"liz"

Blog FW
My first field work was at a local hospital in acute care. I had the pleasure to meet “Liz” she was a young woman who had two below the knee amputations due to an autoimmune disease. “Liz” was married, with a young child and use to be a ballerina but since her illness she hasn’t been able to dance.
Prior to her surgery, she met with the OT team and the prosthetist to discuss what her goals were and how they would go about reaching them. Liz’s first treatment session was the day after her surgery; we were making knee splints for her residual limbs. While we making the splints Liz talked about how hard things have been at home; her husband left because he could not cope with his wife’s condition. It seemed as if she had reconciled the fact that he had left, as if he was put in a box in the back of her mind to be dealt with at a later date. Unfortunately, I only saw her at the one treatment session. She was doing so well that she went to rehab the very next week. During the last year I have thought about her often, hoping that she remained strong and some day she would be dancing on her new legs.

Click here
http://www.mynewleg.net/

What we bring to the table

What each person brings to the table can make a great difference in eachothers lives. Therapy groups are amazing in this way. But even in another type of setting it can make a difference. Each experience I have had in my life, whether it is being a camp counselor dealing ADD, ADHD children or dealing with someone that is depressed from having to change their career because of an injury, my toolbox has grown. We all have a toolbox of events that change how we feel about a situation & how we react to that situation. And tucked away inside we note what works & what does not work. With each new person we meet that toolbox grows. This past week in my fieldwork our leader had two different activities planned, one for the girls & one more focused to the boys. However, each activity could work for either sex. I notice that one of the tools in my toolbox is to change direction very quickly. There are a couple children that are not schoolage yet, which means limited counting ability. The 1st activity we were to do required some counting ability. We taught the children how to make & play mancala out of an egg carton, 36 beans, & 2 cups. To play this game you need to be able to follow the rules & count. Unfortunately, some of the younger children, 4 years old, could not understand the rules, or still have limited attention span in order to play the game.So, in the end we just worked on counting the objects, beans, instead of playing the game with them. But because I had dealt with children with limited attention span, ADD or ADHD, I had the tools ready to make this activity fit what the child was able to do.

The kids still got a lot out of the activity, and had a lot of fun too. Which is the entire point of this work we are getting into. So, think what you get out of every experience you have had, whether it was at work, or home with family & friends. Add to your tool box every day. To start this journey it may help to understand a bit about conflict resolution. Here is a sight that can help with your skills, I hope it helps you to understand a bit more. Conflict Resolution

Power of Music

I know, for myself, that music makes a huge impact. Depending on what type it is, it can energize me, relax/sooth me, irritate me or even bring me to tears. Knowing this, we can use music to great effect when doing any type of treatment. In group this week, it was interesting to see the what type of music would be best. I used slow Hawaiian music for warm-up, and faster songs for a pass the ball and balloon activities. Given the amount of verbal cues needed, I'm not sure the music did much to motivate the group but when we put on the Zumba DVD, having the music seemed to be much more of a factor (as well as the instructors on the video). Both my music and the Zumba music were not familiar to this group and I wonder whether or not playing their favorite music would have had a bigger impact. It's hard though with a large group to find something they all enjoy. On an individual basis though, it can be much more effective. At the NCOTA conference this weekend, I attended a seminar on dementia and the speaker stressed how for the severely demented and agitated patient, familiar music can work wonders for these people. I found a couple of journal abstracts verifying how music can be therapeutic and how individualized music was more effective.

http://journals.cambridge.org/action/displayAbstract?aid=517960

http://journals.cambridge.org/action/displayAbstract?aid=273208

This week at my site went well. The groupleader ran an exercise group. The highlight was when we got the balloons out. Most all the clients got involved, batting the balloons around. We really got them moving. The staff really seemed to enjoy themselves also. After the exercise wound down, I took an opportunity to work on a puzzle with one of the clients. At first, he exhibited a great deal of enthusiasm; however, as time went on, his interest waned. Cognitive impairment is not a simple thing to understand. At first, I thought this client was some kind of puzzle genius. Then I realized that he was not able to complete the puzzle. In fact, he was not that interested in completing it. He was completing something different from the picture on the box. We did work together to complete the puzzle, but I am not sure how satisfied he was.

Virtual Hallucination

Blog 3/23
I came across this article in Time magazine the other day called “De-criminalizing Mental Illness”. It was an interesting article concerning law enforcements handling of suspects who may be having a psychotic break. Law enforcement agencies across the country have implemented CIT , Crisis Intervention Teams; these teams teach fellow officers how to approach the psychotic suspects and they are using technology that allows officers to see what it feels like to have hallucination. It’s a new machine called “Virtual Hallucination”; this machine has visual, verbal and olfactory stimuli that creates the sensation that you are having a hallucination. What a better way to teach officers how a schizophrenic feels in throws of a psychotic break. It would be a great learning tool for all mental health providers. I have provided a link to the Time’s story and to a great Youtube video about the Virtual Hallucination.
Click here
http://www.time.com/time/health/article/0,8599,1651002,00.html
http://www.youtube.com/watch?v=o7lByJfYQ4w

FW

Today we went to Sweet Tomatoes. I liked the idea because it gave our group a chance to incorporate what they learned from last week's session. I was glad to see how much they remembered about portion control. There were times when they needed to be reminded about how much food they were putting on their plate but they used other techniques to make up for it. For example, waiting 10 min before getting another serving. I thought it was a nice experience to see how they acted outside their normal environment. They were great and very sociable. I really enjoyed it.

In this country/Acceptance

In this country I am finding that the more people are aware of mental illness, the more stigmas are created. This is coming to reality. Because there are more diagnosis in the world of psychiatry now, there are also more stigmas being created for each diagnosis. If only there were a way of informing all human beings of the reality that about how many people have a mental illness. If an individual looked more in depth at the people in their life, odds are that they would find more than 1 person with a mental illness. Accepting a mental illness in your family, friends, or neighbors can be hard. But, once there is a diagnosis there is usually a period of denial. The denial of mental illness can be devistating to the individual that may have the diagnosis. Which could in turn cause more symptoms of the mental illness, or exaserbate the disease. Together with many organization we can lesson the impact that stigmas have on people. NAMI is just one organization that is fighting for people with mental illnesses as well as the Mental Health Organization. The more people that know the truth behind stigmas could really make a difference, and I hope each and every person reading this will take this as a challenge to inform the people around them about the truth about mental illnesses.

Stigma of mental illness

Signs & symptoms of mental illness

Field Work

I led my first group last week. A couple of interesting things happened. First, we flew through all of my activities. We planned a cooking activity, teeth brushing and a collage activity. We completed all of the activities in an hour and a half. I did not think we would get everything done in two hours. These clients surprise me in many ways. Second, I saw my first injury. A client with CP injured his thumb by constant involuntary flicking against his fingers. He came to the board to put his picture on the board and I could see that he was bleeding. It looked very painful, but he seemed more interested in the collage and getting his picture up. One of the regular staff took him to see the nurse. Overall, it was a good afternoon.

The Man Without a Face

I don't know if anyone saw this but, there was a man who has been living with a tumor for 35 years. His name is Jose Mestre and he lives in Portugal. He couldn't see out of one of his eyes and he had trouble breathing. His mother didn't want him to have surgery because of her beliefs as a Jehovah's witness. After her death his finally agreed to have surgery to have the face-eating tumor removed. After having the tumor removed it was like he couldn't function. He was having psychological problems, as well as, physical problems after the surgery. Jose felt lost without his tumor. I didn't think it would have that kind of affect on him. I guess after having the tumor over a long period of time he had some kind of connection with it and felt that part of him was taken away after the surgery. With the support of his family, mainly his sister, he was able to over come his problems both physically and psychologically. He is now living a happy and full life.

If you would like to see what he looks like here is the website:

http://www.doobybrain.com/2007/12/06/jose-mestre-the-man-with-no-face/

http://ansblog.com/2010/06/jose-mestre-man-without-a-face/

Hope you find this as interesting as I did.

Therapeutic Use of Self

It's amazing seeing someone apply the things you learn in class in real life. S, my supervisor described the first patient (Mr. G.) we were going to see as a "grumpy old man." This was an accurate description of his general temperament. He argued a lot and made several disparaging remarks to S and about the medical staff in general. She was trying to get him to get up out of bed, do some LB dressing and then get his shoes on in preparation for PT to take him for a walk. She told me before hand that she knew he was from up north (she was too) and that she knew if she didn't push Mr. G, he would not do anything for her. I know if I had been the therapist, he would have had me running and I would have just put down "patient refused treatment" in my note. Instead, S kept herself at eye level with him and calmly but firmly corrected his incorrect statements (nursing was responsible for his PICC lines) and clearly stated to him the behaviors he was exhibiting (yelling, blaming her for things she was not responsible for). This did wonders to calm him down and then he was able to verbalize what was bothering him (he was having some gastric distress). Once he was calm, she thanked him for verbalizing his problems and acknowledge his discomfort. This allowed her to talk through and reason with him the necessary steps needed for him to be able to go home and like magic, he was much more cooperative. Lucky for the PTA who came in right after. He was ready and willing to go his walk. This was a great lesson in knowing the patient and how much you can push. Also, it was an invaluable reminder a patient's refusal to do therapy can be changed if the therapist knows how to use herself/himself effectively

Like or dislike

No matter how much people say they like or dislike someone their feelings are usually totally different than what they actually feel usually. There are some people that say how they feel, but usually not in all situations. I find this very true of the young people I am working with at my fieldwork. I wonder sometimes if we implemented a little psychoanalytic theory if these children would have a breakthrough. And possibly be more self confident if they understood more about themselves. I am running into the situation where 2 teenagers are hitting pinching each other to get "revenge." However, I feel if they could bring the conscience forward they may be more forthcoming about their feelings that they may further their understanding of themselves.

Freud's bringing unconscious to conscience.

I heard a story this morning on the radio about TBI and Community College. Coastal Carolina Community College, near camp Lejeune, held an event to encourage students with TBI to get help. According to one University official, many of those injured, returning soldiers, are reluctant to seek help or assistance as students at the college. I thought this story was interesting on a couple of levels. First, the results of TBI can be subtle. Some people may just need extra time on a test or help from a note taker. Second, like so many things in mental health, there seems to be a stigma attached to TBI. At least, there is in the mind of those who suffer a reluctance to seek help.

Mental Health and Physical Disabilities

I went to a support group meeting for people suffering from a degenerative neuromuscular disease. These people progressively loose control of their voluntary muscle control and become severely disabled until they are completely dependent for all their needs. After hearing about the physical losses these people have had to bear, the fears they have for the future, the worry they have for their caregivers and the impact on their lives due to this disease, it was no surprise to find that these people also suffered severe depression and anxiety. I would not be surprised to find suicide attempts or anger/aggression in this population of people given the prognosis for this disease. What I did find surprising and moving was how these people could joke and laugh about their experiences one minute and cry the next. Watching the the whole therapeutic process of group support was amazing and how the leader got them to share with and connect with each other was a fantastic learning experience.

Premature aging

In my field work I interact with employees who have different levels of mental disabilities, including ones with Down syndrome. I was shocked to see how much older the employees with Down Syndrome looked compare to the others. So I went home and did some research on Down Syndrome and this is what I discovered:
• In l929 the Down Syndrome lifespan was only 9 years.
• People with Down Syndrome are now living well into their 50’s and 60’s. .
• Premature aging is a characteristic of adults with Down syndrome.
• Scientists have discovered that there is a connection between Trisomy 21 and Alzheimer’s disease.
• Scientist also believe Trisomy 21 is linked to why people with Down Syndrome are spared many others diseases, such as heart attacks, strokes and certain types of cancer.
This is a whole new population that we as OTA’s could treat! We need to create a solid foundation for the treatment of “premature aging” of Down Syndrome clients. A treatment program would need to include daily exercise program combined with yoga type of stretching. Activities would need to address their decreasing cognitive functioning and judgment. The opportunities for OT to keep these clients engaged in their favorite occupations are limitless. I have included 2 articles I found interesting

http://www.about-down-syndrome.com/down-syndrome-lifespan.html
http://www.usatoday.com/news/health/2010-03-22-down22_CV_N.htm
click here

clients first

Yesterday, was my first day for fieldwork. We ran an oral care group for about 18-20 adult clients. I believe the activity was well received by clients and staff alike. At one point during the group, I realized that I was making the group activity more important than the clients. We were helping the clients make bingo cards when I realized that I was doing way too much for the man that I was working with. Basically, all he needed was a little help getting started and he could do it himself. I made half the card for him because I was in a heated sweat to make sure the activity ran smoothly.
On fieldwork, there is a lot of pressure to design and run effective groups; but, we need to remain client focused and centered.

Is 6 weeks enough to make a difference?

At my current fieldwork sight, we are working with a group of children, that are, as I said before, in a bit of a difficult circumstance right now. Because of the privacy that is required at this location, we are not allowed to look at our client's charts. So, we do not know much of their background, mental, physical, medical, or otherwise. I have discovered this can be a hinderance in the planning of a group, but can understand that these children do not need to be labeled by yet another person.

My question is, when a child has ADD, ADHD, or any learning disorders should the staff that are working with that child be notified so they can make the proper changes to their plan. Possibly give more one on one, and be ready to interveine if needed with any child. Teachers have to write specialized lesson plans, IEP (Individual education plan). If they would just let me know if there is a deficit of any kind, I could be more prepared to get these kids involved more, and work at their own level.

Adults are affected by everything in their environment. Children even more so. So, if they are living in a stressful environment, somewhere different from their norm, that can lead to behavioral "problems." I put behavior in quotations because not every behavior is a problem. Some children have very good coping mechanisms in place, that they have either been taught, or have learned by themselves. But for these kids, that have been uprooted and do not fully understand the situation their family has been put in, it is devistatingly obvious that they do not have these coping mechanisms, or if they do have one, it is one that is not looked on as "good" by society. Such coping could be hitting a wall, throwing a ball against a wall after you have been asked to stop, hiding underneath a table, and not interacting with others. These are some of the behaviors that I have been witness to. But, getting the child involved, and giving them one on one time can put a smile on their face. We have to be a role model for these kids, they might not have been taught how to interact with others, or are still too young and are just learning social interaction.

Having said that, do these kids need special attention because of the environment they are brought up in, or because of a disorder, such as ADD. And is the environment affecting these disordered thought patterns. Research says yes. Please look at the link I have attached. I found it to be very informative.

Facts on Trauma and Homeless Children.