Post-SIM Encounter

November 15, 2019

I think, despite the overwhelming anxiety I felt throughout the simulation, the encounter went well. Apart from making eye contact, empathic listening is something that comes a little more naturally so that allowed more room for me to think about the content I actually had to communicate and my choice of words. 
I didn't remember this instance until I looked back at the video - After I recommended a weighted blanket as a form of deep pressure, the client mentioned how expensive they can be and asked if there was a way to makeshift one. I was forced to use quick, creative, conflict-resolution thinking which isn't something that always comes easily because I prefer to take time to think through things. So to my surprise, I was able to give a couple spontaneous recommendations on the spot.
Overall, although there are improvements that can be made, the simulation encounter generally went well, and as a result, I was able to practice, reflect and learn from the experience.

If given the opportunity to re-do the SIM lab, I would drink less coffee beforehand - hands down. I was able to calm myself before walking into the room but since I can't just "smell the flowers and blow out the candles" repeatedly in front of the client, I felt the effects of caffeine gradually making its way back throughout the simulation. The coffee I usually drink doesn't exacerbate such strong physical signs and symptoms of anxiety. Treating myself to Starbucks on a Friday morning did not turn out to be as nice as expected (it was just a normal holiday latte!). I digress. ☺ As a result, there were times I noticed in the video, and never realized in the moment, that I appeared visibly nervous, and I don't expect that to be very comforting to any client. Also, I consider myself to be and feel like a happy person but looking at myself from an outside perspective, I realized that I don't smile as much as I think I do. It was nice whenever I did so it will be something to be mindful of in the future.

There are various ways to communicate empathy and caring to a client. As a concerned client, parent or caregiver, his/her input and feelings should always be taken into consideration. Validation of others' emotions allows them to feel understood and helps to build meaningful rapport. Then, as a therapist, it will be easier to meet the client's needs and work toward reaching goals together. Another subtle but effective way of showing to the client that he/she is cared for is active listening. When you're not the one speaking, non-verbal body language communicates for you when others are expressing themselves. Making eye contact, nodding, responding through appropriate facial expressions, repeating what they just said back to them, and more will help to assure the client that they are being heard, understood and cared for.

In future experiences, I'll make a conscious effort to smile more. The people we come across that are always smiling and appear to be happy are contagious and feel like a breath of fresh air. If that is something that helps me feel comfortable when others, I imagine it is to others, too. I will also ask the client for their input and interpretation of certain information they may not be as familiar with. This will give them not only the opportunity to express themselves, but also an opportunity for me to see their level of knowledge, meet them at that level, make mutual connections, and go from there. Finally, now that I know how it impacts my ability to interact with others, I will be more aware of my caffeine intake prior to those personal exchanges.

Adapting to the Unexpected

TEDTalk | Stephanie Buxhoeveden | "Thriving in the Face of Adversity"

I chose to watch a TEDTalk called “Thriving in the Face of Adversity” by Stephanie Buxhoeveden. TEDTalks provide not only a personal and humanizing, but also educational, an account of what someone has experienced and/or accomplished. Because Stephanie was studying to be a nurse, she was able to drive home her message from both of the aforementioned standpoints, and it resonated well with me as a current OT student and future practitioner. Learning relevant material from textbooks or lectures is not sufficient. As an OT, real-life exposure to others and their conditions is important so that through familiarity we can work more adaptably and efficiently. By listening/watching others’ personal accounts, we can deepen our capacity for empathy and use it throughout our practice.

MS initially presented itself as a chronic numbness in Stephanie’s foot and gradually spread upward in both of her legs. Stephanie experienced her first concerning signs of Multiple Sclerosis (MS) the very first time she was going to administer anesthesia as a student. As she was dressing, she realized she was completely numb from the waist down, lost all feeling in her right arm, lost the ability to move her right hand, and her vision became very blurry. Stephanie was diagnosed in the ER after a spinal tap, IV infusions, and several MRIs. During this TEDTalk, Stephanie gave a good explanation of MS in layman’s terms so that her audience could understand. MS is a disease that attacks the myelin covering on nerves in the brain and spinal cord, affecting neuronal communication. There is currently no cure, but her symptoms of numbness, tingling, paralysis, and loss of vision can be treated.

The onset of MS is most common in young adults such as Stephanie. As a young student like Stephanie was, wondering how MS would impact my life at this very moment is unimaginable. Stephanie was a successful student and participated in heavy resistance training for leisure. Now during her relapses, she needs a cane to walk, has to take medication for nerve pain, experiences numbness, and tingling, and undergoes intensive treatment. One day when she went to the doctor as a patient, she was able to educate the nursing student who tended to her. From this, a seed was planted. Shortly after, she received a recommendation from her doctor to change careers. Stephanie took this as an opportunity to change others’ lives and decided to become an expert in MS.

A combination of personal experience and professional expertise gave her an advantageous ability to have a positive impact on the lives of others. She became a board-certified MS nurse and changed her career path to that of a nurse practitioner. She (perhaps unknowingly) acknowledges and understands the holistic approach that OT’s use. Not every healthcare provider has the time or knowledge to educate every patient on everything that has to do with their specific diagnosis, and many clients do not have the assistance of specialists either. While we may not specialize in MS, it is up to OT’s to dedicate our time to our clients so they can have that special physical and emotional attention that other professions fail to give. Stephanie also indirectly advocated for independence by creating a website that is user-friendly so that those with MS may be an active participant in their own care without the need of a specialist. The website provided an understanding to others who may have had the disease for decades and can finally understand their bodies. It is not a cure, but it has made a profound impact on empowering others. Stephanie’s diagnosis of MS was not the end of her life. Rather, it was a new beginning as it made her a better nurse, a better purpose, and gifted her with a purposeful life.

~ Pam ♡

TEDx Talks. (2015, April). Thriving in the Face of Adversity [Video file]. Retrieved from https://www.youtube.com/watch?v=zuLOT6GsAxw

Media Project Reflection

The most meaningful and significant thing I discovered from this media project was a creative part of myself that I didn't know ever existed. Posterboard projects have always been the bane of my existence! To take it a step further, we were challenged to create our own invention that could be used as a part of an OT intervention for a specific case study. The catch was that it was a mundane, everyday item which could not be used for its original purpose. How was I supposed to make a sriracha bottle fun, purposeful, and meaningful?! After brainstorming for what seemed like such a long time, it finally all came together. Through this, I discovered that anything can be used for OT. It is so easy to pick up an everyday object and consider only using it for what it is originally meant for. Through the lens of OT, it is up to us make the therapeutic process something that can be fun and enjoyable so that clients are more inclined to participate, learn, and receive effective treatment. Now I'm able to see everyday objects from a new perspective - one where there is an opportunity for a purposeful therapeutic activity anywhere. 

I was challenged, forced out of my comfort zone, and the outcome was growth. I never considered myself to be a creative person ("I'd rather write a 10-page paper!") and this really helped to strengthen my "OT brain". It allowed me to really and truly consider the client. What on earth could they possibly do with this that they would actually find enjoyable? It was easy for me to think of ways to manipulate the sriracha bottle for physical therapeutic purposes, but that was not the goal here. I needed to make it purposeful and meaningful. Ultimately, it encouraged a genuine, client-centered approach. I realize that I am able to be creative if I put forth the effort and as a result, become a more well-rounded individual, OT student, and future practitioner.

This project was a good introduction and first-time experience in developing a hypothetical intervention for a client that has both a means and an end. It helped me in becoming more familiar with the OT process and what it means and takes to be an OT. Seeing others' projects was very eye-opening, as well. Who knew that everyday items that we normally don't think twice about could be used in such a purposeful way? This just goes to show that OT can be for anybody with the ability to effectively use no/low-tech equipment and find the "just right" fit for someone. This assignment was an amazing opportunity to practice creativity which is essential as an OT. Going forward, and as I become more familiar with this process, I will be able to implement these skills in future classes and clinical practice.

~ Pam ♡

The Dementia Village

TEDTalk | Yvonne van Amerogen | The "dementia village" that's redefining elder care

Occupational Therapy (OT) "has to do with looking at the person in front of you and looking at what does this person need now" and seeing them as more than a diagnosis. Dementia is an incurable disease which affects the brain leading to confusion, and as a result, anxiety, depression, and aggression. The presence of dementia within the worldwide population is prominent. So much so, that it has become problematic resulting in waiting lists for nursing homes. Presently, nursing homes assume a clinical appearance such as a hospital or ward leaving patients more confused and with a desire to escape and "go home". Yvonne van Amerogen wanted to challenge the traditional structure of current nursing homes. Twenty-five years ago, she developed the Hogeweyk dementia care center in Amsterdam. This nursing home is occupied by residents with advanced dementia and who are fully dependent on other professionals for around-the-clock care and support. Hogeweyk imitates that of a regular community with streets, alleys, theaters, pubs, and more so that it may simulate and allow residents to partake in a normal lifestyle. 



The current environment of nursing homes is not ideal or desirable for friends, parents, family, or ourselves, and Yvonne pushed for a change. Although individuals with dementia experience general confusion, they still want a normal life. For example, they want a house with a kitchen with a stove where they can smell dinner and have the freedom to go get something to eat or drink. Future residents' family members such as their son or daughter were asked what is important to their mother or father, what was their life like before their diagnoses, and most importantly, what they want. From this information, residents are placed with a "lifestyle group". These are small groups comprised of ~7-8 people (as opposed to the traditional ~20-30 seen in nursing homes) with similar interests and lifestyles. For example, there is a Formal lifestyle group in which the residents wake up and go to sleep at later hours and have a more formal manner of interacting with others. There is also a Cultural lifestyle group for those who value traveling, meeting other people, and being exposed to different cultures, art, and music. 

People are social animals, and it is in our nature to want to have fun and develop meaning in life. Yvonne says that there is more to life than just living in a house with other people. In Hogeweyk, people can go shopping, go to the pub, go to a restaurant, or go to the park. Even in those with advanced dementia, socializing is a critical part of life. Here residents can have this feeling of belonging along with a natural sense of freedom and safety provided by trained volunteers and professionals who know how to approach dementia. Hogeweyk was created with state budget - the same budget as any other traditional nursing home in the country. This can be possible anywhere!

I chose to watch this TEDTalk because the title was interesting. As I was watching, I realized that this creation resonated and aligned perfectly with the meaning and purpose of OT. Hogeweyk aims to increase its residents quality of life by exposing them to a normal, social lifestyle that aids in facilitating independence. As an OT student and future practitioner, this gave me hope for a universal goal that is realistic. Instead of focusing on a diagnosis, this environment encourages and fully adopts a holistic approach to care for its residents as normal people with normal lifestyles. 

~ Pam ♡

Image retrieved from: Google Images
Amerongen, Y. (2018, November). The "dementia village" that's redefining elder care [Video file]. Retrieved from https://www.ted.com/talks/yvonne_van_amerongen_the_dementia_village_that_s_redefining_elder_care

3 Letters - ALS

TEDTalk | Scott Matzka | How 3 Letters Changed My Life

https://www.youtube.com/watch?v=NOK83OHmTbE

I have only had very superficial exposure to Amyotrophic Lateral Sclerosis (ALS) through the Ice Bucket Challenge, learning about it in class, and knowing about iconic people with the disease such as Lou Gehrig and Stephen Hawking. So, I chose to watch this TEDTalk in order to gain insight into someone's personal experience with ALS. 

Scott Matzka is a University of Michigan alumni, and played hockey for 11 years at the collegiate and professional level. He has been married to his wife for 7 years and is a father of two children. The initial signs and symptoms of ALS he experienced were forearm cramps, stiffness in his fingers, and muscle spasticity in his hands. After seeing a general doctor and after months of MRIs, blood tests, and examinations, he was referred to a neurologist and diagnosed with ALS. Five years prior to his diagnoses, Scott was in peak athletic condition, being able to run a 6-minute mile and hit a golf ball 300 yards. From then to 2017, there was a stark contrast. His day to day life was significantly impacted and he was faced with new challenges, including walking to the mailbox, dressing himself, holding utensils, and getting out of a car or up from a chair. 

When Scott was diagnosed, he knew he had to make a choice - to lie down or stand up. He resonated with other people who have been faced with a similar choice on how to proceed with life when they have had a life-changing event such as losing a loved one or having a career-ending injury. Although he knew he would never walk his daughter down the aisle or hold his future grandchildren, he chose to live life to the fullest. He considered keeping his diagnoses personal in fear of making others sad or upset. Instead, he chose to be vulnerable, and as a result, he strengthened his current relationships with his family, friends, and former teammates, and created new bonds with people he has never met from places he has never visit. With such a strong rapport for emotional support, they were able to build a bucket list and Scott found a new meaning to his life.

Through this encouragement, Scott founded "My Turn" which is a campaign to raise awareness and aid to the ALS cause. This turned into his life's purpose and reason for getting up every morning. Scott shared 2 lessons with his audience. Lesson 1: Vulnerability. If he had not shared his diagnoses with others, he would not have received such love and compassion from his loved ones, or have raised the extent of awareness he had. This leads to Lesson 2: Perspective. As a result of his vulnerability, he was able to change how others looked at and approached their own lives. This prompts the question - what would our life be like if we knew death was close, inevitable, and could occur at any given moment? Maybe we would see less of our daily exposure to terrorism and shootings, and maybe, instead, we would be kinder, more compassionate, and more generous toward others.

This video was so touching and deepened my empathy as an OT student and future practitioner to those with ALS, as well as others who may be experiencing a life-altering disease or injury. Upon being diagnosed, Scott was not informed by any medical professional or website on how to approach life after his diagnoses. No one told him "...that life goes on. They don't tell you that you have to keep on going... even that very same day." With our holistic approach, we as OT's can help and guide others through these emotions so that they can continue to live life to their fullest, possible potential. This gives our role a profound meaning and purpose that others cannot fulfill. By sharing his experience, Scott introduced a ripple effect so that we may continue to advocate for the ALS cause. Although Scott passed away in December of 2018, his legacy thrives and lives on through the lives of those he impacted. 

~ Pam ♡

Picture retrieved from: Google Images
TEDx Talks. (2017, March). How 3 Letters Changed My Life [Video file]. Retrieved from https://www.youtube.com/watch?v=NOK83OHmTbE

Spinal Cord Injury Lesions

There are many effects and ways to categorize the effects of spinal cord injury (SCI) lesions. For example, there are different syndromes that may stem as a result of an SCI lesion, such as Central Cord Syndrome, Brown-Sequard Syndrome, Anterior Cord Syndrome, Cauda Equina Syndrome, and Conus Medullaris. In order to assess the differing degrees and residual function after SCI, the American Spinal cord Injury Association (ASIA) Impairment Scale is utilized. It ranges from Level A to Level E with Level A being the most severe, indicating a complete SCI and no motor or sensory function in the lowest sacral segment of the spinal cord, and Level E indicates normal sensory and motor function with no spinal cord lesion. Depending on where the lesion occurs, upper and lower motor neuron (U/LMN) signs may be present. UPN originate from the brain and are responsible forsending signals to LMN. LMN are also known as spinal nerves and send the received signals directly to the desired target (e.g. muscle). If an UPN lesion occurs, one may experience spasticity below the level of the lesion and paralysis. On the other hand, one may experience hypotonicity (low muscle tone), muscle atrophy, and partial to no motor reflexes if the LMN is affected. A couple other hallmark conditions associated with SCI include neurogenic shock and autonomic dysreflexia. One may experience neurogenic (or spinal) shock immediately following a SCI leading to a loss of motor pathways, tendon reflexes, autonomic function, as well as causing flaccid paralysis. Neurogenic shock may last for hours, days, or weeks before spinal activity returns. Upon the return of this activity and usually at a SCI at T6 or above, autonomic reflexes return and may result in exaggerated sympathetic reflex responses known as autonomic dysreflexia. Signs associated with this include severe hypertension, profuse sweating, bradycardia, and vasodilation. Autonomic dysreflexia is considered to a clinical emergency that can result in death - when it occurs, it is crucial to immediately stop the individual’s activity, elevate his/her head to avoid excessive blood pressure to the brain, and loosen clothing and other constrictions.

~ Pam ♡

Image retrieved from: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury