On American Pickers and some homeless treasures of the occupational therapy profession
Many people accumulate stuff, and people ascribe varying levels of value to their stuff. Some people can ' t part with stuff because of sentimental feelings. Some people can ' t part with stuff because it represents adeeper psychological affliction. We havecultural movements now that address the problematic relationships that people have with their stuff.I initiated an Ebay hobby recently. There is nothing like the death of parents and the associated task housecleaning that prompts assessment of the value of earthly goods. I have had quite a bit of fun selling things that I no longer wanted.I am a f...
Source: ABC Therapeutics Occupational Therapy Weblog - August 9, 2022 Category: Occupational Health Tags: history OT Education OT practice Source Type: blogs
Ways to stop good clinicians leaving pain management (ii)
Last week I started a series of posts on how we can stop good clinicians leaving pain management. I began with funding because, at least in New Zealand, lack of funding is a significant part of the problem of staff retention.
Now I want to look at how we prepare clinicians to work in pain management.
One of the major barriers in New Zealand is the dominance of musculoskeletal rehabilitation in physiotherapy clinics around the country. How could direct access to musculoskeletal rehabilitation be a bad thing, you ask? Well, it’s mainly because pain management is not musculoskeletal rehabilitation – and yet...
Source: HealthSkills Weblog - August 7, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Science in practice Health healthcare pain management Source Type: blogs
Biopsychological pain management is not enough
I recently read a preprint of an editorial for Pain, the IASP journal. It was written by Prof Michael Nicholas, and the title reads “The biopsychosocial model of pain 40 years on: time for a reappraisal?” The paper outlines when and how pain became conceptualised within a biopsychosocial framework by the pioneers of interprofessional pain management: John Loeser (1982) and Gordon Waddell (1984). Nicholas points out the arguments against a biopsychosocial model with some people considering that despite it being a “holistic” framework, it often gets applied in a biomedical and psychological way. In ot...
Source: HealthSkills Weblog - July 17, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Coping strategies Interdisciplinary teams Low back pain Motivation Occupational therapy Physiotherapy Psychology Science in practice Therapeutic approaches biopsychosocial pain management Research Source Type: blogs
The added stress of chronic pain on life
For a minute, I’d like you to grab an ice-cube. If you don’t have one handy, try this at home or when you’re having your next gin and tonic. Hold onto that ice-cube. Keep holding onto it. Put a cloth underneath if it’s going to melt, but keep holding it. Now do your grocery shopping list. Or balance your accounts. While holding the ice-cube.*
Now add some exercises. Exercises you don’t care for, but feel like you have to do “because they’ll help you get better”.
Keep holding onto the ice-cube. Oh, it’s melted?! Fine – go grab another. Hand too cold to pick ...
Source: HealthSkills Weblog - June 19, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Occupational therapy Physiotherapy Psychology Therapeutic approaches biopsychosocial pain management Source Type: blogs
The stories we tell ourselves about the past
The concept of narrative captured my interest sometime around 1984 - ironically - because it may have been the Orwell novel with that year ' s title that prompted my thinking on the topic.I was interested in written narrative and how Winston Smith established his rebellion and then his freedom through a written form (even if it all eventually led to a horrible end). I was also fascinated by his attraction to the paperweight that he purchased - something that was old - and seemingly of unknowable utility.What was the purpose of knowledge, or of the past - except that it all did represent a freedom from the drudgery of the p...
Source: ABC Therapeutics Occupational Therapy Weblog - June 16, 2022 Category: Occupational Health Tags: ABC Therapeutics OT practice OT stories parenting Source Type: blogs
The demise of practical pain management
Cast your mind back to the last time you decided to create a new habit. It might have been to eat more healthy food, to do daily mindfulness, to go for a walk each day. Something you chose, something you decided when, where and how you did it, something that you thought would be a great addition to your routine.
How did it go? How long did it take to become a habit you didn’t need to deliberately think about? How did you organise the rest of your life to create room for this new habit? What did other people say about you doing this?
While we all know a reasonable amount about motivation for change – impo...
Source: HealthSkills Weblog - May 29, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Health Motivation Occupational therapy Physiotherapy Professional topics Psychology Resilience/Health biopsychosocial pain management Therapeutic approaches Source Type: blogs
The New Fascism in Occupational Therapy
I am sometimes hesitant to extend my commentary to the academic editorializing that happens in the occupational therapy literature of other countries, but I am unable to remain silent. Too often the ideas expressed elsewhere slither their way into the thinking of academics in the United States.And, of course, any objection to these ideas immediately causes one to be branded xenophobic, and usually worse, so I will simply gird myself for that criticism; I know it is coming. Over time I have raised the issue of international ' goodness of fit ' of philosophical constructs - initially in OT24VX presentations. ...
Source: ABC Therapeutics Occupational Therapy Weblog - April 26, 2022 Category: Occupational Health Tags: OT Education OT practice philosophy Source Type: blogs
Rehab Fails: What goes wrong in pain rehabilitation 3
I’m beginning to think this series could grow into a monster – so many #rehabfails to pick from!
Today’s post is about rehabilitation that doesn’t fit into the person’s life. Or that the person hasn’t been supported to fit the rehabilitation into their life. THEIR life, not ours!
You know what I mean: for six to twelve weeks, this person has been coming along to their treatment sessions, doing the things the therapist suggests. They make progress and it’s time to end the programme. “Good bye patient” the therapist says. And the patient skips off into the sunset, f...
Source: HealthSkills Weblog - April 3, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping Skills Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Resilience/Health Science in practice Uncategorized Source Type: blogs
Rehab fails: What goes wrong in pain rehabilitation (1)
Well obviously I’m not going to cover everything that goes wrong – and certainly not in one post! But inspired by some conversations I’ve had recently, I thought I’d discuss some of the common #fails we do in rehabilitation. Things that might explain why people with pain are thought to be “unmotivated” or “noncompliant” – because if the rehab doesn’t ‘work’ of course it’s the person with pain who’s at fault, right? So for today, here goes.
Starting at the wrong intensity
One of the main things that happens when someone’s in pain...
Source: HealthSkills Weblog - March 20, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive behavioral therapy Cognitive skills Motivation Occupational therapy Pain conditions Physiotherapy Psychology Resilience/Health Science in practice biop Source Type: blogs
The problems with polarity frames in occupational therapy theory
There is nothing quite like starting off a Monday morning with a good theory article. I opened up my Twitter feed to find a link to Taff& Putnam ' s contribution entitled " Northern philosophies and professional neocolonialism in occupational therapy: A historical review and critique. "The authors " suggest with confidence that the current American philosophical landscape in 2021 is a mix of mostly analytic philosophy accompanied by a smaller measure of neopragmatism predisposed to a Continental mindset. " (Taff& Putnam, 2022). I am uncertain if this is a view shared by all, and to any degree that it is...
Source: ABC Therapeutics Occupational Therapy Weblog - February 28, 2022 Category: Occupational Health Source Type: blogs
Reflective practice
In occupational therapy and some other health professions, reflective practice is a vital part of professional clinical activity. In others – not so much. And the term reflective practice has a heap of assumptions attached to it, so it may mean different things to different people.
I thought I’d unpack a bit about reflective practice today because I think it needs to be part of working with people experiencing pain. It helps us get out of our own mindset (when it’s done well), and opens a space for questioning what we do and why we do it – and as you probably all know, questioning is part of who...
Source: HealthSkills Weblog - February 13, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Pain Professional topics Research Science in practice Therapeutic approaches critical thinking Health healthcare reflective practice supervision Source Type: blogs
Your patient has psychosocial risk factors: what now?
Congratulations! You’re an insightful clinician who’s offered your patient a screening assessment to find out if she or he has psychosocial risk factors – and yes! they do! Well done. Now what?
Do you…
send your patient to the nearest psychologist?spend at least one treatment session offering pain neurobiology education?scramble to find a “psychologically informed physio” to send them to, because it takes really highly trained and special clinicians to work with these peoplegive your patient the same exercise prescription you were going to anyway because, after all, they still have...
Source: HealthSkills Weblog - January 16, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice biopsychosocial healthcare pain management Therapeutic approaches Source Type: blogs
Making first contact: What to do with all that information! Part 5
People come to see us because they have a problem. So the formulation approach I’m taking today begins from “the problem” and works back and forward. It’s called a “network” model, and is something many of us do without knowing that’s what we’re doing. The network model can also be called a functional analysis where we’re looking at what happens, and what a person does, and the ongoing consequences or loops that occur over time.
Angelina comes to see you because her neck is very sore. She’s not sure why it’s sore, or what happened to start it off, but sh...
Source: HealthSkills Weblog - January 9, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Cognitive behavioral therapy Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Resilience/Health Therapeutic Source Type: blogs
Making first contact: What to do with all that information! Part 4
In the previous few posts on what to do with all that assessment information I’ve talked about generating a formulation to guide treatment, and a little about how teams might work together to generate one. This post is a little different because I want to situation the discussion around the ultimate aim of therapy.
I usually work with people who have long-standing pain that hasn’t changed much and doesn’t seem to be disappearing. I’m not a nihilist, but I do wonder if clinicians are trying too hard to “change pain” when the body doesn’t seem to respond all that much to whatever...
Source: HealthSkills Weblog - December 12, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Psychology Science in practice Uncategorized Source Type: blogs
Making first contact: What to do with all that information! part 2
Last week I described some of the reasons for using a case formulation approach when working through initial assessment information, and today I’m going to describe one approach for organising a formulation. This is the “4 P” formulation, and it’s one that’s often used in mental health (Bolton, 2014).
In the 4 P model, there are four questions to ask yourself:
Preconditions – Why is this person vulnerable to this problem?Precipitating factors – Why now? This can mean “why is this person having symptoms now?” or “why is this person presenting to this person ...
Source: HealthSkills Weblog - November 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice biopsychosocial case formulation Occupational therapy pain management Therapeutic approaches Source Type: blogs
