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ADVANCE Outlook: OT

GoBabyGo! Provides Mobility for Young Children
May 23, 2016 1:30 PM by Katherine Bortz

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? 

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CMS Scrutinizes Joint Replacement Outcomes
May 9, 2016 12:26 PM by Jon Bassett
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. 

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Yoga and Mindfulness in OT
April 13, 2016 8:39 AM by Katherine Bortz

"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 were honest about it Its about making choices that are often yes or no, but its 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.

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A Student Perspective on Holistic OT

Two OT students share their experiences with holistic OT fieldwork.

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New Research for Sensory Processing Disorders
April 12, 2016 1:33 PM by Katherine Bortz

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 years 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 dont necessarily qualify for other clinical disorders.

Listening programs have been a part of clinical practice for may years and unfortunately there hasnt 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 audiences 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.

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Empowering the Profession
April 11, 2016 1:53 PM by Dillon Stickle

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.

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Farewell Address from AOTA President
April 9, 2016 11:17 AM by Katherine Bortz

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.”

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Intimacy and Disabilities
April 8, 2016 11:51 AM by Dillon Stickle

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.

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The Road to Independent Driving

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AOTA Annual Conference Coming to Chicago
March 11, 2016 11:26 AM by Brian Ferrie

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!

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Fieldwork in Central America

Applying the Ecology of Human Performance Model to a residential facility in Costa Rica.

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The Frontiers of Discovery
February 17, 2016 1:52 PM by Jon Bassett

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."

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OT and PT Stand Out in 2016 ‘Best Jobs' Ranking
February 4, 2016 1:16 PM by Brian Ferrie

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?

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Historic Double Hand Transplant

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Hillary Clinton’s Autism Initiative
January 8, 2016 12:03 PM by Dillon Stickle
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.

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New Home Health Bill Recognizes OT
December 23, 2015 4:55 PM by Brian Ferrie

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?

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AOTA Announces New York OTA Licensure Law
November 24, 2015 3:02 PM by Dillon Stickle
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.'"

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AOTF Announces Research Priorities
November 5, 2015 11:21 AM by Brian Ferrie

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?

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Baby Boomers and Joint Pain
October 16, 2015 3:36 PM by Dillon Stickle

This blog was written by Debra Karplus, author for the blog "When OTs Wear White Shoes." 

In the 1960s and ‘70s, a good number of baby boomers, post-war people born between the years 1946 and 1964, were rolling, lighting up, and passing around marijuana joints. (Just for the record, that activity was never part of my repertoire!) Now, forty or so years later, those same people are concerned about a different sort of joint, namely, their knees and hip joints. 

Many of my baby boomer peers are already on a new knee (or set of knees) or a new hip. I still have most of my original body parts, thankfully. Though, I certainly notice that my musculoskeletal system has been more vulnerable to aches and pains after performing simple daily tasks. Joint replacement is a surgery that's becoming more and more popular among people in their fifties and even in their forties. In the past, mostly people in their seventies and sometimes eighties were first-timers in the joint replacement arena.

Our skeletal system is simply not designed to last forever, and since people are living longer, bones wear away; spaces between bones, particularly in the spinal column, scrunch together and cause pain and immobility; fluids dry out and our bony framework changes shape, elasticity, and function. Boomers who have taken good care of themselves especially with a healthy diet and appropriate exercise are not immune to the deterioration of our musculoskeletal system.

But those who have exercised in a way that might have been too tough on the body, such as running on hard pavement, might actually be aggravating their bones and joints. There is much controversy out there regarding running as a sport regarding health and safety to our knees.

What about obesity? The Center for Disease Control (http://www.cdc.gov/) in a June, 2015 report states that 35.1% of the population over age 20 can be labeled as obese. Obesity is a factor in numerous diseases, such as heart attack and stroke. Simply carrying all the extra weight around puts way too much stress on our bodies' systems, including our knee and hip joints. Put too much cargo in your vehicle's trunk and the car rides low; put too many heavy items in a box and the box will ultimately fall apart. The physics of our bodies' joints is really no different.

If you are working as an occupational therapy practitioner in a rehabilitation facility, it is likely that many of your patients are receiving your services because they have had hip or knee replacement surgery. It used to be that these people were geriatric patients, and retired from their jobs. But these days, you are likely to have younger patients who have jobs and need to be successful with their therapy in order to get back on the job. Some of these people may even still have children at home.

I would enjoy hearing from OT practitioners about their experiences working with some of these younger joint replacement patients. Specifically, how did your treatment plans differ from those with your geriatric clients?

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