Thursday, January 12, 2012

Evidence Based Practice

Recently I attended a continuing education course on physical agent modalities hoping to get refreshed on how/when/and why to use things like e-stim, moist heat, ultrasound, etc. What I ended up learning was much more important and useful. The instructor lectured mainly about the importance of evidence based practice and research to back up and drive every treatment we use in therapy. I must say, this concept was basically drilled into our minds back in my masters program; however, other than occasionally reading the American Journal of Occupational Therapy and collaborating with other therapists this has not become one of my daily or even weekly habits. This course, however, was a great kick in the butt to use all of the wonderful resources available to us OT's. It has also help drivin my choices for future continuing eduction topics I am interested in to make sure that what I am paying to learn about will be supported by research. Here are a few great websites and resources to use:

When searching from the simple search area, look for systematic reviews or practice guidelines for the best research.

Use the Clinical Queries for the best research.


Use the search bar in the upper right corner.


When looking at the strength of the studies/research look for systematic reviews-the are by far the best and what insurance companies use to validate reimbursement.

Also, search your smartphone's applications. I have a droid and found applications for both PEDro and for PubMed which makes research quick and easy!



Tuesday, May 31, 2011

Reading Reviews

Here are a few of the great books I have been reading over the past year in order to recommend to my patients and their families. Learning about neurological conditions like stroke is one of my biggest interests, so these choices reflect that interest.

This is a wonderful review of the who, what, how, why, when, and where of strokes. It is very informative and I believe that though it is written simply enough for anyone to follow, it is also a great review for therapists and health care professionals about the basics that easy to forget. It also is a great reference because it lets families know what to expect from professionals and also what to expect of their loved ones. I wish I had read this as a general overview before starting OT school and delving into all of the details of the brain, circulatory system, and healthcare system. Great resource.




This is the first hand story of a Neuroanatomist who experienced a left sided stroke. Some of the most interesting parts of this book for me were to learn the thoughts and feelings she experienced during and after her stroke. Hearing how difficult it was to even recognize that she was in fact having a stroke was so interesting. Clinically, I have heard of similar stories of people attempting to go on with their day after/during a stroke and also being so confused as to what they were experiencing so this hit home with me. This is a must read.



This was a very compelling book because it was also the first hand experience of a health care professional (an Occupational Therapist) who experienced a stroke. My favorite thing about this book was the tips she gives to families/survivors of stroke, and other professionals on how to best assist and care for other survivors of stroke. I have at least 10 sticky tabs in this book with notes to myself like, "standing may ease activities on table top;" "USE weak arm to carry items;" and "consider cane management." Though I highly recommend this book as well, I found that after the first 60-70 pages it seemed quite repetitive. To counteract this comment, however, the book IS written in a way that you can skip around to relevant chapters.


For reference, here are the five major signs of stroke as published by the American Stroke Association:
http://www.cdc.gov/Features/Stroke/

 SUDDEN
  • Numbness or weakness of the face, arm, or leg, especially on one side of the body.
  • Confusion, trouble speaking or understanding.
  • Trouble seeing in one or both eyes.
  • Trouble walking, dizziness, or loss of balance and coordination.
  • Severe headache with no known cause.


Wednesday, April 6, 2011

Pets that work

Here's a video I came across on youtube about a dog that has been trained to do useful tricks!

 

It reminded me of a company based out of Boston, Massachusetts, called Helping Hands. They train capuchin monkeys to assist people with disabilities in doing everyday activities. Here's one of their videos! I definitely recommend checking out their website as well: http://www.monkeyhelpers.org/ 

 


Tuesday, March 29, 2011

Adaptive Equipment for Lower Body Dressing

For people with chronic back or hip pain, congestive heart failure or respiratory difficulties, bending over to put pants on can be a struggle. Many times I have shown my patients to sit and use a grabber (also called reacher) for this task. The grabber gives patients a few extra feet of reach so they can donn their pants without leaning too far forward. Last Fall I had a patient (90 year old woman with congestive heart failure) show ME how she successfully uses her cane rather than a store bought grabber. She used the curved end to hook her pants so they wouldn't fall while she reached down and sure enough was able to donn her pants! After a current patient of mine expressed to me that she did not have the funds to purchase a grabber, I remembered back to my 90 year old friend and shared the technique. She loved it.

Though I thoroughly believe grabbers can be helpful in much more than lower body dressing, I hope this post helps when considering the pragmatics of adaptive equipment training, as money can often be a barrier.


Wednesday, March 23, 2011

Apps for Kids with Autism

Here's a link to a page with a GREAT compilation of applications for kids with autism made by a elementary special education teacher (Jeremy Brown). There are apps to help kids increase fine motor coordination, understand cause and effect, improve social skills, and even organize daily routines. I could imagine these links would be very helpful for school teachers, school based occupational therapists, speech and language pathologists, caregivers, parents...really anyone who works one-on-one with kids with autism. Conveniently, Mr. Brown organized this comprehensive list and even displayed the cost of each application.


His list is for apple apps, however, I have an android phone and if you search by the names or even just by "autism" or "life skills," you will find lots of other apps. Hope you can use this information or pass it along to someone who might benefit from it.

Technology is a wonderful way for teachers, therapists and parents to connect with kids and this is one more way for us to have fun with and encourage the development of the children we care for.


http://www.wired.com/gadgetlab/2010/04/apple-scratch-app/


Sunday, March 13, 2011

International Clinical Educators (ICE)

Jan Davis is an OT who provides clinical education for therapist and professionals working in stroke care. She has great videos up on specific treatment ideas and handling techniques, and a lot of resources and info to keep us all up to date on what we need to know when treating individuals who have survived stroke. She often asks for ideas of new videos we want to see and uses facebook a lot to promote her page. I highly recommend this resource!


Tuesday, March 8, 2011

Diabetes Management with Low Vision

Low vision is one of my favorite areas to work in, and would love to share some ideas for adapting equipment for diabetes management. Last Summer, I had a patient with diabetes, diabetic retinopathy (resulting in low vision),  neuropathy (pain and numbness in his hands and fingers), and also happened to be somewhat hard of hearing (for starters). Very rarely do I work with patients who have one single medical diagnosis so it's always important to consider all systems. This particular patient expressed to me that he would really like to be able to independently monitor his blood glucose levels as advised by his doctor.

Due to his low vision, the first thing that came to mind was a Talking Glucose Meter. With Medicare, many patients are eligible for free diabetes supplies so with a doctors order he was able to obtain one for free. 
 
Once the Talking Glucose Meter arrived, I was able to read the (very small) instruction sheet and rewrite the steps to checking his blood glucose in permanent marker on bold and wide lined paper. I later used more of the same paper to make a chart for his to record glucose readings by date and time. Though the device had large print on the screen, the fact that the screen was relatively made it difficult to see so he preferred to put the device directly up to his ear when it spoke a reading--which he heard loud and clear.

In order for the patient to draw blood from his finger, he needed to be able to 1) insert a lancet (needle) into the lancet device (finger prick tool), 2) set the lancet finger prick size, 3) line up and prick his finger. Thankfully with practice the only difficult part about this was that spin knob tended to turn to wider/more narrow settings without his knowing. I was able to mark the preferred setting with bright orange fabric paint for him to line up. (I drew a line on the main devise at the start position and the second line on the spin knob along the "3" line. With these bright and raised lines, the was able to ensure the lancet would always make the correct size prick.


Due to the neuropathy in this patient's fingers paired with his low vision, the next problem was in  getting the test strip into the small slit of the Glucose Meter. To solve this problem, I used adhesive white bumps on either side of the small slit as both a visual cue (high contrast of white bumps on dark gray Glucose Meter) and a tactile guide for the strip to fit between.

With these adaptions and lots of practice with supervision, the patient was able to reach his goal in a matter of two weeks!

*Even with specialized equipment, it is important to remember that creativity and personalization can still be necessary in order for one to safely and effectively use diabetic testing supplies. This particular patient was not insulin dependent at the time however, check out http://www.shoplowvision.com/catalogsearch/result/?producttype=&q=insulin&x=0&y=0 for equipment which may make drawing and injecting insulin safer and easier for someone you know with low vision.