Stress

Recent events in my life have made stress management a key factor in my life. I wonder day in and day out, will I be able to survive the stress of today. This is a normal question, that a lot of people ask themselves. However, people with a mental illness ask this question with a more serious conotation. I know deep down that I will survive these stressful events in my life to enjoy the happy times. But, for a person that is depressed, or bipolar, or any other mental illness this is a real question...Will I survive the stress of today? Not only is stress a factor, but it can bring on these illnesses. On this web site Mental And Emotional Impact of Stress it is explained how much damage stress can do to your system, especially your mind. I really do recommend that every day you find a happy place, or an activity that is just for you alone. Everyone needs their own stress relief, whether it is time at the gym, reading a book, watching television, or playing games you played as a child, even a group activity. Every activity you do for yourself is a step in the right direction. We all need to take time to smell the roses. So, this is my challenge to you. Find something you enjoy, and make it a habit. Stop and smell the roses, you deserve that time, your happiness may depend on that time.

Gardening

At our group session on Wednesday, I was reminded of the benefit of being flexible. I planned an activity of decorating pots and planting pea seeds, but the director of the site asked me to plant seeds in the outside garden instead. This took me out of my comfort zone because I do not know how to do that. I was also not sure about how to manage the group in that type of activity. Of course, I said that I would be happy to plant the garden. I knew I should be flexible and adaptable even if I did not like it.
With some help from my classmate and the staff, planting the garden was a great activity. The most surprising part was that clients who rarely participated in activities with out encouragement were eager to plant the garden. They wanted to rake, plant the seeds and water. It was great seeing those folks get engaged. It was also a reminder that sometimes it is a matter of finding the right activity to engage the client's interest.

Making quick decisions.

Tonight, I was leading the session at the homeless center and a thought came to me as I had to quickly shift gears and make up a new activity. I’m sure every person has done this at one time or another in their life. But, think about if... you were hearing voices that would not be quiet, or seeing things or people that were not there. How would you be able to think on your feet enough to make such a quick decision?

A lot of people with mental problems have a problem with making split decision. However, I make a zillion decisions in a day, what to wear-is it cold, warm, boots sandals, etc. I don’t know what kind of coping mechanisms I would have to live by day in & day out. My life would be totally different in every aspect. My personality would be permanently changed, as would the way the world sees me and the way I would see the world. I would love you to know how different types of people have to think, or cope through every day.

How do you take in information? How do you make decision? Do you base it on your past experiences, or what you have been taught growing up? So, tell me. How do you make decisions every day, easy or hard.

If you are new to the world of mental illnesses there are some things you should know. This website is a fantastic start to getting to understand what it means to have a mental illness & some of the hardships that the people with these disorders go through & most important, how you can help.

Cognitive Impairment

I see a lot of cognitive impairment in my physical dysfunction fieldwork. On Friday, I went and got a woman for therapy who was not well oriented to reality. She was calling for Mr. Brown in a clear, calm, rational sounding voice. She was perseverating on calling for Mr. Brown. At some point, we tried to find out about Mr. Brown, but there was no information. She handed me a cup she was holding and said that I could it in the trash because Mr. Brown was not coming. Soon, she was calling for Mr. Brown again.
In part, this is what dementia looks like.

You Decide

After talking to some about a disorder called Guillain-Barre Syndrome. It's a disorder that affect the PNS and causes the body to become paralyzed. You still have the function of the CNS, but you can't talk, breath on your own, eat, or move. We started wondering how bored and frustrated one might be with their cognitive function working properly, but unable to communicate with others. This lead to the question of "Would you rather have some cognitive impairment with this disorder or not?" Also note that GBS is a temporary condition where the prognosis is over time the person will get well. What are your thoughts? I know this seems like an easy question to answer, but your in the hospital all day looking at the ceiling with all these thoughts going through your head and can't express yourself. Having all these treatments done and not knowing how long you are going to be there can be difficult for some.

Power of Attitude and Psychosocial Support

I met an elderly woman who had transplant surgery and then suffered several set-backs which kept her in the hospital for 2 months longer than expected which left her very debilitated. When I met her a couple of weeks ago, she was frail and pale sitting up in bed but she greeted me with a smile and her hair was neat and her room bright. During her OT treatment, she had a standing tolerance of less than 30 minutes with 1 break and that's all she could tolerate but she was proud of her accomplishment. She has lots of psychosocial support. Her husband and youngest daughter moved from out of state into an apartment near the hospital for the surgery and recovery period. Her other daughter who lives in another state comes to visit every few weeks. She also attends a support group for transplant patients and has made a new best friend. Besides her regular OT treatment sessions, she attends a yoga group for stress management and also meets with a medical psychologist. She is determined to get well and is very positive. Now she can walk over a mile at one go and she is being considered for D/C.

In contrast, I saw another young woman at the same time. She had suffered lung issues also which left her weak and short of breath. She was laying in bed with the room semi-dark and she looked like she hadn't touched her hair in days. She was alone and didn't speak english. She looked fearful and anxious when we went in and smelled of urine. When I saw her again this week, she had made some physical progress but she still was resistant to getting up to the edge of bed and refused to try to access the bathroom. Her hair still was greasy and the room semi-dark. She did smile a little after we helped her get herself cleaned up but still didn't want to get out of bed into the chair. The therapist told me that she was capable of much more and had done better in a previous treatment session when her sister was there to translate and encourage her.

This really illustrates the impact family support and personal attitudes have on recovery. Transplant patients have more resources available to them to help them deal with their psychological problems but other patients do not unless they become a true danger to themselves or others. Perhaps hospitals would see better and quicker recoveries if they attended to patients' psychological needs along with their physical needs.

During my fieldwork experience, I have noticed that one of the major psychosocial factors that impedes many geriatric patients' ability to recover from physical illness/injury is depression associated with social isolation. My fieldwork is in a skilled nursing facility, primarily dealing with short-term rehab of elderly patients. I have been able to tell a considerable difference in patients who have alot of family and friend support and interaction. Those patients generally seem to have a greater ability to deal with their current physical disabilities. This week, the COTA that I was working with and I held a group treatment session for 2 patients that had both had back surgeries. They were 2 men, roughly the same age, whom we had do upper body exercises with bands, then stand to play each other in checkers. The men chatted the whole time and their energy level at the end of the session was much higher than when we started. In a very short period of time, they bonded and fed off of each other's energy, as well as ours, and it ended up being the best session out of roughly 30 that I've experienced since I've been there. The COTA said neither of them had tolerated standing for that length of time and I think they would have kept going if we hadn't stopped them. It was a very good example of how social interaction has a very positive and powerful impact on physical recovery.

Before & After

There is a a patient at my fieldwork that everyone tolerates. I do not know if it is his demeanor or the way he talks to the women there. He loves to push every button possible. But, this week he showed a different side of himself. The first week I was there I wondered how is this women married to this man. She is really nice and he is....grating on the nerves, codescending almost to the point of rudeness. On my first day, the wife said, he wasn't like this when I married him. But, something my supervisor said to me stuck and changed my perspective entirely. I think he wants attention, and this is the way he gets it. He is a nice man and at the end of the treatment session when no one was around except him, my supervisor and me he calmed down and started to talk. This smile came across his face. Not the smile I had seem the past 2 weeks. A genuine smile because he got to talk about some thing he loved, Wine.

This got me thinking. This normal man's life was turned upside down by his injury. He can't work, can't complete his ADL's without some sort of help from his wife. This has changed this man's demeanor into a totally different person, and not always for the better. He tries to find some way to compete with others, I can do this. You can't do that yet, why not? Aren't these ladies pushing you hard enough. They are hard on me. And they aren't even treating my other problem (wrist pain). I've had it for 7 years, and it's hurts every day, but I'm still doing this. These are just examples of what Mr.X might say. But, when other patients are not there he is a completely different patient. By giving this patient an outlet for his "old" identity we got to see the real him for the first time. Now I understand what the real implications can be on the persons psychosocial life. The other staff and I did not want anything to do with this man, until he showed another side of himself. But it still stands to question, was any of this from another source. I guess we might never know. Will his life ever return to normal? This is another question that may not have an answer, but he is on his way to recovery from his hand injury, and maybe, just maybe his attitude did not change permanently. But only his wife can tell you that answer down the road.

After loosing a job because of an accident it is hard to keep spirits high but it is crutial to your future outlook. This site has some more information that is hopefully helpful information about coping with the stress of job loss. This article only deals with the loss of a job, but I feel these coping mechanisms would be good for after an accident as well.

Depression in LTC facilities

For my phys dys FW, I am going to a LTC facility. I have had the privilege of reading patient's charts to get background information. I have not seen any documentation psychosocial diagnoses in the information I have read; however, there does seem to be a common depressed appearance amoung several of the patient's I have seen. I stopped to think to myself about what it must feel like to be away from home in a strange place, away from family support, and the loss of independence. I imagine I would be a little "down" as well. Some of the patients do not have family that comes to visit, which must feel lonely and isolated. This brought me to further realize how important our "therapeutic use of self" comes in to play with this population. For some, interaction with staff may be all they get. Talking with them about things they enjoy and sparking conversation that brings joy to them can make a huge impact on how well the respond to the activity you are doing. People are more willing to interact and do their best when they are interested and engaged. The conversation itself can be therapeutic and give them a positive demeanor that will carry on throughout the day. It also helps them establish a bond and sense of trust with the therapist. Connecting with your clients emotions will not only help them, but also give means for successful sessions to come. It is very important when working with our clients to not forget who they are, and that their feelings are valid. It is very important to keep in mind that medical issues and medications can correlate with depression. Here is a link that discusses the relation between them in reference to long term care patients. http://www.seniorcareservices.org/long_term_care_and_medical_problems.htm

I have seen a couple of psychosocial situations in my physical disability field work. One client was discharged from therapy because she was constantly agitated. She would perseverate on certain facts. In addition, she was paranoid about the therapists and other caregivers being out to get her. Most of the therapists believed that this behavior was related to her stroke. I saw another patient this Friday who was also post stroke and agitated. He had refused food all day and had not gotten out of bed. He was angry and threatening toward the staff. We needed to get him up to make adjustments to his WC. We faced some resistance, but we got him up and in the chair. In both of these cases, there is a relationship between the behavior and the CVA. This kind of behavior is hard to predict and difficult to manage.
Finally, here is a link to an article about a man who developed psychotic symptoms post CVA.