Karissa Simon 0:02
Hello, everybody. Welcome to the Resource Roadmap Show OT Edition. I am your host Karissa Simon and I’m joined by our amazing OT content development team, Megan Wilkinson and Johnny Rider. In our podcast for the new listeners, we talk about the resources released for OTs, by Therapy Insights each month, we also discuss some articles, recent articles, so you guys can have more evidence based practice. And then at the end, we discuss a case study what we would do, what resources we would use and kind of how we would approach the case. So we do want to let everybody know that we’re offering this for AOTA approved CEU credit. And if you want that, you just have to go to therapyinsights.com. And you can get more information there. And because of that, we need to verbalize our disclosures. We are all paid by Therapy Insights to be here and part of this podcast. And we’re going to be discussing resources that are created and offered on therapyinsights.com. All right, and with that, we want to get started with this month’s resources.
Karissa Simon 1:13
So our first one is called Spot the Difference. It is a three page resource and has. It’s an activity. So the second two pages are the activity portion. And the first page kind of explains what the activity is and how you do it. And I’m going to turn it over to Megan to give us a little more information about this great resource.
Megan Wilkinson 1:38
Yeah, so this is a classic one, when we’re looking at some of those visual perceptual skills, the spot the difference, but the thing I really love about the way we did this, this material is we created them in these more functional settings in these places that you would actually spend real lifetime it’s not, you know, something that’s just randomly fabricated for the task, it’s really looking at an outdoor scene and a garden, and then also sitting at a coffee shop. So making it as functional as possible, always, you know, the best that we can. So really simple, I like having two options, you know, you can kind of make it what is more the interest for your client. Or if you’ve got more time, you can do both, see how they do a couple of different options there. You they just on one page has the two separate pictures. And then there’s one page that has the answers. And so you can kind of keep that one to yourself, and score how they do on that. So pretty straightforward, I feel like but always looking for those easy materials that you can just grab real quickly and use with your patients. So.
Karissa Simon 2:52
Yeah, I love that about this one. Again, it’s like another great activity, that if somebody needs something real quick, and they didn’t have time, the night before to make something or time that morning, they can just grab this, and it’s very functional and colorful, bright, looks really nice and professional. So I love that.
Johnny Rider 3:11
The great thing about all of our handouts is that, you know, as occupational therapists, we can use them for different purposes and repurpose these for whatever skill we’re trying to remediate. So I think what’s nice about this is you don’t have to go looking for something, you know, online or trying to piecemeal something you have this available for whatever visual perceptual skill you want to work on, you could use one to work on a certain skill and you almost assess it with the other one, you could come back to this with a different skill, you know, a day in between sessions, there’s a lot of use that you can get out of this for various visual perceptual disorders.
Karissa Simon 3:43
And it’s great that it’s really geared for adults, because if you’re looking for a task like this online, you’re going to find things that are more geared towards children, because that’s what this kind of activity is usually geared towards, but very helpful for adult population. And it’s nice that it’s age appropriate.
Karissa Simon 4:03
Okay, so we’re gonna move on to our next resource. It is a two page resource. It’s called Cooking Strategies for Executive Dysfunction. And Megan, can you tell us a little more about this one?
Megan Wilkinson 4:16
Yeah, so I love this one, because really looking at how can we simplify our lives just in general, I mean, I think that I use a lot of these strategies on a day to day basis too you know, but being able to have this nice and lined out of different options that you can use when it comes to cooking. Cooking is such a complex task that we all just do multiple times a day. But when you have executive functioning deficits, it can be really overwhelming and so a lot of people just kind of tend to opt out. I found in my practice of cooking and you know what, sometimes that’s totally okay and we talk about that in here. too. And so just ways to, to simplify cooking for yourself. So the nice part is at the beginning as it breaks down some of the executive function skills; planning, organizing attention, time management, mental flexibility, and what that specifically looks like in cooking. And so you can kind of break that down for the client or even as an occupation, or as a therapist, you can kind of have that in your mindset of like, okay, like, these are the things we should be working on. And then it goes into different strategies. So just simplify and make a one pot meal or microwave as much as you possibly can, using a salad kit, that’s one of my favorites. As an as a mom is like, I’m not going to chop those vegetables, I’m, I’m just gonna use a salad kit. And so making sure that that mental load isn’t as heavy and you’re not having to focus on 20 different things at a time to make a nice meal come together. And then it talks about go to meals. And so this is these are the ones that you know, by heart, you, you don’t have to have a recipe you just know, hey, this week, I’m making chicken and rice. And I know how to do that. And I know how to where to find the groceries at the grocery store, it’s just very easy. Again, reducing that mental load. Prepping in bulk is a big one too, you know, you can get, you know, if you use like Costco or something like that, getting a ton of chicken and cook it all out, but then separating it out. So the example here is chicken with vegetables, and then you can reheat that chicken for tacos, and then use that chicken on top of your salad for lunch the next day. So making it not this big task every single time you get into the kitchen and just trying to simplify that. Lots of external aides like timers, and then addressing cleanup too, because I think that’s a big part of why cooking again, becomes this bigger task, because it’s not just about oh, I made the meal. Now I have pots and pans and spoons to clean up. And so how can we simplify that. And then of course, having no cooked meal options is a really good option as well. Being able to throw together a sandwich on the day that you’re like, I don’t want to get out the pots and pans today, it’s just not happening. And then some nice little tidbits on the side of, of if you’re following a recipe, how to go about doing that with executive dysfunction, because a lot of times the recipes we find online while they look so delicious, they’re maybe not super easy to follow. If you don’t read through the whole recipe, you might miss something, just lots of tips for being able to follow a recipe. So I think that this handout has a lot of different options that can kind of be combined for different patients, or using all of them at the same time. So things that you can practice in therapy as well, you can kind of have this resource and say, hey, well, let’s go practice meal prep, if you’re lucky enough to have a kitchen and work on some of those types of things. But let’s implement this strategy and see how this works. Does this feel less overwhelming for you? Or is this not the strategy for you? Let’s try a new one. So good, good information with this one.
Johnny Rider 8:11
I that’s how I would use it kind of the last thing you said Megan is, I would take this, and it would be an entire treatment session where we know there’s a goal for meal prep, whether you’re a practitioner that’s very comfortable with functional cognition, and you need a guide, or you haven’t had to address functional cognition in a while. This allows you to one talk about the different components of executive dysfunction. And again, there’s a little bit here to get the ball rolling. And then you can kind of have that dialogue with the client and talk about remediation techniques versus compensatory techniques, and then work through some of these strategies and kind of explore them. How would you feel about you know, meal prepping in bulk? Is that something that would fit your lifestyle? Would that fit your role as a mother, a father, a partner, son, daughter, things like that. And then together identify, oh, I want to work on the use of external aids that works for me. Now you’ve got a plan, and you can still give them this handout. But rather than just handing it to him and walking away are saying, here’s some good strategies to work on yourself. I think this opens up, you know, an awesome opportunity to discuss these, problem solve, dialog, figure out what will work for the client, and then set some goals for the next treatment session or that treatment session you’re in right then as you work through the various strategies, because as you mentioned, there’s a lot on here not everything’s going to be appropriate for every client. But this allows us to use this with pretty much any client with any concern related to functional cognition, or more specifically executive dysfunction.
Karissa Simon 9:43
Yeah, I agree with you, Johnny. That is how I would use it too. I feel like it gives a guideline of what we should be working on with these specific clients in the kitchen, which sometimes can be overwhelming. You know, you want to do a cooking task, but it’s like what exactly am I trying. What is my goal? What is my end? What I want to see at the end. I also liked that you could just give this to patient family who’s a little bit hesitant about their loved one cooking again, or is concerned and say, look, this is, this is what we’re going to address we’re going to try. Do you think any of this could work for you or really work alongside the caregiver or the family member too.
Johnny Rider 10:26
Yeah, I think just the the multi use of all of our handouts, and sometimes I think calling it a handout is a little bit limiting, because it’s not just something that you do give to them. But I work with a lot of new practitioners who have tons of knowledge, tons of skills. But you know, if you haven’t done a session on this one topic in a little while, you kind of start to panic a little bit, and you’re kind of like, how do I handle this, and you pull out one of these quote, handouts that are also like clinical guides in some ways. And it could be enough just to give you, you know, a quick refresher could be a guide for that whole session, it could be a conversation starter, whether you’re, you know, been working 20 plus years, or you’re a brand new grad, or even in your level II, you know, field work experience. You can use this in so many ways. And so I hope that people recognize that, even though we call them handouts, there’s there’s more than just handing them out.
Karissa Simon 11:17
I like that clinical guide. I like that. All right, and we’re gonna go to our next one, which is Knee Replacement and Occupational Therapy. This is a two page handout that has some pictures of adaptive equipment and footwear that you should and should not wear. And Megan, can you tell us a little bit more about it?
Megan Wilkinson 11:40
Yeah, this one was a request from somebody. And so I, like I’ve mentioned before on other shows, I love getting requests, I like knowing what you guys are missing and what gaps you’re feeling are out there when it comes to resources. And so we always try to fulfill that and kind of exceed expectations when it comes to that. So this one is really looking at having some guidelines. As as the client is going into surgery, and what they’re expecting immediately after having a knee replacement, and what they can kind of expect when they go home. The big key points, here are the pictures, I think, and having the resources to really visually look at what equipment looks like, because I think sometimes, you know, as practitioners, we are so familiar with this stuff. And if you just kind of go on a spiel talking about it, and this is all very brand new to someone, it’s kind of like, what’s a reacher I don’t know, you know. So having some of those pictures is a really, really helpful aspect of this handout. And so it specifically is talking about O’s role in therapy as well at the very beginning. And you know, when you have all these people coming into your room after you’ve had a surgery, and you can’t keep anybody straight, having that little piece right there to say, okay, like this is what OT is going to work on with me specifically, after my knee replacement, talking about self care, bed mobility, functional standing, all of that good stuff. And then there’s a nice checklist here of how to prepare for after your surgery. So things you can potentially do beforehand. And so having this in like a packet as a handout, to to them prior would be a wonderful thing as well because family support and caregivers whoever can also have this as a resource and you can kind of like lift some of that weight off your head and know when you’ve taken care of some of those things before you even enter into surgery. So some of the points are like prepare some freezer meals ahead of time and make sure that you have someone to take care of pets and children and some of those types of things. Just to again, reduce some of that stress of going into into a surgery. And then the on the second page is really the bread and butter of like I’m doing my rehab right after my knee surgery and what are we going to be looking at and so it talks about dressing so coming into the hospital with loose and easy slip on and off clothing, so that you can easily practice some of these methods that are going to be taught with with the adaptive equipment and and not feel limited by your clothing choices. And then it goes into a lot of the various you know strategies that we know by heart is OTs, but again it’s in a nice written form for for the client. So dressing you’re going to thread your operated leg first and undressing you remove it in the non operated like last and so just really clear, concise bullet points that they can kind of follow have at hand. It then dives into toileting and shower, and then has these nice pictures of shoes that would be appropriate to be using. And then once that would not be appropriate. And then also fall prevention checklists, obviously we know again, as clinicians that a lot of times falls happen after these surgeries. And we really want to prevent that. And that’s a huge thing that we can really be pointing out. And so that’s an a nice blue box at the bottom, and checkpoints. So making sure you have that proper footwear. And then they have that resource right above to look at, oh, here’s the footwear I should be wearing, making sure your lighting is good, taking your time and then asking for help. So just a really good, concise way to prepare for knee replacement and what to expect when you’re working with an occupational therapist after having knee replacement.
Johnny Rider 15:51
My first thought when this was announced was like this is following evidence because we have found over many years, the more someone understands their procedure, what to expect, as part of all aspects of rehabilitation, the better the outcomes. And so as you mentioned, this is going to really relieve some of that stress. But that’s that’s evidence based as well. So this is something that, you know, occupational therapy practice can use as those pre surgical groups, I used to teach those and there were never any resources, I was constantly trying to make something and type something up and never looked this good, that’s for sure, because I wasn’t very creative. But for those of you that are teaching those pre courses, you know, before someone has a TKA, maybe we’ll have one in the future for tha as well or, you know, total shoulder arthroplasty, things like that. These can be the perfect handout, they can again be a guide, if you’re not teaching those types of courses, maybe you should consider it because the evidence supports it. And it’s a great role for occupational therapist to explain both the medical side, but also the rehab side, and what life is going to look like after and how you can get back to your normal life as quickly as possible.
Karissa Simon 17:00
And like what you were saying, Johnny, when Meghan was talking to this, I was thinking about how it’s a great way for us to advocate for ourselves and our role. Because some not in every in every hospital, OT is not always a priority after knee replacements, which makes for a certain extent, you want to be able to walk again, that’s what everybody’s goal is to get their knee range back. But I think this is a great way to advocate for our role, not just post surgery, but pre surgery and hand it to some of your administrators or unit leadership and say look like this is what I can contribute as an OT, I really think I have a role in this and look at what I can do to help with patients.
Johnny Rider 17:45
Absolutely.
Karissa Simon 17:48
All right, and we’re gonna go on to the next one. And it is a two page handout is called Joint Protection for Arthritic Hands. So there are some pictures on there showing what you should and shouldn’t do, and a lot of different tips and tricks. And Megan, can you go ahead and tell us a little more?
Megan Wilkinson 18:09
Yeah, so this one was actually also a request. There, this information has been out for a long time, but it’s very dated. And so I think that we did an excellent job of providing images that show some of those protective positions that we can be using some of the adaptive equipment that we can be using, in a way that is modernized and easy to very quickly without even reading anything you can kind of tell looking at this sheet, some strategies that you can be using in your everyday life. So it breaks down, again, several different strategies that we can be using in order to to protect our arthritic hands. So planning ahead and pacing yourself and then really talking about the relationship that these these individuals have with their pain, because pain is just a part of their life. And so being able to, like I said, frame it in the way that you have a relationship with that pain, right? It’s a part of you and part of what you’re going through. And so instead of trying to ignore it, or let it limit you basically saying like what what can I do to continue to live life independently, knowing that this is a part of of my my daily experience.
Megan Wilkinson 19:33
And so some of the biggest points that that we know is using those larger and those stronger joints to be able to do things and there’s a nice bullet pointed list of examples of being able to do that that are a lot of them are associated with the photos that are on this page. So carrying a backpack over both of your shoulders versus carrying a handbag or a purse of over one arm using your palms to lift objects and push buttons and then hugging bigger objects to your chest. As to lift them, instead of holding them at your fingertips or at your wrists. Using two hands security and object instead of one sliding things across tables. Lots of lots of good examples here, that while they have specifics, I think can also can, excuse me, influence that creativity of what you might be able to use what is actually applicable to you to your patient in that, which again, we talk about all the time, whether handouts, we I think, as a whole team believe that these resources are, we should go over them with the therapist or with the client in that session, and really discuss this so that you or you are really on the same page. It’s not something to just hand them and say, ok, read at your leisure kind of thing. And so being able to run through some of these examples, and saying, you know, specifically when they’re hugging a bigger object, what what something that might be more applicable to them, that’s not necessarily listed here. It talks about a laptop or a grocery bag. You know, maybe it’s specifically, I’m blanking here, but maybe their back their purse or something like that, that’s really heavy. Being able to bring it, bring it to them and talking about those examples and then putting them into practice. Can you demonstrate to me how that would be how you would pick up this large object using the strategies that we’ve talked about right here to make sure are they understanding you’re not just like rattling off to them, it’s a conversation right? And then modifying their grasp. And so we actually have another handout, in the Therapy Insights, resource or library that talks about buildups and how you can use it on so many different objects. And so that’s talked about here, again, that might be a good one in conjunction to use. And so building up your writing utensils, your kitchen tools, any hobbies you have, such as gardening, and then balancing again, rest and activity, I think that so much of it is again talking about how do I work this into my my life without it limiting me. But also, without ignoring it. It’s really about that balance, how do I accomplish the things that I need to do with this. And then definitely the value on pain free exercise. Again, I think sometimes, there’s the two very opposite mindsets, which is I’m just going to ignore this problem and continue to function at the way I should be, which is damaging. Or I’m going to let it limit me so much that I’m not going to participate. And so this point of like, no exercising is actually really important. We need to continue to move those joints and get things lubricated and moving. And then lastly, talking about the use of splints and braces and some popular ones that are used for for arthritis.
Karissa Simon 22:51
You go ahead, Johnny.
Johnny Rider 22:52
I’ll just say like to build on what Megan so I think if you talk to any occupational therapy practitioner, and you bring up the idea of joint protection techniques, everybody knows what they are, this is kind of a staple intervention. But the nice thing, as you’ve already alluded to about this handout in this guide is that it is a way to conceptualize these joint protection techniques because just verbalizing and talking about this, even though it’s common language for us. Even saying things like larger and stronger joints than smaller joints can be difficult for someone to conceptualize when they’ve never even taken a Kinesiology class where they haven’t really thought about, oh, these, you know, interphalangeal joints are different than my elbow joint, or bringing things in and changing the lever and you know, the force and the effort. And those things become so natural to us as occupational therapists, we need something like this to kind of be that catalyst for our clients to say, hey, let’s walk through this. Let’s talk about it. Then, as Megan said, apply it to you, you know, maybe you don’t carry a big purse, but you carry your your dog or your cat or your child and things like that, or you’re gonna doorknobs don’t look like this. How can we modify that as a partnership and therapy. And so I like this because it opens that discussion, but it still allows us to move into client centered on a topic that may be very comfortable, but it’s hard to educate someone without visuals without demonstrations without application.
Karissa Simon 24:16
Yeah, I was thinking along the same lines that I love how it has those pictures feel like that sparks both the therapist and the client to think about, oh, maybe their door handles are okay, but their locks are tricky. And so it will like spark that conversation. And while you’re looking through these pictures of the examples we’ve given it might help people to think of other areas that they’re having trouble because you have these specific examples.
Karissa Simon 24:48
And then we’re gonna move right into our first article snapshot, which is related to this last handout that we talked about, which I love. So it’s called Assistive Devices and a Effective Strategy to Non Pharmacological Treatment for Hand Osteoarthritis Randomized Clinical Trial. Johnny, can you tell us about this article?
Johnny Rider 25:10
Yeah. So this is a study, a very well done study looking at the use of assistive devices as kind of a strategy for non pharmacological treatment for individuals that have that hand osteoarthritis, right. So it was a randomized controlled trial, it was prospective, the assessors were blinded, so we was really high quality study. So we had participants randomized to the intervention group, where they received assistive devices. And there was a lot of different ones that they could receive, where they went to this control group, where they received basically like a guideline leaflet, like a handout, and just basic information on joint protection and disease features related to arthritis. So they use some common measures that we’re all familiar with the Canadian Occupational Performance Measure, they also use some very specific functional hand function measures related to arthritis. And then they measure things like pain, quality of life, right, that are important outcome measures that we’re already considering. So they looked at these groups after both interventions, kind of that beginning of the study, 30 days and 90 days after receiving these interventions. And so there’s about 19 in the intervention group and 20 in the control group, overall, they found that hand function and occupational performance improved after the intervention group. And when they kind of compared the results, there was a statistical difference in the Canadian Occupational Performance Measure, right. And so we found a little bit more of an improvement in those that received actual assistive devices. So we can kind of say, okay, first of all, the use of assistive device is an effective intervention, you know, especially in the non pharmacological realm for hand osteoarthritis, it can improve occupational performance, they also found that to improve pain, and quality of life, all things that we care about as occupational therapists. However, we also found that educational pamphlets or the leaflets with information related to the disease in this case, osteoarthritis, and joint protection and energy conservation techniques for daily activities. That was also beneficial. It’s low cost, it’s still had an effect, all be it, it was a smaller effect than the intervention group. Okay, so that should start get us thinking that, you know, at very least we should be providing with a handout. But as we’ve said, over and over and over, there should also be education, there should be training. And then we can take it a step further and provide assistive devices because they also help with multiple measures quality of life, pain and occupational performance. Overall, we learned from this RCT that we should be ensuring that we are making assistive device recommendations. Okay. When we do that, though, this article suggests that the suggestions and the training should be contextually dependent, basically. So it should be client centered, we should be considering how do I use this device for my daily activities, which may be different for me versus Megan versus Karissa. Right for each client? And we should be training them how do they use them? Right? What does it look like when you use these? How often should you be using this as something you use all the time only when you’re in pain, right? All of those clinical considerations, that’s where our skill comes from. One other interesting thing from this is they looked at well, what were the most commonly used assistive devices. And so that wasn’t kind of in our snapshot, but they found the most beneficial and the most used things were pot openers, so helping them open pots, zipper and push button adapters, adapted cutters, adaption adaptations for rooms. So how they could sweep and mop utensils was a very big one. And of course, adaptations for getting in and out of the bath, turning levers, things like that. So all things that we should be assessing as part of our initial evaluation. And then we can make recommendations and even trial or problem solve some of those assistive devices.
Karissa Simon 29:08
I love that this gives us such clear evidence that what we do is helpful, the adaptive equipment we provide or recommend is helpful. And it’s also good to kind of show patient families if the family is hesitant, or the patient is hesitant because of cost because we do know some of this stuff can be expensive. Some of its not so much, but some of it is it’s a really good example of why we’re recommending it and that it will really improve their quality of life. It’s not just something they’ll buy and not toss like in a drawer or something hopefully, but it will improve their quality of life.
Johnny Rider 29:46
Right a lot of these are now being printed with 3D printing and getting cheaper and more accessible, which is really nice because you can order these things on Amazon where before you had to get you know a specific rehab have manual I mean, you know, book basically, the ordering from and they were very pricey. We’re seeing increased accessibility and decreased prices with a lot of these assistive devices, which is a positive thing for clients.
Megan Wilkinson 30:16
Yeah, I love the first of all, this is just such a clearer picture as to why our profession is valuable. It’s so good at showing that our ability to to see the specific individual client for their needs our ability to modify our ability to do these low cost, modifications and interventions. And to something that is non pharmacological, I would say, most people would rather not go that route if they don’t have to. And so just such a clear picture on that, and then to comment on what you’re talking about with the advancements, I think a wonderful thing is the fact that we’re able to get on something like Amazon and have all of these different options and to look through reviews and have clients are like I’ve had, you know, OA for five years, and I’m able to use it for this specific thing. And it’s great and whatever I mean, the the resources and the information that we now have, I mean, going back to the way catalogs used to be, you know, I mean, it was just like, well, I hope this works, it’s in the catalog and think we’re gonna order it and it’ll come in however long, you know. So those advancements have been huge. I think specifically for OT and our career.
Karissa Simon 31:34
Yes they definitely have I remember just telling people, you can go to the local pharmacy, you’ll probably be able to find a raised toilet seat there. long handled shoehorn, hopefully. But now you’re right, you just go on Amazon. And that’s been, I feel like it’s been relatively recently that almost everybody has access to that kind of grew really fast.
Johnny Rider 31:55
Yeah, I mean, not to age myself. But when I started out, I didn’t have those big Sammons Preston’s catalogs when I was in home health, and I was taking them around to show them because I needed some visual, and the days of doing that are gone, fortunately.
Karissa Simon 32:12
All right, we’re gonna go to our final handout for the month, which is Adaptive Sports. It’s a three page handout, and it has a bunch of different pictures of people participating in the different adaptive sports. And I’m going to turn it over to Megan to talk a little more about it.
Megan Wilkinson 32:30
I was so excited writing this piece, you guys, this is something I’m very passionate about. And I think it comes from my neuro background, specifically my spinal cord injury patients and being able to watch them get into something like this and have something that they’re excited about. And to build community. I mean, that’s a huge part of sports in general, right is you bond with people who have similar interests, similar passions, and then there’s just that other layer of they understand, right, they understand life through that lens in a way that as therapists we don’t, or some of their friends and family, they don’t. And so there are so many studies out there that talk about the benefits of participating in communities like this. And so being again, being able to write on this was just really, really fun for me. And there are so many other sports, I mean, it is huge breadth of adaptive sports and different groups that you can be a part of, and competitions you can be in. And so this touches on a lot of the popular ones. And there’s a couple some bullet points at the end of the resource that talk about other options if the individual is wanting to explore some of those.
Megan Wilkinson 33:47
So the first one is talking about adaptive skiing, and there are so many different options for adaptive skiing, you can have mono skis you can have bi skis, there’s two track three track four tracks skiing, so all these different options to be able to support yourself while on the snow and it really details in in this handout. And so you can kind of again with with the client be reading through and saying oh hey, like this sounds more like what you would need based off of what you’ve got going on, it would be something to try a lot of these to touch on the fact that there are a lot of places you can go and trial some of these so a lot of ski resorts will actually have at least one set of some of these equipments and big ski resorts will have someone who is trained in adaptive skiing and be able to work with someone with that equipment on the slopes to be able to kind of try out, trial all that stuff out, which is really awesome. I think that’s a great resource to have. And then going into sled hockey and so you can see on the picture if you’re watching that it is in a basically, you’re laying down, essentially, you’re sitting straight up, your legs are straight out, like you’re in a sled. And then you’ve got these specialized sticks on the sides. So you’re really low to the ice, being able to kind of propel yourself, it’s kind of blend of skiing, as well as because you got you got one on either side that’s helping you propel across the ice. And the other thing I did touch on with this piece is talking about potential limitations. So in order to participate in sled hockey, you need to have a rink that has lower entrance levels onto the ice, because it’s really hard to navigate in that low seated sled position, getting on and off the ice if you have a really tall ledge. And so being able to research some of these things in your area, too, is it’s a really good jumping off point. Hey, we’ve read through all these, they’re interested in sled hockey, okay, well, this made the point that the rink needs to have this what are the supports in our local area, being able to just really deep dive into the availability of the community. And again, depending on where you are in the country, some of these might be more popular rather than not down south, you’re probably less likely going to find adapted hockey rinks with that with that low ledge, whereas up north, you are probably more likely to find a lot of those, it was really fun to as I was creating this, I started getting that that Google feed of of my local areas that were saying, oh, these are the adaptive teams that are in your area. I loved it. So cool. And then it also dives into kayaking. And it is amazing the amount of equipment that there is for a lot of these sports, so many different options. So there’s high back seating, which is great for someone who has a spinal cord injury. And then they’ve got these extra balancing pieces that are that are out in the water to make it so that the tipping is less likely to happen, it’s a much safer way to do that there’s ways to lower somebody who is a wheelchair user into the kayak, just lots of different equipment that makes it really accessible. And again, lots of groups across the country that support these things, being able to kind of try these out do kind of like camps almost to figure out what what works for you. Cycling is huge in in the adaptive sport world. And there’s lots of different types of bikes that can fit the specific needs of the individual. So tandem bikes bikes, which is allows for two riders, so these are good for individuals who have like a significant cognitive disability and it’s not something they could safely do on their own, but love that that movement that freedom of riding on a bike. So having a caregiver or a family member with them to kind of help them get get out there and using that the tandem is a great option for that. There’s also recumbent bikes, which is that more lower to the ground, reclined kind of, of bicycle. And again, they have that high back seating which is great for core support and added comfort. And then the trikes typically tend to be more popular with more leisure and older populations. Whereas a recumbent bike is a more competitive cycling sport that these individuals can get into. And then there’s hand cycles again for our individuals who don’t have leg function. And if you’re watching on this picture, it shows someone with the hand cycle on the on their bike and being able to propel it with their upper extremities instead of their their lower extremities. So again, just so many amazing modifications and options for for the sport. Golf is a big one, I grew up in a big golfing community and so it’s it this one is a particularly expensive sport for our disabled clients, but also for people who are more able bodied anyway, so it’s an expensive sport regardless, but this one has that these big carts that can actually move the person into that standing position so that they can swing the golf club but there’s also you can learn how to do seated golf as well that’s a that’s a popular way to learn how to do it without having to get that that equipment. And then there’s all sorts of different tools for extending reach down to the ground to hit the ball. For for grip, there’s some tools that can attach the hand essentially to the golf clubs. So making sure that you’re really because it’s typically a two handed swing, if you have one that has a lot of weakness or reduce grip, it can kind of hold your hand to to the golf club while you swing, which is which is a great modification. And then the last two on here that it specifically goes into detail about our wheelchair basketball and wheelchair rugby. And with wheelchair rugby, we have a nice little QR code, which shows a really good video about what it looks like and kind of getting to watch people playing it, which is awesome. And with all of these being able to go watch a video and see what it looks like is great. But this one is really popular because there was a documentary called Murderball. Because wheelchair rugby used to be called Murderball because it was so aggressive and physical in nature, you’ve got people in these really built up wheelchairs that are very specifically made for the sports, and they’re just crashing into each other and you see people flying and fallen on the ground and doing all sorts of crazy stuff in this sport, but just a lot of of camaraderie too. I think, you know, there’s a deep passion in sports in general and, and being able to carry this one out. And this is such a fascinating sport to me because it is a blend of multiple sports together basketball, hockey, and handball is kind of what this this sport is combined to create wheelchair rugby. And so again on these talking about some of the different rules because specifically wheelchair rugby is basically its own sport within itself that was created for wheelchair users. And then in wheelchair basketball, talking about some of the differences. And so with both of these, they play on teams that have a point system that is determined by people’s level of ability. And so each team has to have make up a certain point system. So someone on the team could have a lower points system, well, someone else has a higher point system, but together their team makes up a certain level of points in order to, to be on the court at the same time. Which I think is a really great way to kind of categorize that. And then again, like I was saying at the end of the resource, it has bullet points talking about other options if you really want to kind of deep dive and look into some more options like sailing and bowling and hunting and fishing and all the different adaptations that can be made to participate in in sport. And there are a lot of local competitions that you can be a part of state competitions, just like you know, any sport, there’s multiple levels that you can participate in this and we you know, the Paralympics is really famous, but there’s also the the Extremity Games, the Special Olympics, and then there’s the Deaf Olympics as well for people who are hearing impaired. So they’re, it’s a really big group and community and just being able to be the person. As OTs, it’s totally in our realm to say, Hey, this is this is something that you should be looking into this is really valuable to your quality of life. And we should investigate this because I think it’s it’s a normal experience for people to feel like this is off the table when something like this happens to them. And it’s just so true. And so as they start to gain that independence, being introducing like, hey, like, how are you going to get back out there? I know you were a big basketball player, did you know that wheelchair basketball is the thing, right? So having this resource to kind of, again, spark some of those conversations.
Johnny Rider 43:56
I love this handout. I’ve also been involved with quad rugby for many, many years sitting on the board of a local quad rugby team, and we’re going to talk about some research behind it. But I had to mention one reason why I appreciate that we have this handout for Therapy Insights. And why we’re ahead of the game is at the AOTA conference, we presented some research that’s been published in the OTJR Journal, later on this week, where we interviewed quad rugby players across the country to understand their experiences of being introduced to and participate in quad rugby. And as we’ll talk about in a minute, what all the benefits are the one thing that the article we’re sharing doesn’t talk about as that introduction, and unfortunately, many of the individuals were not introduced to adapted sports during their rehabilitation process and yet every one that wasn’t said I wish I was introduced earlier. I wish someone had talked to me about this because it’s changed my life. And it hurt my OT heart a little bit when I heard that so many of the experiences were not positive early on and you know, learning about adaptive sports the average time was years after their spinal cord injury before they’re introduced to adapted sport so we can do better as a profession. And this one can educate other practitioners to what’s out there. Because I guarantee you, a lot of people, even in our profession had no idea how many adapted sports are available. And we can also use this to as early as possible, introduced this idea of whether they were an athlete or not, to our clients.
Karissa Simon 45:27
I agree with what Johnny’s saying this is just, this is such a hopeful handout, like a lot of times after such a traumatic injury, people just have such like horrible despair. And they’re having to figure out their whole life again, and let things that they thought were going to be in their future go. And this is just such a hopeful way to say, look, this is this is not the end, like you have so many opportunities, there’s so many ways to be involved in your community, and be active and have such a great time. And I just love this, this handout is so amazing.
Megan Wilkinson 46:03
I think too, even if the individual doesn’t necessarily land on adaptive sports, the the hope and the concept of the fact that there are groups, there are communities out there that you know, are participating in things in a life after injury. Right. And they’re coming together. It is it is a huge part of it. Just being able to like you’re saying early on, which again, Johnny, I agree, we should be catching this much earlier, early on being able to say, you know, to frame it in a way of like, as the therapist, we’re not just trying to, oh, we’re trying to make it you know, better, we’re trying to make things. These are going to be hard. And so therefore we’re doing the best that we can to make things easier on you which is is true, but also coming from the light of like, look at all of these opportunities that you are going to have to continue to live a really full life. I was lucky enough that in my schooling, I actually had a professor who was an OT, who had a spinal cord injury at a very young age. And so went to OT school with a spinal cord injury. And he, it was awesome. I got to do lots of learning with him. And I just remember him telling the story about him hiking with his what was going to be his married family. And then just going oh, how can we help? Like, what can we do? And I’m trying to just like, protect him as he was going down this like very windy Hill down to a lake. And he kept me like, no, no, I got it. But then he fell. And he fell down this hill. And they were like, oh, see, like, we need, you know, and he was like, nope, and he showed them that he could get himself back up. He was back on the trail, he dusted himself off, he was totally fine. That and that that story stuck with me in a way of just like, Yes, like this is not like this is the attitude to have of how capable these individuals still are and how actually, you know how active he was and how very much he advocated for himself as well. And I think that goes really well hand in hand with these handouts. And that that same idea of,of hope.
Karissa Simon 48:21
Yeah, I agree. So now we’re gonna do the article, a snapshot related to this, like Johnny was just talking about. It’s called Adaptive Sports and Spinal Cord Injury, a Systematic Review. And Johnny, can you tell us about it?
Johnny Rider 48:35
Yeah, I’ll be quick because we’ve talked about adaptive sports a lot today. But it was a systematic review, really just looking at the last five years. So an update on the evidence. So it’s very recent literature overall, as we would expect, and no, we work in this realm. Adaptive Sports has been shown to have a pop have many positive health benefits, including physical and psychosocial benefits. However, many of these athletes must overcome a variety of barriers to even be able to participate. Some of those things that they found were transportation issues, accessibility and of course socio economic factors with how expensive it is to participate in a sports compared to some able bodied sports. So they also identified some facilitators to participation. So if individuals had a pre injury interest in sports, they were more likely to want to engage in sports, males tended to want to engage in adaptive sports more if they were injured at a younger age. However, they highlighted these don’t it doesn’t mean these are the only factor that just means those individuals tended to find adapted sports quicker and easier. But we should still be introducing this to anyone and giving them the opportunity to participate if they want. Because we know that as occupational therapy practitioners, individuals might want to explore new leisure, new recreation occupations, especially throughout their life, and so we should be open for to adaptive sports with everyone. So a lot of different sports were highlighted in here. Megan has already highlighted them today. But I think some of the the interesting things that we haven’t talked about is now there’s even virtual options with E-Sports which are brand new. And also we have better knowledge and ways of monitoring athletes, or pre Peri and post competition injuries. We have a lot of knowledge out there about injury prevention for these individuals, and things like concussion management, what healthcare professionals should be involved, how to train coaches and players, we still have more research that’s necessary within this population, we’re still extrapolating a lot from able bodied athletes. But I think the key takeaways are that there’s physical, psychological and social benefits of adaptive sports, for individuals with spinal cord injuries, and those benefits are numerous. We don’t even have time today to talk about all of it. And we as therapists can help address some of these barriers to participating in adaptive sports. And we should be advocating for increased access. All right, we know the benefits, right? We know the evidence. So it’s our job to help increase that access for our clients. And adaptive sports should be a part of that plan of care and how are we going to get them to get involved in this and whatever level of care we we are giving them if that is one of their preferred occupations. And then as we mentioned, we should be introducing clients to adaptive sports as early as possible to maximize their participation and those psychosocial benefits that we just talked about. Alright, So moral of the story adaptive sports are great, introduce them early on, and do what you’ve been trained to do as an occupational therapy practitioner and support them in that goal, if that is one of their goals.
Karissa Simon 51:43
I love it. Amazing. All right, so now we’re gonna talk about our case study. Ms. Little is a 75 year old female in the hospital who has status post a right knee replacement one day prior. She has a five year history of osteoarthritis and her right knee with significant pain that was impacting her ability to participate in desired daily tasks. She is planning to return to a two level home with five steps to enter. Her bathroom and bedroom are located on the second floor and she has a full flight of stairs to reach the second floor with left ascending rail. Ms. Little has two cats at home and provides childcare for her two grandchildren three days a week. She also is very involved in the community and as part of her time challenge Garden Club, along with volunteering at a local animal shelter. Ms. Little currently report she is experiencing nine out of 10 level pain in her right knee and has demonstrated significantly impaired mobility with use of a rolling walker.
Karissa Simon 52:50
So we’re going to discuss what resources we think would be great for Ms. Little’s case. And then at the end, we’ll talk a little more about our case and what we would do as occupational therapy practitioners. So I’ll go first I selected Your Whole Body Rehabilitation Therapy Team. So this is a one page handout. And it discusses the role of occupational therapy, speech therapy and physical therapy. So the reason I picked this one is because Ms. Little is pretty young, young, old 75. And it sounds like she was very active before this. And this might be her first encounter with physical therapy and occupational therapy, since knee replacements are usually elective. So I think it’s just very important. If it’s someone’s first encounter, that we make it very clear what the role of occupational therapy versus physical therapy vs speech therapy is. And so they know if their goal is to get back to volunteering at the animal shelter, we are the ones that are really have that knowledge and to can help them to get back to those important roles and routines. So I just thought this was a great handout to give background information, not just in this case, but really any case where it’s the person’s first experience and rehabilitation or first time working with an occupational therapist. You can do your little spiel and then be like, look, I’m going to give you this handout too, just so you can reference it. And if you have any questions or you think of things that I can address for you, just let me know. So I love this handout.
Karissa Simon 54:32
And then, Johnny picked Teaching Safe Balance Strategies, and it’s a one page handout.
Johnny Rider 54:39
Yeah, so I struggled. There’s lots of options. However, with the information given in this case study, I would guarantee that the occupational therapy practitioner will be working on some safe balance during ADLs and IADLs. And so I thought this handout would be a great place to start. For those of you that can’t see and it provides key points for the therapist when teaching safe, balanced strategies, and they’re written in a way that can be applied to any preferred occupation, so whether it’s, you know, some basic ADLs going up and down the stairs, getting a shower, or you know, kind of progressing to IADLs and preparing a meal and going on to the pet shelter or going and working in the garden, we can apply these to preferred occupations. And even though we’re still in the hospital setting, we can still simulate some of these things in the hospital in preparation for Ms. Little returning home. And so I thought this is a good intervention that we could start with and a great handout to use. However, I was torn because there are so many other ones out there. And I don’t know which one Megan chose, but we have ones on pet care and safety with managing pets. We have ones on knee stiffness after total knee arthroplasty replacements, there’s pain management techniques. So I think it’s gonna get harder for us to just pick one handout, as we do these case studies, because there’s a lot of applicable ones. Yeah.
Karissa Simon 56:03
Now we’re gonna do Megan’s, Megan selected Pain Management, and it’s a three page handout. And Megan, you can tell us about it.
Megan Wilkinson 56:11
Yeah, so I had the same situation, Johnny, I was like, I don’t even know. So many answers to this one. And, you know, to me, the clear winner was that the pain is the issue, right. And so this one is really for the clinician, and just kind of really brushing up on different ways to look at pain management. My my big thing here is, it’s a five year history of osteoarthritis. And so that’s a long time to be living with that pain. And a lot of times, you know, moving through the rehab process, and getting out of that mindset of pain as well is a challenging thing when you’ve lived with it for so long. And then on top of that, she’s reporting 9/10. So she’s, she’s really struggling with that pain. And we’re not going to be able to move into how do we work on feeding your two cats at home safely. And some of those other things that we’re so limited by pain to that, you know, standing and some of those other things, we can’t even get past that. And so I thought that this was, again, like a good place to start at, I imagine a newer graduate or just someone who maybe isn’t a new setting, whatever, just being able to kind of brush up on all of these different ways to manage pain, and when that is the chief complaint of somebody. And so it’s really nice, because it talks about advocacy, it talks about mentality, which again, in this case, when it’s something that we’ve lived with for so long, breaking that mentality is a big thing too, sleep huge. And then different modalities that you can use. So again, kind of brushing up where do I start? How do I how do I look at this pain, which is so limiting to to Ms. Little? And then once we get that under control, we can start to really look at all of the different. She’s so active, all the different things we want to get her back to as OTs.
Karissa Simon 58:07
Yeah, I love how we all kind of took a step back, because it’s a very complicated case, we all took a step back, and we’re like, we’re there’s a lot of components, not complicated, but there’s a lot of components to it. We said, Okay, where do we start? Because there’s just so much with her case. And we can’t address everything all at once, as OTs. I love how are you? Oh, we’re like, Okay, where do we start? Yes.
Johnny Rider 58:29
I think we also have the new handout on total knee replacements today that we all would have chosen if it wasn’t the new one, as a great starting point, but I think she’d be a great plan to work with because it sounds like there’s plenty of things that we can do. She’s already given us, you know, goals and things to work on. And I doubt she would be one that we’d have a hard time motivating for therapy in any setting, but especially in the hospital setting.
Karissa Simon 58:55
Agreed she sounds like a good one.
Karissa Simon 58:57
And now we’re gonna go over some of our other resources that were released by the PT team this month. So the first one is Functional Neurological Disorder. And this talks about what the different two diagnoses are that fall under functional neurological disorder. It’s one page, and also common symptoms of it. So check that out. And our next one is Evidence Based Practice to Improve Walking after Stroke, Spinal Cord Injury or Brain Injury. And again, this is a one page handout and it’s talking about some of the findings of a recent systematic review of literature over the last 30 years to give you like the best evidence for improving or walking after those diagnoses. The next one is two pages. It’s also from the PT team. It’s called the Pain Catastrophizing Scale Interpretation and How to Implement Findings. So this one has a great QR code that takes you to the actual scale. And then it talks about how you score it, why it is important and how you change your treatment if it is pain catastrophizing. Okay, and the final one from the PT team is one page as well. It’s Treatment for Functional Neurological Disorder, a Guide for Clinicians. So it talks about how you should take the subjects history, how you should develop your plan of care what the approach should be, how often you should see them and what the recommendations are for treatment. All of those look like great resources from our PT colleagues, if you want to check those out.
Karissa Simon 1:00:46
And to get instant access to all of the resources we talked about today, and hundreds more, just go to therapyinsights.com, you can access all of them there. All the links for the resources are available in our show notes. And if you have any questions if you have a case you want to discuss, or you want to know what resource we think could work for somebody you have, or you have any questions about any of the handouts we’ve discussed in this episode or any of our previous please reach out at support@therapyinsights.com. We would love to talk about it on our show and answer your questions. And be sure to vote on what we create next. Megan loves when people vote and say what they need. And our next episode is coming out August 1. So I will see you then.