Chart that includes the most effective assessment tools for occupational therapists to assist in reporting outpatient functional data to the medicare program. G-code categories that are addressed include mobility, changing and maintaining body position, carrying and moving objects, self-care, and swallowing.


https://www.aota.org/-/media/Corporate/Files/Advocacy/Reimb/News/AOTAG-CodeChart2013.pdf

When researching Alzheimer's/Dementia I saw there were a lot of sources on what the disease is and its path, behaviors, and tips for caregivers. While researching, I found an article that discusses antipsychotic drugs in dementia care. It was estimated that more than 1 out of 5 residents in nursing homes are still given powerful antipsychotic drugs for symptomology despite a growing consensus that these drugs are typically inappropriate and dangerous. Dementia patients are typically given these drugs in order to calm them down, the majority of the time the drugs used are specified to only be used for schizophrenia. In 2012, the Federal Centers for Medicare & Medicaid Services (CMS) aimed to reduce the usage of antipsychotic drugs in nursing homes from nearly 24% to 20% by the start of 2013; however, they missed this target and aimed to reach this goal by the end of 2013. Although the usage of these drugs is declining, the CMS reports that 21% of nursing homes are still giving their dementia patients these drugs. There was a drug settlement by Johnson & Johnson in 2012 that focused on the issue of antipsychotic drug usage in nursing homes. Johnson & Johnson agreed to a $2.2 billion settlement of civil and criminal charges with the U.S. Department of Justice. The charges were for their aggressive off-label marketing of drugs to nursing homes. Risperdal had been heavily marketed to nursing homes to control behavior in dementia patients, even after the drug was rejected by the Food & Drug Administration as a treatment for dementia. The drug was found to have an increased risk of stroke in elderly patients. Johnson & Johnson is not the only company that has aggressively marketed drugs and agreed to settlements over the past few years. Other drugs that have been over-marketed are Zyprexa, Seroquel, Abott for Depakote. Although it is not illegal to prescribe medications for an unapproved use, it IS illegal to be marketed for those purposes. These drugs typically given to calm dementia patients down may be necessary to reduce agitation in some cases; however, it should not be used routinely in facilities.

There is a clear issue with the way some medications are being marketed but the issues may be within the nursing homes themselves. Caring for individuals with dementia that are often confused, anxious, and may have behavioral issues is not always easy and pacifying them with an antipsychotic drug may make a shift run "smoother or easier". A convenient solution for health care workers that may have other health risks as well as decrease these individuals quality of life. There are other solutions to these issues and these outbursts are often the result of pain or discomfort that they are unable to express. The article suggests research in well-targeted non-drug therapies (including touch), music, and aromatherapy may aid in reduction of behavioral issues in dementia patients. Although occupational therapy cannot prescribe medications it is essential to advocate for your patients. As OT's it is important to be involved in all aspects of your client's care, if medications appear to be reacting oddly or you feel it is harming the individual and their function, you should open the lines of communication with the physician and give them your insight. OT's can use their therapeutic use of self and creativity to assist dementia patients with behaviors as well as get to the bottom of what is causing the behaviors. I thought it was interesting that touch, music, and aromatherapy are becoming more popular in the reduction of behavioral issues because these are all topics we have discussed in a variety or populations to help with stress. These treatments do not necessarily take a lot of effort, I just hope that facilities will open up to these ideas and other therapeutic techniques rather than turning to medication all the time.

LINK TO ARTICLE: http://www.forbes.com/sites/howardgleckman/2013/11/20/dementia-patients-still-getting-dangerous-antipsychotic-drugs-in-nursing-homes/

I chose to look at the differences between hospice and palliative care along with the role of OT in the end-of-life setting. Hospice care is for individuals of all ages with life-limiting illnesses where further curative measures are no longer appropriate or desired by the patients. The focus in this setting is primarily symptom control as well as meeting the biopsychosocial needs of the patient and their families. Palliative care differs from hospice in that it can be initiated during any time throughout the course of illness. There still may be curative care interventions taking place. End-of-life care teams are interdisciplinary and are often made up of occupational therapy practitioners,counselors, clergypersons, volunteers, physicians, nurses, social workers, dieticians, physical therapists, and speech-language pathologists. The primary role of OT in end-of-life care is to assist patients in relief from pain and suffering while also improving their quality of life through engagement in occupations that are meaningful to the patient. The OT's work closely with the families in this setting to identify meaningful occupations and to incorporate strategies to support engagement. It is essential for quality of life to help these individuals adapt and find new ways of interacting with their environment as well as with other people in order to maintain self-esteem and the roles that are meaningful to these individuals. I can see how there is a need for OT in this setting after reviewing the AOTA information on end-of-life care. Prior to reading this, I was unsure how OT could have an impact because these people are not going to regain function. However, through reviewing the environmental, contextual and personal factors, OT play a large role in helping them to adopt new ways of engaging in order to maintain a healthy quality of life throughout the rest of their lives. The loss of independence and grief from their illness can play a large role in depression and giving up on quality of life. By teaching them new ways to enjoy life and engage in meaningful occupations, you can help these individuals see life in a new way, despite their illness.


American Occupational Therapy Association. (2011). T he role of occupational therapy in end-of-life care.American Journal of Occupational Therapy, 65 (Suppl.), S66--S75. doi: 10.5014/ajot.2011.65S66

When someone says "sensory diet," most people would think of children. Sensory seeking and avoiding behaviors as well as the need for sensations within the environment, are typically only recognized as a child's need. However, sensory stimulation is a key component for people of all ages throughout the lifespan. Sensory information is used by the individual and how it is processed may affect self-regulation, motor planning, and skill development. Sensory stimulation can help individuals to engage in their environments in much meaningful ways, and can be trigger memories that have long since been forgotten. Sensory processing disorder or individuals not getting enough sensory stimulation may develop issues with their self-concept, emotional regulation, attention, problem solving, behavior control, skill performance, and the ability to develop new and maintain social relationships. Sensory activities for the geriatric population will assist in maintaining cognition, remind them of memories, assist in engaging within the environment even if they typically do not actively engage, and socially participate. Sensory stimulation can cause individuals to be relaxed as well as sort of "come alive" even if they are typically withdrawn. Sensory stimulation is unique to each individual and you may need to try various techniques in order to identify the best way to activate the elder adult's sensory systems.OTs can use their unique training in neuroscience, anatomy, activity/environmental in order to take identify and treat issues that arise due to lack of sensory stimulation or sensory processing disorder. By taking a sensory integration theory approach, OT can work with clients and their caregivers in order to educate as well as identify the issues and resolve them through providing a sensory diet or interventions that stimulate them. Sensory integration can be utilized through the following intervention approaches: remedial, accommodations & adaptations, sensory diet programs, environmental modifications, and education.

http://www.livestrong.com/article/125089-use-sensory-activities-elderly/

To Read Full Article: http://www.npr.org/sections/health-shots/2015/11/12/455654938/to-prevent-addiction-in-adults-help-teens-learn-how-to-cope

I was browsing on the npr.org website and I came across this article about preventing addiction in adults. The article suggests that the majority of addicts have a common trend that addiction starts during teenage years --addiction is a pediatric disease. I think you can tie this information into OT and try to help with this problem...especially in Southern Ohio. If you start wellness groups and create various service learning projects to help the kids find various outlets, we may be able to help with the drug problem and decrease the number of addiction cases. We worked on service learning projects at various rehab centers in Portsmouth during our program, and many of the women were young or had been using since they were young. Your maturity level when you become addicted and abuse various substances will stay with you your whole life. If you start using at 14, even after you are in recovery, your maturity level will remain similar to what it was at age 14. By having service learning projects, OT's can assist in educating youth about drugs, addiction and healthy lifestyle.

This website is great. There's an extensive list of OT blogs that focus on various settings. They range from treatment ideas to advice for practice. I think it's a great tool to keep in your toolkit, especially for the first few years of practice.

http://www.lindasdailylivingskills.com/2012/05/super-long-list-of-all-ot-blogs-i-know.html

This blog updates daily and includes various treatment ideas and supplies list for each. The majority of the treatments are great for the pediatric setting --which is always good to have many tools you can use, because kids moods and schedules change frequently...sometimes you have to change treatment quickly.
http://101otideas.blogspot.ca/

Link to a blog that has 75 different tools that cost less than $1 that can be used in treatment for pediatric and geriatric population! Fun new ideas and frugal too!

http://otconnections.aota.org/aota_blogs/b/pulsecheck/archive/2015/01/26/75-occupational-therapy-tools-that-cost-less-than-1-for-pediatrics-amp-geriatrics.aspx

The bureau of labor statistics updates current statistics on various jobs. It is a good resource to stay updated on OT salaries, employment and job outlook.


http://www.bls.gov/oes/current/oes291122.htm

The short media clip on npr.org discussed that many families of Alzheimer's patients feel as if they are not being served as well as they should be because these patients are not being told by their doctor about the diagnoses of Alzheimer's. Only about 45% of people with Alzheimer's report that their doctor told them they had the disease. In the past, this was the case with other diseases such as cancer, as well. Doctors were not informing their patients of their diagnosis; however, since the 1960s doctors have been reportedly become more reliable about disclosing information about diagnoses such as cancer and informing the patient about them having the diagnoses. Why is this still not the case for individual's with an Alzheimer's diagnoses. To ensure Alzheimer's patients hadn't forgotten things their doctor had previously said, survey responses were also investigated--these results were only a little better. One excuse that has been given for not disclosing the diagnoses to the patient has been very short appointment times. They have stated that it is a difficult diagnosis to explain and to take it, so it is difficult to squeeze all of the information into just a few minutes. I believe that even attempting to use such an excuse is unethical and absurd. I understand there are timelines and health professionals, at times, have strict guidelines and productivity to meet -but this is no excuse to not disclose information about someone's health. Once a diagnosis is made, this information should be laid out to the patient as well as their family members. A fatal brain disease is not something that should be taken lightly and these patients should have knowledge of this disease before it progresses too much that they do not know what is happening to them. Patients and their families may want to plan trips or create memory books together, for the later stages of the disease. If the patient is unaware of the diagnosis they may miss out on getting to do certain things or make arrangements that they would have made, if they were aware of their diagnoses. Yes, it is a sensitive subject, as is a diagnosis of cancer, but it will allow everyone to be more prepared and comfortable with the care they are receiving. I believe OT could assist in this dilemma by possibly having educational meetings with the diagnosing physician on ways to deliver the news or to collaborate with the whole range of healthcare professionals that will be taking care of the patient to prep them on what they will be doing to help them and what to expect. OT can help with activities such as putting a memory book together or how to make reminders that are safe and reliable for the patient. We may also be able to assist in discussing future planning with the patients and their families as well as utilize our therapeautic use of self to put them at ease during this rough time. If you want to listen to the whole discussion, I've included the link below.

http://www.npr.org/templates/transcript/transcript.php?storyId=394927484

Lin and colleagues conducted a research study to investigate how verbal instructions and target location interact to influence reaching movement of the less-affected limb in participants with unilateral cerebrovascular accidents (CVA) and healthy individuals without any history of CVA. Understanding reaching performance with task constraints and the less-affected limb post-stroke may provide helpful information during rehabilitation during bilateral movements. Participants were recruited from two medical centers. A target ball was used to test movement from a switch during reaching for the desk bells, two target locations were examined (the left and right hemispace relative to start position). Healthy participant showed more programmed movements. Speed instructed movements and ipsilateral reach optimized execution of movements for both CVA patients and healthy participants. The difference between healthy individuals and CVA participants, when looking at kinematic performance, showed that CVA participants typically produced fewer programmed movements and with lower force. The less-affected limb is used in many daily activities and can effect performance of those post-CVA, occupational therapy should focus on the less-affected limb as well as the affected limb when utilizing task instructions with this patients.

Lin, K., Wu, C., Lin, K., & Chang, C. (2008) Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: A study of the less-affected limb. American Journal of Occupational Therapy, 62, 456-465.

The aim of the study was to comprehensively investigate and compare the responsiveness and validity of two ADL measures. The subjects consisted of seventy stroke patients, and they received a three-week intervention. Stroke is one of the leading causes of activity limitations and participation restriction. Rehabilitation aims to facilitate functional independence through preventing restrictions in abilities of the patient to participate in daily activities. The goal of this study was to compare the responsiveness of the Nottingham Extended ADL Scale and Frenchay Activities Index in stroke patients that are in therapy. All participants received distributed constraint-induced therapy, bilateral arm training or control treatment for three weeks. The findings of the study suggested that the Nottingham Extended ADL Scale and Frenchay Activities Index are both valid measures of instrumental activities of daily living in stroke survivors. However, the Nottingham Extended ADL Scale is more responsive than the Frenchay Acticities Index.

Wu, C.-y., Chuang, L.-l., Lin, K.-c., & Horng, Y.-s. (2011). Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies. Clinical Rehabilitation, 25(2), 175-183. doi: 10.1177/0269215510385482

The following was examined: the number and nature of OT portion of fall prevention programs, the extent to which the recommendations with regard to services and assistive devices were implemented in treatment, what OT did to stimulate the implementation of recommended behavior changes. The OT program was carried out in the individuals' home and included both an environmental and functional evaluation in order to identify the risk factors for falls. The evaluations led to recommendations for further services, assistive devices, and assistance for behavior modifications. The OT in the study did not utilize theory-based strategies when targeting the behaviors that affect fall risk. Instead, they instructed individuals' on how to change risky behavior but were not supported further or followed-up with after the instructions were given. This program did not tend to behavior or implement effective modifications due to not utilizing theory in their treatments. In the future, theory-based techniques should be utilized to stimulate behavior changes in fall prevention programs and follow-up sessions to see how affective the training was and to see if behavior still needs to be targeted in treatment.

Bleijlevens, M. C., Hendriks, M. C., Van Haastregt, J. M., Crebolder, H. M., & Van Eijk, J. M. (2010). Lessons learned from a multidisciplinary fall-prevention programme: the occupational-therapy element. Scandanavian Journal of Occupational Therapy, 17(4), 319-325

Many community dwelling older adults share the same fear, falling. This fear can significantly impact their lives and interfere with their activity level, social participation, as well as negatively impact their health and overall quality of life. The fear of falling is a major factor to consider when dealing with this population, and occupational and physical therapists can assist in helping individuals adapt and modify their environment in order to cope with the fear of falling. The fear can lead to more safe behaviors during performing ADLs but can also cause activity restriction -which can contribute to a serious decline in physical condition, loss of independence, and decrease ones quality of life. Assessment tools may be utilized to focus on the psychological domain such as fear of falling, falls efficacy, and balance confidence. Assessments that focus on the behavior domain will measure the activity restriction that is directly caused by the fear. Intervention strategies for these two domains include exercise programs and multifactorial fall prevention interventions. When implementing these intervention strategies it is important to devote time and attention to cognitive-behavioral interventions that are designed to help limit their fear of falling and activity restriction

Filiatrault, J., Belley, A., Laforest, S., Gauvin, L., Richard, L., Desrosiers, J., & Lorthois-Guilledroit, A. (2013). Fear of falling among seniors: a target to consider in occupational and physical therapy practice?. Physical & Occupational Therapy In Geriatrics, 31(3), 197-213.

Continuing competence is a component of lifelong learning and enhancing professional development. It is necessary for all professionals in order to examine their strengths and weaknesses. OT's must develop and maintain knowledge of the profession, performance skills, evidence-based practice, interpersonal skills, critical and clinical reasoning, and ethical reasoning to perform in current and future roles/responsibilities within the field of OT. Continuing competence may be maintained through self-assessment and reflection as well as following various standards. The standards include knowledge, critical reasoning, interpersonal skills, performance skills and ethical reasoning. It is essential to have knowledge of the profession and demonstrate a mastery of the core of the practice and the roots of OT. An OT should be able to use their critical reasoning to make the best decision and judgments for their patients. OT should develop a good rapport with patients and maintain professional relationship while utilizing their therapeautic use of self. OT should demonstrate an expertise and proficiency in their role and carry out their responsibilities as well as follow all ethical guidelines.

Standards for Continuing Competence. Am J Occup Ther 2015;69(Supplement_3):6913410055p1-6913410055p3. doi: 10.5014/ajot.2015.696S16.

In addition to having an AOTA membership, you can also be a part of Ohio Occupational Therapy Association. It offers informational, support and networking opportunities, as well as assisting OT's in obtaining continuing education credits for free or cheap. There are various districts in Ohio and once you are a member you will be notified of upcoming meetings and CEU opportunities. If you sign up before graduation it is only $25 for a student for one year.

http://www.oota.org/website/index.html

Pocket Full of Therapy (PFOT) is a company that was developed for parents, teachers, OT, and learning & developmental professionals to assist with various needs of children as well as their development. There's a full catalog for PFOT products (it does cost money, but it may be reimbursed through your facility if you feel anyone on your caseload may benefit from the products). It can often be difficult to come up with effective, appropriate, and motivating therapy. Many of the products offered target multiple areas such as cognitive skills, play, and sensory needs.

http://pfot.com/

Your Therapy Source was created by a team of professionals with years of experience in pediatric therapy and special education. It offers a variety of free and fairly cheap books/activities that OT and PT can utilize within the school-based setting or pediatric setting in general.It's a quick and easy way to come up with creative, fun, interactive, and sensory based activities for children.

http://yourtherapysource.com/

School-based OT resource that allows professionals to download various HWT screeners as well as score them quickly and easily. The screeners give you a variety of helpful information such as letter orientation, memory, formation and sentence skills. You can access standards for various grades in order to compare your student's progress. Excellent free OT resource.

https://www.hwtears.com

The purpose of this article is to examine group practice and clinical reasoning behind it in OT. Most of the research examines clinical reasoning with individual treatment. Clinical reasoning has the following modes of thinking in practice: procedural, interactive, conditional, narrative, and pragmatic reasoning. Participants were individuals from a community mental health practice and completed a semi-structured interview and 1-day being followed by an observer. Group practice within occupational therapy is essential and should continue to be implemented. It is interactive and allows an understanding of interactive reasoning.
Ward, J. D. (2003). The nature of clinical reasoning with groups: a phenomenological study of an occupational therapist in community mental health. American Journal of Occupational Therapy, 57(6), 625-634.