10 OT Strategies For A Better Quality Of Life: Part 4
OT Strategies For A Better Quality Of Life
1. Everyone wants to walk. No one wants to focus on pooping…at first.
The most common phrase I hear during an initial evaluation in inpatient rehab is “I want to walk.” Regardless of whether this goal is ever achieved, it’s only a matter of time until it slides down the ranks to be overshadowed by a longing for a return to independence in those ADL (activities of daily living) that are typically done behind closed doors.
Sometimes it takes weeks, other times it takes years but the focus shifts to being able to go to the bathroom and getting dressed by themselves. While this is true for most diagnoses, the table below highlights this desire for the SCI (spinal cord injury) population well. Whereas walking was likely top of the list soon after the injury, priorities shift as the true extent of the injury and the impact on caregivers become more apparent.
It’s all relative and it’s okay for the priorities to change.
2. Exercise, exercise, exercise
If there was a pill that extended lifespan, improved healthspan, made you look and feel better, and decreased the risk of every disease and condition, would you take it? Yup. What if “taking it” required 20-30 minutes of voluntary movement a few times a week?Nope.
Often, the patients who to have had the best recovery are the ones who were the strongest at the time of their injury. The ones who have had some degree of frequent movement throughout their lives also learn new cognitive and motor skills much more quickly. As Ben Franklin said, “An ounce of prevention is worth a pound of cure.”
Move often, lift heavy things a few times a week, sprint every once in a while, and make yourself harder to kill.
3. If food is medicine, what is ultra-processed food?
Whatever it is, a diet high in it results in an evolutionary mismatch on the road to a shorter life with disease pitstops along the way. The lack of awareness between nutrition and health always amazes me. Maybe it’s the imbalance between the billions spent on advertisements for processed food compared to the limited available nutrition education. Or maybe it’s just the subconscious default of “this is what everyone else does.” Regardless, it’s rampant with nearly 60% of the American diet coming from ultra-processed food.
Every cell in our body is a product of what we eat. Eat well.
4. Pain is anything but simple
At its evolutionary roots, pain is primarily just there to tell us what to avoid (sharp things, too much sitting, pushing our body too far, etc.). However, the simplicity ends there.
Our perception of pain is modulated by everything from stress levels to the food we eat to our upbringings to the weather and even to things that we know shouldn’t impact it (placebos and nocebos). Pain is associated with a low mood and high inflammation and a poor ability to express social emotions such as empathy, playfulness, and love due to the activation of the sympathetic nervous system (fight, flight, or freeze). This downward spiral can further lead to isolation and depression.
Fortunately, there are effective ways to treat and manage a great deal of pain. It's disheartening to see individuals enduring chronic pain for years, only to have it significantly reduced or eradicated after just a few therapy sessions. Pain management approaches are varied and individualized, offering a range of effective strategies.
Identify the pain early, manage it the best you can, and find help when you can’t.
Sidebar: In my experience in working with knee replacement patients who all had similar surgeries, athletic women tend to have the highest pain tolerance, and sedentary men have the lowest.
5. Modify the landing
If I’m treating 9 patients in a day then I’m experiencing 9 different personalities that are influenced by 9 completely unique situations. As a result, it’s important for me to read the situation and modify my approach so that I’m meeting the patient where they’re at which will likely happen 9 different times.
Once I establish or re-establish (depending on if I’ve met the patient before) a sense of rapport, empathy, authenticity, and expertise then I can begin to use my voice and body language to influence a state of positive change, as appropriate. My approach to the 14-year-old who is in a depressed state and struggled to make it out to the door this morning will be different from the 70-year-old who arrived an hour early, motivated to get back to golfing.
Read the situation, modify the approach, and provide a positive influence.
6. The more that help is given, the more that help is taken
When I work with a patient that needs some help standing I give the least amount of help possible so that they can strengthen their weaknesses, a skill known as scaffolding. Sometimes, however, that patient takes advantage of the help and every once in a while I will give 10% of the help and they will take 11% so I will have to give 12% and this back-and-forth force distribution quickly escalates until I am entirely holding them up. At that point, the benefit is totally lost and they have to sit down to recalibrate.
Realize when you’re helping someone too much or else the purpose is lost.
7. Sexy is overrated
Fad diets, new tech, and the latest thing that the hottest celebrity used are all sexy. Sexy sells but 99% of the time it’s more hype than it’s worth. The talk of the town is the newest advertisement for the newest technology and the latest innovations based on popular headlines. But what's rarely brought up are ways to help with the boring stuff like eating whole foods, sleep hygiene, stress mitigation, vitamin D levels, and how to get the most out of a workout. Don’t get me wrong, technological and medical advancements will continue to improve the lives of countless people but most of the time we just get lost in the flashy flights.
Fads and technology are interesting but it's the boring stuff that moves the needle.
8. The hand is a marvel of the human body
One of my favorite courses in college was a class entirely dedicated to the hand. In each hand, we have 2 main arteries, 3 main nerves, 17 muscles (and 18 more in the forearm which control the hand), 29 bones, 45 other nerves, and 123 ligaments. Even the slightest impact to any of these components can have a profound impact on our independence. I’m as amazed today as I was back then about the intricacies, the types of associated conditions and diagnoses, and the impact it has on our lives, a point Bill Bryson illustrates beautifully.
Realize what you take for granted by using your non-dominant side only for the rest of the day.
9. Sleep is king
There is no shortage of benefits of sleep for humans, yet somehow this peaceful and beautiful thing tends to be put on the back burner of our lives. Snoring, sleep apnea, getting up more than once a night to pee, taking medication to sleep, having an EMF-emitting phone just feet from your head all night, and taking 20 minutes to fall asleep are not healthy behaviors. Unfortunately, they are “normal” because of how many people they impact just as dehydration, chronic stress, phone addiction, and being overweight are all now “normal”.
Sleep hygiene is one of the most important conversations I have with a person to improve their health. Develop sleep discipline and make your sleep sacred.
10. How you say what you say is often more important than what you say
As an OT, my ultimate job is to empower patients and facilitate their independence and overall well-being. While the details of what we say can have significance, the lasting impact lies in how we said it. Patients may not remember every instruction or explanation but they will remember the empathy, encouragement, and support you used through your tone, body language, and authentic interest. By using our therapeutic use of self we improve our rapport and our relationships with our patients which leads to better outcomes. Robots, after all, aren’t good hospice nurses for a reason.
Rarely will someone remember exactly what you said but they will remember how you said it.
What career strategies have you learned from your line of work?
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