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When OTs Wore White Shoes

Baby Boomers and Joint Pain
October 16, 2015 1:09 PM by Debra Karplus

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 ( 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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Cycling Safely
September 30, 2015 2:58 PM by Debra Karplus

My friend died recently. I don't know the official cause of death, but I definitely know that he had some dementia that became totally debilitating during the last years of his life - so debilitating that he couldn't function on his own or even in an assisted living facility. He spent his final years in a long term care facility near his daughter's home, far away from anything familiar. 

I had met him in the late 1980s when he was in his fifties. He was at the "top of his game" back then and had recently retired from the prestigious position of being head physician at a large city hospital. It broke my heart watching his mental abilities erode, first in small, subtle ways like the absentmindedness that all of us experience occasionally; and then later, bigger, more serious memory lapses that jeopardized his judgment about personal safety and, ultimately, the inability to perform even the most simple daily tasks.

He had shared with me that he'd been in a bad bicycle wreck not too long before his retirement while not wearing a helmet, and may have suffered a concussion but he was not really sure. A concussion is described as a temporary and mild form of a traumatic brain injury (TBI). Symptoms include memory loss and confusion. 

Statistics show that concussion symptoms may not go away and can lead to some form of dementia. Joe didn't say if his retirement was related to the concussion, and I didn't ask. But as time went on, I certainly wondered if there might have been a connection between the concussion and his dementia later in life.

Coincidentally, one of Joe's good friends, a University professor, had a similar demise, and he too had been in a serious bike wreck. In his case, he was riding along with no helmet and the tire of his bike got caught in the slit in a street sewer, dramatically throwing him off the bike and onto his head.

When I was growing up in the 1950s, no one ever wore a bicycle helmet. We rode our bikes all over the place, took an occasional tumble, but never anything serious. Mostly we rode on the sidewalk and no one ever scolded us for that, but maybe because we were just kids.

Online I discovered that bicycle helmets weren't even around until about 1975. My children were of bike-riding age in the mid-1980s, and frankly, I don't even remember ever getting them bike helmets. Shame on me! Happily, they never suffered more than a scraped knee from careless riding.

According to, most serious bicycle accidents, including the fatal ones, cause injury to the head. But they claim that the risk of a head injury can be reduced by about 85% by wearing a helmet. And the helmet must be properly fitted and replaced about every five years or so.

What clinical or personal experience have you as OTs had with head injuries related to a bicycle accident?

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Laughter Yoga
September 22, 2015 3:18 PM by Debra Karplus

The Park District here advertises free yoga in one of our most beautiful parks each Saturday morning at nine during the summer months. I enjoy doing yoga, and the word "free" always screams my name, so this activity had been on my bucket list for the past couple years since they first started offering it.

A few weekends ago, I finally had no distractions and nothing keeping me from digging out my yoga mat from the back of a closet, dousing myself with mosquito repellent and heading to the park. I thought I would be one of a handful of people doing yoga in the park, but the leader said that on a given Saturday, approximately 75 men and women of all ages, some even with their children, show up to bend and stretch.

But, like many of the participants, I was caught by surprise when the leader stated that this Saturday would be different as we would be doing "laughter yoga." Most of us looked puzzled and commented to each other that we really didn't know what that was. 

For the first half hour or so we didn't even need our mats. We all got into a sloppy looking circle, some people barefoot, others wearing socks and shoes, and were guided through a bunch of different movements and exercises which involved laughing, or at least forcing ourselves to feign laughter. 

The instructor told us that whether laughter is real or forced, it is good for the core muscles and for emotional well-being. As an occupational therapist that has done yoga as well as various types of aerobic and anaerobic exercise, I could see where this would be true. The last half hour was done while lying supine on our mats with a sort of meditation.

Honestly, I didn't feel like I got much of a workout, but I did find laughter yoga to be fun and it did in fact put me in a better head space than the grumpy mood (for no particular reason) that started my day. So when I returned home, curious, I searched online for "laughter yoga" and sure enough, it is a real practice; Laughter Yoga International ( has a rather impressive website with all sorts of opportunities for finding classes and events, and even training to become a certified instructor.

So, of course, I am curious. In an article that I wrote for this blog about a year and a half ago about Yoga and OT, I discovered that many occupational therapy practitioners utilize yoga or components of yoga and its poses and positions in clinical settings, be it in physical or mental rehab.

But what about laughter yoga? It seems to be an activity that can be done either indoors or outside. Are there any practitioners out there using laughter yoga in combination with OT treatments? I am eager to hear about your experience.

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Respecting Children with Disabilities
September 16, 2015 2:42 PM by Debra Karplus
Yesterday, we stopped at our favorite ice cream store to treat ourselves to hot fudge sundaes. Living in a relatively small town for a long time, I often find myself running into people that I know from some little pocket of my life, and while standing in line watching our sundaes being prepared, it happened once again. There was Lauren, with two adults who, presumably, were her mom and dad.

Lauren is a very sweet young lady whom I know from the middle school and high school where I provide service. In the several years that I have known her, she is mainstreamed for a few of her classes such as physical education, but mostly she spends her day in the self-contained special education classroom at school with a group of other students who have a variety of disabilities.

"Hi, Lauren, how are you?" I greeted her, in exactly the same way I would anytime I see someone that I know. And then, to put her parents at ease, I clarified that I had known Lauren for several years from the schools where I worked. Her dad quickly blurted out, in a volume that all in the entire ice cream parlor might hear, "Oh, she's autistic!" Not knowing what to make of such a loud, bold, and rather condescending and disrespectful comment about his daughter, I said without thinking, "Well, we all have something."

When I was in public school in Chicago and later in the suburbs, I don't remember seeing anyone with a disability. I believe before all the legislation in the 1970s that was passed to enhance life for people with disabilities, students with special needs were all labeled "retarded" and were "sent away to a special school." I don't remember seeing anyone with special needs until I headed off to the University of Illinois in 1970. 

But these days, anyone pursuing a college degree where they will be working in schools with special needs students such as special education teachers, OTs, speech and language pathologists, and physical therapists, social workers can expect to always have a job because there are so many students now needing our services. The National Center for Education Statistics ( states that for the 2012-2013 school year, approximately 13% of students ages three to 21 were receiving special education services and of those, 8% had been labeled as autistic.

Occupational therapy professionals are experts in promoting disability awareness in our communities. But families such as Lauren's need some support and guidance in treating their child with special needs, no matter what their age, with the same respect that they would want for themselves.

I am eager to hear from readers about their experiences, both positive and negative, in relating to their children and other relatives with disabilities in a more appropriate way, both publically and privately.

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Advising New Moms to Use Caution
September 9, 2015 11:01 AM by Debra Karplus

Through a friend, I heard an incredibly sad story that I share over and over, especially with pregnant teens and new moms. An upper middle class, highly educated couple left their two month old with an experienced nanny while they went out for an appointment with their older child, after which they wanted to do some errands. While at the mall, they received the phone call that no parent would ever want to get. The nanny had left the infant on the sofa for just a brief moment to warm a bottle of milk, and when she returned the baby was face down on the floor, unconscious. Paramedics were called before the parents, and the baby ended up in the hospital intensive care unit for weeks, before returning home severely disabled.

Occupational therapy practitioners, among many other health care professionals have been working intensely with this baby, who has many of the symptoms of traumatic brain injury (TBI), in the months since this tragic and unnecessary accident. Gross and fine motor problems exist as do visual problems and many developmental delays. OTs certainly do not need job security from avoidable incidents such as this on their caseload!

Careful and responsible people often forget the split second that it takes to transform an idyllic family life into a disastrous one. A long time ago, another family recalls their young child, sitting and eating in a baby high chair, had wrapped a telephone cord around his neck while the parent momentarily had stepped into the next room. Thankfully, that child was okay and is all grown up now. One of the saddest cases that I have worked with was a few years ago. A baby was born "brain dead" as the result of a home birth gone terribly wrong.

Life throws us enough curve balls, and it's especially sad when a tragedy could have been easily avoided.

But we as occupational therapy practitioners need to remind the parents that we work with, regardless of their education level or their social class, not to assume that if a baby has not yet rolled over, that its first "success" with that skill can't lead to a lifetime of very serious trouble.

All of us can admit to some "it'll only be a second" things that we might have done. Perhaps we left a sleeping child in the car with all windows rolled open, but parked unattended in the driveway during the peak of summer heat while we went into the house to bring in the groceries. Or maybe we set the young baby in the middle of a king-sized bed when we went downstairs to stir a pot of soup.

What personal or professional experiences have you had as an occupational therapy practitioner? How did you deal the with parents' expression of guilt?

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Preventing Falls
August 31, 2015 12:52 PM by Debra Karplus

A friend's father, a robust and relatively healthy man in his eighties, went down to the basement to assess the water damage after recent heavy rains and fell.  One problem lead to another and within about six weeks, he passed away.  We had just been at a barbecue with him right before his fall, and it was hard to imagine such a quick demise.

A patient of mine in his forties had been doing some routine maintenance on the roof of his house.  A generally careful man, he tumbled off the roof.  He's now quadriplegic as the result of this fall.

A home gym is handy and convenient and a wonderful way to stay fit.  One man fell off his treadmill at home.  He hit his head and ultimately died from this fall. Treadmill accidents are more common than one might imagine.  Another man that I know still has shoulder issues from a fall from his treadmill over a decade ago.

An ordinary trip to the supermarket turned dangerous for one friend.  She likes to buy her produce at a particular store, and indeed, the food there looks beautiful.  But she showed up right after they had sprayed the vegetables with water.  She slipped on a wet spot, ended up falling, injured a hip and is in the process of litigation.

Icy weather can throw a curve ball toward being safe, even for very careful individuals. A gentleman that I know went out to get the mail, slipped on an ice patch and fell in his driveway.  He ended up with an ankle injury.

I pride myself in being very cautious, but I have not been immune to falling.  I have taken a few little spills off my bicycle that fortunately caused nothing more than a laceration to my knee.  Once I tripped on the stairs while carrying laundry and talking on the phone at the same time.  I wasn't really injured but it was a good reminder that multi-tasking is sometimes not a good idea.  More recently, I was in the shower and slid on a small glob of hair conditioner on the bottom of the tub.  Again, I was lucky to have dodged any injury.

The Center for Disease Control ( in a July 2015 report states that twenty to thirty percent of falls result in moderate to severe injury such as hip fractures and head injuries.  A good number of these falls occur at home to careful folks performing ordinary tasks.

We as occupational therapy practitioners can informally at home and with our own family and friends, and professionally in our clinics and home visits with patients, can use our expertise and fine bedside manner to guide people toward making their homes safe - especially in the bathroom, where a good amount of falls occur.  Get rid of throw rugs. Install grab bars.  Keep clutter away from stairways.  Improve lighting.  Make the kitchen ergonomically a better place.

What has been your experience with fall prevention?

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Back in the Pool
August 26, 2015 1:22 PM by Debra Karplus

For about twenty five years, I swam laps in an indoor pool near my house once or twice a day almost daily. My form was never great, and my swim lasted only about twenty minutes. After my swim I'd sometimes stay for use of the steam room or the whirlpool. When I was finished, I came out feeling clean and relaxed, like a blob of spaghetti, yet invigorated. People who swim laps regularly can probably relate to this feeling. 

When the facility started making rumblings about building a new sports center on the other side of town, I decided it was time to re-assess my exercise program. I terminated my membership, and found other ways to exercise, including riding my bicycle, playing tennis, attending yoga classes and connecting with friends who wanted to take brisk walks. I felt that my new regiment provided me with the level of exercise that I needed to feel good both physically and emotionally.

People who knew that I had been a long time lap swimmer frequently asked me if I missed swimming, and I really felt that I did not miss it at all. The more recent activities that I did for exercise added a social component to my life that swimming really could not provide, and I am a rather social person.

But this summer, I found myself with some unstructured time, and after many years of not doing lap swim, I had a craving to get back into a pool and go for it. I made some calls around town to find out schedules and rates, and finally found an indoor facility that was a ten to fifteen minute drive from my house that sold a punch card specifically for lap swimming, with no expiration date. So I plunked down my credit card and hopped right into the pool. 

The temperature of the pool was perfect, not warm or even hot like some of the pools for therapy, but not icy cold either. And the other swimmers, all people about my age, seemed super friendly. Initially, as I did my first few laps, I found myself a bit short of breath, and that was worrisome. But then, that stopped and, much to my surprise, I had the endurance for twenty minutes of good swimming using good form. I came out of the pool with a calm feeling that I hadn't felt in a long time, ready to face the challenges of the day.

I have never used aquatics as a modality for my occupational therapy patients, mainly because I have never worked in a setting where a pool was available. But I certainly see how aquatic therapy - low impact, low intensity - can help our rehabilitation patients, even the older ones with the numerous orthopedic problems such as arthritis, hip and knee issues, and neurological problems including stroke or Parkinson's disease.

I would love to hear from readers who have incorporated aquatics into their occupational therapy treatment plans in physical or mental health settings.

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Mindfulness and OT
August 17, 2015 10:05 AM by Debra Karplus
Mindfulness is popular these days. It seems that many conversations I have with people turns toward the subject of mindfulness. People are heading to mindfulness training, workshops, and even retreats. I find it interesting that many of these folks are some of the most neurotic people that I know. But, when I think about it, that really does make sense. Perhaps they need to become more mindful than other people might!

Given the popularity of people striving to be more mindful, I thought I'd better look up to see exactly what mindfulness is. But I quickly discovered that mindfulness isn't much more than I originally thought; that is, simply being focused and being in the moment. But I found that there are experts in mindfulness and various different techniques, so perhaps there is a bit more to it than my simplified definition.

Admittedly, I could truly benefit from some mindfulness training. I pride myself in my ability to multi-task, which, when you think about it, is the exact opposite of mindfulness. For example, I can carry a tub of laundry down the stairs while talking on the phone; but one time I tripped and fell while doing that. And I am certain that sometimes when I am talking with someone whether face-to-face or on the phone, they can tell that I am "not really present", and am preoccupied with some completely different subject or task. I have been confronted on that one more than a few times.

Or when I am practicing yoga, I am often thinking about the errands that I will do when the session ends, about my grocery list, or pondering what to cook for dinner. That's not exactly in sync with the principles of yoga, is it?

So I started to wonder how occupational therapists might use some of the principles of mindfulness. Searching online, I found that concepts of mindfulness can help with pain management, movement, overall better mental health, and other issues and problems that OTs address. But, I did not really see any specifics on how this is done.

I receive lots of snail mail here at home about professional workshops for OTs, and mostly I just put them into the recycling bin without really looking at them. That's me not being mindful again! But it is very likely that I could benefit greatly from what is offered at these sessions, especially if some of them are about mindfulness. I must pay better attention to these brochures.

So now I am curious. I would enjoy hearing from other occupational therapy practitioners as to how they have used mindfulness and mindfulness training in their clinical settings. It sounds like there is potential to help most any population that we as OTs serve, such as people in a geriatric setting, school-aged children, adults with mental retardation and people in settings for mental health.

I hope readers will post comments on this blog about their personal and professional experience with mindfulness.

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Getting Along on the Job
August 10, 2015 12:09 PM by Debra Karplus
The other day, I started thinking about an interesting interaction that happened a few years ago with a couple of co-workers. I'm not even sure what prompted this experience to pop into my head when it did, but I will share the story.

At a long term care rehabilitation facility in a small town just outside of where I live, I worked as an occupational therapist supervising a crew of certified occupational therapy assistants (COTAs) and a couple of rehabilitation aides, whom I will call Alice and Lisa. These two aides worked very hard and had a wonderful friendship with each other, and had great rapport with even the most difficult patients. I had a good relationship with both Alice and Lisa, and every few weeks I treated them to lunch at a place that they both really enjoyed just a few blocks from where we all worked. We looked forward to and enjoyed these meals together.

The town where this rehab facility was located, like many small towns across America, had little diversity. So I kept a low profile on the fact that my religion was different than perhaps anyone living in that town. So when I embarked on a course of study of my religion and some of the rituals, celebrations and ceremonies, I just kept my mouth shut.

At around the same time, I sensed a sort of coldness between the two rehab aides and me. I had a feeling I might have said something or done something that angered one or both of them, or that they figured out about my studies outside of work. But I had no idea if I should confront one or both of them, or just hope that, whatever the problem, it would disappear over time.

One afternoon while at the facility, many people from the staff showed up in the rehab room carrying gifts, some small and some very large. It turns out these were baby gifts. That was when I started asking some specific questions and came to discover that Lisa's son had gotten Alice's daughter pregnant. It was an accidental pregnancy and the two teens had no intention of becoming a couple or a family. The "chill" that I felt in the rehab room during those weeks had absolutely nothing to do with me. It was the disapproval and conflict between Alice and Lisa and with the future of their children and soon-to-be-born grandchild.

So what is the point of this tale?

I am one of those people who are able to get along with most others. Typically, when I have an issue with someone, it turns out that other people do, too. I am willing to take ownership for misunderstandings with others, but, more often than not, my intuition guides me and I generally make good judgments and good choices.

Getting along on the job or even in your non-work life is not rocket science; be pleasant, be congenial, be accepting of differences with co-workers - whether they are your supervisor, supervisee, or your patients and their families.

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Give Credit where Credit is due
August 4, 2015 5:08 PM by Debra Karplus
The other day, I was riding on a commuter train. The last passenger to board the train at my stop was a young woman who was using a blind cane; let's call her Mary. The conductor escorted her to a seat in an area designated for people with disabilities. Not being particularly social when using public transportation, I became engrossed in a Sudoku puzzle as the train started moving. Other passengers were using various electronic devices, reading the morning newspaper or chatting with their seat mate.

After a while, above the rumbling sound of the train and its whistle, I heard Mary say rather loudly to her seat mate, "I hear water running, do you think something might be leaking from the bathroom?" I looked up and toward the front of the train where there was a rest room, as did other passengers on the train. How perceptive Mary was; someone had left the sink running in the tiny train rest room and there was now water all over the floor, a safety hazard, for sure. One of the passengers called the conductor for assistance, and the problem was quickly resolved.

So why am I even sharing this anecdote? Yes, I have worked with people with all sorts of physical, mental, and developmental disabilities over the course of the past forty years as an occupational therapist; and yes, when I am working in a clinical setting and these people are my patients, I am always very positive and respectful to them and, as we learned in OT school, I focus on their strengths and abilities rather than on their weaknesses. But in my personal life I find that, admittedly, I sometimes simply fall short - certain arrogance sets in that I am not particularly proud of.

As the ride continued, I heard Mary tell her seat mate that she was working on a PhD at the university, and I thought "way to go, Mary." She has more education than I do! And I wanted to whack myself on the side of the head and say, "Debbie, you fool, why did you even find it noteworthy that Mary was the person who noticed the bathroom train leak that no one else suspected?"

I think it is good and humbling to have these sorts of reminders in our daily lives: that people with disabilities are really not as different as we are, and that they have skills and abilities, often better than our own.

So once again, I find myself with "egg on my face." Not so unusual. If my adult children or even my grandchildren should be reading this blog, they are probably thinking, "Yeah, that's our mom all right."

Anyway, I would like to hear from readers about times when they might not have given enough credit to a person with a disability either in their professional or their personal life.

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Taking Dad Fishing
July 28, 2015 12:32 PM by Debra Karplus
Last weekend, we took Dad fishing - a sport that he has always enjoyed since he was a young boy who fished with his father. In Dad's younger years, he especially enjoyed fishing from a boat, and has fond memories of yearly trips up to the north woods of Minnesota where he and a bunch of his buddies enjoyed a week of rustic accommodations, fishing from boats, and eating their fresh caught walleye which was prepared and fried for them.

But these days, Dad is moving a little slower (and for that matter, so am I). So, we took him to a small pond managed by the city park district near his house. We have seen other people fishing there, and no signs that say that fishing is prohibited, so presumably the park district expects that people will use the lake for fishing. We have seen people catch good-sized blue gills at this little lake.

We were able to legitimately use Dad's handicapped parking sticker, so we had no trouble finding an easy spot to put the car. And once we got out of the car, there were curb cuts in reasonable places, so Dad could use his rolling walker to walk from the parking spot to the curb. But that's where the challenge began. 

I carefully perused the lake area and was unable to find any ramp or accessible place of any kind for fishing, nor could I find any safe way to get Dad from the curb to the lake. So we carefully guarded Dad on each side as he walked through lumpy grass with deep pits in it, so that we could set a lawn chair near the lake for him and his fish poles. The outing was a success, measured by the pole-bending fish that he caught - which he then quickly and compassionately threw back into the water.

The Americans with Disabilities Act (ADA) has been an incredible piece of legislation signed into law by President George H. W. Bush in the early 1990s. It has helped millions of Americans with disabilities in the employment arena, but also in their communities: shopping, public transportation, and recreation. But our experience taking Dad fishing made me question if the passing of the ADA is just a small baby step toward making life easier for people with permanent or even temporary disabilities, such as the one Dad has right now.

I would enjoy hearing from readers some of the challenges they might have had with matters pertaining to holes in the ADA.

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Backpacks are a Real Pain
July 20, 2015 4:31 PM by Debra Karplus
It's back-to-school time again, the time when parents and children, from pre-kindergarten to high school head to large discount stores for great deals on school supplies. Backpacks are essential for students regardless of age, grade or physical size. How else can they transport essentials, such as pencils, markers, calculator, textbooks, spiral notebooks, and loose leaf binders, plus daily assignment books and organizers?

When I was in school in the 1950s and 1960s, we walked to school daily. I don't remember carrying anything to school. Notes that needed to be sent home from school for Mom to see or possibly sign were simply pinned to our shirt. (If you did something like that today, it could possibly be construed as some sort of child abuse!)The school supply list was simple back then, ruler, scissors, pencils, paste or glue, and some notebook paper. And, I'd never seen or even heard of a backpack; we simply didn't have much to carry. I believe the books just stayed at school because I don't remember ever transporting them. I probably saw my first backpack while in college in the 1970s.

By the time my children entered kindergarten in the early 1980s, backpacks found their way onto the school supply list. Small, lightweight items went to and from school in those bags, and on occasion, a small school library book to be read at home and then returned.  My children also carried separately their lunchboxes, as we were committed to eating meatless meals and healthier food than could be found in the school hot lunch program. But the backpacks that my children carried were never even close to heavy enough to cause any injury.

These days, school kids of all ages are carrying major amounts of "stuff" to and from school. For a short ride on the school bus or in the family car, that is not such a big deal. But the middle school and high school kids, who have classes in different places around the school building or buildings carry their very full backpack from classroom to classroom all day long.

The recommended ratio of backpack weight to body weight is about one to ten, meaning that a 100 pound middle school student should carry a backpack weighing no more than ten pounds. But some of the statistics found online claim that an average sixth grade student might be carrying around eighteen to even thirty pounds of stuff on a given day.

As occupational therapists, I believe we have a role in this, particularly in the area of prevention. I know that I have a small roller suitcase with a handle that I use for myself when I lead workshops, seminars and teach classes. It is a smaller version of the bags you see people using to travel by air or train. I seldom see a student at school using one of these, but ergonomically, it is the way to go.

I welcome input from other occupational therapy practitioners on this issue of backpacks.

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When your Friend has ALS
July 13, 2015 4:53 PM by Debra Karplus
What do you say when your friend tells you that her brother, whom you know, and a man in his mid-fifties who is in the prime of his life, has just been diagnosed with Amyotrophic Lateral Sclerosis, (ALS), the disease that the general public knows as Lou Gehrig's disease? It's tough to come up with words of comfort for a friend or relative who has this cruel disease.

Everyone whom I have known with the disease has been a male in his fifties, sixties, or seventies, and none has had any family history of the disease to the best of their knowledge. According to one of the many websites about ALS, ninety to ninety-five percent of people have sporadic ALS, while the other ten to five percent have familiar ALS, that is, with a genetic component.

ALS is a progressive, degenerative disorder that affects nerve cells to the brain and to the spinal cord. Ultimately the brain can no longer control muscle movement. The disease is difficult to diagnose; there is no one test, just a battery of tests that eliminate other possible diseases. Symptoms vary from patient to patient. For some, the first symptom noticed is difficulty with grasp. For others, there are problems with the voice, vocal cords, and swallowing. Obtaining a second opinion is generally a smart thing to do when someone has these symptoms. Life expectancy is about three to five years for patients having ALS.

A few times as an occupational therapy practitioner, I have had patients on my caseload who were diagnosed with ALS. One was my former family doctor, and that made me especially sad to see him no longer be "at the top of this game." That's really an understatement of how poor his overall functioning was.

Since there is really no cure for the disease, physicians must treat the symptoms of ALS. Similarly, occupational therapists work to minimize the problems typical to the disease. Training in activities of daily living (ADL) is a big part of OT for the ALS patient: dressing, bathing, hygiene and ultimately feeding as oral skills and hand function diminish. And of course, OT's working with patients who have Lou Gehrig's disease make upper extremity range of motion, strength, and coordination part of the treatment plan as well as therapeutic activities to improve balance.

So how does one provide support to a friend who has ALS in the family? Is there a way to put a positive spin of how this disease will play itself out in the few short years that remain for the patients, without being deceptive about the gravity of it?

I would be interested in hearing from other occupational therapy practitioners about their own professional or personal experience dealing with Amyotrophic Lateral Sclerosis.

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Choosing a Health Care Career
July 7, 2015 3:10 PM by Debra Karplus
At a dinner party the other night, one young man, Mike, a newly graduated anesthesiologist, was "holding court," answering "doctor questions" from some of the other guests. One guest, a man with a son in college and a daughter finishing high school, asked Mike if he had to do it over again, would he become a physician. Mike, without hesitation, responded "no." 

I responded that I always encourage young people to consider occupational therapy as a career, and Mike stated that his cousin who is a speech and language pathologist (SLP) says the same thing that I, the occupational therapist, say.

When I asked why he would have chosen a different profession, Mike was quick to divulge that he had over $100,000 in student loan debt, as did his doctor wife. They have a new house and a baby. That all sounds idyllic; but the dark cloud of all this debt makes life somewhat scary for this couple in their early thirties.

These are honest folks but, still, I could hardly believe that anyone of any reasonable intelligence and maturity could rack up so much debt, even if for the honorable pursuit of becoming a doctor. So I looked online, and searched "average student loan debt after medical school". 

According to in a September 2013 report, I discovered that at that time, $166,750 was the average debt after medical school. The article indicated that it would take about thirty years of doctoring to recoup that money. That would put your average doctor into his or her fifties or even sixties. What doctor could ever retire with such a financial dilemma?

I don't remember even having any student debt, but then I went to college and occupational school in the early 1970s when the subject of student loans never made the front page news. And even when I returned to school in the mid-1990s to complete my Master's Degree, huge amounts of student college debt did not seem to be an issue for many people at that point in time either.

I got back online and tried to find out what current students of occupational therapy are accruing as debt, but I could not find any data.

So I would be curious to hear from readers, especially new graduates of OT school, their personal experience with student loan debts.


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Online Occupational Therapy?
June 30, 2015 9:38 AM by Debra Karplus
I don't watch much television, but last night, while dozing, I caught the tail end of a commercial advertising a telehealth service that consumers can subscribe to. I was curious and did a bit of research about this. From what I could figure out, a consumer can get 24/7 access to a physician via a Skype-like service to diagnose a health problem. It is a convenient and affordable way to "see" a doctor.

This jogged my memory to an experience I had actually had when I unknowingly used such a service. A few years ago, I spent part of a summer in a wooded area out in the wilderness. Before I went there, I was told that there was medical care on the premises if I needed it. The idea of such a service gave me peace of mind.

While there, one morning I awoke and the entire left side of my face was swollen, especially around my eye. I figured out that a spider must have bitten me near my eye, causing an allergic reaction. An ice pack applied to the area did not help, nor did taking Benadryl, which always works for any allergic reaction I might have.

I told the director of the facility where I was staying and they quickly directed me to the physician. That was when I learned that the on-premises medical care by a real doctor that I was promised was in fact live, but was on a TV screen. The TV doctor "examined" my rash and nonchalantly said it would go away on its own and that I should not be too concerned.

But I typically have a good sense of intuition and I suspected this was not just a run-of-the-mill rash. So I found a phone and called my own physician back home. He told me to get to a "real doctor," pronto, and he told me exactly what medicine needed to be administered. Barely able to see out of my left eye, and grossly uncomfortable in general, I found someone to drive me into town. At the walk-in health clinic, I was given two injections, both in my bottom, and by morning I was nearly okay.

A TV physician is better than a no doctor at all, in many circumstances, but in my situation, I literally could have died from a severe allergic reaction. 

My incident with this allergic reaction and with the recent viewing of a commercial for telehealth made me start wondering about the future of health care and specifically of occupational therapy. I was at an alternative high school recently and noticed that some of the students take physical education online via a popular school website. That made no sense to me!

So I wonder, will the hands-on approach that OTs have always used as one of their main ways to diagnose and treat someday fall to the wayside in the name of cost containment and "more efficient" service delivery?

I would enjoy hearing your thoughts on this...

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