Workshop: Best Practice Chronic Pain Management and Assessment for Occupational Therapists

istock_000001467580_largeThis two-day interactive workshop will demonstrate how to teach pain neuroscience to clients and use this education to frame treatment direction.  Three dynamic instructors who have developed custom pain programs will highlight the unique role of occupational therapy in pain rehabilitation utilizing the Canadian Model of Occupational Performance and Engagement (CMOP-E; Polatajko, Townsend, & Craik, 2007).  The format includes workbook and small group activities.

Goals and Learning Objectives

Upon completion of this workshop, participants will:

  1. Understand the neurophysiology of pain and how it relates to occupational therapy intervention.
  2. Be able to explain the pain Neuromatrix theory and how it relates to rehabilitation.
  3. Know how and why to educate clients in pain physiology.
  4. Be able to assess and treat clients in pain within the context of the Canadian Model of Occupational Performance and Engagement (CMOP-E).
  5. Be able to identify the benefits of treatment approaches such as: Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Motivational Interviewing (MI) and Progressive Goal Attainment Program (PGAP).
  6. Be able to apply strategies to facilitate behavior change.
  7. Be aware how and when to use various pain-related outcome measures.
  8. Be able to integrate pain science and practice through real clinical examples.

Participants will also enjoy the opportunity to network with other occupational therapists interested in chronic pain management and treatment.

Target Audience

Occupational therapists and students in occupational therapy programs interested in developing or enhancing sound clinical skills in the assessment and treatment of clients living with complex and chronic pain.

Dates and Registration

October 21-22, 2016 in Toronto, Ontario

November 18-19, 2016 in Edmonton, Alberta

If you would like to attend this workshop in another location, please complete this brief survey to let us know. Please note that the registration fee may vary from one location to another as there are different costs involved.

 

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Virtual Reality Research and Rehabilitation in the Canadian Forces: Part 1

GUEST POST

Written by Emily Sinitski, Canadian Forces Health Services CAREN Coordinator

What is a Computer Assisted Rehabilitation Environment (CAREN)?

The Centres of Excellence (CoEs) in Ottawa, Ontario and Edmonton, Alberta each have a CAREN facility. The CAREN is a virtual reality environment that allows clinicians and researchers to systematically manipulate the walking surface and/or visual field to address patients’ treatment needs for physical, cognitive and mental health rehabilitation. The CAREN includes a multi-axis tilting platform that can provide a variety of surfaces including, steep incline/decline, side slopes, and non-level. The CAREN also includes a treadmill with left and right belts that can be controlled independently to provide stability challenging scenarios such as a tripping and slipping. The large curved projection screen is not only used display the virtual world, but to provide busy, interactive environments and cognitive tasks. The primary advantage of a CAREN system is that it can be used to simulate a variety of challenging real-world activities in a safe, controlled environment, which is ideal for both rehabilitation and research settings.

Who can benefit?

The CAREN is used to support traditional rehab modalities and can benefit members with balance and proprioception impairments, visual dysfunction, vestibular impairments, and cognitive processes disturbances. Assessment and treatment goals may include, balance, gait, functional training, sensory desensitization, range-of-motion, cognitive re-training, mental health, complex regional pain syndrome, and high performance training. Currently, the CAREN is used primarily to help our complex members’ rehabilitation. The virtual reality rehabilitation intends to prepare members to return to a full life and duty, allowing stimulations of various systems that are limited in clinic setting.

What is a typical CAREN session like?

At the start of each CAREN session, the CAF clinician and member discuss events since the last session and complete required clinical outcome measures, such as the Simulator Sickness Questionnaire and Borg scale. The clinician determines what applications to use during the session, the appropriate dosage, and other CAREN modalities. The clinician may consult with the operator for recommendations on applications appropriate for the specific treatment goal of the session. Weekly CAREN sessions typically range 20-45 minutes long.

Canadian Forces Member Inclusion Criteria

  • No severe visual impairment – must be able to look at screen without severe nausea and/or stomach sickness
  • No severe motion sickness – must be able to tolerate visual flow without severe nausea and/or stomach sickness
  • Must be able to tolerate wearing a safety harness
  • Member must be willing to participate in the program and commit to scheduled sessions
  • Participant consent to treatment and briefed on non-compliance policy

Interesting? I know right!?

Virtual Reality Research and Rehabilitation: Part 2 coming next week! Stay tuned!

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After an initial Canadian Armed Forces occupational therapy assessment: A Structure Report

Finding yourself being asked to provide additional information in your reports once submitted to the referral source at a Canadian Forces base? I am sure you want to avoid this!

Here is a basic structure you can follow if you are writing an initial, comprehensive report for the Canadian Forces Health Services (these are NOT standards for Veterans Affairs Canada occupational therapy services).

Please note that not every initial report requires all these sections. In fact, only include information (background, assessment descriptions and details etc.) that is relevant to recommendations and referrals or required to assist the member and the health care team to make decisions on care.

What is very important is the recommendations page. It’s design, accuracy and the medical justifications provided are what multiple Canadian Forces Health Services Personnel will review to make plans and move care and rehabilitation forward.

Suggested Basic Structure

  1. Introduction: Members name and rank, age, and referral source
  2. Assessment / referral purpose
  3. Statement of your qualifications (in light of the referral purpose)
  4. Consent obtained from member
  5. Documentation reviewed prior to assessment
  6. Pertinent illness and/or injury information
  7. Pre-illness and/or injury medical history: diagnoses, surgery, medical precautions
  8. Current medical management and rehabilitation: professionals, medical precautions, and medications (pre and post)
  9. Future referrals/assessments as noted by the member and the health care team
  10. Current environment: Home layout/description (if you are specifically conducting a home modifications assessment – often seen as “major home modifications” – this section would be very detailed. In a later post an example of a comprehensive major home assessment will be provided – stay tuned!)
  11. Present complaints: Physical, cognitive, affective, etc.
  12. Self-report screening tools (description of the tool in brief and the results)
  13. Social support and caregiver situation
  14. Physical screening used and results
  15. Cognitive screening tools used and results
  16. Visual and hearing screening used and results
  17. Functional Status: positional and physical tolerances, functional lifting and carrying, Activities of Daily Living and Instrumental Activities of Daily Living, past and current leisure activities, past and current vocational/education situation, past and current driving situation, past and current sleep patterns etc.
  18. Itemized recommendations with medical justification/need/rational for each recommendation. The medical needs identified for each recommendation are found within the contents of your report (as above). Often, each recommendation will have medical information (symptoms, diagnosis etc.)
    • If you are placing a recommendation for a specific occupational therapy program you will be offering you must ensure a) that there is noted medical need / justification for the program (as shown through baseline measures, assessments or expert observations) and b) the program specifically targets the persons occupational deficits and the techniques used utilized the member’s strength. All recommended OT programming must have (1) a description of the service/program, including reference(s) to the evidence, (2) what is the overarching goal / what will be accomplished, (3) the baseline measures used (this shows need for the program), (4) expected outcomes, (5) overview of the time line and (6) has the member agreed to participating in the program? Do they understand the time commitment etc.?
    • The above descriptions are required for programs that are (1) structured, formal programs such as the Progressive Goal Attainment Program or (2) directly related to a specific referred need (i.e., four pain management / energy management occupational therapy sessions).
  19. New report section: The Occupational Therapy Redacted Recommendations Report (OT-RRR): See last weeks post on this!

Don’t forget to review your colleges reporting structure and requirements as well. Speak with the local CAF health care team as well. Ask: what do they want to see? how can your report be best organized to assist them to quickly move your recommendations forward?

Are we missing something important? If so, let us know!

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Mental Health 4 Occupational Therapy: A Resource for Those Working with Veterans and Military Members

Background: The MAVAN Survey Results showed occupational therapists wanting information on current mental health practice for the veteran / still serving military member population.

In light of this MAVAN-identified need we went on a hunt to (1) find the latest literature (coming soon!) and (2) resources that might assist you in your everyday practice.

The Practice Issue: We all know there is no special formula to work with a veteran or military member struggling with mental health issues affecting everyday occupation. Each person brings unique occupational performance issues requiring different assessment and treatment approaches. There are also very real institutional / organizational barriers and facilitators. Often an occupational therapist learns through experience what works well for a particular veteran and military population through consistent exposure. However, what we find difficult (and maybe you do as well) is staying on top of the skills needed to support the population. Or, quoted from MH4OT website, keeping abreast with contemporary practices and exciting new practice ventures”. As practicing occupational therapists in the veteran and still serving military population, we consistently ask ourselves: Are we using best-practice? What are others doing/using? What new tools can I put in my OT “Tool Box” from other occupational therapists experience with a similar population?

Solution: There are answers. Phew! Mental Health 4 OT was developed. Mental Health 4 OT (MH4OT) is a virtual group of occupational therapists (all can join!) that connected together to generate a great online website and working group. The group is a stream of Online Technology For Occupational Therapy (OT4OT) (if you haven’t check out this group, it’s pretty awesome as well).

MH4OTThe Aim of MH4OT:
To make a small corner of the internet where Mental Health Occupational Therapists are able to keep abreast of the latest developments in our profession and become more well rounded clinicians through self guided learning and networking.

The Mission of MH4OT:
The even distribution of knowledge.

 The Answer to the Practicing OT:
www.mh4ot.com

MH4OT has a blog (updated infrequently but still with interesting materials), a resources list and many links. The Facebook group is very active. My personal favourite item on the webpage: The OT Assessment Index.

PSST! We should also quickly share there is a stream of OT4OT specifically for occupational therapy and military and veteran populations. This is on Facebook and is active. Search Military4OT. I’ll see you there if you join!

So we are impressed with what occupational therapists are doing across the globe in mental health. What else can we say.

What mental health assessment and treatment approaches (and even your take on appropriate theoretical models) you are currently taking with the military or veteran population?

 

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The Canadian Forces Health Services Occupational Therapy Redacted Recommendations Report: Mandatory Report for Medavie Blue Cross Occupational Therapists

For those Canadian Occupational Therapist (OTs) that have a valid Medavie Blue Cross number and are working with Canadian Armed Forces (CAF) military members, it is now required to communicate your OT recommendations to the CF health services in a “redacted” report. This redacted report is called the Occupational Therapy Redacted Recommendations Report (OT-RRR)

(NOTE: The OT-RRR is not required for occupational therapists working with veterans of Veterans Affairs Canada (VAC). Please speak with your referral source to verify if the member is considered “still serving” / “with the Canadian Armed Forces” or is currently out of the Canadian Forces and obtaining your services from VAC).

Background: Typically, a Medavie Blue Cross OT will be referred a CAF member to conduct an initial assessment in the home. The OT will, like most industries, write up an initial report regarding their findings and recommendations. This report has basic information (see this prior posts on basic structure / sections of a home assessment report) and, often a recommendations section located at the end of the full report.

A standard encouraged by Canadian Forces Health Services, like all industries, for the Blue Cross OT recommendations section will have:

  • Itemized recommendations with medical justification/need/rational for each recommendations.
  • The medical needs identified for each recommendations are found within the contents of your report.
  • Often each recommendation will have medical information (symptoms, diagnosis etc.)

New report section: The Occupational Therapy Redacted Recommendations Report (OT-RRR):

  • The intent of the OT-RRR is to provide Canadian Forces Health Services with OT recommendations void of medical information (i.e., CAF members diagnosis, symptoms) but functional justification.
  • The OT-RRR is identical to your initial reports recommendations sections (see above) but void of any medical information. Only information about the functional needs are required on this report.
  • The OT-RRR is a stand alone page, placed at the end of your report.
  • OT-RRRs are placed at initial reports, progress reports and discharge reports if there are recommendations by the treating OT.

An Example 

OCCUPATIONAL THERAPY ASSESSMENT: REDACTED RECOMMENDATIONS REPORT

Member:          Service #:                  

DOL:                DOB:

Date of Assessment:              Referral Source:

ASSESSMENT PURPOSES: The purpose of the assessment was to: [Independent examples]

  • Assess the member’s functional abilities and limitations within the home
  • Assess the member’s cognitive functioning using screening tools

RECOMMENDATIONS (Independent examples given)

 

  1. Provision of equipment:
    • Rental of a transport wheelchair: To assist with mobility to/from medical appointments.
    • Non-permanent wheelchair ramp allowing access to/from home.
  2. Housing modification recommendations:
    • Indoor accessibility and safety: Due to the member’s inability to transfer safely and his long term use of a wheelchair, it is recommended the member be provided with a full wheelchair accessible shower to replace his current standard tub. Further to this above justification, the member requires a roll under sink, a tilt mirror, and leaver facets to replace the current bathroom sink.
    • Outdoor accessibility: The current driveway is deep gravel and uneven. The entrance steps to the front door are uneven and warn. The member was observed to have difficulty navigating this terrain with his current equipment. It is recommended the driveway and main entrance steps be repaved to ensure his safety during ambulation and assist with energy conservation.
    • Contact Contract Recommendations: [Name, number]
    • 2-3 quotes attached
  3. Occupational therapy intervention including: 2, 1-hour OT sessions/occurrences are recommended to meet with the barrier free specialist/contractor to (1st Session) negotiate between the member’s equipment needs and the contractors bathroom design on site and (2nd Session) ensure quality control near the completion of the construction.
  4. Referrals: It is recommended the member receive 10 weekly sessions of Progressive Goal Attainment Program (PGAP) to assist with activity reactivation. Baseline measures taken during the initial assessment can be found in full, non-redacted report.

Should you have any questions regarding the information in this report, please do not hesitate to contact the author at [OTs contact information].

Authored by, (Occupational Therapist Signature and registration number)

__________

The non-redacted OT recommendations section will have much more detail. The OT-RRR is brief in nature, void of medical information. Often this information is cut/paste from the non-redacted OT recommendations. Most OT using the OT-RRR now, report it take no more than 15 minutes to complete.

Do you provide redacted reports for other industries? How do yours differ?

 

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Multidisciplinary Conference on Post Traumatic Stress Disorder: Call for Abstracts

Memorial University of Newfoundland is hosting a multidisciplinary conference on PTSD as part of the WW100 Commemoration Program in recognition of the 100th anniversary of the First World War.

ww100

WW100 has academic programs, physical commemorations and Library, archives and resources to mark the centenary of the First World War.

“Organized by the SafetyNet Centre for Occupational Health and Safety Research, researchers from a variety of universities and disciplines, and a range of community partners, the conference will bring together experts, stakeholders, and members of the public with expertise and interest in issues related to the complex realities of PTSD. With a focus on the history, epidemiology, causation, cultural reflections, personal and societal impacts, treatment, and prevention of PTSD, the conference will feature distinguished keynote and plenary speakers, panels on key issues, workshops and poster sessions. We invite submissions of abstracts and conference registration from researchers, graduate students, professionals, and community members.” (MUN, Dec. 2, 2015).

There is a call for abstracts (Due by March 7, 2016) specifically PTSD-related materials:

  • history, politics and economics of PTSD
  • representations of PTSD in the Arts and the media
  • the experience(s) of PTSD—discourses, variations, comorbidities, and stigmatization
  • epidemiology of PTSD—risk factors, social determinants, resilience
  • physiology and neurobiology of PTSD
  • supporting persons with PTSD, caregivers and family members
  • diagnosis, treatment and prevention—best practices, innovations, outcomes

Considering the amount of work occupational therapists are doing in this area nationally and internationally, we encourage you to submit your practice process, research or attend to network.

Are you hoping to attend?

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Canadian Forces Summer Student Opportunity: Federal Student Work Experience Program

Within the Federal government there are opportunities to gain some paid work experience. Over the last four terms the Canadian Forces Physical Rehabilitation Program has had the wonderful opportunity to have a research oriented student within our department assisting us on many initiatives.

But it’s not just for the Canadian Forces looking for students. Other federal departments are searching for that right-fit-student.

The work experience opportunity is called the Federal Student Work Experience Program (FSWEP). They are launching their inventory campaign NOW.

And I have to quote from the FSWEP website. Go here for all the details and to apply:

The Federal Student Work Experience Program (FSWEP) provides full-time students with the opportunity to explore their interests and develop their skills.

  • Students are not required to have previous work experience in order to apply
  • Students must meet the program’s eligibility criteria
  • Jobs can be offered on a full or part-time basis

What kind of jobs are there?

We have a wide variety of cool jobs from coast to coast, varying from outdoor field work and research to office positions in administration, IT and finance, from work in trades to policy and communications and many more!

Be sure to check out our departmental programs that allow you to apply directly to some of our most popular student positions:

  • Student border services officer
  • Student guide in France
  • Crew member and coxswain for the Inshore Rescue Boat Service
  • Science students supporting the work of the Great Lakes Area Program
  • Aboriginal student program
  • Guide interpreter at Rideau Hall and La Citadelle
  • Capital information officer and tour guide
  • Scientific computing student

How does it work?

  1. Full-time students apply to the national FSWEP inventory.
  2. Federal government organizations send a request to the Public Service Commission (PSC), owner of the inventory, for a list of students who match specified criteria for the jobs they want to fill (e.g., education, language, skills, work location).
  3. The PSC performs a random search of the FSWEP inventory, based on the specified criteria, to find a minimum of five students that match.
  4. The PSC contacts the students by e-mail to confirm their interest in the job.
  5. The PSC sends the confirmed list of names to the requesting organization.
  6. The manager at the requesting organization reviews the student applications and invites students for tests and interviews, as required.
  7. A job offer is made to the chosen student(s).
  8. The results appear in the jobs.gc.ca account of the students who were considered for the job.

Last year the Physical Rehab Team had the privilege of working with an outstanding gentleman that assisted us with (1) benchmarking  national  and international policies/instructions (2) conducting large scoping and literature reviews (3) entering, collecting, running and monitoring rehab reports regarding various health policies (4) creating materials for rehab programming (5) reviewing documentation to ensure accuracy and compliance with benchmarked regulation and (6) writing briefing notes in relation to services for rehabilitation with a military content utilizing recent literature. Statistical analysis skills are essential.

For the CF opportunity you do not have to be living in Ottawa. You can be located anywhere in Canada to work with our team.

So what are you waiting for occupational therapy students? You have the skills and education. Hope to see your application!

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