August 8 – National Happiness Happens Day! (Can Happiness Help People Heal?)

August 8 – National Happiness Happens Day! (Can Happiness Help People Heal?)

August 8th – National Happiness Happens Day.

…which got me to thinking about the impact of happiness on healing.  As a clinician, I’ve anecdotally seen the correlation between a positive attitude and better injury recovery.  Conversely, those who do not believe they will heal well, or who are dealing with many life stressors, do not seem to as recover well or seem to experience more chronic pain.  So, on National Happiness Happens Day, I decided to perform a quick search to see if science supports the premise that happier people heal better.

Although I only performed a quick internet survey, the evidence appears to be overwhelming.  A positive attitude helps people cope better with stress and trauma, improves the immune system effect, and lowers pain levels.  On the other hand, stress releases hormones which impede immune system function.

So, today, on National Happiness Happens Day, take a few moments to celebrate the good in your life, listen to some happy music, spend extra time with a loved one, watch a YouTube clip of a late night TV comedian.  Seeking moments of happiness will now only create a positive impact on those around you, but will likely have a positive impact on your health.

Wishing you happiness and good health,

Marji

 

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12 Days of Ergonomic Christmas

12 Days of Ergonomic Christmas

Had some fun with this a few years back.  For all the computer users out there….Enjoy!

The Twelve Days of Christmas with an ergonomic twist…

On the first day of Christmas, the ergo specialist said to me
Keep those fingers relaxed on keyboard keys.

On the second day of Christmas, the ergo specialist said to me,
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the third day of Christmas, the ergo specialist said to me,
Wrists should be straight,
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the fourth day of Christmas, the ergo specialist said to me,
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the fifth day of Christmas, the ergo specialist said to me,
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the sixth day of Christmas, the ergo specialist said to me,
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the seventh day of Christmas, the ergo specialist said to me,
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the eighth day of Christmas, the ergo specialist said to me,
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the ninth day of Christmas, the ergo specialist said to me,
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the tenth day of Christmas, the ergo specialist said to me,
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the eleventh day of Christmas, the ergo specialist said to me,
Don’t squeeze the mouse too tightly
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

On the twelfth day of Christmas, the ergo specialist said to me,
Use a keyboard tray
Don’t squeeze the mouse too tightly
Avoid repetitive typing
Keep shoulders from tensing
Check your monitor placement
Be careful of awkward positions
Stay pain-free while typing
Posture is the key
Heed what I say
Wrists should be straight
Use a vertical mouse
And keep those fingers relaxed on keyboard keys.

A Good Week & Thoughts on Healthcare Trends

A Good Week & Thoughts on Healthcare Trends

The last several weeks have been really good weeks- those types of weeks where you just feel really good about your career choice; those types of weeks where you feel as if you are making a difference in people’s lives. The reason? We had several former clients stop by the clinic to say thanks and to let us know how they were doing. One brought us a bouquet of gorgeous Dahlias. He has one of the largest collections of Dahlias around. He continues to treat us with these beautiful flowers even 3 years after he graduated from hand therapy because of the positive impact we had on his life during a difficult time.

And this case is not unusual. Some common refrains that we hear from our clients are: you provide me with the knowledge I need to recover from my injury; I don’t feel as worried or frightened about the injury and my recovery because I now have that knowledge; and I wish I had known this information earlier.
Unfortunately, as healthcare changes, I see a trend towards fewer referrals, towards fewer people receiving the benefit of our experience. We are having to fight harder to receive authorization for fewer visits with less reimbursement. In spite of my good weeks, now I am the one feeling worried and frightened ….about the future of my profession as an occupational therapist and a certified hand therapist.
A few examples of this trend: (please note that these examples are based on situations with physicians who do not regularly refer to our clinic) Last week I worked with a client who returned to the clinic to be treated for a right carpal tunnel release about 6 months after being seen for her left. She felt she had progressed very well with the previous therapy, returned to work almost immediately post surgery, and was quite pleased with her end result. She assumed her physician would refer her once again for therapy for this recent surgery on her dominant hand. The physician did not. At her second follow-up visit with the physician, surprised that therapy was once again not mentioned, she requested it. Her physician reluctantly wrote a prescription “but for only a few visits”. She was glad to have these few and upon completion, she requested a few more feeling that she had just a bit more work to do with us. Based on early return to work with residual swelling, scar thickness, limited grip and pinch strength, and a moderate pain level with typing, our progress note to the doctor also reflected that a few more visits would be beneficial. However, her physician told her that she should be grateful for what she got as this particular physician only refers 1% of patients to therapy. 1%!
I think I recall coming across a statistic a while back that most hand surgeons refer about 10% of their caseload to therapy services. (I have not been able to find this source again. I would love to have this confirmed if anyone out there has information). So what is happening with the other 9% of the patients that are not being referred? Are they receiving sub-optimal results? Taking longer to recover? Staying out of work longer? Just getting by? Finding information on the Internet instead of through qualified personnel? Having multiple questions that go unanswered? Putting energy into worries that can be resolved with education?
I once had another physician ask one of my clients who had requested therapy, “Why? Do you need someone to hold your hand?” Is that how scar management, retrograde massage, joint mobilization, manual therapy, range of motion is viewed? As hand holding
And, if people are being seen by physicians who seem as callous as in these two examples, I don’t think that a session or two of our “hand holding” is out of order. Why does medicine need to be so cold and unsympathetic? And why do some physicians believe that it is more effective that way?
And for those physicians who believe in our services, even they are being impacted and discouraged by the hounding of insurance adjusters, multiple phone calls received, and the increased need to prove medical necessity (often to ridiculous degrees). It is becoming easier for even them to not take out the prescription pad.
Dr. Roy Meals referenced a study in his newsletter that he believed every hand therapist should be aware/wary of. This study “proved” that wrist fracture recovery was better without the “coddling” of physical or occupational therapists. Of course, the control group (those who did not attend therapy) were seen for frequent follow up visits with a physician who spent 10 minutes each appointment providing them with exercise instruction. Unfortunately, all of the physicians who refer to me do not have that luxury anymore. They count on us to provide eduction and home program instruction. But, if insurances can use this study to deny treatment, do you think they will make that distinction? I sure don’t.
So, what can we do to offset what seems to be an increasing disbelief and disrespect of our services? I personally don’t know what the answers are. Maybe insurance companies (who i believe to be the driving force behind this ennui) are just too big to fight. But in the meantime, I will carry-on at a grassroots level by trying to promote my profession, by returning those annoying calls to adjusters, by answering questions and providing education, by suggesting that my clients tell any and all about the value if services that they receive from us. I will support our local and national organizations who can fight at a political level. And I will hope for the best because I want to continue to have these good weeks.
Best, Marji

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What Exactly Is Occupational Therapy?

While watching a special on CNN last week about the future rehabilitation needs of the Boston Marathon Bombing victims, a beautiful segment was aired that showed occupational therapy at it’s finest.  This program section followed the recovery of a gentleman with a lower extremity amputation caused during an industrial accident.  His return to functional independence was emphasized through balance activities as he performed basic daily and work activities (making coffee and a shoveling-simulation task).

Unfortunately, the segment did not specify that the activities being performed were directed by an occupational therapist.  The general term “therapy” was used, and physical therapy was implied.  But the process certainly felt like an occupational therapy intervention.  Was this an oversight by CNN?  I certainly don’t think so.  But why, as happens too frequently, did occupational therapy hide in the shadows?  My thoughts:  name confusion; a professional philosophy that is difficult to describe in just a few, simple words; and the ever increasing demands of the healthcare industry.

So, what exactly is occupational therapy?  Is it fine motor control (occupational therapy) versus gross motor control (physical therapy). Or is it upper extremity rehab (arms = occupational therapy) versus lower extremity rehab (legs = physical therapy).  These are quick, easy explanations, but certainly not thorough and sets up for division of therapy efforts versus collaboration.

The roots of occupational therapy go back to World War I.  At that time, there was a large demand for the rehabilitation of injured soldiers returning home.  Rather than focusing on only the physical component of injuries,  the nearly 148,000 soldiers admitted to hospitals between 1917 and 1920 were treated with a holistic approach by “reconstruction aides” who borrowed from the fields of nursing, psychiatry, rehabilitation, self-care, and social work.  This whole-body, activity-focused and client-cenered treatment encouraged the patient to take an active roll in his recovery and used purposeful activity to enhance the rehab experience.  By 1920, the field of occupational therapy was officially founded.

Fast-forward to the 21st century, the term “occupation” is now essentially synonymous with work activity.  It’s not unusual for a client to arrive at the clinic and ask: “Are you going to get me a job?”;  or “I’m 78 years old. Why is the doctor sending me to occupational therapy?  I’m not going to go back to work.”  Historically, however, the term “occupation” meant any purposeful activity in the triad of self-care, leisure and work demands that occupied our time.

This historic definition of the term “occupation” is the basis of the occupational therapy philosophy to treatment.  It is what sets us apart from the profession of physical therapy.  Traditionally, physical therapists focus on strength and motion, on the biomechanics of an injury.  As an occupational therapist focusing on the rehabilitation of hand injuries, I borrow from those techniques.  Certainly, the physical recovery of an injury is an essential component of hand rehabilitation.  But the purpose is not just to gain motion and strength.  It goes beyond that.  The following quote, attributed to Mary Reilly, appears on the website for the American Society of Hand Therapists – “…man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health”.

The American Occupational Therapy Association states: “Occupational therapy practitioners bring an added dimension to this [hand therapy] specialty area.  They use an occupation-based and client-centered approach that identifies the participation needs of the client –  what he or she wants to be able to do in daily life that is fulfilling and meaningful – and emphasizes the performance of desired activities as the primary goal of therapy.”  The ultimate goal of occupational therapy is to preserve life roles and habits; to promote a sense of normalcy and psychological well-being during day-to-day functioning; and to make the client a partner in his or her rehabilitation rather than a passive participant.

86% of certified hand therapist are occupational therapists and only 14% are physical therapists.  Yet, the majority of clients attending hand therapy believe that they are receiving physical therapy.  To be honest, each of our professions has benefitted from using techniques from the other.  But I have a terrible confession to make – when I overhear someone on their phone telling their ride to pick them up from physical therapy in 10 minutes, I don’t always correct them.  It’s not that I’m not proud of being an occupational therapist, or that I’m a wanna-be physical therapist.  The truth of the matter is, healthcare providers are struggling to provide quality care with an increased demand for treating a larger caseload, more documentation requirements, and less financial reimbursement.  As awful as it may be, there are times when I have to choose between educating my client about the philosophical difference between OT and PT and providing practical information on scar management, control of swelling, and home exercises. And that is why occupational therapy stays hidden in the shadows rather than taking it’s place in the spotlight.

Yet, occupational therapist should be proud of what they do and of the many people they help to recover from injuries that can threaten well-being as well as physical function.  Some common examples of role disruption that we might see in the clinic include:  a child who is having difficulty with the role of student as fine motor deficits impair his or her writing skills; a young lady who is having difficulty with the role as a mother as “new mom’s tendinitis” impairs her ability to care for her baby; a graduate student who is having difficulty with the role as lab assistant as a snow board fracture impairs his ability to fill pipettes in a science lab; a baby boomer who is having difficulty with the role as wage earner as carpal tunnel syndrome impairs her ability to use a computer keyboard; a retiree who is having difficulty with the role as a volunteer as arthritis impedes his ability to make a full fist. Practically speaking, the occupational therapist looks at these life roles, assesses the amount of dysfunction the injury or illness is causing, and promotes healing through injury recovery or activity modification.   According to the University of Southern California’s Occupational Therapy Program: “no matter what injury, illness, condition, disability, lifestyle, or environment stands in the way, occupational therapists help people to perform, modify, or adapt their skills and activities in order to live healthier, happier, and more productive lives.

So, go live life to the fullest!  Marji

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