An OT built a sensory wall at the playground outside the Whistler Medals Plaza at the Vancouver Olympics

Although this is not actually a metal health story, Sensory Modulation can play a large part in our practice.....and its always good to see OT as a profession getting some positive exposure on a world stage :)

Courtasy of:http://www.piquenewsmagazine.com

Wall-Fly Michael from North Vancouver tests out the RMOW’s new sensory wall. Photo by Scott Brammer, coastphoto.com

Mar 10, 2010 2:47pm

Appealing to kids senses

Regionally-inspired sensory wall stimulates children's motor skills By Holly Fraughton

The concerts that took place at Whistler Medals Plaza may have been the main event for adults during the Olympics but kids were more amped about an attraction just outside of the gates. Since Feb. 1, children of all ages have been eagerly clambering over the new sensory wall located at the edge of the municipality's brand-new inclusive playground.

The popular structure was designed by Jennifer Gellis, an occupational therapist and graduate of Emily Carr University of Art and Design's industrial design program. While on the surface, occupational therapy and industrial design don't seem to be directly related, Gellis has found many parallels and complementary aspects between the two fields.

"...They actually have a lot of similarities in them in terms of the way occupational therapists and designers approach problems; they approach them in the same way and they go through this sort of iterative process with a problem or a challenge."

The North Vancouver resident caught wind of Whistler's sensory wall project through a friend who lives in Whistler.

Sensory walls are small walls often found in playgrounds and public parks, designed to strengthen children's motor skills by stimulating the senses. It's also therapeutic for kids with autism.
"The nice thing about having different components in a sensory wall is that hopefully it can appeal to kids who have different abilities and who may rely on their sense of vision more than their sense of hearing, or their sense of touch more than another sense," Gellis said.

So, a child who is visually-impaired and has a heightened sense of touch or hearing will appreciate the tactile and auditory components of the wall.

"Maybe they'll really be attuned to the shape of the leaf tiles that are in the wall," Gellis suggested, "and the tiles that are round and smooth versus the ones that are angular and rough."
Gellis saw the project as a challenging opportunity to draw on the training and creativity she's gained from her two fields of study. So, she created a proposal, applied and waited. A few weeks later, at the end of August, she was notified that she had been selected for the project. It carried a $30,000 budget to cover all artist fees and expenses, including material costs, consultations with other professionals, travel, insurance and accommodation.

The wall is just one part of the new inclusive playground that the municipality has built in front of Whistler Medals Plaza.

"From what I understand, (the municipality) really wanted the playground to be quite natural and to fit in with the landscape and the theme of other artwork in Whistler," she explained.

Designed to look like mountains, representing Whistler and Blackcomb, the wall is encrusted with natural materials that are meant to be both tactile and visual, including a myriad of sensory components that might not be apparent to the adult eye.

"It's actually based on the skyline of Whistler Blackcomb, so you've got the front side and the back side of the mountain and then where the musical chimes are, that's meant to be where Musical Bumps might be," Gellis said.

There are peek-a-boo holes, a basalt column that represents Black Tusk, and on the back of one hole, "Fitzsimmons' Creek" leads to the base of a tunnel lined with golden tiles to represent the legendary secret gold mine. The sides of the structure are studded with hand-made leaf and snowflake tiles that were painted at Orkidz Art Studio by kids from the community.

But not everything went according to her original vision. "I also really wanted to try and incorporate the sense of smell and taste, but in Whistler we can't have certain plants because of the risk for bears and that type of thing," Gellis said with a laugh. The strawberry plants, a huge bear attractant, were quickly kiboshed.

All of the installation work was done on-site in early winter, which was a real challenge given the early snowfall Whistler experienced this season. It was also a real challenge to get a good portion of the work done in time for the Olympics; there's still more work to be done. They're getting ready to install a metal rain tumbler created by a Vancouver metalwork artist before a ribbon-cutting event on ribbon cutting on Thursday, March 11 at 2:30 p.m

Gellis said it's been particularly exciting to work on this project because it's located in one of the host towns of the Paralympic Games, where children of all abilities will have a chance to check it out.

Peace & Balance

MH OT

Should OT's discuss assessment results with patients in acute mental health?

Courtasy of:http://metaot.com

Assessing patients is part of the rubric of everyday life for most occupational therapists (OT’s). OT’s are trained to gather information from multiple sources and formulate complete, competent and accurate appraisals of the patient’s occupational status, often in the face of time restraints and limited quality contact with the individual. The result of this process is a valuable document reflecting the OT’s unique perspective on the patient’s level of functioning and arguably the closest representation of the patient’s own preferences for treatment. The lifespan of this document, however, does not necessarily end after it has been completed and filed away. Exploration of its uses should justify the rigors of its acquisition. A large and immovable aspect of this exploration is to what extent assessment results can be shared with the subjects themselves.

OT’s legal obligation

The law states that we, as OT’s, have a legal obligation to share assessment results with all patients, regardless of the setting. The Access to Health Records Act (Department of Health (DoH), 1990) was the first Bill to specifically address the responsibility of occupational therapists to disclose any information; ”˜relating to the physical or mental health of an individual who can be identified from that information, or from that and other information in the possession of the holder of the record’ (section 2.1 (f) DoH, 1990). Since this benchmark legislation both the Data Protection Act 1998, European Union Data Directive (1998) and the Freedom of Information Act (FOI) (2000) have refined and reinforced this policy. Significantly for health-care professionals the FOI was designed to promote and highlight patients rights to publicly held information, after the Audit Commission in 1995 found that many health professionals were reticent in permitting patients free access to their records. In light of this legislation, omitting results of a MOHOST assessment, for example, is of equal offence to omitting medical records (section 2.1 (f) DoH, 1990).

The Code of Ethics and Professional Conduct for Occupational Therapy (COT 2005) echoes government directives for information access by stating ”˜access to records shall be granted in accordance with current statutory requirements’ (2.3.5, COT, 2005). The Code also refers to a clause in the Data Protection Act (1998) that exempts information that is ”˜likely to cause substantial damage or substantial distress to him or to another’ (Data Protection Act 1998 section 10A). The closest statement within the code of ethics relating specifically to the process of assessment feedback itself is that ”˜reasonable steps shall be taken to ensure that the client understands”¦the proposed intervention(s) (2.1.4, COT, 2005).

"The Evidence”

Over the last three decades piecemeal research on this subject has been produced, often contrasting psychiatric notes with medical notes to gain insights. A study by Critchon, Douzenis, Leggatt and Hughes (1992), titled ”˜Are psychiatric case notes offensive’, found that acute in-patients found the formulation “chronic schizophrenic” to be offensive but not the formulation “chronic diabetic”, in those patients with a duel diagnosis. Other studies have attempted to measure anxiety levels in patients who were exposed to candid reports about themselves in clinical records, revealing contrasts between physical and psychiatric patients. In one randomized trial, 11% of medical outpatients reported they had “upsetting feelings” as a result of reading their records (Golodetz, Ruess, Milhous, 1976). In a non-randomised controlled trial, 23% of obstetic patients reported that records were “worrying” (Elbourne, Richardson, Chalmers, Waterhouse, Holt, 1987). In three separate studies of psychiatric patients’ anxiety levels, using varied research methods, however, results range from 12% to 50% of patients reporting discontent after reading their clinical reports (Beradt, Gunning, Quenstedt, 1991; Miller, Morrow, Kaye, Maier, 1987; Stein, Furedy, Simonton, Neuffer, 1979).

Within OT itself very little has been written about the way patients interface with assessment results. Kielhofner (2005) admits that although it is common-place to discuss assessment results with patients in both mental and physical health within the MOHO tradition, there is no explicit guidance for practitioners in this area or adequate evidence-base (personal correspondence, 2005). The few examples that exist show the positive effect of sharing feedback between patient and OT, and the scope for creativity in this field.

In a case study by Auzmendia, Gloria de las Heras, Kielhofner and Miranda (2002) the results of a Volitional Questionnaire, an observational assessment ascertaining the level of volition of the individual, were shared with a community outpatient who has a bipolar disorder. At first the OT refrained from sharing the assessment results and instead used it to learn more about the individual. As the goal setting process became more concrete the OT began sharing the results with him and eventually taught him to use the measure himself as a self-assessment.

Kirsty Forsyth, author of the MOHOST, sounds a cautionary note on whether or not a there should be a blanket feeding back of assessment results to patients by stating that sharing is not always appropriate and needs to be flexible (personal correspondence, 2005). A good example of this flexibility is illustrated by Kielhofner, Brenneman Baron, Mentrup, Schulte and Shepard (2002) who describe how an Assessment of Communication and Interaction Skills (ACIS), another observational assessment, was used to help an acute patient with depression self analyze whilst watching a videotape of his social interaction. This empowered the patient to be the main definer of his problems rather than have them defined for him by a health-care professional. An important footnote in this example is that the client had volunteered to be assessed by this method, so would have been more conducive to such a candid process.

If communicated effectively, therefore, the feeding back of assessment results can provide a foundation to mutual and therapeutic goal setting. If communicated bluntly, on the other hand, it can serve to offend the patient (Starke, Andrews, Griffin, Rebeiro, 2001). It is essential for more evidence-based research in the field to be generated because of the unique nature of the OT assessment and partnership between OT and patient. For this reason conclusions from other professions cannot be borrowed. More needs to be learnt about what factors influence the feedback process and how patients and practitioners feel about it. Acute mental health is the ideal platform on which to stimulate debate on this subject.

Peace & Balance

MH OT

10 Common myths about bipolar disorder

Adrienne Carlson has compiled a list of 10 common myths about bipolar disorder with lots of useful information aimed at combating some of the stigma around the condition. The myths are:

1. Bipolar disorder is merely mood swings
2. Manic episodes are characterized by extreme happiness
3. Bipolar shifts happen very quickly
4. It is OK to quit taking medication during manic episodes
5. Bipolar disorder is very rare
6. Bipolar disorder is not an illness
7. People with bipolar disorder are inherently unstable or violent
8. Most people with bipolar disorder are women
9. Prolonged drug abuse can eventually lead to bipolar disorder
10. People with bipolar disorder cannot hold down jobs

You can find out more about these issues on Adrienne's blog at

http://www.x-raytechschools.org/10-common-myths-about-bipolar-disorder/

Crazy Not Stupid

One truck driver was doing his usual delivery to IMH (Institute of Mental Health).

He discovered a flat tyre when he was about to go home. He jacked up the truck and took the flat tyre down.

When he was about to fix the spare tyre, he accidentally dropped all the bolts into the drain.. As he can't fish the bolts out, he started to panic.

One patient happened to walk past and asked the driver what happened. The driver thought to himself, since there's nothing much he can do; he told the patient the whole incident.

The patient laughed at him & said "can't even fix such a simple problem.... no wonder you are destined to be a truck driver..."

Here's what you can do, take one bolt each from the other 3 tyres and fix it onto this tyre. Then drive to the nearest workshop and replace the missing ones, easy as that" The driver was very impressed and asked "You're so smart but why are you here at the IMH?"

Patient replied: "Hello, I stay here because I'm crazy not STUPID!"

MH OT on Twitter

Just a quick note to say that there is now an official Twitter account for the blog :-) @MH_OT so if your on Twitter feel free to stop in and say hi :-)

Peace & Balance

MH OT

Extreme Stress in the First Trimester Linked to Schizophrenia

Courtasy of: www.mentalhealthblog.com

"New research supports a growing body of literature that attributes maternal exposure to severe stress during the early months of pregnancy to an increased susceptibility to schizophrenia in the offspring". - source

The researchers, Dolores Malaspina, Anita Steckler, and Joseph Steckler are referring to extreme stressors such as that experienced during natural disasters, terrorist attacks, war, sudden death etc.

The discovery came about after reviewing a collection of data gathered from 88,829 people born in Jerusalem between the years 1964 to 1976. A correlation existed among a higher risk of developing schizophrenia among the offspring of mothers who were in their second month of pregnancy during the Arab-Israeli "Six Day War". In addition, the correlation was even greater among females. In fact, females were 4.3 times more likely to develop schizophrenia, as opposed to males who were merely 1.2 times more likely to develop the disorder.

The theory is that stress hormones are amplified during such times of great distress and the placenta is very sensitivity to these hormones.

This research does not provide proof or a causal link, but it does support the existing research that suggests similar results. Malaspina makes sure to note that some exposure to maternal stress hormones are necessary, but extreme stress should be addressed in order to avoid any sort of impact on the fetus.

Peace & Balance

MH OT


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Antidepressants May Increase Risk of Stroke or Death in Postmenopausal Women

Courtasy of: www.mentalhealthblog.com

“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:
Anxiety
Sleep disturbances
never seem to be enough
dullness
chronic sadness never seeming to end
obsessions
shakiness when feeling most down
mood swings
Medications used to treat depression:

Tricyclic antidepressants
Amitriptyline
Imipramine
Nortriptyline
Desipramine


Side effects: Fatigue, dry mouth, blurred vision, light-headedness
Selective serotonin-reuptake inhibitors (SSRI)
Fluoxetine
Fluvoxamine
Sertraline
Paroxetine


Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation
Reversible inhibitors of monoamine oxidase:
Moclobemide


Side effects: Insomnia, headache, constipation
5-HT2 antagonists:
Nefazodone


Side effects: Fatigue, light-headedness, nausea, headache
Serotonin-norepinephrine reuptake inhibitors:
Venlafaxine


Side effects: Nausea, agitation, sweating
MAOIs (monoamine oxidase inhibitors):
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
Selegiline (Emsam)


Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating

“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.


Peace & Balance

MH OT


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