FOXcast OT: Combining Fun And Functional In OT Treatment

This is FOXcast OT. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at FOXRehab.org.

Jimmy McKay, PT, DPT: Welcome to FOXcast OT. I’m here with Brett. Brett Herman is the man the beard the legend. If you’ve seen any of our FOX marketing materials with an OT working with older adults and the guy had a substantial beartd.

Brett Herman, MS, OTR/L: Yeah that’s what I try. I haven’t shaved it because I’m now known for the beard. Now people come up to me a conference and said I recognize your beard or you’re in a picture and my senior living center. It’s exciting it’s a good thing to be known for. I guess.

Jimmy: It’s kind of James Harden of the Rockets as you kind of can’t get rid of it now.

Brett: Cause absolutely my trademark I should actually try to trademark it. Well the beard. I like it.

Jimmy: All right so today we are at the big dance in occupational therapy AOTA conference here in New Orleans. We create content to show that we produce for FOX Rehabilitation is really for the entire profession of occupational therapy. So I love when the ideas for episodes come organically. Yeah and you wanted to talk about what?

Brett: I wanted to talk about making things functional again. You know we’re treating our clients in their homes. Where else can you do functional occupation based interventions than in the client’s natural environment? But we also got to be creative because the older adult is ever changing not every older adult client is the exact same. They’re not doing the same exercises that I’m doing when I’m you know pretending to go to the gym every other day or once a week you know whatever. But it’s that idea of how can we link an exercise into their routines. You know we were talking about it earlier Jimmy about the habits and routines and our roles. We are like clockwork you know we do the same things every morning every night. So let’s integrate maybe a hom exercise program into that. If I tell you I want you to lift this dumbbell 10 times throughout the day, three times. What you gonna do are you gonna do it?

Jimmy: Maybe the first day yeah maybe the second probably not the third.

Brett: What if I said okay while you’re brushing your teeth I want to do 10 squats to strengthen your legs. And you know while you’re combing your hair do some lateral leans. You know just weight shift start feeling it do a little dance. Okay. Every time the commercial happens of your soap opera you’re watching every day at 1 o’clock. Every commercial way to stand up five times during that commercial. That’s how we’re gonna integrate a home exercise program that’s gonna get that good compliance.

Jimmy: You’re using the cues that are already ingrained in their brain because you know as we know humans are weird animals absolutely as snowflake an individual as we like to think we are we’re pretty predictable in in terms of our routines creatures of habit. That’s that’s a great example of how you’re integrating what you want them to do into things that they are already doing and want to do to get the desired result which is what you both want to do.

Brett: Yeah. And I think you know that’s a question we have to ask is occupational therapist. What do you enjoy doing? Why am I here? You know I know I’m here maybe because you had a fall but what does that keeping you from doing? What did that ball keep you from? Because now we’re worried about that high level of anxiety that fear falling that’s real. That underlying mental health you know there maybe that client is depressed because they’re no longer able to hold their grandson or great grandson at this point. So maybe I’m doing strengthening and holding kettlebells and holding dumbbells to simulate a baby. Having them stand and rock that that’s how you sooth a baby sitting there holding things. Body mechanics training for you know working with their great grandchild. So it’s something you know got to figure out what’s meaningful to them.

Jimmy: It no long it’s no longer something that this guy who comes into my home a couple of times a week is telling me to do. This is this is will lead me to the thing that I would like to do because I want to hold my great grandchild. I want to garden again or I want to be able to shop for myself. Using those things at the end of the rainbow and reinforcing that when you brought up earlier not being cookie cutter figuring out what’s important by asking them.

Brett: Yeah I think that’s definitely a challenge. You know you have to be really good at problem solving. You have to be flexible. You gotta understand your therapeutic use of self. How do you adapt to each client? You’ve got to know that that same trick is not going to work with everyone. And I think the quicker you realize that the better you’re gonna be as a clinician because you’re just gonna be free. And like I tell everyone the easiest part of my job is the evaluation. I walk in someone home, show me your home let’s walk around. Tell me about you. How are you today. And I’m listening. You say oh my shoulder hurts. Oh it hurts. Doing what? I want to put on my jacket. There’s our function. Now we know what to work on. I’m not just going to do shoulder exercises because I want to because it’s easy to sit there and say oh let’s move your shoulder. No because that’s something you identified I did mention it. You did.

Jimmy: And the model of FOX Rehabilitation uses, who wants to climb a flight of stairs to nowhere? You know in a facility that doesn’t really have any meaning. You know who wants to to lift weights off the floor. You have to lift my stuff because this means something to me.

Brett: Yeah. We get our ass all the time. What about equipment? What kind of equipment you have? And I say the home. That’s my equipment that’s my gym. We get a question oh you have treadmills? Do you have bikes? Why? Because you see that on TV right or you see I’m part of a walking club. What’s better functional and safety the walk on a treadmill at a perfectly controlled environment that’s going to keep you constant or on your wooden floor that probably have been from 1950s that are gonna have those little cracks? Going over that carpet tile transition of that threshold. Let’s step over that. Rather than me put a cane on the ground.

Jimmy: I started in an outpatient and talking with and during the evaluation you’re trying you know we were always taught to ask you know how many how many stories is your how says what type of stairs. And then you look at someone stairs and like oh I didn’t realize I was a spiral staircase. Never Oh my. This is this is completely more complex.

Brett: What color on the stairs? What’s the contrast you have any mark is our carpet? You know in the OT world. We always laughed about throw rugs and I say why they throw rose to throw them out. You know it’s the idea by you going back home you can’t just pick up everything on the ground. So now if you’re gonna keep those throw rugs because you’ve had em in your family for the last 60 years, we better work on foot clearance. And OT’s have to be willing to go down that route and say this is functional mobility in their home. Because there’s three throw rugs to get to their bathroom.

Jimmy: What are some other things that you’ve had success with working with your clients in terms of you know make what we’ll of course keep hip a complying you select the name out but like some some successes and examples of doing just this.

Brett: Yeah I think one of my greatest successes when I first started I was in South Philadelphia. So the clientele I have in South Philadelphia is Italian grandmothers. The holiday season they tried cancelling us a week before Easter because that’s what they were baking that’s when they were doing it. But my role an OT I was I could help you at baking. And they’d be like What do you mean you could help baking. Yeah let’s go with fatigue management let’s go over body mechanics because oh it Oh honey I get so tired when I’m doing it that I need the week off. And I was coming in I was making cheesecake, making stuffed artichokes, making meatballs.

Jimmy: Rough day at work.

Brett: It was. I mean someone’s got to do a Jimmy someone’s gotta do it. Maybe that’s that’s why you know I enjoy doing it cause I like to eat. But that idea I listen to them and I figured out another lady she told me that she was afraid to garden and all her plants start to die. Let’s go outside and not I took out my thing about oh I got to do shoes and socks I got a new dressing you know that’s the basic ADL’s. No. You know I had another lady want to cancel me because she had to go to the bank what do we do? We went to the bank together. We got she had a power wheelchair I’m in Philadelphia went a couple blocks went to a bank and she was absolutely it awe. Couldn’t stop thanking me. She’s like wow that helped me. So I did mention I didn’t say oh I could take you to bank, she was telling me she needed to go to the bank. I actively listened and on my feet I said let’s go to bank .

Jimmy: Led with the goal what do you what do you want to accomplish without me. Well let’s do it together. Yeah I think it’s just important to always know our foundation you know us as occupational therapists tackle those issues head on. Figure out what their daily occupations are and enjoy it. You know we have clinicians who are dancing with clients. We have you know they’re cleaning. Like you said clean the home pick up your laundry basket instead of a dumbbell. I think it just tackle function. Don’t be afraid to do it ask questions. Be comfortable with having the challenging conversations. And I think it’s just be confident your abilities and enjoy every moment. And don’t ever underestimate somebody. You know don’t just because there’s an age you know they tell you they’re ninety five and they say oh I can’t do that anymore let’s get them to do it challenge that you know I think modify, adapt, compensate are the ways to do it. All right.

Jimmy: We have a tradition on the show is your FOXtale. What about older adults really excited you made you want to make it your career? The stories I absolutely fell in love with the stories as I think many OT’s that are here today at AOTA. I thought was Pediatrics all my past experience with pediatrics. And I think just that idea of listening to their stories are my first level one, hearing about when they were my age and just looking at them and seeing what they’ve gone through. I mean it’s just incredible. That changes. You know here I am with my you know iPhone using apps documenting on my laptop using a wireless air card to get it to them. It’s something I’ve never seen before turning my computer around and using programs right to my computer to show them things. I find to be really beneficial. I think the end of the day I was really close to my grandparents and I think seeing them really always had something inside of me that I wanted to work with older population. And I treat everyone to be treated like my grandparents and I think that’s the important thing. I fell in love with them. Their stories are population who they are.

Jimmy: I appreciate you coming.

Brett: Thanks Jimmy.

Jimmy: Making things fun and functional here at AOTA. Appreciate it. Thank you for your time.

Thanks for listening to FOXcast OT. A clinically excellent podcast. It’s brought to you by FOX Rehabilitation. FOX clinicians work hard love their work and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence. Plus freedom and flexibility to have a personal life. Whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy well-trained clinicians make great health care. Are you a fit for FOX? Find out now at FoxRehab.Org.