What can you do to take the Leadership Leap?


As May rolls our way, a new cohort of fresh-faced and starry eyed clinicians enter the workforce.  Whether you are a clinician preparing for your very first day of licensed practice, or a clinician getting ready for your 1000th Monday, it is never a bad time to think about what you can do to take a leap into leadership.

 

But ARC Seminars, I don’t want to be a Manager!

Worry not, fellow clinician.  Leadership and management are not synonymous! Not everyone is interested in management, and that is more than fair.  Managers have to really focus on the day-to-day, goal achievement, key productivity indicators and order.  Leaders, however, inspire others, motivate others, serve as a safe place for ideas and healthy conflict and really get to live in the “big picture.”  Good leaders are able to use their social capital to influence change, achieve goals, shift cultures and encourage movement. Leadership mountain Social capital is something leaders often gain naturally, but can be purposeful!  People tend to view those with high levels of professional competence, strong emotional intelligence, and great communication skills as leaders.  Sound like you? 

Okay, I sound like a leader for sure.  But what is Healthy Conflict? 

We can all agree, conflict can be really uncomfortable.  But, healthy conflict is a key part of any good team.  As new grads enter the workforce, there is bound to be conflict as the team dynamic naturally needs to reconfigure.  As a leader, you can make this healthy conflict by encouraging seasoned clinicians to embrace good change, and new clinicians to embrace wisened methods.  Change the culture of “criticism equals judgment” to “criticism improves my skills” and watch how quickly your team develops a strong, healthy bond!

& What do new grads have to do with leadership?

ARC Seminars may be a little biased in that we love students, and love to watch them blossom into new clinicians.  We are an education company, after all!  But beyond that, we want to encourage you to embrace the possibility of becoming a mentor to new peers.  For our OT friends, AOTA’s Mindful Path to Leadership Foundational Badging program really stresses the importance of mentor/menteeship and professional growth (plus, you can get CE through NBCOT!)  A mentee can be a great opportunity to self-reflect on your own practices, potentially improve skill sets you haven’t utilized in a while and gain new perspective! APTA has best guides for mentorship.  Also of interest, APTA has great resources for leadership development including the LAMP curriculum.  For our SLP buds, ASHA has a leadership development program & leadership academy!

I’m ready to take the leadership leap.  What’s next?

We love that for you.  We suggest taking a good look at what your professional goals are, and how those might look now that you’re being leadership-forward. leadership leap We love this professional development plan outlined on Indeed (and have done it ourselves too!).  Talk with someone you view as a leader professionally–how can you emulate the traits you admire?  Identify at least one challenge you can take on within the next half year, and make it big!  Join a new club or community–our CBIS Journal club is a great place to start!  And most importantly, just leap!

 

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Living with Brain Injury


Living with Brain Injury: A collection of insights we wish we had known along our journey with brain injury

“My brain is scrambled”, my husband sighs in frustration.

This is my cue to pause, step back, and reassess. Picturing Kyle’s overstimulated thoughts as a messy breakfast item is his lighthearted way of reminding me, “hey, I’m in here. I just need a little help sorting me out”.

While I would like to believe my work as an occupational therapist (OT) would make me a model spouse to a person living with a brain injury, I would be mistaken. Through assisting my husband with navigating living with a brain injury, I have gained small insights into caregiver burden, and grief that all the knowledge and training in the world cannot fully prepare you for.

Kyle is living with post-concussion syndrome (PCS- or mild brain injury) because of several concussions sustained during his time as a collegiate platform diver. PCS is a cluster of persistent symptoms a concussed person may experience, such as: problems with attention, memory, fatigue, sleep, headache, dizziness, irritability, or changes in mood or personality” (Kolakowsky-Hayner et al., 2010).

For those who experience a mild traumatic brain injury (mTBI), about 10-15% will experience any number of those listed symptoms chronically. Because these people may appear “normal” after initial recovery many struggle to manage the daily tasks and roles required for success in their environment.

In his junior year of college, Kyle sustained three concussions within roughly three months.

Initially he thought he had recovered, however, the repeated trauma within a short time frame left him with difficulty thinking, severe migraines, sensitivity to light, emotional instability, and difficulty managing his basic self-care. Life changed drastically. He medically withdrew from classes, moved back home for support, and began working with a concussion specialist. After several months of treatment and rest, he was able to return to school to finish his degree.  We got married, and started a new chapter in Tampa, FL. We both believed the worst had passed and things were “back to normal”.

living with brain injury

As life progressed, Kyle still endured occasional migraines, light sensitivity, and difficulties managing stress, but he was able to maintain a full-time job, a new role as a spouse, and engage in several sports related hobbies. Over a year after his presumed “recovery”, things began to change. The migraines became more frequent, his stress management was at an all-time low, and his short-term recall was getting increasingly worse.

For example, he would stare at the oven for several minutes knowing he planned to heat dinner – but was unable to turn it on to get started. Headaches and constant ringing in his ears would keep him awake for hours at a time, and sleep was very hard to come by.  He was emotionally withdrawing from daily challenges and would often catastrophize the most basic of problems. Fear that this was going to be our ‘new normal’ began to overtake us…

We decided to seek out medical management from a concussion specialist…again. After the initial shock of realizing we would likely be “managing” Kyle’s symptoms instead of “curing” them, we came to the realization we could make some small changes in our daily roles, routines, and communication to make a big impact on our quality of life.

living with brain injury therapyIn addition to Kyle’s regular visits to his concussion specialist, he also utilizes an acupuncturist, chiropractor, and photobiomodulation (lasers!!!) therapy for ongoing management of his PCS. At home, we began focusing on simplifying daily routines, lowering stress, focusing on overall wellbeing, and prioritizing communication. We were able to persist, but not without the help of our family, friends, and professionals who offered their continued support and guidance.  It truly does take a village.

Nearly a year later, Kyle is continuing to work full time, play recreational sports and is a proud new dog dad. While we continue to evolve, we have grown throughout this process (and probably will continue to).

We have morphed into better listeners, more supportive partners, and are increasingly empathetic towards the challenges of others.

We are strong in our belief that if we keep an open mind and positive outlook, we can continue to be successful in managing the daily challenges that Kyle’s PCS throws at us.

With all of this in mind, Kyle and I would like to share some of the lessons we have learned along the way. Our hope is to encourage, inspire, and empower persons with BI, their caregivers, and the professionals who are fortunate enough to work with them.  There is space within BI for joy, connection, humor, and growth. According to Kyle, “you can always see the light in every situation… even if you are photosensitive”.

Tips – and a few guiding thoughts:

Slow down

living with brain injury slow down

“It’s hard to explain that you’re confused about why you’re confused… it doesn’t make sense.”  During the several times discussing points for this piece, Kyle would mention how hard it is for him to explain his symptoms, their impact, and the toll they take on his relationships, roles, and self-worth. Our advice is to slow down. Slow down when things get tricky… when your person with BI becomes overstimulated, stressed, and runs into a “mental block”.

I often tell patients and family members to double the amount of time you usually need for a task after injury. You must drastically reduce your commitments, expectations, and daily goals to provide the time needed to best serve your person and facilitate success. This takes lots of practice and even more patience.

I particularly struggle with this since I like to set goals far above what even a neurotypical person may be able to complete in a day. Through mutual patience, reminders, and constant support from our loved ones, we continue to work towards a healthy balance of getting what needs to be done finished while pacing things to allow Kyle to be successful.

Healing is not linear

living with brain injury planning your day

Healing ebbs and flows.  One day may be 2 steps forward, while others may be one step backward. Kyle is at his best when he maintains a sleep schedule, exercises regularly, and has assistance with managing his daily stressors. I double check schedules, appointments, and provide reminders for various self-care things Kyle needs to do to keep moving forward.

With time, Kyle may need less support and oversight to be successful. One of the many things I do as a caregiver is to adjust the routine as needed to ensure Kyle’s success during the day. Each person’s brain is different, and every injury presents with unique characteristics that continually evolve as time marches on. What works for us may not for you, and that’s ok! A few strategies that have helped us along the way include checklists, identifying triggers that intensify symptoms, and limiting screen time.  Try ‘no TV Tuesdays’… it’s wonderful.

Ask questions, and advocate

living with brain injury advocate

Because people with BIs don’t have obvious physical signs, it’s important to recognize and advocate for your person. As Kyle’s mother best describes, “You feel completely discounted because people can’t see your injury. If you had crutches, you would give them a break.” While you do not need to go around shouting who has a BI from the rooftops (HIPAA, anyone?), it’s important that you educate, advocate, and openly discuss the challenges associated with BI as appropriate.

This could look something like researching public spaces with less stimulation or visiting at quieter times to reduce stress potential. It may also look like asking a restaurant manager for a quieter table, a doctor to provide a written copy of medical advice, or a cashier to be patient as you may need extra time to pay. In general, most of us want to be helpful to others and people do best when they’re well informed.  In those spaces that are not particularly comforting for a person with a BI, ask for accommodations – it can’t hurt!

It takes a village

Whether it’s a support group, online forum, or good friend who commits to regular coffee dates, finding support is key. Kyle finds support in mentors, his fishing and hockey buddies, and his most trusted friends. As a caregiver, I find mine in my sister, co-workers, and in reading other’s stories of overcoming and living with brain injury. Together, we find great comfort in our parents, spirituality, and our pets.

My mother-in law, Valerie, has been supporting Kyle’s recovery from day one. Her insights and encouragement help me to refocus on the important things by using her daily mantra, “we are choosing joy today”. Whatever support looks like to you and your person- find it, lean into it, and stay committed to investing in it. These will become the communities you cry with through hard moments and celebrate the victories.

 

Same team

It is easy as a caregiver to feel you need to micromanage each step of your loved one’s life. While this comes from a loving place, it is easy to get lost in this role and almost forget what your original purpose in the relationship is. Kyle often reasserts his independence in tasks when I rush in to “fix it” before he has even struggled. When it’s possible, let them try.

Allow self-efficacy – partnership and independence flourish within reasonable boundaries. We are thankful Kyle has recovered to the point of being able to work, drive, and function successfully within his roles with only minimal assistance, but we understand this may not be everyone’s story. We aren’t advocating for you to stop helping or supporting your person as needed, but we would like to challenge you to set goals toward the restoration of meaningful roles. This could look as simple as asking them to help fold the laundry, or as complicated as picking up milk on the way home from work. Show gratitude for the help they provide and remember you’re a team.

The ability to succeed alongside you will promote connection, confidence, and healing in all parties involved.

Put your own mask on first

You cannot help someone when you are not healthy. I cannot stress this one enough.  It’s hard to hear, and even harder to implement. As an OT, I work with family members and loved ones towards realistic plans for managing the burdens that come with caregiving. While caregiving can take any number of forms, one thing everyone has in common is the risk of burnout.

Initially when Kyle’s symptoms began to worsen, I put my own needs on the backburner.  I neglected both my physical and mental health and was not in a good place.  Several months ago, I went back to counseling to help me reorganize organize myself. We began our health journey, disconnecting regularly from screens, and decompressing from daily stressors. As a result of prioritizing my own health, and implementing one small change at a time, we are both better. I am better able to handle my own challenges while supporting his progress. Take the walk. Drink your water. Practice self-care and love. Ask for help when needed.

 

While living with brain injury is not something we would wish on any person, we are thankful for the lessons we have learned along the way. Finding joy and intimacy in each small moment and accomplishment has forged greater meaning in our relationships with each other and our support teams.

As Kyle continues his healing journey, we aim to grow in compassion, resilience, and understanding. We hope something from this piece may be helpful to you. We encourage you to use what is helpful to you and throw out whatever does not serve you.

 

Acknowledgement

This piece has been written in collaboration with, and inspiration from, my lovely husband Kyle:  who daily manages PCS… and being married to me. Both he does beautifully.

Hope Kennedy Blackwood;  MOT, OTR/L 

 


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CITATIONS

Kolakowsky-Hayner, S. A., & Reyst, H. (2019). Glossary. In The Essential Brain Injury Guide, Brain Injury Association of America.

Provisional Certified Brain Injury Specialization: 3 things Students Must know


You’ve heard of the Certified Brain Injury Specialist (CBIS) certification prep course ARC Seminars proudly offers – but did you know there was an option for students to get one step ahead in this credentialing process?  Read on for 3 things students absolutely need to know about the Provisional Certified Brain Injury Specialization, or PCBIS.

What is a Provisional Certified Brain Injury Specialization?

For students dreaming of working with the brain injury population in their future careers, the PCBIS certification is one way to get a huge step ahead

The Academy of Certified Brain Injury Specialists (ACBIS) has opened up this certification route to students with the hope that they will develop a strong foundation in addressing acquired and traumatic brain injury prior to entering clinical practice.  CBIS is a nationally recognized credential & immediately shows employers, fellow clinicians and patients that you have a vested and dedicated interest in the field of brain injury–the provisional certified brain injury specialist certification is a way for students do to the same!

Students who obtain PCBIS certification will need to obtain 500 hours, verified by a superior, of practice treating traumatic or acquired brain injuries.  These hours must be done within a three year period from the date of the original PCBIS certification.

Only Students are Eligible?  Is there a test?

Yes and Yes. Only students are eligible for the PCBIS certification. Not a student? Please check out Certified Brain Injury Specialization — available to practicing clinicians.  You must be enrolled in a graduate program for one of the following: allied health, psychology, pre-med or medical, special education, neurosciences or behavioral analysis/sciences.

The test is 70 questions, all multiple choice.  You get two attempts to pass within one year of the first attempt before you have to start the entire process over — including application.

Students – don’t wait! Download our Certified Brain Injury Specialist Starter Pack here and be one step ahead in the rehab game!

I’m interested — What should I do next?

Allison provisional brain injury certification and CBIS journal clubTake the first step in preparing for the PCBIS examination by registering for a prep course.   ARC Seminars offers a CBIS prep course — appropriate for our PCBIS examinees as well — with the added benefit of having a specialized CBIS trainer teaching the course!  Allison Frederick, our CBIS-T, has also worked on some amazing extras that you get as a part of the full course including practice quiz questions.

You can also purchase the Essential Brain Injury Guide through ARC Seminars solo if you are interested in studying alone (we’ll always be here when you change your mind).  Allison will help answer questions and provide guidance for the entire process so you can focus on learning and growing as a student clinician. 

If you have questions, or want to find out more, feel free to contact us here! We will gladly guide you along your path to becoming a go-getter, neuro-lovin’ clinician-to-be!


🧠🧠🧠 Obtaining your CBIS really sets you apart from your peers and show that you are committed to keeping your clinical skills with the ABI population sharp. It can inspire confidence in your patients and their families and give you the tools you need to assist your patients recover. Why not be as prepared as you possibly can be for whatever ABI can throw your way?   Also – it makes YOU more marketable, impressive and showcases your dedication to brain injury! 🧠🧠🧠

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Break into Bariatric Care: First Steps for Occupational Therapists


Occupational therapy is breaking into bariatric care, an area where we have been under utilized despite being well prepared to address the needs of the patient population.  Interested?  Read on to get those first steps underway!

Understanding the Bariatric Population

women facing away

The field of bariatrics focuses on the causes of, prevention of and treatment of patients with obesity.  The percentage of adult Americans that qualify as obese is nearing half as of 2018, contributing to a rise in public awareness about bariatrics.  

As practitioners, we are well aware that obesity is more than an excess of fat, and is associated with higher risk for serious medical complications including heart attack, stroke, high blood pressure and some cancers.  Patients living with obesity are challenged in many areas of life — some of which may not be as obvious to us as clinicians.

Recognizing Bias

Before breaking into bariatrics, we want to stress the importance of recognizing the bias and stigma associated with being an overweight person.  Understanding the lived experience of your patients will improve your ability to form a therapeutic relationship, create stronger plans of care & better improve carryover for goal achievement.

It has been shown that weight-related bias affects an overweight persons’ ability to procure goods and services at the same quality and access level as thin Americans.  Weight bias in healthcare is an issue that has recently come back into the spotlight as people share experiences of having their medical issues ignored or entirely blamed on weight alone.  This discrimination is not limited to primary care providers, as unfortunately occupational therapists like you and I have been found to carry implicit bias about weight.  Bias against overweight people has been shown to exist at the student level as well, suggesting it is not a behavior learned on-the-job or through work culture and a much further reaching issue.

Thankfully, there are tools available online to help identify our implicit biases & facilitate correction.  Take Harvard’s Project Implicit test here (be sure to select the ‘weight’ focus), Stop Weight Bias Organization’s weight bias quiz here, and check out other assessment and informational tools available from the University of Connecticut’s bias tool kit here.

Get one step ahead in the patient education game & upgrade your lymphedema skills!  Check out our bestselling Edema Management course

Understanding the Occupational Therapy Role

Now that you have background on obesity and tools to identify any harmful biases against the bariatric population, lets dive a little deeper into the role of occupational therapists serving these patients!

AOTA’s Bariatric fact sheet states that OT practitioners should focus on health promotion, disease prevention, adaptation, modification and remediation with this population.  Patients may require assistance for ADLs at baseline; it will be important to do a thorough evaluation and identify barriers to independence.  Is your patient limited by in-home mobility?  Can your patient successfully navigate getting in and out of the tub or shower?  Does stamina, balance or safety limit them in completing any tasks?

Graded tasks will be important for increasing activity tolerance.  An entire showering routine done in standing may be too physically taxing and too challenging for balance initially, for example.  Encouraging your patient to complete one portion of showering, let’s say hair washing, in standing to start and then finishing the activity while seated is a great way to grade the activity safely and still be challenging.

Education on coping mechanisms for stress management will be very important–especially for your surgical bariatric patients.  For patients that are battling food addictions, it will be important to learn to identify stressors and triggers and how to effectively navigate them.  bariatric occupational therapy

Independence with health management will be a wide focus while working with these patients as well.  A 2021 study found that lymphedema was present in over 50% of bariatric patients.  With this in mind, occupational therapy should include education and techniques for preservation of skin integrity and wound care – which are incredibly important for bariatric patients.  This, alongside the creation and promotion of a skin management routine will decrease the risk of your patient being derailed by a wound or infection.

Living well and self-advocacy are also key areas to be aware of – a person living in a larger body has many roadblocks to navigate, not least access to travel, medical compassion and understanding, insurance coverage, and psychosocial challenges. As an OT, we promote all around health and quality of life, and it is important to include empowerment as part of our plan. This may require self education and working with support groups and anti-fat bias networks, and presenting information relevant to whole health promotion to your client.

The role of Occupational Therapy in the sensitive and emerging field of bariatric care is a valuable one- and we can be at the forefront of helpful, practical health promotion across the spectrum.

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Have you heard? Occupational Therapy’s Value in Jail is Big News


The value of occupational therapy as a community-based service in jail settings is becoming better understood as more research becomes available.  Read up on what these services look like and why you should care…

Occupational Therapy in Community Services

Community-based occupational therapy services in jail is becoming increasingly common, especially as the body of knowledge focused on justice-based occupational therapy (JBOT) grows.  Occupational therapy is well equipped to address patients at a community level as the profession values and prioritizes addressing barriers to engagement, identifying causes of and solutions to occupational deprivation, advocating for access and occupational justice, and promotion of social well-being initiatives.  

Community-based occupational therapy addresses a wide variety of service recipients including families, people struggling with substance abuse, undomiciled persons, incarcerated persons, victims of domestic violence and more.  Geriatrics and mental health-focused community-based OT programs are most common.  Occupational therapy services based in the community are important for the continuum of care for patient populations who are underinsured, under privileged, and/or not appropriate for OT services in traditional clinical settings.

There is a very surprising link between TBI & incarceration…learn more in our CBIS credentialing course!

OT’s Role in Jail 

One important factor supporting occupational therapy’s presence in jail settings is that the USA has the largest population of incarcerated persons compared to other developed nations; this statistic indicates a systemic issue that requires advocacy and occupational-justice informed approaches.  Occupational therapy services are valuable in assisting preparation for offender re-entry into society as a productive member. 

Community-based occupational therapy services within jails may focus on addressing life, work and employment skills as well as psychosocial and interpersonal skills.  Occupational therapy services in jail also aims to reduce likelihood offenders will recidivate through introduction of positive coping mechanisms, awareness of community resources, and addressing mental health factors.

Value of Occupational Therapy Services in jail

Early studies show that participants of jail-based OT services find it valuable, especially when life skills including employment and coping are addressed.  This is important to recognize as it has been shown that offenders who are able to secure and maintain employment post-release are less likely to recidivate.  Many existing non-OT programs are talk-based and heavily theoretical in application; offenders are not given the opportunity to the practice hands-on application and understand applicability of material to their daily routines in the way that occupational therapy allows.  There is unfortunately still a gap in information regarding the effectiveness of occupational therapy services in reducing recidivism.

Where Can I Learn More?

value of occupational therapy

The University of Findlay in Findlay, Ohio is involved in jail-based occupational therapy research bodies and initiatives–they also host fieldwork rotations at the local jail.  Read their 2020 article describing the establishment and purpose behind these services & keep an eye out for future publications.

Dr. Jaime Muñoz of Duquesne University has several publications exploring and fleshing out the importance of OT in jail settings and justice-based occupational therapy (JBOT).  Check out his university profile here to learn more.

St. Louis University (you may have used/heard of their SLUMS assessment) hosts JBOT newsletters and information and seeks to build a collaborative network for JBOT practitioners.  Check that out here

 

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Shoulder Subluxation and Stroke: Can These Three Methods Save a Shoulder?


Shoulder subluxation after stroke can be quite puzzling for therapists to treat.  Can these three treatment methods save a shoulder?

How a shoulder subluxation rears its ugly head can vary greatly–it may develop more quickly with some patients than others, it may be painful or even go completely unnoticed.  As therapists, regardless of the how or when, we consistently try to prevent shoulder subluxation from happening and reduce the severity if it does happen… but are we truly being effective? 

Should we be grabbing that sling to support their shoulder?  Does e-stim help reduce the degree of translation? Is taping effective for prevention?  Let’s dive in and strengthen our evidence-based application.

For strategies on how to help your patients maintain dignity and respect when dealing with dysphagia after stroke, download our ‘Say This, Not That’ handouts here!

Why does Shoulder Subluxation Happen?

shoulder subluxation

Glenohumeral subluxation happens in up to 81% of patients post-stroke.  The shoulder joint is multiaxial and has three degrees of freedom–flexion/extension, abduction/adduction, and internal/external rotation .  The joint relies on the rotator cuff musculature–supraspinatus, infraspinatus, teres minor and subscapularis– as well as other surrounding musculature to keep everything aligned and to give the joint the ability to have smooth and efficient arthrokinematics. 

During the initial period post-stroke, when the affected side may be flaccid, the rotator cuff musculature is not able to provide the stability it normally does to the joint.  This instability combined with the pull of gravity and improper positioning can lead to lengthening of tissues and the separation of the humeral head from the glenoid fossa, also known as a subluxation.

Flaccidity is not our only enemy when it comes to developing a subluxation.  Even if your patient has some degree of active movement in their affected arm, spasticity can also be a factor in developing a subluxation as it often creates a significant imbalance in the movement patterns of a joint or limb.  If the spasticity is strong enough, it can even pull the humerus out of alignment.  

Subluxation may also be influenced by other predisposing factors, according to some research.  One study found that “subluxation occurs more frequently in patients with a known presence of fluid in the subhumeral and subdeltoid bursae and in patients with reduced functional capacity.”  This is interesting to think about and can lead us to the conclusion that there are multiple factors that can help us identify those who are at more risk of developing a shoulder subluxation… versus assuming the patient is at risk solely because they present with hemiplegia.    

What Interventions are Available…and What Do They Do?

Slings

Prevention & Management:  Slings are what we grab first, right?  In fairness, a sling or orthotic has been shown time and time again to be effective at reducing shoulder subluxation while it’s in place and worn correctly.  But there is no evidence that using a sling can prevent a shoulder subluxation from happening or that it can have a long-term effect on the reduction of an already existing subluxation.  One study compared 3 groups (2 with sling and 1 without sling) and found that shoulder subluxation seemed to reduce over time in the group of patients who did not wear a sling. This information alone should make us rethink our ‘one-sling-fits-all’ mindset!

Clinical Application:  It goes without saying that more research needs to be completed (as with many areas of practice), but we should always be striving to tailor our choice of interventions, so they are specific to our patient’s needs.   In the case of a sling, there is still a useful application even if it’s not going to make a difference in the degree of shoulder subluxation.  A sling could be beneficial in protecting your patient’s limb during transfers, or it may be helpful in reduction of pain associated with subluxation.  But if there is no pain and the limb seems to stay in a good position during functional mobility…leaving the sling out of it may be the way to go!


Taping

Prevention & Management:  There is minimal evidence clarifying whether taping is effective at prevention of shoulder subluxation, but there is plentiful research that indicates that taping methods–both kinesiology and inelastic tape–can reduce present shoulder subluxation and reduce pain associated with it.  Other studies found that while unable to prevent subluxation, specific techniques have been found to result in improvements in shoulder flexion and proximal arm function.

Clinical Application:  With taping showing consistent results in the reduction of shoulder subluxation and pain, this should be a staple in your stroke rehab toolbox!  There may be a few reasons you wouldn’t move forward with this, such as patients with fragile skin or sensitivities to adhesives, but with the equipment being both inexpensive and accessible… we need to be moving our thoughts away from slings and more toward taping!


E-stim

e-stim unitPrevention & Management:  Some studies have shown that e-stim combined with other treatments or approaches has been effective in preventing and reducing subluxation in the acute phase of stroke but has not been effective in the chronic stage.  

Clinical Application:  Therapists have been using e-stim for many different indications for decades and we all know well that parameters matter if you want to achieve a specific purpose or goal.  The main consideration for e-stim with shoulder subluxation is timing!  If we can provide this treatment early in the patient’s recovery from stroke, we will have a better chance of preventing and managing shoulder subluxation.  If you can utilize e-stim during the acute or subacute phases in stroke rehabilitation, go for it!  


Where Do I Go from Here?

Make sure to look at your patient as a whole and see what they specifically need in their plan of care–a blanket plan of action will not be as effective as a patient-centered plan of care.  If you are treating your patient in the acute or subacute phase of stroke rehab, e-stim may be a great starting point as a preventative measure.   If shoulder subluxation is unfortunately already present, taping would then be a smart move to prevent further separation & pain prevention.  If that limb looks unstable during transfers or is causing high pain–it may be time to consider our old friend the sling. 

So, it’s all about being up to date with the latest research in combination with the clinical presentation and needs of your patient–if something is not working well enough to meet their needs, do not be afraid to move on and try something else!

 

If you are interested in learning more about Stroke Rehab and upgrading your practice, check out our fantastic, 7 Contact Hour course, In-Patient Stroke Rehab: 14 strategies to get your patient HOME!  to get great techniques and tips to get your patients back to where they want to be: back home!

 

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Self Care and Dementia: 5 Steps to Promote Agency


Completing self care activities including dressing and bathing can be a stressful and frightful experience for the patient with dementia.  They are exposed, potentially in an unfamiliar environment and all too often being made to follow the lead of another person.

Let’s talk about 5 steps we as practitioners and caregivers can take to promote the agency and independence of the patient with dementia–improving their experience and yours all at once!

1 – Prioritize and promote their ability to make decisions

Giving your client agency on choices will help associate your assistance–and the completion of self-care tasks overall–with a positive emotion.

Yes, this means taking the hard no or modifying your expectations for completion of the bathing and grooming task.  While it may not be ideal, completing even a small part of a bathing routine 

If your person is able to, giving them simple choices will make them feel more in control over the task overall and decrease feelings of being tricked or controlled.  Simple choices like what soap to use or if they want to wash their hair or body first will help your person feel more autonomous.

To read more about intervening and helping your patient with dementia manage distressed behavior, check out this article!

2 – Lean on old habits

Your person may have a preferred routine for how they wash themselves or complete a grooming task–like brushing their teeth before they wash their face, or always bathing in the evening versus the mornings. 

 Using these routines and habits to your advantage will decrease the likelihood that your person will feel unsafe, frustrated or frightened and potentially decrease the amount of assistance of cues they require to complete grooming/bathing.

Again, this returns as much control to your person. 

3 – Protect privacy

Try to have a familiar caretaker or preferred provider assist with bathing when possible to reduce feelings of being exposed.  Self care for those dementia can be made easier if there is a safe relationship already established with a trusted carer.

Keep towels on-hand for them to cover up with if they find that more comfortable

Be sure they have access to washcloths and towels in-hand while assistance is given so they can participate and/or cover up.

4 – Minimize steps when possible

Minimize steps with 2-in-1 shampoo/conditioners or body wash/shampoos.  This will reduce the amount of time spent on the bathing task overall

Reduced steps also allows your person to have more autonomy over completion of the task with potentially fewer cues for completion–setting them up for success.

Grab this handy self-care checklist to help with communication when working with your patients with dementia!

5 – Address potential fears to increase willingness

Knowing your person well will be a major strength in identifying what potential barriers or causes of fear may be ahead of time.

For example–It is not uncommon for people with dementia to have fear around stepping into a tub of water; ways to work around this potential barrier would be filling up the tub while your person is already there, using a shower hose or taking sponge baths.

Learn More with ARC Seminars!

Undoubtedly, promoting agency with people with dementia can help patients live safer, more comfortable, and more independent lives. Visit ARC Seminars today to learn how we empower clinicians to treat intimidating conditions like dementia and more!

Plus, register for our self-paced seminar ‘Settled and Secure’: Managing Challenging Behaviors Associated with Dementia to access applicable techniques and skills for engaging with patients, building rapport, and fundamentally improving the way you work with clients.

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Heterotopic Ossification: Why Therapists Need to Know HO


Heterotopic Ossification can be confusing, misunderstood and underdiagnosed in sensitive patient populations including TBI, SCI and ortho. Learn why HO is not your average diagnosis and what you can do to protect your patients.

Why Therapists Need to Know Heterotopic Ossification

stretching to prevent heterotopic ossificationAbnormal bone growth in non-osseous tissues like muscle and other connective tissue?  It sounds like a sci-fi phenomenon that one would only encounter in a movie or on some dramatic medical television show.

In reality, heterotopic ossification (HO) occurs in 10-20% of patients with severe trauma and insults to the central nervous system (CNS), and 20% of people with severe brain injury.   That percentage can climb up to as high as 50% if there is severe brain injury and concomitant femur fracture.  Patients with brain injuries are at greater risk for developing heterotopic ossification if they have significant spasticity in the involved extremity, unconsciousness lasting longer than 2 weeks, long-bone or associated fractures, and decreased range of motion (ROM).

The risk of development of heterotopic ossification in a patient with brain injury increases as the severity of injury, length of immobilization, and duration of coma increase.  The incidence of HO. in military amputees related to conflicts in Iraq and Afghanistan has been found to be as high as 65%.  HO poses a threat to the integrity of wound healing, rehabilitation, and prosthetic fitting.


What Exactly is Heterotopic Ossification?

 HO is essentially bone growth in tissues like muscle and other connective tissues. Several terms have been used to describe the condition, including heterotopic ossification, ectopic ossification, and myositis ossificans .  HO is usually induced by fracture, burn, neurological damage including brain and spinal cord injuries and joint replacement.

Patients with HO experience swelling of tissues, inflammation, pain, limited motion and joint adhesion.  HO can be further specified into three categories:  myositis ossificans progressiva, myositis ossificans circumscripta without trauma (also known as neurogenic HO), and traumatic myositis ossificans.

Myositis ossificans progressive:  a rare metabolic bone disease present in children with progressive metamorphosis of skeletal muscle to bone
Myositis ossificans circumscripta without trauma:  also known as ‘neurologic heterotopic ossification’ localized soft tissue ossification occurring after neurologic injury or burns

Traumatic myositis ossificans:  occurs from direct injury to the muscle; fibrous, cartilaginous, and osseous tissue near the bone are affected and the muscle may not be involved.

For purposes of this article, we’ll be focusing on the latter two types of heterotopic ossification.


How is Heterotopic Ossification Diagnosed?

Not all people who experience trauma or severe brain injury are going to develop heterotopic ossification, however it is important as a clinician to know the signs and symptoms.  This will ensure early intervention for services rendered, preventing additional loss of function and interruption in therapeutic services. It is important to note that 75% of post-traumatic HO was diagnosed in the rehabilitation unit.

If you work in inpatient rehabilitation, you know that someone’s time there is both limited and precious–something like a missed heterotopic ossification diagnosis can completely derail your patient’s rehabilitation course.  Learn more about 14 Strategies to get your CVA patient home quicker!

The first signs and symptoms of heterotopic ossification are reduced joint ROM and painful ROM testing, swelling, erythema, and contracture formation.  In people with severe neurological impairment, other signs including autonomic dysfunction and local inflammation in addition to ROM should be considered.

Local pain and a palpable mass may be present one to three months post-injury, however in severe brain injury, HO may be present up to seven months post-injury.  Things like laboratory tests, radiology studies, and bone scans should be utilized to accurately confirm an HO diagnosis.

heterotopic ossification labs

Lab Tests:  Alkaline phosphates should be measured, as there has been shown to be a correlation between a rise in levels and level of ossification. There is also evidence supporting that when alkaline phosphate levels return to normal, ossification will have stopped.

Radiology:  X-rays will not show HO in the acute phase of inflammation when there is still active pain and swelling.   X-rays taken 4-5 weeks post injury will begin to show immature ossification and possibly mature bone growth.  It can take anywhere from 8-14 months for HO to reach full maturity, so repeat imaging may be in the patient’s best interest if HO is suspected.

Bone Scans:  Triple phase bone scanning has been the most effective diagnostic method for early detection of HO as it detects early increases in vascularity.  The first and second phases of the triple-phase bone scan show increased uptake. Areas demonstrating increased blood flow and soft-tissue concentration of the tracer on early imaging (blood flow phase) correlate with sites of subsequent HO development. The optimal timing of the imaging for accurate assessment of the presence of ectopic bone has not been established, but 3 weeks or more following the injury should be sufficient for early detection (Bruno-Petrina, 2021).


How is Heterotopic Ossification Treated?

Therapy’s role in the management of HO is challenging and somewhat ill defined.  The goal of HO management should be to maintain ROM in order not to lose any function.  The literature generally supports the common use of active ROM exercises and gentle, passive ROM exercises to maintain available joint motion and to avoid progressive contractures.

There has been no evidence found for increased HO or decreased ROM with passive ROM exercises.  Surgical intervention can also take place to remove the abnormal bone growth if it is severely impairing functional mobility, but it is recommended that take place approximately 18 months post injury.

Can Heterotopic Ossification be Prevented?

learning about heterotopic ossification

The short answer is possibly.  (Per Sun in 2021) Prevention involves identifying patients with high risk of developing HO. It is important to note that routine prevention on all patients is not recommended. Current recommendations for prevention of HO are gentle ROM exercises, pharmacologic agents (indomethacin and etidronat), and external beam radiation (which is primarily used after joint arthroplasty).

Management of risk factors, such as spasticity, is also incredibly important. NSAIDS are thought to reduce the inflammation around joints which could prevent the development of HO.  Indomethacin is the most commonly used NSAID for prophylaxis, with other effective NSAIDS being meloxicam, celecoxib, rofecoxib, and ibuprofen. Etidronate is a bisphosphonate–a type of drug that slows bone loss–that has been approved for prevention of HO in spinal cord injuries and complications of total hip arthroplasty.

How Can I Improve my care for Patients with Heterotopic Ossification?

Be well informed--especially if your setting has patients who are at risk of developing HO–it puts you one step ahead if you are up to speed with the potential complications that can occur with a particular patient population.  Seeking out meaningful continuing education and collaborating with the interdisciplinary care team is a great way to stay on top of the most recent developments in HO treatment.

If you feel a patient is meeting the criteria for development of HO or is beginning to display early symptoms, speak up!  Speak with the physician regarding your concerns and ensure you bring the data with you to validate your claims.  It cannot be stressed enough that the best treatment for HO is prevention–prevention of the abnormal bone growth as well as prevention of  any further physical complications if the bone growth occurs.  Advocate for your patients, and educate your fellow staff members & fight back against HO.

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Fall Prevention: It is So Much More than Rug Removal


I’m definitely not saying rugs aren’t public enemy #1 when it comes to fall prevention–in fact my peers have joked before about my personal vendetta against the throw rug.  But fall prevention is a much bigger issue–falls are the #1 cause of injury, hospital visits due to trauma and death from injury among people 65 and older.  It’s time we take fall prevention one step further (but seriously, get rid of those throw rugs, people).

Falls are a Serious Cause of Injury

Especially if you’re working with geriatric populations. It is estimated that in a year, one out of every three older adults will experience a fall per year and that every ~11 seconds, an older adult in the US will be treated for injuries related to a fall.  Falls result in almost 3 million injuries treated in ED’s annually, including over 800k hospitalizations and 27k deaths.  If all of this wasn’t enough to stress the severity of falls–they also account for 48% of all acquired brain injuries. There are losses associated with falls that aren’t represented in many data points that are important for practitioners to be cognizant of– loss of mobility, independence, functional decline, mental health and overall quality of life–all things we aim to prevent or protect for our patient populations.

Well that’s intimidating—Who specifically is at risk for falls?

Is it helpful if I say everyone?  On a serious note, it is important to recognize that not just elderly people are at risk for falls.  People challenged with low vision, polypharmacy, balance and gait issues, and any impaired memory or mental status are all at increased risk for falls both within the home and community.  It may seem obvious that people with a history of falling are at increased risk–but even the first initial fall doubles the likelihood of subsequent falls–so it is worth the mention.  People with ill-fitting footwear are also at an increased risk for falls, so be sure to exercise extra caution with your slipper-loving patients.

Check out ‘Slippin’ on Slippers: How to reduce falls through footwear’ to learn more about footwear’s role in falls!

Fall Risks Within the Home

It can be terrifying for patients to consider the possibility of falling within their home–what is normally a safe space for them is suddenly a potential danger.  For good fall prevention interventions within the home, it will be important to empathize and respect your person’s potential hesitancy to make changes.  After all, if someone came into my home and tried to tell me my Target haul of decor was a potential safety hazard, I probably wouldn’t invite them back.

For fall prevention within the home, generally you will want to be sure that paths, stairways and any thresholds are clearly lit, secure and free of clutter.  If there are concerns about low vision or impaired perception, contrasting colored tape can be used to mark steps and thresholds.  Bilateral, sturdy handrails are ideal for any stairs or inclines.  Encourage your patients to reduce or eliminate floor clutter including shoes, decorations, power cords and the like.  Poorly lit areas and low-visibility areas like a tight bedroom space also present a fall risk.  Encourage your person to consider properly installed grab bars in the bathroom and educate them on safe use.  And it almost goes without saying–those loose throw rugs are a huge fall risk and should be secured down at all edges if your person is unwilling to part with them.

Fall Risks Within the Community

Falls within the community are difficult to track and therefore underreported, however people with good community mobility are naturally at a higher risk for outdoor and community falls.  Uneven pavement on sidewalks, lack of sidewalks or interruptions in sidewalk continuity and sloped surfaces are potential sources of falls.  Areas with poor lightning, poor drainage and potential for ice also increase the risks for community falls.  If you are working with a person that is an active driver, consider referring them to the CarFit program and ensuring their balance is strong enough for getting in and out of their vehicle.  Balance will be an important area to look at for persons mobile at the community level–looking at you, uneven sidewalks–to be sure they can navigate walking spaces that are not necessarily the safest.  Footwear with proper fit and traction for grip will also help reduce the likelihood of a slip and fall.

 

 

Assessments for Fall Prevention

There are a plethora of outcome measures for use to determine a persons’ potential risk of falling–check out these two resources here & here for some great measures.  These outcome measures should always be used in combination with skilled observation and clinical judgement in order to best determine someone’s fall risk and preventative steps to take.  Having a strong understanding of your person, their habits and lifestyle will aid you greatly in enacting fall prevention measures.

What fall prevention interventions can I use?

It goes without saying that your interventions should be tailored to the needs and priorities of your person, so keep that in mind while we suggest the following starting places.  In addition to the aforementioned education & environmental modifications, there are a few great interventions to check out for fall prevention.  Primarily, recognize that there is a way to fall right.  Reviewing and practicing with your person how to fall correctly, get up from a fall and ways to protect their body best in case of a fall is an excellent harm reduction method.  This can take some of the fear out of the potential of falling and empower your person to feel more secure in their ability to recover safely should a fall happen.  Reactive balance training can be a great way to improve your person’s ability to recover their balance and prevent falls in addition to strengthening full-body.  In addition to this, balance rehabilitation approaches in general are always a key intervention point for fall prevention.

Okay, I got it. Fall prevention is serious and not just limited to in-hospital and in-home measures…where can I find more information?

Thrilled you asked!  The National Council on Aging has amazing resources & educational information valuable for both clinicians and families.  USC Leonard Davis school of gerontology has excellent resources including state-specific links, considerations for patients of different ethnic backgrounds and economic backgrounds, and fantastic resources for home modifications.  They host an expert in home modifications for fall prevention monthly, so be sure to not miss out!

Learn More About Practical Aspects to Fall Prevention ?

At ARC Seminars, we’re here to empower clinicians to treat intimidating conditions. To continue your education and further develop your skills to treat patients with the best care possible, register for our self-paced webinar Update Your Care Plan: Balance Rehab today!

Interested in more clinical tips, articles, and resources for your practice? Sign up for our bi-weekly mailing list below! We promise to treat your inbox with the respect and love it deserves.

Top Tips for Preventing Hospital Readmission


How Nurses Can Help Reduce Hospital Readmissions

Reducing hospital readmissions is not only better for your patients’ health—it can also prevent your healthcare facility from facing financial penalties. Fortunately, there are many ways nurses can help reduce hospital readmissions. Read on to learn how to better assist your patients with our tips!

Key Strategies for Preventing Hospital Readmission

Assess Physical Function & SDOH Barriers

Assessing patients’ physical function thoroughly before discharging patients is the first step in preventing hospital readmission. After a proper assessment, you’ll be entirely sure that your patients are ready to leave the facility.

Additionally, you must account for potential social determinants of health (SDOH) barriers before discharging patients from the hospital. SDOH barriers, such as transportation access or housing instability, are common causes for hospital readmission. Understand your patients’ living situations and needs and make a comprehensive plan tailored to patients’ risks before discharging them.

Grab this Free ‘Care Approaches’ Cheat sheet to enhance your dementia practice!

Educate Your Patients

Patient education also goes a long way in reducing readmission. It is essential to make sure patients understand their conditions, know how to communicate their needs, and are informed on future health precautions and needed treatment. This education should start while the patient is hospitalized and continue throughout their treatment and beyond.

Plan for Post-Acute Care and Rehabilitation

Finally, successful and thorough transitions of care are critical in reducing readmission. Patients having access to comprehensive rehabilitation services promptly and consistently after being discharged is also integral to reducing readmission.

When implementing post-acute care (PAC) and rehabilitation strategies, make sure all of your patient’s care team are informed on the patient’s needs, risks, medication safety, and any other information needed to keep your patient safe and healthy. Communication between the PAC provider and the initial provider is vital for PAC success and hospital readmission prevention.

Consider Telehealth Services

Monitoring and manipulating patient data in a streamlined way, such as with a telehealth service, can help keep track of patients’ health and progress and alert you of any issues before readmission becomes necessary.

Communication with patients is key to reducing readmission, which is another reason why telehealth or other encrypted and secure communication services can help open lines of communication and maintain consistency in provider-patient communication. Choose a system that works for your facility’s and patients’ needs. Think about your patients’ age, abilities, and access to technology when choosing a telehealth or communication platform.

Implementing Strategies

While each of these tips can help reduce hospital readmission in your patients, implementing several readmission reduction strategies in conjunction further increases your success. When used together, your facility will see a lower frequency of readmission than just implementing one strategy at a time.

Grow Your Skillset with ARC Seminars

Understanding the leading causes of hospital readmission and educating yourself on successful strategies for preventing readmission are critical in providing your patients with the best care possible. Care doesn’t end when your patient is discharged, and ensuring your patients’ long-term health and safety are paramount to being an effective healthcare provider.

To continue your understanding and education on best practices for decreasing hospital readmission, register for one of our courses or one of our self-paced webinars today!

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