NDT - good or bad?

One of my favorite classes this semester has been neurorehabilitation. I've always been interested in working in rehab and many people needing intensive inpatient rehab have some type of injury to the central nervous system whether that be because of a stroke, a spinal cord injury or a traumatic brain injury. It is fascinating to me to learn more of how the brain and nerves work and what can be done to help people return to doing the things they need and want to do. Over the course of the semester different OTs have taught specific topics based on their area of practice and expertise. Last week the reading was on Neuro-Developmental Theory (NDT). Our textbook called it an outdated theory based on an outdated understanding of movement that has very little evidence to support it. Evidently we were studying this theory so we would have an understanding of what older therapists may be doing with their patients.

We got a completely different take on NDT during our class session which was led by Theresa, an OT that I got to know when I was volunteering at HCMC. (You can read about some of what I learned from her here and here.) She talked about how she had felt ineffective as a therapist until she took a three week course on NDT and learned how to help patients regain movement that had been lost. By the end of our three hours together, most of us were wanting to sign up for that three week course. And we all would love to have Theresa as our Level II fieldwork supervisor. The passion and stories told by one OT convinced us the only reason the evidence doesn't support the effectiveness of NDT is because of the difficulty of designing a study that shows that it is those techniques that make a difference.

I left class that day thankful for God bringing me across Theresa's path. I contacted HCMC about volunteering in their OT department because it was close to where I lived. Theresa took me under her wing and got me involved in patient care as much as possible during the 9 months I was there one morning a week. She communicated to me her passion for her job and her patients giving me as many tips as I could absorb. My essay for the application to the OT program was far better because of what I learned from her. I asked if she would be a reference for me on my application because she was the only OT who might know me well enough to have an opinion. Later on I found out she was connected with the program at the U. I really couldn't have asked for a better person for a reference. It's a small thing that worked out really well. And as I look forward to all the changes that are coming in the next year, it is comforting to know that God is in control of the people I will meet, the therapists I will work with and learn from, and wherever I end up finding a job.

Pediatric clinic

A couple of weeks ago I spent a day with an OT in a pediatric clinic. Each child we saw is a story in itself, but I'll stick to just one. A 1st grade boy I'll call Marcus came in with his mother for the first time.  The four of us headed into a small room where the OT could get some information from his mom while observing what Marcus was like. I quickly observed that Marcus was a bright boy with a large vocabulary for his age. He also had a ton of energy, went at a faster speed than most and the volume was rather loud. The toy trucks and cars were flying across the floor and the table mat. I figured if the rest of us were going to remain sane, he might need some help staying somewhat in control so I got down on the floor to play with him. As we built several things with legos and played with the trucks, I was listening in on the conversation with the mother. Not surprisingly Marcus had a hard time paying attention at school. He also had a hard time getting to sleep.

After all the questions were asked we head out to the big room where the OT checked his coordination and ability to do things like hop, skip, stand on one leg, jump and run. She also verified that he could sense where his body was in space. Before she finished, she had him lay down on his stomach and she rolled an exercise ball up and down his legs and back as she put pressure on it. Marcus said she was being a masseuse. Then he sat up and the OT did joint compressions. That  involves pushing the two parts of the major joints together. You don't pull them apart, just push in 10 times fairly rapidly for each joint. (Google it for demonstration videos.) She did the shoulder, elbow, and wrist of each arm and then the hips, knees and ankles. When we headed back into the little room Marcus was a different kid. He actually crawled under the mat table and laid down. Somehow those last two activities had slowed him down.

I was telling one of my friends about my day. She has a daughter who has a hard time winding down at the end of the day and getting to sleep. For the past several evenings my friend has been doing joint compressions on her before she goes to bed and it's made a big difference. Nobody really knows why they work, but for those they help don't really need an explanation.

OT in the burn unit

Last Friday I spent the day with the occupational therapists who work in a burn unit. While the overall goal of OT is always to help patients do what they need and want to do in life, recovering from severe burns has some unique challenges. We usually don't think too much about our skin because it doesn't seem effect our ability to function. However, skin grafts tend to scar as they heal which means the skin becomes thick and hard rather than flexible and it also contracts. Much of what OT does for a patient in the burn unit is meant to counteract those tendencies.

One of the patients was a little three-year old I'll call "Andy." I met Andy as he was riding a trike down the hallway as he came to the OT room. His head was shaved and quite red since grafts had been taken from there to be used elsewhere on his body. He also wore a clear plastic mask which puts pressure on the grafts to prevent them from becoming thick and hard. He wore pressure garments on his arms and hands for the same purpose. For over an hour, Andy lay on his back with his shoulders propped up enough that his head was tilted back. This stretched out his neck where there were more grafts. If the skin in those grafts shrinks too much he won't be able to tilt his head back to catch a fly ball, guzzle a drink, look up at the stars or see what is on the top shelf. The OT sat on one side of him and worked on stretching out the skin around his shoulder and arm pit. At the beginning of the session he couldn't put his arm above his head. The grafted skin on the front of his shoulder became white as his arm stretched up. With some gentle massage and lots of lotion rubbed in, the whiteness went away and it could be stretched a bit further. By the end of his afternoon session he could put his arm straight above his head. This type of stretching needs to be done every day until the grafts are completely healed which can take over a year.

The most difficult thing for Andy was his mouth. To help stretch out his cheeks and lips, he put  different sizes of tubes between his cheek and teeth. He did alright with the smaller ones but he just held the bigger ones in his hand and said, "It's going to hurt." Yes, it would. It is hard to make a child suffer, but in this case it must be done. If it isn't he will end up having a mouth so small that he can't lick an ice cream cone or take a bite of a thick sandwich, and so inflexible that he won't be able to whistle or more importantly, use his cheeks to help move the food around in his mouth as he chews. I helped one of the adult patients stretch out his hands and when we finished he thanked me for helping to torture him. If a man in his 50s considers the necessary stretching to be torture (even if he was half joking) you can imagine what it is like for a child. One of the therapists I shadowed when I was volunteering told me she had worked in the burn unit for several years. Eventually she needed to move to another area of practice because it was so hard for her to work with children, who seem to be burned more often than adults.

I doubt I will work in a burn unit because there are fewer and fewer around the country. However, I'm thankful for the opportunity to learn from those who have learned to make "torture" manageable to even a three year old.

Beginning the 4th and final semester

I have finished week 3 of our final 15-week semester. So far I'm grateful that this this semester has not involved as much work as previous semesters. We are spending more time on campus with two full days (9-5) of class each week. One of my classes involves learning to make orthotics, more commonly known as splints. Over three weeks we will have 21 hours of practice making different kinds of splints for the hand and wrist. We are using different kinds of thermal plastics. These plastics need to be heated in water and can be molded to fit the person while still warm. Some of these have memory which means you can fix all kinds of mistakes by putting it back in the water where it goes back to its original shape. It's a little harder when it sticks to itself before you are ready for it to.

The first orthotic we made was for the wrist and would take a therapist about 15 minutes to make for a client. We were given an hour. You would think that would give a person plenty of time. In reality I had to hustle to finish on time. The process involves making a pattern, transferring it to the thermal plastic, heating it enough to make it easier to cut, heating it the rest of the way and molding it onto the clients wrist and hand while keeping the wrist angle right. Once that is done we get to smooth the edges, make sure there are no pressure points anywhere and then add the Velcro to hold it in place. One of these three strips had to be attached by a rivet. After being warned to double check we have the Velcro on right before pounding in the rivet, I made that mistake and found out how hard it is to get a rivet out. Mine ended up having 2 rivets to make it work. Other than that, it turned out pretty good for my first attempt. I did miss one of the pressure points and could have used more time to work on smoothing edges. Next week I'll get the opportunity to make it again and this time it will be graded.

Wedding memories

In our culture wedding planning is primarily done by the bride and her mother. The groom participates to some degree and usually has opinions about the food, a few ceremony details and most definitely the honeymoon. The bride takes care of the rest. This weekend my brother, Andrew, married Vicky, his Mexican girlfriend. The story of how they met 8 years, 6 months and 12 days before their wedding is too long to tell here. Suffice it to say that the planning fell primarily on Andrew since Vicky arrived in the US three weeks ago. He pulled it off with the help of friends who opened their homes, fixed the food, arranged the flowers, took the pictures, set up the chairs, and cleaned up after all of us left.

Since I knew there would be plenty of cameras, smart phones, and iPads snapping pictures, I left mine at home. However, here are some of my mental snapshots.

·      I asked Vicky if her mother was as excited for this wedding as Andrew’s mother was. “Oh yes. She loves Andrew very much.”

·      Since Andrew planned the rehearsal dinner, the hot peppers in the pork and beans were the only vegetable in sight. The main item on the menu was the best barbeque in the city.

·      Outside the home where the ceremony was held, there was a signpost pointing in multiple directions including the towns where Andrew and Vicky grew up. It fell to me to explain to Vicky’s mom and the bridesmaid why Wall Drug was included.

·      Elizabeth, presiding over the guest book, was recognized by everyone as Andrew’s favorite niece. Since she is 10 years old and it’s been 9 years since she visited Dallas, it can only be because Andrew is showing pictures of her.

·      Vicky was a nervous bride. The preacher said Andrew was the calmest groom he’d ever seen. As the Groom’s Honor Attendant, I had a clear view of their faces during the ceremony and Andrew’s calmness seemed to rub off on Vicky. The further it went along, the more she relaxed. She didn’t even blush when Andrew was finally able to kiss the bride.

·      We all had to use our imagination during the exchange of the rings since Andrew didn’t realize he had left them on his dresser until the preacher asked him about 10 minutes before the ceremony was to begin.

·      The Mexican part of the wedding included the presentation of a Bible (the foundation of all of life and marriage), a box with some coins (a symbol of God’s provision for them), and a lasso (a symbol of the two becoming one).

·      Ma and Pa Alexander and their three daughters are Andrew’s family in Dallas. One of them helped coordinate everything and they all pitched in to make the food for the reception that was held in their home. If anyone reading this happens to be living in Dallas, I’m sure they will be happy to have you stop by and help them eat the leftovers

I didn’t have to propose a toast to the bride and groom but if I did, my little speech would have included the following. Andrew, we’re proud of your quiet commitment to relationships that has resulted in all of us being here with you today. You don’t rush into anything but you do step up and take responsibility. Alexanders and Texas friends, thank you so much for being Andrew’s family from the time he moved here as a college student. You have had a big impact on the man he has become. Vicky, We are so glad to have you as part of our family. I don’t think I’ve ever seen Andrew so happy. I hope you have sensed that all of us here love Andrew and we love you too.

Vacation

The past two weeks have been my "summer." I had no school and no work. It's been a year since that has happened for more than a week. With that in mind, it makes sense that sometimes I wondered what to do with myself. I spent a week in Iowa with my parents and enjoyed some bike rides in the prairie winds. It took a bit for me to regain an efficient and smooth pedal stroke with my clip-on shoes. The best part of biking on the prairie is going 20 mph on the way home with the wind at my back. I've also been enjoying reading some books that I can actually hold while lying on the couch. I've read some Raymond Chandler and Charles Dickens.

As usual, I got in on some small town farming culture. The local co-op elevator association that serves 5 area towns provided a free meal in honor of their new 16,000 ton fertilizer plant. After a meal of pork chops, cheesy potatoes, baked beans and fruit, we were given a tour by one of my cousins who happens to be a board member. He gave us all the statistics regarding how many tons the different bins could hold and explained how a farmer's fertilizer order can be mixed to order and weighed before being put into the truck.

After my return to Minneapolis, a friend and I took an overnight camping trip near Cannon Falls. Bri is rather adventuresome and organizes a winter camping trip every year. I have always had school and work as an excuse for not going but in August I don't have to worry about being cold, especially not with Bri's tent that is made for winter camping. Ventilation is not its strong suite. However it did keep us dry during the afternoon storm. We ignored the deputy's invitation to go to the "concrete building at the beach" and stayed in the tent. Though we heard the constant roll of thunder it didn't get very close. We were glad when the rain stopped and we were able to get some fresh air. We slept well with our heads near the screen door and I actually needed a sheet by morning. After the sun burned through the clouds and it warmed up a bit we kayaked 8 miles on the Cannon River. It was a peaceful few hours with enough gentle rapids to keep things interesting and at times turn us around so we were heading downstream backwards.

This week I head back to work and I need to take care of some odds and ends before classes start again in a week. A friend commented today that I looked like I'd spent some time out in the sun. I've enjoyed being away from my desk while I could.

Occupational balance

Last Thursday around 1:00 I left campus wondering what to do next. After 15 weeks of living by due dates and the weekly rhythm of class it felt a little strange to have nothing that had to be done before I could go to bed. As an occupational therapy student I'm learning to "promote successful participation in everyday occupations, allowing people to remain engaged and to re-engage in meaningful, contributory roles." The irony is that as a student, about all I do is homework, sleep, eat, and work 10 hours a week. That isn't a very balanced life. Some regular exercise, socializing, and having time to help people would make it a more rounded picture. My housemate would probably appreciate it if I did more of the domestic tasks especially cleaning. I make it through by remembering that this is temporary and, with only one semester left, the light is at the end of the tunnel. In the meantime, I have three weeks to be completely unbalanced in the other direction. No homework and two weeks of vacation from work means I have time to spend with family and friends!

Last weekend my 10 year-old niece, Elizabeth, came to help me break out of the study mode. On Friday we went shopping (yes, for her I will brave the Mall of America) and visited the Mill Museum that chronicles the years when Minneapolis was the city that ground more flour than any other place in the world. By then I was exhausted and Aunt Alice had to have a nap. We finished the day with sweet corn from the farm and grilled brats followed by a lively game of Dutch Blitz with my housemate. Saturday morning we headed out for a bike ride around Lake of the Isles. After a shower, we headed to the big library downtown that is "4 stories tall!" Two book lovers should be able to find something good to read there. It was the first time I had been in the children's section. That afternoon and evening we attended a wedding. Sunday after church we spent the rest of the day with two different families from church. One had us over for dinner and Elizabeth played with their daughter and niece who are about her age. From there we headed east of St. Paul to ride horses. That adventure was followed up by Sebastian Joe's ice cream. There's nothing better than a kid to bring some perspective and balance back into one's life.