Joey Wahler (Host): It helps people to better perform daily life activities, often after an injury or illness. So, we're discussing occupational therapy. Our guest, Taylor Pinson, an occupational therapist with Southeast Georgia Health System.

This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler. Hi there, Taylor. Thanks for being with us.

Taylor Pinson, MOT, OTR/L: Hey, how are you?

Host: Good. You?

Taylor Pinson, MOT, OTR/L: Good.

Host: Excellent. I really appreciate the time. So first, in a nutshell, what initially piqued your interest in occupational therapy?

Taylor Pinson, MOT, OTR/L: I actually started babysitting for a child that had special needs. He had autism and his mom happened to be an occupational therapist. So, it was around the time when I was like applying to colleges and kind of deciding what I wanted to do with the rest of my life, you know, that big decision when you're 18 years old. And that kind of piqued my interest. And then, into college, I had got an extra science degree just kind of as a basis and then started doing some more internships and stuff with other areas, you know, with kids with special needs and other areas of occupational therapy and then graduated and then applied to occupational therapy school.

Host: And it seems like your story is, generally speaking, very typical of people that get into healthcare in some capacity, and that oftentimes it's an experience early on that shapes their interest in the first place, right?

Taylor Pinson, MOT, OTR/L: Yeah, I agree. I think most of my coworkers throughout the years and people I work with now, you know, have some kind of story, especially with occupational therapy. Maybe they have someone in their family that got OT and they saw how it helped, or they have someone in their family with a specific disability, whether it be Down syndrome or autism. So, they grew up around that, which kind of led them to the field.

Host: So, to clarify, before we go any further, for those that don't know, what in essence is the difference between occupational therapy and physical therapy?

Taylor Pinson, MOT, OTR/L: So, I have a fun definition, and I have a serious definition. I'll start with my fun one. My fun definition is physical therapy will help you walk you to the kitchen and occupational therapy helps you do what you need to do once you get there. So, occupational therapy looks at the mobility and strength part of things, but more focused on those what we call ADLs for short or activities of daily living. So, looking at your different occupations, which is where that occupational therapy, so I have a lot of people say, "Well, I already have a job," but it's more your jobs of every day. So, for a kid, their job is to play, to go to school, to be able to do those school skills. For, you know, a 30-year-old woman, it might be taking care of her kids or walking her dog. For an older person, it might just be getting up and taking a shower and then go into their garden. So, whatever your occupations are just for life, not necessarily your career.

Host: Right. Well put, the occupation of life. So, what would you say is your typical day like? What are some reasons that a patient would come to see you in the first place?

Taylor Pinson, MOT, OTR/L: I'll start by occupational therapy does work in multiple settings. For the hospital's purposes, I'll talk about kind of the setting of the hospital, which would be what we call the acute care setting. So, you're sick. You have some reason that you are admitted into the hospital. So, the doctor would put in an order for OT. We would see you and I would come in and do an evaluation. I would kind of ask you about your home situation, what you're used to doing every day. You know, do you still work? Do you still drive? How many steps do you have in your house? Do you kind of stick around the house or do you go play bridge with your friends on Wednesdays? You know, do you grocery shop? Do you do your own medicine or does someone else do it for you? So, I kind of get a picture as briefly as possible that I can when I walk into their room, and then, we kind of do more of what we call our mobility part of the assessment and like strength. So, seeing how you get up and get out of bed, what your arm and leg strength looks like. Can you walk to the bathroom in your hospital room? Things like that. So, kind of as quickly as possible. Of course, you can't do everything in a hospital room, but that's kind of what acute care is versus a different setting like maybe inpatient rehab where you're staying for longer. They have more equipment that they do have driving simulations and things like that, that can be a part of your evaluation process that necessarily can't be done in a hospital room.

Host: Gotcha. And it's interesting listening to you there. It's not just about addressing a patient's health needs. It's also about assessing what their life is like from the standpoint of what they have going on normally when they're well, right? What they're going back to if you will, who else is in their life to help them. It must be an interesting challenge, because you're kind of starting from the beginning with each person, right?

Taylor Pinson, MOT, OTR/L: Yeah. So, typically, you know, when I go in and ask the questions always say answer these questions from the time that you were well, right? So for example, someone comes in with stroke-like symptoms and they have been diagnosed with a stroke. A lot of what we do in acute care for occupational therapy is not only assess what they're doing right now and able to do. So, say, they were going to the bathroom by theirself, but now they're not able to, well, then we have to decide are they going to be able to do that safely with help at home, or do they need to go to a different kind of rehab facility? So, they have inpatient rehab, which is a little bit more intense. They have skilled nursing facilities that you can get rehab at. You can go to like an outpatient clinic, you know, where you have an appointment each week. So, a lot of what we do in the hospital, besides just actually providing the therapy interventions is working with the doctors and the nurses, and kind of assessing the level of supervision and care that these patients are going to need when they get home to see if they're going to need more once they're discharged. Because once they're medically cleared, then they might need to go to a rehab facility because we don't want them to go home and fall or not be able to take care of themselves and not be able to take a shower and go to the bathroom. So, the goal is always to help the patient get back to whatever level of independence they were at before, which might not be, you know, some patients do come in and already had that caregiver helping them, but we want to get them back to kind of what they were doing before they came in the hospital.

Host: And you use the term acute there. So as it relates to what we're discussing here, simply put, what do we mean by acute and what are the differences between acute care and long-term care?

Taylor Pinson, MOT, OTR/L: So, acute care is dealing with what they actually came into the hospital for. So, say, they had a previous stroke that affected them, not that we're not looking at those previous deficits, but I'm more looking at what was currently the new things that are happening to them. Whereas long-term care, they're going to be in there for a while.

The goal, of course, of acute care is you don't want to ever be in the hospital, you know, you want to be in there for as short as possible. But the long-term care, you would be there for maybe multiple weeks and stuff, working on higher level goals. Acute care is we want to get you out of there safely and get you where you need to go, and the long-term would work on the more specific things, such as maybe they need to walk their dog or get in the car and drive or something like that.

Host: And speaking of which, in occupational therapy, what's the importance of what are known as fine motor skills?

Taylor Pinson, MOT, OTR/L: So, on more of like the stroke or another area that occupational therapy works in, of course, is pediatrics. A lot of people know OT mostly because of pediatrics. They can work in the schools or in an outpatient setting. Fine motor skills are things for like a kid holding a pencil, putting puzzle pieces in a puzzle. For adults, it might be stirring things when you're cooking in the kitchen, using a key to open a door I find is difficult. Pressing buttons in the car, pressing the remote that you would lose those fine motor skills with your fingers, say, if you did have a stroke and that tone or strength was affected on one side and you wouldn't be able to use your fingers as independently as you were before. Honestly, we come to encounter a lot of fine motor skills throughout our day. And, you know, a lot of us, it's automatic, so we don't even think about it.

Host: So, along those lines, in order to work with people to bring that all about, bring that skill set back in many cases, what are some examples of treatment exercises that you often do and how do they typically benefit patients?

Taylor Pinson, MOT, OTR/L: So, let's give an example. So, say, the patient had a heart attack, so their endurance has been affected with activities. So, they're having a hard time. They've been in the bed for a while because the doctor has put them on bed rest while they're trying to get all their vitals and everything back to how they want them to be. So, the effects of immobility, laying in the bed, you know, hit pretty fast, so the patient's losing muscle mass, losing strength, losing that independence quickly. If they want to work on some lower body dressing, they want to be able to put on a pair of pajama pants instead of wearing the hospital gown all the time, we would go in and maybe they're not able to put on the pajama pants right away, right? Because that would be the end goal. Maybe the first step was we just work at sitting on the side of the bed and reaching across and slowly lowering our reach to get to our legs so they can eventually reach down and put on their pants without getting tired. So, it's just little small steps to get to that thing, whereas some people are like, "Well, putting on your pants doesn't seem that hard." Well, it doesn't seem that hard until you've just had a major heart attack, and you're hardly even able to get out of the bed.

Host: And so, when you're doing this kind of work, how often do people get frustrated if they need to, to some degree, relearn some of these skills of everyday life? And how often do people sometimes maybe want to rush things and, you know, just get back to their previous life before they may be, in fact, ready to do so?

Taylor Pinson, MOT, OTR/L: Yeah. I would say the frustration is high, especially, I find that the younger the person is, the higher the frustration. To a certain point, of course, kids' frustration is different. I'm talking, like, younger adult versus older adult. I think because us younger adults are used to being so independent and just going and doing, whereas the older population has accepted more that they're okay with getting a little help till they can do things again.

That being said, we try to just encourage. And I think the best way to motivate patients, that's what I love about occupational therapy, is that you can work on things that they actually care about. So like, if I say, "Oh, well, you know, you want to be able to go to the bathroom." Well, that's not quite as motivating as Don't you want to be able to get up and get ready so you can go to your favorite church or, you know, hang out with your friends or something like that. So when you put in that piece, that makes it a little bit more personal. It gets more motivating for them.

As far as length of time, a lot of different research articles correlate the more often an intense therapy is, the faster you're going to get better. And that's kind of where that discharge planning comes in. We also have to use our clinical opinions to determine can this person tolerate inpatient rehab after they're in the hospital? Inpatient rehab would be every day for two to three hours a day. Very intense. Some people can't handle that when they get out of the hospital or they weren't doing enough before to warrant that type of rehab. A skilled nursing facility would still be everyday, but it would maybe be for a shorter chunk of time, so not quite as intense. Maybe their deficits aren't quite as bad, and they don't need that intense of therapy at all. They can go home and get home health. And home health therapy where they would just come out once or twice a week and get it. Or they would go to outpatient where they only go once a week for an hour, which would be, you know, a little less intense. That's kind of where the discharge planning process comes in for therapists too. We're not only doing what we think they need right then in the hospital, but also determining what they're going to need when they leave us to go to that next level of care.

Host: And speaking of which, how important is it to help these patients set goals along the way? You mentioned that you try to point to the big picture. It's not about necessarily just learning this skill or relearning this skill. It's more about what that represents for them in their life. How important is it to set goals where these things are concerned?

Taylor Pinson, MOT, OTR/L: I think it's super important. Again, you have to include the patient, you know, occupational's big thing is being client-centered and holistic. So, when I get done evaluating a patient, I kind of already know in my mind what I think their goal should be. So, I can tell they're having a hard time sitting at the edge of the bed and they can't reach down to even get their socks or shoes on. So, in my mind, I'm like, "Okay, I'll probably do a lower body dressing goal. I'll do a goal to walk to the bathroom." And let's say they can't tolerate standing for more than two minutes without their oxygen levels dropping. So, I put a goal to stand at the sink, to brush their teeth without getting fatigued. So when I have those kind of in my mind, what I do before I leave the room and our whole therapy team does is say, "Hey, these are kind of what I'm thinking for our goals, things that I want to work on while you're still here at the hospital. Do these sound good to you?" And, you know, if we miss something, the patient goes, "Well, you know what? I really wasn't standing at the sink to begin with, like that wasn't something that I was doing." So, I would say, "Okay, well, what would you like to work on?" And they'll say something different.

So, kind of setting those knowing what you're going to kind of set them in your mind, and then including the patient kind of at the end of your evaluation. Because again, if they aren't on board with what their plan of care is, then they're not going to be motivated to work. And therapy at the end of the day is a lot of patient motivation, getting the patient and the families and the caregivers involved.

Host: A few other things, one being, besides helping patients go back to living independently. Any other benefits to occupational therapy, for example, again, mentioning the term big picture, you're also really trying to keep these people from ever having to go through this again, right?

Taylor Pinson, MOT, OTR/L: Right. So, an actual article from, I believe it was 2017, that I like to quote a lot, especially when I'm talking to other people in the hospital, is that I think the main benefit, especially at the acute care level and for Southeast Georgia Health System specifically, is that this article looked at the correlation between the amount of spending on occupational therapy, and if it actually reduced hospital readmissions. So from a financial standpoint, obviously less readmissions means less money spent for the hospitals, so the hospital saving money and less time that the patient has to spend to recover. Because if they were to get therapy and they just went home without anyone evaluating them or about seeing what they needed and they went home and fell, then that's going to be, the patient's going to have to maybe go through another surgery, because they fell and broke their hip now, the hospital's spending more money, et cetera, et cetera.

Host: How would you say occupational therapy has changed over time? For instance, anything innovative in the way of treatment that the health system is offering right now?

Taylor Pinson, MOT, OTR/L: Yeah, it actually started during the World Wars. They worked with soldiers and it was kind of focused more on the, just the fine motor aspect. And it was more like craft-based and did a lot more like art and things like that. It's always stayed holistic. But as things have progressed, you know, the hospital outpatient has a lot of cool equipment over there. One of the things I always think is neat that we have in the acute care side is after people get hip and knee surgeries, if they're going home either that same day or the next day, in the hospital, we have like a little car in the ortho room that they can get in and practice car transfers, as opposed to kind of just practicing on the side of your bed, which I think is kind of innovative and helps put a more realistic aspect to it. There's all kinds of cool equipment out there that outpatient therapists are using with bionic hands after a stroke and stuff like that. Now that AI is out there, I always say I'm a low tech therapist, I got to get more high tech, but they've got driving simulations, they've got social story simulations for kids with autism. So, the possibilities are really endless, but the hospital's got some cool things, you know, especially ortho-related that are helping patients meet their goals a little bit faster and put a more realistic aspect to things.

Host: How about any success story that stands out? I'm sure you have many that you've had the pleasure of experiencing, but is there one that you can mention to us that represents someone that overcame the odds in therapy with you and yours?

Taylor Pinson, MOT, OTR/L: Trying to think. We get cool stories every day. That's one of the best parts of the job. I think for me, I'll put a more personal aspect of it. So I, as you can tell, I am a dog lover. So, a lady had had a stroke. We of course get to talking about her dog when we're in there and she's worried about who's going to be able to take care of her dog if she can't, you know, until she regains function on her left side. You know, there's a lot that goes into it. You got to walk the dog, feed the dog and stuff like that. So, we talked about different ways that she could adapt things, assistive devices she could use. We talked about a like long funnel thing, she was worried about falling when she was bending over to put dog food in the bowl. So, I found like kind of long funnel thing online and she ordered it and she used that when she got home to be able to feed the dog safely without her falling and just so her dog didn't go hungry. And then, actually a couple months later, she came in for something unrelated to that, and we we got to talking and she talked about just how helpful that had been and those suggestions. And it just meant a lot to me as somebody who that is important to me too, is being able to make sure that my dog gets taken care of.

Host: So, you found some common ground with her and that goes back to what you were mentioning earlier about finding something that strikes a chord with someone beyond just the obvious, right?

Taylor Pinson, MOT, OTR/L: Right.

Host: Well, folks, we trust you're now more familiar with occupational therapy. Interesting indeed. Taylor Pinson, thanks so much again.

Taylor Pinson, MOT, OTR/L: Thank you.

Host: And for more information, please visit sghs.org/occupational-therapy. Now if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for being part of Health Matters from Southeast Georgia Health System.