The North Mountain Therapy Department specializes in Pulmonary Rehab, encouraging a multi-disciplinary approach to meet our respiratory patients’ goals of being decannulated, which typically is dependent upon the patient’s ability to return to a regular diet. In an effort to contribute to the greater independence of our patients, the Therapy Department created the SPOT (Speech Pathology Occupational Therapy), a holistic approach to a specialized dining experience to facilitate independence with safe swallow techniques and self-feeding.

The SPOT is a private, home-like, therapeutic dining room that allows our speech therapists and occupational therapists to provide a specialized treatment to our respiratory patients. The SPOT provides a quiet area to concentrate on safe swallow techniques, facilitate functional positioning, assess for any adaptive equipment needs to enhance the ability of our patients to regain their independence and return to the community.

The SPOT includes a small ADL kitchen and is stocked with adaptive equipment for the patients to trial during meals including a deltoid aid, weighted/built-up utensils, specialized drinking cups, and divided plates/plate guards. Additionally, ST has a quiet environment to perform vital stim or cognitive treatments.

The SPOT dining: helping North Mountain serve up independence!

Submitted by Kelly Schwarz, DOR
North Mountain Nursing & Rehabilitation, Phoenix, AZ

What was initially simply a continuing education experience for two therapists has inspired a brand-new program here at Coral Desert Rehabilitation. Recently, a Coral Desert physical therapist, Lindsay Rankin, and a physical therapist assistant, Edwin Stevenson, attended a course to become credentialed clinical instructors. They both enjoy having students, so they were excited to go. After attending the course, they came back with a desire not only to improve their own abilities, but also to help revamp the student program at Coral Desert.

The program was loosely managed before and not standardized from one therapist to the next, so the students often had varied experiences and subjective learning/feedback depending on the therapist. Lindsay and Edwin decided to set a BHAG together to create and implement a better student program based on the principles and recommendations of the course they attended.

With a lot of after-hours work and trial and error with a current student, Lindsay and Edwin were able to create a student resource manual for the clinical instructor. This manual is specific to our building, patient population, etc. and loaded from A to Z with information on how to properly supervise a student of any discipline. They didn’t stop there. They also created a manual for each incoming student, both a PDF file to have prior to arriving and a hard copy for when they get here for reference.

Once both manuals were completed, after many rough drafts, it was presented to our therapy team during an in-service to give an in-depth look at how to use this information and apply it when a student is assigned to a therapist. This has already proved to be valuable with our current students and should continue to be a great resource for students and therapists for a long time to come. Because we have seen a steady increase in the number of students coming to CDR in the past two-plus years, it is just what we have needed since our therapists are at varying levels of experience with having students. We already have seven students committed to CDR from now until November of next year! We are crazy excited about the Passion for learning combined with Ownership shown by our own therapy team, which saw the need and responded in a big way.

Submitted by Asa Gardine, DOR, Coral Desert Rehabilitation, St. George, Utah

Congratulations Kristi Crozier, our Newest SPARC Winner!
Kristi is an OT student at Midwestern University in Glendale, AZ and will graduate in November 2017.

Read her awesome essay here:

As a wilderness therapy guide, I camped in the high desert with at-risk teenage students and taught outdoor survival skills. The most difficult and rewarding skill I taught was making matchless fires using bow drills. The process began by helping students search for the tools needed to create a spark: a straight stick and string for a bow drill, a flawless log for a fire board, dry grass for tinder, and a notched rock for a socket. Using these tools, the students learned the techniques to create fire and began to practice. The process was extremely challenging and weeks of bow drill practice typically yielded only bruised fingers and tears of frustration. However, the students’ frustration melted away when they were able to properly align their tools, find a rhythm, and persevere until they created heat, then smoke, and finally a tiny, glowing ember. Even the most reserved students celebrated and proudly proclaimed their accomplishment to the world when they created a spark. The creation of this spark was significant event and marked the first major step in each student’s journey of transformation and healing.

The creation of a spark, whether physical or metaphorical is a difficult process which yields great rewards. As an occupational therapist, I want to help my clients by creating sparks inside them that can generate blazing fires of achievement and wellness. I will use my knowledge and training from a rich variety of life experiences to help my clients by providing tools, knowledge, and support to ignite sparks of independence, understanding, and hope. Helping others has always been rewarding for me and I relish the satisfaction that comes from doing something for a person that they cannot do for themselves. However, I have learned through my training that the true purpose of therapy is not to help others by doing things for them, rather, it is to provide individuals with the tools they need to spark their own successes. I recently achieved this with a client during a clinical rotation. My client had a goal to live independently in her home but was challenged by a lack of active finger flexion which prevented her from grasping items. Using my training in orthotics and assistive devices, I fabricated a glove with a fastening system that could be strapped to tool handles. This glove enabled her to use both hands to complete cherished gardening and yardwork activities. When my client used this glove to hold a broom and sweep the floor of the therapy room, her eyes glowed with pride. The use of this simple tool allowed her to independently participate in an activity that she was unable to accomplish before and she was elated by her increased independence.

Using this physical tool generated a spark of independence and pride in my client. However, it was not the most effective tool I provided. The most important tool I provided was knowledge. As I worked with this client exploring ways to use the glove, we problem-solved modifications to overcome barriers to many of her occupations. Using basic principles of activity modification and assistive equipment, we identified ways to increase participation in various tasks. As we worked, I helped her to understand principles that she could employ in a variety of situations to facilitate her independence. She was a willing student and soon reported using her new knowledge to create adaptations at home. This knowledge created sparks of innovation and which will fuel her independence for the rest of her life.

The example above shows the power of a spark of knowledge, but before that spark can be used, it must first be acquired. To ignite sparks of knowledge in future clients, I plan to use a model I learned as a PATH therapeutic horseback riding instructor: the “what, why, how” model. First, clients must know “what” they are supposed to learn. This involves using language appropriate to the client’s understanding to explain an overview of the concept. Next, a client must be told “why” this concept is important. This step is imperative to ignite a client’s motivation and gain their trust. The final step is to teach “how”, which is to teach the actual concept in an organized, stepwise manner. This process is meant to shed light on the motivational and practical aspects surrounding a concept in order to help clients be more accepting of new knowledge and facilitate a deeper understanding.
This method of teaching was crucial when I taught a horseback riding class for students with high-functioning multiple sclerosis. I taught clients to perform physically and emotionally demanding tasks by explaining the task and providing a “big picture” of what was expected. Then I gained their trust and “buy in” by teaching them why the task was important and why it would improve their performance. And finally, I taught them the specific steps needed to achieve success. Using this method, I saw greater motivation for change in my students. When they understood what they needed to do, why they should do it, and how they could accomplish the task, they were more willing to listen and follow my recommendations. As a result, my students received sparks of understanding which erupted into success both in the riding arena and in their daily lives. I plan to continue using this method to generate sparks of understanding in my future clients and help them on their path to success.

Before I can ignite sparks of knowledge and understanding in my clients, I must first ensure that my own fires are fueled by actively seeking opportunities for professional development. This spring, I was a co-presenter at both the national American Occupational Therapy Association conference and the Assistive Technology Industry Association. These experiences fanned my flames of knowledge and fueled my enthusiasm for professional growth as an occupational therapist. At these conferences, I shared knowledge with other professionals and learned a great deal from them in turn. My mind was expanded by new ideas, innovative products, and novel research. This knowledge was indispensable during my clinical rotations and I was able to use the ember set aglow by my experiences to enlighten the minds of clients and therapists with whom I worked.

While knowledge and understanding are key elements of change, they are of little use without the spark of hope, a belief that something good can come from one’s efforts. Rehabilitation is a difficult process that takes great toll on clients. The physical and emotional strain can reduce a client’s spark of hope to smoldering embers. As a therapist, it is important to possess genuine concern and use therapeutic interactions to bolster the spirits of clients and rejuvenate their hopes. I witnessed the importance of rejuvenating a client’s sense of hope during my medical mission to Guatemala. The patients I saw struggled with injury and degeneration resulting from years of manual labor. These good people were in great physical pain and were weary of fighting their conditions. With limited resources and a limited knowledge of the Spanish language, it was difficult to find ways to ease their pain. However, I found that I could perform a great service by simply lending emotional support. Through listening and demonstrating concern, I bridged the communication barrier to connect with my patients and renew their sputtering flames of hope. Watching the darkness of despair dissipate as clients perceived my genuine concern and accepted my meager assistance was a powerful experience. I hope to continue that same level of concern and therapeutic connection to spark hope in my future clients. Armed with knowledge, training, and a genuine concern for my clients, I will be a catalyst for change in the lives of my future clients. Just as I helped my students in wilderness therapy create physical sparks, I will use my knowledge and training to ignite metaphorical sparks of independence, knowledge, and hope for my future clients. By providing tools, knowledge, and support I will set the therapy world ablaze.

Clients with dementia living in skilled nursing facilities have occupational needs that are often unmet. Individualized care approaches and engagement in meaningful activities are effective non-pharmacologic approaches to dementia care. However, they are infrequently implemented in SNFs, and patients with dementia are often medicated with antipsychotic medications to manage behavioral symptoms related to dementia.

Occupational therapy practitioners and students who practice in SNFs may benefit from training to develop the knowledge, skills, attitudes and beliefs required to meet the unique occupational needs of clients with dementia who reside in long-term care SNF communities.

Background

• The Centers for Medicare and Medicaid Services created a national partnership in 2012 to improve dementia care in nursing homes
• Individualized to interests and backgrounds
• Tailored to the cognitive and physical abilities of an individual
• Considers medical needs and complications

Abilities Care Approach to Dementia:

• Meets the occupational needs of clients with dementia
• Based on the cognitive disability model
• Utilizes a collaborative model of care, partnering with caregivers to adapt caregiving approaches and the environment to engage clients in meaningful occupations
• Includes the creation of individualized activity prescriptions, care approaches and life-story boards

Abilities Care Approach Process

Implementation: Online Training Program

The online training program is available to OT practitioners and students through Ensign-affiliated SNFs. It incorporates effective teaching methods, including opportunities for student reflection, interaction with content, self-assessment of learning and application.

The training program is designed to:

• Prepare OT practitioners to provide evidence-based, reimbursable services in an emerging practice area
• Support reflection on the beliefs and values of OTs making the shift to a collaborative model of care
• Familiarize OT practitioners with the Abilities Care Approach tools and resources available on the Portal

Note that additional references and literature are available upon request for those interested in implementing the Abilities Care Approach to Dementia.

By Gina Tucker-Roghi, OTD, OTR/L, Therapy Resource, Northern CA