Karissa Simon 0:13
Hello, everyone, welcome to our fourth edition of the resource roadmap show OT edition. We are welcoming all of our new and returning listeners. We’re so excited you’re here with us today. My name is Karissa Simon, I’m your host for the show and I am joined by our wonderful OT content development team, Megan Wilkinson and Johnny Rider. In this show, we’re going to be discussing the resources released by Therapy Insights each month how you can use them in your practice, to make your life easier, how you can provide them to your clients. We’ll also be discussing some recent articles that came out and how you can be more evidence-based and your practice. And finally, we’ll be finishing up with a case study and discussing what we would do as OTs and kind of giving you some ideas of how to provide really quality interventions for that patient.
Karissa Simon 1:09
So before we get started, we just want to remind everyone that this show is being offered for AOTA approved CEU credit. If you’re interested in that, just go to therapyinsights.com and you can get further instructions there. And because of that, we do need to verbalize our disclosures. Everyone here is being paid by Therapy Insights to be part of this course. And we are going to be talking about resources that are provided by Therapy Insights. So now that we got all of that out of the way, let’s dive right in and talk about this month’s resources.
Megan Wilkinson 1:43
So our first one, we’re looking at a resource that’s developed as an actual material to use in therapy related to the Kawa Model. And this is such a wonderful model to use. I love the imagery of using a river as our life’s journey and how we’re moving through it. And on the first page is describing all the different aspects, all the pieces of the Kawa Model. So the water is the flow of the person’s life, the riverbanks and the river bottom are those social and physical contexts or environments. And then the rocks are, they depict our life’s obstacles and challenges, which, you know, that’s really kind of our bread and butter that we’re looking at in therapy, why are we in rehab. And then the driftwood are the personal assets and the resources that can positively affect those circumstances. And so what I really love about what we did with this material is there’s the blank page with a beautiful river and riverbanks running through it. And then we have rocks and logs that can be written on and cut out. And then there’s an example exercise that goes with it as well, because sometimes having that visual is, is really important to kind of understanding and so on our example, we developed a case study, essentially, someone who’s had a brain injury lost their daughter in the accident. And so it does a really good job of showing, being able to write down your positive attributes, they’re educated, they’re outgoing, they’re willing to try new things, they they consider themselves to be a strong individual, but they’re facing the fact that they don’t have any hobbies, they feel really anxious, they have chronic pain, their executive dysfunction, and their grief and their fear. And then it has on the banks, arrows that are either moving in which is narrowing that river that flow of life. So the fact that they lost their daughter, they don’t have a job, they have no friends support. And then there’s arrows moving away from the river things that are widening it, and allowing greater flow of the of the river, such as having good family support, and a supportive rehab team. And so just as a really good job of creating that, that visual image of kind of this stage of life, you’re in rehab for this really traumatic experience, there’s a lot of barriers, but how can then we as therapists, help remove some of those barriers, either by widening the banks or take some of those barriers out of the river so that life can continue to flow and continue to move forward. And I just think this is a really beautiful way to kind of depict that process, the rehab process and then be able to, to set goals and really see where the patient’s mind is, with what their personal barriers are for their life in that moment.
Karissa Simon 4:34
And for anybody listening is four pages. And like Megan was saying, there is a blank page at the end of has that river depiction and there are rocks and driftwood that you can cut out and have your patient draw their barriers or their positive attributes on there and posted on and I do just absolutely love this. It’s such a great thing to use to really help your patient take a look at what’s actually going on in their life, it makes them think about what barriers actually are there that makes it harder for them, or, and what resources that they have that makes it easier. And I like that, you can just sit down with them or give it to them on their own and let them work through it. And just really have them maybe gain some insight into what might be affecting them outside of just a physical ailment.
Johnny Rider 5:27
Similar to the actual Kawa Model, and how flexible it is this handout, it’s very flexible in the ways that we can use it as occupational therapists with clients, caregivers, at the beginning of rehab or middle or towards the end. So I think this is a great resource. And we know that the Kawa Model is very well received by clients. And so this is something that supports us we don’t have to fumble around draw a picture, you know, kind of ad lib in the moment, we have this beautiful picture and an activity that goes with it.
Karissa Simon 5:59
Thank you both, let’s go to our next resource. Oh, it’s actually we’re doing an article snapshot, sorry about that. About the Kawa Model. So The Dynamic Use of the Kawa Model: A Scoping Review. And Johnny, can you tell us a little bit about this article?
Johnny Rider 6:16
Yeah, I’d love to. The Kawa Model as I mentioned is one of the favorites of a lot of occupational therapy practitioners. But interestingly, if you think about the timeline for our profession, the Kawa Model was only developed in the 1990s. So it’s relatively young, when it comes to our use within occupational therapy, it’s gained a lot of popularity because it is so effective, it’s so flexible, it is so adaptive. And so we wanted to look at a scoping review to kind of see well, in the last 30 years, how have we been using this. And so this scoping review found 10 published articles and three unpublished dissertations, looking at how it can be used within occupational therapy practice. And a couple big things that came out of this review that some we might already realize, but it’s nice to see this coming through the evidence as well. The Kawa Model is culturally flexible, which is very important. It’s an adaptable tool, it can be used to examine and enhance well being, it can be used in a lot of different ways. And I think this is one of the coolest parts of this model and the handout that we just presented, we can use it as a framework, right. And that’s how we typically use it, or learn about it in occupational therapy school. But we want to remember that it can be used as a client centered interview guide, it can be an assessment tool, it can be an intervention activity, and it can be an outcome measure. And we see that in the evidence as well. It’s most effective, though, when we have some experience as occupational therapists, and when we use it with other relevant tools that are necessary for this diagnosis for this client for this setting. So part of what they found is some practitioners who really only learned about it in school and didn’t dive into the Kawa Model didn’t use it as much and it was mainly based on experience and kind of that lack of understanding on how to use it. So we’d encourage you, if you are open to learning more, or if you’ve always wanted to learn more, try this handout out, read some of the evidence, read our full article snapshot. They found that really, this tool can help develop a therapeutic partnership, we think of that therapeutic repport that relationship between the client and the clinician, this can be used and has been used to support that. And basically, in all of the studies that they reviewed, they found that the Kawa Model provided a unique platform for open communication, it provided an opportunity to gain a deeper perspective of the client, but also from the client. And it has been used across practice settings. And there’s significant evidence in mental health settings. And that recognition that it is culturally flexible, so it can really be used with all of our clients.
Megan Wilkinson 8:53
Yeah, and
Megan Wilkinson 8:54
Thing I love, sorry, the thing I love most about this is that I think that the river as being a metaphor for life is just this universally understood metaphor, right? I just think no matter what culture or background you come from, so many people use that as the picture of moving through life. So it’s so functional across multiple different cultures and people.
Karissa Simon 9:16
Yeah, I definitely agree. And I love that we’re giving occupational therapists an easy way to use the model. Because I feel like in school, you just are kind of given it as a framework and just a big like overreaching thing that you can use. And here in this handout, we’re just saying this is what you can do as an intervention, it’s an outcome measure. And you can use this, like Johnny said throughout your intervention, to see how they’re doing. I just love that. We’re making it so simple, especially for people maybe who are just coming out of school and heard about it but don’t really know how to apply it to their practice.
Johnny Rider 9:54
I hope anyone listening or watching today walks away and doesn’t only associate the Kawa Model as a framework, and they realize that there’s so many ways that we can use it in clinical practice.
Karissa Simon 10:09
So our next handout is the Overstimulation after Brain Injury. It’s a one page handout. It has two pictures, and then some lists of different things. Megan, can you tell us a little more about this handout?
Megan Wilkinson 10:22
Yeah, so this one, again, I love a one page handout that simplicity of just here’s a resource, everything you need to know is on one, one single page. So this one is really intended for the individual to have as a resource with them to reference with that over stimulation that they are experiencing. Over stimulation is is a really common side effect after having a brain injury. And it kind of talks about normalizing, first of all that sensory overload that you can have with a brain injury, which I think is an important first step is that this is a totally normal thing for you to be experiencing. Now let’s talk about first we go into common triggers for overstimulation so that you can kind of be aware of those information, that information going into a certain situation or environment and prepare yourself before you go in if you must, or avoided if you can. And so some of those look like bright or flashing lights, new environments, loud music, it can even be an unpleasant taste, itchy clothing, things that maybe didn’t bother the client, previously. And now it’s really it just aggravates them. And that’s all they can really focus on. So there’s a nice long list here that that goes into different triggers, for overstimulation common ones, and it can be outside that list as well. But these are some pretty common ones. And then the kind of second half of the page talks about strategies for actually coping with that over stimulation. So being able to regulate their nervous system. So we’ve seen these in a lot of other handouts that we have. But again, this is very directed towards that very specific overstimulation with brain injury. And so taking a walk outside, removing himself from the room, practicing mindfulness, deep breathing, using earplugs if it’s safe to kind of reduce the noise that you’re experiencing in loud situations, having dimmers on your lights, taking a warm shower, using a weighted blanket, chewing gum, so lots of lots of good coping strategies. And again, when it comes to sensory overload, someone might really struggle with that auditory sensory overload and not have anything related to tactile, it’s can be so different for different clients. And this is a really good starting point, kind of having these resources and you can walk through it and check off yes, this is I’m feel this, I experienced this, this is so true to me, or, and draw lines to ones that aren’t, aren’t as as true to them and going through the coping strategies. And maybe you practice some of those in therapy, and see what works for them. Because again, with coping in general, those strategies are going to be very different for different people. So having this as a way to say, this isn’t helping me right now I’ve tried this one, it’s not working, I can go to the next one on my list. So a good simple one page handout with lots of lots of different strategies on it.
Johnny Rider 13:18
We, you know, it’s hard for us to even talk about without having a brain injury, sometimes our own sensory processing and what might be over or under stimulating. And so we have to remember for our clients, just asking an open ended question might be too much, especially after a brain injury. And so we can use this handout to kind of help them walk through, as Megan has already said, but also, in a way give us some ideas, some categories for them. And they might then be able to say, oh, yeah, and this and this, and this from kind of introducing the idea. The other thing that I think is great is we can build on these strategies and basically create a sensory diet for them and help them kind of even on the back of this handout, right, write down those things that they want to use that they want to share with other people. And whatever their level of communication or cognitive level, this can be adapted, and be turned into even more of a tool that helps them with other providers with family as they go back to work as they go back home. You know, whatever their environmental or context is. And so I think there’s just like with most of our handhelds, multiple uses for this.
Karissa Simon 14:24
I like to that you could hand it out maybe to staff on if you have a brain injury unit, you can hand it out to staff, and kind of give them ideas of I’m sure most RNs will know like, what might cause this but maybe they’ve never really thought about it. They know it like intuitively because they’ve had people react, but just giving them such a clear hand out on what can cause it what triggers to watch out for or also to family or friends so that people might not have to explain over and over again, what is triggering to them, kind of just giving them a resource to provide to their family and friends.
Megan Wilkinson 15:01
Yeah, I think with with brain injury in general, one of the biggest things you hear in brain injury is about how it’s invisible, right. And so this is one of those aspects of brain injury that’s invisible. You don’t walk into a room and someone looks at you and goes, Oh, that person is overstimulated by bright lights. Right? No one has any idea about that. So you have to be able to advocate and educate. And this handout can do that.
Karissa Simon 15:21
Definitely. We’re gonna go to our next one, which is another handout, it is two pages for those listening and has a lot of different pictures on it. And it’s called Rehabilitation Settings and lists each one and Megan, can you tell us a little more about this one?
Megan Wilkinson 15:44
Yeah, so this one is actually meant for any discipline. So if we have listeners that are not OTs, this one was designed to be able to be utilized by SLP, by PT who whoever might find it beneficial, but it really details navigating our medical system and moving through the different settings that you can be in because most of the time, when you’re in the hospital, you’re going to end up at a couple of other locations as well in that trajectory. And so that can be really overwhelming. You know, I especially think about some of these really, more complex conditions like spinal cord injury, brain injury, where they they are having potentially multiple years of therapy in and out of therapy, different settings, different therapists rotating through all of that, and how, especially at the start, I think this is a really good resource to have. So that because you’re you’re feeling that intensity of like, oh, my gosh, my loved one, just had, you know, a spinal cord injury, and what does this even look like, I mean, you’re already overwhelmed in that situation, and just having something that you can refer to when you have time to really look through what this might look like, I think is an excellent, excellent resource.
Megan Wilkinson 16:56
So it details six different settings, acute rehab, long term acute care, inpatient rehab, skilled nursing facility, home health, and outpatient. And then under each setting, there, it details kind of what the, the design of that setting is, like, what their ultimate goal is, why you are there and why it’s different from the other ones. So when you’re in acute care, you are there to, to immediately resolve the severe illness injury, or have a surgery or a procedure, right, you’re, you’re there to just resolve that problem to the best of its ability. And then once you move on to being more stable, then you might go down these other avenues. So it kind of details why are you in this setting right now. And then some of the differences and what you might see so talking about being potentially hooked up to lines and tubes, when you still start therapy when when you’re in the hospital, versus you know, an outpatient, right, you typically drive to a brick and mortar and, and walk in and you have appointments that are set a couple times a week. And so just kind of do detailing how many times a week might you see a therapist and then at the end of each paragraph, it also talks about some of the skills you may or may not be working on. And again, of course, we know this is broad, but having kind of a general look at some of those differences. So and again, this is how this is applicable across the different disciplines is it talks about self care skills, mobility, modifications, but also decannulation, which is typically you know, a more SLP thing. So has a nice little bullet pointed list for each each setting of something that you might be working on.
Karissa Simon 18:45
I love how this is like, I feel as OTS we know all of these and we just assume that patients and family kind of know all the different areas they could go to. It’s easy to kind of fall into that like that you get used to it and you expect everyone else to know it. So I love that we could just hand this over to a family member and explain our reasoning why we think especially in acute care why we think they need to go to one setting versus the other. Why one is more appropriate than the other feel like it is a nice kind of follow up to your recommendation to a patient especially in acute care.
Johnny Rider 19:25
It’s a way for us to help improve that health literacy as well. I wish I had this a couple of months ago because probably like you and most of our listeners, if you’re the healthcare professional in your family, you get all the health care questions and I had a grandmother who unfortunately broke her hip across the country and families calling me you know saying what the heck is a SNF I’ve never heard of this and trying to navigate the world of rehabilitation and realize that okay, this is where Grandma’s gonna be next and this is why she’s going here but I still hear as you mentioned, Karissa, a health care professionals using these acronyms sometimes are talking about these settings as if everybody has this, you know, intimate knowledge of what happens in each setting, and they don’t. And so this is a great resource that we can share.
Karissa Simon 20:14
And we’re gonna move on to our next one. So this is a great activity, it’s called a Minimum Wage Activity. And for those listening, it is four pages. The first page is kind of instructions. And then there’s a handout and two pages that have a bunch of cards you can cut out. So Megan, can you tell us a little more about this one?
Megan Wilkinson 20:35
Yeah, so this one is working on those money management skills. But it also has a lot of that real world reasoning and problem solving. Right, it’s not just an equation that’s being put in front of them, it’s looking at what’s necessary and what’s not necessary, really breaking down what it looks like to make a wage in our country. And so the cool thing about this is we have this lovely QR code on the front page that you can link up to what the minimum wage is for specific states. And that will update and change as the years go on. So you’re, you know, we don’t have the the right now, but then in next year, it would be not correct anymore. So this will stay accurate at with the resource as it grows. And so there’s a couple of different ways to use this. This activity, which is nice, I always think as therapists, we kind of need to have multiple backups based on time or the different type of patient and when something gets interrupted, or you know, you never kind of know what’s going to come up. So being able to adjust to your time limit is a really important thing. So this has tasks A, B, and C. And so you can go in starting, I’m just going to do task A and leave it be as it is. And that’s wonderful, you can have the goal of reaching all three tasks, but if something happens, it’s okay. So it has a lot of flexibility to its use. So in Task A, you’ve used that that QR code, you’ve determined what state you want. And you can make this randomized especially I love this activity as a group activity, because it actually acts as having a lot of group discussion about these these topics. And so you can have them randomly pick a state, or you can pick the one that you’re in, you have lots of different ways to use this. And then assuming that you’re working a typical nine to five, Monday through Friday, you have questions to answer. So how much in a day in a week, in a month in a year? And then do you think you could live off of that annual salary? Why or why not? So again, we’re really looking at some of that reasoning. How do we think that, you know, you’re getting that insight into the patient and whether they they really understand what it means to live on a salary in their state? Or is it like outlandishly not accurate? You know, so getting some of that good, good insight for some of those harder real world conversations.
Megan Wilkinson 22:57
So then Task B has you draw these cards, and then you have to calculate the impact that it has on your monthly salary. And so you’re, you’re tracking these events as you track as you are pulling these cards. So if you’re watching, you can kind of see but I will describe that some of the cards are negative, so like a hospital stay costs you $2,750 And some of them are positives, you had a garage sale and so you have $300 deposited back in and so you’re doing some of that actual math, which is great. We’re seeing how are they doing that? And then at the end, being able to look at aspects of how much money do you did you have leftover? What was the biggest expense? What purchases were unnecessary I think to some of these are maybe things we don’t always think about. Like for example on there we have a pet that has an emergency bill, like we think about our our expenses that happen all the time, or fixed expenses, but then there’s always those surprise ones that kind of pop up so also like how are they they responding to some of these ones that they may be like, Oh, I didn’t even think about that, you know, some of those those kinds of questions.
Megan Wilkinson 24:05
And then in tasks D this is really set up for working either in a group therapy session or the the therapists can also do this with them at the same time. So or pre done the activities you have something to compare with. So you’re comparing your salaries in which state made more and having some of those again, big conversations about that. How much, combining them together. How much would you make together? What’s a two person income looking like so just really having those real world conversations about money and, and having lots of different ways to kind of do it in a fun and playful way. So lots of options.
Johnny Rider 24:43
I think, oh, go ahead.
Karissa Simon 24:45
No, you go ahead, Johnny.
Johnny Rider 24:47
I was gonna say when we we talked about functional cognition and other weeks too, but a lot of a prominent researchers and leaders in our field related to functional cognition have come out and said, Hey, if we really want to address functional cognition, we need to do it in the context of instrumental activities of daily living things like what we’re talking about right here. This is how we get down to what is that reasoning? What is that insight process for our client? But also, where do we go from here? How do we start to address functional cognition, the cognitive abilities, they need to go back and live on their own and do some of these things. And so I think it’s great, we talked about this a lot, but we need to actually be doing it in practice. And here’s a resource to help support us as we do.
Karissa Simon 25:29
That definitely, and this is just such a fun activity to it’s something that’s very engaging it’s colorful. If I was a client, I would enjoy doing this. It’s something that’s not just the normal, find the animals or what, what animal is this? Can you spell it? It’s more engaging, more interesting, and something that you can easily pull out and do with your client and have an intervention right there. And I do love the QR code. That’s such a cool feature.
Karissa Simon 26:10
All right, let’s go on to our next one. So this is another article snapshot, the Loss of Financial Management Independence After Brain Injury: Survivors’ Experiences. And Johnny, can you tell us about this article?
Johnny Rider 26:24
Yeah, we wanted to look at the evidence that was related to some of the topics this week. So we had one on the Kawa Model. We wanted to look at what do we know from the literature regarding this topic of financial management, money management after brain injury. And so this was a qualitative study, they explore the experiences in detail of six brain injury survivors, and kind of looked at what happened after their injury, specifically with this instrumental activity daily living regarding financial management and their independence, their perceptions, including the treatment. And so in general, there were three big themes that they found, as they kind of looked at all the interviews and the transcripts, they found that there was this trajectory of financial management change after the injury, which we would expect, and it involved family members as really those key agents. So something for us to consider is, you know, are we involving family members in this discussion? Are we understanding the dynamic, you know, and who had responsibility pre injury for finances, and who’s going to have responsibility as we work through rehabilitation, they found that the current financial management situation really involved a couple different strategies, the biggest ones that came out, and this is from 2016, but still quite relevant was automatic deposits, learning how to do that, and then restricting the budgets until they were able to make sound financial decisions, there was a big struggle for control. Okay, so something we have to consider as therapist in which those survivors desire control, but they also were accepting the support for financial management. So it’s kind of like this balance. And there’s a conversation that we can have, again, with the survivor and the client and their caregiver, right, their family, whoever supporting them in this journey. But all the participants reported that they had a significant change in financial management independence, and that someone had to take control after the injury, and that it was important to them to have this gradual process of regaining control. And I appreciate that they all recorded that, because that’s what we talked about an OT all the time, right? How do we create activities, and we slowly work our way up for them to regain control. So this article helps us recognize when that financial management is a very important IADL. And it is within the scope of our practice. And as we just mentioned, we should be doing this more and it’s an a way to address functional cognition, we should be targeting financial management skills in all stages, and the acute the chronic stages, after brain injuries, because by doing so we can promote independence, we can promote autonomy, intervention should really find a balance between promoting that autonomy, but also preventing harm from, you know, poor financial management when they haven’t developed enough insight. They, they don’t have the cognitive abilities to reason through and make sound decisions. But there is that balance there. We could talk about with Megan’s activity that she just shared, what are maybe some appropriate things that they can start taking control over again, what are things that maybe they’re not ready for control. And so we have to be aware of their experiences, their perceptions, when supporting them through this change, and include them throughout this entire process. But I think hopefully, we’re all comfortable using this in some form. And with this research article, this snapshot article with this resource that was developed, we can even feel it, we can feel more comfortable and be ready to use it without any real preparation, right? We can just have that handout ready whenever a client wants to talk about this. And we’ll be pursuing more of this assessment interview approaches regarding financial management. This was specific to brain injury survivors. But this could also be in other populations as well. And so we can apply some of these principles and use the handout with anyone struggling with financial management independence.
Karissa Simon 30:13
It’s such an important topic that we do need to make sure to address because especially as people are aging, their finances become much tighter, there’s less room for error. And if they’re having any kind of cognitive challenges that could be impacting their financial management, we really should be looking at this and trying to help them find either someone to support them or get them back to a point where they’re able to do this successfully. So they’re not put in a really difficult position as they get older.
Karissa Simon 30:49
Oh, a lot of
Megan Wilkinson 30:52
Sorry, I’ll just say I think this article makes good points about that. Money management is not simple. When we’re looking at IADLs. It’s not just can you add and subtract some numbers together, there’s psychosocial aspects related to money management, and that’s what makes it so complex. You can give someone those numerical calculations in front of them, and they can do it with ease, but then you put them in a situation where someone’s gifted them $200, how do they spend that money? Right? Or what this article points out? Are they stressed? Are they starting to have mental health issues because they don’t have control over their own finances, it’s so much more complicated than what it looks like on paper. So these IADLs, that functional cog, everything you’ve been touching on is essential to our practice. That’s basically what I was gonna add on to and kind of this idea that we have to remember, like, what you know, empathize and recognize what it is from their experience, because some of them shared things like, you know, I’m making all this progress. But yet, how demeaning, can it feel when it’s my money, and someone else is like, oh, here, you can have $10 to do whatever you want. But I can’t control my bank account, or I don’t get to actually pay those bills, because I’m not being trusted with my own money that I worked hard for that I’ve earned. And so it’s something that we can’t, you know, just kind of take lightly when we’re addressing this, as you mentioned, there’s that psychosocial component that requires a very nuanced approach. But this is also more than just a one intervention session. This is something that needs to be ongoing. And I think it starts with understanding their perceptions of their money management before their injury, but also where it is now and really getting down to the heart of what do they want? What are they aware of? And how can we support them through this process, which is going to be a gradual process, not overnight.
Karissa Simon 32:39
Not only that, I remember, I had this patient who he was really struggling because as banking moved online, he had to figure out the internet. And that was just something totally foreign to him, he it was just very, very challenging. And I think I spent, like a total of five, to like six, seven sessions, just trying to help him navigate this learning the new system. And in the end, he was successful, he was able to figure out online banking, but it was very challenging for someone who maybe didn’t grow up with computer literacy.
Johnny Rider 33:17
And we didn’t used to see as much fraud as an issue. And you know, all this stuff that’s happening, which we don’t even understand it used to be you were robbed in person now, you could click on the wrong thing, or accidentally put your password in in the wrong thing. And your money could be taken from you. And that’s hard for some of our clients who didn’t grow up, as you mentioned, with online baking. And so there’s some benefits to having everything digital. But there’s also new challenges that again, are we ready to address those as occupational therapists are we considering those things and so hopefully, you know, if this study was updated in 2023, some of those new themes might come up of that security when I’m using my online banking and how easy it is to buy something online and spend a lot of money with one click, as opposed to having to drive to the store and count out cash or write a check. So positive and maybe some negative changes, but all things that we should be addressing as clinicians.
Karissa Simon 34:17
Now we’re gonna go to our next handout for the month, Subacromial Trauma, and this is a one page handout it has a picture of the anatomy of the shoulder. And then it has some, like it explained some things below it. Megan, can you tell us more about it?
Megan Wilkinson 34:37
Absoutely, so again, love a one-page handout. So I think the visual at the top that takes up about 50% of the page is really great for kind of simplifying some of what the below text is talking about. This handout is indented for staff, for caregivers, for family members. People who are, working closely with individuals who have had hemiplegia. And um, talking about how do we prevent subacromial trauma because there is a lot of research that talks about how we need to be talking about this really early on after somebody has a stroke that has hemiplegia associated with it because people who are not educated on how do we take care of that shoulder joint afterwards can inadvertantly cause subacromial trauma which can lead to more issues down the road. So the first part just talks about what subacromial trauma is and then the second part is talking about prevention. And so very simple bullet points has a nice picture that shows what 90 degrees of shoulder flexion looks like and the bullet points talked about not lifting, or pulling the individual by their arm or not pulling them up from a chair using their upper extremity. We’re not having them self range above that 90 degrees, or letting other individuals do passive movement above 90 degrees, and giving them reminders about cueing them to keep their elbow below the level of their shoulder when doing daily activities. So when they’re washing under under their arms, or putting on a shirt, kind of trying to keep those elbows down so that we’re not getting above that level. And then avoiding using pulleys for exercise. So we’re just really trying not to stress that joint, trying not to cause the the trauma and making sure that everyone who is involved understands these guidelines. This is unfortunately, something that I have seen a lot in a lot of different settings, with just caregivers who just aren’t educated, it’s not part of their background, but it’s also their job to take care of them and make sure that you know, they’re engaging in their ADLs or transferring them. And same with family, you know, they go to Oh, I wanna let me help you out, Johnny, you know, but then they’re like yanking them up by their arms. And you’re just like, Ah, stop and so this is a really simple handout that can just be provided with like basic education, even at the front end after having a stroke. And I think that this hopefully can be an easy lead into conversations with people that we’ve maybe seen doing improper transfers or things that could lead to this problem. So simple, but educational.
Karissa Simon 37:41
I like that. Especially I know, sometimes it’s hard to approach certain caregivers, that when we’re providing like our education, sometimes it comes off as us telling them like that they’re doing it wrong, or, and it can become like a kind of a hostile conversation that has happened to me in the past. I like that you could just provide this handout. And it’s like really not like that you’re telling them they’re doing anything wrong, you’re just providing them education. And hopefully that will smooth things over and create a less difficult conversation to have that person.
Johnny Rider 38:18
Because unfortunately, you know, this, this only takes one wrong movement, sometimes for an injury. And so I think it’s important that we do this early on, and frequently. And this handouts written in lay language that any anyone can understand. But it’s one of those things that we have to keep addressing, because it can set that client back, you can cause a new injury that can really be disruptive to that rehabilitation process. And that’s what we’re trying to avoid. We’re trying to do everything we can to help them and we don’t want anything to actually hurt them as part of their recovery.
Megan Wilkinson 38:49
Yeah, so I, I know a lot of places I’ve worked they do in-services to make sure that everyone is staying educated on these types of topics. And so this will be a really easy way to like, hear like for your next in service. This is a great handout to just make sure that everyone that is getting this literature and it’s been talked about with everybody. So like you pointed out Karissa, it doesn’t feel like a targeting thing. It’s just information we want everyone to have if we’re working with this population.
Karissa Simon 39:18
Or you could even post it to because the caregivers switch so frequently. It would be nice just to leave at the bedside or like you can circle it and try to make it obvious for everyone coming in that this is why we’re transferring a certain way.
Karissa Simon 39:33
All right, and now is the time for our case study. So Mr. Hernandez is a 45 year old male who was bitten by his dog at home and is now status post bilateral forearm irrigation and debridement with brachial to ulnar Aartery bypass with saphenous vein autograph. During his acute stay, occupational therapy was consulted to address new weakness in his hands and forearms post surgery, along with sensory changes. Mr. Hernandez is an electrician and owns his own company. He is concerned about his ability to return to work. He has a live in girlfriend who was able to help with ADLs and IADLs some of the time. Additionally, per the Social Work notes, Mr. Hernandez’s dog was euthanized after the attack and Mr. Hernandez is struggling with the loss of his beloved pet. So now we’re going to talk about some resources that we picked from Therapy Insights from a while ago that you could use in this case, and then after that, we’ll kind of talk about different interventions we would do. So I selected scar massage as a home program. So because it was a dog bite, you know that there’s going to be a lot of trauma, and it’s not going to be clean scars, it’s probably a lot of the incisions are going to require a lot of stitches to sew up. And because of that, there’s gonna be a lot of scarring. Not only that, but he also had to have a graph from his saphenous vein. So he’s also going to have a scar on his leg. And because he’s an electrician, he really needs that mobility in his hands and his forearms, he needs to be able to keep all those joints moving. So I thought this was a great resource to provide him so he can start working on it at home, it sounds like he’ll be really motivated that it’s important to him to get back to work. So I like how it just this handout is like really clear about what a scar is, and when to start the massage how you should do it. I think it makes it very clear like what to do, and it’s not complicated, and it has nice pictures on it. That’s a one page handout for anybody listening, so that it’s very simple. And you can go through it with them. And then they should be able to do it on their own to prevent that scar from reducing his mobility.
Karissa Simon 42:01
And then Johnny you want to tell us about the handout you selected?
Johnny Rider 42:11
Yeah, and with this case study, there’s a lot going on. So I hope all of our listeners realize there’s a lot more than we would probably do as occupational therapists, but we want to highlight a few handouts or worksheets or resources that we think would be beneficial. And so I chose a Sensory Screening Form. And so we have these forms available. And you know, we’ve all done this, we learned it in school. But if you haven’t done a sensory screening, or a very detailed one in a while, you might need a little bit of a refresher. And what’s nice about this is it gives you all that detailed information, we have images here of the forearm, with outlines for our cutaneous nerves, so that then we can take that information. And we could put this as part of our documentation. So it could be scanned, in which some places that specialize in hand therapy have a version of this that is scanned in or we can just draw right on it. It can be kept in a paper chart if you’re working in a place that still has paper charts, but it can also be used to help us write our narratives. So this is kind of like our resource here. And then we’re like, Okay, now we can talk about what nerve are we seeing some impairment in. And so we can track progression, like changes, both good and bad, as Mr. Hernandez is healing, as we’re maybe doing some sensory work with him where we’re trying to integrate and improve that, or maybe we’ve got some sensitivities, and we’re trying to desensitize some areas. But I just think, you know, we can all use a little refresher sometimes with some of our anatomy. And so this gives us all those ideas that also talks about testing, like, two point discrimination, you know, how do we inspect the integuments, and things that we might want to document and share with a physician? And how do we do basic some basic threshold testing and so it’s kinda like a cheat sheet, if you will. But I think it could be good for us to evaluate him at the beginning, maybe at a revaluation at our discharge to provide that more detailed report to the doctor and, and show him that we know what we’re talking about.
Karissa Simon 44:05
And then, Megan, you picked Theraputty for Improving Hand Strength and Coordination. Can you tell us about this handout?
Megan Wilkinson 44:18
Yeah, so I think this one, again, has really nice pictures, really simple ways to show a, a good HEP for improving your hand strength. I know again, similar to Karissa’s thought process, very motivated, he, I think would certainly follow through with with an HEP. And these are just good ways to be able to do that at home. The thing I really love about therapy, just as an OT is it’s something that they can do once they’ve got it down, like while they’re watching TV or you know, those types of things. So it’s a really easy way to make sure they’re getting in those reps every single day. And I think a lot of people find it enjoyable and relaxing too. And so I usually find that with my clients, there’s a pretty high use of, of an HEP with therapy. So just all the different aspects that we kind of hit on for addressing all the problems with his upper extremity. So, you know, looking at the scarring and the sensory and the strengthening and all of the concerns that he had. And, and, like Johnny said, there’s, there’s a lot going on here that we could unpack, I feel like we could have picked a multitude of different resources, but I’m really working on that, that strengths so that he can be getting back to his occupation as an electrician.
Johnny Rider 45:40
And I think we could continue on and progress this into like that work reconditioning or work readiness program, as we get some of that strength back actually simulate some of the electrical work that Mr. Hernandez is going to do. And we could do that in the outpatient setting, or even in the home health setting, wherever he is, we can start preparing him to go back for you know, the actual activities that he’s going to need to do on a daily basis.
Karissa Simon 46:05
Definitely, and do you guys have any other thoughts on this case study, or what you would address how you would address it with this patient?
Megan Wilkinson 46:15
I would say that, it is very important to notice the last bullet point which is related to him struggling with the loss of his pet. You know, I think our team is pretty good at hitting on the mental health and why that’s that’s just intertwined with pretty much every patient. But honestly, this is a very clear, like we’re coping with something really challenging because we’re in rehab because of the pet. Right. I mean, we went through this because of them. And now I don’t have them anymore, but I love them and, and a lot going on there. And so I think, you know, we have the opportunity. A lot of times when we’re doing some of these repetitive exercises, or we’re doing scar massage, or we’re doing some of these things, to be having kind of some conversations alongside of that, and, and checking in regularly with How are you coping, I mean, that’s something that we’ve touched on before is really part of our scope, we need to make sure that he’s doing okay, with his mental health and in coping with those types of things. And if we start to see some of those things, you know, kind of be concerning then getting in touch with the right types of people, but offering, you know, that therapeutic relationship, like, you know, we were here and we understand and you know, it’s someone they show up and see regularly that they can have a building conversation with the troubles that they’re having.
Johnny Rider 47:35
I think it’s important to remember that we’re trauma informed practitioners. And we should recognize that, you know, there’s two parts of this that are pretty traumatic, the actual injury, right and being attacked by a dog. And that’s a dog that Mr. Hank Hernandez loved. But there might be some post traumatic stress disorder related to this. But then the second trauma that is very obvious here is having to euthanize his dog. And so both of those things, when Mr. Hernandez is ready should be addressed by the occupational therapist, and there are screenings that we can use for PTSD, we can ask some open ended questions we can, you know, approach that topic in a sensitive and trauma informed way for when Mr. Hernandez is ready to talk about that. And then, as Megan mentioned, provide some of those interventions that would help him process this and work through it. But I think that needs to be at least assessed at some point. And depending on when we are treating him right in those early stages, it may not be time to talk about that in depth because he might not be ready. But we can offer resources, we can tell him that we can work with him when he is ready. Even if he’s healed physically from that you may need a referral to come back to occupational therapy, or offer and educate him on other psychological and counseling services available for some of that trauma that he experienced.
Karissa Simon 48:52
Yeah, as you both have said, it’s a very complicated case, because of the the dog being his and also his career being so affected by the injury. It’s not like he was someone with a desk job that could hopefully get back to it or use dictation if needed. Like as an electrician, he really needs the function in his hands and arms. And so we would hope that he would recover fully, but you’ve never really know with these injuries and they’re prone to infection and sensory loss can be permanent. So even addressing that part that he might need a new career choice and kind of helping him in that process and really finding a new path forward for him if the outcome is not what we hope.
Johnny Rider 49:37
he might have to go into homes if he continues to be electrician where there are other animals. And so maybe he’s an industrial electrician and working in a warehouse but you know, there’s all those client factors that we’ll never see in a case study only when we’re working with this individual but it just reminds us of the unique benefits and responsibility of being an occupational therapist to truly gain that occupational profile and understand our client, so that we are there to support them in their unique life and in their own context.
Karissa Simon 50:09
Very true, great points. Now we’re going to review some resources you might be interested in from our PT, and speech therapy teams. So from the PT team, we have this Carpal Anatomy and Diagnostic Resource for clinicians. For those listening, it is a one, six page document pretty long one that has all the different bones of the hand, and kind of explains the anatomy and different things about it. So that’s a great resource if you want to check it out. And the speed also from PT we have Should I Use Hot or Cold. So this is talking about the different reasons you would use cold therapy versus hot therapy. And it’s just a one page handout very simple and short, which is great. And also Sleeping Positions for People with Spinal Pain. So again, a one page handout, it has some different pictures of different positions that could cause pain and how you should position in bed if you are a back side or stomach sleeper, so also a wonderful resource to use for our clients. And finally, we have What is Huntington’s Disease? It’s a two page educational resource about what it is and management outcomes and how, as therapists we can optimize the quality of life. And also, what is Johnny or Megan, do you know how to pronounce this first word is? Arthritis, Psoriatic Thank you Psoriatic Arthritis. And it’s also a two page handout. And it talks about what it is and how you diagnose it, how it’s treated. And from the speech therapy team, we have Incentives Spirometer. And what it is, we’ve all seen these in the hospital, the benefits of using and diagnostic recommendations for using, how do you use it, and it has a great chart with the normalized measurements. And I would love to you could provide this to your patients so that they have a better idea of why they’re getting this in the hospital and what it’s for.
Johnny Rider 52:38
I think this one’s great. I’m gonna jump in, if you don’t mind, because no, definitely I can’t believe that they just hand these out. And they don’t give patients anything, because I’ve seen that with my own family. And so it is a great resource for all of us to use whatever profession, but it’s, it’s it’s wonderful that it’s coming from our SLP colleagues as experts in here. But it still just baffled me with how many years we’ve been using these and just handed them and it’s like, oh, blow into this, and they don’t even know what it’s for. So this is awesome.
Karissa Simon 53:05
I agree. I like that the there is a chart because they’re always like, what number am I supposed to get? So I love that there’s a chart and it has like their ages, and what they should be trying to get to. And also from the speech therapy team Organizing and Planning a Calendar. This is a great one, it is a one page resource, or no actually, it’s three pages. And it has a calendar and different examples of how you can plan it with follow up questions and answers.
Karissa Simon 53:42
Thank you so much for joining us for episode four. We are so excited to have you listening. And any of the resources we talked about during the show you can get instant access to at therapyinsights.com. All the links are also available in the show notes if that’s easier for you. If you have any questions at all, we would love to discuss them on our show, please just reach out to support@therapyinsights.com and be sure to vote on what we create next. And our next episode will be dropping July 1 And we’ll see you then.
Johnny Rider 54:13
Thanks for joining us.