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.
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?
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 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.
Why does Shoulder Subluxation Happen?
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!
Prevention & 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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Completing self care activities including dressing and bathing can be a stressful and frightful experience for the patient with dementia. They are exposed, potentially in an unfamiliar environment and all too often being made to follow the lead of another person.
Let’s talk about 5 steps we as practitioners and caregivers can take to promote the agency and independence of the patient with dementia–improving their experience and yours all at once!
1 – Prioritize and promote their ability to make decisions
Giving your client agency on choices will help associate your assistance–and the completion of self-care tasks overall–with a positive emotion.
Yes, this means taking the hard no or modifying your expectations for completion of the bathing and grooming task. While it may not be ideal, completing even a small part of a bathing routine
If your person is able to, giving them simple choices will make them feel more in control over the task overall and decrease feelings of being tricked or controlled. Simple choices like what soap to use or if they want to wash their hair or body first will help your person feel more autonomous.
To read more about intervening and helping your patient with dementia manage distressed behavior, check out this article!
2 – Lean on old habits
Your person may have a preferred routine for how they wash themselves or complete a grooming task–like brushing their teeth before they wash their face, or always bathing in the evening versus the mornings.
Using these routines and habits to your advantage will decrease the likelihood that your person will feel unsafe, frustrated or frightened and potentially decrease the amount of assistance of cues they require to complete grooming/bathing.
Again, this returns as much control to your person.
3 – Protect privacy
Try to have a familiar caretaker or preferred provider assist with bathing when possible to reduce feelings of being exposed. Self care for those dementia can be made easier if there is a safe relationship already established with a trusted carer.
Keep towels on-hand for them to cover up with if they find that more comfortable
Be sure they have access to washcloths and towels in-hand while assistance is given so they can participate and/or cover up.
4 – Minimize steps when possible
Minimize steps with 2-in-1 shampoo/conditioners or body wash/shampoos. This will reduce the amount of time spent on the bathing task overall
Reduced steps also allows your person to have more autonomy over completion of the task with potentially fewer cues for completion–setting them up for success.
Grab this handy self-care checklist to help with communication when working with your patients with dementia!
5 – Address potential fears to increase willingness
Knowing your person well will be a major strength in identifying what potential barriers or causes of fear may be ahead of time.
For example–It is not uncommon for people with dementia to have fear around stepping into a tub of water; ways to work around this potential barrier would be filling up the tub while your person is already there, using a shower hose or taking sponge baths.
Learn More with ARC Seminars!
Undoubtedly, promoting agency with people with dementia can help patients live safer, more comfortable, and more independent lives. Visit ARC Seminars today to learn how we empower clinicians to treat intimidating conditions like dementia and more!
Plus, register for our self-paced seminar ‘Settled and Secure’: Managing Challenging Behaviors Associated with Dementia to access applicable techniques and skills for engaging with patients, building rapport, and fundamentally improving the way you work with clients.
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Heterotopic Ossification can be confusing, misunderstood and underdiagnosed in sensitive patient populations including TBI, SCI and ortho. Learn why HO is not your average diagnosis and what you can do to protect your patients.
Why Therapists Need to Know Heterotopic Ossification
Abnormal bone growth in non-osseous tissues like muscle and other connective tissue? It sounds like a sci-fi phenomenon that one would only encounter in a movie or on some dramatic medical television show.
In reality, heterotopic ossification (HO) occurs in 10-20% of patients with severe trauma and insults to the central nervous system (CNS), and 20% of people with severe brain injury. That percentage can climb up to as high as 50% if there is severe brain injury and concomitant femur fracture. Patients with brain injuries are at greater risk for developing heterotopic ossification if they have significant spasticity in the involved extremity, unconsciousness lasting longer than 2 weeks, long-bone or associated fractures, and decreased range of motion (ROM).
The risk of development of heterotopic ossification in a patient with brain injury increases as the severity of injury, length of immobilization, and duration of coma increase. The incidence of HO. in military amputees related to conflicts in Iraq and Afghanistan has been found to be as high as 65%. HO poses a threat to the integrity of wound healing, rehabilitation, and prosthetic fitting.
What Exactly is Heterotopic Ossification?
HO is essentially bone growth in tissues like muscle and other connective tissues. Several terms have been used to describe the condition, including heterotopic ossification, ectopic ossification, and myositis ossificans . HO is usually induced by fracture, burn, neurological damage including brain and spinal cord injuries and joint replacement.
Patients with HO experience swelling of tissues, inflammation, pain, limited motion and joint adhesion. HO can be further specified into three categories: myositis ossificans progressiva, myositis ossificans circumscripta without trauma (also known as neurogenic HO), and traumatic myositis ossificans.
|Myositis ossificans progressive: a rare metabolic bone disease present in children with progressive metamorphosis of skeletal muscle to bone|
|Myositis ossificans circumscripta without trauma: also known as ‘neurologic heterotopic ossification’ localized soft tissue ossification occurring after neurologic injury or burns|
Traumatic myositis ossificans: occurs from direct injury to the muscle; fibrous, cartilaginous, and osseous tissue near the bone are affected and the muscle may not be involved.
For purposes of this article, we’ll be focusing on the latter two types of heterotopic ossification.
How is Heterotopic Ossification Diagnosed?
Not all people who experience trauma or severe brain injury are going to develop heterotopic ossification, however it is important as a clinician to know the signs and symptoms. This will ensure early intervention for services rendered, preventing additional loss of function and interruption in therapeutic services. It is important to note that 75% of post-traumatic HO was diagnosed in the rehabilitation unit.
If you work in inpatient rehabilitation, you know that someone’s time there is both limited and precious–something like a missed heterotopic ossification diagnosis can completely derail your patient’s rehabilitation course. Learn more about 14 Strategies to get your CVA patient home quicker!
The first signs and symptoms of heterotopic ossification are reduced joint ROM and painful ROM testing, swelling, erythema, and contracture formation. In people with severe neurological impairment, other signs including autonomic dysfunction and local inflammation in addition to ROM should be considered.
Local pain and a palpable mass may be present one to three months post-injury, however in severe brain injury, HO may be present up to seven months post-injury. Things like laboratory tests, radiology studies, and bone scans should be utilized to accurately confirm an HO diagnosis.
Lab Tests: Alkaline phosphates should be measured, as there has been shown to be a correlation between a rise in levels and level of ossification. There is also evidence supporting that when alkaline phosphate levels return to normal, ossification will have stopped.
Radiology: X-rays will not show HO in the acute phase of inflammation when there is still active pain and swelling. X-rays taken 4-5 weeks post injury will begin to show immature ossification and possibly mature bone growth. It can take anywhere from 8-14 months for HO to reach full maturity, so repeat imaging may be in the patient’s best interest if HO is suspected.
Bone Scans: Triple phase bone scanning has been the most effective diagnostic method for early detection of HO as it detects early increases in vascularity. The first and second phases of the triple-phase bone scan show increased uptake. Areas demonstrating increased blood flow and soft-tissue concentration of the tracer on early imaging (blood flow phase) correlate with sites of subsequent HO development. The optimal timing of the imaging for accurate assessment of the presence of ectopic bone has not been established, but 3 weeks or more following the injury should be sufficient for early detection (Bruno-Petrina, 2021).
How is Heterotopic Ossification Treated?
Therapy’s role in the management of HO is challenging and somewhat ill defined. The goal of HO management should be to maintain ROM in order not to lose any function. The literature generally supports the common use of active ROM exercises and gentle, passive ROM exercises to maintain available joint motion and to avoid progressive contractures.
There has been no evidence found for increased HO or decreased ROM with passive ROM exercises. Surgical intervention can also take place to remove the abnormal bone growth if it is severely impairing functional mobility, but it is recommended that take place approximately 18 months post injury.
Can Heterotopic Ossification be Prevented?
The short answer is possibly. (Per Sun in 2021) Prevention involves identifying patients with high risk of developing HO. It is important to note that routine prevention on all patients is not recommended. Current recommendations for prevention of HO are gentle ROM exercises, pharmacologic agents (indomethacin and etidronat), and external beam radiation (which is primarily used after joint arthroplasty).
Management of risk factors, such as spasticity, is also incredibly important. NSAIDS are thought to reduce the inflammation around joints which could prevent the development of HO. Indomethacin is the most commonly used NSAID for prophylaxis, with other effective NSAIDS being meloxicam, celecoxib, rofecoxib, and ibuprofen. Etidronate is a bisphosphonate–a type of drug that slows bone loss–that has been approved for prevention of HO in spinal cord injuries and complications of total hip arthroplasty.
How Can I Improve my care for Patients with Heterotopic Ossification?
Be well informed--especially if your setting has patients who are at risk of developing HO–it puts you one step ahead if you are up to speed with the potential complications that can occur with a particular patient population. Seeking out meaningful continuing education and collaborating with the interdisciplinary care team is a great way to stay on top of the most recent developments in HO treatment.
If you feel a patient is meeting the criteria for development of HO or is beginning to display early symptoms, speak up! Speak with the physician regarding your concerns and ensure you bring the data with you to validate your claims. It cannot be stressed enough that the best treatment for HO is prevention–prevention of the abnormal bone growth as well as prevention of any further physical complications if the bone growth occurs. Advocate for your patients, and educate your fellow staff members & fight back against HO.
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I’m definitely not saying rugs aren’t public enemy #1 when it comes to fall prevention–in fact my peers have joked before about my personal vendetta against the throw rug. But fall prevention is a much bigger issue–falls are the #1 cause of injury, hospital visits due to trauma and death from injury among people 65 and older. It’s time we take fall prevention one step further (but seriously, get rid of those throw rugs, people).
Falls are a Serious Cause of Injury
Especially if you’re working with geriatric populations. It is estimated that in a year, one out of every three older adults will experience a fall per year and that every ~11 seconds, an older adult in the US will be treated for injuries related to a fall. Falls result in almost 3 million injuries treated in ED’s annually, including over 800k hospitalizations and 27k deaths. If all of this wasn’t enough to stress the severity of falls–they also account for 48% of all acquired brain injuries. There are losses associated with falls that aren’t represented in many data points that are important for practitioners to be cognizant of– loss of mobility, independence, functional decline, mental health and overall quality of life–all things we aim to prevent or protect for our patient populations.
Well that’s intimidating—Who specifically is at risk for falls?
Is it helpful if I say everyone? On a serious note, it is important to recognize that not just elderly people are at risk for falls. People challenged with low vision, polypharmacy, balance and gait issues, and any impaired memory or mental status are all at increased risk for falls both within the home and community. It may seem obvious that people with a history of falling are at increased risk–but even the first initial fall doubles the likelihood of subsequent falls–so it is worth the mention. People with ill-fitting footwear are also at an increased risk for falls, so be sure to exercise extra caution with your slipper-loving patients.
Fall Risks Within the Home
It can be terrifying for patients to consider the possibility of falling within their home–what is normally a safe space for them is suddenly a potential danger. For good fall prevention interventions within the home, it will be important to empathize and respect your person’s potential hesitancy to make changes. After all, if someone came into my home and tried to tell me my Target haul of decor was a potential safety hazard, I probably wouldn’t invite them back.
For fall prevention within the home, generally you will want to be sure that paths, stairways and any thresholds are clearly lit, secure and free of clutter. If there are concerns about low vision or impaired perception, contrasting colored tape can be used to mark steps and thresholds. Bilateral, sturdy handrails are ideal for any stairs or inclines. Encourage your patients to reduce or eliminate floor clutter including shoes, decorations, power cords and the like. Poorly lit areas and low-visibility areas like a tight bedroom space also present a fall risk. Encourage your person to consider properly installed grab bars in the bathroom and educate them on safe use. And it almost goes without saying–those loose throw rugs are a huge fall risk and should be secured down at all edges if your person is unwilling to part with them.
Fall Risks Within the Community
Falls within the community are difficult to track and therefore underreported, however people with good community mobility are naturally at a higher risk for outdoor and community falls. Uneven pavement on sidewalks, lack of sidewalks or interruptions in sidewalk continuity and sloped surfaces are potential sources of falls. Areas with poor lightning, poor drainage and potential for ice also increase the risks for community falls. If you are working with a person that is an active driver, consider referring them to the CarFit program and ensuring their balance is strong enough for getting in and out of their vehicle. Balance will be an important area to look at for persons mobile at the community level–looking at you, uneven sidewalks–to be sure they can navigate walking spaces that are not necessarily the safest. Footwear with proper fit and traction for grip will also help reduce the likelihood of a slip and fall.
Assessments for Fall Prevention
There are a plethora of outcome measures for use to determine a persons’ potential risk of falling–check out these two resources here & here for some great measures. These outcome measures should always be used in combination with skilled observation and clinical judgement in order to best determine someone’s fall risk and preventative steps to take. Having a strong understanding of your person, their habits and lifestyle will aid you greatly in enacting fall prevention measures.
What fall prevention interventions can I use?
It goes without saying that your interventions should be tailored to the needs and priorities of your person, so keep that in mind while we suggest the following starting places. In addition to the aforementioned education & environmental modifications, there are a few great interventions to check out for fall prevention. Primarily, recognize that there is a way to fall right. Reviewing and practicing with your person how to fall correctly, get up from a fall and ways to protect their body best in case of a fall is an excellent harm reduction method. This can take some of the fear out of the potential of falling and empower your person to feel more secure in their ability to recover safely should a fall happen. Reactive balance training can be a great way to improve your person’s ability to recover their balance and prevent falls in addition to strengthening full-body. In addition to this, balance rehabilitation approaches in general are always a key intervention point for fall prevention.
Okay, I got it. Fall prevention is serious and not just limited to in-hospital and in-home measures…where can I find more information?
Thrilled you asked! The National Council on Aging has amazing resources & educational information valuable for both clinicians and families. USC Leonard Davis school of gerontology has excellent resources including state-specific links, considerations for patients of different ethnic backgrounds and economic backgrounds, and fantastic resources for home modifications. They host an expert in home modifications for fall prevention monthly, so be sure to not miss out!
Learn More About Practical Aspects to Fall Prevention ?
At ARC Seminars, we’re here to empower clinicians to treat intimidating conditions. To continue your education and further develop your skills to treat patients with the best care possible, register for our self-paced webinar Update Your Care Plan: Balance Rehab today!
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How Nurses Can Help Reduce Hospital Readmissions
Reducing hospital readmissions is not only better for your patients’ health—it can also prevent your healthcare facility from facing financial penalties. Fortunately, there are many ways nurses can help reduce hospital readmissions. Read on to learn how to better assist your patients with our tips!
Key Strategies for Preventing Hospital Readmission
Assess Physical Function & SDOH Barriers
Assessing patients’ physical function thoroughly before discharging patients is the first step in preventing hospital readmission. After a proper assessment, you’ll be entirely sure that your patients are ready to leave the facility.
Additionally, you must account for potential social determinants of health (SDOH) barriers before discharging patients from the hospital. SDOH barriers, such as transportation access or housing instability, are common causes for hospital readmission. Understand your patients’ living situations and needs and make a comprehensive plan tailored to patients’ risks before discharging them.
Educate Your Patients
Patient education also goes a long way in reducing readmission. It is essential to make sure patients understand their conditions, know how to communicate their needs, and are informed on future health precautions and needed treatment. This education should start while the patient is hospitalized and continue throughout their treatment and beyond.
Plan for Post-Acute Care and Rehabilitation
Finally, successful and thorough transitions of care are critical in reducing readmission. Patients having access to comprehensive rehabilitation services promptly and consistently after being discharged is also integral to reducing readmission.
When implementing post-acute care (PAC) and rehabilitation strategies, make sure all of your patient’s care team are informed on the patient’s needs, risks, medication safety, and any other information needed to keep your patient safe and healthy. Communication between the PAC provider and the initial provider is vital for PAC success and hospital readmission prevention.
Consider Telehealth Services
Monitoring and manipulating patient data in a streamlined way, such as with a telehealth service, can help keep track of patients’ health and progress and alert you of any issues before readmission becomes necessary.
Communication with patients is key to reducing readmission, which is another reason why telehealth or other encrypted and secure communication services can help open lines of communication and maintain consistency in provider-patient communication. Choose a system that works for your facility’s and patients’ needs. Think about your patients’ age, abilities, and access to technology when choosing a telehealth or communication platform.
While each of these tips can help reduce hospital readmission in your patients, implementing several readmission reduction strategies in conjunction further increases your success. When used together, your facility will see a lower frequency of readmission than just implementing one strategy at a time.
Grow Your Skillset with ARC Seminars
Understanding the leading causes of hospital readmission and educating yourself on successful strategies for preventing readmission are critical in providing your patients with the best care possible. Care doesn’t end when your patient is discharged, and ensuring your patients’ long-term health and safety are paramount to being an effective healthcare provider.
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Someone once was quoted as saying “You can’t control what happens to you. You can only control how you react to it.” This statement couldn’t be more true… but especially when it comes to clinicians, working with those who have sustained a neurological injury.
Controlling your reactions is easier said than done. To stay calm at work requires not only patience, but also some intense self-reflection. It is very easy to get wrapped up in your emotions when you are working in a high pressure, high stress environment (i.e., healthcare). Not only do you have to manage the patients and their families, but there is also schedules, equipment, co-workers, deadlines… the list goes on. The question that probably always crosses your mind is “How do I maintain my composure when something intense is happening?”.
Suppressing your emotions is any given situation is not healthy, but it is important to remember that there is a time and a place for everything… emotions included.
Our priority should be facilitating a calm environment filled with mutual respect and support for our patients as they recover. At the end of the day, that is why we are all in healthcare, right? Modulating our own behavior can have a positive effect on our patients, especially those who are having difficulty regulating their own behavior.
So how can we maintain a calm, cool, and collected demeanor in the face of adversity? The Crisis Prevention Institute (CPI) is a really great resource regarding verbal de-escalation techniques and management. CPI was founded in 1980 to give people the tools to better manage conflict, and they believe that empathy, compassion, and meaningful connections are powerful tools to maintain a safe working environment.
CPI suggests the following as being the “Top 10” De-escalation Tips:
- Be empathetic and nonjudgmental
- Respect personal space
- Use nonthreatening nonverbal
- Keep your emotional brain in check
- Focus on feelings
- Ignore challenging questions
- Set limits
- Choose wisely what you insist upon
- Allow silence for reflection
- Allow time for decisions
The tips listed above are really great actionable items you can use to stay calm at work, when someone becomes agitated, confrontational, or upset (these can also be useful outside of work as well!). We need to keep in mind that our patients are probably experiencing the worst time in their lives – we are unfortunately meeting them when they are not at their best, and are probably going to be unable to reason and regulate their own behavior/reactions to things. It is up to us, the professional, to take a step back and have empathy for our patients (and their families!).
In addition to those things from CPI that can be done in the moment when things are escalating, there are also other things we can be doing at work to ensure we will stay calm and be ready to implement our training when needed:
Get training… often.
A ‘one off’ training focusing on de-escalation is not sufficient. A training like CPI is a great tool to have in your toolbox, but it is just that… one tool in your toolbox. There are other programs out there as well such as Handle with Care, and NAPPI. You have to choose the training that is being going to fit the needs of your team, and your patient population. Also, consider how you learn best. Some people enjoy going to a live, in person seminar while others prefer a self-paced course that can be completed on their own time at home. There is not one ‘magic training’ that is going to be a one size fits all and it is very important you do your homework to see what is going to fit you best. Lastly, make sure the ongoing education needed is something that is going to be feasible for you and your team/facility. You do not want to set yourself up to fail with something that is not going to fit into your schedule well.
Function as a team.
Management of crisis situations should not and cannot fall onto one person. It truly does ‘take a village’ to be successful and ensuring all members of your team are adequately trained and comfortable with your facility’s plan is paramount to success. If you see a colleague in situation that appears it is going to escalate, hang around and hang back. Stay within an earshot so that way you are able to assist if needed. Try and let your colleague know that you are there for them to increase that overall feeling of security. It can also help to have a designated group of staff that will respond to a crisis situation. There truly is safety in numbers and knowing that your team has your back will enable you to more effectively manage that crisis situation.
It is important that you build in some time to decompress after a crisis situation. Emotions are running high, and there is a solid chance that your heart is beating in over drive. Talk a walk outside, sit in a quiet space, or put on some comforting music so you are able to come down and refocus. The situation that you just handled did not go from 0 to 100 in .2 seconds, and you are not expected to come back to zero instantaneously. It is more than ok to tell your work colleagues that you ‘need a minute’ to stay settled and calm, and that you will be available at a later time in the day.
Set aside time after you decompress from the crisis situation to discuss why and how the situation escalated how it did. It is very important to talk through the good, the bad, and the ugly to further refine your process and response. Constructive criticism and feedback should be welcome and viewed as an opportunity for you to refine your skills and self-reflect instead of punishment. There is always going to be something that could have been better handled in each situation – no one is perfect (and that’s ok!)!
This term is a bit overused at times, but it is something that is vital for you to continue to be your best, calm self in the face of a crisis. Taking a break from your 9-5 can assist you with being fresh and positive at work. Self-care takes many forms, and can range from taking a short walk outside, to planning a relaxing vacation, to listening to some true crime podcasts in your down time. You are no good to your patients and colleagues if you are not being good to yourself first. You have PTO, USE IT!
As you can see, to stay calm in the face of a work crisis is so much more than just attending a one-time workshop on effective communication skills.
Getting training and education and just one piece of the self-regulation puzzle. Taking a step back and looking at the bigger picture for the patient is always necessary. Ask yourself “What am I doing to contribute to this person’s recovery? How can I better conduct myself to ensure a calm, safe environment?”. Remembering that it is not all about you, but the patient, can put things into a different perspective and assist you with how you can change your behavior. The best thing you can do is treat everyone you encounter with a mix of warmth, professionalism, and respect… Remember, people may forget what said… people may forget what you do… but people will never forget how you make them feel – Maya Angelou
How to Choose the Best Physical Therapy Continuing Education Courses
With so many physical therapy continuing education courses out there, it can be difficult to know which ones to choose to further develop your professional skills. Fortunately, ARC Seminars makes it easy to do so, offering a number of courses to choose from in a variety of subjects. Keep reading to learn how to kickstart your career in 2022 with our physical therapy continuing education courses!
Why ARC Seminars?
We know you love to learn and grow your skills (our team does too!), but we also want to ensure you earn the credits you deserve for the courses you take. That’s why all of our professional development courses—including our physical therapy continuing education offerings—are flexible, affordable, and credible.
Our courses are approved for continuing education units by various organizations, including APTA Kentucky, the Physical Therapy Board of California, the American Occupational Therapy Association, and ASHA. Within each course, you’ll receive access to useful resources and information that are immediately applicable to your own practice, as well as guidance for setting up your own successful programs after your course concludes.
For any questions regarding your course certifications, contact our team for assistance.
Our Featured Physical Therapy Continuing Education Courses…
…For Mastering Neurological Conditions
Is your 2022 PT resolution to become an expert on neurological conditions? If so, you should check out:
- Certified Brain Injury Specialist (CBIS) Training — One of the best ways you can super-charge the way you work is to become a CBIS. Specializing in acquired brain injury (ABI) and acquiring the Certified Brain Injury Specialist Credential (CBIS) is a great way to set yourself apart from your peers and indicate that you are dedicated to learning more about assisting patients with brain injuries. Our two-day training will prepare you to sit for the certification exam to join over 7,000 CBISs worldwide.
- In-patient Stroke Rehabilitation: 14 Strategies to Get your Patient Home! — This course will empower you with cutting-edge techniques and strategies to treat people who have sustained a stroke in the in-patient setting! In this course, you’ll focus on real-life patients and the impairments and complications that they have secondary to a CVA, as well as address the most common issues that clinicians face and how to manage them.
- Practical Approaches to Concussion Management — In this seminar, you’ll examine the common complications and side effects that can occur with concussions, or mild TBI. We teach assessment and treatment strategies that can be used to manage patients in the rehab setting, outpatient setting, and in-home care.
- Update Your Care Plan: Balance Rehab — In this 2.5 hour course, you’ll learn how to break free from providing the same intervention strategies over and over again by focusing on evidence-based and current research in the balance rehabilitation field. As with all of our courses, the skills and information presented in this seminar are immediately applicable to the clinician’s practice.
…For Gaining Valuable Expertise in Chronic Conditions
If your 2022 PT resolution is to become an expert in chronic conditions seen in all settings, we recommend exploring these:
- Update Your Care Plan: Diabetes — Diabetes is pervasive condition that complicates diagnoses in many areas of clinical practice. Empower and update your approach to this condition with this course, which will equip you with knowledge of its varying causes, prognoses of different diabetic diagnoses, and complications to watch for, as well as provide you with goal-setting tactics, client-based labs, and case studies.
- Update Your Care Plan: Heart Failure — With congestive heart failure (CHF) being an intimidating, devastating, and often underrepresented condition affecting millions of people worldwide, you need to ensure you have the most up-to-date and effective information to provide the best care possible. By enrolling in this seminar, you’ll learn how to debunk treatment myths, address fears and misconceptions, and make informed decisions when creating a plan of care.
- Cancer Care: A Collaborative Approach — Prepare to upskill your therapy practice when working with the oncologic population! This seminar is presented by two expert oncology therapists, and will equip you with the knowledge and skills needed to debunk common misconceptions, utilize up-to-date therapeutic approaches, and bridge the gap between the patient and therapy/nursing.
- ‘Settled and Secure’: Managing “Challenging” Behaviors Associated with Dementia —Challenging dementia-related behavior can be intimidating for many clinicians and clinical assistants to deal with, especially in a busy clinical environment. That’s why this seminar is a perfect choice for boosting your skills. Learn how to engage with clients, build rapport, and fundamentally change your ways of working during dementia care.
…For Growing Your Wound & Edema Management Skillset
Becoming an expert in managing wounds and edema will also set you apart from your peers. These courses will help you sharpen your skills:
- Edema Management in Inpatient Rehabilitation — This seminar will teach you techniques from Complete Decongestive Therapy to therapeutically manage edema in the in-patient environment, a setting where edema management is a chronically underserved and undervalued aspect of treatment. You’ll learn how to approach common conditions such as joint fracture and replacement, lymphedema, dependency edema, renal and cardiac insufficiency, and more.
- A Comprehensive Guide to Wound Care: Tools for the Everyday Clinician — In this practical and user-friendly seminar, you’ll learn about the common causes and physiology of wounds, gain access to assessment tools, and explore management techniques and documentation/goal setting guidelines. Enhance your practice with accessible and applicable skills that you can use the very next day!
Revamp Your Approach to Physical Therapy Continuing Education!
If you’re ready to make a commitment to expanding your knowledge and career in 2022, let ARC Seminars help! From physical therapy-focused courses to cancer care, dementia management, and more, we’re here to help you grow your clinical skillset for years to come.
Make your success a priority, and register for one of our courses today!
Understanding the types and uses of vestibular rehabilitation therapy can help you to better serve patients. Vestibular rehabilitation therapy (VRT) is a type of physical therapy used to alleviate problems caused by vestibular (inner ear) disorders such as vertigo, dizziness, gaze instability, imbalance, and falls.
Task specific training in motor learning can not only make your treatment sessions more functional and engaging but taking this approach can actually facilitate better learning of the task at hand!
A basketball player will not achieve the skill level that gets them to the pros by playing H-O-R-S-E… they have to play the game! A musician will not make the band by improving their grip strength and learning music theory… they have to play the instrument! And this same concept rolls over into the rehab world. We can do all the exercises that we want, but exercise alone will not improve function. The patients have to practice the actual tasks!
You may be thinking… “But what about all the impairments? They can’t possibly improve on a task if they don’t have the strength, balance, endurance, etc! We have to build them up first.” But I say that you can eat your cake and have it too! Get creative and simulate functional tasks in a way that will still address the patient’s individual impairments and provide opportunity for the practice that will improve the skill. This way, task specific training to enhance motor learning will become second nature to you! Here are some practical examples to improve your motor learning game!
Task: Self-feeding with coordination impairment
If you note that a patient is having trouble feeding themselves because of impaired coordination, you may have them start to work on all the fine motor/coordination tasks under the sun, hoping it will carry over into building independence with self-feeding. Things like peg boards, graded clothes pins and putty will certainly get their hands and fingers moving and will improve their overall coordination with those tasks, but during each meal… you may not find as much improvement as you were hoping for.
Better approach to improve self-feeding –
Practicing the actual task of eating is the most obvious way to complete task specific training of self-feeding and improve motor learning, however this only allows your patient finite opportunities to practice this skill throughout the day.
Other ways to simulate eating may be of benefit as well! You could have the patient practice lifting an empty cup to their mouth, then gradually fill it with more liquid as they gain more control. Or you could have them transfer a small amount of liquid from one cup to the other before lifting it up to take a drink.
With the use of utensils, a patient could practice each part of the task, then put it all together. They could start by picking up small pieces of play dough with a fork and transferring it to another dish, then they could cut the play dough with a fork (or a fork and knife) before picking it up.
For using a spoon, you could first see how well they are able to balance the liquid in the spoon without spilling by having them scoop water from one container to another. All the while, making adaptations and trialing various equipment and techniques for when they get to practice the real task of self-feeding.
Want to learn how to do oculomotor testing in 10 mins or less? This essential assessment can change your whole approach to balance rehab! Watch the webinar, right here
Task: Walking with hemiplegia
With a patient that has difficulty walking due to weakness on one side of their body, you will need to move forward with treatments that strengthen the affected limbs. Seated exercises with free weights or theraband, will certainly improve the strength of the muscle groups targeted… however a better way to move forward with strengthening to improve walking with hemiplegia would be pre-gait activities.
Weight shifting, box taps, and minisquats are straightforward ways to improve strength in preparation to maintain control in stance on the affected limb. Kicking a ball, hip flexion and extension using a skate to eliminate friction and gravity, and marching will strengthen their affected limb and also better prepare them to manage swing phase during gait training.
Better approach to improve walking –
But to really facilitate better walking and better motor learning, you must have them practice walking! Now, you are going to see patients of all ability levels, so simply having them get up and start is not always realistic. But often times, your patients will surprise you and may be able do things you don’t expect them to do if given the opportunity.
For a person who requires more assistance, you may need to utilize a body weight support system. This can usually be completed on a treadmill or over the ground. The treadmill is definitely going to allow your patient to get more steps in (more practice) as the speed of the treadmill will set the pace. However, over ground body weight support walking is very beneficial as well!
With either option you will have both hands free to better facilitate activation of the muscles needed at each phase of the gait cycle. A second helper can facilitate the timing and degree of weight shifting during each step. Body weight support gait training is an excellent option to get patients up and walking before you may have thought they were ready to – and therefore they get more training specific to walking!
If you don’t have a body weight support system available, you may find success using other very effective and supportive techniques such as using a platform rolling walker or an EVA walker. These will offer the patient more stability than a regular rolling walker or hemi-walker and again will allow you more freedom to facilitate where you need to.
Task: Toileting – Clothing management with balance impairment
If you’re working with a patient who is having trouble managing their clothing because they just keep losing their balance, your first inclination is going to be to work on their balance! Now, you may have them stand at the therapy table and complete a task that requires them to only use one hand on their assistive device, so they are not as reliant on upper extremity support. You may have them reach outside of their base of support in order to complete the task.
These sorts of activities will certainly help a patient to improve their balance and it will even improve their standing tolerance however there are a few more things that are involved with managing your clothing during a toileting task. So, these activities may help to an extent but in order to really get to the heart of the problem you need to be stimulating the activity itself or completing the actual activity.
Better approach to improve toileting –
A better way to train your patient how to manage their clothes clothing and maintain their balance all at the same time is to either break it down into its parts and simulate the activities or complete the actual activity itself.
There are a few different ways that you can simulate taking down and pulling up pants. Part of the task requires the patient to have one hand on their assistive device and use the other hand to manage the clothing. This usually requires the patient to alternate between hands so they can get one side of the pants and then the other.
To simulate this task (since there are only a finite number of times that you will be able to bring your patient in the bathroom) … You can complete activities like placing clothes pins at the bottom edge of the back of their shirt and ask the patient to remove them – alternating right and left. This allows the patient to remove one of their hands and reach behind them as if they were straightening out the top of their waist band… Grasp onto the clothes pin and remove it. Another aspect of managing clothing is being able to bend forward and squat down far enough to either pull your pants down past your knees or reach down and pull them up.
A way that you can simulate this part of the task is by having the patient lift and lower items to and from the floor or from a low stool so that it forces the patient to do the same type of transitional movement as when they’re pulling their pants up and down. If they are getting to the point where they can balance adequately enough, you can have them step into a hula hoop and raise the hula hoop up to their waist and then place it back down on the ground. Sometimes, the resistance of the actual clothing can pose a balance challenge to the patient.
If they have stretchy pants or an elastic waist band that they have to pull and stretch to get over their hips, a way that you can simulate this is to put a piece of theraband around the person’s knees and have them pull it up over their hips as if it were a pair of pants. That would give them that resistance that the pair of pants would give and would allow them that opportunity to practice the more task specific activity. Now, the best way to practice managing your clothing with toileting is to actually practice pulling down your pants and pulling them back up.
Most therapy gyms have available and oversize pair of shorts or an oversized pair of pants that are used for ADL practice in the gym setting. So again if you’re not having the opportunity to actually take the person into the bathroom during an episode of toileting… You can break out these practice pants and have the person stand up, pull pants up, pull them back down, and sit down – and they can utilize all of the strategies that you have been stimulating with them.
Task: Carrying packages walking with a cane
Something that is very practical to day-to-day life but we don’t always incorporate into our treatment plan is carrying items when you’re walking with an assistive device such as a cave. There are several ways that you could start to work on this such as having your patient carry various dumbbells while walking, making sure to vary the weight and size of the dumbbells to simulate various objects that someone may need to carry.
Better approach to carrying items while walking –
But as with all the other tasks discussed here, the best way to facilitate motor learning and improve the skill of carrying packages and items while walking with a cane is to have them complete the task specific training. Now that may sound overly simplistic… But there’s a very great opportunity here to determine the best way that a person can accomplish this safely.
You may want to explore different shopping bag options – a plastic bag could be used, a reusable shopping bag can be used, a small box or a brown paper bag. If someone has trouble grasping the handles of the plastic shopping bag it may be more beneficial for them to put items in a brown paper bag and carry it close to their bodies, as this will eliminate the need for them to grip the item so heavily and it will also keep the weight of the item closer to their center of gravity and balance will not be as big of a challenge for them.
After determining what type of package or a bag is best suited for them to carry… You can then work on how they will safely pick it up in order to carry it and then how they can safely place it back down when they get to their destination. It will also give you the chance to see what their endurance level is like with this task. Will they only be able to carry items for short distances? Or will they have the stamina to carry them for longer periods of time?
This is important depending on where the person lives and what their environment is like. A person who has a home with a short driveway where they only need to carry items in from the car to the house wouldn’t necessarily need to build up stamina in this way… However, if someone lives in a home where they are mostly walking everywhere, they may need to walk several blocks from their home to the grocery store.
This would also present you with another opportunity to introduce various ways of carrying multiple packages such as a rolling grocery cart so the person can put several bags in and pull the cart behind them. It also requires a certain amount of coordination and balance if they are normally utilizing an assistive device such as a cane.
No matter what you were doing with your patients to have them improve on their impairment and their skills… You are certainly going to benefit them and help them reach their goals! But knowing that there are certain principles of motor learning that can help us tailor treatments more specifically to what our goals are is a very powerful thing. Whenever possible you always want to do the activity that you’re trying to improve or simulate the parts of the activity that you’re trying to improve. The more task specific, and the more specific the training the better the results for motor learning of the skill and retaining what they’ve learned!
If you liked what you learned here about task specific training for motor learning, make sure to check out our 3-CEU Update your Care Plan: Balance webinar! We discuss some other principles of motor learning and how to best choose interventions based on your comprehensive assessment!
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