What Does It Feel Like To Have Post-traumatic Stress Disorder?


Working in rehab, as a therapist, means that we often meet people who have very recently gone through a life changing, shocking event – like an accident, stroke, Brain injury – or other scary, unplanned event. We may also meet people who have had chronic low-level trauma throughout their lives, or who are having to adjust to a new life or way of living.

And, although we are used to treating these clients for the symptoms of their stroke/TBI/multi-trauma accident -we may not always consider the implications that the trauma has on their psyche.

An awareness and sensitivity to PTSD is helpful to us therapists who are in acute and post-acute care. Not only can we be mindful of issues that we can pick up on quickly, we can also use the knowledge to enhance our treatments and our therapeutic rapport.

So with that in mind, let’s take a closer look at PTSD with this article guest written by the team at Take A Seat – therapy services.

What is Post-traumatic Stress Disorder?

Post-traumatic stress disorder is a psychological disorder that occurs in people who have undergone a traumatic event like an earthquake, terrorist attack, war or rape, etc. It was known as shell shock during the days of World War 1 and combat fatigue after World War 2. PTSD can occur in people of any ethnicity, religion, culture, or age.
However, PTSD does differ in males and females. Women are more susceptible to PTSD. People with PTSD have a pattern of thoughts related to the incident, which makes them anxious, fearful, and detached. They might go through the pain of the incident again through nightmares.

Symptoms and Diagnosis

In psychological terms, a condition has not termed a disorder unless it fulfills all the symptoms criteria and the period for them. Some prominent symptoms of Post-traumatic stress disorder are given below;

  • Intrusions; the victims repeatedly see the same incidents in dreams or routine while sitting idle etc. The flashbacks are intense, like the incident plays in front of the patient’s eyes like a movie.
  • Detachment; the patients tend to avoid people related to the incident even if the link is not direct. Looking at those familiar faces reminds them of their pain and misery.
  • Change in mood; it would not be wrong if we say PTSD change the behavior and attitude of a person to a great degree. They forget some significant part of the tragedy and frequently have negative thoughts about themselves. In some extreme cases, the victims start blaming themselves and often wrongly accuse someone.
  • Change in response; the victims have a 360-degree change in their behavior. They have irritable nature and might have anger outbursts over minor problems.

For a person to have PTSD, these symptoms must have an age of at least a month. We can only describe it as a disorder and start the treatment to improve the victim’s behavior.

Treatment

As it is a psychological issue, PTSD are treated by psychotherapy, specifically CBT. Cognitive behavioral treatment involves the deepest secrets of unconscious and conscious memory. Hormonal imbalances may also be addressed prior to the initiation of psychotherapy, for best outcomes.

Psychotherapy prepares you to deal with life post-trauma with strength. However, completely getting over the therapy experience from familiar counselors can be very beneficial. They add positive energies inside you and help you escape the experience’s dark memories.

Nowadays, therapies are available online at the person’s convenience – although for inpatient rehab there may be a psychiatrist on board who may assist with adjustment and PTSD issues. Many  therapy sessions are conducted online for people who have a problem stepping out of their homes or other issues. Finding an online therapist may be a suggestion that, as a clinician, you can make for your patients.

Medication

As mentioned earlier, if the PTSD has gone to an extreme level, a psychiatrist is referred for the hormones controlling brain activities to be kept under control. The psychiatrist prescribes certain medicines that would calm the mind and reduce the intensity of other psychological issues that might have damaged the patient’s mind.

Patients with PTSD are given antidepressants such as SNRIs and SSRIs. Other medications include a controlled dose of sleeping pills, antianxiety, and medicines to elevate peace so that the patient’s mind can rest from the constant worries and pressures.

Therapy for patients with PTSD

Patients with PTSD undergo a lot of pain that others cannot see or understand. The tragedy takes away the joys from their life and a part of their personality with it. They look for someone to whom they can rant their frustration, speak and cry their hearts out.

Psychologists do help them stabilize, but their profession does not allow them to be an emotional support to the patient. Specific therapy centers with alternative therapists can support patients with PTSD, and alternative therapists provide counseling outside the barrier of mental health sciences. Patients may find it much easier to connect to them than other health care professionals. You can find many online therapists in UK that have a commendable professional background and would help you move on from the trauma quickly.

Conclusion

Each therapy has its benefit for treating Post-traumatic stress disorder. Only if all three possible practices, psychotherapy, treatment from a psychiatrist, and alternative therapies, work together the treatment of the condition can be made 100% efficient.

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Mirror Therapy for Successful Rehab: You Might be Missing the Bigger Picture


Whether you’ve used it in your occupational or physical therapy practice, seen it in an article or heard about it on television, the words “mirror therapy” likely aren’t unfamiliar to you.  But unless you’re a therapist with all of the answers (and if you are, please reach out to me. I have questions) there’s a good chance you’ve had less than amazing success with this technique or are just fuzzy on the details for using it.  I mean, the concept is great, right?  But when you get to the nitty gritty…how and why does this technique work?

 

Mirror Therapy is just one aspect of something called Graded Motor Imagery

Graded motor imagery is a rehabilitation program that has been shown to be effective in treating complex/chronic pain and movement issues including stroke.  It is broken down into three aspects – laterality, explicit motor imagery, and (you guessed it) mirror visual feedback (better known as mirror therapy). That’s right – if you’re trying mirror therapy & not seeing results, it might be because you’re missing the other two pieces!  This top-down treatment approach aims to normalize central processing, correct cortical changes that occur secondary to complex and chronic pain, and decrease the patient’s experience of pain with the added benefit of normalized movement patterns.

Looking to dig deeper into stroke rehab techniques? Look no further…

Defining Laterality

This is left versus right discrimination.  Research has shown that people experiencing pain have decreased accuracy when identifying an image or body part as being right versus left.  As you may have seen in practice, patients with neglect are often challenged to correctly identify their left side versus right side or to attend to task items on the left versus right.

  • You can assess your patient’s skills with laterality by asking them to identify their own body parts as right versus left, images of body parts as right versus left, and ability to  locate right or left task items correctly when cued.
  • Laterality cards showing images of right and left body parts can be correctly identified and sorted – upgrade this activity by requiring increased speed.  Be sure to mark how many your patient was able to sort correctly and how long it took them as this makes a great goal!

 

Explicit Motor Imagery

This is creating a clear mental picture of a movement or activity – actively envisioning the affected body part completing without pain or restriction.

  • This step has been postulated to activate mirror neurons – these neurons help us learn through observation and imagination and have been even shown to activate with auditory cues!  This is thought to stimulate the motor cortex in a meaningful way – almost as if the movement was actually occurring successfully and without pain.
  • Have your patient imagine a very particular task – you can assess their skill with this by asking them to verbalize what they are envisioning with detail.  Demonstration may be effective for your patients here as well to help them independently envision the task at hand.

Mirror Visual Feedback

(Mirror Therapy) Using a mirror to “trick” your brain into thinking the affected limb is moving without pain/restriction by moving the unaffected limb. This is most effective if the affected limb is moving as well.

  • Begin with having the patient observe their functional limb complete a movement or task through the mirror.  If the patient is able to do this without pain or discomfort – progress to moving the affected limb while looking at the unaffected limb in the mirror.
  • This aspect of graded motor imagery is thought to provide strong sensory input that reteaches the brain how to move without pain or limitation.

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Deaf Awareness Week: How Clinicians Can Do Better


Deaf and HOH patients are often dissatisfied with their healthcare & are more likely to have poorer outcomes than hearing individuals. What can we as clinicians do to provide better care for this patient population?

Understanding Your Patient Population:

There are multiple different hearing statuses & understanding this is important when creating plans of care. “Hearing” is defined as hearing thresholds of 0-20 dB or better in both ears. Over 15% of the US population does not meet this threshold for hearing. In other words, you will have patients with barriers to hearing – but you’ve likely already encountered them!  Knowing the preferred terms “d, Deaf , HOH , DHH” versus those which may potentially be offensive such as “hearing impaired,” “disabled” and/or “deaf & dumb,” etc. is crucial.

Awareness: Deaf vs. HOH vs. Deafened Individual

“Deaf” usually means a person has little to no functional hearing, which may be referred to in the medical community as “profound deafness.”

d/Deaf (lowercase d vs. capital D) is a cultural topic within the Deaf community. Being familiar with this distinction can show your patients you know about and respect their culture. In my own practice, I use lowercase d, deaf when referring to the audiological condition of not meeting the 0-20dB hearing mentioned earlier. When referring to my patients who are a part of the Deaf community, I use the capital D, Deaf because I feel it shows respect and admiration for the Deaf community which I have been welcomed into.

“Hard of Hearing/HOH” typically means the patient has some residual hearing that may be amplified with devices. Keep in mind that just because the residual hearing may be amplified with devices, it doesn’t necessarily mean the patient will choose to do so.

“Deafened” individuals experience a change in or decline of hearing due to a particular incident or over time, typically after initial language acquisition. This population is less likely to identify with the Deaf Community–they may prefer lowercase deaf, or they may not be familiar with the distinction at all. Therefore, they may prefer reading/writing to communicate in the healthcare setting. This population may also use the term “late-deafened.”.

DHH or D / HH= Deaf / HOH

“Hearing impaired”, although previously a preferred term, can be considered offensive, as the verbiage implies the patient is less-than/impaired vs. patients with full hearing. Similarly, “hearing loss” is not a preferred phrase either.

People who are born deaf may not feel as anything has been lost since they never had hearing. Some people do not view their deafness as a loss because they have gained an identity and culture as part of the Deaf community.

It is not a reflection on intelligence or ability, and using these terms implies otherwise.  “Deaf & dumb” is, as you can imagine, an offensive term … yet it is still one I have heard from colleagues in practice. It is outdated, offensive  & inaccurate, and clearly should never be used. Likewise, “deaf-mute” is also offensive as it implies that these individuals do not have a voice/a say/an opinion.

Persons who are born deaf or lose hearing before language acquisition are more likely to use a non-verbal language such as American Sign Language (ASL) or Signed Exact English (SEE). It is best to ask a patient what forms of communication they prefer you to use, much like how you would ask about patient pronouns or preferred ways to be addressed, as there will always be  patients who are exceptions to the above statements.

Dedicated to promoting your patient’s agency?  Check out these 5 steps to promoting agency for patients with Dementia

Deaf Awareness Healthcare Facts:

Deaf/HOH patients are less likely to present to primary care for non-urgent care, less likely to attend routine or follow-up visits, and are more likely to have comorbidities or poor health outcomes than hearing patients. This could be the result of various factors – not feeling well-connected or well-understood by their providers, fear of not having an interpreter readily available/having to wait hours for an interpreter to arrive, or lack of understanding of plans of care due to inadequate communication from providers, to name a few.

Other factors that may be contributing to Deaf and HOH patients’ statistical likeliness to have poorer outcomes compared to their hearing counterparts are as follows:

Involvement & Immersion into the Deaf Community

The best way to be an advocate for any patient is to be as informed as possible and create meaningful connections with them. Immersion is a great way to learn the values of any culture, not just Deaf culture! It also provides opportunities to practice your signing. Below is a list of local organizations & resources to get involved in the Deaf community in and around South Jersey.ASL deaf alphabet

  • Deaf and Hard of Hearing Coalition of South Jersey – part of Allies in Caring, this organization is committed to supporting, empowering, and connecting the DHH community in South Jersey – more information available at https://www.alliesincaring.org/sjdhhc
  • Deaf Events on Facebook – NJ Deaf, Deaf and Hard of Hearing Coalition of South Jersey, Atlantic County Society of the Deaf, Deaf Night Out New Jersey
  • National Association of the Deaf (NAD), American Society for Deaf Children (ASDC), American Speech-Language-Hearing Association (ASHA), World Hearing Forum, and others

Interested in becoming a better patient advocate?  A CBIS credential is a great way to start — learn how to approach, treat, and advocate for the brain injury population today!

Furthering Your Education:

There are many resources on cultural competency which can help us be better healthcare professionals when it comes to serving all patients – it goes beyond just Deaf Awareness week! There are educational opportunities and resources (much like this article series) to learn what we can do each day in practice to show our patients we value and care about them outside the office/clinic/hospital, etc. as much as when they are in it.

  • American Sign Language courses
    • Deaf and Hard of Hearing Coalition of South Jersey starting October 4th (see @sjdhhcoalition on Instagram for more information!)
    • Local universities – Rowan University Glassboro, Rowan College at Burlington County (RCBC), and others
    • Online courses/resources – Signing Savvy, Dr. Bill Vicars, Gallaudet University Online ASL Courses
  • Apps: Marlee Signs, The ASL App, ASL Dictionary
  • Media: watching & supporting media about the Deaf can be another way to learn about the community – CODA, Deaf U (Netflix), etc.
  • Support Deaf-owned businesses, create accessible content, support Deaf influencers, share information to raise Deaf awareness, etc.

 

Ten Actionable Items For Clinicians: Communicating with the Deaf or HOH Patient

As healthcare professionals, we play an important role in the lives of all patients but especially those who are underserved, underrepresented, and/or marginalized. The fact that you’re reading this article already shows your compassion and commitment!

  1. Understanding your patient population is key!
  2. Ask about preferred method(s) of communication – American Sign Language (ASL) is not universal, even within the US. ASL is a language with its own grammatical structure which is different than English. Some patients use Signed Exact English (SEE) which is using ASL signs in English order/grammar. Some patients use “home signs” which do not not follow ASL or SEE and is the result of hearing parents trying to gesture to communicate with their DHH child at a young age.
  3. Reading & writing out the entire encounter should NEVER be first move unless the patient declines the offered/provided interpreter. If you would not assume a hearing patient can read/write/has great health literacy, you should not assume anything about your DHH patients, good or bad.
  4. Lip-reading is not an appropriate method of communication, even if the patient tells you they prefer it. It has been shown that lip reading, AT BEST, is only 45% accurate.  Utilize other forms of communication to more effectively meet your patient where they’re at —  such as an interpreter services and visual demonstrations in conjunction with written instructions.
  5. Use certified, hospital- or clinic-provided interpreters instead of who comes with the patient.  Attempting to interact with your patient without these services opens up the potential for neglect, abuse, or malpractice. This also can help build patients’ feelings of security, privacy, trust and understanding as well as increasing the likelihood of good patient outcomes.
  6. Technology-assisted interpreting services are not the preferred method for translating. Unlike verbal translating services via phone for languages such as Spanish or French, ASL is a visual language and therefore in-person is the most effective form of communication. Although ASL is the official signed language in the US, there are regional differences in signing, much like how there is slang or accents in spoken English! For example, if you are treating a patient here in South Jersey and the virtual interpreter is located in California, there can be a mismatch in communication. To add, video interpreting services require high bandwidths, and technology has a habit of glitching when you need it most. Advocate for in-person interpreting services for your patients when possible. If they are not, video services can be used but should not be an office’s sole source of interpreting.

    If advocacy is your jam, check out these tips for advocating for your acute care patients!

  7. Look at the patient, NOT the interpreter. It may be tempting to look at the interpreter because we’re so used to looking at who we speak to, but the interpreter understands you aren’t being rude. Looking at your patient further establishes the patient-centered care approach which has been proven to lead to better outcomes.
  8. Consider your office layout: is it Deaf-friendly? DeafSpace is a concept coined by Hansel Bauman and Gallaudet University and implemented in many Deaf-oriented spaces. Deaf-friendly spaces are well-lit, open-concept, and painted with colors that contrast the skin to easily see signing hands. If you’re passionate about accessibility, this is a great resource!U Notre Dame Deaf Space
  9. Understand that your role within the Deaf community as a hearing person will always have certain boundaries. There are certain instances where it’s acceptable for a deaf individual to do something which would be offensive for a hearing person to do. For example, there are customs associated with choosing a “name sign” — which is a sign used in place of having to fingerspell out your name each time in conversation. Deaf individuals can choose their own name sign, but it is considered unacceptable for a hearing person to do the same. A Deaf person may give you a name sign which you can then use, but choosing your own name as a hearing person is disrespectful to Deaf culture.
  10. Recognize the bias you may be bringing to the encounter, try to consider your patient’s cultural values, and be respectful of their decisions even if it differs from your initial recommendations. Rehab practitioners are great at recognizing the impact of cultural difference, personal values and preferences and how that impacts a patient’s interactions in the daily world – even then it can at times be hard to respect a decision that is different from our own perspective. Members of the Deaf community are proud of their deafness and may make certain healthcare decisions which may not be what you’d recommend/choose yourself.

Final Clinical Gems on Communicating with Deaf and HOH Patients:

  • Not all people who sign/use gestures for communication are Deaf – some people love to “talk with their hands!” Some people who have difficulty with language production/phonation use ASL but are not Deaf.
  • Not all signed language is ASL in the US! There are multiple signed languages – such as British Sign Language or French Sign Language, as well as combination signing and visual aids such as with Makaton.
  • Shouting and over-enunciating is unhelpful, and can even come off as rude. Speaking slower doesn’t always help the patient understand you better, even if the patient states they can “lip-read”.
  • Using facility-provided, certified interpreters minimizes the risk of neglect and malpractice.
  • Seek out opportunities to connect with your DHH patients and practice your signing.
  • Nothing is universal. If you are unsure of something, ask!

 

Finally, Happy Deaf Awareness Week (Sept. 19-25, 2022) from your friends at ARC Seminars!

 


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Mindfulness & Concussion: How can we use it effectively?


As PTs, OTs, and SLPs who work with people who have sustained a concussion of mild brain injury, we are very well acquainted with ‘traditional’ treatment strategies, including vestibular rehabilitation, visual impairment interventions, and even headache management.

In a busy and functional-goal-heavy environment, it can be easy to get so focused on measurable outcomes that we do not consider slowing down and integrating mindfulness and meditation as a skilled concussion intervention… But should we?


Concussion and mTBI

Concussion/mTBI and PCS – the persistent constellation of symptoms that can impair function for those post injury – present a wide range of symptoms. Many of these can be ‘invisible’ symptoms, such as headache, sensory intolerance?, difficulty in executive function, metacognition, and concentration. Difficulty or inability to perform at this higher level can have a devastating effect on the individual– deeply impacting their self-esteem.

In fact, depression can occur in over 50% of people who have sustained a concussion. This suggests a link between brain health and mood, as well as between perceived self-efficacy, or difficulty completing tasks, with mood. This correlation is high enough to be a real concern to clinicians working in the mTBI population.


Why mindfulness?

Mindfulness has received attention in the medical and scientific community for the past few days, as it has been shown to have a direct effect on grey matter growth.

Mindfulness has been proven in  a variety of fields to boost neuroplasticity and actively work on brain regeneration post injury. It is also shown to increase brain activity in areas that may be protective against cognitive decline related to aging– another important consideration for those post mTBI, as dementia is more prevalent in this group.

Integrating mindfulness into your practice with patients’ post-concussion/mTBI can have multiple benefits! 

Mindfulness is shown to improve many of the areas that can be impaired post-concussion; including attention, memory, frustration tolerance, mood, metacognition, and executive function.

How can I incorporate mindfulness into concussion practice?

Using mindfulness may seem intimidating initially, but can be straightforward to include in practice in many ways – no matter what profession you approach it from!


Balance

In the realm of Concussion rehab, physical and occupational therapists may be targeting dizziness, balance impairment, and oculomotor function. Balance impairment and increased falls risk is reported in 30-50% of those who sustain a concussion.

Traditional balance rehab programs may have a place, but consider including mindfulness-based-practices into your therapy as well!

The positive link between mindfulness and body awareness, pacing, balance, and falls risk has been well established – brief sessions of ‘mindful movement’ can have lasting effects on body awareness, postural control, and balance. Mindful movement refers to engaging in different movements and exercises while engaging full attention to the movement of the body and breath.

The practice of mindful movement can even begin seated, where the person may notice the weight of their limbs and then transition into movements. Physical Therapists can assist their patients with these interventions and set them up with HEPs that include mindful walking programs, meditations, and yoga.

This study even demonstrated increased use of external focus strategies in those whose balance was impaired, supporting that even the shortest of mindful attention practices can greatly improve balance overall! 

Read more about how to use attentional focus here!

Mindfulness based yoga has a plethora of benefits to improve balance and decrease falls risk, as well as improve overall mood and self-efficacy.


Pain

Pain, specifically headache, can be a recurring complaint for those post-concussion. Mindfulness practices that focus on breath work, relaxation of tense and tight muscle areas, and release of stress associated with chronic pain, can help alleviate this with your patients.

The link between pain relief and mindfulness is more complex than at first glance – and works on a multitude of neurophysiological pathways! Opioidergic mechanisms have been shown
to mediate analgesia through attentional control, meaning that the using attentional control can quite literally change the brain mechanisms to be able to control pain.

This astounding fact may have clinicians asking – why hasn’t mindfulness been taught to therapists as a keystone intervention?


Sleep

mindfulness concussion sleepSleep disturbances are a common complicating factor for those post mTBI- and are thought to be related to circadian rhythm shifts. Up to 70% of people post-concussion continue to show sleep disruptions months post injury, with consequential fatigue impacting their daily life.

Mindfulness meditation practice has been shown  to have a significant effect on sleep quality in the treatment of those with sleep disturbance.

It goes without saying – if our patients are unable to sleep, or are extremely fatigued, that they are going to be less able to engage in a therapy program; be more at risk of falls and accidents, and have a domino effect of undesirable consequences. Therefore, addressing sleep hygiene should be top of mind for clinicians who work with those post mTBI.

How can you incorporate mindfulness into sleep therapy? Teach your patients Progressive Muscular Relaxation, diaphragmatic breathing, and attentional focus strategies that they can use at night. If they have a device that can play a podcast or music, they can incorporate this as a guided meditation to further improve their practice.


Depression

Mindfulness Concussion DepressionIt is no doubt unsurprising that depression is an issue that affects about 50% of those post mTBI. As stated previously, depression can occur because of physical changes in the brain post injury – suppressing neurotransmitters that regulate mood; from trauma related to the injury; or as a response to low self-esteem and self-efficacy, and what the person perceives as “lost.”

Knowing, as we do, that mindfulness can effect actual changes in brain chemistry, it follows that it can be a powerful tool in assisting with depression management. MBCT (Mindfulness Based Cognitive Therapy) has been shown in some research to prevent depression recurrence as effectively as antidepressant medication.

Powerfully, mindfulness can teach our patients how to recognize their unhelpful thinking patterns, and engage with their mood in a more constructive and empowered way; as well as emphasizing self-compassion.

As therapy professionals, we may be familiar with the term ‘therapeutic use of self;’ practicing self-compassion and mood stabilizing mindfulness with your patients can fall squarely into this category. Furthermore, it may have knock on effects to the rest of your patients function and engagement in both their therapy and their community.


Cognitive impairment

Mindfulness Cognitive ImpairmentFinally, the cognitive impairments associated with mTBI and concussion can also respond extremely well to the integrations of mindfulness. Mental fatigue has shown to be improved through use of mindfulness based stress reduction; and cognitive performance overall also shows improvement with use of these techniques.

Verbal learning, memory capacity, and attention correlate positively with treatment; which again is incredibly important to clinicians working rehab – if our patients are having trouble with concentration, recollection, or processing of instructions, then incorporating brief mindfulness breaks or mediation prior to challenging tasks may boost their outcomes.


As you can see, many of the functional goals that we may set in therapy can be complemented hugely through the incorporation of mindfulness-based practices. Given the strength of the research, it makes sense that every clinician working with concussion and mTBI should consider mindfulness as a therapeutic complement.

To learn more about Practical Approaches to Concussion Management, check out our course on the topic, right here!

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Social Skills post ABI – this tool is a game changer!


Utilizing the Real-Life Conversation Skills Video Course to Navigate Comfort, Stretch and Panic Zones in Social Skills Development for Individual with ABI

Comfort, Stretch and Panic Model

One helpful model for understanding personal growth within the context of social skills development post ABI is Karl Rohnke’s Comfort, Stretch and Panic model, which was developed based on the Yerkes-Dodson law. This law posits that peak performance happens when people experience a moderate amount of pressure.

According to this model, when we either fail to challenge ourselves or become overloaded with pressure, our performance and chance of success will decline. With this in mind, the key to social success is to approach social opportunities that will push us without taking us all the way into a place of panic. For those with acquired brain injury (ABI), this model can become a helpful tool for reintegrating socially back into society. 

The Real-Life Conversation Skills Video Course (part of the Real-Life Social Skills Academy) is a key growth tool for this process, providing users post ABI with concrete, step-by-step breakdowns of conversation skills, video examples of these skills being role-played as well as clearly defined challenges for practicing in the real world.

What do each of these zones look like?

Comfort Zone

social skills waving hello

The comfort zone is characterized by familiar activities or social interactions that are routine for us. Examples might include: waving hello to a long-time neighbor, talking with family members around the dinner table or joking around with familiar classmates/friends in the cafeteria. 

These interactions may not be the simplest to an outside observer, but they are ones that we have done many times and are confident and comfortable with. We feel calm and competent when we are engaged in these activities or enter conversations with these people. 

For most of us, comfort zone activities and interactions will form most of our day to day lives. This is typical and expected. Comfort zone interactions are safe, reassuring and recharging. They are very important for our mental health and well-being. However, it can be a red flag when we find ourselves or our student rarely or never venturing outside of our comfort zone socially. 

Unfortunately, for many of those with ABI, even activities that previously fell in the comfort zone may become more challenging. Their comfort zone may “shift” and a new level of social expectations may need to be established. 

Stretch Zone

social skills post ABI

When we are in our stretch zone, we challenge ourselves with activities or interactions that are outside of our usual comfort zone. For instance, we may go up to a less familiar neighbor and say “hi” or we might sit with a new group of students in the school lunchroom. 

Many of the challenges in the Real-Life Conversation Skills Video Course are geared to provide stretch zone opportunities for users, in order to gradually push themselves into new social territory. 

In the stretch zone, we do not feel panicked and overwhelmed, but are able to step up to the challenge. We may even find a rush of extra motivation and enthusiasm. Often, we need to practice developing a mindset of persistence prior to engaging with activities or interactions that fall within the stretch zone. Otherwise, we may find ourselves bailing out whenever things get a little unfamiliar or uncomfortable. This can be especially true for those with ABI, as activities or social interactions that were once fun and simple may become much more difficult and exhausting.

Panic Zone

When we are in the panic zone, we become completely overloaded and overwhelmed. We are swamped with fear and may enter a fight, flight, or freeze mode. We run on high alert. Being in this zone for extended periods of time often negatively impacts of sleep, mental health, and energy levels. 

When we find ourselves feeling this way in a situation, it may mean that we overloaded our current skill capacity. It would likely be best if we take a step back. Socially, this may mean that we entered a situation or interaction that we were not ready for, and as a result feel trapped or overwhelmed. Social anxiety often manifests because we placed ourselves into difficult or unfamiliar social situations without enough practice or skill-building beforehand. 

The Real-Life Conversation Skills Video Course aims to help those who take the course gain knowledge and watch examples of various conversation skills being utilized with the aim of reducing anxiety in users to help them be more successful in social situations when they venture into the real world. The course is one tool that can help users with ABI avoid entering the panic zone in various social settings, as they will have already seen examples of how to navigate these situations and have a step-by-step plan for how to approach others. 

Check out some of our Brain Injury resources here!

Factors to Consider

Social Skill/Practice Level

Reflect on how much we have practiced various social skills prior to entering real life situations. Role-playing, video modeling, practicing with more familiar friends/family, (all of which are components of the Real-Life Conversation Skills Video Course), etc., can all be helpful tools to prepare us for stretch zone type social interactions. Social skills groups can also be helpful, safe, semi-structured places to grow in our social skills with peers, especially when we are relearning skills following an ABI. Many cities even have specific ABI support groups that one can join. 

Know Our Own Personality

Consider our own personality type. Are we more introverted or extroverted? Do we do better in group situations or 1:1 conversation? How has our personality changed post-ABI? What types of topics would we enjoy talking about with others? The more we know about ourselves, our own strengths and personality type, the more confident we can be entering into a new social situation.

How Are We Feeling Today?

Are we well-rested or fatigued? Are we feeling extra anxious today for some reason? How is our mood? Mood and fatigue levels can be heavily impacted by ABI, and these are all important emotional factors to consider before jumping into a stretch zone social activity.

How Challenging is the Social Situation?

Also, it is important to be aware of the complexity of the social situation. This will vary for every person and is often based on the previously discussed factors listed above. Of course, no single video course or peer group can prepare someone for every complex social situation they might encounter. Nonetheless, the Real-Life Social Skills Video Course does incorporate a variety of common situations that one may encounter in real life. The course is geared to be realistic and aimed for a target audience of older students and adults who may have had an ABI – avoiding many of the “kiddy” trappings of other social skills-focused curriculums. 

And of course, it is important to remember that what is incredibly challenging for one person may be routine for someone else. In general, though, being around fewer familiar people and within a larger group will be more challenging. Specific work or school groups can also have special rules that are more difficult to navigate. The Real-Life Conversation Skills Video Course will help you learn or relearn many of these hidden rules. 

Keys to Finding the Stretch Zone

1) Be aware of when you’re stuck in a social comfort zone and be willing to challenge yourself. 

2) Have a social skills coach, therapist, friend or other person in our lives as an outside perspective to provide us with encouragement to push ourselves forward socially.

3) Order the Real-Life Conversation Skills Video Course or a similar course in order to relearn, review and gain helpful skills in advance of entering more challenging real life situations. 

4) Start out small and take baby steps. Try one new social opportunity each month – whether joining a new ABI support group, signing up for voice lessons, taking a community art class or anything else that is new and intriguing. The possibilities are endless. Start with something small and build up. For instance, your first stretch zone activity would likely involve meeting one new person or a small group rather than presenting a speech to an audience of 500 people. 


Acknowledgement:

 

social skills ABI video courseJohn Williamson, M.S., CCC-SLP

Owner, Lead Therapist at the Social Skills Laboratory, PLLC
www.SocialSkillsLab.com
www.RealLifeSocialSkillsAcademy.com

Certified: PROMPT Level 1, SCERTS Model, Pivotal Response Treatment (PRT) Level 1, Pro-ACT, Non-Violent Crisis Prevention (CPI), LSVT, Youth Mental Health First Aid, Positive Discipline, LiPS by Lindamood Bell

Trainings: Social Thinking: Taste of Our Providers’ Conference, Unraveling the Mysteries of Social Communication Skills for Students with Autism Spectrum Disorder, Using iTechnology as Evidence-Based Practice to Meet the Learning and Behavioral Needs for Students with Autism Spectrum Disorder,  Social Thinking: Informal Dynamic Assessment and Core Treatment Strategies, AAC Across the Lifespan, Sensory Processing Disorder Symposium: Evidence-Based Practice – Evaluation and Treatment of SPD, Innovative Aphasia, AAC in Medical Settings, Special Education Law in Washington State and many more.

About Me:
I have extensive experience working with children across a wide age range with a variety of communication-related challenges. Previously, I worked at Lakeside Center for Autism and Neurodevelopment (now I-CAN) and at Children’s Institute for Learning Differences (CHILD) before starting my own private practice.

I am originally from Washington State and got my master’s degree in Clinical Speech-Language Pathology from Northern Arizona University before moving back to the Pacific Northwest. I also have my Certificate of Clinical Competency from the American Speech-Hearing Association (ASHA).

I am passionate about working with students and adults who have social skills challenges as well as other speech and language-related difficulties!


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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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