Posts filed under ‘Occupational Therapy’
Eutanasia eli armokuolema
Eutanasia on ollut itselleni tuttu käsite viimeistään yläasteen et:n (=elämänkatsomustieto) tunneilta, joilla käsiteltiin lukuisia moraali- ja etiikan kysymyksiä. Olen ottanut jo nuorena varhaiskypsästi armokuolemaan ehdottoman myönteisen kannan. Nuorena näkökulma onkin siinä mielessä helppo, että kuolema ja kärsimys tuntuvat etäisiltä eivätkä useinkaan kosketa itseä.
Vanhemmaksi varttuessa armokuolema saa uusia sisältöjä, kun elämänkokemus karttuu. Itselleni yksi herätys oli Linn Ulmanin kirja Armo, jossa pariskunnan toinen osapuoli sairastuu vakavasti ja puolisot sopivat, että oikean hetken tullen terve puoliso avustaa sairasta kuolemaan niin, ettei tämän tarvitse elää elämää, joka ei ole elämisen arvoista. Oikea hetki on kuitenkin loppujen lopuksi subjektiivinen ja muuntuva käsite, kuten kirjan lopussa käy kolkolla tavalla ilmi.
Eutanasia on esillä tuoreimmassa Lääkärilehdessä, kun Terhokodin (saattohoitolaitos) ylilääkäri Juha Hänninen kirjoittaa pääkirjoituksessaan Laki eutanasiasta – onko nyt aika? eutanasiakäytännöistä Euroopassa. Silmiin osuu erityisesti kirjoituksen lopulla oleva tieto: “Kipu oli harvoin perusteena kuolinavun hakemiselle, vaan useimmiten elämän merkityksettömyys, kyvyttömyys tehdä mitään ja kuoleman läheisyys.” Tämä(-kin) tutkimustulos allekirjoittaa toimintaterapian paradigman ytimen; sen, että merkityksellinen toiminta on ihmiselle välttämätöntä.
Itselleni kirjoituksessa oli myös se uusi tieto, että Suomessa itsemurhan avustamisesta ei tuomita rangaistukseen toisin kuin muissa Pohjoismaissa.
Zen-seikkailu: 7. tehtävä
Jos normaalit liikemallit jostain syystä estyvät ja ihminen toimii uudella tavalla, aivoissa tapahtuu merkittäviä muutoksia vain 16 päivässä havaittiin Zürichin yliopistossa tehdyssä tutkimuksessa. Vaikka toista kättään ei ole järkevää kipsata toisen käden opettamiseksi, asioiden tekeminen toisin kuin tavallisesti on erinomaista aivojumppaa. Totutusta poikkeaminen edesauttaa helposti hetkessä elämistä ja siis ns. mindfulnessia eli tietoista läsnäoloa.
Oikea ja vasen aivopuolisko ovat myös erikoistuneet eri asioihin. Vasen on looginen, järkevä, analyyttinen realisti. Oikea on luova, taiteellinen, tunteva ja kokeva. Karkeasti yleistäen oikeaa kättä käytettäessä ihminen hyödyntää vasenta aivopuoliskoaan ja toisinpäin.
Tehtävä 7.
Kirjoita dominantilla kädelläsi (useimmilla oikea), miltä sinusta tuntuu juuri nyt. Vaihda sitten kynä toiseen käteen ja toista tehtävä. Kun olet kirjoittanut, vertaa tekstien sisältöä keskenään.
Laama ja alpakka toimintaterapioissa
Entinen opettajani Joyce Collin-Kajaala käyttää laamoja ja alpakoita terapiaeläiminä toimintaterapioissaan. Eläinten kasvattajat, Joyce sekä alpakka Fuchsie ja laama Ulla olivat aamuteeveessä.
Headstand to help shoulder pain?
I was reading International Herald Tribune on our flight back from France on the 3rd of August this year when something interesting caught my eye. Jane E. Brody was writing about treatments that “don’t cost an arm and a leg” in which she describes physiatrist Loren Fishman and his innovative methods.
What in particular was fascinating was a treatment developed for people with shoulder pain by Dr Fishman’s. Since yoga exercises form nowadays a centerpiece for his practice, this one was also a modified yoga pose: a headstand without actually requiring standing on your head. Done only for 30 seconds (sometimes combined with a little physiotherapy) for five different sessions this maneuver should ease the pain caused by a rotator cuff syndrome. The benefits matched and sometimes exceeded those following physical therapy alone or surgery and rehabilitation. ON a follow up yoga treated patients maintained the initial relief for as long as they were studied, up to eight years.
The mechanism behind this method is that the modified headstand trains subscapularis , the muscle below the shoulder blade, to take over the job of the injured muscle, supraspinatus. When normally it’s supraspinatus that raises the arm from below chest height to above the shoulder, after the headstand subscapularis will take that job.
According to Dr. Fishman, this doesn’t work for everybody, like for string musicians whose shoulder muscles are overtrained, but it has helped approximately 90% of his 700 patients. Not bad for a yoga pose!
Check Your Happiness Ratio
As I write this on Sunday the 17th of April the results of the Finland’s on-going parliamentary election are being counted. After the preliminary votes have been counted the situation doesn’t really enhance happiness. Still, with the zen quality of mind, reminiscing Tolle’s teachings I’m determined to post about happiness. So here’s to a brighter future!
—
Barbara L. Fredrickson, Ph.D. and the director of Positive emotions and Psychophysiology Laboraty, published a book called Positivity in 2009. In her book she describes ten different emotional states that reflect happiness. I haven’t yet read the book but I found these emotions interesting and useful as means to mindfully learn to facilitate feelings of happiness. I encourage you too to apply these into your life. It’s a possibility to affect the 50 000 to 60 000 thoughts that go trough your head every day. Our thoughts are mostly repetitive so a minor change for the better might result in a noticeable improvement in experienced happiness.
There’s also a test on Barbara’s site (Positivity Ratio) that you can make to score your happiness ratio for today. I suggest doing it to gain a little insight for your emotional status. As for me, the ratio left room for improvement even though I consider myself being quite on the happy side.
10 EMOTIONAL STATES THAT REFLECT HAPPINESS
- Joy - I get joy out of flow experiences such as a good workout or an inspiring conversation. Today I was overjoyed for getting to swim in the sea!
- Gratitude – I’m grateful for having been born in such a privileged position. Today I was grateful for having all my limbs after watching a video of Nick Vojicic.
- Serenity – Working on this one through meditation, currently Tolle as my guide. Today I did a 6 minute meditation in the morning and went for a walk in the evening to calm my election aroused mind.
- Intrest – I’m hopelessly interested in plentiful things in life! Today I was interested in the politics and the feelings the elections generated in people.
- Hopefulness – As a person and as an occupational therapist I’ve always seen more possibilities than boundaries. Today I tried to keep up hope despite of the political shift to the right in Finland.
- Pride – I’m proud of our profession’s ability to see the speciality in every client. Today I was proud of myself entering the coldish sea water.
- Amusement – I get easily amused; it could be a funny dog (or MY dog
), myself screwing things up or some real life comedy such as a person’s “agenda” in a social situation going wrong. Today I was amused by a Spiderman band in the park consisting of elderly spidermen… - Inspiration – I’m often inspired by extraordinary people or strikingly beautiful nature or a good book. Today I was inspired by the amazing Nick Vojicic mentioned above.
- Respect – I (try to) respect all living creatures. Today I really admired Nick Vojicic’s courage and life force. I also bought organic meat in respect of animals being treated well.
- Love – I’m lucky to have a tight knit group of my loved ones. Today I was happy to chat with my mom when I felt a bit lonely.
11 – Poetic Therapy
I want to share a method of guiding someone – almost anyone – to write a poem. I learned this while studying occupational therapy on an intensive course in Dworp, Belgium in 2006. I’ve used this method for several years with a lot of different kind of people: it works for people with mental handicap, it works for the elderly, it works for people with memory deficits, it works for children, it works for you and it works for me.
You better start out some easier subjects such as animals, colors or seasons. You may then proceed in writing poems about places, people, emotions and finally of yourself. The method is very versatile and pretty quick. You may also use it to create a poem with a group. The guiding questions make it simple to get words out of people. Some of the most epic ones have been made by people with autistic features being composed solely of sounds, not words. Extremely impressive and poetic. Hopefully also empowering.
Today I used this method with a client of mine and I asked whether I could publish her first poem in my blog. I got the idea when she told her favourite subject at school was writing. Here it is in English, originally this was made in Finnish. She said this would be a good way to describe the Finnish autumn for a foreigner from the opposite side of the world. After writing this she analyzed it and read it aloud for her roommate. The roommate thought it was fabulous. The writer was very happy about her poem and in getting something back which she thought was already lost.
Autumn
Colourful, dark.
Allows reading relaxed
It snows early, unexpectedly
Creative.
—-
So here’s the method called Eleven:
1. One word - choose a topic – for example pick an animal
2. Two words - describe the animal
3. Three words - what does the animal do – include a verb
4. Four words - what happens then? Something unexpected or surprising, maybe a twist in the story
5. One word - one, final strong word – how does this thing make you feel? Which word sums it all up?
—
Like this:
A Poem.
Delirius, succint.
Captures a moment
Thinks highly of itself.
The fool.
—
I sincerely hope you write your own poem and send it in the comments.
From treating the patient into participating the client’s life
Today we had a lecture by Mika Raulas regarding client and customer managing as a part of my JET (johtamisen erikoisammattitutkinto, a degree in leadership and management) education. Here are some quotes and things that came up, also some of my thoughts during the day.
Peter Drucker: The practice of management is to create a customer (marketing+innovativeness).
Customer satisfaction index = happy customers – (passive+negative customers).
In-bound marketing = while the customer contact is happening.
My first enlightment: instead of asking How does the client participate the occupational therapy service we should be asking How are WE participating the client’s life as therapists?
My second enlightment: the services shouldn’t be built diagnose or segment based. Instead, we should offer services based on the different needs the clients (or citizens) have. For example the care homes for elderly and the supported houses for mentally/cognitively handicapped people should be profiled by the level of functionality: what are the client’s special needs? It’s not about someone being “mentally handicapped” or plain “old“. It’s about the things that restrict normal, independent life that people need some adjustments or help to. Not their age or diagnose.
Applies also to my long term goal: to finally combine the somatic and the psychiatric health care. Only then we can treat the person as a whole. It’s impossible to try help a person when you only see the half of him/her medical history. It’s like seeing only half of the person. Since now some of you may be horrified that I’m suggesting putting loonies (in its most loving meaning) together with frail, fragile elderly people: no, I believe there are other possibilities. The idea needs careful researching and planning but I’m convinced, it can be done. In a way that benefits both the people and the system. We just need to start looking the thing from a new perspective and as a possibility instead of a threat.
Jeff Bezoz: it’s not important to focus on what your competitors do but to what’s happening in your clients’ lives.
Mika Raulas also gave us some homework: to figure out, what does the value of our service consist of. In my case this translates to: which are the elements of occupational therapy service at the city of Helsinki that create value to our clients? Well, I didn’t do my homework yet but I shall reveal my thoughts once they are thought. You are welcome to share yours!
For now, good night! It’s been a long day.
It’s a Shame (that stresses sick people)
Sickness, illness or health problems in general wouldn’t be described as something to be ashamed of. When one’s ill, she/he gets comforting, help and sometimes even pity. But shame? It has been common not to blame people on their conditions (at least if it’s not hangover). I say has been because the tendency has grown quite a bit in the direction of emphasizing one’s own responsibility in taking care of themselves by “living right” (also known as giving up your afternoon coffee cake, walking the stairs, passing the Friday night beer and so forth). But as the information gathers we are now more and more aware of the complicated system a body is. For example, calorie theory has been crushed (Don’t buy that? Read Gary Taubes: Good Calories, Bad Calories). Therefore it’s not as simple as 1-2-3 to go tell someone to stop eating fat/carbs to lose the extra pounds and the diabetes or to blame the years of cigarette smoking on someone’s COPD.
Anyway, I got a bit on the sidetrack. The point is that as I just returned home from the office, I feel ashamed. I feel ashamed because I discovered in the morning that I’d lost my voice totally during the night. I feel ashamed because even if I did go to work it wouldn’t work: it’s impossible not to speak as a therapist. And furthermost I’m ashamed because my work pair (a physiotherapist) commented that “you always have something going on“. No I don’t! I wanted to scream. I’m never ill! I haven’t had a flu in years and I’m vibrant and strong and balanced and… Versatile.
So you see, I would SO like to cherish my image of myself as the invincible human being that continues to work while others fall in the depths of a seasonal cold (or when they sneeze and cough for weeks). It hurts to feel like your body has let you down and it stresses to have all these thoughts going around your head about what people are going to think of me, getting a laryngitis right after my summer vacation. And it’s not that they would or that they will. And it’s not that it WOULD be my own fault that I lost my voice. But still: can’t help but being ashamed.
Which brings me to the key point of this post. For a therapist it’s priceless to be able to go under the client’s skin to better understand the phase and process she/he is going through whether it’s a long term disease or a minor illness. It’s not easy to go see a doctor. It’s not nice to be taken on the ward. It’s HORRIBLE to be dependent on the hospital staff in taking a leak or changing your position in bed. Illness steals away the sense of control one has to her/his life. On the top of that it makes you feel shamed for being weak while seeing others strive.
Sigh. Oh well. Maybe I overreacted. I just wanted to say that trying to relate to your clients’ situation really pays of. It helps to become a better (occupational) therapist regarding client centered approach, minding the psycho-social aspects of the therapy and empowering people to gain back their sense of control. And, first and foremost, their dignity.
Ugh, I have spoken. I shall withdraw to breath some steam and then to lay on the sofa working on some studies. Wish me well!
Green is the Color of an OT
…so it’s only natural to try going green in all our actions. How? For example like this:
The Campaign for Greener Healthcare – 10 ways to cut down CO2 in OT department
Our dog goes green working her backpack!
At my office in the Helsinki City hospital we don’t have cars and mainly use the public transportation and bicycles to get around. That’s green! …even though the home visits from the ward are made using the city’s own transportation service. But that’s inevitable due to the security regulations.
Also we recycle in our kitchen all the following, whether it’s us making the lunch or our client practising cooking:
- glass
- metal
- paper
- cardboard
- biodegradable
The metal we still have to take care of ourselves, which is a shame that the city doesn’t do that, and there’s no way to recycle energy waste.
We also try not to waste any food whether it being cooked by ourselves or the client. Sometimes the hygiene of the product may come in question but if not, we’re happy to eat, say, the remains of a fruit salad prepared in an OT group. We also purchase only as much groceries as we need.
Number 7 is a funny one in the list: sustainabili-tea. I think there’s no point in focusing on the tea drinkers in Finland, at least in my unit there are 5 coffee drinkers against one tea drinker! Of course, the rules apply for coffee drinkers as well, tho the coffee maker takes the time it takes. And I’ve tried this filter that can be used multiple times but THAT DOESN’T work. If you know a solid one, please let me know.
And like they say in the list, preventative healthcare is probably the most effective way to stay green: that way people are better able to take care of their own carbon footprint.
If you come up with some new ideas on how to save environment in OT, please share in the comments!
Thanks to Occupational Therapist Jouyin Teoh from Kuala Lumpur, Malaysia, from the link! Check out Jouyin’s page about The Kawa Model.
R.I.P. Gary K.
Photo from MOHO Clearinghouse
Gary Kielhofner, the man behind The Model of Human Occupation, has unexpectedly passed away at the young age of 61 after a short illness on the 2nd of September, 2010. My condolences to Gary’s family and friends. Gary was a great inspiration for the whole OT community around the world.
Condolences also to the theoretic world of occupational therapy (ot). Gary has without a doubt had a huge impact in the development of ot. Even though I do think that in the ot education program in Helsinki, Finland (Metropolia, university of applied sciences), the teachers have gone a little too wild on the Model of Human Occupation (MOHO) as a result neglecting some other theoretic models, I still find MOHO and Gary’s work invaluable.
Photo from Chips Books
But I’m convinced that there will be a phoenix bird rising from the ashes and new theories, models and work environments yet to be in discovered for occupational therapists.
What do you think is the most useful MOHO instrument? Or what do you think is good in MOHO? What would you criticize?
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