Wednesday, December 10, 2014

Occupational Therapy Ideas with our WWII Vets

Back to my blog home page:

I've had good intentions to write; however, I've been sidetracked. I'm home with my sisters and mom providing care for my father who is on hospice. These times make us ponder how sweet and short and precious life is. We alternate story telling, bursts of silly laughter, tears and moments in which we think we just can't breathe.

We set up the telly in dad's room with a laptop so he can access instant video streaming on Amazon Prime. Band of Brothers was the perfect series to watch, as dad has read a large library worth of WWII books. As we were watching the boys of Easy Company fighting after D Day, we talked about the amazing WWII vets I have had the good fortune to meet and work with over the years.

I decided it's time to write a small piece about ways to address the psychosocial needs of WWII vets through their occupational therapy treatment sessions. Granted, each patient is different. I know that. Every former soldier, however, has some basic needs, whether he speaks them or not.

 (Caveat: I'm focusing on WWII because they are leaving this world at a rapid rate and we don't have many of them to appreciate much longer. According to the National WWII Museum website, an average of 555 of them are dying daily.)

How many from your state are still alive?

Photo Credits: National WWII Museum
So, here goes. Here are my thoughts about these (wo)men from the greatest generation:  (for ease here, I will now refer to them as men)

1) When you meet a WWII vet, ask if you can shake his hand. Thank him for his service and for making this world such a better place. If not for them, you never know where we would be.
2) As you work with a vet, begin to ask him generic questions about his experience. If he wants to talk, he will begin to tell you his story. Sometimes, it takes a while to open up. What I have found from an occupational therapy perspective is that we are able to address our vets' personal healing years after the events through reminiscing about the good and the bad that these men experienced in battle. It's not our place to push. I have witnessed vets experience cathartic moments in which they reveal long-held secrets or grief that they have shared with no one, not even their wives or children. Their generation went home, went to work, and did not discuss it.

3) Play period music.  You Are My Sunshine, When You Wish Upon a Star, I've Heard That Song Before, Chattanooga Choo, Swinging on a Star, Sentimental Journey, Frenesi, I'll Never Smile Again, Body and Soul, Paper Doll, Star Dust, and White Christmas were in the top 20 songs of the 1940's during WWII. See which songs lights up his face or brings back memories. Music is an incredible therapeutic medium!

4) With permission, record his story. Better yet, see about getting a group together to record the stories of the WWII vets in your facility or community. The staff of Sno-Isle Libraries in Marysville, WA interviewed their vets and published the audio downloads on this link: CLICK HERE  

If you have questions about how they did it, call them!
360-651-7000 (local) • 877-766-4753 (toll free)
5) Look into the Veteran's History Project.  It's an amazing initiative to preserve the stories of not just WWII vets, but vets from all wars since WWI.

You can download a VHP Field Kit and Individual Forms and print off information about how to prepare for and conduct the interview. There is even an interview outline you can use to ask the questions.

After the interview, you can send the audio or video to the Library of Congress, where your patients' stories will become part of the Veteran's History Project.

What an amazing way to give back to our soldiers who gave so much of themselves for us....and what a wonderful way for us O.T.s to use our "use of therapeutic self."


Tuesday, November 18, 2014

Falls, Part One: How OT's Can Better Identify Factors that Contribute to Falls in SNF

Back to my blog home page:

I received an email from Jessi, with whom I have communicated about a lovely dementia patient of hers in the past. She writes:

“You were so helpful before, I wanted to ask you for more advice. If you get the chance, would you consider doing a post on reducing fall risks? It's really been on my heart lately to seek more solutions to preventing them at the SNF I work at. Searching online has only revealed the basics we were taught in school (reducing restraints, increasing balance, ADL mobility training, Cane vs walkers, nonskid socks/shoes, education on using caregivers, etc.) but I'm really hoping for more outside of the box ideas. I recently realized that fall mats can sometimes increase fall risks instead of helping if a person is stable on a level surface but has poor balance and is getting out of bed without caregivers present, for example.  If you feel like sharing your own thoughts or others' reading materials too, I am all ears! “

Head injuries, broken skin, broken bones, pain, and fear…
I want share with you how to assess falls, how to write goals related to reducing falls and how to lower your patients' fall risk. It's such a complex subject that it's going to take a couple posts to get through it.
....let's talk first about the factors that contribute to falls (in no particular order):
HINT HINT: you need to identify and assess these factors on your evaluations!!
cause dizziness, altered visual input, reduced alertness and multiple secondary symptoms that can increase fall risk, especially at night. Go to the chart, people.

You may find an answer it the meds.

Vision deficits
include double vision, macular degeneration, a person not wearing his/her glasses, diabetic retinopathy, glaucoma, and cataracts. Visual deficits impair a person's ability to correctly perceive the visual field and depth perception in the environment when walking and transferring between surfaces. The chart may yield info if a person is diagnosed with one of the above conditions; however, don't forget to check vision when you're doing your evaluation.
Postural deficits
include forward neck flexion, kyphosis, and a flexed trunk over hips. Postural deficits contribute to reduced visual field access, a change in center of gravity and loss of control when attempting to change positions or walk.  For example, try to walk with your chin on your chest and look straight ahead. It's impossible to maintain an adequate visual field. I'll write more about posture in the article about treatment; in the meantime, check out a blog I wrote earlier on posture:
Muscle weakness
say no more. Muscle weakness is usually a symptom of another issue such as pain, depression or immobility following surgery/trauma or steep cognitive decline. People stop moving when they experience pain or fear of falling. Get your people moving - and not just while sitting leaning against the back of the wheelchair. Get them on the mat so they have to engage proximal and distal!! Stabilize the trunk, work on the head and neck. (My pet peeve is "lazy therapy."..)
Environmental obstacles
 are a frequent reason for falls, much of which can be prevented. We'll list and address these on the next article.
can contribute to our clients' fall risk when they forget they are unable to stand or walk without losing their balance or when they forget to use their assistive devices. For example: I read this information in a research article referencing the use of the Allen Cognitive during a trial to reduce falls in the elder with mild dementia:
At the 4.4 level of function behaviour is goal directed but people do not visually scan their environment, do not anticipate hazards and cannot solve problems independently, so it is not recommended that they live alone.
Orthostatic Hypotension
can cause a person to begin to feel dizzy, weak, fuzzy, nauseous or faint due to low blood pressure with postural changes. Are you taking sitting and standing vitals at initiation of and during treatment?
can cause a person to drop, literally. Let's help them manage their pain!
Inability to maintain balance while using hands
can cause loss of balance and falls, most notably in the bathroom, in SNF speak. More on this later! Anytime I see a fall in the bathroom, the first thing I want to know is if the person was alone and if they were attempting to pull the pants or skirt up or down. Don't be timid to ask about the details of the fall. It will lead to revelations!
Poor positioning
can cause a person to slide, roll or topple off a bed or wheelchair.
- or should I say - Incontinence - plays a huge role in falls in SNFs! Find out which patients or residents are mildly incontinent. They are the ones with whom you want to start a UI (urinary incontinence) program, including Accelerated Care Plus' protocol using one month of exercises (which are good for all of us!) and moving on to the use of e-stim following one month of exercise.
Reduced supervision of high risk fallers
...some people just need to be checked on frequently. People who are high risk should not be left alone in their rooms! Falling star, falling leaf...any of these people should be engaged with activities, in a public room, such as the tv room or library, and should have frequent contact with staff.
-some people have conditions that prevent them from feeling safe during positional changes of the head, such as Benign Paroxysmal Positional vertigo, when the crystals in the structures of the inner ear that make you sensitive to gravity become dislodged and move into the semicircular canals. For more on BPPV, see:
Treat the BPPV; resolve the dizziness!
Progressive Neuromuscular Diseases,
such as Parkinson's Disease, Multiple Sclerosis, Huntington's, ALS, Myasthenia Gravis and the Muscular Distrophies, cause deficits in muscle strength, coordination and sensation that increase fall risk as a person's medical status begins to decline. We'll talk more about Parkinson's on a future blog!

One of the first things we therapists can do
with someone who is high risk for falling or who is a chronic faller
is to
identify which factors
are influencing the falls.

Did you know there is a Home Fall Prevention Checklist?
Click to access -
it's a great tool to share with family members
or people you are rehabbing back home
even if you are planning a home evaluation!

If you're interested in presenting to the community about Falls Prevention,
don't reinvent the wheel.
which includes a Power Point presentation that you can use
and handouts to print.
Dandy, right?
Jessi, I know I haven't quite gotten to the info you wanted, but I needed to lay a foundation! If there is any factor you think I have missed, please add a comment below. Your comments assist everyone reading in learning more...