Thinking OT

Thoughts from Harrison Training and the occupational therapy world

Posts Tagged ‘rehabilitation

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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What Is Narrative Medicine?

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As I was reviewing the Mayo Clinic’s various social media channels (see my earlier blog post here) I came across this blog post by former patient/client Jillayn Hey.

Click through on the picture to read the blog in full

That in turn led me to this interview of Lewis Mehl-Madrona and his thoughts on Narrative Medicine.

The article suggests that “Narrative Medicine…asserts the importance of an individual’s whole life story to the person’s health-not just the medical history, but a story that includes ancestors and friends, interests and spiritual orientation.”

Given that the subtitle to this blog is “Thoughts, observations and provocations from the occupational therapy world” I thought this would make for good debate.

To what extent do we agree the premise?

The narrative movement can be seen in many disciplines other than medicine.  Another example can be found in narrative mediation, for example, as a dispute resolution process.

Allow me to break out of the OT silo for a moment, and look over to see what they do there.

Within narrative mediation the conflict that disputants find themselves in is held up as being a story that they are involved in.  Referring to the dispute, or, here, the question of illness or wellbeing, as a story is not intended to diminish how real that situation is.

The “Story” label, however, allows mediators, or maybe practitioners, to deconstruct the story.

  • Who are the players in this story? 
  • Who else is effected by it?
  • What is the plot? 
  • Crucially, what is the outcome?
  • How are we using language to tell this story?
  • How else might we re-tell the story, perhaps to a different audience?

A powerful part of narrative mediation, and I can see no reason why it would not have an impact here, is to set up the problem – the dispute or illness – as an entity within the story.  that in turn enables us to ask questions such as

  • How did this thing called conflict lead you to feel or react?
  • When conflict was around, did you notice anything different?
  • How did the pain invite you to respond to others?

That line of questioning can be developed further

  • What was your relationship like before conflict arrived on the scene?
  • How did you imagine your career progressing before the illness?
  • Can you think of a time when the illness didn’t have stop you from doing something?

and further still by asking

  • Am I right in thinking that you would rather this conflict was not ongoing, that you would like to see an end to it?
  • If so, what other ways might you react when conflict appears? What might you do differently?

and so on.

As the dialogue is developed, conflict, or illness, is first recognised as having an impact on our lives and behaviour.  We then go further and look at how we can explicitly recognise the grasp that it has upon us and how we can start to loosen its grip. 

In the words of Winslade and Monk, authors of Narrative Mediation, we then allow room for alternative, newly created and more helpful narratives, or stories to be constructed by ourselves and retold to others. 

In the words of Jillayn Hey herself “Through telling our personal stories of illness and disease, we assist in creating a new story of wellness that facilitates healing and in turn directs a person towards recovery.”  Note how Jillayn explicitly speaks of her new wellness.  In doing so she brings her new symptoms of being well to the foreground.  If she had not done so, then the grasp, or the narrative, that her former condition had on her own expectations of what it is to live day to day might have continued and therefore limited her activities and perceptions.

What are your thoughts?

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