Deployment Stages

As many of you know, my son has orders to the Middle East and is attached to an Army unit now. He actually left last week and my daughter-in-law (DIL) and grandchildren have moved to my house. Our family is transitioning from the pre-deployment stage to the deployment/sustainment stage.

Before my son left, he was detaching from the family and this was causing mental stress with increased arguments between his wife and him. According to the mental health information on deployments, pre-deployment is filled with fear and anxiety.

The deployment stage is also a roller coaster of emotions but in a different way. My DIL is kind of relieved to not have to be brave so her husband will not worry about the family. Although she still is experiencing difficulty sleeping and having problems with depression.

My 21 month old granddaughter now has separation anxiety. She never has had any problems staying with me or had separation anxiety when she was younger. Now every time she realizes her mom is gone, she throws a fit. She has stopped sleeping through the night. All of this is normal for children with a parent deployed, but it is challenging.

The good news is my son is able to video chat almost every day. This is helping my DIL to cope with the separation better. However it is difficult to get her to leave the house if she thinks her husband might call. That is preventing her from meeting other families in the area or going to the park to play.

I am a little surprised with myself. My homework for the week my son left has so many errors that I usually do not make in grammar and typing. I was not able to focus on school because of the anxiety and stress involved with the deployment. I am so lucky because I get to hear from my son frequently and it still is stressful.

To help military families cope with deployments, the federal government has many websites to answer questions and provide support for service members and families.

Following is a link that explains the stages of deployments:

http://www.hooah4health.com/deployment/familymatters/emotionalcycle.htm

Beyond the Blackboard

I watched this movie "Beyond the Blackboard" last night. The movie is based on a true story about Stacy Bess and her first job teaching at a homeless shelter in Salt Lake City, Utah. Ms. Bess is not told she would be working with homeless children, only that she will be working at a new school and was given the address. At first, Ms. Bess thinks she is in the wrong place since the address is an old warehouse. She meets the substitute teacher who is very frustrated and hands Ms. Bess the keys as she walks out. Basically the school consisted of the children watching videos all day and a little behavior management. There are no supplies, desks, books or lesson plans. Ms. Bess is overwhelmed and does not know what to do. She could not really relate to the children. For example she brought her photo album of her vacation and the children had never been on a vacation. Also the children were hungry and had a difficult time focusing. Parents did not always get the children to school on time or would pull the children out of school to do chores.

Ms. Bess contacts the person who hired her and is told to deal with it the best she can. Ms. Bess continues to try and contacts the superintendent who actually helps her get supplies, desks, and books. This helps Ms. Bess but the children need more. Ms. Bess is doing for the children, but it is not until she involves the parents that she becomes really successful with the children. She learned she should not do for but to do with the family to be successful. She spent every day at the shelter working with the children, involved her family and got the school superintendent to help her. Change happened with consistency and dedication to the children.

Doing my field work (FW) at the homeless shelter has been an eye opening experience. There are some similarities in the movie to my FW, several times the children had not eaten supper even though our group session ran from 7-8:30 p.m. Also, things I take for granted were not available to the children there such as a refrigerator in their rooms. At the beginning, I sometimes felt like I was just another person visiting the shelter trying to fix their problems rather than really connecting to the children. Several children enjoyed our group session because we did make them do schoolwork and focused on having fun. Now at the end of the time, the children are giving us hugs and really having fun with us. It is great to see some small changes for the children.

The psycho-social needs of the children were apparent. It was difficult at times because the children are worried about getting their basic needs met and have a self-centered awareness which is entirely understandable under this situation. If I could do this again, I would bring healthy snacks for everyone at the beginning of the sessions. Also, I need to be able to relate to the children at their level and situation, rather than my middle class level. I need realize I am not there to fix any problem, but to encourage and work with the children.

Education laws changed in 1987 to include the education of homeless children. The Hallmark website has links to several organizations to help with the educations of homeless children.

http://www.hallmark.com

Solutions for Postpartum Depression

Postpartum Depression is a term that sounds familiar to most people but is not really understood very well. It is very important that a distinction be made between what we call “baby blues” and true postpartum depression.
A pregnancy causes both hormonal and psychological changes in a woman. Her body and her mindset changes as she carries a baby to term and then prepares to care for it after delivery. These changes are necessary and normal as part of the process of having a baby.
After delivery, normally hormones again change to return to a non-pregnant state. Psychologically a woman naturally experiences some anxiety as she copes with her changing body shape, social role, and her sleep patterns, and she adjusts to the challenges of mothering. These psychological changes and the anxiety that they induce, are as normal as the changing hormones, and the combination of the two often naturally result in “baby blues”. Baby blues are typically the tired, anxious feelings that a new mother experiences the first few weeks after the birth of her child as she adjusts to the experience.
In contrast, postpartum depression is when this anxious state does not subside, but a month or more later persists and often worsens. Sometimes this is due to physical health, such as substance abuse, sometimes it is a chemical imbalance in her body, such as those who suffer from bipolar disorder. Most often it is due to serious stressful anxiety-producing life issues, such a the death of a loved one, financial problems, lack of emotional support in caring for the child, or overall mixed feelings about the desire to have a child at all (such as in an unplanned pregnancy).
The seemingly quick easy solution to this problem is to prescribe medication to alter the mood of the mother and sometimes this is necessary when the situation is chemical and/or extreme. Some women suffer to the extent that they cannot care for themselves or the baby and risk harm to either or both. For other women, the key to their recovery is support from others. This could come in the form of physical help with the baby so the mother can sleep more, it may be financial help to ease the worry on the new mother, or it may be emotional help to assist the mother in processing her thoughts and feelings about all her psychological issues.
I recently read an article about postpartum doulas, which really caught my attention. Postpartum doulas are trained to assist new mothers (parents) in making the transition to parenthood smoothly by “empowering new parents by providing them with the skills they need to take care of and bond with their babies”. Classifying herself as “a professional, a mother, and a baby-specialist” the doula in the article I read, shared that she often takes the place of extended family, providing help and guidance for the new mother. This support has been shown to significantly reduce the incidence of postpartum depression.
A postpartum doula and sleep-coach can also be part of the birth process, and is trained and certified through classes at the Childbirth and Postpartum Professional Association.
Here is the article that peaked my interest: http://www.northraleighnews.com/2011/03/20/7135_she-helps-tired-new-parents.html
And the organization that provides classes and certification: http://www.cappa.net/
To read in detail about postpartum depression including the signs of: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

Psychosocial Effects of Moving

Ok, so you people say you want to hear more about my life, well here it goes. Since I've started the OTA program, I have often felt like my family is a walking OT crisis. My newest issue is my oldest son wants to go live with his dad, which in my opinion will be the biggest mistake of his life. It's not that they're bad people or anything, but I know once he's there for a while, he's going to want to come home and then it's going to be too late. I asked him why he wants to go and his response was that my husband and I are too strict and he doesn't like a certain child in our neighborhood. Man, what a tough life! I have explained to him many, many times that he will have to clean his room there, which he will be sharing with his little brother, and there will most likely be someone in their neighborhood that he won't get along with very well either, because if you've been paying attention to my blogs, my oldest son if not much of a people person.

My son has been acting out for a couple of years now. He even told my husband and I that he thought if he was bad enough, we would send him to his dads. We have put up with a lot, to say the least, but a couple of weeks ago, I came to the realization that it's not fair to my other children and my husband to have to put up with his bad behavior. After my son told me how much he hated living at my house once again and that he wanted to go live with his dad, I said ok.
So the papers are being drawn up and in about a month and a half, he will leave. It's really sad that he never learned that it's ok to love both of his families. For some reason, he has always felt like he had to pick sides.

As I was reading chapter 19 about adolescents who had an ED, I thought I was reading about my son. The reading was talking about how these individuals make good grades but don't do very well in social situations. It describes my son perfectly, and he has an explosive temper, which is the main reason I'm letting him go. I often think of the speaker from NAMI and wonder if this is going to be my son one day. He's just as big as me now, and I know that his father can straighten him out.

I'm worried about how well he will adjust to a new school, living with his dad's family all the time, and having to share a room with his little brother. Also, I'm worried about how all this will affect my other children. I have explained to them that we had G for 13 yrs and now we have to share him with his other family. They seem to be ok with it. Honestly, I think they like the peace and quiet when he's gone. How about all those psychosocial issues?

I have provided a link to anyone else who may been having some tough times with their teenagers or for reference when we are working with teenage clients.

A Place In The World For Autistic Adults

I recently read an article in the Parade Magazine written by Joanne Chen, entitled "Who Will Care For Dana", which told the dilemma of a family whose daughter is turning 21 and faces a difficult future as an autistic adult.

Statistics tell us that 1 in 110 children (1 in 70 boys) born in the U.S. is diagnosed with autism. There are multiple programs that are available nationwide for these children, 14,400 at the moment. Many of these programs are funded through the states and counties. With the average cost of raising an autistic child from birth to 18, at about $3.2 million as compared to the $222,360 it normally takes to raise a child, most parents are at the mercy of their state to help them with this overwhelming expense.

The problem arises when an autistic child turns 21. From this age on there are only 3500 programs nationwide, some of them little more than adult daycare. Many parents put their children on lists for programs a decade or more in advance, in hope that they will claim a space in a program for autistic adults, but even these can be pricey and out of reach for many parents. Fortunately Congress is attempting to pass legislation to help parents with adult autistic children, but at the moment only those with the most severe disabilities are receiving help.

Many parents are stepping up, forming vocational programs, workshops, small businesses and campuses for autistic adults, but these programs are few and far between. With the percentage of children being diagnosed with autism rising 10% - 17% a year, within the next 15 years, 500,000 children will age out of the system and face a world where they cannot find their place. At the moment only 20% of adults with autism are employed and of these, 60% are underemployed or paid below market wages. Though 44% of autistic adults have mild to moderate mental retardation, some have none at all. In the workplace, autistic adults need help such as coaches or aides to guide them and help them develop their skills, but overall they are hard workers with good attitudes who don't mind repetitive work.

I feel like our country is very quickly coming to a point where we will have to make significant changes to accommodate this growing segment of our population. It is up to us to create opportunities for autistic adults to be contributing members of society. With extra money, training and effort, it could be a win-win for everyone.

I found an excellent website that could be used to get information on resources for those with autistic adult family members.
http://www.disability-resource.com/Autism/autism-in-adults.html

A Long Awaited Smile

Last week at FW was interesting. It was my turn to run the stretching session, so I decided to try something different. I went to the Dollar Tree, my favorite store by the way, and got some hula hoops. Let me back track a little bit. The previous week we cut pictures out of magazines concerning healthy indoor activities/food, as well as, outdoor activities, so one of the client's cut out a picture of a hula hoop, and I ran with it.

We stretched for a few mins and then we played gigantic horseshoes with the hula hoops. It worked out perfect because the one who can't see very well won, which was great for him since he's usually the one who can't see what we're doing and gets frustrated. Then things got serious and the guys were really concentrating on trying to win. They had a great time though, and I hope they have continued to enjoy them!

After the regular session, I took one of the guys outside to play basketball. I purposely took my biggest challenge. He's not "bad" just really hard to motivate and doesn't speak more than 1 word and it's hard to even get that out of him! I was so surprised when I gave him the basketball. He enjoyed shooting the ball and even made a couple of baskets. We also bounced the ball back and forth to each other a bit. I was so impressed! The best part of the whole day was when he smiled, and I knew that we're doing something that he actually enjoyed.

It was nice to find a leisure activity that he likes, and I hear he quite well at taekwondo! There's a section in our book that talks about sports and exercise on page 533.

Clink on the title for a very interesting article on TBI and exercise.

The Importance of Rapport

I have had the privilege of working in a large hospital in Raleigh for several weeks. My days are of full of a-ha moments as I see so much of what I have learned come alive, and come together. One of the subjects that keeps coming up in our studies is the issue of rapport with our clients. I have found that this is something that is easier said than done. Some clients are very friendly and talkative and it is so easy to connect with them and establish a rapport, for others who are not in good spirits or cannot even speak, it seems much more difficult, maybe even impossible.

I had a strange experience my very first day when I was with an OT doing an eval on a very sick patient. The nurse was interacting with her so gentling and patiently. Then the OT began her magic and I was so impressed to watch her connect with her patient within seconds, chatting in such a warm friendly way in what I know was a very thorough evaluation, but appeared on the surface as nothing but conversation. I remember thinking "this is what rapport looks like". Right in the middle of this interaction the patient's doctor walked in and loudly interrupted with a "how ya doin'?" I noticed that the patient appeared very startled and almost afraid. She never said a word as the Dr. conversed with the PA about her meds, and then left the room without even a reply from her about how she was doing. I felt really sad for her and wondered what she must be thinking...it didn't seem to me that he was genuinely concerned with how she felt she was doing.

On another occasion I was working with an OTA who was queen of rapport. Every single patient got her full attention and she went out of her way to talk eye-level with them, finding out how they were, discussing any and everything they wanted to, from toileting to eating, going home to even their meds and other therapies they were receiving. I noticed how carefully she tailored herself to each person, adjusting her tone and temperament to benefit the client. I was so impressed with her rapport. What I took away from my experiences is that these patients are first and foremost human beings. They are not machines that we just do stuff to. They have feelings and questions and concerns that need to be heard and responded to. There is simply no substitution for the conversations we have with them in their healing process.

I recently read an article about how the insurance companies are doing away with coverage for talk therapy. What once was a 50-60 min. talk therapy visit with a psychiatrist with a possible prescription for meds, has now become a 15 min. visit for "prescription adjustment". How sad that is that we don't even consider the possibility that words can heal. Some psychiatrists resist the insurance mandates and still offer up to 90 min. visits - good for them. One therapist is quoted as saying "medication is important, but it's the relationship that gets people better." Amen to that.

Below is the link to the complete article I quoted. It has a lot of detail about the changes in talk therapy. Very interesting and worth the read.
http://www.nytimes.com/2011/03/06/health/policy/06doctors.html

Dimentia and ADLs

On my fieldwork, my supervisor and I were called out to the home of a lady with dimensia. She seems to have no serious physical problems, but is having problems remembering to do her ADLs and is doing them in a less-than-safe manner. She has fallen twice in the bathroom, resulting in minor head trauma (just bumps and bruises). The family is concerned (with much reason) that she is going to eventually hurt herself badly.

The thing that I noticed first and most predominantly is that this lady does not see that anything that she is doing is unsafe and does not appreciate the fact that someone is invading her house and telling her how to do something that she's been doing for the past 80 or so years.

There were tell-tale clues of the problems that she is having with sequencing. She did not gather her towel/under clothes until she was finished with her shower. She also did not test the temperature of the water before entering the shower.

She is an avid reader, so we left her with several visual cues on things that she needed to do before entering the shower. Her family had also put carpet in the bathroom so that she is less likely to fall in there. We went over with her the things that she needed to do to be safer, but I'm not sure that she will comply. She resented the fact that we were there.

I'm not sure what we could do different to make her more compliant with things that she needs to do to be safe. Any suggestions?

I found these assessments and interventions for those with the early signs of dimensia.

Denial: Psychologically Healthy or Harmful?

I am at an Acute Care floor for my fieldwork. As the nature of the care setting, patients are admitted to the hospital with life threatening conditions that may or may not get better. As the patients are faced with life changing health events, the patients may go through a grieving process to deal with the reality of the health problems. The first stage of grieving is denial. According to the Mayo Clinic website, denial is a psychological coping mechanism that allows a person time to come to terms with the traumatic changes happening to the person. This stage is beneficial to allow the person to absorb and process the changes happening. However, if the patient refuses to accept the changes and move on to the next stages of grieving, denial can become a negative psychological behavior impacting the patient's mental health and support network. This is the case with two patients I met.

The first patient, age 66, has lung cancer that has spread to his brain and bones. He is in denial and believes he is going to be fine as soon as he can get out of bed and go home. He refuses to talk with anyone about his prognosis or hospice even though the medical staff has explained the medical situation. After a week, the patient realized his health was not going to improve without some medical treatment and agreed to seek support for his family through hospice. By accepting his prognosis, the patient was able to acknowledge the grieving process improving his mental health and receive support from his family and friends as his life comes to the end.

The second patient, age 56, has a severe foot infection and the doctor has recommended a BKA. The patient refused to have the BKA after the medical staff explained the complications of not having the BKA. He has chosen to receive an IV line of antibiotics for 6 weeks at the SNF in hopes the infection will clear up. The course of medical action might work, but there is a strong indication the infection will return and the patient will eventually lose his leg or pass away from the infection. By denying the severity of the infection and situation, he is compromising his physical and mental health. The psycho-social effects of his decision include lack of medical care and family support as he is not doing everything he can to improve his overall health.

In the end, each person needs to decide his/her course of action when some type of traumatic event changes everything in life. Some denial can help the person adjust to the changes or even help the person change his/her life to prevent more problems. An example would be with heart attack patients. Many patients make changes in eating and exercise habits to prevent more health problems. In situations that life decisions can make a difference, denial can be a great motivator for change to a better lifestyle and mental health status.

However, in terminal situations or situation with permanent physical changes such as a brain injury or amputation, denial of the situation can cause significant problems with the person's mental and physical health and family support system. Dealing with any type of loss or grief affects a person's mental health and the person's needs for support and understanding from family members and friends to return to a healthy mental status and accept the new reality of life.

Denial can be a useful psychological coping mechanism to help a person adjust to undesirable news. Denial becomes a negative coping mechanism when the person will not or can not accept the news.

The Mayo Clinic has some great tips on dealing with denial at:

www.mayoclinic.com/health/denial/SR00043

Psychosocial Impact on Physical Disability: an observers perspective

I’ve been blessed to work with the senior population since graduating from college. My first full-time employment was at a Senior Activity Center. I saw first-hand the bliss of aging and also the sadness of physical and mental deterioration. As a whole, the seniors that attended the Center came from different walks of life and were at different stages on their journey. Some were barely 55 years old, still employed and would come to take a line dancing class during their lunch break. Some were fully invested in the Senior Center and would spend 5-7 hours volunteering to teach classes, answer phones, hand out food, etc… Some just came to the Meals on Wheel congregate meal site for lunch and bingo. Whatever their involvement, I saw firsthand the impact physical decline had on attitude and emotion. For the most part, this was a place where people came AFTER a major life change (such as a temporary physical disability) occurred and they were already on the road to recovery. A lot of participants were encouraged by their doctors to attend fitness and wellness classes to continue their recovery and improve their health so that is how they became involved with the senior center. Through their physical setbacks, they came to find community and purpose at the senior center. A specific example…I taught an 8-week exercise class called Fit and Strong that was targeted at sedentary older adults with osteoarthritis. This program encompassed stretching, balance, aerobic and strengthening, exercises which gradually increase in frequency, duration, and intensity over time. The class drew in a few individuals who hadn’t exercised in over 20 years. They were weak in body and in spirit. They had let their physical bodies deteriorate to a point of pain and frustration. The first few weeks of the class, I spent more time coaching and encouraging them to stick with it and to believe that their health can improve, than they actually moved their bodies. One individual in particular didn’t see how she could ever get herself out of the “hole she dug” for herself.

I can compare that to someone who’s gone through a major surgery or a CVA/TBI. These diagnoses require constant energy and will power to push through. During the first few days I think our jobs as OT practitioners are to help the client see a way through the pain, and be a support for them. Our job is to help them see their lives past these hard days and find hope for the future yet walk beside them in the present.

With my work at a rehab facility and nursing care center, I’ve seen a fair share of long-term and short-term patients experiencing anxiety and depression while they stay at the facility. Some have trouble accepting their decreased independence, some are experiencing cognitive decline and are constantly disorientated to where they are, and some haven’t seen family or are saddened by their lack of support throughout this hard time in their lives. I can’t imagine how grueling it is to loose your independence, even for a short period of time. Most of the short-term rehab patients need assistance to move about the room and into the bathroom, to the dining hall, etc. For individuals who are used to taking care of themselves it must be grueling to accept full dependence on someone else, especially when they are used to doing things on their own time and not waiting for a call bell to be answered!

For the long-term resident’s, depression is a common denominator. No matter how wonderful the activities, staff and facility is…it isn’t their home. According to Dr. Nina Moadel a practicing psychiatrist in New York, “Because the signs of depression can mirror the signs of dementia, especially problems with focusing and concentrating, diagnosing depression in an older adult can be difficult.” To learn more about Depression in the Nursing home…click on the title of this blog for a link to a great video.

Coping with a debilitating illness

The other day at FW I met a man in his early 50s who has a motor neuron disorder called Brachial amyotrophic diplegia (BAD), a rare type of ALS. During the evaluation session, I kept thinking how he and his wife were handling the diagnosis so well. They both talked about how vivacious he had been - he would do all the handyman jobs around the house, mow the yard and kept a job. He even commented on how he was a big fan of Arnold Schwarzenegger back in the day, and that Arnold’s bodybuilding book had been his bible. Now the man has limited strength in both arms and chest, and is not able to do any of those things. He has lost a lot of his fine motor skills and cannot cut his food, button his shirt or pants, but he is still able to hold his head up. He and his wife have learned to improvise - wearing pull over shirts, jogging pants, and hiring someone to do the handyman jobs.

It makes me wonder which stage of grief they are in - denial, anger, bargaining, depression or acceptance. Since it’s been about 2 years since the diagnosis, they probably have gone through denial, anger and bargaining, and he didn’t seem depressed. He seem to be in the acceptance stage, but as time goes by and he looses more of his strength and use of his arms, he may backtrack to one or more of the other stages. Luckily his wife and family are very supportive, which makes this transition more bearable.

Click on the title to read more information about the 5 stages of grief.

Ms. T

I have spoken about Ms T before. She is this incredibly sweet, beautiful , little elderly woman who had totally surprised me on the second week of FW. When I first met Ms. T she engaged in about as normal a conversation as could be. She spoke of all very relevant things, such as dressing for the weather, how Friday is always a big day for Bingo, and that church was in two more days. Imagine how surprised I was when I met up with Ms. T on week 2 of FW. She presented such a different scenario. She asked me @ 10 times what day it was, are we going to church today, is her husband getting ready to take her, why is he taking so long to get ready.... She then showed me repeatedly how she shuffles her feet while watching TV at home!! I saw nothing that would have even eluded to the fact that she has dementia, and is delusional!! At our first meeting, she appeared just as lucid as could be. She spoke very well, and even seemed to be up on a few current events. When I asked her how old she was, she answered in a very matter-of-fact tone. She told me that she was 25, born in 1985!! Everyone at this facility just goes right along with her. They suggest that maybe her husband is just taking a nap, and that he will be ready shortly. They remind her that church is in two more days. They compliment her on her choice of clothing, reminding her that the bright colors work well with her!! All this is done so as not to cause this sweet woman any anxiety or stress. For additional reading on the differences and causes of dementia and dilusional behavior, click on the attached site.

Working from the Inside Out

I was thinking about my FW last week and just can't seem to get Mr. Z out of my head. Mr. Z made such an impression on me, but not in the usual way. It wasn't his pleasant personality, the expressions of his face, or the way he expressed himself. In fact, it was the absence of all the above that has left me still thinking about Mr. Z. Have you ever thought about how difficult it is to work with someone who has severe flat affect? Think about how frustrating it must be to have flat affect but be feeling so much inside and not able to express it. In class we all learn about strategies for therapeutic use of self. I watched my CI, with years of experience and an excellent therapeutic use of self therapist, struggle with Mr. Z. I thought about myself and how I thrive off of others energy. Therapeutic use of self is a concept that usually comes easy for me, but in Mr. Z's case there is not a lot to work with. He doesn't give any indication that he is happy, sad, tired, frustrated, or even in pain. We can see "physically" his improvements or deficits, but his emotions and feeling are hidden from us. As OTA's we are looking at the whole client, the inside and out. Some of Mr. Z's psychosocial issues we might have missed. Was he feeling confused, anxious, or even self-conscious? Did he remember his past or have any inner delusions? I can't answer those questions and I think that is why Mr. Z is stuck in my head! I have been working on understanding schizophrenia this semester. This topic of flat affect and psychosocial issues got me to thinking about the schizophrenic client as well. Flat affect can be present in many schizophrenia clients. I came across this web page that really helps the reader see inside this situation. If you start with schizophrenia and the negative affects headline, the author expresses how flat affect actually keeps him from forming relationships. The idea is that people don't want to be around the person because they don't get anything from him. Eventually the person becomes isolated and alone and the schizophrenic symptoms only become more exasperated. The web site is very insightful, I hope you get a chance to explore it. One of the reasons I love OT is because we actually look at the client as a whole. The inside is just as important as the outside. Many physical dysfunctions are medically complicated and people need our help in understanding the illness or help taking care of the body part that was affected. The inside work, gaining insight into the problem, dealing with the emotions the injury brings, and even sorting out different feeling and emotions of family members, are all part of our job as an OTA!!

Cognitive decline

During FW, you come in contact with so many patients whether through your supervising OT or through the rest of the team. When I arrive at site, I am always curious to know how a patient is doing from the last time I was there, especially if you have not seen them in a while. One pt. stands out in my mind. The pt. is being helped in therapy for joint disease and edema, he also suffered from dementia but you could not tell it. He laughed and joked and tell stories, interacted appropriately with the therapist and myself, would need some redirection to task but could complete the session. He unfortunately was sent back to the hospital (not sure why) but eventually he returned to rehab last week. Oh the difference dementia makes! He had declined so much in cognitive ability. During treatment he couldn't do half of what he could do before. As a matter of fact, he was getting so agitated and was ready to leave. The OT changed activites four times and could not get the pt. to particpate/complete the activity. He even tried to get out of the wheelchair; he could move the wheelchair with the brakes locked! Not sure if he would have become combative if we had not ended the treatment.

So treatment will change from a physical dysfunction to a pyschoscial one. We will now work on what he can understand and do and incorporate the physical in it as well.

Found an article about occupational therapy and dementia, improving the quality of life. http://www.medicalnewstoday.com/articles/56942.php

Second thought As a patient's cognitive ability declines whether it's dementia or another disease, is it often that a patient abuses a therapist?

The Effects of Caring For an Ailing Spouse

I am doing my FW at a SNF. One of my clients has a wife that is always there when my OT and I go in for a session. The very first time I was there, she let us have it as soon as we went into her husband's room. She complained about everything that happened the night before that we had no part of. She was in tears, and although I felt sorry for her, I wondered why we were getting all this dumped on us. He had breakfast already, so there was an opportunity to voice her opinion to whoever brought that in, or maybe she just complained to everybody. The gentleman was a very quiet, pleasant soul.

The second time I accompanied my OT into this room, the wife appeared to be pleasant. However, before we could even make it back down to the therapy room, she had already called to complain. You see, we were trying to work on his ADLs so that he could return home, and his wife wanted us to work on shaving and brushing his teeth, so we did. Her complaint was that he didn't need someone standing over him watching him brush his teeth, but w/o us, he would have never completed the task.

After that, the OT sat down with the wife to complete new goals. This time she wanted him to get stronger, so yesterday we t/f him to his w/c and he used the hand cycle to increase his endurance. While this was occurring she told us how unhappy she was with certain shifts but if they left, it would probably be the same anywhere else. She actually smiled one time when she was reminiscing about a trip her and her husband took.

This woman stays at this facility with her husband pretty much all the time. It's not a very big room, and she even sleeps there, in a chair. Her husband is a sweet old man and doesn't seem to pay her much attention either way. My OT said she has been known to leave with her husband in the middle of the night because she wasn't happy with the way something transpired. I can't imagine that being a safe situation for her or him.

I believe her continued stay in that cramped little room is wearing on her mental status. She told us that she can't sleep well there either, so she is most likely sleep deprived, too.

According to our textbook there are many stressors in the aging adults life including: loss of careers or their home, sickness, wondering how to pay for everything, the aging body in itself, and just not having the energy needed to perform the most basic tasks is enough in itself to warrant psychosocial problems. I'm sure this patient's wife has come to the realization that her husband is never going to be "normal" again and is most likely going to just get worse, and she needs to vent and let someone have it. So, we listen and do whatever we can to help ease her pain. The facility has a contract with a psychologist. I think she should probably schedule an appointment. After all, our textbook says, depression is the most common psychiatric dx in the elderly.

My client's wife eventually wants to take him home, so I have included a link to a great website with some very helpful suggestions on how to care for the elderly. I think she needs to pay close attention to numbers 4 & 5. She needs to learn how to trust others with her husband so that she can have a break before she drives herself "crazy" trying to do everything. This is a classic example of why socialization is so important, because everyone gets a little stir crazy without it!