Neuro note 4: Patient Perspectives - Lisa Maczura

For this neuro note, I searched for a podcast to listen to because I was hoping to get a great client's perspective on living life with a disability.  The podcast that I chose is part of a series called Senior Rehab Podcast. This podcast series is guided by a physical therapist named Dustin Jones with a mission to give a voice to the aging population.  In the podcast I listened to was an interview between Dustin Jones and a lady named Lisa Maczura.

Lisa is a women who has lived her life with cerebral palsy (CP). In the podcast, she describes her experiences in life but especially within her physical therapy (PT) treatments. She describes her childhood and the physical therapy services she received through her school up to the sixth grade. From her therapists in elementary school she gleaned that she could get better if she worked hard enough.  It was later in her teenage years that she realized the reality of her chronic disability. When elementary school ended, she felt as if her PTs just dropped her and said, "you can walk, you will be fine." She felt disregarded and had pretty negative feelings about PT.

Lisa encountered physical therapy for a second time when she went to the doctor for lower back pain.  The back pain was due to poor hip flexors and the doctor referred her to PT.  She was nervous about going because of her previous experiences and feeling her physical handicaps were misunderstood.  The physical therapist was testing some of her leg strength and there was a move she could not complete.  She expected the therapist to freak out and scramble and not know what to do.  Instead, he was calm, had her do an exercise to increase movement, and had her try the move again.  This time, she could move her leg some.  This was so important to her because it gave her a small victory and she knew that her therapist was there to help her.  Over time, she developed an even stronger relationship with her PT and she now fully trusts him with her care.

Lisa asks for therapists to take the time to ask what is important to the client.  She pleads for therapist to pursue the client's wishes instead of their own agenda.  She would like for therapists to ask about previous therapy treatments and what worked and what didn't.  Mainly, she wants the therapists that see her to have empathy.

I learned a lot from this podcast about the care I should be providing for my client.  Even though therapy will be my job day in and out and will seem like I'm seeing the same types of clients, I need to remember that each client is their own person and has their own personality and story in life.  I need to be aware of how I treat my clients and the relationship and trust I am forming with them.  I need to be certain not to be discouraging in my initial evaluation because people are often looking for someone else to just reject them.

Please go listen to this great client's perspective to learn how you can become a better caregiver. The link is below!

Jones, D. & Maczura, L. (2016, June 20). 32: Patient perspectives: Lisa Maczura. Senior Rehab Podcast. Retrieved from http://www.seniorrehabproject.com/srp/patient-perspectives-lisa-maczura

Case Study: Allie Calhoun

In class today, we are discussing dementia and my classmate, Rachel, presented the story of Allie Calhoun.  Allie is one of the main characters in the movie the Notebook.  Allie was diagnosed with Alzheimer's disease and she discussed how occupational therapy might help her and her family.  An occupational therapist might focus on decreasing confusion and panic, increasing education for caregivers, increasing routines, and increasing participation in meaningful activities.  Meaningful activities might include painting to music or cooking a meal, being these are activities that are important to her.  I was most interested to learn about sundowning syndrome, which is a phenomenon of a shift in mood around sundown in patients with dementia.  You can see Allie experience this when she has a panic attack about being confused in the movie.  It is important to not only provide treatment for the patient but also to provide resources and suggestions for the caregiver.

Case Study: Bradley Walker

I did my case study on a guy named Bradley Walker.  Bradley is a country music singer. Bradley was born with congenital myopathy,  a form of muscular dystrophy. His diagnosis is non-progressive so he has been able to live a full life. He was diagnosed at birth and has been using a wheelchair his whole life. He dreams of being a famous singer so he is working around his muscle weakness in order to achieve his dreams. In my study, I focused on creating goals that that would help him gain independent living and mobility via a modified van. Mainly, I looked into ways that to work with this disabilities to help him accomplish the occupations and roles he deemed important.

Bradley said, "I’ve never questioned the hand I was dealt. If I hadn’t been dealt this hand, I might not have been given the gift of music that I love so much, and I wouldn’t be singing bluegrass to people. So I wouldn’t change a thing." This struck me because his occupation of singing was more important to him than his ability to walk. I think this is a key lesson for me as a future occupational therapist to learn. Sometimes helping people gain an occupation means so much more to them than their functional ability.

Neuro note 3: Transfatty Lives

For this neuro note, I chose to watch a film that was suggested in class along with our discussion of Amyotrophic Lateral Sclerosis (ALS).  I watched a documentary film by Patrick O'Brien called "Transfatty Lives" that shows first hand Patrick's battle with ALS.

This film was directed by Patrick as his disease progresses.  The film begins by showing Patrick as a healthy film maker with a lot of life ahead of him.  When he was diagnosed with ALS, he turned the camera on himself and began filming parts of his journey.  Throughout the film, he goes from walking independently, walking with a walker, riding in a wheelchair, to bed-bound.  After he was diagnosed, he met a girl that became his girlfriend and together they had a child named Sean.  His son becomes his motivation to live and to continue working with film and video. Patrick's condition declined throughout the movie to the point where he had to chose whether to be put on a ventilator.  This was a hard choice because it would prevent him from speaking but he decided to continue living for his son.  Having the ventilator in resulted in part of the movie being narrated through the computer voice of Patrick.  Patrick's mind is fully intact while his body is crippled.  I was impressed by his statement about this disease maybe being an good thing because it sent him on an inner journey of himself.

I thought this film was so unique because it was done by someone actually experiencing ALS.  It was hard not to experience the emotions he felt.  I learned so much from this movie, from the many physical struggles he faced to the emotional loneliness he experienced.  His attitude when he was first diagnosed and during the earlier stages, he was so positive about his disease and was active in doing what he loved and advocating for a cure.  It was sad to see this happy guy sit in a nursing facility with a ventilator in the later stages of ALS being so lonely.  I felt so much joy for him as he was transferred to the facility for those with ALS and he knew he would not be lonely anymore. Patrick is still alive today, 12 years after being diagnosed with ALS, and what a journey! It is inspirational to see him to continue to do the videoing and editing that he loves, even in the face of impossibility.

I am so glad that he made this film to really bring awareness to his condition but it also encapsulates him as who he was and who he is in his mind and not as simply a ventilated ALS patient.

Please go watch "Transfatty Lives". You will be glad to have gained incite into ALS. It can be found on Netflix!

O'Brien, P., Dupree, M., Green-Dove, A., Hallinan, D., & Mohiuddin, M. T. (Producers). O'Brien, P. (Director). (2015, April 16). Transfatty lives [Motion Picture]. United States of America: Handsome Cargo.

Case Study: Heather Alimossy (Huntington's disease)

Heather is one of the people in the movie "Alive and Well" about Huntington's disease.  Her mother and her brother both have Huntington's so she was screened for Huntington's disease at age 19 and she has the gene for it.  She has not begun to show symptoms yet but she is preparing her life for the symptoms to come.  I think this is an interesting position to be in, to know the effects of the disease is coming but to be healthy now.  Her goals will need to be preparatory methods in order to decrease the effects of the disease and symptoms.

As Foundations class ends

As I reflect on my Foundations of Occupational Performance class, I can see how much I have learned this semester from this course alone.  I feel like I really have an understanding of what occupational therapy is, its history, and how occupational therapists think.  I remember after the first week of this course, going home and telling my husband that this class truly made me excited to be an OT.

I have tried to define occupational therapy in the past for others and for myself and not really known the exact answer.  Now, after this course, I feel I can adequately define and explain what occupational therapy is and my excitement for my future career. It feels good to know I have this base of knowledge that can build upon. I felt we touched on many topics that I will remember for the rest of my life.  I am glad for the set-up of this course and how it facilitated my learning.  I really do feel like I am well on my way to being an occupational therapist!

Case Study: Joseph Heller

Today in class, we discussed Joseph Heller and his struggle with Guillain-Barre syndrome (GBS).  His case was somewhat rare because it did not happen after a respiratory or a viral GI infection but it just spontaneously occurred.  His first symptoms did not begin in his legs and work up like most cases but instead it started in his core and worked outward.  His symptoms began with muscle weakness and he struggled with stepping and grasping with his hands.  When he was diagnosed, he was in the middle of writing his fourth book and later wrote a book about his experience with this condition called "No Laughing Matter".  It took him about two years to recover from GBS.

Therapeutic relationship

The therapeutic relationship is defined as the interaction between the OT and the client.  A good therapeutic relationship is so important to the success of the therapy you provide.  Therapeutic relationships are different from friendships in that instead of both people benefiting from the relationship, only one person is benefiting, the client.  There are several great qualities or skills that one can use to improve the therapeutic relationship.  A few examples include active listening, good verbal and nonverbal communication, empathy, and respect.  Active listening involves restatement of what the client said, reflection of the feelings behind the statements made, and clarification to summarize the thoughts and feelings of the client.  Verbal communication involves disclosing thoughts and asking questions where nonverbal communication involves facial expressions, eye contact, and body language. Empathy, as defined by the OTPF, is the emotional exchange between the OT and client to allow for more open communication that results in a better therapeutic relationship.  Last, respect is so important in that the therapists should respect the individuality of the client's condition while also letting the client know that they are not alone in their struggles.  Working on these few qualities could highly enhance the very important therapeutic relationship.  Having a good therapeutic relationship will only improve the care and the results of the treatment you are providing.

Cultural Competence

As an occupational therapist, I am sure to see many people from many different backgrounds, religions, and cultures.  I feel it is so easy to judge what you do not understand.  So to avoid that, we must try to understand what we do not know.  In class, we discussed being culturally competent to provide great care for all of the clients we serve.  In class, we discussed the cultural iceberg, which I found very interesting.  The cultural iceberg includes behaviors and practices, attitudes, core values, and institutions of influence.  Behaviors and practices are what can be seen by others.  Attitudes are how the values are reflected in specific every day actions. Core values are what are considered right or wrong, good or bad to the person. Institutions of influence are the forces which create and define a cultures core values.  From this I learned just how deep cultural practices can be embedded in a person.  Really, the way a person practices and lives can be traced back to the core or who they are and what they see as truth based on their culture.  It is important that I am sensitive to the ways that my clients practice and realize just how deep their values run.  If I can be competent in other's cultures and values, I will be able to form better relationships and further serve my clients better.

Emerging Areas of Practice: Aging in Place and Home Modification

Occupational therapy has many emerging ares of practice that are a result of a changing world.  As medicine has evolved, people are living longer and many, as they age, are unable to stay in their home for a variety of reasons.  Reasons can include safety, unable to function in their home, or an inability to maintain their home.  Many people value staying in their home as they age and are looking for ways to do that.  Aging in place and home modification is an emerging area of practice in occupational therapy that addresses these things.  Occupational therapists work with clients to evaluate their homes and find ways to improve or modify the client's home so that living at home remains feasible.  Occupational therapists can also teach clients methods to reduce effort and increase safety around the home.  Aging in place centers on helping clients have a high quality of life and making modifications that allow them to do so.  I feel this is such an important area of practice as this is an area in healthcare that is overlooked and frankly, needs an overhaul.  My great-grandmother is 99 and my family has been, for several years, been trying to navigate assisted living and nursing homes.  I think that there are even better solutions for the aging population and I hope that areas of practice like aging in place can help redefine how and where the elderly age.

Case Study: K.T.

Today in class, one of my classmates told about a guy named K.T. that was diagnosed with ALS.  He was a NFL football player.  His symptoms presented first through weakness in his hands and he was diagnosed with ALS in 2010.  His ALS was likely related to the head trauma he acquired while playing football.  This was startling to me that a healthy, professional football player acquired this disease that completely crippled him.  He had cognition but his muscles deteriorated to the point of his death in 2016.  Not only was K.T. a football player but he was a father, husband, and coach and ALS majorly affected each of these roles.  ALS is a progressive disease that weakens the person's muscles overtime.  There is no treatment for this disease.  It was so sad to see the pictures of K.T. from fully healthy to near death, to watch a person of full health deteriorate so much and so rapidly.

Ethical Principles

There are seven ethical principles laid out in the Occupational Therapy Practice Framework (OTPF).  In this post, I will be briefly defining each of these principles.

Beneficence - Looking at the client as a whole and being thoughtful about a client's well-being

Non-maleficence - "Do no harm"; refraining from actions that cause harm to the client

Autonomy & Confidentiality - Freedom to choose and a right to privacy

Social Justice - Right, equable, appropriate treatment of the client

Procedural Justice - Compliance with institutional rules, federal, and state regulations

Veracity - Honest, accurate truth, information, proper credentials, not plagiarizing

Fidelity - Respect and faithfulness to the client

By adhering these ethical principles, an OT practitioner can better avoid or solve sticky ethical situations that arise.  I think having these principles laid out helps practitioners know the correct and appropriate response and it gives a baseline for same practice among all OT practitioners.

Professional Development

I believe the key to being a successful practitioner is to strive for professional development. When I think of professional development, I think of the term lifetime learner.  Lifetime learning enhances knowledge and provides continual growth.  It can be motivated by professional organization demands or just personal curiosity.  The continual pursuit of knowledge produces competence in an area of interest.  Currently, I am in school where material is laid out and I am required to learn.  In some ways, it is easy for me to be professionally developing because I am enrolled in a curriculum that focuses directly on learning about OT practices.  In the professional world, learning is not mapped out in this way and it requires self-discipline to make time to continue learning.  Professional organizations often motivate this learning though with continuing education requirements for retaining a license.  The motivation behind this is to improve quality service and protect the public.  Professional development helps practitioners keep up to date on the newest research and treatment and give the best care to the clients served.  Our profession is only strengthened by a pursuit of continual learning.

Neuro note 2 - Sheryl and Myasthenia Gravis: How I cope!

For my second neuro note, I focused my search on looking for a video or blog telling about a person's life, the disease they face, and part of their story.  I ended up finding this YouTube video about a girl named Sheryl that tells about how she copes with her condition, myasthenia gravis. 

Sheryl is a 17 year old girl that was diagnosed with myasthenia gravis at age 16.  In this video, she talks about the onset of the disease, the description of the disease, and how she deals with it.  Myasthenia gravis is a condition that inhibits the communication between neurons and muscles causing extreme muscle fatigue in voluntary muscles.  Common symptoms are muscle weakness, drooping face, drooping eyelids, and trouble talking, breathing, eating, and swallowing.  Sheryl talks about how she began to experience some of these symptoms one day at school and then the process of being diagnosed with myasthenia gravis.  She receives a treatment called plasmapheresis that keeps her symptoms at bay for a time.  Because of her disease, she can no longer participate in activities to the same degree that she used to.  She talks about how she has made modifications to activities in order to continue participating in some way.  For example, she enjoyed playing softball before her diagnosis and now she cannot play in a game but she continues to participate by going to games and cheering on her teammates and by going to the batting cages to do what she can. 

Listening to her story was inspiring.  I cannot imagine the difficulty of a disability like this while also trying to be a teenager.  I felt sorry for her and yet, she did not feel sorry for herself.  She looked for what she could do, what made her happy, and did it.  She is striving to live as normal of a life as possible.  She even spoke about returning to school after some time spent in and out of the hospital.  However, my favorite part of the video was probably the end when she was showing random pictures she took on her iPad.  This part showed just showed how human she is and how she has many interests that she continues to pursue.  I am reminded that I should encourage the interests of my future clients, especially those with a chronic disease.  I can see the importance of retaining as much normality as possible.  Please go watch this video for yourself to gain insight into this disease and the coping strategies of those dealing with it.

Carter, B. [Bryan Carter]. (2014, October 23). Sheryl and Myasthenia Gravis: How I cope! [Video file]. Retrieved from https://www.youtube.com/watch?v=UZU2nTf6_cc

Mayo Clinic Staff (2016, April 23). Myasthenia gravis. Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/myasthenia-gravis/home/ovc-20200259

The Basics of Clinical Reasoning

Clinical reasoning is a skill that is refined through time and practice by OT practitioners.  The practitioner uses what he or she has learned and seen to clinically reason in order to answer questions and solve clinical dilemmas.  Clinical reason also takes into account the feelings of clients.  This involves keeping the well being of the client as a priority.

There are three elements of clinical reasoning: scientific, ethical, and artistic.  The scientific element asks, "What are the possible things that could be done?"  The ethical element asks, "What should be done?"  Last, the artistic element uses creativity to help with the specific needs of the client.

Some types of clinical reasoning are scientific reasoning, diagnostic reasoning, procedural reasoning, narrative & interactive reasoning, pragmatic reasoning, ethical reasoning, and conditional reasoning.  Scientific reasoning focuses on the facts.  Diagnostic reasoning is the merging of the effects of the diagnosis to the clinical picture.  Procedural reasoning helps with the order or pattern procedures should follow.  Narrative and interactive reasoning is a reliance on storytelling and interaction to solve the problem.  Pragmatic reasoning has to do with logistics like time, resources, insurance, and equipment.  Ethical reasoning looks at what is right and wrong.  Conditional reasoning examines the condition of the client and their situation in a holistic manner.

Various situations will call for various uses of these different reasoning styles.   It is a crucial, learned skill that practitioners use to know what to do in "gray" situations.

Specialty Areas of Practice: Driving and Community Mobility

In occupational therapy, there are several specialty certification that one can pursue.  I believe certifications are important because they allow clinicians to obtain in-depth knowledge about a particular area that can enhance the care of the client.  Today, I am going to focus in on one of the many certifications and talk about it's merits in occupational therapy and how it relates to AOTA's Vision 2025.

Specialty Certification in Driving and Community Mobility (SCDCM) is a certification that appeals to me because I value the difference that mobility makes to a client's well-being and happiness.  SCDCM focuses on mobility in the community through not only driving but walking, taking public transportation, etc.  Practitioners that hold this certification are advocates and facilitators of driving and community mobility.  They prioritize community mobility for their clients.  SCDCM can be helpful to the occupational therapist because it allows the therapist to do more for their clients.  It is a client-centered area of practice and it adapts the equipment and environment to suit the client's needs.

Vision 2025 statement:
"Occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living."

I believe that SCDCM fully embodies the AOTA's Vision 2025.  By giving clients the ability to be mobile, you give them better well-being and a higher quality of life.  Using this certification will provide effective solutions to a incapacitating problem.  By having mobility, client's are able to fully participate in daily living.

I hope to pursue this certification in the future because of great ways it can help my future clients!

Retrieved from http://www.aota.org/Education-Careers/Advance-Career/Board-Specialty-Certifications/Driving-Community-Mobility.aspx

Michael J. Fox

Michael J. Fox was diagnosed with Parkinson's in 1991 and since has created a large foundation for Parkinson's.  He is very vocal about promoting Parkinson's research but he is very private about his own health and treatment. I find it fascinating that he is a star and yet so little is known about the disease he struggling with. In class, we hypothesized that he would require home modifications and treatment could be focused around his love for dogs.  We guessed he was wealthy enough to afford whatever treatment he needed.