Chair Bingo for Tansverse Myelitis

Meet Joe. Joe is a 22 year old male diagnosed with Transverse Myelitis (TM). He was diagnosed after extensive diagnostic testing like, MRI or CT scan with myelography to outline the spinal cord. He was sent to an inpatient multidisciplinary rehabilitative unit for therapy, including OT. Before being diagnosed with TM, Joe was independent in ADLs and IADLs. Currently Joe is independent in eating, requires set up for grooming and upper body dressing. He needs moderate assistance for bathing and toileting, and full assistance for lower body dressing and transfers. His upper body is within functional limits. In his lower extremities, his leg strength is 2/5 and he is unable to bear weight in his legs when standing. Joe is willing to do anything he can to get better.


TM is a neurological disorder caused by inflammation across both sides of one level or segment of the spinal cod. Myelitis means inflammation of the spinal cord and transverse describes the position of the inflammation. Inflammation can damage or destroy myelin. The damage causes nervous system scars that interrupt the communication between the nerves in the spinal cord and the rest of the body. Most clients recover from TM with minor or no residual issues, while others suffer permanent impairments. TM affects any gender, race, and age. Common symptoms include: localized lower back pain, sudden pain in legs, sensory loss, and bowel and bladder issues. The symptoms can develop over a few days or weeks. The most common therapy for TM includes keeping the body functioning, in hopes of a partial or complete recovery. Caregivers may be instructed to manually move a clients limbs to keep the muscles flexible and strong. If limb control is recovered, then other therapies may be started, like OT. This is where bingo can help! 

Joe likes going to sporting events, especially hockey and basketball. I wanted to create a game to bring out his competitive side. I incorporated different types of sports with strengthening and stretching activities. My hope is that therapy would not be boring to Joe, but something that he looks forward to doing to get better. Joe has very little lower body strength. The exercises on the bingo board are designed to strengthen and stretch his legs in hopes of a faster recovery. A few items on the board are focused on the upper body. This is to give Joe a break, so that his legs do not get tired. In order to cover up a space on the board, Joe will have to successfully complete the exercise. Four successful exercise completions in a row equals a bingo! Joe has a close knit family. As a prize for completing a bingo card, I thought it would be a good idea for Joe's family to take him to a sporting event. This brings the family into helping Joe be successful in therapy.

The goals for Joe are as follows:

-Joe will attempt to complete one card each week.

-Joe will practice two of the exercises off the “chair bingo” card every other day.

-Joe will increase leg strength from 2/5 to 3/5 in three weeks.

Those with TM are not the only clients, who can benefit from chair bingo. TM is very similar to Guillain Barre Syndrome. They both attack the nerves and a client can recover over time. Anyone who has a spinal cord injury in the thoracic vertebrae or lower may be able to benefit from this game. Chair bingo can always be graded up or down. 

Description of the exercises. (All exercises are to be performed while sitting in a wheelchair, chair, or on a therapy mat.)

-Chair push ups-Client will place hands on arm rests, as close to shoulder as possible, and push up.

-Leg extension-Client will raise leg into extension

-Knees to chest-Client will bring knee to chest

-Leg Flexion-Place a rolled towel under knee. Client will move knee as far back as possible into flexion.

-Heel raises-Client will lift the heel up and down

-Knees to elbow-Client will bring elbow to knee while keeping chest firm.

-Chest squeeze-Client will hold arms at 90 degrees with elbows bent and push arms together.

-Arm circles-Client will hold arms perpendicular to the body and circle counter clockwise or clockwise.

-Block the ball-Client is the goalie. They will move legs side to side as one unit to keep ball from getting past them.

-Kick the ball-Client will kick the ball 

-Swing the bat-Client will hold arms like swinging bat back an forth in a slow, controlled manner. (emphasis on extending arms during swinging motion)

-Put on a shirt-Client will put on and take off a shirt

-Knee squeezes-A ball will be placed between clients knees. Client will squeeze knees together.

-Sliding toe taps-Client will extend leg out and tap pointed toe

-Dibble through legs-Client will take a basket ball and dribble through legs.

-Touch knees then toes-Client will bend for hands to touch knees and stretch towards toes.

 Bingo in action

Hope everyone finds this helpful!!

Case Presentation-Ronald Reagan

There is a lot of discrepancy as to when Ronald Reagan started to show signs of dementia. Many believe his early onset to have started in the late 80's. Nancy believes that it took place after he feel from a  horse, causing a clot in his brain. However, Ronald did not let anything get in his way. He, with the help from Nancy, began to take steps to keep his mind sharp. He has loved horse for a long time and his home was on  a ranch. Lauren helped to integrate his therapy with his passion for horses. A goal she set out was to have him teach his grandchildren to ride. I think this is an excellent goal. The goal uses the knowledge he already has, and allows him to describe the situation to his grandchildren. This involves them in his life and helps he to constantly remember who they are. Other items that could be helpful to Ronald include: home modification, pill containers, and memory boards. An OT can help provide these resources though insurance.

Neuro Note #4-What is dementia?

Dementia. This is a disease that affects around 5 million Americans and is growing. Dementia is considered a disease of memory loss that goes along with other diseases as a person ages. However new research shows that dementia should be thought of more as a fatal brain failure/terminal disease. This is crucial to understanding, especially when talking to late stage patients. Even though dementia is widely recognized, there is very little understanding of "what it is" when walking family members or caregivers thought the treatment options. More often than not, overly aggressive end of life care is used to help those with dementia. A study mentioned in this article, follows those in a nursing home, diagnosed with dementia, through their final days. The study calls for palliative care to be administered, unlike the rigorous treatment options that are used today. The study also found that many in the study died from dementia and very few died from complications of their symptoms. This leads researchers to consider dementia a terminal disease. What is the link between the two findings? Once an individual enters the late stage of dementia, they typically are not making medical decisions. Their family or caregivers are making the decisions for them. An individual with dementia may be ready to go, but the family is not. This is why aggressive treatment for dementia is seen in the last months of a persons life. There needs to be a better understanding of what the disease is and how it works across all medical professions, so that the same, consistent information is given to families. They need to be allowed to make the best choices for a family member with dementia. Comfort needs to be considered over treatment.

I agree with the underlying message of this article, comfort need to be considered over treatment. Once an individual is diagnosed with dementia, there are treatments and therapies that can help slow the progression, but sadly the disease will end up winning in the end. It is not because someone is older that they will pass, but is is the deterioration of the mind that slowly overtakes the body. I think it would be better to comfort a client suffering from dementia, rather than wear them out and have them suffer through their last few days. I believe this can be achieved through a consistent message of what dementia is across all health care professions. For an OT, they may be asked to help clarify what the doctor has told them the treatment options are or even asked what they might do in this situation. An OT needs to be equiped with the current up to date research to effectively provide support to a client's family in need. The OT should never make the decision for the family, but should help clarify what the family has been told and what the research clearly says about the disease. This is one way that OT's can make a difference in how dementia is perceived and treated in hoping to provide comfort to client's diagnosed with dementia.



(May 23, 2017). Time. Retrieved from: http://content.time.com/time/health/article/0,8599,1930278,00.html

Case Study-Montel Williams

Montel Williams was diagnosed with Multiple Sclerosis (MS) when he was 42 years old. He was acting and serving in the military. He noticed that he started to lose vision in his left eye. He soon started to experience depression. Many believe that this was due to the severe amount of pain that he suffered from MS. He did not want his diagnosis to keep him down. He had goals for himself. He wanted to continue to wok and write each week. He also wanted to land two acting rolls each year. He never let MS keep him from doing anything. He has two kids, and he wanted to continue to stay active to spend time. Working on pain management in the joints is the biggest thing and OT can help with. Hydrotherapy would be a good intervention to allow the muscles to strengthen, but relieves the pressure on the joints. Overall, Montel lives a very productive life with MS.

Woody Guthrie

Woody Guthrie live a fulfilling life, by following his passion for music. He love to travel and play music. He was diagnosed later in life. It is thought that his mother had Huntington's Disease. She was placed in a metal institution for the remained of her life. Woody is quoted as saying, "I think I have what my mom has." That has to be a tough realization, to see the tough time his mom had with what could have been HD and to then realize that he will be living it. However OT helped with some of Woody's symptoms. Surprisingly enough, music was a therapy they used. They did want him to have a consistent schedule, because this helps to control HD, but Woody did not listen. I can not imagine what life would look like being diagnosed with a disease that can show up at anytime and can progress over night.

Neuro note #3-Worst disease know to man

Worst disease known to man.

This is how many describe Huntington's disease (HD). HD is a degenerative disease of the brain. Most describe it as a combo of Parkinson's disease, Alzheimer's, and ALS. HD does not rob the mind or the body of function, but both through its progression. Danielle Valenti gave a Tedtalk on her experience with HD. Her mother had been diagnosed with HD and never told her. It was not until two years before she passed that Danielle found out of the diagnosis. She watched her mother struggle with the disease and then eventually elect to end her life by not eating. Her mother passed 67 days after her last bite. It was not till Danielle had be removed from the "caretaker" phase of life, did she consider that she may have HD. HD has a 50/50 chance of being passed on the offspring. Currently there is no cure, but there is a test to see if someone has the genetic marker for it. Danielle and her friends and family debated if she should get the test. All the test does is tells you if you have HD. There is no cure for HD, only management of symptoms. Did Danielle want to live her life in fear of HD or did she want to live life without knowing? Danielle choose to find out. She had the genetic marker for HD.
I think Danielle's dilemma brings up a good question, do you test for HD if there are no symptoms? The test is very helpful in verifying a prognosis. It gives answers to the doctors, so that they know how to treat. But what if you do not have any symptoms yet? The test recognizes the gene marker whether there are symptoms are not. Does knowing that you have HD change the course of your life? HD can show up at any time. Most cases usually start after 30 years of age. I think knowing would limit someones effective and happy life. I would constantly be thinking, "is today the day?" I think the test is beneficial for the diagnosis when there are symptoms, but not for knowing if HD can develop.
What did Danielle do after her diagnosis? She choose to live life, looking to the happiness that life brings and not the negativity. These are words we can all live by.

Retrieved from: https://www.youtube.com/watch?v=6JRwCdmewl0

Foundations debriefing

I loved this class!! This was the best class to get your "feet wet" with OT. I loved learning the history to actually working though an activity or a profile of an individual. I like that we started with the history of OT. It was a great way to see why we do what we do today and to see how OT has changed over the years. It was great to see the ebb and flow of concepts through the years. My overall favorite activity was the activity analysis. I loved thinking outside the box on an activity that could be used and how to break down all the steps. It was a difficult project, but I loved it. I wish we had more hands on experience with the profile. This is a foundational tool to the OT process and I want to learn more about it and be able to understand it's use in correlation with another individual. I am really sad to have this class end. I wish there was a class like foundations every semester (there may be and I am just not there yet). I will miss this class, but I am excited to see what the next semester of OT school holds.

Case Study-Joseph Heller-GBS

I loved diving into the story of Joseph Heller in No Laughing Matter. The way in which Speed Vogel and Heller tell the story is drastic. I loved the comparison as to how a caretaker and patient see everyday details differently. GBS affected Heller out of the blue. He didn't even know how serious his condition was as he walked into the hospital. He had goals that he wanted to achieve, but need ed a friend to be there for him. Speed Vogel was that friend. Vogel stood by and encouraged him the entire time. I loved learning how GBS affected Heller and how he described the symptoms affecting his body. His background as a writer enabled him to describe the situation in a very clear and understanding way. Heller was able to bring attention to GBS before many knew what it was.

Steve Gleason-case study

Steve Gleason is a former pro football player for the New Orleans Saints. He was diagnosed with ALS in 2011. He currently lives at home with his wife and son. He is not able to move at all. He is dependent on his wife and a friend who stepped in to be his caregiver. Steve has mobility through a chair that was designed for him by Microsoft. They even developed a system that reads eye gaze. This gives him more mobility than he would have had. Steve's priorities are to be able to play with his son, advocate for future research for ALS, and to live a fulfilling life. OT can help with the training of caregivers, optimizing safety, and continue to allow him to participate in social activities. Steve has lived 5 years with the the ALS diagnosis. The typical life expectancy is 3-5 years, but sometime it can be as high as 10 years. I hope that Steve's case is a rarity and he can continue to advocate for future research for ALS for 10 plus years. I can only imagine the amount of stress his family has in doing simple daily activities with him. I love that they include him and even the community. He knows his life is not easy, but he still finds to find the humor in life and shares helpful tips on Twitter. Steve has really become the face of ALS.

Neuro Note #2

In the past week, the two neuro classes that I have been taking in OT school have discussed Parkinson's Disease (PD). No cure exists for this disease. There are different forms of treatment for the symptoms ranging from therapeutic to drug to surgery. Occupational therapists are use to help a client with assistive technologies to make life easier. The most common symptom and earliest visible sign, is a resting tremor. OT's can introduce a client to weighted forks, spoons, or knives. Medications to treat PD focus on preserving dopamine or providing the necessary materials to aid in the production or use of dopamine. A popular drug is called Ldopa. A newer form of treatment is deep brain stimulation (DBS). DBS is considered when a client's symptoms are no longer controllable by medications. DBS is performed by surgically implanting a device called a neurostimulator, like a pacemaker for the brain. The device delivers electrical stimulation to targeted areas of the brain that control motor movement by blocking the abnormal nerve signals that cause PD symptoms. 

How does someone know if they are a good candidate for DBS? They have had symptoms for the last five years, have had off and on fluctuations, still having a good response to meds even though the duration is short, and their symptoms interfering with activites of daily life. There are few brain target areas that the FDA has approved they are: thalamus, subthalamic nucleus, and a portion of the globus pallidus. So how does a client choose the area to treat? A client should talk with their doctor to see which taget would benefit them the most. A client and doctor should also discuss which areas are safer to treat and cause the least side effects. DBS is still a newer treatment and should be considered carefully. DBS does not keep a client from needing to continue medication, but it does lessen the amount they will need to take. Some side affects include: stroke, infection, cranial bleeding or any complications with anesthesia. 

I choose to research DBS, because it was something that was not mentioned well in class. I wanted to look more into a newer procedure that could help those with PD and a possible areas that OT's may be assisting in the recovery and daily functioning in the years to come. It seems that the success of DBS is growing as more research is performed and assessed. I would recommend that any OT be familiar with new treatments, even if they are not specifically performed by an OT, that are offered for diseases that OT's commonly encounter. 

(May 4, 2017). National Parkinson's Foundation. Retrieved from: http://www.parkinson.org/understanding-parkinsons/treatment/surgery-treatment-options/Deep-Brain-Stimulation

Blog Post 10-Cultural perspectives

I really enjoyed listening to the the required materials for class today, even the ones in class. It is easy to forget that there are other people in the world. Some of those people have issues bigger than deciding what to wear or eat that day. They have to survive for their life. America is seen as a safe haven. Because of this, America is a layer of cultural bubbles. Each with their bubble layer has different thoughts, actions, beliefs, and language. I think it is amazing how many different cultural bubbles we move in and out of each day. America is a melting pot of cultures, yet somehow all these cultures work together (most of the time) in the same place. 

The Story that impacted me the most is the podcast on The First Cow. The way she described coming to America and the first experiences she had, really made me think of how I perceive the world around me. It made me think of how I would describe a fire alarm or the schooling process. A refugee is really someone who needs an OT to assimilate into the American culture. They are at a disadvantage to understanding. Obviously the social worker didn't think to describe the sound of a fire alarm, causing them to flee from their house at the sound of the doorbell. OT's could help to explain how society perceives things to decrease the embarrassment that someone may feel from not doing things right. 

Bog Post 9-Higher Hospital Spending OT

I am in school to be an occupational therapist (OT). The most common questions I get is, "what is OT?" and "What can you do with that?" Even thought OT is celebrating its 100th year as a profession, not many people know what OT is or how the degree is used. Those who can describe OT, have usually had OT in some aspect of their life. An issue that has been a hot topic for the past few years is the baby boomers are getting older. This means more individuals are seeking out medical help as they age. This puts a strain on hospitals, rehab facilities, and even insurance companies. So what is being done to decrease this strain? Higher spending for OT services. What?! Why would anyone want to increase spending on OT services? Because higher spending on OT services leads to lower readmission rates. There was a study performed about a year ago on this exact process. The article, "Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates", was published in the Medical Care Research and Review Journal. The aim of the study was to help hospital CEO's see how to better allocate monetary resources within the hospital and to identify specific spending categories where higher spending has the potential to reduce readmission across various conditions.

The article is great! I encourage everyone to go read it. What is so great about OT that this profession alone reduces readmission rates? Well, OT's look at individual occupational roles and the goals that each client has. OT's do not look at the singular reason why someone is in OT, rather they look at the individual as a whole. A client could have an issue with their leg that is keeping them from performing their activities of daily life (ADL's) and they could have stiffness in their wrists, but they were not sent to OT for this issue. They were sent to gain mobility in their lower extremity. OT's would look at this situation and find a way to address it with a client. The OT values the whole person, not just the issue. By doing this, OT's can recommend alternative discharge plans that address the issues and thus reduce the likelihood of readmission.

Something that has been an main focus since entering OT school is, how can I advocate for OT? There have been many projects already that have addressed this. I find it very interesting that this study was not performed with the sole focus of advocating for OT. The researchers did see the benefit of OT. What they did, was to allow the research to speak for itself. " We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed (Rogers, Bai, Lavin, & Anderson, 2016) ."I believe this is the ultimate for of avocation. People want the facts and this article gave it to them. I hope that studies, into the benefit of OT, are continued.

Rogers, A. T., Bai, G., Lavin, R.A., Anderson, G.F. (2016). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, P.1-19, 10.1177/1077558716666981.

Foundations in class blog-Emerging areas

In the field of OT there are multiple emerging areas. One that is of interest to me is community mobility are older drivers. It is a known fact that the baby boomer population is getting older and needs assistance in different ways. That is what this program aims to do. Everyone has their own definition of independence. If you ask a teenager they would say driving is their biggest form of independence. If you ask someone over 65 years, they may not say driving is their biggest form of independence, but they would be mad if it was taken away from them. They have driven for a long period of time and driving has become involuntary. It would be like taking away someones right to breath. I can sympathize with this reaction. I do not like being told that I do not have the right to do something. If you reason with me, I may be less irate about the situation. What is being done to help this area?
OT's help in community mobility and driving issues by talking with caregivers and family members on how to perform this activity. This is definitely hug is helping someone who has had a stroke to find a different way to drive. By not explaining this process, a wreck could occur causing harm to individuals. There is a program called CarFit. This program aims to educate older adults in driving and how to check to be sure that their car fits them. This is a great step in helping older adults assimilate back into driving in the community.
A way to improve upon the CarFit idea, would to be to work with local DMV's and OT's to hold a regular course to educate the older population on how to drive with any disabilities they have or assisstive tech they may be using. To make this even more effective,  a test (similar to a drivers test at 16) could be implemented. That way those who are on the road could have a smaller risk of wrecks. This may also help to decrease the number of people on the road, who are a risk. A Negative aspect of this is that it could take away someones independence, which is what community mobility and older drivers are trying to prevent.
Overall, I would love to shadow an OT and see how they make this idea a reality.

Blog 8-Why are specialty areas needed in OT?

I have previously descried why OT needs to look to emerging areas, but how do those areas differ from specialty areas? Emerging areas are new areas of practice in OT that can be considered nontraditional. Specialty areas in OT are areas where an OT can get further certification from AOTA by taking a board exam to show their dedication to a specific area in OT. This describes a foundational principle of maturation. Maturation occurs when an OT has been in a specific area for a long period of time and has developed and honed skills to a practicing area. Examples are: low vision, driving and community mobility, and environmental modification. Many more are currently being developed as emerging areas are becoming more specialized.

Blog 7-Emerging Areas in OT

I love talking about emerging areas in OT. A list can be created, but really the possibilities are endless. For school we had to read articles talking about ways OT's can work in non traditional settings. My favorite one that was described was telehealth. I love the idea of bringing OT skills to those in areas that are inaccessible. This could be in a different country or in in the backwoods of America.  Another idea that mentioned was advocating for OT' to teach or wok in a field when the job title did not specifically say OT. An example being teach college course to older adults. I guess anyone cold do this. However, OT's really understand how to make an occupation work in an individuals life. This could be through a different learning style, teaching technology with assistive technology if requires, or adapting the course material to pertain to real life situations for each individual. OT's can really do anything that their minds are set to. Where do you think OT's will show up next?

Blog 6-Accessible Fart Machines

There is a Ted talk by Holly Cohen called "Accessible Fart Machines and handless video game controllers." In this talk she describes the need for toys to be altered so that individuals with disabilities can do what they love: play with toys. When a toy company makes a toy, the toy is produced for the masses. Individuals with disabilities may not be considered when the toy is made, but that does not mean they still do not wan to play with the toy. Holly Cohen has been working to make toys accessible to individuals with disabilities. The way to make toys accessible is very simple All that is required is a twenty-five cent mono-jack. It can be adapted to most toys. Holly Cohen said something that really stood out to me. She described the need for devices to be built to the need of each persons ability, rather than build a generic adaptability device that will not help all. I really like the perspective that she has. This is a perspective that all OT's should embrace. I found myself embracing this in the activity analysis assignment for OT school. I took a non traditional approach. I wanted to analyze how to participate in a Nerf gun war. I loved doing this analysis! By far one on the most practice things OT school has taught me. In doing my research to understand a Nerf gun, my next door neighbor built a blow dart Nerf gun for his two year old son, because he could not pull even the simplest of triggers. This idea my neighbor had, got me to thinking how this could be used in OT school. A blow dart gun could be used for someone with a C3-C4 SCI or someone who has breathing issues and needs a fun alternative to strengthen their lungs (like COPD). I would love to find more ways to change the outside of the gun to make it appear like a real Nerf gun, so that there is no discrimination in the outward appearance of the gun. Most kids and adults recognize what a Nerf gun looks like. The blow dart Nerf gun will not be any different, it will just work differently from a traditional Nerf gun.

Sherri Woodbridge-case study-Neuro Aspects

Sherri Woodbridge is a woman who does not let a disease hold her back. Before she was diagnosed with Parkinson's disease (PD), she worked full time and enjoyed playing with her grand kids. After she was diagnosed at age 44, she now works at home as a freelance writer. She still plays with her grandkids, however it may look different. I love that she still works doing what she can to keep using her fine motor skills in her ADL's. She could no longer work out of the home, so she bought work to herself at home. She started writing a blog that has won many awards for the way she details PD. She is wanting to get away from taking medications for her symptoms. It looks like she may not have experienced occupational therapy (OT). This could be beneficial to help stop taking medications to manage symptoms. An OT may be able to help with different exercises or tips. However, medications may be the only way to manage symptoms. Sherri is an extraordinary person!