Cerebrovascular Accident - Stroke.

On my first placement as a brand new baby OT student I had the opportunity to go to the Service, Treatment, and Rehabilitation (STAR), ward at Palmerston North public hospital. The ward I was placed on was for people aged 65 and over; this ward catered mostly for people with hip and knee replacements, falls and stroke rehabilitation. For this task I am going to focus on people who have experienced a stroke.

Firstly I would like to explain what a stroke is. A stroke (or cerebrovascular accident if you being really fancy) results from a lack of blood flow to the brain because a blood vessel is blocked, or because of ruptures (Atchison & Dirette, 2011) which further results in potential loss of functioning in movement, vision, understanding and communicating. There are two main types of strokes: ischemic and hemorragic. An ischemic stroke results from a blockage of a cerebral vessel, this type of stroke is the most common (Radomski & Trombly, 2008). A hemorragic stroke is caused by a rupture in the cerebral blood vessel, which causes either bleeding in the brain or bleeding in areas surrounding the brain, which as a result cut of critical brain pathways, and cause internal pressure on brain tissue (Radomski & Trombly, 2008).  The following video shows a very good visual picture of the brain and how it is affected by stroke

This video is an English advert demonstrating the signs and symptoms of a stroke. It shows the viewer what to look for and what to do when a person is having a stroke; this has been presented through the acronym F. A. S. T. which stands for Face (has it drooped?), Arms (can they raise both arms and keep them there?) Speech (can they still speak audibly?) and Time (the quicker you get help the more of the person you save).

This next video demonstrates the affect a stroke can have on your vision. Featured in this video is a woman called Peggy, she has suffered from a stoke which had caused her to have left neglect visual hemianopia. Hemianopia is the term used when half of your vision is lost. You are able to see as Peggy is asked to draw the images, she draws only half a star, and half a flower, this is because to her, the other half does not exist.

The following video tells Bill’s personal experience of life after having a stroke. Bills stroke was cause by a head injury which caused bleeding in his temple. Bill speaks of the breakdown in his relationship with his partner, and how many of his friends disappeared when he needed them most. Bill, after rehabilitation of movement, eating and speech, gets fed up with people who say ‘oh I can’t do it, I’ve had a stroke’, because as living proof, he knows they can.

The next sequence of videos shows the progress Sarah Scott has made since first having her stroke at the age of 18. As a result of her stroke Sarah has marked aphasia (speech problems). In the first video (7 months post stroke) Sarah's sentences are broken and important words are missed out, she has difficulty finding the right words to explain what she means and she used a word pad to write down what she means when she can’t explain through speech.  In the second video (16 months post stroke) Sarah’s speech patterns have improved dramatically, her sentences are complete and they make sense, she does not leave out as many words when talking and she does not use her word pad. She still has a few problems with reading, writing and speech but she is continuously improving.

References:

Orchanain, D., P & Jamison, P. W, (2011) Cerebrovascular accident. In Atchison, B.,

J. & Dirette (Eds.). Conditions in occupational therapy: Effect on occupational performance. (4th ed.) United States of America: Lippincott Williams & Wilkins.

Woodson, A., M (2008). Stroke. In Radomski, M., V., & Trombly Latham, C., A.

(Eds.). Occupational therapy for physical dysfunction (6^th ed.). United States of America: Lippincott Williams & Wilkins.

Youtube.com (2009) Strokes: brain damage. Retrieved 25^th April 2012

from: http://www.youtube.com/watch?v=gnZcxJ7MZY4&feature=related.

Youtube.com (2009). Stroke prevention: Act F.A.S.T. Retrieved 25^th April 2012

from: http://www.youtube.com/watch?v=CpR5_LQCyzk.

Youtube.com (2011). A visual neglect patient. Retrieved 25^th April 2012

from: http://www.youtube.com/watch?v=ymKvS0XsM4w.

Youtube.com (2009). Surviving a stroke. Retrieved 25^th April 2012

from: http://www.youtube.com/watch?v=w8Wsz2q6wsE&feature=related.

Youtube.com (2010). Broca’s aphasia - sarah scott - teenage stroke. Retrieved

25^th April 2012 from: http://www.youtube.com/watch?v=1aplTvEQ6ew &context=C4c65dc4ADvjVQa1PpcFPX8QbOdJwUXmUegS3C1c3zljrShB8l4aE=.

Youtube.com (2010). Update: sarah scott teenage stroke, broca’s aphasia. Retrieved

25^th April 2012 from: http://www.youtube.com/watch?v=6zNKz7YoUao& feature=context&context=C4c65dc4ADvjVQa1PpcFPX8QbOdJwUXmUegS3C1c3zljrShB8l4aE=.

Assistive Technology

Assistive technology is defined as “any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customised that is used to increase or improve functional capabilities of individuals with disabilities” (States Act, as cited in Cook & Hussey, 1995). To me assistive technology can be anything from a piece of modified cutlery to computerised communication devises that work by blink command; assistive technology is an umbrella term that includes any kind of technology that helps improve function for a person with a  disability.

One piece of high tech assistive technology that was introduced to us in our tutorial was the Apple iPad. The iPad is basically a handheld, slim lined computer, camera and MP3 player all in one. It is shaped like a tablet, 241.2 mm long and 185.7 mm wide, with a depth of 9.4mm and an overall weight of just 652g (the weight of a 6 week old kitten!). As iPads are a new breakthrough technology they are expensive, a 16GB IPad will cost you from $729.00 – $929.00, this is relatively cheap when compared to a 64GB iPad which will cost you from $1029.00 - $1228.00 (price range changes depending on your choice of WiFi connectivity networks).

The Apple iPad has a ridiculously huge range of functions some of which include: memory storage of 64GB, a back lit LED multi touch display screen, Blue-tooth 4.0 technology, wireless internet capabilities, a built in 5 megapixel camera with auto focus, face detection, and video recording. It has: adjustable volume and audio playback, language, dictionary and keyboard support for over 50 languages, voice-over recognition software, full screen zoom, and built in applications for mail, contacts, internet, music and many more.

In our tutorials I was fully engrossed in the iPad. I was fascinated at how the many apps and functions helped us communicate and give directions on how to make a smoothie without actually speaking ourselves. My own engagement in the technology was definitely increased by the shear amount of things I found I could do with the iPad; it had games, fun ways to communicate with others, apps that taught you general knowledge, app that allowed you to make noises, internet, face-time and photo-booth. The iPad to me was very deceptive, it’s so small and thin, but when I got to have a go with it I found it full to the brim with features and activities that would keep me occupied for hours.

The main way in which iPads are so useful to Occupational Therapists is through the use of many different Apps that can be downloaded. Some of these Apps are free though some do cost a small amount. The website linked below is a Occupational therapy based site focusing on the use of iPads in practice. It shows you many different apps that are really helpful to use in practice and it gives instructions on how best to use them. These apps help with leaning, communication, transitioning, scheduling and so much more. It also gives advice on apps in relation to medical conditions – there is an autism section that focuses on structure and timing.

http://otswithapps.wordpress.com/2012/04/13/transition-tools-tips-apps-and-resources/

The clips below show how the iPad is helping people with disabilities learn and communicate easily through its many features and applications that are designed specifically for people with disabilities. You can see how the iPad can assist these children in their occupational transitions through education. They now have the tool to learn in an easier way that is meaningful to them; the iPad encourages the potential and independence to grow and learn and understand in a way that was not possible before.

References:

Cook, A. M., & Hussey, S. M. (1995). Assistive technologies: Principles and

practice. Missouri: Mosby.

Youtube.com (2011). The proloquo2g0 speech app - lovethatmax.com. Retrieved

18^th April 2012 from: http://www.youtube.com/watch?v=E2LnUxFAaM Q&feature=related.

Youtube.com (2011). Ipads help paediatric patients in therapy - My 9 news

reporting. Retrieved 18^th April 2012 from: http://www.youtube.com/watch? v=AaRvU0oYG3g.

Youtube.com (2011).  The ipad is a gamechanger for children with autism.

Retrieved 18^th April 2012 from: http://www.youtube.com/watch?v =GEqV_8ahr90.

Little Viccy Grows Up: Occupational Transition

Our film starts off with a little girl, Viccy, being dropped off at Kindergarten by her dad, this is then merged into a screen shot of her playing with a friend. In the next shot Viccy and her friend have grown up they are now in primary school and this is shown by their independence in crossing the road alone, this is then merged into a screenshot of the girls doing some school work. As Viccy continues to grow we see her reach High school with her friends - this is shown by their interest in Bebo and technology, this is then merged into a screenshot of Viccy and a group of friends all chatting and using cell phones. We see Viccy next in university with an armload of books, this is then merged into a screenshot of her drowning in a pile of paperwork and assignments. Next we see Viccy continue to grow up as we see her in a work environment, this is then merged into a screenshot of her working at her desk. Finally we see Viccy at retirement age, this is then merged into a screenshot of her knitting. 

Our team’s short film was based on the concept of Occupational Transition. Occupational Transition is defined as “Circumstances creating a change in the nature or type of occupational engagement pursued by or available to an individual. (Christiansen & Townsend, 2010). We decided to demonstrate occupational transition through education and the changes in occupation this can bring.

Our group worked really well together. When we were given the four concepts we discussed which one we wanted and threw about ideas on how we could portray the concept on film. We came to an agreement on occupational transition and how we could show this through education and its occupational change over time. With the concept decided we allocated a director, cameramen, story boarders, prop bringers and actors. As a group we collaborated with the story boarders to draw/write up a base idea of what we were going to film and we showed this to James. Once our idea was given the OK we got straight into filming the next time we were together. As we had already planned our filming the process was easy. Our director had good ideas on how to film and when to have still images merged in with filming. As we had the OT storeroom at our disposal we were able to find good props and use them well in the film.

References:

Christiansen, C. H., & Townsend, E. A. (2010). An introduction to occupation: The

art and science of living (2^nd ed.). United States of America: Pearson

Education Inc.

Doing, Being, Belonging & Becoming

Newspaper Presentation

View more PowerPoint from sarahhewerdinepo1

At my placement I was asked to read the daily newspaper aloud to the entire rest home (not scary at all to a person who hates public speaking!), I had requests to read peoples astrology signs, the birth and death notices, to do the quiz and tell them the facts of Today in History. I told them the date, read the main headlines, specific articles the liked, the weather around NZ and the general world news. I chose this occupation as it was a very important activity to many of the residents and it also combined the concepts of doing, being, belonging and becoming in one activity.


The concepts of doing, being, belonging and becoming are essential to Occupational Therapy as they encompass all aspects of occupation and the individuals experience within that occupation. Rowles (1991) states that by 'doing', a person can learn and achieve a sense of accomplishment through occupational performance. The term 'doing' refers to the aspect of occupation that is goal orientated (Wilcock, 1998a). It is the action of the chosen occupation; the ways in which a person will make something happen, whether its for leisure, self-care or productivity. The concept of 'being' is defined as "time taken to reflect, be introspective or meditative, to rediscover the self, savour the moment, appreciate nature, art or music in a contemplative manner, and to enjoy being with special people" (Hammell, 2004). The concept of 'belonging' refers to a sense of inclusion, friendships, and mutual support. It includes a person's idea of their own self worth, and connectedness to others (Hammell, 2004). The idea of 'becoming' is focused on the future of an individual. It is what a persons sees in their future, who they wish to become, and how they see themselves contributing to others throughout their future lifetime (Hammell, 2004).


Images 1, 8, 15, 17, and 19 represent the concept of 'doing'. The people in the images are all depicted reading a newspaper, an occupation of leisure; images 2, 4, 5, 9, 10, 12, 16, and 18 show what was being read on my placement - these photos are of the sections of newspaper that I was asked to read daily. Images 3, 8, 11, 13, and 17 represent the concept of 'being'. Image 17 portrays some inner reflection, while the other images show people savouring the moment, and enjoying being with special people. Images 3, 6, 8, 11, 13 and 19 represent the concept of 'belonging'. The people in the images are all included in a group; they are with friends which shows their connectedness to others. Images 1, 3, 8 and 11 show the idea of 'becoming'. These photos show people contributing to others lives, especially in images 1 and 8, where the older generation can be seen contributing to the younger generation.


When making my presentation I had to adhere to some ethical considerations. All of my online images are creative commons material - they were available to the public for use and so there has been no copyright infringement. For these online images I went through a reputable search engine (Google images) and took only public photos, not private photos from any social media sites. As I was the photographer for the other images i gave informed consent for the photographs to be put online and used in a public domain.


References:

Hammell, K. W. (2004). Dimensions of meaning in the occupations of daily

life. Canadian Journal of Occupational Therapy, 71 (5).

 Rowels, G. D. (1991). Beyond performance: Being in place as a component

of occupational therapy. American Journal of Occupational Therapy, 45, 265 271.

Wilcock, A. A. (1998a). Occupation for health. British Journal of

Occupational Therapy, 61,340-345.