CARE for Caregivers: Clinicians Guide for Addressing Caregiver Burnout

Caregivers are often an overlooked population in a rehab setting and this oversight can be detrimental to the attainment of the goals, safety, and overall success of the client. How do we know this is an important consideration as providers? 

These numbers speak for themselves while bringing to light the need for increased caregiver resources and supports…

  • 40-70% of caregivers suffer significant signs of depression
  • 31% of caregivers contemplate suicide while on the job 
  • Almost ⅓ of caregivers provide direct care for more than 20 hours per week
  • 2 of 5 caregivers have at least 2 chronic conditions 
  • ¼  caregivers are 65+ and report caregiving has made their health worse

Caregiver burnout is described as “… a state of physical, emotional, and mental exhaustion.”

Signs and Symptoms of caregiver burnout can vary based on the client they are caring for and can resemble other diagnoses and can even cause the onset of conditions like depression and anxiety. Overwhelming feelings of guilt, stress, and exhaustion are also common characteristics associated with caregiver burnout which is why it is important for caregivers to understand the signs and symptoms of caregiver burnout to reduce risk of negative impacts on their health and well-being. Some signs and symptoms may include:   

  • Withdrawal from social interactions
  • Lack of interest in favorite activities 
  • Changes in sleep patterns (lack of energy) 
  • Neglecting own needs
  • Emotional exhaustion
  • Physical exhaustion
  • Irritability
  • Feeling blue or helpless 
  • Wanting to hurt yourself or the people you are caring for

Want to read more about supporting caregivers of people with dementia? Read this practical and empathetic article here!

Contributing Factors 

  • Confusion: This can happen when people assume a caregiving position (especially if it is unexpectedly) and are unsure how to separate their caregiving role from their personal life and other roles they embody. As a result, caregivers tend to take the stress of caregiving with them throughout their day-to-day life and never really get a break from the job itself. The inability to separate themselves from this role can lead to feeling lost, confused, and overwhelmed.
  • Unrealistic expectations: It isn’t uncommon for caregivers to feel that their job as a caregiver will give them a sense of fulfillment because they are helping others. However, it can be hard to see a loved one lose their ability to perform basic tasks and the level of assistance required might be unexpected. Spending time with a loved one during their time of need is admirable however, the stress it places on the relationship could be an unforeseen challenge when assuming the role of a caregiver.
  • Lack of control: This can be in many forms including lack of caregiver resources and supports, money, and ability to organize or control one’s life.
  • Unreasonable demands: In some cases, especially when a family member is a caregiver, the client is comfortable placing demands on their caregiver as they neglect their own responsibility to complete tasks they are capable of doing – or at least attempting. This leads to the caregiver’s role exceeding their initial expectations and as a result having an unsustainable amount of responsibilities.
  • Lack of self-care: The responsibilities of a caregiver can become quite overwhelming and persist all hours of the day. For some caregivers, they might not know the signs and symptoms of caregiver burnout, so they are unaware that they are neglecting themselves and their needs. 

How can burnout impact client outcomes?

Burnout can impact clients quality of care in so many ways such as: medical errors, strained relationships, decreased compliance in home programs, and decreased social interaction. Exhaustion, lack of energy, stress, and impaired cognitive function of caregivers can result in negative client outcomes.

For example, in the instance of medical errors, these factors can cause caregivers to make mistakes with medication schedules or dosages and can even mix up medications that can cause adverse effects. It is important for both caregivers AND clinicians to understand what caregiver burnout out is and how to address it in order to prevent decreasing client care and promote caregiver well-being.

Strategies for Clinicians to Intervene 

We as clinicians cannot forget to address caregivers as they are an INSTRUMENTAL teammate during the rehab process and for successful carryover. But how can we offer support during times of burnout?

Caregiver resources and supports we recommend:

Family Meetings:

Bringing the family together with the entire interdisciplinary team can promote positive outcomes within therapy sessions and the home. The primary goal of this meeting should not necessarily be to mediate between opposing sides of conflicts but instead to hear caregivers’ concerns and feelings towards their role in the rehab process. Using our expertise, we may be able to implement compensatory strategies to decrease the physical, mental, and emotional strain associated with the role of a caregiver.

Prior to the meeting day, it may be beneficial to prepare your client and their family to make them feel comfortable; here is a printable resource to help out!

Education on Respite Care:

When caring for a loved one, there can be a lot of pressure put on caregivers to handle all aspects of the care independently. Helping them understand their options and how to accept help can improve their mental health and provide them with breaks from their role as a caregiver. Respite care can be offered by many different parties including other family and friends, government entities, and healthcare providers.

Use this link to provide necessary caregiver resources and supports on respite care with direct links to associations for specific diagnoses, options to inquire about with your physician, and specific examples for including others in the caregiving process.

Support Groups:

Sometimes there is nothing more beneficial than discussing hardships with other people who have experienced or who are currently experiencing the same thing. Caregivers might not be able to recognize the benefits of joining a support group or might not know how to locate these groups. Assisting with this process falls within the scope of the interdisciplinary team.

Here are some wonderful groups to get this process rolling: Family Alliance on Caregiving & Resource Center

Develop & Manage a “Caregiver Plan”:

Organization of the day-to-day can help minimize the stress, anxiety, and exhaustion associated with caregiver burnout. Dedicating a session to helping the caregiver develop a plan will provide a client-centered approach to managing medications, appointments, emergencies, and more. Download this customizable document to assist caregivers with the development of this plan.

At the end of the day, we as clinicians need to recognize caregivers as our clients as well and understand what caregiver burnout looks like, how it can impact your client’s success in the rehab process, and how to support the caregiver and their mental health. Familiarizing yourself with caregiver resources and supports will allow you to successfully intervene substantiate your role as a difference maker in a holistic sense and promote the well-being of all members of the team.

Don’t let your client’s caregiver forget, caregiving starts with you!

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The Vital Role of Evidence-Based Practice in Nursing: A Pathway to Quality Care

In the dynamic and ever-evolving field of nursing, staying current with the latest evidence-based practices is crucial for providing high-quality patient care.

Evidence-based practice (EBP) is an approach that integrates the best available research evidence with clinical expertise and patient values to inform decision-making. As a continuing education resource, we are obsessed with evidence based practice, and making it accessible – and even easier – for nurses to stay up to date and easily incorporate EBP into practice.

Why Evidence-Based Practice Matters for Nurses:

1. Enhancing Patient Outcomes:

Implementing evidence-based interventions has been consistently linked to improved patient outcomes. By utilizing the latest research findings, nurses can provide care that is backed by solid evidence, leading to more effective treatments, reduced complications, and enhanced patient satisfaction.

Keeping abreast of current research and evidence also fosters continuous learning and professional growth. By staying up to date, nurses can identify gaps in their knowledge, seek opportunities for further education, and contribute to the advancement of nursing practice through research and innovation.

Check out our course to find out how you can stay up to date on your EBP!

2. Optimizing Resource Utilization:

EBP helps nurses make informed decisions about the allocation of resources, including time, personnel, and equipment. By utilizing evidence-based guidelines, nurses can identify interventions that are most likely to yield positive results, avoiding unnecessary procedures and ensuring optimal resource utilization. We all know the cost – both financial and personal! – of inefficiency in healthcare.

3. Promoting Patient Safety:

Evidence-based practice promotes a culture of safety by providing nurses with reliable guidelines and protocols. By adhering to evidence-based standards, nurses can reduce the risk of errors, adverse events, and healthcare-associated infections, and improve patient safety.

Staying current with the latest evidence equips you with the knowledge and tools needed to make informed decisions. By incorporating the most recent research findings into their practice, nurses can make decisions that are more patient-centered, effective, and based on the best available evidence.

4. Enhancing Professional Credibility:

Staying relevant! Staying up to date with evidence-based practice demonstrates a commitment to professional growth and development. It enhances nurses’ credibility among colleagues, patients, and other healthcare professionals, fostering a collaborative environment focused on delivering evidence-based care.

Your confidence in yourself will also improve! Being up to date with evidence-based practice boosts nurses’ confidence in their clinical skills and decision-making abilities. It provides a solid foundation of knowledge and empowers you to advocate for the most appropriate and effective interventions for their patients.

So how, in an extremely challenging and ever faster paced environment, can a nurse stay p to date on evidence based practice? Check out these actionable tips that you can use to stay ahead of the game:

Actionable Tips for Maintaining Evidence-Based Practice:

1. Stay Informed:

Regularly access reputable sources of healthcare literature, such as peer-reviewed journals, research databases, and professional nursing organizations’ publications. Subscribe to relevant newsletters or email updates to receive timely information about new research findings.

Register for ARC’s free monthly journal clubs to stay up to date on all relevant new literature

2. Attend Continuing Education Programs:

Participate in conferences, workshops, and seminars that focus on evidence-based practice and provide opportunities to learn from experts in the field. Continuing education programs help nurses stay current with emerging research, technology advancements, and evidence-based guidelines.

3. Join Professional Nursing Organizations:

evidence based

Engage with professional nursing organizations that emphasize evidence-based practice. These organizations often offer resources, webinars, and networking opportunities to connect with like-minded professionals and stay up to date with the latest developments in nursing practice.

4. Collaborate with Colleagues:

Engage in regular discussions with colleagues to share knowledge, experiences, and research findings. Establish or join journal clubs or research groups within your workplace to foster a culture of evidence-based practice and encourage ongoing learning and critical thinking.

5. Implement and Evaluate:

Apply evidence-based interventions in your clinical practice and evaluate their outcomes. Document the results and share your findings with colleagues to contribute to the collective knowledge base of the nursing profession.

Evidence-based practice is the cornerstone of quality nursing care. By incorporating the best available evidence, clinical expertise, and patient values, nurses can deliver effective, safe, and patient-centered care. Staying up to date with the latest research findings and evidence-based guidelines empowers nurses to make informed decisions, enhance patient outcomes, optimize resource utilization, promote patient safety, and enhance their professional credibility.

As clinicians, it is our responsibility to continuously seek knowledge and strive for excellence in our practice. By following actionable tips such as staying informed, attending continuing education programs, joining professional nursing organizations, collaborating with colleagues, and implementing and evaluating evidence-based interventions, we can ensure that our practice remains evidence-based and patient-focused.

Remember, evidence-based practice is not a static concept—it evolves with advancements in healthcare research and technology. Embracing evidence-based practice as a lifelong commitment allows us to grow professionally, improve patient care, and contribute to the ongoing development of nursing as a whole.

Let us embrace the power of evidence-based practice and become catalysts for positive change in healthcare, ultimately improving patient outcomes and making a lasting impact on the nursing profession.

If you’re interested in learning more, check out Evidence Based Practice for the Everyday Clinician, our short course that will empower you to seek, find, and make the best evidence possible!

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How to discuss return to Sex and Intimacy After Stroke

Bringing up the topic of sex after a stroke with your patient can be an intimidating prospect for many clinicians. At what point after this traumatic event is it appropriate to bring up something as sensitive as intimacy?

Although stroke is a serious medical event that requires extensive recovery, it is possible – and probable! – to return to sexual activity post-stroke.

Of course – individuals should discuss any physical, cognitive, and emotional changes with their doctor and rehab clinicians in order to get an accurate overview of any restrictions or limitations, and risk factors that may need to be observed. 

It is important to take precautions when returning to sex post-stroke to ensure that there are no additional complications. 

The medical team can provide guidance about appropriate physiologic changes, frequency of sexual activity, and risk for pregnancy or sexually transmitted infections.

 However, when our patients in rehab present post stroke, it falls into our role as a rehab clinician to make a safe space for sex and intimacy to be brought up!

What is my role as a rehab clinician in addressing return to intimacy post stroke?

The main role of the rehab clinician is to create a safe space and area of discussion for our patients.

Read our article about examining the rehab clinician’s role in addressing sexuality here!

Rehab for intimacy post stroke may address:

Physical changes

After experiencing a stroke, individuals may experience a variety of changes to their physical abilities- such as weakness, numbness, or unilateral paralysis. These physical changes affect the ability to perform sexual activities, such as kissing and intercourse. Additionally, it may be difficult to move or position oneself comfortably, which can make sexual experiences less enjoyable.

There are many ways to incorporate intimacy into a relationship even when physical sensation and desire may have changed after a stroke. 

While physical intimacy may not be feasible for all couples, it is important to recognize that intimacy can be fostered in many different ways. Participating in activities together, such as taking a walk in the park, going out for dinner, or even just cuddling can increase connection. It is also helpful to understand that different people have different boundaries, and it is important to respect them. Everyone should feel comfortable expressing their desires and boundaries to each other.

Encourage your patients to experiment with new positions and techniques that are comfortable and enjoyable.


When it comes to bringing intimacy back into a relationship post stroke, communication is key. Partners should take the time to talk about the changes in sensation and desire, as well as any difficulties with positioning or movement. One way to start is by discussing past experiences in the relationship and finding ways to recreate those fond memories. In addition, focusing on activities that don’t involve physical contact can be helpful, such as playing board games or watching a movie together.

Acknowledging the difficulty of the situation, being thoughtful and honest with each other, and reaching out for help from professionals are all important steps to take. Additionally, activities such as massage, cuddling, talking, and other forms of physical contact can be beneficial. It is important to remember that both partners should be able to express their needs in order to find solutions that work for the relationship.


Compensatory techniques can be used to minimize the impact of stroke-related disability and facilitate a return to sexual activity. These techniques include adapting the environment, using assisted devices, and positional aids. 

Assistive devices can play a crucial role in helping stroke survivors resume sexual activity. Devices like sexual aids, lubricants, and inflatable cushions can help address physical limitations by enabling individuals to maintain comfortable positions while engaging in sexual activity. Some assistive devices can also help with communication, such as visual aids that depict body parts or assistive apps that allow partners to communicate desires and needs. 

Healthcare providers can educate patients and their partners about the available options and help them choose the devices that best fit their needs and preferences.

Resources for your patient

Fortunately, there are a variety of resources available to individuals who are looking to get back into a sexual relationship after a stroke. Websites such as the American Stroke Association provide tips and advice on how to handle such conversations and activities with respect to physical abilities and comfort levels.

 Additionally, therapists specializing in couples and family therapy can assist in creating a safe space to discuss communication hurdles and help build intimacy – outside of physical activity. With support, couples can work together to find ways to expand passion, sex and intimacy post stroke.

 Resources for the healthcare provider

There are also resources to you, as a rehab clinician, to develop your skills in addressing this area! CE courses, such as this course from Sex, Intimacy, OT ( If you would like to become more versant in this field, seeking out further training is a great idea.

Even without further certification, however – your role is always to be open and a safe space for your patients post-stroke. As rehab clinicians, we may find ourselves making the first indelible impression on the person as to whether they are returning to a full life after a stroke, which includes sex and intimacy. Therefore, we should display compassion and empathy for this conversation – despite our level of comfort with this sensitive area.

Want to level up your approach to Stroke Rehab? Have a look at our course, ‘In-Patient Stroke Rehab: 14 strategies to get your patient home!” for an in-depth, highly practical approach to stroke care and rehab.

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The Value of CBIS to your Clinical Practice

CBIS certification has raised the industry standard for educational pursuit and knowledge acquisition. Importantly, it has numerous benefits for the individuals who seek the certification.

1. It will enhance your clinical practice!


Becoming a Certified Brain Injury specialist will connect you to a wider network of other professionals in the brain injury rehab field. Currently, there are over 7,000 CBIS’ practicing here and internationally- and they are all linked through the attainment of this credential! Being a part of this network can help you problem-solve various challenges that can pop up in practice, learn about resources and tools helpful to practice, and initiatives that you may not otherwise have known about. 

Once you become a CBIS, you automatically gain a subscription to the Journal of Head Trauma Rehabilitation, which will help you to stay super current on the best brain injury rehab and resources that are upcoming in the field. 

Staying up to date on the evidence is not always easy- read this for three ways how!

And of course – there is the focus that requires to maintain your Certification status! In order to maintain the CBIS credential, you must take 10 hours worth of continuing education per year related to ABI practice. Those resources must be from current material – published or presented within the preceding three years. This means that once you gain your credential, you are forced to stay current and on top of new advances – sealing your status as a specialist!

2. It makes you a more well rounded clinician

The CBIS specialist course and exam does not only discuss Traumatic Brain Injury (TBI) but also non-traumatic brain injuries (NTBI) – which can sometimes be missed in BI practice. The Certified brain injury specialist course and exam also requires the learner to be versed in mild, moderate and severe injuries – and even touches on disorders of consciousness. This makes us, as clinicians, step outside of our comfort zones and learn more about populations and conditions that we perhaps might not normally have examined. 

Brain injury-serving organizations value hiring and training CBIS certified staff, because it allows them to work with and promote clinicians who understand the unique needs of persons recovering from brain injury and staying abreast of current resources in the field. By becoming more well-rounded, you are also establishing your own value as a clinician- go you!

3. It will empower you to develop programs/problem solve

As a certified brain injury specialist – your knowledge goes beyond management and treatment, and expands into advocacy, visibility, accessibility and systemic issues. This places you in a great position to develop brain injury specific programs for your facility, hospital, clinic or community! You will be able to examine the programs from a larger scale and perspective and look beyond your own practice, into the issues facing the brain injury community.

You will also be able to examine barriers to supportive programs where you work, and have knowledge and resources to be able to roll out initiatives and education in your clinic. This will help empower your colleagues on a larger scale, and create more effective outcomes for all clinical staff and patients. 

 Become a CBIS… and super-charge the way you work!

4. Make you a more effective educator/advocate

The act of studying, staying up to date, and being part of a network of like minded clinicians will have another side effect – it will naturally make you a great advocate. You will have the tools you would need to educate patients, family members, and your own colleagues, about what is supportive, appropriate and what is the most cutting edge in terms of interventions and treatments. 

Also, you can further advocate and educate by initiating or running a local brain injury support group – another aspect discussed in the CBIS Training course! Facilitating a group where those who have lived with brain injury can share successes, challenges, resources and more will be an incredibly empowering and positive addition to your clinic or community. 

Obtaining your CBIS really sets you apart from your peers and shows 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. 

Interested in becoming a CBIS? Check out the Certified Brain Injury Specialization (CBIS) Training

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How to Use Evidence Based Practice in Occupational Therapy

Evidence-based practice (EBP) has become the gold standard for healthcare professionals, including occupational therapists (OTs). It’s a phrase we hear constantly – at school, at work, at conferences – and we all know the importance of testing and examining the efficacy of what we are doing. 

But with so many other demands on us, how do we make sure that we are constantly integrating EBP into clinical practice?

What is Evidence Based Practice?

EBP is the process of using the best available evidence combined with clinical expertise to make decisions about patient care. It helps Occupational Therapists to provide the highest quality of care to their clients, both by informing clinical practice and by providing evidence to back up therapeutic interventions. As OTs, using evidence-based practice will also ensure we are following the latest standards of care, while also considering the individual needs and preferences of their clients.

Why is EBP central to good OT practice?

Evidence-based practice has become a cornerstone of occupational therapy. As OT as a profession moved toward a higher level of academia and science, testing and proving interventions became key to establishing OT as a vital health profession. 

As with many professions, clinicians can become comfortable and settled in a certain way of practicing – and this can take the edge out of our treatments. It is important that practitioners understand not only the importance of evidence-based practice, but also how to realistically integrate it into the therapeutic process. 

How do I include evidence based practice in daily occupational therapy?

First – get clear on your goals. Understand the importance of staying current with new research and continually updating your knowledge and skills. When you are creating your care plans, it is essential to ensure you are basing your decisions on the best available evidence. This means looking at research studies that have been conducted on the topic and considering their results. It also means staying up-to-date on the latest evidence; for example, reading journal articles or listening to webinars.

However, OTs should consider their own clinical expertise and patient preferences when making decisions – your experience and clinical expertise are also a form of evidence based practice!

Research Articles

It is clearly important to be up-to-date on the latest research. This includes the latest clinical practice guidelines, current research, and the best available evidence.

To ensure that you are using the best evidence-based practice, you should have a working understanding of the research process and its components. This includes being able to find, appraise and interpret evidence while also applying it to clinical practice. 

When evaluating a source of evidence for use in occupational therapy practice, there are a few key criteria to consider. Is the article peer-reviewed? Are the authors reputable? Was the sample size appropriate?

Look for high-quality research studies. Look for research studies that are randomized, controlled trials with a large sample size and minimal bias

Consider the author’s qualifications, the study design, and the results of the study. Furthermore, it is important to look for evidence of peer-review and to be aware of any potential conflicts of interest. 

Finally- it is important to consider the generalizability of the results and to make sure that the study results adhere to current ethical guidelines. 

Scholarly articles are a great source for evidence-based practice that have been reviewed and evaluated by peers. Additionally, articles from reputable journals and organizations are also a good source of evidence. 

Peer and Team Collaboration

Additionally, it is beneficial for OTs to consult with other professionals, such as physicians and nurses, to get their perspectives on evidence-based practice. By utilizing a team approach and keeping up-to-date with the latest research, OTs can be sure that they are providing the highest quality of care to their clients.

Clinical Expertise

Additionally, it’s important to consider the individual needs of your clients and critically evaluate the evidence for interventions. 

Three ways to include EBP in your daily practice

1. Subscribe to a journal – that is relevant to your practice!

Knowing that remaining current on literature is the most reliable way to stay on top of what is being examined in your field. Although not every assessment and intervention that you complete in a day is likely to be included in the journal – it will examine issues and treatments that are current in your field and may give you food for thought for future, contemporaneous treatments. 

Reading a journal will also expose you to treatments that are outside of your ‘typical’ practice and encourage more expansive thinking when it comes to approaching your client base and their needs.

Ensure the journal you subscribe to is one that you are interested in and that is accessible to you! Some articles can be overwhelming – and that’s where our next steps come in.

2. Critically reflect and analyze your own practice

Make sure that you are regularly stepping back, asking yourself what your plan of care is going to include, and why. Even for discrete therapy sessions – take a critical reflection on why you chose the intervention, and whether the person is receiving the intensity/repetitions/and so on to ensure the treatment is at an effective level.

Joining or starting a journal club can assist with self reflection, and encourage some inter-disciplinary feedback and learning too. Disease specific journal clubs are a great way to niche down into an area of interest but also appreciate the approach of other clinicians in that space; whereas discipline specific journal clubs can help explore many different conditions and OT interventions that are relevant to your practice!

Join our club here

3. Take a course!

Wading your way through understanding Evidence based practice is not easy. Thankfully, we have a course for that! Learn more about how to critically understand and appraise evidence, how to set up your own research, and much more, with our course “Evidence Based Practice for the Everyday Clinician

Check out Evidence Based Practice for the Everyday Clinician here!

Here, you will:

– Learn to find the most relevant evidence

– Be able to appraise and critically consume evidence

– Know how to formulate your own questions and find evidence to support or refute practice

– Understand variables, data, and analyses

– Have a blueprint as to how to start and manage your own research

Appreciate the true ‘power’ of EBP!

Including Evidence based practice as a daily part of your clinical life can make a huge difference to you, your patients, and your team. Try these techniques to make it an intuitive part of your life!

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Learn How to Maintain your CBIS Certification

So you have done your prep course, studied your head off, and passed your Certified Brain Injury Specialist (CBIS) credential exam – Congratulations!

Now as a practicing CBIS, what do you need to do to maintain your certification?

What do I need to do to maintain my CBIS?


In order to maintain your credential, you have to do 10 hours of continuing education per year related to acquired brain injury.  That education has to be a mix of at least two different mediums – webinars, live courses, journal articles, etc.  For example, you can’t do 10-hour long webinars and count them all – you have to have a mix. 

Once you complete your 10 hours of education, you have to complete your recertification application, and pay the recertification fee ($70) – that’s it! 

Having and maintaining your CBIS really encourages you to keep up with current research related to ABI, new evidenced based initiatives,  and makes you stay at the top of your clinical game. 

Can I use a mixture of resources to maintain my CBIS?

Yes!  You need to obtain the necessary CEUs from at least 2 different mediums such as webinars, journal article reviews, attending conferences, etc.  This ensures that you’re always expanding your ABI knowledge from a variety of different sources.  

Where can I find high quality CEUs to help maintain my CBIS?

Allison provisional brain injury certification and CBIS journal club

ARC Seminars offers a variety of live and pre recorded CEUs (check our courses) that can help you maintain your CBIS credential.  Also, offer a free journal club that counts for 1 hour towards your recertification!  All CEUs have to be acquired brain injury related.  Keep in mind any courses taken prior to obtaining your credential do not count towards your recertification (which includes the CBIS exam prep course itself).

Are there are free resources to help maintain my CBIS?

Yes, here is a link to download our FREE CBIS Starter Pack, which includes lots of great information about the CBIS credential, as well as some excellent clinical resources for immediate use.

Watch the video below for more information!

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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.


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.


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.


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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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.

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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?


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!


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 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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