Wilkinson 38:25
So on the first page, it talks about the very basics of needs versus wants. So you start on the first page, and you outline a need is what is essential to live and survive, it does not change over time, individuals have the same basic needs, it should not change from individual. And then a want to something you would like to have. It’s not essential for survival, and it can change over time. And it might be different from other individuals. And so then again, you can depending on how you want to use this, you can maybe jump off, maybe you some examples, like what would you consider a need? What would you consider a want before you move on, or if you just kind of want to see, see how it goes like, let’s see how much they they’re grasping here, let’s let’s make this more of an assessment. Just get on to the second page. And it has an items lists of different things like cable TV, gas, and electric, your smartphone, gifts and holidays, clothing, home decor, jewelry, lots of different things, and then as two blank categories, two blank columns, that they can sort those items from needs versus wants. And so then after they’ve done that, at the bottom, it asks you to reflect where some of these difficult to answer why or why not. Because I do feel like some of these are maybe a little tricky. So one of my favorite trickster ones is smartphone. Because, yes, a phone in a lot of situations is a necessity. But do you need to have a smartphone right? Do you need to be able to read someone in a case of an emergency, but do you need to have the iPhone 13? Like, is that absolutely a necessity? Is that something you need to be spending hundreds of dollars on? And then also a Netflix subscription? I mean, I the amount of people that are like, yes, I need that, absolutely, I this is something that is a necessity. And it’s like, it’s actually not. And so really having sometimes those hard conversations is part of our job as as OTs, you know, and this is one of them. But I really like how simple this activity is, it can really give you a lot of insight with your client. And it sparks a lot of conversations. And I love this too as a something to be looking to co-treat with speech therapy on to, to really be looking at some of those cognitive skills and how you can kind of both be tackling those, you know, more functionally, on the OT end, and then really hitting those cognitive skills from from speech therapy.
Megan Wilkinson 41:00
So I love this activity, the amount of times I have had these conversations working in neuro is, it’s quite a lot. So I think this should be very helpful for quite a wide range of of clients. This is also great for some of those younger adult clients, so ones that are, you know, maybe autistic and, or developmentally delayed, and working on some of those, like, I want to be more independent, some of those life skills that we’re looking at. And so this would be a great activity for them as well.
Karissa Simon 41:37
I was thinking that too. I spent some of my internship, like the long the level twos, and an inpatient adolescent unit. And I was thinking this would have been so helpful to have, because most of them, yes, they were inpatient for a couple of months, but eventually they were going home, sometimes what ended them like they got in here in there, because they were making these really risky choices. And a lot of times money is part of that. So that’s what I was just thinking this would be so great in a mental health setting. And I love that as an activity, you can just pull out, you don’t have to like create your own list, you don’t have to create your own table, which we, we all know, as OTs, we do that all the time, we create our own handouts, and then have them in a little folder that we use for ourselves. But it’s great that we just have this activity, you could just pull it right out and be ready to go.
Johnny Rider 42:27
I was gonna say, I’ve done activities like this with people experiencing significant mental health challenges as well. And I’m always scrambling to come up with these things, you know, and I don’t want to waste my or my clients time, you know, we try to come up with some things to discuss. So this is just a great starting point, you could lead this as a practitioner in so many ways we did after we do this, the beginning of this activity, then start talking about the cost of some of these things, and comparing that and having them write that down. It could turn into developing a budget. I mean, there’s so many possibilities, depending on the client, the situation that context, but at least you have this to start with, and you’re not rushing around or scrambling to figure something now.
Karissa Simon 43:12
Yeah, I love this one. Okay, so now we’re gonna wrap up with our case study. So Mr. Jenner is a 63 year old man who was diagnosed with early onset Alzheimer’s disease six months ago. Since his diagnosis, he has retired from his job as an electrician and has stopped his role as pack leader for the local Boy Scouts troop because of concerns for his worsening memory. He was referred to your outpatient occupational therapy clinic by his primary care physician because of worsening independence and his daily tasks. Mr. Jenner is married but his wife works full time and is unable to provide supervision or assistance during the day.
Karissa Simon 43:55
So each of us selected a resource that’s archived to use with Mr. Jenner’s case. And I’m going to talk about mine first. So I selected the ADL Checklists for Early Dementia as my resource. So for those listening, it is four pages and it has a bunch of little boxes that have like items listed such as wash hair, shave, make bed, glasses, and you cut them out. And then you post them on a blank sheet of paper. And you can laminate them and then the person can check them off as they go. What’s great about this worksheet is that you also have blank ones. So if there’s something specific to your client, you can fill that out, put a little picture in there, or if you feel like their needs are very specific, you can just keep using those blank ones. So I made one for Mr. Jenner. So mine is about two pages long. You can see it’s nice and large writing and it also has a little picture next to it, which I thought was great. For him, I just made ADL routine, because I thought that, given that this is pretty new, and he’s had to retire, and he can’t do his leisure tasks anymore, his wife’s not home, he definitely wants to be able to at least get up and get himself dressed and showered and eat and take his medicine. So I put all of those on there. And then for my last one, I put call his wife, because that’s always like an important reminder that if he calls his wife and says, Oh, yes, I did everything on the checklist, checked it all off, that’s a way that she can kind of monitor him at home, and make sure that he’s doing what he’s supposed to. So I think that this resource is just really great. And I would use that all the time in my practice. And then next, Johnny, you selected the Working Memory and Adaptive Strategies. Can you tell us a little bit about this resource and why you selected it?
Johnny Rider 45:58
Yes, thank you, Karissa. So this is a one pager. So it’s nice and straightforward. But it’s got some information on there, that is beneficial for both the clinician, occupational practitioner, and much anybody else involved. So as we thought working memory, we know that it’s an essential part of everyday cognition, right. So find strategies to maybe adapt to the loss of this executive function is really important, but it can help us mitigate kind of those declines associated with things such as early stage dementia, and it can help our clients improve independence, and kind of maximize what they can do. So I like this resource and chose it because one, it’s great for non-therapists, so someone that may be less familiar with working memory, such as other health care workers, maybe caregivers, family members, support staff to that will be interacting if you’re in an inpatient facility, and we can use this to help them better understand what the client may be experiencing some basic strategies to adapt and compensate to those changes.
Johnny Rider 47:05
It also though, has ideas for the therapists as well. And this could also be for family and caregivers. It provides various areas that we could challenge. Okay, so maybe we want to take an approach to see what we can remediate what we can work on, or here’s some areas to challenge and engage this individual or Mr. Jenner in this situation, rather than only adapting or only compensating, even though no, we’re going to introduce some of that at some point. So I also think this is great for OT month, which we’ve been talking about, because in this handout, it highlights what an occupational practitioner can do to with someone that may be having some difficulties with working memory, it’s showing some early signs of cognitive decline. So it’s another way we can advocate for our role in functional cognition, which is growing, and it shows how we can support someone with these types of deficits.
Karissa Simon 48:01
Thank you so much, Johnny, and Megan, you selected Strategies and Considerations for Early Stage Dementia? Can you tell us a little more about this resource and why you picked it?
Megan Wilkinson 48:11
Yeah, so I think I kind of went similar thinking to Johnny, I was actually thinking of the wife a lot when I was looking at that that case study. You know, and I think that’s a really important thing that we need to remember as as practitioners that a lot of times if we support the primary caregiver then that makes leaps and bounds for our clients as well. So it’s a one of those things when you think about the team approaching the primary caregivers are a major part of that team. And so relieving their stress is huge. And so I was, again considering using this simple one page handout for the caregiver giving it to his wife in and making her feel a little less stressed and more relieved about his condition and his safety. So working on on wayfinding there’s a really nice picture at the beginning of this that is talking about the decals on the front of it and again, he’s he’s at home, but just considering their home environment. She’s living there with him right and so how do I make visual cues for my spouse to make it so that he can do these things on his own? Again, you know, some small things that she can be looking at to reduce that stress on herself.
Megan Wilkinson 49:35
And so yes, it details wayfinding especially because I think as a a caregiver, worrying about them getting lost or like wandering out the door, or some of those types of things is one of the greatest anxieties. When you’re kind of in this in-between stages, they they their condition progresses, and so has lots of tips there. And then it talks about safety. And talking about like a non-skid mat for the shower brighter lighting, car keys in a safe place again, like, maybe let’s put those up in a way, while I’m not home, I would not want my husband to grab the keys, and one of those kinds of spells that they have and leave in the car. And it talks about the using different cueing for them as well, which I think improving communication is huge, too, that can be such a stressful factor for for caregivers, you know, they, a lot of times can find themselves getting frustrated, because they just don’t have the right words to be able to communicate in those situations. And then later, they’re feeling guilt because they didn’t handle those situations with their partner the right way. And so just giving more tools for her to be able to kind of manage the situation makes it easier for the OT the client, that the PT everybody on the team. Because, frankly, she’s the one that he relies on the most.
Karissa Simon 51:13
thank you, Megan, do you guys have any more thoughts on this case study how you would approach Mr Jenner’s case from a clinical perspective?
Johnny Rider 51:22
I have one thought Karissa, just as I was listening to Megan. It’s kind of just about how to use resources to in this setting, but in other settings. One thing I noticed is that in the typical medical model, when we think about giving resources out, or maybe some of you have been on the receiving end, it’s almost at the end of vacaa stay te or the last visit and all of a sudden you just get the stack. And what do I do with this. And that’s not in my mind the most efficient way of using handouts that may benefit caregivers such as the one that Megan just shared or the one I shared. But I hope that our listeners and our viewers consider how to use these sometimes. And what I found very beneficial and Megan as well as something like this I can give to the caregiver. And I don’t always get to talk to the caregiver for the entire time and I do a lot in home health. So this does work in settings besides inpatient rehab, which I know a lot of people work in, but and I’ll talk to him about how my role is also to support them. I know going through a lot of changes, I want to talk to them. But I want to give them some time to process as well now that they understand what OT can offer, I normally have a few days in between I see them, but in between the time that I see him. And so I might give him something like this short, simple, sweet, but very powerful. And say, I’d like you to read this, take some notes on it. Write down your own thoughts. And next time I come we can talk about how I can continue to support you as a caregiver. And then we’re not putting them on the spot, we may not be asking them to say something right in front of their partner, they’re already overwhelmed. And the majority of the time when I do that, they’re very appreciative and comment how no one has given them a chance to do that. And so I think it can be very powerful. And taking something like this, as Megan said, and giving it to Mr. Jenner’s partner, and then saying, put some thought into this, let’s talk about this more. This is not the only time I’m going to give you this piece of education. I doesn’t always work in an acute care setting where you only see them once or twice. But I think for those of us working, where we see them at least more than once we can consider using these resources. Again, not a one time intervention, not a give it and bye bye, its how do we continue this conversation? How do we give them time to reflect? We know that it’s unnecessary when we’re talking about big life changes, recovery, overall well being.
Karissa Simon 53:47
That’s a great point.
Megan Wilkinson 53:51
When I’m actually writing a lot of my handouts, I envision it as the therapist sitting down and spending a chunk of their session going through it with them. So when I’m writing it, that’s my point of view. Because that I think, is really valuable. Because if something comes up and they have a question about it, then you’re there to answer it and support them in that or if if something doesn’t, you know, if they have the reaction of like, well, that’s not applicable to me, you know, you can kind of support or redirect from your educated understanding of it instead of like, I’m giving this to you to look on on your own time and just expecting one that they read it. And two that they they take it in in the right way and the amount of times that I have given a handout and they have all these questions or like this flood of emotions and they need to process whatever it is and it’s like, that’s part of our job as clinicians is to help them with that information and to process a lot of these changes that are going on in their lives. And so I think that’s an absolutely great point. I love your point about having them take notes and bringing it back. I think that’s a, you know, because sometimes depending on what setting you’re in, you might not see them for a little while, if you’re only seeing them once a week, then, you know, they might have read it had reactions, and then kind of forgotten what they want to say. So I think that’s a great point, Johnny.
Johnny Rider 55:20
I mean, our skill doesn’t come and giving the handout like what you’re saying, like, we’re on the same page, our skill comes from what we provide with this handout. But these handouts are so great to support that kind of give us a framework and guide, give something to the client to consider after and continue pondering and reading. But I mean, that’s why these handouts are great, because you’ve written them. And all the writers have made sure that they are something that helps us provide a field service that is very meaningful to the clients and all those in their supporter roles.
Karissa Simon 55:53
And if you’re not sure what to do, as a clinician, they give you ideas of what you should be doing with a patient like Mr. Jenner. Like just to go back to his case study, like, the things that jumped out at me is that he’s lost, like all of his roles, he’s not working anymore, he gave up his Boy Scout troop leader position, which was very meaningful to him. So for someone like Mr. Jenner, you want to find a way to reengage him in roles and routines and give him some sort of occupation that’s going to be meaningful to him that he can do safely, or find ways to make it safer for him. So he can engage in something and isn’t just sitting in the house, just having nothing to do but think about getting out and going to do something because you need to engage him in something, and work with his wife to do that. And these handouts, kind of help guide you through what you should be doing with Mr. Jenner.
Megan Wilkinson 56:48
Yeah, my thought went to could we contact the Boy Scout troop? And like, is there something he could be doing at home, so he can still be involved like a little project he could be doing or something like that, that he can have it and then when he has like, support caregiver support to like, go see the troop or whatever, he can present his project or something like that a way that he could still be a part of that, but in a safer way. I mean, clearly, he was a part of it for a long time, I’m sure they would love to support him and have him still be a part of it. And so accessing those resources is super important.
Johnny Rider 57:22
There’s been a few case studies, and I won’t like spit out the actual case studies right now. But where occupational therapists have gone into organizations, and trained organizations on the diagnosis or on the concerns and how to effectively deal with this individual who, you know, there’s meaning both ways Mr. Jenner gets meaning from the Boy Scouts, but I’m sure the Boy Scout troop loves Mr. Jenner, too. And so it’s that mutual benefit, I could easily see and I could support it with evidence that we could go in, just like what Megan said, find ways for him to be involved, but also maybe provide trainer some resources to them on how do you continue to engage with Mr. Jenner? Even though there may be some cognitive concerns? How can you support him in the best way that you want to, and that can be applicable in any setting where someone has that meaningful occupation, but maybe their organization or their club, or some of their extended family members aren’t quite sure how to deal with them. That’s a great role for occupational therapists.
Karissa Simon 58:25
I really love that Johnny. And then also, I think, as occupational therapists, a lot of times family when they get these big scary diagnosis or like, diagnoses are like, nope, let’s step back. Let’s stop doing everything like you’re at risk. And it’s really our role to evaluate the client and say, No, you know, he really can still do this for now he is actually better than you think he is. He has the ability to do this. Here’s the evidence, I did this test and it shows that he has this still and let him go back and do that it was meaningful, it was important to him so we’re also advocates for our clients.
Johnny Rider 59:01
Great point.
Karissa Simon 59:01
Okay, and so now we are going to highlight some resources released by the other teams that therapy insight. So for the PTs, and go ahead and switch the slide. So the PT just released a resource called How and When to Calculate Ankle Brachial Index. This handout shows you how to calculate the Ankle Brachial Index. And when you should be doing it to check for peripheral vascular disease. It’s a two page handout and has a bunch of like tables, places where you can write things keep track. And it’s a great resource you can find that on therapyinsights.com. And the speech team just released Apple Watch Safety Features. It’s one page handout and it has different things that are available on an Apple watch that helps with safety. So there’s fall detection on some of them. Emergency SOS, GPS is tracking and the pros and cons of using these features, something to think about. Also this can be found on therapyinsights.com.
Karissa Simon 1:00:07
So thank you so much for joining us for episode two of the Resource Roadmap Show, you can check out all of the resources we talked about today at therapyinsights.com. You can get instant access to all of them and hundreds more in our library by joining Access Pass membership. The link for all the resources are available in the show notes. If you have any questions at all, please reach out to us at support@therapyinsights.com. If you are a current Access Pass member, be sure to vote for what we create next. Megan loves that feedback when she’s creating the handouts and our next new episode will drop on May 1. Thank you so much and we’ll see you then.