Karissa Simon 0:02
Hello everyone and welcome to the OT edition of the resource roadmap show. My name is Karissa Simon, I am your host for this podcast. And, I’m joined by our wonderful ot content development team, Megan Wilkinson and Johnny Rider. In this podcast, we talk about the resources released by therapy and sites each month, and kind of discuss what we would do as OTs with them tips and tricks for how to use them. We also discuss a case study each podcast and how we would address that case. And we also talk about some recent articles that came out and how you can make your practice more evidence based. So before we get started, we just want to verbalize our disclosures because we are offering this for AOTA approved CEU credit. We are all being paid by Therapy Insights to be part of this podcast and here presenting for you guys. And we will be discussing resources that are released by Therapy Insights. If you have any questions, you want to ask something about one of the resources we discussed today, please just reach out to support@therapyinsights.com. And without further ado, we’re gonna go ahead and get started and dive right into our resources for this month.
Karissa Simon 1:14
So our first one is called Median Nerve Injuries. It’s three pages and has different graphics on there showing nerves. And I’m going to turn it over to Megan to tell us a little more about this resource.
Megan Wilkinson 1:30
Yeah, so this one is specifically covering median nerve injury, like you said. I think what’s really nice about the design on this first page, it’s half of it is taken up by this nice beautiful picture that highlights where the median nerve runs through the arm. I think sometimes as clinicians those visual refreshers kind of is a really nice thing to have of, of looking at the anatomy again. And then it just talks about the breakds down the function of the median nerve, what its sensory functions are, what its motor functions are. And then looking specifically at median different types of median nerve injuries. So what you might see as symptoms of having a median nerve injury to kind of start working through that diagnosing. So pain and burning and tingling in the forearm and elbow, difficulty grasping the hand and wrist pain, some of those types of things, it talks about the hand of benediction, being that kind of formation that you get when you try to make a first. And then the second page again, we have a really nice, big, beautiful graphic that talks about the sensory distribution in the hand and labels median nerve, radial nerve and ulnar nerve, since the sensory component is a big aspect of these injuries. And then at the bottom, it talks about different assessments that we might typically perform in order to kind of start to get that differential diagnosis. So the carpal tunnel compression test, the pronator compression test, and then the valence test. And we have a picture of that to the right of it. And it gives really nice simple descriptions of how to perform those assessments. And then on the last page, it goes into common median nerve injury, so carpal tunnel syndrome, pronator teres syndrome, and anterior interosseous nerve syndrome. And underneath each syndrome, it talks about this, what is actually happening with each specific injury, what’s being cut off to cause or the location and the types of injuries that happened to make it be appropriate to that that injury. And then to the left, it talks about what you’re going to see for assessment results per each type of syndrome. So, for example, on a pronator teres syndrome, you’re gonna get a positive pronator compression test, but you’re gonna get negative carpal compression test or a Phalen’s Test. So helping you to really figure out is this carpal tunnel or what is this because they can present so similarly and overlap with each other. And then again, to under each syndrome, it talks about different effective ways of treating carpal tunnel syndrome, pronator teres syndrome, and anterior interosseous nerve syndrome. So, lots of information in this handout to kind of help guide how you’re going to go about assessing and treating these different median nerve injuries.
Karissa Simon 4:43
Yeah, I love this, that it’s just kind of simple refresher for people who might have a patient come in and complain of some of these symptoms. And it’s not always easy to remember every single test, so it’s nice that it’s right there for you, you can refer to this. And then once you kind of determine what you think it might be referred it to the physician, and then it gives you treatment options, which is just really great.
Johnny Rider 5:13
Thanks. Sometimes we assume that, you know, these types of resources would only be helpful if you’re working in like an outpatient or a hand therapy clinic. But it’s important to recognize that we can see median neuropathology, in every setting that we’re working in, and especially therapists that aren’t working in outpatient might need that refresher, or might need this guidance, or just have this handy if a patient is complaining of some paraesthesia, some sensory changes in their hand, or maybe even some atrophy and some of those small muscles around the thenar eminence, then we have this guide. So I think it’s great for all occupational therapy practitioners.
Karissa Simon 5:50
Absolutely. Then we’re gonna go on to our next thing, which is an article snapshot called Short Term Effectiveness of Kinesiotaping as a Therapeutic Tool and Conservative Treatment of Carpal Tunnel Syndrome: A Systematic Review and Meta Analysis. So this ties right back to what we were just discussing. And go ahead and take it away. Johnny, tell us a little more about it.
Johnny Rider 6:15
Yeah, I figured since we’re talking about median nerve injuries, we can look at some evidence, and this is very recent. And also, sometimes it’s hard to read systematic reviews and meta analyses that, so we kind of shy away from that. But this was just published this year. And it gives us a lot of good information. Kinesiotape or Kinesiotape application is something that a lot of occupational therapists don’t get training on in entry level education in school. But I think a lot of us then get some advanced training or kind of pick it up along the way. And so it’s a great topic to talk about, because it is one of those tools in our tool belt. And this review didn’t find any negative effects for kinesiotaping, we also have to recognize that it’s pretty cost effective, pretty easy to apply. So it’s something that we can use as part of our entire comprehensive treatment for carpal tunnel syndrome. In general, though, and looking at a lot of different studies, and you have to remember that some of the limitations with these big reviews is that there’s going to be some variability in the application parameters, maybe. This study found that very few participants across multiple studies were men, and then it was also hard because you can’t blind the therapist or the participant to the intervention. So those are some of the concerns and the research out there. But in general, we find from this study that kinesiotaping can provide some positive short term effects on various symptoms of carpal tunnel syndrome. So we have function being one severity of those symptoms, pain, and even neurophysiological outcomes when they look at like our motor control and some of our sensory information, how quickly we can interpret and/or send signals from the peripheral and central nervous system. So we can kind of conclude that it’s a valid and complimentary intervention, we don’t want to only use kinesiotape to treat carpal tunnel syndrome, that wouldn’t be enough. But when our clients are complaining of symptoms, this might be a great way to get some of that short term relief, or a short term effect. And it’s also something that we can potentially teach them how to do on their own outside of occupational therapy.
Megan Wilkinson 8:31
Yeah, I love this as a complementary intervention, like you said, I think a lot of times with syndromes that bring pain, if you don’t get that under control, there’s so many beneficial methods that we can’t even start touching. And so if we can implement something like using kinesiotape to get the pain under control, so that we can start to use some of those other methods in conjunction with it, then that really improves our ability to make progress with our patients.
Johnny Rider 9:00
That’s a great short term approach while we work on the long term, goals,
Karissa Simon 9:06
That’s great, too. I was just thinking that a lot of patients don’t like the idea of putting like a big bulky splint on their wrist or something that restricts their movement and kinesiotape is not very restrictive at all, and you can hide it easily. So I think it’s such a great intervention. And it’s wonderful to see that it’s evidence based. I hope it encourages some occupational therapists out there to start using it.
Karissa Simon 9:31
And we’re gonna go to our next resource, which is Bowel Management after Spinal Cord Injury. This is a two page handout, and I’m gonna send it over to Megan to tell us a little more about it.
Megan Wilkinson 9:46
So this one is, it’s important. I think that you know, there’s kind of certain areas that maybe just don’t get touched on as much either because they feel intimidating. or, like a touchy topic. But absolutely, this is very much in our scope of practice. And it’s something that is really, really valuable to individuals who have had a spinal cord injury because it really impacts their quality of life, their ability to be out in the community and having normal routines, participating in, in all of those social skills. Everything, it’s a, unfortunately, is something that these clients have to build into their schedule. And so it’s really important to be talking about this early on, and being able to get them on a bowel program, which we’ll go into that in a minute, as soon as you possibly can. Because if they, if this is not addressed, especially early on, then you’re going down the road and trying to get them more out in the community doing more things. And this becomes such a limiting factor. And it’s amazing how many individuals with spinal cord injury that I’ve gotten later on in their rehab process that I’ve they don’t know, really what I’m talking about with this. And so this is really something I’m pretty passionate about is making sure that this is at least being discussed very early on in the process. So this handout, like Karissa said is two pages. So we’ve got some really good information here. It talks about the different types of bowel that you can have after a spinal cord injury. So neurogenic bowel is the term that’s that’s used for individuals with spinal cord injury, and then it’s divided into either reflexive bowel or areflexive bowel. And that’s dependent upon the level of the injury, and then how the bowels are responding based on that injury. And that’s really important to understand, because the way your bowel program looks is going to be dependent upon what type of bowel you have. So it kind of breaks down the different types of bowel. And so you know, as you’re running through this with your your patient, you can in that moment, say, you know, so you would be this because this is the level of injury that you have. And then you can be paying more attention as you’re going through the rest of the handout, which I think is nice. And then it talks about the importance of establishing a bowel program. And what about program is, and essentially we use bowel programs to eliminate the incidence of having a bowel accident. And the goal is that they should be able, to once they are on a program and this is part of their daily routine, they should not have to worry about their accidents, they can revolve their doctor’s appointments, their social engagements, all the things in their life around this and they should know they should have relief and knowing that like this isn’t an anxiety they need to have that they’re going to have an accident while they’re out in public doing something important to them, because they’ve completed their bowel program. And they’ll see once they’ve established it, like it’s very successful once it’s established. So that’s a wonderful thing. But it also talks about how having a healthy diet and drinking plenty of water, making sure you’re active. Using medications, all of that is really important, you know, it kind of all has to go together to really make it function for them. And so it’s it’s, you know, a lot more change on top of the the injury they’ve just had, but at the same time, once these things are implemented, then it really gets them back to having that better quality of life. And so, um, let’s see here. On the next page, it’s talking about the basics of completing the bowel program. And again, we clarify that, you know, you want to work with your therapists and your care team to determine what works best for you as an individual, depending on all of the different factors, comorbidities all the things going on to make it happen but these are general guidelines and it talks about has a nice list of equipment that you might need and then it divides it into a seated bowel program versus a sideline bowel program. And then gives the steps of the general bowel program steps so again, whether you have areflexive or reflexive bowel a suppository may or may not be used so again it’s it’s generalized but also detailed I think and being able to cover what this looks like and it can get you get the conversation started it can get you starting to look at equipment with them the talking about you know, whether a seated bowel program or a sideline bowel program would be great for them. It’s it’s a complex way to to go about it. And so there’s a lot of conversation that needs to be had. So I think that this is a really great introductory handout to, to really be talking about it and to start saying, okay, like this is something we need to start working on this. And these are goals that we’re going to be be working on together. And a lot of times, nursing staff as well as a big part of this because it has to do with suppositories and some of those types of things. So that’s usually like a, in my experience, a code treatment kind of activity that’s going on and being addressed through OT. So and then at the bottom, we have a disclaimer, kind of about autonomic dysreflexia, because that is an important aspect to having to managing your bowel because your AD can be associated with bowel impaction. And so that’s, again, another reason why bowel program is so important.
Karissa Simon 15:53
This is such a great guide to hand your patient or family member and kind of get this conversation started. But it’s also a great reminder, for OTs, that maybe are not too familiar with spinal cord injury, and they’re seeing someone down the road. And just to check in and make sure that this is established, and that this has been addressed.
Johnny Rider 16:16
The important thing that you mentioned early on, as you know, this could initiate the conversation. And I know this can be a touchy subject. But I think it’s important to highlight that we are one of the only professions that has this specifically listed in our scope of practice in our framework. And so if the occupational therapy practitioner is not addressing this, as you alluded to, the chances are that no one is talking to them about this. And so hopefully this guide, this handout can help those that may be a little less comfortable broaching this topic. But time and time we see in the literature that this has not been addressed enough. And so this can also hopefully encourage more people to get out there and talk about this and realize that you don’t have to be an expert on all things spinal cord injury or all things bowel bladder to start helping someone develop a program.
Megan Wilkinson 17:11
I think to using this as a tool to get together with your team, if you find that like generally your hospital is not doing this as often as you should be or clinic or whatever you’re seeing a lot of this kind of slipping through you could bring this and have a discussion about it and say like what do we need to do to get some of this equipment? Like how do we need to implement making sure that they are coming through our doors, and this is something that’s been talked about. And especially if therapists aren’t comfortable, it hasn’t been something that’s being implemented, if you approach it and kind of a team aspect of like, we’re gonna get this back on our table and something that we’re doing and making sure that our, in our patients with spinal cord injury are getting the care that they need. This can be a great point to be talking about that too, with the OT team.
Johnny Rider 18:00
Because every new spinal cord injury should have a goal by their occupational therapy practitioner related to a bowel and bladder program.
Megan Wilkinson 18:09
Yep, absolutely.
Karissa Simon 18:14
Right, and now we have another article snapshot that is related to the resource we just discussed, again, tying it together for everyone. So this is called Social Activity and Relationship Changes Experienced by People with Bowel and Bladder Dysfunction Following Spinal Cord Injury. Johnny, can you tell us about this article?
Johnny Rider 18:35
Yeah. So a little bit older than our other one was still really good information. We wanted to connect it to our resources. This was a qualitative study. So the researchers performed in depth interviews with 22 different individuals with spinal cord injuries, trying to understand a little bit more about what life is like, what’s the lived experience for them regarding things like social activity and relationships, especially those that are dealing with bowel and bladder dysfunction, like we’re talking about. And so I think it’s really important that we always look at this qualitative evidence as well, because we don’t often have a lived experience that our clients do. And every once awhile, we might have a similar experience, but probably not when it comes to spinal cord injury. So this allows us to dig a little deeper into what life is like for them with the hopes that we can address this earlier on at that acute stage, but also let them know that hey, it’s okay to talk to me about some of these things, you know, like bowel bladder, which then leads to relationships and sexual intimacy. And what happens when I’m out in public versus at home or who do I ask for help. And so overall, some of the big themes that they found here was that bowel and bladder dysfunction obviously altered relationships, some of the big things were intimacy. The relationship was really strained because there’s a lot of pressure on the individual that wasn’t injured to assist. And so there’s kind of some role changes and imbalances happening for loved ones or significant others for family and even for friends, especially out in public. And so it’s kind of interesting because a lot of the participants said that a lack of understanding from their friends about what it means to have bowel and bladder dysfunction was frustrating for them. Because they couldn’t go do as much as they did before. And it was hard to explain that to friends and family and they didn’t quite get it. And so then they’re upset that, hey, why aren’t you coming out. And they’re like, You don’t understand how difficult it is, for me, when I need these resources, I need to plan things, I need to have equipment and accessible bathroom. So there was tension between kind of managing bowel and bladder dysfunction, but also wanting to participate and do more, there’s a ton of different factors that were identified that really negatively affected the relationships they have the activities that they were engaged in. So again, great things for us to ask about. And at any stage of that rehabilitation, and maybe even more so after they’ve gone home from, you know, those of us working in outpatient, or community based or home health. And so we’ve kind of already highlighted our role here, but we should be addressing this, we have training in it. And we should be broaching this topic so that we can help them improve and engage and participate in meaningful relationships, meaningful social activities, get them out of the house, in the community, doing whatever is important for them.
Megan Wilkinson 21:34
I think that some of the points here about the you know, you were talking about the frustration that they feel in communicating. And I think that that’s one of the strengths we have as therapists because we can use the way we talk about this with them as a teaching method for being able to advocate for themselves, you know, if we are calm, relaxed, you know, not uncomfortable, make it a very open topic. It’s just a very normal thing. You know, we model that for them, and we work on teaching them advocacy, then the way they’re having those conversations with their loved ones completely changes, it doesn’t become this moment of anxiety, or what are they going to think I don’t want to share all these parts, you know, thbey’re not going to understand it, because I’ve practiced this and had these conversations, and I, you know, this is just part of who I am now, and my friends will understand my family will understand and it’s okay. And we can really change the way that that looks for them too. And I think that that’s, you know, something that we have to consider when we’re having these hard conversations is the way that we approach it can mold the way that they feel about it when they leave us?
Johnny Rider 22:45
Yeah, one thing that I find, like helpful for me when I’m reading research tools, I try to think about oh, like, how do I use this in this setting this setting in this setting, too. And I love that because that’s a great way early on in those discussions. But we can also apply that when they’re actually having to do that out in the real world when they leave the hospital. But some of the things that this study highlighted that we didn’t mention just on the slide was the bathrooms like public and private bathrooms and how important so like you’re saying, how do you talk to someone about, hey, like, can you tell me I need to make sure that I have access to your private bathroom? If I’m coming over to your house like I have a we roleplay or model that discussion? How do we help them learn how to look that up if they’re going to a public space as well. Lots of things like UTIs, UTIs came up a lot in this study, like, how do I manage that? How do I talk to someone about that stress, anxiety about what was going to happen? All these things that we already address as occupational therapist and other realms come into play in this one topic. And so in the end, one of the big things they said that helped foster more participation was social support. And so coming back to what Megan just said, if you can have that conversation and feel supported by your friends, your family, then you’re gonna go out and do more, and then learning how to adapt. And what what is the one word that you know, so many people associate with it is that adaptation, right? So talking to them about this and helping them figure out how to adapt it and lower that stress, lower that anxiety and let them do what they were doing before the injury or what they want to do now.
Karissa Simon 24:26
Something that ocurred to me as you were talking about this, and the difficulty with public bathrooms is that this is also a great role for OT to advocate bathrooms that are accessible in places that we work accessible for people who have these unique needs. Especially like in places like hospitals, like their public restroom should be able to accommodate people there with spinal cord injuries or need specific things and I think that’s a great role of OT to advocate to help change this.
Johnny Rider 24:57
I agree and there’s even some cool resources is out there. There’s some apps that are that allow people to take pictures and comments on how accessible various vacation spots are companies and even bathrooms. So there’s a few of those out there right now that I’ve seen highlighted, and they’re only growing and they’re only getting better. And that’s the beauty of technology that maybe that’s something we can contribute to or point those individuals in the right direction.
Karissa Simon 25:25
I love it. And now we’re gonna go to our next resource, which is Bidets so also is a one page handout and has a nice QR code and kind of relates back to what we were just talking about. So Megan, can you tell us about this one?
Megan Wilkinson 25:42
Yeah, I was gonna say this one ties in so nicely what we were just chatting about. So this one was a request that we got during a OTA which was really exciting. So very happy to produce this one. And again, tying back to what we were just talking about bidet is actually beneficial for all not everyone, but a lot of people who have a spinal cord injury to help with that cleanup afterwards. So good transition here. So one, one page handout nice and simple, really looking at what is a bidget how does it help? What are the benefits? What Why would we or What will we be considering might who it might be appropriate for versus not be appropriate for. So for those who don’t know, I feel like we anyone listening probably does know what a bidet is, but it is usually an attachment that you can put on your your toilet, but they do come as a full, a full toilet that you can purchase that has the ability to spray water to help with cleaning after you have gone to the bathroom. And so this is really beneficial for a lot of populations and a lot of people that we’re working with in OT and I think that we should be recommending them more. In my personal experience. Anyone I know who has used a bidet immediately falls in love with them as weird as they feel maybe going into it they’re like wait like this is this is a wonderful tool. And they kind of start like recommending them to everybody there are our modern ones have heated water, the seats can be heated, there can be an air drying effect. I mean, there’s a lot of cool pieces to bidets. So when we’re thinking about what are the benefits of recommending a day for our clients, it can really improve independence. For for our clients who can’t get there to to wipe for whatever reason. And it also can really reduce the need for caregiver intervention, I think about a lot of our, our clients that they just need help in the bathroom. But that’s so much stress on their caregivers and physical exhaustion. I know we’ve all been in that situation before where we’re helping a client and sometimes you leave and you’re just sweating. And so for a caregiver that is is helping their loved one or they’re hired, and they’re doing it multiple times a day, that’s an exhausting task. And this can really help reduce the strain on our caregivers too. It also really helps improve dignity and privacy, if they’re able to use the benefit of the bidet to be able to be wiping themselves independently, they don’t have to have a caregiver anymore. If this is the difference between needing a caregiver and not what that does for that person’s self esteem and how they feel with participating and toileting, huge. That’s, that’s a really big deal for a lot of our clients. And then just overall quality of life, I think, you know, being able to kind of take this back for for yourself is is huge. And there’s a lot of health risks that can go down with it like UTIs, it can reduce the risk of UTIs because it’s getting thoroughly cleaned. You know, if you think about some of those individuals who maybe have cognitive deficits physically, they’re able to get themselves clean, but we’re just not paying attention. Or maybe we don’t remember something that’s limiting there. And so then we’re not, you know, we’re finished toileting, and then we’re leaving and we’re soiled and then we’re increasing the risk of a UTI. And so if we’ve already had this installed, it’s something they’re using, we can kind of trust that that’s getting, you’re getting more thoroughly cleaned and reducing the risk of UTIs. So, lots of lots of benefits of installing a bidet. So again, it covers some indications. as to who you might recommend a bidet for, so lack of ability to independently wipe themselves because of reduced range of motion or weakness. A lot of our neurological conditions that we’re talking about, I mentioned the spinal cord injury, but also stroke, sensory cognitive visual impairments, ongoing fecal incontinence, reduced endurance, chronic pain, progressive conditions. So a lot of different people that were working with an OT would benefit from a bidet. And then the last thing it talks about is some of the reasons you might not want to, or you might want to like second guess why you would be recommending it. You need to use buttons and knobs to operate it. And so if that’s something they’re not able to do independently, then that might be a reason to at least consider well, can we modify this is there a way we can look at it differently, it would be something to be considering when you’re recommending this. And then the price again, our prices on these types of things have gone down significantly, there’s so many different options of ways that you attach it, most of them are attachments that you can easily buy off of Amazon, and then attaches to a standard toilet there. It’s pretty accessible at this point. But cost is always something we need to be considering when we’re recommending equipment to our clients. And then lastly, if you’re thinking about some of our clients that have that really kind of like hard plop onto the toilet, they might break this device. And so we need to be thinking about those individuals. And then that QR code that Karissa mentioned is a link to equipmeOT, if you don’t follow her. She’s awesome. She’s always talking about new equipment that’s helping patients on her Instagram. And the QR code will take you to watch her install the day on a raised toilet seat. So if you’re helping out a client with purchasing it, bringing it in and getting installed in their home, that video is very helpful.
Johnny Rider 32:02
I’ve actually had to install quite a few of these working in home health. But I think the coolest thing about these now is how much the price has dropped. And so I looked them up before our our little session tonight, and you can get them on Amazon for less than $20. Now, and some of these have 1000s of reviews. But twenty bucks for a decent one, and you can install it in 10 minutes, I mean, that’s what wasn’t available years ago, you know, it cost you hundreds and hundreds of dollars, you’d have to get someone you know, pay a professional to come in or replace your entire toilet. Now it might even be worth problem solving and trying this out once and, and seeing because in the world we live in, you can almost return anything too. So why not try it and see if it works.
Karissa Simon 32:48
It’s not only, well I have many clients who would benefit from this because of privacy concerns and things like that, it would be great for them. Also, for caregivers, if you have someone who is like very difficult to stand, you can do a toilet transfer, but standing for the parry hygiene is really difficult. This is another option to let them continue to toilet on a toilet rather than in the bed. Because there are many facilities now that are no lift, they don’t want to hold the patients up to complete pericare. And this is just another option if a person really can’t stand very long on their own, even if a caregiver has to operate it for them.
Johnny Rider 33:29
I don’t think that even all three of us putting our heads together could list every potential diagnosis or concern that this would benefit. Because I even I mean, I know after my wife, we have five kids, but the doctor recommended that after childbirth and said no, I think you should get a day this makes life easier for the first couple of weeks at home. right all the way down to other surgeries down to just functional limitations down to concerns about hygiene without even huge functional limitations. Really, there’s no limit on who might find some benefit from installing one of these days.
Megan Wilkinson 34:04
Well, certainly if it’s if it’s $20 off of Amazon, and you’re, you know you’re coming home from having neck surgery or shoulder surgery or whatever and you’re worried about, you know, reaching back they’re like, do it, why not? Then you fall in love, because that’s what everybody knows.
Karissa Simon 34:20
And we’re gonna go to our next resource, which is Shopping Strategies for Executive Dysfunction. So this is two pages. And Megan, can you tell us more about this one?
Megan Wilkinson 34:37
Yeah, so this one was kind of jumping off of a few months ago, maybe two months ago, we did cooking strategies for executive dysfunction. And this is another ideal area where executive dysfunction without properly implemented strategies can be super overwhelming, and something that people tend to You get frustrated by or non engaged in. Because of that. So the first page details, all the different executive functioning skills, and specifically where you might run into issues are what is important with shopping. So some examples would just be with planning, you need to identify necessary errands and when to do them. And in what order there’s so many time management aspects of, of shopping, I feel like mental flexibility is a huge one. If you make it to the store, and you’re looking for like a very specific ingredient, or condiment or something for a recipe, and it’s not there, what are you going to do? How do you react in that type of situation. And then being able to organizing is a huge part of shopping, if you’re a list maker and making sure you get everything for your recipes, or you know, whatever you’re missing. At home, there’s a there’s a lot that goes in into shopping that I think we don’t always think about. And so on the second page, this is talking about some very specific strategies that can help with reducing the stress of shopping when you have executive dysfunction. So making a list huge, right? That way, it’s not being all held up in your brain, the more stress we can take out of the brain and put it somewhere else, the less overwhelmed, we’re going to feel by any task. So making a list is really important. And there’s a lot of different methods to this. And you know, it doesn’t have to be that that traditional like list on the side of the fridge, when you realize that you’re out of something. Having it on your phone means that if you are out with friends, and you’re like, Oh yeah, I need to pick up celery, whatever you can like add it to your your list, then and then your phone comes with you to store right you always have the ability to add to your list and bring it with you when you go to the store. So that’s one option. You can use voice technology like Alexa to help you keep track of your errands. A lot of times you can set those up to well, first of all you can when you just think of something, when you’re wandering around, you can tell her to add something to your list, which makes it super easy again. And then they can the smart devices can help remind you about things that you’ve bought previously, when it’s time to reorder things, which is also really helpful. And then you can kind of, you know, organize even further down those lists. So you can keep things separated by store if you know, at this store, I specifically need this. And at the store at this it’s it’s separated. And then again, when you go in, you can have your list organized by the cleaning aisle versus the produce aisle versus pantry items. So that when you’re on that aisle, it’s all together and you’re not all the way at the next end of the store and you go oh crap, I forgot. I forgot the serial, I need to go back and you’re walking all the way to the other end. So having it really organized, so there’s really easy to follow, and you’re less likely to kind of trip yourself up. It helps the next areas looking at creating a plan and a routine. So having a designated spot to keep your things like lists and shopping bags, if you are someone who goes to the library waiting to return your library books, that way, it’s all in one spot you’re not running around and looking for stuff where you again, forget something when once you’ve gone out shopping is is a helpful tip, I typically feel like having it near the garage or near your car is good, because then the connection is just right there. And then having a plan for how you run your errands is really helpful to be so if you know like I’m going to the grocery store on Mondays and Fridays, or whatever, then one that’s worked into your schedule already. And two, you can relax on the days that you aren’t, it’s not a shopping day, right? Like you know, like that’s an established time to go shopping. It’s not something you’re having to worry about. And you can be collecting that list and making sure that that’s all in order. But being as efficient as you possibly can so that you’re not going out every day to go buy stuff because you forgot whatever at the store, right? So having a plan is really important, and then mapping out your route. Again, if you’re stopping at multiple places. Another way to kind of reduce that stress is really a really good tip. Just being more efficient generally. And then consolidating your errands. Right so this kind of I feel like is connected to creating a plan and routine. We don’t want to be going out all the time. So if you can have an errand today, that just makes it easier. And then shopping during off hours, I feel like this is a really big tip because grocery stores are so over stimulated. There is so much happening in the grocery store, even if you were in there by yourself with no other people doing their thing. At the same time, there’s usually music playing, the lights are really bright, you get to you know, the baking aisle, and there’s 20 different boxes of cake mix. And you have to choose which one you want, you’re looking at all the different prices and all the different flavors like that’s an overstimulating thing. And then when you have a whole list of things, and you’re doing the aisle after aisle after aisle, that’s a big thing, right, and then incorporating that with the person who’s on their phone next to you and not watching where they’re going. And they almost ran into with their grocery cart, all of the different aspects of being in a grocery store just makes the the task of having to collect things from your list, way more overwhelming. So shopping in those off hours, if possible, I there’s a reason why people are all there at the same time, because we generally have the same work hours. So it’s not always possible. And that goes to our last tip, which is shop from home. And I think that this is one of the best things that exploded out of COVID times, and all of the different resources that we have to be able to not have to go into the store to get the things that we need. So much stuff is easily delivered, you can also do a lot of drive up pickup stuff. So you make your grocery store and they’ll come loaded in the back of your trunk or grocery list, excuse me, and they’ll load it in the back of your trunk. And then like I was saying before, a lot of things that you would order regularly, you can get refill reminders, you know, it’s saying like, hey, like you are almost out of this thing. And they’re like, oh, yeah, I am almost out of that. And you just click it and then it sends it to your house. And that’s incredible, right? That’s, you know, you can be sitting in your pajamas on your couch, relaxing, or whatever and do your grocery shopping, instead of the whole effort of driving your car and getting out to go get your your groceries. So just kind of highlighting some strategies that that we can be teaching our clients who really struggle with this. And I think if you have the opportunity, where you work to practice these go out into the community and actually practice and implement it, then that’s even better, because you can really see what works to them. Because again, not all strategies work for every person.
Karissa Simon 42:33
Like you were saying, with the out of the pandemic came some of these shop from home options. They also implemented a lot of stores implemented, like off hours for seniors just to shop. And some stores still have that going on, which is great. So that people can go and they know, it’s like a specific time. I know some stores even offer like sensory hours where it’s supposed to be like low sensory for people who struggle with that. So just helping people to find those resources to see what works for them. And I think this handout is a great way to get that conversation started.
Karissa Simon 43:07
All right, and we’re gonna go to our final resource for the month, which is Delayed Recall Visual Memory Activity. And it is a three page handout and has some pictures on the last page, and then some descriptors on the first page. Megan, if you can tell us more about this.
Megan Wilkinson 43:30
So this is a material to be used with clients when you’re working on visual memory, especially delayed recall. And so this on the first page, it’s really talking about what is visual memory? Like? Let’s talk about it. And what does that mean functionally? For for the client, when they have difficulty for with visual memory, excuse me. And then I talks about how storytelling is a really great way to help our brain remember visual information. So it’s giving treatment strategies to our therapists and then diving into the actual treatment material. And so these two pictures on the last page, for those of you who are just listening, they’re very, they’re real life pictures. One is an office scene, there’s a man standing up, holding something demonstrating something, there’s people watching and paying attention to him. And then on the last page is a city scene. So mostly buildings, there’s cars and people moving around some trees, but a very real life scenario. And so with this activity, you’re going to be placing the photos in front of your client. And then you’re talking about the use of storytelling as a visual memory strategy and you can work together with them about creating the storytelling this strategy to remember information about the photo. And then there are questions. Once they have used that strategy and you take it away, there are questions for the client to to answer and see did storytelling work and help you to remember the all of the visual details in these images? So there’s questions and then there’s answer keys. So I think this is a really great dynamic material, because we do have this first page that really talks about what is visual memory? How do we work on it? How do we work on it in a functional a more functional way? And then really, giving some nice examples of storytelling and what stands out and how do we we use that strategy to improve visual memory and then really clear cut instructions for being able to implement the material.
Johnny Rider 46:04
Thanks, um, the best thing about all of our resources, use these in any setting. That’s what’s so nice is, whatever setting you’re working in this could be beneficial be applied and help someone prepare for the next stage in the healthcare continuum, or wherever they’re going next.
Karissa Simon 46:23
Yeah, they’re all great. And now we’re gonna go to our case study for the month. And our case study is Mr. Stone is a 72 year old man with diabetes mellitus type two, and congestive heart failure, who was hospitalized with hypoxia, secondary to acute episode of his congestive heart failure. He was also noted to have poorly controlled diabetes. Mr. Stone lives alone in a one level home with two steps to enter without a railing. He has a tub shower without adaptive equipment, and a normal bed. Mr. Stone has a supportive daughter in the area who comes over several times a week to check on him, cook some of his meals and complete his housekeeping and laundry around the house. He reports that he is still completing his activities of daily living with independence, and still drives to the grocery store to purchase groceries. Mr. Stones daughter has reported concerns for her father’s ability to care for himself at home when speaking with the acute care occupational therapy.
Karissa Simon 47:28
So for my resource that I selected to address Mr. Stone’s case, I picked Heart Healthy Cooking, it is a one page resource, and just has some recommendations on what you can or what you should be eating for your heart health. And it talks about like the research about why you should be eating healthy, and the outcomes and some clinical style and some clinical trials and how it has helped people. So I picked this resource, because it sounds like Mr. Stone is doing all the shopping still. So it’s something important that we should talk to him about, especially with his CHF. He that it keeps flaring up and also that he has diabetes type two that he’s not well controlling. So that I just thought that this was a good resource to talk to him about talk to his daughter about and kind of begin that conversation in case he’s not eating as healthy as he should.
Karissa Simon 48:36
And then Johnny, you picked Home Safety Checklist. Can you tell us about this one?
Johnny Rider 48:42
Yeah, so I just thought this is a really comprehensive resource that occupational therapy practitioners can utilize. And given that our patient lives alone, and has a few potential safety hazards, at least a few that we know of this is a great guy to help us kind of go through every area of the house, but also consider some of the risk factors. And it’s nice because even though I think every occupational therapy practitioners pretty comfortable with you know, home modifications and safety assessments, the fact that this is five pages shows you there’s a lot of things we have to consider when doing a home safety evaluation. So it just ensures that you don’t forget anything. It also lays everything out where you could easily provide this to the individual, their family. And I think it’d be important to address some of these things and kind of identify with the client. This is a high safety risk. Here are some recommendations. Let’s talk about how we can handle this, whether we work on remediation or kind of an adaptation by by changing the environment.
Karissa Simon 49:51
Then Megan, you picked Congestive Heart Failure which is a one page handout, can you tell us about your picks?
Megan Wilkinson 49:58
Yeah, so when I was reading In this case study, to me the fact that his diabetes is poorly controlled, stood out to me. And I think about how important education is. And I think you know, acutely when you end up in the hospital, you have people explaining to you what’s going on and, and what you need to be doing to take care of your your condition. But initially, it can feel scary. And so we’re not digesting that information. And so, going back in when things have calmed down a little bit, and making sure that education is an important part of what Mr. Stone is receiving, I felt was important. So really talking about what congestive heart failure is, do you understand what your risk factors are? Do you understand how we can be prevented? What lifestyle factors can help reduce the effects of all of this? So being another layer of education, I think is always a really important thing, being another person to talk about it. And potentially some, you know, sometimes we have clients that we have to repeat these types of things. So starting off early and talking about education and saying, Hey, do you remember that handout that I gave you about congestive heart failure? Like, what do you remember about how much of that are you actually digesting so that when they go home, these things are better control, they’re more likely to implement like Karissa’s handout and taking care of themselves with a heart healthy meal because they understand the condition that they have.
Karissa Simon 51:37
Do you guys have any other thoughts about Mr. Stone’s case?
Megan Wilkinson 51:45
Like we covered it, we had a pretty wide range of materials that cover all the points.
Karissa Simon 51:53
Yeah. And so now we’re going to share some resources you might be interested in from our PT team. The first one is How to Tape for Lateral Ankle Sprains. And it is two page handout. It has pictures of different taping strategies and gives you step by step directions so that you could do that. The next one is called Doorways Home Modification for Individuals who use Wheelchairs. Again, it’s a two page handout and has some pictures of your the doorways themselves, and different things you need to consider along with modifications. And then What is Proximal Hamstring, Tendonopathy? Which is our final handout and is two pages has some pictures of different exercises you should be doing or treatment for it. And a nice little chart that lists all the different muscles.
Karissa Simon 52:58
Thank you so much for joining us. This is our last show for the OT edition of the resource roadmap show. Thank you so much. We’ve really enjoyed producing this for you guys. And any of these resources are available at therapyinsights.com along with hundreds more. All of the links are available in our show notes. And if you have any questions about anything we discussed today, please be sure to reach out to support@therapyinsights.com and make sure you vote on what we create next for you guys. Thank you so much.