Low Vision: DO you see the pOTential?

“It’s not what you look at that matters,

it’s what you see.”

-Henry David Thoreau

A little cornea, I know,

But… the point is that a group of people looking at an identical image can see and feel different things. An avid runner who wakes up in the hospital from a car wreck to a double BKA will likely see things differently than before her injury. Her accident may not have directly affected her vision, but it definitely will change the way she sees, perceives, and interprets things. Key point is that our clients, with or without impaired vision, may see something completely different than we see when looking through our typical healthcare professional “lens”.

Be empowered to SEE from the client’s perspective.

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—–>Did you know that you can be an occupational therapist (OT) and work in an eye clinic or vision center? Or better yet get certified in this specialty area? OT is everywhere. What a time to be alive.

—–>Did you know that there are ophthalmologists from an osteopathic (rather than allopathic) background? It takes a special person to go through medical school with the intention of becoming an ophthalmologist. It takes an even more special person to graduate from an osteopathic medical school and be accepted into a traditionally allopathic ophthalmology residency. But it’s possible. It has been done before. And I have a friend in DO school who will pursue a residency in a few years in ophthalmology and pursue it well. War eagle, I digress.

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Aubie would like to thank all of his vision team members for helping him see better and keeping his glasses stylish.

 

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Before diving into the job duties of different healthcare professionals including MD/DOs, ODs, OTs, and more, first I want to discuss some general vision components as well as  a few eye conditions related to low vision.

According to the American Academy of Ophthalmology, “Low vision is a loss of eyesight that makes   e v e r y d a y   tasks difficult. A person with low vision may find it difficult or impossible to accomplish activities such as reading, writing, shopping, watching television, driving a car or recognizing faces.”

Clients with low vision are more inclined to rely on others to perform a variety of ADLs and IADLs….hmm I’m pretty sure those are two of the several occupation areas under an OT’s scope of practice. Sounds to me like occupational therapy services can definitely benefit a client who fits this definition in order to address how visual barriers are hindering occupational performance in a variety of contexts.

Not sure what  OT is? Click for more details on the occupation who works to help you live a meaningful and purposeful life at —> OT: the art and science therapy

But what is Low Vision?

  • Less than normal vision that cannot be corrected by lenses, medication, or surgical procedures

  • Is different than blindness (an individual with low vision will have residual vision-a blind individual will not)

  • Is a loss that is not a natural part of normal aging

  • Is a giant umbrella term that includes many disorders or conditions

  • characterized by impairments in visual field or visual acuity

For videos of hope and empowerment directly from clients who have low vision, click to view from the National Eye Institute.

Key Terms-Visual Components

  • Visual Field: This is the range of vision that we have. Try it. Look straight ahead and focus on one object. Can you see 60 degrees up and down (central field) and 180 degrees side to side (peripheral field)?
  • Visual Acuity: The sharpness of an image.
  • Contrast Sensitivity: Can you distinguish the different contrasts? Black to grey to white?
  • Visual Perception: Can you process the image? If a client cannot process the image, maybe there are problems with the neuron folds-the eye is intact but the brain is not receiving the message.

a few of the most common conditions related to LV

  1. Cataracts: clouding of lens
  2. Age related macular degeneration: damage to central part of retina-two types-wet or dry
  3. Diabetic retinopathy: secondary to diabetes-results from change in blood vessels in the retina
  4. Glaucoma: damage to the optic nerve-normal fluid pressure in the eye rises and results in vision loss

To learn in depth about these conditions and several other eye conditions, click here.

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Eye sketched my eyes.

 

the Teamdream

Why are these team members so intelligent?

Cause they are good pupils. 

 

OPHTHALMOLOGISTS (MD or DO)

These are the guys (or girls of course!!) who break up with Med School the Mistress after 4 years of ups and down and trials and triumphs and meet their >>>perfect  prescription<<<–an ophthalmology residency for X amount of years.

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According to American Academy of Ophthalmology, “ophthalmologists differ from optometrists and opticians in their levels of training and in what they can diagnose and treat. As a medical doctor who has completed college and at least eight years of additional medical training, an ophthalmologist is licensed to practice medicine and surgery”.

He or she comes from either an allopathic (MD) OR an osteopathic (DO) medical school background. Don’t worry there was also a time I didn’t know that there were two types of physicians, (cue eye rolls) but it’s a real thing people and they (the doctors that DO) have been around longer than you think. I did the research for you though so click for more information on the differences and similarities of both types of physicians here —> MD vs. DO: DO your research

Some ophthalmologists who have a   h e a r t   for a specific area of medical eye care may choose to become subspecialists by completing more in-depth training. This training is known as a fellowship and can be in a variety of areas such as retina, cornea, glaucoma, and others…

(aka lots of school but they get through it by keeping their eyes on the prize, literally and figuratively).

OPTOMETRISTS (OD)

These are the guys and gals who treat refractive error with glasses, contacts, or magnifiers. Yes, you (as a patient) address them as Dr. ____ . Rightfully so because they worked hard for their doctorate, butttttttt just remember they are different than an MD or DO ophthalmologist because they do not go to medical school and are not medical doctors.

Optometrists concentrate mainly on structure and function of the eyes. These are frame gurus who are licensed to practice optometry which is typically primary vision care. ODs may perform vision exams, prescribe and dispense corrective lenses, detect eye abnormalities and prescribe some medications for some eye diseases. They receive a four year doctoral-level degree in optometry post-undergrad. Optometrists do typically receive advanced clinical experience in the field under a mentor after graduating. If you are interested in learning more about optometry, click here !

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Faithful to my annual eye checkup visits but I could do without the dilated eyes…

 

Why do optometrists live long lives you ask????

Because they di-late.

OPTICIANS

This vision team member uses prescriptions supplied by ophthalmologists or sometimes optometrists to design and fit frames, glasses,  and contact lenses. They do not test vision and do not diagnoses or provide treatment for eye diseases.

CERTIFIED LOW VISION THERAPIST (CVLT)

This certification was created due to the diversity of professions with interest in working with the low vision client population. To meet this demand, a committee comprised of individuals representing the different disciplines active in low vision established this interdisciplinary certification. Some of the committee members represented orientation and mobility, optometry, special education for the visually impaired, rehabilitative counseling, and others. The first low vision certificates were issued in 1997 to eligible therapists who achieved passing scores. This exam was revised in 2005 by the Academy for the Certification of Vision Rehabilitation and Education Professionals (ACVREP).

Occupational therapists are among the professionals who are active in attaining this certification. Perhaps what makes OTs attracted to this certification is the fact that the CLVT does not just address a client’s visual impairments (visual fields, contrast sensitivity function, color vision, visual acuity, visual perceptual skills, visual motor skills, the list goes on…) but also evaluates a client’s ADL, IADL, educational, and work performance which are all areas of occupation that OTs address with their clients. In addition, CLVTs also evaluate a client’s quality of life and address psychosocial aspects that may be hindered due to vision loss/low vision.

CERTIFIED ORIENTATION AND MOBILITY SPECIALISTS (COMS)

These members of the low vision rehabilitation team provide educational instruction to visually impaired individuals in hopes to teach their clients to “utilize their remaining senses to determine their position within their environment and to negotiate safe moment from one place to another”(acvrep.org).

COMS may teach an assortment of skills including training individuals with low vision to use canes, guide dogs, or electronic devices for safer travel.

AND MORE!!

Including… specifically for OCCUPATIONAL THERAPISTS (OT) the SPECIALTY CERTIFICATION IN LOW VISION (SCLV)

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The SCLV is for occupational therapists only. (There is also a SCLV-A for occupational therapy assistants.) It was established in 2006 by AOTA in order to provide a formal recognition of OTs who have both specialized knowledge and clinical expertise with the low vision population.

An OT with this specialty certification is experienced in collaborating with ophthalmologists, optometrists, and other vision team members in addition to experience in the use of optical devices and assistive technology in this area. Basically, you are a huge deal in the OT world if you achieve this recognition by fulfilling all of the requirements, passing the exam, and moreeeeeee-minimum of 600 hours delivering OT services in the certification area to clients in the past 5 calendar years-it is pretty intense.

the OT vision

  • 1990–Health Care Finance Administration expanded the meaning of “physical impairment” to also include low vision
  • 1999–The Balanced Budget Refinement Act of 1999… I repeat since the year 1999 physicians have had the go-ahead to refer clients with a sole diagnosis of low vision to receive occupational therapy services. Hashtag blessed from all occupational therapists who receive referral sources from our MD/DO friends.

mOTivated to intervene-OT interventions for Low Vision

OT focus is on the assessment and intervention of the PERSON, ENVIRONMENT, and OCCUPATION.

“Many older adults experience age-related vision changes that can’t be corrected with eyeglasses, contact lenses, or surgery. Occupational therapy practitioners help people with low vision function at the highest possible level by preventing accidents and injury (e.g., improving lighting), teaching new skills (e.g., eccentric viewing, visual tracking), modifying the task or environment (e.g., recommending magnifiers), and promoting a healthy lifestyle (e.g., ensuring they can participate in their daily activities).”

-American Occupational Therapy Association

(AOTA)

***many of these objectives listed below can be addressed by multiple members of the team; however, an occupational therapist -uniquely- provides intervention to address these items with the goal of facilitating occupational adaptation to improve occupational performance… this is just a preview of how awesome and useful OTs can be as members of the lv rehab team***

PERSON

  • Eccentric viewing:

    • Encourage the client to use the area of her retina that has not been damaged
  • Visual scanning

    • Practice locating an object of interest in the environment-perhaps have client locate a list of items from the pantry for meal preparation (IADL) task
  • Residual vision practice

  • Increase coping strategies

    • Decrease fear of unknown or fear of progressive vision loss-provide psychosocial support to facilitate development of coping skills
  • *be aware of signs of depression and refer to mental health practitioners as needed

ENVIRONMENT

  • Home modifications

    • Safety recommendations-reduce clutter in home
    • Color landing areas at top and bottom stairs to provide high contrast to increase visibility and decrease risk of falls
    • Use white plates on a dark tablecloth
    • Wrap brightly colored tape onto pot handles to increase visibility
  • Increase lighting

    • Recommend better lighting sources-possibly adaptive equipment-change lighting placement
  • Eliminate glare

  • Tactile Markings

    • Ex: a home health OT trains client on tactile markings on frequently used appliances-can simply use puff paint from a local craft store to mark specific knobs or buttons on a stove, microwave, etc to help client foster independence
  • Organization System

    • Encourage client and caregiver/significant other to have objects in their house placed in a manner that is routine and easiest for client to remember and navigate.

OCCUPATION

  • Task modification

    • Provide task adaptations or supports to continue engagement in as many previous occupations as possible
  • Leisure exploration

    • Facilitate participation in new occupations of interest
  • Community support

    • Give client resources to be active in her community
    • Decrease social isolation by advocating for access to services

Envision the extraordinary.

If you or your loved one is experiencing low vision, you are not alone and deserve access to resources to enable participation in activities that you find to be meaningful. The National Eye Institute has a list of resources here!! What strategies work best for you?

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stay mOTivated,

SHANNEN M.

 

References

http://www.aao.org/eye-health/diseases/low-vision

http://occupational-therapy.advanceweb.com/Student-and-New-Grad-Center/Student-Top-Story/Vision-Rehab-in-OT-Education.aspx

http://www.aao.org/eye-health/tips-prevention/what-is-ophthalmologist

https://www.acvrep.org/certification/clvt

https://nei.nih.gov/lowvision/

http://www.aota.org

 

Have any ideas for my next blog post, please comment below!!

 

 

OT Month: ABCs of OT 2016

Occupational therapy is a powerful, science-driven, and evidence-based profession. Part of an OT’s role is to help meet society’s occupational needs. However, how can we help meet these needs, if OT is not widely known much less widely understood? April 1-30 was designated “OT Month” to correspond with AOTA’s Annual Conference & Expo. I decided to participate in the #OTPhoto challenge on IG by posting a picture and description of how valuable OT is using each letter of the alphabet in order to promote #OTMonth.

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the OT Alphabet…

A is for ADAPTIVE Equipment.

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To enable functional outcomes sometimes our clients need a creative way to do an activity differently. We want them to maintain as much independence as possible. Adaptive equipment can come in many different forms. Here are a few examples.

  • Sock aid: a client who recently had a hip replacement will have hip precautions that interfere with his dressing. We use the sock aid to help him put on his socks without bending down too far.
  • Colored overlays: useful for little kiddos who have trouble attending to the reading task or has dyslexia
  • Adaptive door knob: picture a client who has a SCI and cannot grasp or pronate/supinate-wrap foam tubing around a door and zip ties so that client can use his wrist to push down to turn the knob.

B is for BALANCE.

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Balance can come in many forms. Here are a few examples.

  • To improve one’s dynamic sitting balance, the client may be guided through an isometric core routine as a warm up before performing ADL’s on the EOB which will require client to reach and work on balance simultaneously.
  • To improve one’s dynamic standing balance, the client will be asked to perform an activity such as a sorting task (laundry, meal prep, etc) while standing. OT will have a gait belt on the client for safety reasons.
  • Balance is not just for clients. The OT or in my case-the OT student-always will need to work on her own occupational balance. When I prioritize my time and balance my schedule in order to fulfill OT school demands with my leisure pursuits (writing, painting), social needs (spend quality time with family and friends), and self-care/health maintenance needs, then I consider myself in occupational balance.

C is for CONTEXT.

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Context can mean many different things and can be analyzed in every situation. Here are a few examples. 1) Personal Context: an individual’s internal environment that comes from his or her gender, age, values, morals, and beliefs 2) Social Context: this is the human environment that helps us define our roles and can hinder or facilitate one’s occupational function 3) Cultural Context: these are the norms or traditions that the community creates or establishes.

Context applied to my life when I went for a family boat ride… Personal Context: made the choice to wear a life vest during the part of the ride when we were in much deeper water d/t my personal beliefs to be safe rather than sorry. Social Context: my social role was “child” since I was with my parents which influenced my behavior- in contrast to if I was on a boat with a bunch of girl friends. Cultural Context: to comply with unwritten norms my dad chose to pull his boat up to the farthest spot rather than parking at the closer, more convenient spot. Each client brings their own personal, social, and cultural context which influences assessment and guides treatment planning. Before trying to understand our client’s context, we must first think about our own. Becoming familiar with the multiple context in our clients’ lives will help us to empower them.

D is for D R E A M T E A M .

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And no I’m not referring to me and my ☀️, but to what this picture represents in the context of this moment. When you look at this picture you see two seemingly healthy people sharing a meal, but actually I’m pretending to be an OT helping to teach my “client” with visual impairments, dementia, and poor safety awareness how to cut and eat his meal again with the appropriate visual and tactile cues. This was for a project video that my classmate Kris and I did did on our well-mannered patient (my boyfriend) last spring.What you don’t see in this picture is my depression, anger, and anxiety from tearing my ACL literally two days beforehand in my senior recognition track meet which exemplifies how much we don’t immediately see in our patients. If you relook at the picture now you’ll see my long stabilizer brace. However, to make the video seem like a realistic OT/client simulation I tried my best to hide my emotions.

What does this picture have to do with OT month and dream team??
1) SLP: eating and feeding is an ADL but without our speech pathology friends, this fictional client would struggle even more with cognitive and swallowing tasks.
2) PT: without physical therapy this client’s ambulatory and balance ability will decline further; without my PT I would not have a normally functional knee joint again
3) OT: this fictional client wouldn’t have a choice in strengthening his functional ability to perform previously meaningful occupations. Without my OT friends/classmates, I would have forgotten that I was still meant to be in the Class of 2016 and that I could be resilient and practice what we preach to our patients in overcoming an obstacle.
All three of these disciplines are needed! SLP + PT + OT = Rehabilitation DREAMTEAM

E is for ENCOURAGER.

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The art and science therapists encourage their clients on a daily basis. The art of occupational therapy requires the OT to examine different or creative strategies to create a rich intervention while displaying appropriate empathy and giving encouragement as needed to enhance the recovery or to empower a client. The science of occupational therapy requires the OT to plan Evidence-based, Science-driven interventions while adhering to AOTA’s Code of Ethics.

In this picture, my current Clinical Instructor of my fifth and final Level 1 fieldwork (in an orthopedic/hands OP setting) encouraged me last week by giving me a challenge to do by today. Because of her encouragement and guidance I am now able to (without cheating and looking at my anatomy book) draw the Brachial Plexus out, label all of the nerves, group and name the muscles, categorize common conditions and apply this knowledge. OTs encourage their clients, but OTs can also encourage their coworker or student OTs as well!!

{Brachial Plexus: C5-T1; draw it by remembering 3 Y’s, 2 E’s, 1 X and a long thoracic; helpful nemonic is Reach To Drink Cold Beer for Roots, Trunks, Divisions, Cords, Branches (I actually hate beer..) and for the nerves to remember lateral from medial Most Alcoholics Must Really Urinate for Musculotaneous, Axillary, Median, Radial, Ulnar! }

F is for FUNCTIONAL.

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Occupational therapists design client-centered interventions with functional outcomes in mind! It all starts with listening to what is meaningful for that individual client and moving forward from there.

Functional assessment: OTs observe a client’s behavior in a natural context (shout out to home health) or in an environment that closely simulates the natural context to understand how environmental factors affect performance. We observe our clients performing their normal occupations to determine their strengths and what needs to be strengthened, their needed level of supervision/assistance, and address any barriers that are inhibiting their occupational readiness.
Application: A client who works at a coffee shop as a barista was recently diagnosed with MS. She relates that feels depressed and very fatigued and is worried that she won’t be able to keep up with the motor demands (both fine and gross) that it takes to be a great barista.

G is for GROWING.

m7Did you know that the job outlook for occupational therapy is very high in demand!! Not only has it consistently ranked high on multiple lists of top and recession-proof jobs but it is grrrroooowwinnggg! Idk about you but job security is kind of an important trait when deciding your career path.

Don’t take my word for it! Look up the following sites for yourself! List from AOTA website.
•U.S. News & World Report, Jan. 2016, “Ranking of Best Health Care Jobs”
•TIME Magazine, Jan 2016, “These 12 Jobs Will Grow 30% by 2024”
•NPR/WNYC-TV NBC 5, Jan 2016, “Following Up; Occupational Therapist Shortage”
•Career Alley, December 2015, “Hot Jobs for 2016”
•The Examiner, December 2014, “Top 5 Health Care Jobs for 2015”

H is for HOME modifications.

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Home modifications are keeping our baby boomers in their homes as long as possible!
•Currently, only 1 in 6 of these baby boomers have made home modifications that will ensure that they will live safely in the comfort of their own home! •OTs can specialize in home modifications with further education in order to achieve the SCEM or CAPS credentials ~~Specialty Certification in Environmental Modification | Certified Aging in Place Specialist~~•OTs can provide an evaluation in your home to assess your family member’s safety, skills, and abilities and make recommendations and offer solutions to increase accessibility or enhance function within the home environment.

We want your home to work for your individual needs!•Interested in having an OT help you stay in your home, >>>>ask your primary care doc DO/MD<<<< for a referral! Recent medical changes may qualify you for home health services!! Your local home health agency can provide you with a creative OT who is skilled in addressing your needs for home modification. Never heard of a DO???? click here—> MD vs. DO: DO your research

I is for INDEPENDENCE & IADLs

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Occupational therapists do everything they can can to make you as independent as possible again!! If making delicious pizzas for your family is a skill {meal prep/cleanup–> Instrumental Activity of Daily Living (IADL)} that is meaningful to you, well we can improve your ROM and endurance and remove any contextual barriers and even give you adaptive utensils if necessary to give you your independence back! IADLs are the activities you do within your home and community!! IADLs include: care of others,care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal prep and cleanup, religious activities, safety and emergency med, and shopping. OT is so necessary and I think it’s pretty cool how broad this art and science therapy truly is!! Cheers to holistic health-healthy mind and body & this pizza.

J is for JUSTIFICATION.

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How I feel trying to justify my rationale for a group class assignment case study. Mr. Skellie says life would be easier if we didn’t have to back up our intervention ideas with evidence-based practice, but that’d make things too easy (and not skilled)!

Documentation is just one of those things you have to get used to doing a lot of as a healthcare professional to justify your services to insurance!

Justification gets easier with practice and a little creativity! OTs document their evaluations, interventions, daily notes, and more–all to justify why you need our services–and to document your progress.

K is for KINESTHETIC.

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April 11, 2015 was not how I anticipated my USA Senior Recognition Track Meet competing in the steeplechase to have went!! Tearing your ACL can really throw off your plans! I had my reconstructive surgery during my two week “summer” break between second and third semester of OT school on May 12, 2015. This picture (my mom was cheering/taking action shots) was taken seconds before I landed and unfortunately hyperextended my left knee and tore my left ACL.I was a mixture of feelings that day, but I am rejoicing a year later.

In my physical therapy rehab to restore my mobility, I participated in a lot of kinesthetic activities. OT can also use kinesthetic approaches such as in teaching handwriting to kiddos through Handwriting Without Tears and even with an orthopedic client through kinesthetic biofeedback. Hurray for OT month and for overcoming trials!!

L is for LOW Vision.

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Low vision can occur throughout the lifespan! Low vision truly hinders individual’s ability to perform meaningful occupations and/or negatively affect their occupational roles. This is where OT comes in!! OTs believe it or not can work with ophthalmologists (MD/DO)  and optometrists  (OD) on a vision team! Did you know that it wasn’t until 1990 that physicians could refer clients for occupational therapy with a sole diagnosis of low vision!!? Two certifications OTs can receive for low vision include becoming a Certified Low Vision Therapist or receiving a Specialty Certification in Low Vision (SCLV)-formal recognition for OTs for specialized knowledge and expertise with clients in this population. The SCLV is a 5 semester program that practicing OTs can go back to school for aka me after I get a few years into my practice!

M is for MANUAL Dexterity.

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M is for Manual dexterity (and for my advocacy blog mOTivatedtoDO ) Manual dexterity is for typing on our computers for our 250350 group projects we have in our last semester of OT school in the classroom. It’s also for Management, Modifications, Motivation, Motor Skills, Metacognition, MultiSensory and MawMaw at the SNF.

 N is for NBCOT.

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NBCOT – the National Board for Certification in Occupational Therapy// in addition to seven semesters of graduate education to get the beautiful “OTR” behind my name, I will take my boards shortly after graduating at the end of the year!! Can’t thank these two lovelies enough for all of their support through it all!

“NBCOT provides a world-class standard for certification of occupational therapy practitioners. They develop, administer, and continually review our certification process based on current and valid standards that provide reliable indicators of competence of the practice for occupational therapy.”

Mission Statement: “Setting the standard for lifelong professional growth, advancement, and practice excellence in occupational therapy.”

O is for OCCUPATIONAL beings.

m16My current apartment complex encourages my occupational role of graduate student by providing me with obscene amounts of coffee for freeeeee.

>>>>To be human is to be occupational!!<<

This is a founding principle of OT! We believe it is through the therapeutic modality of occupations that clients’ functions can not only be restored, but allows them to flourish!! As occupational beings, we each have our own individual needs that must be met to fulfill life’s daily demands! Occupational therapists recognize that the simple activities we do everyday are “occupations” (ADLs, IADLs, Education, Rest and Sleep, Work, Social Participation, Leisure) and our priority is to promote access, enable participation, restore functioning and more!! If you’d like to really dive into how OTs incorporate and perceive occupations a therapeutic tool then view my blog post at OT: the art and science therapy

P is for PERFORMANCE SKILLS.

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Performance skills are observable elements of action that have an implicit functional purpose for life’s daily activities! OTs look at a client’s performance skills in order to understand the client’s ability to use one’s body functions and structures to engage in desired occupations. The 3 main types of Performance Skills related to occupational therapy intervention are… Motor Skills, Process Skills, Social Interaction Skills

  • Motor Skills: “Occupational performance skills observed as the person interacts with and moves task objects and self around task environment” (e.g. ADL motor skills, school motor skills)
  • Process Skills: ” Occupational performance skills observed as. Person (1) selects, interacts with, and uses task tools and materials; (2) carries out individual actions and steps; and (3) modifies performance when problems are encountered”
  • Social Interaction Skills: “Occupational performance skills observed during the ongoing stream of a social exchange”. Source: AOTA- OT Framework 3rd ed.

Q is for QUALITY of life.

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OTs care about you and hope to use our therapeutic use of self along with our client-centered interventions to help create, promote, establish, restore or maintain your quality of life! We do what we can to help you achieve your goals and participate in what’s meaningful to you!

 

 

 

R is for REGULATION strategies.

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Regulating your emotions is a strategy doesn’t come natural for everyone. OTs help our kiddos (and sometimes adults) with poor frustration tolerance, ineffective coping mechanisms, poor social interaction skills etc. learn how to >>>self-Regulate<<< their emotions to encourage age-appropriate behavior.

3 emotional >Regulation< strategies: (may or may not have used one of these strategies during our sand volleyball game)

  • Take Five“: Place your left hand flat on a table. Place your right index finger on the base of your left thumb (anatomical snuff box) and trace your thumb up and breathe in. Trace your thumb down, breathe out. Repeat for the other four digits.
  • Social Story: Create a visual aid through PPT that is catered to the problem areas that the child needs to work on. Make it fun and include lots of pictures and short captions that models appropriate behavior.
  • Calm Down Corner: create a dim lit space with soothing music, several pillows and blankets, soft colored lava lamp, and stuffed animals for your child to go to when he/she needs a moment to calm down

S is for SPLINTING.

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For my last Level 1 I was in an orthopedic/hands setting! All of these clients were affected by some type of orthopedic injury to the shoulder, elbow, wrist, or hand (rotator cuff injury, lacerated tendons, nerve damage, carpal tunnel syndrome, mallet finger etc..)They each had their own story -patient centered- and hopes to improve their functional outcomes in order to do daily activities that we often take for granted!

One of the coolest parts of this fieldwork experience was helping create >>>splints<<<< for different clients to prevent contractures, promote a functional wrist, improve position of MCP joints and more!! I also was blessed with a great CI for this rotation. The  bottom right picture is a cheapo version of a resting hand splint I made perhaps for a client who does not have insurance coverage. The idea is to decrease pain and prevent muscle contracture with the simple adaptation of a pool noodle and a strapped band.

T is for TEAM-BASED approach.

m21If you want to become an OT you better get used to being on teams. You need to invest in your team’s dynamics. OTs who work in schools will be on an IEP >>team<< comprised of other rebab/medical professionals and teachers. But what if you are like me and don’t want to be an OT in the schools…?? I envision my first OT job to be in a SNF or in a hospital-based setting. I will not only have to frequently co-treat with PTs or SLPs and communicate with social workers and nurses, but also with –> referring physicians. All healthcare practitioners are important to the team and all deserve to be acknowledged for their roles!

And contrary to popular belief, as an OT you should probably learn that physicians come from two backgrounds: allopathic (MD) or osteopathic (DO).

Most physicians will probably be too nice to correct you if you assume they are MDs, but DOs are a thing people and they are our referral source! In fact, DOs are taught from a much more holistic approach which is truly more in line with OT principles, whereas MDs are taught from a more symptoms based approach–but they are both awesome and are the ONLY types of doctors that can treat, prescribe medicine, and perform surgery on OUR clients.

MDs and DOs receive similar medical education and must pass several board certifications and residencies. DOs receive additional training on osteopathic manipulative treatment which is a more hands on approach to diagnosing, treating, and preventing illness.Be inspired to be team player for the sake of your clients and take some time to learn about the backgrounds of your teammates.

U is for UNDERSTANDING & UNIVERSAL Design.

m22Sometimes, we need to lend an extra hand to help out others. OTs understand that if a client has a certain physical disability that causes him to be W/C bound he deserves the dignity of accessibility that doesn’t require him to feel further isolated by wheeling to the back of the store to go through the wheelchair entrance.

Universal design is the correct design choice. Design environments and products usable to all people! When OT makes adaptive equipment recommendations or caregiver education, we place an emphasis on this in order to simplify life for everyone.

V is for VERSATILE.

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This is one of my favorite OT professors and today was my MS2 class’s “going away” party for our Level 2 fieldworks hosted by the MS1’s.

<< OT is versatile because OT is needed and can be found everywhere.>>>

We can work in the “normal” places people assume such as in a hospital or at a nursing home but we can also work in prisons, medical homes, churches or hold in political positions.

 

 

W is for WHOLE-person care.

m24OTs are taught from a holistic approach. We believe that our clients are >>not defined<< by their disease/diagnosis/injury. We recognize that every client brings their own story, upbringing, valued, beliefs, and more to therapy. While we envision always performing evidence-based and occupation-focused interventions, quite frankly it is more than that. OTs must provide client-centered treatment that truly takes the Whole person (mind and body) into consideration. While it’s imperative to strive for and to achieve good outcomes, emphasis must be on the person’s goals and needs from therapy.

 

X is for XENIAL.

m25.jpgI definitely had to look up an “X” word…. anyways OTs are xenial, another word for hospitable, since we serve a highly varied client population and provide a multitude of services. Cheers to my Class of 2016 because we are almost out of the classroom!! Praiseeeee.

Y is for YOUTH.

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this is actually my brain

As OTs one of the populations we serve is children and Youth. AOTA notes that children and Youth is actually one of OT’s emerging practice areas. (This picture is obviously for the adult parents, caregivers, and guardians who care for the kiddos for the 95% of time they aren’t in therapy. Also, it’s for higher caffeine consumption for approaching finals and end of the semester projects, yay.)

 

OT is really cool because we have the opportunity to mentor and serve our communities in places like prisons or in this case-juvenile detention centers-for >>>>Youths who have been incarcerated<<<due to a variety of different crimes. Shout out to my grant group because we are almost done with finalizing our grant that is advocating for (and asking for some moneyyyy🤑🤑) OT services to be provided free of charge to the Youths! We plan to provide Life Skills lessons (care of others, money management, health maintenance)to these Youths since they are experiencing a disruption from their developmental transition to teenage years or young adulthood! Cheers to the future and current pediatric OTs who serve the Youth of our communities! May your ☕️ coffee pot always be hot.

Z is for ZEALOUS

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zigzagging around old, beautiful trees

 


Zealous is a positive adjective that describes a person and is marked by active interest and enjoyment! OTs are the zealous healthcare providers that are known for their creativity in the methods they use when planning client-centered interventions!

Personally, I am a zealous fan of health, fitness, and occupational balance. In the future, I strive to always model healthy, positive behavior for the clients I will be blessed to serve!

 

 

 

Happy OT Month. Until next year.

Stay mOTivated,

SHANNEN M.

MD vs. DO: DO your research

“An osteopath must know the shape and positions of every bone in the body, as well as that part to which every ligament and muscle is attached. He must know the blood and the nerve supply. He must comprehend the human system as an anatomist, and also from a physiological standpoint. He must understand the form of the body and the workings of it. That is a short way to tell what an osteopath must know.”  

{ A. T. Still  MD, DO }

blogshanreads
Lifelong learning

First and foremost… let’s all remember one important thing… A doctor (allopathic or osteopathic) can save your life… BUT AN OT CAN HELP YOU LIVE IT and also advocate for your profession if you’re lucky. >>>NEXT POST IS ON OCCUPATIONAL THERAPY’S DOMAIN AND PROCESS !!!<<<

 

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Neuro block vibes

 

Now I have to be honest; I did not know what osteopathic medicine was until my boyfriend started to consider applying to DO schools. Even now when I describe osteopathic medical school to my friends or peers, sometimes they hear the words “holistic” or “manipulative medicine” and instantly associate it with chiropractors or alternative medicine or Eastern medicine and  even say things like –> “so will he even be a ‘real’ doctor?” in which I bite my lip from saying something sarcastic like    “Are you in medical school?”    ***crickets (that individual pretty much immediately becomes quiet…)

  • When people say things like that I used to get pretty feisty -I sort of still get annoyed  but that is why I am using this blog to       actively advocate     and educate others in hopes they will be more receptive of both professions that are near to my heart and important to our growing society.

The fact of the matter is that osteopathic medicine is not a new philosophy or approach to medicine. My opinion as an occupational therapy student is that it’s time we get behind the DOctors that truly DO… (***especially if you are a PT, OT, or SLP student who will one day receive referrals from MDs and DOs and should therefore respect and probably learn about both types of physicians).

See my comparisons chart I created below of MDs and DOs to appreciate the similarities and differences of the only two types of licensed physicians in the U.S.

Screenshot (17)

Theodore Roosevelt once said…

“The more you know about the past, the better prepared you are for the future.” So let’s take a look back in history to see where it all began.

MDs – History

  • Practice of medicine dates back to colonial times–aka there have been medical doctors in existence for a looooooooong time
  • 1766: New Jersey Medical Society-1st organization of medical professionals in the colonies
  • Early 1880s: Medical societies developed their own society based training programs called “proprietary” medical colleges
  • 1847: About 200 delegates from 40 societies, 28 colleges, and the District of Columbia met and formed the American Medical Association (AMA)
    • Elected president Nathaniel Chapman
    • AMA set higher education standards for MDS that were again revised in 1852
  • 18021876: 62  stable medical schools established
    • 1810: 650 students enrolled; 100 graduates
    • 1900: numbers rose to 25,000 students enrolled; 5,200 graduates- nearly all white males
  • Doctors began choosing to “specialize” in the mid 19th century
  • Check out more information about the history of MDs here!
  • Fast forward to 2016: More MDs choose to specialize than DOs (key word here is choose-there are a multitude of MD students who have passion for non-specialized practices and thank God they do because we need them!)

DOs-History

  • 1828: A baby boy by the name of A. T. Still who would grow up to follow in his father’s footsteps to become a doctor was born
  • Early 1860s: He became a doctor (MD) and went on to serve as a surgeon during the Civil War for the Union Army
  • 1864: His 3 children died from spinal meningitis. He concluded that the orthodox medical practices of his day were sometimes harmful and ineffective
    • Devoted the next 10 years of his life studying the musculoskeletal system and how it interacts with the other systems in hopes to find better ways to treat diseases and disorders
  • Prior to 1874: all allopathic based medical thinking
  • 1874: Dr. A. T. Still. believed that there was more to medicine than treating patients symptom by symptom
    • His research and clinical observations led him to believe that by correcting structural problems of the body, the body’s ability to heal could improve (Osteopathic Manipulative Medicine-OMM coming in clutch)
  • 1892: Dr. A. T. Still ( MD and a DO – can you believe it ) opened the first osteopathic med school in Kirksville, MO
  • Read more about the beginnings of osteopathic medicine here.
    • Fast forward to 2016: single accreditation system for graduate medical education (more info on this below)

 

“Today DOs provide comprehensive medical care to patients in all 50 states and the District of Columbia, and have unlimited practice rights in more than 65 countries. Currently, there are more than 74,000 DOs practicing in the United States in a wide range of medical specialties including surgery, anesthesiology, sports medicine, geriatrics, and emergency medicine.” {aacom.org}

 

Now you are asking yourself…  “soooo why have I never been to a doctor with the D.O. credentials?” the short answer-> more than likely you already have came into contact with a doctor of osteopathic medicine

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    • 31 DO schools  <  141 MD schools
      • Naturally, there is going to be more MD students, residents, and practicing physicians

 

    • DO students  =   about 20% of U.S. medical students
      • YOU have a 1 in 5 chance that you have already been treated by a Doctor of Osteopathic Medicine
      • “In the 2015-16 academic year, colleges are educating over 26,100 future physicians–more than 20 percent of U.S. medical students.” aacom.org

 

 

    • Graduate Medical Education (residency)
    • Single Accreditation System
      • “In early 2014, the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) approved an agreement to transition to a single accreditation system for graduate medical education (GME) by July 2020.”
      • Update as of January 25, 2016: 117 programs have submitted applications for ACGME accreditation
      • 95 programs are “pre-accreditation status” and “continued pre-accreditation status”; 11 programs have achieved “initial accreditation”
      • Click here to stay up to date on the MD DO merger

Prior to the merger…there were 2 separate accrediting bodies for Graduate Medical Education.

  1. ACGME –accrediting body for MD students

    • USMLE licensure exam
  2. AOA –accrediting body for DO students

    • COMLEX-USA licensure exam

Medical students could take the USMLE board exam  and go to an (allopathic) ACGME residency or they could take the COMPLEX-USA board exam and go to an (osteopathic) AOA residency. Because there were hundreds more ACGME residencies in different specialties that AOA didn’t have, many DO students also opted to take the USMLE in addition to their COMLEX exam so that they could apply to an ACGME residency.

Now that the merger is officially in progress (remember to click the link above for more info) between the ACGME and AOA, both licensing exams are accepted almost universally. However, this is a work in progress because there are still many ACGME residencies in highly specialized fields that still require the USMLE and haven’t yet accepted the COMLEX licensure scores. So although there has been some strides made in the path of recognizing the benefits of utilizing the merger, there is still some work to be done to fully implement it. Nevertheless, this is the step in the right direction in allowing our rising doctors of both backgrounds to have the opportunity to immerse themselves in a residency offered by either philosophy in order to become the best physicians of their potential.

Finally, most importantly, for those of us who have not been called by the Lord to be physicians the best thing we can do in our active participation and support of the profession that serves our families and friends is simply to  —-> pray for them.         Pray for every pre-med student, medical student, resident, practicing physician, and retired physician to look always to Jesus, Our Savior, for guidance in serving others and remaining humble in that service. JESUS is the only one in this world who perfectly serves. His whole life, the way he dealt with the poor and especially the sick, the actions and acts of his simple generosity and his integrity all are apart of his perfect self-giving; this is why we must pray so that our future physicians (allopathic and osteopathic) can fulfill what they have been chosen to do in a manner that pleases God.

 

I want to close with a quote from Pope Francis in his Message for the XXIX World Youth Day in 2014 where he went to evangelize and speak encouragement to young adults.

“Jesus challenges us, young friends, to take seriously his approach to life and to decide which path is right for us and leads to true joy. This is the great challenge of faith. Jesus was not afraid to ask his disciples if they truly wanted to follow him or if they preferred to take another path. Simon Peter had the courage to reply: ‘Lord, to whom shall we go? You have the words of eternal life.’ If you are able to say yes to Jesus, your lives will become both meaningful and fruitful.”

-Pope Francis

Stay tuned for my next blog post–switching gears from osteopathic medicine to my first love –occupational therapy

Stay mOTivated,

SHANNEN M.

Shannen Weyer, OTS

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***note: I am simply trying to raise awareness about this profession. I am very thankful for my two orthopedic surgeons (who were both fantastic M.D.s) that have previously operated successfully on both of my not so pretty knees. I look forward to working with M.D.s and D.O.s in the future in order to carry out their occupational therapy referral orders***