Driving and Community Mobility

This was a very informative lecture. The material covered complemented classes we have taken recently. The main take away points from this lecture include:

·      An occupational therapist in driving and community mobility has 3 main roles 1) to assess individuals for safety and potential to drive 2) evaluate persons with physical disabilities for appropriate adaptive equipment 3) train individuals in the use of adaptive equipment and/or compensation techniques for driving.

·      The most common diagnoses include CP, intellectual disabilities, stroke, TBI, SCI, Alzheimer’s Disease, visual processing deficits, and amputations.

·      Clients’ age varies from as young as 14 to 75+ years old.

·      It is difficult for anyone to hear they can’t do something they have had the ability to do in the past, however, it is important therapists separate the feeling the situation and perform accurate evaluations because we are responsible for the safety of the affected individuals as well as everybody else on the road (including us).

·      An evaluation has 2 components – clinical evaluation and the behind the wheel assessment.

·      Driving is a multi-dimensional task – it includes vision, ROM, cognition, sensation, insight and awareness, and grip/strength.

·      Appropriate assessments used for driving and community mobility include Trailmaking Tests A and B, MoCA, SIMARD – MD.

·      Certified Driving Rehabilitation Specialist Therapist (CDRS) is a certification therapists should obtain in order to accurately evaluate whether individuals are competent to drive.

Two occupational therapy interventions appropriate for this topic are:

1) Prepare an individual with intellectual disabilities to driving safely by helping them learn and understand the road signs and laws of the road. This is a one-on-one intervention appropriate for anyone age 14+.

2) Hold a group therapy class where individuals with TBI discuss and work together to come up with strategies to improve their low tolerance to frustration. By working together the individuals will increase their potential for improvement as they will hold each other accountable and share helpful techniques.

Changing Perspectives

At the beginning of my OT journey we were asked to draw a glyph representing our thoughts on leadership. Now, near the end, after all the ups and downs graduate school has presented us with, we were asked to repeat the same exercise. I was surprised to see what aspects of my perspective had changed. Some things had remained the same; I still see myself as a leader behind the scenes, I still believe an introvert can be a leader, and I still believe self-awareness is vital to effective leadership. These elements of what a leader is stayed the same because they were the most solid values; in fact, the past year and a half only reinforced them.

In regard to the opinions that have varied, I suppose my most accurate belief is in the middle: the average of my answers. The biggest view that changed was whether leadership was an inborn trait or if it stems from nurture over nature. I started out with stemming from nature and since then migrated to inborn trait. I believe that some people are more inclined to lead and naturally rise to become leaders, while others prefer to follow a leader, (or be a leader in their own, less obvious, overwhelming way). Yes, the latter will rise up to the occasion in the case of injustice or necessity, however, the trait is still stronger in some individuals.

My experience in graduate school has also allowed me to see that you do not have to see yourself as a leader for other people to see you in that way. As a leader, a person guides/helps while experiencing the same circumstances as everyone else. They will not be able to recognize their actions are setting an example because they will feel the same emotions as everyone else; they will simply react in a different way. This realization was exceptionally eye opening for me.

Nutrition & Aging

This lecture was wonderful; it was very well presented and the information covered will be encountered frequently in many OT settings. The main takeaway points were: 

• Nutrition and exercise are key in recovery from an illness
• As we age our bodies undergo several physiological changes including cardiovascular changes, respiratory changes, urinary/renal changes, gastrointestinal changes, as well as skin and bone changes.
• Role of nutrition in aging is 1) to slow down the aging process 2) slow progression of chronic nutrition – related diseases; maintain functionality, quality of life, fitness, and mental health 3) medical nutrition therapy
• Loneliness and isolation, and food insecurity contribute to malnourishment
• Sarcopenia age related loss of muscle is called; age 30 is the peak of our muscle mass
• Malnutrition is defined as any nutrition imbalance and can be any 2 of the following:
  o   Insufficient energy intake
  o   Weight loss
  o   Edema
  o   Decreased functional status/diminished grip strength
  o   Loss of fat
  o   Loss of muscle mass
• Older adults, chronic diseases, hospitalized patients, and long-term care residents are at risk for malnutrition
• It takes a minimum of 6 months - 2 years to recover from malnourishment
• Nutrition supplements help decrease healthcare cost, decrease hospitalization time, decreases readmissions, and increase quality of life and independence.
• Telling patients that drinking the nutrients/taking the medications will get them home sooner increases their likelihood to cooperate

One example of intervention is education on resources for a client with food insecurity. Education is appropriate for 1:1 consultation with either client or caregiver - potential resources include Senior Food Boxes, Food Banks, Supplemental Nutrition Assistance Program. This is an appropriate intervention for IPR and Acute-Care settings.

Another example for an intervention is a group cooking class. This is an appropriate intervention for outpatient services where 2-5 individuals will be educated on the importance of nutrients for the aging body and provided with examples of healthy recipes. The group will then cook the recipes together as a group activity. This will promote wellness, as well as improve social participation.