Reinventing your life with your Occupational Therapist

A pet peeve for Occupational Therapists (OT) in the world of Rehab is when someone who is not an occupational therapist says, "Oh, the OT helps you with upper extremity exercises, cooking and learning how to take a bath and get dressed." OTs do these things and a whole lot more. The best description of Occupational Therapy comes right from the OT program at the University of Kansas: 

Occupational therapy helps people improve their ability to perform tasks in living and working environments. It's a science-driven profession that enables people of all ages to live life to its fullest by helping them promote health and live actively with illness, injury or disability.

This is a perfect description of the way an OT develops supports and strategies for people with brain injuries in the community. I once had someone tell me they didn't think a woman named Sasha could make improvements because her brain injury was too severe, she couldn't list 3 goals she had for rehab and she didn't want to go out of the house because she knew people would stare.  My immediate response was to send in an OT to work with Sasha. Here are the 5 things that happened: 

5.  The OT was able to help Sasha understand that it is natural to be afraid to go out into the community for the first time after such a big event and that it can feel like everyone is staring but it takes practice to overcome both. They decided to break things down into manageable steps. 

4. The OT got Sasha out into the community for the first time since her brain injury. The OT was able to offer reassurance that she would help Sasha be safe (not fall), figure how what she could do (assess strengths) and have fun (live life to the fullest). Their first time out was a walk to the car and a ride to the store. They sat in the parking lot watching people and Sasha decided that was enough for one day. 

3. Sasha was able to identify a few things she loves to do like make bracelets, cook Indian food and do yoga. All three seemed beyond her capability (to her and to her physician) but the OT decided to help address all 3 goals. They involved not only upper extremities and functional movement but also included cognitive skills like planning, problem solving and reasoning. 

2. The OT was able to translate to the case manager and insurance company why these goals are medically necessary and would lead to a more independent lifestyle for Sasha. Being able to "medical speak" is a wonderful attribute of OT's who are also able to live in the real world of every day language. 

1. The OT was able to help Sasha set goals, achieve those goals and believe in herself. She took the bracelet making, cooking and yoga well beyond those goals and Sasha is now employed in a field she had not experienced before her brain injury. 

So, when in doubt, always call the Occupational Therapist in to help with a fresh perspective on living life to the fullest. OTs have a  great vantage point on the social, emotional, cognitive and physical in a way that helps each individual develop their own plan for achieving goals. 

Navigating Home

Anyone can live at home, no matter the significance of disability. Three critical components to make that happen are significant social support, advocacy and resources. Thankfully Kansas has been a forward thinking state in this regard for many years. They have even passed laws making it a right to live at home and not in a facility. The recently designed KanCare system has not changed the constellation of services available, just how you access them. 

When a significant incident happens forcing you to rely on disability or public assistance, you are forced to deal with the daunting medical issues and decisions while being expected to figure out how to traverse the many steps to get home. The first step in the process is applying for disability. Below is a chart that was developed between Stormont Vail Hospital and Minds Matter LLC to help people navigate the disability and eligibility maze. This is a necessary step in the process to get in home services and supports after brain injury. If you are starting this process from the hospital, the social worker can help you get started. If you are starting this process from another place, like a rehab facility, nursing home, or from home, you can utilize Minds Matter LLC to get started. 

The steps to getting on the Traumatic Brain Injury waiver in Kansas. 

The role of a speech therapist on your journey to inclusion

I remember the first time I sat in on a team meeting about someone who was receiving speech therapy at the rehab hospital where I worked. I was a recently hired social worker who had just graduated from college so I was sure I knew everything. I knew the person we were talking about well. We met weekly to talk about her desire to go home. She was articulate, bright and had no issue telling me what was on her mind. I sat in the team meeting wondering why she needed speech therapy. 'She speaks so well,' I thought. The speech therapist gave a 15 minute report and detailed the reasoning, judgement, problem solving and memory issues they were working on. I was mesmerized by the techniques they were using to address upcoming functional issues the person would address when she went home. From then on, I spent as much time as possible with each of the speech therapists at our rehab and learned about communication, every cognitive challenge after brain injury and fascinating ways to help people improve their functioning. I began to believe everyone with any cognitive- communication issues needed a speech therapist on their team. 

Fast forward a few years later when I became immersed in believing that everyone has a place in the community. I met a great man named Dr. Mark Ylvisaker, a speech language pathologist, who continues to have a profound impact on our work here in Kansas. He gave voice to the need for positive everyday routines for people living in the community, no matter the significance of their disability. He believed that everything we say or do is a form of communication. I specifically learned the most from him about how behavior is an important form of communication. Our job is to help people find ways, through every day routines, to effectively communicate what they need. We find that the transformation that happens when people are able to have control over their daily routines and communicate their needs more effectively, positive behaviors result and negative behaviors go away. We, at Minds Matter, still use Mark's work, across therapy teams, to support positive every day routines. 

Dr. Ylvisaker, and all other speech language pathologists, have taught me that the role of a speech therapist goes well beyond "speaking well" and swallowing. The speech therapist plays a vital role on any team helping assess, and implement plans that address all facets of cognitive functioning. 

We have 9 speech language pathologists at Minds Matter LLC who each have a different approach with the same goal, to support every day routines in the community whether it be using a communication device (see Grant's story), learning to manage their aphasia, learning to communicate in a positive way, or implementing any of a myriad of cognitive strategies to be successful away from professional help. 

Dr. Ylvisaker passed away May 23, 2009. Over the course of his 35 year career, Mark gained worldwide distinction for his ground-breaking approaches to brain injury rehabilitation and his clinical work with children and adolescents with disabilities, assisting programs in all 50 states and over 15 countries in the development of innovative services. He was known and respected throughout the world for his boundless optimism and his passionate commitment to his work, to the people he supported, and for his unique ability to help individuals with disabilities, families, and professionals overcome barriers and achieve success in life. 

Here is a link to a great interview Dr. Ylvisaker did in 2007. It amplifies his belief that formal testing can be very limiting and thinking across disciplines is critical in helping people be successful after brain injury:

http://www.internationalbrain.org/articles/on-neurorehabilitation-a-conversation-with-mark-ylvisaker-phd/

Social Capital the Key to finding a Job

Joe experienced a brain injury in a car wreck. When he finally made it home after numerous rehab stays, he had a cognitive therapist and independent living skills specialist he met with on a regular basis. When he wanted to update his goals and talk about his progress, they would meet at the local donut shop. These meetings went on monthly, and sometimes he would meet with staff there individually as well. After 3 months, Joe said he was ready for a job. He approached the manager at the donut shop who immediately said, “You know, I have seen you in here a lot and a few times I thought about offering you a job.” Joe is now working 20-30 hours a week and no longer has staff.

According to the Bureau of Labor Statistics, in 2013 the unemployment rate for people with disabilities was 82.4%. That means only 17.6% of people with disabilities have jobs. The human service industry spends billions of dollars each year to help people get back to work. So how are we doing?

Thankfully, many people in the human service field have discovered the power and potency of social capital. Social Capital is a construct developed to look at the relationships between people in communities. Originally measured without asking about disability, the research found that those people with more social capital (friends and connections) were happier, healthier and lived longer. Social Capital is what got Joe his job, not a human service professional telling the manager about all of Joe’s deficits and problems. Joe was familiar to the manager as a guy who frequents the donut shop, not someone who was brought in there to find a job.

The best place to start when talking to someone about finding a job is to explore their already familiar relationships and things they like to do. Mary likes to make bracelets and goes to the craft store frequently? How about a job at the craft store? Joe likes to play the guitar and hang out in coffee shops? How about working at the coffee shop? If you start with a person’s passions and places they frequent you will make your job as coach and support a lot easier. You will also find that people are successful because they are doing something they are passionate about and had ownership in discovering.