Editor's Note: This blog was guest-authored by Mayte Lucia Gomez Sosa, MSOT, OTR/L, COTA/L, CLT
Dehydration among our geriatric patients is a real and growing problem, and quite common in skilled nursing and acute rehabilitation centers. Many seniors are on diuretics medication, diet and fluids are often restricted by physician orders, and many older residents limit their fluid intake to avoid burdensome trips to the bathroom.
Fear of falling, clothing management, transfers, and the time-consuming efforts of pericare and handwashing cause many elderly people to dread the frustration of toileting. Lack of endurance, ROM, and strength are limiting factors. Many residents must be accompanied to the bathroom and require some level of supervision.
As occupational therapists, self-care retraining is part of our scope of practice and a primary goal during acute rehabilitation. Toileting is a major component of retraining, and a lack of compliance and care follow-through can create dependency among the elderly, along with the potential skin care issues that can develop when patients don't ask for help or use alternative means of voiding.
Implementing therapeutic exercises along with self-care retraining is vital for maximum independence. Toileting schedules and flow charts can help minimize voiding accidents and facilitate self-care retraining, bladder control, compliance and a reduced of fear of falling. Fluid intake should be encouraged unless medically contraindicated, and patient education on the effects of poor fluid intake should be provided daily.
Our older patients who rely on us deserve no less.
Mayte Lucia Gomez Sosa is an occupational therapist in Florida.
A key component for any child’s development is play. For
some, play can be difficult due to disability. That’s why Dr. Cole Galloway, a
professor at the University of Delaware created GoBabyGo!, a fun and inventive
way to get kids moving.
“I have lots of kids who aren’t invited to birthday parties
ever,” Galloway said on the GoBabyGo! YouTube channel. “Friends are hard to
make when you’re not mobile.”
Galloway, with a ride-on toy car and a few modifications,
has been able to help kids throughout the country gain some independence and skills
that they would not have normally acquired. According to Galloway, there are no
commercially available power wheelchairs for children under three years of age.
After discovering that these ride-on toy cars could provide
the same mobility as a power wheelchair for kids, Galloway has traveled across
the country and presented in clinician’s workshops for parents. He has posted
YouTube videos to teach others how to modify these cars. Once the car is modified and has received certification
from an electrical or mechanical engineer, the car is ready to use.
“I don’t know why we felt the need to give it away, except
that I think everyone would do that,” Galloway said. “There’s no reason to hold
onto this and fight for a territory when there’s literally hundreds of
thousands of kids around the world today sitting still. Now, it becomes a chess
match of how quickly we can get it out.”
The cost of each car is around $200, but the ability to help
a child thrive and socialize can potentially be priceless.
What do you think of these devices?
Some would say it was a matter of inevitability. Others will hail its arrival as a much-needed shift away from pay-per-procedure and toward pay-for-quality.
On April 1, 2016, CMS began the testing phase of its Comprehensive Care for Joint Replacement (CJR) model, a new payment structure for episodes of care related to total knee and total hip replacements under Medicare.
According to CMS, Medicare beneficiaries received more than 400,000 knee and hip replacement surgeries in 2014. While these procedures enjoy massive appeal because of their ability to improve overall quality of life, complications and costs vary significantly.
The CJR testing phase is planned to last five years and will be implemented in 67 metropolitan statistical areas, including almost 800 hospitals.
One such region is the New York Metropolitan area, which includes Northwell Health, consisting of 21 hospitals and nearly 450 outpatient practices. Fourteen of its hospitals will participate in the CJR pilot project, becoming responsible for both the cost and overall quality of care delivered to Medicare patients for 90 days after their procedures.
"The discharge from the hospital is not the end of the medical journey for the patient, but marks the beginning of the next phase of recovery," remarked Zenobia Brown, MD, MPH, medical director at Northwell Health Solutions.
CMS is billing the CJR pilot project as a departure from the traditional "fee-for-service" model of care, in which providers are paid whenever they treat a patient. The bundled payment system holds hospitals accountable for all costs incurred during the entire episode of a patient's care -- from admission, to surgery, inpatient hospital stay, rehabilitation, and other care delivered after the patient leaves the hospital.
"The Impact of Yoga on Activity Patterns of Individuals with
Sedentary Occupations” was presented by Erin Phillips, OTD,
OTR/L, CYT, and Calista Crouthamel MOTS, RYT, on Saturday morning. The short
course was designed to help occupational therapists understand the role of yoga
and mindfulness in the occupational therapy profession and how it can help
those with sedentary lifestyles.
“We need to slow doen and look at the daily choices in our
lives with more clarity,” Phillips said. “Healthy living can
be simple if we’re honest about it…
It’s about making choices that are often ‘yes’
or ‘no,’ but it’s not easy.”
Both Phillips and Crouthamel believe that direct mindfulness is a
fruit of yoga practice and can be used to assist patients and practitioners in
the complicated path of recovery.
The two presenters commented on the link between a sedentary
lifestyle, or a lifestyle in which six or more hours a day are spent sitting,
and mortality rate. They aimed to see how yoga and mindfulness helped those
with sedentary lifestyles.
“Yes, we needed the numbers, but this is for them and what
they got out of it,” said Crouthamel.
A correlation was made between regular yoga sessions and
significant decreases in pain, amount of time spent sitting during the day and
other sedentary behaviors.
The two urge occupational therapy practitioners to incorporate
yoga and mindfulness into their practice, whether that be in a hospital, school
setting or long term care.
While practicing yoga has shown to be beneficial to clients who
live a sedentary lifestyle, it also could be a positive experience for the
occupational therapy practitioner as well.
“How can we more fully show up to our work as OTs?”
Phillips asked. “We live in environment of chaos every
day and practicing more direct mindfulness will effect our health.”
A new addition to the 2016 Annual AOTA Conference and Expo is the
inclusion of scientific panels. In these sessions, research papers are
presented on the multiple areas of expertise that OTs cover. Sarah Schoen, associate director of Research the STAR Institute, was one of many researchers who presented at
this year’s conference.
Schoen studies sensory processing challenges in children and
adolescents. The STAR Institute, which was created through a merger between the
Sensory Processing Disorder Foundation and the STAR Center, is dedicated to
looking at the symptomology in children who don’t necessarily
qualify for other clinical disorders.
“Listening programs have been a part of clinical practice for
may years and unfortunately there hasn’t been a lot of research as to its
effectiveness,” Schoen said concerning her inspiration
for the study. “We are very much an evidence-based
program, so we felt that if we used the various interventions that we use as a
part of our model of treatment, then we needed to study the effectiveness.
The pilot study focused on the use of a particular listening
program (Integrated Listening Systems or iLs) without any other services. Seven
children were included in the study and spent five hours a week using the
program, one with a research assistant and four with parental guidance. She
used a single-subject design as a research model as opposed to randomized
controlled trials. The results reflected the effectiveness of iLs.
“People have a misconception that the only valid research is
randomized controlled trials,” she said. “We are training
therapists to use this single subject design to use in their clinical work. I’m
hoping that others will see this methodology and say ‘I want to validate
what they found using iLs.’ This will only strengthen the findings
that we had.”
Schoen believes that the more information and evidence collected
on the use of iLs, the better.
“Even from the audience’s reaction, there
is some sense of relief when there is evidence in a tool that people are
regularly using in their clinical work. Hopefully it will inspire more people
to do similar types of studies.”
This blog post was written by Kate Bortz, editorial assistant at ADVANCE and the on-site correspondent for AOTA 2016.
The AOTA Annual Conference and Expo officially kicked of on Thursday night with a welcome address from AOTA President Ginny Stoffel. This address, which consisted of updates from AOTA, achievements earned by practitioners and students as well as occupational therapy's prominence in the world, was given to the largest gathering of occupational therapy practitioners in the world.
This year's theme, "Evidence and Outcomes: Empowering the Profession," was promised to be explored throughout the various sessions offered.
At the Welcome Address, attention was brought to those who received IRG grants to support their research. The recipients include Mary Khetani, Mansha Mirza and Juleen Rodakowski the 2016 Presidential Early Career Award for Scientists and Engineers. Elizabeth Skidmore has been honored for her research on promoting independence and community integration after stroke and brain injury. Never before has an occupational therapist been chosen for this award.
The AOTA's New Vision 2025 was also revealed, which states: "Occupational therapy maximizes health well-being and quality of life for app people populations and communication through effective solutions that facilitate participation in everyday living." This statement was explored throughout the duration of the conference.
The address was followed by Keynote Speakers Jessica Kensky and Patrick Downes, a couple who were victims of the Boston Marathon bombings and amputees. They recounted how their lives changed dramatically after they both lost their left legs. Kensky ultimately made the decision to voluntarily amputate her right leg.
"When it comes to being an able-bodied person, you don't think about how you transition from one part of your day to another," Downes said. "We miss that time desperately and wonder how many prosthetic legs it would take to do all of those things.
Both speakers commented on the positivity and confidence gained from their work with occupational therapists at the Walter Reed Military Medical Center. Therapists were included in the process of charting daily activities and associated pain levels, finding accommodating housing and discovering what clothing was appropriate to wear.
"You have given us a gift that words cannot fully capture. You gave us our independence back," said Downes.
"You instantly made us fall in love with you and your profession," Kensky said.
The couple remains as strong and active as ever, from seemingly small achievements like passing driving tests or navigating a grocery store to learning how to sit-ski and hand-cycling the last Boston Marathon.
CHICAGO -- Virginia (Ginny) Stoffel gave her Farewell Presidential Address on Friday afternoon at the 2016 Annual AOTA Conference and Expo. The theme of her address, “Coming Home to Family: Now is the Time!,” focused on how occupational therapy practitioners are a family and how AOTA is their home. She stressed how connected occupational therapists feel with each other compared to other professions, and how it is “undeniably authentic.”
She urged the audience to understand that they can “create the same safe haven for one another which, in turn, gives us all the empowerment we need as occupational therapists.”
Family should not only be considered in terms of other practitioners; Stoffel wants occupational therapists to take a look at their own family roots and connections to one another when dealing with clients. Culture must be taken into consideration for effective treatment. She stated that the idea is not original, but “one that deserves time and attention.”
Stoffel took the time to point out positive changes in AOTA during her term, including the new Vision 2025. In order to create this change, the perspectives of AOTA members and leaders, students and members of the international occupational therapy community were asked for their input. She hopes that the new vision can connect those who work in various settings, including hospitals, school settings, academia and more.
The future of AOTA was also addressed. In terms of membership, Stoffel is hoping to reach a 100,000 membership goal in the near future.
Stoffel thanked AOTA conference attendees for support and growth opportunities; Amy Lamb, future AOTA president and current vice president; officers and members of the Board of Directors; members of the AOTA Management Team; past presidents; and family.
“It has been my honor to serve as your president,” Stoffel said. “I ask you to extend the same love and support as [Lamb] approaches her presidency.”
This blog was written by Kate Bortz, editorial assistant at ADVANCE and the on-site correspondent for AOTA 2016.
CHICAGO -- While occupational therapists deal with the many day-to-day functions of their patients, Kathryn Ellis, MOT, and Michelle Nordstrom, MOT, from the Walter Reed National Medical Center noted an area that hadn't been fully addressed. Ellis, alongside Caitlin Dennison, MOT, published a resource for wounded veterans on intimacy issues entitled "Sex and Intimacy for Wounded Veterans: A Guide to Embracing Change." At AOTA's 2016 conference in Chicago, Ill., Ellis addressed the occupational therapist's role in reintegrating intimacy strategies for those with disabilities.
In order to help the patient, Ellis suggests noting what patients liked prior to the disability and to openly communicate with the patient in an appropriate and respectful manner.
"It's hard for even us to talk about. Imagine how hard it is for the patients," Ellis said.
Ellis urges those in the field to gauge how their coworkers feel about the subject and how they address the issue of intimacy with their patients. She also suggests speaking with the person who coordinates inservice and educate.
"We are really doing a disservice to our patients by not doing this," Ellis said. "We have patients who wind up getting divorced, and we have patients who really enjoyed this part of their life [before the disability]. That can lead to depression."
For those at the conference and interested in this topic, Ellis will be hosting a student session on Friday, April 8, at 3:30 p.m. on "Engaging in Sexual Activity and Intimacy Post-Polytrauma Combat Injury: An Occupational Therapy Perspective."
Ellis and Dennison's guide is available on Amazon.
The American Occupational Therapy Association (AOTA) has issued a press release announcing that an estimated 10,000 occupational therapy clinicians, educators, and students will gather in Chicago to attend the organization's 96th Annual Conference & Expo from April 7-10. The signature event presents an opportunity for OT professionals to network and share innovative ways to help people live life to the fullest.
"AOTA's Annual Conference & Expo has grown significantly over the past five years and we will likely set an attendance record in Chicago," said Frank Gainer, MHS, OTR/L, FAOTA, CMP, CAE, director of conferences. "In addition to having attendees from across the U.S., this year will host more than 100 attendees from 15 different nations."
The conference will offer more than 1,000 educational sessions covering a variety of topics, including:
● Early identification of the signs of autism spectrum disorder, and interventions that make a difference in the lives of families facing these challenges.
● Helping Wounded Warriors regain function, manage PTSD, and lead meaningful lives after their military service.
● Modifying homes and exploring community mobility options so baby boomers can age in place safely, increase confidence, prevent injury, and maintain their independence.
● Breaking research that explains the lifelong benefits of ongoing occupational therapy for those seeking to regain function after a stroke.
● Using animal-assisted therapy to help motivate clients to thrive despite illness or injury.
According to AOTA, the conference expo hall features the world's largest gathering of occupational therapy companies representing products, professional development, and employment opportunities. Many of the more than 350 vendors and 450 booths will have interactive displays of the latest advances in technology and rehabilitation. Companies from Canada, South Korea, Australia, Israel, Vanuatu, and Northern Mariana Islands are expected to be among the crowd. For more information and a full listing of presentations, visit the AOTA conference webpage.
Do you plan to attend? Tell us what you're most looking forward to in our exclusive ADVANCE Web Poll!
Rehab robotics is all over the news these days. In just the past few months, research labs across the globe have announced major engineering breakthroughs designed to assist those with movement impairments to recapture their independence.
Scientists at the University of Melbourne in Australia announced the development of a matchstick-sized brain implant that, when inserted next to the motor cortex, can allow users to control a robotic exoskeleton just by thinking about it. Testing in patients with spinal cord injury could begin as early as 2017.
In September, The University of California Irvine announced that a 26-year-old man whose legs had been paralyzed for five years took his first steps by using a noninvasive brain computer interface (BCI) system. The man walked along a 12-foot course using an EEG-based device that takes electrical signals from the subject's brain, processes them through a computer algorithm, and fires them off to electrodes placed around the user's knees that trigger movement in the leg muscles.
And in the newest issue of ADVANCE, you'll meet the engineering team at the University of Texas at Austin behind HARMONY, a two-armed robotic rehabilitation exoskeleton that delivers data-driven therapy to patients recovering from spinal and neurological injuries.
"If we can marry the expertise and human knowledge with the technology, we have the ability to deliver things that humans cannot," said Ashish Deshpande, PhD, creator of the device. "We need to develop more of these technologies."
Every year, professionals, students and prospective students across the country eagerly await "The 100 Best Jobs" ranking published by U.S. News & World Report. The just-released 2016 list offers great reason for occupational and physical therapy professionals to feel proud, and for students to feel optimistic about pursuing careers in these fields.
Among the 100 Best Jobs overall, occupational therapist ranked an impressive #23, while occupational therapy assistant (#25) and occupational therapy aide (#59) also represented well. The physical therapy profession enjoyed significant recognition too, with physical therapist ranking #14, physical therapist assistant #40 and physical therapist aide #52. In the "Best Health Care Jobs" ranking specifically, the numbers were even more eye-catching, with physical therapist ranking #12 and occupational therapist #17.
U.S. News states, "Good jobs are those that pay well, challenge us, are a good match for our talents and skills, aren't too stressful, offer room to advance and provide a satisfying work-life balance. Even though there is no one best job that suits each of us, the 100 Best Jobs of 2016 are ranked according to their ability to offer this mix of qualities. Also, the best careers are ones that are hiring."
According to U.S. News, the U.S. Bureau of Labor Statistics projects a physical therapist job growth rate of 34 percent by 2024, with an occupational therapist growth rate of 27 percent over the same time period.
What are your thoughts about the rankings and their reflection on these rehabilitation professions? Do you believe that occupational and physical therapy offer some of the best careers in the country?
In her latest big move toward winning the primary elections, former Secretary of State Hillary Clinton announced in Iowa this week her agenda to improve the lives of Americans with Autism. So far, no other presidential candidate has forthrightly spoken about the need for improvements to Autism services and research. "We need more services; we need more support; we need to make sure that the families dealing with autism - the caregiving that you are providing is respected and supported," said Clinton in her speech.
Within her Autism Initiative are major actions that include:
- Conducting nationwide early screening outreach program
- Pushing states to require health insurance coverage for Autism services
- Launching the Autism Works Initiative, which would form a public-private partnership with employers, to help match individuals with autism to jobs
- Authorizing the first-ever adult autism prevalence study in the U.S.
Clinton has also said that, "A lot of those families are just at their wits' end trying to figure how to get the services, to figure out what to do for schooling and then, as a child becomes a young adult, what to do for housing and employment. I want to be the president who helps families in our country deal with some of those issues."
Her announcement also comes after Republican candidate Donald Trump exacerbated the discredited notion that child vaccinations are linked to or even cause Autism.OTs, do you think Clinton's agenda for Autism will be helpful to the way Autism is currently seen? Does this affect the way you will vote in the presidential primaries? Let us know in the comments.
The American Occupational Therapy Association (AOTA), Bethesda, Md., has issued a press release revealing that on Dec. 8, U.S. Senators Ben Cardin (D-MD) and Dean Heller (R-NV) introduced the Medicare Home Heath Flexibility Act (S. 2364). This bill would allow home health agencies the flexibility to use the most appropriate skilled rehabilitation professionals to open cases and conduct initial assessments when related exclusively to rehabilitation cases and when skilled nursing care is not provided. Currently, occupational therapists are unable to conduct initial assessments in the home health setting.
"This discrepancy causes unnecessary inefficiencies and barriers to providing patients with effective, timely, and appropriate therapy services in the home health setting," said Christina Metzler, chief public affairs officer for the AOTA.
The press release continued that occupational therapy has long been a valued component of the home health care team due to therapists' expertise in identifying home safety issues and in establishing routines to maximize client compliance with the plan of care. This legislation recognizes those contributions and seeks to address the arbitrary restrictions currently in place.
"As our healthcare system continues to evolve and our country's population ages, we must strive to maximize individuals' ability to live fuller, more independent lives," says Metzler. "Patients are increasingly receiving care in home and community settings where occupational therapy plays a pivotal role. We are grateful for Senator Cardin and Heller's leadership in recognizing the value of addressing this discrepancy for Medicare beneficiaries."
Current regulation allows for the initial assessment to be made by the appropriate skilled rehabilitation professional only when the need for that service establishes home health eligibility. Since occupational therapy is not a qualifying service for home health eligibility, practitioners are prohibited from performing the initial assessment.
What are your thoughts about this legislative development and its potential impact on the OT profession?
The American Occupational Therapy Association (AOTA) announced in a news release Friday that the state of New York just became the final state to enact a licensure law for occupational therapy assistants (OTAs) following Hawaii, who enacted their licensure law for OTs and OTAs in July 2014. The law will go into effect May 2016, making it official after 40 years that all 50 states, plus Puerto Rico and The District of Columbia, will have licensure laws in place for both OTs and OTAs.
Here are some highlights from the release:
"'This is a landmark event for New York state occupational therapists,' said Gloria Lucker, MS, OTR/L, FAOTA, BCP, President New York State Occupational Therapy Association. ‘Finally, after 30 years, we have full recognition for occupational therapy assistants in our state. I am so proud of our occupational therapists and occupational therapy assistants who worked so hard to make this happen. Having licensure for occupational therapy assistants will assure their full participation in the profession and will enhance practice standards as well as providing greater recognition by the community.'"
"According to the newly-signed S. 1567-A sponsored by Sen. Kenneth P. LaValle (R), the occupational therapy assistant licensure provisions will go into effect in May 2016. Current law requires occupational therapy assistants to meet certain requirements to become authorized to practice by the Department of Education. The bill repeals that provision and establishes licensure requirements for occupational therapy assistants in statute that are consistent with current requirements. The new law changes the composition of the State Board of Occupational Therapy by requiring that one member be a licensed occupational therapy assistant."
"'We are very proud that New York will become the 50th and final state to enact state licensure for occupational therapy assistants,' said AOTA Chief Executive Officer Frederick P. Somers. ‘State licensure for health professionals is essential in protecting the public from unqualified providers and in assuring the ongoing competence of practitioners. The new law will enhance regulation of the profession by including an occupational therapy assistant on the state's occupation therapy regulatory board and will elevate practice standards for occupational therapy assistants in New York.'"
The American Occupational Therapy Foundation (AOTF), Bethesda, Md., issued a press release in late October announcing research priorities to work toward its vision of a vibrant science that builds knowledge to support effective, evidence-based occupational therapy.
According to the release, future AOTF research initiatives will address:
● Health behaviors to prevent and manage chronic conditions;
● Functional cognition;
● Safety and injury prevention in home, clinical and community settings;
● Technology and environmental supports in home and community;
● Development and transitions for individuals and families;
● Emotional and physiological influences;
● Family and caregiver needs; and
● Healthcare experience: access, care coordination, utilization.
These research priorities emerged from a year-long process led by Dr. Julie Bass, AOTF director of research. Activities included a comprehensive review of the strategic plans of federal agencies and major foundations, deliberations by the AOTF Scientific Advisory Council, and input from AOTF's key stakeholder groups.
"Occupational therapy's unique contribution to science is to understand the mechanisms that support occupational performance and participation," stated Dr. Carolyn Baum, chair of the AOTF Scientific Advisory Council. "The protective and preventive role of occupations comes to the forefront as society seeks to improve health and the everyday lives of individuals, families and communities. The Foundation will direct its resources to prepare scientists and fund work that will make occupational therapy's contribution to occupational performance and participation science explicit."
What are your thoughts about these research priorities and the impact they could make on the occupational therapy profession?