Balance and independence-TUG test

TUG test - the person is asked to stand up from a chair, walk 3m, turn back and return to the chair.  you can start with a demonstration by the therapist and a practice trial by the client. Timing begins when the first observable movement of the client occurs and ends when the client’s buttocks touch the seat of the chair. During the test it's beneficial to assess; sit to stand, walking and turning speed. 

Typical times range from under 10 sec to 15 sec. Generally, scores under 10 sec indicate an independent person. Scores under 20 sec indicate people with good mobility who are usually independent in daily activities, can climb stairs and can navigate alone outside of the home. Scores between 20 and 29 sec are considered a gray zone because of the variability in balance abilities and functional mobility; such clients may be independent or need some help with routine daily tasks. Scores above 30 sec are generally indicative of clients who need help with transfers (chair, toilet), bathing and climbing stairs. These clients may not navigate outside of their house alone (Bischoff-Ferrari et al., 2004; Bohannon, 2006; Isles, Low Choy, Steer, & Nitz, 2004; Lin et al., 2004; Podsiadlo & Richardson, 1991).

Occupational Therapy Intervention Approaches

health promotion An approach that does not assume  a disability is present. The goal is to provide enrichment and experiences that will enhance performance for all. remediation, restoration Designed to change and establish a new skill or ability or to restore a skill or ability that has been impaired. Maintain Provide the supports that will allow clients to preserve the performance capabilities they have regained.  Modify=compensation Finding ways to revise the current context or activity demands to support  performance in the natural setting. Prevent Designed to address clients with or without a disability who are at risk for occupational performance problems.

Falls Behavioural Scale

Older Persons’ Adaptations to Protect Themselves From Falling: Ten Dimensions

The Falls Behavioral Scale for Older People (FaB; Clemson, 2003; Clemson, Bundy, Cumming, Kay, & Luckett, 2008) is an assessment designed to evaluate behavioral factors that could potentially protect against falling.

FaB Behavioral Factor Examples Factor 1: Cognitive adaptations Use traffic lights whenever possible. When outdoors move around carefully, and look for potential               hazards. Hold onto a handrail when climbing stairs. When feeling ill take special care when moving around Factor 2: Protective mobility Use a walking stick or walking aid if need it. Moving at a slower pace. When standing up make a pause to get the balance. Bend over to reach only with a firm handhold. Avoid ramps and other slopes. Factor 3: Avoidance Ask for help when needed Use night light. Factor 4: Awareness Ask the physician questions about the side effects of medications. I notice spills on the floor. Factor 5: Pace Don't hurry when doing things. Don't turn around quickly. Factor 6: Practical strategies Avoid walking about in crowded places. Clean spills on the floor. Factor 7: Displacing activities don't go out on windy days. Factor 8: Being observant Check the soles of shoes to see if they are slippery. When walking outdoors look ahead for potential hazards. Factor 9: Changes in level When wearing bifocals I misjudge a step or do not see a                      change in floor level. When I am getting down from a ladder or step stool I think                              about the bottom rung or step. Factor 10: Getting to the phone I hurry to answer the phone.

"No hand walker"

Went today to the Maker Faire - that is, Part science fair, part county fair, and part something entirely new. All of these “makers” come to Maker Faire to show what they have made and to share what they have learned. 

In this very interesting faire I found "LifeGlider" - a walker designed to be used with minimal to no use of arms. The inventor is Rob Karlovich, that is currently still working on prototyps, but they are definitely looking very promising!

Use of Technology in Home Modification

On December, 2014, I traveled all the way from sunny CA to beautiful Charlotte, NC to participate in an AOTA conference on Home Modification and Fall Prevention. The conference exceeded my expectations. There was a lot of new and valuable information I would like to share.

I'm adding links to the items I found interesting, with examples on ways to use them-

http://wirelesstag.net/ - Motion sensor that can send notifications when items were moved. E.g. if you're worried about your parent that lives alone and is losing weight, place a sensor on the fridge door so you have an idea how many times the fridge was opened during the day.

http://www.mobilehelp.com/ - Medical alert that includes GPS and is based on the cellular system instead of the traditional land line, can be used in and outside of the house. Can be beneficial for older adults that are active and enjoy the outdoors. The regular home systems might not have good coverage of the backyard, leaving the older adult unprotected in an area that is not visible to people passing by.

http://www.homedepot.com/p/Chamberlain-MyQ-Garage-Universal-Smartphone-Controller-MYQ-G0201/204394627?N=5yc1vZc1jwZ1z0um34 - Garage door controller, operated by smart phone from anywhere. Wish we had one when we left our garage door open for a few hours. When we returned home and found our brand new bicycle intact, we were very thankful to all the law abiding people that passed by our wide open garage that day.

http://www.managemypills.com/content/ - Medication dispensing system. Can be beneficial for people who take multiple medications at different times, and have difficulty following correct dosage and timing.

The CHAT Model

Recently I read a very interesting article in the OT Practice journal about the CHAT Model. It's a perfect fit to my approach as an OT; Don't say no, instead try to find a different way.

CHAT stands for  - C - critical conversation
                                H - heartfelt hearing
                                A - amiable adjustment
                                T - timed trials

Conversation-The initial conversation should start early on, in a clear and direct manner, addressing safety and functional difficulties.
Hearing-Listen to concerns brought by the older adult and family members.
Adjustment-Act, learn all possible solutions while prioritizing safety and independence of the older adult. Discuss all options with the older adult and family, implement the solutions.
Trials-Evaluate how the solutions have been implemented, how safety observed, make adjustments if needed.  

Reference;
Parnell, Regina. "Don't Take My Wagon." OT Practice (2014): 15. Print.

Well-being

Productive Aging 

Can be achieved by remaining active, maintaining high cognitive and physical function. Don't we all wish that for ourselves and our aging parents?


Through my experience as an occupational therapist working with older adults in rehabilitation facilities and home care, I have become aware of the importance of "productive aging". Being a daughter of an aging father has further emphasized this idea.






Participation in daily activities and social interaction is closely related to successful aging.
Working out in the gym, swimming, playing Bridge with friends, looking for volunteer opportunities, all those daily routines can influence our well being.




The current recommendation for older adults by cdc.gov is to complete moderate physical activity of at least 150 minutes a week. Moderate activity can be brisk walking at the pace of three miles per hour around the neighborhood or riding a bike. In addition it's also recommended to perform muscle strengthening exercises 2 days a week.
Creating a weekly chart can help keep track of the physical activity and adjust the exercise routine as needed.


Fall Prevention

On the other hand, as an occupational therapist I meet older adults in crisis. People after falls, surgeries, fractures, joint replacements and more.


As people age, part of the normal age related changes include; loss of bone density, decreased balance, and changes in vision and hearing. With increase in age there is also increase in disease occurrence such as; heart and lung disorders, dementia, diabetes and Parkinson. To support productive and successful aging, adjustments should be taken into consideration.


One out of every three adults age 65 years or older fall each year! Part of fall prevention is good and safe home environment.


Home Modification

As a therapist, I assess safety at home and make recommendations for home modifications. When I first enter a home, I always remember that home is more than a physical structure. At home we cook, rest, bath and store personal items.




               



During the assessment I observe the physical aspect around me, but I also carefully listen to the patient and family to learn better about the emotional aspect. It's important to understand what people like or dislike, need and wish in regards to their home.

In order to improve independence at home, a good fit between personal abilities and home environment is desired.





Minda Hayat OTR/L
minda.therapy@gmail.com