Plasticine, presentations and planning.

The environment and its affect on occupation.

This week we have explored how the environment can affect an individuals engagement and participation in occupations. This is a really interesting topic and I feel a very important core skill for an OT to consider all aspects of a persons environment as we look at people holistically. We looked at:

• Built environment
• Social environment
• Technological environment
• Financial environment
• Cultural Environment

We discovered that all of these environment contexts interlink and connect, and can all be affected by each other. My classroom group studied the technological environment in more depth and discussed the positives and negatives:

• Positives:

• Technology allows access to information
• Keeps people motivated to learn how to use technology
• Makes occupations accessible
• Engages people to develop new skills
• Promote Independence
• Connectivity
• Improve social skills
• Support disabilities – Communication apps for PECS etc
• Breaks down barriers
• Mobility - Mobility scooters 
• Assistive technology
• Equipment/machinery 
• Safety – Heat detectors, motion detectors

• Negatives:

• Difficult to keep up with
• Cognitive difficulties to keep up with how fast things change
• Hinders social skills - Children playing video games, not socialising with other children and not developing adequate social skills (Social environment)
• Isolating
• Virtual worlds - Avatars, internet dating, using social media.
• Education - people may not be cognitively able to learn new skills and how to operate new equipment.
• Accessibility
• Make vulnerable people more vulnerable – safe guarding
• Cost – budgets (Financial environment)
• Rural communities – No signal (Built environment)

Presentations and plasticine! 

This week we did a presentation based on a scenario given to our case study. Our scenario was that Joan Rivers at the height of her career had osteoarthritis in her hands. We studied this in depth using the compensatory frame of reference, critiquing it against other frames of reference. We discovered that you could use the biomechanical frame of reference primarily alongside the compensatory frame of reference as this focuses purely on movement and the body as a functioning machine. We explored; the condition Osteoarthritis, the OT process in this scenario and possible interventions, compensations and working on exercises with physio's in the wider multidisciplinary team. We related this directly to Joan Rivers and explored the occupations meaningful and personal to her through research, focusing on her self care, leisure and productivity.

To get the audience involved and experience what Joan may have been going through, I handed out writing practice sheets to which I asked them to write their name with their non-dominant hand. I asked how it felt and they answered things like "frustrating" and "weird!" 

I handed out some hand warmers because simple heat wraps and using hot water can be really effective to relieve arthritis symptoms.

I also handed out plasticine as manipulating plasticine is actually a really good activity to do to exercise your hands! It's fun too, you don't even feel like you're working! I think people enjoyed this task :)

Although I felt quite nervous I actually feel that doing all of these presentations is helping me to become more confident and I enjoyed involving the audience/group with an activity. 

This coming week we have another presentation and are designing our own occupational model of health. I also have a couple of deadlines coming up so it's time to start planning, reading and writing!

 I'll leave you with a picture

Over the next few weeks I will mostly be looking like this:

New found wisdom?

Theory into practice.

Aside from arty antics, this week has actually been quite a theory heavy week! The first of many I think! We have begun learning about frames of reference and relating these to practice. It has been really useful to have been out on placement and to have had the opportunity to see the theory in practice! I re-call hearing the expression "theory into practice" a lot and not really understood what it entirely entailed, but it is all starting to make sense now! The frames of reference I have looked at so far are:

• Biomechanical Frame Of Reference
• Client-centred Frame Of Reference
• Compensatory Frame Of Reference
• Cognitive Behavioural Frame Of Reference
• Psychodynamic Frame Of Reference

I still need to do a lot of reading on this topic to expand my understanding, but I have a very basic understanding of some of them, as I have seen them in practice. I have also very briefly looked at some conceptual models of practice.

I made this really simple little picture because I really liked the analogy my tutor Karen gave us explaining that the paradigm is the overarching belief (rainbow) The rain is all theory, the umbrella is the frame of reference, the handle is the model and the hand holding the umbrella is the approach. 

I was shocked to learn that there is actually a Sensory Integration frame of reference which I had no idea about which I would have been working alongside for 3 years at Wirral Autistic Society!

I have a 20 minute presentation to prepare with my learning set for Friday. It is using our occupational case study Joan Rivers and  a scenario in which we have to explore the Compensatory Frame of reference. 

This week I have discovered that it is far less tiring and stressful getting the train to commute to Carlisle, so I am now the proud owner of a student rail card! 

Being on the train at 6am can have its perks! And now with a 3rd off with my railcard!

Today I received my first copy of The British Journal of Occupational Therapy in the post! It felt quite special. It seems a really good resource full of relevant and current articles I can use in my studies.

And finally, if you're wondering about the title of this post? Then wonder no more! This week has seen the emerging of my first ever wisdom tooth! I'm really hoping it will bring me lots of wisdom and help me on my course! So far it's just brought me a bit of pain!

I will leave you with a photo of him! 

 I wonder if he'll help with my reading....

Using Art.

I have mentioned only very briefly in one of my previous posts that I am studying the amazing Joan Rivers as an occupational case study. This is for my life sciences module where we are studying the foundations of occupational therapy and occupational science and looking at development across the life span as well as many theories, models and frames of reference. For these sessions we work in learning sets, I am in learning set 2 :) To choose our occupational case study, there were 2 envelopes: one with the sex of the person and one with their occupation. My learning set chose a female entertainer! Wow! I still feel lucky to have picked that out. The criteria was that the person had to be over 70, who was alive or passed away within the last 5 years and had no on-going health condition. After a discussion my group decided we would use Joan Rivers. She has made our presentations and research so much fun! There is a a lot of rich material within her lifespan which we can use in our studies and assessments.

So as I've researched, read, watched and looked at Joan Rivers I have found myself becoming more and more inspired by her life and her occupations. She is an extremely interesting woman who has had a lot of ups and down's in her life. I found it particularly interesting looking at photographs of her when she first began her career in the 1950's-1960's comparing them to how she looked in the later years after supposedly hundreds of plastic surgery procedures! There are many times when Joan is interviewed and she revealed that she had never been happy with her appearance and her body. She claimed no man ever told her she was beautiful, and that when she looked in the mirror she would view herself as being fat.

I find her image and the reasoning behind it very powerful. I have created some images based on my inspiration of this topic.

Some really simple studies I have created:

I began by simply collaging some images of Joan. A bit of a 'then and now' if you like! Half of her face is before a lot of her procedures and the other half is the result of many procedures. I think these look really interesting and are quite a dramatic realisation of how much her image was changed through plastic surgery. To the naked eye, she never aged! Her huge personality never aged and neither did her willingness to work hard. Joan was 81 when she passed away earlier this year.

The next idea for me was to re-create these images of Joan's then and now portraits in a dramatic statement using the simple style of Pop Art. Why did I use Pop Art? Because in the 1950's Pop Art was a controversial art movement that emerged which challenged all the previous traditions of arts and traditional painting. It focused on imagery of popular culture and imagery that would publicly be easily recognisable through the news and media etc. At this time technology was advancing and TV became more accessible and manufacturing processes became more advanced. Screen printing was a huge method in Pop Art. It meant that many images of the same picture could be easily reproduced within a short time scale, getting away from the expressive brush stroke, and becoming more flat and manufactured with layers of block colour, rejecting traditional methods in a huge statement. I feel this mirrors Joan Rivers, as she too was emerging in the 1950's in her very controversial new career! The method represents Joan's appearance and how this was very commercialised by how she thought she should look from the media and other celebrities receiving plastic surgery. They all have that similar plastic look and have difficulty communicating through facial expressions. But I have not chosen to screen print my images, I have used a traditional brush and paint method. This is to represent that Joan was by no means manufactured, the was very much so unique and her personality shone beyond her appearance and she was a beautiful, one of a kind person.

This image looks at Joan's face before plastic surgery and the other half being the interior skull. This was to represent that we are all made the same on the inside, no matter how much you change your appearance, everybody goes through similar changes throughout their life span development. Also it represents that what is happening psychologically on the inside where nobody else can see can become physical and real through how someone changes their appearance. It could also represent the physical affect of many plastic procedures and how it could eventually take its toll on the body.

Finally just a simple quick sketch using charcoal. Charcoal is an expressive, bold material to use, Just like Joan Rivers.

These images were just some really simple ideas I had and felt inspired by. I felt I needed to bring the research I was learning alive visually. I love being inspired, it's fun!

Take it away Joan....

37 hours down... 963 to go!

Observational Practice Placement One!

This week I have spent an amazing week working with a fantastic community neurosciences team! It was my first placement and just an observational one to link our theory to practice and to give us some insight and experience into occupational therapy.

I feel like I have seen such a huge amount within just one week! Where do I even begin!? 

I was made so welcome on my first day by everyone (and by the way I did not get lost!) I was introduced to the members of the team which included 3 occupational therapists, 3 physiotherapists, occupational therapy assistants and district nurses. Throughout the week I had the opportunity to go out into the community with all 3 OT's (Including my placement educator who is a senior OT) on visits to people affected by neuro conditions. These complex conditions included: 

• Stroke
• MS
• Parkinsons
• Spinal Injury

The thing that shocked me the most is how common stroke is! The majority of cases I have seen over the week have been affected by stroke. Stroke is fascinating as it affects people in many different ways; It can affect a person's mobility, cognitive function, short and long term memory, visual perception, word recognition, speech, psychological impairments, sensory impairments and the list could go on! Stroke can be devastating and ultimately life changing. I have seen a number of cases this week of relatively young adults receiving therapy in recovery after stroke. It is evident that they are feeling very low and depressed. There stoke has had a huge impact on their lives and some of them have lost most of their mobility and speech and as a result are living within residential care or receiving full time care from family, friends or carers. Put yourself into that position... going from being a fully functioning individual, working and enjoying family life and then something life changing like stroke comes along and can be totally devastating. It was important to see the occupational therapists role within this recovery process. The occupational therapists offer a range of adaptive equipment such as; wheelchairs, hoists, standing aids, hand rails to name but a few to enable a person to function around aspects of their daily living activities. The occupational therapist also practised different mobility exercises such as; standing and weight bearing activities. Also the OT would provide support, empathy and understanding towards patients and their families and would work within the specific environment and needs of the individual to enable quality of life.

 During the week I was lucky enough to be invited to attend a network stroke meeting where I met a lot of different professionals from different trusts who were discussing their stroke services and how to improve them. 

                                                My little badge I was given at the meeting!

It gave me a great insight into the current climate of the NHS (scary stuff) But it also taught me about different categories of stroke and how they could be treated. (Category 1 being the most severe to category 6 being less severe). Most hospitals run an ESD service now which stands for Early Supported Discharge. This sees stroke patients length of hospital stay times significantly reduced and they are sent home and provided with an early, intensive therapy and rehabilitation programme to maximise independence as soon as possible. The sooner after the stroke the better as the brain has the ability to heal and change (neuroplasticity) to re-gain and learn new skills. The treatment will be very intensive for the first 2 weeks and then gradually reducing. This is where I experienced the neuro community team coming in! In the guidelines it says that a patent should receive up to 45 minutes of relevant therapy a day but sometimes this is just not feasible. It was great to attend the meeting as it fed straight back in to what I was observing on my placement!

It was great over the week to return to some of the same patients houses and so see their progress with ESD therapy even just within a week people were making improvements! A lot of people make great recoveries over time thanks to the amazing work of the Occupational Therapists and the wider team. 

I realise I have written a lot about stroke but I have found it fascinating!!

Some of the most interesting things I experienced through the week were the Stroke Driving Screening Test, the Chessington Occupational Therapy Neurological Assessment Test and the Behavioural Inattention Test. These assessments we're actually really fun and fascinating! AND I got the opportunity to administer some of these assessments myself which was great! They mainly test cognitive function, memory, visual and perception impairments in people with stroke and other neurological conditions. The stroke driving screening test assesses peoples ability to return to driving post stroke with a variety of different visual timed activities. The assessment I administered myself was part of the Behavioural Inattention test. This was to assess a patient with MS and who was struggling with memory and visual problems.

Here is an example of one part of the test:

                                        http://strokengine.ca/assess/module_bit_intro-en.html

This part of the test was called the Star Cancellation and patients are asked to cross off all of the "small stars" on the page. This can be quite difficult for someone with visual problems as there are a lot of distractions on that page!

Here is a picture of the COTNAB test I also assisted to administer:

This test highlights a person's ability to grip, and hand-eye coordination, fine motor skills and dexterity. http://www.saetrahealth.co.za/cognitive_assessment/cotnab.html

It really made me feel confident performing these tests and I feel I really connected with the patients :)

So as discussed throughout the week I:

• Was introduced to a multidisciplinary community team
• Have seen and learned about different neurological conditions
• Learned some basics of neuro anatomy and the physical affects of neuro conditions presented in the body
• Cognitive and psychological effects of neuro conditions
• Have attended a stroke network meeting
• Learned how different adaptive equipment works from a hoist to a sock aid!
• Have met a lot of lovely individuals whose lives are affected by neuro conditions
• Experienced how important occupational therapy is within the multidisciplinary team
• Have learned how effective and life changing occupational therapy is
• How awesome and hard working occupational therapists are
• Asked a lot of questions to my educator as I was fascinated by everything I saw and wanted to learn more
• Have administered assessments and tests to patients
• Have assisted with interventions
• Have helped to measure up for new banisters in someone's home
• Have witnessed an initial assessment of a patent and activity analysis
• Have offered therapeutic use of self to reassure and praise patients
• The many challenges an OT faces within a household environment including coordinating adaptation, extremely cluttered kitchens to very scary loud, muzzled barking dogs!
• Have supported people out into the community on their first shopping trip after stroke

I also had the opportunity to write notes and complete paperwork which was great experience to see the language used and follow their structure of writing up patients notes. I also attended joint multidisciplinary meetings with patients with other professionals including; social worker, nurse, OT and physiotherapists. It was great to see how everyone worked together complimenting each other, especially the OT's and PT's. Making phone calls and booking patient appointments was also a good experience too!

I really do feel my brain is bursting with the amount of experience I've managed to gain out of just one week and I am sad that I didn't get to stay longer! Neurological conditions are fascinating and there is so much vast information you could go into. I feel this could be an area of interest for me in the future!

As you can see, my brain is buzzing with information that I have learned this week! I am exhausted too, observing is more tiring than you think! I have loved my first placement and have gained a great awareness and understanding of occupational therapy. I have also received some really positive comments from my educator which is really re-assuring, confidence boosting and makes you realise why you have chosen occupational therapy and that I am very capable and suited to the profession... Just need to work on my level 7 writing skills and I'll get there.

I'm going to be an Occupational Therapist :)

I will leave you with a photograph of my BAOT student member badge :) I became a member this week!

By the way did you know it is Occupational Therapy week!? How ironic.

Time for an early night and to rest my brain ready for starting preparation for next week over this weekend!

Understanding Dementia

Today I began a worldwide online course in understanding dementia thanks to a fellow student on my course sharing the link! It is provided by the University of Tasmania in Australia and is a great way to gain a good insight of dementia and it's; causes, symptoms, progression, effects on individual's, carers and family, how to provide support to individuals to promote a good quality of life and well-being.

I feel this course will be a great relevant source of information for me as I will most likely come across a lot of clients with dementia during my training and career and I don't currently have much work experience of dementia. It is relevant currently of course as I am out on placement with a Neurosciences team!

I will post about my placement at the end of the week :)

Here is the link to the course:

http://www.utas.edu.au/wicking/wca/mooc

A week of theories and preparation!

Psychosocial Development Theories.

This week in our Life Sciences module we have been studying psychosocial development theories and their effect on occupations and well being. I have found this really interesting! We looked at; Erikson, Freud, Vygotsky, Piaget and Bronfrenbrenner. It was fascinating learning about the different theories and relating them to our life span development, or the life span development of others, including the occupational case study my learning set is studying: Joan Rivers! It was interesting also when we highlighted the strengths and weaknesses of each theory and made suggestions of what research could have made the theories more reliable sources and equally, what made the theories effective. We also looked at how the theorists life experiences may have been mirrored within the framework of the theory created due to the time within history that they were introduced. Their psychosocial backgrounds and personal events occurring during their own life span could also be related directly to the theory...

... Hey, I've been critically thinking!



Within our groups I studied in more depth the 8 Stages of Psychosocial Development by Erik Erikson, Here is a link I found useful to learn about the different stages: Erikson's Theory

My creative side is tingling....

I am hoping/planning to do something creative regarding my Joan River's occupational case study, as she has inspired my arty side! Watch this space.....

Preparation.

This week has also been about preparation as I get ready for my first observational practice placement next week! I am going to be working with a neurosciences team in a community setting, not too far away from where I live so I can stay at home and commute in the car. In preparation I contacted my placement educator who kindly informed me of; uniform requirements, directions, lunch arrangements etc and has even compiled a timetable for me to structure my week and give me as many opportunities as possible! On Wednesday I will be attending a Stroke Network meeting with the team and meeting up with lots of other professionals working in local trusts and settings. I can't wait! What an opportunity!

I have been studying a basic knowledge of neurological conditions such as; Stroke and Parkinson's.

Here is a really useful link to the Stroke Association with some great easy reading information about the different causes and types of stroke, symptoms and recovery.

And a more in-depth YouTube video about Stroke which I found helpful as there are great visual diagrams and narration. YouTube is great for learning anatomy! Stroke

Here is a link to Parkinson's UK relating to how Occupational Therapists can support an individual with Parkinson's Disease. Parkinson's UK.

I also did a "dry run" on Saturday to find my placement so I know where to go on Monday morning amongst all of the rush hour traffic... This proved to be slightly unsuccessful as I managed to get completely lost! This problem will hopefully be resolved in the morning as I have now programmed the location into my sat nav. Note to self: Improve sense of direction and route planning!

I will leave you then this time with a picture of my beautiful placement shoes....

Wish me luck!