Transcription:
Exploring the Role of Occupational Therapy in Rehabilitation

Scott Webb:  Welcome to Picking Our Brain with Shepherd Center. I'm Scott Webb. And April is National Occupational Therapy Awareness Month, and it's a great time to have on to knowledgeable and compassionate practitioners to discuss occupational therapy and how the interdisciplinary team at Shepherd Center can assist patients in reaching their goals.

And I'm joined today by Melissa Kimball. She's an occupational therapist at Shepherd Pathways, Shepherd Center's comprehensive outpatient rehabilitation program for people recovering from brain injury. And I'm also joined by Erin Prentice. She's an occupational therapist in Shepherd Center Spinal Cord Injury Rehabilitation Program.

Before we get rolling here today, I want to have you tell listeners what your roles are at Shepherd Center. And Melissa, I'll start with you.

Melissa Kimball: So I work in the ABI post acute. So after someone's an inpatient in the hospital, they'll come to post-acute outpatient and often will come there right after their inpatient rehab or maybe after being home for some time. So I work with clients who are typically living at home. Sometimes they're in the housing at Shepherd Center.

And they'll come into the clinic for services inside our clinic here, as well as sometimes we'll go out into the community and meet them at their homes for some special home evaluations. And then this past year we've been doing it over telehealth as well. So I work with clients who have had brain injuries and who are out of the hospital essentially.

Scott Webb: Yeah. And how's that telehealth/telemedicine been going? I know this has been a bit of a shock to the system for many of us, but we're all kind of getting used to doing Zoom and talking to our doctors and things on our phones. How's that been going?

Melissa Kimball: I'll say initially we were very hesitant and not sure how it was going to go for both on our side and on the client side, but a definitely pleasant surprise. And it's gone much better than I think any of us anticipated. And I think it's opened up a lot of doors from the occupational therapy side to be able to do things with clients inside their homes and in that real life home setting. So for example, if they want to work on doing laundry, we can do it simulated here in our clinic, but over telehealth, we can just do it in their home and make the adaptations or recommendations necessary.

So I think telehealth has been a great addition this past year, and we've been able to reach clients during this pandemic when our doors were closed here as well as I think, get creative with new ways to approach the treatment that have really forced us to think outside the box. But overall, I would say clients are really pleased with the progress they've made over telehealth and I'm impressed with how we've been able to adapt and get creative to still meet people's goals and be able to be kind of inside their home, through the computer, so to say.

Scott Webb: Yeah. I've talked to my doctor on my phone and it was pretty weird. You know, I'm sitting there in my kitchen and I'm talking to my doctor and it is really amazing how the entire medical system has really pivoted and, as you say, been very creative through all of this. And I'm sure that's been your experience too, Erin, but tell us about what you do at Shepherd and how has telemedicine been for you?

Erin Prentice: So I have been in Shepherd for almost 12 years. And primarily, when I first started working at Shepherd, I covered a team, so I had a primary like spot location and I worked in inpatient. And after about six or seven years, I transitioned to a float therapist. So currently, I cover all across the continuum of care for spinal cord injury. So I work in inpatient. I can cover in our day program and our outpatient services. As a float therapist, my primary role is to mentor and train new therapists, so a lot of new hires. I do all their initial training. I'm with them for at least three months, teaching them kind of the ins and outs of Shepherd and how our patients' progression is.

Luckily, I have not had to do telehealth because, when COVID kind of hit, I got really stuck with inpatient and just in that area of practice, just training and covering and helping new staff kind of orient. So I have not really done telehealth since COVID started.

Scott Webb: Gotcha. And you both give us a good sense there of one of you is more inpatient to the other is more outpatient and interesting. And we're going to get to all of this today about how you work in the same field, the same area, but do different things. Often helping patients, clients set their goals and working with families and so on. Before we get to all that though, Melissa, just tell listeners what is occupational therapy and who's a good candidate for it.

Melissa Kimball: Yeah. So I like to explain or describe occupational therapy as helping people get back to what they need to do and want to do. And after they've been either unable to do those things from an injury or, in some cases, a disability that you're born with. But for us at Shepherd, it's an injury that someone experiences and then it impacts their ability to do everyday activities, whether it's brushing your teeth, going to the bathroom or working and driving a car.

Really, it's just helping people work on the different components that are interfering with those things. So for someone, it might be their vision or the use of their arms or maybe a cognitive aspect of that. So approaching both what people need to do, but want to do and get back to kind of their everyday living.

Scott Webb: Yeah, you say everyday living and I think, to me, it sounds a bit like a lot of the things that we all sort of take for granted. And you said, you know, doing laundry and brushing your teeth. And, Erin, from your perspective on occupational therapy, is that a lot of what it is, is just really helping people do the things that they maybe used to take for granted, but now they need some assistance with?

Erin Prentice: Yeah, I think for me, it's getting them to live their life to the fullest. It's definitely the things that they want to do and they need to do. It's not just daily care, driving. It's really how do I use these skills to help them enhance their life and continue on with goals that they set out for their life long-term.

Scott Webb: Yeah. And that's one of the things we're going to cover today, is about helping them set those goals, determining what those goals are and then how to best reach them. And sticking with you, Erin, tell us about the interdisciplinary approach to working with patients and clients at Shepherd.

Erin Prentice: Yeah, Shepherd is so unique. We're just not singled out and I'm just me working with occupational therapists, but I get to work with physical therapists, speech therapists, recreation therapist, or psychologist or counselor, exercise physiologists, dieticians or doctors, peer supporters. So it's such a unique experience, but together we get to really focus on the complete person. There's psychological, physical, emotional, social history and really come up with their goals. We get to see them from different perspectives and we get to integrate all those things together to work towards the complete person and getting them back to being as independent or restore as much function or just really improve their quality of life.

Scott Webb: So Melissa, when we talk about setting goals with patients and clients, how do you do that? And how do you then provide the assistance they need to really help them reach those goals.

Melissa Kimball: I would say it definitely starts with the client and identifying what's important to them. And we might be able to look at a medical chart and see, "Oh, this person doesn't have use of their right arm. They have some visual deficits," and have some ideas of some barriers. But until you talk to that client and know what's really important to them, that's really what helps gear our goals.

Is someone wanting to get back to cooking in the kitchen more? Are they wanting to be able to curl their hair or straighten their hair? Or really what do they want to get their function back for helps to identify what their goals are. And then looking at that goal, say, someone wants to get back to driving is a big one that I get in outpatient what are the barriers to getting back to driving and what are the steps that we would need to take to work towards that? And even if it's not something that's necessarily realistic right away, what are steps that we can take to move closer to that goal? And see kind of that big picture of like Erin was talking about, living life to the fullest and what's important to them and what does that mean to that client to live life to the fullest? Sometimes it's the little things. Sometimes it's looking at the big picture and moving progressively towards that big picture goal.

Scott Webb: Yeah, I'm sure it is oftentimes the little things and then trying to figure out what the big things are, the long-term goals are. And it is that one of the things you have to deal with the most with clients and patients, Erin, is really just figuring out what the those barriers are, and then helping patients overcome them?

Erin Prentice: Yeah. Most of my patients are traumatic injuries and so they were, you know, one day fine and the next day, their life is flipped upside down. They have a hard time comprehending what that even means and what that means going forward and what they're going to look like long-term. So a lot of times when we're setting goals, I always tell my patients, "You don't know what you don't know, because you don't know what the possibilities are." And it kind of open our eyes up with what are the little goals and what's your big long-term goal.

And so that's one of the big things you do at Shepherd, is coming up with their big long-term goal that we all work on as a team and then we build on the little steps to get towards that. So that's a really cool and awesome experience, is just helping them build little stepping stones to achieve something that's a major milestone in their life.

Scott Webb: Yeah, I'm just thinking about that. The way you put that, you know, one day these people's lives were one thing, and then it's just completely flipped upside down the next day. And then, you know, helping them to understand what their lives are now and helping them to set short-term goals and what is the big picture and what are the barriers? Really amazing that they have all of you and you have this great interdisciplinary approach.

And, Melissa, I'm sure a big part of what you do is just educating, right? That's what we're kind of talking about, is educating patients and also their families too. So maybe tell us a little bit about working with the families of patients and clients, and maybe helping them as much as you are helping the patients and clients themselves.

Melissa Kimball: Like Erin was saying, that just for the clients, their lives are turned upside down. It's the same thing for these families too. And all of a sudden they find themselves instead of being the spouse, being the caregiver, or whatever family member they are and learning all sorts of new ways that their family member is moving and seeing the world and thinking.

So it's trying to help educate and explain to them what's happening with their brain and what the process for recovery is and educating on how to help them carry over exercises at home. And I think through telehealth, as I was saying this past year, that's been a cool way to include families, because they're home with them and helping us, you know, set up the telehealth appointment or the computers. And so they are the hands on at home, helping clients work through their exercises and really having to be able to follow through with our recommendations and set a table up in one direction so that the family member can get through or whatnot.

Sometimes in a session, our focus of course is on the client, but sometimes we spend the whole time talking to the parents or loved ones, caregivers, because they are the ones who are there with them, especially in the outpatient setting. They're the ones who are with them all the time. So we're setting them up for success to be able to carry over what we teach them in this short time they're in the clinic to carry it over at home.

And also I'll say on the flip side of the learning how to still be the loved one, the brother, the parent, the spouse, and not just assume that caregiver role and, as clients do improve and get better, learning that balance of kind of stepping back from your roles as a caregiver and just being a spouse. Like Erin was talking about, that interdisciplinary role is really helpful with helping families through that transition on both sides as well.

Scott Webb: Yeah. Erin, I'm sure it's probably one of the most challenging and also rewarding aspects of your job, is working with families, because you're dealing with these traumatic injuries and it's not just traumatic for, you know, the patient or the client, but really for the families as well, right?

Erin Prentice: It is, it definitely is. The good thing about Shepherd is we have our counselors and psychologists and they meet with our patients, but they also take the time to meet with our families. And we have support groups for families because they are just as devastated as the patients. And sometimes even maybe more so because it's affecting their life, right? It could be a husband or a wife. It could be a child.

And so a lot of times even having them deal with it and grieve with it just as well as the patient is such a good chance for us to be supportive. And to help them have assurance that, you know, their life is going to go on, they're going to do the things that they wanted to do, they're going to be a successful person, again is a great experience for us to get to do that alongside with them.

Scott Webb: Yeah, just kind of bringing a smile to my face and so great that, you know, these services are available, as you say, that interdisciplinary approach and all the different types of therapy and assistance that's there for patients, clients, families. Melissa, I want to have you tell us about the acquired brain injury unit, which I know is something you work closely with, and also the transitional living apartments for ABI patients. Maybe you can tell us more about that.

Melissa Kimball: The client will be in the inpatient rehab unit. And then as they're preparing to leave, they have a transitional living apartment. It's set up with, you know, a bed and a kitchen and kind of like a small little studio apartment. And the family members will stay in that apartment with them for a few days, to still have the support of therapy and nursing around, but to start to take on the full-time caregiver responsibilities and to kind of learn that dynamic of what's it going to be like when they're out of the hospital. So clients will often with their family members go through that process before they leave the hospital.

And I'll also mention that in our outpatient here, we have a kind of simulated transitional living apartment where clients aren't going to live and stay there, but we have it set up like an apartment so that we can do our training there, have family members come in and do some kind of training on either bed transfers, bathroom transfers, as well as a new thing that we've started looking at this year is using assistive technologies such as like virtual assistants like Alexa or Google home to help out clients who either set up environmental controls, like lights or routines, to remember take your medications or daily rhythms and routines. We have kind of the extension of that once they get to outpatient. We used to continue that kind of home family training even in the outpatient setting.

Scott Webb: This has been really educational today and really eyeopening. And I kind of come to learn that occupational therapy encompasses so much more than sort of that occupational part of it, which is really informative. As we wrap up here, Erin, you mentioned this earlier, but what is the motto, "live life to its fullest" really mean to you?

Erin Prentice: For me, in working with the patients I do, it's about who the people are, who they were before, who they have aspirations to become and getting them to do what they want to do. Activities that make life worth living for them. So many times I get, you know, people who, "I can no longer have kids" or "I can't parent my kids the way that I would have going forward." And it's about taking impossible to possible.

And as James Shepherd, the founder of Shepherd, his motto was not "I can't," it was always, "I can." And so instilling that in my patients, teaching them that they can thrive, they can set goals that they may not think are achievable. But then teaching them how to achieve them and really just giving them hope, which is the whole motto of Shepherd. Our mission is to give our patients hope and help them rebuild their lives and rebuild independence.

Scott Webb: That's really great, such meaningful words. You know, just a few words, but it means so much. Live life to its fullest. And Melissa, what does that mean to you? How do you embody that in your work?

Melissa Kimball: I really think Erin said it beautifully. But I'll just add that we meet people at such a vulnerable point in their journey and being able to say and speak that there's still hope for them moving forward. And it might not look like what they originally thought it would, but there's still is so much that they are going to accomplish and so much purpose and so much they still have to contribute as they continue moving forward even if it doesn't look the same. So just instilling that hope and celebrating the little pieces, the little parts of it along the way as they move forward in that journey. And yeah, just embracing all the ups and downs that this life throws them and throws us as well along the way.

Scott Webb: Yeah, I think you said it so well there. This really is a journey. And along that journey, we have to celebrate the little things, set goals for the big things, try to remove those barriers to get there and, you know, remain hopeful along the way. And in the end, just really try to live life to its fullest. So it has been so great having both of you on today. Educational, informative and so much more. Thank you both. And you stay well.

Melissa Kimball: Thank you, Scott.

Erin Prentice: Thank you.

Scott Webb: And you can learn more about Shepherd Center at Shepherd.org. This is Picking Our Brain with Shepherd Center. I'm Scott Webb. Stay well.