11- FOXcast OT: Katie Swinson On Quality Assurance

Katie: You know, you can learn so much from older adults. And I feel like as a therapist, we provide so much teaching, so much training to our older adult population. But at the same time, you can get so much out of it. That’s what keeps me coming back.

Jimmy: 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.

Welcome to FOXcast OT I’m your host Jimmy McKay. And joining me this afternoon is my colleague here at FOX, OT Katie Swinson. Katie welcome to the program.

Katie: Thank You.

Jimmy: What’s your background, Katie? Where’d you go to school and how long have you been here at FOX?

Katie: So I went to Towson University in Maryland, and I’ve been with FOX since January 2016.

Jimmy: Ok, so coming up on two years here. You work in the Maryland area. Of course, everybody here is doing the FOX outpatient on wheels. That’s our model of care.

But not only are you a treating occupational therapist. You wear a couple of different hats. You do a couple of different roles here at FOX.

And when people do that, it kind of makes the job a little more exciting because you’re not you’re not necessarily stuck doing one thing. You can if you want, but you don’t have to.

What is that thing that you do that you bring to the table?

Katie: So that would be the regional quality assurance liaison and not just a big long title to say that I help people professionally develop and make their documentation clinically excellent just like the care that they’re providing all of our clients. .

Jimmy: When I first found out when I started here at FOX, We have sort of like an organizational structure because none of our clinicians work in the same spot because we all work you know outpatient on wheels. But there’s got to be some sort of structure so you can know who you can bounce ideas off of or ask questions. And when I found out what every kept saying RQAL. So your job is to make sure that the the product the thing that we do which is clinically excellent care stays clinically Excellent. You’re the person, one of many, whose job it is to make sure the thing we say we are, we’re still doing it always. I think that’s great because I don’t think many other companies. No place I worked had that. .

Katie: Right. And the good thing about it is it’s not just me that’s helping provide that you know we have so many different resources and I’m kind of like that stepping stone to those other resources as well. So it’s always a good thing.

Katie: All Right now we got out of the way lets get to some clinical stuff. So you wanted to talk about space retrieval and dementia. Now As a physical therapist I’m on an occupational therapy podcast. I know dementia. I know how a physical therapist would approach it. And I looked at the notes I had for this episode it’s that spaced retrieval. I’ve no idea what that is. But the cool part is Katie does. And you’re going to let me in on it.

Katie: So spaceed retrevial is just a cool technique to help people who have dementia or anyone really to remember something that you want them to remember. So I know a lot of the times when we have clients who have dementia they don’t transfer the right way or they’re not safe at all with what we’re telling them to do you are asking them to do or in the OT world if they’re not doing their self care properly. You know you want them to remember how to do it correctly. So spaced retrieval is just a way to implement this technique and have them basically stored in their long term memory so that it’s a habit. Now it’s not just a technique that you came in and told them to do. .

Jimmy: So How do you do that. What’s what’s the beginning how would you describe it to me if I were a caregiver? You were going to work with my parents. .

Katie: Right. So you basically come up with a question and answer and then you have them do the performance so maybe you want them to transfer out of that chair by using the arm. So I would ask you how to use stand up? Maybe the answer is oh I push from my arms off the armrest and then you’d have them actually do that. So push from the arms of the arm rest to stand up you space it out. So maybe you do that you ask the question they gave you the answer. They do the performance and then you ask that same question give you the answer and then they do the performance like 10 seconds later. And then you might do it 20 seconds later and then a minute later you keep making that time longer and longer until they make a mistake and then you go back to the time that they made the mistake. And if they keep making a mistake you need to go back. But if they do well with that you can keep going and eventually they remember it. .

Jimmy: Repetition And frequency. And that’s what I hear with this.

Katie: Yeah That’s exactly right.

Jimmy: Is That a special population that you enjoy working with.

Katie: I Love it. I think you get a lot of fun stories out of it. You know whether it’s them telling you the life secrets or secrets to marriage or you know you get a lot of fun things. .

Jimmy: Well, You can say you get a lot of fun stories or not. Give us one you’re got to give me a fun story come to mind. .

Katie: I usually ask you about the secrets to marriage. And usually, “if she says jump jump to the ceiling”, Or someone said Don’t lose the humor of it. That was a good one. Have your space, value your space. Because once they come back you gotta work on the harmony of it. .

Jimmy: I Like that advice and we always say what you could learn just as much if not more from your clients than they will from you. Yeah. That can be true especially when you form that bond, that therapeutic alliance that you can get and give at the same time that they buy in, you’ve got they’ll do what you say but you remain with those ears open too. At least I always try to do that a high intensity interval training. We’re doing HIITs. Yes it’s not something you think to do with older adults. Older adults here Katie. .

Katie: I Know but there’s no Burpee’s involved.

Jimmy: Our Anatomy and physiology they respond to the same types of stimulus. You work hard. Your cardiovascular system will improve your musculoskeletal system will improve. So if we don’t push those older adults are not going to get any better. What are some of the fun games that you use or some other fun techniques that use in terms of intensity. .

Katie: So A lot of the times we do circuit training to where it might be that. So it might be where we come up with three different exercises and I ask them to just do as many repetitions and a certain timeframe but go through all three exercises or I might have them do a certain amount of exercise of that exercise like maybe I say 50 reps of less than 25 reps of this and then another 30 of the next. And I time them and that’s a good way to see how they’re progressing to you because if you do the same exercises down the road, time them see if they can do it faster. That’s a great objective measure. Yeah we’ve done that.

Jimmy: That’s Funny. I think the limitations to exercise into and to working out sometimes is a lot of people just don’t know where to start. They know they should, right. They just don’t know number one especially if an older adult should be doing this. And I think as therapists we’re there to let them know we’re going to guide you and dose that appropriately, if we tell you you should be good to go. So trust us the other thing is exactly what you just said. Giving them three things to do. OK. I’ve got three things to do check check check. Right. You know we’re humans we like to get those those lists. Taken care of explaining it that way. You know my friends who are in their 30s and 40s, they know they need to go to the gym and they walk in there like I don’t really do now that I’m here. I love the fact that you’re really pushing those older dog clients to get that stuff done. .

Katie: I Recently have been pushing dual tasking a lot to just because it’s shown to have a better improvement. With clients who do have that cognitive impairment. So it just helps you be safer when you’re walking it helps you to be just better and your overall health as well. So sometimes if I’m walking with a client from their room up to the gym I like to ask them to do some math questions maybe it’s like 170 minus 83 or maybe it’s, Hey name an animal that starts with a Q. A lot of pressure but it’s fun to see. And you know you have an answer in your head if it’s like the animals naming an animal. And it’s great to see what they come up with too and then that can usually start a conversation as well. Oh well how did you come up with quail or something like that.

You Know shoot should have thought quail. Steve Carell was right. The 40 Year Old Virgin. If you don’t use it you lose it. Right. I get it. You know a lot of times we know we hear about these The Brain Game Phenomenon, pushing cognition. But you can use that cognitive training. Really in any environment that’s gritty you’re know sneaking it in when you’re just just walking someone you know to their room or to the gym to get that extra added value out of their therapy session. Tradition here on FOXcast. Are you ready for it? .

Jimmy: Yes. It’s called Your FOXtale. So why do you continue to work with older adults. What about it draws you to it keeps you here? .

Katie: You Know I feel like you can learn so much from older adults and I feel like as a therapist we provide so much teaching so much training to our older adult population. But at the same time you can get so much out of it like life value wise. So I think that’s what keeps me coming back. And just to see the overall progress. These are people that other clinicians might have said while they’re old they won’t get any better. They just leave them alone. But I feel like that disadvantages them and I feel like it’s so worthwhile and it’s so meaningful to get that client she’s been taken advantage of before. And now you can see how amazing they’re doing with you. Like I had one client who hadn’t showered in five years. By herself I mean she had been taken up to the shower and people would shower her. But people just didn’t think she would make it up the stairs. They didn’t think she would be able to shower by herself. Now she did it last session. She showered herself and she was perfectly fine. She was so happy, five years of not being able to shower.

Jimmy: That if you sit there and you honestly were to think about that even in a small way and you lose the ability to do something in your life that’s when you realize it, that’s when you realize how important it is but yet you don’t realize about five years wasn’t able to do it by herself and now she can. You gave that back to her right. I loved to bring up these FOX tales because I think that, I think that sometimes no matter who you’re treating and how rewarding it can be sometimes it can be a grind, it’s a job and sometimes that’s why I like that to be the last thing on the episode as a little bit of a pick me up a rewind. Why are you here and then hearing the Why are you here’s from other people. Can make you say you know what I get to find my why again as well. So that’s why it’s the last thing we do on the show. Katie Swenson appreciate you taking time out and talking to us here on FOXcast. .

Katie: Thank You. Thanks for listening to FOXcast OT, a clinically excellent podcast brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.