The Value of Occupational Therapy

Wanda OT1

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 OT

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.OT quote

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.

 

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Two Hats of Many

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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.

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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.

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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.”

MothersDayImages1To all the wonderful women in the world who benefit lives in a positive way!

Greg Nordfelt’s Story

Laura & Greg

Image credit: Greg & Laura 2011

One of the benefits of my caregiving journey is the people I meet and have the privilege to rub shoulders with. I met Greg and Laura Nordfelt at the 2013 Annual Brain Injury Conference. Immediately, our hearts connected when they shared their story with me. The circumstances which caused Greg’s traumatic brain injury (TBI) were different from Mark’s, but the feelings and experiences with therapy and the fight to return to a familiar way of life are very similar. They agreed to let me share their story on Uniting Caregivers in March of 2014, Greg and Laura Nordfelt’s Story. We have kept in touch over the past two years and I’ve enjoyed my friendship with them. Watching this couple grow and seeing the amazing outreach they both give to others inspires me. Thursday, September 17, 2015, Greg shared more of his story with Channel 4 News. With their permission, I share what Laura writes and the Channel 4 News interview.

“I am so proud of Greg Nordfelt and this interview on Thursday with Channel 4 news. Most of the recording ended up on the cutting room floor, but what showed was a glimpse of what he has been through in the last 4 years with his recovery process. More than all of this is the amazing job he has done volunteering with the TBI patients since then at TOSH, who meet twice a week working through their aphasia issues. On top of all this, three weeks ago he started volunteering at Intermountain Medical Center (IMC) on the very floor where he learned to get his life back with Physical, Occupational and Speech Therapy, giving hope to TBI patients and their caregivers. This is my sweet, giving and incredibly loving husband. xoxoxo .”

http://www.good4utah.com/news/local-news/new-study-provides-better-treatment-for-traumatic-brain-injury-patients

Greg & Laura

Image Credit: Greg & Laura 2011

I appreciate the inspiration Greg and Laura give to everyone who knows them. I am grateful for the awareness of TBI they spread by sharing their story. Together they are a powerhouse and are making a positive difference in our community. I can’t wait to see what they accomplish next. They are wonderful and I’m blessed by their friendship. Ride on Greg and Laura!

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

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?

Cindy’s Story of Faith and Hope

Written by, Glenn Oliver

Cindy was diagnosed with lupus in 1983 at the age of sixteen. She had many flare-ups during her high school years, which meant she spent a lot of time in the hospital recovering. At age twenty she met me (Glenn) and eleven months later we were married. I knew of Cindy’s medical condition before we were married and knew I could handle it. My mother had severe MS (multiple sclerosis) while I was growing up. My siblings and I did most of the cooking and cleaning, so I grew up quickly and understood about health problems.

Six months after marriage Cindy had a grand mal seizure and the lupus had shut down her kidneys. She was on dialysis for eight months.The kidney doctors were very negative about the kidneys ever working again on their own. Our faith helped us feel positive and Cindy’s rheumatologist, Dr. Daniel Clegg, told us when the lupus shuts down the kidneys many times the kidneys will start functioning again. We felt strongly this would happen. After seven long months we saw signs through Cindy’s improved blood work that the kidneys were returning, but the kidney doctors told us this meant nothing. They told us to get used to dialysis because she was going to be on it for a long time. About a month later Cindy was off dialysis. Even then the doctors warned she’d be right back on it. We understood they didn’t see this happen too often so it was hard for them to realize Cindy was an exception to the rule.  We knew she was coming off dialysis for good.

Oliver FamilyWe also learned that when the lupus shuts down the kidneys the lupus goes dormant. During this time we talked about having children. Because pregnancy would be hard on Cindy’s kidneys and they would have a good chance of failing again, we decided to adopt. We have been blessed with three beautiful children. Zach is seventeen, Kade is fifteen and Olivia is nine years old now.

After sixteen years of the kidneys working at partial function, the doctors determined Cindy needed a kidney transplant.The blood work indicated the kidney function was deteriorating and the medicine to help the kidney function may hurt her health. Cindy’s brother Troy volunteered to donate his kidney and was a match. April 25, 2006, Cindy had the transplant and the operation was a success. Both Cindy’s and Troy’s kidneys are doing great after eight years. We are so grateful for Troy’s willingness to give his kidney to Cindy.

On September 3, 2006, about four months after the kidney transplant, Cindy became very ill. She was having headaches for a few days and started to be confused so we took her to Emergency. The doctors thought that Cindy had Meningitis, but the test came back negative. They tested for West Nile Virus and it came back negative. She couldn’t recognize certain things, so they admitted her into the hospital. She had a fever they couldn’t reduce. Cindy had another seizure and went into a coma. They began giving Cindy antibiotics first, but since she wasn’t improving they gave her high doses of steroids. The doctors weren’t sure she was going to make it. After a priesthood blessing by Cindy’s Bishop, she took a turn for the better.

Cindy woke up from her coma after a week of steroids. She communicated with her eyebrows. She could lift them when we asked her yes and no questions. A month later they tested her again for West Nile Virus, and this time it came back positive. The doctors realized the immune suppressant drugs prescribed for her kidney were masking the prior test result, a learning experience for the doctors.

During the time Cindy was in ICU, I was still trying to work. It became very difficult so I decided to take a leave of absence for a few months while we determined what was going to happen to Cindy. Her family and I were constantly with her at the hospital. We also had 3 children at home that needed care. Olivia was only 1 ½ years old. The family split up the time and made sure everything and everyone was taken care of. We made a schedule of who was at the hospital and who was taking care of the children. Cindy’s sister, Michelle, helped a lot, as well as my sister, Colleen, and several friends helped as well. We truly appreciated our family during this time of need.

We thought at the beginning Cindy would take only a few weeks to get better. But when she woke up from the coma and the tubes were finally taken out, we realized she couldn’t speak or walk.  The West Nile Virus went to her brain and affected all of her motor skills.  She had to relearn to speak, walk, write and eat. Cindy was in the University of Utah Hospital for two months and went to Physical Therapy Rehab there for another few weeks. She couldn’t do the rehab they wanted because she was too weak. She was then transferred to South Davis Community Hospital, where she got strong enough to begin her therapy. Cindy met Louise Jarvis, her PT (physical therapist), who was a life saver. She also had Jen Bangs for OT (occupational therapy) and they became good friends. Jen moved out of state, but they still stay in touch through Facebook.

Cindy was at South Davis Community Hospital for six weeks making her total hospital stay over four months. She continued her therapy as an outpatient until Louise retired, and now Louise comes to our home to help Cindy. We feel very blessed to have wonderful therapist who have helped Cindy progress.

When Cindy came home from the hospital she was in a wheelchair, couldn’t walk or talk well and we helped her with her meals. We noticed friends that were not used to medical problems stayed away. This was hard on Cindy because she lost a few of her good friends.

Louise is still working with Cindy to this day, after eight years of therapy. Cindy’s speech, writing, eating and all the things you do daily have slowly come back. She went from a wheelchair to a walker and then to a cane. Now she can walk without a cane around the house, but has a problem with her balance. She uses the walls and railing to steady herself. She does fall once in a while, but she gets up and brushes it off.  When we go out she holds on to me. She is amazing. Even the doctors are impressed with her abilities. The kidney has been working great through all of this and we feel the transplant saved her life.

This has been a life changing experience for both of us. I quit my job and work at home so that I can be with Cindy and the children now. Cindy cannot drive and needs help with things that have to do with balance—like trying to carry things as she walks. She still has hope she will walk one day completely on her own. She can do most everything else.

I love Cindy so much. I would never leave her. My father stayed with my mother when she was ill. He was a great example of sticking through hard times. I have seen men leave their spouses because of their health problems. I know that some men could not handle everything we have gone through which is sad. Those men missed out on something that needs to be learned in life. It’s not all about yourself—it’s about serving others. Cindy has gone through a lot in her lifetime. She is strong even though sometimes she feels she is not. She is a fighter and that is why she has done so well with all that has happened to her. I feel blessed I am healthy enough to be a helpmate for Cindy in all we need to do as a family. Life is good now.

Thank you Glenn for sharing your story. What a great example you are to me! I appreciate how positive and strong you and Cindy are.

If Insurance Denies – Make an Appeal

Dr. 1992After I brought Mark home from Western Rehab, the insurance company agreed to pay “day-patient” therapy for three months, which meant I took him Monday through Friday for all day therapy. After three months, they denied the request for continued therapy, stating, “If he is well enough to be home he didn’t need that intense level of therapy.”

I appealed, by calculating and stating the large amount of money saved in nursing care by having him home. I also requested that they send a representative to come to Western Rehab and observe him in therapy. I was sure if they witnessed his level of care and need for therapy they would approve it.

Blue Cross Insurance did send a representative, and after the observation they did extend his therapy for another three months at “day-patient” level.

In June 1992, I had to make another appeal for therapy to continue. “Half-day” therapy was granted, allowing Mark to have speech, physical and occupational therapy once daily.

In August 1992, a third appeal for continued therapy was made. “Out-patient” therapy was granted through the end of the year, allowing therapy three days per week.

It was a fight to keep the therapy going after Mark returned home — but the fight was well worth it. I did make a forth appeal for therapy because we still hoped for more improvement. The forth appeal was denied.

1992 - Mark with his Therapist at Western Rehab

1992 – Mark with his Therapist at Western Rehab

I was grateful for the year of intense therapy. He learned to drink and feed himself; speak more clearly and work his facial muscles into a smile. His cognitive skills improved. He gained enough strength to propel his wheelchair. All big steps in the right direction.

Even though Mark’s rehabilitation was not at the level we had hoped for when it ended, we appreciated the insurance company for extending the therapy benefit three times.

We are so grateful for the knowledge of doctors and therapist’s who helped Mark achieve a better quality of life.