The Value of Occupational Therapy

Wanda in OT uniform in the middle of the back row

On Mother’s Day, I posted an article about Mark’s Mother’s career as an Occupational Therapist (OTR). I enjoyed interviewing her and thought it was interesting how treatments changed through the years and varied from those with physical, mental or cognitive disorders.

I’d never heard of an OT before I met Wanda. The word occupational lead me to believe they helped people find a job which was most fitting for each individual based on their knowledge and interests. When Mark realized my confusion, he explained she helped people with mental illness perform activities of daily living, which included crafts. Wanda clarified the craft media were used to improve attention span, attention to detail, concentration, planning, generalization, adaptability and socialization skills.

After our accident, I met another OT while Mark was in his coma. She did passive range of motion type exercises with the arms and shoulders. She ordered splints for his hands and wrists so they wouldn’t curl. I learned a Traumatic Brain Injury (TBI) can cause unwanted, excessive muscle tone, pulling hands and feet in positions which would keep him from using his hands properly in the future. Months later, after Mark came out of his coma and in a rehab center, I met another OT. She oversaw a series of full arm castings, which were needed to stretch out his muscles because the intensity of his flexor tone drew his right arm up to his chest and it was impossible, even manually, to stretch it down to his side. After several casts, he graduated into a brace, which he wore for nearly a year.

My experiences with OTs through the years have taught me there is a large range of treatments an OT does depending on the type of rehab needed. I recognize the needs of a TBI patient and one with mental illness are very different, but I wondered if through the years the profession and approach has changed. I decided to ask Wanda, who’s the best resource I know.

How did the field change from when you started to retirement?

“In the late 60s, there was a push to move patients out of institutions into halfway houses and to close the institutions. This was handled very poorly and resulted in a lot of misery for the patients. At this time family involvement became more common.

 When I first started working, there were no tranquilizers or really any other kinds of medications for the mentally ill. Electric shock, insulin shock and “the tubs” were the main types of treatment. A tub treatment consisted of the patient being submerged in a tub of cold water which had a canvas cover with a hole for the patient’s head to stick out and staying there for quite some time as body heat warmed the water. This kind of treatment was given by a Physical Therapist and OTs did not participate in any of these kinds of treatments.”

How did you feel about this treatment and did it seem to work?

“Electric shock therapy did work for many patients. It’s changed a lot since the 50s and is still used for patients who are depressed or suicidal. It works quickly and if I needed it, I’d prefer it to the medications.

Insulin shock therapy was used for patients with other problems, but I don’t remember what the differences were. I haven’t heard of it being used since the 50s.

The tubs worked for some patients, but since I’m always cold, it seemed cruel to me.

These treatments were not used together and OTs did not participate. Treatment was determined by the diagnosis.”

What types of experiences can you share?

“Patients tended to self- isolate when first admitted. Some patients were good to others and some weren’t. They hallucinated freely and were sometimes hostile and aggressive. Sometimes patients had to be isolated until they were in better control of themselves. I can truthfully say I never had a problem with a psychiatric patient, as opposed to a patient with tuberculosis (TB) who was going to bash my head into the wall until other patients jumped out of bed and restrained him.”

Yikes! What caused that?

“During my TB internship, patients were confined to bed and the medications for it were limited. They could have crafts to work on in bed for a certain time limit, fifteen minutes per day for example. I refused to give the patient materials for more time and he got VERY angry. I took refuge behind my supply cart and other patients jumped out of bed and restrained him. These were all ex-servicemen in a VA Hospital.”

Sounds like the military taught them well!

Where did you work?

Wanda on the far right

“Territorial Hospital on Oahu, HI, Northern State Hospital near Mt Vernon, WA, Firlawns Sanitarium in Kenmore, WA, Woodside Hospital in Vancouver, WA and Oregon Health Sciences University (OHSU). Firlawns and Woodside were small, privately owned Hospitals. The others were very large. All patients were legally committed.”

Mark talks about going to work with you at Firlawns as a child and still remembers some of the patients there. He smiles as he recalls one patient who sang Home on the Range. She changed the words to, “where seldom is heard, an encouraging word…”

We have Wanda to thank for our understanding of the benefits of therapy. Many therapists tell me they enjoy working with Mark because he’s willing to try whatever they ask of him. He works hard to recover or maintain the activities of daily living, which he did so easily before the accident. I believe his mother’s influence and her chosen profession kept him from giving up. With just eighteen years of living under the same roof and only twenty-one years in the same state, her inspiration continues to stretch across the miles between them.  It’s a testament to me to the importance of motherhood and the relationship formed in those early years.

I’m forever grateful for the Occupational Therapists who have worked with Mark. Their skills have made a difference in the quality of our lives.

 

Two Hats of Many

Wanda holding sister, Jerrie (1), Karen (2) on Mark’s 11th birthday

I’ll bet every woman feels she is wearing too many hats from time to time as she tries to fulfill the needs of family, friends, personal, professional, neighbors and colleagues. Today we celebrate mothers of the family and the influence women have in society. Next to my own mother who gave me the gift of life and continues to effect who I am today, stands my mother-in-law, Wanda. Her optimistic power in Mark’s life is a great blessing to me too.

Besides being a creative, fun, loving and caring mother, she made a career as an Occupational Therapist (OTR). Wanda was the first OTR I’d met and I assumed she helped people find a job. It didn’t take long for Mark to set me straight. She helped people with mental illness perform activities needed in daily life by using a crafts media.

Mark and Wanda

Through the years after our accident, I quickly learned the importance of skilled OTs. The ability to brush his teeth, feed himself and get a shirt on became the tasks Mark had to relearn after his Traumatic Brain Injury (TBI).

Since 1991, I’ve met more OTs than I can count and I appreciate each one for their help with improving Mark’s quality of life.  Whenever meeting an OT for the first time, Mark proudly states, “My mother is an OT” He then shares some experiences he had as a child with her work.

I’ve written, “I was raised to be a caregiver.” My upbringing helped prepare me for this challenge. Likewise, I believe Mark’s childhood prepared him to be a survivor.

Two hats, Mother and Occupational Therapist, which have had the greatest impact in our lives.

I asked Wanda why she chose this career and she agreed to let me publish this interview.

The first thing that drew me to OT was a movie called Snake Pit. It was about a woman who was committed to an asylum and how she eventually recovered and was released. When I was picking a major in college and looking through college catalogues, OT caught my eye because it involved helping people and a lot of crafts. I learned that psychiatric hospitals had OTs and the deeper I looked into it the more interested I became. Psychiatry and the idea of helping someone improve their attention span, concentration, attention to detail, better living and socialization skills and generalization by using crafts media was what influenced me most.

How long and what kind of schooling did you need before you could practice OT?

I had four years in college with a major in OT and a nine month internship working with other OTs and passing the national exam, which qualified one to add the R after OT. The internships had to be in all these fields: pediatrics, general medicine, tuberculosis, orthopedics and psychiatry and you had to be over 21. I started college in 1948 and got my degree in 1952. By the time I finished internships I really liked both orthopedics and psychiatry and decided I would take either kind of job. Psychiatry was the first job that turned up so I started in 1953. At that time about the only hospitals that had psychiatric patients were institutions. Since then most hospitals of any size have a small unit for psychiatric patients.

How long did you work in this field?

If I remember correctly, I think I worked in psychiatric settings for 22 years: small private settings, large state and territorial settings and the last 16 years at a medical teaching university.

What made a good patient to work with and what made a good family member or caregiver?

All patients were good to work with. We seldom even met family members because until recently, families were ashamed or afraid of mentally ill family members and seldom even acknowledged them. The patients were committed to hospitals and lived there, seldom seeing or hearing from their families.

How did you feel about this separation from family?

I thought family abandonment was terrible, but that’s just how it was. Some of the staff were concerned about the patients, others not so much. In hospitals where patients stayed a long time (years), they formed friendships and the hospital was like a community.

Describe a typical day at work and some of the crafts you did with the patients.

At Oregon Health Sciences University, the day started with rounds, then OTs led an exercise group and a crafts group before charting and lunchtime. After lunch, we led a relaxation group, then an activities group where we worked on attention span, concentration, social skills, etc. This often involved playing games of all kinds, quizzes or planning for the lunch that the patients got together to cook for everyone on the unit once a week, then more charting. Yes, we used a full variety of knives and never had a problem with them in any of the groups. We did check tools and equipment after all groups. In other settings, OTs were responsible for arranging social events, mostly dances and church services. This included everything from getting the band or minister to setting up the room. Sometimes we took patients on outings such as bowling, walks, etc.

 Some of the major crafts we used were: leather work (hand tooled and carved purses, belts, etc.), weaving on pot holders frames to floor looms, ceramics (slab construction, pinch pots, molds), needlework (knitting, crochet, embroidery, sewing) and all minor crafts you can think of.

There was a job cut, so Wanda retired in 1998, seven years after Mark’s TBI. From my own experience with OTs I can imagine the constructive difference she made to hundreds of patients she helped, along with the students and colleagues she influenced. I witnessed some of this when Wanda visited Mark in the rehab center as she quickly became friends with Mark’s OT  The therapist was new to the field and appreciated Wanda’s experience and sought her advice at times. Since Wanda lived several hundred miles away, she mailed things for Mark to work on or sent articles with ideas to help him.

Wanda & Mark 2016

There are all kinds of influential women in this world. If you’re lucky, you get one for a mother. Some people aren’t so blessed, but have other women in their life who nurture, teach and inspire them. Today we celebrate all women who make us feel like we’re easy to love and fun to be with. Who gives us freedom to grow and lets us know it is okay to make mistakes. I’m fortunate to have several such women in my life. The greatest of all are my own mother plus a mother-in-law or more appropriately thought of as a “bonus mom.” I think Mark is equally fortunate. He was raised by a wonderful woman and has the advantage of an ideal “bonus mom.”

To all the wonderful women in the world who benefit lives in a positive way!

“Love Ya Back”

I knew family involvement was essential for Mark’s traumatic brain injury recovery. I’d been taught in the classes I attended at McKay Dee Hospital the importance of family and how they can provide an awakening cord. Both of our families had been supportive in every way. Mark’s mother and sisters, Karen and Jerrie, who lived several hundred miles away, sent cards and cassette tapes regularly. I played the tapes for him daily so he could hear their familiar voices. They also sent sounds of the ocean and the music he loved. My family visited Mark often, as well as helped me with the children and my work.  I felt the consistent love and warmth nurtured and helped to heal his body, so why wasn’t it turning the light switch on in Mark’s brain? After ten weeks, why was he still in a coma?

Every morning the nurse’s aide and a therapist would dress Mark, talk to him about the day, unplug the feeding tube, put him in a wheelchair and buckle him in for safety. They treated him as if he was awake, just like our family did. With the new-found freedom from the ventilator, Mark was able to go to the gym for therapy. The occupational and speech therapists worked on stimulating his brain with taste and sounds. I was there every morning and anxious to be involved in his care, not only because I loved him, but because the direction of my own life was affected by his recovery. I hoped the sound of my voice would let him know he was not left in the care of strangers. Most of all I wanted him to feel my love and support, which I hoped would help and encourage him to wake up.

The therapist would ask Mark a question and ask him to blink once for “yes” and twice for “no”. Sometimes his response was correct and other times it wasn’t. There were times when there was no response at all. My heart skipped a beat every time he answered correctly.

During his two hour rest time, I’d run home to get some work done and then run back to Western Rehab for the afternoon therapies. Before dinner, I’d pick up the kids, gather a quick meal and together we’d eat and spend the evening with Mark.The kids enjoyed asking their dad questions and anticipated his response with a blink. They read to him nearly every night before we left for the evening. We learned to be a family in a different setting and in a new, supportive way. Christopher and Katie got comfortable at the hospital with the staff and other patients. They especially liked being with the younger patients in the playroom. They brought sunshine to many people there and it warmed my heart to see them making friends with children overcoming injuries and disabilities.

Now that Mark was closer to home, I was able to get more work done. Eighteen months before the car accident, I signed up as an Avon Representative. I worked hard to reach the “President’s Club” sales level in my first year and earned the top new representative for the district. I enjoyed sales and working one-on-one with people, so I planned to continue as an Avon Representative after we moved. I realized it would be easier for me to reach the president’s level of sales in the district I was already established in, so I ramped up my sales efforts. My goal was to reach President’s Club before the impending move, which I accomplished in four months. I had a large order delivered the day of the accident. The items were not individually bagged for the customers, so the order was not ready for customer delivery. I was planning to do that on Monday and deliver on Tuesday. Even in the crisis of the accident, I didn’t forget about my customers who had become friends. My brother, Don, and his wife offered to take my order slips and call each one to inform them about the accident and uncertainty of the outcome. The delivery date was unknown and they wouldn’t be charged if they wanted to cancel their order. Every customer was concerned and understanding of our situation. One customer, who had been an Avon Representative in the past, offered to bag the orders, deliver the items along with new sale books and collect the money for me. Carla and my mom helped me keep my Avon business going while Mark was in the hospital.

Steve, my youngest brother, was in a partnership of a landscaping and property management company. For years I had done the billing for him. I had completed the billing for April before the accident, but my brother, Mick, helped me with May and June. Having Mark so close to home enabled me to work on these jobs between therapy sessions and in the evening after the kids were in bed.

Getting back into a family and work routine was not easy, but a necessity to keep life moving forward. The uncertainty of Mark’s recovery was worrisome and work was a diversion. Talking to healthy people who were living normal lives brought me hope for a life that seemed so foreign now.

The beloved bath bed

Part of my new routine included helping the nurse’s aide bathe Mark. I wasn’t expected to do this, but I wanted to. It was important to me that he knew I was always close by and involved in every aspect of his care. It took two people to slide him from the hospital bed onto the bath bed, which was on wheels. Mark’s naked body was covered in warm blankets. He was secured to the bed with two safety belts, one around his chest and another around his legs, for the ride to the “bath” room. The bed was hoisted into a large bathtub with jets. After nine weeks of sponge baths on his hospital bed, he seemed to enjoy being immersed into the water.

One night in July, after his bath, I cut his hair and shaved his cheeks. We were alone in the bath room. All clean and well-groomed with no place to go except into bed, I stepped back to take one more admiring look at him and said, “I sure do love you!”

Ever so softly, I heard, “Love ya back.” His first words in ten weeks and I wasn’t sure I heard them right.

Tears filled my eyes as I moved closer and cupped his cheeks in my hands, “Did you just say love ya back?”

He looked at me and said, “I love you, I love you, I love you.” Each time was slightly louder. I knew he wanted me to be sure of what he was saying and he said it with all his strength.

Exhausted, he closed his eyes. Did I imagine this? No, it was real. I felt his jaw move with my hands and he said it three times, looking straight at me. Without another person in the room, there was no witness. Overjoyed, I wanted to shout to the world that Mark had spoken and recognized me, but I feared they’d doubt me. I didn’t want anyone to squash the joy I was feeling, so I chose not to share this grand news—at least not yet. After helping the aide get Mark back into bed and getting the kids from the playroom, I left the hospital elated, keeping this blessed moment to myself for fear no one would believe me.

Essential Members of a Rehabilitation Team

On our first day at Western Rehab, I was introduced to a team of therapists and their schedule. It didn’t always flow as perfectly as it looked on the white board, but having a written schedule put order back into my life. It also brought hope for improvement and was reassuring. Even though Mark was still comatose, I felt a consistent routine would be helpful for him as well.

I had been familiar with physical therapy for the past seven weeks, but occupational, speech and respiratory were new for Mark. How important is therapy while a patient is in a coma?

image from dreamstime.com

Physical Therapy

Mark’s first therapy after the accident was with a physical therapist.  Right from the start they oversaw positioning in the bed and later got him up in a chair. The PT stretched his legs and arms to keep them flexible, doing range of motion exercises. Sometimes splints were used to help prevent foot drop, clenched fist or flexion of the wrist and elbow. They worked to keep the joints moving and the muscles from getting tight and stiff. As the patient progresses they work on strengthening, coordination and transferring. The ultimate goal is becoming as mobile and independent as safely possible.

Occupational Therapy

In the beginning, the therapist provides sensory and basic motor training therapy to keep the patient engaged in routine activities, even while in a coma. The repetitive motions help with the relearning process.  As the patient improves, the OT coaches the activities of daily living such as dressing, brushing teeth, combing hair and eating. A brain injury may cause these skills to be lost or compromised. They work to improve coordination, endurance and fine motor skills. They provide adaptive equipment needed such as specialized utensils for eating, bathroom equipment and wheelchairs.  The OT overlaps and supports both PT and speech therapists.

image from paraplegiker-zentrum.ch

Speech Therapy

At the first stage of treatment, the therapist focuses on simply getting a general response to sensory stimulation. This may include touching the patient’s hand, talking loudly into the ear or even letting the patient smell an object or food. As the individual processes they may also use a flavored sponge swab in the mouth to stimulate the tongue with something to taste.

The therapist also teaches the members of the patient’s family how to interact with their loved one by asking “yes” and “no” questions and reminding them to blink once for “yes” or twice for “no”.  Another method used was to raise one finger or two. Once the patient becomes more aware and responds to stimuli, the treatment focus is keeping the individual’s attention and informing them of the day of the week, date, where they are and why they are there. In time the therapist ask the patient those questions building their cognitive development. They not only work on speech, but writing, reading and expression skills aimed at both comprehension and communication.  For a person with a traumatic brain injury it may be difficult to pay attention. Organization, planning and sequencing skills may need to be relearned.  They specialize in teaching memory strategies for treating the classic problem.

Respiratory Therapy

A respiratory therapist evaluates the patient’s respiratory care, status  and treatment progress. They manage the ventilator, oxygen levels, aerosol medication treatments and  breathing exercises.

All therapists work closely with the family, doctor and nurses in a rehabilitation hospital, so they are informed of any changes and can help and encourage progress outside of the therapy session. The therapists also help educate the family on what their loved one might be going through and what to expect.

I greatly appreciate the professionals that are skilled in helping others regain abilities lost due to injury or illness. Mark has had many wonderful, hardworking and innovative therapists who have made a positive difference in his life and abilities. Social workers, neuropsychologists, dieticians, family and friends are also important contributors to a rehab team.

Did I miss anyone on your rehab team? How has therapy benefitted you or your loved one? Who made the greatest difference?

Welcome to Western Rehab

The sixty mile ride in the ambulance seemed so strange and unlike the ride I had the day of the accident. I was grateful to be in the passenger seat and not on the stretcher in the back. Both technicians were very friendly and asked lots of questions about the accident and our experience over the past seven weeks. It felt unreal as I talked to them about it. How could all of this have happened to me? Events like this happen to someone else, not me, somebody who is better prepared for it. When would I wake up from this bad dream? A sense of being stuck in it hit me hard.

Picture from http://www.healthsouthutah.com.       Formerly Western Rehab Hospital

Before I knew it we were pulling up to the entrance of Western Rehab. My excitement to finally be there turned to fear, like the first day of elementary school. You can hardly wait to go, but when you get there you realize you don’t know what it’s going to be like. My eagerness turned to worry as the EMT’s unstrapped the stretcher from the ambulance and wheeled it into the hospital. I hadn’t given much thought about what would be expected or how hard and painful it would be until we walked through the doors. Yes, I had taken a tour of the hospital and had met some of the staff before, but all that was discussed on that visit was the details of the facility and their therapy program. My confidence turned to insecurity as we approached the front desk to check in with Mark lying on the stretcher in a coma.

Picture from http://www.healthsouthutah.com. Formerly Western Rehab Hospital

The receptionist welcomed us and said Mark’s room was going to be in the special care unit right in front of the nurse’s station.  She directed us to go straight down the hallway. One EMT pushed the stretcher from the head of the bed while the other guided from the foot. My mother had followed the ambulance in her car and met up with us at the receptionist desk. As we walked by Mark’s side, I noticed a man in a wheelchair with his head bolted to a halo. The sparkling clean, wide tile hallway seemed filled with pain and suffering. I was overwhelmed by what some of the patients were enduring. Sights of treatments for injuries I had never seen before. Would I get used to seeing discomfort, agony and grief? Mark was in a peaceful coma; what would his recovery be like? Am I strong enough to handle it?

As we approached the nurse’s station we were greeted by Rita, a cheerful, friendly nurse who escorted us to Mark’s room. While the EMT’s were getting Mark transferred from the stretcher to the hospital bed, Rita opened the closet door and said, “Bring some clothes for Mark because we plan to dress him every day. He will need loose fitting pull over shirts and pull on pants with high top shoes. Socks and underwear can go in these drawers, along with any other personal belongings you want to bring,” she said as she pulled out one of the drawers on the left side of the closet.  She pointed to the white board on the right side of the closet. “This will be Mark’s daily schedule.” Written on the board was:

Therapy

9:00 am OT – Cheryl

10:00 am Respiratory

11:00 am PT – Leslie

Noon – 1pm – Rest

1:30 pm  Speech – Chris

2:00 pm OT – Cheryl

3:00 pm PT – Leslie

4:00 pm  Respiratory

4:30 pm Speech – Chris

10:00pm Respiratory

Sitting Up

Up – 11:00 am                   Down – 12:00 pm

Up – 2:00 pm                     Down – 4:00 pm

Up – 8:00 pm                     Down – 9:30 pm

Wow, what a busy schedule. How can Mark do all that? At McKay-Dee Hospital Mark didn’t have a set schedule, so I was thrilled they thought he could do it, yet flabbergasted at what seemed unrealistic.  In my mind I could see the doctor at Mackay-Dee Hospital, saying “I tried to tell you it’s too soon.” I pushed the thought out of my head as I remembered my first day of school and the overwhelming feelings of schedules and expectations. However, from the past I’d learned I could adapt, so I silently committed to help Mark in every way adjust to this new schedule and meet their expectations.

I was familiar with the range of motion routine the Physical Therapist (PT) would do with Mark at McKay-Dee Hospital, but I couldn’t imagine why he needed a Speech Therapist (ST) or an Occupational Therapist (OT).

“What will Mark do in speech therapy while he’s in a coma and has a trachea tube?” I asked the nurse as she detached the tube from the portable ventilator to the stationary hospital ventilator and hung his IV to the post on his bed.

“The therapist will come by and explain what they will do in their therapy sessions and the doctor should be in any minute now. Make yourself at home and let me know if I can get you anything.”

I sat in the chair next to Mark’s bed and Mom took one on the other side. I looked at Mark and was relieved that the move appeared to go unnoticed by him. He slept peacefully through the ambulance ride and transferring from the stretcher to the bed. He seemed unaware of his new surroundings. I was grateful to be in our home town of Sandy, UT.

A young, handsome man walked into our room and introduced himself as Mark’s new neurologist, Dr. Wright. He reviewed the reports he’d read  from McKay-Dee Hospital with us and we discussed the  treatment plan. His mannerism was gentle and compassionate. Immediately I felt at ease with him and confident Mark’s recovery was in good hands. He explained Mark would be completing the powerful intravenous anti-biotic in five days and he ordered all therapies to be done in his room until then.

“What will they be doing in respiratory therapy?” I asked, pointing to the schedule.

“The therapist will keep the tracheotomy cleaned and gradually turn down the ventilator, weaning him off of it. The respiratory therapist will help Mark learn to breathe on his own again.”

“What about speech therapy?” I asked.

“They use objects like bells and whistles to try to get Mark to respond to them.”

“Cool,” I said, hopeful and excited. This staff is planning for him to come out of his coma!