Thinking OT

Thoughts from Harrison Training and the occupational therapy world

Posts Tagged ‘rehab

What is Occupational Therapy To You?

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The walk to Harrison Training's offices/ What Is Occupational Therapy?

View From The Bridge

I love coming to work at Harrison Training’s offices here in Bradford on Avon.

The walk from the station takes you across the river, filled with waterlillies and cool promises.

From there you go through the old part of town with its stunning Georgian properties and then walk past the church and up some steps, worn through centuries of use.

Steps leading to Harrison TrainingIt is hard not to imagine the lives that have been lived here over the years.

And then my thoughts shift.

How fortunate we are, those of us able to take these walks and enjoy our surroundings because, let there be no doubt, for all of the beauty in this town, accessibility must be a nightmare.

Inevitably, perhaps, I am drawn once again by this consideration of accessibility, to that old chestnut of a question – What is occupational therapy?

Take me as an example.  I am able to draw meaning, pleasure and fulfilment from being in, walking through and interacting with these surroundings.  And I wonder, is that the point?  Is that what occupational therapy is?

When we enable, reable, rehabilitate, when occupation is not career or work, but being meaningfully occupied, or stimulated, is this what we do?

Forgive me my more metaphysical ramblings this morning, but please share your thoughts.

What is it that you do when you do what you do?  What is occupational therapy to you?

Waterlillies

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Is The Wii Useful?

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There is an article in this month’s OT News magazine (click here) discussing a pilot scheme using the Nintendo Wii games console with individuals who have mild learning difficulties.

It is an interesting article even though the pilot scheme was unsuccessful.  There were only eight proposed members of the group, only six turned up and, of those, only one turned up regularly.

The experiences of the group, or rather those who were leading it, highlight some serious shortfalls in the Wii hardware.  These are not critical, I think, but do need to be recognised.

The Nintendo Wii has caused quite a stir with it’s motion sensitive controls.  Rather than pressing a button to control an on screen character, you physically move and manipulate a controller held in your hand.   Other developments include the Wii Fit board which measures weight, balance and shifts in balance.

There are several games including the ubiquitous Wii Sports which are designed to be played in a more physical fashion, even standing up and leaping around your immaculately tidy and hyper-lifestyle designed living room if the TV ads are to be believed.

This physicality has led to the Wii being applied in various settings to motivate individuals to become more active.

The current project though failed on a couple of fronts.

Users became frustrated with the time it took to swap between players using the Wii Fit program.  It is a time consuming task which entails clicking through several screens.  This can sometimes take longer than it takes to play the activity itself.

Wii Fit is largely an individual system, which may well be better suited to one on one sessions.  The sequel, Wii Fit Plus, has got usability improvements which remove some of the time taken to change between participants which might alleviate issues within group sessions.

The other problem which the Wii presents stems directly from the motion control technology.

The promise of direct control over your on-screen character is an abstracted illusion.

By this I mean that you do not, despite all the hype, have direct control over your character, but only elements of their actions.

Take the famous tennis game from Wii Sports, for example.  You cannot direct where you hit the ball by changing the angle of the controller, as you would with a tennis racquet.  The direction is, instead, determined by how early or late you strike the ball – early plays it to the left of the court, later to the right.

For those of us who game as a hobby this is not a problem, but non-experienced gamers will perceive that they are being offered direct control.  The result can be very frustrating.

Again, the Wii technology continues to evolve and you may well well want to look at the Wii Sports sequel called Wii Sports Resort.  This comes complete with a new widget to attach to the original controller which brings your physical actions closer to the on-screen representation.

A word of warning though;  Do not get started on the Table Tennis service return game.  It is incredibly, marriage threateningly, addictive!

Another problem is highlighted by the original article, namely frustration at a perception that “The machine is not working properly.”  The controls on the Wii, and especially the Wii Fit balance board, are incredibly sensitive and actually require quite a high degree of balance shifting, stability and control.  This can be underestimated.

The Wii should not be abandoned as a possible device for therapy or motivation activity.  Once its limitations are recognised, acknowledged and accommodated the Wii can be great fun, social and energetic.  This will require practitioners to become fully familiar with the system before introducing it to service users, but, hey, there are worse home work assignments.

Do be aware that Sony and Microsoft are both bringing out new motion sensing systems for their Playstation 3 and Xbox 360 which might provide a more seamless interface.

Also be sure to read this excellent blog, albeit not updated since March on WiiHabTherapy.

Headley Court – A Powerful Testimony To Hope

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Yesterday morning I was in a hotel room, going through my final preparation for an Enablement team training day.  As I got dressed, the BBC were covering Headley Court and the amazing work that they do there.

Headley Court is treating many soldiers returning from Afghanistan with amputations.

Throughout the program, and on replays throughout the day, were stories of heroism both on the front line, and now back home in England.

It was good to see an OT being interviewed (sorry I didn’t make a note of her name), which helped to explain the OT role within rehabilitation.

The BBC’s article, with some of the video footage can found here.

Tissues might be needed, or maybe that’s just me.

Written by harrisontraining

May 27, 2010 at 1:14 pm

The OT’s Role in Helping The NHS Rise To The Challenge

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If you have not yet read the NHS Confederation’s report “Rising to the Challenge” then take the time to do so.

The NHS Confederation is the voice for NHS leadership. Their report is a call to the vying political parties about how they should approach NHS policy after the imminent election.

The whole report is only 20 pages.  The report offers some reassurance that the right noises are being made by the professions leaders.  Of course, whether they are heard or not remains to be seen.

Consider, though, this excerpt;

“Patients and groups of patients need more support to manage their own conditions.  National policy can help by commissioning training and education, evaluation of programs and research to support new approaches.  however most of this has to be local and may be organised by patients or social enterprises.  It could include:

  • telecare and homecare services
  • faster procurement of aids and home adaptations
  • more responsive rehabilitation services that are more accessible to both patients and professionals”  page 12 Rising to the Challenge

With all of that in mind, it seems clear to us, that this call, together with Gordon Brown’s call for greater reablement service provision could place occupational therapy at the very front of health care reform in the near future.

Are you ready for that?

Reablement and Personal Care at Home

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There is an important role for occupational therapists in providing more reablement and rehabilitative services to local authorities, to ensure that clients do not find themselves marooned in hospital wards and longer term residential care.

Gordon Brown stumbled into a political storm last week when he spoke about his Personal Care at Home Bill.  The explanatory notes can be found here.

A key part of this was to provide extend reablement or rehabilitative support …

“…to help with the transition back home after a hospital stay, a residential care stay, or simply a fall or accident…” Source

The immediate political storm revolved around funding and the view held by many that this was cynical political grandstanding.  Regardless of the politics, reablement at home will be appropriate in many situations. 

It has to be unattractive that an admission to hospital for a minor issue results in a client not being discharged just because of a lack of rehabilitative care.  To appease the political wing, this is also likely to be uneconomical.

Some of the immediate criticism of the Personal Care at Home Bill was wide of the mark.  This letter in The Times, for example, states that

“Two, three, or even four hours of care a day does not help someone living with a neurodegenerative disease, who is immobile and has other serious health needs. Only 24/7 care can provide this.”  Source

That is, I believe, an extreme position and therefore a false argument to set up.  It does not disprove a role for reabling work.  It simply states the obvious that it would not be adequate for that particular client.

The feverish political baying that surrounds any health care announcement in the run up to an election should not drown out the substantive debate. 

How can the occupational therapy sector facilitate reablement, for example after a hospital visit, using the skills they already have in rehabilitation, adaptive technology, seating, gait and the like?

Neil Denny

Written by harrisontraining

February 18, 2010 at 11:06 am