Driving and OT

This week, we had the privilege of learning about driving and community mobility and OT. This might make you think back to when you were 16 and someone had to get in the car with you to tell you whether you were allowed to drive or not. Honestly, part of it is the same. Except now instead of failing the test because I couldn’t parallel park, I am in a position to obtain a specialty certification and becoming the person who recommends someone to not be allowed to drive.

One main point that was really stressed to us was how important it is to build rapport with a client before and during any type of session. This applies to every setting, with or without a certification specialty. It is especially important when assessing a person’s ability to drive because a lot of the time, you have to be the one to tell an individual that the state is probably going to be taking away their ability to drive. I think this is so vital for every setting because no matter where you are, you will have to deliver bad news about permanent or temporary deficits eventually.

Another key point was just how many different diagnoses can affect an individual’s ability to drive. If you live in your own little bubble, you just assume that everyone can drive because it is so natural and understood for drivers. However, people with a stroke, a traumatic brain injury, a spinal cord injury, an amputation, Alzheimer’s disease, muscular dystrophy, cerebral palsy, an intellectual disability, or an impairment in visual processing can all affect an individual’s ability to drive. I think it is so easy to underscore how many people this affects because not only does it mean that that entire population either needs an adaptation for driving or cannot drive, but it also affects those individual’s caregivers or family members. If they cannot drive themselves, they need someone to take them to appointments which is where the family has to step in. What really intrigued me was when we learned that on average, people outlive their ability to drive by 6-8 years. This means that most people need someone to drive them anywhere they need to go for 6-8 years.

One other (there were several) key take away for me, someone becoming an entry level OT in less than a year, was how many low-cost options there are to help someone improve their ability to drive. Whether that is with reference points on the car or road, enlarged mirrors or bling spot mirrors, speedometer, arrow, or numbers markings, or glare reduction using a towel, there can be simple ways to either improve an individual’s safety while driving, or to allow someone with a motor impairment the ability to continue to drive.

One OT intervention to address these needs could be scanning to the left with a support group for those who just had a stroke and now have left neglect. This is something that needs constant cueing to remember at first, which obviously affects an individual’s ability to drive safely. Without scanning to the left, an individual may merge into oncoming traffic and not even realize it until it is too late. Another OT intervention to do with an individual is collaborating with the client to figure out where their greatest needs are while driving and then figuring out an adaptation for it. Whether that is a higher seat, a bigger mirror, or even just a visual cue to keep the car straight on the road.

Leadership Reflection

Over a year ago, my class was asked to draw a reflection based on a key on what we think an effective leader looks like. It was really interesting to debate in my head about what characteristics make up a leader, and which do not. Last week, we did the same exercise again, but we couldn’t look at our drawing from last year until we finished this year’s. I knew I had grown and changed since I started OT school, but I didn’t realize how much. After completing this year’s, I compared my two drawings. There were several changes that I made from last year’s to todays.

One was that I didn’t feel like I was in more leadership roles than other people my age a year ago. Now, we are two days away from an Art Show and Auction of which I headed up the planning. It’s been a lot of work, but through it, I have lead multiple meetings, delegated many tasks, and networked with several professionals from other departments.

Last year, I was able to name two themes from the Strengths Finder, but this year, I could not think of a single one.

Back then, I thought that to be an effective leader, you didn’t necessarily need to see yourself as a leader. However, now I see the importance of viewing yourself as a leader. I think it is so crucial for you to respect yourself in a way that shows confidence in yourself which leads to others feeling confident in you and your abilities.

Last year, I said that self-awareness was not a vital aspect of effective leadership. However, now I realize how important it is to be able to see your own strengths and weaknesses when leading a group. If you only see your strengths, and think nothing is a weakness, no progress or growth will ever be made.

I also thought that technology was an important aspect of effective leadership, that has actually weirdly changed for me. I do not feel that you have to be tech-savvy or use technology in order to be an effective leader. I think character is more important that skills or devices in leadership. Technology may be important for certain projects, but not necessary to lead a group of people effectively.

Finally, I said that creativity was not really necessary for leadership, I said organization was way more important and creativity was not at all. However, I have since realized that creativity is a very important aspect of effective leadership. If a problem occurs, a creative leader will be able to problem solve to get the job done, just in a new way.

Who would have ever thought a viewpoint on leadership could change in such a short amount of time?

Nutrition and Aging

Today we had a guest lecturer for our Occupation-Centered Practice in Older Adults class who was a Registered Dietitian. It was a really interesting and informative lecture on the importance of proper nutrition in the aging population. It was really crazy to think about the fact that at age 30, a person is at the peak of our muscle mass. At age 40, muscle mass decreases by about 8% per decade and after age 70, muscle loss accelerates to about 15% per decade. The loss of lean body mass can lead to a whole host of complications ranging from decreased immunity and increased infections to death from pneumonia. This is something that can be prevented but is so often neglected in medical care. Most people do not know that they are malnourished or losing lean body mass, and they do not understand how to prevent it. In order to prevent or treat sarcopenia, the age-related loss of muscle, one must have a high protein diet and engage in strength training regularly. 

People who are highly at risk for malnutrition include older adults, people living with chronic diseases, patients in a hospital, and long-term care residents. All of these individuals are people that occupational therapists see regularly, so proper nutrition needs to become an issue at the forefront of an OT’s brain in order to prevent the many complications that can occur from malnutrition. One easy way for an OT to detect malnutrition is from a weak grip strength, another is edema (usually in the lower extremities). These are areas of an individual’s evaluation that OTs are already addressing. With proper education and training, this information can then be given to the patient’s dietitian to hopefully prevent further malnutrition and get the patient back to being well nourished. The information may also need to be given to the patient’s doctors, caregivers, and the patient themselves.

Often times, malnutrition can be treated with nutrient supplements, Ensure. This can really increase the patient’s caloric intake, and most importantly, their protein intake. This is such a vital aspect of a person’s lean body mass that is typically deficient or lacking. This can be from lack of education, or it could be from food insecurity. If an individual has food insecurity, they are 50% more likely to develop diabetes and 3x more likely to be depressed. Both of these diagnoses have a major impact on ADLs and occupational performance. Nutrition is such a vital aspect of an individual’s life, and it is far too often overlooked. We as occupational therapists need to understand the role that an individual’s nutrition plays on their occupational performance and work on advocating for proper nutrition for our clients.

An individual treatment idea could be to make a dietary discharge plan with someone who is in an acute care facility in order to educate the patient and caregiver on proper nutrition, as well as a way to provide proper local resources to supplement for any food insecurity. A group intervention to address nutrition could be an ice cream social in which residents engage in social participation, while receiving the proper nutrition they need from an Ensure mixed with their ice cream. Another intervention that could be applied to a population is educating caregivers and LTC residents about the effects of a sedentary lifestyle coupled with malnutrition.