Staggering Statistics
Return to driving can be a difficult feat after sustaining an injury or in the presence of a debilitating condition… take these stats for a test drive:
81% of the 39.5 million adults in the U.S. aged 65+ hold a driver’s license
25.5 million Americans have disabilities that make traveling outside the home difficult
30-66% of CVA survivors return to driving
Common Diagnoses
Endocrine and Metabolic Disorders
- Diabetes
- Hepatic Encephalopathy
Neurological and Physical Disorders
- Arthritis
- Dementia
- Multiple Sclerosis
- Obstructive Sleep Apnea
- Parkinson’s Disease
- Stroke
- Traumatic Brain Injury
Visual and Other Sensory Disorders
- Age-Related Macular Degeneration
- Cataracts
- Glaucoma
- Hemianopia & Quadrantanopia
- Vestibular Disorders
Deficits That Might Impact Driving
Visual Impairments: This is often the first thing that comes to mind when considering someone’s ability to return to driving. Some common changes in vision can include: visual scanning, attention, acuity, contrast sensitivity, or depth perception. If visual changes go unnoticed, we as clinicians may not adequately assess our client’s ability to safely return to the roads. Utilizing visual assessments, like those found here, during screenings can help gain a better picture of what deficits we should target in our treatment sessions.
Cognitive Impairments: In order to remain safe while on the road, there are several cognitive skills necessary including but not limited to: insight, executive function, visual perception, sequencing, attention, and problem solving. If any of these skills are noted as deficit areas for your client, it is important to inquire about the patient’s intent to return to driving and assess their ability to utilize these skills in simulated scenarios.
Motor Impairments: We also need to be on the lookout for physical limitations to the act of driving in order to fully assess whether a patient is safe to drive. Deficits in: reaction time, motor coordination, bilateral integration, strength, range of motion, and endurance will all need to be adequately assessed prior to return to driving.
Sensation Impairments: Sensory changes are another consideration clinicians need to be aware of because these impairments can limit an individual’s ability to operate a vehicle and can alter their hearing, body awareness while in a vehicle, and perception of stimuli both inside and outside the vehicle. Educating patients on compensatory strategies, devices, and modifications will serve as an effective use of time during treatment sessions to address sensory impairments and support successful return to driving.
Check out this source that discusses these impairments while also providing direct links to different outcome measures that can be used to assess these deficit areas!
Activity Analysis: Driving
If you, the reader, are an occupational therapist then you are an experienced activity analyst and have likely performed (at least) a few in your day. If you are unfamiliar with what an activity analysis is, that’s OK! We are going to provide you an example of what our OT counterparts look for when completing one. An activity analysis is used to break down a task into very specific pieces which allows OTPs to identify what the specific deficit areas are and how to best help the client reach their goals. Below is a VERY general activity analysis of driving that depicts the performance skills & body functions necessary for driving. Keep reading to learn about the compensatory strategies and/or devices as we discuss this in a later section. You can learn more about the language and terminology used in this activity analysis by perusing the Occupational Therapy Practice Framework.
Performance Skills
Performance skills are goal-directed actions that are observable and that reflect a client’s ability to perform a task or occupation. These skills consist of motor, process, and social skills…
Motor Skills: There are so many small movements necessary to safely and successfully operate a vehicle including the client’s ability to:
- Reach: Clients must be able to extend their upper extremities to turn/guide the steering wheel from side to side as well as stabilize the wheel while accelerating forward. Clients will also reach to operate things like music, A/C (or heat), adjust mirrors when necessary, opening/closing the door, and donning/doffing the seatbelt.
- Grip: Client must be able to grip the steering wheel both firmly and loosely while directing as well as turning the vehicle. Clients will also need to grip the seat belt, the door handle, and the gear shift.
- Bend: The client will need to be able to flex or rotate the trunk to get in and out of the car, check their blind spots, use their mirrors, and position the seat of the car.
- Coordinate: The client will have to coordinate movements of two or more body parts at the same time including: their upper and lower extremities, head and neck movements, and trunk rotation or flexion.
- Calibrate: Using appropriate speed/force when pressing the gas or brake pedals and when manipulating the steering wheel will be necessary to ensure safety of the client and those around them while on the road.
- Flow: Using fluid arm/wrist movements when turning the wheel is another consideration for safe driving because if the movement is jerky it can cause the client to move the vehicle in an unintended direction.
- Endure: The client will have to be able to perform all of the motor skills necessary for driving for the duration of the drive without fatiguing.
Process Skills: These skills typically involve preventing problems and/or carrying out specific steps to a task. Just as there are many motor performance skills necessary when driving, there are several processing skills necessary to navigate the road safely, such as the client’s ability to:
- Attend: The client will need to focus on the act of operating the vehicle and sharing the road with others while being conscious of potential hazards.
- Heed: Obeying traffic laws.
- Inquire: Locate road signs for navigation and safety.
- Initiates: Performing necessary components of driving without hesitation that can jeopardize safety.
- Sequence: Knowing what actions come next.
- Organize: Setting up the car environment (mirrors, seat, sun visor etc.) to promote success.
**Not included are social skills; driving by nature is not a social activity however we have to remember that driving can promote our client’s ability to engage in meaningful social occupations. **
Body Functions/Body Structures:
Mental: We have talked about a few of the different cognitive areas that must be intact before a client can safely return to driving but here is a further breakdown of the different mental functions utilized while driving – some of which are often forgotten.
| Higher level cognitive functioning | Judgment; executive functions; insight |
| Attention | Sustained; divided |
| Memory | Long term; Short term; Working |
| Emotional | Regulation; Emotional appropriateness (think road rage) |
| Orientation | Person, time, place, self, and others |
| Mental functions of sequencing complex movements | Regulating speed, response time, & force generation of motor production |
| Consciousness | Awareness & Alertness; Wakeful state |
| Sleep/Energy | Alert; Not fatigued |
Musculoskeletal: Specific movements of the body are used during the act of driving; the body’s ability to transition smoothly from position to position accommodates the dynamic nature of driving.
Head & Neck
- Mobility and strength of eyes
- Cervical rotation
UEs
- Shoulder flexion, abduction, adduction
- Elbow flexion/extension
- Supination/pronation
- Wrist flexion/extension
- Digit flexion/extension
Trunk
- Flexion
- Rotation
LEs
- Hip flexion (transitioning from brake to gas)
- Knee flexion/extension
- Dorsiflexion & Plantarflexion
Breaking down the act of driving into small components can allow clinicians to target specific deficit areas that can isolate barriers to the return to driving and maximize potential to return to driving. But what if the client is not safe to return to driving?
Approaching This Difficult Conversation
Driving represents independence and autonomy for most Americans, so the topic of driving cessation can be a daunting one. When discussing the topic with clients and their families, it’s important to actively listen and acknowledge their feelings and concerns. Answer any questions honestly and defer to others with the knowledge if you can’t answer. Provide them with practical information such as a list of local driving rehabilitation specialists and information about the driving evaluation process.
When communicating with clients and families, be honest without taking away hope for recovery. Focus on the “right now” by informing them that driving is not recommended at this stage of recovery and explain why driving is unsafe at this time. You may need to further educate them on the disease process and its impact on the performance skills required for driving. If insight into deficits is impaired, it’s especially important to educate caregivers and work on improving the client’s insight into potential difficulties with driving.
Formal Driver Evaluation & Process
When clients want to return to driving, it’s important to familiarize yourself with the process and with local resources so that you can provide them with accurate information. The process begins with a doctor’s order for a formal driving evaluation, most often performed by a Certified Driving Rehabilitation Specialist. Inform your patients that they must be medically cleared to return to driving and that the evaluation is to ensure their safety and the safety of others while on the road.
The occupational therapy driving evaluation begins with an extensive battery of visual, cognitive, and motor assessments to determine whether there are any impairments that will affect driving. Once the client passes the “pencil and paper” portion of the evaluation, an on-road driving test will be performed. The client will get behind the wheel with a driving rehabilitation specialist in a car that allows for safety controls, such as passenger side brakes. The therapist will then assess functional driving skills in the natural context. Once completed, recommendations for further treatment of underlying driving skills, vehicle modifications, and adaptive equipment training can be provided to promote independence in driving.
If a client is deemed unsafe to return to driving, it’s important that the therapist communicates all recommendations with the client and relevant others clearly. They should understand why the recommendations are being made and how their impairments make driving unsafe.
Additional Considerations:
- Some states require healthcare workers to report individuals who have impairments that contraindicate driving to the state Department of Motor Vehicles and all states have anonymous voluntary reporting procedures. You must have discussed driving cessation with the client prior to making a report.
- Be empathetic when making recommendations as driving cessation is an emotional topic for both clients and their loved ones.
- Be clear with your clients that insurance typically doesn’t cover the cost of the driving evaluation and that it will be out of pocket. Help them locate local driving rehabilitation specialists if your facility does not offer them in-house. If there are none in the area, you can help refer them to their local DMV for further visual testing and a written licensing exam and/or help with creating a treatment plan that supports return to driving.
Have You Heard of CarFIT?
CarFIT is a free evaluation and training program to assess older adults’ safety within their vehicle with a focus on how each individual vehicle is adjusted specifically to the person operating it. Specifically, volunteers who provide these evaluations look at:
- Steering wheel tilt: towards chest & not the face
- Distance between the chest and the airbag: 10in
- Line of sight above steering wheel: 3in over the steering wheel
- Mirrors and ability to check blind spot
- Operation of the vehicle controls
Anyone can become trained to perform a CarFIT evaluation, check out their site to look into training opportunities near you or virtually as well as other resources used to ensure safety on the road!
Other Ways to Support Return to Driving
Alternative modes of transportation: If a client is unsafe to return to driving, it is likely this news will be upsetting, which emphasizes the need for clinicians to be prepared with other options for transportation to provide to the client and their family. This is heavily dependent on whether you live in an urban or rural area, however here are some ideas to research within your area!
Taxis/Uber/Lyft
Pros: More access in urban settings & locating phone numbers for taxi services can be done online with a google search and there are easy-to-use apps for the other services.
Cons: Timing is not always reliable so if you are using a taxi to attend a scheduled event or appointment you must be wary about calling with plenty of time in advance. The cost of these services can add up too depending on how often clients are requesting them.
Loved ones: Leaning on your friends and family to help with driving can seem like a burden, but if this option is available, clinicians should encourage it.
Pros: Spending more time with loved ones can help those who are unable to return to driving avoid isolation and spend time with loved ones. This option may be the cheapest option yet which will be more sustainable.
Cons: Clients may feel like a burden, scheduling conflicts due to work etc., and can lead to conflict amongst families if nobody is available to drive or perhaps don’t want to.
Private companies: The access of these services will again depend on the location in which clients live, however there are companies that you can schedule pick up times which serves to increase access to transportation to appointments, leisure pursuits, etc.
Pros: Some of these companies have equipment that can be used for transporting clients who are wheelchair bound and/or have other challenges with car transfers. These employees are trained on safety procedures.
Cons: Price and availability within an area.
Treatment Targets
Strengthening
Let’s say you have a client who has the potential to return to driving but requires assistance with specific components of driving you observed in the activity analysis… One area you might need to improve for your client is their ability to perform/sustain movements and operate the vehicle through strengthening.
Visual Perceptual
In addition to visual motor skills, visual perceptual skills such as visual closure, figure-ground, visual memory, visual discrimination, form constancy, spatial relations, and visual memory must also be intact. These skills allow drivers to judge distances between other cars, discriminate between road signs and obstacles and the surrounding environment, identify vehicles from different angles, and see features of the environment that are partially hidden. Incorporating visual perceptual tasks in your treatment plan can support return to driving for appropriate clients.
Cognitive
All components of cognition are needed to safely drive. Memory, cognitive flexibility, attention, reaction time, situational awareness, problem-solving, organization, self-awareness, and motor planning are all needed to plan, execute, and continually monitor one’s driving performance. Interventions to target memory, attention, metacognitive strategy training, safety awareness, and problem-solving in simulated and natural driving scenarios can be performed in both the inpatient and outpatient settings to support driving rehabilitation.
Range of Motion
Drivers need adequate range of motion in their upper and lower extremities to be able to manipulate all parts of the car. Range of motion impairments can prevent a driver from turning the steering wheel fully to avoid obstacles, operate the gas and brake pedals, and maintain grasp on the steering wheel. The primary movements for hazard avoidance are shoulder flexion, shoulder rotation, forearm rotation and wrist deviation. 40-80 degrees of right knee flexion and 20-85 degrees of left knee flexion are also needed to operate the pedals, with differing degrees needed when changing gears. Work on improving clients’ range of motion to functional ranges or suggest modifications to compensate for range of motion deficits. Prescribing a customized home exercise plan can also support return to driving by addressing underlying range of motion and strength deficits.
Topographical Orientation/Spatial Awareness
A driver must be able to navigate in space, identify left from right, follow maps or GPS directions, and understand the spatial relations between themselves, the environment, and the car. Impairments in this area can lead to driving dangerously close to other cars, misjudging turns, and getting lost more frequently among others. Spatial awareness can be addressed via community skills training, wayfinding in the hospital or community settings, recalling landmarks, and constructing puzzles or other projects. Help clients explore car modifications such as parking assists, front sensors, and front and rear cameras that can help compensate for spatial awareness deficits.
Caregiver Section
Research shows that the driving cessation of a loved one, most often a spouse, can negatively impact caregivers who typically take over as primary driver. These caregivers report loss of personal space and time, loss of employment, and lower life satisfaction. They also report a general lack of practical information regarding return to driving and need for more socioemotional support from healthcare workers.
Caregivers are also our clients and their needs should be considered in a comprehensive treatment plan. This may help decrease caregiver burden and help them navigate the role change that comes with driving cessation, both permanent and temporary.
Caregiver Intervention Ideas
- Provide information about local caregiver support groups
- Provide information about respite care for caregivers of patients with greater needs or neurocognitive impairments
- Provide information for local accessible cab services or other appropriate public transportation
- Help caregivers find financial support resources for car modifications or driving evaluation, which are often costly and out-of-pocket
- Help caregivers structure their schedules
- Help caregivers and clients identify others who can help in case the caregiver isn’t available to drive
- AAA and AOTA’s Driver Planning Agreement contract can help caregivers broach the topic with their loved ones and ensure their wishes are respected
Check out our article discussing caregiver burnout and strategies to help support caregivers!
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
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High Quality CPR: Beating Anoxic Brain Injury
Damar Hamlin: A Success Story of High Quality CPR
You don’t have to be a fan of football or the Buffalo Bills to experience the chills associated with Damar Hamilin’s story; I just happen to be a fan of both! Hamlin is a 25 year-old who plays for the Buffalo Bills as a safety. Just moments into a Monday night game on January 2nd 2023, Hamlin collapsed on the field after making a tackle; causing the stadium to fall silent and viewers at home to move to the edge of their seats. The young player went into cardiac arrest and required medical staff on the field to perform high quality CPR to restore his heartbeat. From there, began the road of recovery that would eventually land Hamlin cleared to return to football with no residual complications post cardiac arrest.
How did he defy the odds and escape catastrophe? Well, for that we can thank the trained medical professionals who performed high quality CPR right there on the field. Damar Hamlin’s story will remain one of the most well-known success stories of CPR and serves to remind us all how important CPR is, not only to save a life, but for minimizing the possible deficits after a cardiac arrest event. Without the valiant work done by the Buffalo Bills training staff, things could have gone much differently for Damar Hamilin… Keep Damar in the back of your mind as you continue reading and think about just how lucky he is to not only survive this event, but also to be returning to the football field.
Hallmarks of High Quality CPR
Cardiopulmonary Resuscitation (CPR) should begin within 2 minutes of cardiac arrest for best outcomes. The American Heart Association emphasizes the importance of providing high quality CPR after cardiac arrest and uses these metrics to describe the performance of high quality CPR…
- 100-120 compressions per minute
- >80% compression fraction
- Compression depth of at least 2in in adults
- Avoid excessive ventilation
Not all heroes wear capes, some carry around a CPR certification card. Sign up for an AHA training class to learn valuable skills and become certified in CPR- remember it not only can it prevent significant lasting physical impairment but it can save a life!!
Anoxic Brain Injury: Role of the Heart
Cardiac arrest occurs when the heart suddenly stops functioning properly and usually results in unconsciousness. This event is typically the hallmark of an electrical disturbance within the heart however, it is NOT the same as a heart attack. Anoxic Brain Injury occurs when brain cells are deprived of oxygen and this causes cell death. Anoxic Brain Injury can occur as a secondary injury in the cascade of events after a cardiac arrest due to disrupted blood flow and oxygenation to the brain. Let’s pump the breaks and take a closer look at why/how this occurs.
Post Cardiac Arrest Brain Injury (PCABI) is caused by inadequate blood flow, or ischemia, to the brain. Reperfusion can cause secondary injury as the body attempts to restore blood flow to the brain.
Early signs of Anoxic Brain Injury include:
- Loss of consciousness
- Nausea or vomiting
- Intense headache
- Confusion
- Seizures
- Sensory changes – commonly in the extremities
Physiological Damage:
- Blood carries nutrients to brain tissue and without it, cells begin to malfunction and are at risk for cell death.
- 1 minute: cells begin to die; 3 minutes: damage to neurons and lasting brain damage; 5+ minutes: coma and death
- Temporal lobe is amongst the most susceptible to damage due to lack of oxygen and this area is big on memory → the hippocampus which resides in the temporal lobes, is most susceptible
Other Considerations
- There is such a thing as TOO much oxygen (hyperoxia) and over ventilation that can impair blood flow following a PCABI. Current recommendations for post-resuscitation care hold that pulse ox should maintain within the 94-98% range.
- Coma: 80% resuscitated from cardiac arrest are comatosed due to PCABI
- Seizures: associated with poor outcomes for neurological function post cardiac arrest
Physical and Cognitive Deficits Post Anoxic Brain Injury
- Spasticity
- Motor coordination impairments
- Hemiplegia
- Gait/balance deficits
- Behavioral changes
- Memory loss
- Agitation
- Vision changes
- Swallowing difficulty/dysphagia
Rehab Impact
For those who experience an Anoxic Brain Injury, and do not end up in a comatose state, the above deficits as well as others will need to be addressed in a rehab setting by the interdisciplinary team to maximize client outcomes. Let’s talk about how this is going to impact your treatment sessions and the importance of education…
Memory Impairments
It is likely that if these clients are aware/alert they will have both long and short term memory deficits. These deficits can impact the rehab process all together but luckily there are some strategies clinicians can implement into therapy sessions to address memory impairments:
- Visual cues: These can involve photos of family members around the client’s room, using color coding or numbering (sticky notes, stickers etc.) on objects that are associated with particular ADLs to help with sequencing, or arrows on the wall to help with functional mobility/navigation within a setting.
- Repetition: It’s a good idea to start and/or carryout each session similarly so the client can develop expectations for his/her time spent with their team members. For example: starting the session with introducing yourself, your role, and the goals for the day.
- Working memory: Developing interventions that target the use of working memory (just right challenge- discussed below) in order to initiate the storage of information into short and long term memory.
Behavioral Changes
After sustaining any form of brain injury, clients are susceptible to changes in demeanor and personality that can present as “challenging behaviors”. Not only must we as practitioners provide this education to the family but we also must be prepared to navigate these disturbances during our treatment sessions.
- Redirection: if the client is becoming increasingly agitated it can be helpful to distract them with a new thought but remember to present information slowly and allow time for them to process what you are telling or asking of them to prevent further frustration!
- Just right challenge: When presenting a task, old or new, it is important that it is challenging enough to be beneficial to their rehab process but not TOO difficult to the point it becomes frustrating. This will likely require clinical judgment and trial and error to determine an appropriate difficulty level.
- De-escalation: In moments of increased agitation, the rehab team as well as family members must be prepared to diffuse the situation. Some strategies to achieve this include teaching self-regulation techniques like: counting to 10 before responding, diaphragmatic breathing, and using “I” statements for successful communication.
Interdisciplinary Team Approach
Each member of the team brings a unique set of skill sets that will be instrumental to the rehab process. If there is a member of the team that has formed a stronger relationship in terms of communicating effectively, it might be a good idea to include them during times of conflict or uncomfortable conversations. It is also a good idea to meet with the team on a regular basis to discuss progress and what deficits remain in order to determine a plan of action to address them.
Education
We must remember that both the client and their families require education when navigating the rehab process post PCABI.
- We can suggest additional resources such as peer support groups (for both caregivers & the client) to help both parties feel supported and make connections with individuals experiencing similar challenges.
- Family meetings are necessary in the early stages of the rehab process to bring awareness to the possible changes not only in temperament but in physical & cognitive function to allow families/friends/caregivers to be aware of what they might expect during the rehab process.
- Counseling techniques such as motivational interviewing to grant autonomy, their values, and create a sense of teamwork. Other techniques such as cognitive behavioral therapy are used to change negative thought processes and exchange them for positive thoughts. Check out this great source that explains how to implement these techniques and others into your day-to-day sessions!
Educational Opportunity
The link between Anoxic Brain Injury and cardiac arrest is not always recognized by clinicians, clients, or their families. Increasing education for all parties involved will serve as a stepping stone to positive client outcomes and an overall better rehab process. Another IMPORTANT way to address this is for clinicians to remain up-to-date on brain injury – check out ARC’s CBIS course here to increase your knowledge base and skill sets as a clinician to feel empowered when treating those with brain injury.
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
Allison Frederick, M.S., CCC/SLP, CBIS-T has been a practicing speech-language pathologist for over 10 years. Allison graduated from Bloomsburg University of Pennsylvania in 2007 and has worked in subacute, LTC and intensive inpatient rehabilitation. She is passionate about the brain injury population and making higher-level neuro education available to everyday clinicians. Allison hosts a brain injury journal club which you could find here for free for all interested.
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Becoming a Travel Therapist: How To Start Your Journey on the Right Foot
Are you tired of working a humdrum 9-to-5 job every day? Do you have the itch to explore new places, meet new people, and help those in need while working as a therapist? If you answered yes, becoming a travel therapist could be the ideal profession.
Travel therapy is an exciting way of practicing therapy and exploring new things while building your professional skills. ARC Seminars discusses the benefits of freelance therapy, understanding contracts, balancing work and life, and other areas of travel therapy:
Benefits of Being a Freelance Therapist
Perhaps the most significant advantage of freelance therapy is that you get to choose your schedule and work with clients who you enjoy working with. As a freelancer, you can negotiate your rates, have more control over your professional and personal life, and work in different settings or locations. You can also build a solid reputation as a therapist if you provide high-quality services, give clients personalized attention, and cultivate stronger relationships with everyone you work with.
Taking Online Business Classes
You need a solid foundation in business skills to navigate your freelance career with confidence. Online business classes can help you learn the industry’s best practices, develop marketing strategies, and create a strong professional network. They can also help you with financial management, business plan development, and many other disciplines. In other words, the right classes are a key to success for your therapy business long-term!
Research the various online universities that offer affordable business degrees. And don’t forget to connect with ARC Seminars to learn about our programs and subscriptions!
Jumpstarting Your Career
The best way to launch your career on the right foot is to start early. Research companies or recruiters that offer travel therapy services. If you want to go freelance, research the market and any areas you’re considering as a homebase to see where you can fill a need. Then, create a professional website to showcase your skills, experiences, and services.
Once you have your website, produce content that speaks to your audience, and begin promoting your services on social media. Network with other therapists and healthcare professionals, attend conferences, and always keep an eye out for new job postings to acquire clients quickly.
Navigating Contracts
As a travel therapist, you’ll be required to sign contracts with your clients or agencies. You must understand what’s in the contract and what your legal obligations are. Contracts can be complex, so it’s important to consult a lawyer to clarify any legal issues that are over your head.
Read every aspect of the contract carefully, including payment, terms, schedule, job description, and any other pertinent information. Confirm that the contract aligns with your professional goals and protects your interests.
Striking a Healthy Work-Life Balance
Working as a travel therapist can be challenging because you might work in different locations in settings with clients with unique needs. You must learn how to strike a healthy balance between work and life by establishing a self-care routine and setting boundaries with your clients or agencies. Take time off to recharge, manage stress, and avoid burnout.
Here are a few other tips:
- Plan ahead for travel logistics and schedule flexibility where possible.
- Use technology to stay connected with loved ones and maintain a support system.
- Develop a routine that incorporates healthy habits and is adaptable to various settings.
- Take time to explore and enjoy new places, cultures, and experiences outside of work hours.
Wrapping Up
As rewarding of a career path as it can be, being a travel therapist requires dedication, passion, and a willingness to take risks. If you’re an aspiring therapist, you can jumpstart your career by following the tips above. Remember to have fun, stay motivated, and prioritize your well-being along the way. The road to success may be a long one, but the rewards will make it all worth it!
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CARE for Caregivers: Clinicians Guide for Addressing Caregiver Burnout
Caregivers are often an overlooked population in a rehab setting and this oversight can be detrimental to the attainment of the goals, safety, and overall success of the client. How do we know this is an important consideration as providers?
These numbers speak for themselves while bringing to light the need for increased caregiver resources and supports…
- 40-70% of caregivers suffer significant signs of depression
- 31% of caregivers contemplate suicide while on the job
- Almost ⅓ of caregivers provide direct care for more than 20 hours per week
- 2 of 5 caregivers have at least 2 chronic conditions
- ¼ caregivers are 65+ and report caregiving has made their health worse
Caregiver burnout is described as “… a state of physical, emotional, and mental exhaustion.”
Signs and Symptoms of caregiver burnout can vary based on the client they are caring for and can resemble other diagnoses and can even cause the onset of conditions like depression and anxiety. Overwhelming feelings of guilt, stress, and exhaustion are also common characteristics associated with caregiver burnout which is why it is important for caregivers to understand the signs and symptoms of caregiver burnout to reduce risk of negative impacts on their health and well-being. Some signs and symptoms may include:
- Withdrawal from social interactions
- Lack of interest in favorite activities
- Changes in sleep patterns (lack of energy)
- Neglecting own needs
- Emotional exhaustion
- Physical exhaustion
- Irritability
- Feeling blue or helpless
- Wanting to hurt yourself or the people you are caring for
Contributing Factors
- Confusion: This can happen when people assume a caregiving position (especially if it is unexpectedly) and are unsure how to separate their caregiving role from their personal life and other roles they embody. As a result, caregivers tend to take the stress of caregiving with them throughout their day-to-day life and never really get a break from the job itself. The inability to separate themselves from this role can lead to feeling lost, confused, and overwhelmed.
- Unrealistic expectations: It isn’t uncommon for caregivers to feel that their job as a caregiver will give them a sense of fulfillment because they are helping others. However, it can be hard to see a loved one lose their ability to perform basic tasks and the level of assistance required might be unexpected. Spending time with a loved one during their time of need is admirable however, the stress it places on the relationship could be an unforeseen challenge when assuming the role of a caregiver.
- Lack of control: This can be in many forms including lack of caregiver resources and supports, money, and ability to organize or control one’s life.
- Unreasonable demands: In some cases, especially when a family member is a caregiver, the client is comfortable placing demands on their caregiver as they neglect their own responsibility to complete tasks they are capable of doing – or at least attempting. This leads to the caregiver’s role exceeding their initial expectations and as a result having an unsustainable amount of responsibilities.
- Lack of self-care: The responsibilities of a caregiver can become quite overwhelming and persist all hours of the day. For some caregivers, they might not know the signs and symptoms of caregiver burnout, so they are unaware that they are neglecting themselves and their needs.
How can burnout impact client outcomes?
Burnout can impact clients quality of care in so many ways such as: medical errors, strained relationships, decreased compliance in home programs, and decreased social interaction. Exhaustion, lack of energy, stress, and impaired cognitive function of caregivers can result in negative client outcomes.
For example, in the instance of medical errors, these factors can cause caregivers to make mistakes with medication schedules or dosages and can even mix up medications that can cause adverse effects. It is important for both caregivers AND clinicians to understand what caregiver burnout out is and how to address it in order to prevent decreasing client care and promote caregiver well-being.
Strategies for Clinicians to Intervene
We as clinicians cannot forget to address caregivers as they are an INSTRUMENTAL teammate during the rehab process and for successful carryover. But how can we offer support during times of burnout?
Caregiver resources and supports we recommend:
Family Meetings:
Bringing the family together with the entire interdisciplinary team can promote positive outcomes within therapy sessions and the home. The primary goal of this meeting should not necessarily be to mediate between opposing sides of conflicts but instead to hear caregivers’ concerns and feelings towards their role in the rehab process. Using our expertise, we may be able to implement compensatory strategies to decrease the physical, mental, and emotional strain associated with the role of a caregiver.
Prior to the meeting day, it may be beneficial to prepare your client and their family to make them feel comfortable; here is a printable resource to help out!
Education on Respite Care:
When caring for a loved one, there can be a lot of pressure put on caregivers to handle all aspects of the care independently. Helping them understand their options and how to accept help can improve their mental health and provide them with breaks from their role as a caregiver. Respite care can be offered by many different parties including other family and friends, government entities, and healthcare providers.
Use this link to provide necessary caregiver resources and supports on respite care with direct links to associations for specific diagnoses, options to inquire about with your physician, and specific examples for including others in the caregiving process.
Support Groups:
Sometimes there is nothing more beneficial than discussing hardships with other people who have experienced or who are currently experiencing the same thing. Caregivers might not be able to recognize the benefits of joining a support group or might not know how to locate these groups. Assisting with this process falls within the scope of the interdisciplinary team.
Here are some wonderful groups to get this process rolling: Family Alliance on Caregiving & Caring.com Resource Center
Develop & Manage a “Caregiver Plan”:
Organization of the day-to-day can help minimize the stress, anxiety, and exhaustion associated with caregiver burnout. Dedicating a session to helping the caregiver develop a plan will provide a client-centered approach to managing medications, appointments, emergencies, and more. Download this customizable document to assist caregivers with the development of this plan.
At the end of the day, we as clinicians need to recognize caregivers as our clients as well and understand what caregiver burnout looks like, how it can impact your client’s success in the rehab process, and how to support the caregiver and their mental health. Familiarizing yourself with caregiver resources and supports will allow you to successfully intervene substantiate your role as a difference maker in a holistic sense and promote the well-being of all members of the team.
Don’t let your client’s caregiver forget, caregiving starts with you!
Alicia is a doctoral capstone student working with a non-profit agency to discuss mental health advocacy through various online platforms. She is earning her OTD from Gannon University located in Ruskin, FL.
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
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Sensory Sensitivity and Migraine: Strategies How to Promote Relief
Migraines are debilitating headaches that affect millions of people worldwide. While they are commonly known for their intense pain, migraines can also be influenced by sensory sensitivity and overload. In this blog post, we will explore the relationship between sensory sensitivity and migraines, addressing important questions and providing strategies to promote relief.
Post concussion, migraine can be an issue that has a huge impact on your patients ability to fully re-integrate into the world. Whether you are a physical therapist (PT), occupational therapist (OT), or speech therapist (SLP), these strategies can be integrated into your practice to assist individuals dealing with migraines.
Let’s examine the link between sensory processing and migraine, to see how a therapist is best placed to address the issue!
Teach your patients to monitor their migraine symptoms with this concussion log!
Are Migraines a Sensory Processing Disorder?
While migraines are not classified as a sensory processing disorder, individuals who experience migraines often exhibit heightened sensitivity to various sensory stimuli. Sensory processing disorders, on the other hand, involve difficulties in processing and responding to sensory information. However, sensory sensitivity can contribute to migraine symptoms and exacerbate their intensity.
Can Sensory Overload Trigger Migraines?
Yes, sensory overload can indeed trigger migraines. When the brain is overwhelmed by excessive or conflicting sensory input, it can lead to a migraine episode. Common sensory triggers include bright lights, loud noises, strong smells, and certain textures. For individuals prone to migraines, managing sensory overload becomes crucial to prevent or reduce the frequency and severity of migraine attacks.
How can a PT, OT and SLP be instrumental in treating migraines?
Effective Relaxation Techniques for Treating Migraines
Relaxation techniques can play a significant role in managing migraines and promoting relief. Here are some effective techniques that can be recommended to individuals experiencing migraines:
1. Deep Breathing:
Encourage slow, deep breathing exercises to promote relaxation and reduce stress levels. Inhaling deeply through the nose and exhaling slowly through the mouth can help calm the nervous system and alleviate migraine symptoms.
2. Progressive Muscle Relaxation:
This technique involves systematically tensing and relaxing different muscle groups in the body. Guiding individuals through the process can help release muscle tension, ease physical discomfort, and reduce the impact of migraines.
3. Guided Imagery:
Using visualization techniques, individuals can imagine themselves in peaceful and calming environments. Guided imagery can help distract from migraine symptoms, reduce stress, and induce a sense of relaxation.
4. Mindfulness Meditation:
Practicing mindfulness involves focusing on the present moment without judgment. Mindfulness meditation can help individuals manage stress, enhance self-awareness, and reduce the impact of migraines by redirecting attention away from pain.
Read more about mindfulness/meditation with concussion in rehab right here!
Strategies for PTs, OTs, and Speech Therapists
As PTs, OTs, and Speech Therapists, you have a unique opportunity to support individuals experiencing migraines. Here are some strategies you can incorporate into your practice to help:
1. Education:
Educate your patients about the connection between sensory sensitivity and migraines. By increasing their awareness, they can better understand their triggers and make informed decisions about managing their condition.
2. Environmental Modifications:
Collaborate with your patients to identify and minimize sensory triggers in their environment. This may involve adjusting lighting conditions, reducing noise levels, providing access to quiet spaces, and recommending ergonomic modifications.
3. Sensory Integration Therapy:
For individuals with sensory processing difficulties, sensory integration therapy can be beneficial. Work with an OT to develop personalized interventions that address sensory sensitivities and help regulate sensory input.
4. Stress Management Techniques:
Teach stress management techniques such as relaxation exercises, breathing techniques, and mindfulness practices. By helping patients manage stress effectively, you can contribute to reducing the occurrence and intensity of migraines.
5. Posture and Body Mechanics:
Assist patients in improving their posture and body mechanics to reduce muscle tension and minimize physical strain. This can include ergonomic assessments, postural exercises, and guidance on proper body mechanics to prevent exacerbation of migraine symptoms.
6. Physical Exercise and Activity:
Encourage patients to engage in regular physical exercise and activity, as it can help reduce stress, promote overall well-being, and potentially decrease the frequency and severity of migraines. However, it is important to consider individual limitations and tailor exercise recommendations accordingly.
7. Relaxation Equipment and Tools:
Introduce patients to relaxation equipment and tools that can aid in managing sensory sensitivity and promoting relaxation. This may include weighted blankets, eye masks, noise-canceling headphones, and aromatherapy diffusers with calming scents.
8. Collaboration with Other Healthcare Professionals:
Foster a collaborative approach by working closely with other healthcare professionals involved in the care of individuals with migraines. This may include neurologists, psychologists, and pain management specialists. By coordinating efforts, you can ensure a comprehensive and holistic approach to migraine management.
9. Patient Empowerment and Self-Management:
Empower patients to take an active role in managing their migraines. Educate them about self-care strategies, including lifestyle modifications, stress management, and the importance of maintaining a migraine diary to track triggers and symptoms. By encouraging self-management, patients can gain a sense of control over their condition.
Sensory sensitivity can significantly impact the experience of migraines. By understanding the relationship between sensory overload and migraines, and implementing effective strategies, physical therapists, occupational therapists, and speech therapists can play a vital role in promoting relief and improving the quality of life for individuals with migraines. By incorporating relaxation techniques, environmental modifications, and collaborating with other healthcare professionals, you can provide comprehensive care and support to those dealing with migraines.
Remember, it is crucial to tailor interventions to each individual’s specific needs and collaborate closely with other healthcare professionals to ensure the best possible outcomes. By utilizing these strategies, you can make a positive difference in the lives of your patients who are seeking relief from the burdensome impact of migraines.
*Note: This blog post provides general information and strategies. It is essential to consult with healthcare professionals and specialists for personalized advice and treatment options.*
Want to learn more about specific interventions that you can use to promote health and independence with your patients who have had concussion? Check out our course: Practical Approaches to Concussion Management here for more essential strategies!
Emily Cahalan OTR/L, CLT, CBIS: Emily is an OT with almost fifteen years experience in the field, having graduated from National University of Ireland, Galway in 2010. Emily is passionate about inpatient rehabilitation and specifically lymphedema therapy in this space. In her (limited) spare time, Emily has started accepting OTD Capstone students to do her part in further promoting the advancement of OT in the rehab world.
How to Return to Parenting, Marriage, and More after a Stroke
750,000 people have a cerebrovascular accident (CVA) per year in the United States, which comes out to over 2,000 per day.
Returning home after having a CVA can be a difficult transition for both the clients and their families. Maintaining or re-establishing roles can be an important component of the rehabilitation process and returning to the things that are important to these clients. Due to the prevalence of CVA in the U.S., it is important for practitioners to know how to address the transition home for our patients after a stroke which includes returning to roles such as a partner in marriage and parenting.
Parenting
Whether it is the parent of someone who has sustained a stroke or the client is a parent, there are some things as therapists that we can do to support this dynamic.
1. Awareness to Behavior/Temperament Changes & De-escalation Strategies
There may be times when the client becomes easily agitated and demonstrates “challenging” behaviors. It is important for the family of the client to understand that the area of the brain that was injured during the stroke, could alter behavior within the role as a parent (or in a marriage). There are strategies that can be used to de-escalate the situation during these instances.
- Ask less general questions and more specific “how can I help” questions to decrease overwhelming feelings and develop a positive-collaborative communication style.
- Deep breathing in stressful situations and using this prior to responding in these situations. Breathing in through the nose and out through the mouth 3-5 times.
- Allow the client to express their emotions but encourage respectful vocabulary and remember the importance of staying calm and not responding negatively.
- Allow time for emotions to settle and return to subjects later using “I” statements to resolve the conflict. REMEMBER if safety is the concern it is important that this is prioritized and there is not any immediate danger to the caregiver or the client.
2. Supervision & Knowing Current Functional Limitations
The motor, cognitive, and sensory changes that exist post stroke are not consistent for every client. Conversations about level of function and independence can be difficult for parents and families and typically relate back to safety. Understanding what the client is capable of doing at their current level of function is instrumental to maintaining safety within the home.
3. Support
Including a son/daughter in the rehabilitation is up to the discretion of the family, however there are some benefits to this inclusion. Fostering an understanding of the parent’s injury to the son/daughter can be done through including them in home programs/homework, attending therapy sessions to better understand what to work on within the home, and family education about the nature of the injury and the current limitations the client is experiencing.
Marriage
The challenges associated with returning to parenting and marriage after a stroke might involve some of the same strategies and techniques that we can teach to our clients and their loved ones to ease the transition back into the home.
1. Strategies for Maintaining Relationship & Managing Stressful Situations
- De-escalation strategies
- Counseling appointments together and/or separate
- “Family meetings” with therapy or medical team for conflict resolution
- Support groups
- Attending therapy (and other medical appointments together)
- Developing healthy communication patterns that can help achieve safe ADL collaboration and practicing this with your rehab team
2. Sex & Intimacy
There is often a disconnect when considering sex and intimacy after being discharged from an acute or post-acute facility. Opening communication to topics such as:
- Discussing level of comfortability and the needs of both people in the partnership
- Exploring appropriate assistive devices that can promote independence during sexual activity
- Using body positioning and current level of function to meet their goals as they relate to sex and intimacy.
Other Considerations
1. Return to Work
In addition to marriage and parenting after a stroke, the client might be preparing to transition back into the workplace. If the client identifies returning to work as an important goal for themselves, it is important we know how to support them such as targeting functional movements, strengthening, ROM, etc. necessary for work tasks in therapy sessions to promote return after a stroke. There are other recommendations we can make to assist these clients return to work such as:
- Encouraging open communication about current functional limitations with workplace boss/supervisor
- Education on body awareness and the importance of taking rest breaks during physically or cognitively demanding tasks
- Educating the client about proper ergonomics and strategies to set up the environment for success
- Items are within reach of unaffected side
- Supporting affected side to prevent shoulder subluxation
- Seated position when appropriate
2. Friends/socialization
Recognizing that rejoining friends and attending social events after a stroke may be an emotional experience for the client. Oftentimes it involves working through discomfort associated with friends noticing physical or other limitations. Recommendations for navigating these situations can include:
- Starting with a comfortable environment that is set up for the client to be successful with a smaller crowd and progressing from there
- A plan for instances of incontinence that involve discrete management
- Implementing a space specifically for the client to go to such as a car or bedroom in times of frustration or feeling overwhelmed
Returning home and to the roles within a marriage or as a parent after a stroke can be a difficult transition for our clients and in order to holistically approach this transition, practitioners MUST address marriage, parenting, and the other roles important to each client. Being prepared to navigate these challenges as they arise will leave clients and their families better equipped for this transition.
Interested in learning more about inpatient rehab and strategies to get your client home? Check out our Inpatient Stroke Rehabilitation: 14 Strategies to Get your Patient Home.
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
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Living with TBI: How to Find Support and Resources within the Community
Each year 1.5 million people sustain a Traumatic Brain Injury (TBI) and despite this staggering prevalence, TBI is often referred to as a ‘silent epidemic’ in the world of healthcare. Even though TBI contributes to a third of all injury-related deaths, 75% of TBIs that occur annually are considered mild – meaning that injuries may not be readily obvious, hence ‘silent’.
TBI can result from contact injuries to the head that can be open or closed, or may occur from an inertial injury – in which the brain moves around in the skull. Some of the most common causes of TBI include falls, MVAs, violence, and sport injuries. After sustaining this type of injury, individuals can find themselves experiencing challenges that are brought upon by persistent symptoms. These challenges can impact reintegration into the community. How to find resources for those post TBI is a question we get a lot!
Check out this guide for therapeutic intervention based on the Rancho Scale!
As OTs, PTs, and SLPs we are equipped to address physical, cognitive, and behavioral disruptions during rehab in a hospital setting – but our role should not end there! We should be familiar with and adopt community resources for those living with TBI into our POC to fully and holistically serve our clients.
Let’s explore some of these TBI resources & how to find them.
1. Support groups:
Support groups are instrumental to the recovery process for our patients with a TBI and these resources likely exist in YOUR area! Being surrounded by peers who are/have experienced the same challenges will foster a community feel and allow patients to share personal stories to connect with one another. This connection can combat social isolation, which is often reported by both patients and caregivers of those with TBI.
Introducing the idea of a support group might not be your patients favorite idea, but educating them on the psychosocial benefits and providing them with plentiful options might be just the encouragement they need to take this step in their recovery journey.
- Providing them with both virtual and in-person options will grant them the autonomy to choose a support group they feel comfortable with – REMEMBER group conversations will involve vulnerability so patient comfort is a MUST
- If support groups are not your patient’s jam, there are resources that offer both forums, chat spaces, and other formats that might be preferred
- Facebook groups (and other social medias) are another way to create a sense of community for these patients and their family. Use with CAUTION when sharing personal information on these public pages.
Therapists and rehab personnel might have to be the heroes that connect patients and their families to local transportation services that can support the reintegration into the community. Add these resources to your toolkit to be better prepared if transportation is a burden for your patient and their families.
There are online services through the Modivcare that can provide patients with non-emergency medical transportation in order to make access more readily available. Use this link to create an account and an application to set up scheduled transportation in your local area.
Here is a great resource to find both in person and virtual support groups for individuals with TBI. Use this link Scroll to your state and ‘shop’ around for local groups using the links provided.
Check out this website that presents state-by-state options for support groups both virtual and in person that offers groups for caregivers, people with TBI, as well as other groups including male/female only.
Caregivers are a population we as therapists MUST consider when providing holistic care after a brain injury. Caring for individuals with a TBI can leave families feeling lost, stressed, and confused. Here is a great source to provide to caregivers with tips discussing: caregivers mental health, assistive technology, and managing challenging behaviors.
Here is another great source to provide to families that demonstrates how to find nonprofit, private, and public programs/services by state. This tool will assist caregivers in finding specific services local to them and their loved one.
*Note: this site is not specific to brain injury but is a great resource to locating specific organizations that can help!
2. Vocational Aspects
Employment rate for individuals with a TBI is reported to be only 10-40%. Community reintegration might involve return to work or seeking new employment opportunities after a brian injury. As a member of the rehab team, it is important we are prepared to provide information relating to work and financial literacy to ease the transition back into the community and ultimately everyday life! It is important to remember that work can often times provide patients with a sense of purpose and fulfillment – clinicians are well placed to have a working knowledge of community resources to present to patients with TBI in order to meet their vocational needs. Here are some virtual resources you can offer up to your patients to help them find employment and help them understand their options for financial stability.
- This resource is chalked full of great information that breaks down insurance (car, health, etc.), loss of wages/compensation, government programs etc. for this population. Developing financial literacy can provide patients and their families a firm foundation for financial stability.
- Need tips to ‘stay afloat’ after a TBI? This source provides 10 FANTASTIC tips for managing finances discussing topics such as: budgeting/saving strategies, applying for disability, and more! These ideas can be incorporated into your POC to maximize independence in IADLs and empower families to feel in control of their finances.
- Another wonderful tool that helps individuals with disabilities locate jobs or perhaps jumpstart a new career. This inclusive platform will look at the patient’s skills/experience and collaborate with them to find work- use this link, click ‘find jobs’, and create an account to get started!
3. Transportation
Transportation is an incredibly important part of community reintegration and finding RELIABLE and SAFE transportation services can be challenging. These patients will often have regular doctor appointments, therapy sessions, as well as everyday social events that will need to attend. Special considerations for finding transportation include:
- Cost – can the family afford to pay for these services and if not how can they receive financial support? Check out this source that details the different financial supports available disabled individuals
- Equipment necessary- if the patient has physical limitations that require lifts, space for wheelchair transport, and other supportive devices for car transfers.
- Training of personnel- locating companies with necessary training to perform these transfers and support patient safety is a MUST.
There are online services through the Modivcare that can provide patients with non-emergency medical transportation in order to make access more readily available. Use this link to create an account and an application to set up scheduled transportation in your local area.
Nowadays, companies like Uber and Lyft are popular among anyone and everyone getting from place-to-place conveniently and reliably. Rehab teams can educate patients and their families on how to use these apps to promote independence in locating and managing transportation within the community.
4. Additional Services: Addiction & Substance Abuse
After sustaining a TBI, patients are 10-20% more likely to engage in new substance misuse behaviors and if they were misusing prior to the injury they are even MORE at risk for continuing this behavior post injury. We can’t forget the risk of developing addictions to opioids due to pain experienced after injury as well. Using drugs and/or alcohol can complicate the process of community reintegration by promoting self-isolation, unhealthy coping mechanisms, and difficulty establishing a routine. If you suspect your client is misusing drugs or alcohol, these resources can help guide conversations with patients/families as well as give them the tools to overcoming these challenges.
- Here is your GO TO resource for providing information about substance-abuse after a brain injury! There are fact sheets, treatment programs, online trainings for caregivers, and other resources compiled in this Resource Toolkit that rehab teams can print and distribute to families.
- There are plentiful facilities that offer inpatient addiction services as well as phone consultations to devise a plan centered around the patient’s needs – here’s an example!
- Many of these resources consider the impact of mental health on the development of substance-abuse and incorporate addressing the link between the two. Here is another nationwide service that can link patients to local centers to provide treatment!
Ultimately, we want readers to recognize that there are existing services and resources to assist with returning to life post TBI. As practitioners, it is important to be prepared and become familiar with local and nationwide services that can support community reintegration. We encourage you to create a list of supportive services within your area and create handouts outlining these services to provide your clients with the tools to be successful after they leave the hospital and return to the important things in life.
Continue adding to your knowledge base regarding brain injury by earning your CBIS, use this link to learn more and register.
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
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Living with TBI: How to Find Support and Resources within the Tampa Bay Area
As an OTD student in Tampa, I have researched thoroughly the existing community support services for those post TBI in the Tampa Bay area. We know there are common challenges faced by those who are returning to their day-to-day life after sustaining TBI, but how do we help connect these clients to these services? I have collected a pool of really great specific TBI resources in the Tampa area that include: psychosocial support, work & financial literacy, transportation, and additional services.
1. Psychosocial Support
Isolation and lack of social support can leave clients feeling alone during the rehab process but also after returning home and to daily life. Providing opportunities for clients AND caregivers to meet individuals who are experiencing similar challenges, can afford them the support and feeling understood that is often longed for. Some Tampa specific resources for our TBI patients, include support groups that meet to talk about their story, their needs, their struggles and how coming together either in person or virtually can make a HUGE difference in the lives of patients and their caregivers.
- Tampa South Brain Injury Support → Weekly; virtual meeting
- Florida Brain Injury Support Groups → Categorized by city; both virtual & live; weekly
2. Work and Financial Literacy
There is only a 10-40% reported employment rate after sustaining a TBI in the United States and this is a great opportunity for clinicians to provide tips and tricks to navigate financial waves and establish stability. These resources are Florida/Tampa specific and can really jumpstart the process of locating employment while prioritizing patients’ with TBI interests and skills!
- Websites like Inclusivity can connect you to Success Enablers that assist those with disabilities in finding jobs based on skills/experience as well as training job sites to be more accommodating and accessible.
- Other resources like theworkathomewife are specific to Florida and also provide career centered return to work assistance.
3. Transportation
If the goal is to reintegrate these patients back into the community, we MUST consider the HOW. As caregivers may be limited by financial burdens associated with transportation, physical limitations impacting ability to safely perform transfers, caregiver availability with work, and/or equipment necessary to transport their loved ones. Access to transportation can limit patient’s ability to attend rehab sessions as well as events within the community.
Having reliable and safe transportation can mitigate isolation, empower patients to feel a sense of normalcy, and participate in the activities they want and need to. Here are some Tampa specific resources to provide to patients and their families
Non-Emergency Medical Transportation (NEMT) → Great option for clients with Medicaid & suitable for those in wheelchairs
Lyft & Uber → Some wheelchair accommodations available; accessible mobile apps
Wheelchair Transport Service → Serving Tampa Bay and surrounding counties
4. Additional Services
TBI Specific Services in FL
As no two TBIs are the same, it is necessary to consider other potential resources that individuals may need to reintegrate into the community. There are several state and federal entities that work to support individuals with TBI. Here are some links to Florida specific supportive services:
- Brain and Spinal Cord Injury Program – Florida Department of Health
- Provide all eligible Florida residents who sustain a traumatic brain or spinal cord injury the opportunity to obtain the necessary services that will enable them to return to an appropriate level of functioning in their community
Addiction & Substance Abuse Services
As we know there is a link between substance misuse and TBI, we have to be prepared to help these patients find assistance when navigating addiction and TBI.
- Crisis Center of Tampa Bay → provides drug and alcohol treatment and prevention referrals to local providers in Florida, 24 hours a day, 365 days a year
- HOTLINE: Call 1-800-662-HELP (4357)
- Florida Alcohol and Drug Abuse Administration (FADAA) → non-profit membership association representing substance abuse prevention and treatment providers
This collection of resources can be used by rehab professionals in and around Tampa, FL in order to support community reintegration post TBI. The continuum of care after the patient leaves the hospital is CRUCIAL to the success of the rehab process.
Save these resources and distribute them to your Tampa patients and continue expanding your educational repertoire by becoming a Certified Brian Injury Specialist.
Terrell is a doctoral capstone student working with ARC Seminars to complete a qualitative research study tailored towards benefiting the profession of occupational therapy. He is earning his OTD degree from Gannon University located in Ruskin, FL.
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Empower your career: Upskill In Edema Management
As a dedicated therapist, occupational therapist, or nurse, you understand the importance of continuously improving your skills and knowledge to provide the best care for your patients. One area of specialization that can significantly enhance your clinical practice is lymphedema and edema management.
By upskilling in this field, you can expand your expertise, improve patient outcomes, and advance your career. In this article, we will explore the benefits of lymphedema and edema management certification for therapists and provide valuable insights into its impact on patient care.
What Does It Mean to Be Lymphedema Certified?
Lymphedema certification is a professional credential that signifies advanced training and expertise in the assessment, treatment, and management of lymphedema and edema. Achieving lymphedema certification demonstrates your commitment to providing specialized care to patients with lymphatic disorders, enabling you to offer evidence-based interventions and comprehensive treatment plans.
How Can Education and Skill in Managing Edema Help Your Career?
- Increased Opportunities: Obtaining lymphedema certification opens up new opportunities for career advancement and specialization. Employers and healthcare facilities often prioritize hiring certified therapists due to their advanced knowledge and skill set in managing lymphedema and edema. This certification can set you apart from other candidates and make you a valuable asset to any team.
- Expanded Patient Base: With the rise in the prevalence of lymphatic disorders, the demand for skilled therapists in this area is growing. By becoming certified, you position yourself to cater to a broader patient population, including those suffering from post-surgical swelling, cancer-related lymphedema, chronic venous insufficiency, and other conditions. This can significantly expand your patient base and enhance your professional reputation.
- Improved Referral Networks: Lymphedema and edema management certification can help you establish strong referral networks with physicians, surgeons, and other healthcare professionals. Your specialized expertise in managing lymphatic disorders will make you a trusted resource for colleagues seeking knowledgeable therapists for their patients’ needs.
Need some edema management resources for your clinic? Download these free ones here
How Can Including Edema Management Strategies Help Your Patient Care?
1. Enhanced Treatment Efficacy: By upskilling in lymphedema and edema management, you will gain a comprehensive understanding of the latest evidence-based techniques and modalities. This knowledge will enable you to develop tailored treatment plans that address the specific needs of your patients. Implementing effective edema management strategies can lead to improved treatment outcomes, reduced swelling, enhanced mobility, and increased patient satisfaction.
2. Holistic Patient Care: Lymphedema and edema management certification equips you with the skills to take a holistic approach to patient care. You will learn how to assess and address not only the physical symptoms but also the emotional and psychosocial aspects of living with lymphatic disorders. By providing comprehensive care, you can empower your patients to better manage their condition, improve their quality of life, and achieve optimal wellness.
If You Can’t Afford to Become Certified, What Options to Upskill Do You Have?
While obtaining formal certification is highly recommended, there are alternative options to upskill in lymphedema and edema management if cost is a barrier:
1. Workshops and Continuing Education: Attend workshops, seminars, and conferences focused on lymphedema and edema management. These educational events often provide valuable insights, hands-on training, and updates on the latest research and treatment approaches.
2. Online Resources: Take advantage of online resources, such as webinars, educational videos, and articles, which can offer valuable information on edema management techniques, assessment tools, and case studies.
3. Peer Collaboration: Engage in professional networking and collaborate with experienced therapists who specialize in lymphedema and edema management. Participate in peer mentorship programs and seek guidance from knowledgeable colleagues to enhance your skills and knowledge.
Support for Certified Therapists:
If you are already certified and seeking ongoing support, there are several resources- right here!- available to you:
1. CEU offering: We here at ARC LOVE edema management! Our best selling course “Edema Management in In-Patient Rehabilitation” provides specialized training to enhance your clinical skills- and set up your own program.
2. Edema Management Resources: ARC Seminars also offers a collection of edema management resources for your clinic, including assessment tools, educational materials, and product recommendations – always updated with new findings! Check it out
3. Lymphedema Journal Club: Stay up-to-date with the latest research and advancements in lymphedema management by joining the Lymphedema Journal Club, a quarterly interdisciplinary meeting of the minds
4. Online Videos: Access informative videos on lymphedema and edema management techniques on platforms like YouTube. Videos like Lymphedema Management Techniques and Edema Management: Approaches and Strategies provide valuable insights and demonstrations of various treatment approaches.
As a therapist, occupational therapist, or nurse, upskilling in the field of lymphedema and edema management can have a profound impact on your clinical practice. By obtaining lymphedema certification or pursuing alternative avenues to enhance your skills, you can expand your career opportunities, improve patient care outcomes, and establish yourself as a trusted expert in managing lymphatic disorders.
Take the initiative to invest in your professional development and unlock the benefits that lymphedema and edema management certification can offer – it may be a second wind to your career!
Emily Cahalan OTR/L, CLT, CBIS: Emily is an OT with almost fifteen years experience in the field, having graduated from National University of Ireland, Galway in 2010. Emily is passionate about inpatient rehabilitation and specifically lymphedema therapy in this space. In her (limited) spare time, Emily has started accepting OTD Capstone students to do her part in further promoting the advancement of OT in the rehab world.
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Managing Dysphagia After Radiation: How PT/OT/SLP can be Effective
Dysphagia, or difficulty in swallowing, is a significant concern for individuals who have undergone radiation therapy, particularly those with head and neck cancer. As a physical, occupational, or speech therapist, understanding the prevalence of dysphagia after radiation and your crucial role in its prevention, treatment, and advocacy is paramount.
In this article, we will explore the prevalence of dysphagia post-radiation, along with the various ways therapists can make a difference in their patients’ lives.
The Prevalence of Dysphagia after Radiation:
1. Incidence Rates:
Studies have shown that dysphagia affects up to 80% of head and neck cancer patients who have undergone radiation therapy. The severity and duration of dysphagia can vary depending on factors such as the radiation dose, treatment area, and individual patient characteristics.
2. Long-Term Effects:
While some patients experience temporary dysphagia that improves over time, others may face long-term or even chronic swallowing difficulties. It is crucial to recognize that dysphagia can significantly impact patients’ quality of life, affecting nutrition, hydration, social interactions, and overall well-being.
Dysphagia can be tricky… read Critical Ethical Considerations for Dysphagia Treatment for tips on management!
The Therapist’s Role:
1. Prevention:
a) Education
As a therapist, you can play a vital role in educating patients about the potential risk of dysphagia following radiation therapy. Provide information on lifestyle modifications (hyperlink to article on Dining out with dysphagia), dietary changes, and proper swallowing techniques to minimize the impact of radiation on swallowing function.
b) Pre-treatment exercises:
Collaborate with patients’ healthcare teams to implement swallowing exercises prior to radiation therapy. These exercises can help maintain muscle strength and coordination, potentially reducing the severity of dysphagia.
2. Treatment:
a) Swallowing Assessment:
Perform comprehensive swallowing evaluations to identify the specific impairments and determine the appropriate treatment plan. This assessment may involve clinical and instrumental assessments, such as videofluoroscopy or fiberoptic endoscopic evaluation of swallowing (FEES).
b) Therapy Interventions:
Implement evidence-based swallowing exercises, compensatory strategies, and dietary modifications to improve swallowing function and enhance patients’ overall safety and comfort while eating.
c) Collaborative Approach:
Work closely with other healthcare professionals, including dietitians and physicians, to provide a holistic treatment approach. Collaborative care ensures that patients receive comprehensive support, addressing both the physical and nutritional aspects of dysphagia.
3. Advocacy:
a) Patient Empowerment:
Educate patients about their rights, treatment options, and available resources. Encourage them to actively participate in their care and voice their concerns or challenges related to dysphagia.
b) Awareness Campaigns:
Take part in advocacy efforts to raise awareness about dysphagia after radiation therapy. By sharing your expertise and experiences, you can help educate the public, healthcare providers, and policymakers about the importance of early intervention and appropriate support services for dysphagia patients.
Dysphagia following radiation therapy is a common and potentially debilitating condition for head and neck cancer survivors. As a physical, occupational, or speech therapist, you have a crucial role in preventing, treating, and advocating for patients with dysphagia. By providing education, implementing evidence-based interventions, and collaborating with other healthcare professionals, you can make a significant difference in improving the quality of life for individuals struggling with dysphagia post-radiation.
Want to learn more about working with patient with Head and Neck cancer? Have a look at our fantastic and practical course, Upgrade your care plan: Head & Neck Cancer and take your treatment up a notch!
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