Friday, March 25, 2016

Otago for Balance

Remember the guy I was talking about earlier this week? Let's talk about him a little more. One assessment I conducted on him was the Otago balance protocol. Everything you need to know about the Otago can be found here (all I did was google Otago balance). So far, the clinic has only used it as an assessment. It combines the Timed Up and Go (TUG) test, the  Four-Test Balance Scale, and the Chair Stand test.

All three of these tests indicates fall risk among older adults. The Otago also comes with exercises clients may use to decrease their fall risk and improve their strength and balance. I'm still impressed at the sheer number of assessments available out there--there's no way I could learn about every single one in school. You'd spend 3 years or more just dong that!

As you can imagine, things at the clinic were a mess and I couldn't find the protocol. I had to wing it, and it honestly wasn't too terrible. Unfortunately I didn't get to all three tests because I ran out of time.

Got any thoughts/suggestions/ideas/concerns for me?

Thursday, March 24, 2016

Wheelchair Billing & Funding

Yesterday evening was the monthly TOTA district meeting, and I went for a little while. It's tough attending meetings in the evenings in Galveston since I have such a long commute. But I stayed and enjoyed it. A lady whose name I can't remember presented with knowledge of spinal muscular atrophy related to wheelchair billing and funding. Most of the information was stuff I already knew, having done a few wheelchair evaluations during fieldwork.

Needless to say it was helpful and I learned some stuff! My apologies for being so vague, like I said I wasn't able to stay for very long. Had I stayed for the entire meeting I wouldn't have made it home until 9:00pm or later. Yikes. A really good resource I found for wheelchair funding can be found here. There's a ton of information, so don't let yourself get overwhelmed!

*Update* on Easter Sunday, my uncle who has a spinal cord injury was able to get out of his home and celebrate with family. It was absolutely amazing to see him out and about, thanks to his power wheelchair and new mobility van. Hopefully nobody saw me get teary-eyed because of my excitement and happiness for him being able to have some normalcy return to his life.

Tuesday, March 22, 2016


Today is my first day back in the office after being gone a whole week for spring break plus I took yesterday off to attend my Papaw's funeral in Tyler. Very sad, but his memorial service was wonderful and we knew it was a matter of when he would pass, not if. Thanks in advance for your condolences.

Anyways, the week before everyone left for spring break I completed a new patient evaluation at St. Vincent's clinic. I looked at his range of motion and some muscle testing, as well as quick vision and cognition screens. I felt a little perplexed after doing the evaluation and I haven't given it a second thought until now. He's a middle aged man who had a stroke earlier this year. His primary complaint is dizziness and soreness, and the soreness is all over his body. As I was interviewing him, he misheard some of the questions I asked. Initially, I thought nothing of it but it happened a second time. What I was asking and his answer definitely didn't add up. Occasionally he was unable to follow my verbal commands (like when we were testing range of motion). His balance isn't that great either. Something was off, yet I can't pinpoint what it is.

Being in an academic setting, that afternoon made me feel like my clinical skills have dwindled drastically (nice alliteration, huh?) but I still felt confident during the eval and the students were able to follow and understand what I was doing and why I was doing it.

I want to continue addressing the pain in his upper extremities, while also figuring out more about what's happening with his cognition as well as how his balance is doing. I know he's also receiving physical therapy from the same clinic, but I'm not sure PT is helping him all that much either. We'll see how things go at the end of next week!

Friday, March 4, 2016

Plan of Care & Clinic Role

One thing I've noticed at the clinic is the large number of clients who come in having suffered a stroke. Additionally, the clinic doesn't currently have electronic patient records, only paper documentation, which can make things difficult sometimes. 

As I was doing my research, I found some helpful info from AOTA. It reads as follows:

Stroke is a leading cause of adult disability in the United States, with an estimated 7 million stroke survivors. Each year, approximately 795,000 people have either a new or recurrent stroke (Go et al., 2013). Stroke survivors face multiple challenges, such as weakness on one side of the body, decline in cognitive and emotional functioning, social disability, inability to walk and care for themselves, and a decrease in community participation. Occupational therapy can be instrumental in addressing these challenges at all stages in the continuum of care (i.e., acute, sub-acute, chronic, and post-rehab at home and in the community) and is an important component of the interdisciplinary care provided to stroke survivors in a variety of settings (e.g., neuro intensive care units, inpatient and outpatient rehabilitation facilities, home care).

Rehabilitation and the Resumption of Participation 

The focus of occupational therapy is to help individuals achieve health, well-being, and participation in life through engagement in occupations (i.e., activities) (American Occupational Therapy Association [AOTA], 2014). Occupational therapy practitioners collaborate with clients and their families or caregivers to determine what activities are necessary, meaningful, and/or relevant to them. Based on their education and clinical expertise, and the philosophical basis of the profession, occupational therapy practitioners are uniquely able to analyze the interactions among the person, the environments in which they need to function, and the occupations they need or want to perform.   
Many stroke survivors have changes in their physical, cognitive, and emotional abilities that impede them from independently performing their daily activities related to work, school, parenting, or leisure. Depending on the extent of the stroke, the needs and goals of the client, and the phase of stoke recovery, occupational therapy goals and services may include, but are not limited to the following: 
  • Further retraining in self-care skills and adapting tasks or environments (post-rehab), including the appropriate use of adaptive equipment to maximize the ability to perform activities of daily living (ADLs) safely (e.g., bathing, dressing, functional mobility)
  • Addressing ongoing deficits such as weakness, sensory loss, and cognitive or visual impairments that limit engagement in ADLs and instrumental ADLs (IADLS: carrying groceries, cooking a meal, managing money, parenting)
  •  Training in community reintegration and modifying tasks or environments, including, where appropriate, assessment of and training in the use of assistive technology, to maximize independent engagement in IADLs. 
  • Performing work-related task analysis and work site evaluations, and recommending modifications to the workplace; collaborating with educational facilities to facilitate return to school; working with the client on child-care-related tasks and adaptations for safe parenting responsibilities; and recommending adaptations to resume former leisure activities or develop new ones as feasible.  
  • Evaluating and treating swallowing difficulties
  • Developing coping strategies to support psychosocial health and well-being (including relaxation techniques, if appropriate)
  • Teaching and promoting healthy lifestyle habits and routines to minimize risk of secondary stroke
  • Developing strategies to overcome barriers to sexual intimacy 
  • Providing pre-driving and driving evaluations, equipment recommendations for safe return to driving, or education on alternate means of transportation

Paving the Way for Increased Independence

Occupational therapy during rehabilitation focuses on ensuring that the client will function as well as possible after discharge, which often includes caregiver education and training, if needed, during post-rehab intervention. Other occupational therapy interventions include home modifications, assistive technology training, and wheelchair prescriptions (manual or powered) for improving quality of life and increasing independence.
Home modifications may include accessible designs for all rooms in one’s house, ramps, wheelchair lifts or elevators, and stair lifts.
Assistive technology may include environmental control units, augmentative communication, and computer access technology. The occupational therapist considers the client’s available range of motion, strength, coordination, cognitive status, etc., and works with the vendor as needed to select the most appropriate assistive technology equipment, set it up, and provide training to ensure that it is functional for that individual.  
Community mobility is often a primary goal for people recovering from a stroke, and many people want to return to driving. Occupational therapists can perform pre-driving screens and driving assessments, which include a comprehensive physical, cognitive, and visual-perceptual evaluation prior to a road assessment. A road assessment entails all aspects of driving, such as parking, switching lanes, turning one’s head to look for cars, reaction time, and the ability to follow driving rules. Equipment recommendations may include a spinner knob for people with limited voluntary movement of one hand or arm, or a left foot accelerator for people who have weakness in the right leg. Occupational therapy practitioners also work with individuals and their families in planning alternative transportation and community mobility methods, such as access-a-ride, family or friend assistance, and senior center transportation systems. 


Occupational therapy practitioners understand the importance of emotional well-being, social connections, and healthy life habits for individuals post-stroke. In addition to ongoing physical rehabilitation as needed, they engage stroke survivors and family members to take charge of their lives, create human connections, and lead healthy lifestyles. This may include developing coping strategies to deal with loss, individualized ways to promote psychosocial health, education to minimize potential for a second stroke, promotion of increased exercise and healthy eating, and strategies to overcome barriers to sexual intimacy. 
Stroke can cause serious long-term disability, and many stroke survivors face barriers to engaging in productive activity. Occupational therapy practitioners use their expertise in activity analysis and adaptive methods to facilitate the client’s performance of needed or meaningful occupations within realistic contexts to promote independence.

Retrieved from here. Interesting right? Hopefully this gives you more insight as to the process of working with patients who've suffered a stroke in the past.